Women and Addiction: From Betty Ford to Amy Winehouse

In 1978, a year after she left the White House and at the time of her 60th birthday, the wife of President Gerald Ford, Betty Ford, found that her drinking and use of prescription pain medications had drastically increased. Soon after that she was the recipient of a newly recognized therapeutic process called ‘intervention.’ Her family united from a position of love to confront her about her drinking and drug use and insist she seek treatment. After an initially angry response, she admitted herself to the Long Beach Naval Hospital’s drug and alcohol rehabilitation program. There the former First Lady found herself not only having to share a room with other women, but perform humble tasks like cleaning restrooms and participating in emotionally revelatory therapy sessions with five other women patients there at the same time. Rather than seek to obfuscate the true reasons for her hospitalization or to treat it with shame, Betty Ford decided to fully disclose the details of her addiction and treatment.

Feeling passionate about the possibilities of recovery, she opened the Betty Ford Center in Palm Springs, California. The center was dedicated on October 3, 1982 and today offers gender specific treatment to women. This was not available to women just a few years previously. Betty told her story in the book A Glad Awakening, Doubleday 1987, and was a true pioneer in advocating for women and the possibility of recovery.

Today we know that:

• Female substance abusers metabolize alcohol less efficiently than men, a difference that leads to higher blood alcohol concentrations over a shorter period of time.


• Pound for pound women get drunk or high faster than men as each drink hits a woman like a double. The female body contains less water and more fatty tissue which increases alcohol absorption. Women have a lower activity level of an enzyme called alcohol dehydrogenase which breaks down alcohol.


• Women move through the progression more quickly having a more rapid development of dependence.


• Women experience adverse physiological effects of alcohol on the liver, cardiovascular and gastrointestinal systems more quickly than men. This is called telescoping.


• Women become addicted to narcotics faster than men.


• Women are more likely than males to be hospitalized due to non-medical use of prescription and over the counter medications.


• Women are less likely to ask for and/or receive help.


• Women are more apt to die at younger ages than men who are addicted.
  
  

Addiction is a terminal illness; people literally die from it, be it from overdoses, toxicity, or accidents. But prior to the physical death is the emotional death, the relational deaths, the spiritual deaths. Yet I know of no other terminal illness more treatable than addiction.

Betty Ford’s life was celebrated just a few weeks ago as she was laid to rest at the age of 92. Her recovery is a major legacy that will continue to impact both women and men.

Yet it is with great sadness that the public is quickly confronted with the fact that many who are addicted will die before they can embrace recovery as we just saw with Amy Winehouse, the well known English singer/songwriter dead at only 27. As I write this, others less publicly known, are also dying daily of this horrific disease of addiction.

Don’t stay silent – let those you know who are in trouble that while you love them you cannot condone, or in any way support their addictive behavior. You will support them in recovery but not in their disease.

Your Life's Baggage: What are you carrying?

Think of your life journey as a trip. When people take a trip they think of where they are going, how they are going to get there and what it is they are going to take with them.

I want you to think about the baggage you take with you on your life journey. The baggage I am talking about carries 1) beliefs about yourself, others, and the world, 2) feelings you value and/or the feelings you experienced that you have held onto because it wasn’t safe to express them and 3) the skills you developed that help you to live with others and to achieve your goals.

Think about what it is you are carrying and whether or not you need to consider repacking your bags.

What I am asking you to do is look at the bags you travel with. Unpack them and look inside.
What are you carrying? How long have you been carrying them? Who packed the bags? Do these bags still serve their purpose?

To begin this process, think about the exterior, the shell of your bags. If you were to describe them, what would they look like?
Perhaps your bags are of brown paper that easily tears or disintegrates in the rain. Maybe they are sturdy hardback bags or soft medium size bags. They could be as small as a purse or as large as a trunk. That which shows itself to the world, the shell, is just that, an exterior. That exterior represents your defenses, built to protect, hide and contain beliefs, feelings and skills.

What best describes the exterior of your baggage?
Knapsack - Trunk - Overnight Bag - Hardcover - Paper
Softcover - Tattered - Colorful - Faded - With wheels

How else would you describe your bags exterior?
Metaphorically, what does that mean to you?
How might you want to change the exterior of your bags?
What would that change reflect?

This is an important start to letting go of what may be sabotaging your health and happiness.

Now go inside your bags and take a look at the beliefs, feelings, and skills you may be carrying. These are beliefs about yourself, others and the world, and feelings you’ve experienced and have held onto either because you value them or because it wasn’t safe to express them. Lastly, you can identify skills you’ve developed that help you to live with others and to achieve your goals.

Cognitive Baggage
Let’s look at the bags that carry your beliefs about you and the world.
Are you carrying beliefs that say:

• I am strong, capable.


• I can ask for help if I need it.


• People are trustworthy.


• I am trustworthy.


• It is okay to take risks.


• I deserve respect


• I deserve to be happy


• The world has many wonderful things to offer.
  

Or are you carrying beliefs that say:

• I can’t trust other people - they will take advantage of me.


• No one will listen to me.


• Take what I need.


• The world is scary.


• It’s not okay to make a mistake, something bad will happen.


• Good things only happen to others.


• I don’t expect much from me.


• I’m inadequate, insufficient. I can’t do anything right.


• I need someone to take care of me.


• If I show people who I am, they won’t like me.


• The world owes me, I am entitled.
  

In addition to any of those you identified from above, what other beliefs might you be carrying?

Emotional Baggage

• What are the feelings you carry with you?


• Do you carry memories of laughter, happy times, feelings of pride?


• Do you feel loved? Loving?


• Do you have so much fear in your life that you have one whole bag designated just for fear?


• How much anger, or how many resentments are you carrying?


• Do you have a bag of loneliness?


• How large is your bag of hopelessness, disappointments, sadness, or guilt?


• Are there other feelings you are carrying?
  

And a very important question to ask yourself is, ‘do you find yourself carrying other people’s bags as well?’ Are you carrying your mother or father’s fears, their guilt, their shame? Do you take on your daughter or son’s disappointments or angers?

What often goes unrecognized is that in your luggage, you are carrying a tool bag, a bag of skills. Some people have a large bag of tools filled with variety and abilities, while others may have but one tool, or different versions of the same tool, and are limited in skills.

Do you have a variety of tools or a limited number and type of skills?
Identify the tools you are carrying:

• ability to ask for what you need


• ability to listen


• problem solving skills


• ability to see choices available


• negotiation skills


• healthy expression of feelings


• ability to set limits


• clarity around what is important


• ability to make decisions


• self care skills, eating adequately, basic hygiene skills, appropriate clothing, proper rest, exercise
  
  

In addition to those you identified from above, what are other tools you have in your bags?

As you review the beliefs, feelings and tools you carry, think about what you want to continue to carry with you, what you want to let go of, and what you want to add to your baggage.

Now let's look at how carrying painful feelings, negative beliefs and few tools, or just one kind of tool, you often end up needing a cart for your bags.


While it is not true for everyone, the more you come from a history of childhood trauma and loss, fueling unresolved painful feelings, limited skills and negative beliefs, the more likely it is that your bags will continue to grow as you move through adulthood.

New bags may come as a result of divorce, being passed over for a promotion at work, being arrested, a financial setback, inability to stop smoking, and/or the pain that comes with compulsions or addiction. The negative beliefs you have only become heavier and your feelings become overwhelming as your tools are less and less effective. This is a process that takes time and you probably don’t even realize it is happening.

You develop a tolerance for emotional pain and are able to maintain that for a period of time and then, through no fault of your own, your tolerance lessens and you feel an unbearable heaviness. You need help to carry your baggage, so you seek out a baggage cart of some sort to help you continue to carry everything.

These carts are often addiction related. It could be you’ve dumped all your beliefs, feelings and skills into a bottle, a pill, or a syringe. Or perhaps you’ve a gambling addiction, sexual or spending addiction; or an eating disorder and you’ve put your bags into a vat of chocolate, sugars or starches. It could be your cart is depression or anxiety where all of your feelings have accumulated into despair and hopelessness.

These carts do make things seem better for a while. You don’t seem to feel the weight as you once did. But if you think about it, a cart just allows you to pile on more and more baggage. The load gets heavier and heavier and eventually you need a bigger and bigger cart!

Do you think you are using a cart?
If you are, you need to address the cart as this is the first step in letting go of excess baggage.

You’ve had a chance to identify your beliefs, feelings, and tools; to look at whether or not you have a cart, and now you can begin to look at what you want to carry with you on your life journey.

The fear of feelings may have you immobilized and pushing around an out of control cart. It is the accumulation of feelings that leads to trouble. There are safe people and places in which to explore feelings. Nothing bad has to happen as you learn healthy ways in which to express feelings.

What feelings would you prefer to be carrying with you?

To be able to let go of unneeded, unwanted baggage, it’s necessary to challenge the beliefs you operate from.

• Are your beliefs hurtful or helpful?


• Do they support the way you want to live?


• What are new beliefs that would be of greater support to you?


• What tools are you carrying that are useful to keep?


• Do you need to acquire some new tools you have never had before?
  

Remember to periodically stop and take a look at what you are carrying. As you take on more responsibility for your emotional self, as you develop more positive beliefs, it is easier to recognize the skills you have acquired along the way, and/or to go in search of a greater variety of skills.

February 13 is the beginning of Children of Alcoholics Week! This is a week to acknowledge and re-energize our commitment to the fact that one out of every four children is subject to alcoholism and other substance addictions within their families.
Everyone can play a role in reminding the children and the services in a position to influence them about the seven C’s (I didn’t cause it. I can’t cure it. I can’t control it. I can help take care of myself by communicating my feelings —making healthy choices and celebrating me.). It’s important to remember this is not just a family problem, but a community problem. Everyone needs to ask what they can do to make a difference and then act. I strongly suggest you begin by taking a moment to go to NACoA and see the many resources they have that make this feasible.
Also, please take the time to watch and let others know that the Nick News special on Nickelodeon with Linda Ellerbee, “Under the Influence: Children of Alcoholics,” will be replayed on February 15 at 6:00 pm (EST). Five kids will share their experiences of living with parents who are struggling with alcoholism.

On another note, the Moyer Foundation (Moyer being Major League All-Star pitcher Jamie Moyer and his wife, Karen) has been helping children in distress in a variety of ways, but particularly with the creation of Camp Erin, a camp for children who have experienced the death of someone close to them. It started with one camp in 2002 in Everett, Washington and has now expanded to more than forty camps in over twenty-five states, as well as one in Toronto, Canada. Camp Erin is the largest network of bereavement camps in the United States.
The Moyers approached me a couple of years ago when they personally extended their family as a resource to foster a nine-year-old affected by substance abuse. The Moyers have six biological children and two adopted children. They were touched by the struggles of having an addicted parent and wanted to know what I thought they could do for other kids. Knowing of their success and passion for Camp Erin, I suggested a similar camp experience for children of addiction. To make a long story shorter, I became a part of facilitating their first such program, Camp Mariposa, now offered in partnership with Youth Eastside Services (YES) based in Bellevue, Washington. To date YES has conducted eighteen weekend camp experiences for both pre-teens and adolescents. The no-cost camp offers children a chance to laugh, play, explore, and learn, while increasing their understanding of alcohol/other drugs abuse and its impact on the family; raising their awareness of resources available to help them; reducing their sense of isolation and fear; and helping them avoid repeating generational patterns.
I recently met Ann Espo, appointed by the Moyer Foundation in December to be the Program Manager to take Camp Mariposa national. Ann has fourteen years of experience in nonprofit management, communications, and fundraising with agencies serving children, youth, and families. She spent nine years with Boys & Girls Clubs of King County Washington, including seven years as Executive Director of the Wallingford Branch and was most recently Development and Communications Manager for Successful Schools in Action.
I will be working with Ann and the Foundation as they develop their Best Practices for such camps, introducing them to others who have experience with programs for children of addiction and in this process create a program model with an infrastructure for replication. I cannot tell you how excited I am about this. I will keep you updated on the progress.
For the Moyers to take their love of family and children and extend it to kids impacted by addiction is an incredible gift.

New Book to Be Released in October 2011
I have a new book coming out next fall. The working title is The Truth Begins With You: Reflections to Heal Your Spirit. This is my first book project with Central Recovery Press and they just sent me a mock-up of the cover. This is a small but sweet book, and I think people will find it valuable in their healing and recovery journey. If you liked It’s Never Too Late To Have A Happy Childhood that I did over twenty years ago, you will like this even more. In later NewsNotes I will give you samples of the reflections, but for the moment, here are a couple of my favorites: “Your strengths are more powerful than your vulnerabilities,” and “You can’t be honest in the here and now when you continue to deny your childhood experiences.” I asked my assistant, Sandi, for her favorite and she chose, “Say I love you, and say it often. I love you is a complete sentence.”
Now let me tell you about one last endeavor, something I wanted to do just for fun, and that is. . . My Closet

In my office I have a lot of little knickknacks and pictures of family and friends—things that remind me of good times and special people. I surround myself with things that represent comfort and joy. I believe this is because my work is serious and I realize there is a lot about me that is quite serious as well. I have a grouping of fairies, one in a nest, another sits on the shelf, another standing next to a little sign that says “Don’t Piss off the Fairies.” I love it. We can all attribute different meaning to that, but for me it says “don’t get in the way of my fun,” and represents my inquisitiveness and my curiosity. I also have figurines of cats and lions that, for me, depict strength and my desire to touch.

Recently I had this brainstorm to share with all of you these items that represent fun and whimsicality. This may be about my getting older or possibly willing to take a risk, but these fairies and lions bring me joy, make me smile, and keep me in touch with my inner child. Maybe you too will find joy in having one or a few of them for yourself. Each fairy and lion seems to take on a life of their own, full of color, humor, and joy. I hope that you will take a peek inside My Closet.

Please don’t forget the children next week or during the other 365 days of the year.

Chronic Pain and Addiction: Its Impact on Families

I wrote this article with Dr. Mel Pohl, Medical Director of Las Vegas Recovery Center and author of numerous works on chronic pain and addiction. A version of this article appeared in the October 2010 edition of Counselor Magazine.

Pain is universal and important to all beings—it is a warning that something is wrong and needs attention to prevent further damage to the body. Acute pain functions to protect the body while it heals from trauma or injury. Whereas acute pain protects the body while it heals from trauma or injury, chronic pain is simply ongoing, persisting beyond its usefulness.

People commonly react by resisting the pain; they tighten muscles, stiffen their posture, or try to avoid moving. Resistance causes anxiety, sadness, fear, anger, and frustration. The more resistance, the worse the pain and suffering. Chronic pain includes the physical pain coupled with the emotional pain (suffering), triggered in the brain and generated by the limbic system (the emotional center of the brain). Physical pain and emotional pain are equally real.
As our population ages, chronic pain and its costs—both financial and on a human level—are increasing. Today, medical systems treat chronic pain in over 70 million Americans with a methodology known as “pain management,” which typically includes medications and procedures such as injections and surgeries. The estimated cost of chronic pain treatment in the US is $100 billion annually. The longer we live, the more likely we are to develop pain from a variety of conditions: autoimmune disorders, diabetes, arthritis, cancer, etc. Every time there is a car accident or a sports injury, someone is set up for chronic pain. Furthermore, in the case of back pain, research suggests that obesity, depression, and/or increased awareness of the condition contribute to an increase in back pain. (Griffin, 2009)

Chronic pain syndrome is defined as:
 Intractable pain lasting longer than six months
 Marked alteration of behavior
 Depression or anxiety
 Marked restriction in daily activities
 Excessive use of medications and medical services
 No clear relationship to organic disorder
 Multiple, non-productive tests, treatments, and surgeries

Drugs and Chronic Pain
Addiction treatment professionals will see the similarities and the relationship of addiction to chronic pain. Both involve feelings and loss of control, both affect personality, both are characterized by preoccupation, rationalization, and denial, and both have a profound effect on those around them. If medications are used for chronic pain, it is not uncommon for dependence and compulsive use to occur, especially with opioid painkillers. People with chronic pain often end up medicating their anxiety, fear, anger, and depression with these same drugs. It is common for these clients to have difficulty differentiating physical from emotional pain.

Christine, who struggled with chronic pain from migraines for several years, repetitively commented, “It just hurts, and I want relief.” This was her rationale for continuing to use her drugs. But she had developed dependence, loss of control, and compulsive use—in other words, addiction.


Families and Chronic Pain
With the co-occurring disorders of pain and addiction, the treatment of each becomes much more complicated. Living with someone in chronic pain also has many similarities to living with someone with an untreated addiction.
The problems for families are more diffuse and life-altering than those of the person living with the pain itself. The family suffers along with the person in pain, developing their own dysfunctional symptoms, and they need to find strategies and solutions that allow them to cope in more self-enhancing ways. Just as addiction is insidious, the role of pain in a person’s life is also insidious, and in time, for those within the family’s intimate circle, it becomes the central organizing feature of the relationship. Everyone is focused upon and responding to the pain. Families often need to make adjustments to accommodate both the person in pain and the results of the pain. They have myriad feelings depending on their relationship and role, and those feelings ultimately drive the highly enmeshed family members to frustration, anger, and social isolation.

Kevin was in a severe sports accident as a teenager, which led to several surgeries and chronic back pain. Kevin’s father, now divorced from Kevin’s mother and remarried with much younger children, is blatantly angry with Kevin. He is angry at Kevin for not working and for making excuses for not working, tired of hearing how his son’s life has been ruined by the accident, tired of calls from his ex-wife about Kevin’s escapades. The latest problem is that she wants him to pay for drug rehab treatment because now Kevin has become addicted to drugs and his behavior is out of control—all related to the accident and what his dad calls “this so-called chronic pain.” Kevin feels victimized by his father and the chronic pain and views his mother as his only ally. He also feels entitled, after all, “look what happened to me.” Kevin’s mother is totally preoccupied with his life and problems and in turn views Kevin as a victim because of these horrible things happening to him. She is unable to set any limitations on his behavior, regardless of how upsetting it is to her and the family. His dad is lost in anger and blame, both of which are equally ineffective vehicles for improving his son’s life.

Bill’s wife Eleanor has been in bed twenty hours a day for nearly four years in chronic pain, originally emanating from scoliosis surgery, and more recently with a diagnosis of fibromyalgia. He handles her medical appointments, dispenses her medications, mediates any contact with other family members, and passes on the latest news. He is responsible for feeding her, for making sure she is somewhat comfortable, and for cleaning the house and doing the laundry, in addition to working full-time. When the decision is made for Eleanor to enter a chronic pain treatment program, he is beside himself. Fearful of being without her, he calls or e-mails multiple times every day to question the staff. He is asking not so much whether she will get better or what that will mean for her (or him); he just wants to know when she will be home. In effect, he is going through his own form of withdrawal from Eleanor in this highly enmeshed and dysfunctional relationship. Both these families are reacting to the many ramifications and complexities of having a family member in chronic pain.

The family is a complex organism with diverse parts that make up the whole. It functions best when all the different elements are in good working order. When one member is in pain, the equilibrium of the family shifts, and family members change, adjust, and accommodate in response to the strain on the family system. While this is understandable, unfortunately, in time, even if someone has a strong sense of self and worth, the concerned other finds him- or herself acting out self-defeating behaviors.
Families need to develop an understanding of the consequences of their emotional and behavioral responses that may be impeding healthy family function. As an alternative, they need to develop positive coping and relational skills. Often, families may benefit from time apart (which treatment affords) so the person with chronic pain can improve and the family has some breathing room to do work on their own recovery and their healing process.

Biology of Caring
Neuroscience has done much to help us understand what occurs in the brain of the addict, and now it also offers us a better understanding of what occurs for family members. The brain is wired to react empathetically to someone in pain in order to warn others of danger and elicit help. Functional MRI scans show that when watching someone undergo electric shock, the observer’s brain lights up in the same areas in which the brain of the person in pain lights up. (Bufalari et al, 2007) One doesn’t have to witness the painful experience for the brain to react, simply seeing a person act as if he or she is in pain causes the brain to light up. When the person in pain is a family member, the reaction to his or her pain is exponentially stronger.
In another study, when researchers delivered electric shocks to people with chronic pain, they found that in the presence of a solicitous spouse, pain levels and brain activity increased substantially. This study suggests that even though well-intentioned, when a caring person is present, the pain is reinforced. (Flor et al., 2002)

Lessons for family members are:
 You are suffering as you witness your family member suffer, but your concerned and doting manner causes more pain in the very person you want to help.
 This research implies that family connections may well be the biological basis for enabling a loved one in chronic pain.
 Treatment implications involve developing a sense of equilibrium despite another’s experience of pain.

Fundamental Therapeutic Issues for Family Treatment
Chronic Loss
To be in a relationship with a person in chronic pain results in multiple losses. There is the loss of the relationship as it once was, loss of shared social and recreational opportunities, loss of financial security, loss of hopes and dreams being fulfilled, and loss of sexual satisfaction and intimacy, to name a few.

With these losses come a multitude of feelings:
 Fear that he or she will not get any better
 Fear of financial ruin (e.g., bankruptcy, poverty)
 Fear that your life is over
 Anger for thinking he or she is not trying hard enough
 Anger for what happened to cause this (e.g., God, the drunk driver who was responsible for the accident)
 Anger with the medical system for not having the answers
 Anger at the doctors for creating and perpetuating the addiction
 Anger at insurance companies for denying procedures and holding up the approval processes
 Anger at friends or family for not being there to help
 Embarrassment for his or her behavior when overmedicated
 Guilt for being angry
 Guilt for not being able to do more to make a difference
 Guilt for wanting out of the relationship and feeling trapped
 Sadness for the lost social times
 Loneliness that comes with social isolation
 Loneliness because of the emotional disconnection as he or she is preoccupied, distant, medicated

Understandably, family members often feel guilty just for having these feelings, knowing that the pain is not willful behavior. Their reluctance to express their feelings reinforces the dysfunctional family “Don’t talk” rule. In family systems in pain, people learn to minimize, discount, and deny their feelings. So what do they do with all of those feelings? They learn to stuff them, reinforcing another dysfunctional family rule, “Don’t feel,” which culminates in being stuck in a perpetual, unresolved grief process. Consequently, as with addiction, and to an even greater extent, family members become increasingly more emotionally isolated, not sharing their thoughts and feelings with others.

In addition to the emotional disconnection, they are increasingly socially isolated. They become restricted to the home, not wanting to leave the person in pain for fear that he or she will be need them or fear that he or she will put the house or someone else in jeopardy due to being under the influence of drugs. They become the caregiver, nurse, chef, and parent—their lives consumed with telephone calls, medical appointments, and wading through paper work. They limit people visiting for a host of reasons, such as not wanting to face the questions visitors ask, or not knowing to what degree the person in pain will be overmedicated on any given day.

Chronic Caregiving / Perfect Helper
It is only natural to do what is necessary to help when seeing a loved one in pain, but the role of caregiver often becomes overwhelming and burdensome. Sometimes efforts to make things better actually make them worse. The primary caregiver becomes the insurance expert and patient advocate, running interference with major medical systems and other family and friends, and often takes on a nurse-like role, controlling the dispensing of medication. When this continues for years, it often becomes the caregiver’s primary source of identity and esteem. The consequence of accepting such a role is the essence of codependency: becoming selfless in the service to another. No longer knowing what your own needs and wants are, the needs don’t get met and desires are abandoned. In the process of being a good caregiver, self-care is forgotten. The ultimate consequences for such a lifestyle encompass the unhealthy expression of anger, experiencing yourself as a martyr, sacrificing your needs to the needs of another, believing there are no options, and feeling helpless to create change in your own life. Without support and clarity about what is happening, caregivers can ultimately spiral into their own depression or find themselves self-medicating with food, alcohol, and/or other drugs.

Distorted Boundaries
Feeling sorrow and pity for someone in pain, families often take on responsibilities for that person, when in fact he or she is capable of managing those responsibilities independently. This not only creates an unhealthy dependency, it creates a disparate relationship and doesn’t allow the person in pain the opportunity to maintain self-accountability. Enmeshment is extremely common, fueled by feelings of guilt (often false guilt) and fear. Consequently, family members of people in pain act on their behalf, not allowing them to act for themselves.

Kevin and his mother were so used to her taking care of his needs, that he had become virtually helpless. She acted from a place of sympathy rather than empathy, which only reinforced Kevin’s helplessness. Engaging in empathy rather than sympathy will allow Kevin to maintain a stronger sense of self.

High Tolerance for Inappropriate Behavior
People who are in pain and on various medications frequently act out anger in hurtful ways. They feel frustrated, helpless, and scared.

Kevin's family members are experiencing these emotions, but also want to be empathic with Kevin. As a result, they have developed a high tolerance for inappropriate behavior. They are often raged at, called names, and treated with hostility. In spite of Kevin’s physical limitations, family members were also physically abused by him when he would throw objects at them. They made excuses for his behavior and developed a level of tolerance that had disastrous results, including Kevin’s dad ending up hospitalized for a bleeding ulcer. The belief that Kevin’s pain means he can’t help himself only leads to an abnormally high tolerance for inappropriate behavior. This allows Kevin to become an offender, and his family to move into a victim/martyr role. “After all, poor Kevin is in pain—who am I to complain because he shouts every once in a while? I can take it since I’m the healthy one.” Lacking healthy boundaries, Kevin and his parents are using faulty judgment and in danger of making poor decisions.

Preoccupation
As helpless as family members feel about the pain that is experienced, they often become highly vigilant and preoccupied with the pain and with the person in pain who becomes the central force in their lives.
The family members come to faulty conclusions based on assumptions and inadequate information. They are practicing mindreading, which frequently leads to misinterpretation of the truth. For example:

 When Bill’s wife says, “You go, I’ll be fine,” that must mean she wants him to stay home with her.
 When she rolls over in bed that must mean the pain is worse and she needs more medications.
 When Kevin doesn’t say he feels better that must mean he’s ready to have another temper tantrum.

The preoccupation with the pain and the person in pain also leads to social and emotional isolation.

When Bill is with others he cannot focus on connection, let alone have fun because he is consumed with not being present for Eleanor. Bill talks himself out of being with others so he can stay vigilant, believing Eleanor is incapable of managing for herself. He even started working from home so he could keep an eye on her, not being satisfied with his daughters’ offers to help him.

Controlling Behavior
In an effort to bring stability to what is a fragile situation, family members become controlling and preoccupied by trying to read everything they can find about the problem, searching out all possible remedies. While there is no doubt that everyone needs advocates within the healthcare system, in time this became Bill’s identity and only focus, negating all other needs. Eleanor had cause to be more dependent; for Bill there is a fine line between trying to be helpful and taking over. Controlling behavior is having things done your way, in your time frame, without respect for other people’s needs and boundaries. It is created by a fear (an often unrealistic fear) of imminent disaster, and then it feeds on itself. This controlling behavior is demonstrated not just toward the person in pain, but also toward healthcare providers, other family members, and all aspects of life. The chronic pain has become the central feature of the family member’s life.

Secondary Gain
Preoccupation of this type is also very connected to secondary gain. Family members frequently, consciously or unconsciously, sabotage recovery by being attached to their identity within the caregiving role. It becomes the major source of their identity and esteem, and without it they don’t feel of value. They feel displaced. They may have found a power in such responsibility and are left with a sense of worthlessness when they don’t get to operate in that role. While recovery may be consciously desired, the human element of “but what about me?” needs to be acknowledged and addressed.

Bill’s identity and worth is totally attached to attending to Eleanor’s needs. Likewise Kevin’s mom relies on her relationship with Kevin for the meaning in her life. As Kevin and Eleanor get well and more independent, Kevin’s mother and Eleanor’s husband find their sense of self falters, requiring them to rediscover their own life. As Kevin improves and becomes more accountable for himself, his dad loses the primary focus of his deep-seated anger, which stemmed in large part from his own issues of an abusive childhood. Having more clarity about his feelings enables him to respond in a healthier manner to the present reality.

Treatment Goals
Successful treatment must include family members. Similar to any effective treatment for codependency, clinicians should consider the following when working with families:

1. Offer a framework to understand the differences between emotional and physical pain.
2. Validate that all pain is real.
3. Validate the experience of loss.
4. Help family members decrease their isolation.
5. Help family members recognize codependent behaviors as self-defeating to both themselves and their partner/family member in the long run.
6. Offer them a framework to understand the basis of their codependency.
7. Assess for primary disorders, including pain, addiction, and psychiatric co-morbidities.
8. Assist them to engage in greater self-care practices and establish their own program of recovery.

Critical throughout the process is to help the client and family members discuss their hopes and expectations. Expectations are many times simply fantasy—the expectation that there will be instant intimacy, healthy communication, and no conflicts. Counselors should remind families that they are not performing “brain transplants” in treatment, simply eliminating toxic substances and helping clients’ change their patterns of thinking, feeling, and behaving as the first steps in establishing a healthy lifestyle. As with the client, the family members need their own self-care plan wherein they identify both the behaviors and thinking that need to stop, and the behaviors and thinking that support recovery. They must also learn the areas that are triggers for self-defeating thoughts and behaviors and develop a way in which to address them. Family treatment will facilitate learning healthy communication skills to assist in family members’ ability to talk about the process as they engage in their newly learned ways of relating to the fact that the pain is real, but that the suffering is modifiable and optional.

Successful recovery practices for the client and family draw from many disciplines. Through mindfulness, cognitive practices, and twelve-step philosophy, families and clients can develop skills to work around the “edges” of the pain. (Kabat-Zinn, 2005) Instead of being absorbed in the search for a cure, families can learn that the solution lies with accepting the situation and the condition. Drawing from the gifts of addiction treatment, recognizing your powerlessness ultimately leads to genuine acceptance and improvement of health for the person in treatment and the family.

Kevin gradually learned about pain recovery—the process of knowing that the pain exists, will always exist, and will not kill him. Though they came from opposite directions, Kevin’s parents ultimately came to a mutual understanding and acceptance of healthy boundaries. As a consequence of Bill’s recovery work, he and Eleanor both took responsibility for their part in coping with the pain and now were better able to take responsibility for their part in establishing a healthy, interdependent relationship with one another.

By giving up the struggle, pain is lessened and suffering diminishes for the person in pain and his or her family.

References
Bufalari, Ilaria et al. “Empathy for Pain and Touch in the Human Somatosensory Cortex.” Cerebral Cortex, 17 (November 2007): 2553–2561.

Flor, Herta et al. “Conditioning: Learning that Pain Can Elicit Reward.” Presented at Society for Neuroscience Annual Meeting, Orlando, Florida, November 2–7, 2002.

Griffin, Morgan R. “Is Chronic Pain on the Rise?” Pain Management Health.
http://www.webmd.com/pain-management/features/is-chronic-pain-on-the-rise.

Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. Bantam Dell, 2005.

Under the Influence: Kids of Alcoholics

Dear friends,
NACoA has been working over the past year on an important program about children of alcoholics (COAs) and featuring adolescent COAs. The program promises to be enlightening and moving not only for children and youth so desperately trying to cope with parental alcohol abuse, but it will also open the eyes of people of all ages and in all kinds of families.

Premieres Sunday November 14th at 9:00pm ET/PT on Nickolodeon

For more information about the program click here: http://news.nick.com/11/2010/05/when-parents-are-alcoholics/

Difficult Family Relationships

The struggle for so many recovering adults is how to interact with members of their childhood family — their parents and siblings. Cultural and family values influence the messages and feelings you received regarding family loyalty and commitment. Typically, you want to stay connected with your family. But, how do you re-enter the arena of family relationships and be true to who you are and what you believe? Your efforts may be tentative at first; you will have to learn somewhat from trial and error. Everyone's situation is unique and every individual will need to sort through these issues in a way that is comfortable to them.

It is common to hear adults express loneliness and sadness that their recovery has further alienated them from various members of the family. When a family has not developed healthy alliances, communication patterns, etc., one family member's recovery is often confusing for the non-recovering members.

Being with family members may mean having more superficial interactions — sharing the daily routine without intimacy, recreational interactions, carrying on family rituals. Traditional occasions may be one way to maintain connection to ones you love. Even superficial contact provides connection. Your choice (remember, you do have choices here) may be to choose this level of involvement over no involvement at all. Limited involvement in connection is okay.

It is helpful to know why you are engaging with family. Do you feel a sense of loyalty, duty, enjoyment, or love? People differ as to their history and values, which impact decisions about being loyal and dutiful. In spite of family pain, many people still feel love, and many people have found ways to enjoy certain family members. Or, are you still unconsciously seeking validation or approval?

It doesn't seem to matter how old we are, we all want to know that we are valued by our parents. When we don’t receive validation in our growing up years, it often becomes an even more urgent, yet usually denied, need. Unfortunately, validation and approval are not as apt to be offered by sick or unhealthy parents. They are often no more capable of offering that to us today than they were when we were children. In fact, it is more likely they are now seeking that from us. So know your expectations. And ask yourself if your expectations are realistic. Are they based on hope from seeing behavioral changes, or is it possibly a fantasy?

The holiday season is approaching and this is a time for recognizing your choices about how you spend time with family.

Present Day Relationships

By creating healthier beliefs and developing new skills, you will create new ways of relating to family members with whom you were raised, and others you meet in your life — friends, co-workers, partners, husbands, wives, and children. You have choices about who you invite into your life and how you interact. Yet, you may still be confused about what creates a healthy relationship. One of the most important concepts in creating healthy relationships is to understand that relationships have different levels and purposes.

Some people are only in our lives, or we are only in theirs, to provide a practical service. For example, the bus driver's role is to see we are driven safely to a destination. The barber's role is to provide a satisfactory haircut. A co-worker's role is to develop a relationship that allows the goals of the workplace to be met. The intimacy we develop with friends and partners offers a greater sense of meaning, purpose and connectedness than our more casual and superficial relationships. I do not want to discount that we develop caring feelings toward those who work with us or provide services, but some people overwhelm others in an attempt to garner intimacy with all they meet. As a result, they often distance people in their unrealistic expectations, feel let down when others don't reciprocate, and have little intimacy with anybody. They find they have less time for those they've made commitments to and more with those whose relationship is more superficial.

The levels of adult relationships are:
Casual Involvement occurs in relationships where people interact in a casual manner and have little or no commitment to one another.
Companionship involves two persons associating for the purpose of sharing a common activity. The activity is more important than the person and the person becomes interchangeable.
Friendship is where two people associate for the purpose of mutual support and enjoyment of each other. The person is most important. The activity is secondary.
Romantic relationships are when friendship is shared with sensuality, passion, and sexuality. Romantic love is more than passion and sexuality. Passion and sexuality can be experienced in the context of casual involvement.
Committed relationships are when we commit to working on taking responsibility for our part and mutually agree to do what we say we are going to do. We trust that when there are problems, it does not mean the relationship is over. We agree to work on whatever problems arise with a mutual trust of sincerity and intent. Commitment does not mean you stay in a relationship irrespective of what may occur. At times, as people change, relationships are renegotiated. Commitments are reinforced or lessened, but when we make a commitment, we do what we can to make the relationship work, not allowing ourselves to be abused, nor allowing ourselves to give up our integrity in the process.

While it is not always reality, it is healthiest for people to move through these levels as listed. Once a relationship has moved into a romantic or committed level, the couple continues to incorporate the previous levels into their daily lives. Committed relationships incorporate casual contact from the standpoint that superficial routine is a part of daily life. For people with a troubled childhood, it is important to learn that casual contact is not abandonment. The ability to move in and out of these levels will be incorporated into a committed relationship.

As well, there can certainly be intimate moments and experiences with strangers or companions. Those who experience natural crisis at the same time, those who are witness to a beautiful scene together, may connect in a highly intimate fashion. While such moments may be fleeting in time, they may affect us for life. Those times are seldom forgotten, yet it is with our close friends, partners, and family members that we experience our greatest ongoing intimacy.

Excerpt from Changing Course