During counseling, the counselor establishes a warm, supportive, therapeutic relationship with the client using a variety of skills. Based on the strength of this relationship, the counselor helps the client explore problem areas, set goals and assists the client to work through problems in order to establish a more meaningful and productive life style. During addiction treatment, individual counseling aims at enabling the client to learn how to identify and pursue realistic and satisfying solutions to his/her problems, particularly those related to his/her chemical abuse. In order to make individual counseling effective, the counselor has to understand the client as an individual – the influences which have affected him/her, his/her perception of himself and others around him/her – so that he/she can help the client realize how those forces have led to unhealthy ways of coping both prior and after onset of addiction. This understanding at the level of feelings rather than at the intellectual level will enable him/her to cope with life more satisfactorily. The purpose is to help the client in making decisions about his/her life and enable him/her to understand the need to take responsibility for his actions as well as the consequences.
Counseling includes methods that are sensitive to individual client characteristics and to the influence of significant others, as well as the client’s cultural and social context. Competence in counseling is built upon an understanding of, appreciation of, and ability to appropriately use the contributions of various addiction counseling models as they apply to modalities of care for individuals, groups, families, couples, and significant others. For a DRUG addict it is very important to understand the consequences of drug addiction, and how drugs is affecting his/her life as well as lives of people around them. Unless and until this feeling or sense of responsibility is there recovery is difficult. Counselor has to take into consideration the clients background.
Addiction it’s impact on the family
When one person in a family is addicted to alcohol or drugs, the whole family is affected. A family is like a mobile* which hangs in a room and shifts and changes when the wind blows. If one part of a mobile is touched, the whole thing reacts.
A family is a group of people related by mutual commitment and/or by blood. The people are inter–related, just like the parts of a mobile. If one person is out of balance or in a crisis, all the members find themselves off balance too.
Addiction is a progressive disease, and the addicted person finds himself involved in a series of crises, which worsen over time. In order for the family to deal with that, they learn how to hang out of balance to compensate. This way of relating and behaving becomes familiar, and the whole family finds itself ‘sick’ together.
* A mobile is a light structure, which is hung from the ceiling as a decoration. It usually consists of several small objects which move as the air around them moves, and is often hung above children’s cradles to keep them entertained.
The family’s reactions to the chemical dependent
The family of the chemical dependent usually denies the existence of the problem in order to avoid humiliation and embarrassment. What is obvious to others is flatly denied by those who live on intimate terms with the dependent. The family becomes quite adept at shielding the dependent, making excuses for his behavior, helping him out of tight spots, covering up for him with his employers and others. The minimizing and rationalizing of family members is often deeply ingrained and truly believed – in much the same way as the minimizing and rationalizing of the addicted person. As a result, family members protect the person, deny that the relationship is troubled and deny the addiction of the person to whom they are attached.
The preoccupation of family members is similar to the addict’s obsession for drugs. Their entire thinking revolves around the dependent and they forget to take care of their needs. Their lives are modified to suit the needs of the chemical dependent. Acute stresses drive the wife or parent to some behavior or activity which she compulsively perform.
For example, she may be tracking the movements of the dependent all through the day, even though she might be aware that by doing this, she can not control his drug use. Her compulsive preoccupation drives her to waste her energy in unproductive ways, and the result is that she fails to perform her duties like cooking or looking after the children. She finally ends up in a self–destructive trap, controlled and manipulated.
Making changes in oneself
Most family members believe that the addict is taking drugs because of certain problems. As a result, the family takes responsibilities to deal with those problems. They try to establish a pleasant atmosphere at home hoping that it will help the addict to stay away from drugs. The family may go out of their way to please the addict and maintain a warm and caring attitude towards him even when the situation is difficult. The mother may say:– ”You have been repeatedly saying that we did not pay attention to you. Now I have given up my job. Father has stopped spending time at the club. Now that we have taken these steps, we expect you to stop taking drugs.“
She believes that her son’s problem is just temporary and that once they have made certain changes in themselves, he will stop using drugs.
Bargaining also comes into play as the parents/wife try to cope with this crisis that has invaded their home.
‘I will get you the latest computer, so that you can spend your evenings browsing the Internet. You will not feel bored.’
‘The moment you give up drugs, I will set up a business for you.’
The goal of bargaining is to offer the chemical dependent something in return for the desired behavior. But such bargaining does not work at all. Instead, it leads to frustration and depression.
Unfortunately, the family members start blaming each other. Very often the chemical dependent who is trying to take the focus off himself, uses the situation to his advantage and sets one family member off against another. For example, he may tell his mother that he is using drugs because he is unhappy in his marriage. He may say that his wife nags him continuously and he can’t stand it. To his wife, the same person complains bitterly about his domineering mother who never made any effort to understand him as a child and sent him away to a boarding school. This results in more pain and tension in the family because the two women start blaming each other for his addiction. In so doing, the family is kept from coming together and addressing the most important issue of how to help the chemical dependent recover from the disease.
The family attempts to control his drug taking in the hope of getting him out of this problem. The wife/mother may:
- hide, empty the drug packets or break the bottles.
- ask the addict to avoid his friends.
- extract promises from him.
- cry, plead, threaten and shout at him to stop his use of drugs.
Disorganization of the family
The family gives up all attempts to make him stop using drugs because the wife / mother realizes that none of these methods help. When she takes stock of the situation at home, she finds everything in disarray. She has no control over the addict; other children’s lives have also been affected; she is unable to exercise control even over her own emotions.
Permitting the crisis
At some point in time the family stops taking any responsibility for the consequences of the addict’s behavior. The wife/ mother may refuse to bring him home from the bar, where he lies drunk; refuse to clear his debts; refuse to give excuses to his boss for his absence from work; refuse to take him to the 24–hour clinic whenever he develops withdrawal symptoms.
When the addict is left to face these crisis all by himself, he feels helpless and the family members make use of these situations to intervene and motivate the individual to seek help.
Feelings experienced by family members
In order to offer help and plan effective treatment, it is essential to understand the feelings suffered by the family and the behavior adopted by them as a method to cope with the enormous problems they are left to face.
The emotional response to addictive illness in a family member frequently has its roots in guilt feelings. Our culture often implies that if a person takes to drugs, someone else is to be blamed.
For you, golf was more important than your son’s well being. You never cared to spend time with him.
You had sent him to an ordinary school. If he had studied in a better school, he would not have picked up this habit.
The family has lost all the pleasures of life. Their losses are innumerable – loss of prestige, loss of family and personal dignity, loss of relationships, loss of feelings of love, loss of care and understanding, loss of security, loss of finances – loss in each and every area of their lives. Members of affected families constantly grieve.
Initially the family’s anger is focused on the addict. As addiction progresses and the problems increase, their anger loses focus and direction. They are angry with the addict – even when he is not taking drugs, angry with themselves, angry with their other children, angry at society, angry at the entire world at large.
The wife / mother at times suppresses her anger. As time passes, her mind becomes a storehouse of pent up memories, hidden resentments, hurt feelings and unresolved conflicts. Eventually, the chronic stress of unresolved emotional hurts becomes manifest in serious health problems – ulcers, hypertension, heart disease, etc.
Sometimes her repressed anger leads to a temper that explodes over trifles, frequent feelings of disappointment with others, and a feeling of being let down. Suppressed anger does not protect, it does not make life run more smoothly. On the other hand, relationships become more difficult to handle. It destroys everything that the family hopes it will protect.
Shame and Loneliness
Most of the painful experiences resulting from chemical dependence bring a lot of shame to the family. The inappropriate behavior of the addict in front of relatives and friends makes the family terribly embarrassed. Such shame results in avoidance of all relationships and ends in isolation. Within the family also, there is a breakdown of communication. There might only be telegraphic communication like ‘come and eat’ or ‘go to sleep’. Relevant issues like problems related to the education of the addict or management of finances are rarely discussed. The isolation created by lack of communication leads to bitter loneliness.
Fear and Hopelessness
Living in a problematic, distressed family, produces fear – fear of the future, fear of family life, fear of financial matters, fear of relationships, and a persistent fear that nothing is going to become normal. As the family is unable to fully perceive the problem or find solutions, they feel desperate and hopeless.
The family is deeply hurt. Even though they are prepared to go to any extent to help the user out, none of their efforts are recognized or acknowledged. On the other hand, they are constantly blamed. Like a raw wound, the hurt feelings keep bleeding and the family repeatedly gets affected.
Dysfunctional coping behavior of family members
The family members of the chemical dependent become preoccupied with trying to sort out his life in a meaningful way. They develop a pattern of living, coping and problem solving created and maintained by a set of dysfunctional patterns within the family system. These patterns interfere with healthy growth and make constructive changes very difficult, if not impossible.
What is co–dependency?
The normal reaction within any family to pain, to crisis and to the dysfunction of one member of the family is to reduce the pain, ease the crisis and assist the dysfunctional member in order to protect the family. In the case of addiction, these responses do not make things better. If other members in the family deal with the consequences of addiction, the addict will never realize that he has to give up drugs. The family members will take more and more responsibilities to ease the crisis, but the crisis will continue.
As a result of living in a problematic environment, the family members develop a certain pattern of behavior called ‘Co–dependency’.
‘Co–dependency is a specific condition that is characterized by preoccupation and extreme emotional dependence on a person. Eventually, this dependence on another person becomes a pathological condition that affects the co–dependent in all other relationships.’
– Sharon Wegscheider–Cruse
While the family members try to control the chemical dependent, (over whom they have no power), they lose control over their own behavior (over which they have power). Hence their lives become unmanageable.
When you try to control
what you are powerless over
you lose control
over what you can manage
Loss of Daily Structure
Family members have difficulty in following a daily routine. In any normal family, the children will be certain that breakfast will be ready on time. Mother would have packed lunch. Uniforms would have been ironed. In a chemical dependent’s home, there is no structure or routine. If the son had taken drugs the previous day and created problems, the mother is unable to carry on her responsibilities the next day. She is not able to perform even basic duties like preparing food on time, sending the children to school or going for work on time.
Neglect of Personal Care
Family members slowly start losing interest in looking good and neglect their well–being. They do not attend to any of their physical ailments.
One of our patient’s wife shared with the counselor during treatment that in the recent years she started having excessive bleeding, but never bothered to consult a doctor.’ Later on the problem became very acute and when she went to the doctor, it was too late and her uterus had to be removed.
The family members feel tired all the time (even when they have not done much work). In addition, they also experience physical problems like ulcer, blood pressure, migraine headache, pain in the neck / back, inability to sleep, and lack of appetite.
Getting Involved in Unproductive Activities
The family members know from experience that some of their responses are unproductive and do not help in controlling the addict. In spite of knowing this, they continue to get involved in these activities. For example, calling his office and checking whether he has come for work; checking his belongings for the presence of drugs.
She is convinced that shouting at him when he is under the influence of drugs does not help and that it only aggravates the situation. In spite of this understanding, she is unable to keep quiet and as soon as he enters home in the night, she starts shouting at him.
The ‘Whatever I do is right’ attitude
She is convinced that nobody will understand her problems and maintains that whatever she is doing is the right thing. She neither discusses her problems nor is prepared to listen to others.
For instance, she believes that separating her son from his drug–taking friends will solve the issue and decides to go to her parents’ village. When others point out that this will affect the education of her other children, she is not willing to listen and adamantly proceeds with her decision. Since she is not open to suggestions, relationships get strained and she becomes isolated.
She would beat her 8–year–old child for some silly reason. If her mother–in–law intervened, she would say ‘If I don’t beat him, he will also become irresponsible like his father.’
The family members start blaming each other and hold the chemical dependent responsible for everything that happens at home.
The mother will not carry out her responsibilities, but would blame the addict for her inability. For instance,
- for her inability to cook properly, the addict is blamed
- if siblings get low marks, the addict is blamed
- if she is not able to keep the house clean, the addict is blamed
As days go by, the responsibilities increase. When there are several responsibilities to complete, prioritizing becomes essential. The family member is unable to plan and prioritize her activities. All her efforts are focused on facing one crisis after another.
For example, in the case of an alcoholic, till the schools reopen after holidays, the wife will not plan how to get money to pay special fees for her children. She knows very well that her husband will not take responsibilities. In spite of this, she will not plan ahead.
In the case of a drug addict, the mother would send one of her sons to look for the addicted son instead of sending him for tuition.
What the Family Should Realize
- Addiction has affected me physically and psychologically.
- Some of my behavior patterns were destructive and inappropriate.
- In recovery, it is important that I change my behavior and carry out my responsibilities properly.
If addiction has existed in the family over a long time, it is most likely that all the members of the family will be in need of help in restoring themselves to a state of health and happiness.
During recovery, the family should be made to feel the need to detach themselves from the problem which has for so long been the sole focus of their lives. In due course, it will help both the dependent and the family if they start facing the problem by doing the following.
- Stop telling themselves that ‘if only he decides, he can always give up drugs’. They have to accept that it is a serious problem that requires professional help.
- Start talking calmly and factually to the chemical dependent about his drug use and subsequent behavior when he is drug free. The more open they are, the more uncomfortable they will make him feel about his use of drugs. He should be made to understand that his addiction is causing problems and that he can recover by taking help.
- Stop protecting him by covering up the consequences of his drug use (giving reasons for the addict’s absence from college, or repaying debts incurred by the addict). He will become aware of the enormity of the problem only when he faces the crisis caused by his drug use.
- Not feel or give the impression that the addict is doing them a favor by giving up drugs. If they do so, the addict will become manipulative and this will hinder his recovery. For years, families might have patiently put up with the addict’s behavior just to have some peace at home. By continuing to yield to his irrational demands and difficult behavior, they will only complicate recovery.
- Start communicating honestly and openly to other members in the family about their concerns.
- Start accepting that they are not alone; they have choices and they need the support of self–help groups to cope with the problem. Self–help groups will help them find ways of changing and building up their self–esteem.
- Start looking after their own needs and the needs of other children. They should realize that they have to start doing the duties which they have neglected so far.
- Identify positive methods of diversion like spending time with other children, such as pursuing hobbies, etc. These positive experiences will give them the energy to face problems.
- Plan one day at a time and start executing their plans.