FAMILY INTERVENTION: ALCOHOLISM

1
FAMILY INTERVENTIONALCOHOLISM

• By Nancy D. Losinno, LCSW, CASAC
• BNL EAP Manager

2
Effects of alcoholism on the family

• Development of alcoholism in 1 family member
  affects all the other members
• The longer-lasting more subtle the process,
  the greater the acceptance of it as the norm
• Rigid patterns of behavior for all, attempts to
  change can become thwarted until a crisis
  disrupts the norm-steady state-homeostasis.
• See the scales in background-alcoholic family is
  always in a delicate state of balance.

3
Parallel defenses symptoms

• Jellinek model denial, projection, isolation,
  rationalization, personality change
• A simultaneous process in the members of the
  family
• Social isolation leads to emotional isolation
• Fears, anxiety, guilt parallel those of
  alcoholic
• Family members experience decline in their own
  health, may question their sanity, and suffer
  rages, frustrations self-pity when situation
  does not change, as promised.

4
What is Codependency?

• A dysfunctional pattern of living/problem solving
  developed by family rules in childhood
• CODA have a greater tendency to love the
  unreliable, emotionally unavailable, needy,
  wounded birds who need rehabilitation
• CODA tries to provide control every part of the
  relationship while denying their own needs,
  desires, dreams, setting themselves up for more
  unfulfillment
• Creation of the emotional debt phenomenon out
  of fear of abandonment.

5
Codependent Behaviors

• Controlling
• Distrust
• Perfectionism
• Avoidance of feelings
• Fears of being engulfed (intimacy issues)
• Caretaking
• Hyper vigilance
• Stress-related physical illness

6
How did I get here?

• Families of origin what were the
  patterns/dynamics in yours?
• How did my family handle conflict, anger, love,
  etc.?
• Many people are taught not to be assertive or to
  ask directly for needs to be met
• How do I become more fulfilled feel better
  about myself and the life I live?

7
The Rules of Codependency

• Dont rock the boat.
• Its not okay to talk about problems.
• Keep your feelings to yourself.
• Be strong, good, right, perfect.
• Do as I say, not as I do.
• The best communication is indirect.
• Dont be so selfish.

8
What is Enabling?

• Enabler makes it easier for alcoholic to
  function
• Spouses take over the financial home
  responsibilities
• Spouses make allowances for forgive bad
  behavior
• May continue to be loving/giving in the face of
  physical/mental/emotional abuse
• Parents close their eyes to suspicious behavior,
  hand out generous allowances, write sick notes

9
Enablings Purpose

• Remember the delicate balance!
• Enablers do it to meet their own needs, to
  restabilize the relationship, to lure the
  alcoholic back to them after alcohol has taken
  them away
• Enabling is a poor-quality glue
• Behind enabling is fear of abandonment
• Only allows disease to grow to more serious stage

10
The Disease Concept

• The Jellinek model poses 5 types of alcoholism
  based on male drinking patterns
• Is the most widely used model in treatment
  programs, with abstinence as the primary goal
• Most Americans in AA would be classified as
  gamma type
• Sharply contrasts with growth of psychiatric
  treatment programs for alcoholics who cannot
  recover without aid of anti-depressant meds

11
How Do People Change?The Prochaska Model

• Stage 1 PrecontemplationResisting change.
  Precontemplators rarely take responsibility for
  themselves or their behavior, they do not like
  living with short long term consequences. They
  may have tried failed in the past, and believe
  that it will keep happening. Problem is how to
  become unstuck.

12
Stage 2 Contemplation Change is on the Horizon

• Being aware of your problem with passivity
  depression
• Struggling to understand causes cures
• Seriously thinking about solving problem
• Lets down defenses welcomes others into his
  life
• Some people can get stuck in Contemplation for
  many years.

13
Stage 3 PreparationGetting Ready to Change

• Brings you to the edge of action
• Takes you from the decisions you make in
  Contemplation to specific steps to solve the
  problem
• Some may wish that admitting a problem will make
  it go away some wait for a magic moment
  others get stuck
• Making a commitment during this stage makes
  success more likely (set a date, go public,
  have someone hold you accountable)

14
Stage 4 ActionIts Time to Get Moving

• Action without preparation will last only
  temporarily
• Cheap change will not last long, real change
  takes work mental sweat
• All change creates anxiety you need ways to
  deal with the anxiety of change
• The myth of the magic bullet, there are no
  simple solutions.
• Changing your thinking about your problem can
  result in a better, more productive outcome.

15
Stage 5 MaintenanceStaying There

• The myth of just one (drink, cigarette, piece
  of cake, etc.)
• Successful change is sustained over a period of
  years involves sweat effort
• Must be aware of danger signs times, warning
  signals, areas of vulnerability
• In alcoholism treatment, it is called Building Up
  to Drink (BUD) syndrome or use HALT.

16
Intervention What is it?

• Dynamics within alcoholic family are
  inter-twined, and involve response from other
  members
• By working with the most motivated family member,
  and changing the way they are responding to the
  alcoholism, intervention is made
• Is in contrast to glamorous/confrontational type
  of intervention, often high-priced. If family has
  not yet changed how they respond to the
  drinkingintervention may prove unsuccessful.

17
Intervention How is it done?

• Any method that creates change in the family
  member that is lasting, sincere, and reinforces
  positive behavior in the drinker can be part of
  intervention process
• For family members Al-Anon, private therapy,
  even efforts to improve self-esteem (weight loss,
  depression, etc.)
• EAP can be a valuable first step in the process
  of intervention
• Remember, intervention is a process, not an
  event!
• After taking steps to intervene, no looking
  backward, no sideward glances to check if someone
  is noticing!