AS the tree and the tinsel come down and the decorations are again destined for the attic, many Irish families will be going through another Irish Christmas ritual today; frying to put the pieces back after tiptoeing around an alcoholic for the past week. But the days of tiptoeing may be numbered. More and more treatment centres are now encouraging the families of alcoholics to be actively interventionist in dealing with a problem that can tear them all apart.
To that end, the Rutland Centre in Dublin provides specially designed family mobilisation and intervention programmes. Family involvement has always been an important aspect of treatment in centres like ours," says Rutland Centre director, Maura Russell.
"But what we are doing now is taking a more pro active approach towards getting families' input into diagnosis, intervention and recovery.
"Alcoholism by its nature means that the person with the addiction cannot connect the bad things in their lives with their drinking" she continues. "Nearly every person who has recovered from an addiction has recovered because somebody - family, friend, or work colleague - has intervened and said something must be done about this. The alcoholic will almost never make that discovery alone."
The family mobilisation programme is designed to teach intervention skills to those who are closely involved with the alcoholic. The programme aims to help them acquire skills and responses which will make the addict more likely tub seek professional help.
The benefits of getting the family involved in treatment are numerous. Firstly, the family members are key sources of truth about the behaviour of the addicted person, helping the therapist to a clear understanding of the nature and stage of the client's addiction. "The information a therapist gains from the client's family can help to weaken the alcoholic's defence mechanisms, mechanisms which protect and support the addictive behaviour," says Maura Russell.
Secondly, the key people in the alcoholic's life are helped to identify and understand the problems of alcoholism and to recognise their own problems arising from living and dealing with an alcoholic, so that they can provide the best kind of support. They are also taught improved strategies for dealing with the alcoholic. The ways in which a family normally confronts an alcoholic's behaviour tend to lead to tension and arguments rather than a resolution of the problem. Such confrontation is useless in the face of addiction and the family needs to be taught more effective strategies.
It used to be said that you had to wait for alcoholics to reach "rock bottom", to come to their own realisation of what their drinking was doing to them, before treatment could be effective. But the Rutland Centre is now actively encouraging families to make contact as soon as they feel concern.
An important part of the first contact with family members is to allay their fears as to what might happen when the alcoholic is confronted with the problem. Children may fear losing the parent's love, for example, or may fear reprisals where there's aggression. A spouse or partner may fear their loved one's anger or despair. "The family have to be helped to understand that if nothing is done things will get worse," says Maura Russell,
"and also how to do things in the way that is most likely to succeed, in the ways they want. They also have to deal with their own emotions, stabilise their feelings so that they are not confronting out of anger but out of care and concern."
No small order. But there are strategies which ensure such an outcome, says Russell. These strategies fall within the category of, "intervention" and involve three stages. Firstly, the "key people" sit down together to identify what it is they want the person to do. Some families will be happy if the alcoholic agrees to be assessed or meet with a counsellor; others will feel a course of treatment is required. They need to know what they will do, should the person refuse to do as they demand. For example, sometimes a partner is prepared to leave if things don't go as he or she wants. It is important not to threaten something that won't be carried through.
Then each writes down something they know about the person's alcoholism, a particular set of circumstances that occurred and how he or she was affected. The alcoholic is confronted with these facts, told how the people in his or her life feel, and the reaction they want. The aim is to create a crisis for the person, drive it to the point where continuing to drink will involve a cost to them.
People in the grip of an addiction do not behave normally, she, stresses, and will do anything to avoid having to stop drinking. They will use sophisticated strategies to manipulate the family, say things such as "You know I'm stressed at work" or "I'm not a bad father", she says. "The family needs to be taught not to argue with such assertions but to `roll with the resistance', as we term it. They might respond by saying `yes, you were a good father at one time but not now; here's what you have done' and this is where you bring in your list of specific instances."
SHE also stresses that it is vital to get everybody on board. Without preparation beforehand, one or other member of the family - often a child - can begin to feel sorry for the alcoholic, to say things are not so bad, which sends everything awry. "Most families don't have a clue how to deal with an addict," says Russell. "It's not like dealing with a person under normal circumstances. They need guidance to cope."