Alcoholism is a disease of isolation. Because many alcoholics become intoxicated in the presence of others, the illusion persists that their drinking is merely social. Therefore, the alcoholics, their families, and their friends deny and minimize the alcoholic’s impaired thinking, feelings, and behaviors that are direct results of the drinking. The disruption of relationships that results from intoxication affects both the alcoholic and anyone who is attached to the alcoholic loved one, and all of them suffer from the consequences of this family disease.

Pretending that this disruption can be fixed, managed, or controlled by the family member or friend of the alcoholic leads to chronic, progressive, and relapsing patterns of irrational beliefs, feelings, and behaviors on the parts of family members and friends. These patterns constitute the family disease of alcoholism, which may show up in a psychiatrist’s office as anxiety, depression, or even psychosis. They may also appear in a doctor’s office as fatigue, chronic pain, gastrointestinal disturbance, or a host of other physical complaints. Unless the physician or patient is aware of the presence of alcoholism in a family member or friend, the diagnosis and treatment of a mental or physical disorder may leave the underlying family disease of alcoholism untreated.

Some family members and friends of alcoholics only become aware of the alcoholism when the alcoholic enters recovery by going to treatment and/or Alcoholics Anonymous (A.A.). If we consider A.A. as the pharmacological treatment for the chronic disease of alcoholism, we may understand that ongoing participation in A.A. may be essential for the alcoholic to maintain sobriety. Moreover, if we accept that alcoholism is a disease that affects the entire family, then hoping that the alcoholic’s participation in A.A. will be sufficient for the family or friend does not seem rational. And, therefore, family members remain untreated and continue to suffer from their own disease.

Conversely, some family members and friends of alcoholics find their way to Al‑Anon during a loved one’s active drinking. Participation in Al‑Anon—taking a regular dose of the “penicillin for the family disease of alcoholism”—will not treat the active alcoholic. Among the many miraculous characteristics of this penicillin is that as family members and friends learn new beliefs, feelings, and behaviors, the environment for the alcoholic changes from one that supports the drinking with control, judgments, and resentments to one that offers an opportunity for genuine love and acceptance. Family members and friends begin to recognize that they did not cause and cannot control or cure their alcoholic loved ones, but that they do have choices. They also begin to feel gratitude and joy as other members freely share their feelings of fear, shame, loneliness, hurt, and anger. They also become able to set boundaries that are consistent with detaching with love from the alcoholic.

Since the introduction of this “penicillin” in 1951, many different forms of this medication have been developed. While all Al‑Anon meetings share a basic structure using the same Twelve Steps and Twelve Traditions, each meeting is free to adapt its meeting format to its size, structure, schedule, and other details to meet the needs of its members. Most members suggest to newcomers to attend at least six to eight meetings before deciding whether Al‑Anon is for them.

 By Jeffrey Roth, M.D., FASM, Psychiatrist, Illinois

Al-Anon Faces Alcoholism