The Family Disease Model suggests that alcohol use disorders are not only diseases affecting an individual, they affect other family members, as well. The model indicates that the disease is manifested in other family members in terms of phenomena such as anxiety, enmeshment and other dysfunctional relationships, low self-esteem, and “co-dependence”. Codependency, according to this model, is a complementary or parallel disease to alcoholism, exhibited by the alcoholic’s significant others. The codependent person presumably exhibits a number of symptoms associated with the disease, and engages in “enabling” behaviors. Enabling is described as behaviors that perpetuate another person’s substance use-for example, protecting the person from experiencing the natural consequences of substance use that might have led to deterrence in the future; making access easier; covering up for the other person’s drinking.
Treatment approaches formulated around this model do not address the individual’s substance use directly, but encourage the significant others to heal themselves from their own disease and recover from the impact that the drinking has had on their lives. The family members are encouraged to detach themselves and others, reduce their own emotional distress, and improve their own coping and functioning. There exists little in the way of empirical support for this model that underlies the Al-Anon program.
Family systems models hypothesize a series of homeostatic functions in families that have implications for the processes associated with an individual’s recovery from alcohol problems. The underlying assumption is that an individual’s maladaptive behavior reflects dysfunction in the system as a whole. As such, the alcohol abuse serves an “adaptive” function for the family system as a whole. For example, the family is allowed to divert its attention away from and to avoid even more threatening issues by attending to a member’s drinking behavior. In this conceptualization, the drinking behavior transcends the individual and is relational, thus the relationships are a necessary focus of intervention. These types of approaches are designed to address and restructure family interaction patterns that are associated with the alcohol abuse. As a result, the alcohol abuse is no longer “needed” by the family system for its survival.
Behavioral Family Models
Readiness to Change within a family system may proceed in a manner that closely parallels the change process for an individual. Families that minimize the drinking problem of an individual member are reflecting a process parallel to the individual who is in the precontemplation phase in stages of change concerning an alcohol use disorder. The tendency is to deny that the problem exists, or to acknowledge that drinking is a problem, but to minimize its significance and severity. This precontemplation phase is also generally characterized by a sense of helplessness to change the situation-poor self-efficacy. As the family becomes increasingly exposed to and aware of the negative consequences associated with the drinking, family members or the family as a whole may shift into the next stage in the process of change: contemplation. Families in this stage evaluate the situation, considering the ways in which the drinking makes the family vulnerable-children and adolescents may be experiencing difficulties with behavior and school, the partner or spouse finds relationship problems with the alcohol abuser to be less and less tolerable. At this point, the family becomes convinced that something must change in the system, but they have not yet made a concrete commitment to specific change actions. In preparation for change, the family has begun to take some small steps toward change of the situation, and has a “near future” timeline for implementing change. This is a point in which the family is likely to be seeking help alternatives and information about treatment options, and may also be considering the pros and cons of other alternatives to life with an alcohol abuser.