Foundations of Addictions Counseling 3e Capuzzi amp Stauffer Copyright 2016 2012 2008 by Pearson Education Inc All Rights Reserved 222 million Americans age 12 or older dependent on alcohol or illicit drugs ID: 569150
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Impact of Addiction on Families
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.All Rights Reserved
22.2 million Americans age 12 or older dependent on alcohol or illicit drugs.
Approximately 27.8 million children of alcoholics under the age of 18
Gaps in research
Caucasian, heterosexual, and intact families
Primarily focus on alcoholism
Male partner addicted to a single substance
Little study of comorbiditySlide3
Addiction and Family Counseling
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Family members instrumental in motivation
Became integral part of treatment
Healthy family and positive family rules
Meets needs of everyone
Clear boundaries
Flexible rulesSlide4
Addicted Family Dynamics
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Homeostasis
Relationships strained
Frequent denial
Trying to maintain balance in system
Boundaries
Addiction secrecy
Isolated from the community
Emotional intimacy lowSlide5
Addicted Family Dynamics: Roles
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Roles more rigid in addicted families
Children tend to occupy one of four roles
Hero
Self reliant and responsible
Scapegoat
Acts out – blamed for everything
Lost child
The adjuster
Mascot
Funny and humorous
Provide distractionSlide6
Rules in Addicted Family Systems
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Overt vs. covert
Tend to be arbitrary, illogical, and inconsistent
Shaming to enforce rules or lack of consequencesSlide7
Rules in Addicted Family Systems,
(continued)
Foundations
of Addictions Counseling, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Three major rules
Addict’s drug use the most important thing
Addict is not responsible for behavior nor family problems
Status quo must be maintained
Three other rules
Don’t talk
Don’t trust
Don’t feelSlide8
Four Stages in Addicted Family Systems
Foundations
of Addictions Counseling, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Denial
Hide abuse from each other and everyone
Home Treatment
Attempts to control addict’s behavior
Chaos
Serious emotional or physical problems
Threats of divorce but not completed
Control
Cycle of helplessness
Futile attempts to control addict’s behaviorSlide9
Parenting in an Addicted Family System
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Regular and daily rituals
Structure family life
Provide stable family identity
One non-addicted parent
Can have buffering effect
Provides stability
Better psychological outcomesSlide10
Addiction and the Couple
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.All Rights Reserved
Couple Relationship/Partner Subsystem
Has been overlooked
Limited researchSlide11
The Impact of Alcohol on Couples
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Detrimental to romantic relationships
Improvement with abstinence and recovery
Sexual inadequacy
Violence and aggression
60% of male alcoholics violent to partner in previous year
Prevalence of domestic violence by members of addiction treatment groups double that of general population
Relationship dissolution/divorceSlide12
The Impact of Couples on Alcohol Abuse
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Which came first: The chicken or the egg?
Alcohol use to enhance sex life
Superficial relationships
Blame each otherSlide13
Addiction and the Couple: Codependency and Enabling
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Codependency
Lost identity
Self sacrificing
Low self esteem
Enabling
Maintains the drug or alcohol use
Control both behavior and environment
Appear in controlSlide14
Recovery and the Couple
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Partners as resources
Important motivators
Assistance in counseling
Improving partner relationships
Motivation to stop drinking
Challenges
Increased tension after “honeymoon period”
Need for forgivenessSlide15
Effects of Addiction on Children
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Adult Children of Alcoholics (ACOA)
Shifted attention to include effects on children
Prenatal exposure to drugs and alcohol
Addiction tends to run in families
Family chaos and ever changing reality
Lack of structure
Rigid or non-existent boundaries
Abuse: physical, sexualSlide16
Addiction’s Impact on Children’s Behavioral Outcomes
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
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Many children do fine
Severe physiological consequences
Lower cognitive performance
Attention deficits
Impulsivity, conduct disorders
Depression/Anxiety
Lower academic achievement
External locus of control
Elevated risk for alcoholismSlide17
Addiction’s Impact on Children’s Psychosocial Outcomes
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Life in addicted family system is distorted
Children have no control in home environment
Children believe they are the cause of the problem
If they could just “fix” themselves, family could be healedSlide18
The COA Self/Defensive Self
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
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Adapting coping mechanism
Denial, cognitive distortions, fear of losing control, and negation of self
Distrust of one’s own senses
Distrust of others
Feelings of unreality
Inhibition of curiositySlide19
COAs’ Relationships With Others
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Difficult to trust themselves or others
Alcoholic parents are often abusive
Encouraged to be independent and compliant
Self-blaming
Black and white thinking
Fail to develop pro-social skills
Difficult to have positive friendshipsSlide20
Efficacy of Couples and Family Counseling
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Among best outcomes for recovery from addiction
Among the top five treatments
Superior to peer group, individual oriented treatment modalitiesSlide21
Assessment of Addicted Family Systems
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Alcoholic family or family with alcoholic member?
Structured clinical interview
Include all adults and school-age children
Minimizes distortion
Genogram
Focus on function and severity of the addiction
Individual and family as a wholeSlide22
Treatment Strategies for Addicted Family Systems
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Abstinence or harm reduction?
Three areas of interest for treatment
Environment
Family system
Individual – through the whole processSlide23
Addressing the Environment
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Two primary tasks
Create safety
From external threats
From family of origin issues
Each family member tells the trauma story
Also consider helping individuals plan how to handle changes in relationships to prevent relapseSlide24
Addressing the Family System
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
Where most work will take place
Educate
Family may experience “emotional desert”
Normalize and validate
“Distrust days”
Criticism journal
Letters
Focus on couple subsystem
Restabilize for healthy relatingSlide25
Useful Web Sites
Foundations
of Addictions Counseling
, 3eCapuzzi & Stauffer
Copyright © 2016, 2012, 2008 by Pearson Education, Inc.
All Rights Reserved
American Association for Marriage and Family Therapy
www.aamft.org
American Psychological Association’s Division on Family Psychology
www.apa.org/divisions/div43
International Association of Marriage and Family Counselors
www.iamfc.com