How To Approach A Drinking Problem in the Family By Daniel Keeran, MSW President, College of Mental Health Counseling www.collegemhc.com
The following is an excerpt from the training manual “Effective Counseling Skills: the practical wording of therapeutic statements and processes” by the Daniel Keeran, MSW, listed on Amazon at http://www.amazon.com/Effective-Counseling-Skills-therapeutic-statements/dp/1442177993 Briefly, the helping process works like this: I'll have a family meeting (intervention conference) and identify the issue as something the client may need to work on, and I'll elicit how the drinking affects them as family members and have them give the client feedback on it. I may meet with the family without the client and prepare them to meet with the client so that the feedback can be given without anger or dumping but in a caring way. An example of what family members might say is, “When you drink I feel afraid and sad and distant because we can’t have a meaningful conversation.” Understand the drinking as a cry for help, a suicide process, or as a way of distancing due to loss of parental caring. STEP ONE: Let Him Control It and Agree On Limits And then I'll outline a treatment approach or a treatment plan with the entire family involved. If the client thinks that he can control his drinking, I'll make that Step One, which means restricting the time, place, amount, and people he drinks with. I may allow two glasses of wine per weekend or per Friday night or Saturday night with a meal at home or at a restaurant with the family. That covers time, place, amount, and people. STEP TWO: Stop Drinking I'll then say, “What if you can't control the drinking, what will happen then?” If the client is able to control the drinking, fine. If not, then we'll go to Step Two. The steps increase in confrontation or consequence. Step Two is to stop drinking altogether. I'll have the family set the parameters in Step One, and these will vary from family to family as to what is acceptable, and parameters may have to be renegotiated after time. It may be that the amount of use is too much, and has to be reduced. THE ENABLING FAMILY A co-dependent type of family would just allow the client to drink as much as he wants, so I'd be meeting with them again to see how things have been going; to see what their report is. And the addict will be letting me know or I'll be picking up on whether they've been letting him get away with violating the limits. They may say, “But he only had an extra drink.” So I'll be picking up on whether or not they're enabling his use in some way, and I'll point that out to them. And then I'll recommend total
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abstinence with 12-step Alcoholics Anonymous if control doesn't work. This means abstinence combined with attending 90 meetings for a period of 90 days. STEP THREE: Residential Treatment So I'll say to the family, “If abstinence doesn't work, what will happen then?” Step Three then is to recommend residential treatment so that the substance is unavailable and so that he can begin to identify underlying issues. Addictive behavior is often a defense against unresolved painful life experiences, usually in childhood. STEP FOUR: The Addict Refuses To Comply Then I'll say, “So suppose he refuses to go for residential treatment or relapses following treatment?” I'll talk about restricting the client's involvement with the family. It may mean separation from the family or exclusion to a varying extent from the family. The client may not be permitted to drive the kids or the grandkids anywhere any more, or be left alone with him. I'm going to have them state the restrictions, but I'll outline at the beginning what they are like. I'll say, “If you're not able to control your drinking, then there will be various degrees of consequence going all the way up to separation from the family, does that seem reasonable?” It's important to get the client's validation and acceptance of the plan. TRUST, MOTIVATION, DIGNITY, AND RESPONSIBILITY So this is very much structured around extending trust to the addict, and the client's willingness to cooperate. His willingness is motivated by seeing 1) what the effects of his drinking have been for the family and 2) what the effects will be for him if he continues. His being able to see what's ahead of him in terms of increasing confrontation and consequences, is designed to motivate him while preserving his dignity and power of choice: “Does this seem reasonable to you?” Once he is in the treatment center it will be harder for him to forget the limits when there's someone waiting on the other side who's down the road in recovery saying this is what it looks like over here; it's much easier and cheaper to get a handle on it now. The enabling family is going to be giving double messages. They're going to be saying things such as, “Well, his drinking really upsets us,” but the other message is, “He seems to need something to relax,” or “It was only one more drink.” So we need to point out the fact that they're giving double messages. We can help them sort out double messages by saying, “What effect does that have on the person who is having the problem? How is it helping? Or how is it undermining his recovery?” Modified versions of the above process can be applied to other forms of addiction such as overeating, pornography, and gambling. Daniel Keeran, MSW, President of the Online College of Mental Health Counseling, is also author of "Counseling In A Book: How To Help Common Life Problems" available as a free PDF download here http://www.ctihalifax.com/images/CounselingInABook.pdf To see the introductory course description and Register for online training, visit http://www.ctihalifax.com 2