Addiction & FamilyFunctioning

Curtis: Chapters 1-3

• Prior to 1950’s, 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 1950’s, treatment focused mainly on wife

Whalen (1953): Wife “chooses” alcoholic

• 4 types of wives:1. Suffering Susan low self esteem;

mistreatment by alcoholic husband confirms self image

2. Controlling Catherine husband’s drinking gives her something to control

3. Wavering Winnifred high dependency needs; as long as he drinks, he will continue to “need” her

4. Punishing Polly envious & resentful of men; belittles husband constantly, so he will continue to drink (this increases his vulnerability)

Criticism:

• Not representative sample

• Does not consider progressive nature of alcoholism

• Does not consider possibility that relationship changes as alcoholism progresses

• Further stigmatizes alcoholism

Jackson (1954)

• wife goes through “stages of adjustment” to husband’s drinking

• Stage 1 = husband’s drinking causes tension & embarrassment. Denies problem to avoid facing it.

• Stage 2 = becomes more socially isolated to cover up husband’s drinking. Drinking now a focal point so conflict increases. Wife develops self-pity. Husband resents her attempts to control his drinking

• 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

• 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

1960’s

• Through 1960’s, research noted that alcoholics whose wives also in treatment:

1. Stayed in treatment longer

2. Had significantly improved recovery

3. Felt major improvement in marital harmony

• 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 family’s dysfunction

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

Theoretical Approaches cont’d• Kaufman 4 different types of alcoholic

families, each needing different interventions

1. 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

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

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

4. Absent Family System

• Alcoholic’s behaviour now results in complete separation from family; reconciliation unlikely

• Treatment directed toward establishing new social networks

Family Therapeutic Theories(Ch. 3)

• Whitakeer Symbolic Theory

• Bandura Social Learning Theory

• Satir Process Model

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

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

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:

1. Placater

• Cannot express anger or displeasure

• Pattern of avoidance

• Self-worth based on acceptance by others

2. Blamer

• Critical, judgmental & shaming

• Deflects from facing own issues and meeting responsibilities

3. Intellectualizer

• Tries to analyze and fix others

• Feels vulnerable if own feelings exposed

• Wants to make sense of problems

4. Distracter

• Attempts to protect self and others from pain (i.e. charmer or clown)

• May use drugs and alcohol to avoid problems