Chapter 7Chapter 7

Growing Up in an Alcoholic Family System

Chapter ObjectivesChapter Objectives

Describe the scope of the problem and awareness of adult children of alcoholics.

List several behavioral characteristics of adults who grew up in alcoholic homes.

Compare growing up in an alcoholic family system with post-traumatic stress disorder (PTSD) and describe the five major symptoms of PTSD.

Identify the scope of the adult-child of an alcoholic problem, including an estimate of how many people are affected.

Chapter ObjectivesChapter Objectives

Describe the behaviors and communication patterns of parents and children in an alcoholic family system.

Describe the kinds of denial that children in an alcoholic system maintain and some behavioral characteristics of children of alcoholics.

Define codependency and list the criteria of codependency.

Describe the family disease model.

Chapter ObjectivesChapter Objectives

Describe the impact of alcoholism on marriage. Describe the thoughts, feelings, and behaviors

of overseparated and overattached individuals. Discuss the rationale for doing grief work with

adult children of alcoholics. Describe second-order change and changing

interactions with family members. Identify the 11 curative factors of group

psychotherapy and their applications to adult children of alcoholics therapy groups.

The Adult Children of Alcoholics The Adult Children of Alcoholics MovementMovement

Bosma (1972) – ACAs as victims in a hidden tragedy

28 million Americans have at least one alcoholic parent.

Children of alcoholics are frequently victims of incest, neglect, and other forms of violence and exploitation.

ACA movement was a wildfire of information, education, and treatment.

Characteristics of ACA’sCharacteristics of ACA’s

Fear of losing control All-or-none Fear of feelings Overdeveloped sense

of responsibility Difficulty with

intimacy Flashbacks of

childhood, but many memory gaps

Unreasonable loyalty

Feelings of being like a child when under stress

Addiction to excitement Difficulty relaxing Feelings of guilt Confuses love with self-

pity Backlog of shock/grief Compulsive behavior Living in denial Guessing at what is normal Physical symptoms

Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

The following major symptoms of PTSD are similar to symptoms experienced by ACAs”– Reexperiencing trauma as evidenced by:

• Nightmares• Recurrent obsessive thoughts• Sudden reemergence of survival behavior in the fact of

events that resemble the original trauma• Emotional overload

– Psychic numbing, as evidenced by• Sense of depersonalization• Sense of not fitting into one’s surroundings• Feeling of emotional anesthesia

Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

• Constriction of emotions• Lack of feelings• Sudden experience of a wall between self and feelings• Confusion• Physical reactions instead of feelings• Feelings that emotions will be overwhelming

– Hypervigilance, as evidenced by• Inability to relax• Frequent startle responses• Chronic anxiety• Panic attacks

Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder

– Survivor guilt, as evidenced by• Chronic depression• A sourceless sense of guilt

– Intensification of symptoms by exposure to events that resemble the original trauma

Childhood in an Alcoholic HomeChildhood in an Alcoholic Home

Children in alcoholic homes learn to distrust their own observations and feelings, and they feel powerless to change the family system.

Children do not realize that alcoholism and drug addiction is a disease that results in unpredictable behavior.

Identification of Children in Alcoholic FamiliesIdentification of Children in Alcoholic Families

Behavioral characteristics– Superachievers or perfectionists

– Need to control their environment

– Display social disengagement from or excessive attention to peer groups

– Signs of physical neglect and/or physical abuse

– Unable to concentrate and sometimes showing marked variations in academic performance, especially when parents are in a binge pattern

Denial of FeelingsDenial of Feelings

Children maintain the illusion of normalcy. The following factors product damage in

the lives of children of alcoholics:– Role reversal– Unpredictability– Unavailability– Social isolation

CodependencyCodependency

Diagnostic criteria for codependent personality disorder:– Continual investment of self-esteem in the ability to

influence or control feelings and behaviors

– Assumptions of responsibility to meet others’ needs

– Anxiety and boundary distortions

– Enmeshment in relationships with personality-disordered, drug-dependent, and impulse-disordered individuals

CodependenceCodependence

– Maintenance of a primary relationship with an active substance abuser for at least two years without seeking outside support and/or exhibiting three or more of the following characteristics:• Constriction of emotions• Depression• Hypervigilance• Compulsions• Anxiety• Excessive reliance on denial• Substance abuse• Recurrent physical or sexual abuse• Stress-related medical illnesses

Family Disease ModelFamily Disease Model

The family suffers from alcoholism, codependency, and enabling behavior.

The family is organized around the alcoholic’s drinking and the consequences of that drinking.

The family responds to the alcoholic in a codependent fashion.

Family members disconnect from their own feelings, distorting their perceptions and invoking the “no-talk, no-feel, no-trust” rule.

Impact on MarriageImpact on Marriage

Feelings of betrayal Continuous conflict Chaos Resentment Sexual problems Ambivalence

Grief WorkGrief Work

Children in alcoholic families experience loss, violation, and trauma.

Mourning allows feelings of loss to surface. Grief work requires the help of a

professional therapist trained and experienced in ACA recovery.

Choice MakingChoice Making

Changes involve integration and congruency with feelings and choosing not to respond in dysfunctional, codependent ways.

Positive choices can establish the foundation for more significant growth-related choices later.

Second-Order ChangeSecond-Order Change

Second-order change is a cognitive-behavioral technique to change the way one traditionally responds to situations and interpersonal interactions.

Changes in Family InteractionsChanges in Family Interactions

ACA’s may need to let their parents know how they feel about continued use of alcohol/drugs.

Many ACA’s must let go and accept that their parents may never choose to stop using alcohol/drugs.

Group PsychotherapyGroup Psychotherapy

Group psychotherapy is a process in which each group member gets feedback from other group members.

The following 11 curative factors make group psychotherapy an effective process:– Instilling hope, sharing universality, imparting

information, fostering altruism, recapitulating the primary family group, developing socializing techniques, imitating behavior, sharing interpersonal learning, developing group cohesiveness, sharing catharsis, exploring existential factors