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Overview
Drawing on soundly tested theories of transactional behavior, Dr. Steiner describes the three distinct types of alcoholics -- Drunk and Proud, Lush and Wino -- and their games, scripts and rackets: Debtor... Kick... Cops and robbers... Plastic Woman... Captain Marvel...Ain't it awful... Schlemiel... Look how hard I've tried... and others.
His approach is the single most useful tool for dealing with alcoholism since A.A. and the Twelve Steps, and offers the first real help -- and hope -- for problem drinkers and their families.
Product Details
| ISBN-13: | 9780307783820 |
|---|---|
| Publisher: | Random House Publishing Group |
| Publication date: | 03/09/2011 |
| Sold by: | Random House |
| Format: | eBook |
| Pages: | 224 |
| File size: | 3 MB |
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Introduction
THERE IS powerful and pervasive evidence that alcoholics seem driven, whether sober or drinking, by an inner compulsion for self-destruction. An alcoholic sober for years will commonly return to his previous state of alcoholism regardless of how long he has stayed sober. For Alcoholics Anonymous (AA), this is evidence that alcoholism is incurable, a disease that lurks in the depths of the personality, waiting to spring forth in full strength at the mere consumption of a single drink. Persons who believe in the AA approach feel that “once an alcoholic, always an alcoholic,” and recovered alcoholics in AA consider themselves alcoholics regardless of how long they have been sober.
To date, AA has achieved more success in the treatment of alcoholism, when the criterion is sobriety, than any other approach. The group’s wisdom about alcoholism is considerable. One of Alcoholics Anonymous’ official publications states:
We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever regains control. All of us felt at times that we were regaining control … [but] we are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any period of time we get worse, never better … Physicians who are familiar with alcoholism agree that there is no such thing as making a normal drinker out of an alcoholic.
According to the Manual on Alcoholism of the American Medical Association, alcoholism is a
“ … highly complex illness … characterized by preoccupation with alcohol and loss of control over its consumption such as to lead usually to intoxication when drinking is begun; by chronicity; by progression; and by tendency toward relapse.”
To say that alcoholism is an illness implies that it is “… an interruption or perversion of function of any of the organs, an acquired morbid change in any tissue of an organism, or throughout an organism, with characteristic symptoms caused by specific micro-organismal alterations.”
The above definition, however, does not seem to describe a large number of bona fide alcoholics. For instance, can it be said convincingly that a year after his last drink and the day before his next binge a young alcoholic is suffering from an interruption or perversion of the function of an organ or that there is an identifiable morbid change in any of his bodily tissue? Defining alcoholism as an illness implies that its treatment is basically a function of physical medicine. Further, defining it as a progressive or chronic illness implies that its treatment should be approached, as the Manual recommends,
“… in much the same way as are other chronic and relapsing medical conditions [in which] the aim of treatment is then viewed more as one of control than cure.”
The theory of alcoholism as an incurable disease is weakened by evidence, thoroughly documented, that a number of individuals, once unquestioned alcoholics, returned to social drinking without returning to alcoholism. These cases provide evidence that alcoholism is not incurable, always ready to be triggered by the consumption of alcohol.
This book presents a theory about alcoholism in particular, as well as emotional disorders in general, and a method of treatment which follows from this theory. The theory can be called a decision theory rather than a disease theory of alcoholism or emotional disturbance. It is based on the notion that some people make conscious decisions in childhood or early adolescence which influence and make predictable the rest of their lives. Persons whose lives are based on such a decision are said to have a script, and a script may involve life plans such as becoming an alcoholic, committing suicide or homicide, going crazy, or never achieving any success.
Like diseases, scripts have an onset, a course, and an outcome. Because of this similarity, scripts have been mistaken for diseases. However, because scripts are based on consciously willed decisions rather than on morbid tissue changes, they can be revoked or “undecided” by similarly willed decisions. Thus, I believe that a cured alcoholic (though he often does not choose to) will be able to return to social drinking, while the person who returns to uncontrollable drinking after one drink has been essentially unable to dispose of his script.
Psychoanalytic theories have attempted to show that persistent behavioral disorders such as alcoholism are based on psychic misalignments which persist because they are deeply buried and therefore unconscious. These theories may see the alcoholic as someone with a “passive-aggressive oral character who drinks because of a deep-lying ego deficit”; script theory is more likely to see him as someone who decided early in life to lead a self-destructive life based on a game of “Alcoholic” with a certain course and outcome. Yet many persons with a passive-aggressive oral character do not become alcoholics, and in general, psychoanalytic explanations of alcoholism have been regarded with bemused disbelief by most alcoholism workers.
Various psychological theories have attempted to account for alcoholism on the basis of personality traits such as dependency, oral fixation, or latent homosexuality; however, considerable research investigating these theories has failed to show any systematic relationship between these traits and alcoholism.
On the other hand, McCord and McCord found that while “alcoholics were, in childhood, not plagued by inferiority feelings, oral tendencies or homosexual leanings more than ‘normal’ men,” there did seem to be a prevalence of certain situations that characterized the childhood homes of future alcoholics. Script theory agrees with this and goes on to say that, for the alcoholic, it is these situations, according to script theory, that lead to conscious decisions that eventually lead to an alcoholic life course.
The same statement can be made about other kinds of disturbances which are parts of life scripts, such as suicide, homosexuality, drug addiction, or “mental illnesses” such as schizophrenia.
Considering alcoholism a script rather than an incurable disease makes possible a more thorough understanding and a treatment approach which enables a competent practitioner to cure the alcoholic so that he may “close down the show and put a new one on the road.” Questioning the assumption that alcoholism is incurable also generates positive expectancy and hope, whose importance Frank and Goldstein have amply documented. From their studies, it is clear that an assumption of chronicity and illness on the part of workers will have the effect of generating chronicity and illness in the patient, while an assumption of curability will tend to generate cures. Thus, considering alcoholism a chronic illness, as many who work with alcoholics do, may be potentially harmful to, and may in fact promote illness and chronicity in, large numbers of alcoholics. On the other hand, the assumption that alcoholism and other psychiatric disturbances are curable because they are based on a reversible decision, will bring to bear the potent effect of positive expectancy on their treatment.
The following pages describe the various aspects and stages of life scripts and their treatment. Examples from case histories of alcoholics will be used throughout, although not exclusively. Sections on the alcoholic game and the treatment of alcoholics are included.