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The spirit of the Lord is upon me . . . to proclaim release for prisoners and recovery of sight to the blind; to let the broken victims go free.

-- Luke 4:18 (NEB)

Those who are concerned about alcoholism and who also believe that the church has a significant role in the second half of the twentieth century long to see it take a more dynamic role in the solution of this gigantic problem. Local congregations, viewed collectively, represent a sleeping giant of influence and help to the burdened, so far as their potential contributions in this area are concerned. Many individual clergymen are providing valuable services in alcoholism education, working with local Councils on Alcoholism and helping alcoholics and their families. But most local churches, as total congregations, have hardly scratched the surface of their potential opportunity to be the "servant church" in the area of alcoholism.

The clergyman should set the tone of concern and help provide leadership for his church’s ministry in this area. His job is to catalyze interest, motivate key laymen, work with them to plan strategy and train a task force to implement it, and be available as a knowledgeable resource person. In the contemporary understanding of the church, ministering is a function of the entire congregation. The clergyman is a pastor of pastors, a teacher of teachers, a counselor of counselors. ^1. His role is to inspire, train, coach, and work alongside the lay ministers who composed the congregation, in their ministering to persons in need (and to the needs of society through social and political action). This approach reflects a recovery of the New Testament understanding of the nature of the church and the Christian life. ^2.

Every member of a congregation has a job to do in the healing-redemptive ministry of his church. It is his unique job -- only he can do it. Only as increasing numbers of us catch this vision and accept this challenge -- to be where the action is in the church -- can our congregations become redemptive communities, centers of help and healing. Only thus can they be gardens and hospitals, places of growth and healing, rather than museums.

`One of the challenges-to-service to which some members of every congregation should respond is the problem of alcoholism. Think of five and one-half million alcoholics and twenty million family members caught in a gigantic web of suffering. What an opportunity to make one’s life count in helping to meet human needs in the name of the Great Physician!

Implicit in the preceding chapters has been the belief that the minister and his congregation have many strategic opportunities in the area of alcoholism. The purpose of this final chapter is to discuss a five-pronged approach by which a local church can fulfill its opportunities and release its potentialities for good in this area. This chapter will be an overview of a plan and strategy for the church. As such, it will summarize some of the salient points in the chapters of Part III.

The five areas in which important contributions can be made by a congregation are: Education, prevention, community outreach, helping the alcoholic, and helping the family.

I

Alcoholism education aimed at developing a climate of understanding and acceptance. A church has an opportunity to help build the solid foundation of informed concern on which any effective approach to the problem must be based. Taken together, the churches and temples have the widest educational contact with adults of any institutions in our society. Over 121 million Americans belong to a church. Each week, forty or fifty million adults and many young people in the formative years listen to a spiritual leader speak on something which (hopefully) touches people where they live. Each week some three million teachers function in church programs of religious education for children, youth, and adults. Through these channels, the churches have an unrivaled opportunity to help develop understanding of alcoholism at the grass roots of our population. To take advantage of this opportunity, the church’s lay and ministerial leadership should plan and carry out a sustained, systematic educational effort to reach all ages from junior high up with the basic facts about alcoholism.

Education is concerned with aims, target groups, content, and methods. Choice of content and methods will be determined, to a large extent, by the aims or objectives of the educational program and the target groups one hopes to reach. In addition to its broad target -- reaching the entire congregation with a message that will help them understand alcoholism -- the church has a number of more limited and strategic target groups: teen-agers and pre-teens who are making or are about to make decisions about alcohol; parents who are searching for ways to prepare their children to cope constructively with alcohol and to avoid alcoholism; alcoholics and their families who need help but are afraid to come out of hiding (see Chapter 8). In addition, there are in nearly every congregation employers who have alcoholics in their businesses or plants, workers who know of untreated alcoholics in their unions, professional people with alcoholics among their clients or patients, public schoolteachers and opinion molders who through social prestige, political leadership, or involvement in the mass media help to create new images of public problems. By reaching target groups such as these with an enlightened view of alcoholism, church leaders can help key people in the community think, write, speak, and act more creatively on this problem.

Alcoholism education ought to be integrated into the church’s ongoing program of education on social problems in general, including other problems of alcohol and problems of mental health and illness. Whether one’s goal, so far as drinking is concerned, is abstinence or moderation, it is wise to approach education concerning alcoholism via the sickness conception and AA. Educationally these provide the best entrée to the interest of the average person. Nearly everyone, I have found, is interested in the dramatic story of AA, and this is a natural point of departure for a discussion of alcoholism. In this post-Prohibition era there are many people who are "allergic" to the usual temperance approach, but who will listen with rapt attention when alcoholism is presented as an illness to the danger of which one exposes one’s self when he drinks. Many young people find it almost impossible to conceive of taking a drink as a major moral issue, but they can readily understand the danger of getting a disease. Speakers from AA, Al-Anon, and Alateens often make an unforgettable impact on church groups by personalizing the problems and the recovery from alcoholism.

Whatever is taught about alcohol and alcoholism should be put in the context of a positive view of the good life as seen from the religious perspective. Emphasis should be placed on what the church is for rather than on what it is against. An important aspect of the unique contribution of a church is to provide a context for alcoholism education -- a view of life as a glad adventure and a gift from God. Within this frame of reference, decisions about all matters including alcoholism can be made, and an understanding of the congregation’s mission to the burdened, including the alcoholic, can be gained.

Alcoholism education in churches, schools, and families should have two phases. The first has as its objective head-level understanding. Rigorously accurate presentation of the facts about alcoholism is the method of helping people move toward this objective. Information about the nature, causes, and treatments of alcoholism now available, plus an emphasis on the importance of knowing the warning signs of approaching addiction, are germaine to this phase. The new hope which now surrounds the problem should be highlighted, perhaps by describing the spiritually refreshing AA program and other treatment resources. The atmosphere of hopelessness which still attaches itself to "alcoholic" in the minds of many people is no longer appropriate to or in conformity with the treatability of the illness. Particular emphasis should be put on the inaccuracy of the Skid Row stereotype of "alcoholic," so far as the great majority of actual alcoholics are concerned. It is important, of course, to avoid oversimplifying the enigmatic complexities of the problem and to avoid painting an overoptimistic picture which ignores the dark realities and the unsolved problems which still exist in abundance.

Phase two of alcoholism education should move beyond head understanding to heart understanding of the persons suffering from the problem. This objective is much more difficult to achieve than the first. It involves modifying attitudes and feelings about alcoholics, increasing compassion toward them and their families, saying "yes" to them as persons of worth, whatever their problems in living. What is required is education in depth.

There are at least two things that seem to be crucial in changing attitudes. First, attitudes are changed in relationships and through experiencing something new that does not fit one’s old images and biases. One way of approaching this is to ask all the teachers in the church school to attend two open meetings of AA as a part of their preparation for teaching in the general area of alcohol and alcoholism. A schedule of nearby meetings should be provided with the suggestion that no more than two go to a given meeting. It should also be suggested that they stay after the meeting and get acquainted over coffee with some of the members. Person-to-person contacts with recovered and recovering alcoholics in AA have probably done more to lessen punitive attitudes toward alcoholics than any other influences. Such contacts will allow the teachers or pastoral care team members to discover that recovered alcoholics are not only people; they are frequently fine and likeable people.

The second thing about attitudinal change is that, although relatively little of it occurs in most formal educational procedures, it does take place spontaneously when people get involved in constructive action on a problem. Laymen should be encouraged to serve on local Councils on Alcoholism, work as volunteers in enlightened treatment facilities and halfway houses, both because such help is often needed and because the experiences will help to modify relationship-blocking stereotypes concerning alcoholics. A congregation’s own program for alcoholics can be invaluable for the same two reasons. Somehow people who are to be effective in this area must be helped to get beyond their fears of alcoholics and their anger toward them, to a warm fellow-feeling which makes possible a joining of hands in mutual acceptance.

The basic attitudinal climate in a congregation with respect to alcoholism provides either a bridge or a barrier to its work with alcoholics and their families. If it is to be a bridge, so that the congregation can use its potential helping resources creatively, then somehow the hard lumps of judgmentalism which linger in our psyches, even when we wish they would go, will have to be melted by compassion. Only thus can a person become a channel of that acceptance of others which is the healing force in religion. The ultimate test of a church’s redemptive concern is its ability to accept the socially unacceptable, including the alcoholic.

The blocks to fuller acceptance of others are within the individual; they have to do with his lack of self-acceptance and his inability to accept God’s acceptance. In small personal growth and spiritual discovery groups, some laymen and pastors are discovering how to remove these inner blocks. They may discover, for instance, that it is because alcoholics and other social deviants threaten them psychologically that they become anxious and therefore hostile in their attempts to relate. Working through to a living experience of grace in group relationships can heal the inner alienation that keeps us alienated from others.

Some church people are troubled by the sickness conception of alcoholism, believing erroneously that it denies that there are ethical issues involved. Since the sickness conception is the only sound place to begin, in either prevention or therapy, this is a serious dilemma for them. Wrestling with the issues raised in Chapter 7 may help resolve this dilemma. It should be emphasized that to say that alcoholism is an illness does not necessarily imply that there are no ethical dimensions to the problem. An alcoholic is simply a person with a condition called alcoholism. His behavior, like yours and mine, is composed of a complex mixture of sin and sickness, compulsiveness and freedom, accountability and drivenness. The point is how one handles the ethical aspects of the problem. To moralize, as indicated earlier, is utterly futile. To treat the alcoholic as a person who has the capacity to become more responsible is close to the heart of both sound counseling and the AA approach. The point is that the sickness conception need not be seen as amoral in order to be an instrument of acceptance in the relationship.

There is a growing body of useful materials in the area of alcoholism education. ^3. Sources of pamphlets, films, books, and teaching guides include local Councils on Alcoholism (or the National Council, ^4, if there is no local affiliate), state alcoholism agencies, and denominational social problems agencies. An excellent, brief film for introducing a program or series is "To Your Health," produced for the World Health Organization.

II

. As indicated in the previous chapter, this is probably a church’s most important contribution in the struggle to conquer alcoholism. It is obvious that one of the chief channels of prevention is the program of alcoholism education. Prevention and education overlap, but they are not identical.

A congregation needs a strategy for prevention which is. a part of the larger strategy for preventing the broad spectrum of individual, family, and community problems. One of the mistakes that many churches have made in the past was to conceive of the prevention of alcohol problems on one level -- in terms of persuading people not to drink. The most important point in the last chapter was that the prevention of alcoholism can and should occur on several different levels simultaneously. Since prevention was discussed in detail in that chapter, the consideration here will be limited to illustrations of how a congregation can contribute to prevention on two of the four levels.

Prevention at the grass roots includes the whole range of activities in the program of a local church, which contribute to the development of wholeness in persons and the vitalizing of families so that they satisfy the basic interpersonal hungers of children, youth, and adults. A marital enrichment group, a family camp, a child-study group, a youth fellowship, a preparation for retirement group, a nursery program, a senior citizen club, premarital counseling, marriage counseling, pastoral care in bereavement, parent-child counseling, and the entire spiritual growth and educational thrust of the church -- all these are examples of resources which are designed to stimulate the growth of personality toward the realization of each individual’s potentialities. To the extent that a church program succeeds in this, it helps to prevent alcoholism and other forms of personality illness at their source. The church’s role in presenting its message in pro-life ways, and in changing cultural attitudes such as moralism and success worship, is another contribution to grassroots prevention.

Prevention through influencing symptom selection is accomplished through alcoholism education which actually leads to either abstinence or the prevention of drunkenness. In a society in which a majority of adults not only use alcohol but attach considerable social significance to drinking, it is safe to assume that the majority of persons who are now children and youth will eventually decide to drink. Since this is the case, it is essential that a part of their preparation for living constructively in the adult world be to learn to distinguish responsible from irresponsible drinking. (The ethical distinctions, for example, between drinking as a part of a relaxed evening at home and drinking prior to operating a car or other piece of potentially lethal machinery, need to be seen clearly by a young person.) There are gradations of social responsibility and irresponsibility involved in a wide variety of drinking situations. With reference to the prevention of alcoholism, it is important to help young people see that the why of drinking is directly related to whether or not a person moves into problem drinking and that frequently intoxication or use of alcohol to cope with personality problems is dangerous and therefore irresponsible. It is at the point of failing to help youth develop ethical controls on the extent, occasion, and reasons for drinking that the one-track abstinence approach to alcohol education fails to prepare them for life in a society where the majority of them will probably drink.

The church’s role in prevention through early detection and treatment, and prevention through helping the children of alcoholics has been discussed adequately in the previous chapters.

III.

Community outreach and leavening. The church that is isolated from the problems of its community (which extends from the local to the world community) is not being true to its mission to become the "light of the world" and the "salt of the earth." Ministers and laymen should see involvement in community alcoholism programs as an expression of their religious dedication. ‘What is needed is for churches to devise imaginative ways of getting more of the hundreds of thousands of dedicated laymen directly involved as trained volunteers in projects to deal with all kinds of personal and social problems, including alcoholism.

One of the encouraging aspects of the present picture is the amount of preventive educational work that is being done by individual ministers in their communities. The 146 Yale ministers had almost all been very active in this field. As we have said, five of them had helped to organize local Councils on Alcoholism. Another was engaged full time as the director of a state alcoholism program; still another reported that he was executive officer of a state "pilot experimental project" which included an information and rehabilitation center for alcoholism. Three respondents told of the following significant work on the community level:

1. Facilitated some friendly contacts between AA and a judge of the municipal court as well as the personnel manager of a large industrial firm.

2. Behind-the-scenes attempt to get the city welfare association to begin the educational approach to the problem in the community.

3. Tried to promote consideration of alcoholism as a public health problem with local council of social agencies and state council of social welfare.

Almost all the ministers reported giving talks on alcoholism to all manner of youth and adult groups in public schools, youth camps, AA groups, and various community organizations. Twelve had written one or more articles on alcoholism. The impressive contributions which this particular group of ministers is making in the educational and community leavening areas are evidences of what can and is being done. ‘What they are doing is but a small fragment of the total contribution of thousands of ministers over the country.

These men are convinced, for the most part, of the validity and importance of the scientific-therapeutic approach to alcoholism. They are rendering yeoman’s service in helping to spread the kind of knowledge in their communities that will bring hidden alcoholics to help and lead gradually to the prevention of the disaster of alcoholism. It is hopeful that their number is increasing and that many of them are beginning to involve their laymen in this work.

Here are illustrations of what some churches are doing, usually through their social action committees, to implement an outreach ministry in alcoholism:

Many churches have invited AA, Al-Anon, and Alateen groups to use their fellowship halls. This is often a mutually enriching and enlightening experience, particularly if church members take the initiative in getting acquainted and expressing interest by occasionally attending open meetings, and by inviting speakers from these groups to address church groups.

Churchmen have worked with others to establish alcoholism inpatient and clinic facilities. A survey of clergymen conducted by Benson Y. Landis showed that a majority "expressed the opinion that the local church should help other community agencies establish special clinics to treat alcoholics." ^5. Public clinics for alcoholics are right from the humanitarian and therapeutic standpoints. (They are also less expensive than the present "public care" system in which local governments spend millions each year on court, police, and jail facilities.)

Church members have helped establish local Councils on Alcoholism and have served as volunteers to "man" the information centers. Alcoholism is too big and complex a problem for any group to handle alone. Dedicated, knowledgeable churchmen have often seen the need to join forces with others in sparking a community-wide action program, coordinated by an Alcoholism Council.

Working to help open local hospitals to accept alcoholics as any other sick person is an important form of community outreach. It is particularly ironical when church-related hospitals have a policy (written or simply understood by the admissions staff) of not accepting alcoholics. Effective action can be taken by working through hospital boards.

Mobilizing moral support for state alcoholism programs is another way in which concerned churchmen can be an influence for good in this field. Unless public support is evident to state legislators, the programs may suffer from budgetary strangulation.

Many churches have had a role in backing alcohol education in public schools. The crucial issues are that it include alcoholism education and that it be sound in method and objective in content.

IV and V

Help for the alcoholic and his family. It is not valid to assume that, since there are now numerous specialized agencies engaged in alcoholism treatment, the church can properly relinquish all responsibility for direct services to alcoholics. For one thing, many alcoholics are not being reached in time with help by any of the community agencies. Alcoholics are very different and their treatment needs varied. An approach that suffices with one may not with another. Many require a combination of treatment resources to achieve recovery. For this reason, we need a diversity of approaches so that as many as possible may be helped. Equally important, the church has unique contributions which it can and should make to the helping process. Therefore, it is not appropriate to say, "Let AA and the local alcoholic clinic do the total job."

A church ought to support (with volunteer time, interest, and, if needed, money) the community’s alcoholic treatment programs and agencies. It should use them as often as appropriate to make referrals. Where needed community treatment resources are lacking, the clergyman and his lay leaders should help to spearhead efforts to provide them. But, at the same time, a church should be engaged in some one experimental approach by which it seeks to develop (1) ways of bringing a unique service to the helping o~ alcoholics and their families, and/or (2) new ways of reaching and motivating hidden alcoholics to accept help. Just what project a particular congregation should choose to do depends on the unmet needs of its community and the resources of the members who are available to help.

The following are examples of what various churches are doing. They are presented to suggest the wide variety of possibilities open to a congregation, possibilities limited only by the needs of the community and the resourcefulness of a church’s leaders.

An East coast church is sponsoring an experimental program in alcoholic rehabilitation for men on probation because of alcohol problems. The weekly meetings alternate between AA speakers and mental health or alcoholism education films. ^6. A Southern California church sponsors "Sunday Night with Recovered Alcoholics" for these two purposes:

(1) To create an occasion and an atmosphere in which members of the clergy and other professional people may learn more about alcoholism and observe the recovered alcoholic through his own story. And, to give the recovered alcoholic a similar opportunity to listen to members of other disciplines who are interested and knowledgeable in the problem of alcoholism. (2) To give recovered alcoholics the means of better learning about the eleventh step, namely, "to seek through prayer and meditation to improve their conscious contact with God." ^7.

Recovered alcoholics and professional people, in approximately equal numbers, are invited to these weekly meetings.

The Cleveland Center on Alcoholism has set up a series of afternoon discussion sessions at a church in a marginal economic area for wives of men with drinking problems. Since women from this particular area seldom come to the Center for help, it was decided to take the Center to them. The women could walk to this meeting place, which was in familiar surroundings, and their children could be left under supervision in the church’s recreation room. This is an illustration of a church cooperating with a community agency in a new pattern of service to families of alcoholics. There is no reason why a local church could not take the initiative in setting up a similar type of group, calling on whatever community resources are needed to provide the desired program.

On the West coast a halfway house for alcoholic men is sponsored cooperatively by several churches of one denomination. A church of another denomination, in the same area, is developing plans for a halfway house for alcoholic women. In such projects, it is important to train a group of laymen within the church for the various roles which they may fill.

A refreshing example of direct, congregational involvement in working with homeless alcoholics is a Church of the Brethren program. About a dozen congregations have "sponsored" alcoholics released from mental hospitals and prisons with no place to go. Sponsorship is similar to that accorded refugee families. The sponsors are responsible for helping the person find a job, obtain housing, and bear expenses until his first paycheck. A group within the congregations is trained to receive and relate to the alcoholic. Their assignment is to assist him in any way that may help him to adjust to living outside the institution. The educational impact of this program on the congregations -- in terms of their understanding of alcoholism and their acceptance of alcoholics -- has been a valuable by-product. A staff member from the office of Social Welfare of the denomination provides the preparatory training for the congregation, secures the alcoholic, and is available for follow-up guidance as problems arise. The first alcoholic to be sponsored by a congregation had four slips in that many years, but since then has had some eight years of complete sobriety. That one church has sponsored eleven other alcoholics. The most important thing a congregation must give a recovering alcoholic is a sense of acceptance in the fellowship. Such direct involvement in helping deeply troubled people forces a congregation to test the reality of its dedication to loving God and neighbor.

The use of personal growth groups as an aid in the spiritual development of recovered alcoholics was suggested in Chapter 10. Many of the depth Bible study, prayer fellowship, and koinonia groups which now function in many churches can serve alcoholics (and others) as means of stimulating growth which they desire in the vertical dimension of their lives. Frequently these groups are led by spiritually mature laymen who have had special training and preparation, including extensive small group experience.

The pastoral care team was mentioned in Chapter 11. This is a task force composed of those committed to pastoral care as their primary focus of lay ministry. Carefully selected and trained, this group works under the minister’s guidance, supplementing and broadening his work with the troubled. To help alcoholics effectively, the team should include stable AA and Al-Anon members of both sexes, and a physician who is acquainted with current medical approaches to the problem. The team should meet regularly for in-service training. Team members serve at the minister’s discretion, as "befrienders" ^8. of those in crisis and those bearing heavy loads.

Organizing for Action

Alcoholism programs in local churches, which have been effective, seem to have gone through certain general steps:

1. Someone who is a "self-starter" and is concerned about alcoholism took the initiative. In some cases this was the minister. If a layman is the initiator, it is important for him to discuss the matter with the minister and get his support. Most clergymen are delighted when a layman takes active leadership in beginning such a project. The key point here is that in almost every case of a successful action project, one person started the ball rolling.

2. A group (usually small) was selected or recruited to share the responsibility. This can be an already-established committee on social action or a committee on alcohol problems. In some situations it is better for an ad hoc task force to be recruited to do a particular job. In any case, the responsible group must be brought in on the planning of the project as well as the implementation phase. Unless something of their thinking goes into the planning, it is probable that their motivation will be minimal.

3. The needs of the local situation were studied and a decision made by the responsible group concerning which unmet need should have top priority. In some cases, the minister or someone else had already decided what he felt needed to be done, and a group was invited to help in doing it. This may work, if the project has obvious merit and the group has some voice in deciding how it will be carried forward. But, in general, the earlier the working group can be included in the decision-making and strategy-devising activities, the stronger will be their motivation to invest themselves in the project.

Careful study, by all members of the action group, of the recommendations of the Cooperative Commission on the Study of Alcoholism, should precede the decision- and strategy-making steps. The Commission’s major report (Alcohol Problems, A Report to the Nation) is an invaluable resource for any clergyman or lay church leader who is searching for fresh insights and directions in the church’s approaches to alcoholism. Church groups have an opportunity to help implement its salient recommendations in cooperation with other groups at both the local and national levels. ^9.

4. Plans were formulated on how to proceed on the chosen project, and work was begun. It is important for a group to concentrate its efforts on one project at a time, to have frequent evaluation sessions on the progress of the project, and to draw in such resource people as may contribute to achieving the goal of the project. One aspect of planning is for task force members to consult with others who have attempted similar projects and to read relevant reports and other literature. A congregation considering a ministry to alcoholics and their families, for example, might well read the summary of the seminar on "The Pastoral Care Function of the Congregation to the Alcoholic and His Family." This seminar was sponsored by the Department of Pastoral Services of the National Council of Churches. ^10. Sources of literature and guidance include local Councils on Alcoholism, the National Council on Alcoholism, and denominational social problems agencies. It is encouraging that several of the major denominations have developed plans and resources in the areas of alcoholism education, community action, and rehabilitation. ^11. It may be productive for a minister or task force member to write to several denominational agencies, in addition to his own.

The five-pronged approach described above for use by a local church can also be used advantageously by denominational and ecumenical groups in their planning of alcoholism strategy. There is a need for each denomination to develop its own unique style and contribution, but there is also a need for much increased cooperation by religious groups across denominational, faith, and national lines. This is the place where ecumenical bodies such as the National Council of Churches and the World Council of Churches (perhaps in cooperation with the World Health Organization) have a major opportunity to provide coordination and joint strategy designing.

If the influence of church groups is to make a contribution in relation to the federal mental health and alcoholism programs (in the U.S.), it will have to be expressed through ecumenical channels. In the light of this, it is fortunate that a foundation for joint action was laid in a statement adopted by the General Board of the National Council of Churches in 1958. Here are some excerpts:

The churches share a pastoral concern for alcoholics, problem drinkers and their families. . . . Alcoholics are persons in need of diagnosis, understanding, guidance and treatment. They are especially in need of pastoral care and the divine love which the church can bring them. . . . Ministers and churches should not be content merely to direct alcoholics to treatment centers.

The concern of the churches for alcoholics and their families is being shared increasingly by the community as a whole. We look to the member churches of the National Council to encourage the establishment and maintenance of clinics and other appropriate therapeutic facilities when competently conducted, for the victims of alcoholism. . . - The churches should disseminate such sound information as is now available concerning the understanding and counseling of persons with alcohol problems. The churches have a special responsibility to assist pastors to become more effective counselors in this field. ^12.

The Key -- The Helper’s Personality

If a minister or layman desires to maximize his effectiveness in any dimension of the alcoholism field; he must become competent in both skills and knowledge about the illness. But there is one factor which is more important than either of these: his personality and particularly his feelings about himself in relation to alcoholics and other deeply troubled persons. To the extent that he possesses a therapeutic attitude toward himself and others, he will be able to use his knowledge and skill. This attitude will be reflected in his relationships with alcoholics and their families. It will show in his tone and manner as he participates in alcoholism education. His approach to prevention and alcoholism action projects will be colored by it. In short, his ability to implement strategies in all five areas -- education, prevention, community outreach, helping alcoholics and their families -- will be influenced by the relative presence or absence of the therapeutic attitude.

The nature of this basic personality orientation has been illuminated by research in the field of counseling and psychotherapy. A study reported by Carl R. Rogers points to three components which are a part of what I am describing as the therapeutic attitude: Congruence, empathic understanding, and unconditional positive regard. ^13. Congruence means genuineness as a person. Rogers declares, "The most basic learning for anyone who hopes to establish any kind of helping relationship is that it is safe to be transparently real." ^14. Congruence involves knowing one’s feelings and owning them. The most important thing a person brings to any helping or teaching relationship is himself -- unbidden and real. Congruence is particularly important in working with alcoholics. They are hypersensitive to its absence -- "being a phoney" or "putting on an act."

Empathic understanding means being able to "tune in" on the inner world of feelings and meanings of another person. It means being with him in terms of what really matters to him behind his façade. In relating to an alcoholic, empathic understanding means that one is able to understand, to an appreciable degree, the chaotic complexity of his fears, guilt, despair, and hopes. This understanding, which is a thing of the heart as well as the head, is crucially important because of the alcoholic’s feeling of haunting aloneness in a bizarre world and his belief that others could not possibly comprehend.

Unconditional positive regard means warm, human regard for the individual as a person of unconditional worth. With his fragile self-esteem (hidden by his defensive grandiosity), the alcoholic desperately needs positive regard. He hungers like a starving man for the acceptance he cannot give himself. The alcoholic’s emotional immaturity causes him often to react in ways that are selfish, irresponsible, and impulse-ridden. This makes it difficult for a helping person to remain accepting and nonjudgmental. It helps to remind one’s self that he is the way he is, in large measure, because of some inadequacy in his early relationships which blocked his emotional growth. The thing that Longfellow said about our enemies is equally applicable to the alcoholic: "If we could read the secret history of our enemies, we should find in each man’s life sorrow and suffering enough to disarm all hostility." The link between empathic understanding and unconditional positive regard is very direct.

Acceptance of the alcoholic is dependent, as has been suggested, on the helping person’s acceptance of the reality of the illness from which he suffers. This is the basic reason for the emphasis which has been placed on the sickness conception of alcoholism throughout this book. A prerequisite for any constructive approach to the problem is the recognition that alcoholism is not an isolated problem, but a part of the total sin and sickness of our society -- a sin and sickness in which all of us are participants. The problems of the alcoholic are the problems which all of us share in differing degrees and with varying symptoms. This sense of involvement in the total cultural problem, of which alcoholism is one painful expression, and an honest recognition of our complicity in the kind of world which produces alcoholics are the points at which we must begin. This was where Lyman Beecher began over a century ago when he wrote concerning alcoholism, "For verily we all have been guilty in this thing." ^15. We can choose no better starting point today.

The recognition by the helping person that he has a basic kinship with the alcoholic, that he is not better but only luckier that his symptoms are different, helps him to accept the alcoholic without condescension. This is the application of Tillich’s "principle of mutuality," mentioned earlier. Deep inside himself, the helping person must be aware of the fact that the alcoholic is not essentially an alcoholic. He is essentially a human being with alcoholism. This affirms the alcoholic’s humanity and provides a link with the humanity of the helping person. To be able to establish this link the person must be aware of his own dark side, his own inner conflicts, dishonesties, anxieties, compulsions, and grandiosities. The surrender experience is as important for the minister or lay worker as it is for the alcoholic. ^16. It is also equally important that they be aware of the grace and acceptance of God in their own lives. Otis Rice put the matter in this way, in a talk to a group of ministers: "More than anything else we need to learn to love the alcoholics. The only way I know to do this is to remember that God loves them, and to remember how much he puts up with in order to love us." The words of Tolstoy come to mind at this point: "Only he who knows his own weakness can be just to the weaknesses of others."

The therapeutic attitude begins to dawn as the helping person senses, in the presence of the alcoholic or of his spouse, that "there but for the grace of God go I!" It exists more fully as he moves beyond even this to the deflating awareness -- "There go I!" This fellow feeling lowers the walls which block the flow of healing forces in the relationship.

Retaining this fellow feeling is very difficult for most of us. To identify with the essential humanness of the despairing threatens our fragile defenses against our own despair. To recognize that the [alcoholic in D.T.s] is more like than different from oneself shakes the very foundation of our defensive self-image. To accept this truth at a deep level is possible for most of us only to a limited degree. It requires an inward surrender of subtle feelings of self-idolatry and spiritual superiority. One student referred to this as "getting off the omnipotence kick." Even a partial surrender of one’s defensive superiority feelings helps to open the door to mutually redemptive relationships. Somehow it melts a hole in the icy barrier of pride that freezes real self-esteem and keeps people -- especially disturbed people -- at a distance. ^17.

The helping person’s own religion can help him maintain the therapeutic attitude. He knows that he is only a finite and fallible instrument, through which the healing, growth-producing forces of life can, at times, operate. He is aware of the fact that, at best, he is an imperfect channel for the flow of these God-given forces. Because of this he is better able to accept the fact that there are many people he cannot help or whom he can help only in very limited ways, no matter how hard he tries. This awareness makes it easier for him to avoid the false humility of unproductive self-blame when he fails, and to look honestly at his approach to discover weaknesses or mistakes which need not be repeated. Because of his own experiences of growth, reconciliation, and healing, he has a confidence in the power of the divine forces in every person which makes these experiences possible. This faith helps to prevent him from applying the easy label "hopeless" to the people he cannot help.

The therapeutic attitude includes a realistic awareness of one’s limitations as an instrument of growth and health; but it also includes an awareness of one’s potentialities as such an instrument. A certain alcoholic had been drunk nearly every night for five years. During his drinking he considered himself an agnostic. Finally, he came into AA, and at the time I heard him speak, he had been sober for three-and-a-half years. Here is what he said about how he was helped by a minister:

For the first seven months in AA I was dry on conceit and ego pride. I had nothing to do with the higher Power, and no support from the outside. I stayed sober, but it’s a hell of a way to stay happy. At the end of that time my wife told me, "You’re just as drunk in your mind as you ever were." I went to have a talk with a member of the local clergy. That day I saw the grass, the buds, the sky in a way I’d never seen them before. I’ve never lost the experience I had that day, and I now have a speaking acquaintance with Someone greater than myself.

We do not know what the minister did or said in his meeting with this man. But it is safe to assume that, whatever it was, it occurred within a relationship to which the minister brought the precious ingredient which I have called the therapeutic attitude. The results of the encounter were more immediate than is usually the case in working with alcoholics (or others). But the helpfulness of the contact is not atypical.

In this meeting of two human beings, decisive events occurred which changed the direction of a man’s existence -- turning him toward life, opening his eyes to the world around him, and beginning his relationship with "Someone greater than myself." Ministers and other persons of religious dedication can be instruments in such a life-transforming process. This is the challenge and the satisfaction of working with the alcoholic and his family.

END NOTES:

1. H. R. Niebuhr et al., The Purpose of the Church and Its Ministry (New York: Harper & Row, 1956), pp. 83ff.

2. See Clinebell, Basic Types of Pastoral Counseling, Chapter 16, "The Layman’s Ministry of Pastoral Care and Counseling."

3. Here are a few of the many resources available for use in alcoholism education: The two basic books are Raymond C. McCarthy, ed., Alcohol Education for Classroom and Community, A Source Book for Educators (New York: McGraw-Hill Book Co., 1964); and Margaret E. Monroe and Jean Stewart, Alcohol Education for the Layman (New Brunswick, N.J.: Rutgers University Press, 1959). The latter is an annotated list of library materials -- books, pamphlets, articles, films, and filmstrips -- for use in alcohol and alcoholism education. The Association for the Advancement of Instruction about Alcohol and Narcotics produces a newsletter which contains useful material. Background books include: the AA and Al-Anon books; Marty Mann’s New Primer on Alcoholism; Arnold B. Come, Drinking: A Christian Position (Philadelphia: The Westminster Press, 1964); Wayne E. Oates, Alcohol In and Out of the Church (Nashville: Broadman Press, 1966).

4. 2 East 10 3rd Street, New York, New York.

5. "A Survey of Local Church Activities and Pastoral Opinions Relating to Problems of Alcohol," QJSA, VIII (March, 1948), 636-56.

6. Robert E. Bavender, "Rehabilitation in Brentwood," The Methodist Story, November, 1964, pp. 39-40.

7. From a leaflet describing the program.

8. This is the term used by the "Samaritans," laymen who staff crisis counseling centers in the British Isles and elsewhere, to describe their work.

9. Another resource for the action group is a report entitled Alcohol and Alcoholism (Public Health Service Publication No. 1640), produced by the National Center for Prevention and Control of Alcoholism, Chevy Chase, Maryland 20203, in 1967. It gives a brief survey of present scientific knowledge concerning the causes, treatment, and prevention of alcoholism; describes present research and that which is needed; and outlines the national alcoholism program. For a survey from the international perspective, see "Services for the Prevention and Treatment of Dependence on Alcohol and Other Drugs: Fourteenth Report of the WHO Expert Committee on Mental Health" (Geneva: World Health Organization Technical Report Series, No. 363, 1967). This report summarizes the WHO approach to drug dependence and describes treatment, education, training, and research programs in various countries.

10. This seminar was held at Columbus, Ohio, October 12-14, 1962.

11. The Episcopal and Methodist Churches have done pioneering in this area. The North Conway Institute, which meets in New Hampshire each summer, provides a channel for interdenominational collaboration and discussion of the problem of alcoholism. On the international scene, it is noteworthy that one of the sections of the Twenty-Eighth International Congress on Alcohol and Alcoholism (held in Washington, D.C., October 1968) was on "Religion and the Church."

12. Statement adopted February 26, 1958, at New York City.

13. On Becoming a Person, pp. 47-49.

14. Ibid., p. 51.

15. F. W. McPeek, "The Role of Religious Bodies in the Treatment of Iniebriates," Alcohol, Science and Society, p. 406

16. For an illuminating discussion of this point, see John E. Keller’s Ministering to Alcoholics.

17. Clinebell, Basic Types of Pastoral Counseling, p. 297. (The words "alcoholic in D.Ts" substituted.)

The church’s most important task, in relation to the problem of alcoholism, is prevention. In this area it has a tremendous mother lode of practically untouched opportunity. Organized religion has direct contact with over half the people in the country. This is more than any other non-governmental organization. If a substantial share of the religious organizations in our country would undertake an enthusiastic and realistic program of prevention, America’s fourth largest public health problem could be brought under control and hundreds of thousands of persons would be protected from becoming alcoholics.

Prevention is the only real solution to the problem. As things are now we are like Alice in Wonderland, running as hard as we can to stay at the same place. (Actually we are falling behind.) Alcoholics are being created wholesale while all the therapeutic agencies together are able only to treat them retail. As the great Japanese Christian, Toyohiko Kagawa, once put it regarding the problem of slums, this is like building a rescue station at the bottom of a cliff to help those who have fallen over, without working at the top of the cliff to keep others from falling. ^1. There are 5½ million alcoholics in the country, and AA has approximately 375,000 members. This means that AA, with its amazing effectiveness, has been able to reach slightly less than one out of every fifteen alcoholics in the country. That it has been able to achieve this in thirty years makes it a near miracle, but it is not the complete answer to the problem. Too many are falling over the cliff into the morass of the sickness of alcoholism each year. Somehow we must build a fence that will reduce the number of new alcoholics.

But what kind of fence is effective in preventing alcoholism? ‘What constitutes real prevention? We must have an answer to this before we can expect to approach the problem of prevention realistically. Our effort to point toward an answer will be divided into three categories. In Chapter 2 it was shown that the various causes of alcoholism operate on three levels: (a) the "soil of addiction," (b) symptom selection, (c) perpetuation of the addictive cycle. A comprehensive program of prevention can and should operate on each of these three levels of the alcoholic sickness. The three corresponding levels of prevention are: (a) prevention at the "grass roots," (b) prevention through the influencing of symptom selection, (c) prevention through early detection and treatment.

Prevention at the "Grass Roots"

The place where grass roots prevention must ultimately take place is at the point where alcoholism begins -- in the home. By exerting its educational influence in terms of the type of parent-child relationship that will satisfy the emotional needs of the child, the church can cut the roots of alcoholism. This is, of course, a long range program. . . . Some within the church will prefer to continue to engage in the less time-consuming business of manipulating symptoms -- for example, by attempting to shield people from becoming compulsive drinkers by making them compulsive non-drinkers.

The church is primarily concerned with making the life of abundance -- of full psychological and physical need satisfaction -- a reality in the lives of men. If it is successful in its primary task, it will help to deal the death blow to the status of alcoholism as a major area of human tragedy. ^2.

As we saw in Chapter 1, approximately 6 percent of those who drink are vulnerable to alcohol addiction. In Chapter 2 we found that this 6 percent seems to be people who, because of inner conflict and anxiety, have an abnormal craving for the anesthetic effects of alcohol. Their personality problems and emotional immaturity constitute their Achilles’ heel which renders them vulnerable to alcoholism. Conversely, those who are fortunate enough to have relatively mature and well-integrated personalities have a much smaller chance of becoming alcoholic. Whatever the church can do, then, to promote mental, emotional, and spiritual health helps to prevent alcoholism at the grass roots. The prevention of alcoholism is thus related to the prevention of all other forms of social pathology.

Prevention of alcoholism at the grass roots is a gigantic task. Just how gigantic becomes clearer when one sees alcoholism as a symptom of the large areas of social malignancy within our culture. Leslie A. Osborn has said, "Big as it is, the problem of alcoholism opens into vastly bigger difficulties of our tangled and complex civilization." ^3. The late Christopher Morley stated the same truth in another way when, in commenting on The Lost Weekend, he wrote: "It becomes almost the history of a whole era of frustration." ^4. One can understand the depth and complexity of alcoholism, and therefore its prevention, by seeing it as a "tragic response to areas of tragedy in our culture."

We have seen that alcoholism is rooted in personality conflicts. In her illuminating discussion of inner conflicts, the late Karen Homey wrote:

"The kind, scope and intensity of such conflicts are largely determined by the civilization in which we live." ^5. The civilization or culture into which an infant is born is channeled to him through the mothering adult in the early period of his life. The aspects of the culture, harmful or beneficent, which she is able to focus on the infant are determined in considerable measure by the way in which the culture was focused on her. Each culture tends to develop what Ruth Benedict has called its "configuration," ^6. a certain pattern of attitudes and practices which control individual and group behavior and produce a nucleus of personality shared by most members of the culture. One configuration may make for emotionally satisfied and secure individuals who develop to a high degree their personality potentiality. Another culture’s configuration may produce patterns of child rearing, family life, interpersonal relations, social and economic life which produce a high degree of frustration and emotional warping in its members. The latter would lay the groundwork for maladjustments of all kinds. It would prepare the soil of addiction of which we have spoken above.

Our cultural configuration seems to provide amply for the conditions which cause the traumatization and emotional deprivation of personality. Because of the wide individual differences which are seen in any culture, these destructive attributes are focused with greater force on some than on others. The chart at the end of this chapter is a summation of factors found to be the most common in the parents of the alcoholics interviewed by the writer. It attempts to show the following in schematic form: column A, three cultural attitudes which are prominent in our "configuration" and in the personality patterns of the parents of the alcoholics; column B, the effect that these cultural attitudes have on the parents; column C, the way in which these effects tend to deprive the child of the satisfaction of certain vital needs; column D, the relationship between this deprivation of satisfaction and the psychological characteristics which are typical of alcoholics.

A child’s basic emotional need is for adequate love. This includes a sense of being wanted, of approval, of achievement, of belonging, of emotional warmth, acceptance, and nearness or relatedness to security-giving adults. Adequate love also includes the satisfaction of the child’s need for increasing autonomy, self-direction, and individual self-fulfillment. This implies accepting the child’s individuality, his physical drives, and his feelings. The maintenance of the balance between the child’s need for security and his need for independence is essential for emotional growth. David Roberts has written: "The child’s foremost need is an adequate supply of wise love. By ‘wise’ I mean steady and natural, instead of sporadic and forced; unsentimental and geared to growing autonomy instead of plaintive and smothering." ^7.

If a child gets enough "wise love," love that is as free and accessible (and as important) as the air he breathes, he will become a healthy, loving, and self-reliant person, a person who does not need to use alcohol as a personality crutch. The three cultural attitudes mentioned on the chart -- authoritarianism, success-worship, and moralism -- all tend to impair the parent’s ability to give the child wise love. Thus they help produce the soil of addiction.

Unfortunately, Protestant churches have unwittingly contributed to the cultural configuration which has produced emotional damage. These past mistakes give Protestantism an added responsibility to contribute to those attitudes which produce emotional health. A group of chaplains of the Council for Clinical Training, men who have unusual opportunities in their work in mental hospitals and correctional institutions, to observe the mistakes of Protestantism, puts it this way:

American Protestantism has frequently made critical and tragic errors in its presentation of the Christian religion -- errors which have contributed to the emotional and spiritual conflict and immaturity in our people. Most of these errors find a focus in a stern, legalistic, absolute and Pharisaical moralism which is the characteristically American form of Puritanism. . . . Churches have had too little concern for understanding why people behave as they do and have been most relentless in their condemnation of acts contrary to social standards, with the result that many have responded with intense guilt feelings. - - . The guilty feel a sense of fear, loneliness and rejection and the result is various degrees of emotional disturbance. ^8.

The report goes on to point out that the churches and their leaders have often propagated an unhealthy authoritarianism, resulting in fear, submissiveness, and immature dependence. Further, they have often made the mistake of saying directly or indirectly that sex is morally wrong.

We might add that the church has erred in that it often has made religion and the vitalities of life seem as opposites. Further it has often failed to create a healing fellowship which would attract people because it met their deep emotional needs. In his poem "The Little Vagabond," William Blake describes his contrasting feelings concerning what the church and the tavern have to offer in this respect:

Dear mother, dear mother, the church is cold

But the ale-house is healthy and pleasant and warm. ^9.

If the church had more often offered a fellowship that was "healthy and pleasant and warm" to children, youth, parents, and families, it might have done much more than it has toward preventing emotional ills, and it would have been unnecessary for persons to find their fellowship in taverns.

The chaplains quoted earlier go on to point out that the unhealthy attitudes and practices do not represent the "deepest and best in the Christian tradition or in the contemporary church." They state that the errors represent a departure from the spirit of the life and teachings of Jesus who was non-authoritarian in his dealings with people, understanding and not condemnatory to those involved in sin, and who reserved his anger for the legalists and moralists of his day.

The church’s first contribution to the prevention of alcoholism at the grass roots, by helping to prevent emotional conflict and illness, is to examine its own message and approach to people to make sure that they are in conformity with the principles of mental health and the best in the Christian tradition.

A church that is concerned about human values has no business allowing itself to be an agent in the perpetuation of harmful attitudes in the culture.

But it must go further than simply avoiding the doing of harm. It can put the weight of its educational program solidly behind the movement which aims at disbursing to people in general the precious discoveries of the social sciences in the area of healthy personality growth. The leaders of the Emmanuel Movement called for a "preventive psychiatry" which could help parents prevent the "wounds of childhood." Herein lies a tremendous educational opportunity for the church, with its natural entrée to families.

Let us see how this applies to alcoholism. The most cogent psychoanalytic explanation of alcoholism indicates that the emotional damage involved probably occurred in the very early life of the person -- during the period when the child’s primary way of relating to the outside world is oral. During the very early months of life the baby not only ingests food but also absorbs security and love through his body, and especially through his mouth. Several authorities in this field have indicated their conviction that alcoholism represents an attempt to return to the so-called oral stage of life. Whether or not this is true -- and the essential orality of alcoholism would suggest that it is -- the important fact is the one on which child-development authorities agree, that it is during the first six years that the foundations of personality are laid. What would happen educationally if the church would face the implications of the fact that the first six years are the most important years of a person’s life from the standpoint of character structure and personality? Would it not embark on a comprehensive program of parent education as a central focus of its work, making the discoveries of the psychologists concerning the emotional hungers of children, from the very dawn of life on, easily available to all its parents? Through such a program parents could come to see that healthy personality is "homemade" and that an ounce of mother is worth a pound of psychiatrist. Such parent education should put particular emphasis on helping the parents of infants to satisfy their babies’ oral needs, the babies being allowed abundant sucking and given cuddling as well as generous amounts of "t.l.c." (tender loving care). By helping parents to do that which they basically want to do but often cannot -- namely, raise children who are mentally, emotionally, and spiritually healthy -- the church would help to prevent alcoholism at its very roots.

Fortunately, an increasing amount of attention is being directed to the resources for enhancing mental health within the program of the church. For example, the author’s Mental Health Through Christian Community ^10. was written to assist a local church in enhancing its ministry of growth and healing by releasing the mental health potentialities within its many-faceted activities. Each dimension of a church’s program -- worship, preaching, social action, the church school, church administration, small groups, family life, counseling, and the ministry of the laity -- has untapped possibilities for helping children, youth, and adults move toward greater personhood. Mental health seems to be "an idea whose time has come." Churches should be playing an increasingly vital role in the surge of interest in this area. As they do, they will be making a significant contribution in the area of prevention. These developments are completely consistent with the central concern of the church -- the growth of persons in ways that develop their God-given potentialities. It is well to remember that the words "health," "hale," "whole," and "holy" all come from a single Anglo-Saxon root. ^11.

In discussing the role of the church in relation to alcoholism, several of the Yale ministers wrote some insightful words concerning prevention. Two of them pointed to the social dimension of the sickness when they wrote: "The Church’s job, I think, is to shed the searchlight of the Gospel on the causes of human misery of which alcoholism is a symptom"; and "We can prevent it by helping people learn how to live in a complex world." And a third wrote: "The best preventive measure for alcoholism is developing normal, wholesome personalities in tune with God."

As a matter of fact, the church through the years has made a real though unmeasurable contribution to the prevention of alcoholism at the grass roots. To the extent that it has succeeded in its objective of helping people to a sense of acceptance and belonging, to love and be loved, to find meaning in life and a faith for meeting death, it has prevented people from needing to escape into the pseudoworld of alcoholism. No one can know how many people might have become alcoholics but didn’t because of the faith and fellowship which they found in their church. By utilizing the newer insights of the mental health movement, the church can make a much larger contribution in this area in which it has long been serving.

Prevention Through the Influencing of Symptom Selection

Some will say that attempting to prevent alcoholism at the grass roots is so large an undertaking as to be almost Utopian in nature. There is some truth in this point of view, and we should never allow our concern with the long-range and fundamental program of prevention to deter us from also working to attain the nearer preventive goals. As a matter of fact, there is a danger from the educational standpoint involved in the grass-roots approach. The danger is that, having heard that "emotionally healthy people don’t become alcoholics," the individual will assume that he is not a potential candidate for the sickness. Consequently, he will become overconfident in his relationship with alcohol.

In order to counteract this danger, it is important to emphasize certain facts as we push for grass-roots prevention: First, that one need not be aware of severe neurosis or emotional instability to become an alcoholic. Many of our deep psychological problems are hidden and disguised even from ourselves. The emotional damage which underlies alcoholism seems to have happened at a very early age, in many cases, and has been overlaid by many strata of comparatively normal personality adjustment. Alcohol seems to reactivate these buried problems. Few, if any, of the people who become alcoholics think that they are neurotic or pre-alcoholic before they enter their addiction. Second, at the present stage of psychological knowledge it is impossible to predict with any degree of accuracy just which six people out of any one hundred drinkers will become alcoholics. Until it is possible, it is wise to accept the warning contained in the title of a pamphlet which came to my desk, "You, Too, Can Be an Alcoholic."

We know that there are factors other than the possession of healthy personalities which help prevent some people from becoming alcoholics. We know, from Chapter 2, that even very neurotic people will usually not become alcoholics if they live in a sub-cultural group which makes drinking or drunkenness unattractive. We know that if a person lives in a group that encourages the use of alcohol to excess and as a means of interpersonal adjustment, he may become an alcoholic even if he has a relatively adequate personality. It is clear that the culture factors which control inebriety have definite implications for the prevention of alcoholism.

Robert Straus, Sociologist on the faculty of the University of Kentucky Medical School, has said regarding alcoholism, "Those who drink constitute the ‘exposed population’ from an epidemiological standpoint." ^12. It is true, as those who advocate total abstinence hold, "If you don’t drink you won’t become an alcoholic." Let us evaluate the strengths and limitations of total abstinence as a means of preventing alcoholism. If an individual decides that it is smarter not to drink, he is detaching himself from the "exposed population" so far as the sickness of alcoholism is concerned. One may well make this decision in the light of these facts:

1. One person in fifteen who drinks will become a problem drinker. If one is a male, the risk is much higher. (Approximately 80 percent of all alcoholics are males.) This is the realistic danger that all drinkers should face.

2. No one really knows whether or not he is a potential alcoholic.

3. Even if one is not a potential alcoholic, abstinence may prevent one from having an adverse influence on others who may be. This is especially applicable to influence on children and youth.

On the other hand, it is well to recognize the limitations of the abstinence position, if it is regarded as the only approach to the prevention of alcoholism. For one thing it does not provide protection for the majority of people who do not hold to this position and who are not likely to be persuaded in the foreseeable future. The Mulford Study (see Chapter 2) showed that only 37 percent of Protestants and 11 percent of Catholics practiced total abstinence. Of the 15,747 college students surveyed by Yale, 74 percent use beverage alcohol. In spite of the abstinence teachings of their church, 70 percent of Methodist students drink. Of the 26 percent who abstain, slightly less than one third do so because drinking is contrary to religious or moral training. ¹³. These facts do not, of course, invalidate total abstinence as a tenable position, but they do show that it cannot be the only approach to the problem.

Secondly, if it is assumed that, so far as alcohol is concerned, there are only two groups ethically speaking -- drinkers and nondrinkers -- an unfortunate splitting of the ranks occurs. Those who hold very strongly to the abstinence position often forget that there is another group who are as opposed to excess as they are and who might be allies in developing sanctions against drunkenness. From our study of the Jewish culture we know that such sanctions are extremely effective in preventing alcoholism. We also know that unified sanctions against drunkenness do not exist in American life in general, and that their absence contributes to the high rate of alcoholism. Those who are compulsive in their espousal of abstinence tend to drive the real moderationists -- whose existence they do not recognize -- into identifying themselves with those who use alcohol to excess.

Even the churches tend to divide ranks along these lines. The churches in the temperance tradition have tended, on the one hand, to regard their position as the only "Christian" one, to misunderstand the nature of alcoholism, to divide all persons into two groups-drinkers and nondrinkers. They have tended to ignore the more fundamental problem in alcoholism -- the sick personality -- which should have been their primary concern as Christians. On the other hand, the non-temperance churches, partly as a reaction to the temperance churches, have tended to overlook the realistic dangers of the use of alcohol in our neurotic culture, to treat drinking as if there were no moral problem involved, and to ignore the seamy side of drinking. Both sides have oversimplified the ethical complexities of the problem. Thus the churches, which should have been helping to form unified cultural sanctions concerning the use of alcohol to excess, have contributed to the confusion.

From the standpoint of potential alcoholics, the abstinence position if compulsively held has another limitation. This is the "forbidden fruit" atmosphere which can be especially dangerous for young people who are in the rebellious period of adolescence. A considerable number of the alcoholics I interviewed had come from rigidly prohibitionist homes and attributed their early excess in part to a reaction against the taboos of their early lives. It was apparent that Prohibition affected some pre-alcoholics in the same way.

J. H. Skolnick, using data from the College Drinking Survey, ^14. compared the drinking behavior of students of various religious affiliations. He devised a "social complications" measure, to ascertain the amount of problem behavior connected with the drinking of each group. He found that 39 percent of Episcopalians, 34 percent of all male students in the College Drinking Survey, and only 4 percent of Orthodox Jewish students reported social complications related to their drinking. In contrast, 50 percent of the Methodist students and 57 percent of the nonaffiliated (with any religious group) students from abstinence backgrounds reported social complications. ¹⁵. (All percentages are of drinking students in a particular group.) The Jews had the highest proportion of students who drink at home and whose most frequent drinking companions are their families. The Methodists had the highest occurrence of initial drinking experiences in automobiles or bars and current drinking in commercial establishments among small male groups.

The crucial issue of why the abstinence orientation seems to promote problem drinking behavior is explored by Skolnick. He concludes, "Abstinence teachings, by associating drinking with intemperance, inadvertently encourage intemperance in those - . . who disregard the injunction not to drink." ^16. The fact that the students from abstinence backgrounds frequently begin drinking outside their homes, without their parents’ knowledge and in opposition to their religious teachings (which would tend to arouse guilt), and with no ethical guidelines from their churches to distinguish responsible from irresponsible drinking, also may contribute to the high incidence of problem drinking behavior.

Parents who choose personal abstinence will help their children most by doing so in a matter-of-fact manner, without making it a great issue. A study of the drinking habits of college students showed that the most important factor in determining these habits is parental example. Many, but of course not all, of the young people were found to drink (or abstain) like their parents. What the parents taught on the matter was of little importance compared with what they actually did. ^17. The study suggested that confliots in sanctions in the home concerning the use of alcohol is a factor which seems to encourage incipient alcoholism in young people. ^18. Further, the attitudes and practices of the parents were much more influential on the young people’s thinking and action than were the teachings of their schools or churches.

The Jewish culture can provide valuable insights concerning the prevention of alcoholism through influencing symptom choice. In Chapter 2 we saw that most Jews drink, that very few become alcoholics, even if they are emotionally disturbed. This is an example of the control of cultural sanctions against drunkenness. What can we apply from the Jewish situation to American drinking patterns in general? It is not realistic to say that all that is needed to prevent alcoholism is to do as the Jews do. The Jewish attitudes and sanctions are a part of the total milieu of the religio-social community which is Judaism and which is the product of many centuries of historical development. It is not possible to transplant one segment of this and expect it to thrive in a different environment. Cultural sanctions have deep roots, and it is not possible to create them by any short-term educational procedure.

It is possible to learn from the Jewish group the effectiveness of unified sanctions against drunkenness. It is also possible for individuals and institutions -- in this case, the church -- to exert their influence in the direction of a gradual growth of such sanctions in American life. The sickness conception of alcoholism is the best foundation for such a development. If it were generally recognized that habitual drunkenness is a symptom of a disease that is both personally and socially devastating, and if it were generally accepted that frequent use of alcohol as a means of interpersonal adjustment can lead to alcoholism, a new climate of public opinion would come into being. Instead of accepting and even encouraging drunkenness, cultural attitudes would exert pressure against it. More of this in the third section.

Closely related with this is the matter of deglamourizing drinking. Of course this is much easier said than done. But the fact is that people, especially young people, do not have an opportunity to make a free choice about drinking. On every side drinking is presented as an indispensable part of gracious and fashionable modern living. Their choice is made under pressure from their normal desire to partake of this living. One need not believe in the prohibition of all drinking or even in abstinence for oneself to be concerned about reducing this pressure, which undoubtedly causes many who cannot handle it to use alcohol through social conformity. A candid look at America’s drinking patterns reveals a measure of truth in the quip, "If alcoholism is a sickness, a lot of people are trying to catch it." The unrestricted, high-pressure advertising of a product which will produce untold tragedy for 6.7 percent of those who use it has ethical implications which our society must face. Related to this are the pressures in American life which associate ability to drink and "hold one’s liquor" with masculinity and being "in." These pressures have an unfortunate effect on teen-agers and are one reason why many alcoholics have trouble accepting the truth about their sickness so that they can get help. [ Note: The Cooperative Commission on Alcoholism, in an illuminating discussion of prevention, makes these proposals for modifying drinking patterns and thus lowering the rates of alcoholism: First, reduce the emotionalism associated with drinking; second, clarify and emphasize the difference between acceptable and unacceptable drinking; third, "discourage drinking for its own sake and encourage the integration of drinking with other activities"; fourth, "assist young people to adapt themselves realistically to a predominantly ‘drinking’ society." (See Alcohol Problems, A Report to the Nation, pp. 136-52.)]

The late E. M. Jellinek did a cross-cultural comparison of the relation between drinking practices and alcoholism rates in 25 countries. His findings demonstrate the relation between the two types of prevention described above. Diagram #2 at the end of this chapter delineates his major conclusion: ^19.

The top bar represents the degree of psychological disturbance in the individuals in a given population, producing vulnerability to alcoholism. The grossly disturbed persons are represented by the "high" (right) end of the continuum, the mentally healthy by the "low" end of the bar. The lower bar represents the degree of acceptance of heavy drinking as "normal" behavior in a particular culture or subculture. The "high" end represents societies in which heavy drinking is viewed as normal (for instance, France); the "low" end those societies or groups in which normal behavior is seen as including only abstinence or extreme moderation (for instance, the Jews).

As the arrows indicate, Jellinek found that in cultures in which there is non-acceptance of heavy drinking, persons who become alcoholics tend to be drawn from those in the population suffering from a high degree of psychological disturbance. In contrast, in cultures in which heavy drinking is seen as normal behavior, some persons from all degrees of mental health or illness (i.e., all degrees of psychological vulnerability) become alcoholics.

Jellinek summarized his study in what he described as his "working hypothesis":

In societies which have a low degree of acceptance of large daily amounts of alcohol, mainly those will be exposed to the risk of addiction who on account of high psychological vulnerability have an inducement to go against the social standards. But in societies which have an extremely high degree of acceptance of large daily alcohol consumption, the presence of any small vulnerability, whether psychological or physical, will suffice for exposure to the risk of addiction. ^20.

The importance of the implications of this study for an understanding of prevention cannot be overemphasized. If one lives in a culture or closely knit social group in which there are strong sanctions against heavy drinking and drunkenness, the chances of becoming an alcoholic are relatively small, even if one is markedly disturbed psychologically. Conversely, if one lives in a heavy-drinking culture or group, one can become an alcoholic with relatively minor psychological problems. Thus, alcoholism can be prevented by reducing the degree of general psychological vulnerability in a population (prevention at the grass roots) and/or by education which reduces drinking, especially heavy drinking and drunkenness (prevention through influencing symptom selection).

Prevention Through Early Detection and Treatment

In spite of the many new resources for helping alcoholics, countless sufferers from this illness are reaching treatment only after they have wasted what should be the most productive and creative years of their lives. Thousands of others are dying without ever reaching or becoming receptive to effective treatment for their total problem. Any seasoned minister could give examples of such tragedies from his pastoral experience. Somehow we must devise better means of early detection and motivation-to-treatment of the majority of alcoholics whose problem is still hidden. The importance of early treatment is highlighted by the now well-established fact that those who have treatment while they are still holding jobs and with their families have significantly higher recovery rates than do those who have lost these key incentives to recovery. In Chapter 8, certain methods of bringing hidden alcoholics to help were explored. The importance for prevention of the utilization of such techniques cannot be overemphasized. To use them with maximum effectiveness, one must understand the forces which tend to keep alcoholics in hiding and away from the help that is available.

In Chapter 2 we saw that one group of etiological factors operates on the level of perpetuating the addiction once it is established. It is these factors that make it necessary for the sickness to grind on and on through years of agony before the person is open to help. To the extent that these factors can be altered and early treatment instituted, the alcoholic will be prevented from having to go through the terminal period of suffering. What are the factors and what can be done about them? In many cases it is a combination of a lack of knowledge concerning the early signs of alcoholism, plus the voluntaristic, moralistic attitude toward alcoholism still prevalent in our culture which allows the sickness to go so long untreated.

The fact is that alcoholism slips up on many people. The loss of control is usually insidiously gradual and therefore difficult to recognize, particularly in oneself. Everyone has at least a little magic in his attitude toward himself -- magic of the "It can’t happen to me" type. This, plus the power to rationalize, so that one gives normal reasons for one’s abnormal behavior, causes many to fool themselves for years about alcoholism. A contributing factor in this process is widespread ignorance concerning the danger signals of early alcoholism. How often the alcoholic or his relative says in retrospect, "If I had only been aware of the early symptoms, I could have looked for help rather than trying to fight it through myself." Overcoming this ignorance is an educational task in which the church should play a part.

Let us review some of the danger signals. A person is in the early stages of alcoholism or is in serious danger of entering them:

1. If he uses alcohol rather than his personality resources as a persistent means of solving his problems.

2. If alcohol holds a prominent place in his thinking and the planning of his activities.

3. If he uses alcohol as a persistent means of gaining social confidence or courage.

4. If he spends money for alcohol which he really needs for the necessities of life.

5. If he is defensive about how much or when he drinks.

6. If he gulps drinks, or drinks in secret.

7. If he drinks in the morning to cure a hangover, or to "pep up" for the day.

8. If he has blackouts when he is drinking.

9. If his drinking behavior is in defiance of the drinking standards of his important social or fellowship group.

10. If he begins to feel "normal" only when he has alcohol in him.

11. If his drinking interferes with his homelife, his job, his social life, or his health.

Early detection and treatment are dependent on more than simply the knowledge of early signs. They depend even more on whether the person can apply his knowledge to himself. Even if a person has accurate knowledge about the early signs, he can still rationalize and say: "These don’t apply to me. I have very good reasons for my drinking behavior. I can quit when I want to." The fact is that when an alcoholic can stop, he usually doesn’t want to stop, and when he wants to stop, he can’t. What is involved, then, is a change in basic attitudes toward the problem.

Why does the alcoholic rationalize and resist the idea that he might be an alcoholic? One of the chief reasons is because he lives in a culture that traditionally has regarded inebriety largely as a matter of morals and willpower, and still does to a considerable degree. The survey cited in Chapter 2 showed that a majority of Americans accept the fact that alcoholism is in some sense an illness. However, in the thinking and feeling of a large proportion of these, an underlying moralism still blocks full acceptance of the sickness conception. In spite of all that has been written and said about alcoholism being a compulsive illness and an addiction, many Americans still think of it in moralistic, willpower terms. This lack of deep-level acceptance of the sickness conception is naturally internalized by the alcoholic in his thinking about himself.

As long as the alcoholic thinks of his trouble as essentially a matter of willpower, he will tend not to seek help. To do so would be an admission that he is weak or morally corrupt. But as soon as he accepts the sickness conception and applies it to himself, he will tend to take action appropriate to a sickness -- get help. Those whose attitudes help perpetuate the moralistic conception of alcoholism are thus unwittingly responsible for pushing alcoholics deeper into the dark morass. As Marty Mann puts the matter:

Up to now the alcoholic has been made to feel shame if he could not handle his drinking by himself. Our goal must be to reverse that: to make him feel shame at riot seeking help for his illness. If he himself really comes to believe that he has a disease, the chances are greatly enhanced that he will seek treatment for it. Thousands of cases have proved this. ^21.

That alcoholism is an illness has been known for a long time. Ulpian, a Roman jurist who lived in the second century, urged that inebriates be treated as sick persons. In a paper published in 1785, Benjamin Rush, a signer of the Declaration of Independence and foremost physician of his day, referred to alcohol addiction as a disease. In 1804 a Scottish physician, Thomas Trotter, wrote a doctoral dissertation in which he said: "In medical language, I consider drunkenness, strictly speaking, to be a disease." ^22. Around the year 1820, Lyman Beecher sat beside the bed of a young parishioner, a chronic alcoholic who was dying. Later Beecher said, "I indulge the hope that God saw it was a constitutional infirmity, like any other disease." ^23.

In spite of Beecher’s early recognition and that of some others like him in the church, there has been considerable resistance on the part of religious leaders to the sickness conception. This has been especially true among the temperance denominations. Until the sickness conception is generally accepted, realistic prevention on a large scale will be very difficult. If a religious group helps to foster the general acceptance of the conception, it promotes the following constructive conditions: (1) Community pressures are mobilized in the direction of motivating the alcoholic toward help rather than away from it, in the early stages of his illness. (2) A major obstacle to early treatment is removed from the mind of the alcoholic himself. (3) He will have community support rather than rejection during and after his treatment. (4) Society at large will come to recognize that it is to its advantage to provide adequate facilities for treating the alcoholic.

If one has doubts about the effectiveness of a wide dissemination of realistic knowledge about alcoholism in encouraging earlier treatment, he has only to look at what has happened in AA. Each year from almost the beginning, the average age level seems to have declined in AA. The reason for this seems to be that AA itself, by its dramatic success based on the treatment of alcoholism as an illness, has had a tremendous educational impact. Through its influence, many younger alcoholics came to recognize their trouble and seek help. The existence of "Thirty-five and Under" groups and the AA pamphlet "Young People and AA" are both indications of what has happened. AA has and will continue to have a leavening influence on our whole society, so far as a more enlightened view of alcoholism is concerned.

Prevention through early detection and treatment is directly related to a fourth form of prevention -- prevention through helping the children of alcoholics. In Chapter 2, a study by Jellinek was cited as evidence of the fact that many alcoholics have alcoholic parents. It is probable that between 20 and 30 percent of children of alcoholics eventually become alcoholics because of the emotional damage inflicted on them in their early lives. Since children of alcoholics have a high degree of vulnerability to the illness, they constitute an important target group for prevention! Such prevention may take one or more of three forms. First, early treatment of the alcoholic parent prevents the extreme emotional trauma to the children of the advanced stages of the illness. Second, helping the nonalcoholic spouse cope more effectively with her parental role, using methods described in Chapter 11, can diminish the emotional malnutrition suffered by the children. Third, direct help of the children, by pastoral counseling, Alateen group participation, and the other means described in the last chapter can enhance their mental health and thus make them less vulnerable to alcoholism a decade or so hence. These forms of direct and indirect help for the alcoholic’s children are ways of preventing the various personality illnesses and social deviancies to which such children are prone. As a focus of preventive activities, it combines prevention at the grass roots and prevention through early treatment.

CHART OF CULTURAL ATTITUDES:

GRAPHIC: DRINKING PRACTICES AND ALCOHOLISM:

END NOTES:

1. E. 0. Bradshaw, Unconquerable Kagawa (St. Paul, Minn.: Macalester Park Publishing Co., 1952), p. 90.

2. H. J. Clinebell, Jr., "American Protestantism and the Problem of Alcoholism," Journal of Clinical Pastoral Work, II (Winter, 1949), 214-15. Used by permission.

3. "New Attitudes Toward Alcoholism," QJSA, XII (March, 1951), 60.

4. Charles Jackson, The Lost Weekend (New York: The New American Library,1949), Preface.

5. Karen Homey, Self-analysis (New York: W. W. Norton & Co., 1942), p. 27.

6. Ruth Benedict, Patterns of Culture (New York: Houghton Muffin Co., 1934).

7. Psychotherapy and a Christian View of Man, p. 65.

8. "American Protestantism and Mental Health," journal of Clinical Pastoral Work, I (Winter, 1948). Used by permission.

9. Quoted in Charles Clapp, Jr., Drinking’s Not the Problem, How You Can Help a Potential Alcoholic (New York: Crowell and Co., 1949), p. 62.

10. (Nashville: Abingdon Press, 1965).

11. Paul B. Maves, ed. (New York: Charles Scribner’s Sons, 1953), p. 1.

12. From a paper presented at the annual meeting of the National Committee on Alcoholism, March 18, 1955.

13. Harold A. Mulford, "Drinking and Deviant Drinking, U.S.A., 1963," p. 637. The Yale survey of college students is reported in Straus and Bacon, Drinking in College. See pp. 46 and 65 for the facts mentioned.

14. Conducted by the Yale Center of Alcohol Studies, 1949 -- 1951.

15. J. H. Skolnick, "The Stumbling Block: A Sociological Study of the Relationship between Selected Religious Norms and Drinking Behavior," Yale University Thesis, 1957.

16. J. H. Skolnick, "Religious Affiliation and Drinking Behavior," QJSA, XIX (1958), p. 470.

17. Drinking in College, p. 85.

18. Report by R. Straus in a speech before the annual meeting of the National Committee on Alcoholism, March 18, 1955.

19. This diagram is similar to the one which Jellinek used to illustrate the lecture in which he reported on this study at the Yale Summer School of Alcohol Studies, 1961.

20. The Disease Concept of Alcoholism, pp. 28-29.

21. New Primer on Alcoholism, pp. 198-99.

22. Taken from a history of the sickness of alcoholism by H. W. Haggard and E. M. Jellinek, Alcohol Explored (Garden City: Doubleday & Co., 1942), p. 142.

23. F. W. McPeek, "The Role of Religious Bodies in the Treatment of Inebriety in the United States," Alcohol, Science and Society, p. 406.

My husband is an alcoholic, but will not ask for help. He thinks he can work it out for himself. He’s not doing it, but what can I do? Is there anyone in the world who can help us or will try to? Please, for God’s sake, can you help me? ^1.

-- Letter from the wife of an alcoholic

This letter came to the clearinghouse for the Al-Anon family groups which are an outgrowth of AA. The words are familiar to a pastor -- words that he hears when the spouse of an alcoholic comes in despair seeking help.

A Major Pastoral Opportunity

The average parish pastor has considerably more opportunities to help members of families of alcoholics, than he has to help alcoholics. There are two reasons for this. One is the numerical factor. There are usually several people in the circle of chaos and concern clustered around an alcoholic. This means that around the five and one-half million alcoholics there are probably at least twenty million with a direct concern for them. One authority puts her estimate of the size of this group at twenty-five million. ^2. When we recall the variety of types of relationships represented by those close to alcoholics who have come -- in my case for instance this includes a husband, wife, daughter, son, mother, father, fiancée, nephew, sister-in-law, neighbor, intimate friend -- we realize that this estimate may not be far from accurate.

The other reason why the pastor has more opportunities of this kind is the fact that members of the family are often accessible to him when the alcoholic is not. Frequently, they are more open to help by a minister. Deterioration often hits the home before other areas of the alcoholic’s life. Because the family is less defensive than the alcoholic himself, they are more likely to come to the minister before the final stages of the illness have developed. Work with the family, therefore, represents an opportunity for prevention through early detection. One of the Yale ministers reported, "Families ordinarily will work with the minister to better advantage than the alcoholic himself." This has been the experience of many clergymen.

Working with the families of alcoholics represents multiple opportunities. It is sometimes an indirect way of helping the alcoholic. One of the Yale ministers told of helping to sobriety an alcoholic whom he had never had an opportunity to see, by helping the wife to change her attitudes toward him. It is probably not very often that an alcoholic problem can be completely solved through a relative, but such an approach can certainly contribute to a solution. Although it is important for the family to see their role in the situation which produces alcoholism, they should usually not be led to believe that they alone can lead the person to sobriety. This expectation would only complicate the interpersonal relations of the family and lead to guilt when they fail. Another side of the pastor’s opportunity lies in the fact that members of an alcoholic’s family often need understanding counsel as much as the alcoholic. Anyone who has not lived with an alcoholic can hardly appreciate the shame, loneliness, and despair that develops in such an atmosphere. Truly, as is often said, "Alcoholism is a family disease." What is more, studies have shown that the mates of alcoholics are often almost as disturbed, anxious, and in need of treatment as the alcoholic. For example, at the Cornell University Medical College, New York Hospital, alcohol research project, the psychiatrists found it as essential to treat the families as it was the patients themselves. ^3.

The various facets of the clergyman’s opportunity in helping the family could be summarized as follows: (a) Bringing the hidden alcoholic’s family out of hiding. This may be accomplished by using the same methods as those described in Chapter 8 for bringing the hidden alcoholic out of hiding. (b) Sustaining and guiding the spouse and children during the period before the alcoholic seeks help. (c) Increasing the likelihood that the spouse’s way of relating to the alcoholic will hasten rather than retard his becoming open to help. (d) Helping the spouse respond constructively during his treatment. She can help or hinder his chances of success. (e) Educating the congregation to fulfill its pastoral care function in relation to the alcoholic’s family. It is clear that this dimension of ministry is a rich and challenging one.

Preparation for Counseling the Family

One’s general preparation for counseling alcoholics is also useful in counseling the families of alcoholics. In addition, an understanding of the dynamics of the interpersonal relationships in the alcoholic’s family and the effects of alcoholism on these relationships is important. Fortunately, there are a number of articles written by social scientists on the subject. Several of these are listed in the references at the end of this chapter. ^4.

Beyond this a pastor will need to have an acquaintance with what has been written concerning helping the families of alcoholics to meet their problems constructively. Here is a list of books and pamphlets which will be useful in this regard. Those with an asterisk are suitable for loaning to the family.

*Living with an Alcoholic, with the Help of Al-Anon (New York: Al-Anon Family Group Headquarters, 1960). This is a basic book for the family and for the pastor in helping the family. It is for the family what the Big Book of AA is for the alcoholic. Included is a series of illustrative case histories of families who found help.

*AlAnon Faces Alcoholism (New York: Al-Anon Family Group Headquarters, 1965). This book contains statements about Al-Anon and the family problems created by alcoholism. The statements are by professionals who

work with families of alcoholics and by "those who live with the problem." 1 The working principles and history of Al-Anon are also included.

*The Dilemma of the Alcoholic Marriage (New York: Al-Anon Family Group Headquarters, 1967). This is a guidebook for the alcoholic spouse. It includes a chapter on applying the Twelve Steps to marriage problems.

^New Primer on Alcoholism by Marty Mann, in a chapter on "What to Do About an Alcoholic," has sections entitled "If You Are the Wife of an Alcoholic" (206-13), "If You Are the Husband of an Alcoholic" (213-17), "If You Are the Son or Daughter" (217-19), "If You Are a Friend" (219-21), and "If You Are the Employer" (221-24).

*"The Alcoholic Husband, A Message for Wives" and "The Alcoholic Wife, A Message for Husbands" are two pamphlets produced by AA. They seek to help the person understand the problem of alcoholism, AA, and how he may help get his alcoholic mate into AA. The Big Book of AA has a chapter on "The Family Afterwards" (122-35).

*These pamphlets are produced by Al-Anon: "Al-Anon, You and the Alcoholic," "Al-Anon Family Groups at Work," "How One AA Wife Lives the Twelve Steps," "Alcoholism, the Family Disease," "To the Mother and Father of an Alcoholic." Alateen pamphlets include: "It’s a Teen-Age Affair," "Youth and the Alcoholic Parent," "Operation Alateen," and "For TeenAgers with an Alcoholic Parent." (Al-Anon and Alateen literature is available from Al-Anon Family Group Headquarters, P.O. Box 182, Madison Square Station, New York, New York 10010.)

These resources are useful for the person counseling with the family of alcoholics: Pastoral Psychology, Vol. 13 (April, 1962), No. 123, special issue on "Counseling with the Family of the Alcoholic"; John E. Keller, Ministering to Alcoholics, Chapter VI, "Counseling the Spouse," pp. 124-37; Thomas J. Shipp, Helping the Alcoholic and His Family (Englewood Cliffs, N.J.: Prentice-Hall, 1963), Chapter 12, "Helping the Alcoholic’s Family," pp. 120-32.

In his preparation for helping the family, it is important for the minister to acquire a firsthand understanding of how Al-Anon and Alateen groups function. It is also helpful, for purposes of referral, to become well acquainted with several key Al-Anon members. The most efficient method to prepare oneself in both of these ways is to attend Al-Anon meetings with regularity fot several months. The time and place of nearby meetings can be ascertained by calling the number listed in the phone book for "Alcoholics Anonymous." ^5.

Alcoholism as a Family Crisis

It is important for the pastor to have an appreciation of the manner in which the nightmare of alcoholism engulfs an entire family. Joan K. Jackson, formerly a research sociologist, department of psychiatry, University of Washington School of Medicine, did a three-year study of the wives of alcoholics, the results of which are reported in "The Adjustment of the Family to the Crisis of Alcoholism." ^6. In this article she gives a picture of the cumulative nature of the family crisis, as it develops from stage to stage.

Stage 1: Incidents of excessive drinking begin and, although they are sporadic, place strains on the husband-wife interaction. .

Stage 2: Social isolation of the family begins as incidents of excessive drinking multiply. The increasing isolation magnifies the importance of family interaction and events. Behavior and thought become drinking-centered. Husband-wife adjustment deteriorates and tension arises. The wife begins to feel self-pity and to lose her self-confidence as her behavior fails to stabilize her husband’s drinking. There is an attempt still to maintain the original family structure, which is disrupted anew with each episode of drinking, and as a result the children begin to show emotional disturbance.

Stage 3: The family gives up attempts to control the drinking. . . . The disturbance of the children becomes more marked. There is no longer an attempt to support the alcoholic in his roles as husband and father. The wife begins to worry about her own sanity and about her inability to make decisions or act to change the situation.

Stage 4: The wife takes over control of the family and the husband is seen as a recalcitrant child. Pity and strong protective feelings largely replace the earlier resentment and hostility. The family becomes more stable and organized in a manner to minimize the disruptive behavior of the husband. . .

Stage 5: The wife separates from her husband if she can resolve the problems and conflicts surrounding this action.

Stage 6: The wife and children reorganize as a family without the husband.

Stage 7: The husband achieves sobriety and the family . . . reorganizes to include a sober father and experiences problems in reinstating him in his former roles. ^7.

This developmental scheme is important to the pastor because his approach as a counselor will depend in large measure on what stage of deterioration or reconstruction the family is in when he encounters the situation. He will usually encounter them when they are in Stage 2, 3, or 7. Should it be Stage 1, the family will be absorbed with attempts to deny that a problem exists. In Stage 2, the effort will be to hide the problem from the outside world, coupled with desperate efforts on the part of the family to control the alcoholic’s drinking by any and all means. Stage 3 represents family disorganization in which a spouse begins to adopt a "V/hat’s the use?" attitude. In Stage 4 the wife, mother, or husband may become protective and masochistic in a way that makes the relationships unhealthy for all concerned, including the alcoholic.

If one omits the happy ending of Stage 7 (which Joan Jackson could include because her study was done in an AA wife’s group), and translates the language of the social scientist into the parlance of everyday living, one has a picture of the starkest interpersonal tragedy. The picture includes the family’s attempt to adjust to a person who lies and is least responsible when he most needs to be, who is unbearably irritable and egocentric, who embarrasses them in front of friends and spoils their holidays by being on a binge, who spends money they need for necessities on whiskey, and who seems completely oblivious to their welfare or their pleadings. The picture includes the dark spiral of drinking, nagging, drinking, remorse, promises, drinking ad infinitum. Fear pervades the entire picture -- fear of violence to herself or the children, fear of loss of family status, fear that others will find out, fear of insanity, fear that she will return home to find him drunk. Sexual relations within the picture, reflecting the interpersonal conflict, are usually very unsatisfactory. Heartbreak hangs over the picture like a dark cloud. In the midst of the chaos and insecurity is the crowning tragedy of what is happening in the emotional life of the children. Into this picture of sick horror the pastor is sometimes able to bring a ray of light.

In one sense, the family crisis of alcoholism is more difficult than a crisis such as bereavement because it is an unstructured crisis. When death strikes a family circle, there are socially prescribed patterns of behavior and feeling which help the persons involved cope with the crisis. Alcoholism, in contrast, is a crisis for which there are no socially structured responses. In this way it is like mental illness and death by suicide. All are forms of social deviation which do not elicit community support of the family. Since most of us do not expect them to happen to our families, we are unprepared emotionally for their rude intrusion. The family response is to feel alienated, baffled, and stigmatized.

Getting Inside the Family’s World ^8.

V/hen the spouse of an alcoholic ventures out of hiding, it is important that she ^9. experience a high degree of empathic understanding. The more the pastor can feel with her, the more he can share the agony of her inner world, the better are the chances that she will stay out of hiding and in the helping relationship.

Here is a fragment of a pastor’s first session with Mrs. John R., a middle-aged parishioner:

Mrs. R.: I’m not sure I should be here talking about this problem, pastor. But I’ve tried everything to help John, and nothing seems to work. He says that his drinking is nobody else’s business, including mine. (Pause) It’s started to affect the older boy’s schoolwork. (Pause) I feel I just have to help John, but everything I do seems to backfire and make his drinking worse.

Pastor: It wasn’t easy to come, but your situation is getting so difficult you decided you had to seek some help. I’ll be glad to help in any way I can.

Mrs. R.: I thought perhaps you could tell me how to approach John so as to help him see what he’s doing to himself and his family. If I even mention his drinking, he flares up and stomps out of the room. I don’t think he’s an alcoholic, but he’s been coming home drunk several times a week lately, and he often can’t make it to work on Mondays. One of these days his manager is going to get wise to his excuses.

Pastor: The drinking is getting heavier and affecting his work, but he’s so sensitive about it you can’t discuss the matter with him.

Mrs. R.: I thought when he changed jobs last fall and got out from under some of the pressure that things would get better. But he seems to be worse. Last night he came in after midnight. First he insisted on waking up the children to give them a bawling out about leaving their bicycles in the way in the garage. Then he got sick and made a mess right in the middle of the living room -- in front of them. He’s home sleeping it off today. I can’t understand it -- he’s so different. All he thinks about is himself and liquor.

Pastor: It’s hard on you and the children when he is so inconsiderate.

Mrs. R.: Yes, (eyes filled with tears) his temper is terrible when he’s drinking, and he seems to pick on the older boy especially. I try to protect him, and John gets furious. (Pause) I try to keep the kids from irritating John, but you know how children are. Whatever I do seems to be the wrong thing.

Pastor: It gets very frustrating when you feel blocked whichever way you turn in trying to help.

Four facets of Mrs. R.’s inner world are evident in these opening statements. First, she communicates some of her feelings about coming for help. It was important for the pastor to recognize and respect these feelings. Otherwise the person may be reluctant to trust the minister with other painful feelings. It usually suffices to say, as this minister did, "It wasn’t easy to come."

A second aspect of Mrs. R.’s inner world is her picture of what constitutes her problem. As she now sees it, her husband’s drinking is the problem. Closely related is the question of why she came for help now -- the crisis the night before. The pastor was probably correct in not following the lead presented by her reluctance to apply the label "alcoholic" to her husband. Her understanding of the nature of his problem will be an important goal of subsequent counseling, but the early part of the first interview is not the time to explore or educate. It is the time for the counselor to concentrate on disciplined, intensive listening.

The third facet of her inner world is her picture of the kind of help she needs and wants. Wives are usually at one of three stages when they seek help: (a) "Do something to help my husband." (b) "Help me to help my husband with his drinking problem." (c) "Help me with my problems and those of the children." In my experience, 90 percent are at stages one or two. To Mrs. R., the purpose of counseling is to help her help her husband. She does not think of herself as being in need of counseling for her own sake. Her limited picture of what kind of help she needs is an expression of her frantic desire to change her painful situation and a defense against her guilt. She cannot realize, at this point, that her obsession to help her husband makes her do the very things that allow him to excuse his drinking. Because she feels so responsible and guilty, she will be threatened by even a hint that what she fears is true -- that she is contributing to her husband’s problem and that she is also disturbed and needs help.

Yet Mrs. R. does need help in her own right. She is disturbed, in spite of her façade of competence. Whatever personality problems she brought to the marriage (and these may be great or small) have been magnified tremendously by the family trauma of alcoholism. She needs help with these problems and in coping with the impact of Mr. R.’s drinking. She needs this help for her own sake and for the children’s sake, whatever Mr. R. does or does not do about his problem. Furthermore, Mrs. R.’s chances of relating helpfully to her husband also depend on her learning to handle her own inner problems more adequately.

The fourth aspect of Mrs. R.’s inner world is her own painful feelings and experiences connected with the family crisis of alcoholism. In his third response, the pastor encouraged her to ventilate these feelings. (A somewhat better response would have been, "It must be very hard for you and the children in such a situation.") This process continued in his fourth (and subsequent) responses. In this way the minister helped her move toward an awareness of her own need for help. If a wife is reluctant to turn in this direction, it is usually because she is sitting on a volcano of explosive feelings which she fears may erupt embarrassingly and expose her as the weak person she feels she is. The façade of self-sufficiency, however, is a burdensome defense. After a tearful torrent of pent-up resentment, fear, and confusion came gushing forth in a dark tide, one wife said: "I’ve felt I had to be so strong because he was so weak. I didn’t dare let myself go before." The safety of the counseling relationship had allowed her to relax her defenses.

Through sensitive listening and responding, the minister encourages the wife to ventilate her feelings concerning the private hell in which she has been living. This helps to accomplish four things: (a) Rapport is established through significant communication on a feeling level. She knows that the pastor is with her in her nightmarish problem. As in other counseling, the quality of the relationship is the essence of helping the alcoholic’s family. (b) She experiences relief from the pressure of her mountainous burden of negative and frightening feelings. (c) This unburdening enables her to cope with her life situation more constructively. Her anger toward her husband will not distort her relationships with him and the children so severely because she has worked out part of it through counseling. (d) Through sensitive listening, the pastor forms a tentative picture of the nature of the problem. His diagnostic impressions should include his clinical hunches concerning whether he is dealing with true addictive alcoholism or with non-addictive problem drinking. It may be that Mr. R.’s drinking is mainly a response to the pain of a deep, but hidden problem in the R.s’ marriage relationship. If so, and if he has not yet lost his ability to control his drinking (become addicted), skilled marriage counseling may allow him to return to moderate drinking by healing the source of pain in the relationship. If the minister suspects, in the light of his discussion with Mrs. R., that this may be the case, he should recommend marriage counseling, though probably not in the first interview. Should R. be addicted (as the initial facts about his drinking seem to suggest), changes in his marriage will either not occur or, if they do, they will not reduce his drinking significantly.

When the alcoholic’s or problem drinker’s wife comes to the minister, his first job is to help her and through her, the children. He may never have an Opportunity to counsel with her husband, but she is there in his study pouring out her problem. But she sees her "real problem" as her husband. Somehow she must be helped to make the difficult transition from the role of "helper" to that of one who is also being helped. By gently encouraging her to look at her own feelings and reactions, the pastor can help her become aware of how her own needs as a person are not being met. By allowing her to experience a helping relationship, he may assist her in coming down from her lonely pedestal of "helper" to accept help for herself.

Ascertaining the Alcoholic’s Motivation

During the early phases of counseling with the spouse, the question of her husband’s degree of openness to help should receive attention. Obviously the kind of help she needs depends in part on whether or not he can be helped at this point. Equally important, an inquiry about the husband is a way of connecting with the "presenting problem," as seen initially by the wife. If, unlike Mrs. R., a wife does not volunteer information about the husband’s view of his problem, a simple question such as, "Does your husband feel he has a problem with alcohol?" will open up this area. While the wife should realize that wanting help is a precondition to receiving it, she also needs to see that wanting help is usually mixed with a degree of not wanting it.

In sizing up the husband’s motivation, it is wise for the minister to remember that the wife may be unaware of certain of his feelings, because of his defensiveness toward her. If it is possible to see the husband, the pastor may be surprised to discover openness to help which is hidden from his wife. The husband will reveal these feelings to the minister only if he sees the minister as genuinely concerned for him and not primarily as the wife’s representative.

Supportive Crisis Counseling

Suspecting that Mr. R. might be more open to help than Mrs. R. thought, the minister contacted Mr. R. by phone. It should be emphasized that this was done only after receiving permission from Mrs. R. to make the call and say that she had been in for a talk concerning her relationship with her husband, about which she was worried. The minister offered Mr. R. an opportunity to come in for a talk, if he wished to do so. Mr. R. rejected the invitation curtly, saying that he felt they could handle their family problems themselves.

Counseling with the spouse or other relatives of an alcoholic who is not yet open to help, is essentially crisis counseling. Its method should be primarily supportive-adaptive (following the "revised model" described in the last chapter) rather than insight-oriented. Helping Mrs. R. with her problems in coping does not mean attempting to dig for insight concerning the subsurface levels of neurotic interaction with her husband. She is too disturbed by the destructive emotional tornado in which she is living, and too threatened by awful feelings of failure, to look deeply within herself. To try to do one-sided marriage counseling with a drinking alcoholic’s wife is something like attempting to discuss the redecoration of his living room with a person whose house is on fire. The living room may need redecorating, but the discussion is ill timed. The realistic and constructive goal of pastoral care with the family of a drinking alcoholic is to help them deal constructively with the runaway family crisis in which they are emotionally entangled.

Just as alcoholism is best approached as a "runaway symptom" (Tiebout), the family’s problem is approached most effectively when seen as a runaway adaptation to the crisis of alcoholism. As in the case of alcoholism, the very mechanisms which came into being in response to the crisis tend to intensify it. For example, the family increasingly isolates itself, as alcoholism develops, in an effort to protect itself from social disapproval. But this very isolation produces intense feelings of alienation and even greater fear of "what others will think." Supportive-adaptive counseling aims at reversing this out-of-control adaptive mechanism which has become maladaptive to the family’s coping with the crisis. They are cut off from supportive and perspective-giving relationships with friends and relatives, at precisely the time they need them most. By encouraging the family to reestablish social relationships -- with Al-Anon, Alateens, and with the fellowship of the church -- the pastor can help them interrupt the vicious cycle of isolation, at the same time he helps them increase their supply of interpersonal satisfactions.

The supportive-adaptive approach is based on the premise that there are only certain kinds of "insights" that a person in crisis can use. In the case of Mrs. R., these include an understanding of the nature of alcoholism (as it eventually became clear that Mr. R. is an alcoholic), the futility of her attempts to coerce him to stop drinking, and the importance of her changing her assumption that any improvement in the family situation is totally dependent on his sobriety.

One important aspect of supportive crisis counseling is to help the wife cope with the pressing practical problems that face her and threaten to overwhelm her. Enabling her to handle acute problems constructively will usually help her to reassemble her shattered self-confidence. By assisting her in reducing the pressures of her external situation, her inner crisis is lessened and her resources for coping released. As one wife put it, "I feel that my head is above water and I can swim now, even though I’m still in the whirlpool."

This phase of counseling often is closer to first aid than basic therapy. But, as in a battle or accident situation, first aid sometimes can be a life-and-death matter. Even when it is not, it may save the person from much suffering and prepare him for other therapies.

V/hen Mrs. B., a woman in her early thirties, phoned, the pastor sensed that he must arrange to see her at once. In the interview, he learned that Mr. B. had become increasingly destructive and violent during his sprees in recent months. The day before, his cruelty toward his wife and children had included brandishing a gun in a threatening manner. Mrs. B. was nearly paralyzed with fear and indecision. The minister saw his role as that of helping her face the implications of what she already knew -- that she and the children were in a dangerous situation. As she began to think more clearly, with the support of the minister’s understanding, she was able to examine the alternative courses of action, as she saw them. She finally decided that a legal separation, coupled with moving temporarily to a relative’s home in another city, was the safest approach.

 The spouse often needs such help in making decisions and in planning direct action to meet practical problems realistically. Effective counseling often involves referral to specialized community agencies which complement and supplement what the minister is equipped to bring to the situation. The counselor needs to know the mental hospital commitment procedures in his state to help the family of an alcoholic with severe mental disturbance. But he will also need to help the family see commitment as a step toward rehabilitation rather than a "betrayal" of its loved one.

Where there is no immediate danger to life and limb, it is wise to encourage the spouse to postpone a decision about leaving her husband until she has had an opportunity to get a broader perspective on her situation through counseling. It is well to remind a wife who faces cruelty that no one really has to put up with such behavior. When an alcoholic understands that his wife means business about calling the police or taking other direct action, he will usually desist (unless he is psychotic or has a severe character disorder).

Knowing and Facing the Facts

If the wife is to halt the runaway family crisis, it is essential that she become acquainted with the facts about alcoholism. The educational phase should begin in the second half of the first interview or as soon as the minister is reasonably sure that he is dealing with alcoholism. The wife’s understanding of alcoholism provides a solid foundation for realistic decisions and attitudes on her part. The matter can be introduced by saying, "It will be helpful to you in handling your situation to learn all you can about the problem." A primary goal in exposing her to the facts about alcoholism is to help her accept the fact that her husband is suffering from a compulsive-addictive illness of which she is not the basic cause. The sickness conception, if accepted, has tremendous guilt-reducing potential. It is not easy for most families to accept this conception as applied to one of their members. It seems to be a blow to the family’s self-image to think of one of their number as an "alcoholic" and as one who is not fully in control of his behavior. The counselor’s task is to help them work through their emotional resistances to accepting what is, for them, a distasteful fact.

When the family comes to face the fact that their member has a chronic, progressive illness, they will be in a position to insulate themselves to a degree against some of its destructive effects. (As long as they cling to the futile hope that "maybe he’ll lick it by himself this time," they are vulnerable to bitter disappointment.) Acceptance of the facts will prepare them to relate to the alcoholic in ways that may eventually contribute to his becoming open to help.

Certain kinds of knowledge are especially useful to the family. For example, it helps to know that the alcoholic’s almost unbearable egocentricity and dishonesty are really desperate attempts to cope with deep feelings of chaos, fear, and worthlessness. As one wife said, "It takes some of the sting out of his obnoxious behavior." Knowledge that his symptoms such as blackouts, nameless fears, and secretive drinking are common among alcoholics often has a reassuring effect. To know that alcoholism is incurable but highly treatable is important in that it revives realistic hope. The pastor should acquaint the family with AA and other treatment resources that are available so that, if and when the alcoholic becomes open to help, they may know how to proceed. Timing is important, and the family, being on hand, can sometimes be the key if they are alert for an opening on the alcoholic’s part and know the resources for help. A visit to an open AA meeting may help to prepare the family to contribute to his rehabilitation through understanding.

The sickness conception should not be presented too early in the first interview, since its effect may be to cut off the wife’s catharsis of resentment and anger. The danger that this conception will stimulate the wife’s maternal impulses leading to pampering can be minimized by frank discussion of the danger. When a counselor raised the question of possible overprotection, one wife responded, "After all, if Frank had pneumonia, I would make all kinds of allowances for his actions." To counter this faulty analogy, the pastor can point out that alcoholism (and other emotional illnesses) is different from pneumonia in that one of the surest ways of keeping the person from becoming open to help is to reward his illness by pampering him.

At the close of the first interview, the educational phase of the counseling can be expedited by lending the wife one of the books or pamphlets listed earlier, or a copy of Alcoholics Anonymous. ^10. New windows of understanding often open between sessions. The person may return with a comment such as, "I feel as though I have a solid foundation under my feet for the first time. Things are beginning to make sense."

"Releasing" the Alcoholic

As suggested in Chapter 9, the most salutary thing the wife of a drinking alcoholic can do is to "release" him. A member of Al-Anon said, "When I got out of the driver’s seat, it took a terrific load off of me." She told how her determination to get her husband sober had become a passion into which she had poured herself. The more she failed, the more frantically and obsessively she tried. Somehow her sense of worth as a person had become bound to her husband’s sobriety. He sensed this, and it gave him tremendous power over her. Finally, after years of futile struggle, she gave up, accepting the fact that nothing she could do could make her husband get sober. In a real sense, she "hit bottom" and "surrendered." For the first time in years, she felt a sense of inner serenity. (There is a remarkable parallelism between this kind of experience and the surrender experience of the alcoholic.)

Facilitating this kind of surrender is a major goal of pastoral care of the alcoholic’s spouse. This surrender invariably produces beneficial results in the lives of the wife and children, insulating them emotionally from much of the destructiveness resulting from the alcoholic’s drinking. Frequently it produces a positive turning point in the alcoholic’s openness to help. One wife reported:

"My husband told our minister that he had to join AA to figure out what had happened to me in Al-Anon." What had happened was that she had succeeded in releasing her husband.

Releasing the alcoholic means letting go of him emotionally, giving up all attempts either to control his drinking or protect him from its consequences. A wife is able to release him because she has had a surrender experience and because she recognizes the futility of her attempts at control. She has, in effect, cut the power which he had over her by no longer needing or attempting to control him. The change in her responses to his behavior often shocks the alcoholic by changing the interdependency pattern in their relationship. Her surrender may hasten and facilitate his surrender.

The alcoholic’s psychic economy often depends on perceiving his wife as a mother figure. The more he regresses into alcoholism, the more he needs to keep her in that role. He sees her less and less as the "good mother" who gives and cares for him, and more and more as the "bad mother" who controls and deprives. This seems to him to justify his angry drinking. By thus attacking her, he maintains his grandiose illusion of self-sufficiency. The more the wife attempts to "help" him, the more she reinforces his conviction that she is a bad, controlling mother. When she is able to release him, this neurotic interaction pattern is interrupted. He is deprived of his method of avoiding responsibility for his behavior by blaming his wife.

Put in terms of Eric Berne’s structural and transactional analysis, what is interrupted by the wife’s release is a Parent-Child game. ^11. The wife gives up parenting her husband, which upsets his half of the game. Often he will try frantically to force her back into the parent role by acting even more irresponsibly. An insightful portrayal of the dynamics of an alcoholic marriage was in the movie Country Girl, which many readers may recall. It showed clearly the manner in which each person fed the neurotic needs of the other. The alcoholic, being immature, craved mothering. The wife, having a dominant, protective personality, fell naturally into the mothering role. The more she accepted the responsibility for running the family, the more dependent and irresponsible he became, as well as resentful and alcoholic. The more irresponsible he became, the more she felt she had to manage everything for the family. Thus a vicious, self-perpetuating cycle developed.

The general principle which should guide the family is this: Avoid both punishing and pampering. On the one extreme, some families make the mistake of attempting to coerce the alcoholic by continual threats and recriminations. This succeeds only in giving the alcoholic an additional rationalization for his drinking. By taking the nagging, punishment approach, the family only brings more suffering on itself. Tactics such as pouring the liquor down the drain or hiding it from the alcoholic are forms of parenting which are no more effective than trying to hide all water from one with a hand-washing compulsion. The alcoholic’s craving is so powerful at times that nothing short of actual incarceration will keep him from getting alcohol. Furthermore, he responds to parenting attempts to control his behavior with childish rebelliousness which produces increased drinking.

An even greater error, at the other extreme, is protecting the alcoholic from the painful consequences of his drinking, which is a form of "cruel kindness." In such cases, the pastor’s greatest service is to help the wife discover the specific ways in which she is coddling the alcoholic, often without realizing it. The way to do this is by examining in detail a particular drinking crisis and how she responded to it. By "withdrawing the props" which protect him from reality, she may help him to hit bottom and become open to help. The pattern of overprotection is difficult to break because the spouse is usually protecting herself, the children, the family reputation, and perhaps the family income, as well as the alcoholic. She reasons: "If I don’t take care of him, he’ll cause me more embarrassment, heartache, and expense." It is not until the wife realizes that as long as she protects him from the consequences of his behavior, he will have little incentive to accept help, that she may be willing to release him in this way. Seeing release as an act of concern rather than rejection may also help her release her husband. Furthermore, it is important for her to see that this may be of help in protecting her children from the worst emotional damage of their father’s illness.

The book Alcoholics Anonymous contains an example, written by the wives of early members, of how a wife might avoid overprotecting the alcoholic:

Frequently, you have felt obliged to tell your husband’s employer and his friends that he was sick, when as a matter of fact he was tight. Avoid answering these inquiries as much as you can. Whenever possible, let your husband explain. Discuss this with him when he is sober and in good spirits. Ask him what you should do if he places you in such a position again. ^12.

The pastor’s goal in counseling with the family is to encourage any tendency in them, however weak, to make the alcoholic face the reality of adult life and of his drinking. In order to be helpful, the family must be firm with the alcoholic, walking the middle ground between recrimination on the one hand and pampering on the other. This is something like walking a tightrope, and they will need all the help they can get both from the pastor and from Al-Anon. Walking the middle ground is possible only if the spouse has released the alcoholic to an appreciable degree and resists the temptation to slip back into the mothering role.

It is possible for the minister unwittingly to block rather than facilitate the wife’s release of the alcoholic. In the play The Pleasure of His Company by Samuel Taylor and Cornelia Otis Skinner, Mackenzie Savage is asked by his daughter, "You were never very happy with mother, were you?" He replies, "Your mother was a saint who made our home an outpost of heaven. It’s why I spent so much time in saloons." The message of this fictional fragment -- that behind the alcoholic is a wife who subtly "drives him to drink" -- is a common theme in the folklore of our culture. It is a feeling that both the minister and the alcoholic’s spouse (as well as the alcoholic) have somewhere within them. The minister’s knowledge of certain research findings may confirm this feeling for him. In her review of the professional literature on alcoholism and marriage, Margaret Bailey concludes: "Most students of the problem have found in some or all of their cases this interactive pattern of the dependent, inadequate alcoholic male married to a dominating woman who is usually seen as maintaining a semblance of adequacy only at his expense." ^13.

The effect of this influence on the minister is to tempt him to make the focus of counseling the wife’s hidden neurotic needs which allegedly find satisfaction in the husband’s continued alcoholism. This approach tends to block rather than facilitate her releasing of her husband. She already suspects that she is somehow driving him to drink. For the minister to imply that she has unconscious needs which contribute to his drinking increases her guilt and her frantic, futile struggling to change things or change her husband so that he won’t drink as he does.

There is little doubt that some wives find neurotic satisfactions in being married to weak, dependent, drinking alcoholics. One study showed that when marital bonds are dissolved by death or divorce, the wives of alcoholics frequently marry another alcoholic. ^14. Some wives of alcoholics hold tenaciously to their masochistic, martyrish, controlling postures. I recall one case where separation from the alcoholic husband was clearly indicated in order to protect both the wife and the children from physical and emotional harm. The wife consistently refused to consider leaving him. Her reasoning was simply, "How would he get along without me? Someone has to take care of him when he’s drunk." In some cases the spouse or parents of an alcoholic justify overprotective behavior on religious principles -- "going the second mile" -- failing to see that such cruel kindness is anything but redemptive in its effects. Various psychological studies have shown that the presence of a mothering figure in his immediate interpersonal world is one of the most characteristic aspects of the alcoholic’s picture. This is often the most difficult factor in helping the alcoholic, and it may be the key to helping the family help him. If the wife of the alcoholic derives satisfactions from her power as head of the family while he is drinking, she will have ambivalent feelings about his getting sober. In extreme cases, wives of alcoholics have developed psychosomatic or psychological illnesses after their husbands achieved sobriety.

Being alert to the possibility that some wives may attempt to sabotage their husbands’ sobriety does not mean that one should use this as a general approach to helping the family. There are tremendous differences among alcoholics, their wives, and their marriages. For many wives, factors which militate against the husbands’ sobriety are either practically nonexistent, or they are offset by other needs for strength in their husbands. Let us assume that a particular wife does have self-punishing and controlling tendencies which contribute to her mothering behavior with the alcoholic. Focusing on her neurotic tendencies or .searching for their causes will usually make such a person guiltier and more anxious, and therefore more self-punishing and controlling. This will make releasing her husband more difficult for her. To be able to release him, she must be helped to feel less responsible and guilty, not more so. If she can release him, the influence of her neurotic tendencies will be neutralized to a considerable extent; this is because the neurotic interaction which strengthens these tendencies will be interrupted.

As studies by Joan Jackson have shown, the personality disturbances of many wives come directly from the runaway crises in which they are caught. In counseling, the minister should proceed on the assumption that the wife’s disturbance is the result of the crisis. What appears to be a marked personality disorder may clear up as the husband gets treatment or the wife neutralizes the impact of his behavior by releasing him. In any case, it is therapeutically unproductive to try to correct deep inner problems in the midst of a crisis.

Here are some implications of this approach, by way of summary: (1) Focusing on why the wife married an alcoholic or a potential alcoholic is definitely contraindicated. This kind of awareness is available only through long-term psychotherapy in depth. Her crisis will be intensified, in most cases, by attempts to search for such insight. (2) It is equally unwise to encourage her in her futile search for the magic key to handling her husband so as to stop his drinking problem. This is parenting, and the opposite of release. The futility of the "home treatment" -- pleading, threatening, moralizing, coercing, nagging -- should be emphasized. (3) The counselor should emphasize the medical nature of the problem of alcoholism, pointing out that if her husband had diabetes she would not feel an obligation to cure him. This approach often helps reduce her exaggerated, unrealistic, and unproductive sense of responsibility for her husband’s drinking problem. By reducing her irrational guilt, it can help her release him. (4) The counselor should describe the meaning of "releasing" and help her work though the feelings of guilt and inappropriate responsibility that keep her from moving in this creative direction. He can point out that release does not necessarily mean separating from the alcoholic, since it is a psychological process, although in some cases it may be well-nigh impossible without a separation. (5) The pastor can help the wife discover ways in which she can make real progress in handling her problems, in spite of the husband’s continued drinking. At the same time she is told that she can’t do anything to reform her husband, she must be helped to see that there is something very important that she can do: to work on her own attitudes and problems in living. After she has released the alcoholic and gained some sense of serenity, usually she will begin spontaneously to look into the adequacy of her own life as a person.

Developing the Family’s Maximum Potentialities

A vital ingredient in the release process is the refocusing of the spouse’s energy on increasing the adequacy of her own inner life and of her relationships with her children and friends. In order to do this, the wife must have relinquished her assumption that any improvement in the family is dependent on her husband’s achieving sobriety. Her holding to this assumption, in effect, makes it true. Only when she lets go of it and begins to develop her own potentialities and those of the family does she discover its fallacious nature. The Big Book of AA recommends to wives of still-drinking alcoholics:

Be determined that your husband’s drinking is not going to spoil your relation with your children or your friends. They need your companionship and your help. It is possible to have a full and useful life, though your husband continues to drink. We know women who are unafraid, even happy under these conditions. Do not set your heart on reforming your husband. ^16.

Developing her own potentialities as a person helps to make life more satisfying and her self-esteem more robust. Both of these factors help make it possible for the wife to function more adequately as a need-satisfying parent. They also help her to tolerate the inevitable frustrations of her husband’s drinking and the inadequacy of the marriage.

The long-range role of the church in this process can be vitally important. Once the minister has helped the family over the crisis stage, his function broadens from pastoral counseling to the more inclusive function of pastoral care. He maintains a steady, dependable relationship which helps to sustain them through what may be an extended period of time before the alcoholic becomes open to help; this makes the minister readily available for additional counseling when crises recur. Much of the sustained-supportive ministry to the family is provided by the corporate worship and group life of the church. The pastor should encourage the family members to find group relationships that are satisfying to each of them. If a pastoral care team ^16. has been selected and trained by the minister, these laymen can be invaluable allies to him in providing the ongoing supportive ministry to the alcoholic’s family. Certainly every team should include at least one male and one female Al-Anon member. These persons will have a special entrée to the alcoholic’s family and can therefore be of help in relating the family to both the church and to Al-Anon.

Abundant Use of Al-Anon

Early in the counseling relationship with the alcoholic’s spouse, the minister should recommend that she visit the local Al-Anon Family Group. Helping her work through her fears and resistances to attending Al-Anon and then arranging, with her permission, for a stable Al-Anon member to take her to a meeting are strategies for helping her to relate to this excellent helping resource. Attendance at Al-Anon should parallel pastoral counseling in most cases. It is, for the family member, what AA is for the alcoholic. In order to coordinate these parallel therapies, the pastor should take an active interest in her Al-Anon experiences.

There are now over three thousand Al-Anon groups with more springing up each month. "Purposes and Suggestions for Al-Anon Family Groups," published by the Al-Anon Family Group Headquarters, describes the groups as follows: "The Al-Anon Family Groups consist of relatives and friends of alcoholics, who realize that by banding together they can better solve their common problems. Both before and after the alcoholic joins AA, there is much that the families can do to help the alcoholic, and themselves." The primary focus of the groups is to encourage each person to apply the Twelve Steps of AA to his own problems in living. Any two or three relatives of alcoholics can start a Family Group. Most groups begin in the living room of the wife of an AA member and are conducted somewhat like AA closed meetings (for instance, centering on the discussion of how one of the Twelve Steps has helped or might help the persons present). The groups follow the principle of allowing no criticism of an alcoholic partner in the meetings. Instead, newcomers are encouraged to make friends with more experienced members with whom they can discuss their personal difficulties in private.

The Al-Anon group can serve a valuable function both before and after the alcoholic is in AA. Fellow Al-Anon members give massive emotional support to the wife during the lonesome, dreary days when the alcoholic refuses help. They have the special empathy of those who have "lived in the same squirrel cage." Like AA members, they are bound together by the common crisis through which they have all gone or are going. Al-Anon participation will bring the wife out of her lonely, frightened shell and help her to a feeling-level acceptance of her husband’s illness. It will encourage those attitudes which make possible her surrender and the emotional release of her husband. (The term "release" was coined by Al-Anon members out of their experience.) Her fellow members will help her identify the subtle ways in which she is overprotecting her husband; they will help her learn how to handle all sorts of practical problems by sharing their own experiences. Participation in Al-Anon will stimulate personal growth and self-awareness through the application of the Twelve Steps to her own life. After she has released her husband, she will be able to look at her own life and the changes she needs to make in the marriage without its stimulating inappropriate guilt and controlling behavior. The Twelve Steps will assist her in maintaining her release of her husband -- through the first step in which she admits she is powerless over his use of alcohol. Most important, practicing the Twelve Steps in Al-Anon will help her find spiritual resources, through relationship with a higher Power, which she will need in coping with her problems in living and her existential anxiety.

How the Family Can Help the Alcoholic Accept AA

For a wife to nag her husband to go to AA is an almost foolproof method of keeping him away. Because of the hostility in their relationship, resulting in his need to thwart her, she has given him another reason for not going. Even if a wife is successful in getting her husband to AA under duress, the chances are that he will not "get the program." In fact, most of the interviewees, in my study who had had a time gap of more than a year between contact with AA and active participation in it were those who had been pushed in by well-meaning but misguided relatives.

A wife or other relative often can help the most by keeping a hands-off attitude or by working indirectly. Clifford Earle gives an example of how this was done in one case:

A lawyer whose wife showed unmistakable signs of alcoholism included several AA pamphlets and other suitable literature in a stack of papers on his desk at home. Then he had his secretary phone her for information she could get only by going through the things on her husband’s desk. In this way he was able to get her to read selected literature on alcoholism that she would have resented and rejected if he had given it to her directly. The method was devious but successful. ^17.

The technique of leaving AA literature around where the person will find it, without making it seem that it was planted, is a subtle way of informing him concerning the help that is available, without threatening his ego. Some pamphlets which are useful for this are: "Is AA for You?" "This Is AA," "AA, 44 Questions and Answers About the Program of Recovery from Alcoholism," "Medicine Looks at Alcoholics Anonymous," "AA for the Woman," "Young People and AA." All are obtainable from a local AA group or from the General Service Office of AA, 305 East 45th Street, New York, New York 10017.

If an alcoholic has a trustful relationship with his physician, it is sometimes possible for the family to enlist his help in getting the alcoholic to AA. The family members may describe the problem, as he sees it, to the doctor and ask if he would broach the subject with the alcoholic, should the opportunity arise. This approach is effective only if the doctor is favorably disposed toward AA.

The use of any indirect method should be considered only if a frank, aboveboard approach has failed or is nearly certain to fail. The weakness of indirect methods is that they are manipulative. Even if such a method does not backfire (as it will if the alcoholic discovers what is occurring), it tends to compromise the openness and mutual trust that should characterize marriage and family relationships. The fact that such a method is used usually indicates that such trust and openness do not exist in the relationship. The question that must be asked in such cases is whether the end (getting the person in contact with AA) justifies the means.

The family’s fundamental contributions to helping the alcoholic accept help from AA or any other treatment resource consist of releasing him, as described previously, and of accepting the sickness conception themselves. A psychiatrist, speaking at the Yale Summer School of Alcohol Studies, declared: "I’ve very seldom convinced an alcoholic that he has a disorder until I have convinced the family that he has a disorder." ^18. Until the emotionally significant people in his life accept the sickness conception and apply it to him, it is difficult for the alcoholic to do so. Until he does accept it, he is unlikely to become open to the kinds of help he needs.

There is, of course, no reason why the spouse should hide her desire that the alcoholic get help. A part of the firmness of attitude, which is neither pampering nor punishing, is the attitude on the family’s part that lets him know that they expect him to get treatment and what will happen, as far as they are concerned, if he does not. This should be done without nagging and certainly without empty threats. The tone should be that of holding up reality, emphasizing particularly what steps the family intends to take if the alcoholic’s self- and other-destructive behavior continues. In this way the spouse and other family members can exert a steady pressure on the alcoholic to accept treatment. Unless the marital relationship is thoroughly disintegrated, such reality pressure can help to motivate the alcoholic. This is an additional source of pressure, along with the pressure that results from external circumstances to which the alcoholic is exposed when the family stops "covering" for him.

A discussion which may prove helpful to a person who is attempting to interest a mate in AA is that written by the wives of the first hundred AA’s. Derived as it is from their experiences, it includes many practical suggestions as to how one may approach alcoholics who are in different stages of the illness and who have varied attitudes toward getting help. This discussion is in Chapter 8 of the AA book and is entitled "To Wives."

Helping the Family During Treatment

The attitudes and behavior of the wife can constitute either a barrier or a bridge to sobriety for the alcoholic who is in the early stages of treatment. The counselor’s goal is to help her make these attitudes a bridge. He can do this in several ways. First, the wife who has not been in contact with Al-Anon prior to her husband’s entry into AA should be encouraged to affiliate with Al-Anon and to attend open AA meetings with her husband. This will help her understand the AA approach and support his striving for sobriety. Second, the pastor can sometimes help the wife by interpreting what is happening in the particular treatment program (AA or otherwise) in which her husband is receiving help. Third, the pastor can emphasize the importance of letting him make the decisions concerning what shall be told friends and neighbors about his problem. Closely related is the importance of not attempting to "protect him from temptation," which, like other forms of overprotection, usually backfires. He must learn to live in a world where liquor is available. It is unrealistic for the wife to believe that she can really protect him in this way, and, more important, the recovering alcoholic usually resents being treated in this manipulative and sub-adult fashion.

If the pastor senses that a wife is unconsciously blocking her husband’s attempts to get help, he has the difficult task of trying to help her see what she is doing. I recall one wife who consistently planned for her husband to do something else on the night when AA met in their town. This was in spite of her conscious eagerness for him to achieve sobriety. It was not until her unconscious sabotaging was explored and diminished that she was able to support his participation in AA.

The pastor should stay close to the entire family during the early stages of treatment for other reasons also, including supporting them if the alcoholic slips. By helping the spouse understand the uphill struggle her husband is going through, he will enhance her appreciation of his progress and cushion her disappointment at the occasional setbacks. Emphasizing the importance of patience has a salutary effect on the family. It can be pointed out that it took the husband an extended period of time to develop his addiction and it may require several years for him to achieve stable and productive sobriety. The AA motto "Easy Does It" is good advice for the family.

The "suggestions for newcomers" in an Al-Anon brochure can be used by the pastor with families of alcoholics. Here are some of them:

Remember that the alcoholic is an emotionally sick person. Try to stop nagging and causing scenes.

Take a personal inventory of your own faults and make a sincere effort to overcome them.

Try to learn all you can about AA and alcoholism.

Cooperate actively with the alcoholic in his or her AA work. But do not push. The alcoholic has a far better chance when the family really understands and follows along.

Be gracious about the alcoholic’s closed meetings and 12th Step work. To overcome the alcoholic obsession will require an equally strong AA obsession.

Some alcoholics are much sicker than others. Don’t be discouraged if progress is slow. The AA seed has been planted. Growth is slower in some soils than others.

When AA’s assume an attitude of superiority, don’t be dismayed. This is a perfectly natural reaction from their previous tragic inferiority . . . spiritual growth usually levels off this attitude. Then real partnership becomes possible, for there will be neither superiority nor inferiority.

Above all don’t expect too much too quickly. Because of distorted relationships, directly or indirectly resulting from drinking, both you and your AA partner will have many personal problems to solve.

Finally, have faith in the AA member of your family. The AA program has been successful in thousands of cases. So it can be in yours. ^19.

The Family After the Alcoholic Is Sober

If all the troubles in the family of an alcoholic were the direct effects of alcoholism, it would be reasonable to assume that, given a certain period of time after sobriety, most of these troubles would disappear. As a matter of fact, they often do not, and the pastor does well to keep close to a family even after the alcoholic member has achieved sobriety. It may be that he will be able to render valuable help during period of readjustment.

We have already mentioned the wife’s personality problems as one cause of interpersonal difficulty when the husband is sober and attempting to assume the normal role of an adult male in the family. On the alcoholic’s side of the problem is the fact, emphasized by sociologist Selden D. Bacon, ^20. that the same kind of personality problems which tend to make one susceptible to alcoholism also give rise to marital discord. Merely removing the inebriety does not solve these problems. Rather than thinking of the problems of an alcoholic family as entirely the effects of alcoholism, it is well to remember that an inadequate marital adjustment can be as much a cause as an effect of inebriety. For example, the immature male who cannot accept the demands of his role as husband and father, may retreat into alcoholism to escape the anxiety of adult responsibility. His inadequacy and the attendant problems are aggravated by alcoholism, but the basic problems are there when inebriety is removed.

All this makes it doubly fortunate that AA is, in a real sense, a family program. Long before there were Al-Anon Family Groups the wives of AA members were taking an active interest in the program. Beginning with Lois W., wife of co-founder, Bill W., AA wives have shared the sense of belonging and the resultant re-socialization of the AA group. Very early they realized that they could well apply the Twelve Steps to themselves. In the chapter "To Wives" in the original edition of the Big Book, the wives of the first hundred AA’s wrote to the wives of other alcoholics: "If God can solve the age-old riddle of alcoholism, he can solve your problem, too." ^21. The husband and wife who together try to live the AA program will have a great advantage in the business of solving their family problems. One of the valuable functions of the Al-Anon Family Groups is that of giving wise counsel concerning the problems of adjustment after sobriety. Further, these groups fill an important need by helping to re-socialize the mate, giving her a strong sense of belonging similar to that provided by AA. This is especially important for, as the Family Group brochure puts it, "When your alcoholic partner goes on AA business, Family Group activities will cure that lonely and left-out feeling."

One of the most helpful descriptions of the marital problems that beset the alcoholic family after sobriety and how they can be met, is in the Big Book, Chapter 9, entitled "The Family Afterwards." The pastor who has occasion to counsel with such a family will do well to read and absorb the insights of this chapter which was written by alcoholics.

This chapter suggests, among other things, that the family may be helped in its readjustment by establishing or reestablishing their connections with a religious organization. By encouraging the family who have gotten away from the church during the nightmare of alcoholism to reenter the Christian fellowship, the pastor can render valuable service to them and to his church. He can help them try their new social wings in a non-alcoholic circle and can put them in touch with all the resources and opportunities for service represented by the church. On the other hand, as the Big Book puts it, in discussing the alcoholic who returns to church, "He and his family can be a bright spot in such congregations. He may bring new hope and new courage to many a priest, minister or rabbi." ^22. All this is contingent on the willingness of a congregation to accept an alcoholic and his family into the fellowship, without reservations. Sad to say, this is not always the case. But where it is, the pastor will find that a vital resource for helping the families of alcoholics is very near at hand -- in his own church.

If involvement in AA, Al-Anon, and the church program do not suffice in helping the alcoholic and his wife make the marital adjustments which will undergird productive family life, the pastor should help them obtain marriage counseling. If he is trained in marriage counseling and has the time to invest in this function, he may decide to offer his help to them. If not, his role is to help them find a competent marriage counselor. One of the most encouraging methods of helping alcoholics and their spouses with marital problems is that of group marriage counseling in which five or six couples meet under the leadership of a group counselor or, in some cases, two co-counselors. ^23.

Helping the Children of Alcoholics

In its advanced stages, alcoholism crushes the interpersonal relations of family life like a heavy boot on a delicate spider web. It is in the intricate interdependencies of the family that the agonies of alcoholism are devastatingly felt. Family life is the most intimate and therefore the most demanding of all human relationships. The very qualities which make possible a growth-producing family -- tenderness, compassion, emotional maturity in parents -- are in short supply or are early casualties of the illness of alcoholism. It is not surprising, therefore, that few, if any, children of alcoholics escape without emotional scars. The dependable supply of emotional nutrition which children need to grow strong, resilient personalities is not available in most alcoholic families.

The damage to the children varies, depending on a number of factors -- the strength of the nonalcoholic parent, the age of the child at the onset of the most destructive phases of the illness, the nature of the relationship with the alcoholic parent, and the social class level of the family. On this last point, middle-class, status-seeking families seem to be disturbed the most deeply by parental alcoholism. In families where the father is the alcoholic and the mother has received help, damage can be minimized. Where the mother is the alcoholic, damage is often deep. One husband told of the response of his young son to finding his mother in an alcoholic stupor. He said, "Mommy is dead." Emotionally, she was dead to him, in that she was non-giving and non-available to him when he needed her. The child’s involvement in the husband-wife conflict was reflected in these words to his father: "We don’t like Mommy, do we?"

There are at least four factors in the alcoholic family which are disturbing to children and teen-agers: ^24.

1. The shift and reversal of parental roles in an unpredictable and confusing way is the first factor. When the father is drinking, he abdicates his parental role which is taken over by mother. This distorts her functioning in her unique role as mother. During periods of sobriety, the whole family tries to adjust. The lack of a strong male with whom a son can identify and thus achieve a sense of his own emerging maleness is a serious deficiency. The same can be said for the lack of a male figure who is both loving and strong with whom a daughter can discover a sound way of relating to males. When the mother is the alcoholic, the identity problems are reversed, and they are compounded by the limitations of the alcoholic mother’s ability to give to her children.

2. The inconsistent, unpredictable relationship with the alcoholic is the second disturbing factor. The alcoholic may be alternately cold and rejected, and sentimentally overindulgent for reasons that are not apparent to the child. Attempts by the child to grasp the pattern of how to relate to the parent so as to obtain the security, approval, and affection he needs are continually frustrated by the unpredictable nature of the alcoholic’s responses.

3. The nonalcoholic parent is unable to relate in a need-satisfying way with the child because of her disturbance. The wife is obsessed with her husband’s drinking and filled with fears which make parenting roles very difficult. Her own needs are not being met in the marriage, thus leaving her lonely and frustrated. This makes it increasingly difficult for her to satisfy the emotional needs of her children. One response to loneliness may be to exploit the children by attempting to derive emotional satisfactions from them which she should be getting from the marriage. She may unwittingly use the children in her struggle with the husband. Divisive alliances -- mother-son vs. father-daughter -- are frequent and damaging to the emotional health of the children.

4. Increased social isolation of the family is the fourth factor. The family turns in upon itself; interaction is too intense. The family loses the supportive relationships with friends and community which are so vital to its health. Family morale rises and falls with the alcoholic’s drinking behavior. The child’s peer relationships are distorted or eliminated. He feels, "I can’t bring my friends home because Dad might be drunk and embarrass me in front of them." He may withdraw from peer relationships in an effort to protect himself from the discovery by his peers of the family stigma. The more the family turns in upon itself, the more its problems feed upon themselves and grow.

What can the minister do to help the children? The most important way of helping the children is by helping their parents. Even if the alcoholic parent resists treatment, the nonalcoholic spouse can, through the approach described in this chapter, change the emotional climate of the home and make her relationship with the children more need-satisfying.

In addition, the pastor can do these things to provide direct help to the children: He can encourage them to stay actively involved in the church school and youth groups within the church, resisting the temptation to withdraw into protective but harmful isolation. Church school teachers, adult advisors to the youth groups, or youth within the groups can be enlisted as allies in the effort to surround the children of alcoholics with a supportive network of relationships. This must be done without breaking the confidences which the family may have with the pastor about the nature of their problems.

The minister can encourage the adolescent sons and daughters of alcoholic parents to participate in an Alateen group. These groups help the teen-ager to understand the nature of his parent’s illness, to experience the group support of peers who share many of the same problems, and to apply the Twelve Steps to their own problems of living in an alcoholic home. The opportunity to talk openly about painful experiences that were formerly kept in secrecy surrounded by feelings of shame has an unburdening effect; feelings of self-confidence are strengthened by group acceptance. In these and other ways, Alateen groups do for the adolescent what AA does for the alcoholic and Al-Anon does for the spouse.

If the children show signs of serious disturbance -- . -- either the inward retreat of withdrawal or the outward attack of aggression and delinquency -- the minister should recommend and assist the parent in obtaining professional help for the children at a child guidance clinic. If the alcoholic is still drinking, the nonalcoholic spouse may have to handle making these arrangements; but certakily the alcoholic should be informed that his children are disturbed and why. If the family is intact, it may be that some form of conjoint family therapy ^25. will prove to be the most efficient way of helping the disturbed child by alleviating the disturbance in the total family of which the child’s problems are expressions. Marriage counseling for the parents, conjoint family therapy for all the members of the family, or psychotherapy for the disturbed child and the parents at a child guidance clinic -- all these can be effective ways of healing the emotional wounds suffered by children in the chaos of the alcoholic home.

A final way in which the clergyman can help the children is by establishing a strong, accepting relationship with them himself. This does not require large investments of time, in most cases. What is required is for the pastor to be interested in them and to express warmth and caring in his contacts with them. Such relationships between a pastor and children can have a qualitative meaningfulness, on both sides, that far outweighs the investment of time. To the extent that a relationship of this kind helps satisfy the child’s need for stable, loving adult identity figures, it is a long-range investment in the child’s future mental and spiritual health.

END NOTES:

I. Jerome Ellison, "Help for the Alcoholic’s Family," The Saturday Evening Post, CCXXVIII (July 2, 1955), 48. Used by permission of the author.

2. Marty Mann, New Primer on Alcoholism, p. x.

3. Joseph Hirsch, The Problem Drinker (New York: Duell, Sloan and Pearce, 1949), p. 111.

4. S. Futterman, "Personality Trends in ‘Wives of Alcoholics," Journal of Psychiatric Social Work, XXIII (1953), 37-41; T. Whalen, "Wives of Alcoholics. Four Types Observed in a Family Service Agency," QJSA, XIV (December, 1953), 632-41; S. D. Bacon, "Excessive Drinking and the Institution of the Family," Alcohol, Science and Society, pp. 223-38; Margaret B. Bailey, "Alcoholism and Marriage, A Review of Research and Professional Literature," QJSA (March, 1961), pp. 81-97; D. E. Macdonald, "Mental Disorders in Wives of Alcoholics," QJSA, XVII (June, 1956), 282-87; K. L. Kogan, W. E. Fordyce, and J. K. Jackson, "Personality Disturbance in Wives of Alcoholics," QJSA, XXIV (June, 1963), 227-38; "Some Concomitants of Personality Difficulties in Wives of Alcoholics and Nonalcoholics," QJSA, XXVI (December, 1965), 595-604; K. L. Kogan and J. K. Jackson, "Stress, Personality and Emotional Disturbance in Wives of Alcoholics," QJSA (September, 1965); R. C. Ballard, "The Interaction Between Marital Conflict and Alcoholism as Seen Through the MMPI’s of Marriage Partners," The American Journal of Orthopsychiatry, XXIX (July, 1959), 528-46; M. B. Bailey, Paul Habennan, and Harold Alksne, "Outcome of Alcoholic Marriages: Endurance, Termination or Recovery," QJSA, XXIII (December, 1962), 610-23.

5. If no number is listed, AA and Al-Anon meetings can often be located by contacting a clergyman who has been in the area for several years. Information about the nearest Al-Anon group and about the Al-Anon program in general can be obtained by writing the Al-Anon Family Group Headquarters, P. 0. Box 182, Madison Square Station, New York, New York 10010.

6. QJSA, XV (December, 1954), 562-86. See also Jackson’s article, "Alcoholism as a Family Crisis," Pastoral Psychology (April, 1962), pp. 8 ff.

7. "The Adjustment of the Family to the Crisis of Alcoholism," pp. 568-69.

8. Much of the material in this and subsequent sections of this chapter is adapted from the author’s article, "Pastoral Care of the Alcoholic’s Family Before Sobriety," Pastoral Psychology, XIII (April, 1962), 19-29.

9. Since there are at least four times as many wives as husbands of alcoholics, the words "she" and "wife" will be used generally throughout this discussion. However, much that is said will apply to other close relatives of alcoholics who seek help -- husbands, parents, grown children, etc.

10. (New York: Alcoholics Anonymous Publishing, 1955).

11. For a discussion of Berne’s Parent-Adult-Child ego states, see his book Transactional Analysis in Psychotherapy (New York: Grove Press, 1961). The game of "alcoholic" is discussed in Berne’s book Games People Play (New York: Grove Press, 1964), pp. 73-81.

12. Alcoholics Anonymous, pp. 115-16.

13. "Alcoholism and Marriage," p. 85.

14. From a report read by Gladys Price at the Cleveland Symposium on Alcoholism, reprinted in the first issue of QJSA.

15. Alcoholics Anonymous, p. 111. Used by permission of AA General Service Headquarters.

16. For a description of how such a team can be selected and trained, see Clinebdll, Basic Types of Pastoral Counseling, pp. 287-91.

17. How to Help an Alcoholic (Philadelphia: The Westminster Press, 1952), p. 61.

18. Lecture by William Wade, Yale Summer School, 1949.

19. From "Purposes and Suggestions for Al-Anon Family Groups." Used by permission of Al-Anon Family Group Headquarters.

20. Ibid.

21. Alcoholics Anonymous, pp. 129-30.

22. Ibid., p. 132.

23. For a description of one approach to group marriage counseling see Genevieve Burton, "Group Counseling with Alcoholics and Their Nonalcoholic Wives," Marriage and Family Living, XXIV (February, 1962).

24. A relevant paper on "The Effect of Parental Alcoholism on Adolescents" was presented by Herman E. Krimmel and Helen R. Spears at the National Conference on Social Welfare, Los Angeles, California, May 26, 1964.

25. For a discussion of the application of family group therapy in pastoral counseling, see Clinebell, Basic Types of Pastoral Counseling, pp. 120-30.

The four operational goals of alcoholic counseling were outlined in Chapter 8. In the chapter just concluded, the achievement of the first and most difficult of these goals was explored -- helping the alcoholic to accept the fact that his drinking per se is a problem with which he requires assistance. It was shown that the process is one of reaching and helping to mobilize his inner motivation to accept help. The heart of this approach is the establishment of a trustful relationship which then becomes the instrument by which the alcoholic is helped to face reality with reference to his drinking. One aspect of the process is the educative dimension of counseling aimed at increasing the person’s understanding of his addictive illness. Although the pastor may be the key person in working with a resistant alcoholic, the help of an AA member or understanding physician who can "talk turkey" in ways that reach the alcoholic may be needed to complement the minister’s efforts.

Recognizing Openness to Help

Here is a segment from a counseling session involving a minister and an alcoholic:

Mr. B.: I didn’t mean to get drunk last week. It was the first time in a month that I’d had anything to drink. I was worried about a few things at the office that weren’t going well. I decided I’d walk around a little, and I passed by this beer joint -- well, you know, the first thing I realized I was inside drinking. I didn’t want to, but I just couldn’t help it.

Pastor: You thought that getting drunk would solve all your problems. Did it help?

Mr. B.: No, it only made things worse. I broke my promise to you and God -- and I feel terrible. I’m sick, I tell you. I’ve got to have some help!

Pastor: You feel sick because you broke your promise and got drunk.

Mr. B.: I -- don’t know. Maybe that’s the reason. Maybe it goes beyond that. I I guess I’m all wrong inside. ^1.

This interaction illustrates the difficulty which a counselor may have in hearing an alcoholic’s cry for help when he begins to utter it. In his first statement, Mr. B. apparently seemed to the pastor to be giving a rather lame excuse for beginning to drink again. (The pastor responded with a statement which may or may not be the way B. felt, and an obvious and finger-pointing question that must have felt rejecting to the alcoholic.) What the minister missed was the possibility that B. was really expressing his fear and desperation at finding himself drinking against his conscious intention. This should have been explored by the minister, beginning with a response such as: "How did you feel when you realized you were drinking in spite of your decision not to?" or "Somehow you felt as though things were beyond your control?" This might have opened B. to talk about his awful feelings of weakness and of being trapped by his compulsive drinking and distorted thinking. If he is beginning to experience the panicky fear of not being in control and of the destructive consequences of his drinking, he is probably becoming open to help. The last two sentences of B.’s second response and his third response support the view that he is feeling desperate and is crying out for help. In the pastor’s second response, he again misses the alcoholic’s-desperate plea for help, focusing instead on B.’s guilt feelings related to the broken promise. These feelings are certainly within the legitimate concern. of counseling, but focusing on them at this point distracts the process from the crucial issue -- B.’s reaching out for help. The pastor’s second response might well have been a recognition of his feeling, such as, "The situation feels desperate to you, and the need for help is very pressing." The pastor could then say, "You mentioned that you feel sick. Tell me more about how you see this and what kind of help you feel you need." This would give the minister some grasp of B.’s perception of his problem and the required treatment. By moving in this direction, the pastor could eventually introduce the idea of getting help from AA or such other resources as seem appropriate.

Obtaining Medical Help

The second goal of counseling is to get the alcoholic to a physician who I can, if necessary, facilitate detoxification and treat the physical consequences of prolonged inebriety, as well as decide whether brief hospitalization is needed; if the physician is oriented psychiatrically, he may be of assistance in identifying cases of severe underlying psychopathology. Medical treatment is often required long before the alcoholic hits bottom psychologically. Many alcoholics require repeated hospitalizations before their motivational teeter-totter tilts decisively and they determine to accept treatment for the addiction per se. In such cases, it is essential that the alcoholic and his family know that simply treating the physical effects of excessive drinking, as important as this can be, does not constitute treatment of the addiction. Some persons erroneously believe that "unsuccessful treatment" of alcoholism has occurred when actually only the preliminary stage of treatment -- "drying out" and physical rehabilitation -- has taken place.

Alcoholics who are obviously in need of medical attention, who have the "shakes" or other withdrawal symptoms, and those who say that they feel "sick" (Mr. B., for example) will usually not resist seeing a physician to get relief from their pain. It is wise for the minister to encourage even those who are feeling relatively well to have a physical checkup to ascertain if there are less obvious organic problems which need treatment. The minister’s role is to assist the alcoholic to "connect" with a doctor who accepts alcoholics as patients, knows the latest methods of treating the problems associated with alcoholism, and is appreciative of the contributions of AA and pastoral counseling. A physician who does not understand alcoholism and AA can, by his attitudes, unwittingly push the person deeper into his addiction and away from the help he desperately needs. To illustrate, the statement by a trusted family doctor to an alcoholic patient, that he "is not an alcoholic but simply drinks too much and should cut down," can petrify that man’s resistance to seeing his problem for what it is. The doctor’s statement usually reflects a Skid Row stereotype of "the alcoholic." On the other hand, because of the status of physicians in our society, an accurate explanation of the nature of alcohol addiction and a recommendation that the help of AA be sought can carry special weight with some alcoholics.

What is the minister’s role during the period when an alcoholic counselee is hospitalized? He should maintain a supportive pastoral relationship, showing his continuing interest by visits and phone calls to the alcoholic and to his family. In addition, he has an opportunity to encourage carefully selected AA members to establish a relationship by visiting the alcoholic in the hospital (with the permission of the person and his doctor). Al-Anon members can do the same for the spouse and other family members.

If the minister is contacted by an alcoholic or the family of one who has been on a prolonged bender, it is crucial to make sure that he gets medical attention. As indicated in Chapter 8, withdrawal symptoms such as delirium tremens and alcoholic convulsions can be very dangerous, even fatal. The danger is compounded if the person has been combining alcohol and barbiturates ("goof balls"), since each tends to enhance the depressive effects of the other. The alcoholic may have been taking barbiturates without the family’s knowledge. The only safe course is to make certain he gets medical help.

Interrupting the Addictive Cycle

The third goal of counseling is to help the person learn how to avoid reactivating his compulsive-addictive chain reaction of drinking. Early in the process of working with an alcoholic, it is helpful to discuss the fact that he has an uphill battle against an insidious illness, and then to spell out what is involved in winning the battle. Gordon Bell, a physician who directs an addiction treatment center in Ontario, Canada, has an effective way of describing to the alcoholic the task he faces. Bell explains to the person that his body has burned out its ability to handle the chemical (alcohol) which he has been using to cope with stress. He then points to that person’s symptoms of loss of this ability, such as, getting drunk on less, having blackouts, and so forth. Next, he stresses the fact that the person must, for health reasons, learn other ways of handling stress -- by "people methods" rather than chemical methods. Finally, he tells the person that he is caught in a self-perpetuating process in the interruption of which there are two phases. The first is "turning off the physical motor" by getting the alcohol out of his body (thus interrupting physical craving), and second, "turning off the mental motor," which means terminating obsessive thinking about alcohol (mental craving) and the response of automatically turning to alcohol to handle any stress. ^2. This general outline is useful in pastoral counseling with the alcoholic.

The focus of counseling, in this stage, is on the drinking pattern itself and the need to learn how not to take the first drink. A part of this learning consists of identifying and interrupting the rationalization process which leads to the first drink. (For instance, "One glass of beer can’t possibly hurt me. After all, I’ve been stone sober for three weeks.") The alcoholic should be helped to see that although his heavy drinking may have begun as a symptom of other problems and may continue to be aggravated by them, the drinking itself has now become a problem which must be treated in its own right if the person is to recover. The late Harry M. Tiebout likened the "runaway symptom" of the alcoholic’s out-of-control drinking pattern to the dangerously high fever of pneumonia. The fever is a symptom of the underlying infection, but unless it can be lowered, the person may die of the "symptom." As Tiebout pointed out, the direct treatment of the alcoholic’s "runaway symptom" is essential, and it consists of methods by which the cycle of drinking to overcome the effects of previous drinking is blocked.

Counseling procedures, in this stage, should deal primarily with behavior and only secondarily with feelings. The counselor should not allow himself to be diverted into extensive discussion of why the person drinks excessively, whether this discussion is in terms of attempts to understand his inner conflicts, early life experiences, or current external pressures. Searching for causes, in whatever direction, is usually unproductive with respect to the alcoholic’s problem of highest priority -- how to keep the addictive cycle from being reactivated. The "causes" which are discovered may be used by the alcoholic to avoid responsibility for changing his present irresponsible (self- and other-damaging) behavior. Instead of searching for the why of his drinking, counseling should focus on the facts about his drinking and its consequences, and on how he can avoid taking the first drink and thus increase his ability to be more responsible in other areas of his life.

The alcoholic’s other problems can become accessible to handling and help only if he learns how to avoid the first drink. For example, a counselee makes a statement such as, "If I didn’t feel so depressed, it would be easier to stay off the bottle"; or "If my wife hadn’t left me . . ."; or "If I didn’t have to live in one room .. ."; at this point the counselor can point out that although there is certainly some truth in his statement, his first problem is to stay off alcohol. This is his first problem in that its solution is a prerequisite to getting at the others. Even though he feels depressed, misses his wife, and abhors living alone in one room, he doesn’t have to drink. The choice is still within his power to make. Furthermore, his wife’s leaving was a consequence of his drinking, and his chances of getting her back are contingent on interrupting the drinking. If a person continues to put other problems ahead of sobriety, it may be an indication that he is still fighting acceptance of the fact that he is an alcoholic. A frank discussion of this issue is in order in the counseling session.

The most widely available means of keeping the addictive cycle broken while new coping patterns are learned is AA. The minister should do whatever is required to help the person establish a strong relationship with a local AA group. When the pastoral counselor senses that an alcoholic is evidencing some receptivity to help, he should ask: "How would you feel about talking over your situation with someone who has been through the same problem and has found an answer that works for him?" If the person agrees, the minister can make a phone call while that person is present to arrange for a three-cornered talk involving the two of them and an AA member. (The AA member should be of the same sex, general age, and socio-educational group as the person, if possible.) After explaining that the person they will be talking with is an AA member, the pastor should inquire what the alcoholic knows about that fellowship. This may reveal blocks to Successful affiliation with .AA, which the person needs to work through in counseling. When asked what she knew about AA, a woman responded, "Am I that badly off?" Behind her question was the misconception that AA is designed to help only those in advanced alcoholism. Another alcoholic responded to the minister’s suggestion that he try AA with the information that his alcoholic uncle had stopped on his own by simply deciding to quit drinking. The message the person was communicating was two-pronged -- discomfort at the thought of identifying himself with a group of self-acknowledged alcoholics and the feeling that he should, like his uncle, be able to gain sobriety without outside help. ^3.

In describing why the person should go to AA as well as participate in counseling, it is well to stress that making the grade to stable sobriety is a difficult accomplishment in which several forms of help are often needed. The AA fellowship will give group support that the person will need in addition to what he derives from counseling. Although the minister knows that the person will receive a multitude of benefits from AA beyond group support, it is better for him to restrain his enthusiasm and avoid seeming to oversell the AA program.

If the three-cornered meeting goes well, communication will be well-established between the AA member and the counselee before it is over. When this has happened, the pastor may decide to excuse himself, thus encouraging the two of them to develop their relationship without his presence. The typical outcome of such a meeting is that the AA member invites the alcoholic to come with him to an AA meeting.

The counselor should encourage the alcoholic to attend as many AA meetings as possible during the early phases of his recovery, whether or not his reactions are entirely positive. If the person continues to expose himself to the AA philosophy and group élan, he may begin to identify with AA, almost in spite of himself. The sense of belonging which exists in most AA groups is a powerful magnet. The counselor can help the person deal with any blocks to full identification which may arise during the early stages of AA attendance, by inquiring regularly about the person’s reactions to AA.

Many alcoholics are now encountered who have dabbled in AA, or tried it seriously but unsuccessfully. Some seem to be "vaccinated" against it by having attended a few meetings when they were in a highly defensive state. To help such persons, the counselor can first explore the nature of the resistance to AA. Does the resistance reflect the limitations of a particular AA group or the person’s reluctance to admit his need for help? Second, the counselor can recommend strongly that he try AA again, perhaps going to a different group or to several, if they are available in the vicinity. Third, the minister can arrange for him to get acquainted with an experienced and accepting AA member who may serve as a bridge to feeling at home in an AA group [In a study of factors which produce "readiness" for affiliation with AA, Harrison M. Trice discovered that alcoholics with the following characteristics tend to relate effectively to AA: Before contact with AA, they often shared troubles with others, had lost drinking friends, had heard positive things about AA, had no relative or friend who had quit through willpower. These and other findings of Trice’s research can be useful to the counselor in his efforts to reduce the resistance of an alcoholic to affiliation with AA. (See: A Study in the Process of Affiliation with Alcoholics Anonymous," QJSA, XVIII [March, 1957], No. 1, 39-54.)]

With those alcoholics who will not attend AA or do not respond to it, the minister’s role is to assist them in finding other help. Referral to an alcoholic clinic or to a physician for Antabuse may supply the help that is needed to break the addictive cycle and achieve stable sobriety. Such a referral is also appropriate in the case of alcoholics who are continuing to work at the AA program but seem to need additional help. If an alcoholic counselee suffers from a severe underlying personality disturbance, he will probably require psychiatric and other medical treatment, in addition to AA, in order to keep the addictive cycle broken. Disturbed persons sometimes use alcohol to deaden their overwhelming anxiety. Abstinence, without psychiatric help, may cause them to deteriorate psychologically. ^4.

Many alcoholics have one or more "slips," particularly in the first year or two of their serious efforts to keep the addictive cycle broken. It is important for the counselor to handle these in such a way as to make them opportunities for insight -- concerning the rationalization process, the buildup of resentments, or the pattern of staying away from AA meetings, which tend to precede a return to drinking. The alcoholic may avoid the minister after a slip because of his guilt feelings. Under such circumstances, it may be wise for the minister to take the initiative in reestablishing contact. Otherwise, his opportunity to help the alcoholic may be terminated. It is particularly salutary for a person with alcoholism to discover that a clergyman is not judging him or angry at him because he had a slip.

The pastor’s tolerance of failure and his not becoming ego-involved in the outcome of counseling (as discussed in Chapter 9) are extremely important in counseling with alcoholics because of the practical fact that he will fail so often. The process of such counseling is often slow and characterized by many setbacks. The counselor must be content with "little successes" in many cases. For example, counseling is a relative success if a person who has had an average of five binges a year is able to cut the number to two or three. Counseling with alcoholics is difficult and often frustrating to the counselor. It can also be deeply satisfying when the counselor senses that he has been an instrument in helping a person who has been engaged in slow suicide to move into a new and constructive chapter in his life.

The Resynthesis of Life

The fourth goal of counseling is to help the person develop a new way of life to replace his alcohol-centered way of life. To reintegrate his life without alcohol, he must find new, satisfying values and new, effective ways of coping. The recovering alcoholic must find nonalcoholic means of satisfying the needs he formerly satisfied or attempted to satisfy through drinking -- reduction of anxiety, closeness to others, psychological "vacations" from painful reality, a sense of adequacy, experiences of transcendence, and euphoria. Permanent sobriety and productive living are contingent on finding such satisfactions in relationships -- with fellow AA members, family, and, in many cases, a "higher Power."

The rebuilding of one’s values and relationships is obviously a long-range objective. Its achievement involves clearing up the debris in one’s inner life, striving for constructive relationships, surrendering one’s self-centeredness, finding a place to make one’s life count for something, discovering a sense of meaning in existence, learning to draw on the help of other people and also to be of help to them, and finding some transcendent resource for coping with the burdens and anxieties of existence.

For many, AA’s Twelve Step recovery program is an invaluable means of stimulating precisely these types of personal growth. As was evident in Chapter 5, the AA group and program are designed as a means of facilitating the particular kinds of continuing growth which are necessary to under-gird productive sobriety.

The clergyman-counselor can contribute significantly to helping the alcoholic move toward the goal of reconstructing his life without alcohol. During the early stages of recovery in AA or in an alcoholic treatment facility, the minister’s role is mainly a supportive one. The primary responsibility for learning to avoid the first drink is the alcoholic’s, and his major resource for accomplishing this is AA (or other treatment approaches). His main source of emotional support (often hour-by-hour) during the first difficult days and weeks are his fellows in AA.

The minister’s role is to give pastoral care, to maintain a warm, caring relationship with as much support as the person needs and to be easily available for counseling if the alcoholic desires it. Without being possessive or prying, the pastor should show interest in the person’s experiences in AA or in treatment. Dropping by for a cup of coffee, phoning to express interest in "how things are going," occasionally attending the open meeting of his AA group -- these are some of the ways the minister can keep in touch with the early-stage recovering alcoholic. He should express his pastoral interest and support without "hovering" over the person or seeming to check up on him. As the alcoholic identifies more closely with AA, he may need to withdraw some of his emotional ties with the pastor. This is a part of his growth. In many cases, the alcoholic eventually moves beyond this and chooses to relate to his minister on a new and close basis.

There are at least three points at which the minister’s counseling skills can be particularly helpful to the recovering alcoholic, after he achieves a reasonably stable interruption of his drinking cycle and begins to strive for a re-synthesis of his life. The first is in assisting the alcoholic who requests it with the "moral inventory" steps in AA (4 through 10).

AA member: Pastor, I’ve talked these things over with my sponsor, and it helped, but it seems like it would be a good idea to discuss them with you, too. There are a couple of points in my inventory where I really felt hung up-and still do. The guilt and resentments just won’t seem to go.

A minister who is trained in counseling is equipped to help the alcoholic take his moral inventory in depth, to look below the surface behavior to some of the sources of resentment, self-pity, guilt feelings, and self-rejection which feed the behavior and push the person toward drinking.

In his discussion of the minister’s role in assisting the alcoholic with the moral inventory, John E. Keller states:

The inventory procedure needs to be talked about in a positive way, pointing up the value of taking such an inventory. Hopefully he will benefit by being able to: (1) Get to know himself better; (2) Become more keenly aware of how he needs to change; (3) Recognize danger signals to his sobriety before he takes the first drink; (4) Live more comfortably with himself and others; (5) Have the door opened for a more personal and meaningful relationship with God. ^5.

Helping AA members with their moral inventories can be a means of engaging them in an ongoing counseling process through which the hard, cold lumps of guilt which immobilize growth and block relationships can be melted. An indispensable part of the inventory process is making amends to the persons one has harmed (steps 8 and 9). The counselor should encourage this follow-through, in spite of the pain involved. Otherwise the recovery process is short-circuited. By taking action to assume some responsibility for past irresponsibilities, guilt is reduced, self-acceptance enhanced, and relationships improved. As the alcoholic makes a list of those he has harmed, one person in particular should not be forgotten. As Keller put it: "Essential also is to put himself on the list and make amends with himself. He may have hurt a lot of people, but no one quite as much as he has hurt himself." ^6. During fourth step counseling, the minister can help the person see that self-forgiveness and forgiveness of others are always linked and that the way one makes amends to himself is to live in those ways that fulfill one’s person-hood and potentialities.

A second area in which the clergyman can help the alcoholic reconstruct his life is by being easily available to counsel with him regarding his problems of coping constructively with responsibilities and relationships. Such counseling, usually at the alcoholic’s request, can complement the help the person receives as he continues to work at the AA program. By the time the alcoholic achieves sobriety, his marital, parental, vocational, and social relationships frequently are in shambles. Interrupting the drinking cycle is a prerequisite to rebuilding these vital relationships, but it does not automatically accomplish it. The permanency of his sobriety may be dependent, to some degree, on the revitalization of these shattered relationships or their replacement if they are beyond repair. The counseling process here is relationship-centered, helping the person change those attitudes and behavior patterns by which he gets in his own way as he attempts to relate to others. Marriage and family counseling is the most important form of such counseling help.

The minister who is well trained in counseling and psychotherapy may help the alcoholic whose inner conflicts and residual feelings from early relationships make his hold on sobriety tenuous. Earthquakes from the cellar of the person’s psyche shake the house of his present relationships so continuously and violently that some form of psychotherapy is essential. The minister who is trained in pastoral psychotherapy and has the time and inclination to do so can render a significant service to such alcoholics. However, these considerations should be kept in mind. First, exploration of depth feelings and early-life relationships can be very disturbing and should be attempted only after other forms of help have proved inadequate and only after sobriety has been reasonably stable for several months or longer. Second, looking at the past can become a substitute for responsible coping with the demands of the present, and over-focusing on feelings can become a way of evading responsible action. To minimize this second danger, it is well to keep a four-pronged focus in psychotherapy with alcoholics -- on the past and the present; on feelings and actions in relationships.

The Spiritual Dimension of Recovery

A third way in which the minister’s counseling skills can be useful to the recovering alcoholic’s re-synthesis of his life is in helping to further his spiritual growth. The discussion of philosophical and religious factors in the etiology of alcoholism (Chapter 2) and of the psychodynamics of a religious approach to alcoholism (Chapter 6) emphasized the following points:

Alcoholism is a spiritual illness (as well as an emotional, physiological, and cultural illness). It is a spiritual illness in two senses: There are spiritual factors among its causes, and full recovery depends on the discovery of a philosophy of life and/or a religious experience that can satisfy the alcoholic’s fundamental religious needs.

As one who is professionally trained to be a spiritual growth enabler, the clergyman can fulfill a unique role in helping alcoholics. When a recovering alcoholic comes to him for help with his religious problems or with the "spiritual angle" in AA, he has an opportunity to contribute to the creativity of that person’s new way of life. The goal of counseling in this area is to help the alcoholic develop a meaningful relatedness to the vertical dimension of life -- the dimension of values including the ultimate value which is called God. In counseling with alcoholics, one discovers that problems in the vertical dimension are always intertwined with problems in the horizontal (person-to-person) dimension. Spiritual and interpersonal difficulties, and growth are actually two sides of the same reality -- the reality of one’s relationships. Anything that enhances the quality of one’s relations with one’s fellows will tend to improve one’s relationship with God, and vice versa. Conversely, blocks in relationships with one’s spouse, children, and friends have .their counterparts in blocked relatedness with God. The skilled counseling pastor should be able to move in both dimensions with equal facility and to help the alcoholic see the connections between them. It is noteworthy that again and again in AA, as an alcoholic reconstructs his relationships, his spiritual life gradually becomes more meaningful to him.

A major block in the spiritual life of the drinking alcoholic, which often continues as a barrier during his sober life, is a magical understanding and use of religion. Until this changes, the channels of a more vital relationship with the spiritual universe seem to remain blocked. Typically, if the drinking alcoholic has any religious life, it reflects his narcissism and his unresolved inner conflict between autonomy and dependence.

He often expects God to take care of him in infantile, magical ways. He tries to use God as an overprotective grandmother whose main function is to extricate him from alcoholic scrapes scot free. He makes impossible demands, expects a special set of rules-of-the-game, and then feels rejected when God does not "come through" according to his demands. His religion both reflects and enhances his narcissistic self-worship and his dependency conflict. Rather than allaying anxiety it increases it because it operates in the same manner as his neurosis. The underlying meaning of much alcoholic atheism seems to be, "All right, if you won’t take care of me like a child, I’ll show you! I’ll destroy you by the magic of thought -- by not believing in you!" ^7.

Thus, during active alcoholism, as the person is cut off from nurturing relationships including his relationship with God, he is forced into a kind of idolatrous position in which he is his own god. His grandiosity and feelings of being above needing others are a part of his defense against deeper feelings of isolation, vulnerability, and fear of closeness.

Some drinking alcoholics come to ministers seeking easy, magical solutions to their complex problems. The pastor must not comply and seem to sanction their expectations. Many recovered alcoholics tell of praying "until they had calluses on their knees" during their drinking days, to no avail. Generally their prayers are of the magical, manipulation-of-reality type described above. The minister should work with persons who have such orientations to help them see that problems of their relationships with God are directly related to problems in their human relationships, and to guilt-producing living. The counseling process should first aim at interrupting the addictive cycle and straightening up human relationships; then it is appropriate to turn to overtly spiritual problems, which are interrelated with all of the alcoholic’s other problems.

The counselor can help the recovering alcoholic gain the inner strength to let go of his tendency to defeat his own spiritual quest by his manipulative style of relating to God and the universe. The AA approach provides a sound model for the counselor in helping the alcoholic move toward a reality-respecting religious life. Step eleven of that program says, "Praying only for knowledge of His will for us and the power to carry it out." If the "will of God" is understood as a symbolic way of saying "the way things are" (the nature of reality in an orderly, cause-and-effect universe), the profound significance of this step becomes clear. The alcoholic is asking for the knowledge and ability to line up his life with reality rather than expecting (as in his drinking days) that reality should adapt itself to him. The recovering alcoholic thus is striving to develop a relationship with God which is almost the exact opposite of that of his pre-sobriety days. In doing spiritual counseling with a person having a magical, immature faith, the aim is not to deprive him of that faith (which he may need to hold his world together), but to help him outgrow it and replace it gradually with a more mature faith.

Surrender and Recovery

To understand the psychodynamics of recovery and particularly the role of spiritual growth in this process, the concept of surrender, as explored by the late Harry M. Tiebout, ^8. is illuminating. The phenomenon which he described has been observed by various workers with alcoholics, including the author. Surrender occurs on different levels at progressive stages of recovery. The first and most decisive surrender is the alcoholic’s illusion that he can handle alcohol. To take step one of the AA recovery program -- "We admitted we were powerless over alcohol, that our lives had become unmanageable" -- the alcoholic must let go of that factor in his self-image which makes him need to feel equal to whatever comes. Another surrender is required by step three: "Made a decision to turn our will and our lives over to the care of God as we understood him."

Tiebout observed that when an alcoholic really surrenders, there is a dramatic shift in his inner life. His self-deceiving "alcoholic thinking" is replaced by openness and honesty. He stops fighting life and begins to cooperate with it. Feelings of inner peace, acceptance, and genuine humility replace his guilt, tension, isolation, defiant-grandiosity, and self-idolatry. Surrendering seems to be letting go of a terrible burden -- the unsuccessful attempt to play god. It is significant that step eleven states that a "spiritual awakening" occurs as a result of the previous steps -- the surrender and moral inventory (and restitution) steps. This sequence can serve as a guideline in the counselor’s work with alcoholics on their spiritual blocks. Tiebout stated the matter this way:

A religious or spiritual awakening is the act of giving up one’s reliance on one’s omnipotence. The defiant individual no longer defies but accepts help, guidance and control from the outside. And as the individual relinquishes his negative, aggressive feelings toward himself and toward life, he finds himself overwhelmed by strong positive ones such as love, friendliness, peacefulness. ^9.

Surrender, as used here, is not a negative giving-up. It is a turning away from a futile, self-defeating orientation and toward a reality-accepting way of feeling and coping. By accepting his weakness and finitude, the alcoholic finds relatedness and strength for coping constructively with his problems.

Mark M., age 40, came to his minister because his marriage was on the verge of disintegration because of his alcoholism. He made it plain to the counselor that he wanted no part of AA. He had tried that approach, he said, and felt that he was too intelligent to need that kind of help. He expressed the view that he could handle his drinking himself and that he just wanted a few tips on "how to keep the little woman off my back." During the first three weeks of counseling, he maintained this mask of defiant self-sufficiency, tinged with superiority feelings. He kept the minister at a distance. His view of his problem was that all would be fine if his wife would nag less and be more appreciative of his good points. Nothing significant was accomplished in counseling, and he continued to come only because he was afraid his wife would leave him if he stopped. His drinking was undiminished.

After a two-weeks break in the counseling, Mr. M. appeared at the minister’s study door for a counseling session with a strikingly different look on his face, which caused the minister to exclaim, "What happened?" Mr. M. replied, "I don’t know, but I guess I’ve given up my 1-ism." He described a family crisis, during the past two weeks, involving the tragic death of a child. Instead of joining with other family members in giving the mutual support that everyone desperately needed, he had gone on a binge to end all binges. Following this, his guilt and remorse were intense. It was in the midst of this painful self-confrontation that Mr. M. "hit bottom." His smug mask of self-sufficiency, denying his problem and blaming others, was jarred loose by the awareness that he had been living a self-centered lie. His alibis and his compulsion to "run the show," as he put it, collapsed. His defensive pride crumbled, and he experienced the self-disgust that was behind it. After a while, this began to pass, and he felt more relaxed, self-accepting, and grateful for life than he could have imagined before this happened.

Mr. M. reported that he had gone back to AA after letting go of his I-ism; he said that that it was a new experience, as though he had not been to AA before. He said that he felt closer to his wife and children than ever before. Even the colors in nature seemed more vivid to him.

In counseling, Mr. M. showed a new openness. He began searching for ways of making his marriage more constructive. The focus of counseling was on this and on how he could keep his 1-ism from returning, which was one of his major concerns. Reflecting on his drinking, he said, "When my 1-ism increased, I drank more, and the more I drank, the stronger my 1-ism became." Gradually he learned to recognize the danger signs of regression into 1-ism- -- the ego-centric, self-pitying, demanding superiority feeling that always seemed, in retrospect, to precede a drinking bout.

Flow can we understand the surrender experience? The 1-ism which Mark described seems to be derived from infantile narcissism. Alcohol facilitates psychological regression to this position of magical power and grandiose self-sufficiency. Narcissism is a defense against deeper feelings of powerlessness and fear of death. ¹⁰. But the regression to the psychological position of the infant exposes the person to the giant anxieties of that period of development. As alcoholism progresses, these produce "nameless fears"; the illusion of special power becomes more and more difficult to maintain in the face of increasing failure in the various areas of one’s life.

The surrender experience seems to have at least two components. First there is the unconscious renunciation of the path of regression to infantile narcissism, which no longer gives satisfactions to offset its disadvantages. David A. Stewart, in Thirst for Freedom, describes the operation of the alcoholic’s narcissism as "the little dictator," an unconscious complex of magical thinking, false pride, fear, anger, lack of insight, and resistance to facing one’s need for outside help. When surrender occurs, the little dictator is deposed, ^11. and the self-damaging defense of narcissism is given up.

The second component in surrender is a desperate leap toward trustful relationships to fill the void left by the now-empty pattern of distance from people and self-centeredness. One alcoholic gave this description of the experience: "It’s a leap of fear. You leap from the chasm blindly, not knowing what’s on the other side. Fear is pushing you, and hope is pulling you." During his drinking days, the alcoholic often saw the world as peopled with depriving mother figures. Having taken the leap toward trust, he discovers (in AA, for example) that trustworthy relationships are possible for him and that he can participate in the give as well as the take of life. For many alcoholics, this is a strikingly new experience. By his leap toward trust, the alcoholic breaks the vicious cycle in which he has been trapped, the cycle of spiraling anxiety, isolation, anger, and grandiosity. Thus, as one alcoholic put it, "he rejoins the human race."

As a direct result of this positive surrender to life, the person begins to develop feelings of genuine self-esteem (the opposite of narcissism), rooted in trustful and mutually nurturing relationships. New and effective ways of coping with anxiety are discovered within these relationships. The alcoholic has let go of his narcissistic need to play god. Because of this and because of his involvement within a group (AA) which incarnates and communicates the accepting love of a higher Power, the alcoholic begins to develop a relationship with God as he understands him. As this relationship grows, it reinforces his ability to trust people and to become a giving person himself. By remaining in a dependent relationship with the higher Power, he is helped to retain his humility and to resist the temptation to regress to narcissistic self-idolatry and to drinking. Equally important, a trustful relatedness to God gives him an effective way of facing and handling his existential anxiety, depriving it of its terror and making it a stimulus to creative living. As Tillich holds, it is only when existential anxiety is confronted and taken into the person’s self-affirmation that it enriches rather than diminishes life. The alcoholic who has developed trustful relationships -- with himself, others, and God -- is able to "die living rather than live dying," as one put it:

Yet the surrendered alcoholic must continue to exercise vigilance to avoid losing his humility. The underlying problem of infantile narcissism is not resolved but instead is walled off in the experience of surrender. When deep-seated anxieties are aroused by threats to his self-esteem or by failure to grow spiritually, the old temptation to regress to his primitive defense and curse still remains. This accounts for the necessity which most AA members feel to "work the program" continually, even though their sobriety has been stabilized for years. ^12.

Counseling and Surrender

Surrender represents a profound reorientation at a depth level of the psyche. It seems to occur when an alcoholic "hits bottom," i.e., is faced by the bankruptcy of his old way of life. It usually follows a long and painful struggle within the person. Although it involves a person’s consciously letting go of old self-damaging patterns of living, it is not a simple matter of deciding to surrender. Since it occurs at least in part at an unconscious level, it involves a more than conscious intention to change.

The counselor can help to create the conditions under which surrender is most likely to occur by utilizing the methods of "elevating the alcoholic’s bottom," described in the last chapter. In particular, these conditions can be created by: (a) Avoiding and helping others avoid protecting the alcoholic from the consequences of his self-centered behavior. Mr. M. was not shielded from the reality of his wife’s intention to leave unless he changed, nor from facing the fact that he responded inappropriately to the death in the family. (b) Providing an accepting relationship which will stimulate the alcoholic’s hope and encourage him to take the leap toward trust. (c) Helping the person see that his I-ism is the cause of his inability to accept help and the source of his agonizing loneliness. (In some cases, discussion of the "little dictator" or an opportunity to read Harry Tiebout’s or David Stewart’s discussions of surrender may help develop awareness of the nature of their trapped condition.) (d) Helping the person see that his denial of reality is depriving him of the very things he wants out of life. (e) Avoiding strengthening his defensive grandiosity by not becoming engaged in a futile power struggle with him. The alcoholic may feel that he must outwit the counselor or in other ways prove that he is smarter than the counselor. If he can lure the counselor into a position of taking responsibility for his sobriety, giving him advice, or making decisions for him, he can "defeat" the counselor by getting drunk, or proving that the advice or decisions were not sound. (f) Exposing him to a group such as AA in which the contagion of genuine self-acceptance is present because many of the members have experienced surrender. Spiritual growth occurs most readily in a group committed to spiritual values. In such a group a stimulus to growth is caught from others who are growing spiritually.

The Alcoholic’s Basic Religious Needs

Every human being has certain fundamental needs which can be satisfied adequately only within some religious (philosophical, existential, or spiritual) context. These include: (a) The need for an experience of the transcendent and the numinous. Anthropologist Ruth Benedict referred to the belief in "wonderful power" which was found to be ubiquitous among the cultures she studied. Abraham Maslow describes the "peak-experiences" which are the raw material of religions.^13. (b) The need for a sense of meaning, purpose, and value in one’s existence. Viktor Frankl calls this the "will-to-meaning" ^14. and sees it as more basic in man than Freud’s will-to-pleasure or Adler’s will to-power. (c) The need for a feeling of basic trust and relatedness to life. Maslow uses the phrase "oceanic feeling" in his discussion of the self-actualizing person to describe the experience of being a part of the whole universe. (d) The need for an "object of devotion," to use Erich Fromm’s phrase. Each person needs something that transcends himself to which he may give devotion and in which he may invest oneself. (e) The need to share a common philosophy of life and object of devotion with a group of one’s fellows.

The minister’s distinctive contribution to helping alcoholics is in the spiritual dimension of recovery. It consists of assisting them in discovering effective ways of satisfying the fundamental religious needs listed above. This is particularly crucial since many alcoholics suffer from spiritual longing and emptiness, which they have been attempting to fill by a pseudoreligious means: alcohol. Only as they are successful in developing spiritually vital lives can their religious needs be met in a satisfying way. The renewal of "basic trust" (Erikson) and the filling of the "value vacuum" (Frankl) are indispensable to full recovery from alcoholism.

The minister has several resources for use in this work, in addition to his counseling skills. One is the church fellowship. Many recovering and recovered alcoholics find help in the supportive relationships of a person-centered church. The spiritually feeding experiences -- worship, religious festivals, communion, fellowship groups, service opportunities -- help gratify dependency needs, renew basic trust, and strengthen the alcoholic’s sense of meaning and purpose in life. The clergyman-counselor can help the person discover which small groups within the church help to satisfy his particular spiritual needs and stimulate his spiritual growth. The counselor must avoid pushing the alcoholic toward involvement in the church before that person is ready for this experience. Often considerable spiritual growth in AA must precede such readiness to participate in the more heterogeneous church group.

Increasing numbers of churches are establishing personal growth and counseling groups under a variety of labels. ^15. Their aim is to stimulate growth in relationships, including one’s relationship with God. As increasing numbers of alcoholics are sober for extended periods, the desire for study and growth experiences beyond AA becomes more prevalent. In some cases, this desire is the result of a flare-up of underlying personality problems, often after a decade or more of sobriety. In other cases, it is simply the result of an inner push to move ahead in one’s spiritual growth, building on what has occurred in AA. Whatever its source, this desire represents a growing opportunity for the churches. In small (usually twelve or less) spiritual growth groups, people with a variety of problems can assist each other in moving toward more authenticity in relationships and a richer, more meaningful faith.

The new way of life of the recovering alcoholic is a path along which he moves rather than a static goal which he achieves. David Stewart describes five stages of sobriety:

Initial sobriety: Physical health regained; preoccupation with sobriety, reduction of guilt and anxiety; increased self honesty.

Learning sobriety: Loss of freedom (to drink in moderation) accepted; gi~ve and take of real personal relations replaces grandiose behavior; regains acceptance of family and friends; sense of humor replaces self-pity; learning to cope with anxious or depressed states.

Accepting sobriety: Loss of desire to drink becomes lasting; thinking, feeling, and ethical perception improves.

Creative sobriety: Freedom from alcohol deeply appreciated; religious desires centered on new way of life; appreciates need for help from others; uses new freedom in other activities.

Pleasurable sobriety: At peace with oneself and the world; anxiety and shyness diminish in genuine interpersonal relations; enjoys sobriety; rewards of sobriety clearly exceed tough times. ^16.

However one conceptualizes the stages of sobriety as a new way of life, it is clear that it is a process. The role of the clergyman and the church in stimulating spiritual growth varies from person to person and from stage to stage. In general, the spiritual growth factor becomes more crucial as one moves ahead in the process. The aim of the counseling minister should be to contribute to each person’s spiritual growth by helping him meet his spiritual hungers at his particular stage of growth.

The Use of Religious Resources

A natural question which arises in the mind of a pastor is this: Shall I use prayer, sacraments, or scripture in counseling with the alcoholic? There are no fixed answers to this question. The general principle is to use such religious resources only after rapport has been established and the minister has an understanding of what they will probably mean to the particular counselee. Even then, they should be employed with extreme care and in moderation. One reason why some alcoholics are reticent about going to talk with a clergyman is the fear that they will be "prayed over." Even those who come to clergymen may feel some hostility toward religion and God. So the minister whose tendency is to pray at the drop of a hat should restrain himself where alcoholics are concerned. It is well to remember that it is sometimes necessary to avoid the outward symbols of religion in order to preserve the relationship with the alcoholic which can become religious in the deeper sense of being a channel for the healing power of cod. As AA’s are fond of saying, the spiritual angle often has to slip up on an alcoholic.

Marty Mann has a valuable suggestion concerning work with an alcoholic about whose religious attitudes the pastor is not certain. "If he is not sure of the alcoholic’s attitude, he would be wise to understate the spiritual aspects, not only of AA but of his own interest in the case?’ ^17. This is important because, if the pastor presents AA as a spiritual approach, he may prevent the alcoholic from going to it for help.

The establishing of a strong counseling relationship should always precede the use of religious tools. Only within such an interpersonal context can they be used meaningfully. One of the Yale ministers put it well: "In some cases I have had prayer. The patient must be well chosen and must understand that the minister understands him before prayer can have the right psychological results. A lot of pious phrases from a minister can leave a sense of guilt that may send him out to get drunk again." If one does pray, it is well to reflect the feelings of the alcoholic in the prayer (showing him that one regards his feelings, however negative, as acceptable to God). It is also well to avoid any phrase which might be construed to mean asking for a magical solution, to emphasize the idea that God stands ready to help us when we actively participate in using his help, and to point to the fact that help comes through a revitalization of our own inner resources. The "faith without works is dead" philosophy is a healthy emphasis in counseling with alcoholics.

It is true that an alcoholic who comes to a minister may want something different from what he wants when he goes to a psychiatrist. He may want the strength and help of religion. Satisfying this need may or may not involve the use of overtly religious tools or resources. The clergyman should remember that whatever he does will register as religious in the sense that he represents the spiritual dimension of life and the religious community to the alcoholic. It is well for the pastor to adopt the Emmanuel philosophy that healing by any means involves the action of God. On the other hand, if prayer and scripture reading are familiar and natural, and they seem to have value for the particular person, they should be used. Ernest A. Shepherd expresses an important caution in this matter when he writes: "Every clergyman should be warned against using these means as ways to make himself feel more useful, regardless of the effect on the parishioner." ^18.

In deciding whether or not to use religious resources in a counseling relationship, the minister may ask himself the question of whether such use will contribute to the person’s sobriety and to his development of a more mature faith. Will such use increase or lessen the possibility that the person will move toward the experiences of surrender and spiritual awakening? Will it stimulate spiritual growth or contribute to the neurotic misuse of religion that contributes to spiritual cripplings. Only when the pastor is reasonably sure that such use will not block growth and may stimulate it should he employ traditional religious symbols and practices. In counseling with the drinking alcoholic, such resources are apt to be experienced in a distorted fashion by the alcoholic. In contrast, the person who has achieved stable sobriety and is searching for a deepening of trust may find the use of such resources, by the minister and in his own personal devotions, exceedingly helpful.

Counseling Homeless Alcoholics

Most ministers, especially those with downtown churches, are frequently confronted with the perplexing problem of how to deal constructively with the homeless alcoholic who comes to the door. He may be one of the "town drunks" or a part of the great mass of homeless men who live on an itinerant basis.

The homeless alcoholic usually comes to the minister for an "easy touch," since he regards a minister as a "live one." Of course hitting a minister for a "loan" is not confined to derelict alcoholics. Many alcoholics, particularly those who have not yet reached the lower levels of the disease, are extremely ingenious in concocting stories as to why they need money. Most ministers acquire a protective skepticism concerning hard-luck stories from strangers -- a skepticism based on disappointing experiences when they were more naïve.

What about giving money to alcoholics or to persons one suspects are alcoholics? The best rule is almost never do it. No matter how convincing the story, the minister should follow the procedure of all social agencies and investigate. For example, if the person says that he is down on his luck because of a prolonged illness, ask for the name of the physician and check with him before giving any monetary help. If the person is an alcoholic, he will usually develop his story in such a way as to make it seem imperative that he have some money at once. This is the bait which the clergyman sometimes takes, to his subsequent regret. A wise procedure is to say, "I’m sorry but it is my policy never to give financial help without investigating first. If you will come back this afternoon, I’ll be able to tell you whether or not I can loan you the money you need." After the person leaves, the pastor can check the address given and any other facts in his story. If the person is not on the level, he will usually not return. If his story is factual and his need legitimate, he will return.

But does not this procedure mean missing many opportunities to give real help to sick persons? No, because an opportunity usually does not exist. If an alcoholic’s only motive in coming is to get money for drinking, the odds are great that he is not open to real help at that point. I recall once giving a "town drunk" type alcoholic some money on the theory that he might return when he became open to help. The hope proved illusory. In spite of the fact that I gave him no more money, I was plagued for several years by return visits motivated only by his desire for a "loan." Each time he came he looked more like the shadow of death, but he showed no desire for basic help. It is probable that, by giving him money, I had blocked rather than opened the way to real counseling.

The type of alcoholic who makes his living by panhandling has an inner contempt for those he exploits. Underneath his surface show of gratitude he is sneering at the sucker he has duped and reveling in his own superior cleverness in having accomplished the duping. By giving him money one is contributing to his neurotic, exploitative orientation, as well as helping to push him a little further into the morass of alcoholism.

Even if an alcoholic shows what appears to be a genuine desire for recovery, it is not wise to give him more than a little money. AA experience has shown that it is better for a newcomer to work his way up from the bottom. This forces him to rely on his own resources and if he succeeds, it is his victory. Second, it helps to keep him from becoming overly dependent on the helper. This is particularly true because of the fact that money is a symbol of power and independence in our culture. The alcoholic cannot tolerate the dependence of being too indebted. Third, it tends to help him face the fact that his problem is not the lack of money, which has been one of his favorite rationalizations, but staying sober.

If a person says he is hungry, give him food, not money. If he needs clothing, give him some that has little pawn value. If he needs shelter, it would be better to make direct arrangements for it rather than give him money for a room. If he has a legitimate and pressing need for a little money (for example, for carfare to get to work), let him work for it. This will keep him from feeling weak and dependent as well as test the legitimacy of his need.

In assaying the available resources a pastor will need to visit the local Salvation Army center and/or mission. By discussing the work of the institution with the leaders, one can determine the basic philosophy and procedure, and discover whether constructive handling is likely. If the Salvation Army men’s service center has an AA group connected with it, the pastor is fortunate insofar as referral of homeless alcoholics is concerned. It means that the alcoholics will have an opportunity to get help through either the evangelistic or the A A approaches; it also indicates a broader philosophy on the part of the leadership.

However hard or well he tries, the minister should not expect to succeed in a very large percentage of cases of homeless alcoholics. For, as we said in Chapter 3, one is dealing, not with just one problem but with two. To the problem of alcoholism is added the psychosocial problem of homelessness. For this type of alcoholic, homelessness often is a way of life that fits his psychological eccentricities with the least pain.

Detroit attempted to do something constructive about the problem by establishing a "counseling center" in a storefront adjacent to the main Skid Row area. In addition to the counseling proper, the center was also equipped to arrange for food, lodging, and employment. Out of the original group of 770 men who were counseled, only 70 were judged successful. ^19. Even with optimum resources, success is not high in this type counseling.

It might be helpful to a minister in sizing up a counseling situation to know about certain factors which were found to be linked with success in counseling homeless alcoholics in the Detroit project. It was found that the chances of success were greater if (a) a homeless man had been married, (b) his occupation was clerical, skilled, or professional rather than unskilled, (c) he recognized that he was an alcoholic, (d) he did not ask for money, and (e) he attended church during and after the counseling.

There are several rays of hope on the horizon in the treatment of homeless alcoholics. One is the enlightened approach of the Men’s Service Center of Rochester. ^20. The director is Thomas B. Richards, a clinically trained minister with broad experience as an institutional chaplain. He has transformed the center from a conventional evangelistic mission to an institution which is pioneering in a combined religious and scientific approach. An AA group meets there, and a new philosophy of social service for homeless alcoholics has been developed. There is also a halfway house to which those who are motivated to stop drinking can go. Pilot experiments such as this may, it is hoped, provide both the pattern and the inspiration for other cities to take constructive action in relation to their Skid Row problems. The cost of such rehabilitative work is undoubtedly less than a city spends for the police-jail-public shelter approach to alcoholism which is essentially futile.

Another ray of hope (mentioned in Chapter 3) is the work that AA has done and is doing with low-bottom alcoholics. In the early days of AA a high percentage of members had spent time on Skid Row. This fact shows that AA is often effective in helping such alcoholics. In some areas, AA groups have made special facilities available for contacting and helping homeless alcoholics, by providing physical help as well as the basic AA program. One reason why AA is able to help many who have lived on Skid Row is the fact that a considerable portion of these men have not accepted the homeless life as a permanent state. They are there only temporarily while they are on a binge. These who are not resigned to permanent homelessness still have the psychological resources to identify with an AA group.

This leads to the suggestion that in cases in which a homeless alcoholic seems to have even an embryonic desire for help, it may be wise to discuss the matter with an AA member who has himself lived on Skid Row, rather than referring the person directly to the Salvation Army. The AA member will be able to size up the situation rather accurately. Having lived on Skid Row, he will be better able to establish rapport with the homeless man.

One of the few helpful discussions of an effective pastoral approach to homeless alcoholics is in an article by Thomas B. Richards, who was mentioned earlier; it is entitled "The Minister and the Bum." His discussion reminds me of the all too accurate definition of a city as "the place where people are lonely together." Richards writes:

The city minister, busily engaged in church activities and active in all manner of worthy civic causes, may forget the fact that for many, many people a city is a cold, lonely place. In his preoccupation with the obligations of a clergyman in a big city he may overlook the growing multitude of those who are friendless and alone on the city streets, in the hospitals, and in the institutions that are within a stone’s throw of his church.

On the basis of this, Richards suggests an area of special opportunity for the city pastor:

If his basic interests are with people . . . he will discipline himself to the point where he will be able to find the time to follow through on those whom he refers to the expert for professional care.

There is need, heart-breaking need, for his intelligent interest and friendly concern. He can supply the personal touch, the time to listen, and the patience to understand, which the institutional officials are too busy to give. They are inundated by sheer weight of numbers, tired out and pressed down by the masses of those in any institution who await their professional care.

Herein lies the minister’s greatest opportunity. The harassed institutional official will welcome his help. This does not mean that he is to "meddle" in the diagnosis or attempt his own particular "cure." It does mean, however, that his intelligent interest and friendly concern for the individual involved will be of tremendous importance in the entire healing process.

This is the "team" approach discussed earlier. Richards puts it well when he writes: "The minister who readily assumes that the doctor, the psychiatrist, or the social worker have no need for him, or that they resent his presence, is too easily dissuaded from his ‘high calling,’ or else he is allowing himself to rationalize an unpleasant responsibility." ^21.

The development of "halfway houses" for homeless alcoholics, in various parts of the country, is another bright spot in a generally dark picture. Such facilities provide a temporary residence, halfway between life on Skid Row and the demands of living as a part of a family in a normal community. Having a bridge of this sort helps some men make it across a gigantic social chasm. Halfway houses are sponsored by a variety of agencies including Councils on Alcoholism, churches, municipalities, and groups of AA members. The most effective houses are small (not more than twenty-five clients), have simple rules, maintain an atmosphere of homelike informality, and employ staff counselors who are recovered alcoholics, often former Skid Row-ers. ^22. In June, 1966, the Association of Halfway House Alcoholism Programs of North America ^23. sponsored a significant conference involving the directors of such programs.

A number of hopeful programs are underway using a combination of medical, psychiatric, and vocational therapies. Most workers in this field agree that some form of institutional care is an essential ingredient in the treatment of Skid Row alcoholics. The program at Boston’s Long Island Hospital has been in operation for over ten years. Only volunteers are accepted for treatment. After a careful social, psychiatric, and physical evaluation, the man is put on Antabuse, given psychiatric help and "religious counseling" to deal with some of his emotional problems as he begins to work and attempt to reestablish relationships in the community. AA is an integral part of the program. A three-year follow-up study of one hundred men who had attempted the program showed that twelve had achieved complete sobriety and had reestablished themselves with their families; forty-two showed improvement in their drinking patterns but remained dependent on the structured hospital community; and the remaining forty-six had changed little if any in their drinking or social patterns, in spite of all the help offered them. ^24.

New York’s "Operation Bowery" is a multifaceted program of action, research, and community planning. With an interdisciplinary staff of fourteen full- or part-time persons, the project maintains a diagnostic and treatment center where homeless men receive medical and psychiatric examinations, psychological testing, group or individual psychotherapy, vocational counseling, and Antabuse. A "Fellowship Center" at the Men’s Shelter provides lay counseling services. A pilot detoxification center for drying-out, treatment, and referral is planned. Operation Bowery helps to interrupt the futile "revolving door" practice of the police and courts, with its repetitive arrests of homeless alcoholics -- "life imprisonment on the installment plan." ^25. When attorneys of the Legal Aid Society began to represent homeless men arrested on "disorderly conduct" charges, convictions dropped from 98 to 2 percent. A second blow to the revolving door system came in 1966 when the Federal Court of Appeals ruled, in effect, in the Driver and Easter cases, that public intoxication per se is not a crime. Columbia University’s Bureau of Applied Social Research carries on sociological studies of homelessness under a contract with Operation Bowery.

A Philadelphia project has as its goal the relocation and rehabilitation of Skid Row inhabitants so that the Row could be terminated (as a part of Urban Renewal) without creating new ones elsewhere. Phase one consisted of organizing the cooperation of the City Council and social welfare agencies, and of publicizing a casework-oriented program. Phase two was a careful census and sociological study of Skid Row, involving 2,278 interviews.

In the third phase a diagnostic and relocation center was established, located near Skid Row, staffed by professionals and a research team as well as former Skid Row residents, and offering to a systematic sample of the men diagnostic, recreational, therapeutic, vocational-counseling and housing-relocation services, including training in social as well as occupational skills. ^26.

A Model for Counseling with Alcoholics

To maximize his counseling effectiveness with alcoholics, the minister should have a clear picture of the style of counseling which has proved to be most functional with alcoholics. The author has described such a "revised model" of pastoral counseling elsewhere, ^27. contrasting it with the client-centered or Rogerian model. In brief, the revised model has these characteristics:

(1) It emphasizes short-term, crisis counseling methods aimed at helping the person cope constructively with his current situation rather than exploring the past extensively. It uses supportive rather than uncovering methods. It focuses directly on assisting the person in increasing the constructiveness of his behavior. (2) It emphasizes helping the person face reality and function more responsibly. (3) It seeks to help the person enhance the constructiveness and mutual satisfaction of his relationships, rather than to aim at intrapsychic changes. Increase in self-esteem and the reduction of guilt are seen as the results of improved relationships.

In the early stages of an alcoholic’s recovery, counseling with him is essentially crisis counseling. The insights and methods of psychiatrist Gerald Caplan and his associates are highly useful in this phase. ^28. Several key insights emerge from experience in crisis counseling. First, one does not need to know how a fire started in order to put it out, in most cases. ²⁹. To illustrate, it is usually unnecessary to discover why an alcoholic became an alcoholic in order to help him to recover. In fact, the search for "causes," while the crisis is whirling, often produces a worsening of the drinking problem. Second, the personality is like a muscle -- it atrophies with disuse and is strengthened with exercise. While an alcoholic is drinking, his personality resources are increasingly immobilized. Interrupting the addictive cycle and beginning to cope with responsibilities such as holding a job, lead to the strengthening of the coping "muscles." Third, facing and handling a crisis constructively give the person new resources for coping with future crises. Each crisis that is handled in a reality-oriented way makes the alcoholic stronger and better able to handle the next crisis.

As mentioned in Chapter 5, the drinking alcoholic becomes increasingly like a car with the engine racing but the clutch disengaged. His personality is "out of gear"; he is not going anywhere. Breaking the drinking cycle puts his personality back in gear; he can now use his personality resources for handling adult responsibilities and rebuilding fractured relationships. The more he uses his "engine" to move in these directions, the stronger it becomes. In this way, many alcoholics can recover and live constructive lives without any pressing need to rebuild the engine (through psychotherapy). This is not true of the alcoholic who is deeply disturbed.

The orientation of ‘William Glasser’s "reality therapy" ^30. is close to the revised model for counseling alcoholics. A central emphasis of this approach is on responsible living in the here and now. By "responsible," Glasser means satisfying one’s needs for love, self-esteem, and identity, within the realities of one’s relationships, and doing so without depriving another of the satisfaction of his needs. Glasser’s therapy consists of establishing a relationship with the troubled person, diminishing self-defeating (reality-denying) behavior, and then helping the person "learn to fulfill his needs in the real world" of human relationships. ^31. Glasser’s approach is similar to what AA has been doing to help alcoholics for some thirty-plus years. Along with the other "action therapies," it can help balance the emphasis on feelings in pastoral counseling.

END NOTES:

1. N. S. Cryer, Jr., and J. M. Vayhinger, eds., Casebook of Pastoral Counseling (Nashville: Abingdon Press, 1962), p. 221

2. Lecture at the University of Utah Summer School of Alcohol Studies, June 18, 1963.

3. If a person feels strongly that he can do it without help, the counselor should wish him success but then add that, should things not work out well, he should bear in mind that help will still be available.

4. See E. M. Pattison, "A Critique of Alcoholism Treatment Concepts," QJSA, XX’II (1966), 61-62.

5. Ministering to Alcoholics (Minneapolis: Augsburg Publishing House, 1966), p. 119.

6. Ibid., p. 57.

7. H. J. Clinebell, Jr., "Philosophical-Religious Factors in the Etiology and Treatment of Alcoholism," QJSA XXIV (September, 1963), 484.

8. Tiebout’s writings on surrender include: "Surrender Versus Compliance in Therapy, with Special Reference to Alcoholism," QJSA, XIV (1953), 58-68; "The Ego Factors in Surrender in Alcoholism," QJSA, XV (1954), 610-21; "Alcoholics Anonymous -- an Experiment of Nature," QJSA, XXII (1961), 52-68

9. "AA and the Medical Profession" (AA Publishing Company, 1955), p. 24.

10. For a more comprehensive discussion of how this operates see: Clinebell, "Plulosophical-Religious Factors in the Etiology and Treatment of Alcoholism."

11. (Toronto, Canada: The Musson Book Co., 1960), Chapters 3 and 6.

12. Clinebell, "Philosophical-Religious Factors in the Etiology and Treatment of Alcoholism," p. 486.

13. Religions, Values, and Peak-Experiences (Columbus: Ohio State University Press,

14. The Doctor and the Soul (New York: Alfred A. Knopf, 1955’).264

15. See H. J. Clinebell, Jr., "Group Pastoral Counseling" in Basic Types of Pastoral Counseling, pp. 206-21.

16. This description of the five stages is abbreviated from Stewart’s Thirst for Freedom, pp. 273.75.

17. "The Pastor’s Resources in Dealing with Alcoholics," Pastoral Psychology, II (April,1951), 18.

18. Pastoral Care, p. 178.

19. For a report on this project, see W. W. Wattenberg and J. B. Moir, "Factors Linked to Success in Counseling Homeless Alcoholics," QJSA, XV (December, 1954), 587-94.

20. Pastoral Psychology, VI (May, 1955), 6, 65, 66.

21. This series of quotes is from Thomas B. Richards, "The Minister and the Bum," Pastoral Psychology, VI (May, 1955).

22. Earl Rubington, "Halfway Houses," a lecture presented at the Alumni Institute, Summer School of Alcohol Studies, Rutgers University, July 18, 1966.

23. 334 Mounds Boulevard, Saint Paul, Minnesota 55106.

24. For a description of this project, see David J. Myerson, "Rehabilitation for Skid Row: The Boston Long Island Hospital Rehabilitation Program for the Homeless Alcoholic," Fifth and Sixth Annual Institutes on the Homeless and Institutional Alcoholic (New York: National Council on Alcoholism, 1960-1961), pp. 1-5.

25. "Dedication to Human Restoration, Operation Bowery" (Annual Report, September 3, 1965 -- September 2, 1966), p. 1.

26. Leonard Blumberg et al., "The Development, Major Goals and Strategies of a Skid Row Program: Philadelphia," QJSA, XXVII (June, 1966), 257.

27. Basic Types of Pastoral Counseling, Chapters 2 and 9.

28. Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964), pp. 26-5 5. For a discussion of pastoral crisis counseling see Clinebell, Basic Types, Chapter 6.

29. This apt figure of speech is from William Menninger.

30. Reality Therapy (New York: Harper & Row, 1965).

31. Ibid., p. 60.

Learn your theories as well as you can, but put them aside when you touch the miracle of the living soul. Not theories but your own creative individuality alone must decide. -- Carl C. Jung 1.

Before describing the principles and methods of counseling with alcoholics, it should be emphasized that the heart of any effective counseling process is a relationship characterized by warmth, genuineness, acceptance, caring, and trust. This quality of relatedness is described in psychological language as "therapeutic" and in religious language as "redemptive." Such a relationship is the basic channel of the helping process. If it does not exist, no amount of finesse in "counseling techniques" is of value. If a therapeutic quality of relationship does exist, constructive changes can occur in spite of weaknesses in a counselor’s methodology. Within such a relationship, skill in counseling techniques is a potent factor in enhancing the healing-growth process.

Each counseling relationship is a new creation. Each is unique, developing as it does from the interaction of two unique individuals, a counselor and a counselee. Because of this, all counseling is, to some extent, "by ear." This is the meaning of Jung’s words (quoted above), addressed originally to psychotherapists but applicable to all types of counseling relationships. The uniqueness of each relationship makes counseling both an art and a science. A counselor’s effectiveness depends on his discovery of his own creative style which will allow him to connect with others and to use himself (in his uniqueness) as a growth facilitator in relationships.

One danger of any description of counseling approaches is that the artistic essence of the helping process may become obscured by a concern with technique. To reduce this danger, it should be made clear that what follows is a description of general guidelines, principles, and methods which have proved useful in counseling with many alcoholics. They should be seen as suggestive rather than definitive; rough guideposts rather than precise directions. To be most useful to the reader, they should be employed experimentally, evaluated critically, and adapted to his own particular mode of relating. It is salutary to remember that different counselors, using a variety of methods, obtain positive and roughly comparable results with alcoholics. It should be clear from this that there is no one "right" way of counseling with alcoholics. The point is not that counseling techniques are unimportant but that each counselor must develop his own approach which will release his unique personality resources in the counseling relationship.

Counseling is a disciplined art in that it is based on generic principles which transcend the infinite differences in both counselors and counselees. In learning to play the piano, there are principles of harmony, rhythm, and technique which must be mastered as a part of the discipline of the art. By mastering these, the person becomes free to use them as a foundation for developing his own unique musical expression. As he progresses in skill, the music he produces becomes more and more his own. It flows through and from him, expressing a musical individuality as much his own as his fingerprints. In an analogous way, the counselor aims at that mastery of the principles of his art which will free him to develop his own style of counseling -- a style which releases his unique personhood in the human encounter called counseling. If the process of learning and adapting the principles in the laboratory of actual counseling experience with alcoholics can be supervised by someone skilled in counseling, one’s growth will be greatly accelerated.

Establishing a Counseling Relationship

Counseling with an alcoholic is fundamentally the same as counseling with anyone else in that the general principles of sound counseling apply in both cases. To discuss these principles in detail is beyond the scope of this book. ^2. . However, it is necessary to apply the general principles to the specific problem of counseling with alcoholics, and to do so with particular reference to some of the psychological characteristics which are typical of many alcoholics.

When the minister makes contact with an alcoholic, the first step in counseling is to begin to build a relationship-bridge with him. As in other counseling, this is done by listening in depth and relating with one’s full being. Karl Menninger has observed that "listening is the most important technical tool possessed by the psychiatrist^{." 3.} It is also the pastoral counselor’s most important tool. Listening requires suppressing one’s urge to interpret, reassure, or ask a series of informational questions. Listening in depth means listening with the "third ear" (as Theodor Reik put it), or being sensitive to the feelings that are behind the words and the subtle messages communicated in mood, posture, and facial expression. "Psychotherapeutic listening" ^4. is different in basic ways from the superficial listening of most everyday relationships. It is a skill which the counselor must learn through disciplined practice.

Intensive listening allows the counselor to begin to sense how the alcoholic feels about himself, others, and his problem. Gradually the counselor begins to grasp precious fragments of understanding of his inner world of hopes, fears, and pain. He begins to see how life looks through his eyes. Listening and responding with warm understanding serves to establish the first strands of the interpersonal bridge called "rapport" over which the counseling process moves back and forth.

It is not easy for a nonalcoholic to understand the inner world of an alcoholic, but it is also not impossible. Heart-understanding can be acquired by really listening to recovering alcoholics and allowing them to become one’s teachers. If an alcoholic counselee senses that the pastor really desires to understand, even though his initial efforts to do so are fumbling, this may open the door. The alcoholic’s awareness that the counselor cares and is trying to understand allows the counselor to establish a beachhead from which he may move into the dark terrain of the alcoholic’s world. As one becomes familiar with the typical experiences and feelings of many alcoholics, it is easier to pick up the feelings of a particular alcoholic more accurately and respond to them more precisely. Often one can sense what the person is feeling before he actually verbalizes it fully. As the counselor is able to stay on the alcoholic’s emotional wavelength, the relationship is strengthened by the alcoholic’s awareness -- "This man really does understand and care!"

In Chapter 2 we noted that many alcoholics are plagued by low self-esteem and a sense of isolation (and differentness), as well as guilt and anxiety. These painful feelings make them defensive and increase the difficulty of establishing rapport with them. Because of this, the first interview may require more time than would be true in some other counseling. One must move slowly and work carefully in building the relationship. Because of his anxiety the alcoholic is hypersensitive to anxiety in others. If alcoholics make a minister anxious, this will be communicated to the alcoholic counselee, to the detriment of the relationship. Because the alcoholic feels so guilty (although he often hides it behind a façade), he often expects and even courts rejection. His emotional antennae are always up, and he is hypersensitive to condescension and rejection. The counselor should try to avoid saying anything that might be interpreted as criticism or passing judgment on him.

The emphasis on the importance of listening does not mean that the counselor should function passively or give the impression of detachment. Because of his low self-esteem, the alcoholic is easily threatened by feelings of being alone and under scrutiny. Not knowing what a silent counselor is thinking, he tends to project his own self-disparagement onto the counselor and thus feels judged by the latter’s silence. To be effective, the counseling relationship must be a warm, human relationship. It should be more than this, but it must not be less. The "more" consists of the counselor’s skills and understanding not present in non-counseling relationships. But the human quality is the indispensable foundation of whatever else is present.

The late Otis Rice once suggested that the counselor must "stay close to the alcoholic’s ego." ^5. Somehow the pastor must let the alcoholic know that he is with him emotionally -- that he is reaching out to him as one human being to another. Conveying this is important because the alcoholic tends to see the clergyman as one who reaches down rather than out to him. Because the minister is perceived as a "superego figure" by many people -- as one who represents the "oughts" of society -- counselees may believe that he is sitting in judgment when he is not.

There are various ways of staying close to the alcoholic’s ego. Not threatening him with a barrage of questions but rather responding to his painful feelings in an empathic, accepting way has an ego-supportive effect. Jellinek stressed the importance of not asking any save "tiny little questions" during the early phases of counseling, thus respecting the alcoholic’s right to stay as hidden as he needs to stay. ^6. In contrast, asking questions which seem impertinent or irrelevant may strike the alcoholic as prying into his private affairs.

The pastor should do whatever he can to let the alcoholic know he is "feeling with" him in his problem, as he sees it. The appropriate use of what Rice said one of his colleagues called "encouraging grunts" ^7. lets the alcoholic feel that one hears. It may be helpful to paraphrase occasionally what he thinks the alcoholic is saying and feeling in order to communicate understanding or correct misunderstanding. How one responds or at what points are not crucial issues. ‘What is crucial is that one’s responses be an expression of a genuine fellow-feeling and growing understanding on the counselor’s part.

Often an alcoholic comes to a minister because he wants desperately to unburden himself. The pastor is not only the most accessible professional person to many people, but he is also the one to whom many turn for help with guilt feelings. As the alcoholic pours out his painful feelings, three helpful things occur. First, emotional unburdening takes place. This has value in itself, lightening his guilt load enough to free some of his previously paralyzed energies for use in coping. Second, as the counselor listens and resonates, the bond of rapport grows stronger. Such a bond develops between any human beings who share an emotionally meaningful experience. Being listened to, in one’s agony, by an accepting authority figure is a profoundly meaningful experience. Third, by avoiding getting in the way of the verbal-emotional flow, the minister usually acquires much of the relevant information which he needs in order to understand the person’s problem. What he does not obtain spontaneously, he can get by direct questions.

Here is an illustration of how one minister got in the way of the developing therapeutic relationship:

An alcoholic came to talk to his pastor and began to pour out all manner of self-condemnation and remorse. Feeling that the man’s self-blame was exaggerated and distorted, the pastor sought to reassure him, pointing out that after all there were extenuating circumstances involved. Each time the alcoholic tried to express his deep feelings of guilt and despair, the pastor pointed out that things weren’t as bad as he seemed to think. Finally the alcoholic left and did not return for another interview.

The two facts that this minister had overlooked were that reassurances of this kind do not reassure, and that the man’s negative feelings must be expressed and accepted before they could be replaced by more positive ones. By attempting to reassure, the pastor unintentionally convinced the man that his feelings were not recognized or understood. Thus, instead of helping the alcoholic experience forgiveness, the minister had blocked the path of confession by which one moves from guilt to forgiveness.

The use of the "we" approach is a method of staying close to the alcoholic’s ego by avoiding putting him in an exposed position. Otis Rice, who suggested this approach, gave these illustrations of how it might be put: "Now what can we find in the situation?" or "What can we do with the problem you have brought?" The use of "we" lets the alcoholic feel the counselor’s collaboration and support in the difficulties he is facing. It puts the counselor on his side as an ally. Jellinek once told of discussing an alcoholic’s relationship with his wife and of doing so, not in terms of "your wife," but in terms of his relation with his own wife. The interjection of the counselor’s personal relationships may seem to some to be anathema so far as principles of good counseling are concerned. In practice, this approach seems to be a sound way of keeping the alcoholic from feeling on the spot and from raising his defenses. Since he is uneasy about his dependency needs, it is supportive to know that the counselor has needs and problems too. The example, par excellence, of the use of the "we" principle is the manner in which AA’s operate in their Twelfth Step work.

The AA member stays close to the alcoholic’s sensitive ego by talking about his own drinking problem and AA experiences. Thus he communicates forcefully that he is not talking down to the other person or judging him. This is what Paul Tillich once described as the "principle of mutuality," a principle that is basic in all pastoral counseling. Tillich pointed out that the counselor must communicate to the counselee the message that he understands well on the basis of his own experience. ^8. Marty Mann has this useful idea concerning the pastor’s approach to the alcoholic:

The pastor who feels it is his bounden duty to act as a spiritual mentor to an alcoholic who comes to him could perhaps succeed if he could recall out of his own experience some time of deep crisis or personal suffering in which he found comfort from his faith, and could tell that story simply and directly. In other words, if he could come down from his symbolic mountain above the battle and meet the tormented soul of the alcoholic on its own level of suffering; the soul could perhaps accept comfort from him and gain some of his faith. ^9.

She recommends that if the minister can’t draw on his own experiences in meeting personal crises, he should tell of someone he has known who has received help with the problem of alcoholism.

In the author’s experience, reference to one’s own problems or struggles is best made in a kind of "in passing" manner. This lets the alcoholic know that the minister has problems, is aware of his fallibility, and is speaking as one who shares the foibles and limitations of the rest of the human race. Alluding casually to one’s problems lessens the risk that the alcoholic will resent a comparison of what seem to him to be the clergyman’s relatively minor problems with his all-consuming and devastating problem.

The fundamental way of staying close to the alcoholic’s ego is by communicating acceptance in the relationship. In Modern Man in Search of a Soul, Carl Jung declared:

If the doctor wants to offer guidance to another, or even to accompany him a step on the way, he must be in touch with the other person’s psychic life. He is never in touch when he passes judgment. Whether he puts his judgments into words, or keeps them to himself, makes not the slightest difference. ^10.

A basic factor which influences the acceptance-climate of the relationship is whether or not the pastor really accepts the sickness conception of alcoholism. Unless he accepts it at a heart as well as at a head level, he will convey a judgmental attitude in spite of his conscious intentions. By accepting the sickness conception with all of its ramifications, the counselor divorces from his mind the feeling that he is dealing with what is basically a moral deviation or perverse habit; he accepts alcoholism as one symptom of the common sickness of our culture, in which all of us share.

Protecting the alcoholic’s ego so that he will not become defensive is not the same as protecting him from the consequences of his immature behavior. The former is therapeutically constructive; the latter is unconstructive. Accepting the alcoholic does not mean approving his destructive behavior which is harmful to himself and others. It is important that the alcoholic know that the counselor, who accepts him as a person, does not approve of his irresponsible behavior. It is because the counselor accepts and cares about him and his family that he does not approve of behavior which hurts any of them. Only as the people around the alcoholic are able to be both accepting and firm will he be required to face the reality of the adult world and his irresponsible relation with it. Allowing him to avoid reality by protecting him is what John Ford calls "cruel kindness." A part of the counselor’s firmness must be insistence that people who are sick have an obligation to society to obtain treatment.

The Alcoholic’s Motivation

During the first contact with an alcoholic, it is essential to find out to what extent he is open to help and what kind of help, if any, he desires. If the alcoholic’s initial motivation is inadequate and this is overlooked by the counselor, the usual result is that nothing productive occurs even though there may be an extensive exercise of "going through the motions" of counseling. It is an axiom in counseling that people can be helped only with those problems which they regard as problems and with which they want the counselor’s help, to some extent.

In order to discover the nature of the alcoholic’s motivation, questions such as these should be in the counselor’s mind as he listens and talks with the alcoholic during the first interview:

What does he see as his problem?

From his point of view, is his drinking a problem or a solution?

Does he see it as a cause of his other problems or simply a way of gaining relief from them?

Does he feel that he needs help from others? From me?

If so, what kind of help does he want? (Does he want someone to pacify his wife, intervene with his boss, help him learn to drink in moderation, or help him lick his drinking problem in whatever way is required?)

Why did he come for help now? (He has had the problem for several years.)

Was he threatened or dragged into coming by his spouse?

Is there some special crisis that puts him under acute pressure at the moment, but which will pass?

Is his primary motivation for coming external pressure or internal pressure?

Why did he come to a clergyman?

Does this throw light on the kind of help he expects?

If, as the first interview progresses, the counselor finds that he is not getting clear answers to questions of motivation such as these, it is appropriate to ask enough of them to gain a picture of the alcoholic’s reason for coming and the help he expects.

Generally speaking, an alcoholic’s motivation is inadequate, so far as successful treatment is concerned, if he mainly sees alcohol as a solution, wants help in changing those around him or avoiding the consequences of his immature behavior, and/or comes because he was pressured (either by a person or by crisis circumstances of which he feels himself the victim). Conversely, motivation adequate to successful treatment is usually present if he sees alcohol as one factor which contributes to his many troubles, has some desire to change himself or his way of behaving, and comes primarily because of inner pain which he sees as resulting from his use of alcohol, directly or indirectly.

In sizing up the alcoholic’s motivation, the key question is this: Is he able to admit that alcohol is giving him serious trouble and that he needs help in handling it? In attempting to answer this, it is important to bear in mind that the alcoholic’s motivation, like all human motivation, is mixed. Few, if any, alcoholics desire unambivalently and wholeheartedly to stop drinking. That is to say, they seldom completely want to stop drinking, nor do they want to stop drinking completely. They are pulled in opposite directions by inner forces. A part of their psyche wants to stop; another part drives them to continue drinking. Put another way, many alcoholics want to stop because they are afraid of the disastrous consequences of continuing, and yet they are also afraid to stop because alcohol has become the center of their psychological universe. To some extent, this conflict is present in most alcoholics.

Thus, to ask: Is this alcoholic ready to stop drinking? is not a precise or satisfactory way of ascertaining the adequacy of his motivation for recovery. The useful question is whether his desire to stop is stronger than his desire to continue. Put differently, one can ask whether the pain resulting from drinking outweighs the satisfactions derived therefrom. Often this is not easy to determine. It is helpful to think of the alcoholic’s motivation as something like a teeter-totter which tips back and forth. At times the pain of drinking and the fear of the probable consequences of continuing outweigh the craving for alcohol’s anesthetic effects and the fear of life without it. When this happens, the alcoholic "hits bottom" -- becomes open to help. At other times his motivational teeter-totter tilts away from being receptive to help. A hangover period following a binge may present a "little bottom" -- i.e., a state of emotional receptivity during which the alcoholic’s defenses against recognizing his need for help are temporarily cracked by the physical and emotional pain of the experience. The counselor should encourage the alcoholic to get help immediately and not "to wait until he feels better." There is quaint wisdom (which is relevant to the "fall" which is alcoholism) in the old Christian hymn:

Come, ye weary, heavy-laden,

Lost and ruined by the fall;

If you tarry till you’re better,

You will never come at all. ^11.

In the light of the complexity of human motivation, the familiar statement, "You can’t help an alcoholic until he is ready!" is, at best, a dangerous half-truth. The danger is that the counselor will use it to avoid his responsibility which is to discover, stimulate, and mobilize the alcoholic’s latent motivation toward accepting help. Since few, if any, alcoholics are ever completely "ready," it is more productive for the counselor to ask: Does this person show a possible willingness to consider sobriety, providing he can be shown that there is a better way than the one which he has been following? This question recognizes that the person may not be able to admit his need for help (even to himself) until he has some ray of hope that help for him is a possibility. Beyond this question, it is crucial to ask: What can I as a counselor do to help this person become more open to help?

I recall a Twelfth Step call upon which I accompanied an experienced member of AA. The person upon whom we were calling mentioned that he wasn’t sure whether he was an alcoholic or just a heavy drinker because he had never taken a morning drink. (Later he admitted that this was usually because he hadn’t made sure the night before that he had a supply for the next day.) The response of the AA member suggests both a useful test of a person’s motivation to stop and an excellent general approach to an alcoholic:

To discuss whether one is a heavy drinker or an alcoholic can easily become a matter of semantics. The important question is this: Are you satisfied with your life as it’s been going for the past year, two years, five years? Take any period you want. If you are, there’s no problem. If you aren’t satisfied and feel that alcohol is the cause or at least part of the cause of the way your life has been going, then the thing to do is to make a decision that you’re going to stop. Then the problem is to make the decision stick -- that’s where AA comes in.

The discussion turned in the direction of the individual’s painful experience during the recent binge and his resolve not to let it happen again. The AA member said, in effect:

The problem is to make your present feeling stick -- to keep it alive. You’re very sincere now, we’re assuming that, but how about in three months or six? AA is the way you keep the desire alive -- keep on remembering that you have a problem with alcohol. After you’ve been away from alcohol for a while, you begin to question whether it’s really a problem or not. AA helps keep your present desire from dying.

Toward the end of the visit, the AA member said: "You have to remember, John, that nobody really cares if you have a few drinks. It’s up to you. If you want to stop drinking, then AA can help you. But it’s your decision." The purpose of such a statement was apparently to make sure that the initiative was left with John and that he did not feel that he had been persuaded to stop drinking. Here is a demonstration of the recognition that the alcoholic himself must make the initial decision to accept help (however mixed his feelings about it), before any real counseling or therapy can begin.

The extent to which the alcoholic considers drinking a cause, as contrasted with an effect, of other circumstances and problems is often a significant indicator of his degree of motivation. I remember one alcoholic who was in wretched condition, but who could not admit that his drinking was a real problem. Again and again he would attribute his drinking to his poor sexual relationship with his wife. Undoubtedly his poor sexual relationship (and the inadequate interpersonal relationship which underlay it) was a contributing cause of his drinking. But the fact that he could not recognize that alcohol was a problem per se and one cause of his poor sexual adjustment showed that his motivational teeter-totter had not yet tipped toward openness to help with his alcoholism.

The Resistant Alcoholic

Many alcoholics who come to ministers and other counselors are still resisting facing the truth about their addiction. They, therefore, resist any real commitment to help. About one third of the persons seeking treatment at outpatient alcohol clinics in one state did not return after the first interview. ¹². Deficient motivation was undoubtedly a cause of many of these failures to continue treatment. Recall that Jellinek’s chart (Chapter 1) showed that the mean age for "felt religious need" was 35.7; where as the mean age for "hit bottom" was 40.7. This helps explain why many alcoholics come to ministers before they are "ripe" -- open to help. I would suspect that the majority of alcoholics, at the point of their first contact with clergymen, are still resisting to a considerable degree. It is very important, therefore, to learn the skills which frequently are effective in helping to motivate the resisting alcoholic.

A pastor was completely baffled by the behavior of a man in his early thirties who in the period after his binges would come to see him full of remorse and good resolutions. Each time the minister would attempt to help him relate to AA without avail. In spite of repeated defeats in his "battle with the bottle," he was still sure that he could "lick the thing" himself. To the minister it was apparent that the man was not yet "at bottom," and he pointed this fact out to the family. To this the family posed the obvious question in its most disturbing form: "Do you mean that we must sit and watch him go down and down and down, and do absolutely nothing?"

Few things in life are more heartrending or frustrating to a counselor or to the family than to watch helplessly while the alcoholic engages in what amounts to protracted suicide. But, as a matter of fact, it is not necessary simply to wait and do absolutely nothing. The discussion which follows delineates what the counselor can do to discover and stimulate the alcoholic’s motivation to accept help. The family’s role in this process will be explored in Chapter 11.

There are two general principles for work with recalcitrant alcoholics. First, avoid if possible doing anything which may destroy the possibility of developing a helpful relationship at some later time. Private sermons and pleadings should be avoided for this reason, as well as for the fact that they are utterly ineffectual. Second, attempt to sow seeds of understanding -- of the person and of alcoholism -- which may take root and eventually flower in openness to help. Implicit in this suggestion is the concept that motivation of a resisting alcoholic is a process which may extend over a considerable period of time.

In some cases, the need to help motivate an alcoholic is indicated by the circumstances under which the pastor is contacted.

A pastor received a phone call from a parishioner, Mrs. P., in which she asked in a tearful voice, "Will you please come over and talk to Henry? He’s having his problem again." Because of his strong desire to be helpful, the pastor’s automatic response was to accept her plea as a challenge to his ability to help. When he arrived at their home, he discovered that Henry was quite drunk and in no mood to talk to the pastor about anything, particularly not about his drinking. In fact, he was intoxicated enough to be unrestrained in his expression of resentment toward his wife for calling the minister and toward the minister for "sticking his nose in other people’s business!"

By responding as he did, this pastor had allowed himself to be drawn into the power struggle between P. and his wife, on the side of the wife. This naturally incurred P.’s resentment which practically eliminated the possibility that the minister might have been of real help at some later time, when P. had become more receptive. Nevertheless, having gotten himself in this situation, the minister might have salvaged something for the future by saying to Mr. P. that he had come thinking he needed him, but since he was mistaken, he apologized. If he had done this and accepted the man’s resentment, the door might have been left ajar for future help.

A more constructive approach would have been this. When Mrs. P. called, he might have first determined whether she and the children were in danger of physical harm from P. If so, he would have suggested some direct action to the wife such as going to stay with relatives for a few days or calling the police if P. became violent. Further, he should have found out more about P.’s condition and attitudes during his phone conversation with Mrs. P. An important question would have been: "How does your husband feel about talking with me, at this point?"; another would have been: "Does he feel that his drinking is a problem with which he wants help?" In view of the situation which these questions would have brought to light, the minister could then have said, "It would probably do more harm than good for me to try to talk with your husband if he does not want to talk with me. It would only antagonize him and perhaps give him added reason to go on drinking. However, as soon as he is sober, I suggest that you consider telling him that I will be glad to talk with him anytime, about whatever he wants to discuss with me. If he can come to my study, fine; or, if he wants to talk but doesn’t feel up to coming here, I’ll come to your home. In the meantime, why don’t you keep in touch with me and let me know how things are going?" If P. does respond to the minister’s invitation -- either by coming to his study or indicating his willingness to talk with him at the P.s’ home -- he will have exercised some initiative in the matter, thus improving the possibility of a constructive outcome. Coming to the pastor’s study may indicate stronger motivation on P.’s part, and it will give the minister an opportunity to talk with him without having Mrs. P. complicate the interview. If P. does not respond, it would be appropriate for the minister to make a pastoral call in a few days, to make himself available to be of assistance either to Mr. or Mrs. P., or both.

It should be emphasized that Mrs. P.’s phone call provides an opening for the minister to give pastoral care to her and the children, and perhaps to counsel with her, even if P. does not become accessible to help. In many cases, a person who calls requesting help for someone else is, in this indirect way, asking for help himself.

When a minister goes to see an alcoholic at his request, it is often advisable to obtain his permission to bring a member of AA along. If possible he should find a person in approximately the same age bracket and general socio-educational background in order to increase the chances of his establishing rapport with the alcoholic. In calling on a woman alcoholic, it is crucial for the minister to take a woman member of AA with him. In general, it is wise for a male minister not to call on female alcoholics who are drinking and alone, unless a stable female AA member is available to accompany him. Taking an AA member along is particularly helpful if the pastor’s visit to an alcoholic is made during the period following a binge. The AA member may be able to utilize the alcoholic’s openness to help during this time in a way that the nonalcoholic minister cannot.

When the minister talks with a resistant alcoholic, in whatever setting, it is important to find out if he has been nagged or dragged to come to the minister (or let the minister come to him). If the alcoholic has come under third-party pressure, the counselor’s first job is to get rid of the third party. Unless this occurs, there will usually be no real counseling relationship. If the spouse or relative is physically present, it may be advantageous to get a "feel" for the quality of the interaction between that person and the alcoholic. After this, however, it is imperative that the pastor talk with the alcoholic alone. A polite but firm request such as this usually suffices:

Pastor: I appreciate having your perspective on the situation. Now I believe it would be helpful for me to have a chance to talk privately with your husband about the situation. You’ll find a magazine in the next room.

Even if the "motivating party" is absent physically, he is present psychologically; he must be removed psychologically before a counseling relationship with the alcoholic can be established. This may be accomplished by an approach which begins like this:

Pastor: I realize that your wife thinks that you have a problem with alcohol, or she wouldn’t have pushed you to come to see me. But what I’m mainly interested in at this point is knowing how the situation looks from your point of view. I can imagine that things must look somewhat different from where you stand. What seems to be the trouble, as you see it?

Hopefully, as this approach is followed, the alcoholic will sense that the counselor is not siding with the wife in the struggle between them by accepting her view as the complete and accurate picture. Equally important, the alcoholic may begin to realize that the counselor is genuinely interested in understanding the situation, including his perception of it, and he is interested in being of whatever help he can be to them. When this happens, the alcoholic begins to lower his defenses and to risk some openness with and trust of the counselor.

In removing the pushing person from the alcoholic-counselor relationship, it is important not to criticize or side against that person. The pastor’s responsibility is usually to be of all the help that he can both to the alcoholic and his spouse (or other relative). The spouse may need help as desperately as does the alcoholic. If the counselor’s criticisms are quoted (or misquoted) to the spouse in a moment of angry attack, the possibility of being of help to that person is virtually destroyed. Further, by being critical of the spouse, the counselor may have contributed to the worsening of an already deteriorated relationship between the alcoholic and a "significant other" who has a concern for the alcoholic, however misguided it may seem.

The wife-motivated alcoholic is familiar to most pastors. Like many other things in counseling, shifting the initiative from the wife to the alcoholic is usually easier said than done. However, its importance cannot be overemphasized. In a workshop on counseling alcoholics, at the Yale Summer School, ^13. E. M. Jellinek told how he proceeded when an alcoholic had been "brought" or "sent" by a spouse. He described inviting the alcoholic into the counseling room, whereupon he would direct the conversation to some irrelevant subject. During the course of this light discussion, he might drop a few seed thoughts about the nature of alcoholism. For example, he might ask, "Have you heard about the experiment they tried at Yale?" He would then tell about the rat experiment (see Chapter 2) which he found useful in conveying to the person the reality of the physical component in alcoholism. After a while he would say, "Well, I guess you’ve been in here long enough to satisfy your wife. You may go now if you wish." This approach has a kind of shock value, and it tends to put the counselor on the "same side of the table" as the alcoholic. It prevents the alcoholic from keeping his hostile feelings toward his wife attached to the counselor by perceiving him as her ally. Further, it forces the person to make a choice -- to leave or to stay on his own initiative. Respecting his ability and right to make this choice enhances his self-esteem and strengthens his relationship with the counselor. I would recommend the use of this technique in those situations in which the alcoholic remains resistant (actively or passively) during the interview in spite of the use of the other strategies described in this chapter.

It is important during the first interview to help the person verbalize his feelings toward being there. Whether the person comes under pressure or threat, on the one hand, or merely fighting his inner resistances to admitting he needs help, on the other, the counselor should assist him in getting his negative or conflicting feelings out into the open. As these feelings are being discussed, the counselor should let the person know, by his attitudes, that he respects his right to whatever feelings he may have.

Pastor: I can imagine that it must annoy you to feel pushed into seeing me.

If the alcoholic’s hidden resentment is overlooked by the counselor, he may stay as tightly defended as a clam for no apparent reason. Not recognizing and helping the person ventilate such feelings accounts for the failure of many potential counseling relationships to "get off the ground." The hidden feelings about being coerced or of weakness for having to ask for help may function like a logjam blocking the flow of interaction in counseling. The log-jam tends to be dispersed as the alcoholic senses the counselor’s acceptance of his feelings, including his reluctance to admit that he needs help.

In dealing with the resistant alcoholic, it is essential for the counselor to accept the person’s right not to accept help. This is a right which he can exercise regardless of the counselor’s preference in the matter. In some cases, the pastor’s acceptance of the alcoholic’s right and freedom not to accept help actually is a dynamic factor in enabling the alcoholic to accept help. Speaking symbolically, it is as though the counselor must respect a person’s right to go to hell before he can be an instrument in helping him move toward heaven. Implicit in this is the principle of not attempting to push help toward a person who has no openness to his need for it. A person’s "right to fail" should be respected.

In working with any counselee, but particularly the one who is resistant, it is important to discover the point or points at which he is hurting. It is at this point that the offer of help is most likely to be accepted. Often the hurt-points can be found by encouraging the alcoholic to talk about his problems as he sees them. About what is he worried, afraid, angered, frustrated, hopeless? ‘What would he like to see changed? Which of his wants or needs are not being met, as he sees matters? The late Harry M. Tiebout once pointed out that even the most adamantly resisting alcoholic usually has an Achilles heel and that it is the counselor’s job to find it in order to reach the person with help. A person’s Achilles heel -- the place where he is "motivatable" -- is the place where he is hurting, worried, or aware of some need for help.

I am not suggesting that the alcoholic necessarily be given the kind of help for which he is asking the counselor. Frequently, what he wants would in the long run work against his recovery, for instance, a loan or gift of money, intervention with an authority to protect him from the consequences of his behavior, or bringing pressure to bear to change someone else in the alcoholic’s interpersonal world. What I am recommending is that the counselor begin by understanding what the alcoholic wants and then, if necessary, attempt to modify gradually his expectations of what the counselor can do.

The counselor should encourage the resistant alcoholic to talk about his drinking -- when he drinks, with whom, how he feels, what happens when he drinks? Does he see any relationship between his "hurt-points" and his drinking? Early in counseling, the alcoholic is usually defensive. He will therefore give an inaccurate or incomplete picture of both his drinking pattern and his feelings about drinking. He may be much more concerned about his drinking than he admits to the counselor at this point. But, if the counselor resists the temptation to put too much pressure on him, he may gradually reveal more of the truth as the relationship grows stronger.

Whether or not tile alcoholic gives an accurate picture of his drinking, his discussion of it gives the counselor an opportunity to plant seeds of understanding (educative counseling) and seeds of creative anxiety. Several of the following questions can be asked as they fit into the flow of the conversation:

Have you ever pulled a blank (had a memory loss) while you were drinking?

Do you ever have a desire to drink alone, just to get loaded?

Do you sometimes find yourself drinking more than you intend?

Are your "must" times coming earlier in the day?

When you’re at a party, do you ever find yourself sneaking a quick one on the side when no one is looking?

Do you ever take a drink in the morning to ease a painful hangover?

Have you ever found yourself taking a drink to get you through tough social situations?

Do you ever get a bit defensive when your wife questions you about whether you’re drinking too much?

Does food lose its appeal when you’re drinking?

Is your efficiency at work ever cut down by a hangover or by drinking at lunchtime?

Have you lost time from work because of drinking?

Do you feel that the problems in your marriage may be increased by your drinking?

Do you sometimes spend money you can’t really afford on liquor?

Without seeming to "grill" the person, which would make him defensive, a few of these questions can be sprinkled into the discussion, followed by the observation that these are some of the typical early symptoms of problem drinking or alcoholism. It is well to make it clear that a person need not have all or any of these experiences to be headed for trouble with alcohol, but that they are frequently present in the early stages of what becomes a serious drinking problem.

The defensive alcoholic often will deny that he has had any of the experiences mentioned by the counselor. This does not mean that the effort has been wasted. If the person is in the process of losing control over alcohol, the odds are that he will have had several of the experiences mentioned. What the counselor may have done was to help him begin to recognize the symptoms of alcoholism in his drinking behavior. After he leaves tile minister, he may ruminate: "I certainly pulled the wool over that stupid minister’s eyes . .but I wonder if there’s anything to what he said about blackouts." Hopefully, the seeds of creative anxiety which the minister has sown will eventually flower in willingness to face the reality of his drinking problem and his need for help.

Two instruments which are "useful tools in diagnosing alcoholism" (and can be so described to the alcoholic counselee) are Seliger’s list of twenty questions (see Chapter 1) and the "valley chart," (see end of chapter).. Here is an illustration of how the chart can be used with the mildly resistant alcoholic.

Pastor: It might be helpful for us to use a kind of diagnostic approach to see if you might, by chance, be on the road to the illness. Here, as you go down the left-hand side of the chart, you’ll find the typical symptoms which identify the various stages of this progressive illness. Let’s take a look at these to see if any of them fit.

The medical model of diagnosis is useful at this point in helping the alcoholic take an objective look at his drinking pattern. By tracing the road down into advanced-stage alcoholism, the counselor gives the person a preview of where he may be headed if he continues drinking. The road up toward recovery, on the right-hand side of the valley chart, shows the typical stages of the recovery process after one hits bottom. There is value for the alcoholic in seeing these alongside the road down, since it tends to kindle hope that recovery is possible. The chart in larger form is available from the National Council on Alcoholism (2 East 103rd Street, New York, New York 10029). The counselor who does not have a printed chart can draw his own, during the counseling interview, discussing the alcoholic’s reactions as they proceed. The essential thing in all this is for the counselor to be familiar with the warning signs of alcoholism so that he can help the person recognize them in himself, if they are present.

In attempting to motivate the resistant alcoholic and in the early phases of working with an alcoholic who is gradually becoming more open to help, it is advisable to emphasize the physical component in alcoholism. Drawing an analogy between this problem and allergic reactions or diabetes is an effective way of communicating to the alcoholic that his illness is a reality -- that it’s not "all in his mind" -- and that obtaining treatment is therefore essential to recovery. Psychological explanations still carry overtones of moralism and free-will-ism in our culture, whereas medical analogies seem to escape these overtones to a large degree. Most people have an allergy of some kind or know someone who has; most are acquainted with someone who has diabetes. This serves as a bridge to accepting the physiological component in the illness of alcoholism. The parallelism between alcoholism and diabetes makes the latter a particularly useful communication device. Both the alcoholic and the diabetic have conditions which are incurable but treatable. Both must learn to live within the limitations imposed by the condition and, if they accomplish this, both can live productive lives. Both conditions involve some malfunction of the organism and, if untreated, become progressively more severe and inimical to healthy living.

Helping the counselee understand the basic facts about alcohol addiction is an essential part of all alcoholic counseling. This is true even in those cases in which the person appears to be quite open to recognizing his illness and accepting help with it. As indicated earlier, all motivation is mixed. In every alcoholic, the counselor should assume the presence of some degree of resistance. Relative openness to help may lessen as the pain and the memory of the suffering resulting from excessive drinking subside. The person may begin to question whether he is really an alcoholic, since he feels so well and is obviously in competent control of his life. It is at this point that the person’s knowledge of the nature of his illness, including the tendency to rationalize, can help him resist taking a course that will probably eventuate in a drinking bout. In the case of the alcoholic who has not achieved sobriety as yet, the appearance of openness to help may hide an underlying resistance; it may be a passive-aggressive way of defeating the counselor by seeming to agree and comply.

In counseling aimed at motivating a resistant alcoholic, it is sometimes helpful to point out that loss of control is gradual in most alcoholism and is, therefore, a matter of degree. The process is often so gradual as to be imperceptible to the person, particularly because of the universal human tendency to see one’s own behavior as "normal" even when it is grossly abnormal. It is also important to discover and attempt to change the person’s inner picture of an "alcoholic" if he is holding to a Skid-Row stereotype which naturally excludes him. Furthermore, it is helpful to point out that one need not be a psychiatric cripple in order to lose control of alcohol. All of these procedures are aimed at removing the misconceptions which make it difficult for the individual to see his own alcohol problem.

After some degree of trust exists between the alcoholic and the pastor, the use of constructive confrontation may be in order. If the alcoholic continues to avoid the truth by rationalizing his abnormal drinking, confrontation in one of its various forms may help. The counselor may describe for him how his alibi system functions ¹⁴ and why he feels he must defend his need to drink. By showing understanding of how difficult it is for the alcoholic to let go of his alibis, the counselor may help him to do so. He may begin to become aware of the fact that it is his alibi system which blinds him to the danger signals which are present in his drinking pattern. If the alcoholic is nearly "ripe" for treatment, this direct attempt to reduce the operation of his rationalization system may be effective. If not, he may become more defensive for the time being; but, the seeds of recovery may have been planted.

Here are some of the factors which cause the alcoholic to avoid facing his need for help: ^15. his fear of the pain of abstinence (life without his pain-killer); his fear of not belonging to a drinking group which he enjoys; his feeling that alcohol is all that "works" for him; the blow to his self-esteem of admitting loss of control and, in the case of a male, of his inability to "drink like a man"; his fear of recognizing that he has a socially unacceptable condition; his fear of unsympathetic and punitive professional helping persons; his fear of what it might do to his job, family, church, or social relations to be identified as an "alcoholic." It is important that these inner barriers to admitting his need for help be discussed with understanding and empathy by the counselor. If the person can bring his fears into the open, the help of the counseling process becomes available for coping with them.

Constructive confrontation may include saying to the resisting alcoholic that he appears to have some of the warning signs of addiction. If the person is obviously defensive, it is wise to understate the case and thus avoid a head-on collision with his defenses which would only make them more rigid. The late Harry M. Tiebout once told of an alcoholic who came to see him in a defiant mood. He described his drinking pattern and then demanded of Tiebout, "Tell me, does that make me an alcoholic?" Rather than giving a direct answer that the man could easily have rejected, Tiebout responded, "I suppose that what really matters is your answer to that question. But frankly, I’m glad I’m not in your shoes." Several years later, the man introduced himself after an AA meeting at which Tiebout had been guest speaker. He reported that he had been sober for some time in AA and that Tiebout’s words had been a key factor in his decision to seek help.

Constructive confrontation means confronting the person with reality and helping him look at it squarely. In biblical terms, it is "speaking the truth in love" (Eph. 4:15). If the alcoholic feels the minister’s concern, he may listen, and the words may have an impact even though the person has to deny verbally that they describe the way things really are. The alcoholic may resent the minister’s picture of the truth about his drinking and its consequences; yet, in spite of this, constructive wheels may be set in motion in the alcoholic’s thinking. It is important to offer help and hope at the same time one holds up reality, firmly and acceptingly. It is less difficult for the alcoholic to face the grim fact that his life is in shambles because of his drinking if he knows that there are effective ways of stopping and of rejoining the human race.

The various methods of attempting to motivate the resistant alcoholic, described in this section, are all ways of "elevating the alcoholic’s bottom." This apt phrase was suggested by internist Daniel J. Feldman -- formerly with the Consultation Clinic for Alcoholism, Bellevue Medical Center, New York University. ^16. He pointed out that it is possible to save some alcoholics from years of suffering by hastening the point at which they become open to help -- "hit bottom" psychologically. Feldman emphasized two factors in this process: "acceptance" and "bringing reality through." By acceptance he meant accepting the alcoholic as a sick person. If a counselor cannot do this, he should refer the alcoholic to someone who can. Obviously the alcoholic cannot be receptive to the help that is appropriate to a sickness until he accepts the fact that he has a sickness; a counselor’s lack of acceptance of this fact will reinforce the alcoholic’s resistance to accepting it. "Bringing reality through" is the same as constructive confrontation. Feldman advises counselors: "Keep holding the reality situation before him in a factual, non judgmental way. For example, ‘I’m not saying that it’s good or bad -- that’s for you to decide -- but it’s a fact that your employer is just about through with you.’" It is usually better to mention the ways in which the person is hurting himself and blocking himself from goals he desires, rather than to call his attention to the harm he is doing to his family. As long as he is drinking, he will be highly ambivalent toward them. On one level he feels overwhelming guilt feelings about his harming of them; on another level (often unconscious) his drinking may be a way of expressing hostility and resentment toward them. If the counselor is able to keep the reality situation before the alcoholic without the therapeutic bond of acceptance being broken, he may move him toward openness to help.

A key factor in elevating the "bottom" of the resisting alcoholic consists of working with the spouse to "release" him emotionally. This working concept, drawn from Al-Anon, will be explored in more depth in Chapter 11. Briefly, it consists of three actions: (a) letting go of the obsessive and futile efforts to "get my husband sober"; (b) letting go of her overprotective behavior by which she has unwittingly kept him from experiencing the painful consequences of his behavior which may have been precisely what he needed to become open to help; (c) letting go of the assumption that any improvement in the family situation is totally dependent on her husband’s achieving sobriety. This third release enables the wife and children to develop their own lives and relationships, whether or not the alcoholic decides to accept help. When a spouse succeeds in releasing her husband in these three ways, a crisis is created in his psychic economy which may result in his becoming accessible to help sooner than he otherwise would.

The first two elements in release also apply to the counselor’s attitudes and behavior in relationship to the alcoholic. The counselor must let go of any illusion that he can "get the alcoholic sober." Ultimately, motivation to recover can come from only one place -- within the alcoholic. Second, the counselor can be alert to the danger of unwittingly becoming an overprotector of the alcoholic.

Almost without exception, alcoholics attach themselves to those upon whom they can lean and upon whom they can depend for protection from the consequences of their drinking. It is possible for a counselor to allow himself to be used in this way. One of the Yale ministers told of working closely with an alcoholic, saying, "He recovered, but only after I too had withdrawn my support, and he was forced to return to a hospital for treatment."

An alcoholic’s strong dependency needs, coupled with the role of parent-image into which the minister is cast by the emotionally immature, make it easy for unconstructive dependency relationships to develop. One minister tells of the hours and hours he spent trying to get and keep an alcoholic parishioner sober. The experience ended in failure and convinced the minister that he had made the mistake of "babying" the alcoholic -- doing things for him which he should have been doing for himself. This conclusion fits with the recognition in AA that it is not helpful to pamper or "hold the hands" of a still-drinking alcoholic.

It is essential to keep the responsibility for recovering with the alcoholic. In his efforts to "get and keep" the alcoholic sober, the minister had taken over this responsibility. This is bound to fail since no one can get or keep another person sober. The alcoholic’s dependent side tends to draw the counselor into the trap of assuming responsibility for his sobriety. Some alcoholics will expect the minister to be a wonder-worker who can, by some magic religious formula, cure him of his alcoholism. This is where it is wise to let the alcoholic know, gently but firmly, that no one, including God, can cause him to recover from his alcoholism unless he takes the initiative and is willing to work at recovery. He must use his own God-given resources, with the help of the counselor, AA, and other resources, to work out his own sobriety. No one can do it for him or to him.

The alcoholic’s ambivalence toward authority is a psychological characteristic which must be taken into account in counseling. The alcoholic may be relatively mature in many ways, but he is often like an adolescent in his relationship to authority, alternately craving and resenting dependence. He tries to make the counselor into an authority figure, upon whom he can be dependent and against whom he can then rebel. If the counselor falls into this trap, the counseling relationship will be seriously distorted.

In order to avoid becoming ensnared in assuming responsibility for the alcoholic’s sobriety or lack of it, the counselor should strive not to become ego-involved in the outcome of the counseling process. If there is any kind of counseling in which a success drive on the part of the counselor is detrimental, it is in work with alcoholics. If the alcoholic senses that the counselor has too great a stake in his getting sober, he has acquired a weapon to use against the counselor in periods of hostility and anti-dependency. The alcoholic unconsciously senses that he can frustrate him by not moving toward sobriety. The counselor who tries too hard and thus reveals that he must prove himself by succeeding as a counselor conveys a lack of concern and respect for the person in and of himself. The alcoholic with his low self-esteem catches this feeling of being manipulated and reacts to the counselor in the same way that he would to a mission worker who gives the alcoholic the impression that he is interested in him as an opportunity to save a soul. Otis Rice once warned against the attitude of those clergymen who enjoy "collecting spiritual scalps"; this warning has its relevance for counselors of alcoholics.

The counselor should not give the impression that the alcoholic’s lack of sobriety is the counselor’s defeat, nor that the alcoholic’s success is a victory for the counselor. Thus, he respects the alcoholic’s right to drink or not to drink, and he keeps the initiative where it must be if he is to stop. How does a counselor achieve this attitude? It is not easy, for it requires a high degree of self-esteem not to need to prove one’s self or to be threatened by the alcoholic’s lack of success. Most of us achieve this attitude only to a limited degree. It helps some to recognize that if an alcoholic becomes happily sober, it is because he, the alcoholic, has achieved sobriety with the help of God. The counselor, at best, is only a catalytic agent. As one seasoned worker with alcoholics observed, "If an alcoholic with whom I’ve been working gets sober, I try to remember that it may be that it occurred in spite of what I did." The same can be said, of course, about the alcoholic who does not make the grade to sobriety. Any counselor who is worth his salt has a genuine concern for his counselees and their welfare. The point that has been emphasized in this section is that the concern should be for them and not mainly for the gratification of his own need for success. A discussion of this whole matter, which could be read with profit by the minister, is found in an article by Giorgio Lolli entitled "On ‘Therapeutic’ Success in Alcoholism." ^17.

The counselor should use great caution in deciding to do anything that might have the effect of protecting the drinking alcoholic from the normal consequences of his irresponsible behavior. Seldom is it constructive to intervene with an employer, a spouse, or the law, to ask for special concessions on the alcoholic’s behalf. Such interventions may prevent immediate consequences such as loss of a job, but the long-range results are usually negative in that they deprive the alcoholic of his right to experience the pain which might bring him to the point of openness to help. Such overprotection, as we have mentioned, has been called "cruel kindness." It appears to be kind, but its effects are usually cruel in the long run.

A psychiatrist who was connected with a sanitarium treating alcoholics described an alcoholic who had been going on periodic binges for a number of years, using the sanitarium as a drying-out place. It was only when, through a prearranged plan, the man’s wife told him she was leaving if he didn’t follow through on getting help, his employer announced that he was through unless he got help and stopped drinking, and the psychiatrist informed him that he would not be accepted as a patient unless he agreed to stay long enough to allow for effective therapy, that the man admitted he was licked and needed help. Before this, he had been shielded from the consequences of his behavior by the sizable allowances that significant people in his life had been making. It was when they stopped making these allowances, and meant what they said, that he was forced to face reality.

In most cases, it is not necessary to use such a calculated approach to "withdrawing the props" which have been supporting the alcoholic’s denial of reality about his drinking. If the over-protectors in his life can get out of the way and stop blocking the normal consequences of his immature behavior, a tipping of his inner motivational teeter-totter toward accepting help will often occur. In effect, the over-protector sits on the wrong end of the teeter-totter, delaying the person’s "hitting bottom." By withdrawing the dependency shields and allowing the alcoholic to experience the pain of being "clobbered by reality," the relative or counselor allows the teeter-totter to tilt toward getting help.

Non-addictive Excessive Drinking

The counselor should be alert to the possibility that an excessive-drinking counselee is not an alcoholic in the sense of being addicted to alcohol (Jellinek’s Gamma, Delta, and Epsilon types). Many problem drinkers (Alpha alcoholics) do not respond to AA or other alcoholism treatment methods because they are actually not addicted. Instead, their heavy drinking is a direct response to the pain of a disintegrating marriage, a severe loss, frustration of a cherished dream, or a temporary depression. The drinking may, of course, worsen the marriage relationship, thus producing a vicious cycle. But, if the person has not yet moved into the zone of progressive "loss of control," the appropriate therapy is that which is aimed at lessening the pain for which the alcohol is being used as a self-prescribed anesthetic. For example, the minister may recommend marriage counseling (or offer it himself, if he is so trained), help the person work through his grief, or refer him for medical assistance with his depression, as the person’s needs may indicate. If the person is not addicted, his drinking will diminish as the pain is alleviated. However, if he is addicted, the attempts to reduce the pain will usually fail. The person will not respond to marriage counseling. If the person is addicted, the heavy drinking will tend to continue, even if the pain is reduced, since the drinking is the result of a self-perpetuating inner process and not just a response to the pain.

On the subject of diagnosis, it is well for the counselor to have in mind the possibility that a person who appears to be addicted actually may be suffering from quasi-alcoholism. Ernest A. Shepherd, head of the Connecticut State Alcoholism Program, has pointed out that some persons who are psychotic, mentally deficient, pre-psychotic, or psychopathic personalities drink excessively but are not addicted. ^18. The drinking pattern appears to be that of an alcoholic but when confined where alcohol is unobtainable, they do not experience the withdrawal symptoms and craving characteristic of an alcohol addict. Actually, their excessive drinking is almost entirely a symptom of the major pathology from which they suffer and which needs treatment. There are, of course, persons in all the above mentioned categories of pathology who are also addicted to alcohol. If a minister suspects that he may be dealing with a person suffering from a major mental disturbance or mental deficiency, whether or not he is addicted, the appropriate action is to refer him as soon as possible for a psychiatric evaluation.

(Above) CHART OF ALCOHOL ADDICTION AND RECOVERY:

Reprinted from M. M. Glatt, "Group Therapy in Alcoholism," The British Journal of Addiction, Vol. LIX, No. 2 (January, 1958). Used by permission of the author.

END NOTES:

1. Psychological Reflections (New York: Pantheon Books, 1953), p. 73.

2. See H. J. Clinebell, Jr., Basic Types of Pastoral Counseling (Nashville: Abingdon Press, 1966), chapters 1-4.

3. The Vital Balance (New York: The Viking Press, 1963), p. 352.

4. This is Ernst Ticho’s phrase; quoted by Menninger in The Vital Balance, p. 350.

5. "Pastoral Counseling of Inebriates," Alcohol, Science and Society, p. 454.

6. Workshop on "Therapy with Alcoholics," Yale Summer School, 1949.

7. "Pastoral Counseling of Inebriates," p. 451.

8. Paul Tillich, "The Theology of Pastoral Care" in Clinical Education for the Pastoral Ministry, Proceedings of the Fifth National Conference on Clinical Pastoral Education, Ernest E. Bruder and Marian L. Barb, eds. (Published by the Advisory Committee on C.P.E., 1958), p. 5.

9. "The Pastor’s Resources in Dealing with Alcoholics," Pastoral Psychology, April,1951, p. 18.

10. (New York: Harcourt, Brace and World, 1933, Harvest Book edition, p. 234.)

11. Quoted by Wayne E. Oates in Religious Factors in Mental Illness (New York: Association Press, 1955).

12. Edith S. Lisansky, "Alcoholism in Women: Social and Psychological Concomitants," QJSA, XVIII (December, 1957), No. 4.

13. Held at Fort Worth, Texas, 1949.

14. From a paper "Criteria for Assessment and Motivation of the Alcoholic in Early Contacts," presented by Sam E. Wilson at the Utah School of Alcohol Studies, June 21, 1962.

15. Several of these are from a lecture by Gordon Bell at the Utah School of Alcohol Studies, June 18, 1963.

16. Presented at the Annual Meeting of the National Council on Alcoholism, March 18, 1955. Dr. Feldman is now with the Department of Physical Rehabilitation, Stanford University.

17. QJSA, XIV (June, 1953), No. 2.

18. Pastoral Care, J. R. Spann, ed. (Nashville: Abingdon Press, 1951); see the chapter entitled "Alcoholics," by Shepherd, p. 175.