Parents of young addicts suffer the aftershocks of trauma long after the addict has entered REHAB and begun recovery. The Family Member PTSD Scale © Note1 which assesses family members of drug addicts for SHOCK, ISOLATION, VICTIMIZATION, SHAME, OVER-RESPONSIBILITY, LACK OF HOPE, and GRIEF, as well as for other symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex Post-Traumatic Stress Disorder (C-PTSD), is the first tool to use when starting to work with families of addicts. The scale was designed to determine the degree of trauma and the residual effects that trauma has had on parents and siblings. There are stages of unresolved trauma which must be known before beginning family reconciliation.
Examples of some of the typical SHOCK questions on the scale that parents of addicts endorse include: "I am numb from dealing with the crisis of addiction" or "I am shut down emotionally and do not respond like I used to" or "I have flashbacks of incidents that happened in our family when we were dealing with active addiction" or "When the phone rings late at night, I sometimes still experience startle, fear and vivid memories."
Most families have some form of PTSD. A parent who found their child collapsed in the bed or bath nearly dead from an overdose, who experienced a surge of adrenalin to handle the emergency, and never processed the crisis, is frequently haunted by vivid recollection, and nightmares. The nightmares can last for years. For many parents, the long battle with trying to save their teenager's life has resulted in C-PTSD. C-PTSD was first described in 1992 by Judith Herman in her book Trauma & Recovery. It is a psychological injury that results from protracted exposure to prolonged interpersonal trauma with "loss of feeling in control", "disempowerment", or "feeling trapped," which parents suffer knowing they are responsible for underage children in grave danger. The key difference between PTSD and C-PTSD is the concept of "protracted exposure."
All previous family models for working with addiction have approached the family system from the point of view as if addiction began with adults and was passed down generationally. Today we are seeing a very high percentage of first-generation addicts, and the devastation to relatively normal parents when their children turn to drugs is incomprehensible. We have begun to work with families using a different model from the traditional model of family systems theorists of 20 years ago. Once the addict is admitted to REHAB, an immediate assessment for Post Traumatic Stress (PTS) of parents and siblings of these young addicts is begun. Some form of relief from the PTS symptoms is the most immediate need of family members. For some parents, the admonition to just "start working on your own issues" feels like a slap in the face. When the very first advice parents get from treatment center staff are things like "look at your enabling" or "look at your codependency" or "go find an ALANON group and work on your own stuff", some are offended and further traumatized by the lack of empathy for their current state of SHOCK.
"The most painful thing that we see parents dealing with," says April Lain, M.Ed, L.L.S.A.C, who has facilitated over 360 family workshop sessions integrating young adults back into their family of origin, "is the confusion of being told to disengage and leave the addict on their own - the concept of ALANON of "detach with love" is healthy but can be confusing. Parents are sometimes even made to feel guilty for continuing to seek help for their adult children who are caught in the grip of addiction, when intervention is required." She goes on to say, "I tell these parents not to feel guilty for seeking help. If you saw a stranger standing out on the ledge of a 14-story building about to jump off, wouldn't you at least call 911 and try to save their life? If you would do that for a stranger, why not for your own son or daughter who is standing on the proverbial window ledge and their life is in great danger from drug and alcohol use?" For parents who are in the trenches strategizing interventions, they are still on the battle ground. The adrenalin is still pumping. Lives are at stake.
The PTSD/C-PTSD approach to dealing with families is cutting-edge and compassionate. Without fail, along the way, the family members have suffered severe abuse from the addict. Abuse comes in several forms: Overt, Covert, Stealth, Structured, and Impulsive.
Overt abuse is clear-cut and easily recognizable and easy to describe. Cursing, name-calling, fighting, and verbal threats are overt and obvious. If your beloved son or daughter is standing in your kitchen threatening you with a knife, it is obviously abuse and is easily describable to others. If your teenager is throwing things or kicking holes in doors, you have evident visible damage. If you have bruises, broken lamps and you've started to put locks on your bedroom door out of fear, you are dealing with overt, tangible abuse.
On the other hand, covert abuse by an addict revolves around the addict's need to assert and maintain control over his/her parents or brothers and sisters. Covert abuse may not be visible to others such as to the non-custodial parent in divorced families, or with grandparents or schools and even police or coaches who continue to see the addict as charming. These "outsiders" will say, "Oh, you are making a big deal out of nothing." Or, "They will grow out of it, quit nagging them." Covert abuse is emotional and manipulative. It takes advantage of trust and costs parents their self esteem and confidence. Covert abuse is made all the more painful because others do not see the emotional damage - they only see a seemingly "crazy person" who is dealing with the aftermath of addiction.
Stealth abuse such as gaslighting is a form of abuse where the truth gets denied so often and so convincingly that the parent starts to believe they are going crazy. It is the deliberate use of false information to make others doubt his or her own reality, doubt their own memory, and not trust their own perceptions. (The term gaslighting comes from a 1944 film called "Gaslight" starring Ingrid Bergman. Her charming new husband deliberately attempts to drive her crazy, i.e., gaslighting.) Many parents report a feeling "like I was losing my mind".
Sometimes addicts manifest what is known as a patterned (or structured) abuse. That is someone who abuses everyone around them, not just parents but other children, friends, authority figures. The abuse is predictable- everyone gets a fair share. Other addicts are more unpredictable and impulsive with their abuse - they are nice at times and then they strike "out of the blue" in a flurry of chaos. One never knows when the rage fit will hit.
Bessel van der Kolk, in his "Assessing and Treatment of Complex PTSD" identified depression, lack of self worth, problems with intimacy, inability to experience pleasure, satisfaction, or to have fun, as symptoms of C-PTSD. There are no reliable statistics of the number of marriages that do not survive dealing with a child addict, but it appears it could be as high as 20 percent. It is complicated because other factors might have impacted the marriages. The emotional toll is very high on the family.
Drugs and alcohol have taken a foothold on our younger generations on an epidemic scale. Validating the stress that the families have endured is the first step for starting to work with the family. Helping the family to recognize the PTSD characteristics of their reactions, helping them to heal and finally, helping the addict to feel and show empathy for how the trauma has impacted those who love them- that is the work of a REHAB Family Counselor.
Bonnie A. DenDooven
Bonnie A. DenDooven, MC, LAC, a family workshop therapist at Gatehouse Academy, is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work behaviors. She is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the "un-DSM").
As part of its ongoing video series, The Meadows presents an 11-part interview with John Bradshaw, world-famous educator, counselor, motivational speaker, author, and leading figure in the fields of addiction and recovery.
In the sixth video of his series, Mr. Bradshaw, senior fellow at The Meadows, discusses the use of families as social systems in the treatment of addiction and trauma.
"One of the things I like about The Meadows is that they use the model of families as social systems," he says, explaining that members of an addictive or abusive family will typically involve the other family members in their behaviors. As an example, he cites a mother addicted to prescription medication. "Family members make excuses for her and assume her responsibilities, thereby becoming codependents in her addiction."
"At The Meadows, we treat that," Mr. Bradshaw says. "We want people to understand the family of origin. The Meadows brings the family in, helps the whole family to understand."
Mr. Bradshaw has been affiliated with The Meadows since 1979, giving insights to staff and patients, speaking at alumni retreats, lecturing to mental health professionals at workshops and seminars, and helping to shape its cutting-edge treatment programs. He also has authored several New York Times best-selling books, including Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.
In other videos in this series, Mr. Bradshaw discusses such topics as the importance of after-care facilities, and the relationship between shame and depression. To view all the videos in this series, visit www.youtube.com/themeadowswickenburg.
For more about The Meadows' innovative treatment program for addictions and trauma, see www.themeadows.org or call The Meadows at 800-244-4949.
May 5, 2011
Sarah B. Warren, PhD will be speaking at The Meadows Free Lecture on May 5, 2011, at 7pm at the Winnetka Community House in Winnetka, Illinois. Dr. Warren will discuss Hope for Families: A New Approach to Intervention. Even if it seems like you've tried everything, even if it seems like the alcoholic or addict will not accept treatment, there is help for your family. Dr. Sarah Warren will share her innovative, respectful, customized and highly-effective approach to Intervention which draws on her years of experience as a hospital trained clinical psychologist. She will answer these questions:
Is it possible to get someone to go to treatment even if they’re in denial?
Don't you have to use deception to get someone to an Intervention?
What if someone has "failed" in treatment before?
How do we get off the addict's roller coaster ride?
Contact Jenna Pastore at 815-641-2185 for more information. No registration required. We look forward to seeing you.
The Meadows is proud to present its 2010 Annual Symposium from Wednesday, October 13 through Friday, October 15 at Hoffman Estate, Illinois. The Symposium will include presentations by Pia Mellody, Maureen Canning, MA, LMFT, John Bradshaw, MA, Bessel A. van der Kolk, MD, and Jerry A. Boriskin, PhD, CAS.
This dynamic event will feature the insights of the speakers as they share their philosophies, treatment techniques, and skills regarding such issues as trauma, addictions, relationships, healthy sexuality, codependence, spirituality, and family systems.
Interested persons can sign up for the entire event or may choose to attend the Wednesday evening lecture only. More information about the Symposium, including program session descriptions, a detailed schedule, and information about Continuing Education credits, is available at the Symposium page on The Meadows web site.
Note: This article was originally published in the Summer 2006 edition of Cutting Edge, the online newsletter of The Meadows.
Sharing the Disease
by Claudia Black, PhD, MSW
It has long been known by addiction professionals that, for every person addicted, approximately another four persons, usually immediate family members, are directly affected - husbands, wives, committed partners, mothers, fathers, siblings, and young and adult children.
Would the impact of addiction be reduced if four times the number of family members took part
in recovery programs? Would the impact be reduced if educational and treatment programs addressed the confusion, fear and pain suffered by families and children when the addicted person enters treatment? How might the lives of family members be altered if interventions were directed to them?
As the addict deserves his or her recovery, so do codependent family members. When family members recognize their codependency and its similarities to the addict's addiction, they can recognize the mutuality of their recovery processes.
The following, excerpted from my recently published Family Strategies: Practical Tools for Professionals Treating Families Impacted by Addiction, helps therapists working with family members to link the addict's behaviors with similar behaviors experienced by the family. This approach allows family members to realize they also have issues from which to recover.
The following provides examples of each disease symptom as experienced by the addict and by the family member (codependent).
"I wonder if there's enough booze at home or if my dealer will be home or if I have enough money for my drugs."
"I will need to cover my bases with my family by ..."
The addict has a repetitive focus on behaviors connected to his/her acting out behavior.
The codependent experiences the inability to focus on other things without intrusive thoughts about the addicted person and his or her behaviors.
Codependent Family Member
"I wonder where my husband is, who he is with and what I will say to him when he gets home."
"I used to get drunk on six beers. Now it takes a dozen."
"I used to be satisfied with pornographic magazines; now I need contact with someone on the Internet who will interact with me."
The addict needs to engage more frequently in the behavior or the substance to garner the desired effect, which is usually related to a neurochemical change.
The codependent displays an increase in psychological tolerance as he/she increases acceptance of inappropriate and/or hurtful behavior with lower expectations.
Codependent Family Member
"He used to be critical of me and I would get really upset; now he calls me horrible names and it's no big deal to me."
Loss of Control
"I told myself I was only going to spend 50 dollars at the casino and lost my whole paycheck before I left."
"I told myself I would only have one glass of wine at the wedding, and I got drunk and passed out."
The addict is no longer able to predict engaging or using behavior.
The codependent is also no longer able to predict his or her own behavior.
Codependent Family Member
"When I know that he is going to be late for dinner again, my plan is to give him the cold shoulder and go about my business. On occasion I'll snap. Yesterday I planned on ignoring him, but I ended up screaming in front of the kids. I, not my husband, was out of control."
"I don't know where I was, what I did, or who I was with last night."
Blackouts are the one symptom the addict experiences that is not an exact carryover to the codependent. The substance addict has a period of amnesia, usually lasting from hours to days. He/she is conscious and interacting, but the memory is not imprinted on the brain, and therefore it cannot be recalled.
The codependent's blackout, often referred to as a "brown-out," is due to the stress of heightened emotions; there is too much emotionally charged stimuli for details of what occurred to be recorded. It may not be a well-delineated block of memory as a substance abuse blackout. It is more a sense of something occurring without clarity. This could be referred to as a trance-like or dissociative experience in which the memory may or may not be recorded and is not readily available for conscious memory. The process addict's (gambler or sex addict) blackout is more similar to the codependent's than the substance abuser's.
Codependent Family Member
"We had a screaming fight the other night. I don't remember exactly what I said."
"I wanted cocaine so bad I could taste it."
The addict has a severe physical or psychological urge or craving to reengage in the substance or behavior.
The codependent experiences a deep obsessive psychological urge or longing for the times when things were better. Frequently, craving goes hand in hand with euphoric recall (romanticizing the good times).
Codependent Family Member
"I really miss him. When he is gone, I ache for him."
"When I had a craving, I knew I shouldn't drink, but I found myself in the bar last night anyway."
Addicts begin engaging in behavior in a manner that they feel driven and obsessed, and they do so repeatedly, which often reduces cravings or preoccupation.
Codependents may begin engaging in behaviors such as snooping, spending money, eating, sex, etc. Codependents' compulsivity may be acted out in perfectionistic tendencies.
Codependent Family Member
"My house is clean, with everything in its place. It makes up for how I feel inside."
"I used to be able to stay out for hours using, and now I am in trouble shortly after I begin."
Progressively the addict cannot engage or use to the extent he/she once did and begins to experience negative symptoms more quickly.
The codependent becomes less patient, is less likely to stay in denial and may experience an emotional bottom. Usually these symptoms transpire more in the latter stages of the addictive process.
Codependent Family Member
"I can't take any more. Everything he does irritates me."
"I thought running marathons was proof I was healthy, fueling my denial about my substance abuse - to find myself slowly and silently becoming physically sick."
In the latter stages of addiction, particularly if the addict is a substance abuser, physical problems can run the gamut from heart and lung disease, brain disease, liver damage, throat and mouth diseases to diabetes and digestive disorders.
Medical problems may also be related to unsafe sexual practices, accidents, and injury.
Codependents are more apt to experience stress-related health problems ranging from headaches, stomach or digestive problems, hives, back problems, ulcers, depression and/or anxiety. Many diseases codependents suffer are fueled and complicated by stress, most specifically autoimmune disorders.
Codependent Family Member
"I went to one doctor after another, thinking my problems were all physical, to find after months in a 12-Step program my physical ailments disappeared."
In conclusion, it is important to continue to talk about disease-related behaviors such as lying, sneaking, etc. and the many feelings related to living with addiction. To understand the addict's process and then consider the family's similar experiences helps family members understand that they are in need of recovery as well. Family Strategies offers a wide variety of tools to assist families in their healing processes.
As family members share in the disease, they may now share in the recovery.
About the Author
Claudia Black, PhD, MSW, Clinical Consultant for The Meadows, is a lecturer, author and trainer internationally recognized for her pioneering and contemporary work with family systems and addictive disorders. She serves on the Advisory Board for the National Association of Children of Alcoholics, and has been a keynote speaker on Capitol Hill in Washington,DC. Claudia has been featured in numerous publications, appeared on many national television shows, and written several well-known books, including Changing Course, It Will Never Happen to Me, A Hole in the Sidewalk, Depression Strategies, Straight Talk, Relapse Toolkit, The Stamp Game: A Game of Feelings, and her latest book, Family Strategies.