Families and Addiction

Contrary to widely held belief, alcoholics and other drug abusers are far more often found in the

context of intact family situations than on Skid Row. Only a minority of addicts live in social

isolation and homelessness (World Health Organization, 1977)

Familial Transmission of Alcoholism

It has been. established in various research including Cotton (1979) that alcoholism and other drug abuse is familially transmitted.

Several studies of alcoholic groups have reported alcoholism rates of 50% among their fathers, 30%

among their brothers, and 6% among their mothers(Goodwin, 1980). Among first- and

second-degree males relatives, the risk is 25% (Cotton, 1979)

The “Alcoholic Family”

This term refers to a family in which alcohol is the organizing principle. Family members develop

the same behavioral and cognitive disorder as the alcoholic; they are controlled by the organizing principle of alcohol and yet deny it at the same

time. (Steinglass, 1980)

Family Adaptation

The family of the addict is characterized by denial(Bean, 1982). There is an atmosphere of shame (Arentzen, 1978) and an underlying core of fear and tension. In most alcoholic families, there is a major secret. The maintenance of that

secret, the alcoholism, is the central focus around which the family is organized (Brown and

Beletsis, 1981)

Why Family Interventions

Understanding the individual family environment is also extremely important in dealing with

individual patients. (Moos et al., 1989)

Families and Potential for Change

Dysfunctional families, characterized by impaired communication among family members and an inability to set appropriate limits or maintain

standards of behavior, are associated with poor short-term and long-term treatment outcomes for

patients with substance abuse disorders.Controlled studies have shown family therapy to

be effective for adolescents, patients on methadone maintenance, and patients with

alcohol dependence.(APA, 2004)

Characteristics of Families with Addiction

➢ Chaos➢ Inconsistency➢ Unclear roles

➢ Unpredictability➢ Arbitrariness

➢ Changing limits➢ Repetitiousness

➢ Illogical arguments➢ Violence (sometimes incest)

(Beletsis and Brown, 1981)

Family Roles

Family members in alcoholic families take on roles. Based on the work of Virginia Satir,

Wegshieder-Cruse(1985) proposed that the roles in these families are:

➢ Hero➢ Scapegoat➢ Lost child➢ Mascot

The “Revised” 12-Steps1. We admitted we were powerless over nothing. We could manage our lives perfectly and we could

manage those of anyone else that would allow it.2. Came to believe that there was no power greater than ourselves, and the rest of the world was

insane.3. Made a decision to have our loved ones and friends turn their wills and their lives over to our care.4. Made a searching and fearless moral inventory of everyone we knew.5. Admitted to the whole world at large the exact nature of their wrongs.6. Were entirely ready to make others straighten up and do right.7. Demanded others to either “shape up or ship out”8. Made a list of anyone who had ever harmed us and became willing to go to any lengths to get even

with them.9. Got direct revenge on such people whenever possible except when to do so would cost us our own

lives, or at the very least, a jail sentence.10. Continued to take inventory of others, and when they were wrong, promptly and repeated

told them about it.11. Sought through nagging to improve our relations with others as we couldn't understand

them at all, asking only that they knuckle under and do things our way.12. Having had a complete physical, emotional and spiritual breakdown as a result of these

steps, we tried to blame it on others and to get sympathy and pity in all our affairs.

From the ACA Communicator, March 1990- Omaha, Council Bluffs Area Intergroup

Enabling Behaviors

Enabling behaviors allow the addicted person to continue with the disease. It feels helpful, but it promotes the addiction and the denial that is so crucial to

the process.

Examples:

● Making excuses for the addict● Paying their bills● Bailing them out of jail● Making rationalizations for irresponsible behaviors● Ignoring the problems caused by the addict's use● Cleaning up their messes● Accepting their excuses or believing their lies● Not discussing the problem ● Not getting help for themselves

When to Intervene

Family interventions are indicated in circumstances in which the patient's abstinence

upsets a previously well-established but maladaptive style of family interaction and in

which other family members need help in adjusting to a new set of individual and familial

goals, attitudes, and behaviors.(APA, 2004)

`

Family therapy that addresses interpersonal and family interactions leading to conflict or enabling

behaviors can reduce the risk of relapse for patients with high levels of family involvement.

(APA, 2004)

Benefits of Intervening

Couple and family therapy are also useful for promoting psychological differentiation of family members, providing a forum for the exchange of information and ideas about the treatment plan,

developing behavioral management contracts and ground rules for continued family support, and reinforcing behaviors that help prevent relapse and enhance the prospects for recovery. (APA,

2004)

Need for ongoing intervention

In many cases, formal termination of family treatment should be followed by renewed contact at times when the pt, the psychiatrist, or family members feel the need to reassess progress in

treatment, intervene in behaviors that may ultimately lead to relapse, reinforce familial

interactions that enhance the pts ability to remain substance free (APA2004)

Measuring Success

Treatment success is measured according to not only the quality of abstinence achieved by the

identified pt, but also the magnitude of improvement in the level of functioning of the

family system or unit ( Galanter and Castaneda, 1999)

Research Measures of Success

Research indicates that family-based interventions can have an effect, but cannot yet tell us which

type of intervention works best overall or for any specific group.

Goals in Family Therapy✔Encouraging family support for abstinence

✔Providing information about the pts current attitude toward use and treatment compliance

✔Monitoring social/vocational adjustment

✔Level of contact with peers

✔Maintaining marital relationships

✔Improving treatment compliance and long-term outcomes

Areas for Intervention

Behavioral parent training

Family skills training

In-home family support

Brief family therapy

Family Education(Kumpfer et

al., 2003)

Behavioral parent training

✔ Positive reinforcement

✔ Monitoring techniques

✔ Effective discipline methods

Family Skills Training

✔ Positive “play” skills

✔ Family meetings

✔ Effective communications styles

✔ Effective discipline methods

In-home Support

Addresses the basic needs of the family to free up coping capacity

Brief Family Therapy

Guided by family systems theory, this intervention follows the therapeutic process rather than a set

curriculum. Goals include reduced family conflict and maladaptive coping patterns.

Family Education

Drug and alcohol education conducted through homework assignments and readings processed at

home with interactive exercises

MATRIX Model InterventionsGoals:

1) To present accurate information about addiction, recovery, treatment, and the resulting interpersonal dynamics, through presentation of the most current material available

2) To teach, promote, and encourage indivduating of patients and family members in addictive relationships

3) Provide an atmosphere which conveys the highest level of professionalism where patients and their families are treated with dignity and respect.

4) To allow patients and families an opportunity to become comfortable in the treatment facility

5) To give patients and family members a non-threatening group experience with other recovering people and their families

6) To provide a program component designed for the patients and their families in which they can participate together

7) To help patients understand how the recovery process may affect relationships in the present and the future.

(MATRIX INSTITUTE, 2000)

Al-Anon Family Groups

A fellowship of relatives and friends of substance abusers who share their experience, strength and hope in order to solve their common problems by

practicing the 12 Steps, giving comfort to families of substance abusers, and by giving

understanding and encouragement to the substance abuser