Alcoholism Within A Multigenerational Traumagenic Family Framework

Alcoholism within a Multigenerational Traumagenic Family Framework

P. Robert Rhoton PsyD

[email protected]

www.Azturamatherapy.com

Psychological Health and Wellness

Today’s objectivesToday’s objectives

•Family Patterns Related to multi-general Alcoholism

•Traumagenic family patterns

•Addiction cycle

•Summary and Questions

What are Addictions?

Habitual patterns of intentional, appetitive behaviors

Become excessive and produce serious consequences

Stability of these problematic behavior patterns over time

Interrelated physiological and psychological components

Addicted individuals have difficulty modifying and stopping them

Traditional Models for Understanding Addictions Social/Environmental Models Genetic/Physiological Models Personality/Intra-psychic Models Coping/Social Learning Models Conditioning/Reinforcement Models Compulsive/Excessive Behavior Models Integrative Bio-Psycho-Social Models

A basic truth No single developmental model or

singular historical path can explain acquisition of and recovery from addictions

A focus on the process of development and maintenance of interacting systems can be useful to comprehending Alcohol use and family dynamics

BECOMING ADDICTED Happens over a Period of Time Has a Variable Course Involves a Variety of

Influencers/Predictors that can be both Risk and Protective Factors

Involves a Process of Change

Defining the Traumagenic Family

When patterned and habituated family behavior and interactions interrupt or interfere with the normal developmental (emotional, psychological, and social) processes --- this can be designated a traumagenic family structure.

Families with multigenerational Alcoholism meet the criteria of being traumagenic

WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES They are often socially isolated, and have little

emotional and financial support. Depression is a common factor in the neglect of

children. They are prone to use the same abusive techniques

with their own children, that they hated as children.

WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES They often show limited insight into the

complexity of the child's emotional and psychological needs and development

Such parents are at high risk to become overwhelmed and frustrated, and engage in hostile discipline and parenting as well as increased substance use.

Parents who do not understand these issues often attribute their child's misbehavior to willfulness on the child's part, a conscious intention to cause the parent aggravation and frustration.

WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES They often experience high levels of stress and

discord in their lives, often as a result of the chaotic and unhealthy environments in which they live.

The parents who have substance abuse problems show higher levels of marital discord and violence.

Substance abuse generally exacerbates stress, and stress is more likely to occur after a partner has been using substances. As a result, the children experience high levels of anxiety and become "emotionally overloaded."

WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES The children often feel responsible for the

stress, and experience intense feelings of helplessness and powerlessness related to dealing with the dynamics created by parents that use.

children receive inconsistent structure, support, and affection for extended and unpredictable periods of time. "Interrupted parenting" or a "wavering commitment" to parenting is most harmful.

WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES Sometimes children show extreme difficulty

bonding with the parent and feeling safe with them

Parents use power control strategies (e.g., threats, demands, disapproval), and fail to respond positively to the child's good behavior.

Parents respond to the child's increasing disobedience with more negative, controlling, and punitive behaviors, and the child's behavior becomes worse.

WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES The parent is likely to show hostility, be demanding

and rigid, and respond critically to the child. Family shows poor conflict resolution skills The children are likely to withdraw from the parent,

show more aggressive behavior and disobedience, and initiate poor quality positive peer and child-adult contact.

Children more likely to adopt and use family interactional style and abuse substances to cope with family dynamic

Five Traumagenic Family Themes DISCONNECTION & REJECTION

IMPAIRED AUTONOMY & PERFORMANCE

IMPAIRED LIMITS

OTHER-DIRECTEDNESS

OVERVIGILANCE & INHIBITION

Theme #1: DISCONNECTION & REJECTION A family Pattern where a child’s expectation

that their needs will not be met in a predictable manner. Especially those needs for:

1. Security and safety

2. Stability, nurturance, and empathy.

3. Sharing of feelings, acceptance, and respect.

Theme #1: DISCONNECTION & REJECTION The perceived instability or unreliability of those

available for support and connection. Involves the sense that significant others will not provide emotional support, connection, strength, or practical protection

Family members are emotionally unstable and unpredictable (e.g., angry outbursts), unreliable, or erratically present, frequently related to substance use.

Theme #1: DISCONNECTION & REJECTION The three major forms of deprivation are: Deprivation of Nurturance: Absence of attention,

affection, warmth, or companionship. Deprivation of Empathy: Absence of

understanding, listening, self-disclosure, or mutual sharing of feelings from others.

Deprivation of Protection: Absence of strength, direction, or guidance from others.

All forms of deprivation are increased with high levels of substance abuse in the family

Theme #1: DISCONNECTION & REJECTION Family members including children frequently have

the feeling that they are defective, bad, unwanted, inferior, or invalid in important respects; or unlovable.

May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one's perceived flaws.

Theme #2 DEPENDENCE / INCOMPETENCE Belief that one is unable to handle one's

everyday responsibilities in a competent manner

Belief that without considerable help from others (e.g., take care of oneself, solve daily problems, exercise good judgment, tackle new tasks, make good decisions) one will fail

Belief that substance use will improve overall performance and ability.

Often appears as helplessness to others

Theme #2 DEPENDENCE / INCOMPETENCE Excessive emotional involvement and

closeness with one or more significant others (often parents), at the expense of full individuation or normal social development.

Often involves the belief that one cannot survive or be happy without the constant support of another or a substance.

Theme #3: IMPAIRED LIMITS Deficiency in internal limits, responsibility to others,

or long-term goal-orientation. Leads to difficulty respecting the rights of others,

cooperating with others, making commitments, or setting and meeting realistic personal goals.

Family pattern characterized by substantial substance abuse, permissiveness, overindulgence, lack of direction, or structure.

Poorly established limits in relation to taking responsibility, cooperating in a reciprocal manner, and setting goals.

Theme #4: OTHER-DIRECTEDNESS An excessive focus on the desires, feelings,

and responses of others, at the expense of one's own needs.

Behaviors to gain love and approval, or avoid retaliation.

Family patterns of conditional acceptance where family members must suppress aspects of themselves in order to gain love, attention, and approval.

Parental emotional needs and desires are valued more than the unique needs and feelings of each child.

Theme #5: OVERVIGILANCE & INHIBITION Excessive emphasis on suppressing one's

spontaneous feelings, impulses, and choices OR on meeting rigid, internalized rules and expectations about performance and ethical behavior often at the expense of happiness, self-expression, relaxation, close relationships, or health.

A family pattern that is demanding, punitive and focused on performance, duty, perfectionism.

A family pattern of hiding emotions, and avoiding mistakes dominate over pleasure, joy and relaxation.

Traumagenic Families Experience Agitation and irritability Sadness, grief, depression Feeling hopeless (nothing they do will make

things better) Feeling numb (poor or little recognition of

emotions) Suspicious/untrusting (constant testing of

every relationship)

Characteristics of children and adults

Victim Stance1. Blame others for not meeting responsibilities

2. Blames others for their inappropriate behavior

3. Always have a ready excuse

4. Fight for the right to be a victim

5. Resist efforts to appropriately solve problems that are causing them distress

6. Focus away from assuming responsibility


Sense of Injustice1. View normal expectations as unfair

2. Refuses to follow “unfair” directions

3. Refuse to meet “unfair” expectations

4. Complain that the consequences for any of their actions that bring negative feed back or correction is unfair


Uniqueness (Grandiosity)1. Claim that they are different or unique and

should have a different set of rules and expectations

2. Demand others understand them

3. Accuse others of not understanding them or making adequate efforts to understand them

4. Focus on how they are not understood rather than resolving problems or conflicts


One way boundaries1. Demands respect and privacy in inappropriate

ways

2. Violates others privacy

3. No reciprocity in respecting the rights of person or property

4. Behaves suspiciously and then becomes enraged when those behaviors are questioned


Concrete transactions1. Sees rules, guidelines, and restrictions as

obstacles that must be overcome

2. Manipulate others by being charming or compliant in order to avoid being held accountable to the rules

3. Focus on one-way rights (seeing their own rights and not the rights of others)


Pride in Negativity1. Enjoy showing off their knowledge of negative

or inappropriate things

2. Gets power from negative behavior or ideas

3. Places high value on learning and knowing things that are hurtful, hateful, evil or demeaning to others


Anger that is instrumental1. Loses control to get their own way

2. Trains others to avoid them when angry or else

3. Claim that they “lost control” after and aggresssive, destructive or abusive incident

4. Uses anger to have power in a situation

5. Others become timid and “walk on eggshells” when they have to discuss problems or responsibilities


One way training1. Uses inappropriate behavior to train others to

give in to them

2. Uses inappropriate behavior when their wishes are opposed or resisted

3. Resists attempts to problem-solve and be re-directed


One Way Role Models1. Models self after negative peers, neighbors,

the famous “bad” people

2. Adopts behaviors of negative role models

3. Act non-responsively to or directly reject positive role models


Wishing1. Has unrealistically high opinion of their own skills and

abilities

2. Talks about how things will be but avoids goal setting or commitments designed to achieve goals

3. Acts as if talking about it is the same as doing it

4. Constantly put off activities or tasks which are perceived as “responsibilities”

5. Respond with anger when pressed to perform in a timely manner


Casing (or) Sizing Up1. Size people up for how much power they have

and respond differently based on their view of that power

2. Reacts negatively to or dominates those that appear to have less power

3. Act charming toward those with more power4. Resist developing relationships with those that

might be more powerful than they or threaten their power


Dishonesty and misinformation1. Use omission and vagueness to confuse or avoid

2. Pretend to have misunderstood

3. Keep secrets for no apparent reason

4. Tell others what they think the other wants to hear

5. Say yes and agree to avoid further feedback

6. Act confused when challenged on an inappropriate comment or behavior

Traumagenic Families Experience Emotional outbursts (screaming, yelling,

crying, etc) Self-soothing or distracting behaviors

including early on-set of substance use Poor communications (not effective and

responding to feedback well, or making behavioral changes based on feedback)

Social withdrawal

Traumagenic Families Experience Social isolative behaviors (doing things to

create distance) Poor Attachment (repeated failures to

effectively engage in a relationship, or maintain relationships)

Pre-occupation with stressors

Traumagenic Families Experience Difficulty concentrating, focusing or attending Appears inattentive or distracted Difficulty making effective decisions Difficulty following through on decisions to

accomplish goals Engages in pointless lies, deceptions or

partial truths to avoid

Highlights of the behaviors common for children raised in Traumagenic familiesImpaired executive functions:

Inhibiting Shifting Planning Organizing self-monitoring emotional control working memory

Stage I: Introductory Phase

Hangover/Feeling IllMay Be ExpensiveMay Be IllegalMay Miss Work

EnergyThinking AbilitySexual/Social ConfidenceEuphoriaWork OutputIncreased Status Relief from: Loneliness Insomnia Depression Anxiety

Parties

Special Occasions

Triggers

Responses

Infrequent Use

No Physiological Response

Pleasant thoughts about AOD



Confidence Boost

Sexual Enhancement

Social Lubricant

Boredom Relief

Depression Relief

Beginnings of Physiological DependenceFinancial ProblemsVocational DisruptionRelationship Concerns

Stage II: Maintenance Phase


Triggers

Responses

PartiesFriday NightsFriendsConcertsAlcohol“Good Times”Sexual Situations

Thoughts of AODCravings Occur as Use

ApproachesMild Physiological

ArousalEager Anticipation of

AOD UseOccasional Use


Social CurrencyOccasional EuphoriaRelief from LethargyRelief from Stress

Nose BleedsInfectionsRelationship DisruptionFamily DistressImpending Job Loss

Stage III: Disenchantment Phase


Triggers

Responses

WeekendsAll FriendsStressBoredomAnxietyAfter WorkLoneliness

Continual Thoughts of AOD

Strong Physiological Arousal

Psychological Dependency

Strong CravingsFrequent Use


Relief from FatigueRelief from StressRelief from Depression

Weight LossParanoiaLoss of FamilySeizuresSevere DepressionUnemploymentBankruptcy

Stage IV: Disaster Phase


Triggers

Responses

Any EmotionDayNightWorkNon-Work

Obsessive Thoughts about AOD

Powerful Automatic Response

Powerful Physiological Dependency

Automatic Use


No Simple Answer

What can we do to address the multigenerational nature of Alcoholism?

Family-focused Intervention & Prevention

Positive outcomes from rigorous studies

Increase Caregiver-child bondingIncrease effective Child managementIncrease Social, emotional and cognitive

competencies (e.g., problem solving, goal setting)Reduce substance use community wideIncrease effective mental health treatment

Objectives

─ Enhance family protective factors (e.g., caregiver-child bonding)

─ Reduce family-based risk factors for child problem behaviors

─ Reduce family-based risk factors for adult and caregiver problem behaviors



Improved parenting skills Improved youth skills (e.g., peer resistance, social

competencies) Improved school engagement and grades Decreased aggressive/destructive behaviors,

conduct problems Decreased mental health problems (e.g.,

depression)

Alcoholism Within A Multigenerational Traumagenic Family Framework

Health & Medicine

family dynamics

traumagenic family structure

habituated family behavior

childs behavior

traumagenicalcoholic

family interactional

childs emotional

neglect of children