Medicine: Out in the Open

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As Poet Robert Bly, the son of an alcoholic, puts it in a book called Family Secrets, edited by Rachel V. (Harper & Row, 1987): "Every child of an alcoholic receives the knowledge that the bottle is more important to the parent than he or she is." To mend the damage from those year-in, year-out traumas, hundreds of thousands of Americans have turned to Al-Anon and other family-therapy organizations. An offshoot of A.A. that was formed in 1951 for relatives and friends of alcoholics, Al-Anon has more than doubled in size since 1975 and now boasts some 26,000 regional groups. But the real comer is the children-of-alcoholics movement, aimed at the nearly 30 million offspring of chronic drinkers in the U.S. Made up of a variety of organizations, the movement took off four years ago with the best-selling book Adult Children of Alcoholics, a guide to the dilemmas C.O.A.s face, by Janet Geringer Woititz, a human-relations counselor in Verona, N.J.

At a typical C.O.A. meeting, participants sit in a circle and offer reflections on their own experiences, from a paralyzing fear of intimacy to acute conditions like bulimia, a disorder marked by episodes of excessive eating. At the heart of their pain and confusion is a childhood fraught with anxiety. "When we were kids and our parents were drunk, it was our problem," a 21-year-old daughter of an alcoholic told TIME's Scott Brown. "Somehow it seemed that we should be super people and make our family healthy." Reliving painful childhood experiences among sympathetic listeners enables the C.O.A.s to feel emotions they had suppressed. Recalls Rokelle Lerner, a pioneer in the movement: "I had to learn to re-parent myself, to comfort the little girl inside."

For both family members and chronic drinkers, the greatest frustration is the absence of a surefire treatment for alcoholism. The truth is that success rates often depend more on the individual makeup of the alcoholic than on the treatment. Alcoholics fitting Cloninger's male-limited type are less likely to remain sober after treatment, along with those with unstable work and family backgrounds. "The best predictor of patient outcome is the patient," says Thomas Seessel, executive director of the National Council on Alcoholism. "Those who are steadily employed, married and in the upper middle class are more likely to succeed. They have more to lose." In response to allegations that some centers have exaggerated how well their patients do after treatment, Congress has ordered the NIAAA to investigate treatment programs.

Today about 95% of in-patient treatment centers in the U.S. use a 28-day drying-out program developed in 1949 at Hazelden. For the first few days, staff help patients through the tremors and anxiety of withdrawal. From that point on, the emphasis is on counseling. The aims: dispel the alcoholic's self-delusions about drinking, drive home an understanding of alcohol's destructive properties, and make it clear that the only reasonable course is to stop drinking -- permanently. Some centers use Antabuse, a drug that induces vomiting and other symptoms if the patient has a drink. Schick Shadel, a program with hospitals in California, Texas and Washington, employs aversion therapy to condition alcoholics to recoil at the smell, taste and even sight of a drink. Most programs, however, rely on A.A. or other counseling programs to help reinforce the message of abstinence.