Ideas / Alcoholism

Alcoholism

Steiner's first major contribution to the field: a Transactional Analysis approach to understanding and treating alcoholism that challenged prevailing assumptions and offered genuine hope that problem drinking can be resolved, not merely managed.

Applying TA to alcoholism

Steiner's interest in alcoholism began early in his career, and his 1971 book Games Alcoholics Play was his first published work. It represented a significant departure from how problem drinking was understood at the time, and in many ways it remains a challenge to conventional thinking.

Using the framework of Transactional Analysis, Steiner analysed alcoholism not as a disease that happens to a person, but as a pattern of behaviour sustained by specific interpersonal dynamics. In TA terms, the person with a drinking problem is engaged in a set of "games": predictable, repetitive sequences of interactions that produce familiar outcomes. These games involve not just the drinker but the people around them: partners, family members, friends, and even professionals.

This perspective was important because it shifted attention away from the drinker as an isolated individual and towards the relationships and social systems that sustain the behaviour. It also implied something radical: if alcoholism is maintained by games, and if games can be identified and interrupted, then alcoholism can be stopped. Not managed. Not kept in remission. Actually resolved.

The interpersonal dynamics of problem drinking

Steiner identified several recurring patterns in the relationships surrounding alcoholism. In each pattern, the people involved adopt complementary roles that, despite appearing to address the problem, actually perpetuate it.

One common dynamic involves a rescuer: someone who takes responsibility for the drinker's behaviour, covering for them, making excuses, managing consequences. The rescuer's actions are motivated by genuine concern, but their effect is to shield the drinker from the natural consequences of their choices, making it easier to continue drinking. Meanwhile, the rescuer receives a psychological payoff of their own: a sense of being needed, of moral superiority, of control.

Another pattern involves persecution: harsh judgment, punishment, ultimatums. This approach feels like the opposite of rescuing, but Steiner argued that it serves the same function. Persecution provides the drinker with a justification ("I drink because you're so hard on me") and reinforces the belief that the situation is hopeless. The persecutor, like the rescuer, is participating in a game that keeps the drinking going.

Steiner's analysis was not intended to blame family members or loved ones. It was intended to help everyone involved understand the dynamics they were caught in, so they could make different choices. The games are not anyone's fault; they are patterns that people fall into because they do not know there is another way.

Cure, not management

The most controversial aspect of Steiner's approach was his insistence that alcoholism is curable. The dominant model, associated with Alcoholics Anonymous and widely adopted by the medical profession, holds that alcoholism is a chronic disease. A person who is an alcoholic remains an alcoholic for life, even if they stop drinking. Sobriety is maintained through ongoing vigilance and the acknowledgment that the disease can never truly be overcome.

Steiner rejected this framing. He argued that calling alcoholism an incurable disease disempowers the very people it claims to help. If you believe your condition is permanent and beyond your control, you are less likely to make the sustained effort needed to change. Steiner believed that people who understand the games they are playing, who develop the emotional skills to meet their needs without alcohol, and who change the interpersonal dynamics that sustain their drinking can genuinely recover. Not just stop drinking, but reach a point where the compulsion to drink no longer operates.

This position remains controversial. Many addiction specialists disagree with it, and Steiner himself acknowledged that his approach was not suitable for everyone. But for those who found the disease model disempowering, his framework offered an alternative grounded in personal agency and the possibility of real change.

How this approach differs

Several features distinguish Steiner's approach from both the twelve-step model and purely medical approaches to alcoholism.

First, it is interpersonal rather than individual. The focus is on the relationships and dynamics around the drinking, not just the drinker's internal state. Treatment involves not only the person who drinks but, ideally, the people closest to them.

Second, it emphasises understanding over willpower. Rather than asking people to resist the urge to drink through determination alone, it asks them to understand why they drink: what emotional needs the alcohol is meeting, what games are sustaining the behaviour, what scripts are operating underneath it all.

Third, it is explicitly hopeful without being naively optimistic. Steiner did not promise easy solutions. He was clear that changing deeply entrenched patterns is difficult and painful work. But he refused to tell people that their situation was permanent, because he had seen too many people change to believe that was true.

If someone you love is struggling

If you are dealing with a loved one's drinking, our families page has practical resources, crisis contacts, and guidance on Steiner's approach.

Support for families

Further reading

Books

  • Games Alcoholics Play Steiner's groundbreaking first book, applying TA game analysis to the interpersonal dynamics of alcoholism.
  • Healing Alcoholism A more accessible, practical guide written for people dealing with problem drinking in themselves or someone they love.

Related ideas

  • Transactional Analysis The theoretical framework Steiner used to analyse alcoholism's interpersonal dynamics.
  • Life Scripts Steiner saw alcoholism as often connected to deeper life scripts formed in childhood.