Alcoholism: The Genetic Inheritance [?]
by Kathleen Whallen Fitzgerald
Doubleday, $24.95
A Time to Heal
by Timmen L. Cermak
McClelland & Stewart, $22.95

The view that alcoholism is a disease to which some definable proportion of the population is genetically predisposed is singularly comforting. After all, if alcoholics are categorically different, then the rest of us need never question the wisdom of having wine with dinner or beer at the ballpark. We can drink and promote drinking with impunity. But the theory is much less widely accepted in the field of addiction than Kathleen Whallen Fitzgerald presupposes in Alcoholism: The Genetic Inheritance. She argues that the very term alcoholism should be replaced to highlight the idea that we are dealing with a medical entity that can be treated and healed. The essence of her position is that "those with Jellinek's disease have inherited a body chemistry that, in the presence of alcohol, produces the addiction, the disease."

Physical dependency is the central feature of alcoholism. The role of personal qualities and social constraints is minimal. The addiction cycle involves an increasing tolerance of alcohol and a concomitant rise in the biochemical craving for it. Because the toxicity of the alcohol does not decrease for the alcoholic, untreated alcoholism progresses to a certain end point: death. Any intervention process, then, should guide alcoholics to admit that they have a degenerative disease, to recognize that this disease is the primary cause of their problems and to accept that total abstinence is the only way to arrest it. Fitzgerald clearly favors intervention programs based on the principles of Alcoholics Anonymous, but discusses various other treatment options likely to be available to the alcoholic.

It is ironic that Fitzgerald so stridently limits her definition of alcoholism, for the intervention strategies she promotes are expressly designed to develop psychological insight and to dismantle the social and environmental supports for the alcoholic's behavior. Surely what is required is a broader view of alcoholism, encompassing inherited biochemical factors as well as sociocultural ones and the whole question of the addicted person's personality.

Although Timmen Cermak explicitly embraces the alcoholism-as- disease perspective, his focus in A Time to Heal is not on alcoholism per se but the psychological consequences of parents' alcoholism on children. As founder of the U.S.-based National Association for Children of Alcoholics, he writes to assure the adult children of alcoholics that there is hope for their recovery from a painful childhood.

Growing up with an alcoholic parent places a child under great stress. The child's needs are secondary to the alcoholic's. The child is emotionally neglected and may be physically ignored too. Communication within the family is closed and communication with outsiders often superficial, as the family strives to keep the alcoholic's secret. Not only do such dysfunctional experiences have an immediate effect on the child, but they continue to color his or her adult life.

Adult children of alcoholics lack many of the coping skills fostered within healthy families. They find it hard to gain insight into everyday problems. Feelings tend to overwhelm them. In some cases, the symptoms of post-traumatic stress resemble those seen in combat veterans: nightmares, an inability to feel emotion, a sense of being caught up in a chronic state of hypervigilance, and survivor guilt.

To illustrate the stages of recovery, Cermak draws on numerous case histories. The adult children of alcoholics must come to acknowledge the influence of their parents' alcoholism on their identity and must recognize that their lives have been distorted. The sense of unworthiness and personal unimportance must be replaced with self-esteem. Not until then can the healing process begin.

Whereas Fitzgerald turns to the research literature to support her discussion of treatment, Cermak relies heavily on his clinical expertise. He offers his own specific advice on how to decide whether therapy is needed and how to choose a therapist. Like Fitzgerald, he favors adapting the Alcoholics Anonymous approach to the needs of grown-up offspring, urging them to accept the impact that alcoholism has had on their lives. Fitzgerald's book and Cermak's each make only a small contribution to the field, but they're part of the larger effort to make us more aware of alcoholism's terrible impact on our society. Cynthia Fekken teaches psychology at Queen's University.