# Presentation: 046591

## 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;”
- 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.

## 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.”

## 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.

## Codependent Behaviors

- Controlling
- Distrust
- Perfectionism
- Avoidance of feelings
- Fears of being engulfed (intimacy issues)
- Caretaking
- Hyper vigilance
- Stress-related physical illness

## 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?

## 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.

## 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

## 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

## 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

## 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.

## 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.

## Stage 3:  PreparationGetting 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)

## Stage 4:  ActionIts 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.

## Stage 5:  MaintenanceStaying 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.

## 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.

## 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!

## Treatment Resources 

- Get more information.  Go online & Google. Call your 24/7 EAP at Cigna: 1-877-622-4327.  Do something!
- Visit _[www.cignabehavioral.com](http://www.cignabehavioral.com/)_ to visit library of topics, or Personal Stress Navigator to check your own stress level (user ID: bnl, password: employee)
- Come talk to EAP.  Call X4567 for short-term assessment/counseling/referral; help is confidential.
- Access your mental health benefit through your insurance.  Ask for someone with experience in alcoholism & substance abuse.
- Find local Al-Anon Family Group meetings for free in your community.  Visit: www.**al-anon**-**suffolk**-**ny**.org