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FAMILY INTERVENTION: ALCOHOLISM. By: Nancy D. Losinno, LCSW, CASAC BNL EAP Manager. Effects of alcoholism on the family. Development of alcoholism in 1 family member affects all the other members; The longer-lasting & more subtle the process, the greater the acceptance of it as the “norm;”

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FAMILY INTERVENTION:ALCOHOLISM

By: Nancy D. Losinno, LCSW, CASAC

BNL EAP Manager


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Effects of alcoholism on the family

  • Development of alcoholism in 1 family member affects all the other members;

  • The longer-lasting & more subtle the process, the greater the acceptance of it as the “norm;”

  • Rigid patterns of behavior for all, attempts to change can become thwarted until a crisis disrupts the norm-steady state-homeostasis.

  • See the scales in background-alcoholic family is always in a delicate state of balance.


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Parallel defenses & symptoms

  • Jellinek model: denial, projection, isolation, rationalization, personality change;

  • A simultaneous process in the members of the family;

  • Social isolation leads to emotional isolation

  • Fears, anxiety, & guilt parallel those of alcoholic;

  • Family members experience decline in their own health, may question their sanity, and suffer rages, frustrations & self-pity when situation does not change, as “promised.”


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What is “Codependency?”

  • A dysfunctional pattern of living/problem solving developed by family rules in childhood;

  • CODA have a greater tendency to love the unreliable, emotionally unavailable, needy, “wounded birds” who need “rehabilitation”

  • CODA tries to provide & control every part of the relationship while denying their own needs, desires, dreams, setting themselves up for more unfulfillment;

  • Creation of the “emotional debt” phenomenon out of fear of abandonment.


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Codependent Behaviors

  • Controlling

  • Distrust

  • Perfectionism

  • Avoidance of feelings

  • Fears of being engulfed (intimacy issues)

  • Caretaking

  • Hyper vigilance

  • Stress-related physical illness


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How did I get here?

  • Families of origin: what were the patterns/dynamics in yours?

  • How did my family handle conflict, anger, love, etc.?

  • Many people are taught not to be assertive or to ask directly for needs to be met;

  • How do I become more fulfilled & feel better about myself and the life I live?


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The “Rules” of Codependency

  • Don’t rock the boat.

  • It’s not okay to talk about problems.

  • Keep your feelings to yourself.

  • Be strong, good, right, perfect.

  • Do as I say, not as I do.

  • The “best” communication is indirect.

  • Don’t be so selfish.


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What is Enabling?

  • Enabler makes it easier for alcoholic to function;

  • Spouses take over the financial & home responsibilities;

  • Spouses make allowances for & forgive bad behavior;

  • May continue to be loving/giving in the face of physical/mental/emotional abuse

  • Parents close their eyes to suspicious behavior, hand out generous allowances, write sick notes


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Enabling’s Purpose

  • Remember the delicate balance!

  • Enablers do it to meet their own needs, to restabilize the relationship, to lure the alcoholic back to them after alcohol has taken them away;

  • Enabling is a poor-quality glue;

  • Behind enabling is fear of abandonment

  • Only allows disease to grow to more serious stage


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The “Disease Concept”

  • The “Jellinek” model poses 5 types of alcoholism based on male drinking patterns;

  • Is the most widely used model in treatment programs, with abstinence as the primary goal;

  • Most Americans in AA would be classified as “gamma” type;

  • Sharply contrasts with growth of psychiatric treatment programs for alcoholics who cannot recover without aid of anti-depressant meds


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How Do People Change?The “Prochaska Model”

  • Stage 1: Precontemplation—Resisting change. Precontemplators rarely take responsibility for themselves or their behavior, they do not like living with short & long term consequences. They may have tried & failed in the past, and believe that it will keep happening. Problem is how to become unstuck.


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Stage 2: Contemplation Change is on the Horizon

  • Being aware of your problem with passivity & depression;

  • Struggling to understand causes & cures;

  • Seriously thinking about solving problem;

  • Lets down defenses & welcomes others into his life;

  • Some people can get stuck in Contemplation for many years.


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Stage 3: PreparationGetting Ready to Change

  • Brings you to the edge of action;

  • Takes you from the decisions you make in Contemplation to specific steps to solve the problem;

  • Some may wish that admitting a problem will make it go away; some wait for a “magic moment;” others get stuck;

  • Making a commitment during this stage makes success more likely (set a date, “go public,” have someone hold you accountable)


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Stage 4: ActionIts Time to Get Moving

  • Action without preparation will last only temporarily;

  • Cheap change will not last long, real change takes work & mental sweat;

  • All change creates anxiety & you need ways to deal with the anxiety of change;

  • The myth of the “magic bullet”, there are no simple solutions.

  • Changing your thinking about your problem can result in a better, more productive outcome.


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Stage 5: MaintenanceStaying There

  • The myth of “just one” (drink, cigarette, piece of cake, etc.)

  • Successful change is sustained over a period of years & involves sweat effort;

  • Must be aware of danger signs & times, warning signals, areas of vulnerability;

  • In alcoholism treatment, it is called Building Up to Drink (BUD) syndrome or use HALT.


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Intervention: What is it?

  • Dynamics within alcoholic family are inter-twined, and involve response from other members;

  • By working with the most motivated family member, and changing the way they are responding to the alcoholism, intervention is made;

  • Is in contrast to glamorous/confrontational type of intervention, often high-priced. If family has not yet changed how they respond to the drinking—intervention may prove unsuccessful.


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Intervention: How is it done?

  • Any method that creates change in the family member that is lasting, sincere, and reinforces positive behavior in the drinker can be part of intervention process;

  • For family members: Al-Anon, private therapy, even efforts to improve self-esteem (weight loss, depression, etc.)

  • EAP can be a valuable first step in the process of intervention;

  • Remember, intervention is a process, not an event!

  • After taking steps to intervene, no looking backward, no sideward glances to check if someone is noticing!


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