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On this track we will discuss substance abuse and misuse. I have found that there are five steps in the adjustment stage of substance abuse and misuse following a divorce or separation. These five steps are the erosion of trust, avoidance and control, the family becomes reactive, communication breakdown, and monitoring. We will also discuss the frustration towel twist and the feelings excavation technique as ways to begin to treat substance abuse and misuse.
As you listen to this track, consider your divorced or separated client. Is he or she abusing or misusing substances such as drugs or alcohol? Could the technique on this track help you get started in a substance use treatment?
The 5 Steps in Adjusting
#1 The Erosion of Trust
The first step in this adjustment process was the erosion of trust within the family. Family members in this first stage of substance use want to give the addict the benefit of the doubt, but increasingly their instincts tell them not to. For example, Jennifer, age 32, was drinking two to three bottles of wine each day following her divorce. Jennifer’s sister, Val, was concerned.
However, Jennifer explained to me that one day Val would express concern, and the next day she would bring over a bottle of wine. As a result Jennifer found it impossible to see Val’s concern as genuine, thinking her loved ones were trying to trick or force her into stopping her substance use. Think of your client’s situation. What is precipitating an erosion of trust in your client’s family life?
#2 Avoidance and Control
The second step in the adjustment process is avoidance and control. As you know, when substance use leads to addiction, it is based on the false belief of control. When an Jennifer was drunk, she often believed she had found the ‘answer’ that provided the control she needed to ensure a good life. I find that, just as the divorced or separated client believes he or she can control their substance use, the family believes they can control the client.
#3 The Family Becomes Reactive
In addition to the erosion of trust and avoidance and control, the third step in the adjustment stage is the family becomes reactive. Family members begin using anger and arguments to stop feeling helpless. For example, Jennifer’s sister, Val began to argue with Jennifer.
Jennifer stated to me, "Val couldn’t reach me the other night because I drank a little to much and fell asleep. So she came over. She said she was concerned but all she did when she got to my house was freak out, yell, and call me names. She’s such a bitch." Do you agree that anger distances the families of addicts from their fear and makes them feel more in control?
#4 Communication Breakdown
The fourth step of the adjustment phase is communication breakdown. As you know, healthy communication is a dialogue in which each family member is willing to listen to and be influenced by each other, and each participant is equally vulnerable.
Do you agree that the goal of healthy communication is to listen for what the truth is, and to move towards it? In my experience, truth poses a threat in to the divorced or separated client if the client sabotages the truth and communication process to protect his or her substance abuse or misuse.
The fifth and final step in the adjustment phase for Jennifer was monitoring. She was beginning to feel that she couldn’t make it through the day without a drink. She stated, "Oh, I need it to get by now. Just everything that has happened before and after the divorce is too much for me." Jennifer mentioned that her sister still wouldn’t leave her alone.
She stated, "Val still calls three time a day and checks on me whenever I go out." Clearly, Val was exhibiting classic monitoring. This step occurred near the end of the adjustment stage for Jennifer. In this step, Jennifer’s sister Val still believed they could solve the problem together, and they became alert for any signs of danger.Val put aside her own needs for Jennifer’s immediate ones.
Technique: The Frustration Towel Twist
Jennifer was obviously experiencing a great deal of frustration. I found that she was having trouble expressing this frustration in a healthy way, so I walked Jennifer through the "Frustration Towel Twist" exercise. I offered Jennifer a rolled-up bath towel, and instructed her to grab it with both hands.
I then instructed Jennifer to take a deep breath, tense her body tightly, and hold her breath while twisting the towel in her hands tighter and tighter. When the tension in the towel was as strong as she could make it, I told Jennifer to slowly release the towel and her breath, making a sighing ‘haaa’ sound. I had Jennifer repeat this twisting and release three times. With practice, Jennifer found that by using the towel twist exercise when she was frustrated with her sister or when she felt the need to drink, she was able to approach Val more rationally, and focus on using conversation patterns she had practiced with me in our sessions.
Technique: Feelings Excavation
I asked Jennifer to work through the "Feelings Excavation" exercise with me. First, I asked "What is the predominant feeling you have right now?" Jennifer thought for a moment, and answered, "Well, I guess I’m a little upset." I then asked Jennifer to make a list of words that more accurately described how she was feeling. Jennifer listed: frustrated, embarrassed, disappointed, and hurt.
"Ok," I said, "Now, what happened that made you feel this way?" Jennifer answered, "Several months before the divorce, Larry and I were supposed to go have dinner with our closest friends, but Larry came home drunk, and we couldn’t make it. I had to call our friends and tell them Larry had to work late. Just last week I ran into those friends. All of those awful memories came flooding back."
I encouraged Jennifer to think about how she expressed her feelings when she bad memories of her failed marriage resurfaced. Jennifer stated, "Well, I get drunk and clean the house." How might you have responded to Jennifer? Since Jennifer correlated drinking with expressing her feelings, I asked Jennifer to come up with some other ways to express herself. Jennifer said, "Well, I suppose I could have talked to me friend about how embarrassed I was when that whole thing happened. I do always have a good time with our friends, and I really shouldn’t have to miss them because my ex husband was a jerk."
As you can see, the feelings excavation technique benefited Jennifer regarding an understanding of what was triggering her alcohol abuse. Thus it was a good starting point for addressing Jennifer’s substance abuse. How would you proceed in the future treatment of your client’s substance abuse or misuse?
On this track, we have discussed substance abuse and misuse. We discussed the five steps in the adjustment phase of substance use. The five steps in the adjustment phase are erosion of trust, avoidance and control, the family becomes reactive, communication breakdown, and monitoring. We also discussed the frustration towel twist and the feelings excavation technique as ways to begin to treat substance abuse and misuse.
On the next track we will discuss dealing with the ex. One technique for dealing with the ex is revealing hidden issues. I find that even though it often wasn’t done in the marriage, after a divorce revealing hidden issues can still be productive. Four indications of hidden issues are wheel spinning, trivial triggers, avoidance, and scorekeeping.
Peer-Reviewed Journal Article References:
Wolchik, S. A., Sandler, I. N., Tein, J.-Y., Mahrer, N. E., Millsap, R. E., Winslow, E., Vélez, C., Porter, M. M., Luecken, L. J., & Reed, A. (2013). Fifteen-year follow-up of a randomized trial of a preventive intervention for divorced families: Effects on mental health and substance use outcomes in young adulthood. Journal of Consulting and Clinical Psychology, 81(4), 660–673.
Question 11: What are the five steps in the adjustment phase of substance use? To select and enter your answer, go to the Test.
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