PARQUEADEROS PUBLICOS

In this section I aim to provide psychotherapists with a set of guidelines for the therapy of alcoholism. These guidelines will also be of interest to the spouses, relatives, and friends of alcoholics, since they can be used, with a few

modifications, by anyone who wants to relate to an alcoholic in a helpful way. Let me summarize.

Alcoholism is not a disease; therefore, the best solutions to alcoholism are not medical.

Alcoholism is not incurable. It is an acquired condition different from person to person, based partly on innate, biochemical responses to alcohol, partly on social pressure to drink, and partly on the emotional, thinking, and nutritional habits of the alcoholic.

Alcoholism can be healed, and a few former alcoholics (about 10%) are evidently able to return to normal drinking though the majority either can't or choose not to. The physical factor responsible for alcoholism is the addictive properties of alcohol. This is treated by maintaining sobriety for at least a year.

The social factors responsible for alcoholism are the intense social pressures to drink, and the participation of alcoholics and their circle in the Alcoholic game with its three roles: Victim, Rescuer, Persecutor. These roles must be avoided by

anyone who wishes to help the alcoholic

The psychological factors responsible for alcoholism reside in the Enemy. The Enemy is a collection of harmful messages that have been adopted by the person and that

interfere with thinking, feeling, getting strokes, and being aware of one's bodily states. This is treated by confronting and neutralizing the messages and emotional patterns which the Enemy promotes. One very effective method to achieve this goal is emotional literacy training.

AA should be enlisted whenever possible. The therapist’s job is to encourage the client to take action against the alcoholism and to provide protection as the alcoholic changes his or her life.

Chapter 12. Myths of Alcoholism.

There are many theories about what causes alcoholism but precious few specific

approaches to the problem. Alcoholics Anonymous remains the best choice for people who find themselves in difficulties with alcohol. The professional literature, on the other hand, is filled shot through with big words like compulsion, regression,

passivity, dependency, character disorder, psychosis and so on. These terms humiliate alcoholics and do not seem to answer the main question: what do we do to help the alcoholics?

As a result of this poverty of approaches, it is very difficult for an alcoholic to obtain reasonably competent treatment. Many therapists feel afraid and uncomfortable with alcoholics and are therefore reluctant to get into therapy with them. The more experienced therapists will happily refer alcoholics to other therapists while they keep the more pleasant clients for their own comfortable practices.

Let us briefly explore certain myths about alcohol and alcoholism. These myths have served to obscure the obvious in a field that has been riddled with contradictory opinions and points of view. Disposing of these myths can clear the way for a sensible and objective approach.

1. Alcoholism is just an illness

As we have seen, the notion of alcoholism as an illness (in the sense that the medical profession defines it) is an obstacle to its proper treatment. It is important not to confuse the illness, which is a consequence of excessive drinking with excessive drinking itself, which is not an illness at all. Saying that alcoholism is an

illness (because of the different illnesses that are associated with it, like delirium tremens, heart disease, or liver or brain disease) is like saying that driving

recklessly is an illness because it often leads to broken bones and concussions, which are treatable only by physicians.

On the other hand alcoholism is a health disturbance in a more general sense. Modern holistic medicine, regards disease in a completely different light from Western

allopathic, (drug-and-surgery-centered) medicine. In the holistic view any disturbance of healthy bodily functioning is a health disturbance.

The approach outlined in this book, and even its title, are strongly influenced by holistic health ideas. Holistic medicine's specific treatment of alcoholism bears little resemblance to what has been the traditional medical approach. Above all, sedatives and tranquilizers are not used. Instead, diet and life-style changes are recommended, together with an expectation of the alcoholic's active participation in the healing process.

Attempts to treat alcoholism with drugs have failed even though at certain points of a drinking episode it appears that certain drugs can be of some help. However, at this moment, there are no drugs that specifically treat alcoholism, nor are there or have there ever been any drugs that show any promise. In my opinion drugs for alcoholics should be avoided altogether-except for medical emergencies. It is important that alcoholics and their therapists abandon the notion that alcoholism and medicine are necessarily related in any way except in the terminal stages of alcoholism when it has become intimately associated with bodily tissue damage.

The sense that the alcoholic is progressively, incurably ill and that therefore nothing can be done about the illness, except to keep the cork on the bottle, is as much a myth as the other extreme of thinking, which states that alcoholism is strictly a matter of choice.

2. Alcoholism is just a choice

This myth lies beneath the notion that the alcoholic chooses to be an alcoholic and that the remedy is simply a matter of choosing differently. According to this view, the alcoholic or any other addict doesn't need therapy, A.A., or any help at all. All she needs to do is make her mind to stop, "just say no" and "do it." This view is all the more prevalent since it is clear that some alcoholics do just that; they quit and even return to social drinking.

But for the majority of alcoholics who are not able to just stop, this approach overlooks the many pressures to drink that the alcoholic finds herself under and how those pressures are, at times, irresistible. It is an approach that leads to

callousness on the part of the helper; nothing but the alcoholic's will to drink or not to drink is considered of any importance.

Only someone who has never been under the compulsion of drug or other substance abuse can understand how humiliating and persecutory such a point of view can be. Some alcoholics are so browbeaten by this view that they will accept and defend it

themselves. "I am just a weak-willed person." "All I have to do is stop drinking-then I’ll stop being an alcoholic" or "I have to do it myself-that's all there is to it'" are the kinds of things alcoholics who have been thus indoctrinated will say about themselves.

These views are not very useful, they sound brave and responsible, but they don't help because they are unrealistically simple and almost never work. Most frequently they result in nothing more than guilt and further feelings of powerlessness because they ignore the powerful factors other than choice that are the causes of alcoholism (addictions habit, social pressures, the inner Enemy, etc.) They interfere with a realistic view of people's responsibility in their own life.

3. Alcoholism is just a symptom.

This point of view, though less and less prevalent, is that drinking is merely a symptom of a deeper psychological or social problem. As a consequence, these

therapists will choose not to discuss the drinking (because it is merely a symptom) but will attempt to investigate its "dynamics" and origins (childhood traumas, social environments, script injunctions and attributions, early family constellations,

emotional conflicts, or repressed primal screams) through a variety of techniques such as psychoanalysis, gestalt therapy or psychodrama-all of which ignore the

everyday realities of the alcoholic's drug use.

Since these views consider drinking just a symptom of a deeper problem these

therapists do not typically seek complete cessation of drinking and will have to deal with clients who are almost always under the influence of alcohol, (or between binges) and cannot realistically exercise enough common sense and Adult control to deal with whatever they must do from day to day to make their lives work.

From the Transactional Analysis point of view, the therapist who chooses to ignore the client's drinking in favor of dealing with his more "basic" conflicts is playing the role of Rescuer (Patsy variety) in the game of Alcoholic and is contributing to the continuation of the problem. Regardless of whether drinking is a symptom or not, it is necessary and desirable that the alcoholic take some realistic action.

Regarding alcoholism as only a symptom can be a major mistake comparable to forgetting to bail out a sinking boat while looking for leaks.

To stop drinking is the very first step. Stopping the drinking may not be a cure, but it does stop the progression of the script and is thus an indispensable move. Only a reliably sober person can find the energy and clarity of mind necessary to deal with the "underlying" causes of alcoholism. Changing life styles, friendships and social circles follows.

Allied with the misconception that alcoholism is just a symptom of deep underlying emotional conflicts is the assumption that only "deep" one-to-one individual

psychotherapy can be effective in dealing with it. In fact, group psychotherapy has proved to be every bit as effective as one-to-one therapy-especially in the treatment of alcoholics. In groups, alcoholics seem more capable of ridding themselves of the problem permanently than in deep" one-to-one analysis. In my experience alcoholism does not require "deep" or heroic methods of therapy. It does require a

relaxed, patient, nurturing, well-informed, experienced, demanding, persistent and optimistic approach.

In summary: alcoholism isn't any one single problem. Instead, it is the result of a combination of physical, personal, and social factors which exist in different people at different times in their lives. When the 'right" combination occurs-and it occurs in about twenty million people in this country at this time-alcoholism results.

Alcoholism can be healed and what can be done to heal it will be discussed in the rest of this book.

Chapter 13. Can Alcoholism Be Healed?

Some argue that alcoholism is incurable. Can Alcoholism really be healed? This is a good question that deserves a serious answer. The short answer is "Yes!" and that nature’s healing powers are on our side.

In Transactional Analysis we believe that children are born OK, with an innate potential for spontaneity, awareness, and intimacy-or, as Eric Berne put it: "People are born princes and princesses (and their parents turn them into frogs.)" Depending on what kind of a household or situations we are delivered into by fate, our

development to full potential may be fully allowed, or we may be "turned into frogs" when our potential is nipped in the bud or barely permitted to muddle along.

Another way of saying this is that human beings are imbued with a life force for health and survival which, if give the opportunity, will heal the body and soul from most damage. This force, Nature’s helping hand named Vis Medicaterix Naturae by Hippocrates, is present in all the living and is the greatest ally of the client and therapist in the struggle against alcoholism.

The cynics are convinced that people don't change, not really. The optimists believe that everyone can, given the proper motivation and help. As usual the answer is somewhere in between; of course people can change. A donkey will never be a mule but change is the essence of life. The question is how much and how fast.

Change is inevitable but three things promote or stimulate it. The first is intense need. That is what alcoholics call "hitting bottom," the point at which the

alcoholic wakes up facing financial, personal, social or health disaster and he says to himself: "This has to change I have to do something about my drinking!"

The second major requirement is the capacity to manipulate one’s behavior through symbolic thinking or what we in TA call "Adult control" Neither of the two alone— desire or control--is sufficient but together they are capable of shaping behavior in a permanent way.

Thirdly, radical change requires action. The significant changes that healing

alcoholism requires are unlikely to happen without concerted action on the part of the alcoholic.

Change, as I said, is an inevitable aspect of life. Healing change is generated from within and we can either help it along or interfere with it. As long as there is life, the struggle to change for the better usually continues and the therapist can help. Sometimes, for a while, a person may not want to improve his or her life but that too is liable to change.

A recent study by Timko et al published in the Journal of Alcohol Studies (July 2000) supports these views. 466 alcoholics who participated in a detoxification program, indicating that they had hit some sort of bottom were studied for eight years. Some received no treatment, others had some sort of psychotherapy some went to AA and some had both treatment and AA. After eight years it was shown that all improved. Those who had both forms of intervention did best, AA and psychotherapy separately had a lesser but roughly equivalent improvement and of those who had no treatment 25% improved anyway. It is a feature of living things that they have self-healing mechanisms independent of any healing administered by any intentional healer.

There are many recorded cases of extreme alcoholism that was healed without healing intervention of any sort. Still a good therapist can be very helpful. A competent, honest therapist works for a living and is mindful of her job. She is humble as to what, in the end, helps the client: a combination of nature's healing power, the clients efforts to take responsibility and bring about changes and the therapist's direction and skills. Every session she reviews what progress is being made, openly rejoices or regrets the client's changes and is ruthlessly analytic about the process using the most advanced knowledge to inform her work. She recognizes the unique individuality of each client and applies her creativity to the client's specific difficulty. She is tuned into and respectful of the client’s perceptions and opinions. She provides permission to change. She provides protection against the demons that beset the client in uncharted, healing waters and she devotes constant, potent attention to the whole process. Her love of truth keeps her honest about the effects of the therapy; positive, negative or neutral.

A jungle healer

Here I would like to tell a brief, apocryphal story: A physician was called to visit a village in the jungle because of epidemic of dysentery that affected 8 out of 10 of the people. After a brief tour of the town he called a meeting of the elders: "I noticed that your latrines are next to the river. Here is what you must do right away. Always take your drinking water upstream of the latrines and your problem will be solved.

The villagers followed this basic, generic, public health principle and the epidemic abated. Still 20% of the villagers continued to be ill. Later measures such as boiling the water, moving the latrines away from the river, antibiotics, etc reduced disease by another 15%

With alcoholism, stopping the drinking, like stopping the drinking of polluted water is an essential aspect of the process of healing. In addition most psychotherapies share a number of mental health principles which will be beneficial to the sober alcoholic. A good therapist will be nurturing and will endeavor to be attuned,

thoughtful and soothing while the client is encouraged to talk about problems and vent feelings.

But every person’s problems are different and the basic methods described above are often not sufficient; a higher level of expertise is needed to combat the Critical Parent, deal with unruly emotions, handle emotional complications and nutritional and other health issues. The various factors that are important in the healing of

alcoholism will be explored in the next chapters.

Chapter 14: Personal Responsibility

How does it happen that in spite of having the capacity for choosing any kind of life, we wind up with the particular enslaving scripts that we live?

Even North America where people have an unusual range of choices and reasonable

freedom to choose between them, approximately 10 percent will become slaves to alcohol and suffer the devastating horrors of alcoholism. One-fourth will be addicted to cigarettes and (this is my guess) as many as one-third will let themselves be

dominated by some form of addiction: caffeine, sugar, fattening foods, prescription or over-the-counter drugs or narcotics.

Does the alcoholic simply lack will power and insists in making bad choices? Or is the alcoholic a victim of his heredity childhood experiences and family? Heredity matters and childhood experiences matter but no one is willing to claim that they are the reason why alcoholics are alcoholics. We assume that the alcoholic has choices, yet he feels powerless.

Powerlessness

One experience is common to all addictions, and that is the feeling of powerlessness. If there is an innate healing positive force within all of us why is alcohol so powerful and alcoholism so difficult to overcome?

Being unable to control one's behavior is a devastating experience. Not having the power to stop the use of cigarettes, sleeping pills, coffee alcohol, amphetamines, heroin, marihuana or prescription drugs, gambling or sexual compulsion when we know they are harmful, is most damaging to self-esteem. When we experience the humiliation of powerlessness, it poisons our daily life, makes us feel worthless, contemptible, and ashamed. We look around and see other people who appear to be in control of their lives, doing what they must do, avoiding what they must not. Yet we see

Many people manage to avoid confronting their powerlessness over substance abuse by telling themselves and others that the amount of harmful substances they consume is reasonable, that there is no problem, that they are in fact consuming these substances voluntarily, because they enjoy it and don't see anything wrong with it. Still many of those people secretly would like to stop.

The terror that comes with the realization of how helpless we really are is one of the greatest obstacles to people's success. Discovering that we are powerless to stop doing things we don't want to do is an experience we wish to avoid. Many who know and believe that it would be desirable to do something about their harmful habits simply do not attempt it because they believe they will fail, and, quite understandably, do