Chapter 14 Alcohol Addiction and Families

The COA Self

(Brown) COA's develop a defensive self, one that decreases their vulnerability. To include denial, perceptual and cognitive distortions, fear of losing control, back and white thinking, over responsibility and a negation of self, distrust of others, inhibition of curiosity, feelings of unreality, distrust of ones own senses.

Stages in Addicted Family Systems-4 stages in the family system of the addict

1) Denial. Family begins to hide the abuse from each other and everyone else. Isolating themselves from people that suspect the addiction. 2) involves home treatment, attempts by family members to get the addict to stop using, usually by controlling their behaviors. Roles may undergo significant shifts. 3) chaos. The addiction is now so out of control that it can no longer be hidden. Family members spin out of control, conflict and confrontations escalate without resolution and consequences for family member become more pronounced. The Stage in which partners and children may experience serious emotional & physical problems, and threats of divorce or separation are made but not completed. 4) Control. Family members identify the problem as an addiction, and control is often attempted through divorce, separation or total emotional isolation. The family then becomes ensnared in a cycle of helplessness and futile attempts to control the addict's behavior.

Wegscheider 3 major rules that characterizes and addicted family system

1) The addict's drug use is the most important thing in the family's life. The household routine, family outings, finances, holidays and how family members interact with one another all depend on the substance abuse. 2) The addict is not responsible for her or his behavior, and the drug not the cause of the family's problems. Excuses are made for how the addicted person responds. 3) The status quo must be maintained at all times. Family members are extremely carful not to upset the routine. Black listed 3 other rules for people living in an addicted family system: don't talk, don't trust, don't feel.

5.9% of U.S. women giving birth used illicit drugs sometime during their pregnancy & 11.5% drank at some time during pregnancy.

40% of students may be being raised by an alcoholic caregivers

COA's Relationship with others

Attachment to such a parent lends itself splitting or black and white thinking, children blame themselves for the abusive behavior and see themselves as deficient and unworthy of respect and care. Fail to develop appropriate prosocial adkins and find it difficult to have positive friendships. Maladaptive relationship outcomes, parent conflict and dissatisfaction, disrupted family environments, and ineffective or inefficient parenting practices.

Addicted Family Dynamics: Boundaries

Boundaries delineate the ways in which people relate to each other. They govern the rules surrounding how close family member can get to one another, how the family connects with the larger society and how conflict is tolerated. Family systems can be either rigid or disengaged boundaries. Families members exhibit poor communication, higher levels of negativity and conflict, inadequate problem-solving skills, low cohesion, lack of organization and consistency.

Behavior Outcomes of (COA) children of alcoholics

Can experience significant damaging effect as a result of the dysfunction; lower cognitive performance, attentional deficits and poorer neurological functioning, negative behavior outcomes, elevated impulsivity, conduct disorders and anxiety, lower academic achievement, elevated risk for alcoholism (2.5 to 9 times more likely to develop an alcohol disorder in adulthood.

Addiction and the Children

Children have the least control over what happens & rarely have the freedom to leave. 26.8 million children of Alcoholics in the U.S. with over 11 million under the age of 18. 76 million Americans roughly 43% of the adult population have been exposed to alcoholism in the family. Genetic component to alcoholism and other addictions. Children of addicted parents are at risk for prenatal exposure to drugs & alcoholics. Growing up in a addicted family system characterized by chaos, uncertainty, and an ever changing reality. Violence affect children by addiction. Sexual and physical abuse.

Enabling and Codependence

Codependency is excessive dependence upon a loved on by a person who looks to external sources for fulfillment. Enabling is the manner in which the partner inadvertently maintains the drug or alcohol use. Attempts to control both the addicted person behavior as well as the surrounding environment. Partners appear to be in control of their lives and to be labeled over responsible when in reality they are attempting to prevent their world from falling apart.

Assessment of Addicted Family Systems

Counselors should determine whether the family is indeed an alcoholic family or a family with an alcoholic. Alcohol families contain 3 diagnostic tracks- the environment(culture), the family system and the individual- all of them respond differently. Use of a genogram symbolic representation of generational family relationships, used to pinpoint patterns of & how it disrupts relationship.

Counseling Addicted Family Systems

Couples and family counseling have among the best outcomes for recovery from addiction. Effective at engagement and retention of problem drinkers as well as adolescent substance abusers. Task for counselors is to conceptualize behavior problems within a multidimensional framework and direct intervention strategies toward the systems targeted for change.

Functions & Characteristics of COA's

Dependence, Difficulty expressing emotions, difficulty relaxing, excessive loyalty, overly responsible, fear of losing control, fear of conflict, overly self critical, sensation seeking.

In 2012 report approximately 22.2 million American ages 12 or older were dependent on either alcohol or illicit drugs.

For every person who is addicted to drugs or alcohol, it is believed that there are at least four to six other people especially parents, partners, and children who are equally affected.

Treatment strategies for addicted family systems

Harm reductions model or abstinence. 3 areas of interest; environment(2 tasks- the family must create safety from external threats & the internalized family, or the family of origin, second each family member must tell the story of the trauma (eliminates compartmentalizing, denial, repression), the system, and the individual. Family systems is the arena in which most work will take place. Repairing distortions, educating, inferring rules and punishments for breaking them & challenging the rationalizations that supported the rules.

Addicted Family Dynamics: Roles

In families people like to know how they are supposed to act and how they should respond to others. They tend to take on roles, or specific ways of behaving. Everyone knows what they are suppose to do and how they are expected to respond to the roles other play. It changes based on gender, culture and the individual family.

Parenting in an Addicted Family System

One parent that can provide consistency & stability, positive outcomes can be achieved. Family rituals did not transmit alcoholism to the offspring, In contrast families whose rituals were disrupted were more likely to produce alcoholic children. Alcoholic parents are less satisfied with being parent, have higher stress, engage in punitive behavior, less responsive to their infants, women- higher rates depression, partner violence, sexual abuse, psychiatric disorders, violent behavior and criminal behavior.

Partners as Resources

Partners are important motivators for their significant other to change their addictive behavior and can assist in the counseling process. 53% of male alcoholics were motivated by the spouses or a family to seek treatment. Forgiveness can be a source of tension.

4 main roles children occupy in the addicted family system

The first is that of the family hero. These children are extremely successful, self-reliant, and responsible. They give self-worth and validation to the daily through their achievements. They take care of everyone in the family. The second role is the scapegoat. This child acts out and is blamed for all of the family's problems. By acting out, the scapegoat takes the focus off the family's problems. The third role is that of the lost child or the adjuster. These children follow directions, adjust to family dynamics and offer relief by not needing attention. The last role is the mascot. These children are funny and outgoing. Everyone in the family tends to like them as they provide distraction by entertaining everyone around them. Roles can be rigid particularly during times of stress.

Family structure is viewed as an organism surrounded by a semi-permeable boundary, a set of rules determining how people interact with those both inside and outside the family.

When homeostasis is broke, other family members adapt to the substance use behavior in an effort to return balance to the family. They deny the addictions, change their behavior to cover up the substance abuse and often sacrifice their needs for the sake of protecting addict and the family system. Family starts to hide their true feelings and distort reality.

The Impact of Alcohol on Couple Relationships

contributes to sexual inadequacy, martial discord, higher rates of psychological & physical problems among nondrinker spouses, martial aggression, separation, and divorce, hinders the development of intimacy.

Interpersonal Violence

male violence against women at 24%, female violence against men at 37%, partner violence at 50%. 1.3 million women are assaulted by an intimate partner annually. Approximately 60% of alcoholics had been violent toward their female partner in the year prior to treatment. Twice as high in addiction treatment groups than in the general population. Male physical aggression toward their female partner was more than eight times higher on days when they drank.

Addicted Family Dynamics: Rules

overt or covert (unspoken regarding behavior) Healthy families both overt and covert rules tend to be present, logical, consistent and designed to promote growth. In contrast addicted families rules tend to be arbitrary, illogical, inconsistent and/or punitive. Families use shaming to enforce rules or be a lack of consequences for breaking rules.

Diathesis stress model

variations between personality characteristics & stressful life events can make a difference. More positive personality traits coupled with less stressful life events can lead some children of Alcoholics towards resilience while others, with different personality/stress pairing, spiral downward.

Addiction and the family

whenever there is a disruption in one family member, other members react to return the overall family dynamics to something that resembles normal functioning. Homeostasis- the tendency of systems like families to balance themselves in response to change.