Alcohol or substance-abuse in the family is often a central theme around which the entire family is organized and operates. Yet, substance-abuse treatment is often individual focused and does not actively involve the entire family.
State of the Problem
Family members with substance-abuse are often treated in separate silos. For example, it is commonplace for an individual recovering from alcohol addiction to attend AA (Alcoholics Anonymous) groups while their family members separately attend Al-Anon (support group for loves ones of alcoholics). But there is no active family treatment with both parties together in the same room.
In addition, the constant drama and conflict around substance-abuse can result in these three types of secondary trauma:
- Vicarious effects: Other family members are traumatized vicariously when they learn that another family member is experiencing the emotional trauma of addiction.
- Chiasma traumatic stress: Other family members are traumatized through seeing the traumatized member struggle with addiction.
- Intrafamilial trauma: Family members are traumatized by other family members, such as in cases of abuse or neglect which are the direct result of the substance-abuse.
The longer the substance-abuse continues, the great the risk of secondary trauma. The reason is that over time, family life can become organized around the alcohol or drug abuse. And the substance-abuse can become an important element in the family’s sense of itself (the family identity) and even determine the rules and patterns of behavior within the family. In turn, this can lead behaviors such as overaccommodation or enabling. For example, when family members start to “walk on eggshells” around a family member for fear they might trigger them to start drinking or using drugs again.
This article will show the benefits of seeing the role that family systems trauma can play in treating substance-abuse.
A Family Trauma Solution
In the book, The Alcoholic Family, Dr. Steinglass and his team can be credited with one of the first extensive research projects that saw substance abuse from a family systems lens. Or that the family is a living system with its own rules of behavior and personality attributes around the substance abuse.
Steinglass called these “stable wet,” “stable dry,” and “transitional” phases of alcoholism or substance abuse. In other words, some families live through only one major transition from an active drinking or drug period to a period of permanent abstinence. Most families, however, experience multiple transitions between wet and dry phases.
These phases can be illustrated as interactional patterns or feedback loops between family members. Feedback loops can show how the substance-use serves a function to solve specific problems in the family. For example, in some families the alcoholic member of the family might, through his or her drinking, protect or distract a spouse from depression. And if they stop drinking, that spouse’s depression immediately returns.
Or how a marital couple might explain that the marriage will be saved if the substance-abusing spouse gets sober. But when sobriety happens, divorce is the result. Why? Because the sober spouse still interacts in the same exact way with the now sober spouse as they did before sobriety. There are no new rules of engagement.
In response to these challenges, the Family Systems Trauma (FST) Model tackles substance-abuse using the following FST feedback loop technique:
- “Before” Feedback Loops- The FST therapist draws out feedback loops that illustrate for the family how the alcohol or drug abuse plays a central role in controlling or regulating roles and interactions (i.e., unhealthy undercurrents). This is the “before” feedback loop or current state of the family in the here and now. [see Figure 1]
- “After” Feedback Loops- The FST therapist then draws the “after” feedback loop or what it can look like in the future if the roles and interactions change (i.e., healthy undercurrents) around the substance-abuse. And kicking the toxic seed of substance-abuse out of the family.
The FST feedback loop technique is one of the most effective ways to “externalize the problem”. This means that it is the alcohol or drug that is the problem, not the person. And it must be kicked out of the family with everyone’s help instead of just fixing the individual through drug rehabilitation and individual therapy. This both/and perspective of individual sobriety and family change is an ideal non-blaming and non-shaming first step in substance-abuse treatment using a family systems trauma lens.
Using Movie Scenes to Onboard “Before” Feedback Loops
To illustrate a family systems connection to substance abuse, a key movie scene is shown from the 1994 film “When a Man Loves a Woman” This movie stars Alice Green (Meg Ryan), as a school counselor with a serious drinking problem, who is married to Michael (Andy García), an airline pilot with nine-year-old Jess and four-year-old Casey.
The recommended movie scene (1 hour and 14 minutes into the film) shows what happens when Alice returns home sober after rehab. Alice tries to parent her daughters when they misbehave only to have Michael immediately take over and treat her as if she were still drinking. A fragile patient that must be cared for. Alice ends the interaction by telling her husband how badly she wants to start drinking again.
The FST therapist first maps out this scene using a “before” feedback loop to illustrate the alcoholic dance between both parents and their marriage and how it prevents good parenting and true marital intimacy (see Figure 1). After the feedback loop is presented, the movie clip is shown. Rich discussion follows between you and your family as you can parallel the movie scene to how substance abuse has:
- Organized the family interactions around alcohol or drug abuse.
- Become an important element in the family’s sense of itself (the family identity)
- And determined the rules and patterns of behavior within the family.
- And how this, in turn, can lead to overaccommodation or enabling.
Seeing actors on the screen and a movie clip can make this important discussion less threatening and illustrate clearly the family systems trauma interactional dance around substance-abuse.
Figure 1: The “Before” Feedback Loop
Please note: This movie scene occurs at 1hr and 14 minutes into the film
As Figure 1 illustrates, the feedback loop “externalizes the problem” by showing that alcoholic or substance abuse as a toxic seed with a set of unhealthy undercurrents that have overstayed their welcome in the marriage or family, caused great harm, and need to be kicked out.
After showing this “before” feedback loop, you and your clients can then discuss how this movie scene or substance-abuse dance parallels their own family or marriage and if they want to as a family or couple, kick out the alcohol or drug abuse seed with its unhealthy undercurrents.
In addition, it sets up you, the FST therapist, to show the next step. The “after” feedback loop (beyond the scope of this article) that illustrates what it can look like in the future if the unhealthy undercurrents were replaced with their health counterparts. For example, what would happen if Alice were seen and treated as a competent equal by Michael instead of a fragile patient and if Michael could safely grieve the loss of the old Alice (pre-sober) and feelings abandonment and giving up the role of savior.
A Success Path to Become a Family Trauma Expert
If you want to learn about an intensive application of this technique and others, register for the next monthly webinar at www.familytrauma.com or join our FST Advanced Training Course. This self-paced course teaches professionals the 12 Core Techniques of the FST model.