Presentation on theme: "Treating the Chemically Dependent Family Presented by: Steve Brugge."— Presentation transcript:
Treating the Chemically Dependent Family Presented by: Steve Brugge
Treating the Chemically Dependent Family Presented by: Dellena Hoyer
Treating the Chemically Dependent Family Introduction:Introduction: –Are we there yet? –What is addiction? a.Scientific b.Medical – DSM IV c.Clinical – Bio/Psycho/Social d.Community – Will Power At the very core each individual must have core relationship skillsAt the very core each individual must have core relationship skills –What is important in a healthy relationship –Why am I seeking these things outside of me? Roles of family participants:Roles of family participants: Addict / AlcoholicAddict / Alcoholic EnablerEnabler HeroHero ScapegoatScapegoat Lost childLost child MascotMascot
Treating the Chemically Dependent Family How does the family get sick/betterHow does the family get sick/better –When does it begin? Continuum of effects: stage 1, 2, 3, 4 –How does it progress? Rationalization: it is just a little…bad luck, if he/she cuts out coke… Attachment: Munchausen’s by proxy Denial/Dishonesty: at least he/she is not-keep it behind doors Enabling: making excusing, violating belief systems Dependency: addicted to chaos, pain, misery Projection: whose fault, anger, victim –What are the outcomes? Stay sickStay sick ExhaustionExhaustion AbusiveAbusive AloneAlone
Treating the Chemically Dependent Family Get Healthy CommunicationBoundariesDetachmentRecoveryFree Truth Truth Family members are as sick as the alcoholic/addict Responsibility not to rear children in the env. (History repeats) Families need transparency Sick not bad Goal is well not good What is common sense to you is not to the world What it takes AccountabilityResponsibilityConsistency Action: Nothing happens without action – Einstein Support – Alanon, AA, 12 step support groups, church etc.
A Continuum of Alcohol or Other Drug Use No use → Proper use → Misuse → Abuse → Dependence (addiction) DSM – IV: Substance Abuse Maladaptive pattern of use Clinically significant impairment of distress One or more of these in 1 year Recurrent use results in failure to fulfill major role obligations at work, school or home Recurrent use results in failure to fulfill major role obligations at work, school or home Recurrent use in physically hazardous situations Recurrent use in physically hazardous situations Recurrent substance-related legal problems Recurrent substance-related legal problems Continued use despite persistent social or interpersonal problems Continued use despite persistent social or interpersonal problems Does not meet criteria for dependence
A Continuum of Alcohol or Other Drug Use DSM – IV: Substance Dependence Maladaptive pattern of substance useMaladaptive pattern of substance use Clinically significant impairment or distressClinically significant impairment or distress 3 or more of these in 12 months3 or more of these in 12 months Tolerance Tolerance Withdrawal Withdrawal Substance taken in larger amounts or over longer period than intended Substance taken in larger amounts or over longer period than intended Persistent desire or unsuccessful efforts to control Persistent desire or unsuccessful efforts to control A great deal of time is spent on use, obtaining drugs, recovering from use, obsession, etc. A great deal of time is spent on use, obtaining drugs, recovering from use, obsession, etc. Gives up important activities (social, work, recreational) Gives up important activities (social, work, recreational) Continued use despite recurrent problems Continued use despite recurrent problems May be with or without physical dependenceMay be with or without physical dependence
Red Flags for Addiction in Anyone Note: These “Red Flags” indicators can each be caused by problems other than addiction and none are, by themselves, indicators that a person is addicted. However, if a number of these indicators are present, you would have to consider that they may be caused by a substance abuse or addiction problem and consider seeking assistance. It is the multiplicity of problems, not any unique criterion, that leads to a diagnosis of substance dependence or addiction Note: These “Red Flags” indicators can each be caused by problems other than addiction and none are, by themselves, indicators that a person is addicted. However, if a number of these indicators are present, you would have to consider that they may be caused by a substance abuse or addiction problem and consider seeking assistance. It is the multiplicity of problems, not any unique criterion, that leads to a diagnosis of substance dependence or addictionPhysical Impaired physical coordination Impaired physical coordination Somnolence Somnolence Red eyes Red eyes Jumpiness, rapid speech Jumpiness, rapid speech Signs of self-neglect Signs of self-neglect Tremors Tremors Cigarette addiction Cigarette addiction “Looks alcoholic” “Looks alcoholic” Smell alcohol on breath Smell alcohol on breath Slowed, slurred speech Slowed, slurred speech Pupils dilated or pinned Pupils dilated or pinned Excessive perspiration Excessive perspiration Poor hygiene Poor hygiene Runny nose Runny nose Lip and finger burns Lip and finger burns
Red Flags for Addiction in Anyone Confusion Confusion Anxiety Anxiety Memory loss Memory loss Poor psychological adjustment Poor psychological adjustment Depression Depression Insomnia Insomnia Forgetfulness Forgetfulness Excessive mood swings Excessive mood swings Mental and Emotional Behavioral Extremely talkative Extremely talkative Poor judgment Poor judgment Anger of defensiveness if topic is brought up Anger of defensiveness if topic is brought up Legal problems Legal problems Financial problems Financial problems Impulsivity Impulsivity Unusual or erratic behavior Unusual or erratic behavior Loss of interests: activities, friends Loss of interests: activities, friends Problems at work Problems at work History of drug or alcohol problems History of drug or alcohol problems Violence Violence
Progression Chart “Phases and Symptoms of Chemical Dependency” Early Preoccupation/planning next use Increased tolerance/increased usage Manipulation of environment Hiding/protecting supply Unplanned use Blackouts Attempts to control use Loss of interest-apathy Increased consequences
Progression Chart “Phases and Symptoms of Chemical Dependency” MiddleIrresponsibility Attempts to quit Geographic escape Low self-esteem Rigid defenses Delusions/lies Decreased tolerance Erratic behavior Physical health problems
Progression Chart “Phases and Symptoms of Chemical Dependency” Final Life in chaos/unmanageability Loss of values Self-hateSuicidal Increased health problems InsanityIncarcerationDeath
The Family Progression Learning Phase oRandomly experiments with defensive behavior oProtects self oRelieves stress oTries to maintain balance Seeking Phase oVague awareness of alcohol/drug problem oRationalize/deny problem oProtective behavior to manipulate environment oFamily tries to control use Harmful Phase oBehavior becomes survival roles: compulsivepredictableautomatic oFamily structure becomes rigid oIncreased tolerance to pain Escape Phase oSearch for way out oFamily members carry defensive lifestyle with them
Family Types Nurturing Family oFlexible, open to change oHigh self worth, sense of identity oFunctional defenses oClear rules oFamily can take risks oFamily can deal with stress oStrong parental coalition Marginal Family oLess flexible oShaky self-worth oDysfunctional defenses oBegins to focus on scapegoat oAvoids confronting problems Dysfunctional Family oRigid, fixed system oLow self-worth oCompulsive defenses oSecret, inhuman rules oBizarre behavior ignored oDenies stress
Healthy vs. Dysfunctional Family Healthy People feel free to talk about inside feelings All feelings are okay All subjects for discussion Person more important than performance Individual differences accepted Each person responsible for own actions Respectful criticism and appropriate consequences or actions Few should Clear flexible rules Atmosphere is relaxed Joyous People feel loving Growth is celebrated People have high self worth Faces and works through stress Nurturing Dysfunctional People compulsively protect inside feelings Only “certain feelings” OK Many taboo subjects, lots of secrets Performance more important than person Everyone must conform to strong peoples ideas, values Lots of control, criticism Punishment and shaming Everyone should Unclear, inconsistent, and rigid rules Atmosphere is tense Lots of anger, fear People feel hurt, disappointed Growth is discouraged People have low self worth Avoids stress
Good Communication Points to Remember Pick the right opportunity to communicate serious matters. “Right” may be different for each of you, but generally… When everyone isn’t angry When everyone is sober When there are a minimum of distractions Focused body posture for sending and receiving messages: S=Squarely face the person O=Open body posture L=Lean slightly forward to indicate interest E=Eye contact R=Relaxed body posture and facial expression Do not interrupt. Allow the person to finish their statement. Avoid the trap of formulating your response while they are talking and waiting for them to take a breath so you can make your point. Do not make assumptions that you know what they “always” say, they must be saying it again. When talking about feelings, always, use the “I feel” statement Stay in the present. Resist the temptation to drag up the past. “You always…”Aren’t you, in fact, hoping for change in the present? How is focusing on the past helpful?
Good Communication Points to Remember Avoid rambling and repeating yourself to make sure you are being heard. If they tuned you out the first time, they most assuredly will be tuning out your repetition. Make sure all parts of your message match (body language, feelings, thoughts, words). Focus on behaviors, not personality or name-calling. Use the “say-ask” approach. I would like to go to the movie. What would you like to do.” Discuss, do not attack. Aggressive behavior elicits defensive responses. Keep your voice low. Don’t talk over the other person or talk louder. You are probably not being heard by a person who is yelling anyway. REMEMBER: If the message was not received, no communication occurred because nothing was exchanged.
Victim Lines: I fell so lostI’m not capable I’m confusedI’m worthless I’m so afraidI can’t do anything right I can’tNothing I do seems to please you I don’t knowI’m ugly It’s not my faultI’m too fat Tell me what to doI’m too thin (Remember, healthy people make up their minds and act or seek God’s help and turn it over. I’ll TRY is a way of leaving the door open for failure). Rescue Lines: It’s all going to be fineDon’t worry, I’ll fix it I’ll help youI’ll take care of you I’ll do it for youBless your heart, you are so tired I’ll talk to them for youI’ll explain it for you Don’t be afraid, I’m hereDon’t worry, I’m here (Remember, healthy people never do for others what others can do for themselves, that is a CRIPPLE YOU ACT).
Persecute Lines: You are ….!!!You can’t Don’t be that wayYou shouldn’t feel that way After all I’ve done for you and…You are wrong You are fat, stupid, etc…Shut up! If you don’t stop that I’ll (Remember, healthy people do not threaten. They discuss a problem and if a solution doesn’t come, they simply act. Healthy people don’t threaten to leave, they make a decision to do so and leave).
Listening –An Act of Love 1.Be interested and show it. Genuine concern and a lively curiosity encourage others to speak freely. Interest also sharpens your attention and builds itself 2.Hold your fire. Avoid jumping to conclusions. Hear the speaker out. Plan your response only after you’re certain that you’ve gotten the whole message. 3.Look for the main ideas. Avoid being distracted by details. Focus on the key issue. You may have to dig hard to find it. 4.Monitor your own feelings and point of view. Each of us listens differently. – Our convictions and emotions filter, even distort, what we hear. Be aware of your own attitudes, prejudices cherished beliefs and your emotional reaction to the message. 5.Watch for feelings. Often people talk to “get something off their chests.” Feelings, not facts, may be the main message.
Listening –An Act of Love 6.Notice nonverbal language. A shrug, a smile, a nervous laugh, gestures, facial expressions and body positions speak volumes. Start to “read” them. 7.Get feedback. Make certain you’re really listening. Ask a question. Confirm with the speaker what he or she actually said. 8.Work at listening. Hearing is passive. Our nervous system does the work. Listening is active. It takes mental effort. 9.Give the other person the benefit of the doubt. We often enter conversations with our minds already made up, at least partially, on the basis of past experience. Prejudgments can shut off new messages. 10.Tune into the other person. Try to understand his or her viewpoint, assumptions, needs, and system of beliefs.
Intervention Principles Delusionary System: Why the Addict Cannot See the Problem 1. Physical effect of the drugs → alter perception, judgment and memory 2.Blackouts → major memory problem 3.Misinformation and confusion 4.Denial (Distortion of reality to prevent emotional distress) There are a number of types of interventions. Good interventions help addicted people take action before they have to “hit rock bottom.” A personal expression of your concern for a friend or colleague may be a fully effective intervention, prompting them to see the problem and take action.
Intervention Principles In many cases, a structured, planned intervention is required. It is important to obtain consultation and assistance with formal interventions. Effective structured interventions are based upon: Direct, honest feedback Multiple concerns from several concerned others simultaneously Genuine caring and support from interveners Data clarity Meticulous preparation Timing Capitalizing on the natural crises that come with addiction Clarity of goal → a specific treatment plan, immediately available and aranged in advance Preparation for all possible arguments against treatment Leverage!