The Disease Concept and The Relationship Model of Addiction.

Hi Daniel,

A short history of the problem is... my boyfriend and I were living together here in Southern California when he was transferred up North for his career. I agreed to move with him after finishing the contract with my job. We were apart for 5 months and while up north seemed to develop some depression from the isolation of the move. Two weeks before the scheduled move he sought out help for the depression and was prescribed Celexa and was told not to drink with this medication because of severe side effects. He flew down two weeks later to assist me with the move. Up until this point I though his drinking was social and "normal". One day (while we were visiting his mother) he drank vodka before leaving the house for reasons that are unclear to me and also to him at this point because the interaction between the alcohol and SSRI rose his BAC to toxic levels. The result of this interaction was a completely crazy person... just out of control drunk. When he sobered up he told his mom and dad that he did not want to return to the bay area and that part of the reason is due to his drinking.

Apparently he was doing a lot of drinking in secret. So much so that when we cleaned out his apartment to vacate it we found bottles wrapped in paper and hidden all over the house. He was living alone, couldn't he just throw them away? I suspect that he was hiding the problem even from himself, although we found a hand written referral to a treatment facility in SF.

I never thought our relationship was in danger. He was never mean, cruel or abusive to me. There was a three day period when he didn't speak to me following a argument on the phone which scared the hell out of me, but other than that I believed I was in a happy relationship that was suffering the consequences of long distance. The little arguments that we did have were all out of frustration which comes with trying to maintain a relationship one two visits per month. Thought that all would be right again when I moved up there.

I am proud of him for admitting his problem and asking for help. He is a strong willed man, almost to the point of stubbornness and I have little doubt that if he decides not to drink anymore, that he wont stick to that. However, I feel like the members of Alanon think I am crazy and being unrealistic. To the point that in a Alanon chat meeting last night they told me that it would NEVER work if I didn't also work my Alanon program and that Alanon is the only way. As a mental health professional I appreciate that the program may work for them, but don't feel that it is right for me, at least at this point... I am still giving it the recommended 5-6 tries.

When I discovered your website I immediately drawn to your statement picking up where the medical model left off. If alcoholism is a disease, what about the antecedents to it? My boyfriends mother compares it to cancer, but i think if anything it should be compared to situational diabetes. Meaning that if someone develops diabetes as a result of poor eating and lack of exercise, they have a disease, but it occurred because of actions that they took or did not take. Can someone who has never had a drink contract the disease of alcoholism? I don't think so... but someone who makes unhealthy choices about drinking can. I hate that she keeps calling him sick. Its hard for me to think of him as sick, but easier for me to think of him in terms of falling victim to something that he contributed to, but may have also been preconditioned genetically for. Does that make sense?

He still has 40 days left in treatment as he decided to participate in Betty Fords step down program as well. I have no idea what to expect of him when he is out as our communication is VERY limited (only phone calls on Saturdays and short visitation on Sunday). I feel like I have to at least wait until he is "out" before I can make any decisions on the future of our relationship. I don't think it would be helpful to me to make any rash decisions. To take care of myself I went to my first Alanon meeting Monday. Sought out therapy with another MFT Intern at a counseling center focusing on addiction and took a meditation class tonight to try to find some peace within myself.

I look forward to your input and thank you so much for taking the time to answer.

Response from Daniel....

Drinking at odd times by himself in secret, out of character behavioral changes while under the influence that deviate from what you'd normally expect and hiding bottles around the house are clear indicators of alcohol dependence. It sounds like your boyfriend came to the conclusion that he has an alcoholic problem and sought treatment on his own, probably upon realizing that the problem was bigger than he (and you) thought or wanted to believe it was, and bodes well for his prognosis as it means earlier intervention, short of bottoming out and that he is not completely in denial. He appears self-motivated, aware that he was his social environment needs changing, that he is out to save himself and perhaps the relationship. Presumably he is currently undergoing treatment for depression as well alcohol dependence (dual diagnosis).

Continued self-work in individual therapy and Alanon could go a long way towards how learning to effectively deal with his potential to relapse after completing the program, as well actual relapses if they happen. Fear not that Alanon is not the only only of such guidance, but it is up to you find alternative resources. Certainly, attend the 5-6 meetings, see how you feel and write back summarizing your experience. The trap you don't want to slip into is working his program for him (co dependently), taking on responsibility that is his alone. It may help to establish a zero tolerance in your relationship regarding any future drinking, and a action plan regarding what he will do if he does happen to relapse.
In response to your questions regarding how the disease concept may or may not apply to alcoholism, I will highlight some main points in The Relationship Model of Addiction. Even if a person had never had a drink, the potential to become alcoholic will loom depending on predisposing conditions and understanding etiology. Although subjective, the level of pre-existing pain from unconscious unmet emotional needs determines the level of risk of becoming dependent, if not on alcohol, on some other activity that brings relief, i.e., other substances, gambling or porn. Rather than seeing alcoholic as a disease, which it is given that it meets basic criteria to be viewed as such, look at addiction as a relationship with a source of relief, and that recovery requires making the transition from unhealthy, non-emotionally nourishing relationships to healthy, emotionally nourishing ones, including the relationship with oneself. Shift the focus from genetic or bio-chemical factors to the level of emotional pain that originates from family of origin relationships as well as current ones, and how one has learned to cope with or relieve that pain. Also, understand that given his relationship with alcohol, the odds are that he will never be able to drink alcohol in any amount without putting himself at risk of quick progression and self-destruction. As long as he learns to develop internal resources, relationship building skills and utilizes his support system he is less likely to relapse.

Keep your sights set on his completion of the program and continue taking care of yourself all the while.

I Just Found Out My Partner/Boyfriend is an Alcoholic. What Should I Do?

I am an MFT Intern in Southern California and just discovered my partner/boyfriend has an alcohol problem. He asked to enter rehab and is currently at The Betty Ford Center. I have shied away from addiction in my career and focused on DD and SED children. I have no idea where to start in supporting him and myself and have HUGE problems with, what I find to be, the victimizing language of Alanon. So, do you have any suggestions for me? I love this man, but not more than I love myself and my sanity.

Response from Daniel....

(Just some general questions...how did you discover the alcohol problem? How was it handled? What specifically was communicated? Was it clear that an alcohol problem was wrecking the relationship or could wreck the relationship? Did he decide to enter treatment on his own or was responding to pressure coming from you? Was this his first treatment?)


Great questions. Discovery of alcohol problem in a relationship... How do you support yourself? How do you support him? How can Alanon be used in a constructive way in the overall scheme of things?

When you say that your love for this man is not greater than your love for yourself or your sanity, you sound healthy, alive, present, a person who is self-aware, who relies on and values herself. You're certainly on the right track to avoiding the trap of a victim role or state or even being at risk of such when self-preservation is the number one priority. Growing and learning to develop oneself, the relationship you have with yourself so that you're no longer depending on sources (others) outside of yourself for emotional sustenance or relief are part of the recovery journey. It should not be considered unusual or surprising necessarily to find yourself with an addict, as addiction is so rampant, so many people in so much pain. Yet, at the same time. being with an alcoholic for the first time can and will poses challenges you are seemingly ready to face. You might discover that there are unconscious unmet emotional needs driving you and drawing him to you; in short, some unmet needs uncovered, some unresolved. You might uncover some unresolved, deep-seated co-dependency issues. Some individual therapy with an addiction specialist may be on order just to serve as a reality check, keep you on the right track.

In terms of Alanon, you may look at Alanon as an opportunity to learn about addiction, how addiction affects those around and in relationship with addicts, rather than automatically equating co-dependency with victimization.

In terms of supporting him... the more you're able to maintain clear boundaries and distinguish between his problems/issues and yours, and who takes responsibility for whose problems, you'll be supporting him. Understand that commitment to recovery requires strict adherence to a program of practice on a daily basis, that recovery is a discipline of developing sources of support and guidance, a track of self-work maintained only when there is sufficient internal motivation to do so. You could be supportive by acknowledging his courage to acknowledge a problem, his willingness to seek help. You could also discuss what his program is with him. The more is able to talk about it, the more clear his challenges will be and be able to prepare himself accordingly, with some vital support in place. You could also acknowledge yourself -- your desire to learn more about how to best support him without compromising yourself by attending (some, perhaps) Alanon meetings or seeking of venues to enhance your understanding of potential pitfalls..