ADDICTION AS A FAMILY DISEASE: HOW TO HELP FAMILY MEMBERS STOP ENABLING

AND START HEALING

Elizabeth Frei Williamson, LCSW, LCADC

Inspire Wellness

“The worst thing is watching someone you love drown and not being able to convince them that they can save themselves just by standing up.”

OBJECTIVESParticipants will be able to…

Understand the family disease concept of addiction.

Define enabling, codependency, limits and boundaries.

Identify skills to utilize with families in order to assist them with reducing enabling and codependent behaviors and enhance limit and boundary setting.

ADDICTION AS A FAMILY DISEASE

ADDICTION AS A DISEASEPublic Policy Statement: Definition of Addiction

According to the American Society of Addiction Medicine: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

ADDICTION AS A FAMILY DISEASE“Within this model, practitioners have come to appreciate substance abuse as a disease that affects all members of a family as a result of the substance abuse of one or more members and that creates negative changes in their own moods, behaviors, relationships with the family, and sometimes even physical or emotional health. In other words, the individual member’s substance abuse and the pain and confusion of the family relate to each other as cause and effect.” (Center, 2004)

ADDICTION AS A FAMILY DISEASE

In what ways do we see these possible negative changes in family members? What are signs our clients are struggling? Enabling/Codependent behaviors** Physical health declining Increase in stress/anxiety/depression Increase in anger/resentment Decrease in academic or work performance

ADDICTION AS A FAMILY DISEASEWhy is this critical to understand as treatment providers? “It is important to understand the complex role that families can play in substance abuse treatment. They can be a source of help to the treatment process, but they also must manage the consequences of the IP’s addictive behavior. Individual family members are concerned about the IP’s substance abuse, but they also have their own goals and issues. Providing services to the whole family can improve treatment effectiveness.” (Center, 2012) Unfortunately, few families engage in true family therapy or their own individual therapy

What are barriers to this treatment?

ADDICTION AS A FAMILY DISEASE

As a therapeutic provider, you are in a critical role to understand this model and the effects family members’

substance abuse can have on our clients, or, similarly, the effects a client’s substance abuse may have on their family.

ENABLING & CODEPENDENCY

CODEPENDENCY & ENABLING

“A mother’s love for her child is like nothing else in the world. It knows no aw, no pity, it dares all things and crushes down remorselessly all that stands in its path.”

– Agatha Christie

ENABLINGEnabling is doing for others what they can and need to do for themselves.

Enabling behavior, simply put, shields people from experiencing the full impact and consequences of their behavior. Enabling is different from helping and supporting in that it allows the enabled person to be irresponsible. (Hazeldon)

Examples include: Keeping secrets Protecting the addict from the consequences of their behavior Making excuses or blaming others for the addict’s behavior Gives money Sees “the problem” as something else (shyness, loneliness, adolescence, etc…) Avoidance/Silence

CODEPENDENCYCodependency “…codependency is still frequently the “diagnosis” attached to the behavior, thoughts, or “condition” of a person who is involved in a highly dependent relationship with someone who requires extra care or vigilance, such as a practicing alcoholic or drug addict.” (Wegscheider-Cruse, 2012) “…one who has let another person’s behavior affect him or her, and who is obsessed with controlling that person’s behavior” (Beattie)

CODEPENDENCYSigns and Symptoms Low Self-Worth Low self esteem, feeling guilty, not good enough to be in a healthy relationship, not worthy of a two sided relationship

Weak Boundaries Continues to allow and accept certain behaviors or situations into their lives they once felt were unacceptable. Can feel responsible for other people’s feelings or problems.

Controlling/Obsessing Feeling in control of the other person can help the codependent feel safe or secure. Worry and obsess over the other person’s needs.

Care Taking Enabling and putting the other person’s needs in front of your own.

CODEPENDENCY & ATTACHMENTCoined by John Bowlby, Attachment theory is a concept in developmental psychology that concerns the importance of "attachment" in regards to personal development. The ability for an individual to form an emotional and physical "attachment" to another person gives a sense of stability and security necessary to take risks, branch out, and grow and develop as a personality

Four Characteristics of Attachment: Proximity Maintenance - The desire to be near the people attached to. Safe Haven - Returning for comfort and safety Secure Base – A base of security from which the child can explore Separation Distress - Anxiety that occurs in the absence of the attachment

figure.

CODEPENDENCY & ATTACHMENTAnxious Attachment Crave closeness and fear rejection, feeling unsure of a partners/loved

one’s feelings and seeks reassurance in the relationship, sometimes becoming demanding or possessive to create that sense of safety

Avoidant/Dismissive Attachment Uncomfortable with closeness and intimacy, little distress regarding the

relationship ending and can be unemotional.

CODEPENDENCY & DIFFERENTIATION OF SELFAccording to Bowen Family System Theory, the differentiation of self is our ability to maintain our identify, beliefs and feelings when pressured to do otherwise. People can vary based on how differentiated they become. The less developed a person’s “self,” the more impact others have on his

functioning and the more he tries to control, actively or passively, the functioning of others. The basic building blocks of a “self” are inborn, but an individual’s family relationships during childhood and adolescence primarily determine how much “self” he develops. People with a poorly differentiated “self” depend so heavily on the

acceptance and approval of others that either they quickly adjust what they think, say, and do to please others or they proclaim what others should be like and pressure them to conform

CODEPENDENCY & DIFFERENTIATION OF SELFIntrapsychic differentiation is when we can tell apart our thoughts from

our emotions. In other words, it’s self-awareness.

On the other hand, interpersonal differentiation is when we can distinguish our experience from the experience of people we are

connected to.

Both aspects of self-differentiation are important, as they empower us to be aware of our current state and the influence of different interactions and environments on our state so we can take action.

CODEPENDENCY & DIFFERENTIATION OF SELFImagine a loved one who is caught in the raging rapids. Maybe they are in the throngs of addiction, maybe just incredibly depressed or lonely, but regardless they are drowning. Of course our first instinct is to jump in and rescue them, thinking that is what love looks like. But if you jump into the raging river, you too will surely be sucked into the torrent and swept away by the rapids. That is not love, but suicide.

True love and proper differentiation is to stand on solid ground, with feet firmly planted on the water’s edge, with your arm reaching out towards your loved one, allowing them to swim towards your hand, when they are ready to receive the help they long to attain.

HOW CAN WE HELP?

FAMILY EDUCATION

As a professional, our job includes providing family members with the support and education that they need in order to become aware of their own enabling or codependent behaviors.

We need to assist them interpersonally by giving them skills to begin setting limits and boundaries, improving communication skills and reducing enabling behaviors, and intrapersonally, by assisting them with becoming secure and differentiated.

DEFINITIONSLimits/Boundaries

“Boundaries are the limits of love” (Beattie, 2009)

A boundary is something that marks a limit, be it physical, mental or emotional, within a relationship. We set these to help protect ourselves from harm as well as to keep our needs a priority. Boundaries are the dividing line between what we find acceptable or unacceptable in our lives.

Why is this so difficult for family members? Low self-esteem Guilt Don’t know how to put myself first Don’t know what I want/need in my relationships or from my children

BOUNDARIESHow do we set boundaries? What we'll do if people don’t stop treating us a particular way What people can or cannot do in OUR space How far we’ll go for someone and how far others can go with us What we will and will not tolerate What we will and won’t do if people don’t respect our boundaries

(Beattie, 2009)

BOUNDARIES

Assist family members to begin setting boundaries by identifying what their needs and wants are and what is important to them. For instance… Having their home safe/calm Feeling safe Feeling respected Feeling cared for/taken care of

TEACH THE 3 C’S“Alcoholics couldn’t control their drinking. How could anyone else

control hem? The only person I can control is me, and I wasn’t doing that. I was letting his drinking control everything I did.”

(Beattie, 2009)

I didn’t cause it

I can’t control it

I can’t cure it

DETACH WITH LOVE

DETACH: Don’t. Even. Think. About. Changing. Him/Her.

“How can I best help the alcoholic? By not interfering when he gets into difficulties. I must detach myself from his shortcoming, neither making up for them nor criticizing them. Let me learn to play my own role, and leave his to him. If he fails in it, the failure is not mine, no matter what others may think or say about it.” One Day At a Time in Al-Anon, pg.29)

SECURITY AND DIFFERENTIATION

Assisting in interpersonal changes is important, however it will be challenging for family members without noting intrapsychic changes

Raising self awareness (therapeutic rapport/psychoeducational)

Challenging irrational belief systems (CBT)

Enhancing motivation to make changes as needed (MI)

Supporting changes within and without

QUESTIONS??

WORKS CITEDAguilar, M.A., DiNitto, D., Franklin C., & Lopez-Pilkinton, B. (1991). Mexican-American

families: A psychoeducational approach for addressing chemical dependency and codependency. Child and Adolescent Social Work Journal, 8(4). Retrieved from: http://link.springer.com/article/10.1007/BF00756300.

Beattie, M. (1986). Codependent No More: How to Stop Controlling Others and Start Caring for Yourself. Center City, MN: Hazelden.

Beattie, M. (2009). The New Codependency: Help and Guidance for Today's Generation. New York, NY: Simon & Schuster.

Center for Substance Abuse Treatment. (2004). Substance Abuse Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series, No. 39. Rockville, MD: Substance Abuse and Mental Health Services Administration (US).

Simonen, J. & Torronen, J. (2016). Older women’s experiences, identities and coping strategies for dealing with a problem-drinking male family member. Drugs: Education, Prevention and Policy. Retrieved from: http://www.tandfonline.com/doi/abs/10.1080/09687637.2016.1184622.

Wegscheider-Cruse, S. & Cruse, J. (2012). Understanding Codependency: The Science Behind It and How to Break the Cycle. Deerfield Beach, FL: Heath Communications, Inc.