Addictions Therapist

Addiction can be defined as a family disease. It is a fact that the entire family suffers with the addict. This is the reason that professionals consider treatment of the family to be the part of the whole treatment of addiction.

First, it is important to understand that the tendency to become addicted is genetically transmitted. This is proved by a research that has been undertaken to know the exact reason of raise in the cases of addiction.

When it comes to the family suffering, there are a number of ways a family suffers with the addict. According to a study, about one third of the families in the United States have at least one member in the family with a substance abuse problem.

About one-fourth of this problem exists in nuclear family. In such families, there are more chances of divorce, domestic violence, anxiety, child abuse, depression and general medical problems.

When an addict & the whole family gets into the recovery mode, many effects of depression are supposes to go away in a couple of years. However, there needs to be an active participation from the addict, the family & the recovery professional.

It may be quite difficult to deal with addiction in the family as it’s hard to see a family member in trouble but one needs to be strong enough to cope up with such troubles. The most important thing to remember is that there are many important issues to explore as soon as someone in your family requires help. First, you need to make out whether you are contributing to the core problem or working towards eliminating it.

Here are certain contributions you may be making to increase the problem:

• Making yourself believe that you are responsible for the whole scenario rather than caring for yourself.

• Getting judgmental towards the addicted person.

• Concealing the addict’s behavior & covering up for them.

• Doing certain things for the addict that they require to carry out all by themselves.

• Accepting your lack of control & giving up after some trials.

• Paying attention to your feelings & needs rather than taking care of the addict.

Here are certain important facts that you must know regarding how to deal with addiction:

• The family must suggest some actions to the addict that are required to help him get out of the addiction.

• Individual counseling also works really well with the addict. Here, a professional puts an effort to provide some cool tips to get out of the situation and fight addiction bravely.

• People who are fighting against a drug or alcohol addiction, a variety of detox treatments are suggested and these treatments may be conducted in a hospital, specific clinic or even a treatment facility.

• Certain types of addiction also require adept or special type of medication. For instance, a drug called nicorette helps a lot to those addicted to smoking.

• One can also contact self recovery groups where special help is provided to addicts. Addicts are taught how to recover & maintain their self esteem here.

• Different types of out-patient facilities are also available where the addict is provided adept treatment. He needs to visit where facilities regularly in order to meet their program expectations.

The task of helping an addict overcome his problem may be difficult but with hard work & determination, it is possible.

Abuse & Violence in the Family

(Dr. Samson Omotosho, PhD, APRN/PMHN)

Introduction: Abuse and violence in the family refer to physically and emotionally harmful behaviors that occur between family and household members. It includes child abuse, child neglect, intimate partners abuse and violence, marital rape, and elder abuse. It could be a learned behavior that can be unlearned through therapy. Perpetrators try to isolate the family to keep it secret and avoid sanctions. They usually have some power and control over the other members of the family. They may rationalize the violence with their drug use. The use of cocaine, PCP, amphetamine etc may increase violent behavior.

Forms of Abuse: Physical abuse includes hitting, punching, shoving, stabbing, shooting, kicking, and withholding medication, wheelchair, food, and fluids. Sexual abuse includes coercion, marital rape, and withholding sex. Psychological abuse includes threat, harassment, and blackmail. Emotional abuse includes name-calling, insults, and ridicule. Economic abuse includes total control over finance, running up bills, forbidding school or work.

Myths and Reality About Violence: Family violence occurs at all levels of society. Separation or divorce may not end violence. Abuser does not need to be provoked. Some survivors wrongly tend to blame self. Treat the violence but also the alcohol, drug, stress, and mental health problems if any. Violence occurs between gays and lesbians too. Abused women are discouraged from disclosure by threats, fear, denial and disbelief expressed by ‘confidants’.

Models of Intervention: The Paternalistic model assumes that the clinician has more knowledge than the patient; that the survivor is responsible for ending the violence; that the clinician should give advice and sympathy; and see the patient as a victim. Whereas, the Empowerment model, which is better, assumes that the clinician should mutually share knowledge with the patient, plan strategies with the patient, respect patient’s competence, experience and strengths, and see the patient as survivor.

Response of Survivors to Violence: Physical signs include injuries at multiple sites in various stages of healing (head, neck, face, throat, sexual organs), headache, insomnia, and stress. Behavioral sign is that the individual does not leave the abuser or leaves and returns before making a final break. Psychological signs include delayed reaction, depression, lowered self esteem, attributions e.g. self-blame, impaired school or work performance and conduct, poor concentration and poor problem solving.

Why Individual Does Not Leave the Abuser? Abused individuals do not leave the abuser for any of many reasons, which include fear of being stalked and killed (which is a realistic fear), strong emotional attachment to the abuser, determination to end the abuse, sanctions present in the couple’s culture, fear of stigma, lack of resources to live away from the abuser, and consideration of what will happen to her children if she leaves. She may leave and return, thinking, “Maybe he will change”.

Child Abuse & Neglect: In every state, child abuse and neglect are must be reported. Types of abuse include child sexual abuse, child physical abuse, child emotional abuse, and child neglect. Child that witnesses family violence may also suffer abuse.

Child Sexual Abuse: This is the involvement of children in sexual activities that they do not fully comprehend and to which they do not or cannot freely give consent. This violates child’s trust in the adult that is supposed to protect him/her. Threat to the child, pet, and others keeps the child quiet. It results in confusion, shame, and helplessness. Its effect may last a lifetime and affect mental health. It may be guarded as a family secret.  

Observable Signs of Sexual Abuse: The observable signs of child sexual abuse include physical aggression, excessive masturbation, social withdrawal, low self esteem, impaired school performance, sleep disturbance, STD’s, bleeding, soreness, itching, UTI, pregnancy, bruises, swelling, redness, fracture, burns, and unkempt appearance.

School Violence: School violence is usually due to child drug use, child’s access to guns, antisocial and impulsive behaviors, family dysfunction, community unresponsiveness, interpersonal disputes, and bullying and harassment by peers.

Child Abduction: Most abduction is done by a parent. 70% are by fathers, 25% by their mothers. Parents that are likely to abduct include those that have threatened or attempted it in the past, suspect abuse by the other parent, may be paranoid, may intend to use it as revenge, punishment, trophy, or one that strongly believes that child be raised in his or her home country.

Child Abuse Assessment and Intervention: Explore and be aware of your own attitude to abuse survivors so as not to be judgmental. Do a thorough history & physical assessment. Use private, quiet uninterrupted environment. Honestly state the purpose of the interview. Inform victim of the pending physical assessment. Use a calm and supportive approach

If possible, interview child separately first before joint interview with parent or guardian. Pay attention to child’s affect (look) and behavior, mother’s understanding of the problem, discrepancies in their stories, and parent’s emotional responses. Document your assessment fully. Report suspected abuse to CPS. Coordinate services such as further assessment, psychological testing, individual psychotherapy, family psychotherapy, and group psychotherapy.

Intimate Partner Violence (IPV): IPV is a pattern of coercive and assaultive behavior between intimate and dating partners. Abuse of female partners is the more prevalent IPV. Female violence is more often in self-defense. Many IPV end in homicide or homicide-suicide. Leaving or an attempt to leave by the victim increases homicide risk. There is a higher homicide risk with handgun, history of suicidal ideation or attempt, battering during pregnancy, sexual abuse, substance use, extreme jealousy, and controlling behavior (“if I can’t have you, no one can”). Few women kill their abusers if there is no intervention. Assessment of IPV should be part of mental health assessment. Ask partners about history of conflicts, “pushing and shoving”, and quality of relationship. Observe for hesitation, looking away, and unease. Be supportive, let victim know she is not alone. Describe and map the extent of injuries. Assess for attribution e.g. self-blame. Assess for depression, PTSD, and anxiety. If patient is the abuser, assess potential for further violence. Consult legal advisor for “Duty to Warn”. Courts have made it mandatory abusers (happens to be mostly men) to be treated. Treatment includes confronting the violence, affirming that responsibility lies with the abuser, behavior therapy, anger control, attitude change to women, couple counseling, and cognitive behavior therapy (CBT). Empower the woman, using laws, community resources, support groups, and safe shelters. Mutually set goals with the victim. Mutually consider and choose from options. Help mobilize natural, social and professional supports.

Rape and Sexual Assault: This affects men, women and children, especially women and children. Sexual assault is a forced act of sexual contact without consent. It is usually done to humiliate, defile or dominate the victim. Rape is a felony, yet majority is unreported. Survivors of marital rape do not seek care because of embarrassment and humiliation. Careful assessment and questioning is needed. In caring for the victim, listen, be nonjudgmental, and provide emotional support. Document your observation and assessment fully. Help collect evidence if patient chooses to litigate. In the acute stage, assess for fear, disorganization, shock, and restlessness. In the second stage, assess for flashbacks, phobias to places and people, and sexual difficulties. Encourage the victim to discuss feelings. Explore options e.g. changing phone number. Explore available community services and support groups. Refer for physical treatment and psychotherapy. Plan for a follow-up phone contact in a few days.

Elder Abuse: There are about 5 million abused elderly persons in the US annually. Spouse abuse overlaps with elder abuse

The abused does not report for fear of being abandoned to a nursing home or being isolated. Signs include bruises on arms, wrists, ankles, face lacerations, vaginal lacerations, fractures, malnutrition, poor hygiene, dehydration, flinching and shrinking away in the presence of abuser. Help and care include reporting a suspected abuse to the Adult Protective Services (APS), counseling, psychotherapy, substance abuse and treatment of the abuser, if necessary.

Reference: Stuart, G. W. & Laraia, M. T. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis, MO: Elsevier Mosby.

Because the person suffering from the addiction acts untrustworthy, the family stops trusting the person, and the members consciously or unconsciously start to distance themselves… When the person starts to act like his or her self again, not like an Addict, the family feels ashamed for having distanced themselves. They decide to reach out once more, only to feel betrayed once again.

Addiction never simply affects the addict alone. The addict pulls friends and loved ones into the vortext of their addiction, which can easily consume them all.

Friends and family try to make sense out of what is happening to their addicted loved-one. In trying to understand, people around the addict inevitably label him or her in an effort to cope with the changes.

What is really being labeled is the addictive personality. The addicted person may get labeled as ‘irresponsible,” ‘troubled,” ‘tense,” ’strange,” or ‘weak.” If people suspect the true source of the problem, addicts will be labeled more aggressively, to reflect what is happening, and how others perceive them. Family members use many labels when speaking about the addict:

He’s a bum.

He eats too much.

She’s so irresponsible.

All he does is buy, buy, buy!

All she does is work, work, and work!

He does drink a little too much.

He’s oversexed.

You just can’t trust her anymore.

When the labeling process occurs, it’s a sign that the illness of addiction has progressed to the point where family and friends have noticed it and must protect themselves from the addictive personality. People sense that the addict doesn’t care about others. They will protect themselves by either removing themselves from his or her presence or trying to control the addicted person.

Thus, for families, the labeling process is an attempt to control what is happening. Addicts react in turn to protect themselves. In doing so, the addictive defensive system becomes even better developed.

For the addictive process to continue, the addicted person must learn how to deflect the concern of others. One of the most dangerous aspects of the labeling process is that, once the addicted person is given a new label, the family starts to adjust to the ‘new person.”

The ‘new person’ can indeed be given a significant place within the family, who adjust and may even become dependent on having him or her around! ‘The Addict” becomes a role within the family and starts to serve a vital purpose. Family members are caught in a dilemma: they hate the Addict but still love the person they once knew, who still exists within the addict. It’s not typical for family members to realize they’re dealing with an illness; as the addiction progresses within the family, everyone slowly adjusts to it.

Family members or others, such as co-workers, start to see what a good scapegoat a person suffering from addiction can be. They start to hate the Addict. As family members feel attacked, used, and abused by the Addict, they want to get even and fight back. Family members then become locked into the same fight that the Addict and the Self are locked into. The family tries to make the addict more responsible and respectful, but fails because a practicing addict is not able to change. The struggle continues, becoming a ritual embedded within the fabric of the family.

For example, suppose you love a family member who suffers from an addiction and is unable to love you back. You have deep mood swings, as the person you love swings from the Self to the Addict. One minute you may be relating quite well to the person’s Self; then something is said that awakens the Addict. The personality shift occurs, and the next minute you are hating the person, trying to figure out what happened. Perhaps you made a caring statement that triggered feelings of shame in the person and out came the Addict to protect his or her territory.

Because the person suffering from the addiction acts untrustworthy, the family stops trusting the person, and the members consciously or unconsciously start to distance themselves. This is a natural means of protection. When the person starts to act like his or her Self again, not like the Addict, family members start to feel ashamed for having distanced themselves. They decide to reach out once more, only to feel betrayed once again. This goes on and on until a family member cannot take it anymore and gives up trying to have any relationship with the person. But whenever family members feel the person’s Self trying to emerge, they will feel a longing to connect, but also a sense of shame for not wanting to for fear they will be hurt once again.

Because the person suffering from the addiction acts untrustworthy, the family stops trusting the person, and the members consciously or unconsciously start to distance themselves… When the person starts to act like his or her self again, not like an Addict, the family feels ashamed for having distanced themselves. They decide to reach out once more, only to feel betrayed once again.

Addiction never simply affects the addict alone. The addict pulls friends and loved ones into the vortext of their addiction, which can easily consume them all.

Friends and family try to make sense out of what is happening to their addicted loved-one. In trying to understand, people around the addict inevitably label him or her in an effort to cope with the changes.

What is really being labeled is the addictive personality. The addicted person may get labeled as ‘irresponsible,” ‘troubled,” ‘tense,” ’strange,” or ‘weak.” If people suspect the true source of the problem, addicts will be labeled more aggressively, to reflect what is happening, and how others perceive them. Family members use many labels when speaking about the addict:

He’s a bum.

He eats too much.

She’s so irresponsible.

All he does is buy, buy, buy!

All she does is work, work, and work!

He does drink a little too much.

He’s oversexed.

You just can’t trust her anymore.

When the labeling process occurs, it’s a sign that the illness of addiction has progressed to the point where family and friends have noticed it and must protect themselves from the addictive personality. People sense that the addict doesn’t care about others. They will protect themselves by either removing themselves from his or her presence or trying to control the addicted person.

Thus, for families, the labeling process is an attempt to control what is happening. Addicts react in turn to protect themselves. In doing so, the addictive defensive system becomes even better developed.

For the addictive process to continue, the addicted person must learn how to deflect the concern of others. One of the most dangerous aspects of the labeling process is that, once the addicted person is given a new label, the family starts to adjust to the ‘new person.”

The ‘new person’ can indeed be given a significant place within the family, who adjust and may even become dependent on having him or her around! ‘The Addict” becomes a role within the family and starts to serve a vital purpose. Family members are caught in a dilemma: they hate the Addict but still love the person they once knew, who still exists within the addict. It’s not typical for family members to realize they’re dealing with an illness; as the addiction progresses within the family, everyone slowly adjusts to it.

Family members or others, such as co-workers, start to see what a good scapegoat a person suffering from addiction can be. They start to hate the Addict. As family members feel attacked, used, and abused by the Addict, they want to get even and fight back. Family members then become locked into the same fight that the Addict and the Self are locked into. The family tries to make the addict more responsible and respectful, but fails because a practicing addict is not able to change. The struggle continues, becoming a ritual embedded within the fabric of the family.

For example, suppose you love a family member who suffers from an addiction and is unable to love you back. You have deep mood swings, as the person you love swings from the Self to the Addict. One minute you may be relating quite well to the person’s Self; then something is said that awakens the Addict. The personality shift occurs, and the next minute you are hating the person, trying to figure out what happened. Perhaps you made a caring statement that triggered feelings of shame in the person and out came the Addict to protect his or her territory.

Because the person suffering from the addiction acts untrustworthy, the family stops trusting the person, and the members consciously or unconsciously start to distance themselves. This is a natural means of protection. When the person starts to act like his or her Self again, not like the Addict, family members start to feel ashamed for having distanced themselves. They decide to reach out once more, only to feel betrayed once again. This goes on and on until a family member cannot take it anymore and gives up trying to have any relationship with the person. But whenever family members feel the person’s Self trying to emerge, they will feel a longing to connect, but also a sense of shame for not wanting to for fear they will be hurt once again.