My parent was an alcoholic ; IT’LL NEVER HAPPEN TO ME
She started to drink
as a way to cope
that makes her less able to cope.
Knots (Laing, 1970)
This week is COA week, highlighting the problems facing children of alcoholics (COAs).
Laing, himself an alcoholic, writes how self medicating with alcohol as a solution to pain
ends up creating more pain. One may expect children of an alcoholics
to shun alcohol but they don’t; they are at a 2 10-fold increased risk of alcohol-
ism compared with children who do not have a parent with alcoholism (Lieberman,
2000). Many of them approach a therapist for help. Therapists are well placed to offer insight into the states of mind a COA is looking for via alcohol so that they can ultimately leave it behind. A COA loses a parent to alcoholism which leaves a void, a developmental deficit vulnerable to the same coping mechanism. A COA has watched their parent deal with pain via alcohol. This models how to deal with pain. A child may be determined to be different from their parents but this model runs deep..
Addictive processes have much in common. Alcoholism is increasingly prevalent, potentially deadly and the psychological effects on the family can be devastating. The contrast to the ubiquitous, significant role it plays in British culture and the association with fun makes the problem hard to address. Jokes about becoming inebriated are common on social media. However, the Royal College of Psychiatrists reported 8.4 million adults drinking at high risk during the pandemic, at a time when addiction services were cut to a minimum (Royal College of
Psychiatrists, 2020). The devastating impact on children is now being more widely
publicized. The member of parliament Jonathon Ashworth, a COA, expressed his concerns for children during the covid lockdown, saying ‘With schools largely closed
to most pupils, many vulnerable children will be suffering in silence with nowhere
to turn’ (Ashworth, 2021). This suffering in silence prevails long after lockdowns. Not surprisingly, many who were children then will turn to alcohol themselve as soon as they are old enough to.
When someone is worried about their drinking, it can be difficult to define what is and is not alcoholism. For example, how bad does alcoholism have to be before therapy is ineffective? This is confusing, it is impossible to think straight, feel or reflect when all feelings are drowned in substances. The physical vulnerability inherent in alcoholism affects the ability to think. Building a secure therapeutic alliance is a fragile and precarious task. It is also difficult to determine when harmful drinking for psychological reasons becomes physical dependence, crossing over into alcoholism. Sometimes the more useful question is not how much is drunk but the relationship to alcohol that is important. In his book The War of the Gods in Addiction, Schoen (2009) talks about alcoholic priests he has worked with who could drink wine with communion without relapsing. He
posits that the sacred wine is received in a non-addictive way. This raises questions about why control is possible on some occasions but not others. This seems to be connected to the reasons the alcohol is taken. When alcohol is drunk to deal with a feeling, the loss of control can take over more destructively. This perhaps helps us to understand how hard it is for some alcoholics to return to moderate use once a line has been crossed; it is so effective in obliterating painful feelings.
A behavioural approach can help someone reduce their intake, but may not keep them sober if reasons for substance misuse remain unaddressed. As Rosenfeld’s (1960) paper ‘On drug addiction’ argues,‘One has also to consider the symbolic meaning of the drug, which is related to the unconscious phantasies attached to the drug and drugging and the pharmacotoxic effect which increases the omnipotence both of the impulses and of the mechanisms used’.
He felt that a key element to the addiction was an identification with a dead or ill
object that is incorporated via the substance. If a love affair with alcohol replaces a parent lost to alcohol, the only lasting cure is a living, breathing relationship with someone who can help sort out the emotional legacy the family disease has bequeathed.
THE DEVELOPMENTAL IMPACT OF GROWING UP WITH ALCOHOLISM
Cavalli’s (2012) paper ’Transgenerational transmission of indigestible facts’ explains
how trauma is passed through generations. A COA has experienced a frightening parent
who changes into an unpredictable force. Because commonly, it’s not talked about, the
COA cannot give form to the traumatic experience. It feels shameful. Cavalli under-
stands the experience of trauma as ‘the transmission of disorganising deadly ghosts and
mental void’. The deadliness of the void generates anxieties that cannot be represented
symbolically. Alcohol provides illusory relief and thus it can be seen how the problem
could become the solution. A COA learns, through identification, how alcohol can alle-
viate pain and give a fantasy of control. Perhaps the experience of much-needed omnip-
otence relieves the helplessness evoked by trauma. This is frustrating because often a
COA consciously wants to be different from a malevolent parental influence.
The void created by trauma is what is described by Cavalli as ‘This third, made
of undigested facts which create annihilation anxieties, shadows like a ghost the
development of the second generation, who create an attachment to it. It is this
attachment that the third generation seems to absorb into their selves’ (2012,
p. 601). In my view, alcohol attaches itself to this third (or the emptiness/death in
the psyche). The attachment to alcohol may become a surrogate relationship, an internal babysitter that cannot replace or rectify the loss of a real parent. As a substitute, alcohol can become powerful and longed for but also hated. To encourage separation from alcohol, therapy needs to address the acute anxiety that may come when facing life without this relationship. This may feel deadly. The loss of alcohol as well as what it represents needs to be understood, expressed and elaborated on, much like weaving a web. This web of sobriety can then begin to contain the powerful affects that the original parent, lost to alcohol, could not help with.
In many ways, the failure of therapy to ‘cure’ alcoholics led to the commonly held view that abstinence is the only antidote to this ‘disease’. This view serves to absolve both psychotherapists and alcoholic patients from what is at times a seemingly impossible struggle. Because alcoholism, as it progresses, physically influences a capacity for reflection, many are denied the therapeutic help they need. Moreover, the label ‘alcoholic’ can often prevent people from asking for help with problematic drinking because of
its pejorative associations.
A less polarized attitude to alcoholism in psychotherapy would help, especially given the ubiquity of the problem within our culture and the huge, growing personal cost to individuals. Recognition of the transgenerational nature of alcoholism could lead to more openness to working with individuals struggling with their drinking, as well as their families. If the void left by trauma remains because of a lack of containment in childhood, the effectiveness of behavioural approaches will be limited. Therapy can begin to address some of the unmet relational needs that drive the drinking. The takes courage but is the first step towards breaking transgenerational cycles.
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