Fragmented Intimacy: Addiction in a Social World

New York: Springer, 2008   (340 pages)   ISBN:  0387726616,    9780387726618


I recall during my early years as a clinical psychologist being asked by hospital staff to speak with a 32-year-old man addicted to alcohol who was being discharged following treatment for pancreatitis. This had been his third admission for the same illness, and hospital practitioners were exasperated by his choice to continue drinking despite being repeatedly told it would cause irreparable damage to his pancreas from which he would be unlikely to survive. I met him in a side-room on the ward. He sat in his pajamas in the corner of the room, thin and ashen looking, with a worried frown fixed across his face. Our conversation was initially stilted and I was trying hard not to replicate the lectures and sermons he was likely to have already received from hospital staff. As we talked I was able to piece together bits of information about his current circumstances: he lived alone, he was unemployed, and his only family contact was with a brother who visited to check on him occasionally. He started to relax into the conversation and then talked about his long struggles with alcohol: his drinking had begun in his early teens; it had provided him with confidence and friendships; he had had some serious motor vehicle accidents; he had tried to stop drinking but soon continued; he had lost friends, jobs, and family relationships; and in response he had increasingly sought intoxication as a refuge.

Fragmented Intimacy transcends familiar concepts of addiction by focusing not on addicts in isolation but on the social contexts that are disrupted and on the struggle that affects all those involved as they attempt to regroup and initiate change. Applicable to drugs, alcohol, and gambling, this engagingly written book offers both innovative theory and practice-strengthening interventions.

Peter Adams’ social-ecology framework examines in depth how addiction disrupts social identity, becoming the dominant relationship in a person’s life and leading thereby to a weakening of connections to family, friends, workplace, and community. It examines how in the long-term course of an addiction one-on-one counseling will have little effect unless it assists in the re-engagement of these core intimacies. The author enhances the reader’s understanding with vignettes of addicted individuals’ lives as relationships are altered (and insights from such chemically-intimate authors as Burroughs and Poe), new takes on the therapeutic relationship, and examples of families, neighborhoods, and communities mobilizing as powerful forces for re-entry.

A sample of the coverage:

  • Rethinking addiction through the lens of intimacy.
  • Social processes in intimacy versus social processes in addiction.
  • Effects of addiction throughout the individual’s social networks.
  • Opportunities for intervention at different stages of addiction.
  • Resilience building at the individual, family, and community levels.
  • Guidelines for family members in initiating change.
  • Using social approaches to complement mainstream forms of therapy—starting with assessment.

Fragmented Intimacy provides fresh perspective and new tools for frontline addiction counselors, clinical and health psychologists, social workers, and public health professionals while remaining accessible to the researcher or student in these fields. Its focus on the role of intimacy also provides a useful guide to family members in their response to addicted loved ones.