Understanding addiction and the family setting moral better! Book review!
Information comes from:
Substance Abuse and the Family by Michael D. Reiter.
Michael D. Reiter, PhD is Professor of Family Therapy in the division of Social and Behavioural Sciences; he is a marriage and family therapist and wrote the textbook Substance Abuse and the Family but also three other textbooks. He wrote the book as he was unable to find the right textbooks with an overview of the field.
The book will teach you what it means to view addiction through a system lens. Throughout the book you will learn about the neurobiology and genetics of addiction, family relationships and the larger systems.
Three models of addiction:
1. The moral model: The person abuses the substance not because of physiological reasons but because he lacks willpower. The person can stop if he is strong enough.
2. The disease model: There are several characteristics to this model.
It impacts many people the same.
- The disease is primary.
- It follows a predictable course.
- It is permanent.
3. The family model: Addiction is a symptom of a larger issue within the user’s family.There are four systems in this model:
- Microsystem: Inner system, the person and people close to him.
- Mesosystem: Including systems that directly influence the microsystem. Example: Work.
- Exosystem: Finances or social and economic status.
- Macrosystem: The social and cultural milieu the person is part of.
I believe that we are putting people too quickly in certain boxes/labels. I believe you should find a balance in all three models as every person and situation is unique and therefore two or more models could apply on one person.
The four species of alcoholism:
1. Alpha alcoholism: The person is still in control and can decide when to stop and may not have many withdrawal symptoms.
2. Beta alcoholism: The person drinks when they have the opportunity but do not feel the need to drink. Social drinkers.
3. Gamma alcoholism: The most damage happens with this specie. Relationships and work will suffer.
4. Delta alcoholism: Is similar to the Gamma alcoholism, yet this does not include the person losing control. They are able to function in their social, personal and work lives.
There seems to be a fine line between the various species, it is hard to see for yourself in which of the four you fit in. I believe people will quickly slip from one species into another, in most cases in a negative way. Alcoholism seems to be a difficult addiction as drinking is socially so accepted; you can have a serious problem with alcohol without you noticing.
The four-phase progression of alcoholism is mentioned:
1. Pre-alcoholic phase: The person drinks mainly for social reasons. A connection between drinking and stress reduction occurs.
2. Prodromal phase: The person is in control of most of their actions but begins to develop problematic patterns; sneaking in drinks and having blackouts.
3. Crucial phase: The person has changer the normal pattern of behaviour so they can consume alcohol more frequently and their tolerance has increased.
4. Chronic phase: The person might go on benders, suffers serious withdrawal symptoms and experiences difficulty at work, social and family relationships.
Again for these guidelines there seems to be a very fine line between them. If you would take them into account with your personal life everybody that drinks is in the pre-alcoholic phase.
A very medical chapter is the neurobiology of the addiction & the genetics of the addiction. I found the following topics very interesting:
1. Blood-brain Barrier: is the crossing between the blood and the brain. All psychoactive drugs (drug that alter mental functioning) reach the blood-brain barrier in order to effect thoughts and behaviour.
2. Mesolimbic Dopamine System: help you to get motivated and gets us to move in a goal directed manner. It is your reward system.
3. Dependency versus biologically addicted: with dependency you feel the need to take it and the need will take over. With biologically addicted your body needs the substance otherwise there will be withdrawal symptoms.
Genes are located within strands of DNA. DNA is made up of two strands, the two strands of DNA fit perfectly together.
Whether or not a person becomes addicted depends on various things:
- The person’s surroundings
- The personal history of the person.
- The types of drugs that are being used.
- The way the person’s body and brain respond to the drugs.
The way your genetics are decides how prone you are towards certain chemicals and how you will react. This does not mean that everything is set in stone as you also react to your environment. This is part of the nature-nurture discussion; what you get from your genes and what you learn from your surroundings. People are unique and you have to take both sides into account.
In families where a member suffers from addiction the family focuses around the addict. They are trying to protect the family from the outside systems.
There are various family systems:
- Functional family system: At the start of the addiction, the family is still able to function as normal.
- Neurotic enmeshed family system: The behaviour of the addict will interrupt the normal family behaviour.
- Disintegrated family system: The members might develop survival roles to cope with the situation. The family might have separated.
- Absent family system: It got so severe; the members have lost hope of change.
I think that the family systems also apply to families that have to deal with abuse. In order to help the addict to recovery you need to know in which system his family is otherwise they only bring each other down.
The alcoholic family has three phases:
1. Early phase: they are developing an alcoholic identity. It all starts to focus on alcohol instead of on the family.
2. Middle phase: Family members alter their behaviour. They will take on various roles to maintain the stable family system.
3. Late phase: There is a shifting of the family rules.
I find it quiet shocking that one addicted person can change the whole family system. I suppose it is because humans have a natural survival instinct, changing is the safest option at the start.
The various dysfunctional families:
- Protective: Most functional, they are trying to shield the children from the addiction.
- Emotional disruptive: Maintains rituals and routines. The children will notice the addiction.
- Exposing: Will have severe disruptions.
- Chaotic: Most severe disrupted. There is a high level of stress.
The diversity of the families and how various cultures might influence the addiction and the recovery is mentioned. You have to be open-minded and try to understand the addict’s background as this is for him the norm.
There are various survival roles the members of the family can pick up. In order to stay a functional unit and to protect themselves members of the family take on various roles.
A few examples of the roles:
- Dependent: the addict.
- Co-dependent: focus on others.
- Enabler: helps maintaining the addiction (Unintentionally).
- Hero: successful in something.
- Scapegoat: gets in trouble.
- Lost Child: Shy and may become socially isolated.
- Mascot: the clown.
I believe they are trying to protect themselves from the hurt and pain addiction brings to the family unit.
When a family is dealing with addiction the growth of the family and their members will be slowed down or stopped. They are so focussed on trying to deal with the issue.
I think it is understandable as it is tiresome and painful to deal with the situation, you do not have the energy or emotional balance to deal with your growth.
It would be easier if every member of the family would be ready for the treatment; this is mostly not the case. They might be in denial and don’t realize that there is an issue.
Five of the family therapy approaches:
- Natural Systems: there are certain predictable forces which shape the behaviours of individuals.
- Contextual: how past issues impact the current.
- Experiential: They try to focus on the present. Focus on the in-session interactions.
- Human Validation Process Movement: helps to take people responsibility, teaches the members of the family how to cope with problems.
Five of the better known family therapy approaches:
- Strategic: the therapist is responsible to change the family.
- Milan Systemic: uses suggestion and neutrality to get the family system to change.
- Structural: focussed on making the family more functional.
- Narrative: tries to group events in past, present and predicted future and creates the person.
- Solution focused brief therapy (SFBT): focusses on solutions. Action oriented approach.
- Multidimensional Family therapy: family-centered treatment for drug abuse and related behavioural problems.
- Brief Strategic Family therapy: has a family system approach. Brief intervention.
I would prefer the SFBT or Human Validation Process Movement therapy the most. The Human Validation Process Movement seems ideal because they focus on the person taking responsibility, when dealing with addiction the addict can blame others for their usage. By taking back the responsibility they have to deal with their issues. This therapy also teaches how to cope with those issues.
The SFBT seems great as they focus on solutions. I believe that some ways of therapy focus too long on the issue and do not offer a solution to the person.
If in the family system one member changes it impacts the other members.
The four-stage model of family recovery is:
1. To maintain denial of any problem.
2. Belief that there is no issue and no loss of control.
3. Inventing explanation for the issue.
4. Cover up and maintain the family secret.
I believe this lines up with the recovery of the individual, with the family recovery you have various members who might be in different stages. You will adjust the counselling accordingly.
Wet and dry family systems:
- Wet: substance is present.
- Dry: substance is not present.