Lecture # 215:
Alcoholism

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

Alcoholism is a Carousel Named Denial

Alcoholism is a tragic three-act play in which there are at least four characters - the drinker, his family, his friends and co-workers, and even counselors. Alcoholism rarely appears in one person set apart from others; it seldom continues in isolation from others. The above characters keep the carousel going around and around.

Once a person drinks too much and gets drunk, others react to his drinking and its consequences. The drinker responds to this reaction and drinks again. This sets up the carousel of blame and denial, a downward spiral that characterizes alcoholism. Therefore, to understand alcoholism, we must look not at the alcoholic alone but view the illness as a play where we can sit and carefully observe the roles of all the actors in the drama.

As the play opens, we see the alcoholic as the star of the first act. He does all the acting; others react to what he does. He is usually a male between the ages of 30 and 55. He is usualy smart, skillful, and often successful in his work; but his goal may be far above his ability. We see that he is lonely, sensitive, and tense. He is also immature in a way that produces dependence. However, he may act in an independent way in order to deny this fact. He also denies he is responsible for his behavior. For him to act the way he does, others must help him. That is why we need to observe carefully what each actor in this play does.

Meditate Word By Word On These Verses:
Luke 21:34.

The alcoholic has learned that the use of alcohol makes him feel better. To him, it is a blessing, not a curse, his medicine, not a poison. For a few hours it floats away all of his troubles; it melts away his fears, reduces his tension, removes his loneliness and solves all his problems.

Question:
1. Does alcoholism occur in a vacuum? Why or why not?
yes / no.

 

 

ACT I

The play opens with the alcoholic stating that no one can tell him what to do. This makes it very difficult for the family to talk about drinking and its results. Even when the drinking is obviously causing serious problems, he simply will not discuss them. For example, if he uses his salary for drink, someone else has to feed his children. Talking goes only one way. No one seems to hear what the others in the family are saying. On both sides, people say one thing and yet do another. To observe the alcoholic alone, to read a scientific description of the illness, or to listen to the family's tales of woe, is only a small part of the story. The key word in alcoholism is "Denial", for again and again people do what they say they will not do or deny what they have done.

Early in the first act of the play, the alcoholic needs a drink and so he takes one. He drinks hard and fast, not slow and easy. He may drink openly; but more likely, he will drink in secret - not with his family present. This is the first part of the denial: hiding the amount he drinks. But we know that he knows he is drinking too much. He drinks more than others, more often than others and alcohol means more to him than anyone or anything.

Drinking too much and too often is not a matter of choice. It is the first sign of alcoholism. Repeating denial by hiding the bottle and drinking alone reveals how important alcohol has become in helping the alcoholic feel better. After one or two drinks, he cannot stop.

After a few more drinks, there is a profound change in the alcoholic. He reveals a sense of success, well-being, and self-sufficiency. He is "on top of the world" and may act as if he were a little god. Now he is right and everyone else is wrong. This is a very likely response if someone objects to him about his drinking.

There is no one way all alcoholics act while intoxicated; but they are not sensible or rational; they are not responsible. They are apt to ignore the rules of social conduct, sometimes even to a criminal degree, such as driving while drunk. If a sober person acted this way, we would consider him insane.

If drinking continues long enough, the alcoholic creates a crisis, gets into trouble, and ends up in a mess. This can happen in many ways, but the pattern is always the same: he is a dependent person who behaves as if he were independent, and drinking makes it easy to convince himself he is independent. Yet the results of his drinking make him even more dependent on others. When his self-created crisis strikes, he waits for something to happen, ignores it, walks away from it, or cries for someone to get him out of his crisis. Alcohol, which ar first gave him a sense of success and independence, has now stripped him of his mask and reveals him as a helpless, dependent child.

ACT II

Summary: In Act II, the alcoholic does nothing but wait for others to do for him. Three others in the play act out their roles and the alcoholic benefits from what they do. He does little or nothing, everything is done for him in the second act.

The next player is the Enabler. He is helpful and a "Mr. Clean" who may be directed by his own anxiety and guilt to rescue his friend, the alcoholic, from his predicament. He wants to save the alcoholic from the immediate crisis and relieve him of the tension created by the crisis. In reality, this person may be meeting a need of his own, rather than that of the alcoholic. The Enabler may not realize what he is doing. The Enabler may be a male outside the family, perhaps a relative. Occasionally, a woman plays this role.

This role may also be played by the professions that are called "helping": clergymen, doctors, lawyers, and social workers. These people may have little knowledge about alcohol and alcoholism, which is essential in such specialized counseling. Lacking this knowledge, they handle the situation in the same way as the non-professional enabler. This denies the alcoholic the process of learning by correcting his own mistakes and there is reinforcement that someone will always be a protector who will come to his rescue, even though the Enablers insist that the will never again come to the rescuer. They have always helped him and the alcoholic believes they always will. Such rescue operations can be just as compulsive as drinking.

The next actor is the Victim. This person may be the employer, the immediate supervisor, the commanding officer in military life, a business partner, or a fellow employee. The Victim is a person who is responsible for getting the work done. If the alcoholic is absent due to drinking or comes to work occasionally, the victim does the alcoholic's job. The boss or supervisor may be a very real friend of the alcoholic. Protection of a friend is a very normal response, there is always hope that this will be the last time the alcoholic is drunk. The alcoholic has become dependent on repeated protection and cover-up by the Victim; otherwise he could not continue to drink and miss work. He would be compelled to give up drinking or give up the job. It is the Victim who enables the alcoholic to continue his irresponsible drinking without losing his job.

The next player is the Provoker. This is a key person in the play, the spouse or parent of the alcoholic, the person with whom the alcoholic lives. This is usually the wife or mother. She is a veteran at this role and has played the role much longer than others in this act. She is hurt and upset by repeated drinking episodes; but she holds the family together despite all the trouble caused by drinking. In turn, she feeds bitterness, resentment, fear and hurt into the marriage. She controls, she tries to force the changes she wants; she sacrifices, adjusts, never gives up, never gives in, but never forgets. The attitude of the alcoholic is that his failure should be acceptable, but she must NEVER fail him! He acts with complete independence and insists he will do as he pleases, and he expects her to do exactly what he tells her to do or not do. She must be at home when he arrives - if he arrives.

Question:
2. How many times have you heard that a wife is the cause of her husband's alcoholism?
(Only one of the following answers is correct.)
Never.
Seldom.
Almost always.

 

 

This character may also be called the Adjuster. She is constantly adjusting to the crises and trouble caused by drinking. The alcoholic blames her for everything that goes wrong with the marriage. She tries everything possible to make the marriage work to prove he is wrong. She is wife, housekeeper, and most likely works to keep the family in food and clothing. She attempts to be nurse, doctor and counselor, but she cannot be all of these persons without hurting herself and her husband. She is so upset that she cannot talk to her husband without adding more guilt, hostility, bitterness and resentment to the situation, which is already unbearable. Yet the customs of society train and condition the wife to play this role. If she does not, she finds herself going against what family and society regard as her role. No matter what the alcoholic does, he ends up "at home". This is where everyone goes when there is no other place to go.

Act II is now played out in full. The alcoholic in his helpless condition has been rescued, put back in his job, and restored as a member of the family.

This gives him a costume of a responsible adult. As everything was done for him and not by him, his dependency is increased. He remains a child in an adult suit. The results, effects and problems caused by drinking have been removed by others. They have cleaned up the mess caused by the alcoholic. The painful results of the drinking were suffered by persons other than the alcoholic. This permits him to continue drinking as a way to solve his problems. In Act I, the alcoholic killed all his pain and woe by getting drunk. In Act II the trouble and painful results of drinking were removed by other people. This convinces the alcoholic that he can go on behaving in this irresponsible way.

Question:
3. What can you add to the description in the above scenario?

 

 

Act III

Act III begins in much the same way as Act I, but something has been added by the first and second acts. The need to deny his dependence is greater now and must be expressed often and emphatically. The alcoholic denies that he has a drinking problem, denies he is an alcoholic, and denies that alcohol is causing him trouble. He refuses to acknowledge that anyone helped him. He denies that he may lose his job and insists that he is the best or most skilled person at his job. Above all, he denies he has caused his family any trouble. In fact he blames his family, especially his wife, for all the fuss, nagging and problems. He may even insist that his wife is crazy and needs to see a psychiatrist. As the illness and conflict get worse, the husband often accuses his wife of being unfaithful, having affairs, although he has no reason for these accusations.

Some alcoholics achieve the same denial by a deep silence, refusing to discuss anything related to their drinking. The memory is too painful. Others permit the family to discuss what they did wrong and what they failed to do. The wife never forgets what her husband does. The husband may not remember what he did while intoxicated but he never forgets what his wife tells him he did or failed to do. This causes even more problems because the husband and wife remember the hurtful things that have been said.

The real problem is that the alcoholic is well aware of the truth, which he so strongly denies. He is aware of his drunkenness. He is aware of his failure. His guilt and remorse are a heavy burden to him, but he cannot tolerate advice or criticism from others. Above all, the memory of his helplessness and failure after a drinking binge is more than embarrassing; it is painful to think about since he acts as if he is god of his own world.

In time, the family adjusts their way of living together. The alcoholic may deny he will drink again and others in the play may vow never again to help him. The Enabler says he will never again come to the rescue. The Victim will not allow another job failure due to drinking. The Provoker tells the alcoholic they cannot live together under these conditions.

What is said is completely different from what everyone has done and will do again. The result is that the alcoholic's sense of guilt and failure is increased, his god-like assurance is that he can always do as he pleases. However, this attitude is challenged and all this adds to his heavy burden of tension and loneliness. There is only one sure way to remove this pain, overcome his guilt and sense of failure, and recover a sense of worth and value. The memory of the comfort and benefits of drinking blot out the knowledge of what happens when he drinks. So what seems absolutely necessary is that he begins to drink again.

When he takes that drink, the play does not come to an end, but simply repeats Act I and Act II again.

Question:
4. Does this same cycle of behavior occur with gluttony or using narcotics?
yes / no.

 

 

Thus his behavior becomes a carousel of problems that go around and around with a repeating pattern. If Act I had not occurred, we would not have had the beginning of a play about alcoholism. This makes Act II the only act in which recovery can begin. It starts with the actions of those who surround the alcoholic. In Act II, the alcoholic has accepted everything that is done for him by others. They help him because it is their choice or because they cannot resist helping him. Let us see what happens with the alcoholic when those around him determine to create a change in the situation.

Recovery Begins in Act II
A planned recovery from alcoholism must begin with the persons in the second act. They must learn how people affect each other in this illness and then learn the most difficult part - they must begin to act in an entirely different way.

New roles can be learned only by turning to others who understand the play and putting into practice their insight and knowledge. If Act II is re-written and replayed, there is every reason to believe that the alcoholic will recover. He is locked in by his illness; others hold the key to the lock. We cannot demand that he give up drinking as a means of solving his problems, but if we unlock the door, he will be free to come out of his alcoholism.

If the alcoholic is rescued from every crisis, if the boss allows himself to be a Victim again and again, and if the wife reacts as a Provoker, there is not a chance the alcoholic will change. He is helpless. He may recover if the other actors in the play learn how to break his dependency on them by refusing to give in to help him. The alcoholic cannot keep the carousel going unless others ride it with him and help him keep it going. It is NOT true that an alcoholic cannot be helped until he wants help. It is true that there is almost no chance that he will stop drinking as long as other people remove all the painful consequences for him. The people in Act II find it will find it difficult to change. It is much easier to say that the alcoholic cannot be helped than for them to learn and play a new role.

The Enablers and the Victim must seek information, insight and understanding if they want to change their roles. The wife or mother must become active in a program of counseling and therapy if she wants to make a change in her life.

In understanding the role of the three supporting actors in the play, we must remember that they did not learn to play these roles overnight. They play the role that is expected of them: they have been taught to act this way. They imagine they are helping the alcoholic and do not know they are perpetuating the illness and making it almost impossible for the alcoholic to recover.

The Enabler thinks he must not let the alcoholic suffer the consequences of his drinking when he can so easily prevent this by a rescue. It is like saving a drowning man. The Enabler reveals a lack of faith in the alcoholic's ability to take care of himself, which is a form of judgment and condemnation. The role of the professional Enabler (clergyman, doctor, lawyer, or social worker) can be most destructive if it conditions the family to dismiss a drunken crisis rather than to use it to start a recovery program. The alcoholic may seek these professionals out to use them as Enablers. The family, which may be told initially that there were no signs of alcoholism is now taught that the way to deal with it is to remove symptoms, rather than deal realistically with the illness. The very Enabler who may have failed to identify alcoholism in the early stages may now treat the more advanced symptoms by helping the alcoholic deny his problems and continue riding the carousel. The family then thinks that nothing more can be done to cope with alcoholism. The Enabler influences the second part of Act II because he sets the direction of the movement of this part of the play.

The Victim does not get onto the carousel until the drinking has begun to interfere with the alcoholic's work, usually after the alcoholic has been on the job for many years and a friendship exists between the immediate boss and the alcoholic. The boss protects his alcoholic friend because he knows the alcoholic's wife and children will suffer if he loses his job. Personal interest and friendship give the alcoholic the very "help" that increases his dependency and need for denial.

Question:
5. In what way must the supporting actors change, in order to break this cycle?

 

 

The wife is the first person who joins the alcoholic on the carousel. If she absorbs the injustices, suffers deprivation, endures embarrassments and perhaps beatings in her effort to cope with alcoholism, her reaction is hostility, anxiety, anger and bitterness. This makes her sick. She is not a sick woman who made her husband become an alcoholic, but a woman who becomes part of an illness by living with it. She is forced into the role of a Provoker. She is crushed and needs information and counseling, not because she caused the illness, but because she is being destroyed by it.

The Wife Stands Alone
If the wife changes her role and begins to act in a new way, she will discover that she is standing alone. Others - friends, relatives, co-workers - will treat her as an actor who is deserting the carousel when there is no substitute to take her part. This is especially true when the wife leaves her husband, whether by choice or necessity.

Some wives can change their roles by having talks with a counselor, or by attending Al-Anon Group meetings. Having new friends understand her new role because they have lived through the same pain and agony, is very important for the wife at this stage. Relatives may tell her how wrong she is in trying to play a new role, but she needs people around her to give her support and search for answers she needs.

The basic mistake that women make in seeking help for their husbands is that they want to be told that they can do something to stop the drinking, not realizing that it may take a long time to learn a new role in an alcoholic marriage. Long periods of regular weekly meetings are often necessary before a wife begins to change her feelings and learns to act in a constructive way.

The wife should seek help for herself to recover from her own anxieties, resentments, and other destructive forces that are in an alcoholic marriage. As she changes, her husband has a greater chance of changing also. Few husbands can stand a drastic change in their wives without making basic changes in their own lives, but this change is not guaranteed. Many wives drop from a counseling program when their problems are not solved in a short period of time.

To avoid injury to the children, the wife must seek help outside her circle of family and friends. When she plays the role of the Provoker, the children are placed between a sick father and a sick mother. The wife who seeks help early enough can prevent much of the harm, which is passed on to the children through her reaction to her husband. If she seeks and finds help early, it will protect the children in many ways and may open the door to her husband's recovery.

Question:
6. What should the wife do, in order to really help her alcoholic husband?
(Only one of the following answers is correct.)
Find a pill that will instantly cure her husband's alcoholism.
Find help for this problem among the circle of her friends.
Take several months to learn how to change her feelings and actions.

 

 

The Moral Issue
The wife has every right and responsibility to refuse to act as if her husband is the supreme authority in her life. She does not have to obey every wish or command he makes. Usually, the only effective way of telling him what she needs is to learn to free herself from his attempt to control and dictate what she is to do. The assumption is that the wife truly cares for her family and wants to help them and herself. This independence may be exercised in silence; it need not be expressed in words.

Two things interfere with success in a long-range program for the wife. First, the husband's attitude toward the new role may range from disapproval to direct threats or violence. Second, responsibilities in the home, especially if there are young children, make it difficult for the wife to get away to group meetings or counseling. At night, few alcoholic husbands will stay with the children while she is away. It is at this time the church family can help the wife.

The wife may find herself in a difficult position if she wants to change herself early in the downward path to severe addiction to alcoholism. Many professionals are unwilling to accept alcoholism as a problem until it reaches the addictive, chronic phase. The doctor may not recognize the early symptoms. If the minister condemns alcoholism, the wife may not turn to him when in need. If she consults a lawyer, he may talk in terms of separation and divorce. This increases her realization of failure. Thus, often the wife does nothing.

We need changes and education in cultural and social attitudes toward drinking and alcoholism. If the wife or family member is willing and able to enter into a program of education there and work at it for a period of six months, changes can occur in her life. al-Anon is the most widespread group resource for the family today, just as AA is for the alcoholic.

Guidelines for the Family

  1. Attend Al-Anon or a similar program regularly. If Al-Anon is not available, attend the open meetings of AA.
  2. Get additional literature on alcoholism for personal study.

Adult Children of Alcoholics
In recent years there has been a sizeable increase in the number of adult children of alcoholics who are seeking help from Al-Anon to recover from the effects of a parent's alcoholism. Some still live at home. Many no longer live with the alcoholic parent but in their lives unmanageable because of the heavy emotional interaction they continue to have with the family. For example, an alcoholic father may call one of his children while he is drunk and shout at them or threaten to hurt himself if the child does not agree to his wishes. Other adult children of alcoholics have just been made aware of the scars they carry due to alcoholism. These people have lingering emotional pains that affect their relationships, self-worth, and their sense of family life.

In Al-Anon, adult children of alcoholics have shared similar feelings of anger, guilt, and denial. Having grown up in alcoholic households, they believed it was easier not to talk, trust, or feel. They learned ways of coping that later proved to be inadequate. This caused a sense of despair, confusion, and difficulty knowing their own personality. Some reached adulthood feeling alone and abandoned. Many tried to please others rather than caring for their own needs. Others tried working very hard in order to forget the pain they carried.

In Al-Anon, children of alcoholics find the tools that enable them to put the past to rest, to forgive and go on to meaningful adult lives. Al-Anon helps to resolve the feeling of anger, guilt, and denial. Through working in Al-Anon, children of alcoholics begin to change attitudes and behaviors that no longer work into rewarding and productive ways of living. They discover that no situation is too hopeless to be bettered and they are able to turn their lives around.

Question:
7. Write the names and telephone numbers of programs in your church or neighborhood for alcoholics and their relatives.

 

 

Here is one person's story:

I began my care-taking role at the age of five when my baby brother was born. Mom already had an 11-month-old baby. She could not cope with two babies so I helped out and took over the nurturing of the newborn. As brother grew, mother could not relate to him. I could, I always knew what he wanted. I could do something mother could not do; I was better than she.

I was a good child. I never misbehaved. I was the example to the three other children. Except that I had contempt starting to grow deep inside me. My mother is the alcoholic. I remember being embarrassed by her behavior, being hurt that she was killing herself, that she denied that we loved and cared about her.

I was the bad person in mother's life, she thought. I accepted her emotional and verbal abuse because I deserved it. I was somehow responsible for who she was, how she lived. Obviously, I had disappointed her in some way. But I learned some valuable lessons from that childhood environment; care-taking was powerful and controlling; one could pity those one cared for; one could resent them for being dependent and feel contempt for their weaknesses. I identified with my father - powerful, dominating, and strong. Mother was weak, dependent, and fearful.

Three years after high school I married. I picked someone who was incapable to take responsibility for himself. He needed me. And I was going to save him and change him into the wonderful person I knew he could be. What I needed though was love, recognition, and help. I did not know how to ask for them. I chose divorce.

My mother went into treatment again. This time the hospital contacted me and asked me to come and work through family problems with mother. I decided to go and intuitively knew I needed to face all the problems I had in the past. I was able to confront my mother with her past behavior and how it affected me. I was now exposed to Al-Anon for the first time. I have been learning that I cannot control events and outcomes, that I can't always have what I want and I seldom know what is best for me. I learned that I must rely on the wisdom of God. I have become aware of my character defects and I have been working on letting them go. I work on my impatience and trying to control other peoples' lives.

To replace my irrational ideas and attitudes, Al-Anon is showing me spiritual truths. Here are some:

Question:
8. Can a person use the sayings, "I cannot control another person" and "I cannot control the outcome of events" as an excuse for doing nothing?
yes / no.

 

 

Here is a copy of the 12 steps:

  1. We admitted we were powerless over alcohol - that our lives had become unmanageable.
  2. We came to believe that a Power greater than ourselves could restore us to sanity.
  3. We made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. We made a searching and fearless moral inventory of ourselves.
  5. We admitted to God, to ourselves and to another human being the exact nature of our wrongs.
  6. We were entirely ready to have God remove all these defects of character.
  7. We humbly asked Him to remove our shortcomings.
  8. We made a list of all persons we had harmed and became willing to make amends to them all.
  9. We made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. We continued to take personal inventory, and when we were wrong we promptly admitted it.
  11. We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to others, and to practice these principles in all our affairs.