Addiction and the Role of Family

Marilyn G Stein

MGS Consulting, LLC

Prevention efforts can …

Dispel myths about substance abuse. Assure family members that they are not alone.

Provide information that helps families understand addiction.

Tap into resilience and pro social coping skills for both parents and children by offering simple, concrete suggestions for coping that promote the use of innate resilience.

Link to local resources. What does your community offer for children and

About Addiction

• Addiction is a chronic, progressive, primary disease of the brain that stems from an altered brain chemistry.

• If left untreated or mistreated, this disease can and will result in death.

• It is a disease characterized by denial and relapse. • It is manifested by repetitive, compulsive use of

substances (drugs, alcohol, food) or activities (sex, gambling) despite adverse consequences.

• It has strong genetic components. • It cannot be cured and requires lifelong treatment.

A Brain Disease

• Drug addiction is a brain disease that develops over time as a result of the initially VOLUNTARY behavior of using drugs.

• For many people the compulsive use is truly uncontrollable.

• Similarly schizophrenics cannot control hallucinations

• Depressed patients cannot control their moods• Addicts cannot control their use

Another Definition

A pathological love and trust relationship with an object or an event.

Craig Nakken,

The Addictive Personality

The Progression of Addiction

Experimentation

Habituation(Increased Use

For relief)

AbuseRecreational

Use

Dependency

“Every drug user starts out as an occasional user, and the initial use is voluntary but as time passes and use continues the drugs change the brain.”

Alan Leshner

The Reward Pathway The brain stem is in charge of all

of the functions our body needs to stay alive—breathing, circulating blood, and digesting food

The limbic system links together a bunch of brain structures that control our emotional responses, such as feeling pleasure when we eat chocolate.

The cortex, known as the frontal cortex or forebrain, is the thinking center. It powers our ability to think, plan, solve problems, and make decisions.

There are many doors into the reward control room of the brain.

Food and sex are natural doors. Objects and events are chemical doors. Some doors to the control room are bigger and

more easily opened. When the chemical door is bigger and opens more easily, addiction follows.

The Selfish Brain

Robert Dupont

About Genetics

Whether teens engage in pathological relationships with objects or events is

environmental

HOWEVER

Genetics and biology determine whether the behavior develops into addiction.

Robert Dupont, The Selfish Brain

Like a Dog with a Bone

• The Dog– Never wants to let go– Pesters till it gets what it wants– Never forgets– Is easily reminded that it is could get another

bone– Really LOVES the bone

Traits of a healthy family• carry out basic

functions• provides emotional

safety• promotes individuality• promotes continuity• communicates

effectively• accesses support as

necessary

Traits of unhealthy family• lack of safety• poor boundaries• ineffective

communication• mistrust• extremes

The ideal childhood

Kids from healthy families don’t have to protect themselves externally so they get

to go inside and see how they feel.

Impact of Addiction on the Family

• When a parent is addicted to alcohol, drugs, or processes, over time the entire family is organized around the addict and the emotional chaos he or she generates.

The entire family system responds

• When a family member is addicted, the whole family usually develops ways of coping with the problems.

• The family avoids talking about the issue, so there is less communication.– avoids expressing emotions– keeps the addiction secret from the

community.

• Feeling is out of the question

The burden of trauma and neglect

• Early neglect, trauma and abuse predict future problems including borderline personality disorder

• All dysfunctional behavior patterns grow out of actions and attitudes that were supposed to solve a problem.

How is this true?

Unhealthy FamiliesLife in unhealthy families demand the skill of external self protection.

The result is those from unhealthy families are unfamiliar with their internal landscape because it is scary.

They look for external distractions that soothe their discomfort like cutting, sex and drugs.

These distractions initially work but over time cause more pain.

All dysfunctional behavior patterns grow out of actions and attitudes that were supposed to solve a problem.

Adverse Childhood Experiences

• Childhood abuse, neglect, and exposure to other traumatic stressors which we term (ACE) are common

• The ACE Score has a strong and graded relationship to health-related behaviors and outcomes during childhood and adolescence including early initiation of smoking, sexual activity, and illicit drug use, adolescent pregnancies, and suicide attempts.

ACE is

• A study of the relationship of adverse childhood experiences to adult health status.

• In over 17,000 persons studied, results show addiction to be a readily understandable although largely unconscious attempt to gain relief from well-concealed prior life traumas by using psychoactive materials.

The Adverse Childhood Experiences (ACE) Study

1) Recurrent physical abuse

2) Recurrent emotional abuse

3) Contact sexual abuse

4) An alcohol and/or drug abuser in the household

5) An incarcerated household member

6) Someone who is chronically depressed, mentally ill, institutionalized, or suicidal

7) Mother is treated violently

8) One or no parents

9) Emotional or physical neglect

“What was done to you?”“What wasn’t done for you?”

“Someone who was not allowed to be aware of what was being done to them has no way of telling about it except to repeat it.” Judith Miller

(See article: Child Witnessed Domestic Violence)

Activity for use with Clients

1. List family members2. Write 4 words that describe each family

member listed.3. Consider if each family member is a

positive or negative influence in your life?4. Will each family member listed support

your goals?5. How will you handle those who aren’t

able to support your goals

CAGES

1.Have you ever [wished] that your parentwould Cut down on his/her drinking?2.Have you ever felt Angry about yourparent’s drinking?3.Have you ever felt Guilty about yourparent’s drinking?4.Does anyone in your family have Eye-openers(drink first thing in the morning)?5.Does your family keep Secrets or tell lies

How do family members contribute to the problem?

• They Avoid — Just keep the peace, take care of problems, don’t upset anyone.

• They Minimizing — It’s not so bad…things will get better when…

• They Protect — Protecting their image with co-workers and friends…while we protect our own image.

• They Taking responsibility — He’s hung over so I’ll take out the trash, cut the grass, etc.

• They Act superior — Treating the addict like a child. • They Suffer — If I can just be patient, things will get

better. Or God will take care of it.

Symptoms of the Dis Ease

Weak Boundaries

Enabling

Co-dependency

Personal Boundaries

• One's own body• One's own possessions• One's own space which surrounds the

body and possessions• One's own relationships (and roles) with

others• One's own internal space (emotional,

intellectual, cultural, & spiritual space)

Enabling behaviors

What are they?Enabling behaviors are those behaviors that support our addicted loved one’s chemical use.

These behaviors let the addict :off the hook.”

Enabling sounds like

Denial — Expecting the alcoholic or drug addict to be rational or to be able to control their use is denial. Accepting blame for their use is denial.

Using with the addict or alcoholic — So we can watch them, limit their intake, make sure they don’t drive drunk.

Justification — Agreeing with their rationalizations — got a stressful job so he/she deserves two martinis after work.

Keeping feelings inside —We get our feelings of fear denied and we begin to keep our feelings inside.

Being in tune to your feelings and needs

Are you focused on the addicted person rather than on your feelings and needs?

Are you putting yourself aside in your attempts to help them?

Are you abandoning yourself in your efforts to get them to stop abandoning themselves and harming themselves?

Ask the family member: If you focus on your own feelings and your responsibility for yourself, what would you be doing differently?

Co dependence

Unhealthy relationships lead to co-dependence.

Defined as: Someone whose core identity is undeveloped or unknown. Someone who

maintains a false identity built from dependent attachments. An addiction to security.

Source: Charles Whitfield

Are you co-dependent?

If you were to ask yourself these questions about your family, what would be the truthful answers?– Do my feelings about who I am come from being liked

by you? – Do my good feelings about who I am come from

receiving approval from you? – Is my mental attention focused on pleasing you? – Is my mental attention focused on protecting you? – Is my self-esteem bolstered by solving your problems

or relieving your pain?

• Myth: I can keep my loved one from drinking or drugging…

• Reality:Your loved one is sick. He or she has a disease. You’re sick, too. It’s called CO-DEPENDENCY. You’re part of a denial system but you just don’t know it. You’re in no position to "cure" your loved You can only control yourself. You can’t

control your loved one’s addiction.

The three C’s

• You didn’t cause it

• You can’t control it

• You can’t cure it.Abraham Twerski, MD

Resiliency

• The capacity to rise above adversity; to be hurt and rebound at the same time. To keep hacking away at the thorny underbrush and moving through life.

(Wolin, S. and Wolin, S. (1993).

Resilient children

• Find ways to feel good about themselves and life in spite of the powerful influence of their parents.

• Understand that everything is not their fault

• Internalize their successes; they take own what goes right in their lives.

7 key resiliency

1) Insight - the ability to ask tough questions and givehonest answers2) Independence - the ability to separate emotionally andphysically from one’s troubled environment3) Relationships - the ability to develop fulfillingrelationships with others to fulfill needs4) Initiative - the ability to take charge of personal problems,set goals and be productive5) Morality - the ability to seek a fulfilling personal life,demonstrate ethical conduct, and possess self-respect6) Creativity - the ability to impose order and beauty onthe chaos of troubling experiences and feelings7) Humor - the ability to resolve conflict and heal painthrough humorWolin and Wolin (1984)

Protective factors, which support aresilient personality

• Consistent behavioral limits, • Praise,• Encouragement, • Approval, • Guidance, • Physical affection• Companionship (Needle, 1983).

• PANDORA'S BOX

Key Factors of Resilient Kids

Future focused

Strong sense of identity

Ability to be flexible

Willingness to “see through a different lens”

Sense of purpose

Resources

• Addictive Thinking; Abraham Twerski• Co dependent No More; Melody Beattie• Facing Shame; Marilyn Mason• In the Realm of Hungry Ghosts; Gabor Mate,

MD• The Four Agreements; Don Miquel Ruiz• The Addictive Personality; Greg Nakken• The Places That Scare You; Pema Chodron