Alcoholism Within A Multigenerational Traumagenic Family Framework

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This is a presentation that presents the nature of traumagenic family dynamics and how those dynamics support the inter-generational transmission of trauma and addictions

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  • Chassin and Colleagues; Jessor and Colleagues; Schulenberg et al., Dennis Wholley Courage to Change Anne Fletcher, Sober for Good
  • Alcoholism Within A Multigenerational Traumagenic Family Framework

    1. 1. Alcoholism within a Multigenerational Traumagenic Family Framework P. Robert Rhoton PsyD [email_address] www.Azturamatherapy.com Psychological Health and Wellness
    2. 2. <ul><li>Today’s objectives </li></ul><ul><li>Family Patterns Related to multi-general Alcoholism </li></ul><ul><li>Traumagenic family patterns </li></ul><ul><li>Addiction cycle </li></ul><ul><li>Summary and Questions </li></ul>
    3. 3. What are Addictions? <ul><li>Habitual patterns of intentional, appetitive behaviors </li></ul><ul><li>Become excessive and produce serious consequences </li></ul><ul><li>Stability of these problematic behavior patterns over time </li></ul><ul><li>Interrelated physiological and psychological components </li></ul><ul><li>Addicted individuals have difficulty modifying and stopping them </li></ul>
    4. 4. Traditional Models for Understanding Addictions <ul><li>Social/Environmental Models </li></ul><ul><li>Genetic/Physiological Models </li></ul><ul><li>Personality/Intra-psychic Models </li></ul><ul><li>Coping/Social Learning Models </li></ul><ul><li>Conditioning/Reinforcement Models </li></ul><ul><li>Compulsive/Excessive Behavior Models </li></ul><ul><li>Integrative Bio-Psycho-Social Models </li></ul>
    5. 5. A basic truth <ul><li>No single developmental model or singular historical path can explain acquisition of and recovery from addictions </li></ul><ul><li>A focus on the process of development and maintenance of interacting systems can be useful to comprehending Alcohol use and family dynamics </li></ul>
    6. 6. BECOMING ADDICTED <ul><li>Happens over a Period of Time </li></ul><ul><li>Has a Variable Course </li></ul><ul><li>Involves a Variety of Influencers/Predictors that can be both Risk and Protective Factors </li></ul><ul><li>Involves a Process of Change </li></ul>
    7. 7. Defining the Traumagenic Family <ul><li>When patterned and habituated family behavior and interactions interrupt or interfere with the normal developmental (emotional, psychological, and social) processes --- this can be designated a traumagenic family structure. </li></ul><ul><li>Families with multigenerational Alcoholism meet the criteria of being traumagenic </li></ul>
    8. 8. WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES <ul><li>They are often socially isolated, and have little emotional and financial support. </li></ul><ul><li>Depression is a common factor in the neglect of children. </li></ul><ul><li>They are prone to use the same abusive techniques with their own children, that they hated as children. </li></ul>
    9. 9. WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES <ul><li>They often show limited insight into the complexity of the child's emotional and psychological needs and development </li></ul><ul><li>Such parents are at high risk to become overwhelmed and frustrated, and engage in hostile discipline and parenting as well as increased substance use. </li></ul><ul><li>Parents who do not understand these issues often attribute their child's misbehavior to willfulness on the child's part, a conscious intention to cause the parent aggravation and frustration. </li></ul>
    10. 10. WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES <ul><li>They often experience high levels of stress and discord in their lives, often as a result of the chaotic and unhealthy environments in which they live. </li></ul><ul><li>The parents who have substance abuse problems show higher levels of marital discord and violence. </li></ul><ul><li>Substance abuse generally exacerbates stress, and stress is more likely to occur after a partner has been using substances. As a result, the children experience high levels of anxiety and become &quot;emotionally overloaded.&quot; </li></ul>
    11. 11. WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES <ul><li>The children often feel responsible for the stress, and experience intense feelings of helplessness and powerlessness related to dealing with the dynamics created by parents that use. </li></ul><ul><li>children receive inconsistent structure, support, and affection for extended and unpredictable periods of time. &quot;Interrupted parenting&quot; or a &quot;wavering commitment&quot; to parenting is most harmful. </li></ul>
    12. 12. WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES <ul><li>Sometimes children show extreme difficulty bonding with the parent and feeling safe with them </li></ul><ul><li>Parents use power control strategies (e.g., threats, demands, disapproval), and fail to respond positively to the child's good behavior. </li></ul><ul><li>Parents respond to the child's increasing disobedience with more negative, controlling, and punitive behaviors, and the child's behavior becomes worse. </li></ul>
    13. 13. WHAT DO WE KNOW ABOUT TRAUMAGENIC/ALCOHOLIC FAMILIES <ul><li>The parent is likely to show hostility, be demanding and rigid, and respond critically to the child. </li></ul><ul><li>Family shows poor conflict resolution skills </li></ul><ul><li>The children are likely to withdraw from the parent, show more aggressive behavior and disobedience, and initiate poor quality positive peer and child-adult contact. </li></ul><ul><li>Children more likely to adopt and use family interactional style and abuse substances to cope with family dynamic </li></ul>
    14. 14. Five Traumagenic Family Themes <ul><li>DISCONNECTION & REJECTION </li></ul><ul><li>IMPAIRED AUTONOMY & PERFORMANCE </li></ul><ul><li>IMPAIRED LIMITS </li></ul><ul><li>OTHER-DIRECTEDNESS </li></ul><ul><li>OVERVIGILANCE  & INHIBITION </li></ul>
    15. 15. Theme #1: DISCONNECTION & REJECTION <ul><li>A family Pattern where a child’s expectation that their needs will not be met in a predictable manner. Especially those needs for: </li></ul><ul><ul><li>Security and safety </li></ul></ul><ul><ul><li>Stability, nurturance, and empathy. </li></ul></ul><ul><ul><li>Sharing of feelings, acceptance, and respect. </li></ul></ul>
    16. 16. Theme #1: DISCONNECTION & REJECTION <ul><li>The perceived instability or unreliability of those available for support and connection. Involves the sense that significant others will not provide emotional support, connection, strength, or practical protection </li></ul><ul><li>Family members are emotionally unstable and unpredictable (e.g., angry outbursts), unreliable, or erratically present, frequently related to substance use. </li></ul>
    17. 17. Theme #1: DISCONNECTION & REJECTION <ul><li>  The three major forms of deprivation are: </li></ul><ul><li>Deprivation of Nurturance :  Absence of attention, affection, warmth, or companionship. </li></ul><ul><li>Deprivation of Empathy:  Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from   others. </li></ul><ul><li>Deprivation of Protection:  Absence of strength, direction, or guidance from others. </li></ul><ul><li>All forms of deprivation are increased with high levels of substance abuse in the family </li></ul>
    18. 18. Theme #1: DISCONNECTION & REJECTION <ul><li>Family members including children frequently have the feeling that they are defective, bad, unwanted, inferior, or invalid in important respects; or unlovable. </li></ul><ul><li>May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one's perceived flaws. </li></ul>
    19. 19. Theme #2 DE PENDENCE / INCOMPETENCE <ul><li>Belief that one is unable to handle one's everyday responsibilities in a competent manner </li></ul><ul><li>Belief that without considerable help from others (e.g., take care of oneself, solve daily problems, exercise good judgment, tackle new tasks, make good decisions) one will fail </li></ul><ul><li>Belief that substance use will improve overall performance and ability. </li></ul><ul><li>Often appears as helplessness to others </li></ul>
    20. 20. Theme #2 DE PENDENCE / INCOMPETENCE <ul><li>Excessive emotional involvement and closeness with one or more significant others (often parents), at the expense of full individuation or normal social development.   </li></ul><ul><li>Often involves the belief that one cannot survive or be happy without the constant support of another or a substance.    </li></ul>
    21. 21. Theme #3: I MPAIRED LIMITS <ul><li>Deficiency in internal limits, responsibility to others, or long-term goal-orientation. </li></ul><ul><li>Leads to difficulty respecting the rights of others, cooperating with others, making commitments, or setting and meeting realistic personal goals. </li></ul><ul><li>Family pattern characterized by substantial substance abuse, permissiveness, overindulgence, lack of direction, or structure. </li></ul><ul><li>Poorly established limits in relation to taking responsibility, cooperating in a reciprocal manner, and setting goals. </li></ul>
    22. 22. Theme #4: OTHER-DIRECTEDNESS <ul><li>An excessive focus on the desires, feelings, and responses of others, at the expense of one's own needs. </li></ul><ul><li>Behaviors to gain love and approval, or avoid retaliation.   </li></ul><ul><li>Family patterns of conditional acceptance where family members must suppress aspects of themselves in order to gain love, attention, and approval.   </li></ul><ul><li>Parental emotional needs and desires are valued more than the unique needs and feelings of each child. </li></ul>
    23. 23. Theme #5: OVERVIGILANCE  & INHIBITION <ul><li>Excessive emphasis on suppressing one's spontaneous feelings, impulses, and choices OR on meeting rigid, internalized rules and expectations about performance and ethical behavior often at the expense of happiness, self-expression,  relaxation, close relationships, or health.   </li></ul><ul><li>A family pattern that is demanding, punitive and focused on performance, duty, perfectionism. </li></ul><ul><li>A family pattern of hiding emotions, and avoiding mistakes dominate over pleasure, joy and relaxation.   </li></ul>
    24. 24. Traumagenic Families Experience <ul><li>Agitation and irritability </li></ul><ul><li>Sadness, grief, depression </li></ul><ul><li>Feeling hopeless (nothing they do will make things better) </li></ul><ul><li>Feeling numb (poor or little recognition of emotions) </li></ul><ul><li>Suspicious/untrusting (constant testing of every relationship) </li></ul>
    25. 25. Characteristics of children and adults <ul><li>Victim Stance </li></ul><ul><li>Blame others for not meeting responsibilities </li></ul><ul><li>Blames others for their inappropriate behavior </li></ul><ul><li>Always have a ready excuse </li></ul><ul><li>Fight for the right to be a victim </li></ul><ul><li>Resist efforts to appropriately solve problems that are causing them distress </li></ul><ul><li>Focus away from assuming responsibility </li></ul>
    26. 26. Characteristics of children and adults <ul><li>Sense of Injustice </li></ul><ul><li>View normal expectations as unfair </li></ul><ul><li>Refuses to follow “unfair” directions </li></ul><ul><li>Refuse to meet “unfair” expectations </li></ul><ul><li>Complain that the consequences for any of their actions that bring negative feed back or correction is unfair </li></ul>
    27. 27. Characteristics of children and adults <ul><li>Uniqueness (Grandiosity) </li></ul><ul><li>Claim that they are different or unique and should have a different set of rules and expectations </li></ul><ul><li>Demand others understand them </li></ul><ul><li>Accuse others of not understanding them or making adequate efforts to understand them </li></ul><ul><li>Focus on how they are not understood rather than resolving problems or conflicts </li></ul>
    28. 28. Characteristics of children and adults <ul><li>One way boundaries </li></ul><ul><li>Demands respect and privacy in inappropriate ways </li></ul><ul><li>Violates others privacy </li></ul><ul><li>No reciprocity in respecting the rights of person or property </li></ul><ul><li>Behaves suspiciously and then becomes enraged when those behaviors are questioned </li></ul>
    29. 29. Characteristics of children and adults <ul><li>Concrete transactions </li></ul><ul><li>Sees rules, guidelines, and restrictions as obstacles that must be overcome </li></ul><ul><li>Manipulate others by being charming or compliant in order to avoid being held accountable to the rules </li></ul><ul><li>Focus on one-way rights (seeing their own rights and not the rights of others) </li></ul>
    30. 30. Characteristics of children and adults <ul><li>Pride in Negativity </li></ul><ul><li>Enjoy showing off their knowledge of negative or inappropriate things </li></ul><ul><li>Gets power from negative behavior or ideas </li></ul><ul><li>Places high value on learning and knowing things that are hurtful, hateful, evil or demeaning to others </li></ul>
    31. 31. Characteristics of children and adults <ul><li>Anger that is instrumental </li></ul><ul><li>Loses control to get their own way </li></ul><ul><li>Trains others to avoid them when angry or else </li></ul><ul><li>Claim that they “lost control” after and aggresssive, destructive or abusive incident </li></ul><ul><li>Uses anger to have power in a situation </li></ul><ul><li>Others become timid and “walk on eggshells” when they have to discuss problems or responsibilities </li></ul>
    32. 32. Characteristics of children and adults <ul><li>One way training </li></ul><ul><li>Uses inappropriate behavior to train others to give in to them </li></ul><ul><li>Uses inappropriate behavior when their wishes are opposed or resisted </li></ul><ul><li>Resists attempts to problem-solve and be re-directed </li></ul>
    33. 33. Characteristics of children and adults <ul><li>One Way Role Models </li></ul><ul><li>Models self after negative peers, neighbors, the famous “bad” people </li></ul><ul><li>Adopts behaviors of negative role models </li></ul><ul><li>Act non-responsively to or directly reject positive role models </li></ul>
    34. 34. Characteristics of children and adults <ul><li>Wishing </li></ul><ul><li>Has unrealistically high opinion of their own skills and abilities </li></ul><ul><li>Talks about how things will be but avoids goal setting or commitments designed to achieve goals </li></ul><ul><li>Acts as if talking about it is the same as doing it </li></ul><ul><li>Constantly put off activities or tasks which are perceived as “responsibilities” </li></ul><ul><li>Respond with anger when pressed to perform in a timely manner </li></ul>
    35. 35. Characteristics of children and adults <ul><li>Casing (or) Sizing Up </li></ul><ul><li>Size people up for how much power they have and respond differently based on their view of that power </li></ul><ul><li>Reacts negatively to or dominates those that appear to have less power </li></ul><ul><li>Act charming toward those with more power </li></ul><ul><li>Resist developing relationships with those that might be more powerful than they or threaten their power </li></ul>
    36. 36. Characteristics of children and adults <ul><li>Dishonesty and misinformation </li></ul><ul><li>Use omission and vagueness to confuse or avoid </li></ul><ul><li>Pretend to have misunderstood </li></ul><ul><li>Keep secrets for no apparent reason </li></ul><ul><li>Tell others what they think the other wants to hear </li></ul><ul><li>Say yes and agree to avoid further feedback </li></ul><ul><li>Act confused when challenged on an inappropriate comment or behavior </li></ul>
    37. 37. Traumagenic Families Experience <ul><li>Emotional outbursts (screaming, yelling, crying, etc) </li></ul><ul><li>Self-soothing or distracting behaviors including early on-set of substance use </li></ul><ul><li>Poor communications (not effective and responding to feedback well, or making behavioral changes based on feedback) </li></ul><ul><li>Social withdrawal </li></ul>
    38. 38. Traumagenic Families Experience <ul><li>Social isolative behaviors (doing things to create distance) </li></ul><ul><li>Poor Attachment (repeated failures to effectively engage in a relationship, or maintain relationships) </li></ul><ul><li>Pre-occupation with stressors </li></ul>
    39. 39. Traumagenic Families Experience <ul><li>Difficulty concentrating, focusing or attending </li></ul><ul><li>Appears inattentive or distracted </li></ul><ul><li>Difficulty making effective decisions </li></ul><ul><li>Difficulty following through on decisions to accomplish goals </li></ul><ul><li>Engages in pointless lies, deceptions or partial truths to avoid </li></ul>
    40. 40. Highlights of the behaviors common for children raised in Traumagenic families <ul><li>Impaired executive functions: </li></ul><ul><ul><li>Inhibiting </li></ul></ul><ul><ul><li>Shifting </li></ul></ul><ul><ul><li>Planning </li></ul></ul><ul><ul><li>Organizing </li></ul></ul><ul><ul><li>self-monitoring </li></ul></ul><ul><ul><li>emotional control </li></ul></ul><ul><ul><li>working memory </li></ul></ul>
    41. 41. Stage I: Introductory Phase Hangover/Feeling Ill May Be Expensive May Be Illegal May Miss Work Energy Thinking Ability Sexual/Social Confidence Euphoria Work Output Increased Status Relief from: Loneliness Insomnia Depression Anxiety
    42. 42. Stage I: Introductory Phase Strength of Conditioned Connection MILD Parties Special Occasions Triggers Responses Infrequent Use No Physiological Response Pleasant thoughts about AOD
    43. 43. Sports Hobbies Homework Work Family A.O.D. Stage I: Introductory Phase
    44. 44. Confidence Boost Sexual Enhancement Social Lubricant Boredom Relief Depression Relief Beginnings of Physiological Dependence Financial Problems Vocational Disruption Relationship Concerns Stage II: Maintenance Phase
    45. 45. Strength of Conditioned Connection MODERATE Stage II: Maintenance Phase Triggers Responses Parties Friday Nights Friends Concerts Alcohol “ Good Times” Sexual Situations Thoughts of AOD Cravings Occur as Use Approaches Mild Physiological Arousal Eager Anticipation of AOD Use Occasional Use
    46. 46. A.O.D. A.O.D. A.O.D. Homework Hobbies Sports Work Family Stage II: Maintenance Phase
    47. 47. Social Currency Occasional Euphoria Relief from Lethargy Relief from Stress Nose Bleeds Infections Relationship Disruption Family Distress Impending Job Loss Stage III: Disenchantment Phase
    48. 48. Strength of Conditioned Connection STRONG Stage III: Disenchantment Phase Triggers Responses Weekends All Friends Stress Boredom Anxiety After Work Loneliness Continual Thoughts of AOD Strong Physiological Arousal Psychological Dependency Strong Cravings Frequent Use
    49. 49. Stage III: Disenchantment Phase A.O.D. A.O.D. A.O.D. Homework Hobbies Sports Work Family A.O.D. A.O.D. A.O.D.
    50. 50. Relief from Fatigue Relief from Stress Relief from Depression Weight Loss Paranoia Loss of Family Seizures Severe Depression Unemployment Bankruptcy Stage IV: Disaster Phase
    51. 51. Strength of Conditioned Connection Overpowering Stage IV: Disaster Phase Triggers Responses Any Emotion Day Night Work Non-Work Obsessive Thoughts about AOD Powerful Automatic Response Powerful Physiological Dependency Automatic Use
    52. 52. Stage IV: Disaster Phase A.O.D. A.O.D. A.O.D. A.O.D. A.O.D. A.O.D. A.O.D. A.O.D. A.O.D. A.O.D. A.O.D.
    53. 53. No Simple Answer
    54. 54. What can we do to address the multigenerational nature of Alcoholism?
    55. 55. Family-focused Intervention & Prevention <ul><li>Positive outcomes from rigorous studies </li></ul><ul><ul><ul><li>Increase Caregiver-child bonding </li></ul></ul></ul><ul><ul><ul><li>Increase effective Child management </li></ul></ul></ul><ul><ul><ul><li>Increase Social, emotional and cognitive competencies (e.g., problem solving, goal setting) </li></ul></ul></ul><ul><ul><ul><li>Reduce substance use community wide </li></ul></ul></ul><ul><ul><ul><li>Increase effective mental health treatment </li></ul></ul></ul>
    56. 56. <ul><li>Objectives </li></ul><ul><ul><li>Enhance family protective factors (e.g., caregiver-child bonding) </li></ul></ul><ul><ul><li>Reduce family-based risk factors for child problem behaviors </li></ul></ul><ul><ul><li>Reduce family-based risk factors for adult and caregiver problem behaviors </li></ul></ul>Family-focused Intervention & Prevention
    57. 57. Family-focused Intervention & Prevention <ul><li>Improved parenting skills </li></ul><ul><li>Improved youth skills (e.g., peer resistance, social competencies) </li></ul><ul><li>Improved school engagement and grades </li></ul><ul><li>Decreased aggressive/destructive behaviors, conduct problems </li></ul><ul><li>Decreased mental health problems (e.g., depression) </li></ul>

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