A System (Family/Co-dependency)
Perspective on Addictions
William J. Udrow Jr. PsyD, LCP, CRADC, MISA I, PCGC
Ecuador: 2012
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A System: Family Perspective on Addictions:
U.S.A Data
Combined data from 2002 to 2007 indicate that over 8.3 million
children under 18 years of age (11.9 percent) lived with at least one
parent who was dependent on or abused alcohol or an illicit drug
during the past year
Of these, almost 7.3 million (10.3 percent) lived with a parent who
was dependent on or abused alcohol, and about 2.1 million (3.0
percent) lived with a parent who was dependent on or abused illicit
drugs
About 5.4 million children under 18 years of age lived with a father
who met the criteria for past year substance dependence or abuse,
and 3.4 million lived with a mother who met the criteria.
(NSDUH, 2009)
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A System: Family Perspective on Addictions:
U.S.A Data
The National Survey of Substance Abuse Treatment
Services (N-SSATS) is an annual survey of all facilities in the
United States, both public and private, that provide
substance abuse treatment. In 2000, the 13,428 facilities
responding to the N-SSATS were asked about the provision
of 26 services, grouped into five types: assessment,
substance abuse therapy and counseling, testing,
transitional, and other. In the substance abuse therapy and
counseling domain 78% of the facilities provided “Family
Counseling.” (DASIS, 2003).
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A System: Family Perspective on Addictions
Like machines, organizations, oak trees and bodies,
families are systems. Each system is made up of
components parts that are linked together in a particular
way to accomplish a common purpose.
In a family the components are the members. Family
components/members include: mother, father, children,
siblings, extended family living at home, stepparents, even
an absent or deceased person may continue to be a
“member” and in some cultures close friends and
neighbors can be considered members. (Wegscheider-Cruse, 1989).
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A System: Family Perspective on Addictions
Everyone whose life touches the alcoholic/addicted
person is in one way or another affected. The direct
consequences fall on the members of the immediate
family. Anyone who shares their life with an addicted
person.
Member of a family cannot so easily turn their back on
the addictive person’s problems. Generally, members
choose to adapt to the addictive persons behavior/illness.
Children have no opportunity for choice, they tend to
suffer the consequences of the addicted persons
behaviors/illness. Research on children of alcoholics has
found that they are often neglected and victims of
physical or sexual abuse. (Kaufman & Pattison, 1981)
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A System: Family Perspective on Addictions
Family: Flexible versus Rigid Rules.
Rigid Rules:
Makes no allowance for differences in people or
circumstances.
Discourage change, seeing it as a potential threat to the
status quo (homeostasis).
Flexible Rules:
Appreciation for differences in circumstances and family
member’s needs.
Encourage change and potential source of growth.
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A System: Family Perspective on Addictions
Family: Open and Closed Systems.
Open System:
Appreciates free flow of communication. Each family
member feels free to negotiate personal needs without
paying a price.
Closed System:
Family members are walled off from one another so that
they cannot interact. Information and feelings are not
shared. Does not admit communication from outside
sources.
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A System: Family Perspective on Addictions
Rules in Substance Using Family
Rule: The Dependent’s use of chemicals is the most
important thing in the family’s life. Family members
arrange to be or not to be at home in order to avoid the
dependent’s fury of possible embarrassment in front of
their friends.
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A System: Family Perspective on Addictions
Rules in Substance Using Family
Rule: Chemicals is not the cause of the family’s problems.
The dependent tends to blame someone else for their
using. The scapegoat may be a child in trouble or a job the
dependent does not like—anything.
The scapegoat often goes along with the delusion and is
overwhelmed with guilt and feelings of worthlessness.
Someone or something else caused the substance users
dependency; the dependent is not responsible.
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A System: Family Perspective on Addictions
Rules in Substance Using Family
Rule: The status quo must be maintained at all cost.
Rigid rules and a closed system tend to maintain
homeostasis. When the dependent is the rule-maker they
make sure the family system stay rigid enough to protect
their drug using behaviors. Outside
input(counselor/clinician) is discouraged as it may
challenge the status quo.
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A System: Family Perspective on Addictions
Rules in Substance Using Family
Rule: Everyone in the family must be an “enabler.”
Family members are quick to say that they would do
anything to get the dependent to stop. But unconsciously
they continue to “enable” the dependent. Family member
will make alibi for the dependent and these actions will be
defended on the grounds of love or family honor and
loyalty.
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A System: Family Perspective on Addictions
Rules in Substance Using Family
Rule: No one may discuss what is really going on in the
family, either with one another or with outsiders.
Maintaining a rigid and closed system of communication.
The rule-makers tries to avoid letting outsiders know
about family affairs—specifically, the degree of the
dependency and the magnitude of its impact on family
members (i.e., wife, husband, children…). Also this system
avoids access to new information and advice from
outsiders.
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A System: Family Perspective on Addictions
Rules in Substance Using Family
Rule: No one may say what they are really feeling. This is
a standard rule in severely dysfunctional families.
Communication among family members is severely
hampered. Eventually as the disease advances the
dependent completely represses their own feelings. The
dependent begins to experience internal contradictory
messages.
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A System: Family Perspective on Addictions
Roles in a substance using family:
•
•
•
•
•
•
The Dependent
The Enabler
The Hero
The Scapegoat
The Mascot
The Lost Child
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A System: Family Perspective on Addictions
The Dependent: This is the family member that uses
chemicals whose primary motivating feeling is shame. As
the Dependent recovers, they gradually learns to trust,
first within the family, then in a widening circle of
relationships. Eventually they find a deeper meaning and
purpose in life.
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A System: Family Perspective on Addictions
The Enabler: They too have suffered, and carry a burden
of shame and guilt. They, however, are different. They
feel shame for what they see as their problem, guilt for
their inability to change the dependent one. This person
needs to be taught that the controlling purpose in life
which has been to change the Dependents’ behavior is an
impossible dream. This person will exhibit traits of codependent.
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A System: Family Perspective on Addictions
The Hero: This is the child who is “9 going on 40.” Their
self-worth is higher than the others’, and their pain may be
less acute. Until now the Hero has occupied a special and
honored place in the family. When they give up their role,
they must also give up being the most special.
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A System: Family Perspective on Addictions
The Scapegoat: This is the child that the family feels
ashamed of—and the most emotionally honest child in the
family. They act out the tension and anger the family
ignores. This child provides distraction from the real
issues in the family. The scapegoat usually has trouble in
school because they get attention the only way they know
how—which is negatively.
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A System: Family Perspective on Addictions
The Mascot: Some Mascots can be a delightful addition to
the treatment process, adding a needed light touch with
their sense of humor. This child takes responsibility for the
emotional well-being of the family. They become the
families ‘social director’ and clown, diverting the family’s
attention from the pain and anger.
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A System: Family Perspective on Addictions
Lost Child: This child escapes by attempting to be invisible.
They daydream, fantasize, read a lot of books or watch a
lot of TV. They deal with reality by withdrawing from it.
They deny that they have any feelings and “don’t bother
getting upset.”
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A System: Family Perspective on Addictions
Primary Care:
1.
To let down the wall of defensiveness: Family
members are not able to feel their true feelings. A caring
clinician/counselor can be the beginning of honest
communication. Listening alone can often melt rigit
defenses in a single session.
2.
To let the pain emerge: People from a substance
abusing family seem to have a very difficult time
distinguishing one emotion (hurt, rage, hate, shame, grief,
loneliness, fear, jealousy, & guilt) from another. Putting
labels on these feelings is a beginning.
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A System: Family Perspective on Addictions
Primary Care:
3. To begin to experience some positive feeling: Allowing
people in the family to feel their pain will make it possible
for the person in primary care to begin feeling positive
emotions as well.
4. To accept the family illness and one’s own part in it:
Education featuring lectures, films, or visits from
substance abusers who have successfully re-formed. AlAnon & FA.
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A System: Family Perspective on Addictions
Primary Care
5. To make a personal commitment to an ongoing
recovery program for the family and for themselves: It has
taken years for the family’s disease to develop to its
present crisis, and it will take a long time and a lot of hard
work to create a new, health family in its place. The work
begun in primary care must go on long after supervised
treatment is over.
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A System: Co-Dependent
“A codependent person is one who has
let another person’s behavior affect him
or her, and who is obsessed with
controlling that person’s behavior.”
(Beattie, 1992)
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A System: Co-Dependent
• Codependency occurs when another individual,
perhaps the addict's spouse or family member, is
controlled by the addict's addictive behavior.
Codependents become codependent because they
have learned to believe that love, acceptance,
security, and approval are contingent upon taking
care of the addict in the way the addict wishes. In
their decision making process, they allow the
addict to define reality.
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A System: Co-Dependent
• Codependency. Unfortunately, this excessively
care giving behavior tends to foster even more
dependency on the part of the addict. Some
codependents are adult children of alcoholics or
addicts and their codependent behavior is the
result of growing up in the environment of
addiction.
• Because the codependent “needs to be needed”
they may impede the progress of the recovering
person as the recovering person begins to
become more independent. (Lawson & Lawson, 1989)
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A System: Co-Dependent
Symptoms:
• controlling behavior
• distrust
• perfectionism
• avoidance of feelings
• intimacy problems
• caretaking behavior
• hyper-vigilance (a heightened awareness for
potential threat/danger)
• physical illness related to stress
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A System: Co-Dependent
Difficulties:
• Difficulty in accurately identifying feelings
• Difficulty in expressing feelings
• Difficulty in forming or maintaining close or intimate
relationships
• Perfectionism—unrealistic expectations for self and
others
• Rigidity in behavior and/or attitudes
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A System: Co-Dependent
• Treatment
Healing takes time and hard work, but talking with
other codependents and seeing a therapist are two
of the best ways to start the recovery process.
Therapy: Treatment may consist of individual therapy,
group therapy and couples and family therapy. A
clinical social worker, psychologist or psychiatrist
with experience treating codependents and families
of addicts can help a codependent person identify
and discuss the feelings, thoughts and behaviors that
they and others find troubling.
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A System: Co-Dependent
• Treatment
Twelve-step groups: Many advocates of the
codependency theory view codependency as a type
of addiction. Therefore, they maintain that
codependents can overcome their symptoms with a
12-step process similar to that used by Alcoholics
Anonymous. Twelve-step recovery programs bring
codependents together as a group to talk about their
struggles and share hope and experiences. The 12step recovery process involves spirituality and is
nondenominational. Codependents Anonymous
meetings can provide participants with a great
source of emotional and practical support.
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Reference
Beattie, M. (1992). Codependent No More. Center City, Minnesota. Hazelden Educational
Materials
Drug and Alcohol Services Information System (DASIS) (2003).
http://www.samhsa.gov/data/2k3/ServicesTX/servicesTX.htm
Kaufman, E. & Pattison, E. M. (1981). Differential methods of family therapy in the
treatment of alcoholism, Journal of Studies on Alcohol, 42, 951-971. 1979.
Lawson, G. W. & Lawson, A. W. (1989). Alcoholism & Substance Abuse: In Special
Populations. San Diego, California. An Aspen Publication, Inc.
National Survey on Drug Use and Health (2009): The NSDUH Report: Children Living with
Substance-Dependent or Substance Abusing Parents: 2002 to 2007.
http://www.samhsa.gov/data/2k9/SAparents/SAparents.htm
Wegscheider-Cruse, S. (1989). Another Chance: Hope and Health for the Alcoholic Family.
Palo, Alto, California. Science and Behavior Books, Inc.
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A System: Family Perspective on Addictions