Transcript Addiction A Family Matter by Marilyn Stein

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
Dependency
Experimentation
Recreational
Use
Abuse
Habituation
(Increased Use
For relief)
“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 Families
Life 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 members
2. 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 parent
would Cut down on his/her drinking?
2.Have you ever felt Angry about your
parent’s drinking?
3.Have you ever felt Guilty about your
parent’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 codependence.
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 give
honest answers
2) Independence - the ability to separate emotionally and
physically from one’s troubled environment
3) Relationships - the ability to develop fulfilling
relationships with others to fulfill needs
4) Initiative - the ability to take charge of personal problems,
set goals and be productive
5) Morality - the ability to seek a fulfilling personal life,
demonstrate ethical conduct, and possess self-respect
6) Creativity - the ability to impose order and beauty on
the chaos of troubling experiences and feelings
7) Humor - the ability to resolve conflict and heal pain
through humor
Wolin and Wolin (1984)
Protective factors, which support a
resilient personality
•
•
•
•
•
•
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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
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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