Alcoholism and the Family “A Systemic Approach”

Alcoholism and the Family “A Systemic Approach”

The total cost to American society of excessive alcohol consumption including lost productivity, healthcare costs, “drunk driving accidents” and the criminal justice system was nearly $224 billion in 2006. Alcohol-related deaths number almost 80,000 people per year and 2.3 million years of potential life are lost annually. Nearly one third of U.S. adults drink enough to cause or place themselves at risk of adverse consequence. Attaining and maintaining sobriety is hard work. The relapse rate is high. Family therapy is critical to the optimal treatment of alcoholism and chemical dependence. Engaging the entire family has multiple benefits in multiple domains including treatment outcomes, patient recovery, family recovery and long-term prevention of alcoholism in other family members. Family therapy helps initiate change even when the alcoholic denies the problem and is unwilling to seek help. Family therapy is necessary treatment for alcoholic “pride” and the struggle for power and control. The efficacy of family interventions result in increased rates of entry into treatment, decreased dropout rates during treatment and a two to fourfold increase in long-term sobriety. Both the alcoholic and the family require psychoeducation and support. Healing family relationships helps reduce the negative impact of excessive alcohol consumption. Living with an alcoholic is not a “spectator sport”. What often happens is the family organizes itself and becomes rigidified around caring for the alcoholic and so it loses its ability to deal with normative life cycle changes and fails to develop and evolve. Long-term maintenance of sobriety requires family members to break out of the responsibility trap and adapt to new roles. There are far more non-alcoholic family members than alcoholics and they are all affected by the relational trauma of alcohol abuse and dependence. These far-reaching traumas include marital discord, abuse, neglect, chaos and unpredictability. Intergenerational effects include cutoffs and other disruptions of the family career. While waiting for sobriety, many families fall apart. In their landmark book, The Responsibility Trap: A Blueprint for Treating the Alcoholic Family, Claudia Bepko and Jo Ann Krestan address the systemic, circular processes that results from the interaction of symptom and system. They delineate three stages in the transition to family recovery: attainment of sobriety, adjustment to sobriety and long-term maintenance of sobriety. It is vital to prepare the family for the “crises of sobriety” and the adjustment to a more functional lifestyle that supports both abstinence and a stable family system. Family-based models are now consistently recognized as among the most effective approaches to support continued treatment and achieve time in recovery (Journal of Marital and Family Therapy, January 2012).

Please see the video below on the multigenerational effects of alcohol on the family system. Please note the video intentionally has no sound or audio so that you can better concentrate on the rapidly evolving interactive images. The relational traumas of alcohol and chemical dependence include chaos, unpredictability, marital discord, abuse, neglect, incest and interruption of the healthy development of the family career.

As demonstrated in this video and the Five Generation Genogram of the playwright Eugene O’Neill, the alcoholic family represents a systemic, reciprocal, circular, interactive process of power, autonomy and dependence in which no family member is spared psychological damage and distress. Someone has to do the work to break the negative cycles and it might as well be you. What is not solved in this generation is left of one’s descendants to struggle with. Hopefully this is not the legacy to be left to one’s children and grandchildren.

Please feel free to ask any questions or to comment in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here. You are encouraged to forward this blog to anyone who would be interested in reading it.  

Ronald B Cohen, MD, PC Ronald B. Cohen, MD Bowen Family Systems Coach 1 Barstow Road, Suite P-10 Great Neck, NY 11021 (516) 466-7530

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  1. Ronald B Cohen, MD on November 28, 2012 at 3:00 am said:

    For future study; The Responsibility Trap: A Blueprint for Treating the Alcoholic Family (Bepko and Krestan, 1985) in which the family systems model of treatment was first elaborated. This model included three sets of constructs central to the understanding and treatment of addiction in family systems: over- and under responsibility; pride, shame, and power; and the role of alcohol as a mediator of gender role constriction.

    Here’s the link from SAMHSA for TIP-39 Substance Abuse Treatment and Family Therapy about “how substance abuse affects the entire family and how substance abuse treatment providers can use principles from family therapy to change the interactions among family members. “ or you can print it out in pdf form SAMHSA also has a 68 page Quick Guide for Clinicians Based on TIP 39 They’re both free government publications. Best of luck.



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