1. Ground Zero: The Family Trauma of Addiction and Recovery Dale MacIntyre Family Programs Supervisor EDGEWOOD

2. 19 th Century Family as a vessel for addiction: Drunkenness appears to be in some measure hereditary. We frequently see it descending from parents to their children. This may undoubtedly often arise from bad example and imitation, but there can be little question that, in many instances, it exists as a family predisposition. (1835) The Temperance Movement: Drew attention to the impact of alcoholism on the family Provided a therapeutic function for children and wives Personal pain transformed into political advocacy

3. Early 20 th Century Inebriates treated in asylums Family treated with ambivalence: loyal angels hostile interlopers The universality of good wives to intemperate husbands suggests an inquiry into the connection they may bear, and the influence they may exercise, however innocently, in the downfall of their husbands. (1898) The thin line: family as obstacle to recovery, family as cause of addiction

4. Early 20 th Century continued: bad breeding and degenerate families (1936) three basic causes of alcoholism: Inheritance of a nervous system that was not resistant to alcohol The effect of early family environment The influence of later experiences in marriage, college or work parental role as causative agents – mother-blaming family viewed as a nuisance or threat to treatment: (1938) wives efforts to sabotage treatment – hold childish resentments. working with families consisted of obtaining agreement of noninterference in treatment (1942) demanded abstinence from family members (1937) need for education noted: the person with the greatest need of psychiatric treatment is the marital partner who has not become alcoholic

5. Mid 20 th Century (1930s) Alcoholics Anonymous - family voices heard indirectly (1940s) Alanon – family groups (1957) Alateen family advocacy – banding together for mutual support – focus on needs of family members To give cooperation and understanding to the AA at home To live by the Twelve Steps ourselves in order to grow spiritually along with our AA To welcome and give comfort to families of new AA.(1951)

6. Mid-20 th Century continued… The Twelve Steps and family involvement: … the seeds of Al-Anon actually germinated when the families of early AA members first felt the stirrings of their own regeneration, and began to do something about it. (1994) … we cannot change another human being – only ourselves. By living our own lives to the best of our ability, by loving deeply and not trying to mold another to our wishes, we can help not only ourselves but that other also. (1994) A pattern in addictive relationships identified: Sick and irresponsible child Resentful mother Pattern disrupted by sobriety and recovery Al-anon provides guidance through reconstruction of relationships in recovery

7. Late 20 th Century Family systems Codependency – the concept and the backlash Adult Children of Alcoholics (ACOA) Family Treatment Programs Family Recovery Research Feminist Critique

8. Early 21 st Century The Legacy : Family shame and secrecy Family advocacy Looking inward – mutual support Challenges of the Present (especially for clinicians): Finding ground to stand on: personal psychopathology or normal adaptations to a disorder? family as recovery sabotage or resource for recovery? individuals deserving services in their own right?

9. Addiction: The Essentials A disease of the whole person and all his or her relationships Biological Psychological Social Spiritual …

10. …Relational Addiction is a Relational Disease Addiction: An essential Definition The Nature of Addiction The Essential Elements of Addiction Addiction: The Traumatic Effects

11. Addiction: An Essential Definition A committed pathological love relationship of a person to any mood-altering experience with the expectation of a reward, that has life damaging consequences Pathological: Cant stop – want more and more Mood-altering: Running away from, or toward, feelings Experience: Substance or behaviour Life-damaging: Inevitably fatal Relationship? Committed: Self-surrender

12. The Nature of Addiction Permanent Progressive Primary Predictable Pervasive

13. Addiction: Essential Pathological Elements ADDICT Psychological Mental Obsession Emotional Compulsion Low Self Image Rigid Negative Attitudes Rigid Defense System Delusion Powerlessness Physical AOD Other Behaviours 15 % 85 %

14. The essence of the relational illness The addicts first, most important, committed, love relationship is with their drug of choice The familys drug of choice is the addict.

15. Addiction: Pathological Relativity ADDICT AOD Other Behaviours Enabling Control Caretaking CODA These are the same

16. The eighty-five percent Essential Elements Psychological Mental Obsession Emotional Compulsion Low Self Image Rigid Negative Attitudes Rigid Defense System Delusion Powerlessness Physical

17. Psychological Dependency Drug involved lifestyle - - An irrational need to use alcohol, drugs or other addictive behaviours - - Changes of personality - - Manipulation of personal life and other people to accommodate the drug relationship and ingestion

18. Psychological Dependency Addict involved lifestyle - - An irrational need to enable, blame or control the addict - - Changes of personality - - Manipulation of personal life and other people to accommodate the addicts drug relationship and ingestion

19. Mental Obsession Increasing concern about drugs themselves - - Uneasiness when, supply threatened glorifying their drug use Increasing concern to preserve the alcohol or drug relationship Decreased mental activity about other matters

20. Mental Obsession Increasing concern about the addict - - Uneasiness when, the addict is absent Increasing concern to preserve the relationship with the addict Decreased mental activity about other matters

21. Emotional Compulsion An urgency to ingest drugs Unplanned, unpremeditated, impulsive ingestion Continued alcohol or drug ingestion in a self- displeasing manner

22. Emotional Compulsion An urgency to enable, blame, control the addict Unplanned, unpremeditated, impulsive enabling Continued enabling in a self-displeasing manner

23. Low Self-Image Lowered moral standards and actual immoral conduct Defense of irresponsible behaviour Guilt and moral anxiety Low self-esteem/self-respect

24. Rigid Negative Attitudes Complex avoidance reactions: Rigid negative mental attitudes Intolerance, stubbornness, rigidity of mind Rigid negative emotional attitudes Postures of anger, self-pity, despair, rejection Rigid stereotyped, negative behaviour patterns Postures of defiance, grandiosity, frustration Used to deny or negate whatever or whoever threatens ones love relationships.

25. Rigid Defense System Defensiveness about drug involvement - - Denial, minimizing, rationalizing, excusing, projecting, justifying… Negative attitudes employed as defenses … - Expressions of hatred, rejection, avoidance, resentment, belligerence, self- pity, defiance…

26. Rigid Defense System Defensiveness about involvement with the addict and/or enabling, blaming, controlling the addict - - Denial, minimizing, rationalizing, excusing, projecting, justifying… Negative attitudes employed as defenses - Expressions of hatred, rejection, avoidance, resentment, belligerence, self-pity, defiance…

27. Popular Defenses … Manipulation Projection Intellectualizing Blaming Agreeing Disagreeing Inappropriate humour Minimizing Raging Passive Aggressive Argumentative Lying Bullying Helplessness Denial Rationalizing Grandiosity and so on ….

28. Delusion Unawareness manifested by sincere denial - - Denial of existence of a problem, of particular items of data, minimizing Unawareness manifested by sincere affirmation - Everything is fine, something/someone else is causing the problem, use is under control

29. Delusion Unawareness manifested by sincere denial - - Denial of existence of a problem, of particular items of data, minimizing Unawareness manifested by sincere affirmation - Everything is fine, something/someone else is causing the problem, my relationship with the addict is under control

30. Powerlessness Inability to control drug ingestion Inability to change manner of ingestion Inability to terminate drug ingestion Inability to recognize drug-involved condition Dysfunction or unmanageability of life

31. Powerlessness Inability to control enabling, controlling Inability to change manner of enabling Inability to terminate enabling Inability to recognize enabling Dysfunction or unmanageability of life

32. Physical Symptoms Increased tolerance Break and decrease in tolerance Inability to function normally without drugs Blackouts Euphoric memory recall

33. Physical Symptoms Increased tolerance for inappropriate behaviour Break and decrease in tolerance Inability to function normally without the addict Brown out due to the stress of heightened emotions Euphoric memory recall Stress-related pain or other physical symptoms

34. Ground Zero: The Family Trauma of Addiction 1. Addiction as the central theme of family life. Effects of single overwhelming event, or more likely, the more complicated effects of prolonged, repeated behaviours. 2. Addiction as a family condition. Traumatized people say common things – Were fine, were tough … leave us alone – let us do our jobs. If he/she would stop drinking everything would be fine 3. Stigma, shame and silence Promotes forgetting Keeping secrets: Dont Talk, Dont Trust Dont Feel Rule Victims co-operate with the perpetrator

35. 4. 4. Making accommodations to the addict –resulting in the loss of self of family members. Popular tried-and-true Accommodations:: Attempts to control the others AOD use or other behaviours Ruminating over whose fault it is, self-analysis, guilt Rescuing others from the dependents behaviour Resolving to do something about the problems, then backing down Accepting verbal, physical, emotional, or sexual abuse from loved one

36. Accommodations, continued… Comprising personal moral values to stay in the relationship Refusal to allow oneself to express, or even feel, feelings Develop defenses to protect oneself from the hurt, pain and guilt that surrounds the deteriorating relationship: denial, minimization, rationalization, sarcasm, etc… Holding onto a persistent belief, despite serious evidence to the contrary, that the dependent will change Refusal to allow the dependent to experience the consequences of his/her behaviour Somatic complaints stemming from the stress and anxiety inherent in living with a dependent person: headaches, stomach aches, insomnia, depression, appetite changes, anxiety, etc. And so on ……..

37. Ground Zero: the Family Trauma of Recovery The Process: Tracking the Vacuum The Stages of Family Recovery Drinking/Using Transition Early Recovery Ongoing Recovery The Domains of Family Recovery Environment System Individual

38. Treating Adults affected by Addiction: Education Experiential Practice Support

39. Education About addiction and codependency About addiction and codependency The trauma of couples and families in recovery The trauma of couples and families in recovery Responsibility for self and ones own behaviour Responsibility for self and ones own behaviour

40. Experiential Practice Self-Awareness- feelings – reconnecting with self Self-Awareness- feelings – reconnecting with self Boundaries: family of origin, creation, recovery Boundaries: family of origin, creation, recovery

41. Support Creating a support network – family of recovery Creating a support network – family of recovery

42. Treating children affected by addiction Education Support Play Prevention Resiliency-based

43. Education Learn about addiction as a disease Its not my fault Im not alone

44. Support Self-awareness – feelings Connect with resources – at least one nurturing adult

45. Prevention Over 44,000 teens ages 12 to 14 participated in a US 4-year survey, of whom 5.9 percent said they drank alcohol in the previous month. Nearly half either got their alcohol from a parent or guardian (29.6 percent), or from home (15.7 percent). Others acquired it from an unrelated adult (13.5 percent) or from another underage youth (19.6 percent). "People who begin drinking alcohol before the age of 15 are six times more likely than those who start at age 21 and older to develop alcohol problems … Parents and other adults need to be aware that providing alcohol to children can expose them to an increased risk for alcohol abuse and set them on a path with increased potential for addiction." - the US Substance Abuse and Mental Health Services Administration (SAMHSA). (February 2011)

46. Prevention, continued … If a child has the predisposition - genetically, socially or psychologically - to developing the disease of addiction, delaying first use can help him or her avoid developing the disease.

47. Resiliency-based Successful Adaptation Despite Risk Individual Resiliency Traits: Social Competence Problem-Solving Autonomy Sense of Purpose and Future

48. The family should be at the heart of therapy and treatment of addiction Healing begins in the circle of children and the family Treatment that pays respectful attention to this circle is based on love and relationships

49. REVIEW Mood-altering Family disease Codependency Enabling Caretaking Etc……. = compulsively avoiding or enhancing feelings = essentially relational, with all relationships centered on, and reactive to, the disease = making accommodations to the disease, resulting in loss of relationship with self = whatever one does to prevent the addict from experiencing the consequences of their behaviour. = doing for another person what is their responsibility to do for themselves. It is also about getting the caretakers needs met. It is mood-altering behaviour.

50. References Beatty, Melody 2009 The New Codependency Simon and Shuster, New York Brown, S. and V.M. Lewis, 1998 The Alcoholic Family in Recovery: A Developmental Model, The Guilford Press, New York Brown, S., V.M. Lewis and A. Liotta 2000 The Family Recovery Guide: A Map for Healthy Growth, New Harbinger Publications, Oakland, CA Dear, Greg E. et al 2005 Defining Codependency: A Thematic Analysis of Published Definitions, in Advances in Psychology, Volume 34, S. Shohov, ed. Nova Science Publishers Inc. Irvine, Leslie 1999 Codependent Forevermore: The Invention of a Self in a Twelve-Step Group The University of Chicago Press, Chicago

51. References, continued: Kaminer, W. 1992 Im Dysfunctional, Youre Dysfunctional Vintage Books, New York Kellogg, T., 1990 Broken Toys, Broken Dreams, BRAT Publishing, Santa Fe, NM Lovern, John D., 1991 Pathways to Reality: Erikson-Inspired Treatment Approaches to Chemical Dependency, Brunner/Mazel, New York McAuliffe, Robert M. and Mary B. McAuliffe 1975 The Essentials of Chemical Dependency, American Chemical Dependency Society, Minneapolis McAuliffe, Robert M. and Mary B. McAuliffe 2007 The Essentials of Chemical Dependency, (Revised and Expanded) American Chemical Dependency Foundation, Minneapolis McCubbin, Hamilton I., et al, 1997 Families Under Stress: What Makes Them Resilient? www.Cyfernet.orgwww.Cyfernet.org

52. References, continued: Moe, Jerry 2007 Understanding Addiction Through a Childs Eyes Health Communications Inc., Deerfield Beach Florida Plattor, C. 2010 Loving an Addict, Loving Yourself,, www.candaceplattor.com Steinglass, P. et al 1987 The Alcoholic Family, Basic Books White, W.L., Selected Papers www.williamwhitepapers.comwww.williamwhitepapers.com