424 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
using acquaintances, or think they can “handle myself
now” are at high risk for relapse, and loved ones need
to take action. Whether a client plans to attend a self-
help group or has other resources, a specific plan for
continued support and involvement after treatment
increases the client’s chances for recovery.
ADDRESSING FAMILY ISSUES
Alcoholism (and other substance abuse) often is called
a family illness. All those who have a close relation-
ship with a person who abuses substances suffer emo-
tional, social, and sometimes physical anguish.
Codependenceis a maladaptive coping pattern
on the part of family members or others that results
from a prolonged relationship with the person who
uses substances (Beesley & Stoltenberg, 2002). Char-
acteristics of codependence are poor relationship
skills, excessive anxiety and worry, compulsive be-
haviors, and resistance to change. Family members
learn these dysfunctional behavior patterns as they
try to adjust to the behavior of the substance user.
Codependent behaviors (sometimes called enabling
behaviors) seem helpful on the surface but actually
perpetuate the substance use. For example, a wife
who continually calls in to report that her husband is
sick when he is really drunk or hungover prevents
the husband from having to face the true implica-
tions and repercussions of his behavior. What appears
to be a helpful action really just assists the husband to
avoid the consequences of his behavior and to continue
abusing.
Roles may shift dramatically such as when a
child actually looks out for or takes care of a parent.
Codependent behaviors also have been identified in
health care professionals when they make excuses for
a client’s behavior or do things for clients that clients
can do for themselves.
An adult child of an alcoholic is someone who
was raised in a family in which one or both parents
were addicted to alcohol and who has been subjected
to the many dysfunctional aspects associated with
parental alcoholism (Beesley & Stoltenberg, 2002).
In addition to being at high risk for alcoholism and
eating disorders, children of alcoholics often develop
an inability to trust, an extreme need to control, an
excessive sense of responsibility, and denial of feel-
ings; these characteristics persist into adulthood.
Many people growing up in homes with parental al-
coholism believe their problems will be solved when
they are old enough to leave and escape the situation.
They may begin to have problems in relationships,
low self-esteem, and excessive fears of abandonment
or insecurity as adults. Never having experienced
normal family life, they may find that they do not
know what “normal” is.
Without support and help to understand and
cope, many family members may develop substance
abuse problems of their own, thus perpetuating the
dysfunctional cycle. Treatment and support groups
are available to address the issues of family members.
Clients and family also need information about sup-
port groups, their purpose, and their location in the
community.PROMOTING COPING SKILLS
Nurses can encourage clients to identify problem
areas in their lives and to explore the ways that sub-
stance use may have intensified those problems.
Clients should not believe that all life’s problems will
disappear with sobriety; rather, sobriety will assist
them to think about the problems clearly. The nurse
may need to redirect a client’s attention to his or her
behavior and how it influenced his or her problems.
The nurse should not allow clients to focus on exter-
nal events or other people without discussing their
role in the problem.
Nurse: “Can you describe some problems you’ve
been having?”
Client: “My wife is always nagging—nothing is
ever good enough—so we don’t get along very well.”
Nurse: “How do you communicate with your
wife?”
Client: “I can’t talk to her about anything; she
won’t listen.”
Nurse: “Are you saying that you don’t talk to her
very much?”
It may be helpful to role-play situations that
clients have found difficult. This is also an opportu-
nity to help clients learn to solve problems or to dis-
cuss situations with others calmly and more effec-
tively. In the group setting in treatment, it is helpful
to encourage clients to give and to receive feedback◗ CLIENT ANDFAMILYTEACHING:
CLIENTSWITHSUBSTANCEABUSE- Substance abuse is an illness.
- Dispel myths about substance abuse.
- Abstinence from substances is not a matter of
willpower. - Any alcohol, whether beer, wine, or liquor, can
be an abused substance. - Prescribed medication can be an abused
substance. - Feedback from family about a return to previous
maladaptive coping mechanisms is vital. - Continued participation in an aftercare program
is important.