EXPLORING MARRIAGES AND FAMILY, 2ND EDITION

Karen Seccombe

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Chapter 11

Family Stress and Crisis: Violence among Intimates

Special Topic:Alcohol Abuseand Alcoholism

Family Stress and Crisis

• Stress: ongoing challenge or tension– e.g., work-family balance, chronic illness,

others?• Crisis: critical change of events that disrupts

functioning– e.g., job loss, injury

• Not all stress and crises are negative in nature. Can you think of any positive examples?

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Phases of a Crisis

• The event that causes the crisis• The period of disorganization that follows• The reorganization that takes place

afterwards

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Alcohol Abuse and Alcoholism

• Text discusses violence among intimates.• Here we will discuss another issue:• Alcohol abuse and alcoholism – why?

– Alcohol is the most widely abused drug.– One in four children lives with an alcoholic or

someone abusing alcohol.– Alcohol abuse has serious health

consequences.

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Alcohol Abuse and Alcoholism

– Alcohol abuse has serious social and emotional consequences for the abuser’s family.

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Alcohol….

• Alcohol is the most widely used recreational drug.– 61% of men and 43% of women are:

• “current regular drinkers,” i.e., have a couple of drinks about twice a week.

• However, some people drink far more than this….

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Binge Drinking

33%

14%

44%

28%

42%

19%

28%

10% 10%

2%

0%5%

10%15%20%25%30%35%40%45%

18 yearsand over

18-24 years 25-44 years 45-64 years 65 yearsand over

Percent of adults (18 years and over) who had 5 or more drinks in 1 day at least once in the past year,

by age group and sex, 2009

MalesFemales

Source: CDC/NCHS, National Health Interview Survey, January-September 2009, Sample Adult Core component.

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Binge Drinking

19%

27%

15%

0%

5%

10%

15%

20%

25%

30%

Hispanic White Non-Hispanic Black Non-Hispanic

Percent of adults (18 years and over) who had 5 or more drinks in 1 day at least once in the past year, by

race/ethnicity, 2009

Source: CDC/NCHS, National Health Interview Survey, January-September 2009, Sample Adult Core component.

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Regular Binge Drinking Can Be Problematic• About 14-18 million Americans “abuse

alcohol” or are “alcoholics.”• What do these terms mean?

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“Alcohol Abuse”

• Failure to fulfill work or home responsibilities

• Drinking in situations that are physically dangerous (e.g., driving a car)

• Having recurring alcohol-related problems– e.g., being arrested, fighting

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“Alcohol Abuse”

• Continued drinking despite having problems that are caused/made worse by drinking

• May or may not include addiction

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“Alcoholism”

• A disease that includes 4 symptoms:– craving– loss of control/cannot stop– physical dependence (withdrawal symptoms

such as nausea, sweating, shakiness)– tolerance (needing larger amounts to get

high)

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What’s the Big Deal?

• Alcohol has serious health consequences:• 12% of men and 4% of women die from

alcohol-induced causes, a steady increase since 2000.

• Alcohol is a factor in 38% of car fatalities.• Alcohol is a factor in 70% of intimate

partner violence.

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What’s the Big Deal?

• Alcohol-related problems contribute to 500 million lost workdays each year.

• Alcohol-related programs cost $185 billion each year.

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What Causes Alcoholism?

• Genetics vs. environment? – Genetic component may be 50%-60%

• Identical twins, who share the same genes, are about twice as likely as fraternal twins to resemble each other in terms of the presence of alcoholism.

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What Causes Alcoholism?

• Like diabetes and heart disease, alcoholism is considered genetically complex – a different array of genes underlies risk in different people.

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Consequences for Family

• Consequences can be severe—everyone is touched.

• Spouse/partner: Strains relationship because everything begins to center around the drinking person -- their moods, feelings, stresses, problems; how to hide and cover up their problem.

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Effects on Spouse/Partner

• Risks of:– Co-dependency: relationship pattern in which

a person assumes responsibility for meeting others’ needs to the exclusion of their own needs; may engage in enabling behaviors

– Violence– Financial and work pressures and problems

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Effects on Children

• Children often suffer emotional consequences from turmoil, dysfunctions, chaos, secrets, broken promises.

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Effects on Children

• May experience:– guilt– anxiety– embarrassment – difficulty with relationships – confusion – anger– depression

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Children….

• Child and adolescent psychiatrists advise that these behaviors may signal a drinking problem at home:– failure in school; truancy– lack of friends; withdrawal from classmates– delinquent behavior, e.g., stealing or violence– frequent physical complaints, e.g. headaches– abuse of drugs or alcohol

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Children….

– aggression toward other children– risk-taking behaviors– depression or suicidal thoughts/behavior

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Children….

• “My mother’s frustration, anger, rage, and contempt were our ‘home’ atmosphere. It was an atmosphere with little respite, which birthed unshakable depression, confusion, hatred, self and life loathing, and an unrelenting fear of exposure.”

– Steven

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Children….

• “I realize I am very similar to other children of alcoholics; low self-esteem, lots of emotional ups and downs in life, looking for approval often….critical of self and others, fatigued by routine in life and unable to see the positive when there is lots of good around me. A worrier and always trying to figure out how others take life in stride!

--S.P.

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Children…

• Children may play a particular role in family:– Enabler: puts aside personal feelings and

becomes responsible for the control of the drinker

– Family hero: overachiever outside the home -- tries to succeed and be perfect

– Scapegoat: gets in trouble, seeks negative attention

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Children…

– Lost child: deals with problems alone, often forgotten by the family

– Mascot: deals with personal pain by trying to be funny and charming

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Fetal Alcohol Syndrome

• Between 9% - 13% of women report drinking alcohol when pregnant; 3% report binge drinking.

• Fetal alcohol spectrum disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy.

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Fetal Alcohol Syndrome

• May include:– physical disabilities– mental disabilities– behavioral disabilities– learning disabilities

• Prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disabilities in the U.S.

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Fetal Alcohol Syndrome

• Each year approximately 1 out of every 100 live births are affected by alcohol use during pregnancy.

• Federal law requires pregnancy and alcohol warning labels on alcohol containers. – Some states require that signs be posted in

the facility as well.

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Alcohol and Pregnancy: Mandatory Warning Signs as of January 1, 2010

                                                                

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Treatment vs. Cure

• According to NIAAA, there is treatment but no cure.

• Treatment programs use both counseling and medications.– Disulfiram: makes a person feel sick after drinking

alcohol– Naltrexone: reduces craving after stopping – Acamprosate: reduces symptoms following lengthy

abstinence, such as anxiety and insomnia

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If You Drink

• Best to keep your drinking to “low risk” levels:– Men:

• No more than 4 drinks on a given day AND• No more than 14 drinks per week

– Women: • No more than 3 drinks on a given day AND• No more than 7 drinks per week

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If You Drink

– Research shows that women have alcohol-related problems at lower drinking levels than men do. One reason is that, on average, women weigh less than men.

• In addition, alcohol disperses in body water, and pound for pound, women have less water in their bodies than men do.

– Note: LOW risk does not mean NO risk.

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References

• About.com. Children From Alcoholic Homes Take Themselves Very Seriously. March 30, 2011.

• American Academy of Child and Adolescent Psychiatry. Facts for Families: Children of Alcoholics. Washington DC. November 2007.

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References

• Centers for Disease Control and Prevention. Early Release of Selected Estimates Based on Data from the January-September 2009 National Health Interview Survey. March 2010.

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References

• Ensuring Solutions to Alcohol Problems - The George Washington University Medical Center, “Workplace Screening and Brief Intervention.” available online: www.ensuringsolutions.org.

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References

• National Institute on Alcohol Abuse and Alcoholism. FAQs for the General Public. Online: www.niaaa.nih.gov/FAQs/General-English/Pages/default.aspx February 2007.

• National Institute on Alcohol Abuse and Alcoholism. What’s “Low-Risk” Drinking? April 2011.

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References

• National Organization on Fetal Alcohol Syndrome. “Alcohol and Pregnancy Don’t Mix.” June, 2004

• National Vital Statistics Report. Deaths: Final Data for 2007. Volume 58, Number 19. May 20, 2010.

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