Alcohol and Alcoholism Vol. 38, No. 3, pp. 288, 2003
© 2003 Medical Council on Alcohol
BOOK REVIEW
The Alcoholic Family in Recovery. A Developmental Model.
By Stephanie Brown and Virginia Lewis. The Guilford Press, New York. 1998, 308 pp., £26.95. ISBN: 1-57230-402.
The Alcoholic Family in Recovery offers a developmental model exploring the process of recovery from addiction as it affects the entire family.
The model of recovery is very much based on the 12-step philosophy espoused by Alcoholics Anonymous and Al-Anon. The process of recovery is delineated by qualitative research within the Family Recovery Research Project.
A total of 52 couples and families with lengths of abstinence ranging from 79 days to 18 years were interviewed and assessed, with particular emphasis being given to the meaning of abstinence, the use of alcohol previously, the process of denial of other life problems, and the speed of transition to recovery for individual family members, compared to the family unit. The work of the therapist was to help families to understand recovery as an interactive process. The task of the therapist in supporting such a process was explored in some detail throughout a number of chapters in the book in terms of family life stories.
The book defines terms such as ‘recovery’ and ‘abstinence’ carefully and provides a detailed framework for assessing family functioning and the status of recovery. It was both a strength and a weakness of the book that these concepts were explored in a rather repetitive manner. One was perhaps rather tempted to skim through the theory in order to engage with the clinical material documented across the chapters.
In my opinion, the setting in which this research was conducted, i.e. at the Mental Research Institute, Palo Alto, California, USA in the early 1990s, has to be stressed. Without an awareness of the North American provenance and a familiarity with family therapy concepts, one would struggle to understand the material presented and rather jargon-laden use of language. There is an underlying assumption that individual and family therapy are widely available, but an acknowledgement that the families recruited onto the research programme are all of Caucasian origin and of limited ethnic and religious diversity. The genuine engagement with the families’ researchers interviewed and their ability to follow families over the longer-term was refreshing. One recognized that change is neither quick or easy, nor necessarily always in the direction of promoting the good of the family as a whole. Researchers recognized and struggle with ethical issues, such as the need to protect children, particularly during the early stages of recovery, when adult members of the family may be preoccupied with their own need to abstain from alcohol, having hit ‘rock bottom’. Simply getting through from day to day can seem an enormous and unobtainable goal.
The therapists, when talking about their work, promoted the need to accept that individuals had to struggle. Rushing to promote change could do more harm than good. It is always helpful to be reminded that abstinence itself is only a very limited first post on the recovery journey. Despite gains in relation to physical health from abstinence, improvements in psychological health are much less solid.
This is not a book that explores the physical health of recovering alcoholics. It does not explore the use of medication, nor does it look at alternative models of recovery not based on an Alcoholics Anonymous philosophy. There is no debate about the usefulness of modified drinking; abstinence is the only starting point. As a professional reading this book, I was intrigued by the clinical material presented. I know that this is a book not only intended for professionals, but also for families. I can see that, for families, who may need to repeat the cycles of therapeutic growth and development over a number of years, the book’s repetitive format helps to reinforce this concept.
I found this a very interesting book that explored in great detail the ways in which families might change. For many individuals and families, the cost of such change is very great, leading inevitably both to relapse and to the breakdown of family units. Success stories are described, bolstered by the genuine optimism and interest demonstrated by the researchers throughout their writing.
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