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The role of the family in the maintenance and treatment of addiction

Assumed roles in families: How we perpetuate addiction

Families are a system and each family member plays a role in the system. These roles are assumed. That means they are based on learned actions and reactions rather than assigned.  Families with a member addicted to a substance or process tend to organize around the addiction.

In this article, I discuss ways a family maintains an addiction. These ways include internal forces stabilizing the addiction and addictive patterns being passed on to children. Then, I introduce effective Neurolinguistic Programming (NLP) strategies for working with family members and present a hypothetical case in which the strategies are applied.

Internal Forces Stabilize Addiction in a Family

Dr. Murray Bowen, well-known psychiatrist and researcher, suggests individuals cannot be understood in isolation, but must be viewed as part of their family. He sees the family as a system of interconnected and interdependent individuals; no one can be understood apart from others in the system.

I think of a family system in terms of a mobile attached to a baby’s crib. The mobile has several connected moving parts. When one part of the mobile is moved, other parts move as well. With that in mind, let’s consider a family with a member addicted to drugs or alcohol.

  • One family member abuses drugs; other family members over-compensate for and take care of the addicted member.
  • A parent uses drugs and their children engage in role reversal. They become parents to each other and to the using parent.
  • Family members suffer numerous losses due to death, accidents, and crime caused by substance abuse. Yet, they continue to focus on the pain they suffer without acknowledging the cause.
  • Family members frequently ignore the problem. They fear pushing the loved one away and they fear that addressing the problem will be ineffective.

Family Members Model Addictive Ways

Experts suggest a child’s early life experiences are critical for optimal development and success in life. Experts also indicate parents are a child’s first and most influential teacher. So, in a family where addiction is a factor, the following behaviors may occur:

  • Denial becomes an established pattern.
  • Parents use rigid and over reacting styles at times and ignore misbehavior other times.
  • Patterns of chaos and disorganization are exhibited.
  • Family members grow accustomed to parental binges as ways to avoid problems and be affectionate.
  • Family members offer codependent advice such as “Ignore the behavior,” or “Don’t worry, the behavior is just a phase and will pass.”
  • The message that abuse, codependency, and deviant behavior are acceptable is communicated.
  • Relatives share substances to be close and to soothe each other.
  • Problem solving is impaired.

Family’s Stage in the Addiction Process

Treatment options can be based on a family’s stage in the addiction process. One way to assess these stages is listed below.

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Early Phase – The family does not recognize substance abuse as a problem. They see symptoms of abuse as problems in and of themselves, and not the deeper problem.

Middle Phase – The family recognizes substance abuse is a problem. However, at this point, family members may not be ready to deal with the problem or they may be excited about getting help.

Late Phase – The family unit may be beyond help. The abuser may never change. The focus is geared towards helping the children disengage from the dysfunctional aspects of the family and form new and healthy relationships.

Neurolinguistic Programming

As a review, Neurolinguistic Programming examines the fundamental dynamics between the thinking processes (neuro) and the words (linguistic); as well as, how their interaction affects behavior (programming). NLP targets how people:

  • communicate externally and internally
  • process, store, and recall information
  • alter their communication to achieve the results and goals they want

NLP Practitioners believe human beings have an extraordinary capacity for flexibility and there is nothing that happens mentally or spiritually they cannot learn to handle. They also focus on how a person formulates thoughts and beliefs – those which maintain the use and those that help affect and maintain change.

So, the following NLP strategies may be helpful to the family in managing the addiction of one of its members.

Outcome Specification

The Outcome Specification process is a way to clarify goals and desires. Knowing what a client truly wants to achieve helps the counselor find a purpose-driven course of action and identify unnecessary courses of action.

The Meta Model

People have a tendency to speak in shorthand. The Meta Model provides a way of discerning what is not being said by helping identify and transform vagueness. The model was designed to deconstruct the wording of a problem and get to the bottom of it.

Accessing Clues and Predicate Phrases

Typically, accessing clues refer to eye movement. They indicate the sensory representational system a person is using. These visual, auditory, or kinesthetic cues are activated as a person attempts to gain access to information. Voice tone, breathing patterns, and posture also provide clues.

Once clues are understood, rapport can be built by matching a client’s preferred style of thinking. This is achieved by using words that match his or her representational style such as “I see what you mean” for visual retrievers or “I hear what you say” for auditory retrievers.

Similarly, visual, auditory, kinesthetic and auditory words, known as predicate phrases, offer clues to a person’s preferred representational system. Comments such as “see what I mean” or “sounds good” provide information.

Hypothetical Case with a Family Whose Son is in an Alcohol Detox Program

Molly and Mike made an appointment to see me because Brian, their son, has been drinking heavily for several months. Fifteen-year old Brian was recently admitted to a three-week Detox Program. The Program offers family sessions; however his parents want further counseling to ensure that Brian remains drug free. Mike and Molly appear to be in the Middle Stage of the addiction process; they are facing Brian’s alcohol problem head on.

After building rapport with Mike and Molly and assuring them I can help with their goal, I conducted the nine-question Outcome Specification. This process provides me with an in-depth look at their goals as well as their dedication to them. My questions and their answers follow:

1. What do you want?

PARENTS: We want Brian to remain alcohol free. If we don’t stop his drinking now, “they” said the problem will only get worse.

2. How will you know when you have reached the goal?

PARENTS: When he no longer comes home drunk. When he goes to school regularly as he should and is involved in our family activities as he once was.

3. Why is your goal relevant and/or irrelevant?

PARENTS: The goal is relevant because we love him and he should be a part of our family.

4. What stops you from pursuing the goal wholeheartedly?

PARENTS: If we push too hard, he will hate us. In some ways it is our fault because we have wine with dinner. On one hand, we don’t want to give that up. On the other hand, we may have given Brian the message drinking was acceptable.

5. What personal resources can you use to help achieve this goal?

PARENTS: Our love for him, our willingness to forgive him for having these problems, and our determination to fix him.

6. What additional resources will you need to achieve your goal?

PARENTS: Therapy to find out why he is drinking so much.

7. How might the goal affect important people in your life? Is there any risk associated with achieving this goal?

PARENTS: We would be thrilled. The risk is that in trying to be closer, we may push Brian away.

8. What daily actions will you take in order to achieve your goal and what is the first step?

PARENTS: We are meeting with you, we plan to attend the family sessions at the Detox Center, and we are willing to do whatever it takes to fix him. So, the FIRST STEP is to develop a plan we can live with.

9. Given everything you have considered to this point, is achieving the goal worth it?

PARENTS: He is our son, absolutely.
Mike and Molly displayed several examples of Meta Model patterns. In asking the following questions, my goal is twofold:

a) to explore their vagueness and
b) to model ways to meaningfully communicate with their son

Their patterns and my questions follow:

  • Unspecified Referential Index
    COMMENT: “They said.”
    MY QUESTION: “Who said?”
  • Modal Operators of possibility and judgement.
    COMMENTS: “. . . he should go to school” and “he should be a part of the family.”
    MY QUESTION: “According to whom?”
  • Mind reading
    COMMENTS: “If we push too hard, he will hate us.” and “we might push Brian away by wanting to be closer.”
    MY QUESTIONS: “How do you know that?” and “What has Brian said that would lead you to that conclusion?”
  • Cause-Effect
    COMMENT: “It is our fault because we had wine with dinner.”
    MY QUESTION: “How does your drinking wine at dinner cause Brian to become an alcoholic?”

In answering these questions, Mike and Molly began to see how their beliefs and expectations are playing a role in in the situation. They begin to realize they can’t fix their son and the only behavior they can change is their own.

I taught Mike and Molly about eye accessing cues and predicate phrases; so they can identify and talk to Brian in his primary representational system. Mike and Molly identified Brian as being auditory and themselves as being visual. Both parents were pleased to learn that by using auditory words such as “I hear you” or “sounds like,” they could make a stronger connection with their son.

I taught Mike and Molly about Perceptual Positions. In the first position, they look at what they want and how they want him to behave. In the second position, they are able to consider how they think Brian might feel. After all, he is an only child and a 15-year old teenager, who is attending a new high school and trying to fit in. In the third position, they are able to view his side of the situation and their side.

After completing these activities, Mike and Molly understand the situation differently. Prior to completing the exercises, Brian is the problem and they want to help him. After completing the exercises, Mike and Molly realize their role in the continuance of the problem. We decide to redo the Outcome Specification exercise with a new goal in mind: develop a better relationship with Brian.

1. What do you want?

PARENTS: We want to build a healthy relationship with Brian.

2. How will you know when you have reached the goal?

PARENTS: When we have quality conversations and do activities together. In the past, we enjoyed going to hockey games, for example.

3. Why is your goal relevant and/or irrelevant?

PARENTS: The goal is relevant because we love him and we want him to be happy.

4. What stops you from pursuing the goal wholeheartedly?

PARENTS: Not knowing how to proceed.

5. What personal resources can you use to help achieve this goal?

PARENTS: Our love for him, our willingness to change, and our willingness to listen.

6. What additional resources will you need to achieve your goal?

PARENTS: Better communication skills.

7. How might this goal affect important people in your life? Is there any risk associated with achieving this goal?

PARENTS: Hopefully, Brian will be happier and more fulfilled. However, there is always the risk that he will be angry and refuse to talk to us again.

8. What daily actions will you take in order to achieve your goal, and what is the first step?

PARENTS: We will continue to see you, we plan to attend family sessions at the Detox Center, and we plan to respond differently with Brian. The FIRST STEP is to develop a plan of action that works for the three of us.

9. Given everything you have considered to this point, is achieving the goal worth it?

PARENTS: He is our son, absolutely.

In this article, I discussed the role the family plays in the maintenance and treatment of addiction. I also discussed NLP strategies which can be effective in the treatment plan and presented a hypothetical case in which the strategies were applied. Additionally, now we have a solid goal and can proceed. In future sessions, we will use other strategies such as the Logical Levels exercise, the New Behavior Generator, and Future Pacing. We may also want to include Brian in those sessions.

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About Dr. Janice Walton, PhD

Dr. Walton has a doctorate in Psychology and is a licensed Marriage Family Therapist. After following traditional counseling approaches for years, she became interested in neurolinguistic programming and how those techniques can be used with individuals whose lives are affected by addiction. To this end, she joined the staff of the iNLP Center and has recently developed a course for professionals entitled "NLP for Addictions". All courses offered by the Center can be viewed at: http://inlpcenter.org/; the link to Dr. Walton's website is: http://www.tlcorner.com/.

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