Taken from our sister publication Irish America Magazine's latest Aug/Sept Health issue.
Casey Duffy will not be mistaken for anything but Irish – the lightly graying hair is clearly that characteristic red, and he has the prized hail-fellow-well-met manner. Long established in Pennsylvania, his family hails from both the south and west of the old country.
Nor will you mistake Casey for a drunk. He got rid of that decades ago. “I have a choice today,” he told me when we spoke this past June. “I can do what I want to do. Driving through Center City at noon last week, I looked in the bar window and I saw those guys on barstools with their drinks in front of them – they don’t have a choice. They have to be there.”
Casey readily acknowledges that the Duffy family has been in a struggle with addiction for generations. He dates the family story to his paternal grandmother, Jane, who lived in Corktown, a former Irish enclave of West Philadelphia. When her beloved mother died at home just around the corner, Jane was passed out drunk on the sofa. She never got to say goodbye. For penance, she foreswore alcohol. True to the oath she made on her knees at her local church, Jane Duffy never touched another drink. Succeeding Duffy generations didn’t, however, escape their own challenges.
Excessive alcohol consumption is, of course, an inescapable part of the Irish stereotype. “For all our success as immigrants, it is sad to say that we are still known as a race of drunks,” the late Dr. Garrett O’Connor, a respected psychiatrist and addiction treatment pioneer, wrote in a 2012 article for Irish America. “Even today, hard drinking, alcohol dependence, shame and ‘keeping up appearances’ are still detectable as historical undercurrents in the Irish Catholic community.” The problem persists on both sides of the Atlantic. Dublin born singer and alcohol counselor Frances Black, founder of the non-profit RISE (Recovery In a Safe Environment) Foundation, noted at a recent conference in Northern Ireland that “people are almost blasé about the extent and reach of the pernicious use of alcohol. Sometimes I think the whole of Ireland is in denial about it, but it’s a massive problem.”
In a follow-up conversation, I asked Black about her remarks. “I do believe that we have a very serious issue here,” she told me. “Everyone has to look at their own relationship to alcohol, and we need to talk about why we feel it’s acceptable to drink as much as we do. That’s difficult for us.” (For her work at RISE, Black was presented with the 2015 Emerald Spirit Award at the annual New York City Sober St. Patrick’s Day party.)
The U.S. Department of Health and Human Services estimates that some 14 million Americans (7.4 percent of the population) meet the diagnostic criteria for alcohol abuse or alcoholism. Other commentators suggest that 43 percent of adults in the U.S. have been exposed to a relation with an active substance use disorder.
When asked about statistical data on the prevalence of alcoholism and addiction in the Irish American community, Andy Pucher, President and Chief Executive Officer of the National Council on Alcoholism and Drug Dependence, expresses doubt that the state would keep track of figures based on ethnicity. “That would be labeling a community,” he says, confirming that an approximate instance of 10 percent in the population at large is realistic. He also doubts that prevalence in the Irish American community is any higher than in other communities.
Nonetheless, according to O’Connor, “Breaking the national silence about alcohol abuse and dependence in Ireland and Irish America needs to become a priority. Breaking the silence, and spreading the message that recovery is possible.”
“Anonymity has never really been part of our experience.” Casey responds. “My father – Jane Duffy’s son – was an attorney of note in the Five Counties [as the greater Philadelphia area is known locally]. He was an alcoholic who didn’t sober up until he was in his early 40s. He would be out drinking with clients, including his criminal clients, until two in the morning and then back in court for 9 a.m. His drunken escapades frequently ended up on the front page.” Eventually, John Duffy lost his license to practice law and, with it, the means to earn his living. John’s second-generation alcoholism was causing ever increasing and wide-ranging problems for his family.
“Family pain can pass through generations, from grandparent, to child, to grandchild,” argues therapist Ann W. Smith, author of Grandchildren of Alcoholics and clinical consultant to Breakthrough at Caron. “The dynamics of painful family systems are passed on across the generations.”
Dr. O’Connor could identify. “My own family history is, perhaps, a classic example of how alcoholism can be handed down from one generation to another,” he wrote in 2012, 35 years after his last drink. He describes a painful initiation into active addiction: “An attack of tuberculosis when I was 12 was treated at home with bed rest for eight months and up to three pints a day of stout. Gradually, I developed cravings for the relaxing effect of the alcohol – so much so that I took to searching the house for places where I thought my mother might have concealed her clandestine bottles of cheap South African sherry.” Of his experience, one story among many, O’Connor concluded, “This uniquely Irish treatment for TB launched me on the path to hard drinking by the age of 18, and to full-blown alcoholism by the time I was 27 or 28.”
Casey’s family story differs only in the details. “My grandmother gave up alcohol after her mother’s death and was a miserable ‘dry drunk’ for the rest of her life,” he says. “She was the most miserable woman you could meet.”
(For those unfamiliar with the term, a “dry drunk” is commonly defined as a person who has given up drinking and yet retains all the other aspects of the condition. “If the emotional or psychological side is [unhealed], the alcoholic can find themselves lazy, irritable, easily annoyed or quick to anger,” writes counselor and author Carole Bennett in the Huffington Post. “You may feel like you need to ‘walk on egg shells’ or watch every move or word since you don’t want to incite an angry exchange.”)
Dry drunk or not, Jane was mother to John Duffy, the first family member to fully embrace their recovery. “Just before my sixteenth birthday, my father John hit his bottom,” Casey recalls. “He found himself in treatment at Chit-Chat [renamed Caron in 1983 to honor its late founders, Richard and Catherine Caron]. Chit-Chat saved his life.” Caron’s Pennsylvania campus now includes a building named for John Duffy and his fellow alum, Ken Gill, to honor 30-plus years of service on the Board of Trustees, which Duffy also chaired. The Gill Duffy House was dedicated this June at a ceremony attended by generations of sober Duffys.
“I’m sure there were people who wouldn’t use my father’s legal services after he got sober, because of that stigma,” Casey reflects. “But because he got sober, he could help maybe twice as many when he got his license back. Service has been a huge value in our family ever since.”
In treatment circles, addiction is now recognized as a family disease with multi-generational implications. The National Association for Children of Alcoholics estimates that one in four children under the age of 18 lives with a parent active in addiction, just as Casey did. Cheryl Knepper, vice president of Continuum Services at Caron Treatment Centers, confirmed to Irish America that today, from a treatment perspective, “Addiction is understood to be part genetic predisposition, part socio-cultural environment, and it’s a disease that impacts the entire family.”
This last point is reinforced by Frances Black, who has made it her mission to support families through awareness, education and therapy, and to combat the associated shame and stigma which so often impedes recovery. “In my work, I see alcoholism impacting the whole family on a daily basis,” she says. “It puts a huge stress on the family if one person is using alcohol. All that worry, all the waiting for that dreaded phone call, can give rise to a host of stress-related conditions including mental health issues such as depression. There’s a ripple effect.”
Casey Duffy knows about the ripple effect. “As a child,” he remembers, “I watched what booze and drugs did to my father and to our family.”
“As the oldest son with six siblings, I worried that I might need to take care of everyone before I was capable.”
This exaggerated and inappropriate sense of responsibility is one of the hallmarks of children growing up with addiction.
Casey also believed, in common with many children of alcoholics, that he was never going to take a drink himself. “I didn’t ever want to be like my father. Watching what he was doing, I was never going to do that. I’d made up my mind.”
Despite his best intentions, John Duffy’s recovery couldn’t prevent active addiction manifesting in his eldest son. “What this 16-year-old saw was a father who had done whatever he wanted, whenever he wanted, to whomever he wanted, for years,” Casey recalls. “And when it finally crumbled around him, he went to treatment for 28 days, came home, and everybody loved him again. Well, I thought, now it’s my turn… ”
For the active addict, this distorted reasoning makes perfect sense. Describing the process, Tian Dayton, author of several books on family addiction and recovery and a leading practitioner of psychodrama, a group therapy practice using role play and dynamic interaction to explore and heal relationships, observes, “Because we’re trying so hard to hide the pain of watching ourselves and those we love become mired in the disease and losing our grip on our own happiness, we use our thinking to twist and bend the truth into a more palatable shape.”
It’s becoming increasingly understood that, when a parent suffers from addiction, it’s exponentially more likely that a son or daughter will also become dependent on the same drug or behavior. Dayton claims that, “Children of addiction are four times more likely to become addicts themselves, and these statistics don’t include multiple addictions such as food, sex, gambling, work addiction, etc.”
Today, Casey is under no illusions. “I believe in my heart that I was born an alcoholic,” he says from the perspective of several decades of sobriety. “Once I started, it was a one-way street. I wasn’t that average guy who can just have one or two. There was only one control mechanism in my life: I’d drink and drug virtually every day until I ended up where we all end up, in an institution or a cemetery.”
It took Casey just six years to discover his alcoholic “bottom,” a phrase used to describe that moment when the addict becomes ready to admit there’s a problem and reach out for help. He was twenty-four years of age. “In a nutshell: You could count on not counting on Casey,” he explains. “I was an ambitious guy who started blowing off my work and my future. I was a funny guy who turned sarcastic and bitter. I showed up late, under-dressed and under-funded. When I was ready to give up, I had no job, no credit, and no money.”
Because of his father’s experience less than a decade prior, Casey knew where to turn for treatment. “It was fortunate for me, because I saw what his life had been like. I didn’t have to crash and burn to the extent that he did, and I knew how to get help.” Casey says that getting into treatment gave him a “huge head start” on recovery. “I discovered the problem and I got some tools.” He’s been sober ever since, and there haven’t been any problems with his three children.
“It doesn’t seem to be an issue,” he says with gratitude. “But if it were, we’re ready! My grandmother gave it up and, with my father’s example, I got rid of it. For my kids, my gift will be that they don’t get on the elevator at all.”
Professionals treating addiction are extending services to embrace the impacted family members. At Caron, where Duffy father and son were both treated, Knepper says that engaging with the family and not just the “identified patient” seeking treatment is a key value. “We try to have the conversation about addiction with the immediate family and find out what they know about the disease, how it’s affected their family life, how they feel about the family member going into treatment, what their individual goals are for the treatment process.”
From the other side of the Atlantic, Frances Black adds that “We have to break the legacy through education and therapy. You can help someone who is in addiction, but they are still going to go back into an unhealthy environment because the family needs its own support and recovery.”
Knepper agrees. “We believe that the family’s active participation in treatment is necessary for everyone’s long-term recovery,” she says. “Statistics show that patients whose families participate in their drug and alcohol treatment have lower relapse rates than patients whose families are not involved.” According to Knepper, Caron offers robust family support and after care programs for just this reason.
“We practice ‘Recovery for Life’.”
Meanwhile, Casey is on a mission to promote treatment. He founded The Sober Samaritan to raise funds that will be used to provide treatment to an alcoholic and addict who has reached out for help. “It’s a three-fold mission,” he explains. “We also want to raise awareness and to generate participation from individuals and institutions not previously involved in the support of drug and alcohol treatment, and to lay a foundation that will support our ongoing efforts, support Caron, and the treatment of alcoholism and addiction.” It was a proud moment when Casey presented the first Sober Samaritan scholarship check to Caron president and CEO, Doug Tieman, in October 2007.
Following in his father’s sober footsteps, Casey now serves as chair of the Caron Board of Trustees and on the Caron Philadelphia Regional Advisory Board. “The treatment industry is changing almost on a daily basis,” he explains. “When I went into treatment, I was the youngest guy in the room. Now you have so many young people, especially with the opioid epidemic.” Casey confirms that the days of the “plain old drunk” are almost gone; just about everyone active these days is also using another substance. “It’s often harder for kids to get alcohol,” he says.
Another challenge is presented by the arrival into the treatment sector of for-profit providers, an unexpected consequence of the Affordable Care Act. Casey isn’t fazed by these developments. He stays mission focused: “Our job is to make sure that Caron is still offering the very best specialized treatments for another 50 years and beyond.”
Casey would undoubtedly agree with Dr. Garrett O’Connor, who found his personal mission “helping others to achieve sobriety.” Widely honored for pioneering work in his lifetime, he was the subject of fulsome tributes after his death last year.
“While my family story exemplifies the transmission of alcohol dependence across multiple generations,” O’Connor wrote, “it also shows that recovery – with all its gifts and miracles – can be transmitted in the same way.”
The Caron mantra summarizes the scope of the issue, “The family is the patient and the patient is the family.” Healing multigenerational addiction is an enduring mission.
Certified Addiction Recovery Coach & Peer Educator, Ruth Riddick is a 2015 Irish America Healthcare honoree and an occasional contributor to Irish America magazine. Her work is featured in the Field Day Anthology of Irish Writing.