The Alcoholic Family

The Alcoholic Family

A Systemic Lack of Responsibility for Self

“… Bowen Theory can be helpful
no matter whom the client is!”
— Kevin Cundiff

How to develop a drunk in 8 or more easy steps (with apologies to Murray Bowen)?

Start with an imbalance of responsibility among family members, toss in 100-year-old patterns of family emotional isolation, simmer over a large base of chronic anxiety, season with some acute stressors and then note:

  1. The more the family is threatened by irresponsible drinking behavior, the more anxious they get;
  2. The more anxious they get, the more they become critical;
  3. The more they become critical, the greater the emotional isolation;
  4. The greater the emotional isolation, the more the alcoholic drinks;
  5. The more the alcoholic drinks, the higher the anxiety;
  6. The higher the anxiety, the greater the criticism and emotional distance;
  7. The greater the criticism and emotional distance, the more the drinking becomes problematic;
  8. The more the drinking becomes problematic, the more the family is threatened by irresponsible drinking behavior, and the music goes ‘round and ’round, Whoa-ho-ho, Back to number 1.’

Voila! A fully decompensated alcoholic. Even Bobby Flay would approve. As the family more and more organizes itself around caring for the alcoholic, it loses its ability to deal with normative life cycle changes, and fails to develop and evolve.

So as the hole in the bucket gets larger and larger dear Liza, how do we help the family keep from seeping deeper and deeper into the ground?

Ronald B. Cohen, MD of Family Focused Solutions discusses alcoholism and the family.The answer may not be blowin’ in the wind but modification of family relationship patterns may help alleviate the severity of the decree. Helping the alcoholic family starts with inquiries about developing increasing levels of functional differentiation and solid self, working to diminish levels of fusion and/or emotional cut-off, i.e. helping all interested and committed family members to become more productively responsible for their own behavior.

The good news is that even if the one who is drinking alcoholically refuses to engage in the therapeutic process, he or she cannot sabotage it. It only takes one motivated family member, committed to change his or her behavior in the context of family relationship dynamics, to improve the entire family’s functioning. A change in functioning of one family member is automatically followed by compensatory changes in other family members.

The Bowen Family Systems Theory approach understands individuals who drink alcoholically, as part of a family unit that has a multigenerational history that has led to this behavior. Alcoholism and chemical addictions affect the psychology of entire families. Intergenerational patterns of power, loss and control (imbalances in responsibility, functioning and adequacy) transmit poisonous attitudes from parent to child.

These unresolved problems often remain even after sustained sobriety. And because over- and under-functioning in families and relationships provides a welcome mat for alcoholism, substance abuse and chemical dependence, therapeutic interventions are aimed at modifying ineffective and inefficient family patterns in which symptomatic behavior is embedded. This necessitates a re-organization of the family in order to establish healthy relationships, adapt to new roles, address other family issues and help achieve desired levels of intimacy.

The goal is to solve problems in current relationships so as not to leave a damaging legacy for the next generation.

Best of luck on your unfolding journey of a lifetime.

Please share your thoughts and experiences concerning The Responsibility Trap of Alcohol in the “Leave a Reply” box below. If you found this post helpful, please don’t keep it a secret. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page and share this article with your own networks. To request more information please click here. Looking forward to continuing the conversation.

Ronald B Cohen, MD, PC Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530

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  1. hyacinth Charles on October 25, 2014 at 6:02 am said:

    Hi Ronald,

    We miss your posts on Family Health Counsel. Please come back!


  2. SHenson on October 27, 2014 at 8:10 pm said:

    You’ve painted a very interesting picture. I believe, however, that Bobby Flay would want you to deconstruct, not decompensate, the alcoholic.

    • Ronald B Cohen, MD on October 29, 2014 at 8:55 pm said:

      Hi Shellee,

      Thank you for your question and observations. As a systemic thinker for whom life is rarely, if ever, either/or and almost always both/and, I would respond that the simple answer is yes. Since I never met Bobby Flay and ethically cannot comment on the mental status of anyone I haven’t directly interviewed, I am not able to speak to his thoughts. The word I did intend to use was decompensate which in the medical vernacular refers to the loss of physiological function or psychological balance.

      Episodes of decompensation, according to the Social Security Administration (SSA), include:

      1. A temporary worsening of symptoms
      2. A loss of the ability to adapt to normal changes and stress, and
      3. Difficulty with normal activities of life, including concentrating, being persistent at tasks, pacing oneself, or maintaining social relationships.

      In short, an episode of decompensation refers to a time when you experience an increase in symptoms and a loss of function.

      As for deconstructing the process whereby an individual begins drinking alcoholically, that was what I hoped to do in the eight steps at the beginning of my blog post. Hope this helps.


      — Ron

  3. Claudia on November 13, 2014 at 7:24 pm said:

    Ron, this is really good stuff, but would be so enhanced with a story. For example, of what a person who decides to change the family system might do differently or say differently…

    I’m like to feature you in my GaiamTV blog but would need more stories…

    -claudia luiz

    • Ronald B Cohen, MD on November 17, 2014 at 2:00 am said:

      Hi Claudia,

      Nice to hear from you. I am both honored and humbled by your offer and request. I have stories galore. Please let me know the format in which you would like them. Looking forward to a productive collaboration.


      — Ron

  4. sheryl simons on November 16, 2014 at 3:51 am said:


    I appreciate your articles so much! They are very helpful. I would greatly appreciate some clarification. So, from a Bowenian point of view, if the “critical” one just stops the criticism, might that be enough to stop the cycle? Would there be any other steps a person might take to calm the family anxiety? It seems as if the alcoholic suddenly had free drinking privileges, he may drink more, then it might taper off. Any comments here are appreciated.

    • Ronald B Cohen, MD on November 17, 2014 at 1:45 am said:

      Hi Sheryl,

      Yes it would “stop the cycle” but no it would not create, cause or necessarily result in sobriety. While BFST helps initiate change even when the alcoholic denies the problem and is unwilling to seek help, sobriety remains the responsibility of the individual who is drinking alcoholically.

      There are far more non-alcoholic family members than alcoholics and they are all affected by the relational trauma of alcohol abuse and dependence. These far-reaching traumas include marital discord, abuse, neglect, chaos and unpredictability. What often happens is the family organizes itself and becomes rigidified around caring for the alcoholic and so it loses its ability to deal with normative life cycle changes and fails to develop and evolve. While waiting for sobriety, many families fall apart.

      It is crucial to work with family members on their resistance to change in their own roles. This necessitates a re-organization of the family in order to establish healthy relationships, adapt to new roles, address other family issues and help achieve desired levels of intimacy. Therapeutic interventions are aimed at modifying ineffective and inefficient family patterns in which symptomatic behavior is embedded. Taking responsibility for what you can take responsibility for, and attending to your needs in the context of emotionally important relationships opens the door to facilitating healing of the entire family.

      Intergenerational effects include cutoffs and other disruptions of the family career. Family therapy can help families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another. Children are molded by the alcoholic family to be either over-responsible (calm, efficient, but lonely and filled with self doubt) or under-responsible (filled with rage, demanding constant care and praise, but filled with violent resentment towards anyone that helps them). At the same time over- and under-functioning in families and relationships provides a welcome mat for the development of problems with alcohol and addictive chemicals.
      The intergenerational impact may be the most significant reason for addressing family dynamics. Reorganizing the family to stabilize and rebalance the system has long term benefits. Healing family relationships helps reduce the impact of addictions on future generations.


      — Ron

  5. Joan on November 21, 2014 at 11:52 am said:

    Your points are so succinctly made. I’m in awe. Obviously, you have plenty of experience. I want to read more and will. Thank you.

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