Addiction

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Addiction FamilyFunctioning

• Curtis Chapters 1-3

2

• Prior to 1950s, family problems kept secret
• Most families believed that once drinking
  stopped, family problems would disappear
• Therapists recognized that many treated
  alcoholics not success in recovery
• During 1950s, treatment focused mainly on wife

3
Whalen (1953) Wife chooses alcoholic

• 4 types of wives
• Suffering Susan ? low self esteem mistreatment
  by alcoholic husband confirms self image
• Controlling Catherine ? husbands drinking gives
  her something to control
• Wavering Winnifred ? high dependency needs as
  long as he drinks, he will continue to need her
• Punishing Polly ? envious resentful of men
  belittles husband constantly, so he will continue
  to drink (this increases his vulnerability)

4
Criticism

• Not representative sample
• Does not consider progressive nature of
  alcoholism
• Does not consider possibility that relationship
  changes as alcoholism progresses
• Further stigmatizes alcoholism

5
Jackson (1954)

• wife goes through stages of adjustment to
  husbands drinking
• Stage 1 husbands drinking causes tension
  embarrassment. Denies problem to avoid facing
  it.
• Stage 2 becomes more socially isolated to cover
  up husbands drinking. Drinking now a focal
  point so conflict increases. Wife develops
  self-pity. Husband resents her attempts to
  control his drinking

6

• Stage 3 kids begin to have problems sexual
  intimacy fades violence becomes frequent.
  Family members begin to feel helpless. Wife may
  seek outside help but then feels guilty for being
  unable to cope.
• Stage 4 wife assumes responsibility for family
  functioning may gain new self-confidence
  children begin to experience fewer problems and
  family stabilizes

7

• Stage 5 wife kids leave alcoholic husband
• Stage 6 mother kids establish themselves
  without alcoholic husband
• Stage 7 if he remains sober, husband returns to
  family, but has difficulty re-establishing adult
  role within family.
• Criticism does not consider differences in
  family adjustment fails to consider treatment
  efforts does not address cycle of abuse/hope

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1960s

• Through 1960s, research noted that alcoholics
  whose wives also in treatment
• Stayed in treatment longer
• Had significantly improved recovery
• Felt major improvement in marital harmony

9

• Bateson (1960) ? family works as unit to maintain
  homeostasis (balance). Family members unable to
  adjust to non-drinking
• Ewing Fox (1968) ? alcoholism is a family
  disorder. Family members need to be aware of how
  interaction patterns might have contributed to
  familys dysfunction

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Theoretical Approaches toFamily Treatment (Ch. 2)

• Dulfano ? views family as system
• Any change in role of one member also changes
  other members in order to maintain homeostasis
• Non-drinking threatens family environment as much
  as drinking does
• Alcohol abuse distorts family relationships
• Therapist holds alcoholic responsible for own
  behaviour and focuses on communication patterns

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Theoretical Approaches contd

• Kaufman ? 4 different types of alcoholic
  families, each needing different interventions
• Functional Family System ? Alcoholic drinks due
  to problems outside of the family. Members seem
  happy and stable little conflict. Not likely to
  present for treatment

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2. Neurontic, Enmeshed Family System

• Normal family functioning disrupted
• Members feel guilty and responsible for alcoholic
• Members try to take care of each other, while
  alcoholic becomes more isolated
• Verbal abuse by alcoholic common
• Treatment involves encouraging members to become
  involved with support groups

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3. Disintegrate Family System

• Alcoholic frequently absent from family
• Reasonable family interactions broken down
• Treatment begins with alcoholic
• Once sobriety achieved, focus on re-defining
  family roles and re-establishing communication

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4. Absent Family System

• Alcoholics behaviour now results in complete
  separation from family reconciliation unlikely
• Treatment directed toward establishing new social
  networks

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Family Therapeutic Theories(Ch. 3)

• Whitakeer ? Symbolic Theory
• Bandura ? Social Learning Theory
• Satir ? Process Model

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Symbolic Theory(Whitaker)

• Healthy family ? functions to uphold unity and
  promote growth
• Unhealthy family ? limited sense of unity rules
  and roles inflexible expression of individual
  differences not possible
• Central beliefs ? Family members need to switch
  roles to experience what others in family
  experience
• Goal of treatment ? increase creative problem
  solving skills

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Social Learning Theory(Bandura)

• Inappropriate behaviour is learned during
  childhood through modelling
• Central beliefs behaviour is maintained through
  reinforcements
• Goal of Treatment behavioural modification and
  healthy learning environment

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Process Model(Satir)

• Family system is balanced each member pays a
  price to keep it that way
• Central Beliefs dysfunction leads to low
  self-esteem prevents appropriate communication
• Goal of Treatment using sculpting to move
  family from state of dysfunction
• 4 types of individuals with dysfunctional
  communication styles

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1. Placater

• Cannot express anger or displeasure
• Pattern of avoidance
• Self-worth based on acceptance by others

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2. Blamer

• Critical, judgmental shaming
• Deflects from facing own issues and meeting
  responsibilities

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3. Intellectualizer

• Tries to analyze and fix others
• Feels vulnerable if own feelings exposed
• Wants to make sense of problems

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4. Distracter

• Attempts to protect self and others from pain
  (i.e. charmer or clown)
• May use drugs and alcohol to avoid problems