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Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic. By sarita Uhr, m.d. Legal Notices no part of this publication may be reproduced without written permission from the author. This book does not guarantee your family member will be "saved" from his or her drug or alcohol abuse.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic. By sarita Uhr, m.d. Legal Notices no part of this publication may be reproduced without written permission from the author. This book does not guarantee your family member will be "saved" from his or her drug or alcohol abuse.
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Scarica in formato PDF, TXT o leggi online su Scribd
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic. By sarita Uhr, m.d. Legal Notices no part of this publication may be reproduced without written permission from the author. This book does not guarantee your family member will be "saved" from his or her drug or alcohol abuse.
Copyright:
Attribution Non-Commercial (BY-NC)
Formati disponibili
Scarica in formato PDF, TXT o leggi online su Scribd
an Alcoholic __________________________________________________________________
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From the Grumpy Spouse Series: Book One
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Warning: DO NOT READ this book if you want to change your spouse, but not yourself!
by Sarita Uhr, M.D.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "! Stop Being a Victim!
Ten Steps To Rescuing Your Marriage to an Alcoholic
Ist Edition Copyright 2009 by Sarita Uhr, M.D
Legal Notices
No part of this publication may be reproduced without written permission from the author except for brief passages which may be used by a reviewer. Copying by any means including electronic methods, selling or hiring, transmission by voice, electronic mail, posting to a Web site or uploading to an ftp site or CD duplication is strictly forbidden. Legal action will be taken against offenders.
The Author, his publishers, agents, resellers or distributors assume no liability or responsibility to any person or entity with respect to any loss or damage alleged to be caused directly or indirectly by the use of and the advice given in this publication. It is recommended that users of this publication seek medical or other independent professional advice if treatment seems necessary before acting on any of the advice in this book. This book is not intended as a substitute for medical advice from a qualified physician. The intent of this book is to provide accurate general information in regard to the subject matter covered. If medical advice or other expert help is needed, the services of an appropriate medical professional should be sought. This book does not guarantee your family member will be saved from his or her drug or alcohol abuse or that your marriage will be saved
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Dr. Sarita Uhr is a psychiatrist, educator, writer, and speaker. She treats professionals and their family members for anxiety, depression, and addiction. She specializes in finding the right combination of medications to get people on track. Her psychiatry training and fellowship in psychopharmacology at Stanford University School of Medicine has made her an expert in this area.
During her training, she was taught by the foremost leaders in the field of psychiatry. In addition to learning psychotherapy, she received special training in clinical and laboratory research where she gained an advanced understanding of how the psychiatric medications work. She is well versed in cutting edge research on anxiety, depression, and addiction. Her academic background coupled with twenty years of clinical experience puts her in a unique position to determine the needs of her patients. She is respected by her colleagues for her ability to balance medication management with talk therapy and lifestyle changes. She specializes in treating addiction.
Dr. Uhr has over 40 published articles including, Anxiety and Depression, Is Medication the Answer? , The Addictive Personality: Why Some People Get Hooked, and Combining Psychiatric Drugs to Beat Depression. Her speaking topics focus on the impact of stress on our mental and physical health.
Dr. Uhr graduated Phi Beta Kappa from Pomona College in Claremont, California. She attended medical school at the University of Texas Health Science Center in San Antonio where she later served as an Assistant Professor of Psychiatry. She completed her psychiatry training and a fellowship in psychopharmacology at Stanford University School of Medicine in Palo Alto, California. Dr. Uhr is in private practice in Dallas, Texas.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %!
Dear Alcoholic, I have learned a lot about your disease from the many people I treat who suffer from addiction. Many of you are wonderful individuals. Some of you are very sensitive and find it difficult to handle the curve balls life throws at you. Some of you feel vulnerable as though you have no buffer or filter. Many of you are charming, colorful, and fun. Maybe you never learned the coping skills to help one face life head on. Some of you find it easier to push conflicts under the rug. With others, pride and ego may get in the way. Some of you like to be in control and like to be right. Many of you dont trust easily. Some of you feel hurt and vulnerable and are holding a lot of feelings inside.
Each of you has his/her story and each story is unique. You are in a battle with your own brain. Your spouse feels like a victim to your problems and in many ways, you are a victim, too. You are a victim of your addiction which is a medical disease.
You may equate having a problem with anything to losing everything. Your first step will be the hardest which will be admitting that alcohol controls you rather than vice versa.
My goal is to save your marriage, not dissolve it. By the time your spouse needs this manual, there is not enough room in the marriage for both your spouse and alcohol. Your spouse is feeling that you value alcohol more than the family.
Lets figure out together how to change this so that everyone wins. I am on the side of the marriage surviving, but your spouse cant do this without your help.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! &!
Dear Spouse of an Alcoholic, Do you feel that you are a victim of your spouses drinking? Do you feel you come in second to alcohol or that your wants and needs arent that important to your spouse any more? Do you remember how much better things were before alcohol took your spouse away from you? Can you remember the core of that love you had for your spouse before it got covered up in resentment, anger, and fear? Are you the one sinking all the effort into saving your marriage, but your efforts seem futile? I want to help you turn things around, but it means giving up your old ways of doing things. I also want to educate you about alcoholism so that you understand what your spouse is up against. Your spouse has a medical illness, alcoholism. He/she is at war with his/her own brain. The brain has ammunition to use against him/her. With appropriate treatment, your spouse can improve his/her fighting prowess to help win against his/her brain. He/she needs your compassion, not your anger. If you can admit that you need changing too and that it is not only your spouse that needs to change, I can help you! Read on and good luck!
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! '!
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Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! (! Is your spouse an alcoholic?
When you accuse your spouse of drinking too much, he/she probably denies having a problem with alcohol. If you argue with your spouse, he/she probably blames you or stress for the need to drink. Your spouse says it is the only way to relax. You wonder, Is he/she really an alcoholic? In Step 1, I list the general medical used by psychiatrists to determine if a person has a problem with alcohol abuse. Abuse means the person is drinking to excess. Next, I will list the medical criteria for alcohol dependence. This is the term used to describe alcoholism. I am not sure how useful or important it really is to distinguish between alcohol abuse (excessive use that is mild on the drinking spectrum) or alcohol dependence (excessive use that can be considered severe). It is important to understand that there is a spectrum of mild to severe symptoms, like most illnesses.
PROCEED TO STEP 1
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! )! Step 1: Assess if your spouse is an alcoholic
Warning Signs of Alcohol Abuse Is your spouse unable to stop drinking after one or two drinks? Is your spouse drinking everyday or, if not, is he/she binge drinking on weekends? Have you asked him/her to quit drinking and noticed he/she is unable quit or cut back on the number of drinks he/she consumes? Are you worried he/she will get in a car accident when drinking or get pulled over by the police? Has his/her job suffered because of his/her drinking? Is he/she not taking care of his/her daily responsibilities (household chores, taking the kids to school, getting to appointments on time etc.)? Has he/she suffered physical consequences from drinking alcohol such as blackouts, liver problems, pancreatitis, or seizures?
Warning Signs of Alcohol Dependence Have you noticed your spouse needs increasing amounts of alcohol to get the effect he/she wants (i.e. feeling intoxicated)? Does he/she continue to drink despite his/her knowledge of all the negative consequences (i.e. marital strife, physical consequences, risking an accident when driving under the influence of alcohol, risking legal consequences, risking job, etc)? If he/she quits abruptly or lowers the amount he/she drinks too quickly, does he/she experience withdrawal symptoms such as shaking, sweating, insomnia? Has he/she tried to quit, but have not been successful?
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! *! Learn about the disease Alcoholism is a medical disease. It is not a sign of weakness or poor willpower. People who are very judgmental about addiction (ex: Whats wrong with him, why doesnt he just stop drinking) do not understand the medical basis of the disease. Scientific research on the brain in the last 10 years has shown that alcoholism has both a genetic and biochemical basis. Many people are not aware of this and/or do not understand how serious and life threatening the illness is. Many doctors are not up to date about the latest addiction research and share some of these old judgmental attitudes! Step 2 will guide you through the statistics about alcoholism. Your awareness of these statistics will strengthen your resolve to take action. I will then guide you through an easy to understand lesson about what is happening to the brain when it becomes addicted to alcohol. I will outline, in laymens terms, the scientific basis of cravings and compulsions that are the main cause of an alcoholics irrational behavior. I will give you a clear explanation of how the primitive brain rules over the alcoholic as opposed to the more sophisticated, modern brain. At the end of Step 2, you should come away with a more compassionate view of what your spouse is up against (battling his own brain). PROCEED TO STEP 2
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "+! Step Two: Get Educated about the Disease Learn Facts and Statistics about Alcoholism
Alcohol abuse is a progressive and potentially life threatening disease. 8.5% of adults in America, 17.6 million people, 1 in 12 adults meet the medical criteria for an alcohol use disorder. 18-24 year olds have the highest rate of alcohol abuse. Men are three times more likely than women to abuse alcohol. In a recent study, even low levels of drinking alcohol in women raised cancer rates. Alcoholism runs in families. There is a genetic component to the disease. If a parent is an alcoholic, their child is 50-60% more likely to develop an alcohol use disorder than a person whose parents are not alcohol abusers. Any one who drinks frequently can become an alcoholic. External factors may contribute to alcohol abuse such as losing a job, a spouse, or self-medicating anxiety with alcohol. 100,000 people die each year from alcohol related deaths. Alcohol reduces life expectancy by ten to twelve years. Someone dies in an alcohol related car crash every 31 minutes. Alcohol abuse is a global problem and crosses all economic groups. Alcohol abuse has significant mental and physical effects. The longer you stay sober, the better chance you have of remaining sober. Recovery from an alcohol use disorder is characterized by both periods of sobriety and periods of relapses (90% chance of a relapse over 4 years). Roughly, 7 drinks a week for women and 14 drinks a week for men can produce alcohol dependence (see ,-.!/0123405!64712181.!34!95:3-35! 9;87.!04<!95:3-3527=!>82<.524.7!in the Resource Section at the end).
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! ""!
Sex Number of Drinks/Week Men 14 Women 7
Potential Consequences of Excessive Drinking Loss of job Loss of marriage Increased incidence of depression and anxiety Loss of physical health ( ex: heart and/or liver problems) Increased cancer rates in women Decreased life expectancy Loss of nerve cells (shrinkage of the brain) Legal consequences (DUI, DWI)
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "#! Step Two: Get Educated about the Disease Understand How Alcohol Affects the Brain
The effects of alcohol on the brain (central nervous system) are very complex. Alcohol is a central nervous system depressant. It depresses or quiets the brain and can contribute to depression. The brain is made up of billions of nerve cells called neurons. Neurons communicate by chemicals and electricity. The chemicals are called neurotransmitters (chemical messengers). The neurotransmitter, which plays the main role in alcoholism and other addictions, is called dopamine. Dopamine is involved with the reward system of the brain. Increased dopamine leads to a feeling of pleasure or euphoria. We experience a natural high when our brain releases dopamine in response to winning a tennis match or getting a standing ovation at a performance. Drinking alcohol leads to increased dopamine release (an artificially produced high) in the brain. More dopamine release means more pleasure. Other neurotransmitters are involved in alcohol use disorders namely GABA (which inhibits our impulses), glutamate (which excites our brains), serotonin, and norepinephrine. The latter two have effects though out many different areas in the brain.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "$! Step Two: Get Educated about the Disease Understand How Alcohol Affects the Brain
Over time, with excessive drinking, the brain gets depleted of dopamine. The brain, biochemically speaking, is shouting, Where is the dopamine, get me some dopamine! The brain creates a craving , an urge , a drive which encourages the person to get dopamine (drink alcohol). Many alcoholics complain of depression, boredom, agitation, or restlessness. These mood states may represent the brains urging to seek dopamine. Over time, the brain adapts to repeated exposure to alcohol by lowering its own production of dopamine (called neuroadaptation). The addict, by drinking alcohol, provides the brain with an external source of a substance that causes the release of dopamine. In other words, from the brains point of view, Why bother putting money in the bank (making dopamine) when I can rob a store and get what I need (i.e. drink alcohol)? The brain comes to rely on this external source of dopamine.
Neurotransmitters affected by alcohol
Dopamine Serotonin GABA Glutamate Norepinephrine
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "%! Step Two: Get Educated about the Disease Learn About Cravings and Compulsions
Addiction is characterized by cravings and compulsions. Cravings refer to the strong urges to use a substance that your brain has become dependent on. Compulsions refer to the repetitive behavior an addict uses to obtain the substance (get drunk). Alcohol Dependence is when your brain is yelling (figuratively speaking, of course), Where is the dopamine, where is the dopamine? Rational thoughts are blocked as the brain is obsessed with its goal of getting more dopamine (alcohol). An addicts denial of the addiction and the lack of control over drinking seems crazy to the non-addict spouse, who thinks, Why doesnt he/she consider the consequences of drinking alcohol (such as a DUI)? Maybe the addict has even gotten an advanced educational degree like an M.D. or Ph. D. How can he/she trade this past ability to delay gratification for the irrational drive for the immediate gratification that several drinks provide? Why? The primitive part of the brain is driving the relapse. Our ability to plan is ruled by the cortex of the brain; the outer layer. Humans have the thickest cortex of all mammals. The cortex is the mammalian part of the brain which has been the most recent to evolve. The primitive part of our brain is situated deeper inside. Structures such as the amygdala, hippocampus, and midbrain form connections known as the mesolimbic dopamine pathway which make up the reward circuit. This is the reptilian or primitive part of our brain.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "&! Step Two: Get Educated about the Disease Learn About Cravings and Compulsions
When the brain demands more dopamine, the primitive part of the brain rules over the cortex (therefore you do not think before you act). The addict, over time, can be viewed as mere primitive organism whose main instinctual drive is to get dopamine. The reptilian brain produces cravings (these may take the form of restlessness, sadness, anger), which drives the dopamine-depleted brain into the compulsion (getting the fix). Cravings override the ability to delay gratification or use rational judgment (mammalian brain). The vicious cycle of craving and compulsion continues.
Reptilian Brain Mammalian Brain Most primitive Most recent to evolve Deep in the brain Outer layer of the brain Drives relapse Higher level thinking
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "'! See the marriage from a fresh perspective All of us tend to focus on our own point of view when a situation triggers strong emotions. It is key to learn how to see things from your partners perspective. In other words, what is your partner feeling? This understanding enables you to change your reactions to his/her behavior. As a spouse of an alcoholic, you feel so angry and frustrated that your negative feelings color all aspects of your marriage. You and your spouse get in a vicious cycle of arguing and then withdrawing. Negativity breeds negativity. What are your complaints, frustrations, and worries in the marriage? Conversely, what are his/her complaints, frustrations, and worries? Step 3 tells you how to view your marriage from both sides. It also outlines the personality traits of both you and your partner. As a couple, you are like two pieces of a jigsaw puzzle that fit together. Your personality traits complement one another. You attract an alcoholic. Why?
PROCEED TO STEP 3 (to find out why)
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "(! Step 3: See the marriage from both sides The Non- Addicted Spouses Complaints, Frustrations, and Worries
Its how he treats me when he has been drinking that bothers me the most. She lies a lot and I dont trust her. I know she is cheating on me. I dont know if he is coming home for dinner or not coming home at all. Has he gotten a DWI or has he been in a car accident? Do I pretend to be asleep when he comes in at 4AM? I cant depend on him anymore. I never know what to expect with her moods. He never thinks about my feelings any more. He doesnt participate in the marriage or family any more. I do it all. She gets defensive if I ask her about her drinking. He embarrasses me and makes inappropriate remarks. He argues and fights with me. She isnt intimate emotionally or physically any more. He doesnt think he has a problem with alcohol. Sometimes he is quiet and seems down. She is self absorbed. He is spending too much money. He is late for work when he is hung-over. Will he lose his job? She expects me to cover up for her about her drinking. What would I do without him? What would my future be like? I do so much for our him and our family and I dont feel appreciated.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! ")! Step 3: See the marriage from both sides The Addicted Partner Often has the Following Personality Traits:
Selfish and self absorbed. Impulsive (doesnt think things out. Cant delay gratification such as buying a car or changing jobs). Procrastinates (any alcoholic I have treated puts things off instead of dealing with situations right away). Lies and makes excuses for things instead of taking personal responsibility. Overly sensitive (uses alcohol to anesthetize themselves from any emotional pain or fear). May have a history of physical or sexual abuse in their childhood. Experiences anxiety and worry and uses alcohol to self medicate. Easily frustrated. Perfectionist. Problems with intimacy. Problems with authority. Defiant. Likes control. Easily bored, restless, and discontent. Seeks stimulation of some sort all the time. Cant sit still and relax without drinking. Easily angered. Gets angry out of proportion to what the situation warrants. Minimizes the importance of most situations (has incredible capacity for denial). Feels different than other people and doesnt fit in. Poor coping skills. (Relies on alcohol as a crutch to get through stress). .
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! "*! Step 3: See the marriage from both sides The Addicts Complaints, Frustrations, and Worries about his Non- Addicted Spouse
All she cares about is my drinking. Every positive thing I do doesnt seem to count like providing for my family, fixing things around the house, and trying to be supportive. My spouse nags me. She is always depressed. She doesnt support me. She gives me the cold shoulder when I come home. Why would I want to go home to that? I dont think I have a big problem with alcohol. My spouse exaggerates it. She cant stop me from drinking and I dont want to stop. He tries to control me. I feel guilty when I hide my drinking and lie to cover it up. I know I have made some bad choices. She doesnt understand how hard things are for me. I feel bored and restless. If I hadnt been drinking, I would have been more successful. I know I spend too much money. Im embarrassed to face my family when I have been drinking. I feel desperate and dissatisfied with everything.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #+! Step 3: See the marriage from both sides The Addicts Complaints, Frustrations, and Worries about his Non- Addicted Spouse
I feel unhappy with my wife and my job. Will she take the kids and leave me? He gives me the cold shoulder when I have been drinking. She wants me to stop drinking, but it is one of my few pleasures. I am not sure I can stop drinking, even if I want to. Knowing all the negative consequences from drinking has never stopped me from having a drink when I really want one. I feel guilty that my kids pick up the slack for me.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #"! Step 3: See the marriage from both sides The Non-Addicted Spouse Often has the Following Personality Traits:
Weak sense of self. Comfortable with the martyr role (many grew up with an alcoholic parent or parents that didnt meet their needs). Has intimacy problems and fears abandonment. Bottles up their feelings (poor communicators). Has difficulty reaching out for help. Overly responsible and takes on more than they should. Distrustful. Mixes up being needed with being wanted (will take on role of a caretaker to become indispensable to their partner). Low self esteem. Avoids confrontation (their needs have never counted so they are not comfortable asserting themselves). Wants to be appreciated by their partner for rescuing them. Does more than their fair share to make them feel invaluable to their partner. Feels empty inside and obsesses on their partners behavior to avoid facing this feeling. People pleasers. Ignores their gut feelings. Allows their fear of being alone to dominate everything.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! ##! Learn to understand yourself and your choices Are you at the point where you are too embarrassed to tell your own family and friends what really goes on every day? Let me guess. Is he late for work? Does she rely on you to get her up in the morning? Do you lie to his boss about his absences? Is she cheating on you? Do you have to make excuses about him to your own children? Do you have to pick up all the slack of every day responsibilities? You dont want to tell any one these things because you know how they would respond. LEAVE! To every one else, its a no brainer. Most people cant imagine putting up with this kind of life. That is why alcoholics tend to find the jigsaw piece that fits with their needs. Life is hard. You have your needs too. Step 4 guides you through the reasons that you stay in your marriage. It will give you a clear understanding of your psychological make-up. I will outline for you your specific fears and needs. You must understand your own fears before you can face your fears and be willing to change.
PROCEED TO STEP 4
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #$! Step 4: Understand why you stay in the situation Your Fears: Why Do You Put Up with This Rut?
Your friends and family who know about the situation think you should leave your spouse. They think you are crazy to put up with his/her behavior. Your self- esteem suffers because you are choosing your partner (by staying in the marriage) and your partner is choosing alcohol over you. You love your spouse and he/she loves alcohol. Whats wrong with this picture? The shocker is: You are addicted to him/her the way he/she is addicted to alcohol. Think about it. You obsess about /her behavior the way he/she is obsessed with drinking. You try to control his/her behavior. You try to change your spouses thoughts and feelings. You cant stop focusing on your spouse and his /her behavior despite the fact it is driving you crazy (ex: doesnt come home on time). You may even experience anxiety symptoms such as a tight chest, rapid heartbeat, insomnia, changes in appetite, or feelings of depression in response to your situation. These are the same symptoms an addict may experience when he/she is in physical withdrawal from a substance! You may even have become addicted to pain pills or started anti-anxiety medication in an attempt to cope with this marital stress. You deny how bad your marriage is and rationalize why you stay (When its good its good even though when its bad, its really bad. I wouldnt leave him/her for cancer, would I? How can I consider breaking up our family when he/she has a disease?). You have even lied to family, friends, coworkers, and bosses to cover up your situation. You are protecting your family secret. You compulsively take care of everything for him/her and your family. You say you are the stabilizing force. Does any of this sound familiar? You are experiencing ADDICTION!
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #%! Step 4: Understand why you stay in the situation Your Fears: Why Do You Put Up with This Rut?
The bottom line is very painful to face: You are as sick as your spouse. I know that really stings to read that sentence. You are codependent. You and your partner depend on each other to fill different needs: his/her need to drink and your need to rescue. All along you have been thinking, Hes /shes the one with the problem, not me. Let me explain why you are in this pickle. Its easier for you to focus on another person than yourself. Why? Lets start with your fears... Here are some examples of big fears: Abandonment, rejection, intimacy fears, loss of lifestyle (ex: may have to get a job), loss of having his/her children everyday if there is a divorce, and fear of the alcoholic spouses ability to take care of the children in the case of divorce.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #&! Step 4: Understand why you stay in the situation Your Fears: Why Do You Put Up with This Rut?
These are examples of some common fears that may drive a person to try to fix someone at his/her own expense. Is it worth it? Why would any one being willing to sacrifice the quality of his/her life for another? Here are some potential reasons why: Maybe you grew up in a family that did not meet your emotional needs. Maybe you did not feel valued for who you are. Maybe you grew up with an alcoholic or a parent that was so self-absorbed or busy (working or taking care of a sick brother or sister) that he/she did not give you the nurturing, warmth, and attention that you needed and deserved (and that you still deserve). Maybe you were overly responsible as a child to make up for an irresponsible parent and you are used to a caretaker role. Maybe you crave love because you have never gotten enough. Maybe you mix up love with dependence (being needed) by becoming superman or superwoman and taking care of everyone, but yourself. You may have put incredible effort into being a caretaker of your spouse and rescuing him/her in order to get the goodies (his /her attention and love). Maybe you need a pat on the back or external validation of what you can do for someone in order to boost your self esteem rather than recognition of the wonderful person you are with good values and a good heart. Maybe your ultimate fear is that if you are not needed, you will not be wanted. Your value has become what you provide, not who you are. Maybe you are afraid this defective relationship is actually the best you can hope for, that no one else will ever want you. Maybe you have learned to push your feelings under the rug and avoid confrontation so he/she will not get angry with you and abandon you. These are some reasons, but you may have others that are unique to you
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #'! Step 4: Understand why you stay in the situation Your Fears: Why Do You Put Up with This Rut?
You may be terrified of being alone and unloved. At some level, it feels, like you could just die. Maybe it feels like all the oxygen will be sucked out of you if you let go of your partner, as sick as he/she is. Your spouse is like your lifeline. Its an illusion! Not a good or healthy feeling to be tied to a drowning person, is it? With all your efforts, you are actually enabling your partners addiction to continue! You take care of your spouses every need and more. You do all the chores, are mother and father to your kids, take the kids to school when he/she is hung-over, lie to his/her boss and to your friends when he/she doesnt show up, and on and on. You put up with lies. Your spouse never has to face the negative consequences of his/her addiction. You protect your partner from it. In doing this, you disable him/her! What can you do to change this? Stop rescuing him/her! Support your spouse in his/her own independence. Assert yourself more. Focus on taking care of you.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #(! How is your spouses alcoholism affecting you and your children?
Most people in your situation rationalize the impact of their loved ones addiction on themselves and their children. Addiction destroys families. Every one is affected at a deep level. Both spouses suffer a lack of intimacy. Basic needs are unmet. You feel isolated and alone. Your needs do not count. You feel unlovable and unworthy. Your self-esteem is shot. The children feel it is their fault that they arent worthwhile enough for the addict to overcome his/her addiction and be available as a responsible parent. They grow up with a poor self-image, anger, and resentment. These feelings lead to life long problems. In Step 5, I outline the different problems that arise from your spouses alcoholism both on you and your children. This step will help break through you denial of how serious your situation has become.
PROCEED TO STEP 5
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #)! Step 5: Face the impact on the family The Impact: Family Fall-Out
The impact on the spouse of an alcoholic includes: Loneliness and isolation. A lack of emotional intimacy due to poor communication. Resentment and anger. Verbal abuse. Possible physical and/or sexual abuse and fear for his/her safety and/or the childrens safety. Lying for his/her spouse in order to keep the family secret. Increased responsibility for the house and the children because he/she cant depend on his/her spouse. Depression and anxiety (What would you expect if you were trapped in that situation?). Low self esteem. Not functioning well at work because of distress over the marriage. Inadequate sexual intimacy. Physical health problems due to constant stress in his/her personal life and not getting enough sleep or eating well. Financial consequences of his/her spouse not working, spending too much, or using his/her money for legal problems such as arrests for drunk driving. Guilt that the children are deeply affected by this stressful situation.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! #*! Step 5: Face the impact on the family The Impact: Family Fall-Out
The impact on the children of an alcoholic includes: Problems with trust and feelings of insecurity as a result of living with someone who is unpredictable and unreliable (intimacy issues). Feelings of guilt that they are responsible for their parents disease. A constant need to lie for their alcoholic parent to keep the family secret (pretending to be a normal family). Low self esteem (its hard to feel valued when your parent loves alcohol more than you). Higher rates of their own substance abuse, depression, anxiety, and eating disorders compared to children growing up in non-alcoholic families. Not as successful in school (less likely to go to college). Feelings that they are different and therefore tendency to become isolated. Fear of shame and embarrassment that their peers will discover that they have an alcoholic parent. They dont invite friends over to the house. A greater risk of being physically or sexually abused by the alcoholic parent than children growing up in household without an addict. Increased responsibility around the house compared to children of non- alcoholic parents. For example, older siblings are often seen taking care of younger siblings needs to an excessive degree. Picking dysfunctional partners for marriage whom they play a caretaker role with. They are used to this role from childhood. Higher rates of being born with Fetal Alcohol Syndrome (FAS) if the mother drinks alcohol during pregnancy. Alcohol hurts the developing fetus. A baby with FAS is born with facial abnormalities and brain damage.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $+! Quit trying to control your spouse You have tried every thing you can think of to make him/her stop drinking. Let me guess? Not only has it not helped, the situation is getting worse. No matter how angry, dramatic, or cold you act toward your spouse, he/she continues to drink. You have even gotten him/her to promise to cut back or stop drinking, but have not seen any results. You can cut the tension in your house with a knife. You cant even concentrate at work or on other things at home because you are always wondering what trouble he/she is getting into now. You dont believe anything your spouse says. You have become the worlds expert at being a snoop and catching him/her in different lies. Have your attempts gotten you anywhere? You once thought of yourself as a relatively normal person. What do you think of your own behavior now? Crazy? Step 6 will identify the approaches you have tried that are making the situation even more unbearable.
PROCEED TO STEP 6
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $"! Step 6: Learn to give up on useless strategies Ten Strategies That Have Been Ineffective in Improving Your Marriage (Trying To Change Your Spouses Behavior)
1. Arguing (which leads to bad feelings). 2. Ignoring the problem in hopes it will improve on its own (it never does). 3. Withdrawing or acting cold (emotional punishment which is passive aggressive). 4. Trying to control your his/her behavior (checking your spouses cell phone, taking car keys away, following him/her in order to expose a lie). 5. Being needy (thats the quickest way to get your spouse to avoid you). 6. Blaming (stop holding him/her responsible for your feelings of anxiety and depression over your family situation. You are choosing to stay. Think about it again and ask yourself- who is the one with the problem?). 7. Instilling guilt (dont bring up that the kids do not invite their friends over. Dont focus on how much money he/she could have made). 8. Giving them a false ultimatum (dont threaten to leave him/her if you are not going to follow through). 9. Whining and complaining (UGH! Who can stand to be around a whiny baby?). 10. Bailing them out of situations (dont cover up for his/her irresponsible behavior or you are actually delaying their recovery). Quit rescuing!
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $#! Learn to be the solution, not the problem Without realizing it, you have contributed to the problem. You want your marriage to improve, but cant figure out how to reach this goal. You feel helpless. You are scared if you let go of your attempts to control your situation that you will lose everything! You are terrified of ending up alone. It feels as though you have no lifeline and nowhere to turn. Its scary to change your approach, but your old ways are clearly not working. You have no choice, but to try something different. Step 7 will give you new strategies to implement that will turn your life around. Your life and your marriage have the best chance of improving with these proven techniques. Be brave. Ask for help. This is very often something you cannot do alone. Some people go to a support group such as Al-Anon, Family Anonymous, or Alateen. Some people go to a therapist or a psychiatrist. Get the guidance and support you need to carry out the strategies outlined here. PROCEED TO STEP 7
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Ten Effective Strategies that will Help Improve Your Marriage (Trying to change your own behavior)
1. Focus on yourself, not your spouse. You can change yourself! Your behavior is something you can and should control. 2. Get your own life going! Pursue an interest, take a class, or participate in a sport. Have fun. Start working out. Enjoy your job and your children. Call a friend. Quit obsessing about everything your spouse is doing. All your energy is focused on your spouses problems. This obsession is toxic to you. 3. Reach out for support. Call a close friend. Tell your family what is going on. Reconnect with a college friend. Start building a support system. Go to Family Anonymous or Al-Anon. 4. Work on being independent. No spouse can meet all of your emotional needs. Its not healthy. Learn to rely on yourself and your support system. Again, make new friends, reach out to extended family, and/or even go to therapy. Pursue new activities. Learn to stand on your own two feet. 5. Let your spouse experience the consequences of his/her addiction. Let him/her be late for work. Let your spouse miss an important event for one of the kids. Dont make excuses or lie for him/her. Quit policing: his or her every move. 6. Show empathy. When your spouse is stressed, let him/her know you are aware of this. Acknowledging your partners stress doesnt make him/her abuse alcohol. Your spouse is fighting the primal urges produced by his/her brain.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $%! Step 7: Learn new helpful strategies Ten Effective Strategies that will Help Improve Your Marriage (Trying to change your own behavior)
7. Dont use your new independence as a weapon against your spouse. As you concentrate on changing your own life, you will not be so dependent on him/her. Your partner will feel this change. As you develop a better balance in your own life, you will feel less angry and find it easier to be nice to your spouse. 8. Go to activities without your spouse. Go to the movies with a friend. Go to Church even if you feel self conscious about your spouses absence. Go away for a weekend with friends. Quit pretending to the outside world that you are the perfect family or couple. 9. Take responsibility for your part of the problem. Quit acting like you are the one without the problem in the family. The problem could not have continued this long without your enabling/rescuing your partner. 10. Be up front about your feelings. Dont bottle up your feelings and let them fester or you will explode when your feelings finally come to the surface. Learn to communicate in a constructive way when things bother you and this will save you loads of time and trouble. Consider going to therapy to learn this skill. Be more assertive. Take better care of yourself emotionally and physically. 11. If all else fails, and your partner is not willing to get help, evaluate your options. If your children or yourself are in physical danger, you must consider leaving the situation. Protecting your life or your childrens life comes first!
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $&! Learn how an intervention works
For every reason you bring up to your spouse to stop drinking excessively, he/she will give you an excuse for his/her behavior. This powerful denial is a core feature of alcoholism. Without confronting your spouse with the consequences of his/her disease, he/she will never get it. Your spouse views you as the one with the problem. You are the nag that causes he/she to drink more. You feel like you are beating your head against the wall. What are you supposed to do? Organizing an intervention is a common method used to penetrate the denial that accompanies addiction. An intervention is a very intricate and emotional process that is best guided by a professional. If the process fails, it often makes the situation even worse. People risk it because it is may help the alcoholic admit that he/she has a problem. Admitting this is the first step in accepting help. In Step 8, I explain what an intervention is. I guide you through the nuts and bolts of the process. More often than not, a professional should be involved to organize and oversee the process.
PROCEED TO STEP 8
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $'! Step 8 : Learn how to stage an intervention
The Final Rescue Attempt to Get the Addict to Accept Treatment
Q: What is an intervention? A: An intervention is when family and friends get together as a group and confront the addict with the consequences of his/her addiction. Each one states the impact of the alcoholics disease on his/her life. Often, a trained professional, known as an interventionist, is included.
Five Steps for Staging an Intervention
Step One- Hire a professional interventionist
A professional interventionist can guide you through the complex process of a successful intervention (rehabilitation programs can recommend interventionists as well as therapists that specialize in addiction or you can do an internet search for alcohol interventions for information). The role of the interventionist is to keep the process positive and non-judgmental. The interventionist teaches you to approach the addicted family member in a caring way. Angry emotions and resentment have built up as a consequence of the addicts irresponsible behavior and these feelings must not dominate the process.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $(! Step 8 : Learn how to stage an intervention The Final Rescue Attempt to Get the Addict to Accept Treatment
Step Two- Carefully plan the intervention
Decide who is going to be included in the intervention (the more people the better), where it will take place and when it will take place. It takes 2-3 weeks to plan an intervention. Family members, close friends, or even bosses may be included. Each person writes a letter stating the positive contributions of the addicted family member (or employee) before they started abusing alcohol. For example, You used to come to all my soccer games or We loved when we ate dinner as a family. The second part of the letter addresses the consequences of how his/her drinking has impacted you. Specific examples of his/her behavior are given.
Make arrangements for a treatment program prior to the intervention. Make arrangements for admission to a program to take place on the day of the intervention. Work out health insurance and financial arrangements in advance. Decide who will escort the person to the program (in many cases, the interventionist will do this). Get appropriate plane tickets, if necessary. Pack his/her suitcase.
Have a back up plan. If the intervention fails, make legal arrangements, if necessary, for the safety of the children.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $)! Step 8 : Learn how to stage an intervention The Final Rescue Attempt to Get the Addict to Accept Treatment
Step Three- Practice the Intervention Without The Person Present
Organize the intervention in advance. Practice reading the letters out loud the day before the intervention. Angry or judgmental letters should be rewritten. Determine the order of who reads the letters. Anticipate different outcomes. For example, what happens if the person gets angry and walks out of the intervention? Who should try and bring him/her back in the room? Who has the most positive influence? Is there any physical danger? For example, are there weapons in the house? (Remove them).
Step Four- The Intervention The interventionist introduces him/herself and explains to the addicted family member why the intervention is taking place and asks him/her to sit and listen to the letters. Each person takes a turn reading his/her letters. At the end of this process, the interventionist informs him/her of the treatment arrangements that have been made. The interventionist directs the entire process. There are a lot of very powerful emotions that surface during an intervention and it is the interventionists job to keep it on a positive track.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! $*! Step 8 : Learn how to stage an intervention The Final Rescue Attempt to Get the Addict to Accept Treatment
Five things you should know about interventions: An intervention is an important step in breaking down the denial of the addict regarding his/her disease. It may save his/her life. Sometimes the process can fail and can cause even more harm than good to family relationships. Interventions are a very emotional process. Interventions can help family members identify the role he/she has played in enabling the addiction. A good recovery program helps the family, not just the addict. I cant overstate this. In addition to the intervention, family members can get a lot of help by participating in Families Anonymous (FA) meetings. There are several locations in different cities and the meetings are free. The program is excellent because the focus is the family unit. Al-Anon is a very important support group for family members of addicts. There are multiple locations in every city and there is no charge to attend the meetings. Both groups have on line options to participate as well.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %+! What does treatment for alcoholism involve? Alcoholism cannot be cured. Often the recovery process involves times of sobriety as well as relapses. There is no magic form of therapy or magic pill that guarantees sobriety. A multi-factorial approach has the best chance of success. For example, the combination of different disciplines such as the use of medications, psychotherapy, group therapy, family therapy, 12 step programs such as Alcoholics Anonymous, relaxation training, yoga etc. enhances the chance of a successful recovery. Step 9 educates you about all aspects of alcohol treatment. I outline different treatment options. For example, some alcoholics go to a rehabilitation facility for treatment whereas others participate in an intensive outpatient program. Others choose to participate in AA regularly and may supplement this with weekly therapy. These decisions are influenced by how severe the alcohol problem is, finances, legal consequences, and the preferences of the person suffering from alcoholism and his/her family. In step 9, I explain the different types of medications used for both withdrawal symptoms and maintenance therapy as well as outline in a clear way the different forms of psychotherapy that are available.
PROCEED to STEP 9
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %"! Step 9: Learn about potential treatments Options for Treatment
What does the treatment of alcoholism involve?
There are often four components to treatment: 1. Detoxification 2. A Rehabilitation program. 3. An Aftercare program 4. A 12-step program such as Alcoholics Anonymous (AA and Al-Anon).
Detoxification The goal is to prevent symptoms of alcohol withdrawal. May be done in the hospital over 4-7 days or on an outpatient basis. Typical medications used to prevent and/or reverse symptoms of alcohol withdrawal are Ativan, Valium, Librium, Neurontin. or Baclofen. The patient is given thiamine and folic acid (both B vitamins) to correct the nutritional deficiencies common in alcoholism. (Thiamine deficiency can lead to Wernickes Encepholopathy. This is a neurological disorder involving problems with eye movement, balance, and memory. Folic acid deficiency can lead to anemia). The patient is hydrated with IV fluids. Physical problems such as any heart, liver problems, or high blood pressure may be addressed and if present may lead to a longer hospital stay until the patient is medically stable.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %#! Step 9: Learn about potential treatments Options for Treatment
Rehabilitation Program May be an inpatient program or an intensive outpatient program. Inpatient programs typically last 30-90 days. In some cases, the patient goes to a residential aftercare program to increase their chance of remaining sober. Intensive outpatient programs typically meet for 3 hours, 3-4 days a week, often in the evening. These programs are geared toward people who cant miss work. They often last about 12 weeks.
Components of a Rehabilitation Program Education about alcoholism Counseling (individual, group therapy, and family counseling) Psychiatric evaluation and possibly pharmacotherapy Stress Reduction 12-Step Participation Structured Activities
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %$! Step 9: Learn about potential treatments Options for Treatment
Counseling: Individual counseling may involve forms of cognitive behavioral therapy that help correct the distorted thinking and negative attitudes that alcoholics experience. In therapy, the person identifies his/her triggers for drinking and learns skills to avoid relapses. Communication skills are worked on. Techniques to reduce stress are learned. Anger management is often addressed. Group Therapy is helpful for getting through an addicts denial. The addicts peers are likely to confront an addicts excuses for his/ her behavior. Group sessions help the addict learn to deal with confrontation in a positive way. Family Counseling is crucial. It focuses on education about the disease as well as the roles different family members play in enabling the disease. Often an addict has as easier time maintaining sobriety if he/she is no longer enabled. Psychiatric Evaluation Every person should be assessed by a psychiatrist and should be evaluated for alcohol abuse versus alcohol dependence. It is important to determine what other substances are being abused such as cocaine or marijuana. It is extremely important to evaluate for other diagnoses such as Anxiety, Depression, or Bipolar Disorder. Different diagnoses may change the treatment options.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %%! Step 9: Learn about potential treatments Options for Treatment
Pharmacotherapy Options May include: Anti craving drugs: Campral - reduces the craving for alcohol by affecting a neurotransmitter called glutamate. It restores the balance of glutamate in the brain. Revia reduces craving for alcohol by blocking the high from opiates and alcohol. It may speed up the healing process of the damaged brain from repeated alcohol exposure. Vivitrol -is an injectable form of Revia and lasts 30 days. Topamax- is an anticonvulsant that has been shown to reduce alcohol cravings. Deterrent Drug: Antabuse (Disulfiram) - causes severe nausea, flushing, and headache if someone drinks with it. It deters an addict from relapsing because the experience is horrendous. Antidepressants and anti-anxiety drugs- treat the depression and anxiety that often accompanies alcoholism. Examples are Lexapro, Zoloft, Pristiq, Paxil. Mood Stabilizers are effective if Bipolar Disorder is present. Examples are Depakoate, Seroquel, Lithium, Limictal
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %&! Step 9: Learn about potential treatments Options for Treatment
Stress Reduction may include: Biofeedback Yoga Exercise Relaxation techniques Life style change Improved communication skills A strong support system
12 Step Program The 12-step program for alcoholics is called Alcoholics Anonymous (AA). It is a support group comprised of alcoholics at all different stages of sobriety. The goal is total abstinence from alcohol. People share their experiences and encourage and support one another. AA meetings are free to attend. The organization is supported by member donations. There are multiple locations available as well as different meeting times. It is not affiliated with any organization or religious group. It is spiritually based in that one is supposed to recognize the existence of a greater power to surrender oneself to (this puts some people off).
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %'! Step 9: Learn about potential treatments Options for Treatment
12-Step Program Early on in sobriety, a person may choose to attend AA every day. Others go less frequently, but it is recommended that a person at the early stages of his/her sobriety attend as frequently as possible. In my experience, as a psychiatrist, the people who attend AA on a regular basis have the best chance of remaining sober. It is no guarantee, but it helps people stay committed to his/her goal. A person who goes to AA is encouraged to get a sponsor who has some success with sobriety. The sponsor is a mentor that can help support the person as well as guide them through the 12 steps. Without listing the individual steps, the highlights include admitting you are powerless over your addiction, taking an inventory of your actions while you were drinking, listing the people that have been impacted by your disease, and making amends to the people you have hurt. AA does not provide therapists. It does not take the place of therapy. It is a very important part of most alcohol treatment programs. Family members are encouraged to attend Al-Anon, the organization that is the 12-step program for the spouses, friends, and adult children of an alcoholic or they may attend Families Anonymous. Alateen is part of Al- Anon and is the 12-step program for teenagers whose family member is an alcoholic. The goal of these programs is to support one another in solving the problems of codependency and enabling as well as other problems they share.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %(!
Step 9: Learn about potential treatments Options for Treatment
Structured Activities Inpatient programs often offer fun enrichment activities such as going to the movies, sports activities etc. These activities are supervised so the patient has less chance of relapsing during their recovery program.
Residential Aftercare Many recovery programs offer residential aftercare programs. These programs represent a transition phase before the person is ready for discharge. The program provides a room in a house or an apartment that the person shares with another recovering alcoholic. There is less supervision (more freedom) than the first phase of the recovery program. The person is expected to become involved with the community. This usually means starting a job and showing more responsibility. The person continues to participate in therapy and AA. This transition phase tests the skills learned in the first phase of treatment. If there is a relapse, certain freedoms are lost. As responsible behavior is demonstrated over time, certain privileges can be regained. Studies show that longer programs tend to increase the chance of sobriety.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %)!
How Do Help Your Recovering Spouse When a person is in recovery, the dynamics of the family completely change. It can actually be a very difficult time. In the marriage, typical problems that occur are feelings that you are no longer needed. Your partner is taking more responsibility for him/herself. You may even feel jealous and resentful with the 12-step program that takes him/her away from you and the family for hours at a time. It can feel very threatening and lonely when he/she starts out on this new path. You will have to learn to take care of yourself for the first time. Your spouse, too, is learning to take care of him/herself in healthier ways. This transition takes time and patience. Also, relapses are common and can bring up a lot of old feelings of resentment and fear. Step 10 provides the roadmap of steps to take to be supportive of the recovery process.
PROCEED TO STEP 10
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! %*! Step 10: Help Your Spouse in Their Recovery Speak up at the time something is bothering you. Dont expect consistent progress. Relapses are common. Over time, longer periods of sobriety may occur. Encourage your spouse to attend AA meetings. He/she needs this support even though it takes time away from the family. Dont feel guilty that sometimes you resent coming in second to sobriety. Many people in your position share this sentiment. Get support! Go to Al-Anon, talk to friends and relatives, Talk to a therapist that specializes in addiction and understands what you are going through. Encourage your spouse to develop his/her own support system. Dont micromanage your spouses sobriety. Encourage your spouse to be responsible for his/herself. Dont lie or cover up for your spouse if he/she relapses. Acknowledge his/her improvement and encourage attaining new goals. Take care of your physical health by getting a good nights sleep and eating nutritious meals. Encourage your spouse to follow suit. Learn to listen to each other and show compassion and support. Be respectful with each other in your words and your actions. Spend time together as a couple and get reconnected. Recognize it takes time for both of you to adjust. Dont expect overnight improvement when he/she gets sober. You are learning to be wanted, not just needed. A lot of negative feelings have built up and damaged the relationship. Over time, these feelings may diminish as trust is rebuilt. Some couples cant overcome these angry feelings and choose to get divorced. Aim for a new healthier relationship and lifestyle mentally, physically, and emotionally.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! &+! Main Obstacles to Treatment
The alcoholic is still in denial and refuses treatment. There may be drug abuse in addition to alcohol abuse (cocaine abuse, pain pill abuse, Xanax abuse, or amphetamine abuse). This may make the treatment more complicated. There may be another mental health disorder on top of the Alcohol Dependence such as Bipolar Disorder, a Depressive Disorder, an Anxiety Disorder, or Narcissism that must be addressed as well. This is a very common scenario (this is called dual diagnosis which means more than one diagnosis) is present. Both spouses may be alcoholic and one spouse does not support the other spouse getting treatment. There may not be the finances available to pay for treatment. (Remember Alcoholics Anonymous is free). *
Obstacles to Treatment Denial Accompanying drug abuse Another mental health disorder Both spouses alcoholic Lack of finances
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Copyright ! 2009 Sarita Uhr, M.D. ! &"! Summary of the Key Points
Alcoholism is a chronic and progressive disease. Alcoholics drink because their brains are addicted to alcohol, not because they have a weak character or lack willpower. Alcoholism is a treatable disease. The longer one maintains sobriety, the greater the chance sobriety will continue. It is a family disease. Family members perpetuate the illness by not allowing the alcoholic to experience the consequences of his/her disease. A person who abuses alcohol gets better only when his/her family members quit enabling him/her. The new medications for treating alcoholism are very beneficial in both reducing cravings and speeding up the healing of some of the brain damage caused by excessive drinking. From a psychiatrists perspective, treating anxiety, depression, or other mental health disorders with the appropriate medications increases the chance of sobriety. Rehabilitation programs with their multifaceted approaches to therapy as well as encouraging life style changes are often a necessary step in starting an alcoholic on a recovery path. 12-step programs such as AA are often crucial to maintaining sobriety. 12-step programs such as Al-Anon are often crucial to the family members of an alcoholic to overcome their codependency issues as well as get support. Therapy is key for dealing with the distorted thinking of an alcoholic, working on his/her childhood issues, and dealing with the psychological fall out from his/her disease on his/herself and the people he/she loves.
Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic
Learn to affirm yourself every day Put 100 good thoughts in your head. Start with thinking one positive thought, then two, then threethen 10, 20100. Think about it. You take your thoughts everywhere you go. The more positive your thinking, the more positive your mood. Think positive. This affirms you. And you affirm your life!
Bibliography and Resources Websites Alcoholics Anonymous- http://www.aa.org/ Al-Anon- http:// www.al-anon.alateen.org, Families Anonymous - http:www.familiesanonymous.oig Betty Foiu Chiluien's Piogiam- http: www.bettyfoiucentei.oigchiluien CAuE questionnaiie (scieening tool foi alcoholism)- http: www.meick.healthinkonline.commeickTools AssessNeickSouiceCAuE.asp CDC Center for Disease Control and Prevention (Department of Health and Human Services)- http:// www.cdc.gov ( Facts on Fetal alcohol syndrome) Co-dependents Anonymous- http://www.codependents.org/ index.php BealthatBealth.com- http:www.athealth.comconsumei uisoiueisalcoholfamily.html Nayo Clinic -http:www.mayoclinic.comhealthalcoholism BSuuS4uBSECTI0N=tieatments-anu-uiugs (This piogiam is baseu on a meuical mouel, not a 12 step piogiam). Mental Health America- http://www.nmha.org/go/ codependency National Institute of Alcohol Abuse and Alcoholism (NIAAA)- http://www.niaaa.nih.gov Substance Abuse/ Mental Health Services Administration- http://www.samhsa.gov/ http:ncaui.samhsa.gov National Alcohol Substance Abuse Infoimation (Inteiventions) http:www.auuictioncaieoptions.com Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic Copyright 2009 Sarita Uhr, M.D. 53 Bibliography and Resources !""#$ American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed, revised (DSM-IV-TR). Washington, DC, 2000. Conyers, B: Addict in the Family: Stories of Hope and Recovery, Hazelden, 2003. Herrick, C, Herrick Ch: 100 Questions and Answers about Alcoholism, Jones and Bartlett Publishers, 2007. Kellogg, T: Broken Toys, Broken Dreams: Understanding and Healing Codependency, Compulsive Behaviors, and Family, BRAT Publishing Corporation, 1990. Stahl, Stephen M. Essential Psychopharmacology: Neuroscientic Basis and Practical Applications, 2 nd Edition, Cambridge University Press, 2006. Urshel lll, H: Healing the Addicted Brain: The Revolutionary, Science-Based Alcoholism and Addiction Recovery Program, 1 st Edition, Illinois, Sourcebooks Inc., 2009. %&'()*+$ !""#$%&'()#*+",+)-#.()#/,0123"#$%&'(4"45"3%%04478(119:;; 3""9%&'(<'47;=420+3";3"'4(4",%7<(17" .()039&#$"3')<'478#(119:;;>>><?1()039&9"3')<'47#@3AA,'1,4+# 301,'")%B Stop Being a Victim! A 10 Step Guide to Rescuing Your Marriage to an Alcoholic Copyright 2009 Sarita Uhr, M.D. 54