1. ©2010 McGraw-Hill Higher Education. All rights reserved. Chapter 7 Growing Up in an Alcoholic Family System ACA is a social reform movement

2. ©2010 McGraw-Hill Higher Education. All rights reserved. National Association of Children of Alcoholics (NACOA) Charter Statement (1983) An estimated 28 million Americans have at least one alcoholic parents. More than half of all alcoholics have an alcoholic parent Children of alcoholics are at the highest risk of developing alcoholism themselves or marrying someone who is alcoholic In up to 90 percent of child abuse cases, alcohol is a significant factor Children of alcoholics are frequently victims of incest, child neglect, and other forms of violence and exploitation.

3. ©2010 McGraw-Hill Higher Education. All rights reserved. Characteristics of Adult Children of Alcoholics (ACA) 1. Fear of losing control 2. All-or-none, black-or-white thinking 3. Fear of experiencing feelings 4. Overdeveloped sense of responsibility or irresponsibility 5. Difficult with intimacy and with asking for what is wanted or needed 6. Flashbacks of childhood but many memory gaps 7. Feelings of being like a child when under stress 8. Unreasonable loyalty 9. Inadequate; don’t trust their talents, skills, and accomplishments

4. ©2010 McGraw-Hill Higher Education. All rights reserved. ACA Characteristics cont’d 10. Addiction to excitement 11. Difficulty relaxing 12. Feelings of guilt, abandonment, and/or depression 13. Tendency to confuse love with self-pity 14. Backlog of shock and grief 15. Compulsive behaviors 16. Living in a world of denial 17. Guessing at what is normal 18. Tendency toward physical symptoms (e.g., headaches, gastrointestinal problems) 19. Exhibiting PTSD (Post traumatic stress disorder) symptoms (Tim Cermak)

5. ©2010 McGraw-Hill Higher Education. All rights reserved. Behavioral Characteristics of ACAs Being superachievers or perfectionists or exhibiting efforts that go far beyond the reasonable criteria of every task. Exhibiting an inordinate need to control their environment and therefore becoming anxious with the slightest threat to their security (e.g., a teacher’s comment on homework or an unusually low grade may provoke emotional upset)

6. ©2010 McGraw-Hill Higher Education. All rights reserved. Behavioral Characteristics of ACAs cont’d Displaying social disengagement from or excessive attention to the peer group (as an isolated loner or a class clown) Exhibiting signs of physical neglect (untidiness, soiled clothing, poor hygiene) and/or physical abuse (bruises, cuts, etc.) Being unable to concentrate and sometimes showing marked variations in academic performance, especially when parents are in a binge pattern of alcohol use or in codependent conflict (Robert Ackerman [1978])

7. ©2010 McGraw-Hill Higher Education. All rights reserved. Second-Order Change A cognitive-behavioral technique to change the way one traditionally responds to situations and interpersonal interactions. First-order interactions are often mechanical, automatic, and even rhetorical.

8. ©2010 McGraw-Hill Higher Education. All rights reserved. Defining Codependency (Tim Cermak, M.D.) Cermak defined codependency in diagnostic terms in the hope that codependency would be recognized as a psychiatric disorder. The following are diagnostic criteria for codependent personality disorder: 1. Continual investment of self-esteem in the ability to influence or control feelings and behaviors in the self and others in the face of obvious adverse consequences. 2. The neglect of oneself while preoccupied or obsessed with changing the partner.

9. ©2010 McGraw-Hill Higher Education. All rights reserved. Defining Codependency cont’d 3. Assumption of responsibility for meeting others’ needs to the exclusion of acknowledging one’s own needs. 4. Anxiety and boundary distortions in situations of intimacy and separation 5. Enmeshment in relationships with personality- disordered, drug-dependent, and impulse- disordered individuals.

10. ©2010 McGraw-Hill Higher Education. All rights reserved. Defining Codependency cont’d a. Constriction of emotions with or without dramatic outbursts b. Depression c. Hypervigilance d. Compulsions e. anxiety f. Excessive reliance on denial g. Substance abuse h. Recurrent physical or sexual abuse i. Stress-related medical illnesses 5. Maintenance of a primary relationship with an active substance abuser for at least two years without seeking outside support and/or exhibiting three or more of the following characteristics:

11. ©2010 McGraw-Hill Higher Education. All rights reserved. Codependency Metaphor Being a lifeguard on a crowded beach, knowing that you can’t swim

12. ©2010 McGraw-Hill Higher Education. All rights reserved. Overseparation and Overattachment (Coleman & Colgan, 1987) Overseparation Thoughts You’re not good enough They want so much. They give so little. I’m ambivalent. If only they would… I am a rock. You should be grateful. Overattachment Thoughts I’m not good enough I want so little. I give so much. You don’t care. What am I doing wrong? I’m nobody without you. I’m so unappreciated.

13. ©2010 McGraw-Hill Higher Education. All rights reserved. Overseparation and Overattachment (Coleman & Colgan, 1987) Overseparation Feelings Fear, abandonment Out of control Needy, burdened Unsafe alone Shut-out Desperate Overattachment Feelings Fear, smothering Self-controlled Indifferent Unsafe with others Trapped Numb

14. ©2010 McGraw-Hill Higher Education. All rights reserved. Overseparation and Overattachment (Coleman & Colgan, 1987) Overseparation Behaviors Is self-protective Controls others Acts to guard feelings Denies Is compulsively independent Overattachment Feelings Is self-sacrificing Please others Acts contrary to feelings Explains Is compulsively dependent

15. ©2010 McGraw-Hill Higher Education. All rights reserved. 11 Curative Factors of Group Psychotherapy (Irving Yalom, M.D.) 1. Instilling hope 2. Sharing universality 3. Imparting information 4. Fostering altruism 5. Recapitulating the primary family group 6. Developing socializing techniques 7. Imitating behavior 8. Sharing interpersonal learning 9. Developing group cohesiveness 10. Sharing catharsis 11. Exploring existential factors