Family treatment has become an ongoing component of most alcoholism treatment programs. The main emphasis of such treatment is on the affects of alcoholism on family roles and enabling patterns. However, many programs lack clear goals and objectives for involving family members or provide the same type of treatment for each family. This may be due to the fact that there is no universal or routine model of family treatment for alcoholism.
Most proposed interventions focus on individual family members and do not address interactions and roles among members. Whats more, treatment is often provided without a through assessment of the familys unique needs.
Alcoholism is a progressive illness that occurs in stages. In broadening this definition to include a progressive family illness, the first step in intervention and treatment for the alcoholic family is to determine its stage of adjustment to the illness. As with individual alcoholics, different stages of family illness require different interventions, and the right intervention at the right time improves the chance for a successful treatment outcome.
This paper offers criteria for diagnosis and intervention with three stages of family alcoholism-early, middle, and latter-and conducts with helpful interventions on treatment resources for alcoholic families.
Early Stage Family Alcoholism: Early stage family alcoholism is characterized by denial. Drinking episodes are minimized, rationalized, and discussion about alcoholism is avoided. Most often during this stage, family members experience no great adjustment in their roles and expectations because of the alcoholic members drinking. Anger and resentment toward the drinking person or other family members is repressed, and disagreeing goes unvoiced for fear of causing a drinking episode. The family adopts other means to cope with the illness, yet to the outside world, the early stage alcoholic family is the looking good family..
Case#1: Jack is 27 years old and an alcoholic. His parents, John and Mary, are both professionals, John an accountant, and Mary a teacher. Jack was recently arrested for his second DWI (driving while intoxicated) charge in three years, and John and Mary agreed to undergo counseling as significant others of an alcoholic.
The familys obsession taking case of Jack has put a strain on the marriage. Mary denies any negative feelings, yet becomes angry when the discussion turns to Jacks alcoholism. Jack was raised well, she states. Hes not really an alcoholic. Her need to deny the severity of the problem and to repress her feelings is further revealed by her refused to go to Al Anon meetings.
The entire family has been disrupted by alcoholism yet denies the problem. By rescuing and controlling his alcoholic son, John has neglected his wife and daughter and has kept Jack from recognizing the severity of his illness. The shame and humiliation felt by both parents has led each to deny their real feelings.
Middle Stage Family Alcoholism: During the middle stage, the family system begins to adjust to the illness. Family roles begin to shift and members often change their expectations of each other and of the alcoholic.
Also during this stage, the family recognizes that a problem exists and attempts to solve the problem either through outside assistance or internal change. The family carries a significant amount of stress, tension, and guilt, but it is not fully explored or personalized. They may be expressed in terms of abuse, resentment, isolation, and greater responsibilities of other family members.
Case#2: Desiree is a 27-year-old married female who has been in treatment for five months. Her 9-year-old daughter, Samantha, completed a childrens group at an outpatient clinic and now receives individual counseling. Desirees husband, Maurice, is still actively drinking, although he has cut down and is still living with his wife and daughter.
Samantha feels alone. Shes afraid of the future and guilty about her ambivalence toward her father. Desiree is dealing with her own guilt regarding her mixed feelings toward Maurice, she often projects (blames), giving Samantha the message that its not okay to dislike daddy. This only causes Samantha further guilt. Desiree took Maurice back twice after leaving him. Samantha asked her mother not to take Maurice back if he cant stop drinking. Samanthas need for her father to stop drinking shows a desire to be back with him.
Latter Stage Family Alcoholism: This is indicated by rigid roles that often exclude the alcoholic member from the family system. Its as if the alcoholic no longer exists. The familys shame and guilt overshadow feelings of hopelessness and resignation. Because they believe that nothing can help the situation. Many families are unlikely to seek help at this point. Those families that seek treatment hope it will cure the situation and it will go away.
Case#3: Charlene is 25-year-old. She initially entered treatment with her estranged husband, Matt, who is an alcoholic, but complied with treatment only to win his way back into the marriage. He dropped out and she continued in therapy. Charlene felt stuck in the relationship and felt ambivalent about the marriage. She sensed that things wouldnt get better. She felt hopeless and couldnt bring herself to terms of divorcing Matt.
Charlene recently began to get in touch with her feelings that have been repressed for many years. She suffers from guilt over losing the relationship, yet she has enrolled in college and has new goals for herself. She feels greater control over her destiny, which has increased her self-esteem. She remembers the marriages better moments only to bounce back by recalling its painful reality.
Guidelines for Intervention: Early Stage Intervention: The goal in this stage would be to capitalize on the familys inherent strengths and assets and to maintain appropriate family functioning. Methods to maintain the alcoholics involvement should be stressed, yet each family member should be allowed to discuss and identify when the alcohol problem was first recognized and each should be given permission to identify the cause of the familys problem as alcoholism. Family members should also be taught how to respond to drinking episodes. Involvement in a family education group where members learn about alcoholism, its effects on the family, and enabling behaviors increases the familys awareness of their role in the situation and may generate ambivalence as to how they should deal with their illness.
Middle Stage Intervention: The professional should first respond to any existing crisis, such as the alcoholics need for intoxication. Intervention should encourage consistency in behavior during future drinking episodes and the development of clearly defined roles among family members.
Latter Stage Intervention: The professional must weigh the benefits of readjusting the alcoholic member back into the family. Family members must then learn how to reinforce each members role. With treatment children in this stage become stable after a period of acting out. There is a need to become aware of just how thoughts, feelings, beliefs, and actions interact with the goal of changing core beliefs, which further leads to more positive, self-affirming behaviors.
Treatment Options: A comprehensive treatment approach that emphasizes individual, conjoint, family, and group counseling, and relapse prevention skills training is recommended for alcoholic families.