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Alcohol & Sub. Dep.: Family Struggling with Sobriety
While the specific physical and psychological effects of drug abuse and addiction tend to vary based on the particular substance involved, the general effects of abuse or addiction to any drug can be devastating. Psychologically, intoxication with or withdrawal from a substance can cause everything from euphoria as with alcohol, Ecstasy, or inhalant intoxication, to paranoia with marijuana or steroid intoxication, to severe depression or suicidal thoughts with cocaine or amphetamine withdrawal. In terms of effects on the body, intoxication with a substance can cause physical effects that range from marked sleepiness and slowed breathing as with intoxication with heroin or sedative hypnotic drugs, to the rapid heart rate of cocaine intoxication, or the tremors to seizures of alcohol withdrawal.
Recognizing and Intervening with Family Members:
Enabling is defined as making possible or easy. In this case, behaviors by family members allow individuals with substance use problems to avoid the negative consequences that may accompany their actions. There are many ways in which this behavior can manifest. In addition, enabling behavior can be instigated by various individuals including:
Though initially enabling occurs as a way to protect the individual from their behavior, it can go on to perpetuate actions that cause repetitively bad behavior. Some ways in which enabling takes place is as follows:
Part of enabling behavior is the concept of denial. Most striking in the denial phenomenon is the enabler’s refusal to acknowledge the deterioration of the relationship he or she has with the substance abuser. In fact, quite often the denial mechanism will continue until it no longer can. Meaning, until something horrific occurs; the individual may refuse to acknowledge the problem.
The benefits of enabling are twofold: the individual who is using substances can continue the behavior they want and secondly, the enabler does not have to acknowledge that anything is wrong. This action however, is a short term solution to a long term problem. Long term, enabling drug abuse behavior leads to unhappiness for the enabler and the further deterioration of the individual using drugs. Another reason enabling occurs is because of the idea of co-dependency.
Co-dependency is a vicious circle in which the person being enabled and the enabler need to extricate themselves. It is recommended by experts in the field, that co-dependent family members or loved ones remind themselves on a regular basis that they did not cause the problem, cannot control or fix the problem. They need to understand that the only thing they can do is offer assistance which may or may not be heeded. The codependent person needs to understand that the only person, who can help the substance abuser, is the substance abuser- he or she needs to go obtain the help that is available.
In a co-dependent situation, both the abuser and dependent person need assistance. The substance abuser needs to fix both the chemical and psychological bonds, he or she has to alcohol or substances and the co-dependent individual has to understand why he or she feels the need for this dependency. Experts in the field recommend that help in the form of substance abuse counseling be obtained for the substance abuser as well as therapy for the dependent person.
Like any other substance abuse problem, steps can be taken towards recovery. In this case, help should be obtained for all parties involved. There are treatment centers in which everyone in this scenario can be assisted. It is a matter of the co-dependent person to realize he or she has a problem and then go from there.
Involvement in the recovery activities is beneficial to the family in more than just providing support to the substance-affected family member. Other members of the family benefit when they have the opportunity to learn about addiction and its physical, psychological, and emotional effect. Family participation in the recovery plan helps them identify relapse warning signs, support efforts to remain abstinent, and achieve some control over the recovery process (Daley & Raskin, 1991). Participation in the process gives family members the opportunity to heal any emotional pain they may have experienced as a result of the addict's substance abuse history (Daley & Marlatt, 1992).
Effect of Substance Abuse on Children
Psychological, cognitive-behavioral, and behavioral risks to children of substance-abusing parents are well-established (Aktan, Kumpfer, & Turner, 1996; Curtis & McCullough, 1993; Dore, Doris, & Wright, 1995; Julianna & Goodman, 1992; Sheridan, 1995). Dore, Doris, and Wright, in a review of how substance abuse affects children, reported that studies of psychosocial functioning have found that children from substance-abusing families are prone to behavior problems involving hyperactivity and conduct disorder, drug and alcohol use, impaired intellectual and academic functioning, clinical levels of anxiety and depression, low levels of self-esteem, and perceived lack of environmental control. Aktan, Kumpfer, and Turner reported that children in families of substance abusers are inclined to have ability deficits that impair their ability to solve problems, cope with stress, tolerate drugs, communicate effectively, consistently apply good standards, hold reasonable expectation, and be sufficiently interactive and supportive with others.
Effect of Substance Abuse on Parenting
Assistance to Substance-Affected Families
Tracy (1994) noted a reluctance on the part of social workers to address substance abuse problems adequately. Moreover, even when the social worker appropriately recognizes these family issues, the case management plan may be inadequate because of limited treatment sources and lack of preparation for addressing the effect of drug and alcohol use. Few programs have the comprehensive range of services to address the diverse needs of substance-affected parents, which include special and developmental needs of children, child care and parenting skills, housing and vocational assistance, and counseling directed at the emotional consequences (for example, guilt and shame) of substance abuse.
The Child Welfare League of America's North American Commission on Chemical Dependency and Child Welfare (1992) has recommended that child welfare agencies recognize that parental alcohol and drug dependency places children at risk of abuse and neglect and provide services to undo the effects of abuse and neglect, stabilize the family, improve parenting skills, and prevent maltreatment. According to the Child Welfare League of America, "Chemically dependent families need intensive immediate and ongoing assistance to resolve AOD dependency, improve family functioning, and remedy the problems that chemical dependency creates for children" (p. 20). The report asserts that services must be provided to help parents improve their ability to perceive, understand, and respond appropriately to their children's needs. Also, it is important to consider the larger context of alcohol and drug use and how it might affect family needs such as housing, employment, medical care, sufficiency of social network, and contact and integration with the community.
Intervention Domains: The Bridges Program
The four domains are
Achievement in each domains is measured through a series of assessment questions at case opening, case closure, and six weeks after closure of the case. Four levels of progress are depicted on a pictograph of the components of each domain (see Figure 1):
Components are scaled on a motivation to change or achievement of change dimension fashioned after the preparation stages of the change model of Prochaska and his colleagues (Prochaska, DiClemente, & Norcross, 1992). The domains and their components are used to develop and implement the treatment plan, which addresses family functioning and relapse prevention issues. Level of functioning within each domain is addressed so that the focus on the work with the family is to establish a strong link between family behavior and support actions and the substance-affected parent's functioning and recovery actions. The resulting picture that is created on the pictograph shows the individual and family movement toward recovery functioning and what specific domain components may need further work. (Examples of the intervention strategies derived from the model are presented in Gruber, Fleetwood, and Herring, 1998, which is available from the authors.)
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