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FAMILY INTERVENTION:FAMILY INTERVENTION: ALCOHOLISMALCOHOLISM By: Nancy D. Losinno, LCSW, By: Nancy D. Losinno, LCSW, CASACCASAC BNL EAP ManagerBNL EAP Manager Effects of alcoholism on the familyEffects of alcoholism on the family n n Development of alcoholism in 1 family member Development of alcoholism in 1 family member affects all the other members;affects all the other members; n n The longer-lasting ”the greater the acceptance of it as the “norm;” n n Rigid patterns of behavior for all, attempts to Rigid patterns of behavior for all, attempts to change can become thwarted until a crisis change can become thwarted until a crisis disrupts the norm-steady state-homeostasis.disrupts the norm-steady state-homeostasis. n n See the scales in background-alcoholic family is See the scales in background-alcoholic family is always in a delicate state of balance.always in a delicate state of balance. Parallel defenses rationalization, personality change; n n A simultaneous process in the members of the A simultaneous process in the members of the family;family; n n Social isolation leads to emotional isolationSocial isolation leads to emotional isolation n n Fears, anxiety, Fears, anxiety, n n Family members experience decline in their own Family members experience decline in their own health, may question their sanity, and suffer health, may question their sanity, and suffer rages, frustrations developed by family rules in childhood; n n CODA have a greater tendency to love the CODA have a greater tendency to love the unreliable, emotionally unavailable, needy, unreliable, emotionally unavailable, needy, “wounded birds” who need “rehabilitation”“wounded birds” who need “rehabilitation” n n CODA tries to provide unfulfillment; n n Creation of the “emotional debt” phenomenon Creation of the “emotional debt” phenomenon out of fear of abandonment.out of fear of abandonment. Codependent BehaviorsCodependent Behaviors n n ControllingControlling n n DistrustDistrust n n PerfectionismPerfectionism n n Avoidance of feelingsAvoidance of feelings n n Fears of being engulfed (intimacy issues)Fears of being engulfed (intimacy issues) n n CaretakingCaretaking n n Hyper vigilanceHyper vigilance n n Stress-related physical illnessStress-related physical illness How did I get here?How did I get here? n n Families of origin: what were the Families of origin: what were the patterns/dynamics in yours?patterns/dynamics in yours? n n How did my family handle conflict, anger, How did my family handle conflict, anger, love, etc.?love, etc.? n n Many people are taught not to be Many people are taught not to be assertive or to ask directly for needs to be assertive or to ask directly for needs to be met; met; n n How do I become more fulfilled Enabler makes it easier for alcoholic to function; n n Spouses take over the financial responsibilities; n n Spouses make allowances for behavior; n n May continue to be loving/giving in the face of May continue to be loving/giving in the face of physical/mental/emotional abusephysical/mental/emotional abuse n n Parents close their eyes to suspicious behavior, Parents close their eyes to suspicious behavior, hand out generous allowances, write sick notes hand out generous allowances, write sick notes Enablings PurposeEnablings Purpose n n Remember the delicate balance!Remember the delicate balance! n n Enablers do it to meet their own needs, to Enablers do it to meet their own needs, to restabilize the relationship, to lure the restabilize the relationship, to lure the alcoholic back to them after alcohol has alcoholic back to them after alcohol has taken them away;taken them away; n n Enabling is a poor-quality glue;Enabling is a poor-quality glue; n n Behind enabling is fear of abandonmentBehind enabling is fear of abandonment n n Only allows disease to grow to more Only allows disease to grow to more serious stageserious stage The “Disease Concept”The “Disease Concept” n n The “Jellinek” model poses 5 types of alcoholism The “Jellinek” model poses 5 types of alcoholism based on male drinking patterns;based on male drinking patterns; n n Is the most widely used model in treatment Is the most widely used model in treatment programs, with abstinence as the primary goal;programs, with abstinence as the primary goal; n n Most Americans in AA would be classified as Most Americans in AA would be classified as “gamma” type;“gamma” type; n n Sharply contrasts with growth of psychiatric Sharply contrasts with growth of psychiatric treatment programs for alcoholics who cannot treatment programs for alcoholics who cannot recover without aid of anti-depressant medsrecover without aid of anti-depressant meds How Do People Change?How Do People Change? The “Prochaska Model”The “Prochaska Model” n n Stage 1: PrecontemplationResisting Stage 1: PrecontemplationResisting change. Precontemplators rarely take change. Precontemplators rarely take responsibility for themselves or their responsibility for themselves or their behavior, they do not like living with short behavior, they do not like living with short passivity n n Struggling to understand causes Struggling to understand causes n n Seriously thinking about solving problem;Seriously thinking about solving problem; n n Lets down defenses into his life; n n Some people can get stuck in Some people can get stuck in Contemplation for many years.Contemplation for many years. Stage 3: PreparationStage 3: Preparation Getting Ready to ChangeGetting Ready to Change n n Brings you to the edge of action;Brings you to the edge of action; n n Takes you from the decisions you make in Takes you from the decisions you make in Contemplation to specific steps to solve the Contemplation to specific steps to solve the problem;problem; n n Some may wish that Some may wish that admitting admitting a problem will a problem will make it go away; some wait for a “magic make it go away; some wait for a “magic moment;” others get stuck;moment;” others get stuck; n n Making a commitment during this stage makes Making a commitment during this stage makes success more likely (set a date, “go public,” success more likely (set a date, “go public,” have someone hold you accountable)have someone hold you accountable) Stage 4: ActionStage 4: Action Its Time to Get MovingIts Time to Get Moving n n Action without preparation will last only Action without preparation will last only temporarily;temporarily; n n Cheap change will not last long, real change Cheap change will not last long, real change takes work takes work n n All change creates anxiety deal with the anxiety of change; n n The myth of the “magic bullet”, there are no The myth of the “magic bullet”, there are no simple solutions.simple solutions. n n Changing your thinking about your problem can Changing your thinking about your problem can result in a better, more productive outcome.result in a better, more productive outcome. Stage 5: MaintenanceStage 5: Maintenance Staying ThereStaying There n n The myth of “just one” (drink, cigarette, The myth of “just one” (drink, cigarette, piece of cake, etc.)piece of cake, etc.) n n Successful change is sustained over a Successful change is sustained over a period of years period of years n n Must be aware of danger signs warning signals, areas of vulnerability; n n In alcoholism treatment, it is called In alcoholism treatment, it is called Building Up to Drink (BUD) syndrome or Building Up to Drink (BUD) syndrome or use HALT.use HALT. Intervention: What is it?Intervention: What is it? n n Dynamics within alcoholic family are inter-Dynamics within alcoholic family are inter- twined, and involve response from other twined, and involve response from other members;members; n n By working with the most motivated family By working with the most motivated family member, and changing the way they are member, and changing the way they are responding to the alcoholism, intervention is responding to the alcoholism, intervention is made;made; n n Is in contrast to glamorous/confrontational type Is in contrast to glamorous/confrontational type of intervention, often high-priced. If family has of intervention, often high-priced. If family has not yet changed how they respond to the not yet changed how they respond to the drinkingintervention may prove unsuccessful.drinkingintervention may prove unsuccessful. Intervention: How is it done?Intervention: How is it done? n n Any method that creates change in the family member Any method tha