• Expect mutuality & respect. Couples in happy relationship have high expectations from one other even early in their marriage. The couples who are the most successful do not accept hurtful behavior from one another even very early in their marriage. There is a clear relationship between a “low level of tolerance for bad relationship behavior” and a couple’s happiness.

• Get help when necessary. Healthy couples are proactive and tend to seek help for marital concerns sooner rather than waiting the nearly six-year average seen in couples with marital problems. While it is natural look for simple and straight-forward solutions to difficulties, successful relationships tend to view counseling as a positive resource and attempt to overcome concerns before they lead to despair.

• Think before you speak. While it is important to be open and spontaneous, certain subjects or situations call for a more caring or thoughtful approach. The happiest couples learn to balance their desire to share critical opinions. They recognize when to hold off talking about difficult issues during a tough moment or conversation.

• Bring up problems gently. All relationships face conflict and couples need to be able to know how to sit down together and have a conversation when there are difficulties. The happiest couples have developed the skill of knowing how to approach one another about uncomfortable subjects in a manner that is not confrontational or blaming. Learning to overcome their anxiety or insecurity about how discussing negative feelings can often help develop relational self-esteem.

• Gender clarity. While our society has changed in many ways with respect to equal rights for women, when it comes to our personal relationships the way we were raised by our parents can have a powerful impact on our marital life. Couples who have the strongest marriages have flexibility in their relationship and how they openly interact about the roles and expectations they each have with regards to men and women. In particular, research indicates women are more flexible in relationships and the happiest relationships are seen where men are able to allow their wives to have a greater amount of influence in the marriage, retaining a less rigid gender definition.

• Learn the rules for a healthy argument. Strong emotions are a natural and healthy part of a relationship. Successful couples learn very early that there need to be strategies to bring an argument to an end so it does not get out of control. They use various tactics that include humor, backing down, compassionate recognition of the difficulties involved, joining and finding common ground even if there are differences, acknowledging the other’s courage in raising a difficult subject, extending a caring or thoughtful acknowledgment, changing subjects, or just showing an appreciate the other’s feelings about what is being discussed. Occasionally, when an argument is very serious and tempers flair, couples may choose to take a “time out”, agreeing to return to the discussion after tempers have cooled a bit. Avoiding derogatory language and developing healthy arguing habits allows healthy couples to feel confident about approaching difficult situations with confidence.

• Emphasize strengths. In successful relationships, even while discussing problems, couples tend to emphasize the positive rather than focusing on the negative. In fact, research suggests satisfied couples will make at least five times as many positive statements to and about each other and their relationship as negative ones. For example, “We have a lot of fun” as opposed to “We never do anything fun any more.” A successful relationship is built on a positive and supportive climate of togetherness and strengths.

While there is no “one size fits all” approach to relationships, there are definitely tools we can use that tend strengthen and enhance our satisfaction and sense of togetherness. Couples therapy or marriage counseling may be a great way to strengthen your relationship. To set up an appointment with a San Diego therapist, call David Christopher, M.S. at (858) 792-0777.

According to the ultimate authority in the US for alcoholism and addiction related issues, (The NIAAA or The National Institute of Alcohol Abuse and Alcoholism), a history of alcoholism in a family is a very strong indicator that other relatives may also be at risk!

The History of Alcoholism – An Overview

Down the ages, alcohol has served many different purposes for a wide cross-section of people hailing from various strata of society with the first drinkers taking alcohol for medicinal reasons or as a part of their religious rituals.

 These reasons for drinking alcohol still hold good for many people across the world even today, with some manufacturers claiming to produce organic or nutrient-rich alcohol-based beverages that further add to the rising number of regular alcohol drinkers on a global scale.

However, when the principle of moderation is not adhered to and alcohol abused by users, the result can be devastating and sometimes even fatal, for many people who develop a taste for alcohol, which leads to progressive degeneration through various stages of alcoholism, culminating in an irreversible disease that could well have been a preventable condition with timely action.

History of Alcoholism – A Family Matter

There are millions of people – both men and women, sometimes, sadly even children – who are alcoholics. Some may have an individual in their family who is a victim of the bottle-hugger syndrome, i.e. alcohol substituted for real relations turning the person into an addict.

In fact, it is perfectly natural for people confronted with this possibility to try and shrug off the risk of alcoholism having far reaching effects for other members and some people even try to disassociate themselves from the problem by not wanting to discuss it at all – saying, it’s a family matter after all.

 Which it well is – alcoholism definitely is a family matter – one that every loving family should seriously consider seeking timely, qualified medical help for!!

Learn the Risks of a History of Alcoholism in the Family

A grandparent, parent other close family member clinically diagnosed with alcoholism may put you at risk of the very same problem too, but this is something very few people realize.

•  A history of alcoholism exists where a parent is an alcoholic parent, who is likely to have suffered depression apart from associated psychological problems, which are likely to influence family decisions and quality of life for others if not treated properly
• Families where both parents were known to abuse alcohol and/or other drugs are high-risk situations for other members and require clinical counseling and re-habilitation for reducing risks for others in the family unit and helping them lead a well-adjusted life
• A history of alcoholism may result in severe abuse patterns for the drinking habit by addicts including frequent conflicts, sustained aggression and also violence that can and should be prevented before long term treatment is sought on an individual as well through family intervention programs by qualified therapists to address the disorder and any overlapping symptoms arising due to alcoholism.

So that your family problems related to alcoholism do not shadow your future or that of your loved ones, just because they were a very real part of the family’s history of alcoholism, it is important to consult the right professionals for learning how to lower risks, control and treat the disorder for enjoying a happy, meaningful and fulfilled life.

Vicodin addiction (Hydrocodone) damages the closest of relationships, those between parents and children, wives and husbands, siblings, lovers etc. As the addiction progresses, it takes more and more of a toll on the friends and family members of the addict in the following ways:

Addicts

• Forget scheduled dates and act flippantly when reminded
• Take/steal medications that are legitimately prescribed for others
• Experience mood changes that are unexplained and frightening to others
• Become secretive where he or she was previously engaging
• Manipulate physicians and health care organization as they try to get more and more of the drug they can no longer legitimately procure on their own
• Spend money meant for living expenses on trying to obtain the drug
• Act aggressively or helpless when confronted with family concerns
• Face legal issues resulting from drug seeking behaviors
• Lose jobs, education, family and friends
• Isolate themselves
• Make impaired decisions regarding safety of themselves and loved ones
• Become inept at life 

Family and Friends 

• Make allowances for the addicts changes in behavior such as lateness, unreasonable fears, acting agitated, talking nonsensically, etc.
• Begin to suspiciously track the whereabouts of the addict, also becoming secretive
• Experience feelings of dread, depression, anxiety as their loved one becomes more addicted
• Lie for the addict often covering for them at work or school
• Deal with financial and legal “wreckage” the addict leaves behind
• Confront the addict in non-productive ways leading to more anger and hopelessness
• Feel betrayed and lonely
• Become isolated from the addict and each other
• Can be physically threatened or even hurt by the addicts behavior

Since the  addictions often progresses slowly and over extended periods of time, many of the behavior changes in the addict and their families happen so gradually that the family as a whole can hardly recognize the changes that happen. Mich like aging, weight gain, financial difficulties and other life challenges, when you are very close to the problem and experience the difficulties day in and day out, the tendency of those experiencing the problems is to get used to the challenges, rationalize what has happened and move on to the next day. Before they realize what has occurred, the problem has gotten much worse than they ever dreamt possible.

 The end point may be a health care professional becomes involved by a family member’s because a family member asks for help, the addict is arrested, or when a social service agency such as Child Protective Services is alerted. Treatment and healing for all effected by the addiction hopefully ensues.

As much as we might look to deny it, women also become alcoholics.  It’s not a gender-biased disease.  Having said that, however, there are certainly elements of alcohol addiction in women that are somewhat different from what men tend to experience.  Lex (1991) notes the following aspects of alcohol addiction that seem to characterize women’s struggles with alcohol:

1. Family/Genetic Factors – Women with alcohol problems are more likely to have an alcoholic role model in their nuclear families and to have alcoholic spouses than are alcoholic men.
2. Onset – Women usually have drinking problems at later ages.
3. Consumption patterns – Women typically consume less alcohol than men and are less likely to drink daily, to drink continuously, or to engage in binges.
4. Course of illness – Women progress rapidly from onset of drinking through later stages of alcoholism (known as “telescoping”).
5. Attribution of Etiology – Women often attribute their drinking to a traumatic event or stress.
6. Co-existing Mental Disorders. Women with alcohol problems tend to have affective disorders (mood disorders such as depression, mania, and bipolar disorder), whereas alcoholic men are more likely to have antisocial personality disorder.
7. Societal Response – Women experience more social disapproval for alcohol use, and women with alcoholism are more stigmatized.
8. Social Consequences – Disruptions for women are more likely to occur in family life and more likely to result in separation or divorce. Disruptions for men tend to occur in the job arena.
9. Medical Consequences – Women have more liver cirrhosis than men.
10. Personal Response to Illness – Women with alcoholism generally feel more guilty, anxious, or depressed than do men with alcoholism.

As a society, we are probably becoming much more aware that alcoholism is as much as a problem for women as it is for men.  Perhaps women go to greater lengths to hide their use of alcohol, given their own awareness that society seems to be more critical towards women who become alcoholics.  Sadly, addictions take a truly equal opportunity to gender. Our grandmothers, mothers, wives, daughters and sisters are just as likely to end up struggling with alcoholism as any young or old man in our life. The odds are that will will show up a bit later, but that may be changing as our stereotypes allow women the freedom to express themselves more openly. Perhaps that may mean earlier treatment. Compassion, kindness and thoughful caring support is the recomended approach. It may be a great time for family members to get supportive counseling to learn how to most effectively share feelings and talk openly about concerns.

Deciding which drug rehab program to use out of the more than 10,000 in the United States can feel daunting to say the least. Frequently, family members are attempting to select an alcohol or drug rehab program for a loved one. The generally increases feelings of responsibility but it can be a bit challenging since you have to use your best guess about the details of the person’s alcohol or drug use history. Each alcohol treatment center has certain unique aspects to how they help get someone clean and sober. There are also similarities in how many programs approach substance abuse recovery. This generally means there is a standard of care that most programs will attempt to offer, but a slightly unique style they will use or niche a treatment center will attempt to fill to keep up their market share.

Choosing a drug rehab center will be easier if you clarify your situation. If you start by asking yourself some questions that will give you a foundation to ask useful questions when you speak to the admissions or intake coordinators at each rehab program it will make thing a lot simpler for you.

Here are some important questions to ask as you prepare to start the process of choosing a rehab program for someone. Ideally, once you finish with these questions you will be able to begin an interview with a brief, very clear paragraph that provides an outline of your situation and needs.

1. What is your relationship to the person you might be calling the treatment program about and what is his/her age?
2. Where do you live and where does he or she live – That is to say, where is your son, daughter, wife, husband or friend living right now now?  Does the person you are calling about have any family he or she lives with and are they actively involved in his/her life?  This helps convey how stable their family life is or has been.
3.  Are you calling at their request or without their knowledge? In other words, what led up to the current call? Possibly a family intervention…maybe he has asked for help.
4.  To the best of your knowledge, what is his or her current drug of choice? If you have any knowledge about the history of their drug or alcohol use, what is the brief overview of how that looks: briefly describe duration, intensity, consequences that have included legal, financial, physical or other difficulties and what the current situation is to the best of your knowledge. 
5. What is the current social situation for the person? Do they have family, friends, a job or other stable elements of their life? How much of an impact has the person’s drug use had on their relationships and possible support? Have they burned bridges in their life? A thumbnail sketch helps a lot.
6. Do you have a sense of how treatment might fit into their employment? How stable and reliable is their job?  Do they have insurance that might help them seek treatment? You do not need to know all the answers, but having some general information about the type of position the person holds may make it easier to answer questions together.
7. Does the person have any religious or spiritual inclinations in their life?  
8. Although you may not be trained, do you suspect or are you aware of any other major mental health concerns or diagnoses the person may be dealing with in their life? Is there a family history of depression? Are other family members dealing with any psychological issues you know about? 
9. Has he or she ever been in any drug or alcohol treatment before? If so, talk about the relapses that took place and what they looked like. Has he or she ever worked with a psychotherapist or counselor? Are you aware of any medications, drugs or others substances he or she is or has used? 
10. What resources does the person have as they seek help? This might include insurance or other means such as family. Have they ever sought out help through self-help programs such as AA or NA and if so, what was the reaction they had?

 With the above in mind, your side of the conversation with an intake or assessmenr counselor at a treatment program might sound something like this:

“Hi, could I speak to someone who could talk with me about your program please?”

 “My name is Jane Doe and I am calling you today from Del Mar, California about my 28-year-old son, John Doe who lives in San Diego, California with his wife and 4-year-old son. I am calling because my son asked me to help him try to figure out what to do to start to sort out his life.”

“I think John has smoked pot or drank since he was maybe fifteen or so on a fairly regular basis. When he went to UC Berkeley I am sure he just continued getting high, but he somehow managed to keep up pretty good grades. He got a degree in economics and moved back here to San Diego with his girlfriend from up at school. I think she probably got high with him too until she got pregnant. They were already thinking about getting married and did when she first learned she was going to have a baby. For a while he seemed to quit smoking pot and kind of got serious about being a father. Then he slowly got back into it. He seemed like he was just sort of moody…kind of sad at times like his grandfather used to get. He says pot helps him from getting down on himself so much. My Dad always drank when he was down like that.”

“Now, his wife is getting more frustrated daily, as she doesn’t want him getting high around their son. He still has a job with an investment company in town that provides health insurance, but John is really reluctant to go into some program.  He is not a very religious guy and is kind of unsure how he could deal with 12 step programs and the God thing.”

“I am very worried for him and want him to get some help. I know he and his wife are really struggling with this, but she loves him a lot. I want to learn about your program and see if it would be a fit for him.”

 The person doing the assessment might be hearing something like this:

You have described a person who has a history of substance use that extends through his teenage years and into early adulthood and includes mostly alcohol and marijuana with occasional use of other drugs. You established that the person has a genetic history of alcoholism and possibly depression. The possibility was raised that he may be self medicating to cope with depressive symptoms.

 He has not had any major legal problems that result from his drug involvement however his condition is beginning to impact his marriage and general family life. The stressors connected to work, marriage and the responsibilities of growing-up may be weighing on him. His coping skills are in question. You have made it clear that your son has a support system in his wife, parents and son and is maintaining a job. However, time and repeated difficulties could undermine his support.

He lives locally in San Diego and has insurance. His religious tendencies might make it somewhat difficult for him to connect with AA. Being an economist, he has a strong mathematical background that has many of the same attributes as an engineer. Problem-solving and logic are probably strong suites for him.

Most important, it is clear that you care a great deal about him and it certainly sounds as if others do as well.

The ideal setting initially sounds like a locally based intensive outpatient program that emphasizes cognitive-behavioral therapy and uses a SMART recovery self-help program. Psychoeducational components will benefit him and the family a great deal. A psychiatric evaluation will help to determine if he is depressed . Building on his family support and connections will likely help him engage in a recovery process. Couples/family counseling will be important for John and his wife. A strong therapist for aftercare will increase his chance of recovery, so insure that the program is local or has a clear path for local aftercare service .

As you begin to discuss the various programs available, you will now be in a stronger position. You have created a personalized profile that clarifies that type of program your family needs. Now you can begin to ask some focused questions about the program itself. Here are ten questions to help you in your search for the right drug or alcohol rehab facility.

1. What is their success rate and how do they define success? There are many variables to consider in outcome evaluations. Each program may use a slightly different set of criteria and will likely report somewhat different outcomes at the one year mark. However, the most important issue will be that they are performing outcome research on their clinical work. 
2. What are the staff’s credentials and how long have they been in the field of drug rehab? The least credential you should expect for the line staff is a Certified Addictions Counselors (CAC) or Certified Alcohol and Drug Counselors (CADC). Supervisory staff should have higher a credential, such as a Licensed Clinical Social Worker (LCSW), Marriage and Family Therapist (MFT) or Licensed Psychologist (Ph.D.). Having extensive experience working with addiction treatment is a must. 
3. Is the facility accredited as a drug rehab center and if so, with what organization? Since there are only a few creditable national level accreditation organizations, this is important. In order to receive accreditation, a facility will undergo a site review and all rules reviewed to have met up to national level standards. Two well-known accreditation organizations are the Joint Commission on Accreditation of Healthcare Organizations (JACHO) and the Commission on Accreditation of Rehabilitation Facilities (CARF). 
4. Will they accept your insurance plan or is there any flexibility in rates? Financial planning for treatment is an essential part of developing a plan for working with a treatment program. The finances of treatment, like all business, are fluid and tend to reflect the current national economic picture more than you might expect.  As such, there is often some room for negotiation of rates, scholarships that cover extended stays and other flexible approaches to finances.  
5. Do they offer medically supervised withdrawal? Some treatment centers do not have detox programs and use the facilities of hospitals or other centers. Withdrawal management is an extremely important part of early recovery and if not handled correctly, is very dangerous.  
6. What is their ability to help with aftercare? Time spent in treatment is directly related to success in recovery. Regardless of whether you are in an inpatient or outpatient program, the use of an effective aftercare program can extend the length of treatment and increase the likelihood that treatment will be effective. Most programs will say that they offer this service.  It is OK to ask for specifics if you are considering going to a treatment program out of your area e.g. what are the names of the therapists they refer to? Can you speak with them before initiating treatment about their experience working with patients from the program? 
7. What is the normal schedule for a day in their rehab? Treatment is serious business and how well it is implemented can mean the difference between life and death. Group therapy, individual counseling, education and family treatment are all important elements of effective treatment. 
8. What is the program’s level of privacy and how well does it fit the needs for the intended patient? As mentioned at the beginning of the article, there are some 10,000 drug and alcohol rehab programs in the United States. In recent years, there has developed an increasing awareness that some might wish to seek help without drawing any attention to themselves in any way. Small, extremely private treatment setting have shown up throughout the country to fill this niche. While generally quite expensive, the patients who use these programs have the resources and need for such services. Take the time to reflect on each aspect of your needs as you consider what program might fit your situation best.
9. What basic their treatment modality or philosophy and do they support others? Find out if they are 12-step oriented, provide options for “smart recovery”, use motivational, cognitive or behavioral therapies, and then ask them to explain any terms you might not understand. 
10. Are their therapists diverse in their skills and training and how is the decision made about your matching patients with their primary therapist? Developing a strong bond with your primary therapist can dramatically improve your chances of success.  How does the program decide the therapist who will work with each client? 

The decision to seek treatment in a rehab program for drug addiction, alcoholism or some combination of the two can generate anxiety and a wide range of emotions. More often than not, families have seen this coming for some time, but faced with the decision where to get them help, may become somewhat overwhelmed with the number of choices.  You may find it helpful to speak with a trusted therapist who does not work for the treatment programs and can help you in sorting out your specific situation. Be patient and kind with yourself and take your time.  You will find a program that provides a great setting for you or your loved one once you put your mind to the task.