Hello everyone and welcome back. In our last section we began a discussion of screening and assessment along with all the issues which go along with that. In this section we begin discussing about family systems and how they work and how that all impacts with substance abuse and dependency. So let's begin by going to slide two.

As we can see here, families have a major impact in substance abuse treatment and substance abuse as well. They are also a major protection against use and within the treatment process. Each member plays a role. The roles are different however in different cultures and within different societies within those cultures. Families also have functions within the communities. What is considered a family differs within different cultures and different communities.

There are a lot of different types of families and I have listed some of these here on slide three. There is the traditional family with mom and dad, a house in the suburbs, two and a quarter kids, and a couple of dogs. There are also single parent households or families having a step-parent, and on and on and on. So, again, there is a wide variety of different types. Also in here are Hillary’s villages that she talked about a long time ago.

Why is the family so important? As we can see in slide four, families are basically the base unit of all societies and all cultures. They provide major support for a variety of things. They are the major role in child rearing, their secondary role is in family support of each other, and you may have extended families as well. Basically, they provide support for all the people within the family unit and they give each other support in a variety of different ways. The other aspect about the family is that it has a tertiary involvement within the community itself. Families also influence substance abuse, that is, the use of particular types of compounds. Some families say, "Well, it’s okay, we can do that." Other families say that there is no use at all. So basically, the family unit often times has a major role and a major impact on whether the other person will use or not. So as a result of that substance use influences family functioning but family function will also influence substance abuse.

Now the big think about families as we see in slide five, is that family systems are not static. They are in fact, dynamic. The members of the family change over time. You have births, you have family members entering by marriage, and you have people that are dying. People in the family unit also change. They grow up, they begin to have problems, and these problems may be overcome or they may be around for a long time. And ultimately, within the families there are a variety of good and bad experiences. Also, within the family there is a variety of things that begin to change. Relationships change and that occurs over the course of a marriage within a family structure, there may be divorce, etc. And, finally, you have a variety of context changes. You may move from one area to another, you may get a new job, new house, new neighborhood, new schools, and on and on and on. So in essence when one looks at a family, you have to remember and understand that a family system does not stay constant. It is always moving. It is always changing. And even from day to day the changes can be pronounced.

Now there have been a variety of different models in areas that have focused on the family. And, with all of these they all revolve around a lot of different things and I have posted some of these things on slide six. Basically for lack of a better term I am going to call these themes. There are a variety of themes revolving around rituals and routines, themes revolving around shame, and there are also themes around rules and roles.

Overall, as we see in slide seven, most family system models view the family as a homeostatic unit or homeostatic system. It is seen as a unit regardless of the cost to the individual members. The units use basically serves as a stabilizing force and the system maintains a balance to prevent some particular change.

Now what happens if something does occur? As we see in slide eight, change causes stress. Most of the models assume the system is balanced like a scale. When you add problems it takes it out of balance. An example of a problem would be substance abuse. Consequently, families do things to try to put the system back into balance. They may isolate the members or the members might take on more roles, etc. Ultimately all of these changes can be positive or negative. And in general most of the systems one has within the family unit are very resistant to the change, whether it is positive or negative. All change within families or most other things as well, requires some kind of adaptive energy, or some kind of adjustment to a system. These adjustments over time tend to require resources to be delivered toward it. So in general, when one has a system the system resists change. It seeks to preserve the homeostasis, equilibrium, or balance that it has.

Now there are a variety of different family models related to family systems and these include behavioral models and stress-coping models. These models have more of an empirical base than other family systems models that we will be discussing shortly. So in essence what they do is look at the reinforcing systems occurring in families or some other type of aspect.

There is a variety of different family systems models and we talked about that they run around three basic groups.

So let's look at rituals and routines models on slide eleven. Basically, Steinglass, which is a major proponent of this model, contends that there are two types of family systems that are related to alcohol. There is the alcoholic family and all the things that go with it. And the family with an alcoholic member.

Let's look at the alcoholic family first on slide twelve. In the alcoholic family, chronic alcoholism is the major organizing theme. Alcoholism in this case has inserted itself into every aspect of the family’s life. It is related to the behavior of the alcoholic, it is related to the behavior the alcoholic elicits in responses from the family, and ultimately from all of this the family member’s behavior becomes impaired. This then causes more stress which causes more drinking and the cycle then continues.

Family behaviors, according to Steinglass, are homeostatic in nature. As we can see in slide thirteen, they are basically designed to return the family to some kind of stability. The changes that occur are organized to bring some kind of stability to the family. Ultimately, this stress then causes continued drinking. And ultimately the family system becomes organized to maintain the drinking. Normal rituals may be disrupted by their drinking as well. These include meals, holidays, etc.

Family growth also begins to occur. And ultimately this encompasses the family developing a variety of different aspects including boundaries, themes, etc. All decisions for the family revolve around these areas. They all become disrupted when the family has alcoholic members. Ultimately the family consolidates itself and begins to defend its identity. And these begin to pass on from generation to generation unless it is changed.

Shame systems are a little bit different and as we can see in slide fifteen, shame is normal and necessary for social functioning. It keeps us from doing things that are bad for society. Shame-bound families are a little bit different from all of that. Basically what they do is use shame as a sort of pathological pattern in communication which instills a since of toxic shame (for want of a better word) in their offspring. This ultimately develops problems in relationships, promotes secrecy, changes in boundaries, etc. This causes disruption throughout the family. Ultimately shame systems within family systems cause problems in all aspects of their lives.

Within a shame system as seen in slide sixteen, the network within the family begins to hide the alcoholism from each other and from the community. The alcoholism is also correlated with other aspects such as emotional abuse, sexual abuse, physical abuse, etc. All of these things that occur are surrounded by secrecy. As a result the secrets inhibit the members, stops changes in behavior which may be positive, and ultimately permits the behaviors to continue. Parents can help children within these kinds of systems by explaining that the alcoholic is responsible for their behavior, not the child.

Now, there is a thread major model and these are the rules and roles models which have been developed by Wegscheider-Cruise. In this model there are six typical family roles that have been identified and these are listed on slide seventeen. Let's walk through each of these first.

The dependent role as we can see in slide eighteen is the alcoholic. The alcoholic becomes dependent on others to help them to maintain their addiction. The person is self-centered. Focus on the next time of use is very important to avoid possible withdrawal symptoms. And of course is going to deny that any of these things apply to this person.

The chief enabler role is a little bit different. This is usually the spouse who tries to help the alcoholic. But in essence what it does is help support the alcoholics drinking. It needs to pick up the roles of the alcoholic as well as maintain their own roles. This individual often is seen as powerless in the family system. But in essence what it does is it has a lot of power over the other family members.

The family hero role according to Wegscheider-Cruise, as we see in slide twenty is the child who can do no wrong. This is the child with the exceptional grades. This is the child who wins at all the events that they do, etc. It is the common overachiever in all aspects. And this is the one who provides all the hero aspects to the particular family.

In contrast, as we see in slide twenty-one, the family also has the scapegoat and this is the reason the alcoholic drinks says the family. This person is the black sheep of the family. It is the one who is always causing problems in for family. The blame is always placed on this person for all the families’ problems that are occurring. It is very difficult to change out of this role even with family counseling.

The lost child role as we see in slide twenty-two, is again a little bit different. This is the person who seems to be lost in the family. No one pays attention to it and it just is kind of there.

The family mascot role as we can see in slide twenty-three, is again, different. This is the family clown that makes everyone laugh. It is always getting attention by engaging in some behavior out of the ordinary. It is very, very hard to change this role as well because it gets lots of reinforcement both inside and outside the family.

Now usually, as we see in slide twenty-four, members may have one or more roles. For example, you might be a family hero and a family mascot, etc. The roles may even shift over time. Now, you may be thinking to yourself, man I have a lot of these characteristics in my family, does that make us weird? The answer is no. Often you will see a variety of these roles in normal families. The difference in alcoholic families, the roles are very rigid and much more intense.

So what happens when the user tries to regain control or goes into recovery, or whatever it may be? As we see in slide twenty-five, When the person tries to regain the original or traditional role they used to have in the family, that is, decisions regarding sex and intimacy, parent-child relations, on and on and on.

The problem occurs that members that are currently in these roles try to maintain these roles. So they do not want the alcoholic who has been in recovery to now take these over. The reason is, as we see in slide twenty-six, there is a major lack of trust. The issue is you, the user, have let us down before so why should I risk letting you do this again? The second major reason is the power. The classic statement goes something like this, "I like the power I have right now, thank you, I do not want to relinquish that" or "I have had to do these tasks for a long time while you were all messed up" or "I need to keep doing them because you are going to start using again." So ultimately the person who is in recovery begins the have many, many problems and often times they relapse. And of course when that occurs, what happens? "Well, we knew you could not make it", etc.

So, we have talked about a few of these models, so what are some of the problems with the models? As we can see in slide twenty-seven, most of the theories are descriptive and lack a lot of scientific rigor. They are often imprecise, untestable, and for lack of a better word they lack commonsense. In addition to that, many of the systems models in family systems have a gender bias. The boundary that we call a family unit does not take into account all the other social forces that are going on in the community. And, families are not equal. Some families have females that have lots of power. But in general most females have less power than males in families and society. You cannot ignore that. Also, in many models in family systems models are very correlational. They are often developed after the fact. They have a lot of face validity but they do not have a lot of empirical validity.

Now there are a lot of defenders of these family systems models. Basically, as we see in slide twenty-eight, they content that the criticisms are irrelevant. The main value, they say, is not from the scientific models used amongst themselves. What they are basically saying is that it is a different approach to conceptualizing clinical problems and interventions. Regardless if one wants to take a scientific approach to data or not the fact is that these family systems models have some problems.

Now, there is a different approach that relates to family systems and these are related to behavior models. As we see in slide twenty-nine, they are related to behavioral theory. Behavioral theory contends that all behavior is learned and maintained through environmental or social consequences (reinforcers and punishers). Further, behavior models insist that the data and the procedures are rigorous and the results are data driven and that we have a regularly monitored scientific methodology that one is using. Social learning models basically have a similar system. What they contend is that there are cognitive processes that mediate between the person and the environment and these include social learning, modeling, and expectancy.

Both of these groups of models contend that families use reinforcers and punishers to maintain drinking behavior. The positive aspects are that you give attention to the person when they are drinking. And if the person is behaving out of control what do you do? You give them lots of attention. It also provides a variety of negative reinforcers which protects the individual from negative consequences for using. Punishers are also used in family systems and there is an infliction of penalties for using substances. What the problem is say these behavioral theorists is that the family uses all these aspects of approaches for individuals that are drinking and ultimately all can cause an increase in using the substance.

Now, behavioral models as we can see in slide thirty-one differ from other family systems models. Instead of looking at a more of a role system what they do is focus on behavioral assessments. They target the antecedents of a particular behavior, the nagging, and communication issues). And, they look at the consequences of the events. Does the behavior make the person feel good, do they not have to go to work, etc? So, ultimately in treatment for a behavioral system within a family systems model the treatment is going to focus on an observable event. The causes in this case are linear not circular. They are heavily researched, unlike other family systems approaches, and have strong empirical research base. However, unlike the other family systems models they are not used very much in the treatment process.

Now another aspect of family systems models focuses on stress-coping models. These are very similar to behavioral models in that both address addiction within the family and within the individuals and both include family and marital relationships. However stress-coping models do not look at the family as a unit unto itself instead what these models contend is that family is used for stress and coping of individual members from the issues of society. This model also contends that a person uses compounds to temporarily decrease life stress and strain.

Basically, stress focusing models, as seen in slide thirty-three focus on stressful life circumstances, the social resources that are available for the family, the individuals coping responses, etc. These can be useful in identifying the processes for relapse and the processes by which family members adapt to the user and the substances they are using.

Now as we see in slide thirty-four, stress may not cause the use, say the stress models, but stress may be associated with consequences after the use and these are the things that ultimately maintain the use. Drugs say the stress models, may actually reduce the stress. That is when you are using. What happens is the family stays away, your spouse is not bothering or nagging you, and if you are out drinking people are not yelling at you, etc. So there are immediate versus delayed consequences that go along with stress models. You basically want to go to that little place where everybody knows your name, on the television show. But basically, when you are there and having a good time and you do not have a lot of stress you want to return back to that situation.

So, in conclusion, as seen in slide thirty-five, families do have a major role in the behavior. However, they may or may not cause the behavior. They may play a role in the maintenance of the behavior. And how it does it depends on the particular family model you use. And, how reliability or validity of that also relates on the particular model that you use. Finally, families systems do have a role in the treatment process but it may not be as important as other factors that may be out there. So consequently family systems models are important in relation to the overall aspects of a program and the family may be important in relation to the treatment support that one gets for the addict it may not be important as other things such as the reinforcers of the antecedents that are out there when one does use.

Well, that concludes this section. In our next section we are going to begin talking about co-dependency and how that relates to the family. So until then we hope you are having a great day and we look forward to talking with you again soon.

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