Children of alcoholics and of individuals who abuse other substances are reported as a population "without a clear definition." (COAF.org, 2012) Behavior in families where alcohol and other drugs are abused is characterized by unpredictability and unclear modes of communication with chaos defining the family life and home environment. The range of behavior is stated to be such that is "from loving to withdrawn to crazy." (COAF.org, 2012) There may be little in the way of structure and rules and these are at best inconsistent and even nonexistent in some homes. Children do not know that the behavior and mood of their parents is based upon the volume of alcohol they have consumed or the amount of drugs that they have taken and the result is children that are scared and lack security. These children spend much time worrying about their parents and while they do love their parents, they feel a great deal of anger and hurt that their parents do not care enough for them to stop these habits. These children suffer greatly and oftentimes place blame on themselves for the substance and alcohol abuse of their parents. Unfortunately, these children are reported to believe it "when their parents scream that they wouldn't drink so much or use other drugs if the children didn't fight, or rooms were kept clean or grades were better." (COAF.org, 2012) The report states that these children sometimes attempt to exert control over the alcohol and drug abuse through making all A's on their report cards or by keeping the house immaculately clean and by getting along with other children in the family while other children become withdrawn. These children are sometimes the victims of incest or physical violence and are oftentimes witness to violence in the home resulting in their suffering from post-traumatic stress syndrome (PTSD).
I. Consequences of Alcohol and Drug Abuse by Parents
Reported as consequences of alcohol and drug abuse by parents are those stated as follows:
(1) Behavioral consequences;
(2) Medical and psychiatric consequences;
(3) Educational consequences; and (4) Emotional consequences. (COAF.org, 2012)
There is reported to be a "growing body of literature that suggests that substance abuse has distinct effects on different family structures." (COAF.org, 2012) The impacts of substance abuse are reported to "frequently extend beyond the nuclear family. Extended family member may experience feelings of abandonment, anxiety, fear, anger, concern, embarrassment or guilty; they may wish to ignore or cut ties with the person abusing stances. (COAF.org, 2012) The effects on families are reported to be such that is ongoing for generations. Intergenerational effects of substance abuse are reported as having a potential negative impact on the role modeling, trust, and concepts of normative behavior" resulting in damaging the relationships existing between generations. Some of the characteristics of the patterns of interaction resulting in the family where the parents or children are abusing alcohol or drugs are those reported as follows:
The interventions of the individual in the role of nursing and working with the family with alcohol or drug abuse assists the family "collectively' and focuses on the individuals and notes that the family has a "collective personality, collective interests, and a collective set of needs." (Assessment of Families, nd) The nurse desires to assist the family members to work as a team for their collective benefit. The nurse must first conduct an assessment of the family and then determine collective interests, concerns, and priorities. Third the nurse must adapt the nursing intervention to the family's stage of development because the awareness of the developmental stage of the family assist the nurse in assessing the appropriateness of the level of functioning in the family and to develop an intervention that is appropriate for that stage of development. The nurse has a responsibility to assist families in dealing with changes and to do so with a nonjudgmental attitude. The family should be viewed by the nurse as a unique group with its own set of needs and whose interest are best served through care that is unbiased. The nurse should emphasize the strengths of the family and conduct assessment exploring all aspects of the family's functioning to determine the family's strengths and weaknesses. (Assessment of Families, nd) The following is a list of areas that should be assessed by the family nurse:
1. Family demographics
2. Physical environment;
3. Psychological and spiritual environment;
4. Family structure/roles
5. Family functions;
6. Family values and beliefs
7. Family communication patterns
8. Family decision-making patterns
9. Family problem-solving patterns
10. Family coping patterns
11. Family health behavior; and
12. Family social and cultural patterns. (Assessment of Families, nd)
Only after conducting, a thorough assessment is the nurse ready to present the information to the family to see if the family is ready for this level of self-examination in addressing their problems or concerns. Olsen, Allen and Azzi-Lessing (1996) report in the work entitled "Assessing Risk in Families Affected by Substance Abuse" reports the Risk Inventory for Substance Abuse-Affected Families which is inclusive of eight scales which are all reported to be "anchored with four to five descriptive statements, ranging from no risk to high risk." (Olsen, Allen and Azzi-Lessing, 1996) It is reported that the first scale conducted assessment of the commitment of the parent to the recovery process. Stated as the second scale is the assessment of the patterns of the parent's substance use, which is reported to "recognize that relapse is part of the recovery process and takes into account the likelihood that it may occur, even among those parents fully committed to recovery." (Olsen, Allen and Azzi-Lessing, 1996) The next two scales are such that examine the impact of the substance abuse of the parent on "the ability to care for their children and to carry out their everyday responsibilities." (Olsen, Allen and Azzi-Lessing, 1996) The two following scales are reported to assess dimensions of the parent's well being that are more personal including the effect on their life-style and supports for recovery. The next scale is reported to be one assessing the parent's self-efficacy followed by the scale assessing parent's self-care and finally the last scale, which assesses the quality of the neighborhood. These scales are reported to "update the process of risk assessment in child welfare to match current realities." (Olsen, Allen and Azzi-Lessing, 1996)
III. Change Theory
Change theory was first introduced by Kurt Lewin who posited a three-stage change model known as the "unfreezing-change-refreeze model" which makes the requirement that prior learning not only be rejected but that it be replaced. This theory of Lewin's holds that behavior is a "dynamic balance of forces working in opposing directions." (Nursing Theories, 2011) Included in this theory are specific forces including: (1) driving forces; (2) restraining forces; and (3) equilibrium. A requirement of change theory is that the driving and restraining forces are to be analyzed prior to the implementation of a change that is planned. (Nursing Theories, 2011) Motivation for change in individuals being treated for substance abuse is key as reported in the work of Miller (1999) who states that 'Treatment Improvement Protocols' (TIPS) are the "best practice guidelines for the treatment of substance abuse…" (Miller, 1999) The TIP reported in the work of Miller (1999) is such that has as its basis "a fundamental rethinking of the concept of motivation. Motivation is not seen as "static but as dynamic." (Nursing Theories, 2011) It is redefined by Miller as being "purposeful, intentional and positive -- directed toward the best interests of the self." (Miller, 1999) Miller (1999) reports that motivation is: (1) a key to change; (2) multidimensional; (3) dynamic and fluctuating in nature; (4) such that can be modified; and (5) such that the clinician's style influences the motivation of the client. (Miller, 1999) Reported as strategies the clinician can use for encouraging the client to change are the following stated strategies:
(1) Focus on the client's strengths rather than his weaknesses.
(2) Respect the client's autonomy and decisions.
(3) Make treatment individualized and client centered.
(4) Do not depersonalize the client by using labels like "addict" or "alcoholic."
(5) Develop a therapeutic partnership.
(6) Use empathy, not authority, or power.
(7) Focus on early interventions. Extend motivational approaches into nontraditional settings.
(8) Focus on less intensive treatments.
(9) Recognize that substance abuse disorders exist along a continuum.
(10) Recognize that many clients have more than one substance use disorder.
(11) Recognize that some clients may have other coexisting disorders that affect all stages of the change process.
(12) Accept new treatment goals, which involve interim, incremental, and even temporary steps toward ultimate goals.
(13) Integrate substance abuse treatment with other disciplines. (Miller, 1999)
The FRAMES approach is stated to be such that is comprised by the following: