Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 14 Alcohol Addiction and Families Updated by Melinda Haley, Walden University

Impact of Addiction on Families Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 22.2 million Americans age 12 or older dependent on alcohol or illicit drugs. Approximately 27.8 million children of alcoholics under the age of 18 Gaps in research Caucasian, heterosexual, and intact families Primarily focus on alcoholism Male partner addicted to a single substance Little study of comorbidity

Addiction and Family Counseling Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Family members instrumental in motivation Became integral part of treatment Healthy family and positive family rules Meets needs of everyone Clear boundaries Flexible rules

Addicted Family Dynamics Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Homeostasis Relationships strained Frequent denial Trying to maintain balance in system Boundaries Addiction secrecy Isolated from the community Emotional intimacy low

Addicted Family Dynamics: Roles Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Roles more rigid in addicted families Children tend to occupy one of four roles Hero Self reliant and responsible Scapegoat Acts out – blamed for everything Lost child The adjuster Mascot Funny and humorous Provide distraction

Rules in Addicted Family Systems Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Overt vs. covert Tend to be arbitrary, illogical, and inconsistent Shaming to enforce rules or lack of consequences

Rules in Addicted Family Systems, (continued) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Three major rules Addict’s drug use the most important thing Addict is not responsible for behavior nor family problems Status quo must be maintained Three other rules Don’t talk Don’t trust Don’t feel

Four Stages in Addicted Family Systems Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Denial Hide abuse from each other and everyone Home Treatment Attempts to control addict’s behavior Chaos Serious emotional or physical problems Threats of divorce but not completed Control Cycle of helplessness Futile attempts to control addict’s behavior

Parenting in an Addicted Family System Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Regular and daily rituals Structure family life Provide stable family identity One non-addicted parent Can have buffering effect Provides stability Better psychological outcomes

Addiction and the Couple Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Couple Relationship/Partner Subsystem Has been overlooked Limited research

The Impact of Alcohol on Couples Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Detrimental to romantic relationships Improvement with abstinence and recovery Sexual inadequacy Violence and aggression 60% of male alcoholics violent to partner in previous year Prevalence of domestic violence by members of addiction treatment groups double that of general population Relationship dissolution/divorce

The Impact of Couples on Alcohol Abuse Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Which came first: The chicken or the egg? Alcohol use to enhance sex life Superficial relationships Blame each other

Addiction and the Couple: Codependency and Enabling Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Codependency Lost identity Self sacrificing Low self esteem Enabling Maintains the drug or alcohol use Control both behavior and environment Appear in control

Recovery and the Couple Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Partners as resources Important motivators Assistance in counseling Improving partner relationships Motivation to stop drinking Challenges Increased tension after “honeymoon period” Need for forgiveness

Effects of Addiction on Children Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Adult Children of Alcoholics (ACOA) Shifted attention to include effects on children Prenatal exposure to drugs and alcohol Addiction tends to run in families Family chaos and ever changing reality Lack of structure Rigid or non-existent boundaries Abuse: physical, sexual

Addiction’s Impact on Children’s Behavioral Outcomes Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Many children do fine Severe physiological consequences Lower cognitive performance Attention deficits Impulsivity, conduct disorders Depression/Anxiety Lower academic achievement External locus of control Elevated risk for alcoholism

Addiction’s Impact on Children’s Psychosocial Outcomes Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Life in addicted family system is distorted Children have no control in home environment Children believe they are the cause of the problem If they could just “fix” themselves, family could be healed

The COA Self/Defensive Self Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Adapting coping mechanism Denial, cognitive distortions, fear of losing control, and negation of self Distrust of one’s own senses Distrust of others Feelings of unreality Inhibition of curiosity

COAs’ Relationships With Others Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Difficult to trust themselves or others Alcoholic parents are often abusive Encouraged to be independent and compliant Self-blaming Black and white thinking Fail to develop pro-social skills Difficult to have positive friendships

Efficacy of Couples and Family Counseling Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Among best outcomes for recovery from addiction Among the top five treatments Superior to peer group, individual oriented treatment modalities

Assessment of Addicted Family Systems Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Alcoholic family or family with alcoholic member? Structured clinical interview Include all adults and school-age children Minimizes distortion Genogram Focus on function and severity of the addiction Individual and family as a whole

T reatment Strategies for Addicted Family Systems Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Abstinence or harm reduction? Three areas of interest for treatment Environment Family system Individual – through the whole process

Addressing the Environment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Two primary tasks Create safety From external threats From family of origin issues Each family member tells the trauma story Also consider helping individuals plan how to handle changes in relationships to prevent relapse

Addressing the Family System Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Where most work will take place Educate Family may experience “emotional desert” Normalize and validate “Distrust days” Criticism journal Letters Focus on couple subsystem Restabilize for healthy relating

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved American Association for Marriage and Family Therapy American Psychological Association’s Division on Family Psychology International Association of Marriage and Family Counselors