Drug Abuse “Intervention:” Why it Works

In Jonah’s Berger’s excellent new book, The Catalyst: How to Change Anyone’s Mind, he discusses effective ways to get people to look at things in new ways. Even die hard ideologues can sometimes be reached using many of his methods. He also talks about why persuasive arguments and presenting new information in an effort by one person to get another person to reconsider entrenched positions usually does not work. 

In the chapter called “corroborating evidence,” he uses a successful “intervention” with a drug abuser to illustrate how, in influencing others, having multiple people give information is often much more powerful than just one person’s speaking , especially when the multiple sources are all operating at or near the same time. 

In the Intervention technique in substance abuse treatment, the actual intervention is having an outside therapist come in and coach the family members to write out a speech about how much they care about the user and how his or her behavior is hurting everyone. They are instructed to avoid telling him what to do. Nonetheless, the therapist has a rehab facility lined up in hopes that the object of the intervention will agree to do something about his “problem.”

They each say how sad they are because of the problem and how much they miss him and want the drug abuser “back.” They also give the addict the message, “If you want to be an addict, we can’t stop you. But if you want to get high, you aren’t going to do it here.” 

With families, Berger points out, several members have often -  over time and individually – “asked, begged, yelled, screamed, and threatened. All to no avail.” But then he goes on to say things that consist of the usual wisdom about these sorts of things, such as “They (addicts) don’t believe they have a problem.” They are “in denial.” They may not remember wrapping a car around a lamp post” because they “blacked out.” If an addict doesn’t think he has a reason to quit, “is one person really going to change their mind?”

That sounds reasonable, but is it really? Doesn’t the addict find out what happened to the car after he comes to? Isn’t losing a good job and resorting to crime to finance an addiction considered by the drug abuser to be problems? As I often say, he would have to have the IQ of a kumquat – or maybe a rutabaga, I’m not really sure – to not “know” he had a problem. So what’s really going on here?

Berger attributes the relatively high success rates of organized family “interventions” to the number of people giving a similar message. He's partly correct. But he also seems subliminally aware that there is something else going on here. He states, “In order to get addicts to change, their entire ecosystem has to be altered. Without realizing it, friends and family members may be unintentionally enabling the problems. So for change to stick, the whole system has to change…”

Was the particular family the author described enabling the abuser, “Phil”? Why as a matter of fact, quite so. In the author’s description, the family didn’t seem to think of him as an addict for extended periods, especially at first, because he had a job and didn’t steal to support his habit. He did start to steal a bit later. They sent him to rehab 19 different times even though each of them was unsuccessful. They repeatedly let him move back home. They resorted to having him sign a contract promising to turn over a new leaf, but all that did was to “train him to be a better liar.”

Hearing this, it might seem fairly clear why Phil may have thought his family was actually invested in him continuing to be an addict, because they made it so damn easy! Unlike most of us, they know that family members are not that stupid even if they seem to be “in denial.” Of course, I have to put the usual caution here: since I haven’t personally evaluated this family I can’t say what follows with certainty, although IMO what I am about to describe is extremely likely.

Another hint that the above formulation may be on the mark is a statement by the book author that "family was everything to Phil." The author thinks that Phil realizing he was tearing the others to shreds was the motive for quitting. But again, how could Phil possibly think that this hadn't been the case all along? Because he thought the family needed him to be an addict!

In dysfunctional families with shared conflicts over certain behavior, say for example puritanical attitudes towards work and intoxication, several members are usually involved in either enabling or refusing to notice the problems of the addict. The addict is actually taking the cue to deny that he has a problem from the family. When one member occasionally seems to object about addict-like behavior, another family member may give the addict the opposite message. In such a situation, this can become a game without end even more easily than when just two people are stuck in this game. So no wonder the addict ignores the asking, begging, yelling, screaming, and threatening from any one family member.

However, when the whole family comes together to give the same message – that they all will no longer deny that the addiction has become a problem — and all clearly state that all of their enabling behavior in toto is going to cease, their wanting him to stop becomes far more believable. So it isn’t just multiple sources of info as Berger assumes, but the fact that they are all indirectly acknowledging their own contributions to the addict’s continuing addiction.

Of course, the addict may still be skeptical. If Phil leaves yet another rehab program without success, and his parents still let him return home, nothing will stick. In this case, that fortunately did not happen.

Conventional Wisdom that Seems Obvious Once Again Found to be Actually True

As I did on my posts of November 30, 2011,  October 2, 2012, September 17, 2013, and June 3, 2014, it’s time once again to look over the highlights of the latest issue of one of my two favorite psychiatry journals, Duh! and No Sh*t, Sherlock. We'll take a look at the unsurprising findings published in the latest issue of No Sh*t Sherlock. My comments in bronze.

As I pointed out in those earlier posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already known to be true but have yet to be "proven"? Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

 

5/28/14.  Physical activity program may reduce mobility disability in seniors.

USA Today (5/28, Painter) reports that for seniors, “losing the ability to walk a short distance often means losing independence.” Now, “researchers say they have found a treatment that, for some, can prevent that loss of mobility,” and that is “a moderate exercise program.” The Washington Post (5/28, Bahrampour) reports that the study, “called the Lifestyle Interventions and Independence for Elders and funded by the National Institute on Aging and the National Heart, Lung, and Blood Institute, was the first of its kind to test a specific regimen of regular physical activity for sedentary older people.” The Boston Globe (5/28, Kotz) “Daily Dose” blog reports that the study, published online May 27 in the Journal of the American Medical Association, “found that elderly people who walked and did basic strengthening exercises on a daily basis were less likely to become physically disabled compared to those who did not exercise regularly.” The study control group consisted of people who were instructed to take health education classes. 

I guess it's still OK for seniors to sit very, very still while posing as nude models for art students.

6/17/14. Study Shows Association Between Mental Illness Severity and Employment and Income.

More severe mental illness appears to be associated with lower employment rates in recent years, and people with serious mental illness are less likely than people with no, mild, or moderate mental illness to be employed after age 49, according to the report, “Employment Status of People With Mental Illness: National Survey Data From 2009 and 2010,” published in Psychiatric Services in Advance.

We now know for sure that employers are not always hot to hire people who are too mentally impaired to perform the work.

6/20/14. Brain Injuries Linked To Higher Risk For Headaches.

HealthDay (6/20) reports that research scheduled to be presented at the American Headache Society meeting suggests that “U.S. veterans of the Iraq and Afghanistan wars who suffered brain injuries are at a much higher risk for headaches, especially migraines.” This “study included 53 veterans who had suffered a traumatic brain injury during deployment and...53 veterans without brain injuries.” Investigators found “that all of the veterans in the brain injury group said they experienced headaches, compared with about 76 percent of those in the control group.” Eighty-nine percent of the headaches in those with brain injuries were migraines, while just 40 percent of the headaches in the control group were migraines.

Now just a minute. Bodily injuries produce pain?? Since when?

9/1/14. The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa. 

European Child and Adolescent Psychiatry, 09/03/2014: Focker M, et al.  In this study, the relationship between pre-morbid body mass index (BMI) percentile and BMI at admission was solidly confirmed. In addition to pre-morbid BMI percentile, BMI at admission and age were significant predictors of BMI percentile at discharge. BMI percentile at discharge significantly predicted BMI percentile at 1–year follow–up. An additional analysis that merely included variables available upon referral revealed that premorbid BMI percentile predicts the 1–year follow–up BMI percentile.

Oh, I did not see it before, but I get it now. More severe disorders have a worse prognosis.

11/25/14. Talk Therapy May Prevent Suicide in High-Risk Patients

Talk therapy may decrease risk for future suicide attempts and completions in patients who have already made a previous attempt, new research suggests. 

God, I should hope so, or I'm in the wrong business!!

1/13/15. Self-injurers experience greater negative emotionality, particularly self-dissatisfaction, compared to individuals with no NSSI history.

Self-injurers also reported less positive emotion, but these effects were smaller. The pattern of results was similar when controlling for Axis I psychopathology and borderline personality disorder.

And here I thought cutters and burners did so because their joy was just soooo unbearable.

1/30/15. Repeated Blows To Head In Boxing, Martial Arts May Damage Brain.

HealthDay (1/30, Preidt) reports that research published in the British Journal of Sports Medicine “supports the notion that repeated blows to the head in boxing or the martial arts can damage the brain.” Investigators studied “93 boxers and 131 mixed martial arts experts,” as well as 22 individuals who had never suffered a head injury. “MRI brain scans and tests of memory, reaction time and other intellectual abilities showed that the fighters who had suffered repeated blows to the head had smaller brain volume and slower processing speeds, compared to non-fighters.”

So I guess I should quit beating my head against the wall trying to get researchers to actually look into things we actually do NOT already know.

1/30/15.  The US Food and Drug Administration (FDA) has approved lisdexamfetamine dimesylate (Vyvanse, Shire) to treat binge eating disorder (BED) in adults.

The drug is the first FDA-approved medication to treat this condition. "Binge eating can cause serious health problems and difficulties with work, home, and social life," said Mitchell Mathis, MD, director of the Division of Psychiatry Products in the FDA's Center for Drug Evaluation and Research. "The approval of Vyvanse provides physicians and patients with an effective option to help curb episodes of binge eating." The efficacy of Vyvanse in treating BED was shown in two clinical studies that included 724 adults with moderate to severe BED, as reported by Medscape Medical News. In the studies, participants taking Vyvanse experienced a decrease in the number of binge eating days per week and had fewer obsessive-compulsive binge eating behaviors compared with patients in a placebo group.

Shocking new finding: appetite suppressants reduce eating.

January 2015.  Alcohol, Depression potent risk factors for suicide.

BERLIN– Alcohol dependence and major depressive disorder are similarly potent yet independent risk factors for suicidal behavior, according to Dr. Philip Gorwood. Although alcohol use disorder and major depression are extremely common and often comorbid, the mechanisms by which they boost the risk for suicidal behavior are very different, he said at the annual congress of the European College of Neuropsychopharmacology.

Insert your own joke here. No prize will be awarded for best gag, but let's see what you got!

And yes, it is OK to joke even about suicide. Black humor often helps us all to squarely face up to very serious issues, and is therefore to be encouraged. 

Researchers Aren't Wasting Time Looking for Cures for Alzheimer's Disease or Schizophrenia

As I did on my posts of November 30, 2011,  October 2, 2012, and September 17, 2013, it’s once again time to look over the highlights of the latest issue of one of my two favorite medical journals, Duh! and No Sh*t, Sherlock. Let’s take a look at the unsurprising findings published in the latest issue of Duh! My comments in bronze.

As I pointed out in those earlier posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already known to be true but have yet to be "proven"? Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

9/13/13. Effects of Child Abuse Can Carry Over, Study Finds.

Researchers with the National Academy of Sciences reported Thursday that the damaging consequences of abuse can not only reshape a child’s brain, but can last a lifetime. Untreated, the effects of child abuse and neglect, the researchers found, can profoundly influence a child’s physical and mental health, their ability to control emotions and impulses, their achievement in school, and the relationships they form as children and as adults.

Cognitive behavioral therapists are all up in arms in reaction to this, thoroughly annoyed that the psychoanalysts were right about some things.

9/16/13.  Teens Who Text About Fighting, Drug Use More Likely To Engage In Those Behaviors.

HealthDay (9/14, Preidt) reported that research published in the Journal of Abnormal Child Psychology suggests that “teens who text about bad behaviors such as drug use or fighting are more likely to actually engage in those behaviors.” Researchers examined the text messages of more than 170 ninth-graders. Their behaviors were rated by their teachers, parents, and fellow students. The investigators “found a strong link between antisocial text messages and higher ratings of antisocial and aggressive behavior at the end of the school year.”

If they were real sociopaths, they wouldn’t have to brag about it.

 

9/27/13. Common Pain Relievers May Reduce Depression In Individuals With Osteoarthritis.

Reuters (9/27, Doyle) reports that research published in the American Journal of Medicine suggests that common pain relievers may reduce both pain and depression among individuals with osteoarthritis. Investigators came to this conclusion after looking at data from five trials that included approximately 1,500 patients.

Pain causes people unhappiness??  I always thought pain was something that causes unremitting happiness and celebration.

10/21/13. Stalking May Cause Psychological Distress.

HealthDay (10/19, Dallas) reported that, according to a study published online in the journal Social Science Quarterly, “women who are the victims of stalkers are up to three times more likely than their peers to experience psychological distress.” Researchers arrived at this conclusion after examining data “compiled on over 8,100 women from three major surveys.”

And here I thought stalkers were spreading joy wherever they went.

2/27/14.  Suicide Attempts Early in Life Signal Long-Term Social, Health Problems, Study Finds

Young people who attempt suicide are not only more likely to have persistent psychiatric problems as they approach midlife than non-attempters, but they are also more likely to have physical health problems, engage in violence, and need more social supports as they age. These are key findings from a study by led by Sidra Goldman-Mellor, Ph.D., and colleagues at Duke University and several other institutions and reported in JAMA Psychiatry.

The best predictor of future behavior is past behavior?  Who knew?

2/27/14. Study: Stigma Associated With Mental Illness May Prevent Many People From Seeking Care.

HealthDay (2/27) reports that research published in Psychological Medicine suggests that “the stigma often associated with mental illness prevents many people from getting the care they need.” Investigators looked at data from 144 studies that included a total of approximately 90,000 people. The researchers found that “stigma ranked as the fourth highest of 10 barriers to care.” The investigators also found that, “aside from the stigma of using mental health services or being treated for mental illness, the participants also reported feelings of shame and embarrassment as reasons for not seeking care.”

Caring about what other people think?  Worrying about your reputation?  Who does THAT?

3/17/14. Stress May Impact Kid's Health, Well- Being  

HealthDay (3/15, Preidt) reported that according to research presented at the American Psychosomatic Society’s annual meeting, “stressful events can have an almost immediate impact on children’s health and well-being.” After analyzing data on some 96,000 US children, researchers also found that youngsters “who experienced three or more stressful events were six times more likely to have physical or mental health problems or a learning disorder than those who had no stressful experiences.”

Nonsense.  Learning how to react to constant threats to your well being builds character!

4/8/14. Study: Physician appointment availability greater with private insurance than Medicaid.

Reuters (4/8, Seaman) reports on a new study, published in the current edition of JAMA Internal Medicine, which shows the availability of physicians varies depending on a patient’s insurance coverage. Researchers, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, found they were able to book appointments 85% of the time when claiming private insurance, compared to just 58% when they claimed to be covered by Medicaid.

Oh come on. Doctors absolutely hate to make money.

4/14/14. Paternal Alcoholism Tied To Family Conflict.

Reuters (4/11, Bond) reported that according to a study published online March 15 in the journal Addictive Behaviors, families in which the father had a problem with alcohol appeared to experience increased levels of conflict. However, treating men for alcoholism may result in an improved home life for their children.

Gee, and I thought drug addiction was a symptom of family harmony.

4/22/14.  False-Positive Mammograms Linked To Increased, But Temporary, Anxiety.

The Los Angeles Times (4/22, Kaplan) “Science Now” blog reports that in a study published in JAMA Internal Medicine, investigators “examined data from a large clinical trial of digital mammography and concluded that false-positives produced a ‘significant increase in anxiety,’ though it was only temporary.”

       

People get nervous if they think they might die. Really?

5/1/14. Effects of Recurrent Violence on Post-traumatic Stress Disorder and Severe Distress in Conflict-affected Timor-Leste: a 6-year longitudinal study

Silove D, et al. – Recurrent violence resulted in a major increase in post–traumatic stress disorder and severe distress in a community previously exposed to mass conflict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The findings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from conflict.

So what does trauma have to do with PTSD anyway?

Guest Post: Addictions and Development

Today's guest post is by Emma Haylett. She decribes growing up with an alcoholic father who literally tried to recruit her as his drinking buddy, and in the process put her smack dab in the middle (triangulation) of her parents' relationship. This may be a telling example of someone in the role of go-between.

A Revelation

My father bought me my first 6-pack of beer. I was only 14 at the time and drank it behind closed doors, away from him and the rest of my family. It was a late summer night and I remember my mother was already hidden away in her room, lights off, TV on such a low volume like she was whispering with ghosts. Dad sat in a broken recliner watching western violence, occasionally calling my name to come drink with him. Instead, I wrote. I started writing before I popped the first cap and continued to do so after all of them were empty and stagnant around me.

I knew the other kids at my school drank. I knew my dad drank. I watched him every day, but what I didn’t realize was the problem he held. Within the next two hours, I was dizzy and tired. The spoken words of my father were surrounded in quotation marks intermittently written down the page, phonetically spelled out: “Em-uhh,” “ehmm,” and “c’mon to the livin’ room, now.” 

As my state of clarity became more and more unclear, my dad’s stayed exactly the same. I didn’t know he was permanently inebriated until pouring over my notes the next morning. This revelation became something of an alcohol abuse study for years.

My mother never noticed the extra beer my father bought. I think she always assumed Dad was going to drink them, and it was a fair enough assumption. As he pressured me to drink them, I would sip slowly and watch him become more intolerable by the bottle. It didn’t taste good and I don’t remember it feeling good either. 

His speech slurred to the point of intelligibility and his breath was something similar to a laboratory experiment gone wrong. His actions embarrassed me – he would yell at the television if a star delivered a line poorly, and wrap his arm around my shoulder to tell me how to buy liquor underage. Whenever my mother entered the room, his face became tired and uninterested.

One evening, after Dad was snoring deeply in the chair, my mother sat me down and asked me if I drank with him. Of course I didn’t lie – I told her he would give me a few bottles and we would watch TV together. She told me Dad wasn’t healthy and that what he was drinking wasn’t, either. She told me he was always cracking cans since he was about my age, partying much too hard with his friends and family. I wasn’t old enough, she very sternly told me, “and your dad’s decisions reflect poorly upon this family.” I stopped drinking with him after that night.

Family Treatment

Dad was kinder in the early hours of the day and progressively became more incoherent and rude towards the time he usually passed out in the recliner. I come to realize, from lengthy trial-and-error experiments, that the trick to getting lunch money, permission to go out on school nights, or even a small favor was asking him in the mornings after his first coffee with a whiskey cream substitute. 

My mother took the opposite route and, when she thought I wasn’t around, suggested rehab programs later in the evenings, or else, she threatened, she would leave…again and again. But she never did. Their relationship became empty threats with the two of them screaming about whose turn it was to buy essential toiletries with the little money we had, and who was going to raise their daughter standing behind them unnoticed.

There was more hidden behind my father’s alcohol addiction than what was obvious: the empty bottles clacking together as he put another one down was always accompanied by false affection when we had father-daughter talks around the dining room table late at night about being a responsible adult, trust, and his image of love. I learned that being responsible was saving a bit of grocery money for a tall bottle of cheap alcohol. Trust was believing him when he said, “Just one more,” and love was “don’t tell your mother” followed by a bribe.  

Promises to attend my school-sponsored activities came to a screeching halt as the more dangerous drugs became the better part of him. I once found him asleep in the truck idling in the driveway with the windows down and a burnt cigarette between his still fingers. The long stem of ash flaked away as I shook him to remind him that he was supposed to take me to school.

Emotional Detox

I lied to my friends. I lied to my teachers, and I lied to myself - for years. It goes without saying that I don’t trust long or often. I had a hard time believing my ex-fiancé Jake was going for a quick run to the gas station without bringing home a brown paper sack around a bottle or plastic baggie of some substance. I am reminded of being alone when my new neighbor’s empty beer cans crash and echo against each other as she pushes her trash bins to the curb every Thursday morning. I am still angry at my mother who should have tried harder to get my father some help.

I always wished he would have even considered alcohol rehab. I firmly believe our family life could have been different, saved even, with detox and therapy. As an adult, I hesitate to show affection and honesty. I have daylight visions of my father wrecking the truck. I lose hours of sleep over the conversations I should have had with Jake about trust and what it means to be loved without stipulations.

Looking back, it’s hard to know what it is I was feeling. From adulthood, it is easy to know that my father was using me as a crutch, as a tool with which to hurt my mother. And I dutifully played the part of loyal daughter to both of them. I was a substitute, in many ways, for their relationship—an embodiment of the good in my father as my mother saw him, a (albeit young) drinker still capable of offering love - and so she ignored it. For my father, I was a female who served as his caretaker and confidant, a secret-keeper who acted without judgment, an enabler. While my father was dependent upon alcohol, I was simply (or not so simply) using it—more on that here. This was my first experience as an enabler too.

I do remember feeling trapped in between them and, because they were my parents equally, wanting to please both. If I could do it simultaneously, even in secret, it felt like a win. I didn’t like the taste or feel of alcohol, but I also didn’t like the way my father breathed my name until I came out. For me, this drinking was easier, especially since I never outright lied to my mother. Like my father, I had my justifications.

Therapy

I’ve learned that addiction is better treated as a disease. With a non 12-step program, doctors treat addicts with proper medical treatment as you would any other chronic medical illness. Working with addicts in this program has taught me that sometimes you can’t rely on having faith or attending self-help meetings. Sometimes real help (however you find useful to define it) is necessary. 

Addicts can come to an understanding of trust and commitment, as well as formulating a self-betterment plan that is supported by people like me. I provide the guidance and encouragement as well as sensitivity to the issue.

My father would always get upset if the word “addiction” was even quietly muttered.

I realize what it is like to be an addict. I watched and recorded one my entire life. To approach the issue with proper intelligence and caution is critical – to provide them with real courage and motivation rather than standing idly by will push the addict towards getting the appropriate help and the chance of staying healthy will greaten. It’s a very rewarding opportunity to be there for somebody and to see them succeed.

I help myself by helping people overcome these dangerous addictions. I help them make that sensitive reconnection to their family and children. There is always hope that they can raise their kids to live without being exposed to the fear and emotional emptiness that that I hold inside and that is so overwhelming. Getting help can change more than one life. That first step is always the hardest, but I know in my heart of hearts it can make a difference.

Author Bio: Emma Haylett finds comfort in writing. When she’s not helping coordinate non 12 step recovery programs for addicts and their families, you can find her watching terrible made-for-TV movies.

Guest Post: Having a Parent with an Addiction

Today's guest post is by Stephanie Green. This is the third post in which a writer recounts his or her own experience in a family with a problematic history, as well as its aftermath. She describes the fear and the sense of needing to protect family members in a household dominated by an unstable drug addicted father.

Growing up with an addicted parent is not easy. In my case it was my father. When I was a teenager he decided that he had enough of responsibility and wanted out. He left my mother, my younger brother and me for a few months. But then he suddenly wanted back in. I, of course, was hurt and angry with him for his actions but my mother wanted to give him a second chance -even after my expressions of disapproval. What she and I did not know, however, was that during his time away from home he had fallen back into bad habits.

When my mother first met my father he had been out of jail for a few years and had turned his life around. She knew he had gone to jail for drug use but she thought that he was rehabilitated. And in a way he was, for a little while at least. However after almost twenty years of being drug free he turned to drugs once again to solve his problems.

When he came back home he was using several different drugs including crack, marijuana, and excessive amounts of strong liquor like Jagermeister. We found out he had come back because he had lost his job due to his drug and alcohol abuse.

It was a very hard time in all our lives. While he was on these substances he was verbally abusive and emotionally erratic. He pawned everything in the home that was of value to get money for his drugs. He also got in several car accidents, totaling the family vehicles. When pawning no longer covered his debts he started harassing my mother for her paycheck, took out a loan on the house, and even pawned my mother’s wedding ring.

My younger brother was about ten at the time and did not quite understand what was going on. Our father had never been the most loving person but my brother had always wanted his attention and affection. Now he still wanted the attention but was afraid of the person our father had become. My brother stayed in his room most of the time to cope and relied on his video games and computer to distract himself from reality. He also clung to me as I was more stable than our distraught mother. 

The two of us created our own little world as much as was possible away from the influence of our father. It was a very hard time in my life as I was old enough to understand what was happening and yet too young to really do anything about it. I tried to help my mother and brother as much as I could. We all slept together in the same room for protection because my father got very bad at night especially and would become irrational. We were afraid to let him get any one of us alone.

“Why didn’t your mother leave or kick him out? When you were old enough, why didn’t you leave?” I can hear you thinking. Well, part of the problem was that my mother had herself grown up with an alcoholic father. Through her experiences she did not see a lot of the damage this was causing to our family. Hiding in the bedroom at night was perfectly normal to her, as was avoiding someone in your own home and living with verbal abuse. Like I said, I was not old enough to do anything about the situation besides leave, and I would not leave them in this disaster!

However I did offer a form of protection for them in ways I don’t really understand. Because of my anger and refusal to coddle or ‘help’ my father, I was the only one he respected. Time and time again he would start to hassle one of them and I would get between them and threaten to call the police on him. My mother knew she could not stop me from doing that if he pushed me too far. He would always back down, although sometimes I would also arm myself with a baseball bat just in case he snapped. It was not a pretty picture. A six foot two man so high he’s insane versus a five foot nothing spindly teenager. Needless to say, logic was not my strong point in the heat of the moment.

Even my brother grew to the point where he would stand up to him. One time when I was not home my father reared up to strike my mother when she would not give him money. My brother stepped in and yelled at him, “Don’t you hit my mother!” He may have been a tiny ten or eleven year old and shaking like a leaf, but he meant it. Thankfully that situation resolved without physical violence, but if it is brought up my brother still get pale and refuses to talk about it even now.

Needless to say, this period of time was very hurtful to all of us. In my case I formed trust issues that last to this day. I have problems - especially with men - and am very fearful in situations that feel out of my control.  Just hearing about anyone’s drug or alcohol use makes my stomach churn.

My brother has gone the opposite way, to some extent. I do not know why, but he felt the need to try everything his father had done. Perhaps through imitation, or, as he once said, “I wanted to see what he loved more than us.” His troubles with drug use have only compounded his problems with responsibility and anxiety. As an adult he is starting to break free of the bonds of addiction but it is something he will struggle with the rest of his life.

That was just an additional hurt to an already sore spot in our lives. When my brother became a user as well my mother and I could not believe it. We tried to help him in many of the same ways as we tried to help my father. Repeating the same cycle again was terrifying and disheartening. However once we got him to graduate high school, by the skin of his teeth, things changed. We stopped enabling his drug use and threatened to kick him out of the house if he did not comply with the rules. Unlike my father he actually cared about normal things like having a roof over his head and having a family that loved him. 

He turned his life around slowly but surely. Thankfully he is doing much better but he has yet to become an independent and responsible adult.

It hurts me that he chose to continue his father’s legacy but I am thankful he did not go to the extremes his father did. Hopefully he can learn to cope with his pain and addictive tendencies in a healthy way and mature into a self-sufficient adult.

My mother did not come through unscathed either. Her anxiety levels are through the roof and she has trouble ever leaving the house. Although my father is long gone and remarried now she still has nightmares about that time in our lives. She is continually apologizing for her part in the situation and keeping us around him for so long.

For a long time I was angry with her despite her apologies. After all, she was the responsible adult in the situation and should have been the one that was the voice of reason. Instead that task fell on me as once I got old enough I found a new home for us and made us move, leaving my father behind in an empty and foreclosed home. The fact that I had to practically carry her out of the house always irritated me and made me resentful of my continued responsibilities of taking care of our new dwelling, my brother’s fragile emotions, and my mother’s day to day life. Becoming a caretaker as a teen is not something that anyone is prepared for.

As time passed and I got older I grew to better understand the reasons behind my mother’s breakdown. That kind of abuse and hurt from someone you chose to love is life shattering. My mother and I have very different reactions and emotional makeup, so it was not easy for me to understand her for quite a while. Now that I am an adult we have a better relationship and I am able to help her without carrying her. It has been and continues to be a long struggle against fear, hurt and dependency. 

As far as my father goes, like I said he is off of drugs and remarried now. He lives in the same town as us still but I do not see him except for his birthday and major holidays. My brother tries to visit him more often as he still wants him in his life. As for me, I had a very hard time even thinking about seeing him for years after the abuse. However this anger and hate towards him only hurt me. Through much prayer and effort I finally forgave him for his abuse. However that does not mean I have to be around him or have a relationship with him. He has clearly shown that he can’t be trusted, so although I try to honor him and include him in my life for the sake of my brother, I do not make a big effort to be around him routinely.

Having a parent with an addiction can leave you with issues that go far beyond the time you move out or get away from the situation. It is not easy to deal with that kind of abuse in your life. However it is possible to still be a happy and productive person despite your past. Moving on and learning to deal with the hurt and emotional scarring is a long process that I am still working on to this day.

Author Bio:

Stephanie has many years of experience as a nanny. She has always loved children and has continuously been involved in childcare activities. Currently she is one of the writers for houstonnanny.com. If you want to get in touch with her, you can email her at stephanie. Houstonnanny @ gmail. com.

The 12 Steps of Alcoholics Anonymous - a Translation

Getting all of the blame, but none of the credit

One of the central ideas I use in trying to understand the relationships between various theories and treatment models within psychotherapy is that, within all groups of human beings, there is a constant battle (called a dialectic) going on between what Murray Bowen’s protégé Michael Kerr called the "forces of individuality" versus the "forces of togetherness" (collectivism, in politics speak). The dialectic between individual desires and group norms can be seen dramatically within the twelve steps of Alcoholic Anonymous (AA). 

Caveat: while this post may seem critical of some aspects of 12 Step Programs, I want to emphasize that these groups do help a certain percentage of addicts. Being addicted to substances is usually far worse that endorsing any of the problematic aspects of the AA ideology. Until something much better comes along, AA represents the only hope for some individuals. 

The strategy that AA uses to help alcoholics and other addicts is based on techniques used by Protestant religious denominations to convert non-believers. Those, in turn, are based on the techniques that such groups use to enforce group behavioral norms while still allowing a certain degree of individuality, as described by Erich Fromm in his classic book, Escape From Freedom. 

While giving some praise to the individual in a series of clever paradoxes and ambiguities, certain aspects of individuality are ritually denounced - most usually, the "dangers" of unrestricted willfulness. Willfulness, or the desire to follow our own inclinations, is equated with sin, and is seen as leading invariably to de­gredation and despair. 

The alcoholic and the teetotaler really believe much the same thing and need one another desperately. The teetotaler says that self-indulgence leads to ruin, and the behavior of the alcoholic proves the point. Without the example of the latter, the philosophy of the former could not be reasonably maintained. Without the warnings of the non-drinker, the alcoholic would have no one to defy. The success of AA is dependent on a continuing supply of new "sinners." 

The 12 Steps refer to the issue of the individual versus the collective both directly, when the issue of human will is discussed, and indirectly, when they speak of God or a "higher power." To show how often the denigration of individuality arises in Twelve Steps and Twelve Traditions, I am going to list some quotations from the book. 

Admittedly, I am taking these quotes out of context. The reason that I do so is that, as I will show shortly, the context contains large numbers of contradictory statements that are not juxtaposed for comparison, as well as paradoxical statements, which mask the underlying message. Of particular note is that the entire book is written using the collective pronoun we. 

[Page numbers that are referred to are from the following edition: 
Alcoholics Anonymous. Twelve Steps and Twelve Traditions. New York: Alcholics Anonymous World Services, Inc., 1981. (Originally published 1952)]. 

…self confidence was no good whatever; in fact, it was a total liability. (p. 22) 

…the average alcoholic, self-centered in the extreme... (p. 24) 

"How he [the practicing alcoholic] does cherish the thought that man, risen so majestically from a single cell in the primordial ooze, is the spearhead of evolution and therefore the only God that his universe knows!" (p. 25) 

…those filled with self sufficiency who have cut themselves off [from God] (p. 28) 

Now we come to another problem, the intellectually self-sufficient man or woman... far too smart for own good... blow ourselves into prideful balloons... (p. 29) 

cut away the self will... (p. 34) 

The philosophy of self sufficiency is . . . a bone-crushing juggernaut whose final achievement is ruin. (p. 37) 

We want to find exactly how, when, and where our natural desires have warped us. (p. 43) 

It is not by accident that pride heads the procession [of the seven deadly sins]. (p.48) 

It is worth noting that people of very high spiritual development almost always insist on checking with friends or spiritual advisers in the guidance they feel they have received from God. (p. 60) 

It is a spiritual axiom that every time we are disturbed, there is something wrong with us. If someone hurts us and we are sore, we are in the wrong also. (p. 90) 

…any success we may be having [in remaining sober] is more His [God's] success than ours. p. 92) 

…personal ambition has no place in A.A. (p. 183) 

…A.A.'s twelve traditions repeatedly ask us to give up personal desires for the common good... (p. 184) 

Moved by the spirit of Anonymity, we try to give up our natural desires for personal distinction ... p. 187) 

…a loving God as he may express Himself in our group conscience. (p. 
189) 

As I mentioned earlier, these types of statements are intermixed with paradoxes and ambiguities. On page 26, we are told that the AA group does not demand any belief or behavior — that all twelve steps are merely suggestions. Of course, on page 174, we are told that any group member that defies the "suggestions" has probably signed his own death warrant. 

We are exhorted to keep an open mind while at the same time to "resign from the debating society" (p. 26). We are told that the best way to get rid of self-will is through our willingness to do so. We are told that dependence upon a higher power is a means of gaining "true independence of the spirit" (p. 36). 

One rather frequent ambiguity in the book is that it sometimes implies that its ideas concerning over-indulgence apply primarily to the issue of alcohol, while at other times it seems to apply its concepts far more generally. Page 36 implies strongly that the twelve steps do not apply just to the issue of alcohol. 

Throughout the entire volume, debatable statements about self-indulgence are mixed up with statements concerning over-indulgence that only a fool would debate. Page 44 sensibly discusses instincts running wild, and, on page 65, we are even told, paradoxically, that God does not expect us to fully eliminate all of our natural drives. 

The book's discussion of pride also presents us with a mix of statements that confuse one type of pride — unwarranted pride — with all types of pride. It is also fascinating that, shortly after discussing the alcoholic's generic pride, the book goes on to discuss the alcoholic's generic feelings of inferiority and inadequacy. Are we to assume that alcoholics are both truly proud and ashamed of themselves simultaneously? 

Allow me to translate the 12 Steps from the collectivism vs. individualism perspective. In step one, addicts admit their powerlessness over their own impulses. The way to stop behaving self-destructively, says step two, is to turn to a power greater than ourselves. Step three defines exactly what it is that we are supposed to do in relation to that power. We are supposed to turn our will over to it. We must not trust our own instincts, but only some power greater than ourselves- the collective, of course. 

In step four, we make a moral inventory, in order to discover our liabilities. The type of "defects" under consideration here are spelled out quite dearly. They are the old familiar seven deadly sins. Notice that the issues of the harm that we have done to others and making amends to others do not come up until steps eight and nine — after this moral inventory. We must deal with our own intrinsic evil before we can address the evil that we have inflicted upon others. 

In step five, we are to admit the exact nature of the wrongs discovered in step four to ourselves, God, and another person. We cannot be honest with only ourselves and God; after all, we may be deluding ourselves about God's will. We must confess our sins to others. We must let them know that we were not in control of our impulses. 

The AA book clearly compares this step with the confession of sins in organized religion. In the group meetings, members announce their names and add, "and I am an alcoholic." They say there is no shame in this, but clearly members are ritualistically humiliating themselves in front of the group. 

They may say that they are doing this in order to overcome the denial characteristic of the alcoholic. However, if alcoholism truly is a manifestation of willfulness, then, when practicing alcoholics insist that they can control their drinking whenever they want to, they are telling the truth. The real denial comes when they "admit" that they were not deliberately choosing to drink all along, but were responding to their "disease." 

Steps six and seven involve asking the higher power to remove our shortcomings; again this is to be done before we even consider the harm that we have done to others. The concept of humility and our own powerlessness over our impulses is stressed. 

If we do well in the future, the credit goes to the higher power who has removed our shortcomings. If we screw up?  Well, that's just our own shortcomings.

After we deal with the harm we have done to others in steps eight and nine, step ten involves continuing the process of self-criticism that had begun in step four. The priority goal of this process is self-restraint and the avoidance of pride. This is accomplished by attributing any sobriety we have achieved not to ourselves, but to God. Kindness and love to others arises from our devotion to God, not from our own selfish instincts or will. 

Step 11 involves the personal relationship to God. We are to meditate. and pray to God "as we understand him." On what this understanding is supposed to be based is never specified exactly. In fact, the book takes a religious stance by adopting the notion that the Lord works in mysterious ways which no mere mortal can understand. 

It is clear that what happens in the world is not supposed to happen according to our own notions of right and wrong or our own will. We are to pray for what God wants, not for what we want; we are to ask only for knowledge about God's will for us and His power to carry it out. 

This knowledge does not involve specific answers to behavioral dilemmas, but only knowledge about how we might best forget ourselves and serve the collective. Only then will love, forgiveness, truth, and harmony come about, and we will be rewarded by a sense of belonging to the group. In the twelfth and final step, we are encouraged to spread the gospel, and to apply it to all of our affairs. 

Why are the anonymous groups so powerful when it comes to stopping compulsive behavior? (At the risk of offending the devout, I am going to discount the possibility of divine intervention.) I submit that the answer to the question lies in the fact mentioned above —that both the practicing and the recovering AA alcoholic prove the point that individual will power is a bad thing: Many of the families of addicts are grappling with problems created by the increasing value placed on the individual by society at large, and how the newer prevailing philosophies conflict with the need for their families to function according to an old set of rules. 

Practicing alcoholics appear to be rebelling against collectivist tendencies by indulging themselves with no concern for the health and safety of loved ones or anyone else. They often lie, put others in double binds, defeat expressions of caring and concern, and drive while intoxicated. 

Many individuals and family members directly involved with the problem of alcoholism argue that this behavior results primarily from the influence of the drug, but the 12 Steps argue more convincingly than I ever could that they really do not believe it. The behavior of the alcoholic is clearly attributed to a self-centered attitude. 

The alcoholic's willfulness, pseudo-selfishness (they are really self-destructive), and lack of concern for others, however, does not work. Alcoholics end up depressed, humiliated, and often physically ill. Their rebellion has failed. Willfulness has failed. The only way to happiness is to return to conformity. When they stop drinking and join AA, their lives improve. 

This proves beyond a doubt that conformity is superior to willfulness. By providing such proof, they help to reinforce the role functioning of other family members who are themselves experiencing internal pressures to express selfish impulses at the expense of old established family rules.