Presentation on theme: "Treating the Chemically Dependent Family"— Presentation transcript:
1Treating the Chemically Dependent Family Presented by:Steve Brugge
2Treating the Chemically Dependent Family Presented by:Dellena Hoyer
3Treating the Chemically Dependent Family Introduction:Are we there yet?What is addiction?ScientificMedical – DSM IVClinical – Bio/Psycho/SocialCommunity – Will PowerAt the very core each individual must have core relationship skillsWhat is important in a healthy relationshipWhy am I seeking these things outside of me?Roles of family participants:Addict / AlcoholicEnablerHeroScapegoatLost childMascot
4Treating the Chemically Dependent Family How does the family get sick/betterWhen does it begin?Continuum of effects: stage 1, 2, 3, 4How does it progress?Rationalization: it is just a little…bad luck, if he/she cuts out coke…Attachment: Munchausen’s by proxyDenial/Dishonesty: at least he/she is not-keep it behind doorsEnabling: making excusing, violating belief systemsDependency: addicted to chaos, pain, miseryProjection: whose fault, anger, victimWhat are the outcomes?Stay sickExhaustionAbusiveAlone
5Treating the Chemically Dependent Family Get HealthyCommunicationBoundariesDetachmentRecoveryFreeTruthFamily members are as sick as the alcoholic/addictResponsibility not to rear children in the env. (History repeats)Families need transparencySick not badGoal is well not goodWhat is common sense to you is not to the worldWhat it takesAccountabilityResponsibilityConsistencyAction: Nothing happens without action – EinsteinSupport – Alanon, AA, 12 step support groups, church etc.
6A Continuum of Alcohol or Other Drug Use No use → Proper use → Misuse → Abuse → Dependence (addiction)DSM – IV: Substance AbuseMaladaptive pattern of useClinically significant impairment of distressOne or more of these in 1 yearRecurrent use results in failure to fulfill major role obligations at work, school or homeRecurrent use in physically hazardous situationsRecurrent substance-related legal problemsContinued use despite persistent social or interpersonal problemsDoes not meet criteria for dependence
7A Continuum of Alcohol or Other Drug Use DSM – IV: Substance DependenceMaladaptive pattern of substance useClinically significant impairment or distress3 or more of these in 12 monthsToleranceWithdrawalSubstance taken in larger amounts or over longer period than intendedPersistent desire or unsuccessful efforts to controlA great deal of time is spent on use, obtaining drugs, recovering from use, obsession, etc.Gives up important activities (social, work, recreational)Continued use despite recurrent problemsMay be with or without physical dependence
8Red 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 addictionPhysicalSmell alcohol on breathSlowed, slurred speechPupils dilated or pinnedExcessive perspirationPoor hygieneRunny noseLip and finger burnsImpaired physical coordinationSomnolenceRed eyesJumpiness, rapid speechSigns of self-neglectTremorsCigarette addiction“Looks alcoholic”
9Red Flags for Addiction in Anyone Mental and EmotionalConfusionAnxietyMemory lossPoor psychological adjustmentDepressionInsomniaForgetfulnessExcessive mood swingsBehavioralExtremely talkativePoor judgmentAnger of defensiveness if topic is brought upLegal problemsFinancial problemsImpulsivityUnusual or erratic behaviorLoss of interests: activities, friendsProblems at workHistory of drug or alcohol problemsViolence
10Progression Chart “Phases and Symptoms of Chemical Dependency” EarlyPreoccupation/planning next useIncreased tolerance/increased usageManipulation of environmentHiding/protecting supplyUnplanned useBlackoutsAttempts to control useLoss of interest-apathyIncreased consequences
11Progression Chart “Phases and Symptoms of Chemical Dependency” MiddleIrresponsibilityAttempts to quitGeographic escapeLow self-esteemRigid defensesDelusions/liesDecreased toleranceErratic behaviorPhysical health problems
12Progression Chart “Phases and Symptoms of Chemical Dependency” FinalLife in chaos/unmanageabilityLoss of valuesSelf-hateSuicidalIncreased health problemsInsanityIncarcerationDeath
13The Family Progression Learning PhaseRandomly experiments with defensive behaviorProtects selfRelieves stressTries to maintain balanceSeeking PhaseVague awareness of alcohol/drug problemRationalize/deny problemProtective behavior to manipulate environmentFamily tries to control useHarmful PhaseBehavior becomes survival roles:compulsivepredictableautomaticFamily structure becomes rigidIncreased tolerance to painEscape PhaseSearch for way outFamily members carry defensive lifestyle with them
14Family Types Nurturing Family Marginal Family Dysfunctional Family Flexible, open to changeHigh self worth, sense of identityFunctional defensesClear rulesFamily can take risksFamily can deal with stressStrong parental coalitionMarginal FamilyLess flexibleShaky self-worthDysfunctional defensesBegins to focus on scapegoatAvoids confronting problemsDysfunctional FamilyRigid, fixed systemLow self-worthCompulsive defensesSecret, inhuman rulesBizarre behavior ignoredDenies stress
16Healthy vs. Dysfunctional Family People feel free to talk about inside feelingsAll feelings are okayAll subjects for discussionPerson more important than performanceIndividual differences acceptedEach person responsible for own actionsRespectful criticism and appropriate consequences or actionsFew shouldClear flexible rulesAtmosphere is relaxedJoyousPeople feel lovingGrowth is celebratedPeople have high self worthFaces and works through stressNurturing DysfunctionalPeople compulsively protect inside feelingsOnly “certain feelings” OKMany taboo subjects, lots of secretsPerformance more important than personEveryone must conform to strong peoples ideas, valuesLots of control, criticismPunishment and shamingEveryone shouldUnclear, inconsistent, and rigid rulesAtmosphere is tenseLots of anger, fearPeople feel hurt, disappointedGrowth is discouragedPeople have low self worthAvoids stress
17Good 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 angryWhen everyone is soberWhen there are a minimum of distractionsFocused body posture for sending and receiving messages:S=Squarely face the personO=Open body postureL=Lean slightly forward to indicate interestE=Eye contactR=Relaxed body posture and facial expressionDo 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” statementStay 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?
18Good 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.
19Victim Lines: Rescue Lines: I fell so lost I’m not capable I’m confused I’m worthlessI’m so afraid I can’t do anything rightI can’t Nothing I do seems to please youI don’t know I’m uglyIt’s not my fault I’m too fatTell me what to do I’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 fine Don’t worry, I’ll fix itI’ll help you I’ll take care of youI’ll do it for you Bless your heart, you are so tiredI’ll talk to them for you I’ll explain it for youDon’t be afraid, I’m here Don’t worry, I’m here(Remember, healthy people never do for others what others can do for themselves, that is a CRIPPLE YOU ACT).
20Persecute Lines: You are ….!!! You can’t Don’t be that way You shouldn’t feel that wayAfter all I’ve done for you and… You are wrongYou 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).
21Listening –An Act of Love Be interested and show it. Genuine concern and a lively curiosity encourage others to speak freely. Interest also sharpens your attention and builds itselfHold 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.Look for the main ideas. Avoid being distracted by details. Focus on the key issue. You may have to dig hard to find it.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.Watch for feelings. Often people talk to “get something off their chests.” Feelings, not facts, may be the main message.
22Listening –An Act of Love Notice nonverbal language. A shrug, a smile, a nervous laugh, gestures, facial expressions and body positions speak volumes. Start to “read” them.Get feedback. Make certain you’re really listening. Ask a question. Confirm with the speaker what he or she actually said.Work at listening. Hearing is passive. Our nervous system does the work. Listening is active. It takes mental effort.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.Tune into the other person. Try to understand his or her viewpoint, assumptions, needs, and system of beliefs.
23Intervention Principles Delusionary System: Why the Addict Cannot See the ProblemPhysical effect of the drugs → alter perception, judgment and memoryBlackouts → major memory problemMisinformation and confusionDenial (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.
24Intervention 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 feedbackMultiple concerns from several concerned others simultaneouslyGenuine caring and support from intervenersData clarityMeticulous preparationTimingCapitalizing on the natural crises that come with addictionClarity of goal → a specific treatment plan, immediately available and aranged in advancePreparation for all possible arguments against treatmentLeverage!