2.  The purpose of this presentation is to show how substance abuse effects the family system. It should answers some question you might have about how substance abuse effects families, and show treatment approaches with family therapy. It’s also going to have some reflection on your own family patterns, and is attended to reach families who might have a family member suffering from substance abuse.

3.  There is no single definition of a family, but several broad categories that fits most families. › Traditional families  Heterosexual couples, single parents, families including blood relatives, stepfamilies, adopted families. › Extended families  Grandparents, uncles, aunts, cousins, other relatives › Elected Families  Self-identified and joined by choice not usually blood.

4.  Family is a long lasting involvement on a emotional level. Families have patterns of communication, boundaries, and interacted patterns that provide clues as to how they function. A family is a system and change in any part of the system will bring change in all other parts.

5.  Substance abuse disrupts the consistency and predictability that should be present in a family. Because of this, life may feel chaotic, roles are unclear, rules are based on random choice rather than reason, family members may have problems in relationships, illogical thinking, and living in denial. Your family may develop a strategy for coping, and your family life is based around the alcoholic.

6.  Having someone in your family that abuses substances can affect you in many ways. › 1. Don’t feel  Living with the constant pain of an alcoholic you may quit feeling in order to survive › 2. Don’t talk  Learn not to talk about a huge part of your reality. › 3. Don’t trust  Learn not to count on others as a result of broken promises and forgotten celebrations. May also learn not to count on others.

7.  A family that has a drug or alcohol addicted family member has an emotional impact on all its members. Family members may develop survival roles to help cope with the dysfunction of the addicted person.

8.  The codependent role is taken by the type of person commonly called the “enabler”. An enabler is characterized as a person “who reacts in such a way as to shield the dependent from experiencing the full impact of the harmful consequences” of the disease (Curtis, 1999). A codependent is the person closest to the addicted person and is usually the first family member to react dysfunctional.

9.  Generally the oldest family member. The hero sees and hears more of what is really happening in the family than other children, and carries the most responsibility for the family pain. The hero is likely to grow up and marry an alcoholic and assume the role “enabler”.

10.  This is the problem child. The scapegoat cannot afford to look at the pain created by the family’s dysfunction, because to do so would make the scapegoat feel helpless. The scapegoat is aware of the manipulative communication of the enabler and hero with the addict, and considers them dishonest. The scapegoats reaction is silent anger turned inward.

11.  Child who tries to bring something fun and humorous to family, and is the family pet. The mascot works hard to get attention, and his role is to relieve tension. He is noticed by clowning around, and diffuses anger by laughter. Usually unable to express deep feelings.

12.  Child feels unimportant within the family, learns quickly that the family spends most of it’s energy protecting the addict. The lost child finds it’s easier to become a loner, and never creates a need to worry. For this child to survive he/she becomes independent, and stays on the fringe of the family pain.

13.  Family therapy is a form of counseling that specializes in treating the family. Family therapy has a various amount of approaches that share the belief in family-level assessment and intervention. Family therapy believes that individuals first learn about themselves, there emotions, and how to manage close relationships from our experience we have with our family of origin.

14.  1. The family Disease model  2. The family System model  3. Cognitive- Behavioral approaches  4. Multidimensional Family Therapy

15.  The family Disease model looks at substance abuse as affecting the whole family. Family members of the people who abuse substances may develop codependency which in turns may led in enabling the addicted person.  The Family System model is based on the idea that families become organized by their interactions around substance abuse. By doing this it is possible for the family to maintain homeostasis (balance).

16.  Cognitive-behavioral approaches is based on the idea that maladapted behaviors, including substance abuse, are reinforced through family interactions (O’Farrell and Stewart, 1999).  Multidimensional family therapy is the most recent and has blended together several different techniques with emphasis on behavioral, emotional, cognitive, and environmental input. (Liddle, 1992).

17.  For family and friends of drug or alcohol addicted people addressing the addiction is one of the most difficult aspects of helping the addicted person seek treatment. Often, over time, family involvement only leads to enabling the addicted person.

18.  Each family is different and the way you approach family involvement with addiction therapy will differ with every person. Your family may decide to have a private talk with family member or you may have an intervention.

19.  Family interventions in substance abuse means that a group of family and friends have a confrontation with a person abusing drugs or alcohol. The goal is to show the impact of substance on the addicted persons life and family members and try to urge the addicted person into treatment.

20.  Family therapy for substance abuse treatment has two main purposes; use family strength to find a way to live without substance of abuse, and helps the impact of substance abuse on the patient and family. Another major goal is prevention, and education.

21.  One of the main goals in involving family members into treatment is to increase the family understanding of the clients substance abuse disorder as a disease.

22.  Increase support for the family member in recovery › Family sessions can increase the addicts motivation for recovery, and show family members that the addicts substance abuse problems intertwine with problems in the family.  Identify and support change of family patterns that work against recovery. › If family members are supporting addicts substance use or enabling.

23.  Prepare family members for what to expect for person in recovery. › Make sure family doesn't have any unrealistic expectations that this is a quick fix.  Educate family about relapse warning signs. › Family members who understand warning signs can help prevent the clients relapse if they know what they are looking for.

24.  Help family members understand the cause and effect of substance abuse disorder from a family perspective. › Most family members do not understand how substance use disorders develop or that patterns of behavior and interaction have developed in response to the substance-related behavior of the family member who is in treatment. It is valuable for individuals in the family to gain insight into how they may be maintaining the family's dysfunction. Counselors should help family members address feelings of anger, shame, and guilt and resolve issues relating to trust and intimacy. (NCBI, 2013).

25.  Take advantage of family strength. › Family members who have positive attitudes and positive support attitudes will help motivate the addicts recovery.  Encourage family members to obtain long term support. › As the addict recovers the family members need to take responsibility for there own emotional, spiritual, and psychical recovery process.

26.  The best way to move forward is to face the past, it’s importance, and it’s meaning for you. You can actively work to replace self destructive behaviors with healthy ones. A good way to do this is through Al-ANON which is a twelve stepped based program. It’s a fellowship of relatives and friends of alcoholics who share their experience, strength and hope in order to solve their common problems.

27.  For everyone to understand some family patterns in your own family I would like everyone to make your own family genogram. Genograms are a helpful tool in assessing family patterns, functioning, and behavior. There are many ways to figure out what your family genogram means, and I can help you identify some clues.

28.  Dates provide information that helps place events in perspective. They indicate simultaneous related events or suggest possible sequences of experiences. For example, if you discover that a person or family was dealing with three significant losses within a year, you can question the effect of these stresses on family members, such as a new baby or a child leaving home (Galvin, 2010).

29.  Gender beliefs and values may flow through families in powerful and subtle ways, creating difficulties when a member marries or partners with someone with different gender beliefs. For example, discovering that a particular family has sent clear messages that men are strong and do not show emotions may provide greater understanding of the struggle of a younger generation husband and wife (Galvin, 2010).

30.  Secrets: Genograms can reveal information about communication patterns and boundaries in families.  Losses: A key genogram factor is losses, and the depth and pain of loss vary greatly.  Themes: Themes can provide information like; who you are, why you behave certain ways. Themes show a family’s core belief system and values.

31.  Culture: Your genogram can show you your cultural heritage and give you clues about values, beliefs, communication patterns, and behaviors.  Boundaries: Your genogram will show you how your family established relationships with the outside world, as well as between and among family members.  Substance Abuse: Genograms can also show patterns of substance abuse from generation to generation.

32.  Once you evaluate and understand your genogram I would encourage you to discuss it with other family members. Once you have identified some of your family functioning you can understand ways to change patterns. If your genogram suggests substance abuse runs strong in your family you can change old dysfunctional patterns, and incorporate some new healthy patterns. The first step you have already taken; starting to understand your family system.

33.  Lamenan, A Beth. (2013). How drug and alcohol abuse affects families and steps to recovery for all family member. Chicago Tribune. Retrieved from: http://www.chicagotribune.com/sns- health-addiction-families,0,2311189.storyhttp://www.chicagotribune.com/sns- health-addiction-families,0,2311189.story  NIH. (2013). DrugFacts: Treatment Approaches for Drug Addiction. National Institute on Drug Abuse. Retrieved from: http://www.drugabuse.gov/publications/drugfacts/treatment- approaches-drug-addiction http://www.drugabuse.gov/publications/drugfacts/treatment- approaches-drug-addiction  King, Kyle. (2013). Family Therapy. GoodTherapy. Com. Retrieved from: http://www.goodtherapy.org/family-systems- therapy.htmlhttp://www.goodtherapy.org/family-systems- therapy.html  Smith, Dan. (n.d.). Understanding the family as a System. Retrieved from: http://smith.soehd.csufresno.edu/system.htmlhttp://smith.soehd.csufresno.edu/system.html  SAMSAH. (2013). Substance Abuse Treatment and Family Therapy. SAMSAH. Retrieved from: http://store.samhsa.gov/shin/content//QGAT39/QGAT39.pdf http://store.samhsa.gov/shin/content//QGAT39/QGAT39.pdf  Curtis, Olivia. (1999). Chemical Dependency A Family Affair. CA, Belmont. Brooks/Cole Cengage Learning