Why is Alcoholism Considered a Family Disease?

Why is alcoholism considered a family disease?  Because alcoholism, unlike any other diagnosis on record, is a disease of behavior.  Being a behavioral counselor, I have a unique view of the relationship between behavior and the environment that it occurs in.  At my job, I look at what in the environment that is essentially causing the behavior.  I look at what happens before the behavior and what happens afterwards to determine the function of the behavior, and there is always a relationship between the environment and the behavior.  For instance, if a client hits me whenever I ask him to build a puzzle, and then I let him get out of building the puzzle, then he is hitting to escape from the task assigned.  My behavior is followed by his behavior, which is followed by the result.  Now, I wouldn’t let a child get out of a particular task after hitting, but then I’ve been trained in these techniques.  That said, when dealing with adults, as is the case with alcoholism, it is a little more difficult.  It’s not as if you can force an adult to do something that they don’t want to do.

Now, in an alcoholic situation–the alcoholic does something–let’s say comes home and screams and yells at his/her significant other or at their daughter (I’m an adult child of an alcoholic, so I need to make this pertain to my situation, too).  The significant other or daughter argues back or learns to hide, and the alcoholic drinks more or continues fighting, perhaps things escalate.  Or conversely, the significant other nags alcoholic about drinking; alcoholic argues or leaves; significant other resolves to nag alcoholic some more.

In both of these cases, there is a direct link between the behaviors of the alcoholic and the behaviors of the significant other(s).  In the first example, the alcoholic screams at the significant other, the significant other reacts by arguing back, so the situation escalates.  Or the significant other, hides or leaves, and the alcoholic drinks more or becomes angry because of significant other’s reaction and tries to find him/her.

In the second example, we start with the significant other nagging the alcoholic.  The alcoholic becomes defensive and argues back or simply leaves, because (s)he cannot deal with what is happening.  This reinforces the significant other into believing that (s)he is right, and therefore resolves to nag even more the next time.

As is the case with my clients, something needs to change in one part of the equation–and by changing any part of the equation, you change the overall outcome.  In the case with the client hitting….I can offer him choices other than a puzzle, preventing the behavior altogether.  I can teach him to tell me “no thanks” when I ask him to build the puzzle rather than hitting me to escape.  Or I can prevent him from escaping.

Now remember where I said that it is not so simple when dealing with adults?  This is why.  In the first example, the alcoholic screams at the significant other.  As I was not the alcoholic in this situation–there was absolutely nothing I could do to stop the alcoholic from screaming, because we really can only control our own behavior.  And what about the alcoholic drinking more or trying to find me if I were hiding?  Nope.  Because I can’t control what the alcoholic does.  The only thing I can try to control is my own behavior.  I can do something different.  I can choose not to argue or hide and simply go about my business.  This is not to say that if the situation becomes dangerous that I should not just get out and keep myself safe.  A safety plan is always a good thing to have if things are escalating, but the point is that by changing my response, I can change the overall outcome.  The alcoholic could still try to argue, but it’s harder for one person to escalate an argument when the other person is speaking to them calmly.  That’s not saying that it can’t be done, but it is more difficult.

Now, with the significant other nagging….in order to change the situation, the significant other can choose not to nag.  In this case, the alcoholic has little reason for arguing or escaping.  As a significant other (SO), it is not possible to control the alcoholic’s response to our behavior, but the SO can choose not to nag in the future as well, even if they forgot and ended up nagging in that particular incident.

Now there is an important thing to add:  extinction burst.  Extinction is the procedure I would be using in the example with the child who hits.  By choosing to not allow him to escape from the puzzle, I would be putting his behavior on extinction.  Something that happens when we do this is that the behavior escalates before it stops, meaning that he’d likely try to hit me more to try to get me to give in and let him out of building the puzzle.  It’s the same way with the alcoholic.  People don’t like change.  At the very least, (s)he is going to be confused by the SO’s new responses–worst case scenario, the behavior will get worse to try to manipulate the SO into responding in the old ways.  It is important here not to give in, because the second SO gives in, the alcoholic will continue the new escalated behavior–not go back to the old behavior.

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