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If you’re reading this, you may be at a point of realizing you can’t continue being under the same roof as the substance user. The answer to this question will vary greatly as it can only be answered by determining one’s threshold of pain. Families often cycle through the 5 stages of grief. These include denial, anger, bargaining, depression, and acceptance. The final stage is where most families seem to get stuck. In the normal grieving process, acceptance is a good thing. In addiction, it often means accepting the alcoholic or drug addict is not going to change and the family accepting the abnormally new normal. Families at this stage will start to adapt and allow the destruction to become commonplace. The primary enabler accepts their new maladaptive coping skills and becomes a manipulator of the family system. Going to bat for the substance user in spite of other family pleas is now routine. It is very common for them to cycle through the stages, especially bargaining with the substance user and other family members who are frustrated.
We can only hope that while in the acceptance phase the family accepts the fact they do not have to live this way and sets boundaries for themselves and their loved one. At some point, the family has to ask themselves why they are allowing themselves to remain in a relationship with an addict. We believe at some point every person living with an addict or alcoholic gets to their bottom and allows themselves to do something different. Setting aside what will happen to you if you change is a necessary first step. When you protect the addict or alcoholic’s feelings you are only protecting your own. It is far too common that the addict and alcoholic have built a wall of entitlement around the home and the people in it. We don’t believe that living with an addict or alcoholic who is not changing or improving their condition is a sustainable option.
What is Considered an Alcoholic?
Calling someone an alcoholic or believing you are one yourself is all in the eyes of the beholder. For simplicity, alcoholics are most often people who consume alcohol in spite of its destruction. They are people who can not stop themselves from starting and once they start they can not stop. There are those who are unable to stop on fear, consequences, self-knowledge, or willpower. And no, you do not have to drink every day for these things to happen. Binge drinking can cause just as much destruction as a daily drinker.
More importantly and regardless of the quantities and frequency of alcohol consumption, there are behaviors that occur in almost every drug addict and alcoholic. These behaviors include:
- Selfishness: Utter disregard for how their actions affect others. The alcoholic acts as if they are the only person being hurt. Almost every decision they make involves only their needs and no consideration of the welfare of others.
- Blaming others: Everything that goes wrong is someone else’s or something else’s fault. If something goes well then of course it is all their doing. From DUI’s to foreclosures to loss of employment it wasn’t them that caused it, it was some other person, place, or thing.
- Resentments & Victim: Similar to blaming others, alcoholics continuously flip the script on seeking help so they can secretly remain victims and hold onto resentments. It doesn’t matter to them what they did to someone else. They are only interested in what you did to them and how you reacted to them. They have zero ability to see what they did to set the ball rolling and keep the ball rolling in regards to the problem(s).
- Dishonesty: Alcoholics will lie when the truth will suit them better. Through their distorted perception of reality, they seek to spin the story as they see it.
- Ego & External Validation: Alcoholics can not do enough to have their egos stroked and to have others notice their accomplishments and material possessions. The alcoholic feels as if the world would not function properly if they were not here. Everything everyone else is doing could be done differently and better if others were to just see it their way and take their suggestions. There are also not enough ways for the alcoholic to look better externally to cover the internal voids they have. They almost always try to impress others so the perception of them is different or favorable to them.
- People Pleasing and Expectations: People pleasing may be difficult for many to identify with because if you’re reading this your alcoholic loved one may not be making you too happy. People pleasing is a way an alcoholic tries to cope. They are a different person to each and every person they meet. Their angle is selfishness and their downfall is resentment. This happens as a result of people not behaving or reacting to the good deeds of the alcoholic based on expectations the alcoholic sets for them. Alcoholics do things for other people and on the surface, they look like great loving caring individuals. What is really going on is they are selfishly acting out the good deed; they are not being nice or doing something nice for other people, they are doing it for themselves. The expectation set is for the other person to stroke their ego and to change or formulate their opinion about them. They are setting themselves up with an expectation as to how others should acknowledge their good deeds and when they don’t meet that expectation they harbor a deep resentment towards them. You may not realize this and this becomes a justification for them to drink. This comes as the result of them believing others have wronged them and their resentment builds and they consume alcohol and spew venom in their minds over how the other person behaved. If they did things unselfishly with no expectations they would not be upset regardless of the reaction by the other person.
Assessment Instruments for an Alcoholic
There are several tools that help determine one’s severity rating based on an assessment. We believe these assessments should focus more on the behaviors above and unfortunately they do not. The assessment tools focus on the three things that occur as a result of the behaviors listed above. These are the frequency, the quantity, and the symptoms or problems as a result of the substance use. The three most common tools are:
- DSM V(5) Diagnostic Criteria: The diagnostic statistical manual breaks down the severity with 11 questions classifying the problem as mild, moderate, or severe.
- ASAM Criteria: The American Society of Addiction Medicine has 6 dimensions that result in a score of 0-4 for each dimension. The problems are classified as no problem, mild, moderate, substantial, and severe.
- ASI: The addiction severity Index uses a problem scale of 0-4. Not at all is 0, Slightly is 1, Moderately is 2, Considerably is 3, and 4 is Extremely. The areas of focus are Medical, Employment/Support Status, Alcohol, Drug, Legal, Family/Social, and Psychiatric. This assessment tool looks at two different time periods. Within the last 30 days and lifetime.
In addition to the assessment tools that help determine severity ratings and level of care, here are some clinical terms to reference for heavy alcohol use from SAMHSA (Substance Abuse and Mental Health Services Administration) and the NIAAA (National Institute on Alcohol Abuse and Alcoholism). Please keep in mind these definitions view alcohol problems based on frequency, quantity, and symptoms. Problems that occur with alcoholics are not about how much you drink, how often you drink, or what you lost because you drink. Alcoholism and Drug Addiction is driven by the behaviors that cause these three things. Focusing only on the other variables does not help a family or substance user through the emotional destruction nor does it address the underlying issues:
- Binge Drinking: A short window of drinking that brings BAC over .08, which is typically 4-5 drinks in about two hours on any given day.
- Heavy Alcohol Use: Binge drinking on 5 or more days within a given month, or a predictable pattern of dependency via binge drinking.
- Moderate Pattern Drinking: The NIAAA defines moderate pattern drinking as having 2 drinks a night for 5+ nights a week for men, and 1 drink for the same amount of days for women. Many cases of alcohol use disorder begin as ‘functionally’ dependent, where they use alcohol to cope with life or relieve stress every day.
- Problem Drinking: These symptoms are where a loved one’s actions become more questionable – drinking in the morning or alone, reclusive behaviors so that someone can drink, or binge drinking daily to the point of lifestyle detriment. There is not one set way in which problem drinking will affect your family member and household and the issue must be addressed immediately.
To summarize the point of turning our attention to the behaviors rather than frequency, quantity, and symptoms, please consider this. Does a family or alcohol user reach out for help only because of the frequency and quantity consumed? They may think they do and most reach out because of the way they feel. If you call for help and tell us your loved one was drinking a gallon of whiskey a day only to find out later they drank only one shot a day would it change the reasons you called for help?
Drug of choice, frequency, quantity, and symptoms is important information for clinicians to perform an accurate assessment. The bigger picture is these things are not the core problem; the alcoholic and their behaviors are. Think about someone with many years of sobriety who relapses. They just don’t slip on a banana peel and fall through the front door of a bar. They worked hard on the relapse. Their old behaviors slowly came back over time and they eventually gave in to the obsession and compulsion. If you interview them or their family they will almost always tell you they were as bad if not worse than before they were drinking. In the days, weeks, and months leading up to the first drink of the relapse they were impossible to be around due to their behaviors, yet no alcohol. Anyone of these assessment tools would have missed that. This is because they focus on things that do not solve the problem or cause the problems. In other words, these assessments are guides, not solutions.
Setting Boundaries for Your Family
Until you realize you can no longer live this way, here are some helpful things you can do to help yourself through this.
- Do not try to control the situation: Interventions are not about learning how to control a substance user. They are about letting go of believing you can. Families often believe they can control the situation by having long talks that end up going nowhere. Even more often families believe that enabling and comforting the substance user as a form of control will end with a positive outcome; it almost never does. The only control one has is the control they have over their own actions. Much of what you do affects what they are able to do. Control yourself and you can partially control the outcome for them.
- Do not enable them: Human beings have instinctive survival qualities. When you take care of the survival instincts for them, it takes away their ability to fend for themselves. Any time you provide comfort or resources to the substance user they are allowed the energy and focus on only one thing and that is their substance use. Enabling them disables their ability to change. Enabling prevents the addict or alcoholic from seeing the need for change and moving through the stages of change.
- Do not make it personal: Although the addict or alcoholic tries to make this an impossible task with verbal assaults, the problem isn’t with you, it’s with themselves. Through constant manipulation, dishonesty, lack of ownership, and flipping the script, the substance user does everything they can to beat you into thinking you are the problem. You would not make it personal if it were someone you didn’t know and they were psychologically ill. Please remember that you didn’t cause them to use drugs or alcohol as the solution to their problems. You may however be helping it stay the same or encouraging it to get worse with enabling and codependency. Even when there are family secrets and past experiences you would like to forget that may have caused some of this, the current solutions of substance use along with guilt and shame-based enabling isn’t a sustainable solution.
- Seek Help for Yourself: The best thing anyone can do when you are in a relationship with a substance user is to seek help for yourself. The more a family learns to detach and set boundaries the greater the opportunity for you to heal and for the substance user to seek help. Groups such as Al-Anon and individual therapy can be beneficial. Family First Intervention offers a full continuum of care and support for families after the intervention. When we look at the families who take advantage of our services and engage in Al-Anon and therapy, they improve exponentially compared to families who do not follow their own recovery path.
When a substance user gets into recovery, they are encouraged to look at what behaviors they can change and those that are affecting their ability to stay sober. There is a strategy that involves not looking at what other people have done to them and rather looking at what they may have done to other people to create the problems or reactions from another. The same applies to a family. Rather than focus on what you can do for the substance user, look at what you can do for yourself. Putting valuable resources into trying to change someone else is exhausting. Like the substance user trying to change others to fix themselves, the family must take ownership of their recovery and let go of thinking they can fix or change the addict or alcoholic. There are so many things a family system can do for themselves that encourages change in their loved one. Trying to control them without getting control of yourself almost always ends up going nowhere.
Approaching an Intervention
One would hope a family could understand the importance of a substance user surrendering to professional help. The substance user has most likely been unable to navigate sobriety or addiction recovery efforts on their own resources and thoughts. With that being said, is the family of the substance user, who is equally affected by addiction, not on that same path? Families approaching an intervention often do so with expectations that are not in line with the mission of an intervention. Families are frequently consumed with the thought of an intervention being about someone coming to talk their loved one into treatment. They also believe the intervention is about learning how to control them after the intervention.
When hiring an interventionist to help your family and your loved one, please remember the intervention is not a 12 step call or a speech, and nowhere during the process will you be taught or encouraged to continue trying to control the outcome of the substance user. Although much of your change will cause them to change, nothing you do outside of addressing your behaviors will initiate a change in thought for them. Please follow the same path you would expect for the addict or alcoholic. You do not know what you’re doing, why you’re doing it nor how to do it and someone else can show you another way to look at it.
Here are some tips for staging an intervention:
- The waiting for ‘rock bottom’ to trigger the timing for an intervention always fails. The reason for this is twofold. The first is, bottom for a substance user is when things get worse faster than they can lower their standards. Families are often enabling and providing comfort that is preventing rock bottom or any consequences from being felt. Secondly, the bottom isn’t something you hit, it is something you feel. This feeling is almost always brought on by the intervention process.
- Stop focusing on the drug of choice. Even if you’re unsure about the frequency, quantity, or drug of abuse, by the time you’re considering an intervention, it’s safe to say your loved one’s behavior and lifestyle is the main problem. Your family is likely affected at this point too and it is helpful to remind yourself why you picked up the phone to research help in the first place.
- Do not cancel your plans or thoughts of an intervention due to your fears of the outcome. What if they say no? What if they say yes? Both questions are borne out of fear by family members and the substance user. Your loved one abusing drugs or alcohol has most likely taught you not to even think about doing an intervention or getting them help for you will pay dearly if you do. An addict and alcoholic is consumed by their substance of choice and will rarely make moves that aren’t selfish and don’t include shortcuts. There is a reason we do not include the addict or alcoholic in the initial stages of the intervention process.
- Do it yourself (DIY) interventions are not interventions, they are speeches. You may help your loved one into treatment temporarily and the family is still the same. Also, never attempt to provide your own treatment such as allowing them to detox in your home. Some drugs such as alcohol and benzodiazepines can cause medical complications resulting in death. A plan collaborated with an intervention specialist, therapist, or medical professional is always going to go better than your plan.
Yesterday was the best day to put a plan in motion for an intervention and a better life. Every day you stay the same you can tell yourself each morning “today is as good as it is ever going to get if I don’t do something different”. Families who wait to intervene or do something different are making it about their fears and concerns of what will happen to them if they intervene. As much as we suggest families put themselves first, we mean in a healthy way. Not by fulfilling your maladaptive coping skills and sidestepping your fears of the unknown with the choice of inaction. This doesn’t help you or the substance user.
Contacting Family First Intervention
At Family First Intervention, we have experienced firsthand how difficult co-existence with an addict or alcoholic can be. We understand the fears families are faced with. For many, as much as they despise the current situation, it is all they know. Families often feel stuck and struggle with change, even if the change is good. It can be more fearful to venture through the gates of the unknown than it is to stay where they are at. It’s like most things in life, we stay in what we believe to be a comfort zone even when it is uncomfortable. Our job is to hold your hand, build your trust with us, and have you allow us to walk you through the unknown to the other side.