“LifeLines is a monthly column dedicated to addressing issues of mental, behavioural, and social health. The column appears on the 1st weekend of the month, and is written by professionals in the field of social work, mental health, and community medicine”.
By Dr. Mary Jo Cannon
Why do we call alcoholism a “Family Disease”? Because the identified patient has the disease, and the family has the patient; therefore the family also has the disease. For the patient, the disease entails a loss of the ability to control use of alcohol to a point of major negative consequences. These negative consequences impact the patient, the family and the community at large. This disorder is chronic, progressive and ultimately (if unrecognized and untreated) fatal. It will lead to premature death for the identified patient, and it will have a lifelong impact on those nearest and dearest to the patient— i.e family, spouse, offspring, siblings, and friends. It can even prove injurious and fatal to innocent victims such as people killed by drunk drivers or harmed by the patient while under the influence or in an intoxicated state. And so this means, quite frankly, that if you are related to—fall in love with—or are born to a person afflicted with the disease of alcoholism, you will “have it”, too. Or perhaps I should say it will “have” you. For it will affect you.
When one thinks of an “alcoholic” (and we’ve all heard the term) what does one think of? What would an “alcoholic” look like? For the majority of us we picture an adult male…homeless, unemployed, unkempt, unwashed, dressed in rags, lying in a gutter and drinking from a bottle of liquor inside a brown paper bag. So it may be hard to find out that this image is only the tip of the iceberg. For a long time before the alcoholic is homeless and begging on the streets, he or she is simply living in the center of the chaos and drama generated by lifestyle choices made to support an increasing need for the drug of choice…alcohol. The typical person affected by this disease can be identified not by age, sex, job or educational level achieved (after all, this is an “equal opportunity disease) but rather by continued use of alcohol in the face of very negative consequences.
For the person at risk for the disease, the process starts with the first drink and continues with the decision to continue to drink over time. Because the onset and progression of the disease is insidious, it is oftentimes unrecognized in the early stages…yet it does move forward in a predictable manner. And, what’s more, as the disease progresses for the person afflicted (the “identified patient”-or I.P.) it progresses in a predictable manner for the family as well.
So let me go through the progression as it moves forward for the I.P. and the family.
1.) The I.P. experiences increasing tolerance for the drug of choice (alcohol for the alcoholic). Over time it takes more alcohol to get the “buzz”. As the I.P. indulges in greater tolerance for drinking, the family develops greater tolerance for this behavior.
2.) The I.P. becomes more obsessed with obtaining and using the drug of choice, and the family becomes more obsessed with the I.P.’s behavior….e.g absences at expected family events; coming home late or not at all; watching the time and wondering where the I.P. is; calling and leaving messages or calling and trying to track the I.P. down; or going to places the family expects the I.P. to be trying to figure out what is going on, where they are and what they are doing.
3.) The I.P. experiences a decreasing “high” from the usual amount of drug and the family experiences decreasing dismay at inexplicable changes in their loved ones’ behavior.
4.) The I.P. tries to figure out how to get more time to drink and party and the family tries to figure out how to get the I.P. to stop…and the threats begin. “If you do that again, you’re out!” And it happens again…”Well, I’ll forgive you JUST THIS ONCE…if it happens again, you’re out”. And it happens again.
5.) The I.P. misses work and the family “covers” with excuses.
6.) The I.P. gets into accidents and makes messes and the family cleans them up, sometimes without even letting the I.P. see them. Like when the I.P. stumbles in late at night, slips and falls and then vomits. The family picks the I.P. up, cleans him/her up, tucks him/her into bed and cleans up the vomit, the blood, and the mess.
In the big picture of this progressive scenario the I.P. is getting progressively sicker, and the family is getting sicker and more dysfunctional, too. What’s more, there are distinct roles the family members will fall into:
1.) The “Enabler”…usually the spouse, this is the family member who makes the excuses for the I.P., takes up the slack of duties and obligations the I.P. is missing, and keeps everything going in the face of increasing disability.
2.) The “Super Star”…this is the family member who unconsciously needs to ensure that the family image remains untarnished. This person needs to project the image “there’s nothing wrong with my family” and they will be perfect in all they do. They are the overachiever, the perfectionist, the straight “A” student.
3.) The “Lost Child”…this is the family member who sinks into the background and seemingly disappears. They may be in the room, yet they are quiet and not heard from, they don’t get into trouble, they keep a low profile and they are present yet extremely quiet and unheard from.
4.) The “Scapegoat”…this is the trouble maker who is hurt, angry and unable to be heard, who ends up acting out subconsciously to get attention away from the I.P. The scapegoat is the bully, the truant child, and the belligerent teenager who is always “causing a scene”.
And thus we have a brief introduction to the ways in which the disease of alcoholism impacts the family and affects all its members. Yet this is the first step in understanding the nature, once again, of the disease of alcoholism/addiction. Stay tuned, more shall be revealed!
Dr. Mary Jo Cannon is a Professor, International University of Nursing