From Alcoholic Enmeshment to Rational Recovery

Todd came to see me at the encouragement of his mother. He "talked the right talk" about leaving his drugs and alcohol behind, although he had a long track record of failed attempts. Todd had been in and out of residential treatment programs without success. This young man looked to me and rational recovery as his last chance to live a lifestyle free of the ravages of addiction.

I pushed Todd to explain to me, in every conceivable manner, how "this time" things would be different from all of his other failed attempts at sobriety. In a straightforward, yet probing way, I took him apart in the process of working to hold him accountable for his wasted life. Fortunately, he didn't run away from therapy.

Todd came to see me every week as we combined my cognitive-behavioral treatment with a local outpatient rational recovery program. Since the efficacy of inpatient substance abuse treatment programs is marginal, I felt that this would be a more effective treatment approach. This two-pronged strategy appeared to be the perfect mix. Naltrexone, a medication employed to stop the urges and cravings of alcohol was used with my patient. The goal of treatment was to focus on his lifestyle of excessive drinking and to rationally, reconfigure patterns of behavior that were consistent with a lifestyle of sobriety.

Todd began drinking when he was eight years old. His father would take him on camping trips and would provide him with hard liquor during their journey. Todd recalled his father handing him small, open alcohol bottles for consumption which had been purchased from the airlines. Todd reminisced about how he would eventually end up vomiting during stops along the way to the camping sites. According to Todd, his father was too "wasted" to be of any assistance to him.

This father and son drinking dynamic went on throughout Todd's adolescence. Todd began being admitted to residential treatment programs by the time he was thirteen years old. Each time Todd was placed in a rehab program for drugs and alcohol, Todd's father would make a special effort to visit him during recovery. Ironically, he would wish his son well and then would depart. On one occasion, Todd remembered his father drinking and smoking pot with him in their car just prior to his being admitted.

I found it fascinating that Todd never thought about the peculiar, symbiotic, outrageous abusive nature of his father/son relationship until we began exploring it. Even then, Todd deflected the experience through anxious laughter. As I "turned up the heat" on the emotional impact of what he experienced, Todd's vision of his past became clearer. He began to understand the betrayal, shame and humiliation foisted upon him by his father’s alcoholic enmeshment. It was painful for Todd to learn to hold his father responsible for the hurt, disappointment and destructive behavior he created.

As we moved through therapy, Todd was afraid of his anger and where it would lead him. We addressed that fear along with ways of coping with his enfeebled, alcoholic father in the present. Todd set more appropriate boundaries related to any contact with his father, and on several occasions broached the subject of his father's past behavior to no effect.

Todd learned to accept the fact that his father would never change, and that he would need to grieve and release a history filled with horrible memories. Todd's rational recovery, based upon cognitive-behavioral therapy, is working. He has a positive support system, medication for his urges and cravings, and takes full responsibility for his recovery. Every day is a choice about whether to allow his father to continue to have power over his life or to choose to forgo a pattern of drinking that started many years ago during his father/son camping trips.


{Note: This narrative is a composite. It has been deliberately altered in order to protect an individual’s right to confidentiality and privacy.}