FAMILY INTERVENTION: ALCOHOLISM

1. FAMILY INTERVENTION:ALCOHOLISM By: Nancy D. Losinno, LCSW, CASAC BNL EAP Manager

2. Effects of alcoholism on the family • Development of alcoholism in 1 family member affects all the other members; • The longer-lasting & more subtle the process, the greater the acceptance of it as the “norm;” • Rigid patterns of behavior for all, attempts to change can become thwarted until a crisis disrupts the norm-steady state-homeostasis. • See the scales in background-alcoholic family is always in a delicate state of balance.

3. Parallel defenses & symptoms • Jellinek model: denial, projection, isolation, rationalization, personality change; • A simultaneous process in the members of the family; • Social isolation leads to emotional isolation • Fears, anxiety, & guilt parallel those of alcoholic; • Family members experience decline in their own health, may question their sanity, and suffer rages, frustrations & self-pity when situation does not change, as “promised.”

4. What is “Codependency?” • A dysfunctional pattern of living/problem solving developed by family rules in childhood; • CODA have a greater tendency to love the unreliable, emotionally unavailable, needy, “wounded birds” who need “rehabilitation” • CODA tries to provide & control every part of the relationship while denying their own needs, desires, dreams, setting themselves up for more unfulfillment; • Creation of the “emotional debt” phenomenon out of fear of abandonment.

5. Codependent Behaviors • Controlling • Distrust • Perfectionism • Avoidance of feelings • Fears of being engulfed (intimacy issues) • Caretaking • Hyper vigilance • Stress-related physical illness

6. How did I get here? • Families of origin: what were the patterns/dynamics in yours? • How did my family handle conflict, anger, love, etc.? • Many people are taught not to be assertive or to ask directly for needs to be met; • How do I become more fulfilled & feel better about myself and the life I live?

7. The “Rules” of Codependency • Don’t rock the boat. • It’s not okay to talk about problems. • Keep your feelings to yourself. • Be strong, good, right, perfect. • Do as I say, not as I do. • The “best” communication is indirect. • Don’t be so selfish.

8. What is Enabling? • Enabler makes it easier for alcoholic to function; • Spouses take over the financial & home responsibilities; • Spouses make allowances for & forgive bad behavior; • May continue to be loving/giving in the face of physical/mental/emotional abuse • Parents close their eyes to suspicious behavior, hand out generous allowances, write sick notes

9. Enabling’s Purpose • Remember the delicate balance! • Enablers do it to meet their own needs, to restabilize the relationship, to lure the alcoholic back to them after alcohol has taken them away; • Enabling is a poor-quality glue; • Behind enabling is fear of abandonment • Only allows disease to grow to more serious stage

10. The “Disease Concept” • The “Jellinek” model poses 5 types of alcoholism based on male drinking patterns; • Is the most widely used model in treatment programs, with abstinence as the primary goal; • Most Americans in AA would be classified as “gamma” type; • Sharply contrasts with growth of psychiatric treatment programs for alcoholics who cannot recover without aid of anti-depressant meds

11. How Do People Change?The “Prochaska Model” • Stage 1: Precontemplation—Resisting change. Precontemplators rarely take responsibility for themselves or their behavior, they do not like living with short & long term consequences. They may have tried & failed in the past, and believe that it will keep happening. Problem is how to become unstuck.

12. Stage 2: Contemplation Change is on the Horizon • Being aware of your problem with passivity & depression; • Struggling to understand causes & cures; • Seriously thinking about solving problem; • Lets down defenses & welcomes others into his life; • Some people can get stuck in Contemplation for many years.

13. Stage 3: PreparationGetting Ready to Change • Brings you to the edge of action; • Takes you from the decisions you make in Contemplation to specific steps to solve the problem; • Some may wish that admitting a problem will make it go away; some wait for a “magic moment;” others get stuck; • Making a commitment during this stage makes success more likely (set a date, “go public,” have someone hold you accountable)

14. Stage 4: ActionIts Time to Get Moving • Action without preparation will last only temporarily; • Cheap change will not last long, real change takes work & mental sweat; • All change creates anxiety & you need ways to deal with the anxiety of change; • The myth of the “magic bullet”, there are no simple solutions. • Changing your thinking about your problem can result in a better, more productive outcome.

15. Stage 5: MaintenanceStaying There • The myth of “just one” (drink, cigarette, piece of cake, etc.) • Successful change is sustained over a period of years & involves sweat effort; • Must be aware of danger signs & times, warning signals, areas of vulnerability; • In alcoholism treatment, it is called Building Up to Drink (BUD) syndrome or use HALT.

16. Intervention: What is it? • Dynamics within alcoholic family are inter-twined, and involve response from other members; • By working with the most motivated family member, and changing the way they are responding to the alcoholism, intervention is made; • Is in contrast to glamorous/confrontational type of intervention, often high-priced. If family has not yet changed how they respond to the drinking—intervention may prove unsuccessful.

17. Intervention: How is it done? • Any method that creates change in the family member that is lasting, sincere, and reinforces positive behavior in the drinker can be part of intervention process; • For family members: Al-Anon, private therapy, even efforts to improve self-esteem (weight loss, depression, etc.) • EAP can be a valuable first step in the process of intervention; • Remember, intervention is a process, not an event! • After taking steps to intervene, no looking backward, no sideward glances to check if someone is noticing!

18. Treatment Resources • Get more information. Go online & Google. Call your 24/7 EAP at Cigna: 1-877-622-4327. Do something! • Visit www.cignabehavioral.com to visit library of topics, or Personal Stress Navigator to check your own stress level (user ID: bnl, password: employee) • Come talk to EAP. Call X4567 for short-term assessment/counseling/referral; help is confidential. • Access your mental health benefit through your insurance. Ask for someone with experience in alcoholism & substance abuse. • Find local Al-Anon Family Group meetings for free in your community. Visit: www.al-anon-suffolk-ny.org