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Addictions: Treating Family Manipulation, Mistrust, & Misdirection
Substance Abuse Addiction: Treating Family Manipulation, Mistrust, and Misdirection - 10 CEUs

Section 5
Communication in Addiction Affected Families

CEU Question 5 | CE Test | Table of Contents | Addictions
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed the survival skills used by the families of addicts.

On this track, we will discuss establishing cooperation within the family of an addict, through identifying who is most open to change, asking for help, finding allies outside the immediate family, and dealing with family members who refuse to cooperate.

As you are well aware, addiction isolates families. Family members are not only isolated from the outside world, but they are often isolated from each other. As we discussed in the last track, unspoken rules prevent negative feelings from being discussed. I find that the first step when working with the family member of an addict is to establish communication about the addiction with the other non-addicted members of their family. There are four steps in this process: identifying who is most open to change, asking for help, finding allies outside the immediate family, and dealing with family members who refuse to cooperate.

4 Steps to Establish Communication about the Addiction

Step # 1 - Identify who is Most Open to Change
I find that the first step, identifying who is most open to change, involves looking for the family member who is the most discontented with the current state of affairs. Discontentment sparks the desire for change, and your client may find that a frustrated, discontented family member is ready to break the unspoken rules and discuss the problem of addiction openly.

Nancy, 35, discovered that all of her children were discontented with their father’s drinking. After leaving the military, Aaron began drinking heavily, often 120 shots of scotch a week. Nancy’s oldest son, Steve, age 11, became increasingly frustrated with Aaron’s behavior. Steve said, "I got a glider for my birthday, and I asked Dad to help me put it together. He told me ‘maybe someday, but not today’. That glider never got put together."

The day Aaron was fired, Nancy came home to find him completely intoxicated. Her younger son, Ben, was hiding under the kitchen table, scared. Nancy told me, "I took the kids down to the basement and asked them if they had noticed anything about their dad. Steve told me he was scared, and that Aaron looked depressed, and that his speech was slurred. I told them their dad had lost his job because of his drinking. It was the first time I had really talked to them about the problem."

Step # 2 - Asking for Help
In my experience, the second step, asking for help, is usually the hardest. Nancy’s case, with all of her family being ready to discuss Aaron’s problem, is rare. Family members of addicts are trained not to let themselves be vulnerable, and, as you know, asking for help makes them very vulnerable.  In most families, there is a mixed bag of reactions to a request for help.

Some complain frequently, but quickly shoot down suggested courses of action with a "yes, but…" Others have ‘washed their hands’ of the situation, and distance themselves, saying, "I’ve done all I can." Some family members are outright hostile, believing all help is meddlesome, and reject the idea of interfering with the addiction. They often believe the family is planning to treat the addict unjustly.

Encourage your client to find the family member who says, "yes, I’ll help. You can count on me," and to open a dialogue with that person. Approaching this person first makes the task of asking for help less daunting, and each person gives the other strength to keep working towards change.

Step # 3 - Finding Allies
In addition to identifying who is most open to change and asking for help, I find that the third step is necessary when the addiction has taken such a toll on the family that your client can find no one to collaborate with them. This step involves asking for help outside the immediate family. Usually, the best sources of help may be the extended family- an aunt, cousin, or grandparent your client trusts.

Encourage them to approach this person in measured steps, rather than saying "we need to intervene on Gary’s painkiller addiction right away, but no one will help". I find a good first step for asking for help from outside the immediate family is for your client to describe the problem, and ask for advice or help learning more about addiction. I often find that if a client goes to someone outside of the emotional turmoil of the family first, they have greater success bringing everyone together.

Step # 4 - Dealing with Members who Refuse to Cooperate
In addition to identifying who is most open to change, asking for help, and finding allies outside the immediate family, your client may need to deal with family members who refuse to cooperate. Often, these are family members who have been deeply wounded by the addiction, and have trouble finding the compassion to help the addict as a result. These family members may need to be reminded that confronting the disease means starting a healing journey for everyone.

Frequently, the first response from family members who refuse to cooperate is "I need more information". Although your client may want to rush right into an intervention, encourage them not to rush in to anything. In Nancy’s case, I helped her find children’s books and resources to teach her two sons about their father’s illness in terms they could understand.

'Building Up Courage Muscles' Exercise - 3 Steps
Peg, 21, recently began seeing me after discovering that her mother, Michelle, was addicted to painkillers. She was having trouble working up the courage to talk with her father about Michelle’s problem, so I asked her to try the "Build Up Your Courage Muscles" exercise. I told Peg that to build up her courage muscles, she would need three things: support, a history of success, and a courage talisman.

-- Step # 1 - Find Support
For the first step, Peg chose her college roommate Kate as her support. She had already told Kate about the problem, and felt confident that Kate would help her role-play talks with her father, and remind Peg how strong she was. Next, I asked Peg to list three challenges she had successfully handled in the past. Peg’s list was: moving to college, working part-time while going to school, and finding a great apartment.

-- Step # 2 - Establish a History of Success
After Peg had made her list, I asked her to journal a response to the following questions: What qualities of character allowed you to handle these challenges? In what ways were your resourceful? What did you learn from these experiences that might serve you now? By doing this, Peg created a written reminder of her strengths and abilities. We agreed that she would post this next to her computer as a daily reminder of her history of success.

-- Step # 3 - Find a Talisman
Finally, I asked Peg to think of a talisman that she could carry around to remind her of her strength. Peg chose the carabineer she had used on her first outdoor rock climbing trip. This served as a physical reminder of her courage; a mental security blanket. For some clients, a physical object works best, for others, a special phrase, or a painting hung in their room, may work better.

On this track, we have discussed establishing communication within the family of an addict by identifying who is most open to change, asking for help, finding allies outside the immediate family, and dealing with family members who refuse to cooperate.

On the next track, we will discuss the three types of anger found in the family of an addict: instructive, safe-guarding, and relationship anger.

Peer-Reviewed Journal Article References:
Church, S., Bhatia, U., Velleman, R., Velleman, G., Orford, J., Rane, A., & Nadkarni, A. (2018). Coping strategies and support structures of addiction affected families: A qualitative study from Goa, India. Families, Systems, & Health, 36(2), 216–224. 

Eddie, D., White, W. L., Vilsaint, C. L., Bergman, B. G., & Kelly, J. F. (2021). Reasons to be cheerful: Personal, civic, and economic achievements after resolving an alcohol or drug problem in the United States population. Psychology of Addictive Behaviors, 35(4), 402–414.

Farmer, R. F., Seeley, J. R., Gau, J. M., Klein, D. N., Merikangas, K. R., Kosty, D. B., Duncan, S. C., & Lewinsohn, P. M. (2018). Clinical features associated with an increased risk for alcohol use disorders among family members. Psychology of Addictive Behaviors, 32(6), 628–638.

Otten, R., Harakeh, Z., Vermulst, A. A., Van den Eijnden, R. J. J. M., & Engels, R. C. M. E. (2007). Frequency and quality of parental communication as antecedents of adolescent smoking cognitions and smoking onset. Psychology of Addictive Behaviors, 21(1), 1–12.

Samek, D. R., Rueter, M. A., Keyes, M. A., McGue, M., & Iacono, W. G. (2015). Parent involvement, sibling companionship, and adolescent substance use: A longitudinal, genetically informed design. Journal of Family Psychology, 29(4), 614–623.

Wills, T. A., Gibbons, F. X., Gerrard, M., Murry, V. M., & Brody, G. H. (2003). Family Communication and Religiosity Related to Substance Use and Sexual Behavior in Early Adolescence: A Test for Pathways Through Self-Control and Prototype Perceptions. Psychology of Addictive Behaviors, 17(4), 312–323.

Online Continuing Education QUESTION 5
What three steps are required for the "Build Up Your Courage Muscles" exercise? To select and enter your answer go to CE Test.

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