1. Family Systems and the Impact of Substance Abuse

2. Impact on Family Developmental Stages
Early Phase
Chemical dependency emerges and proves powerful in the family, that all other issues are ignored.
Individuals are powerfully influenced by their families of origin
Chemical dependency affects family identity formation in two instances
Family enters the early phase with an already established problem of dependency
Chemical dependency arises while the family is working out its identity issues
Brooks/Cole, Cengage Learning, 1999

3. Impact on Family Developmental Stages
Middle Phase
Committing to set of family norms that will ensure stability is the major task for the middle phase of development.
The chemically dependent family builds:
Maintenance activities around a core of alcohol
Drug-related behaviors
Family development , because of chemical dependency invades the family regulatory behaviors and becomes altered.
During the middle phase the seeds of generational transmission of chemical dependency are being sown.
Brooks/Cole, Cengage Learning, 1999

4. Impact on Family Developmental Stages
Late Phase
The family’s identity is firmly established in this stage and the major task is recognizing and stabilizing as it plans for the future.
Generational transmission of alcoholism or addiction is clearly noticed:
Transmission of beliefs and values regarding the use of alcohol or drugs
Perspective of family culture is incorporated and then transmitted into the children
The family is now forced to make an explicit statement about chemical dependency. The nature of that statement determines which possible options or pathways the family will follow.
Brooks/Cole, Cengage Learning, 1999

5. Impact on Family Developmental Stages
The four different pathways or options the alcoholic family is directed include;
The Stable Wet Dependent Family
The Stable Wet or Controlled Use Nondependent Family
The Stable Dry Dependent family
The Stable Dry Nondependent Family

6. Impact on Family Developmental Stages
The Stable Wet Dependent family:
Evidence of an accommodation of the family to the chemical dependency and its related consequences
The family has taken a firm stance
Family members periodically challenge and question the wisdom of this way of life
Family members may also threaten to leave unless change occurs
The family seems to have lost its ability, but its will to change
Brooks/Cole, Cengage Learning, 1999

7. Impact on Family Developmental Stages
The Stable Wet or Controlled Use Nondependent Family:
Although drinking or drug use may not stop, movement strives away the dependency as a core development or identity issue
The reduction of consumption from time to time
Drug use is no longer a controlling factor in the family regulatory behavior
Brooks/Cole, Cengage Learning, 1999

8. Impact on Family Developmental Stages
The Stable Dry Dependent family:
The family has successfully negotiated a conversion to no use by the dependent
There is no movement away from the dependent family identity
Behavior patterns that has been established around the dependent continue to dominate family life
Brooks/Cole, Cengage Learning, 1999
The Stable Dry Nondependent Family:
The drug use has stopped, but the family has given up its preoccupation with drugs and drug-related issues
Some families make no particular commitment to reorganize the family, just no longer focus on drug-related behavior
This stage does not resolve issues related to the dependency but also involves major family reorganization and transformation of individual members
Brooks/Cole, Cengage Learning, 1999

9. Critical Issues in Chemically Dependent Families
The most vulnerable members of any family are children. The impact of chemical dependency on the family’s regulatory structure and international patterns can in themselves create adverse outcomes for developing children.
Rules and disciplinary inconsistencies;
Projection of blame
Extreme rigidity or lack of boundary definition
Lack of trust
Role confusion
Brooks/Cole, Cengage Learning, 1999

10. Critical Issues in Chemically Dependent Families
Alcohol and drugs serve as a disinhibiting factor in many cases of child sexual abuse and domestic violence.
Some factors that contribute to domestic violence include;
Child abuse, examples are;
Physical sexual abuse, any kind of touching in a sexual way ranging from sexualized hugging or kissing to actual intercourse
Emotional sexual abuse, involves a parent’s inappropriate bonding with a child to get his or her emotional needs met
Brooks/Cole, Cengage Learning, 1999

11. Critical Issues in Chemically Dependent Families
Factors that contribute to domestic violence continued;
Shame, a defined factor that is associated with chemically dependent systems
Shame differs from guilt.
Shame is an intensely painful feeling about one’s self as a person and can seriously damage emotional growth
Guilt constitutes regret for an action and presents the opportunity to assert personal values, make amends, and to grow from the experience
Shame-bound families operate according to rules that demand control, perfectionism, blame, and denial
Brooks/Cole, Cengage Learning, 1999

12. Critical Issues in Chemically Dependent Families
The Families,
Every year, more than 3 million children witness domestic violence in their homes.
Children who live in homes where there is domestic violence also suffer abuse or neglect at high rates (30% to 60%).
A 2005 Michigan study found that children exposed to domestic violence at home are more likely to have health problems, including becoming sick more often, having frequent headaches or stomachaches, and being more tired and lethargic.
A 2003 study found that children are more likely to intervene when they witness severe violence against a parent – which can place a child at great risk for injury or even death.
violence--abuse-53/domestic-violence-the-facts-195.html

13. Critical Issues in Chemically Dependent Families
Family Survival Roles:
The Chemically Dependent person
Codependent
Family hero
Scapegoat
Mascot
Lost Child

14. Critical Issues in Chemically Dependent Families
The Chemically Dependent Person; Process of projection Attempting to place on others the responsibility for using and for the family’s problems.
Codependent; this role is taken on by the enabler 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

15. Critical Issues in Chemically Dependent Families
Family Hero; Generally the oldest child in the family and works in close alliance with the codependent to maintain the family homeostasis The hero is likely to grow up to marry an alcoholic and assume the role of enabler
Scapegoat; The problem child, with disruptive behavior that demands urgent, fast attention The scapegoat is keenly aware of the manipulative communication of the enabler and the hero with chemically dependent person Brooks/Cole, Cengage Learning, 1999

16. Critical Issues in Chemically Dependent Families
Mascot; The member who at least tries to bring some fun and humor into the family and usually functions as the family pet Characteristic defensive behaviors are hyperactivity, charm, being super cute, and doing anything to get a laugh or be the center of attention (the joker) Brooks/Cole, Cengage Learning, 1999
Lost Child; The lost child has much in common as the scapegoat. Both feel insignificant and unimportant within the family and learns quickly that the family spends its prime energy and creativity in protecting the dependent person The role of the lost child lays in being overweight, physical and emotional distances, promiscuity, sexual identity problems or sexual dysfunction

17. Critical Issues in Chemically Dependent Families
A wide range of services is available for those who have experienced violence in their homes or in dating relationships. They include:
Individual counseling for survivors of abuse, and children and teens who have witnessed abuse.
Family counseling for children and their non-abusive parents.
Group counseling for women, children and teens.
Men's groups for men who have used abusive behavior in intimate relationships.
Case management and advocacy services, including help acquiring public assistance, orders of protection, housing and shelter as well as referrals for other services when necessary.
intervention-services

18. Critical Issues in Chemically Dependent Families
Adult Children of Alcoholics: Characteristics
guess at what normal is....have difficulty in following a project through from beginning to end.
...lie when it would be just as easy to tell the truth.
...judge themselves without mercy.
...have difficulty having fun.
...take themselves very seriously.
...have difficulty with intimate relationships.
...overreact to changes over which they have no control.
...constantly seek approval and affirmation.
...feel that they are different from other people.
...are either super responsible or super irresponsible.
About.com Alcoholism, 2013

19. Critical Issues in Chemically Dependent Families
West and Prinz (1987) also consider that other factors may increase the probability that short and long term psychological, social and physical problems may ensue for children raised in chemically dependent homes. Other factors may include; higher divorce rates more family conflict, more parental psychopathology, economic factors, physical abuse and neglect, and birth complications Brooks/Cole, Cengage Learning, 1999

20. Family Assessment
The purpose of conducting a chemical dependency assessment is to determine the severity of the clients problems based on symptoms and longevity of symptoms in order to determine the best interventions. When conducting an assessment of someone’s alcohol or drug use, it is helpful to understand the clients goal for seeking professional services. The clients answer should be a part of your clinical consideration. Martha St. Enterprises, Inc. 2009

21. Family Assessment Common reasons to seek help include:
To stop use due to the progression of consequences
To stop use because of potential consequences
To stop or limit use to get someone off their back
To limit use to not accumulate consequences
To decide if the person actually has a problem with alcohol or drugs
Martha St. Enterprises, Inc. 2009

22. Family Assessment Substance Abuse Assessment questions may include;
1. How much are you using?
2. What is the frequency of use?
3. Have there been any changes in frequency or amount of use? If not, how long has this amount and frequency of use been for?
4. What is your drug of choice?
5. Any history of poly substance use?
6. When was first use?
7. What has been the longest period of no use?
8. Have you ever tried to change the amount or pattern of your use in the past? What did you do?
9. Any family history of chemical dependency?
10. Have you ever been in formal treatment?
11. Are others concerned about your use?
12. Are you concerned about your use?

23. Family Assessment Substance Abuse Assessment questions continued;
13. Have you experienced tolerance – the need to use more of the drug to create the same effect?
14. Do you ever experience withdrawal when not using?
15. When you come down from the drug, do you ever experience thoughts of wanting to hurt yourself? Have you ever done so?
16. When was your last physical exam, where there any problems?
17. Consequences fall into five categories. I’ll describe the category and you tell me if you have ever experienced problems in this area of your life due to your use.
a. Health
b. Financial
c. Relationship
d. Work/school
e. Legal
18. What do you want to do differently, if anything, about your use?
Martha St. Enterprises, Inc

24. Working With Chemically Dependent Families
To work effectively with chemically dependent families, counselors need a conceptual framework that acknowledges all the complexities involved. Framework views the family as a social unit Brooks/Cole, Cengage learning, 1999

25. Working With Chemically Dependent Families
There is one simple fact when working with families in addiction treatment: family participation greatly increases the person's chances for recovery.
Goals of The Family Treatment
Provide factual information on addiction and families.
Decrease the family’s response to the chemical dependency.
Encourage family members to gain their own sources of support.
Assist families in learning healthy ways to support their loved one’s recovery.
St. Christopher's Addiction Wellness Center,

26. Working With Chemically Dependent Families
In addition in working with chemically dependent families, there are down falls that necessarily won’t be effective. Such as;
When too much data is given by the family members at once, not enough time is available for the deeper exploration necessary for effective counseling. The counselor needs to place the focus more on the process of what is occurring in the family, than on the content of the complaints.
A counselor’s reluctance to encounter resistance can result in not meeting issues head on. Upsetting the family balance and risking possible outbursts are often necessary to promote change.
A counselor eager to see quick results may attempt to push change before the parties are ready
The counselor, for whatever reason, may be unable to maintain a basic respect and caring for the family members or may tend to side with one family member against another.
Brooks/Cole, Cengage Learning, 1999

27. The Family Recovery Process
Pretreatment Stage
Stabilization Stage
This stage encompasses the motivational crisis that brings the family or individual family members into treatment
This primary task of the stabilization stage is the family members’ recognition that they did not cause the addition, but are responsible for their own contributions to the problems and dysfunctions

28. The Family Recovery Process
Early Recovery Stage
Middle Recovery Stage
In the early recovery period, the family members begin to emotionally and cognitively process their own motivational crisis or crises
Within the middle recovery stage, the family begins to rebuild self-image and self- esteem and establishes a personal structured recovery plan

29. The Family Recovery Process
Late Recovery Stage
Maintenance/Remission Stage
During this stage, the family members must begin to identify and resolve long- term life problems and to work on issues of the family of origin and identity
This stage of necessity, requires a full acceptance by each individual for the need for life-long recovery through continued personal growth

30. In Conclusion
The Treatment Improvement Protocol explains that family therapy in substance abuse treatment can help by using the family's strengths and resources to find ways for the person who abuses alcohol or drugs to live without substances of abuse and to ameliorate the impact of chemical dependency on both the patient and the family. Family therapy, the treatment improvement protocol says, can help families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another. It is very crucial that any counselor be educated in the treatment process and further proper training and licensing, but they should know enough to determine when a referral is indicated. About.com Alcoholism, 2013

31. References:
1) Chapters of Chemical Dependency: A Family Affair 2) PowerPoint presentation on concepts associated with substance use disorders and family treatment 3) Read research article titled ,The Psychological Characteristics of Children of Alcoholics. 4) codependency/ ) 6) 7) psychotherapist.com/Chemical-Dependency- Assessment.html 8) 9) 10)