The Family-an integral part of therapy for alcoholism

The effects of alcohol use on family and marital functioning are complex. As alcoholism has profound effects on the family and because relationships within the family and family relation patterns may affect the course, severity and pattern of alcohol misuse, several family-focused management plans for the alcoholic and his/her family are used.

There are several advantages to a family based approach to conceptualizing and treating substance abuse disorders.

  1. Involvement of the family is associated with better compliance with treatment
  2. Involvement of the family usually leads to better treatment outcomes
  3. Substance abuse has a negative impact on the functioning of the rest of the family and involving the family in treatment may ease their distress as well
  4. Family therapy provides a framework for conceptualizing the inter relationships between substance use and family functioning
  5. Involvement of the family can reduce the sense of isolation of the alcoholic
  6. Involvement of the family can facilitate establishment of common goals for the family as a unit
  7. Can help the family identify and deal with other problems like poor communication
  8. Can be used as a guide for treatment with any part of the family that is available for treatment

Heavy alcohol use has been associated with a number of types of liver injury, various cardiac conditions, immune system depression, damage to endocrine system and reproductive function and multiple adverse neurological effects.

Alcoholism is also associated with a high incidence of serious and fatal injuries, high risk behavior and suicide.

About 48% of people with alcohol abuse/dependence meet criteria for another psychiatric disorder, a rate that is 2 times higher than non alcoholics

The divorce rate among alcoholics is estimated to be about 4 times that of the general population.

Family disruption is probably more likely with alcoholism than with other mental disorders.

Families with alcoholic parents experience more marital conflict and more parent child conflict than non alcoholic families.

Besides divorce and family disruption, alcoholism is often linked to family or domestic violence.

Research indicates that a substantial number of child abusers are also excessive drinkers and that alcohol often is involved in the abuse when the abuser is an alcoholic. Family members of alcoholics experience higher levels of psychological distress than individuals without alcoholic family members.

Children of alcoholics also appear to function more poorly compared to children from alcoholic families.

Treatment using Cognitive Behavior Therapy (CBT) model:

CBT models of the functioning of spouses and children in alcoholic families utilize a stress and coping perspective. Multiple factors are hypothesized to impact on the functioning of family members, including their own coping repertoire, other psychological problems, the types of stresses in their environment created by the drinking and the quality of the marital or parent-child relationship.

Family members utilize a variety of maladaptive coping strategies to deal with the chronic stress of living with an actively drinking alcoholic family member.

Spouses may engage in a variety of ineffective behaviors intended to change the drinking such as nagging the drinker to change or attempting to control the drinking or the drinking behavior.

These behaviors are conceived as maladaptive coping strategies, rather than indicators of underlying psychopathology. Over time, spouses assume extra role responsibilities and often decrease the time they devote to activities that they experience as pleasurable. Depression, anxiety and social isolation are understandable consequences.

The focus of cognitive behavioral therapy varies with the presenting problems and with the person presenting for treatment. The goals of a comprehensive cognitive behavioral assessment are to assess the interrelationships between drinking and family behavior, evaluate the current functioning of each member of the family unit, including strengths, problem areas, and coping skills and assess the functioning of the family as a unit.

The results of the assessment are used to develop a specific treatment plan to impact on the individual’s drinking, enhance positive coping for members of the family and to enhance the quality of marital or family relationships

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