deaths, separations, and losses which are not effectively resolved or mourned. The homeostatic family processes and feedback mechanisms make heroin abuse a likely response for coping with the overwhelming stress associated with the loss experience. Drug use further serves to keep the abusing member helpless and dependent on the family, a process which unifies and sustains family intactness. Within the complex set of interlocking behaviors, there is an overall sense of hopelessness and a lack of purpose or meaning in life which accompanies the repetitious cycle of family transactions.

THEORY OVERVIEW

DEATH AS A PSYCHOSOCIAL ISSUE

Death has conventionally been regarded as the logical cessation of life, the other end of the birth phenomenon. Except for its relationship to theological issues and philosophical thought, death was associated most often with the terminally ill or the elderly. In recent years, however, views of death have changed. In the late 1960s, Kubler-Ross undertook her classic study of dying patients and delineated four stages which terminal patients seem to experience prior to their death. Subsequently, she expanded her original work and presented her view of death as the final stage of human growth (1975). This idea of death as an integral part of life was shared by Becker (1973), the major theme of his psychological mystico-religious writing being that death served a central function to all mankind.

Beyond the view of death as an individual experience is the concept of death in its social context. Some years ago, Hamovitch (1964) and Wahl (1960) suggested that the family system of the dying person had not been given enough attention. The dying person does not die alone but in relationship to others--family, friends, etc. (Pattison 1977). Kastenbaum and Aisenberg (1972) propose that the dying member assumes special status in the family and may even serve as a symbolic representation of all of the family's deceased ancestors. They give particular attention to the social participation imposed by death, a view first expressed by Slater (1964), who was intrigued by the way people surround the corpse at a funeral, giving it love and attention. Kastenbaum and Aisenberg add to the notion that death accelerates group interactional processes by noting that the dying person also participates in idiosyncratic rituals related to the terminal condition. This causes the dying person to become a participant in his or her own death. The authors feel that the closer one is to death, the greater the probability of becoming an active part of the process.

The functional or purposive nature of death suggests that it may precipitate additional types of behavior. Recently, Eisenstadt (1978) proposed a theory of the eminence of genius as a consequent of parental bereavement. Eisenstadt states that there is a creative mourning process that "is related to a sequence of events whereby the loss triggers off a crisis requiring mastery on the part of the bereaved individual. . . . If the crisis is worked through, that is, if the destructive elements and the depressive features of the experience of bereavement are neutralized, then a creative product or creatively integrated personality can result." Eisenstadt suggests that a major intervening variable between the death of a parent and the desire for fame, eminence, and occupational excellence is the nature of the family unit

prior to the disruptive period preceding the death. The author offers support for his theory by reconstructing parental loss profiles of 699 eminent persons who experienced early loss of one or both parents. Comparative orphanhood data from the general population, i.e., actuarial information, indicated that the eminent group had a considerably greater degree of parental loss. Comparisons with delinquent groups, however, showed that they were orphaned at rates comparable to those found among the eminents. Thus, Eisenstadt suggests that the critical issue is not necessarily the loss itself but the way it is mastered; the eminent group seemed to invest considerable energy in intellectual pursuits, which may represent one creative approach to coping with bereavement.

The important question arising from Eisenstadt's theory is, what happens when bereavement is not mastered? The delinquency data suggest that the inability to mourn creatively may well be a function of family characteristics which emerge at the time a member dies. If this is the case, the important variable is not death but the family transactions and interrelationships that lead to the successful or unsuccessful resolution of death.

Death, Loss, and Separation

Background. The basic tenets of the present theory were developed several years before Eisenstadt's work was published (Coleman 1975), but the central concepts are remarkably similar. The foundation of this theoretical model lies in a study that I began in the early 1970s. From doing therapy with recovering heroin addicts and their families, I observed somewhat serendipitously a recurring pattern of unusual deaths which had occurred many years earlier, yet which still seemed to have profound effects on the surviving family members. This led to a pilot investigation of the histories of 25 drug addict families, the primary purpose of which was to determine the prevalence of death in two generations, i.e., the family of procreation and the family of origin. Severe or life-threatening illnesses were also studied because critical illness is so often followed by death. Only the untimely, premature, or unexpected deaths were quantified; deaths resulting from normal aging processes were not included in analyzing the data. Thus, the majority of deaths included in this study took place during the addicts' or parents' developmental years. Results indicated that some families felt the impact of more than one death; 18 (72 percent) experienced at least one traumatic or unexpected loss of a loved one. Seventeen (68 percent) were witness to a severe or unusual illness, and a similar number of families had an alcoholic parent or sibling in either of the two generations studied. When the variables were combined, 13 families (52 percent) experienced death and severe illness, and 12 families (48 percent) were found to have death and alcoholism in their backgrounds. Eleven (44 percent) of the families had a combination of illness and alcoholism, but when alcoholism was subsumed under the category of illness, there were 24 families affected. The latter figure suggests that 96 percent of all the families studied were in some way affected by either alcoholism or some other chronic debilitating illness. Nine families (36 percent) experienced a combination of death, illness, and alcoholism. Although this was not a controlled study, these data suggest that this is an area that needs further systematic investigation. Further clinical evidence of the significance of death to addict families emerged from findings that death and death-related issues were major

themes in my group therapy sessions with siblings of recovering addicts (Coleman 1978a,b). In addition to talking about death, this small group of 20 preadolescents experienced several traumatic family deaths during the course of the two-year project.

Supporting Research. A comprehensive review of the literature on death, separation, and loss appears in previously published literature and will not be elaborated upon here (Coleman and Stanton 1978; Stanton and Coleman 1979; Coleman 1979a). It is important to emphasize, however, that there are three central sources of support for viewing death and death-related phenomena as major theoretical compo

nents.

The first is that addict deaths at an early age occur relatively often, suggesting that there may be an intrinsic suicidal element (Coleman and Stanton 1978; Stanton and Coleman 1979). The discrimination between intentional and accidental drug overdose is difficult and goes beyond the purpose of this chapter; however, it is important to note that death is a frequent corollary to drug-abusing behavior.

In addition to the statistics on addict deaths, and more central to this theoretical position, is the degree to which an unusual number of untimely deaths occur among addict family members. Supportive evidence for the data presented in the pilot study discussed earlier (Coleman 1975) indicates that there is a high incidence of early loss of at least one of the addict's parents due to death (Ellinwood et al. 1966; Blum and Associates 1972b; Miller 1974; Harbin and Maziar 1975; Klagsbrun and Davis 1977). It is interesting to note that a more recent study on treatment outcome (Harris and Linn 1978) found that one of the few background characteristics that significantly differentiated heroin addicts from nonheroin drug users was that the heroin addicts were more likely to have experienced the death of their fathers before the age of 16.

Second, the prevalence of death symbols further reflects the unique role which death plays in addict families. From my study of the roles, communications, and interactions within the 25 families (Coleman 1975) three symbolic, death-related phases could be distinguished on the addiction continuum, i.e., the imminence of death (early drug use); the funeral (removal from the home to a residential therapeutic community); and the resurrection (family treatment). In this sense addiction is analogous to a slow dying process. Coleman and Stanton (1978) suggest that addiction facilitates the family's death-related participatory behavior. By treating the drug abuser as if he or she is going through a slow, tedious death, the family members are able to perpetuate (vis-a-vis the addict) the premature and unresolved death of a former member. The addict thus becomes a substitute or revenant of the deceased. This is consistent with Stanton's (1977b) view of the addict as the sacrificial member who martyrs himself/herself in order to fulfill the family's need for a death. Stanton considers that the addict's role as "savior" allows the family to become mutually involved in a suicidal conspiracy.

Finally, in addition to separation caused by real death, any type of familial disengagement is particularly difficult for addict families. Stanton (1977a, 1979d) and Stanton and Coleman (1979) have written extensively about the conflicting elements of separation and doubt that it is mere coincidence that drug use becomes intensified during adolescence when separation conflicts are at a peak. As Stanton et al.

(1978) point out, heroin abuse is a "paradoxical resolution" to growing up and leaving the family. The drug permits the user to leave as a means of establishing some independence, but it also facilitates the return to the hearth when it is time to "crash." This perpetuates the cyclical pattern of leaving and not leaving, keeping the heroin addict straddled between home and the outside world of drugs. The profound conflict which separation presents for these families has been discussed extensively in other publications.

Religiosity and Philosophical Meaning of Life

Akin to exploring the role of death in addict families is the investigation of the function of religion' in family life. The family's religious beliefs or philosophical systems of thought are apt to be the major interface between death and the future pattern of adaptation. A sense of faith may either alleviate or exacerbate the concomitant sorrow, rage, and guilt that accompany or follow the loss of a loved one. Feifel (1959) feels that, in addition to other factors, one's religious orientation and coping mechanisms are strongly related to that individual's personal reaction to death. The major thesis underlying Frankl's (1963) logotherapeutic system is that the primary life force is the search for meaning. He suggests that the loss of feeling creates an "existential vacuum" in which one lacks a rationale for living, thus creating hopelessness and despair. He even explains alcoholism as a function of the "existential vacuum" and further suggests that the frustrated will to meaning may be compensated for by the substitution of a will to pleasure. Could one then suppose, in view of such a theoretical premise, that drug addiction is also a means of coping with the spiritual void?

In Blum and Associates' (1972b) study of high- and low-drug-risk families, the role of religion was found to be significant with respect to the developmental trend of its inception. For example, high-drugrisk families were uncertain about their belief in God and tended to allow their children to determine their own beliefs. As the children began to reach preadolescence, however, the parents became worried and began to consider forcing their children to become exposed to formal religion. In contrast, the low-drug-risk families affirmed a strong belief in God's existence during the early childhood years but after adolescence did not insist on church attendance. They felt that they had instilled the foundations for belief and were not preoccupied with religious participation, per se. It is important to note, however, that Blum and Associates' definition of religion is a traditional one and refers to church attendance and formal doctrine as opposed to the broader concept used in the present theory.

Although these findings are interesting, it is felt that the nature of the interactions between child and parents is perhaps more important than the specific religious practices in which they are engaged.

'Religion, or religiosity, as used here extends beyond formal doctrine and includes any system of philosophical belief which represents a specific view about the meaning of life. Thus, the term "religion" embraces a sociological view or weltanschauung that includes the conceptualization of the purpose of one's existence. This is considered as one of the motivating forces which guide purposive behavior--an internal determinant, to some extent, of one's life process.

Kastenbaum and Aisenberg (1972) relate object loss, in the form of death, to alienation from God in that significant loss tends to increase the fear of further loss. In addition, they suggest that the fear of what happens after death can be involved with the threat of punishment. Such fears can result in severe alienation from God and religion, which again impinges on the role of rejection. The loss or lack of a belief system may, especially in conjunction with the loss of the loved one, produce even more feelings of despair, helplessness, and loss of power, thus reinforcing the depressive state. In a study focusing on religion as a critical influence on attitudes toward death among religious and nonreligious students, Alexander and Alderstein (1959) found some significant differences, yet failed to find the anticipated degree of variance. The authors explained the results as indicating that both groups had a religious belief system and were not in doubt or conflict about their religiosity.

Although some of the evidence is still inconclusive, there is overall consensus that, with regard to alcohol abuse, religions that support abstinence are apt to have fewer problem drinkers among their populations (Maddox 1970; Snyder 1958; Gusfield 1970). Even more significant than doctrinal orientation toward alcohol is the evidence that religion is a consistent predictor of those who can be expected not to use drugs. Although the data have not sufficiently explained the reasons for the relationship between religion and drug use, the association between the two is supported by results from a relatively large number of investigations (Gorsuch and Butler 1976a). These authors suggest that the correlation between religion and abstinence may be due to the fact that an individual's basic needs are most likely to be met by traditional parental socialization factors, which generally include the institution of religion. This conclusion appears even more likely when it is considered in conjunction with Blum and Associates' (1972b) findings that youngsters from traditional families, regardless of social class, race, or ethnicity, are least apt to engage in drug usage.

The drug experience itself is steeped in what might be considered a hybrid version of contemporary religion. The administration of drugs is surrounded by ritual, including verbal and nonverbal gestures, music produced by instruments that emit unique, captivating, and haunting sounds and an aura of mystical sacrifice. The spiritual state that evolves during the "high" imposes a sense of love, awareness, and communion. Perceptions are heightened during intense drug experiences which alter the state of consciousness and create a sense of being at one with others and with nature. These rites can readily be compared with traditional religious ceremonies or services and the powerful gestures of the priest, minister, or rabbi in regal garb. The experience derived from the induction of drugs simulates the effect of the choir and the resonating organ.

It is also important to consider some of the recent treatment alternatives for drug addiction. Religious groups such as Hare Krishna and the born-again Christians are often successful in converting the drug addict into a religious advocate. The strength of newfound "religions" in diminishing drug use indicates that, at least for some addicts, adopting a belief can make an important difference. The fact that the Eastern religions tend to dominate is particularly pertinent. This may be due to the fact that Eastern philosophy is more readily integrated into one's daily life.