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Please also note that posts have been gender neutral since autumn More often than not, the primary issue that women focus on is the emotional unavailability but there are always physical and spiritual issues to prop it up. Mr Unavailable or as some refer to him EUM — emotionally unavailable man — or EU with his inability to tap into his emotions, his lack of self-awareness and his mismatched actions and words, has millions of women investing their time and energy into fruitless liaisons with him.

Mr Unavailable is very much about the chase. He pursues hard, showers you with attention and lays it on thick with a trowel in order to reel you in, but from the moment that you are hooked and things get comfortable, he backs off. Then he homes in again. This is a good time to read about blowing hot and cold , Future Faking , and Fast Forwarding. When you look at the pattern of your relationship, you will notice that it always, no matter how much blowing hot he does, rolls back to his comfort zone.

After a while it seems as if he wants to avoid doing anything that involves being close to you — think emotional intimacy — despite starting off very eagerly when he was pursuing you and unsure that he could win you.

Did I mention that Mr Unavailable associates the feeling of desire with the feeling of uncertainty and being out of control? Make sure you are aware of the implications of red flags in relationships also code red and amber behaviour having little or no boundaries. And I agree with Ananda. Glad I woke up to myself. I always thought this was ok because we still saw each other frequently. But in retrospect I can see the pattern. For 3 and a half years he ditched my anytime someone else wanted to hang out.

The times we saw each other were when neither of us had plans, or in his case potential plans. He says one thing but does something completely different. His excuse was he had made wrong choices in the past and felt he was incapable of making a right one so he would turn to them to decide. He says that he does not want a relationship but and when you back off from him, he tries to get you back, only to repeat the same pattern. He is the KING of mixed signals!! They want to control the pace of the relationship not you.

Lastly, they are very quick to get to the sex thing and when its over that intimate feeling is just not there, making you feel used. This is very familiar, I have just been dumped by someone who I now see is emotionally unavailable. I recognise the majority of these statements… and how hurtful it has all been. We work together and I was very reluctant to start an office romance, yet he pursued relentlessly and i gave in.

Yet the relationship, had to be kept a secret. I adhered to his schedule. There was real pressure to sleep with him. He constantly referred to his ex girls friends… so and so got too serious too soon, she was a bit older and was to settle down etc.

What the hell is that all about. I had no intention of ever having 10 but I mourn the loss of the one or two I may have had with him, which makes it even worse. Yet he had the audacity to incidate I had been causing him to feel pressure!!!!! I called my EUM after reading comments on this site the night before. It was so utterly sad and pitiful the way in which he feigned such complete and total ignorance as to whom had he dated first. I needed to know if I was the other woman or was she.

He was so mean that I literally could not bellieve this was the same guy I had given myself to so completely for 8 months. I thought that my day would be disasterous and stressful. I was truly trying to spin straw into gold, begging and pleading for the straw to immeditely do so. Count this as my testimony of Jesus Christ and who I am in Him.

Stay strong sisters, and know whether you believe in Him or not, God does Love you and wants a lot more for your life than what we have settled for!

As for me and my Heart- I will serve the Lord. Plans for you to prosper and not harm you. I am seeing a EUM. Part of me wants it to end and my desperate side wants to just take what I can get. I keep telling my self that he is still healing from a cheating wife and given time he see the wonderful lady I am.

I have dated 4 EUM which suggests to me that I have some unresolved issuses of my own. To anyone who is being ignored, hurt, stood up, insulted and emotionally abused by a EUM, we are worth more than that. I plan on taking my own advise. It is not that bad being alone it is kind of peaceful. I was seeing an EUM for about 12 weeks but technically not that long because I broke it off twice in the last six weeks.

We probably had five weeks of dating him constantly calling me him talking about marriage him telling me he loved me him holding onto me at night like he was trying to melt my body into his I sweat so much I almost awoke with an afro Me resisting and despite having that irritable bowel syndrome feeling in my stomach letting my self melt away into the cloud of his attention on the edge of 23 story building.

Actually around the second week I told him not to call me anymore because he went ghost one night and it felt uneasy IBS -something did not feel right. So I told him to lose my number and of course he left several messages and texts begging me to give him a chance.

That is when he said he loved me and that I reminded him of this grandmother no offense his mother is kinda shaky character wise so I did not take offense to being compared to I guess the only positive female in his life- that should have been a sign Well I should have listened to my intuition then. Thank God I do not hop into bed quickly. Not judging anyone else To make a long story short he saw me in my professional capacity watched me for several weeks asked about me and asked me out around the last week in April.

The only thing I can say is listen to your gut the first time. One thing I am proud of is that I was not instantly attracted to him. I had to hear his resume and see some of the actual fruits of it which made him appear successful and driven. Thanx for all the input. I know this sounds like a cliche but there are deep rooted reasons for everything we do in life.

Humans learn things in their family of origin. It is there that I fell in love with my first EUM, my dad. Sure, he was in the home, but certainly not plugged in to his kids. Not able to really bond with me or know me intimately as a dad should.

Just taking inventory girls. Time to move on! Take it from someone who has thought very deeply about this whole scene.. Most of us women who are drawn to this type man also have a profound unawareness going on within that cultivates the dynamic of the relationship. You may not choose another man who is a drinker or some other behaivor that is glaring , but rest assured you will pick a man with the same core qualities just different window dressing.. This is a fact and unless intense soul searching with rigorous honesty is done the underlying causes will remain hidden.

Ladies it is subtle , and here in America it is prevelant. Tao help us all…. What a great site! I love reading all of your comments — makes me feel better knowing that there are loads of other fabulous, strong women out there who are going through exactly what I am! I am — or, at least am trying to no longer be, as of a few days ago — involved with an UAM who also has post-traumatic stress disorder.

I consider myself to be an incredibly intelligent and independent woman, but feel like a complete idiot for continuing to see this man, despite the red flags and warning signs.

But, I also work with this guy, so that makes things incredibly difficult. I now realize that this man is a carbon copy of my emotionally unavailable father, minus the alcoholism. I want to stop this madness!! Wish me luck, my forum friends — any words of encouragement or wisdom would be greatly appreciated!

Totally concur with this. He refused to talk about our relationship for six months, and blamed me for wanting to talk about it; yet he told me that I owned him. Dumped a week ago by an EUM who I believed to be my soulmate… together 3 months after 12 months of fancying each other. Now I know why he never initially pursued me!! I truly believe the dumping has happened for a reason because I am finally going to rid myself of all my past relationship traumas.

I have been the nest-builder for 4 men now — preparing them for the next gf who incidentally they have all moved in with. Sick and tired of it. Dream on m8 it was there till I told you I really liked you and was feeling vulnerable! Sad thing is he spent christmas with my family and me with his. We looked right together and it was so easy He said too easy and too serious too soon. It is his loss and my gain. Since he dumped me I have become so pro-active: I booked my flights to New Zealand for a month, saw a clairvoyant, am putting my house on the market, gonna finish my degree then emmigrate to NZ.

I believe we meet ppl for a reason. And you must remember that an ending opens the door for a new beginning. You are all strong women. Exorcise these past traumas from your life and become the Goddess you are.

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How do you deal with unacceptable behavior? | Al-Anon Family Groups

I am very concerned for the safety of my daughter and cannot trust him. I feel that this co parenting relationship is going to be an uphill battle for many years to come. I thougt i was the only one. I dont personally know any other person going through this. I dont want to be an 80yr old woman with the same life.

It breaks my heart to hear these stories and I know that I am not alone. I married last year and recently realized that I married a functional alcoholic. I love my husband very much however I am gradually losing myself trying to stay in this marriage.

He drinks an average of 36 to 48 beers a week. I have done everything I know to do from threatening to leave to exposing him to others. He is almost 60 years old and wants to be intimate like a 25 year old. He works and stays busy around the house in which he uses projects, football, cookouts, etc to support his reason for drinking. He is loving and attentive when he has not been drinking or has had under 3 beers or when others are present but he turns sarcastic and hateful the more he drinks and when we are alone.

I have always been an outgoing bubbly kind of person however I have become so depressed and now somewhat of an introvert. I feel so ashamed that I am living like this and I pray daily that God changes him. He hurts me so much with his words and makes me feel so little.

Losing ones self should not be an option to stay with an alcoholic however I have no choice at the moment. God bless you all and you are in my prayers. The previous stories have helped me, as my husband is an abusive alcoholic. He works hard, but comes home from the oil rigs, and hits the bottle. He usually gets into a binge, and when it starts he blames me for everything. I then get more abuse. I wish I could break the cycle, but it is hard when you love a person. I try to go out and about with friends and family, as its good to have a network of sincere folk to turn to.

My husband would prefer me to ony bother with him, and I did that for a while, but its not a good way to live. I pray for all people coping with alcoholics. Its a hard life! I have a wonderful husband who works very hard for his family. He is attentive, thoughtful, loving, helpful, kind…. I used to look forward to the weekends because he got to be home with his family.

Now, I dread them because although the day starts off good he ends up drunk and passed out by the evening. I tend to sleep on the couch because I hate the smell of beer and being in the same bed with him just makes me angry. We have 3 beautiful children together that absolutely adore their Dad. He is horrible at night once they have gone to bed.

But, if we go camping, out to the river for the day…etc he always gets drunk. I hate it because he acts like a jerk and it is unsafe for all of us. That puts us in danger. He feels because he works hard all week that he deserves to be this way on the weekend.

But I work too! I may be a stay at home Mom but I take care of our kids, cook, clean, do laundry, grocery shopping, make sure bills are paid, all of that…everyday. My boyfriend and I have been dating for 5 years this October. He was always jealous and short-tempered, but this past year has been extreme. That escalated into him punching holes in the wall, smashing his phone into pieces with his bare hands, breaking his laptop with his own hands, and throwing everything I own into a pile on the floor.

Similar incidents have happened since then. Mostly the same story line though… Gets belligerently drunk.

I have begged him to stop… Told him I will pay for the rehab! As long as he has his pills and alcohol…. After yet another attempt to stop drinking I came home last night to bottles and cans all over the floor and a drunk passed out slug at 7pm in the evening.

God Bless to you all you struggling and living with this. I am 26, we have a 1 year old daughter together. We have been together for 7 years married for 4. We have been through a lot he has been involved in an accident which left him with a traumatic brain injury.

He started drinking whilst in hospital. His friends encouraged him. He has physically abused me before and he constantly emotionally abuses me. I feel so low I wish he would just leave. I feel without me he will be worse and I feel guilt when I imagine him without me. I stay in my room and lock the door. Or if he catches me out and starts to argue I leave with my daughter. He gets up to follow me sometimes.

It scares the hell out of me. I have been living with an alcoholic my whole life, parents, now my spouse. What I find interesting about this topic is that the unacceptable slowly becomes acceptable as the alcoholism progresses.

It is hard to define what is normal , because alcoholism attributes are normalized. I am no longer able to even cope with all the unacceptable behavior because as far as alcoholism is concerned, none of it is acceptable. I feel like I have wasted so much precious time. I am worried about my kids, stay or go, complicated either way.

I have come to believe that alcoholism is an assault , on the sober members of the family, on our boundaries, emotionally, verbally, physically, financially, and mentally. Therefore the ultimate boundary is to stay no more. Through this trial my saving grace has been 2 strategies in dealing with the unacceptable, practice gratitude and focus on my own behaviour.

Love to you all. I am trying to build a wall between my husband and my feelings. I am isolating myself so I cant be hurt by his neglect. Its so painful to be rejected. He picks drinking every night over me. I admit its true. Everyone else is laughing away. He says I am always so negative, and a pessimist, which I admit I now am. I am lonely and see a very bleak future once my four kids move on. I am surrounded by people, but totally alone.

Everyone loves my husband-he is the life of the party and I am the anchor who is weighing everyone down. He thinks I should just be grateful for how hard he works and appreciate all the good-he has me convinced I am impossible to please. He drinks and passes out every night sitting up on the couch, in front of my daughter. She resents me because she sees I am angry at him and she loves him so much. I am not OK with this. I am so lonely-my family may be better off without me.

I have been with my fiance on and off for 19 years. He is a functioning alcoholic. We have 4 kids together ages 17,13, and 6 year old twins. He started out only drinking a few beers a night he worked 2nd shift so he got off at 11 pm and only had time to drink 2 beers before he has to go to bed but now he is training on 1st shift. He drinks from the time he gets off work till the time he go to bed and passes out. He always says mean hurtful things to me and accasionally is abusive.

He is always picking on our kids saying they are yelling or being to roudy when to me they are being typical 6 year olds. When I tell him to leave because of his actions he either gets violent or spits in my face literally literally spitting in my damn face. He went to jail for public intoxication and when he got out he blamed me for him going to jail and locking his keys in his car. My daughter who is 6 said i love daddy in the morning but not daddy at night your know why she says that because he is drunk mean weird and makes everyone uncomfortable at night.

Sorry to unload so much on you but I have No one to talk to. Your in my prayers. My partner is lovely and sharp when sober — I am so tired o this roller coaster of emotions when he is drunk. I think I have to leave for my own survival. My husband is an alcoholic, I am being mentally abused by him, He lost a good paying job for stealing, He refuses to get help, I have Lupus, And I am not supposed to be stressed, My health is going down really fast, The reason why I have not left is because I have no where to go, We have been married for 33 years, At first for many years I did not know that he drank, He was hiding bottles around the house, I know that I am rambling, But that is what I do a lot, Because I am so hurt that the bottle is more important than me, I hope I can make it, But it looks very bleek.

My husband was single for 23yrs. We have been married right at 2yrs now. Yes, he was on that pitty pot! I was out of town. I finally just sent a text and told him that I loved him. Well, I had to go get him and put him back together. I almost called the wedding off. Now, I feel like he is breaking me down. He is a good hard worker. This is my 4th marriage. He turns everything around to it being my fault. He gets madd and goes and gets on the couch.

I told him fine we will just grow apart. He just wants me to be his wife. How in the hell do you handle this???? Dear God give us strength. Husband used to just have a couple of drinks almost every night after work. I have long suspected that he hides bottles around the house like his little trips to the garage for nothing…. He was on a bender one day really bad like almost black-out drunk by noon.

His parents called and he was insensible on the phone, very slurred speech, and then he passed out while talking to them. Looks like he decided to start journaling his thoughts and feelings about drinking. Worst part is our son. Today was the ultimatum, get professional help or your out of the house until you get treatment.

I have been married for 4 years. When I go yo work I have to have my mom babysit because he drinks so much. When he drinks he gets argumentative.

My husband never comes to any of my son sports. What do I do. I am so tired of this, I am a nurse so it is my nature to not give up on people and help them, however I am tired of being lied to and blamed for all negative actions my husband does.

My husband is going to end up alone like his real dad, drinking his problems away, he never sees problems in his actions and says I am being hyper-sensitive, this is a sad time for my family. My wife has a serious drinking problem. We just had a huge fight because she got drunk yesterday and said a lot of very mean things to me.

After this I decided I needed to take the kids out and away from the toxic environment and we went to the beach. We got back and she was drunk, of course.

The law her will never let me take my kids away from their mother. I get so stressed if she goes anywhere with the kids. I never know if she will drink and drive with them in the car. I lost my job last week because she came to my work completely drunk and started yelling at my boss because she wanted me to take the kids so she could go party.

Hi My husband prefers to stay out at night always. He thinks going out at night and drinking with friends is enjoyment. We are married for 4 years now. What do i do to get him and myself out of this situation? I have no clue how to deal. He is spending all our money. He has a great new job now. He promises to stop then drinks the next day. Me saying if you drink its your problem, dont make it mine. If you choose to drink I choose to end our marriage doesnt phase him. Hes a very violent drinker.

Every week he drinks so much he blacks out. I dont know what to do anymore. Hes such a good guy minus alcohol. I have no family to turn too so thats not an option. Thank you God Bless everyone…. I am 82, husband 87 soon. Family is due to arrive for holiday. Married over 65 years. My heart is crushed. Never know how he will be. Not assuming good today. I cannot thank you all enough for your painful stories. I am in everyone of them. I am severing my Relationship at this moment.

I know I am doing the right thing that is: Every single story is my story too. Thank you for giving me the courage to do this. God bless all of you. Stay strong and know you are not alone.

This time I came home from work to find his staggering drunk and having trashed the plumbing to the shower thanks to another drunken DIY attempt. As always it is always some how my fault in his eyes. We have been together for 5 and a half years. At first I was worried that I would end up alone at 45 years old. That fear kept me putting up with his drunken damage and verbal abuse. I realise now that I am alone anyway as he prefers to spend most of his day either drunk or passed out.

It breaks my heart because I do love him and realise that he is in so much emotional turmoil. He deserves a happy and healthy life. Last night I asked him to chose between going to an AA meeting he has never been to one or moving out. He chose the latter and has starting moving his things out today. It is painful even though I know that it is for the best. There is comfort in reading others stories and knowing that I am not alone.

The similarities of the what we are dealing with is astounding. The guilt, the hurt, the feelings of helplessness are themes in all of our experiences. Wow these stories really are pretty sad I hope most woman can get the help they need. My fiance has a wonderful job is the breakmaker of our family, which besides his health scares me the most about his drinking.

I use to drink with my fiance when we went out or made fun drinks at home. But I never really thought anything of it. Slowly he started drinking after work a glass of vodka and cranberry almost every night. Then that glass turned into half a bottle, to now he drinks a whole bottle of vodka easily without any chasers atleast times a week. He thinks since he still has a job and not walking around as a day drinker then he cant be considered am alcoholic.

Although drinking a big party size vodka bottle to himself is not concerning to him. He can be freshly ahowered but the smell of vodka smells through his clothes. Im very worried for his help and me pushing him getting help isnt doing anything but pushing him to drink even more. I know he feels guilt because he tries to hide his drinking and bottles. I just dont know what else to do. Only thing i have not done was reach out to his family.

Im afraid they will not take me seriously since he is not a heavy day drinker walking and driving drunk but more of a night binge drinker when he is alone. Leaving him may be my only option. I fell in love with a man whom I soon found out was a drug addict, womanizer and alcoholic. He gave up drugs, women but refused to give up liquor. For the last 10 years I believed his hype. On the verge of losing his job and the house later… I sit hear and type this letter with my eyes nearly sealed shut from the tears I shed for the pain in my heart.

But he continues to scave by. I wish someone can tell me how to turn off my love and emotions for this man. How do I make the first step to free myself from him? Those closest to me, tell me to prepare myself for the call…How do I do that? I wish there were more hopeful stores here. My husband of 6 months and I had a kismet story. We dated years ago, fell out of touch and then fate brought us back together and things moved quickly. He would warn me early on, joke about the fact that he was an alcoholic.

I grew up a child of abuse but never knew a drinker so I didnt know what to expect, what to look for, or JUST how hard it would really be. I was so cocky to take it on. He would stop drinking hard liquor for a month, maybe even 3 months at a time— always drinking wine and beer. And hide little bottles. Now the little bottles are less frequent but the beer and wine are at a peak. I want him to turn his life around like Robert Downey Jr or something. He knows he has a problem and he says he wants to change, knows he has to change.

I just worry that the disease is stronger. Are we all nuts for thinking our men are different? I have been with my husband for 9 years and married for 4. We have two wonderful daughters that he is missing out on because of his alcoholism. Before we had kids he would drink on the weekends but once we had our first daughter he started getting drunk every night and not even coming home at least 2 nights monday-thursday.

He always had an excuse to work late, then he would start lying about where he was and what he was doing just so he could drink….. I beg and plead with him to stop but then he will keep it up and use me as his excuse.

I just want the drinking to stop. After through reading through all of these stories, I see that so many are similar to my own. I have been with my fiance for a year and a half now… It took me a while to realize that he had a problem.

I used to drink with him when he wanted to drink, but stopped when I realized he was an alcoholic. I thought maybe we were starting to do okay, but today found him out drinking from a bottle of Vodka he had hidden in my car.

I know we all love him. I feel so weak and curl. I love my husband so very much. We have been together for 7 years. We have 2 little girls together.

I kills me to leave him alone but i have too. He lost his job… Water is off. I have to put my kids first but i feel like the bad guy. He keeps saying if you cant haddle me at my worst you dont derives me at my best. I guess 7 years of tempers and walking on eggshell wasnt good enough. I have to be strong for my girls but it hurts to push someone you love away.

I hope he can get better. I just cant be there. It the hardest thing ive done. So I suppose we come here when we make the realisation that things are never going to change and it will never be easier. My husband is a functioning alcoholic. He has work tomorrow. I keep thinking of following him when he goes out but deep down I know I will believe his lies, even if I catch him he will have the perfect excuse. He makes me doubt myself all the time and my sanity is affected by this!

Sad, lonely and wishing I could be anywhere else than here. I hate my life. Or how can you be attracted to someone who is drunk or passed out every night???

My brother is middle aged and has two kids and a wife. I care about the kids, so I try to help by taking them places, games, etc. We enjoy being together. I am the youngest in our family and was left to pick up the pieces from drunk fights until I was My dad is still a random psycho, but my brother is the one who drinks.

So, how do I help the kids and keep my sanity of dealing with my brother? My perspective is pretty narrow at times.

A couple of years ago I met someone online in a chat room, since then we have established an online relationship. Why do I walk away? When is enough is enough? Why am I not able to walk away? I have been married for 27 years. The logical side of my brain says it is time to go but I feel guilty.

My family all wants me to leave him but I want to know that I have him every chance. I am wondering if others feel this way. I have been married for 30 years. My husband is the one who drinks and has done so for a long time but not as bad as now. We have 2 kids who are grown, one of which has basically estranged the whole family.

I have been telling him he needs to stop because it is affecting his health. He refuses to go to the doctor and will not work now. He has gotten weak. I have been out of work for 6 years and within the last 4 years he has started to drink first thing in the morning. My being here with him is not working. There is no affection anymore, no conversations, etc. Luckily, the one time he got caught stealing in which I was with him, they did not prosecute.

I thank god for that at least. I am in a crisis right now trying to get my life back together. I have grown up with alcoholic parents and I know what I am facing.

I have talked to him about his excessive drinking but it only leads to arguments. I have called the police on him once already and he went to jail. He has tried to retaliate back at me. Need someone to talk to and maybe get some help. I knew she was a recovering addict when we got together, I thought, I can handle this and signed up. For years we drank together, sometimes a little, sometimes too much. We were trying to conceive and there would be sleepless nights of anxiety waiting for her to come home, hoping she was alive.

I was trying to be healthy and stress free, while struggling to get pregnant and every week, would come the night. I would wake up to an empty room. Over time I became sick and unreasonable myself, trying to force a solution, force communication, force everything. Becoming frigid in my ways, and affection, in my understanding. I was unpleasant to be around and more like a parent than a wife.

In one of my failed attempts to force a solution, I talked her into moving across the country, we had talked about moving many times, but this time it stuck. We moved clear across the country. We took a break from trying to get pregnant. We gave up the dog we had just adopted 2 other attempted solutions of mine and we left.

This would help our relationship, she insisted! I disagreed profusely, but my opinions on this were dismissed as she signed a lease for her own studio apt. I found myself in pieces, sitting in my first Alanon meeting a month after she left me. In one weekend I think I made it to about 5 meetings.

I cried through every single one. I lost about 10 lbs bring me down to a measly I thought about quitting my job, moving back home, killing myself. I no longer cry through every meeting and I have good days. Good days and bad, I can whole heartedly say, I am a better version of myself today than I was 7 months ago.

I have more love to offer myself and more to offer the world. There have been days of hope and others of pure white, blinding rage. There have been relapses, drug use, hospital visits, fights and desperate pleads for forgiveness. I can choose to stay and hold on if I accept what the reality of it is or I can choose to let go. Today, through tears, I have chosen to let go, and let God. I do all of this with love, not just with love for myself but love for my wife and her recovery as well.

I hope she finds her path. I still have spiteful thoughts of resentment and revenge, but I try to just let them go as they come. My story is similar. He lies and steals and thinks he is better than everyone else.

Trust is a foreign word to him. He is waiting for his mom to die so her money will right all his wrongs. He has no credit rating, no driver licence , no vehicle and expects everyone to be at his disposal. He shows no affection to me even when sober. He thinks as long as he tends meetings at aa then I will forgive and forget the unfaithfulness, lies, cheating, deception and anguish.

Nice legacy for innocent children. What am I living for? My life is such a fake. I look like I have it all together. But…you will see me in church each Sunday.. You will see me shining at my career. My children are known as polite and talented. I would sneak away when staying at friends so i could call my mom and ask her if everything is okay. Yet he is horrible to me most of the time. He spends our hard earned money on 12 pack after 12 pack, yet blames me for our financial stress.

So…now the strange part. Why do I stay? Why do I keep hoping things will change. My dreams are dwindling. I so badly want it to work out…and we live that happy life. Alcohol has changed him more than I could. For now, the fake front continues. Just happy I could finally say it to someone. I have been on that roller coaster for 21 years…it will e 22 in July.

We are no legally married and have a 13 year old daughter together. He will binge drink for days…. They are maintained right now…. I dont want to live like this anymore but i feel like i stuck!

Family and friends have witnessed his verbal abuse while he was drunk and sober and he embarrassing all the time with side remarks. I feeling like i am slowly dying inside…i cry myself to sleep almost every night. When he is drinking my daughter and i will lock ourselves in her bedroom so he doesnt bother us. This is no life…. Dont know what to do…. My story is so similar to the others I have read only difference being its my wife that is the alcoholic.

She is the type that loves a drink and could probably drink most guys under the table. Only problem is that she is an emotional nasty drunk behind closed doors and unfortuantely I am the one who cops it.

When she is not drinking she is a great mum and loves our daughter to bits. It appears the alcohol mixed with a lack of sleep is an even bigger problem. She puts the baby to bed 5 minutes after getting up but forgetting she has already had the morning sleep, feeds her unusual food at strange times and even put her into an ice cold bath when it was supposed to be warm…. On this particular day she gave her 5 straight bottles of formula and there is nothing I can do. I am at my wits end. I love my wife or at least i love the person that she can be when she is sober.

She is beautiful dresses fabulously and is a fun caring person. But when the alcohol kicks in everything is completely different. Whilst she thinks she is hiding the drinking from me she so many obvious tells. Basically she turns into a completely different person. To say Im stressed would be an understatement. I have had to rush home early from work on a few occasions as I could tell that the alcoholic different person was with our baby.

I am at my absolute wits end and do know what to do for my baby and myself. I am so desperately seeking help. I have never faced or been involved with an alcoholic. He would wake up in the morning and start drinking. He would be drunk around his kids be verbally abusive. I tried everything to help him.. He got fired from numerous jobs. After the 2nd dui he stopped drinking but then starting doing drugs. After not having a drink for 6 months we got married, moved in together and started building a life together.

I literally feel like I need a babysitter for him. I am supposed to get married in seven days to the love of my life. He admitted he had a drinking problem seven months ago and went to AA and supposedly quit drinking. I was the happiest I had ever been in my life. Six days ago, I found a receipt with a bottle of vodka on it. He was drinking it in his tea right there in front of me.

He lied and said it was a mistake on the receipt and that he did not buy any vodka. Then he admitted it. Then he admitted two other times he had bought alcohol secretly but that was it. Suddenly all of the lies became clear. I asked repeatedly if there was anything else I should know. He said, no that was it. Well I asked again and again and he finally admitted that he has been drinking regularly for months and had several months ago as well. He blamed me for being unapproachable to discuss his thoughts about being able to drink again.

He now admits he is an addict and has gone to AA twice this week and we saw our counselor together. He says that he wants me to marry a week from today like we planned or that we are going to break up. I told him I want to postpone the wedding as this is a lot of stress and new information just days before our marriage. He refuses to postpone the wedding. I love him so much this is insane. In reading all of these posts, I see one thing in common…we stay too long. We put up with too much.

Is it possible if we had just drawn the line from the get go, that many of these folks would have ended up getting help? Just curious of the women that may have left early on…did those men get help. I have been married to my husband for 21 years. His drinking at night has gotten worse. He drinks beer nightly. We have a 12 year old son who is in bed most of the time when my husband gets home. Our son has seen him stumble to the couch once. I have noticed him shaking during the day more than usual.

His mother is hard on him. We love each other very much. He just goes to sleep. We are starting marriage counseling May 1 because I get mad and build up walls and he avoids discussions and drinks too much. I am hopeful he wants to decrease the drinking and talk when we have things to solve together.

Thank you for allowing me to vent. I know he needs to want to do this for himself and for us. I want to know the best way to help and be loving. I feel empty inside to my soul. I cant even put it in words, he can be so nice and so mean and cruel.

I have read many of these stories and myself have a story of love and loneliness and a rollercoaster of emotions. I have a list of incidents that are embarrassing and ugly but mostly in between I just feel lonely and empty. I feel the stories I read are much like mine and I would like to say that there is hope.

There is no cost too high. Accepting some temporary help from friends and family is nothing to be ashamed of. For me, I am in no danger other than letting more years slip by while I feel like an empty paper bag floating around in a wind storm. I wanted a deeper emotional connection to my friend and husband… but I cannot control him or force him to see things the way I do.

I have begun taking college classes and will be on my way to becoming a nurse. That is a plan that works for me. I will have HOPE and faith in myself. I will love myself and seek happiness in something other than a relationship for now.

I am sad to see that so many people suffer in such horrible ways! I hope you find courage and peace. I feel so sorry for my partner because his dependence upon alcohol is isolating him. If I mention the drinking he tells me to shut up. He is an alcoholic he is very materialistic, he thinks and believes he doesnt need help.

During our marriage I became bored with all of his promising to slow down so I started gambling. My way of escape I thought but I too got addicted to that. I soon became a regular on the pokie scene what a huge mistake I made.

Always making excuses to be out of the house especially if he drank for 3 to 4 days of a week on our fortmightly centrelink payment,his second favourite pass time besides drink was sleeping recouperating thats when Id gamble more.

At least I didnt have to listen to his very boring repeated conversatiom about the same topics , the pokie machines never talked back I was hooked. So two to tango as they say. He started hating me as much as I hated myself,eventually leading to his cutting words of how useless I was. The year is nearly over in this time weve had sex. Im happier now then I ever was Im sleeping with another man not the conditions.

Today I want to ask for a divorce but terrified for my own life. I am a prisoner to Alcoholism and I am the one who seriously needs counselling,help,advice. Im so mentally drained from Addiction. The person you are sharing your life with. The father of your children.

He who would drink regardless of the impact on all of us. Who can drink for days and then sober up without any though of how it affects us. We are totally dependent and that is how you like it. Vulnerable,isolated and easy to manipulate. This is how these Alcoholic husband operate. They humiliate and hurt you to the depth of your soul.

Make you wish you were deaf out of sheer desperation. Yet, they are blameless unwilling to take any responsibility for their selfish acts. Too wrapped up in their own needs to care about the pain they inflict on others. What happens to us wives and mothers? We grow old and disillusioned. Tired of trying so hard to keep it all together when he destroys everything.

Your children grow up damaged and move away. All anon is full of people who understand You are powerless over Alcohol addiction.. My husband and I haven together for 18 years. We had the greatest relationship. He was funny and attractive and the kind of guy everybody loved to be friends with.

That all changed… The year that changed was our eleventh year of being married. He decided to have a girlfriend. I found out about her through people at my church. I also found that throughout their relationship he started drinking. He has called me a cunt for the last seven years, says he hates me, he has punched me in the head to many times to count. I stay because I love him, I stay because I have no where else to go. I want to be treated good everyday, I want to trust again, I want to feel loved.

I want him to be not married to a bottle but to his best friend. I truly miss him! This is my first time reading through these comments. It almost cost him his life one year ago this month. Now alcohol is his choice. Well we are living a lie. We pretend to be happy, we can actually fake it for a few days here and there, but no one around us knows the battle every night we face when he lies to me about getting alcohol. I truly never know if he is taking some type of pill or is saving drinking a bottle of liquor for when I go to sleep.

We have two amazing sons and he really is a great father, until after they go to sleep. Our oldest is 2. But I am broken. How do you not trust your own husband, your best friend? Which in turn he says gives him more of a reason to drink. We started seeing a counselor and there was hope for two weeks, until he starred drinking again. I know my hope should be found in Jesus, but I just want this cup to pass from me. I want healing for my husband. I want healing for me.

Any advice or prayers would be so appreciated. My 26 year old daughter is a drunk. She has a 4 year old son. I am so tired of her behavior. She refuses to admit that she has a problem. After a month of writing, oh how I loved to receive those new emails, we met at a park.

But then he pulled out a thermus of wine against bylaws. We said goodbye, he assuming I was a teetotaller, but I had seen his hands were shaking. After after a couple of phone calls a couple of weeks later, we wanted to meet up again. I have loved him very deeply at times, and at others have been disgusted with his drunk behaviour and foul moods.

He got angry when I started going to Al Anon a month ago, and has been jealous of my having good friends. Writing about it and this had been edited over and over I see how crazy the relationship has been, especially for me. Thank goodness I started going to Al Anon, and thank you to all of you who have shared your heartbreaking stories here.

What I see is a lot of really great people who get stuck in emotionally dangerous relationships; and it seems that the instability of the relationships makes them addictive in themselves.

But you know what? I am scared of my husband…he refuses to get help! He becomes violent when drunk. I have spoken to his mother about it but when he finds out he threaten to divorce me. I am all alone here, i am stucked, have no where to go or talk …. Me and my husband have been together for 4 years now. This exercise helps partners notice and understand what each does for the other, while increasing positive actions within the relationship.

Conflict or dysfunction resulting from substance abuse can lead to a significant decline in the amount of time couples spend together in recreational activities. To change this pattern, this exercise first requires couples to list activities they enjoy doing with their partner either with or without children, inside or outside the home. At their next session the couple shares their lists, and the therapist points out areas of agreement on both lists. The therapist models ways to present activities in a positive manner, plan for potential problems, and learn to agree on activities.

Couples subsequently plan and carry out a mutually enjoyable activity Noel and McCrady In structural family therapy, family problems are viewed as the result of an imbalanced or malfunctioning hierarchical relationship with indistinct or enmeshed, too rigid, or flexible interpersonal boundaries.

The complexities of these approaches defy any brief, simple review. Though it well oversimplifies the complexities, one could say that the primary goal is to strengthen or rearrange the structural foundation so the family can function smoothly Walsh After an assessment stage, the therapist generally begins by preparing, with the family, a written contract that clearly describes the goals of treatment and explains the steps necessary to reach them.

This contract increases the likelihood that the family will return after the first session because they have a clear idea of how they will resolve their problems Kaufman The structural family therapist generally tries to be warm and empathic while at the same time remaining firm and objective Huycke in therapeutic relationships with clients. The therapist motivates clients to change through a process of joining with the family. During this process, the therapist. One of the ways to make respectful individuation possible is to make the family aware when a family member.

When appropriate, the therapist will take action necessary to stop behaviors that contribute to enmeshment in the family. The therapist needs to observe the family closely by tracking family interactions or by having the family enact a dysfunctional behavior pattern within the therapy session.

The therapist then acts accordingly either to restructure boundaries that are too rigid or strengthen boundaries that have become enmeshed or fused. In such cases, the therapist needs to strengthen boundaries that support the parents as a unit or subsystem capable of maintaining a hierarchical relation with their children and able to resist interference from older generations of the family or people outside the family Kaufman Structural therapists motivate and teach a family new ways of behaving using structuralization.

Using this process, the therapist sets an example for how family members should behave toward one another. By setting an example in this manner, the therapist provides a model for how the family can behave and applies gentle pressure on family members to change their behavior. Other important techniques for restructuring family relations include system recomposition, structural modification, and system focusing Aponte and Van Dusen System recomposition helps family members build new systems perhaps outside the family or remove themselves from existing systems which can imply physical separation or changing existing patterns of interaction and communication.

Structural modification is the process of constructing or reorganizing patterns of interaction for instance, by shifting triangles to develop better functioning alliances. System focusing, also called reframing or relabeling, is the process of presenting another perspective on an apparent problem so that it appears solvable or as having positive effects for those who look at it as a problem.

For example, the therapist might show children that they gain greater freedom if their parents abuse substances. Relabeling also makes new options for solving problems more apparent and can act to provoke family members to change their behavior. Overall, structural intervention techniques may be difficult to use without some further training.

However, they can be employed easily in assessment to understand the ways by which the organization of the family may be structured to support the substance use. Strategic family therapy shares many techniques and concepts with structural family therapy, which are often used together.

For example, reframing or relabeling is a process common to both approaches. The structural therapist seeks to alter the basic structure of family relations working on the theory that this will improve the presenting problem. The strategic therapist, however, focuses on solving one specific problem that the family has identified and is concerned only with basic family interactions and behavior that perpetuate the presenting problem.

To the strategic therapist, interactions are not the result of underlying structural problems Walsh Different approaches fit into the strategic approach. They differ in the scope length of the interaction they observe; however they all look for the sequence of interaction and then develop a directive to modify the sequence.

Indirect techniques are specific types of directives that may seem unrelated or contradictory to the task at hand but that actually help the family move toward its goal. Reframing is an indirect technique. This approach is less concerned with the origins of problems and more oriented toward future changes in family interactions. One such technique is to ask the client to remember a time when problem behaviors were not present and then to examine what behaviors occurred during these times.

What were things like at that point? How can that behavior be repeated now? This technique is described in greater detail in chapter 4. The causes of substance abuse are multidetermined, with biological, psychological, social, and spiritual components. Within the substance abuse treatment field, a variety of different approaches are used.

Two of the most common are described in this section. Two models have contributed to our contemporary understanding of substance abuse and dependence: The medical model of addiction emphasizes the biological, genetic, or physiological causes of substance abuse and dependence. A body of biological research suggesting a genetic component to substance abuse supports this theory Cloninger , particularly in the case of alcoholism, since it is the type of substance abuse that has been most thoroughly researched Li and it is the type involved in the vast majority of substance use disorders.

From a medical perspective, treatment involves medical care and can include the use of pharmacotherapy to help manage withdrawal and assist in behavior change.

See below for more information on pharmacological treatments for substance use disorders. A variety of pharmacological interventions have been developed to aid in the treatment of substance use disorders, and many more are in development. The information provided here is merely an introduction to this topic. Further, the information is subject to change as new medications are approved by the Food and Drug Administration.

Medications are available that can help: Discourage continued substance use. These include disulfiram Antabuse for alcohol use and naltrexone Revia for alcohol and opioid abuse.

These include benzodiazepines for alcohol withdrawal and methadone maintenance for opioid addiction. Block or alleviate cravings or euphoric effects. Replace an illicit substance with one that can be administered legally. These include methadone and other forms of opioid replacement therapy. Medications should be used in conjunction with other therapeutic interventions CSAT c. Research findings indicate that the use of medication in substance abuse treatment is much more effective when combined with psychosocial interventions McLellan et al.

The ideas of the medical model can be incorporated into family therapy. In family therapy, the recognition is growing, too, that the field needs to develop a better understanding of pharmacological treatments for disorders that affect family dynamics. For this reason, family therapists need some knowledge of the medical issues related to substance abuse and need to know when to refer clients for an assessment of a potential substance use disorder.

Sociocultural approaches to substance abuse focus on how stressors in the social and cultural environment influence substance use and abuse. Sociocultural interventions often stress the strengths of clients and families. Each of the two models presented above—medical and sociocultural—has some validity and research to support its credibility. Most treatment providers, however, do not believe that any one of these approaches adequately describes the causes or suggests a single preferred treatment for substance use disorders.

The holistic model, a biopsychosocial model, has been presented as a way to understand the multifaceted problem of substance abuse Wallace This is a fourth model for understanding substance abuse, one that regards recovery from substance abuse as, at least in part, a spiritual journey. The consensus panel believes that effective treatment will integrate these models according to the treatment setting, but will always take into account all of the factors that contribute to substance use disorders.

A variety of treatment modalities are widely used in substance abuse treatment. When referring a client to a particular substance abuse treatment program, however, a number of factors must be considered in addition to the necessary intensity of treatment and the specific services available.

Some main considerations are. Nonetheless, the consensus panel believes that family therapy as distinguished from family education programs or visiting programs has a place in all treatment modalities. The panel has highlighted ways to use family interventions in most of the treatment settings described here. People who have a substance use disorder will likely require a period of detoxification before they can begin intensive treatment. Detoxification is not substance abuse treatment, but for many clients it is an essential precursor to treatment.

Without subsequent treatment, detoxification is unlikely to have any lasting effect Gerstein Not all clients with substance use disorders require the same intensity of detoxification services. Detoxification services range from medically managed inpatient services to services that can take place in outpatient or even social service settings. The most intensive detoxification service is a medically managed inpatient program set in a facility with medical resources.

Medically managed programs can treat a wide range of medical complications that can arise in people detoxifying from dependence on substances of abuse. Clients who require this level of care include those who have had severe overdoses, have acute or chronic medical or psychiatric conditions, are pregnant, or have developed considerable physical dependence CSAT in development a ; Inaba et al.

Providers should also be aware that most insurers do not cover this level of service unless the client meets certain clearly defined medical criteria. Medically managed outpatient programs can provide medication and a range of medical services, but patients are free to leave the premises and are not as closely monitored as are those in inpatient programs.

Many clients do not require medically managed services, and for them, social detoxification programs either residential or outpatient may be the best option.

Social detoxification programs provide counseling and other forms of nonpharmacological assistance for managing withdrawal, but generally do not have any onsite medical services. Furthermore, most social detoxification is carried out without the use of medications. Staff members do, however, observe a client closely especially in residential settings and can contact a physician or nurse if necessary. It is rare, however, to find any of these modalities in their pure form; most are a blend of methods and modalities.

Patients receive psychiatric and psychological evaluations, assist in developing a recovery plan based on the tenets of AA, attend educational lectures and groups, meet individually with counselors and other professionals, and participate in family or codependent therapy. Unfortunately, clients may have to become engaged in an entirely different system for their continuing care, as funding for services may not carry over.

Further, family therapy would need to be highly structured as other activities in these programs are and the therapist would need to work around a schedule of other activities in the treatment program. If family therapy is being added to an inpatient residential program, it should not take the place of family visiting hours.

Clients also need recreational time with their families. That may be true in some cases, but even if a client is unable to deal simultaneously with the cessation of substance use and family issues, the family of the client can still benefit from family therapy.

The traditional TC program provides residential care for 15 to 24 months in a highly structured environment for groups ranging from 30 to several hundred clients. In addition to helping clients abstain from substance abuse, TCs work on eliminating antisocial behavior, developing employment skills, and instilling positive social attitudes and values De Leon TC treatment is not limited to specific interventions, but involves the entire community of staff and clients in all daily activities, including group therapy sessions, meetings, recreation, and work, which may involve vocational training and other support services.

Daily activities are highly structured, and all participants in the TC are expected to adhere to strict behavioral rules.

Group sessions may sometimes be quite confrontational. A TC ordinarily also features clearly defined rewards and punishments, a specific hierarchy of responsibilities and privileges, and the promise of mobility through the client hierarchy and to staff positions. Clients in TCs often lack basic social skills, come from broken homes and deprived environments, have participated in criminal activity, have poor employment histories, and abuse multiple substances.

For these reasons, the TC process is more a matter of providing habilitation than rehabilitation De Leon Family therapy is not generally an intervention provided in TCs at least not in the United States , but TC programs can use family therapy to assist clients, especially when preparing them to return to their homes and communities. Outpatient treatment is the most common modality of substance abuse treatment. It is also the most diverse, and the type of treatment provided, as well as its frequency and intensity, can vary greatly from program to program.

The most common variety of outpatient program is one that provides some kind of counseling or therapy once or twice a week for 3 to 6 months Gerstein Many of these programs rely primarily on group counseling, but others offer a range of individual counseling and therapy options, and some do offer family therapy. Some outpatient programs offer case management and referrals to needed services such as vocational training and housing assistance, but rarely provide such services onsite, not because they do not see the need, but because funding is unavailable.

Outpatient treatment has distinct advantages. Compared to inpatient treatment, it is less costly and allows more flexibility for clients who are employed or have family obligations that do not allow them to leave for an extended period of time. Research has demonstrated, as with many other modalities, that the longer a client is in outpatient treatment the better are his chances for maintaining abstinence for an extended period of time.

For this reason, exit planning, resource information, and community engagement should start in the beginning of treatment. Because of the great diversity in services offered by outpatient treatment programs it is difficult to generalize about the use of family therapy.

Certainly, however, family therapy can be implemented in this setting, and a number of outpatient treatment programs offer various levels of family intervention for their clients. Methadone requires a daily dosage, but LAAM only needs to be administered every 2 or 3 days.

This pharmaceutical substitute acts to prevent withdrawal symptoms, reduce drug craving, eliminate euphoric effects, and stabilize mood and mental states. The side effects of these prescribed medications are minimal, and they are administered orally, thereby eliminating many of the hazards associated with injection drug use.

Methadone maintenance programs require daily attendance for new clients, but many programs allow clients to take doses home if they have complied with treatment requirements for a period of time for example, if urine tests are negative for illicit drugs and clients have attended counseling sessions regularly. Physicians may dispense it or prescribe it to clients in their offices if they 1 obtain a waiver exempting them from Federal requirements regarding prescribing controlled substances and 2 obtain subspecialty board certification or training in treatment and management of patients with opioid dependence.

A physician locator at this Web site can help clients find qualified physicians in their area Clay These activities include supporting the certification and accreditation of more than 1, opioid treatment programs that collectively treat more than , patients annually more information can be found at www.

Opioid addiction treatment has been shown to be an effective way to mitigate the harmful consequences of substance abuse, reduce criminal activity, slow the spread of AIDS in the treated population, reduce the client death rate, and curb illicit substance use Effective Medical Treatment of Opiate Addiction ; Gerstein Despite these findings, approximately 1 in 4 individuals do not respond well to this treatment for a variety of reasons that are not apparent in clients prior to treatment Gerstein Retention rates and outcomes are improved, however, if methadone maintenance programs offer more frequent counseling and provide higher doses an average of 60 to milligrams per day of methadone Gerstein Some evidence suggests that these ties are already strong.

It is important that therapists realize that family therapy organized around substance abuse will not be effective unless the substance abuse is dealt with directly.

Therapists should also understand that substance use disorders are typically chronic, progressive, relapsing conditions. Relapse should be viewed as part of the recovery process and not as a cause for automatic termination of treatment. Family therapists must be apprised of community services for people with substance use disorders and be able to refer clients to them. Substance abuse treatment providers recognize the importance that spirituality regardless of the particular faith or spiritual path chosen can have in recovery.

Family therapists can use spirituality by recommending that families connect or reconnect with their spiritual traditions or discuss spiritual beliefs. Connecting a family who is new to treatment with another more experienced family in treatment can help both, encouraging the new family to see the possible gains and helping the more experienced family reaffirm its commitment to treatment and the difference it has made.

The Internet can serve as a good point for finding out local information about these kinds of groups. A listing of various mutual aid resources by the Behavioral Health Recovery Management project can be found at www. Harm reduction concepts e.

Turn recording back on. National Center for Biotechnology Information , U. Chapter 3 Approaches to Therapy. Differences in Theory and Practice Theory The fields of substance abuse treatment and family therapy share many common assumptions, approaches, and techniques, but differ in significant philosophical and practical ways that affect treatment approaches and goals for treatment.

Denial and Resistance The fields of substance abuse treatment and family therapy often use different terms and sometimes understand the same terms differently. Practice Following is a general overview of the differences that exist among many, but certainly not all, substance abuse and family therapy settings and practitioners. Family interventions Substance abuse treatment programs that involve the family of a person who is abusing substances generally use family interventions that differ from those used by family therapists.

Spirituality Spirituality is another practice that clinicians in the two fields approach differently. Process and content Family therapy generally attends more to the process of family interaction, while substance abuse treatment is usually more concerned with the planned content of each session.

Focus Even when treating the same clients with the same problems, clinicians in the fields of family therapy and substance abuse treatment typically focus on different targets. Identity of the client Most often the substance abuse counselor regards the individual with the substance use disorder as the primary person requiring treatment.

Regulations Finally, different regulations also affect the substance abuse treatment and family therapy fields. Assessment Specific procedures for assessing clients in substance abuse treatment and family therapy will vary from program to program and practitioner to practitioner. Assessment in substance abuse treatment Assessments for substance abuse treatment programs focus on substance use and history. Neurological signs or symptoms e.

Emotional or communicative difficulties e. Domestic violence history, child abuse, battering many survivors and perpetrators of violence abuse drugs and alcohol. Family therapists and screening, assessment, and referral for substance abuse Family therapy assessments focus on family dynamics and client strengths.

Genograms One technique used by family therapists to help them understand family relations is the genogram—a pictorial chart of the people involved in a three generational relationship system, marking marriages, divorces, births, geographical location, deaths, and illness McGoldrick and Gerson Figure Basic Symbols Used in a Genogram. Figure Eugene O'Niell Genogram. Screening and assessment issues When a family therapist refers a client to specialized treatment for a substance use disorder, the client need not be excluded from participation in family therapy.

Constraints and Barriers to Family Therapy and Substance Abuse Treatment Family therapists and substance abuse counselors should respond knowledgeably to a variety of barriers that block the engagement and treatment of clients.

Contextual factors that affect motivation and resistance The differential influence of power The approaches used by the substance abuse treatment and family therapy fields to motivate clients typically have been different. Stages of change Families with substance abuse problems constitute a vulnerable population with many complicating psychosocial issues. At this stage, the person abusing substances is not even thinking about changing drug or alcohol use, although others may recognize it as a problem.

The person abusing substances is unlikely to appear for treatment without coercion. If the person is referred, active resistance to change is probable. When the IP is in the precontemplation stage, the therapist works to establish rapport and offer support for any positive change. A person in this stage is ambivalent and undecided, vacillating over whether she really has a problem or needs to change.

A desire to change exists simultaneously with resistance to change. A person may seek professional advice to get an objective assessment. Motivational strategies are useful at this stage, but aggressive or premature confrontation may provoke strong resistance and defensive behaviors.

Many contemplators have indefinite plans to take action in the next 6 months or so. The role of the therapist is to encourage ambivalence. Helping the IP to see both the pros and cons of substance use and change helps her to move toward a decision. Client education is an effective tool for creating ambivalence. In this stage, a person moves to the specific steps to be taken to solve the problem. The person abusing substances has increasing confidence in the decision to change and is ready to take the first steps on the road to the next stage, action.

Most people in this stage are planning to take action within the next month and are making final adjustments before they begin to change their behavior. One or more family members in this stage begin to look for a solution. They may seek guidance and treatment options. The goal may be as simple as creating a written record of every drink during the time between sessions. Specific actions are initiated to bring about change. Action may include overt modification of behavior and surroundings.

This stage is the busiest, and it requires the greatest commitment of time and energy. Commitment to change is still unstable, so support and encouragement remain important in preventing dropout and regression in readiness to change. At this point the forces for change in a family reach critical proportions. Ultimatums and professional interventions are often necessary. The role of the therapist is to encourage the person and continue providing client education to reinforce the decision to stop substance abuse.

This stage requires a set of skills different from those that were needed to initiate change. Alternative coping and problemsolving strategies must be learned. Problem behaviors need to be replaced with new, healthy behaviors. Emotional triggers of relapse have to be identified and planned for. Gains have been consolidated, but this stage is by no means static or invulnerable.

It lasts as briefly as 6 months or as long as a lifetime. In maintenance the family adjusts to life without the involvement of substances Prochaska et al.

During this stage it is important to maintain contact with the family to review changes and potential obstacles to change.

Confrontation Generally, substance abuse treatment has relied on confrontation more than family therapy has. Motivation levels Motivating a person or a family to enter and remain in treatment is a complex task, made all the more complicated by the fact that the IP and the family may have different levels of motivation as may different members of the family.

Cultural barriers to treatment Cultural background can affect attitudes concerning such factors as proper family behavior, family hierarchy, acceptable levels of substance use, and methods of dealing with shame and guilt. Integrating Substance Abuse Treatment and Family Therapy The integration of substance abuse treatment and family therapy may be accomplished at several levels see chapter 4 for a full discussion of integrated models of treatment.

Family Therapy for Substance Abuse Counselors Substance abuse counselors should not practice family therapy unless they have proper training and licensing, but they should be informed about family therapy to discuss it with their clients and know when a referral is indicated. Traditional Models of Family Therapy The family therapy field is diverse, but certain models have been more influential than others, and models that share certain characteristics can be grouped together.

See Steinglass et al. View of substance abuse Substance abuse stresses the whole family system. Use enactments and rehearsals to enlighten the family system about triggers of substance use, to anticipate problems, and avoid them. See Bepko and Krestan View of substance abuse Focus is on the person who abuses substances and the substance of abuse as a system while also looking at intrapersonal, interpersonal, and gender systems. Goals of therapy Help everyone in the family achieve appropriate responsibility for self and decrease inappropriate responsibility for others.

Unbalance the system that was balanced around substance abuse in order to promote sobriety. Rebalance the system in a deep way by going back and working on developmental tasks that were previously missed. Reparative and restorative work with children in order to have children express feelings in a safe environment. Behavioral marital therapy Theorists: See Epstein and McCrady View of substance abuse Developed to treat alcohol problems in a couples counseling framework.

Cognitions and affective states mediate the relationship between external antecedents and substance use, and expectancies about the reinforcing value of substances play an important role in determining subsequent substance use.

Substance use is part of a continuum that ranges from abstinence to nonproblem use to different types of problem use.

From this perspective, problems may be exhibited in a variety of forms, some of which are consistent with a formal diagnosis, and some of which are milder or more intermittent.

Goals of therapy Abstinence is the preferred goal for treatment. Developing positive reinforcers for abstinence or changed use. Strategies and techniques Intervene at multiple levels, with. Begin with a detailed assessment to determine the primary factors contributing to the maintenance of the substance use, the skills and deficits of the individual and the couple, and the sources of motivation to change.

Help the client assess individual psychological problems associated with use, potential and actual reinforcers for continued use and for decreased use 2 or abstinence, negative consequences of use and abstinence, and beliefs and expectations about substance use and its consequences.

Teach individual coping skills e. Teach behavioral and cognitive coping skills individually tailored to the types of situations that are the most common antecedents to use. Help clients identify interpersonal situations and people associated with substance use, and situations and people supportive of abstinence or decreased use. Brief strategic family therapy Theorists: Rigid family structures can increase substance abuse as parents need to be able to renegotiate as the adolescent grows.

Intrafamily and acculturation conflict impact relationships negatively and increase substance abuse. Goals of therapy Change parenting practices such as leadership, behavior control, nurturance, and guidance. Strategies and techniques Do preliminary phone work to determine who will be resistant to treatment and engagement. Identify the normal processes of acculturation and then help families learn to transcend these differences.

Intervene in the family system through the parents rather than directly intervening and therefore put traditional hierarchies back into place. See Liddle ; Liddle and Hogue View of substance abuse Developed to treat adolescent drug problems and related behavioral problems such as conduct disorder from a multiple systems perspective.

Uses an integrative developmental, environmental, and contextual framework to conceptualize the beginning, progression, and cessation of drug use and abuse. Uses knowledge about risk and protective factors to arrive at a case conceptualization that includes and integrates individual, familial, and environmental factors. Both normative failure to meet developmental challenges and transitions and nonnormative abuse, trauma, mental health, and substance abuse in the family crises are instrumental in starting and maintaining adolescent drug problems.

To enhance and bolster the psychosocial functioning of the youth and family in their key developmental domains. To improve adolescent functioning in several realms, including individual developmental adaptation, coping skills relative to drug and problemsolving situations, peer relations, and family relationships. To improve adolescent and parent functioning in the extrafamilial domain, including more adaptive and positive transactions with key systems such as school and juvenile justice.

Strategies and techniques The overall therapeutic strategy calls for multilevel, multidomain, multicomponent interventions. As such, therapy length, number, and frequency of the sessions is determined by the treatment setting, provider, and family.

Treatment format includes individual and family sessions, and sessions with various and extra familial sessions. See Kaufman and Kaufmann View of substance abuse Traditional medical model and disease concept. Goals of therapy Work to achieve abstinence for family member s with substance use disorders. After sobriety is achieved, deepen intimacy through appropriate expression of suppressed feelings such as mourning of losses or hostility. Maintain a sober family core that acts as a central homeostatic organizer for the client who abuses substances, especially during times of stress.

Strategies and techniques Therapy begins with an assessment of substance abuse, individual psychopathology, and family systems. Address developmental issues and individual Axis I and II disorders, and include these issues as part of a family contract. See Cunningham and Henggeler ; Henggeler et al. View of substance abuse Understand fit between substance abuse and the broader systemic context:. Goals of therapy The initial goal is to engage family members and, if necessary, to identify barriers to engagement and develop strategies for overcoming those barriers.

Examine the strengths and needs of each system and their relationship to the identified problem. Strategies and techniques Interventions are designed to promote responsible behavior.

Goals of therapy Balance the family system in terms of gender, age, relationship, and so on. Family and significant others work to help the individual who abuses substances maintain his abstinence and a stable support system that promotes his recovery.

Avoid people, places, and things that promote substance use. Family and significant others work as a team and are coached to help the person abusing substances to achieve and maintain abstinence. View of substance abuse Emphasis is placed on the solutions that are available to the family, not on how the problem developed or what function it might serve. Goals of therapy A therapeutic relationship needs to be built on trust and respect. Help client to realize that she can maintain sobriety and has done so on occasions in the past.

Focus on problems that can be solved and on finding unique solutions to those problems that can enhance optimism. The focus is on solution, not problems. Focus on solutions by asking the IP how she will know the problem is improved. What will she be doing? How will she be feeling? See Stanton et al. View of substance abuse Substance abuse is part of a cyclical process that takes place between connected people who form an intimate, interdependent, and interpersonal system.

Goals of therapy Specific goals are negotiated with the family at the beginning of treatment. The IP should be either gainfully employed or involved in some sort of school or training program. Strategies and techniques Emphasize present situation.

View of substance abuse Substance abuse is a progressive family disease affecting every member and every facet of life.

As the member who abuses substances progressively experiences a sense of worthlessness, so do all other family members. Goals of therapy Make the family system more open, flexible, and whole—as the family system begins to change, other problems will subside as well. Strategies and techniques Educate every family member about the disease.

Figure Individual, Family, and Environmental Systems. Elements of the family as a system Complementarity. Capacity for change Families that have members who abuse substances are more likely to show a lack of flexibility, rather than an excess. Triangles Murray Bowen developed the concept of triangulation, which occurs when two family members dealing with a problem come to a place where they need to discuss a sensitive issue.

Family Therapy Techniques That Substance Abuse Counselors Can Use Family therapists have developed a range of techniques that can be useful to substance abuse treatment providers working with individual clients and families.

Behavioral techniques Behavioral Marital Therapy BMT is a behavioral family approach for the treatment of substance use disorders. Adapted from Walitzer Structural techniques In structural family therapy, family problems are viewed as the result of an imbalanced or malfunctioning hierarchical relationship with indistinct or enmeshed, too rigid, or flexible interpersonal boundaries.

Conveys understanding and acceptance to each person in the family so that everyone will trust the therapist enough to take his or her advice. Shows respect to each person by virtue of their family role, which could mean, for example, asking parents first for their views on the problem at hand.

Listens as each person expresses feelings, because most people in therapy think that no one understands or cares how they feel. Makes a special effort to form linkages with family members who are angry, powerful, or doubtful about therapy so that they are engaged Nichols and Schwartz Strategic techniques Strategic family therapy shares many techniques and concepts with structural family therapy, which are often used together.

Substance Abuse Treatment for Family Therapists The causes of substance abuse are multidetermined, with biological, psychological, social, and spiritual components. Traditional Theoretical Understandings of Substance Abuse Two models have contributed to our contemporary understanding of substance abuse and dependence: Medical model The medical model of addiction emphasizes the biological, genetic, or physiological causes of substance abuse and dependence.

Adjunctive Pharmacotherapy for Substance Use Disorders A variety of pharmacological interventions have been developed to aid in the treatment of substance use disorders, and many more are in development. Sociocultural theories Sociocultural approaches to substance abuse focus on how stressors in the social and cultural environment influence substance use and abuse.

Holistic approach Each of the two models presented above—medical and sociocultural—has some validity and research to support its credibility. Common Treatment Modalities A variety of treatment modalities are widely used in substance abuse treatment. A recommendation from a substance abuse treatment professional if there is any doubt about the treatment modality to which the client should be referred. Detoxification services People who have a substance use disorder will likely require a period of detoxification before they can begin intensive treatment.

Outpatient treatment Outpatient treatment is the most common modality of substance abuse treatment. When the going gets tough, get help.

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