"Workaholism" is not a black-and-white matter. Just as "alcoholism" refers not only to the bum in the gutter, but to the relatively well-functioning professor who gets quietly soused every night, the term "workaholism" describes a wide spectrum of behaviors. For some people in my clinical practice, workaholism takes outwardly bizarre forms, such as working around the clock for three or four days straight and periodically catching a few hours' sleep in sweat clothes. For others, workaholism is subtler: work is the place where "life" really takes place, the secret repository of drama and emotion. Family and friends are little more than a vague, if pleasant, backdrop.

Many workaholics, I find, grew up in homes dominated by parental alcoholism, mood disorders or other problems that forced the children to take on adult emotional and practical responsibilities. They became gravely serious "little adults," and were young when they first forgot how to play. One star saleswoman I treated--who was afraid she'd be considered lazy if she took a lunch break--had gone to work picking tobacco and raking yards at the age of 12 in order to eat.

Members of Alcoholics Anonymous often speak of the moment they "hit bottom." The glamour peels off like old varnish, alcohol stops working for them and they can no longer think of themselves as simply "bon vivants" or "men-about-town." Workaholics, too, hit bottom: a spouse may threaten divorce; a long-ignored back problem or stress-related illness like psoriasis may become painfully disabling; or valued employees may quit, tired of trying to meet impossible deadlines. Many of the workaholics I see in private practice are dragged there kicking and screaming by their partners; others finally burn out, or get tired of being perceived as the impossible boss at work and the Nazi parent at home. I myself hit bottom in 1983, when I stopped thinking of myself as an extraordinarily talented and dedicated professional with so much to offer the world and realized how empty my life had become.

Up until then, I'd been proud of my workaholism, and well rewarded for it. Jamey might complain that I was never home--and that when I was, I didn't listen--but my university colleagues called me responsible and conscientious. Jamey might call me controlling, inflexible and incapable of living in the moment. But the promotions, accolades and fat paychecks that came my way built an ever-stronger case against his accusations, and I used them to further vilify him: Why couldn't he pull his own weight? Why couldn't he be more supportive? Why didn't he appreciate my hard work and the creature comforts it provided? Why was he constantly bothering me with problems that distracted me from earning a decent living?

In1983, after nearly 14 years together, Jamey--who had been trying without success to talk to me about my absence from our relationship and his growing problems with alcohol--told me that he had found someone who would listen to him and moved out. I was 38. My first book had been published, and I had two more books and several funded research projects in the works. I was also recovering from surgery from stress-related gastrointestinal problems. My life was crumbling under my feet, and there was nothing I could do about it. I lost weight. I couldn't eat. I didn't care if I lived or died.

I was a chain-smoking, caffeine-drinking work junkie, dogged by self-doubt. I had no close friends. I didn't smile. I felt that my colleagues didn't really appreciate my hard work and were breathing down my neck. My memory got so bad that members of my family wondered if I was developing an early case of Alzheimer's. I snapped at colleagues, and they snapped back. I once angrily confronted a college librarian for the name of the irresponsible faculty member who had kept, for three months, a book I wanted. She gave me the name: my own. Work had been the one thing that I had always done well, and now even that was failing me. Yet I couldn't stop working.

In the summer of that year, Jamey and I reconciled, and in the fall, he checked himself into a treatment center for alcoholism. When I eagerly took part in the family treatment component to "help Jamey with his problem," a facilitator confronted me with my own work obsession. I joined Workaholics Anonymous, entered therapy and began my climb out of the pit into a saner life. And Jamey and I started to understand the crack in the foundation of our relationship.

In the early 1990s, I began to study workaholics and their families, and what I found suggests that workaholism has devastating systemic effects on other family members--as severe, or even more severe, than the familial effects of alcoholism. Like the partners of alcoholics, the partners of workaholics often play the role of resentful "enablers" who try to limit their partners' overwork while unwittingly supporting it. Just as the wives and husbands of alcoholics will cover bounced checks or serve a hot dinner whenever the drinker returns from the bar, the partners of workaholics do the workaholic's home chores, give alibis to children and party hosts, build the family schedule around the workaholic's impossible work schedule and put dinner on the table at midnight for the umpteenth time after the workaholic promised to be home by 7:00. Other partners put their workaholic spouses in a double bind, complaining about their absenteeism while spending thousands of dollars of the monetary rewards for that absenteeism on clothes, or tens of thousands on remodeling the kitchen.

The partners of workaholics also may plead, threaten to leave, insist on weekends together and otherwise try to control the work addict's behavior, much as the partner of an alcoholic searches for hidden gin bottles--the way Jamey had once searched my luggage. Like the partners of alcoholics, these unhappy spouses live with loneliness, try to control the uncontrollable and build up enormous resentments. They often experience the workaholic's emotional unavailability and unreliability as a personal rejection and failure.

There is one major difference, however, between the spouses and children of alcoholics and those who live with workaholics. In our present culture, the partners and children of alcoholics usually are given understanding, professional help and referrals to self-help programs like Al-Anon. But when the partners and children of workaholics complain, they get blank looks. Therapists--some of whom are workaholic themselves--may suggest the partner simply swallow and adapt to the workaholic's schedule, or tell the spouse not be a "pop psychologist."

 This can lead spouses to blame themselves for their gut sense that something is wrong. "I know how pathological it sounds, but my feelings of rage, confusion and abandonment are such that I often wish that my husband would bruise my face or break my arm," one woman, married to a famous New York lawyer, told me. "That would enable me to say to myself and everyone else, 'See, he really is hurting me. He's doing something terrible to this marriage, and it's not my fault.'" The woman's relatives looked at her expensive townhouse and European vacations and couldn't understand what she was complaining about; she had tried couples counseling, only to be told by the therapist at the first session that she'd been reading too many pop psychology books.

This woman may have felt alone, but she is not alone: in 1999, I studied a random sample of 326 women members of the American Counseling Association, asking them to fill out questionnaires on their partner's work habits and the state of their marriages. The 22 percent who reported being in workaholic marriages also reported far more marital estrangement, emotional withdrawal and thoughts of separation and divorce than those whose partners were not workaholic. The spouses of workaholics also felt more helpless: they were more likely than the partners of nonworkaholics to report that external events controlled their lives.

Likewise, the children of workaholics often grow up in a vacuum of parental attention, feeling valued only for what they achieve, and not for themselves alone. They look at their externally picture-perfect lives and draw the conclusion that "something must be wrong with me," silently reprimanding themselves for being the unappreciative bad guy. Some report poorer self-concepts and higher rates of depression and anxiety than the children of alcoholics. Of 207 students who filled out questionnaires in 1999 at the University of North Carolina at Charlotte, those who reported growing up with a workaholic parent had higher depression levels (as measured by the Beck Depression Inventory) and higher rates of parentification (as measured by the Jurkovic Parentification Questionnaire) than a control group of adult children from alcoholic homes.

The children of workaholics also report that they sometimes find themselves colluding with a parent's workaholism, the way some children of alcoholics let themselves be propped up on the counter at the corner bar in order to have time with Daddy. One woman told me that when she was 35 and her workaholic father was dying, she smuggled memos and contracts into his hospital room for him. "It was the only way I could be with him," she said. "The only time he'd pay attention to me was around the subject of his work. He died working, a pen in his hand."

Given that our culture so often admires this sort of "dedicated" devotion to work, it is not surprising that it is the wives and husbands who often bring their workaholic partners into my office to force them to invest in their marriages. They say they feel like widowed partners and solo parents. With little support from the workplace, the mental health system or their families, many are self-doubting and depressed.

"There are times that I would actually be relieved if my husband were dead," said the woman married to the attorney who carried his briefcase on family picnics when the kids were small. "He doesn't hit me, he doesn't drink, he doesn't use drugs. There are a lot of things he doesn't do--the most important being that he doesn't do anything with me or our three kids." When she asked him to spend more time with the family, he called her an ingrate and said he was only working day and night for her and the kids and their future. Without support from her family or friends, she tucked her feelings neatly away inside and tried to fix some faulty aspect of herself that she couldn't put her finger on.

These family issues are doubly difficult when therapists don't tune their radars to pick up workaholism. Often, I find, therapists either suggest that the workaholic just cut back on working hours, subtly pressure the spouse to adapt to the partner's work obsession or miss the issue altogether.

When an alcoholic decides to get sober and joins Alcoholics Anonymous, she's expected to follow simple, black-and-white rules. She may be told, "Just don't drink, no matter what" and "Go to 90 meetings in 90 days." But workaholics can't quit working any more than compulsive eaters can quit eating. Transformation involves becoming attuned to shades of gray and making gradual, gentle changes. The goal is not to eliminate work and its joys, but to make it part of a balanced life rather than the 800-pound gorilla that sits wherever it wants. First, of course, workaholics have to recognize that there's a problem, and be reassured that the therapist does not plan to force them to quit work or even necessarily reduce their working hours.

In my own recovery, and in the clinical work I now do with workaholic clients, therapy usually involves an ordinary, commonsense blend of emotional and interpersonal work, cognitive techniques, family-of-origin work, self-nurturing exercises, pencil-and-paper exercises and behavioral tactics to help people reorganize time and space so that they're not working or thinking about work "24/7." The only thing unique about therapy with workaholics is focusing the microscope so that overwork comes into view as a problem to begin with.

Once clients recognize that compulsive work is a problem, I find that pencil-and-paper exercises can help them assess and visualize how they live now--and how they'd like to live. Using what I call a "healogram," I ask them to make a bar graph assessing five basic life areas: relationships, career, spiritual needs, self-care and play. How much time, I ask them, do they spend in each area of their lives? Usually, the bar in the category called "career" towers over all the rest. Then I ask them to redraw the bar graph, illustrating how they'd like to live. This simple process gives clients a clear sense that the goal is balance, not elimination of work altogether.

The pencil-and-paper exercise may bring to the surface the catastrophic, all-or-nothing thinking that lies behind some workaholic patterns. One man said to me, "I can spend time with my family or provide for my family financially, but not both." Another client, a successful, 38-year-old heart surgeon, had not gone on a vacation in 10 years because he was convinced that if he took even a week off, his multimillion dollar business would crumble. I asked him to draw a line across a sheet of paper and write his two extreme beliefs on each end. He put, "I must work nonstop to build my business" on one end and wrote, "If I take a vacation, my business will crumble" on the opposite end. 

This helped him externalize and dispassionately examine the unspoken assumptions that had driven his financially successful but lonely and harried life. I asked him to consider an option and write down a new phrase at the line's midpoint: "It is possible for me to take a week's vacation and for my business to continue to grow." I call this simple process "accessing the graydar," because it helps clients get in touch with an internal radar attuned to shades of gray rather than extremes.

I often tell workaholic clients that the goal is not to cut back on work hours, which they find immensely relieving. The goal, rather, is to create water-tight compartments between work and other areas of their lives, and to prepare for easy transitions between them. Some solutions are simple, modest and practical. Mildred, an overweight, 43-year-old psychotherapist, for instance, had no sense of containment for either her work or her diet. She scheduled clients six days a week anytime between 8:00 a.m. and 8:00 p.m. She literally didn't know when her plate was full because she would open the refrigerator and drink or eat directly from a milk container or take-out carton. At my suggestion, she discarded a Day-Timer that listed hours from 7:00 a.m. to 11 p.m. and replaced it with one that stopped at 5 p.m. I also suggested that when she ate, she pour out a glass of milk and spoon a serving of potato salad onto a plate.

Before she made these changes, my client had felt as though she had to be available to all people all the time. But keeping a more limited Day-Timer and serving herself food on a plate reminded her, physically and practically, that she had choices, could set limits and could decide for herself when she would see a client or have a glass of milk. This empowerment and self-care helped her slowly reinstate boundaries that had been blurred in childhood, when she had acted as her depressed mother's emotional caretaker. Over time, she was increasingly able to question old beliefs that had confused legitimate self-care with selfishness.

Other workaholics need help in making transitions between work and other activities, and need to learn not to schedule themselves so tightly that they leave no time for bathroom breaks or travel between appointments. By scheduling "time cushions" around appointments, they can drastically reduce tension. One man, for example, invariably fought with his fiance´e when he returned home because she would be eager to talk intimately while he was still tense and preoccupied with work. An earlier therapist had seen the problem strictly in terms of the "pursuer-distancer" dynamic. But once he started to schedule "time cushions," his days became less harried. He also started using his drive home not to chew over the events of the day but to decompress, play enjoyable music and do relaxation exercises as he mentally thought ahead to seeing his fiance´e. By the time she met him at the door, he was actually glad to see her and capable of making the transition.

Sometimes I teach simple behavioral techniques to stop work thoughts from elbowing their way into every waking moment: once, for example, I taught a financial planner who worried obsessively about his job to compartmentalize his intrusive thoughts by mentally placing each one in a box, putting a lid on the box and setting it on a storage shelf in a basement or attic. He was to take the thoughts off the shelf and out of the box only when he planned to give them his full attention. I also suggested he wear a thick rubber band around his wrist and if an intrusive work thought got loose, to snap the band and say, "Stop!" in his mind. You would have thought that this simple rubber band was a miracle cure. He proudly wore it to each session, proclaiming the dramatic changes in his life. Combining these simple strategies with an antidepressant and basic relaxation and breathing techniques, the planner slept better, was more present with his wife and young son and tackled work problems with more clarity and energy.