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The Alcoholic Family in Recovery

Jeffrey D. Roth, M.D., F.A.G.P.A.

Key Words: Books Reviewed

This is the most recent addition to a prodigious series of books by Stephanie Brown describing a developmental model of recovery from alcoholism in the alcoholic,¹ in the adult child of the alcoholic,² and in the family of the alcoholic.³ The authors are ambitious in the scope of their work: they include in their analysis of recovery its impact on the family environment, the family system, the parental couple, and the individual family members. They take us on a tour of these domains across recovery as a developmental process, through the stages of drinking, transition from drinking to abstinence, early recovery, and ongoing recovery. Each cell of this matrix is painstakingly described, using the real experiences of families in recovery from alcoholism. The result of this analysis is both theoretically fascinating and emotionally gripping and poignant.

The form or process of the book is as brilliant as its hypotheses. One central hypothesis is that alcoholism is a disease—one that affects the whole family. The authors then assert that the family can recover from its disease of alcoholism in a manner parallel to the alcoholic's recovery from alcoholism. Exposure to the direct experiences of recovering families in this book gives the reader as close a replica of actually being at an Al-Anon meeting as one can get without showing up in person. As at an Al-Anon meeting, where a family member's denial inevitably and inexorably wears down in hearing the experiences of others, readers of this book may have difficulty withholding identification with the struggles of these families.

Although the authors are scrupulously careful not to portray recovery from alcoholism as accomplished through dogmatic adherence to any particular theoretical framework, including twelve-step ideology, detractors may criticize the authors' insistence on abstinence from alcohol and focus on loss of control over drinking as essential to recovery. Therefore, the only serious limitation to this masterpiece is that the very clinicians who most need to read it may reject its wisdom out of a need to preserve the idea that alcoholism is not a disease, and thus that alcoholism certainly cannot be a family disease.

Indeed, this book may well disrupt even the sympathetic reader's fixed ideas about recovery from alcoholism and treatment of the alcoholic family and its members. The authors recommend a consummately pragmatic approach to treatment that is committed to serving the needs of the family at whatever point the family finds itself in its developmental process. Because they are not bound by loyalty to a particular theory, cognitive-behavioral and psychoeducational approaches are suggested in transition and early recovery, whereas intensive psychodynamic approaches are offered in ongoing recovery. Of particular comfort to those of us who object to treatment dictated by uninvolved third parties is the authors' repeated emphasis on the importance of continued professional support and treatment throughout the course of recovery. This book raises a serious challenge to the myth that the need for treatment for alcoholism ends with abstinence or even with early recovery. Instead, the authors illustrate the profound disruptions of family systems dynamics that can unfold only after abstinence and can progress for years thereafter. They wisely caution the reader against the pitfall of reacting to the collapse of the old pathological family system as if the goal of treatment were to prop up a failing dictatorship. In this manner the book tactfully serves as a primer guiding us away from professional codependence.

The most useful approach to reading this book is to trust its authors. Even for those of us who are seasoned clinicians with years of experience working with alcoholism in families, denial of the agony and trauma of living with alcoholism may blunt our finest work. Surrendering to the repetition of themes and reading this book in its entirety will offer the greatest benefit to any reader who is open to its message of recovery from the family disease of alcoholism.

Footnotes

Dr. Roth is Chairperson of the Family and Generational Issues Committee, American Society of Addictions Medicine. He is in private practice in Chicago, IL.

References

1. Brown S: Treating the Alcoholic: A Developmental Model of Recovery. New York, Wiley, 1985
2. Brown S: Treating Adult Children of Alcoholics: A Developmental Perspective. New York, Wiley, 1988
3. Brown S, Lewis V: The alcoholic family: a developmental model of recovery, in Treating Alcoholism, edited by Brown S. San Francisco, Jossey-Bass, 1995, pp 279–315

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