Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 1
Track #1 - Introduction & Stage One of Family Addiction

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Welcome to the Home Study Course sponsored by the Healthcare Training Institute, homestudycredit.com.  This course is entitled, Treating the Family Struggling with Sobriety.

Our primary intent for this home study course is to provide quality education to foster your professional growth.  The Institute has provided quality education since 1979.
 
Hi.  My name is Catherine Appleton.  I will be the narrator of this CD set.  We appreciate that you have chosen us as a vehicle for you to earn your Continuing Education Credit.

The purpose of the course is to assist you in increasing your knowledge regarding how to treat patients, clients, etc. dealing with family recovery for addiction.  As each case study is given, if the concepts seem to be applicable to your situation, I encourage you to turn your CD player off and make a few notes regarding the application of the principle to your setting.  However, these notes are for your purposes only and are not to be sent to the Institute.  Also each track is very content dense.  So feel free to replay the track to review the content either for your own purposes, or if you feel appropriate play the track in an individual or group session for client education.  Also permission is granted to reproduce this CD.  We encourage you to duplicate and give copies of this CD to colleagues, clients, etc. as you deem appropriate. We feel the information on our CD's is valuable.  Thus, we have an interest in distributing CD's in as many ways as possible, to benefit the greatest number of people, who have a need and are receptive to this practical information.

The questions in your Answer Booklet are sequential and deal with the section of content that preceded it.  For this reason, to facilitate the answering of each question, you might read the question from the Answer Booklet prior to listening to that CD track.  By knowing what the question is ahead of time, you will then know the content to listen for that contains the answer.  So just a hint, after you write down the answer to a question in your Answer Booklet, read on to the next question in order to give you a “heads up” to listen for the content that contains the answer to the next question.

Merely write the correct letter on the corresponding blank line in your answer booklet. Each answer is only used once. Keep in mind there is nothing tricky or hard about these questions.  They are merely intended to verify the playing of this CD.

For the purpose of brevity, most generally, I will use the term “therapists” or “mental health professional.”  However, don’t let these terms deter you from applying the concepts to your situations.  When you hear the word “therapists,” if your job title is social worker, psychologist, marriage and family therapist, mental health counselor, professional counselor, resident director, program assistant, etc. merely substitute the appropriate term that is the most meaningful to you. In short, don’t let my use of the term “therapists” cognitively set you off track from hearing the content because your job title is school counselor, for example.  I will also use the term “client” for the purposes of brevity.  However, if you deal with patients, residents, students, consumers, etc., transpose “client” for the term that is the most meaningful to you in your work setting. 

On this CD set we will discuss such topics as stage one of family addiction, the development of a protective persona, hopelessness, addiction in relationships, effects on children, becoming ready for recovery, a new view on enabling, parallel recovery, the phenomenon of release, collapse, middle recovery, the amends process, and the spiritual principles of late recovery.

So  let’s get started

On the rest of this track, we will discuss the first stage of a family’s adjustment to an addicted family member. I have found that the five steps in this adjustment stage of family addiction are the erosion of trust, avoidance and control, the family becomes reactive, communication breakdown, and monitoring.

As you are well aware, as addiction takes hold, the addict drifts away from his or her family, and the family begins to adjust and adapt to the continuous presence of the addiction. With Mark, the first step in this adjustment process was the erosion of trust within his family.  Family members in this first stage of addiction want to give the addict the benefit of the doubt, but increasingly their instincts tell them not to.  Do you find that addicts in this stage find it impossible to see concern as genuine, thinking his or her loved ones are trying to trick or force them into stopping their substance use? As you will see with Mark, the addict becomes increasingly mistrustful, and distances him or herself from the family. Mark’s withdrawal further eroded his family’s trust in him. Mark’s apologies and promises become meaningless.

With Mark, the second step in the adjustment process was avoidance and control. As you know, addiction is based on the false belief in control. When an addict is high, they believe they have found the ‘answer’ that will provide the control he or she needs to ensure a good life.  I find that, just as the addict believes he or she can control their substance use, the family believes they can control the addict. When Jerry’s son Mark began drinking in high school, Jerry stated,  “if I can just help Mark make it through the baseball season, get him to go to all his games, everything will be all right!” Long after the baseball season ended, Mark’s addiction was still progressing. I find that the more family members fear for an addict’s life, the more they try to exert control over the addict.  However as with Mark, this only pushes the addict further away, creating more fear. Do you agree? One way families in the adjustment stage cope with this fear is by protecting themselves through avoidance. For example, when Mark got his second DUI, Jerry told me “it could happen to any kid. It’s just bad luck.” Do you agree that this statement protected Jerry from feelings of fear by avoiding and minimizing the problem?

I have found, probably like you, that when people are scared and in need of protection, they instinctively seek power, because power distances them and makes them feel less vulnerable. As you know, as the family sinks deeper into the addictive process, the family’s fear level increases. With Mark, this led to the third step in the adjustment stage, the family becoming reactive- family members begin using anger and arguments to stop feeling helpless. For example, when Mark failed to return home by three am, Jerry was understandably frightened. When Mark finally showed up, drunk, at 4:00, Jerry’s fear turned into anger, and he yelled “Where the hell have you been!?” In my experience, feeling angry distances the families of addicts from their fear and makes them feel more in control.
                                                                                 
I have observed that reactivity leads directly into the fourth step of the adjustment phase, communication breakdown.   As you know, healthy communication is a dialogue in which each family member is willing to listen to and be influenced by each other, and each participant is equally vulnerable.  Do you agree that the goal of healthy communication is to listen for what the truth is, and to move towards it? In my experience, truth poses a threat in the addictive family, and the addict sabotages the truth and communication process to protect the addiction.  For example, every time Jerry mentioned Mark’s drinking, Mark would react angrily and start a fight.  In Mark’s family, each member built an emotional wall for protection.  Communication moved from a dialogue to a monologue.  Do you have clients who no longer expect to be heard, so they just shout at each other?  In Mark’s family, making one’s point became critical. When any individual family member was in the monologue style, no one was respected, and this is was very damaging to the family. Jerry told me, “I don’t think anyone actually heard anything anyone else said in our family.  Words became bullets, we would just shoot them at each other.”

In addition to the erosion of trust, avoidance and control, the family becomes reactive, and communication breakdown, the fifth step in the adjustment phase for Mark’s family was monitoring. Jerry told me “Mark just kept getting worse and worse. If he was out, I’d be up all night worrying about him. So I started following him when he went out. I thought, if I followed him, maybe I could keep him from getting hurt.” Clearly, Jerry was exhibiting classic monitoring. This step occurred near the end of the adjustment stage for Mark’s family. Mark tried to stay connected with his son and keep him out of danger by chasing him, which only made Mark more defensive.  In this step, Jerry and his wife still believed they could solve the problem, and they became hyperalert for any signs of danger. Jerry  put aside his own needs for Mark’s immediate ones. Are you currently treating a client who would drop everything to drive 300 miles to bail their heroin-addicted son or daughter out of jail? Jerry told me, “One night, Mark got smashed and wound up totaling his car. I paid for all the repairs, and I thought he’d be grateful. But after a week of acting sorry, he was back to treating me the same as ever. I felt… well, I felt ripped off!!”

Jerry was obviously experiencing a great deal of frustration. I found that he was having trouble expressing this frustration in a healthy way, so I walked Jerry through the “Frustration Towel Twist” exercise. I offered Jerry a rolled-up bath towel, and instructed him to grab it with both hands. I then instructed Jerry to take a deep breath, tense his body tightly, and hold his breath while twisting the towel in his hands tighter and tighter. When the tension in the towel was as strong as he could make it, I told Jerry to slowly release the towel and his breath, making a sighing ‘haaa’ sound. I had Jerry repeat this twisting and release three times.  With practice, Jerry found that by using the towel twist exercise when he was frustrated with Mark, he was able to approach his son more rationally, and focus on using conversation patterns he had practiced with me in our sessions.

On this track, we have discussed the six steps of the adjustment stage of family addiction. These six steps are: the erosion of trust, avoidance and control, the family becomes reactive, communication breakdown, and monitoring. On the next track, we will discuss the second stage of family addiction, the development of a protective persona. There are five aspects of the development of a protective persona. These are: polarization of the family, distancing, the breakdown of family rituals, the creation of new rules, and shame and blame.

QUESTION 1
What are the six steps in the adjustment stage of family addiction? To select and enter your answer go to Answer Booklet.