Treating the Treating the Chemically Chemically

Dependent FamilyDependent Family

Presented by:Presented by:

Steve Brugge Steve Brugge

Treating the Treating the Chemically Chemically

Dependent FamilyDependent Family

Presented by:Presented by:

Dellena Hoyer Dellena Hoyer

Treating the Chemically Treating the Chemically Dependent FamilyDependent Family• Introduction:Introduction:

– Are we there yet?Are we there yet?– What is addiction?What is addiction?

a.a. ScientificScientificb.b. Medical – DSM IVMedical – DSM IVc.c. Clinical – Bio/Psycho/SocialClinical – Bio/Psycho/Sociald.d. Community – Will PowerCommunity – Will Power

• At the very core each individual must At the very core each individual must have core relationship skillshave core relationship skills

– What is important in a healthy relationshipWhat is important in a healthy relationship– Why am I seeking these things outside of me?Why am I seeking these things outside of me?

• Roles of family participants:Roles of family participants:• Addict / AlcoholicAddict / Alcoholic• EnablerEnabler• HeroHero• ScapegoatScapegoat• Lost childLost child• MascotMascot

Treating the Chemically Treating the Chemically Dependent FamilyDependent Family

• How does the family get sick/betterHow does the family get sick/better– When does it begin?When does it begin?

Continuum of effects: stage 1, 2, 3, 4Continuum of effects: stage 1, 2, 3, 4

– How does it progress?How does it progress?Rationalization: it is just a little…bad luck, if he/she cuts out Rationalization: it is just a little…bad luck, if he/she cuts out coke…coke…

Attachment: Munchausen’s by proxyAttachment: Munchausen’s by proxy

Denial/Dishonesty: at least he/she is not-keep it behind doorsDenial/Dishonesty: at least he/she is not-keep it behind doors

Enabling: making excusing, violating belief systemsEnabling: making excusing, violating belief systems

Dependency: addicted to chaos, pain, miseryDependency: addicted to chaos, pain, misery

Projection: whose fault, anger, victimProjection: whose fault, anger, victim

– What are the outcomes?What are the outcomes?• Stay sickStay sick

• ExhaustionExhaustion• AbusiveAbusive• AloneAlone

Treating the Chemically Treating the Chemically Dependent FamilyDependent Family

Get HealthyGet HealthyCommunicationCommunicationBoundariesBoundariesDetachmentDetachmentRecoveryRecoveryFreeFree

TruthTruthFamily members are as sick as the alcoholic/addictFamily members are as sick as the alcoholic/addictResponsibility not to rear children in the env. Responsibility not to rear children in the env.

(History repeats)(History repeats)Families need transparencyFamilies need transparencySick not badSick not badGoal is well not goodGoal is well not goodWhat is common sense to you is not to the worldWhat is common sense to you is not to the world

What it takesWhat it takesAccountabilityAccountabilityResponsibilityResponsibilityConsistencyConsistencyAction: Nothing happens without action – EinsteinAction: Nothing happens without action – EinsteinSupport – Alanon, AA, 12 step support groups, Support – Alanon, AA, 12 step support groups,

church etc.church etc.

A Continuum of Alcohol or Other A Continuum of Alcohol or Other Drug UseDrug Use

No use → Proper use → Misuse → Abuse → Dependence No use → Proper use → Misuse → Abuse → Dependence (addiction)(addiction)

DSM – IV: Substance DSM – IV: Substance AbuseAbuse

Maladaptive pattern of useMaladaptive pattern of use

Clinically significant impairment of distressClinically significant impairment of distress

One or more of these in 1 yearOne or more of these in 1 year Recurrent use results in failure to fulfill major Recurrent use results in failure to fulfill major

role obligations at work, school or homerole obligations at work, school or home Recurrent use in physically hazardous Recurrent use in physically hazardous

situationssituations Recurrent substance-related legal problemsRecurrent substance-related legal problems Continued use despite persistent social or Continued use despite persistent social or

interpersonal problemsinterpersonal problems

Does not meet criteria for dependenceDoes not meet criteria for dependence

A Continuum of Alcohol or Other A Continuum of Alcohol or Other Drug UseDrug Use

DSM – IV: Substance DSM – IV: Substance DependenceDependence

• Maladaptive pattern of substance useMaladaptive pattern of substance use• Clinically significant impairment or distressClinically significant impairment or distress• 3 or more of these in 12 months3 or more of these in 12 months

ToleranceToleranceWithdrawalWithdrawalSubstance taken in larger amounts or over Substance taken in larger amounts or over

longer period than intendedlonger period than intendedPersistent desire or unsuccessful efforts to Persistent desire or unsuccessful efforts to

controlcontrolA great deal of time is spent on use, obtaining A great deal of time is spent on use, obtaining

drugs, recovering from use, obsession, etc.drugs, recovering from use, obsession, etc.Gives up important activities (social, work, Gives up important activities (social, work,

recreational)recreational)Continued use despite recurrent problemsContinued use despite recurrent problems

• May be with or without physical dependenceMay be with or without physical dependence

Red Flags for Addiction in AnyoneRed Flags for Addiction in Anyone

Note: These “Red Flags” indicators can each be caused by Note: These “Red Flags” indicators can each be caused by problems other than addiction and none are, by themselves, problems other than addiction and none are, by themselves, indicators that a person is addicted. However, if a number of indicators that a person is addicted. However, if a number of these indicators are present, you would have to consider that these indicators are present, you would have to consider that they may be caused by a substance abuse or addiction problem they may be caused by a substance abuse or addiction problem and consider seeking assistance. It is the and consider seeking assistance. It is the multiplicity of multiplicity of problemsproblems, not any unique criterion, that leads to a diagnosis of , not any unique criterion, that leads to a diagnosis of substance dependence or addictionsubstance dependence or addiction

PhysicalPhysical

Impaired physical coordinationImpaired physical coordinationSomnolenceSomnolenceRed eyesRed eyesJumpiness, rapid speechJumpiness, rapid speechSigns of self-neglectSigns of self-neglectTremors Tremors Cigarette addictionCigarette addiction““Looks alcoholic”Looks alcoholic”

Smell alcohol on Smell alcohol on breathbreathSlowed, slurred Slowed, slurred speech speech Pupils dilated or Pupils dilated or pinned pinned Excessive Excessive perspirationperspirationPoor hygienePoor hygieneRunny noseRunny noseLip and finger burnsLip and finger burns

Red Flags for Addiction in Red Flags for Addiction in AnyoneAnyone

ConfusionConfusion AnxietyAnxiety Memory lossMemory loss Poor psychological Poor psychological

adjustmentadjustment

DepressionDepression InsomniaInsomnia ForgetfulnessForgetfulness Excessive mood swingsExcessive mood swings

Mental and Emotional

Behavioral Extremely talkativeExtremely talkative

Poor judgmentPoor judgment Anger of defensiveness if Anger of defensiveness if

topic is brought uptopic is brought up Legal problemsLegal problems Financial problemsFinancial problems ImpulsivityImpulsivity

Unusual or erratic Unusual or erratic behaviorbehavior

Loss of interests: Loss of interests: activities, friends activities, friends

Problems at workProblems at work History of drug or History of drug or

alcohol problemsalcohol problems ViolenceViolence

Progression ChartProgression Chart“Phases and Symptoms of “Phases and Symptoms of

Chemical Dependency”Chemical Dependency”EarlyEarly

Preoccupation/planning next usePreoccupation/planning next useIncreased tolerance/increased usageIncreased tolerance/increased usage

Manipulation of environmentManipulation of environmentHiding/protecting supply Hiding/protecting supply

Unplanned useUnplanned useBlackoutsBlackouts

Attempts to control useAttempts to control useLoss of interest-apathyLoss of interest-apathy

Increased consequencesIncreased consequences

Progression ChartProgression Chart“Phases and Symptoms of “Phases and Symptoms of

Chemical Dependency”Chemical Dependency”MiddleMiddle

IrresponsibilityIrresponsibilityAttempts to quitAttempts to quit

Geographic escapeGeographic escapeLow self-esteemLow self-esteemRigid defensesRigid defensesDelusions/liesDelusions/lies

Decreased toleranceDecreased toleranceErratic behaviorErratic behavior

Physical health problemsPhysical health problems

Progression ChartProgression Chart“Phases and Symptoms of “Phases and Symptoms of

Chemical Dependency”Chemical Dependency”

FinalFinalLife in chaos/unmanageabilityLife in chaos/unmanageability

Loss of valuesLoss of valuesSelf-hateSelf-hateSuicidalSuicidal

Increased health problemsIncreased health problemsInsanityInsanity

IncarcerationIncarcerationDeathDeath

The Family ProgressionThe Family ProgressionLearning PhaseLearning Phaseo Randomly experiments with defensive behaviorRandomly experiments with defensive behavioro Protects selfProtects selfo Relieves stressRelieves stresso Tries to maintain balanceTries to maintain balanceSeeking PhaseSeeking Phaseo Vague awareness of alcohol/drug problemVague awareness of alcohol/drug problemo Rationalize/deny problemRationalize/deny problemo Protective behavior to manipulate environmentProtective behavior to manipulate environmento Family tries to control useFamily tries to control useHarmful PhaseHarmful Phaseo Behavior becomes survival roles:Behavior becomes survival roles:

compulsivecompulsivepredictablepredictableautomaticautomatic

o Family structure becomes rigidFamily structure becomes rigido Increased tolerance to painIncreased tolerance to painEscape PhaseEscape Phaseo Search for way outSearch for way outo Family members carry defensive lifestyle with themFamily members carry defensive lifestyle with them

Family TypesFamily TypesNurturing FamilyNurturing Familyo Flexible, open to changeFlexible, open to changeo High self worth, sense of identityHigh self worth, sense of identityo Functional defensesFunctional defenseso Clear rulesClear ruleso Family can take risksFamily can take riskso Family can deal with stressFamily can deal with stresso Strong parental coalitionStrong parental coalitionMarginal FamilyMarginal Familyo Less flexibleLess flexibleo Shaky self-worthShaky self-wortho Dysfunctional defensesDysfunctional defenseso Begins to focus on scapegoatBegins to focus on scapegoato Avoids confronting problemsAvoids confronting problemsDysfunctional FamilyDysfunctional Familyo Rigid, fixed systemRigid, fixed systemo Low self-worthLow self-wortho Compulsive defensesCompulsive defenseso Secret, inhuman rulesSecret, inhuman ruleso Bizarre behavior ignoredBizarre behavior ignoredo Denies stressDenies stress

Healthy vs. Dysfunctional FamilyHealthy vs. Dysfunctional Family

HealthyHealthyPeople feel free to talk about People feel free to talk about

inside feelingsinside feelingsAll feelings are okayAll feelings are okayAll subjects for discussionAll subjects for discussionPerson more important than Person more important than performanceperformanceIndividual differences Individual differences acceptedacceptedEach person responsible for Each person responsible for own actionsown actionsRespectful criticism and Respectful criticism and appropriate consequences or appropriate consequences or actionsactionsFew shouldFew shouldClear flexible rulesClear flexible rulesAtmosphere is relaxedAtmosphere is relaxedJoyousJoyousPeople feel lovingPeople feel lovingGrowth is celebratedGrowth is celebratedPeople have high self worthPeople have high self worthFaces and works through Faces and works through stressstress

Nurturing DysfunctionalNurturing DysfunctionalPeople compulsively protect People compulsively protect

inside feelingsinside feelingsOnly “certain feelings” OKOnly “certain feelings” OKMany taboo subjects, lots Many taboo subjects, lots of secretsof secretsPerformance more Performance more important than personimportant than personEveryone must conform to Everyone must conform to strong peoples ideas, valuesstrong peoples ideas, valuesLots of control, criticismLots of control, criticismPunishment and shamingPunishment and shamingEveryone shouldEveryone shouldUnclear, inconsistent, and Unclear, inconsistent, and rigid rulesrigid rulesAtmosphere is tenseAtmosphere is tenseLots of anger, fearLots of anger, fearPeople feel hurt, People feel hurt, disappointeddisappointedGrowth is discouragedGrowth is discouragedPeople have low self worthPeople have low self worthAvoids stressAvoids stress

Good Communication Points to Good Communication Points to RememberRemember

Pick the right opportunity to communicate serious matters. Pick the right opportunity to communicate serious matters. “Right” may be different for each of you, but generally…“Right” may be different for each of you, but generally…

When everyone isn’t angryWhen everyone isn’t angryWhen everyone is soberWhen everyone is soberWhen there are a minimum of distractionsWhen there are a minimum of distractions

Focused body posture for sending and receiving messages:Focused body posture for sending and receiving messages:S=Squarely face the personS=Squarely face the personO=Open body postureO=Open body postureL=Lean slightly forward to indicate interestL=Lean slightly forward to indicate interestE=Eye contactE=Eye contactR=Relaxed body posture and facial expressionR=Relaxed body posture and facial expression

Do not interrupt. Allow the person to finish their statement. Do not interrupt. Allow the person to finish their statement. Avoid the trap of formulating your response while they are talking Avoid the trap of formulating your response while they are talking and waiting for them to take a breath so you can make your point.and waiting for them to take a breath so you can make your point.Do not make assumptions that you know what they “always” say, Do not make assumptions that you know what they “always” say, they must be saying it again.they must be saying it again.When talking about feelings, always, use the “I feel” statementWhen talking about feelings, always, use the “I feel” statementStay in the present. Resist the temptation to drag up the past. Stay in the present. Resist the temptation to drag up the past. “You always…”Aren’t you, in fact, hoping for change in the “You always…”Aren’t you, in fact, hoping for change in the present? How is focusing on the past helpful?present? How is focusing on the past helpful?

Good Communication Points to Good Communication Points to RememberRemember

Avoid rambling and repeating yourself to make sure you Avoid rambling and repeating yourself to make sure you are being heard. If they tuned you out the first time, they are being heard. If they tuned you out the first time, they most assuredly will be tuning out your repetition.most assuredly will be tuning out your repetition.

Make sure all parts of your message match (body Make sure all parts of your message match (body language, feelings, thoughts, words).language, feelings, thoughts, words).

Focus on behaviors, not personality or name-calling.Focus on behaviors, not personality or name-calling. Use the “say-ask” approach. I would like to go to the Use the “say-ask” approach. I would like to go to the

movie. What would you like to do.”movie. What would you like to do.” Discuss, do not attack. Aggressive behavior elicits Discuss, do not attack. Aggressive behavior elicits

defensive responses.defensive responses. Keep your voice low. Don’t talk over the other person or Keep your voice low. Don’t talk over the other person or

talk louder. You are probably not being heard by a person talk louder. You are probably not being heard by a person who is yelling anyway.who is yelling anyway.

REMEMBER: If the message was not received, no REMEMBER: If the message was not received, no communication occurred because nothing was communication occurred because nothing was exchanged.exchanged.

Victim Lines:Victim Lines:I fell so lostI fell so lost I’m not capableI’m not capableI’m confusedI’m confused I’m worthlessI’m worthlessI’m so afraidI’m so afraid I can’t do anything rightI can’t do anything rightI can’tI can’t Nothing I do seems to please youNothing I do seems to please youI don’t knowI don’t know I’m uglyI’m uglyIt’s not my faultIt’s not my fault I’m too fatI’m too fatTell me what to doTell me what to do I’m too thinI’m too thin

(Remember, healthy people make up their minds and act or seek God’s (Remember, healthy people make up their minds and act or seek God’s help and turn it over. I’ll TRY is a way of leaving the door open for help and turn it over. I’ll TRY is a way of leaving the door open for failure).failure).

Rescue Lines:Rescue Lines:It’s all going to be fineIt’s all going to be fine Don’t worry, I’ll fix itDon’t worry, I’ll fix itI’ll help youI’ll help you I’ll take care of youI’ll take care of youI’ll do it for youI’ll do it for you Bless your heart, you are so tiredBless your heart, you are so tiredI’ll talk to them for youI’ll talk to them for you I’ll explain it for youI’ll explain it for youDon’t be afraid, I’m hereDon’t be afraid, I’m here Don’t worry, I’m hereDon’t worry, I’m here

(Remember, healthy people never do for others what others can do for (Remember, healthy people never do for others what others can do for themselves, that is a CRIPPLE YOU ACT).themselves, that is a CRIPPLE YOU ACT).

Persecute Lines:Persecute Lines:You are ….!!!You are ….!!! You can’tYou can’t

Don’t be that wayDon’t be that way You shouldn’t feel You shouldn’t feel that waythat way

After all I’ve done for you and…After all I’ve done for you and… You are wrongYou are wrong

You are fat, stupid, etc…You are fat, stupid, etc… Shut up!Shut up!

If you don’t stop that I’llIf you don’t stop that I’ll

(Remember, healthy people do not threaten. They discuss a (Remember, healthy people do not threaten. They discuss a problem and if a solution doesn’t come, they simply act. problem and if a solution doesn’t come, they simply act. Healthy people don’t threaten to leave, they make a decision to Healthy people don’t threaten to leave, they make a decision to do so and leave).do so and leave).

Listening –An Act of LoveListening –An Act of Love1.1. Be interested and show it. Genuine concern and a Be interested and show it. Genuine concern and a

lively curiosity encourage others to speak freely. lively curiosity encourage others to speak freely. Interest also sharpens your attention and builds itselfInterest also sharpens your attention and builds itself

2.2. Hold your fire. Avoid jumping to conclusions. Hear Hold your fire. Avoid jumping to conclusions. Hear the speaker out. Plan your response only after you’re the speaker out. Plan your response only after you’re certain that you’ve gotten the whole message.certain that you’ve gotten the whole message.

3.3. Look for the main ideas. Avoid being distracted by Look for the main ideas. Avoid being distracted by details. Focus on the key issue. You may have to dig details. Focus on the key issue. You may have to dig hard to find it.hard to find it.

4.4. Monitor your own feelings and point of view. Each of Monitor your own feelings and point of view. Each of us listens differently. – Our convictions and emotions us listens differently. – Our convictions and emotions filter, even distort, what we hear. Be aware of your filter, even distort, what we hear. Be aware of your own attitudes, prejudices cherished beliefs and your own attitudes, prejudices cherished beliefs and your emotional reaction to the message.emotional reaction to the message.

5.5. Watch for feelings. Often people talk to “get Watch for feelings. Often people talk to “get something off their chests.” Feelings, not facts, may something off their chests.” Feelings, not facts, may be the main message.be the main message.

Listening –An Act of LoveListening –An Act of Love6.6. Notice nonverbal language. A shrug, a smile, a Notice nonverbal language. A shrug, a smile, a

nervous laugh, gestures, facial expressions and body nervous laugh, gestures, facial expressions and body positions speak volumes. Start to “read” them.positions speak volumes. Start to “read” them.

7.7. Get feedback. Make certain you’re really listening. Get feedback. Make certain you’re really listening. Ask a question. Confirm with the speaker what he or Ask a question. Confirm with the speaker what he or she actually said.she actually said.

8.8. Work at listening. Hearing is passive. Our nervous Work at listening. Hearing is passive. Our nervous system does the work. Listening is active. It takes system does the work. Listening is active. It takes mental effort.mental effort.

9.9. Give the other person the benefit of the doubt. We Give the other person the benefit of the doubt. We often enter conversations with our minds already often enter conversations with our minds already made up, at least partially, on the basis of past made up, at least partially, on the basis of past experience. Prejudgments can shut off new messages.experience. Prejudgments can shut off new messages.

10.10. Tune into the other person. Try to understand his or Tune into the other person. Try to understand his or her viewpoint, assumptions, needs, and system of her viewpoint, assumptions, needs, and system of beliefs.beliefs.

Intervention PrinciplesIntervention PrinciplesDelusionary System: Why the Addict Delusionary System: Why the Addict Cannot See the ProblemCannot See the Problem

1.1. Physical effect of the drugs → alter Physical effect of the drugs → alter perception, judgment perception, judgment and memoryand memory

2.2. Blackouts → major memory problemBlackouts → major memory problem

3.3. Misinformation and confusionMisinformation and confusion

4.4. Denial (Distortion of reality to prevent Denial (Distortion of reality to prevent emotional distress)emotional distress)

There are a number of types of interventions. Good There are a number of types of interventions. Good interventions help addicted people take action interventions help addicted people take action before they have to “hit rock bottom.” A personal before they have to “hit rock bottom.” A personal expression of your concern for a friend or colleague expression of your concern for a friend or colleague may be a fully effective intervention, prompting may be a fully effective intervention, prompting them to see the problem and take action.them to see the problem and take action.

Intervention PrinciplesIntervention PrinciplesIn many cases, a structured, planned intervention is In many cases, a structured, planned intervention is required. It is important to obtain consultation and required. It is important to obtain consultation and assistance with formal interventions. Effective assistance with formal interventions. Effective structured interventions are based upon:structured interventions are based upon:

Direct, honest feedbackDirect, honest feedbackMultiple concerns from several concerned others simultaneouslyMultiple concerns from several concerned others simultaneouslyGenuine caring and support from intervenersGenuine caring and support from intervenersData clarityData clarityMeticulous preparation Meticulous preparation TimingTimingCapitalizing on the natural crises that come with addictionCapitalizing on the natural crises that come with addictionClarity of goal → a specific treatment plan, immediately available Clarity of goal → a specific treatment plan, immediately available and aranged in advanceand aranged in advancePreparation for all possible arguments against treatmentPreparation for all possible arguments against treatmentLeverage!Leverage!