Family Therapy for Alcohol Dependence

Abstract

　The author recently had an opportunity for performing family therapy for a patient of alcohol dependence who had experienced 5-time-hospitalization. The patient was a 45-year-old male public official under suspension from his duty. The family comprised of IP (the patient) and his parents. In 1986, he divorced his wife and their children were decided to be looked after by the latter. Our department was requested to perform psychotherapy for the patient while he was an in-patient of alcohol dependence and hepatocirrhosis in the department of internal medicine of a hospital. In hospital, he did not drink a drop of spirits as en exemplary patient, but upon leaving the hospital, he began to drink from that evening and uttered wild words and used violence to his parents. He was made to enter the hospital at that limit of the tension of his parents. This vicious circle of behavioral sequence was repeated 5 times.

　The therapeutic plan of our department for this patient was as follows. Antidepressants for his observed depression and weekly conjoint family therapy. First, complications between the patient and his parents were promoted so that he can speak out soberly the context of his opposable arguements to his parents which he could have done only by drinking. He often fell into silence when found himself in a situation disadvantageous to him while talking with his parents, so that the therapist urged him to assume a glass of water as alcoholic drink, facillitating his open arguments. Consequently, he becames gradually opposable without using a glass of water.

　He left the hospital after 6 months hospitlization, but 3 days after he drank again and used violence to his parents. Then, the therapist visited his own house: he became gentle in the presence of any other persons but for his family members. The therapist intervened in his selection of whether he enters a department of psychiatry in a Tokyo hospital through the therapist’s introduction or return to work. As a result, he preferred the latter and went to work for 2 months and a half from a hotel, separately from his parents. On Oct. 21 he drank at his own house and used violence to his parents as usual, returning to the previous drinking condition. His parents becames sleepless because of his violence and hoped his hospitalization. For fear of his repeating vicious circle, the author make him enter a special hospital for alcohol dependence in Tokyo through the author's referral late in November.

　After all, the treatment was a failure for this case. The therapist, who could not help the patient to establish autonomy from his parents, seems to have been involved in a vortex of familial troubles. The author reports the present case, together with some additional reflections as the therapist.