Friday, April 17, 2009

Substance abuse a family disease - emotional systems

In Western Civilization in the last 100 years with the ascendency of psychology, human behavior has been described and studied as an intra-psychic phenomenon. A person does what he/she does because of the kind of personality he/she has. We believe that if we want to predict how a person will behave in the future or explain why they behaved the way they did in the past, we can study their personality traits to understand “what makes them tick” and develop such an understanding and gain some control over predicting future behavior.

While this model of intra-psychic functioning is somewhat helpful, a more powerful undersanding has developed in the last 30 years called “systems theory.” A person participates in multiple emotional systems and it is in understanding the rules and roles that a person follows and plays in the system which is a more accurate tool for understanding past behavior and predicting future behavior. In the substance abuse field, substance abuse professionals have been aware of this phenomenon for years coaching individuals in recovery to change their “people, places, and things” if they want to avoid the triggers for relapse.

A key concept is that emotional systems seek equilibrium, homeostasis and balance, even dysfunctional balance. Once dysfunctional systems have stabilized around their dysfunctional rules and roles they are very difficult to change. An abrupt change is experienced as a “crisis” and they will work to restabilize in familiar patterns even when those patterns are hurtful and have negative consequences.

There is some evidence that alcoholic marriages will end in divorce after the drinking spouse gets into recovery. This finding is counter- intuitive and contradicts what everyone says they want, but the readjustment of a couple to an abstinent life style is so difficult that most dysfunctional couples cannot successfully make that transition unless they are able to renegotiate the rules and roles of their marriage contract which is usually unconscious.

Substance abuse professionals are usually not trained family and marital therapists and therefore there is a tendency to focus on the individual and intra-psychic and medical aspects of treatment and ignore the interpersonal and family aspects of recovery and yet, in reflecting on my practice of 40 years, it is my observation that a great deal of relapse is related to family and interpersonal factors. Conceptualizing the problems as being influenced by factors in the emotional systems in which the client is functioning is a very helpful way to understand the problems being dealt with in treatment and to design efficient and effective treatment activities.

This is article #3 in a series on Substance Abuse a Family Disease.

1 comment:

John Bennett said...

Family systems work has always made the most sense in working with an emotional system. I rarely talk about the disease concept with patients...only occasionally to allivate the anxiety of a patient who is struggling with shame.