Addiction & Family Functioning Curtis: Chapters 1-3

Prior to 1950’s, family problems kept secret Most families believed that once drinking stopped, family problems would disappear Therapists recognized that many treated alcoholics not success in recovery During 1950’s, treatment focused mainly on wife

Whalen (1953): Wife “chooses” alcoholic 4 types of wives: 1.Suffering Susan  low self esteem; mistreatment by alcoholic husband confirms self image 2.Controlling Catherine  husband’s drinking gives her something to control 3.Wavering Winnifred  high dependency needs; as long as he drinks, he will continue to “need” her 4.Punishing Polly  envious & resentful of men; belittles husband constantly, so he will continue to drink (this increases his vulnerability)

Criticism: Not representative sample Does not consider progressive nature of alcoholism Does not consider possibility that relationship changes as alcoholism progresses Further stigmatizes alcoholism

Jackson (1954) wife goes through “stages of adjustment” to husband’s drinking Stage 1 = husband’s drinking causes tension & embarrassment. Denies problem to avoid facing it. Stage 2 = becomes more socially isolated to cover up husband’s drinking. Drinking now a focal point so conflict increases. Wife develops self-pity. Husband resents her attempts to control his drinking

Stage 3 = kids begin to have problems; sexual intimacy fades; violence becomes frequent. Family members begin to feel helpless. Wife may seek outside help but then feels guilty for being unable to cope. Stage 4 = wife assumes responsibility for family functioning; may gain new self- confidence; children begin to experience fewer problems and family stabilizes

Stage 5 = wife & kids leave alcoholic husband Stage 6 = mother & kids establish themselves without alcoholic husband Stage 7 = if he remains sober, husband returns to family, but has difficulty re- establishing adult role within family. Criticism: does not consider differences in family “adjustment”; fails to consider treatment efforts; does not address cycle of abuse/hope

1960’s Through 1960’s, research noted that alcoholics whose wives also in treatment: 1.Stayed in treatment longer 2.Had significantly improved recovery 3.Felt major improvement in marital harmony

Bateson (1960)  family works as unit to maintain homeostasis (balance). Family members unable to adjust to non-drinking Ewing & Fox (1968)  alcoholism is a family disorder. Family members need to be aware of how interaction patterns might have contributed to family’s dysfunction

Theoretical Approaches to Family Treatment (Ch. 2) Dulfano  views family as system Any change in role of one member also changes other members in order to maintain homeostasis Non-drinking threatens family environment as much as drinking does Alcohol abuse distorts family relationships Therapist holds alcoholic responsible for own behaviour and focuses on communication patterns

Theoretical Approaches cont’d Kaufman  4 different types of alcoholic families, each needing different interventions 1.Functional Family System  Alcoholic drinks due to problems outside of the family. Members seem happy and stable; little conflict. Not likely to present for treatment

2. Neurontic, Enmeshed Family System Normal family functioning disrupted Members feel guilty and responsible for alcoholic Members try to take care of each other, while alcoholic becomes more isolated Verbal abuse by alcoholic common Treatment involves encouraging members to become involved with support groups

3. Disintegrate Family System Alcoholic frequently absent from family Reasonable family interactions broken down Treatment begins with alcoholic Once sobriety achieved, focus on re- defining family roles and re-establishing communication

4. Absent Family System Alcoholic’s behaviour now results in complete separation from family; reconciliation unlikely Treatment directed toward establishing new social networks

Family Therapeutic Theories (Ch. 3) Whitakeer  Symbolic Theory Bandura  Social Learning Theory Satir  Process Model

Symbolic Theory (Whitaker) Healthy family  functions to uphold unity and promote growth Unhealthy family  limited sense of unity; rules and roles inflexible; expression of individual differences not possible Central beliefs  Family members need to switch roles to experience what others in family experience Goal of treatment  increase creative problem solving skills

Social Learning Theory (Bandura) Inappropriate behaviour is learned during childhood through modelling Central beliefs = behaviour is maintained through reinforcements Goal of Treatment = behavioural modification and healthy learning environment

Process Model (Satir) Family system is balanced; each member “pays a price” to keep it that way Central Beliefs = dysfunction leads to low self-esteem; prevents appropriate communication Goal of Treatment = using “sculpting” to move family from state of dysfunction 4 types of individuals with dysfunctional communication styles:

1. Placater Cannot express anger or displeasure Pattern of avoidance Self-worth based on acceptance by others

2. Blamer Critical, judgmental & shaming Deflects from facing own issues and meeting responsibilities

3. Intellectualizer Tries to analyze and fix others Feels vulnerable if own feelings exposed Wants to make sense of problems

4. Distracter Attempts to protect self and others from pain (i.e. charmer or clown) May use drugs and alcohol to avoid problems