all questions will be attached.
SHORT ESSAY
SHORT ESSAY
Identify and describe four (4) of the six chief personality characteristics/traits of codependency according to the Family Systems Model (20 Points):
1.
2.
3.
4.
SHORT ESSAY
Give a description of each of the following constructs of the Social Learning Model and why they are pertinent in relationship to addiction (20 points):
Self-efficacy:
Self-regulation:
Reciprocal Determinism:
Modeling:
SHORT ESSAY
Give a description of each of the following constructs of Family Systems Model and why they are pertinent in relationship to addiction (20 points):
Boundaries:
Family Projection Process:
Differentiation of Self:
Emotional Cutoff:
Social Learning Theory (SLT) (Aka Social Cognitive Theory) – Albert Bandura
One of many different forms of cognitive theory.
Understand the covert mental processes involved with our cognitions (thoughts):
Think
Internal dialogue
Self-talk
Beliefs/perceptions – about drugs. Whether or not good or bad. Cultural influences
Expectancies – related to addiction, Form expectancies about what a drug will do for us.
Schemas – a representation of a plan or theory in the form of an outline or model
Representations, symbols, meaning of things.
A cognitive model helps to explain the initiation of addictive behavior and the maintenance of addictive.
Bandura SLT Believes in a concept known as
reciprocal determinism
. Interactions between our thoughts (cognitions), our behavior, and the environment. These three things are in constant reciprocal interactions with each other. Back and forth relationship.
Thoughts (Do I drink or not?/ Should drink more?)
Behavior Environment
Behavior of drinking Party!!!!!
Example about alcohol or drugs?
Thoughts (Relapse crisis – Thoughts about using)
Behavior Environment
(begin to use) (Around others who are using and having fun)
Thoughts (thoughts of drinking to relieve stress)
Behavior Environment
Increased Drinking Stressful environment
Thoughts (thoughts about eating taboo food)
Behavior Environment
Eating bad food Full of unhealthy eating options
Bandura also believed that within this reciprocal process lies each person’s ability to influence their own destiny. Why? Because we have self-direction.
Why does that matter in addiction??
Bandura believed that through our cognitions (thoughts), we acquire new behaviors and decide to regulate our behaviors.
Bandura believed that its process based on prior experiences that helps people to decide to either initiate a new behavior or maintain a behavior.
1) We determine which environmental stimuli to pay attention to and what to ignore
2) We determine how to perceive these environmental stimuli (Good vs Bad, wanted vs unwanted)
3) We determine whether we should remember these environmental stimuli
4) Determine how they will affect future behavior
We go through this process all day every day. We are constantly appraising our environment. Based on our observations we create symbolic representations and use these representations to anticipate future outcomes.
Self-Regulation
IS the capability of people to regulate their own behavior. We do this through external standards set by others and self-evaluative assessments (internal standards set by ourselves).
SLT theory and the concept of self-regulation disputes the disease model and its concepts of loss of control.
Addictive behavior is behavior that is actually highly self-regulated. It’s not out of control behavior, it’s highly in control.
Addictive behavior is often predictable, goal-directed, and not random. Purposeful.
Obtain, use, recover, conceal its use from others, interact with other drug users, etc.. goes on in a very predictable way.
It is explains functional addiction better than the other models.
People can self-regulate an addiction for years. Holding onto jobs, family, and a lifestyle.
How do we decide to initiate new behaviors? In the absence of reinforcers and punishers.
Modeling
– is vicarious observation or vicarious learning. One of the ways in which we acquire new behavior. Learning by observing others. These others are known as “models”.
We watch what happens to others and the outcomes, and then we decide whether or not to engage in the same behavior.
Teens initiate substance use behaviors through the concept of modeling.
Smoking cigarettes age of onset 13 years old. I quit when I turned 20.
Cognitive Theory (Cont’d)
Self-Efficacy
– Perception or judgment of a person’s capability to carry out a course of action that will lead to an outcome.
Two components of self-efficacy
1) Outcome expectations – A person’s estimate that a particular outcome will occur if they take a course of action. A course of action will lead to an outcome. If I study I will get a good grade.
2) Efficacy expectations – A person’s belief or doubt that he/she can carry out the necessary course of action to obtain the anticipated outcome. It’s the belief or doubt that one can do it.
Why is this important in addiction???
People have to have self-efficacy when it comes to getting control of their addiction and believe they can overcome their addiction.
We need to teach our clients about the importance of self-efficacy and we need to assess where clients are in terms of their self-efficacy.
Clients who are low in self-efficacy need to have their self-efficacy worked on. Raised.
We learned in psychoanalytic theory that we can improve self-efficacy by:
Performance accomplishments
Vicarious learning
Coaching/verbal persuasion
Controlling negative emotions/emotional arousal
Other ways we can improve self-efficacy is by addressing issues of competence and mastery. This enhances one’s motivation!!!
5 Types of Self-Efficacy –
1) Resistance Self-Efficacy- Judgment about one’s ability to avoid the initial use of a substance. Prevention programs should focus on developing resistance self-efficacy!
2) Harm Reduction Self-Efficacy – Perceptions of one’s ability to avoid harm following initial use of a substance. Using less; Teaching harm reduction practices; not driving an automobile;
3) Action Self-Efficacy – One’s perceived ability to achieve abstinence or controlled use.
4) Coping Self-Efficacy – One’s perceived ability to cope with relapse crises. Efficacy expectations are extremely important in relapse prevention and developing relapse prevention plans.
5) Recovery Self-Efficacy – Judgments about one’s ability to return to recovery following lapses and relapses. Lapses turn into relapses because the person has low recovery self-efficacy.
This has a lot to do with something call the
abstinence violation effect
. Intense shame, guilt, and self-blame for sabotaging or violating their own recovery efforts.
Protracted process of recovery aka protracted state of recovery
I—-I——–I—————–I————————————–I——————————————————————≥
Create longer and longer periods of abstinence.
Stress Dampening Response Model –
People turn to alcohol or drugs to dampen their stress.
Lessen, extinguish,
Teach people other ways to dampen their stress other than drinking or drugging.
Psychoanalytic Theory (Cont’d)
Personality Structure (3 subsystems)
1. Id – Biological force
2. Ego
3. Superego
Id – Original source of personality consisting of internal drives, needs, urges and cravings
Id produces an expressed wish craving for a substance. The wish is expressed as bodily excitation.
This excitation motivates the addict to seek out the substance and consume it.
Id is responsible for addiction. Biologically becomes addicted to the substance.
The id operates on the pleasure principle. – To seek out pleasure and avoid pain. The id is pleased by getting its urges and cravings met. Food, water, alcohol, drugs, sex.
Your id is concerned with instant/immediate gratification. It wants what it wants when it wants it.
Id is responsible for lapses and relapses.
The id is not concerned with reality demands or moral concerns
The id finds frustration and deprivation to be painful.
In order to be successful in recovery according to this model. The person can no longer see drinking or drugging as being pleasurable. They must now view drinking and drugging as being painful.
EGO – Emerges from the ID. It is the psychological origin of behavior. The ego seeks to satisfy demands of the id and does so by making external transactions with the world.
The ego seeks out food, water, the ego seeks out alcohol or drugs. The ego must answer the demands of the id.
It does so using cognitive resources. Reasoning, planning, delaying of immediate gratification, and other rational resources.
Ego operates on the reality principle. The reality principle is to suspend the pleasure principle temporarily until an appropriate place and time to release the tension caused by the id.
But that requires ego strength.
Alcohol and drugs weaken our ego strength.
We need to build ego strength in people who are getting help for alcohol or substance use.
How to build ego strength:
1. Performance Accomplishments – Recognition of achievement that sustains motivation and gives people the power to keep going. Highlighting their performance accomplishments.
2. Vicarious learning experiences/vicarious observation – Get them to learn by observing others and their experiences.
3. Coaching/Verbal Persuasion – Provides encouragement and gives direction on how to live life. Recovery coach. Certified Peer
4. Controlling negative emotions – teach people coping skills to control their negative emotions.
Superego – the moral component of personality. It emerges from learning morals and social norms or taboos. This is also known as your conscience. It is concerned with right and wrong, good and bad, do’s and don’ts.
It develops from early childhood and adolescence as a result of reward and punishment.
3 main functions.
1. To suppress the impulses of the id
2. To press the ego to abandon realistic goals for moralistic goals
3. To strive for perfection
Alcohol and drugs can weaken our superego as well.
Anxiety and Defense Mechanisms
Anxiety is purposeful. Anxiety is our body’s natural alarm system. It warns us when we are in danger. It motivates us to take action when there is a threat.
Anxiety is useful. People are motivated by discomfort.
However, most people can deal with anxiety using rational resources. Coping skills. We are not overwhelmed by our anxiety.
Ex. Breathing exercises, rest, hobbies/interests, exercise, medication, meditation, talk to someone.
Other times, people are overcome by their anxiety. When we can no longer deal with anxiety using rational resources, we turn to irrational resources. These irrational resources are known as defense mechanisms.
Typical ego defense mechanisms among the chemically dependent include:
1. Compensation: making up for the deprivation of abstinence by overindulging in another pleasure. (Example: A recovering drug addict becomes compulsive about gambling, work, eating, etc.)
2. Denial: inability to perceive an unacceptable reality. (Example: An employee denies he is suffering from alcoholism when confronted about the bottle he keeps hidden in his desk.)
3. Displacement: directing pent-up feelings of hostility toward objects less dangerous than those that initially aroused the anger. (Example: An addict in treatment comes home from a group counseling
session and screams at his wife. In group, he had received feedback from the facilitator indicating that he was not actively participating.)
4. Fantasy: gaining gratification from past experiences by reliving the euphoria and fun. (Example: While in rehabilitation, a group of addicts experience cravings as they reminisce about the “good ol’ times.”)
5. Isolation: withdrawing into a passive state in order to avoid further hurt. (Example: A depressed alcoholic in early recovery refuses to share her problems.)
6. Projection: assuming that others think badly of one, even though they have never communicated this negative regard in any way. Example: An addict unexpectedly blurts out to a counselor, “I know you think I’m worthless.”
7. Rationalization: attempting to justify one’s mistakes or misdeeds by presenting rationales and explanations for the misconduct. (Example: An addict reports that he missed a 12-step meeting because he had to take a very important telephone call from his attorney.)
8. Regression: retreating to an earlier developmental level involving less mature responses. (Example: In a therapeutic community, an adult resident “blows up” and makes a huge scene when she learns that iced tea is not available for lunch that day.)
9. Undoing: atoning for or making up for an unacceptable act. (Example: An alcoholic goes to a bar after work and gets “smashed.” He doesn’t get home until 4:00 a.m. His wife is furious. The next day he brings her flowers and cooks dinner.)
10. Repression: pushing away and avoiding issues that a person does not wish to deal with.
NAME: ________________________________________
NAME: ________________________________________
LEHMAN COLLEGE
DEPARTMENT OF SOCIAL WORK
SOCIAL WORK PROGRAM
SWK 351
FINAL EXAM SPRING, 2020 PROF. LOWY
MATCHING (2 points each)
A) The inability to perceive an unacceptable
1)___ Respondent Conditioning
reality.
B) Occurs when the patient applies to a psycho-
2)___ Generalization
analyst feelings, thoughts, attributes and motives
he/she had in a past relationship.
C) Learning of different responses to two or more
3)___ Resistance
similar but distinct stimuli because of the different
consequences associated with each one.
D) Directing pent-up feelings of hostility toward
4)___ Projection
objects less dangerous than those that initially
aroused the anger.
E) Behavior which appears to voluntary and not
5)___ Displacement
under the control of a
well-defined stimulus.
F) Whatever interrupts the progress of analytical work.
6)___ Transference
G) Withdrawing into a passive state in order to avoid
7)___ Operant Conditioning
further hurt.
H) A tendency to perform a response in a new setting
8)___ Discrimination
because of the setting’s similarity to the one in which
the response was originally learned.
I) Behavior that is under the control of a
9)___ Denial
well-defined stimulus.
J) Assuming that others think badly of one even 10)___ Isolation
though they have never communicated this in
any way.
NAME: ________________________________________
LEHMAN COLLEGE
DEPARTMENT OF SOCIOLOGY AND SOCIAL WORK
SOCIAL WORK PROGRAM
SWK 351 FINAL EXAM SPRING, 2020 PROF. LOWY
MULTIPLE CHOICE (2 points each)
1. The presentation of an aversive stimulus that serves to increase or maintain the frequency of a behavior in behaviorism is:
A. Positive reinforcement
B. Negative reinforcement
C. Punishment
D. Extinction
2. The experience of intense shame, guilt, and embarrassment that frequently occurs after a lapse is called:
A. The Tension Reduction Hypothesis
B. The Stress Response Dampening Model
C. The Abstinence Violation Effect
D. None of the above
3. Which model defines addiction as a conditioned response whose tendency becomes stronger as a function of the quality, number, and size of reinforcements that follows each drug-ingestion?
A. The Disease Model
B. Social-Learning Theory
C. Family Systems Theory
D. Behavioral Theory
4. Which of the psychoanalytic constructs relies on the reality principle?
A. The Superego
B. The Id
C. The Ego
D. All of the above
5. Making up for the deprivation of abstinence by overindulging in another pleasure is the defense mechanism known as:
A. Displacement
B. Compensation
C. Projection
D. Undoing
6. All of the following are sources that contribute to efficacy expectations except:
A. Self-regulation
B. Performance accomplishments
C. Coaching/Verbal persuasion
D. Vicarious experiences
7. The moral component of personality that emerges from learning of moral values and social taboos is:
A. The Id
B. The Superego
C. The Ego
D. The conscience
8. The type of self-efficacy that involves one’s perceived ability to achieve abstinence or controlled use is:
A. Coping Self-Efficacy
B. Recovery Self-Efficacy
C. Action Self-Efficacy
D. Harm-Reduction Self-Efficacy
9. The component of the personality that mediates between the demands of impulses, urges, and cravings, and the realities of the external world is:
A. The Ego
B. The Id
C. The Superego
D. A and C only
10. The family member in a chemically dependent family who appears to do very little right and is quite rebellious and perhaps even antisocial is known as:
A. The Enable
B. The Hero
C. The Mascot
D. The Scapegoat
NAME: ________________________________________
LEHMAN COLLEGE
DEPARTMENT OF SOCIOLOGY AND SOCIAL WORK
SOCIAL WORK PROGRAM
SWK 351
FINAL EXAM SPRING, 2020 PROF. LOWY
FINAL EXAM SPRING, 2020 PROF. LOWY
SHORT ESSAY
SHORT ESSAY
Identify and describe four (4) of the six chief personality characteristics/traits of codependency according to the Family Systems Model (20 Points):
1.
2.
3.
4.
NAME: ________________________________________
LEHMAN COLLEGE
DEPARTMENT OF SOCIOLOGY AND SOCIAL WORK
SOCIAL WORK PROGRAM
SWK 351
FINAL EXAM SPRING, 2020 PROF. LOWY
SHORT ESSAY
Give a description of each of the following constructs of the Social Learning Model and why they are pertinent in relationship to addiction (20 points):
Self-efficacy:
Self-regulation:
Reciprocal Determinism:
Modeling:
LEHMAN COLLEGE
DEPARTMENT OF SOCIAL WORK
SOCIAL WORK PROGRAM
SWK 351
FINAL EXAM SPRING, 2020 PROF. LOWY
SHORT ESSAY
Give a description of each of the following constructs of Family Systems Model and why they are pertinent in relationship to addiction (20 points):
Boundaries:
Family Projection Process:
Differentiation of Self:
Emotional Cutoff:
FamilySystems Theory – Murray Bowen
Families are complex units/organizations.
Hierarchy with roles and status
Sometimes Rules and sometimes there is minimal rules
Sometimes families have predictable patterns of relating and sometimes unpredictable
Sometimes families are stable and sometimes are not.
Families have become unstable, unpredictable, chaotic, or dysfunctional.
Whenever 1 element in the system changes, all others are affected and attempt to compensate for that change.
Interdependence. Is about the family as a whole unit and dependent upon each other to have needs met.
Interdependence is organized by Boundaries.
Boundaries distinguish the elements contained within a system from other elements in the environment.
Boundaries define membership within a system. In this case within a family. Boundaries characterize the relationships amongst family members.
Boundaries on a range
≤————————————————————————————————————≥
Permeable (move in and out easily) boundaries – Diffuse boundaries – Over-involvement
People have enmeshed relationships
People are too close to each other
Little room for freedom and flexibility
Little room for individual differences
No separateness
Overemphasis on sameness and unity
Rigid boundaries
People are distant, no connectedness
Little intimacy
Great deal of isolation
Little positive emotions shared
Clear Boundaries – optimal place where families function best
Allows for individuality but maintains intimacy
Based on mutual respect
Members show genuine love and concern for each other
Freedom and flexibility
Communication patterns are clear and direct
≤———————————————————————————————————————-≥
Permeable Clear Rigid
Baby adult Teenager
Elderly parent
Boundaries in families do not stay static. Boundaries shift and change.
Addiction causes boundaries to shift and change.
Adolescents
Families that are too permeable, too enmeshed (helicopter Mom). Some adolescents might rebel from this by turning to Alcohol and other drug use (AOD) use.
Families that boundaries are too rigid, individuals of the family may be too isolated and use alcohol or drugs to cope with isolation.
Family as Systems
Families are a system and within families there are subsystems.
Marital subsystem
Parental subsystem
Sibling subsystem
External subsystems that exist outside of the family
Welfare
Single Mom
4 kids
Kids
School
Family Court
WEP
Assig.
ACS
Drug Tx
Program
Kinship Care or Foster care
Homeostasis –
Balance, Equilibrium, Steady State
Families are striving to achieve equilibrium. Families will take action to restore the balance.
In addicted families, the non-addicted person in charge is usually in charge of keeping the balance, restoring the equilibrium.
Families, in an attempt to maintain homeostasis, will become pathological. Physically or mentally diseased. Families become sick as a result of the person with an addiction affecting them. Family members become sick as they strive to achieve homeostasis.
How does this pathology manifest?
Family members may try to resist change or reverse change
Family members may try to make compromises by allowing things to occur
Family members may bargain and negotiate with the addict
Family members may compromise their values, morals and ethics
Family members may to try to re-establish the boundaries in an effort to maintain family balance.
Triads – Family subsystems form and they consist of 3 members
This typically happens between
Mother Father
Adolescent (Addiction) Sex of this adolescent makes a difference
Overinvolved/punitive parent/caregiver is the member of the same sex
Permissive/pampering parent/caregiver is the member of the opposite sex
This tends to be the majority – that the person of the opposite sex fulfills the pampering roles
Triads form as a way of shifting stress around within the family
Sometimes these triads form Triangles – They are still are group of 3 but with a different dynamic.
A process known as triangulation occurs. A group of 3 however there is a comfortable twosome and 1 uncomfortable outsider.
Step-Dad Mother Dad Step-Mom
Adolescent
Adolescent Adolescent
Triads can sometimes become stuck in chronic, repetitive patterns of interaction. Addiction can cause this to occur within families.
Differentiation of Self – A person being able to separate the intellectual self from their emotional self.
Classifies people on a continuum/Range/Spectrum.
On one end are people who are considered Fused (Glued Together)
Fused – No differentiation, No Separateness exists between one’s emotional self and intellectual self. Their emotions are fused together with their intellect. Emotions dominate the self. These people are dominated by automatic emotional reaction.
These are people who are less flexible, less adaptive, and more emotionally dependent on others. Easily stressed into dysfunction, and it’s difficult to recover.
≤—————————————————————————————————————————-≥
Fused Highly Differentiated
≤——————————————————-Addiction
Highly Differentiated – Possess a balance between their emotional self and intellectual self. These people are more autonomous, more flexible, better able to cope with stress, and more independent of emotion. These people are more emotionally mature, and their lives tend to be more orderly and successful.
Not Permanent.
Behavioral Theory
Believes that most if not all human behavior is learned. Adaptive behavior or maladaptive. (addiction is learned behavior)
Behaviorists are concerned with studying and analyzing observable, measureable behavior (empirical evidence)
Addiction is created because people are conditioned to engage in frequent drug taking behavior over and over and over again.
There are two types of conditioning:
1. Classical Conditioning (aka Respondent Conditioning/Pavlovian Conditioning). Where behavior is under the control of a well-defined stimulus. It is actually the pairing of stimuli together that can elicit a behavioral response.
Pavlov – Used dogs to demonstrate involuntary learning. Reflexive learning.
Food
+ Bell = Salivate (drool)
(Stimuli #1) (Stimuli #2) Behavior
The bell alone without the presentation of the food caused the dogs to salivate. The dogs had become conditioned to just the sound of the bell alone, to drool.
Little Albert experiment White rat + Loud noise = startle
Alcohol/drug use example
Stress social influences
Stimuli #1 + Stimuli #2 = Alcohol or drug use (behavioral response)
Cravings social users = Use
Go away to a rehab and come home. Stress stimuli alone —- can lead to behavior of use
Social influences stimuli alone can lead to behavior of use
Stimuli Withdrawals/cravings —— Relapse
Stimuli hanging out with active users ——- Relapse
Triggers are stimuli that can cause relapse or use because we have been classically conditioned to respond to those stimuli, to those triggers.
Euphoria/Urges/withdrawal + Smell/sight/environment = Substance Use
(Triggers) people places things
Stimuli 1 Stimuli +2 Behavior
2. Operant Conditioning – This is how most voluntary behavior becomes learned. It’s behavior that is produced that doesn’t appear to be directly elicited by a stimulus. This type of conditioning occurs through reinforcement and punishment. Behavior becomes learned as a result of reinforcement and punishment.
Operant behavior is conditioned if it is followed by a reinforcer.
Behavior is maintained by events that occur after the behavior and not before it.
A reinforcer can be both positive and negative.
A reinforcer is any event that increases the probability and rate of behavior
Positive (+) = to add
Negative (-) = to take away or subtract or remove
We are talking about the adding or subtracting of stimuli.
Positive Reinforcement
Means adding a stimuli after a behavior that the person finds rewarding or valuable that increases or maintains the frequency of behavior. (gold star on the work, or you receive a bonus at work after good production, or praise).
What is rewarding or valuable about alcohol and drug use?
Reinforcers?
Euphoria, have a great time/party!!!!, social inclusion,
May maintain the likelihood of using at the same rate or increased rate.
Negative Reinforcement – maintaining or increasing in the rate of behavior.
IT does not matter if I say positive or negative reinforcement
. As long as the word reinforcement or reinforcer is there, it means to maintain or increase the rate of behavior.
Negative reinforcement does not mean decrease
!!!! The only thing that decreases the probability or rate of behavior is punishment.
Negative Reinforcement
Begins with an unwanted, irritating, aversive stimuli that we want to remove from our lives!!!
The behavior we generate is to remove the unwanted stimulus. The result is an increase in that behavior because it provides relief from the unwanted stimulus.
Example #1 The sound of an alarm clock. IT’s irritating! It’s unwanted stimuli. The behavior we do is to remove, subtract, take away the sound. We get relief or reinforcement from the sound being gone. And the next time it comes back, we will do the same behavior to remove it.
Example #2 The headache. The feeling is irritating and unwanted. The behavior we do is to pop a pill. In a little while, we get relief from the headache being gone. The next time it returns, we pop another pill.
Example #3 The crying baby. Feed the baby, change the diaper, swaddle the baby.
How is addiction negatively reinforced?
Withdrawal symptoms (unwanted!) the behavior I do is to use again. Ahhhh relief from the unwanted withdrawal symptoms. And when the sickness returns??? Use again.
In fact addicts can condition themselves through both positive reinforcement and negative reinforcement.
Punishment
is the only thing that decreases the probability or rate of behavior.
Punishment can be both positive and negative.
Positive Punishment – Add a stimuli after a behavior that the person does not find rewarding or valuable. They find it punishing. Spanking or scolding, Criticism, make them clean their room. Chores.
Example in addiction: Hangover. Anxiety and paranoia added after smoking pot.
Example: DWI – Add a Fine, add court dates, add a lawyer, Add points onto your license, add on drinking and driving classes, add on handcuffs.
Negative Punishment- Taking away or removing stimuli after a behavior that the person does not find rewarding or valuable. (Taking away a toy, a phone, a computer, an event, time-out)
Example: DWI – Pay fine (Take away money), take away your license, take you away and put you in jail, take away your car, take away your dignity.
Example: The frustration and deprivation of being without our drug of choice.
Sometimes we want to get to what behaviorists call extinction. Extinction is the complete elimination of the behavior.
Punishment, if done correctly, can lead to the extinction of behavior. But, punishment has to be applied consistently and it has to be meaningful.
Two other types of learning according to Behavior Theory
Generalization can be defined as the tendency of an action to occur in a new setting because of the setting’s similarity to the one in which the behavioral response was originally learned, with the likelihood of the response recurring being proportional to the degree of similarity between the settings.
Setting A Setting B
Kindergarten 1st grade
CVS K-Mart
For example, let us imagine that a cocaine addict, 4 years into recovery, goes on a business trip to a distant city. After arriving at the airport, he heads to the subway to catch a train for a downtown meeting. While riding on the subway train, he experiences intense cravings for cocaine. The last time he can remember having such an intense desire for cocaine was when he used to snort the drug with his buddies while riding the trains in his hometown. His cocaine cravings (and use) essentially generalized to all subway trains.
Discrimination can be defined as learning distinct responses to two or more similar but different stimuli due to differing benefits and costs associated with each one.
Offer 1 Offer 2
SWK 446 Tuesdays at 4pm Saturdays at 9am
Prof. A Prof. B
The failure to discriminate contributes to many relapses during early recovery.
For example, let us suppose that an addict is discharged from an inpatient treatment facility. He has many new friends whom he has met through NA and many old friends with whom he used to get high. He insists that he can be with his old friends and not “pick up” or “slip.” Unfortunately, he soon relapses, but he gradually learns that his old friends represent a stimulus condition that he must avoid.
Definition of addiction
: “an operantly conditioned response whose tendency becomes stronger as a function of the quality, number, and size of reinforcements that follow each drug ingestion”
The greater the enticement, the greater the feeling, the greater the fun, the greater the experience, the more you become conditioned.
Roles in a chemically dependent family
The victim
This is the chemically dependent person who has developed a primary love relationship with the chemical, making all other relationships secondary. The victim is processing two main feelings: anger and fear. He is angry because he believes that significant others in his life do not understand him. The chemicals he uses are not his problem—they are his solution. Why, he wonders, can’t people understand that his problems are his spouse, children, or boss? At the same time, the victim is under constant fear of losing some things he values: his job (which provides the money for his supply of chemicals), his family members (whom he labels as one of his main problems), and his sanity. It is difficult if not impossible to hold on to something that is both a major problem and a highly valued behavior. Strong delusion, no matter how sincere, results in creating chronic, painful emotions of shame, loneliness, and guilt. The victim cannot deal with this overwhelming personal pain, but continues to apply his solution: the chemicals. Without professional help he will thereby continue to travel the maze of addiction unto death.
The protector (enabler)
The protector is usually the person closest to the victim, perhaps a spouse, boyfriend, girlfriend, parent, sibling, employee, or boss. The protector develops the same dynamics as the victim. Just as the victim denies that he has a problem with the chemical, the protector (as well as all other family members) will fiercely deny that chemical dependency is the problem facing the family. This denial is practiced with sincere delusion until it can be practiced no longer. Also, as the chemically dependent victim becomes more and more addicted to the chemical, the protector becomes increasingly addicted to the unpredictable behavior and mood swings of the chemically dependent victim, which in time dominate the life of the protector entirely. Eventually the protector cannot live with or without the chemically dependent victim any more than the victim can live with or without his chemical. These are the true markings of addiction. By desperately attempting to protect the family from the tidal waves of the chemical dependency, the protector will be the main one responsible for enabling the illness to run its full course, and even hastening it along. By making excuses to the boss—for example, telling him that the victim has the flu (i.e., hang over)—the protector shields the chemically dependent victim from being fired; by taking over the finances, looking after the yard, car, house repairs, and children, the protector shields the victim from the sharing of responsibilities and from feelings of guilt. These protecting acts make up the protector’s survival role, which, completely unknown to him, becomes an addiction in itself, making it possible for the chemically dependent victim to go on using his chemicals. Although the protector is motivated by love, his predominant feeling is anger at self and others for not being able to control the ongoing crises caused by the chemical dependency.
The hero (high achiever)
The hero is usually the firstborn child. Often the hero and the protector work in close alliance to maintain family equilibrium in the face of crisis. Quite soon the hero assesses what the rules of the family are and adheres to them. This rewards him with positive strokes, and he is entrusted by the family system with the task of finding solutions to the ongoing crises. Early on he is greatly praised and told how proud his family is of his achievement at home, school, and work. He determines to become a successful achiever, giving pride and relief to the family system and effectively distracting them from the real problem: chemical dependency. This enables chemical dependency to continue its downward spiral. In spite of appearing well adjusted on the outside, the hero experiences chronic feelings of guilt, inadequacy, and loneliness. Coming up with answers to the ongoing problems created by the family illness is a lonely and impossible job.
The scapegoat (problem child)
The scapegoat is usually the second-born child. Like the hero, the scapegoat attempts to follow the rules of the family system. He learns very quickly, however, that he is unable to compete with the hero, who has a strong alliance with the protector and is regarded by the family as an all-around good guy, highly successful in what he does. Thus, the first thing the scapegoat learns is to resent the hero for “getting there first.” This produces feelings of guilt, for he is taught that he should love his siblings. Because of his inability to compete for needed positive strokes and attention from family members, the scapegoat eventually learns to get attention by breaking family rules. He hides under the bed or in the attic, runs away, or gets into drugs and/or early sexual activity. He becomes the problem child. This survival role gives a kind of relief to the family. A scapegoat has been identified. He can be blamed instead of the true source of the problem—the chemical dependency that no one .in the family is able to solve. Emotionally, like the rest of the family members, the scapegoat experiences a lot of anger and hurt. He is hurt and angry because his efforts to gain attention do not result in acceptance within his own family, and he ultimately withdraws. The family members feel angry and hurt because they interpret the scapegoat’s behavior as disloyalty. They blame the scapegoat for much if not most of the family problems.
The lost child (forgotten child)
As did the scapegoat, the lost child (usually the third-born) learns quickly that he is not as important as the chemically dependent victim and the hero, who use up most of the available attention. While the scapegoat becomes the focus of the family through destructive behavior, and the hero manages to find his place in the family through compliant behavior, the lost child finds it easier to become a loner. He withdraws from the family through excessive reading, watching TV, listening to music, and living in a fantasy world. Increasingly, the lost child opts to live in a world of his own creation. The family finds this behavior not only acceptable but a relief. This survival role frees the family from having to worry about him. As a matter of fact, the family system seems to operate more efficiently without interacting much with the lost child, and the feelings of unimportance and low self-worth hit hard. Although outwardly the lost child appears self-reliant, feelings of loneliness and confusion are deeply rooted. Confusion exists because of the lost child’s inability to distinguish clearly between the reality of chemical dependency and codependency and his private world of fantasy.
The mascot (family pet)
By the time the mascot (usually the youngest child) arrives on the family scene, the psychopathology displayed covertly and overtly within the family system requires fast and drastic actions, and the mascot will do almost anything to secure attention. He becomes a family clown. He learns to perform well. Using humor, telling jokes, playing the con artist, he learns to survive by gaining attention and producing much laughter in the family, once again distracting the rest from the real family problem, and producing welcome temporary relief. Thus, like other survival roles, the role of the mascot enables chemical dependency to continue its work of destruction. Viewed superficially, the mascot is a witty, lighthearted entertainer. His predominant emotion, however, is the chronic fear of not having a meaningful place in the family unless he continues to be the center of attention.
Family Systems Theory Cont’d
Family Projection Process – The way parents transmit their emotional problems onto a child.
Increases the child’s vulnerability to clinical symptoms.
Examples of issues that may surface later on in adulthood include:
· Heightened need for attention and approval
· Difficulty dealing with expectations
· The tendency to blame oneself or others
· Feeling responsible for the happiness others
or
that others are responsible for their happiness
· And acting impulsively to relieve the anxiety of the moment rather than tolerating anxiety and acting thoughtfully.
The projection process happens in three steps:
1. The parent focuses on a child out of fear that something is wrong with them;
2. The parent interprets the child’s behavior as confirming the fear; and
3. The parent treats the child as if something really is wrong with the child.
For example: A parent begins to wonder whether or not their child has low self-esteem. The child says and does something that confirms this suspicion. The parent begins to treat the child differently. The parent repeatedly starts affirming and praising the child in an effort to boost their self-esteem. As a result, the child’s self-esteem grows dependent on the parent’s compliments, affirmations, and praise.
Later on in life, the adult needs attention and approval from others to feel good about the self. I may feel as though my spouse is not meeting my esteem needs. They are not meeting my expectations.
Germs – Fear of germs. They might project that fear onto their children. That child may grow up to have the clinical issue. A constant fear or phobia of germs.
Make mommy happy. May project this onto their child and the child develops issues with feeling responsible for the happiness of others and blaming themselves when others are not happy.
Neurotic parent full of anxieties. May project this onto their child and the child develops issues with managing anxiety
Emotional Cutoff – Emotional separation. Where individuals will emotionally begin to separate from their parents/caregivers. Look at the manner in which adolescents begin to emotionally separate from their caregivers.
Examples of emotional cutoff:
1. Isolating or avoiding a relationship with a parent/caregiver
2. Physically move away
3. We may to stop speaking to a parent/caregiver
4. We may argue and fight a lot with our parent or caregiver
5. Alcohol or drug use may be a way of emotionally cutting-off from our parent/caregiver
The more severe the emotional cut-off, the greater the likelihood that the individual will bring their unresolved emotional attachments into their future relationships.
Codependency
Is an unhealthy pattern of relating between a Substance User and Non-User. Because the non-user is to closely involve with the user.
The Codependent – As also known as an Enabler.
The codependent is overly focused and overly involved with the user
The relationship is usually too enmeshed. It’s usually full of problems
The codependent is usually preoccupied with the addict and overactive
The relationship is unstable unpredictable, filled with chaos and crisis.
The codependent is usually hypervigilant
The codependent usually loses all sense of self and self-identity.
The codependent works to protect the addict from consequences and they will take on all of the responsibilities
Six chief characteristics or personality traits of a person who becomes a codependent
1.
Poor self-esteem
– Here the codependent feels little personal self-worth and think poorly of themselves. May have self-denigrative thoughts (I talk badly about myself).
2.
Need to be needed
– Some codependents who gain feelings of worth from taking care of others and how well they do that. Taking care of an addict fulfills that need to take care of someone. These codependents will neglect their own needs as a result and put all of their energy into meeting needs/demands of the addict.
3.
Strong urge to change or control others
. This codependent believes that they have the power to control another person’s addiction and use their abilities to influence change (Cut-down or stop). It’s an overdeveloped sense of responsibility. Grandiose thinking.
4.
Willingness to Suffer (Martyr Syndrome)
. Some codependents want to be a martyr. Why? They get pleasure or satisfaction from the feeling that they have sacrificed or suffered. This causes them to feel superior even though they report unhappiness.
5.
Resistance to Change
– To the codependent, leaving the addict is not an option. Why? They cannot deal with the sense of guilt that comes with separating from the addict. So….They become immobilized. The guilt, the anxiety, and pain serve as blocking mechanisms preventing the person from doing anything about the addiction.
6.
Fear of Change
– codependents fear and resist change due to an emotional investment in the addict’s continued use. Often this is unconscious. They may fear change for several reasons:
a. They may not want an assertive loved one. They have to give back power.
b. May be financially dependent on the addict and fear divorce or separation might happen if the addict becomes sober
c. May want to avoid sexual relations with the addict.
d. Worry that some family secret or family conflict might emerge if the addict becomes sober.