The Alcoholic Marriage: Perspectives
by and , New York , Grune and Stratton , 1977 , 211 pp. $14.50 .
This is an overly ambitious book. It presents five theoretical perspectives of the alcoholic marriage and describes and critiques the research for and against each perspective. Along the way it tries to educate us about each school of human behavior and the historical development of each perspective on alcoholism. It then tries to offer a choice. The result is an embarrassment of riches that is a studious compendium but practically unreadable. It suffers from a decided cautiousness, verging on pickiness, about most research. This contrasts with a blithe acceptance of some attitudes (e.g., the value of group therapy), which are accepted without data. As a critical bibliography of research on alcoholic marriage, it is probably invaluable for prospective researchers in this area. But as a guide for therapists of alcoholics and their families, the book is frustrating, as it refuses to define the state of the art.
The subject of the book is the marriage of a male problem drinker to a female non-problem drinker. The bias is stated: “A person must have the help of at least one other person to become an alcoholic.” Yet considerable effort is made to avoid blaming the non-alcoholic for the alcoholism. The tone is self-assured, almost dogmatic in its criticism, yet tentative in the conclusions. There is a chapter on each of the five perspectives, a chapter on treatment implications, and appendices explaining statistics, defense mechanisms, Murray Bowen, and transactional analysis.
The first perspective, the Disturbed Personality Hypothesis, is simplistically analytic. The authors present data in opposition to the idea that women married to alcoholics are abnormally dominant and masochistic. They conclude that”… there is ample evidence” (from MMPI's and the like) “that the only common denominator among spouses of alcoholics is that they have married alcoholics.” So, psychoanalyzing the wife would seem unhelpful. It does seem important, however, to know if she knew of the alcoholism before the marriage.
The second perspective is the Decompensation Hypothesis, which claims that the “… the alcoholic's excessive drinking is necessary to preserve the marital relationship.” The wives would theoretically experience nervous breakdowns if their husbands stopped drinking. There have been dramatic case reports to support this, but no data. The logical point is made that the wife cannot be shown to keep her husband alcoholic unless it can be shown that she could cure his alcoholism if she wished. Data is even presented to show that wives' personalities would be unchanged and marriages unimproved by abstinence.
The authors don't ridicule the other three theories as much. The Sociological Stress theory is less concerned with why alcoholics drink than with how the family reacts. It recounts stages of family adjustment to the crisis of alcoholism and styles of coping. They conclude from the data that withdrawal from the marriage is most frequent, that no specific coping style is associated with a good outcome, and that all marriages don't go through the same stages.
The fourth perspective is Behavioral. The authors seem to favor it. The chapter focuses on ways in which reinforcement and punishment affect alcoholic marriages. “The data strongly suggest that many antecedents to drinking lie within the marital relationship of the alcoholic.” Some behaviorists find that”… the marital stresses which serve as antecedents take the form of spouse nagging, excessive talk about alcohol and past alcoholic transgressions, and attempts at communication which do not result in satisfactory conflict resolutions or goal attainment for either partner.” Others suggest that drinking is maintained by spouse “…attention to the drinking behavior in a variety of ways, ignoring appropriate and desirable behavior, protecting the alcoholic spouse, to name a few.” The appropriate conclusion would seem to be that it would help to withdraw attention from drinking and from the alcoholic while drinking, and at the same time to reward sobriety. It is not clear from the data that this is the case. The authors note, significantly, that considering the alcoholic mentally sick relieves him of the responsibility for his behavior and is counterproductive. They suggest considering alcoholism a problem in learning or adjustment.
The fifth perspective is Systems and leans heavily on Bowen, suggesting that alcoholic families have a low level of differentiation. The Systems Perspective assumes sobriety would upset the equilibrium of the system. The family system may grant the sick role, may cement roles by deciding who is in control, may signal stress, and may help the alcoholic avoid responsibility. The authors are unimpressed with the data to support the theory, despite the good results reported from couples treatment. They acknowledge that systems theorists don't believe”… any one role, rule or communication pattern should characterize all alcoholic symptoms.”
The final chapter, on treatment, dismisses psychoanalytic approaches for lack of data and endorses behaviorist approaches to the couple, with “enriching” ideas from the other perspectives. Motivation, i.e., overcoming denial, comes first. Denial of alcoholism is considered the failure to experience fully the negative aspects of drinking. “For a spouse to help her alcoholic mate to experience consequences of his drinking, she could begin to arrange his consequences to make immediate consequences of drinking unpleasant and consequences of sobriety more pleasant.” The treatment prognosis is determined to be optimistic, and outcome data are good with treatment from any perspective except psychoanalytic. Once the unique features of each case have been assessed, treatment involves problem-solving, modification of consequences, and overcoming irrational beliefs. Many techniques are examined without enthusiasm. The discussion is obsessive and lacks daring, as it tries to leave the choices to the reader.
The book succeeded with me in that I finished the laborious job of reading it with an eagerness to treat alcoholic marriages. I will keep it as a valuable reference and will recommend it to anyone who is still treating alcoholics without involving spouses or spouses without involving the alcoholic. For me, the book's greatest virtue is its convincingly sympathetic approach to the much maligned alcoholic's wife.
