1、Alcohol and the Family,NIAAA Social Work Education Module 10J,(revised 8/04),Outline,Background Family Systems Family Influences on Alcohol Use Disorders Alcohol Use Disorder Influences on Family Families and Recovery,Background,Approximately 17.6 million American adults abuse alcohol or are alcohol
2、 dependent Approximately 1 in 4 children is exposed to effects of alcohol abuse or dependence in a family member,Background (continued),“Family” is relevant because: Alcohol may influence family functioning Family functioning affects alcohol use/abuse Alcohol use disorders “run in families”,Backgrou
3、nd (continued),Family takes many diverse forms Nuclear Single parent mother Single parent father Ex- and Step- relations Grandparent, Aunt/Uncle as parent Foster families And others.,Background (continued),Family and family functions are defined differently in different cultures “Blood” relatives Le
4、gal bonds (marriage, adoption) Kin (extended family, multiple generations, close friends as kin),Background (continued),Family roles, rules, values about interdependence and relations, support systems vary by culture,Family Systems,Family systems are dynamic, changing over time as: membership change
5、s, individuals change, relationships change, context changes,Family Systems (continued),Family system is more than sum of parts Interactions Dynamics Rules Roles Boundaries Patterns Circularity of influence between individuals and whole,Family Systems (continued),Change in part of a system affects t
6、he entire system Developmental change of individual Loss of member (death, divorce, runaway, incarceration, cut offs) Gain new members Shift in a relationship,Family Systems (continued),Subsystems are embedded and operate in larger system Couple Parent-child Sibling Extended family Gender dynamics,
7、etc.,Family Systems (continued),Families exist within a larger social environment context,family,extended family,neighborhood,church,School/workplace,Legal system,Health/Mental Health services,Human services,Society,History,friends,Ethnic/cultural systems,Family Systems (continued),Families are mult
8、igenerational,X,X,X,X,X,Family Systems (continued),CHANGE = STRESS All changes: positive, negative Change requires adaptive energy, adjustment requires resources Systems resist change (systems seek and preserve homeostasis, equilibrium, balance),Family Systems (continued),Points of difficulty betwee
9、n individual in recovery and family system: Person tries to regain roles, positions in family system (decisions, authority, sex, intimacy, other reciprocal exchanges) Difficulties in parent-child relations (discipline, communication) Developmental changes, family life cycle transitions, situation ch
10、anges,Family Systems (continued),Conclusions: Family is a context for an individuals drinking problemsmay play a role in emergence and maintenance of the alcohol use disorder, may also play a role in treatment and recovery processes; family remains relevant to individuals,Family Influences on Alcoho
11、l Use Disorders: Genetics,Genetics matter in risk and resilience Family pedigree studies (4-7 x risk for 10 relatives) Adoption studies Physiological aspects of alcohol use disorders appear to have considerable heritability Genetics alone do not explain outcomesnot deterministic,Family Influences on
12、 Alcohol Use Disorders: Genetics (continued),Genetic factors interact with other biological and environmental context factorsGenetics x Biology x Environment=OutcomeSome factors are risk/vulnerability factors Some factors are protective/resilience factors Genetics explain vulnerability, environment
13、contributes to emergence or expression,Family Influences on Alcohol Use Disorders: Genetics (continued),Specific pathways are becoming better understood E.g., differences in physiological responses and sensitivity to alcohol,Family Influences on Alcohol Use Disorders: Family Context,“Individuals rea
14、red with an alcohol-abusing parent are at risk for developing alcohol problems due both to genetic factors and to faulty role modeling” (OFarrell, 1995) Some effects are direct, others are indirect effects (e.g., child temperament or hyperreactivity to stress),Family Influences on Alcohol Use Disord
15、ers: Family Context (continued),Exposure to key antecedants to heavy drinking episodes: Family arguments Poor family communication Inadequate family problem solving Nagging at home Exposure to key consequences for heavy drinking episodes Deliver reinforcement Remove negative consequences,“Causes“,“E
16、ffects“,Family Influences on Alcohol Use Disorders: Family Context (continued),Exposure to a parents alcohol use disorder may: Result in easy access to alcohol by children, adolescents, young adults Establish norms of tolerating heavy alcohol use by family members Result in poor/absent parental moni
17、toring of alcohol use by children, adolescents, young adults Lead to development of risky “alcohol expectancies” early in life,Alcohol Use Disorder Influences on Family,Relationship of alcohol abuse to other family problems may be:Causal A BReciprocal A BIterative A B A B A BIncidental to other caus
18、es A BC,Alcohol Use Disorder Influences on Family: Couples,Alcohol Use Disorders affect couples Communication Conflict levels increased Nagging Poor sexual relations Domestic violence Partner stress,Alcohol Use Disorder Influences on Family: Parent-Child Relations,Parenting practices can be affected
19、 by alcohol use disorders Family life may be chaotic, involve poor quality environments when parents have alcohol use disorders Childrens exposure to conflict is common when parents have alcohol use disorders,Alcohol Use Disorder Influences on Family: Parent-Child (continued),Parental Drinking,Child
20、 Behavior Problems,Poor Parenting Practices,?,Alcohol Use Disorder Influences on Family: Children of Alcoholics,children of current alcoholics,children of parental period alcoholics,children of lifetime alcoholics,Alcohol Use Disorder Influences on Family: Children (continued),Parental Alcohol Use D
21、isorder,Heterogeneity of Child Outcomes,filtering influences,Alcohol Use Disorder Influences on Family: Children (continued),Resilience factors also act as filters that help shape the developmental impact of parental alcohol use disorders,Alcohol Use Disorder Influences on Family: Children (continue
22、d),Preventive and treatment interventions for children of alcoholic parents face barriers: Children having access, transportation Payment, resources Fear, anxiety, embarrassment, trust, other emotional hurdles of children Parents minimization and no consent Developmental appropriateness of program,A
23、lcohol Use Disorder Influences on Family: Children (continued),Fetal alcohol exposure concerns are important considerations with regard to alcohol use disorders and their potential impact on children,Alcohol Use Disorder Influences on Family: Siblings,Sibling research helps address heritability ques
24、tionsthere is a genetic influence combined with an environmental influence Siblings act as agents of socialization through: Modeling Reinforcement/punishment Rule enforcement Shaping developmental environments,Alcohol Use Disorder Influences on Family: Siblings (continued),A persons drinking can aff
25、ect relationships with brothers and sisters Siblings may be role models for each others drinking behavior Siblings may be a source of access to substances like alcohol Structured sibling support interventions may help,Families and Recovery,Family,Influence Relapse?,Facilitate Recovery,Families and R
26、ecovery (continued),Family Systems Models: family homeostatic functions preserve balance for system as a whole, regardless of “cost” to individual members Individuals alcohol use disorder “serves” a family “stabilizing” function and system maintains the behavior to prevent change,Families and Recove
27、ry (continued),Behavioral Family Models: based on social learning theory, alcohol use disorders are learned and maintained through interaction with social environment Observational learning Operant learning Presence/absence of opportunities,Families and Recovery (continued),Family can affect recover
28、y if they: Provide drinking stimuli/cues (-) Model drinking (-) or other “coping strategies” (+) Influence vulnerability (+ or -) Reinforce or punish sobriety efforts (+, -) Prevent negative consequences from being experienced (-),or,Families and Recovery (continued),Family Disease Model: Alcohol us
29、e disorders represent diseases that affect both individuals and the family Treatment from this approach helps family members heal themselves,Families and Recovery (continued),Family “Readiness to Change” parallels individual change process Precontemplation Contemplation Preparation Action Maintenanc
30、e,Families and Recovery (continued),Interventions involving family and “significant others” are more effective (better compliance, better outcomes) than treating individuals with alcohol use disorders in isolation SSO=supportive significant other,Families and Recovery (continued),Relative effectiven
31、ess of intervention type interacts with nature of the social support networks (e.g., family at home) METTSP if low support for drinking, TSPMET if support for drinking in social network SO intervention and family therapy improves outcome for individuals with low abstinence support,Families and Recov
32、ery (continued),Factors affecting family therapy acceptance by alcoholics: Couple lives together or reconciling if separated Couple enters treatment after relationship threatened Only one person has alcohol use disorder; others do not have serious mental health problems No family violence problem,Fa
33、milies and Recovery (continued),When both partners have alcohol use disorder, advantages gained by working simultaneously In all couples, priority should be addressing alcohol abuse before relationship work, then address family problems caused by alcohol,Families and Recovery (continued),Most import
34、ant “significant others” might not be the most obvious For a particular individual, it might be: Parent Partner Friend Grandparent Sibling, cousin Son/daughter,Families and Recovery (continued),Barriers to family intervention with alcohol use disorders: Potential for violence/safety risks Legal restrictions More than one family member actively abusing substances High blame levels Practical barriers (geography, separations, schedules, child care, reimbursement),
