1. The Family in Addiction and Recovery
Ken Roy, MD, FASAM
Addiction Recovery Resources, Inc. • River Oaks Hospital
Tulane Department of Psychiatry

2. Family Systems Theory
Contemporary systems theories about families are derived from General Systems Theory, which is both a transdisciplinary field of study and a theoretical framework in which various microlevel approaches are known as “systems theories.” These theorists attempt to explain the behavior of complex, organized systems of all sorts, from thermostats to families. Systems thinking is a way of looking at the world in which objects are interrelated with one another

3. Family Systems Theory
Patterns develop as certain family member's behavior is caused by and causes other family member's behaviors in predictable ways
Families have interrelated elements and structure. The elements of a system are the members of the family. Each element has characteristics; there are relationships between the elements; the relationships function in an interdependent manner. All of these create a structure, or the sum total of the interrelationships among the elements, including membership in a system and the boundary between the system and its environment

4. Family Systems Theory
Families interact in patterns. There are predictable patterns of interaction that emerge in a family system. These repetitive cycles help maintain the family’s equilibrium and provide clues to the elements about how they should function

5. Family Systems Theory
Families have boundaries and can be viewed on a continuum from open to closed. Every system has ways of including and excluding elements so that the line between those within the system and those outside of the system is clear to all. If a family is permeable and has vague boundaries it is considered “open.” Open boundary systems allows elements and situations outside the family to influence it. It may even welcome external influences. Closed boundary systems isolate its members from the environment and seems isolated and self-contained. No family system is completely closed or completely open

6. Family Systems Theory
Families use messages and rules to shape members. Messages and rules are relationships agreements which prescribe and limit a family members’ behavior over time. They are repetitive and redundant. They are rarely, if ever, explicit or written down. They give power; they induce guilt; they control or limit behaviors; and they perpetuate themselves and reproduce. Most messages and rules can be stated in one or a few words. For example, More is good, Be responsible, and Be Perfect are all examples of messages/rules

7. Family Systems Theory
Families have subsystems. Every family system contains a number of small groups usually made up of 2-3 people. The relationships between these people are known as subsystems, coalitions, or alliances. Each subsystem has its own rules, boundaries, and unique characteristics. Membership in subsystems can change over time

8. Virginia Satir Early Family Systems therapist
The "presenting issue" or "surface problem" itself was seldom the real problem
How people coped with the issue created the problem
“She took the mental health field out of seeing people with problems as 'pathology' generated by the psychiatric network of Freud into seeing people as a product of their negative family scripts which could be changed by learning to communicate with feelings“
Lynne Namka, author of “The Doormat Syndrome”

9. The Family in Addiction
Virginia Satir – adopted by Sharon Wegsheider & Claudia Black
This (Family Systems Theory) is especially true in addiction
Addiction is the “presenting problem” around which the whole family develops roles, rules and expectations

10. Family Roles – Alcoholic/Addict (?Dad)
Role: To act irresponsibly
“ I want what I want when I want it”
Purpose: To suppress more basic marital conflict To divert attention away from more threatening family issues

11. Family Roles – Chief Enabler (Mom)
Role: To reduce the tension in the family by “smoothing things over”
“ I will fix it”
Purpose: Offers the family a (false) sense of stability and protection

12. Family Roles – Family Hero
Role: Source of pride for the family
“ I can handle anything and succeed”
Purpose: Offers the family a sense of being okay; To give them hope and something to feel good about

13. Family Roles – Hero Often the oldest child
Attempts to do everything right
Helps care for younger siblings and complete household chores
Frequently does well in academic and athletic pursuits

14. Hero Many later become “workaholics”
May be susceptible to stress-related illnesses later in adulthood
Ex. - ulcers, coronary heart disease
May be more prone to “Type A” Behavior as an adult
Competitiveness, hostility, time urgency, etc.

15. Family Roles – Scapegoat
Role: Alter ego of the family hero
“I’ll show you; I don’t care what I say”
Purpose: Offers the family a sense of purpose by providing someone to blame and a focus for anger

16. Family Roles – Scapegoat
Often the second oldest child
Expresses the family’s anger and frustration
Male: may be violent
Female: may runaway or engage in promiscuous sexual activity
BOTH: most likely to abuse drugs also

17. Scapegoat
This role allows the chemically dependent parent to blame someone else for his or her own drinking/drugging
Shields the chemically dependent parent from some of the blame and resentment that would have been directed towards him/her

18. Family Roles – People Pleaser
Role: Caretaker and non-judgmental
“I’ll care for you”
Purpose: Provides the family someone to rely on emotionally

19. Family Roles – People Pleaser
Often the oldest girl or oldest boy
Caring and compassionate
Good listener
Gives well
Sensitive to others

20. People Pleaser Carries the family guilt
High tolerance for inappropriate behavior
Strong fear of anger or conflict
Denies personal needs
“Doormat” behavior
Strong potential to marry an alcoholic/addict

21. Family Roles – Lost Child
Role: Seeks to avoid conflict at all costs
“I’ll be invisible; I don’t need anyone”
Purpose: Offers the family a sense of relief and success, and is not a trouble to the family

22. Family Roles – Lost Child
May be a middle child; or maybe the youngest
Very shy and withdrawn
They tend to be followers, not leaders
Often think that the family wouldn’t notice if they left

23. Lost Child
Difficulty with developmental transitions as they fear taking risks
May put off making decisions about careers or housing
Trouble with intimate relationships
As adults they may exhibit a myriad of mental health problems, anxiety depression

24. Family Roles – Mascot Role: To play the “family clown”
“Let me entertain you”
Purpose: To bring laughter and fun into the home

25. Family Roles – Mascot Often is the youngest child in the family
Develops a dire need for approval from others
Viewed as the most fragile and vulnerable
Behaviors are an act of defense against feelings of anxiety and inadequacy

26. Mascot
As adults they tend to be very likeable but often appear anxious
May self-medicate with alcohol and/or tranquilizers
May be the one family member that nobody complains about

27. Family in Addiction Roles and boundaries dictate communication
Feelings are stuffed
Resentments develop that are not communicated
Until they come out sideways
Family members keep secrets from each other
Sick families keep secrets
The family isolates from the larger world

28. Healthy Families
Healthy Family function lies in its ability to avoid getting caught in shaming/blaming, to talk honestly with each other, to listen to and be curious about each other’s perspectives on the problem, to admit ignorance, to listen to and respect the wisdom in their feelings, to problem solve together, and to seek help when they are powerless to mend themselves

29. Families in Recovery Are educated about all of the above
Are taught better communication skills
Find the humility to accept and correct their individual parts in the disturbed family system
Embrace change much the same way that the identified patient accepts change
Alanon
“I didn’t cause it. I can’t cure it, and it’s not my fault.”
Detach with love

30. Treatment for Addiction
Requires family participation
Without change the system tends to inertia in dysfunction
Families require education about the disease idea of addiction
Families also require attention to the functions of the family system that contribute to and support the development of the disease