 Hi everyone and welcome to today's presentation on the Family Dynamics of Addiction. Over the next, you know, 35, 45 minutes, we're going to define how, define what a family is. Examine how addiction impacts the family emotionally, socially, physically, and spiritually. So this is going to be a real high-level overview. Obviously there are volumes of books that you can read on working with families that are impacted by addictions. I just want to give you sort of a high-level insight, so you have an idea about what some of your patients may be dealing with if they have an addicted family member. So why do we care? The identified patient doesn't exist in isolation, and at least in the school that I went to for counseling, we didn't talk a lot about identified patients unless we were talking about family therapy. The identified patient is the person who is identified as being the sick one, when in reality the entire family is kind of sick. As the identified patient's behaviors and problems develop, the family's behaviors change to try to maintain stability. So you want to try to keep the family together, and this person's kind of going rogue here. So how do we adjust in order to keep this family together? When the identified patient begins to change in recovery, that disrupts the balance too. So we've already adjusted to you being rogue out here, and then you're coming back into the fold, so we've got to readjust. This causes problems because the family members aren't prepared to have to adjust. They're used to reacting and acting with the identified patient in a certain way. When John does this, when John was late coming home from work, that always meant that he had been out at the bar. Well, John's in recovery now. When he's late coming home from work, maybe it means there was a traffic jam. Or he had to stay late to finish up something that he was working on. These are not things that automatically click into the minds of people who have been living with a family member who has an addiction. Another example, when Sally started sleeping late and going to bed early, it always meant that a major depressive episode was coming on. That could be true, although when Sally's in recovery and has started coming out of those major depressive episodes, what other things might be causing her to sleep late and go to bed early? Maybe she's coming down with a flu, or maybe she just had a really hard day at work. Let's look at some other alternatives before we start jumping to conclusions and assuming things are going back to the way they were. In some ways, the family wants to bring people back into sort of the way it was, because change is hard for the individual and change is even harder when you've got multiple individuals. So once the family is adjusted to the sick identified patient, if you will, they kind of want to stay there. They know how to act, they know what to expect, and it's better in some ways or less threatening in some ways than going back to normal, if you will, and then having to hope that the identified patient doesn't fall off the wagon, relapse, whatever you want to call it. So the family needs to understand the impact of the identified patient's behavior on the family. So when the addict was using, how did that impact the family? What did you learn to expect from him or her? How did you change your perceptions and expectations of him or her? What was the function of the identified patient's behavior? What was the function of the acting out? Was it to distract from something else that was going on in the family? Was it to try to escape themselves because they were suffering? What was the function? Why were they engaging in that behavior? And then we have to look at how to examine old behaviors like coming home late from work in a new context and not just assume that we're going back to the beginning and it's the same old, same old. It takes time. These are ingrained patterns of behavior when somebody starts to see certain behaviors, sort of the knee-jerk reaction is, I know, here we go again. I do want to caution you, I guess, and not to be a downer. But in many cases, the person is in recovery and there's a very benign explanation for what's going on. But there are cases where people relapse. So it's important for family members to be able to talk about what's going on and be able to talk with the identified patient and be able to have somewhere to figure out, is this real or is it Memorex? What's a family? Too often we start to think, well, that's your mom, your dad, your grandma, your grandpa, your aunts and your uncles. That's not necessarily a family. Family members are a group of people that are linked together by rules, you know, more or less. Which in healthy, balanced systems serve to protect and promote the welfare and development of the individual members. So there are groups of people who travel, you know, there are groups, especially of youth, who kind of form their own family on the street and they travel around. So a family is not necessarily your blood relatives. They're those people that, in theory, are there to support you and protect you and promote your welfare. When everybody in the system is sick, it's kind of hard to promote one another's welfare. But there's not malice. There's not the intent of harming one another. So what does addiction look like? The addict, the person with the addiction, in this particular case, often has erratic behavior patterns. If they're getting their fix, they're good. If they're not getting their fix, they're having a lot of difficulty dealing with life on life's terms. So they make, you don't know which one's going to show up. It's sort of a Jekyll Hyde sort of thing. Moodyness goes along with erratic behavior. Because addiction, whether it's gambling addiction or, you know, drug addiction or anything else, we're monkeying with neurotransmitters. And so there's moodyness when the person is not, again, getting their fix. They may not actually be able to feel happy. They may be anxious or irritable if they're not able to access whatever that is that helps them numb the pain or escape. Lying, manipulating to try to protect that addiction. Because, you know, that's what's working for them right now. So they're going to protect it. Blaming and throwing focus so people aren't looking at their behavior under a microscope and their addiction isn't at risk. Disconnectedness, you know, disconnecting yourself from the family so people aren't looking at you so much. A lot of tension and anger. If there's enough hostility, nobody wants to look too close because there's a good chance that it may set off the person with the addiction. Hypervigilance, the person with the addiction and you've got to remember and I want you to try to envision the addiction as this person's best friend and it's the one thing that's helping them survive. So they're going to kind of protect it at all costs. They're hypervigilant. They want to protect this and they know people are trying to take it away from them. And almost all addicted families have an identified patient, which is the person with the addiction. This is the person that theoretically is causing all the problems. So we want to look at what are the causes or functions of these behaviors. And I just talked about some of the functions, but how do they impact the family? If your identified patient is erratic and moody, regardless of whether it's a child or a parent, it puts everybody on edge. Everybody's walking on eggshells because it's not fun to be around somebody who's just totally unpredictable and usually in the negative. So people are on edge. People are stressed out. If you know they're lying and manipulating, then it's hard to trust them. And when the trust goes away from the relationship, you know, you've got a whole host of other problems because going back to those rules that everybody in the family is supposed to protect and support one another. If you can't trust them, you can't trust them to protect you. Blaming and throwing focus, it means everybody in the family could potentially be a target for this person's anger, frustration, or just anything in order to keep people from looking at them. I wouldn't have to drink if you wouldn't do this. I wouldn't be late all the time if it weren't for your bill in the blank. Disconnectedness. When the person is not able to integrate with the family when they are not feeling like they're able to integrate, they may just withdraw and become emotionally disconnected and sometimes physically disconnected. If you've worked with people with addictions, you know that sometimes they do go off on two, three, four day, sometimes week benders and they just completely disconnect. They're like, I can't deal with anybody or anything else and they disappear into their addiction. Tension and anger. We know what it's like to be around somebody who is constantly stressed out and just angry and nasty all the time. It creates a tone of unhappiness and it's not safe to be happy in these families. The mantra of the addicted family is don't talk because you don't want to set off the person with the addiction. Don't trust because you don't know what's going on and you know you're being lied to and manipulated and don't feel because your feelings are going to be wrong and it's not safe to feel angry at the addict because you will get blamed for that. You will get in trouble for that. It's not safe to feel sad for the addict because they'll lash out at that saying I don't want your pity. It's not safe to feel anything and there aren't a lot of happy feelings in this family anyway. So there's homeostasis that I talked about before. In an addictive family, people are trying to constantly regain balance. Think of the teeter-totter. You know constantly trying if you're standing on the middle of the teeter-totter and trying to stand up without holding on to anything. This is the addicted family. They're trying to control an addict who doesn't want to be controlled. Right now the person with the addiction is not saying I want help. The person with the addiction is saying eh no I can't, the one thing that is protecting me right now is the addiction. All the other alternatives are not as rewarding or as not as safe as the addiction. So we have to say alright, so why is the addiction more rewarding? What is it that's unsafe or unrewarding or unfulfilling out here that makes you feel like you need to escape or hide? And it could be within the family. It could be within the environment or it could be within the person with the addiction themselves. That's where we have to kind of do a little bit of sleuthing. The addict becomes more defensive and withdrawn. The more people try to balance things out and keep control of stuff, the more the addict withdraws. Stay out of my life, stay out of my way and everything will be fine. So in order to maintain this homeostasis, each family member starts taking on different roles to diffuse tension and we're going to talk about those roles. Why? Because as people grow up and they become adult children of alcoholics or adult children of addicts, and I don't necessarily like that term because the same thing happens in families where the person with the addiction is the child. But if you come from a family where there is an addicted family member, there's some pretty common roles that occur. And so we want to look at what happens and why that happens because these behaviors are often continued at the person's workplace and in their future relationships, which just creates havoc. So the enabler, this is the one that we hear about the most often or talk about the most often. This is the caretaker that makes all the other roles possible. This is the person who is desperately trying to hold this family together. They make excuses for all behaviors and actions of everybody in the family and presents this picture of a family without problems. It's just perfect. Beaver Cleaver would be envious to live in this family. Usually this person is closest to the addicted person and their aim is to help them. They really do want to help them get better. But in this person's mind, it's if I do all the right things, then this person will get better. If I show them how much I care, then this person will get better for me. It's all about them in reality. Instead of saying, why is it or what is motivating the addict's behaviors and trying to get into their frame of mind. This person is saying, okay, well, if I do this, maybe they'll get better. That doesn't work. Well, maybe if I do this, they'll get better. Well, I'm being very dedicated and I'm not leaving so they need to get better for me. The reality is that the enabler does things that allows the addicted person to continue their behavior without facing consequences, bailing them out of jail, giving them a place to live when they've spent all their money and become homeless. There are a lot of consequences and you know, you could go through the list. And I've seen just about all of them. And it's painful. It is agonizing to know that your child is homeless. It is agonizing to know that your child is sitting in jail. However, at a certain point, it has to become more uncomfortable to continue to use. And in 12-step circles and stuff, we call this raising the bottom. Instead of constantly rescuing them every time they ask for help, there are consequences. They've got to face those. How they do this is different for every family. Not every family is going to say, you know, that's fine. You can rot in jail because you're going to need to experience the consequences of what happened. That's not okay with every family member or every family. And you know, we have to talk about what's going to work for the whole family, but we also have to look at if you bailed Johnny out of jail. What does that tell Johnny? And what are the—let's play the tape all the way through. You bail him out. He's out for a while. Okay, you bail him out and he comes live with you. And in two weeks, what's going to happen? In a month, what's going to happen? What do we need to do to make this a happier ending so we don't keep repeating the same patterns? It's agonizing for the enabler to confront the reality that their family is dysfunctional because they take it personally. It's about me. They're desperate to protect themselves, which leaves them exhausted and angry and resentful. It's like, really? You know, I've given you all this. I've done all this for you and this is what I get in return. It sends the message that the addict doesn't have to confront the addiction because someone will always be there to save them. We want to remember that. Now, there's a difference between being there for them and being there to save them. You know, I can be there for them and visit them in jail and letting them experience those natural consequences. Being there to save them means I'm bailing them out of jail and going, okay, just don't do it again. The underlying fears for the enabler are inadequacy, fear, and helplessness. They can't control the addict. Well, in reality, we can't control anybody, but they can't control the addict. And the addict won't change for them, which leads to a feeling of inadequacy. Why won't you do this for me? Enablers are often considered codependent and have several patterns of behavior. Not all enablers have all patterns. Many believe that others are incapable of taking care of themselves. A lot of enablers are very overbearing. They're going to make sure everybody's eating. They're going to make sure everybody's doing everything, and they're just like super control freaks. They typically have low self-esteem and a tendency to deny their feelings. They may be feeling hurt, but they feel like they need to be a martyr and buck up and do the next right thing. Because they derive their self-esteem from other people going, wow, you are an awesome wife. You are an awesome mother. You are an awesome whatever. If they have a good self-esteem, then they'll be looking and going, I'm an awesome person and I don't deserve this. They compromise their own values and integrity to avoid rejection or anger. Again, we're looking back at why do they do this? Why do they need to avoid rejection and anger? Generally because this family, this situation is where they get their validation. In some situations, the enabler came from an addicted family and they're basically replaying their family of origin and trying to do it right this time. They couldn't fix or save daddy, so now they're going to try to fix or save their spouse. They often react in an oversensitive manner and they're hypervigilant. Hypervigilance you're going to hear over and over and over again because everybody has to walk on eggshells in the addicted family. They are at their wit's end. They are angry, they're exhausted, they feel inadequate, so everything that happens is like rubbing salt into an open wound. So what happens to the kids in an addicted family? We develop our coping skills over years, not just, you know, five minutes. Children that are growing up in an addicted family, just kind of think for a second what it would be like if you were maybe four. Growing up in a family where there was constantly lying, arguing, stress, you may not know what it's about, but you can feel it. When I worked in IOP, we had situations like they would come up with spring break and our clients couldn't afford spring break camps or day care, so they would bring their kids. And the kids would come into group, especially the younger ones, the older ones we had activities for, but the younger ones would sometimes come into group, which would be changed to be more psychoeducational. I'm not going to do any hot button topics while we've got, you know, ankle biters in there. But you could tell when you hit a sore topic or when two clients started having a discussion and it got a little heated because the child of the person who was getting upset would often start acting out. Children are very perceptive. They don't understand what's going on. And my staff got really upset about this because, you know, it was disruptive and whatever. And coming from the perspective that I came from, like I said, I was really not taught a lot about identified patients and those sorts of things. Thankfully, our director at the time was a marriage and family therapist. And so we brought it to him and we were talking about in a supervision one day and he's like, so the kids are, you know, acting out and distracting. Yeah, he goes, that's awesome. And, you know, everybody in the room just kind of fell silent and looked at him and he said, that's what they're supposed to do. They're perceiving what's going on and they don't know what's happening. So they're trying to distract attention from mommy. They're actually trying to protect mommy or daddy from what's going on. So that tells us, I mean, they're like little biofeedback creatures. That tells us that something's going on there. Children can't put a name to that. They can't say, I'm upset. I'm scared for you on this or on that. And a lot of times in the addicted family, when the child starts acting out, what happens? Shut up, go to your room, be quiet. Why are you acting so bad? It may work. It may divert everybody's attention to the child who's acting out or it may get the child in trouble. Either way, it generally stops whatever argument's going on. But it's overwhelming to the child and they're like, okay, now wait a minute. What just happened there? Was that my fault? And small children are egocentric. They take everything personally. So they may start to assume that all the chaos in the family is their fault. And then when they get in trouble, things settle down for a little while, mainly because mom and dad just forgot what they were fighting about. So children growing up in this situation shut down their own feelings. It's like it's overwhelming. I don't know what to call it. I'm just going to box it up and put it back here for a while. These are the children that grow up with a lot of underlying resentment and anger and agitation that we work with in treatment a lot. And it's then that they start unpacking these boxes and going, yeah, you know, this kind of really sucked. They deny there's a problem. They're told there's no problem. They're told it's not their problem. So they're told to leave it alone. They can rationalize what's going on. As they get older, they start seeing some things not right, but they start rationalizing. They may start blaming. You know, they may start blaming the enabler for what's going on and believing the ramps of the person with the addiction. That's the safest thing to do. Intellectualizing, over-controlling, withdrawing, acting out, and self-medicating. We see a lot of families where there is one addict have many people in the family unit that are addicted to something. It may not be the same drugs. It may not be the same activity, but there is some self-soothing behavior. In the addicted family, it's exhausting. There are high levels of clinical anxiety, clinical depression. It's just not a happy place to be. So the hero. This is the one that we start talking about because it's generally the oldest child. It's the person who needs to make the family and role-players look good. Switch from being the little four-year-old for a minute to the oldest child in the family. Mom and dad are always fighting. You're going to school. You're trying to do what you need to do to make them proud. Maybe if they can focus on you, if they can agree on something, then they'll stop fighting. Ignore the problem and present things that family problems didn't exist. They make excuses for the addicted parent. They make excuses for the enabler. They find something to excel at to make the family look good and take the focus off the addict. Because look, I am the valedictorian of my class, so I must come from a good family because how else could I be valedictorian? Or I'm the quarterback of the football team, whatever the case is. Their role is to overachieve, take on the responsibilities of the addict. So this person often, let's say the star quarterback, goes to school all day, studies hard, goes to practice, does his thing there, comes home and then has to do what the father or the mother in the household would normally do. This person sometimes becomes the family breadwinner, the surrogate spouse or the parent. Heroes rarely feel good inside. You think you see this person who theoretically comes from this perfect looking family who succeeds at everything. I mean their star football player, their valedictorian or their class, how could they feel bad? Instead of being in touch with who they are and what they need, they've sacrificed their emotional lives trying to preserve the family unit. They're just trying to keep things together. They're trying to make sure that the little siblings have lunch packed and everything is as copacetic as can be. The underlying feelings are fear, guilt and shame. Sometimes the hero believes that if he or she were perfect, the addict would get better. You see this recurring theme here? That's the same thing we heard from the enabler. You know, I'm doing all this so why aren't you getting better for me? Maybe if I did something else. The same thing for the hero. The scapegoat often acts out in front of others. They'll rebel, make noise, divert attention from the person who is addicted and their need for help in addiction recovery. They can draw attention away from the real problems through constant crises ranging from addictions to school or legal difficulties. One of the things that I often think about when I have a child, a young adolescent especially come to my office who is the problem child, the black sheep. Why is that? What function did that serve? Why did you want to rebel against your family so much? Because you didn't like them? That's usually what people assume. But maybe it was you were trying to detract attention from them because there was so much going on that you couldn't control and if they could at least agree on something. I've heard this a lot with patients that I've worked with who have had an anorexia. When I'm in the hospital, things go so much better. When I get out of the hospital and I start getting better, then everything goes to hell again. Okay, well that's pretty straightforward about what's going on. This is someone whose behavior, bad or dysfunctional, can be acknowledged by family members unlike that of the addict. So now we can talk about the anorexic child. We can talk about the drug addicted son because that's not the primary addict in the family. We're still not paying attention to the fact that dads are raging alcoholic. So we can focus on this person instead of focusing on the primary addict. It brings family members together in sort of a perverse way and can make them feel good about themselves by comparison. Well at least I'm not like Sally in and out of the hospital all the time. It provides family members with a focus that enables them to avoid facing their own problems and becomes a means of releasing anger and frustration. They can get angry at this scapegoat, at the secondary identified patient. So thinking about clients that you've worked with, how many of them may have been scapegoats in their family? They may have developed those behaviors as a way of sort of distracting attention from what was going on. The underlying feelings are shame, guilt and emptiness. Then you have the lost child who is just kind of out of the way, lost, quiet and reserved. The lost child is careful not to make any problems. This is the kid who will be sitting in class and will not be able to read the blackboard but won't say anything because they don't want to bother anybody. This person gives up or ignores self-needs and makes efforts to avoid any conversations regarding the family's problems. A lot of times they try to avoid any conversations at all so they can just fly under the radar until they can escape the family. Once they've escaped the family though, guess what? They don't know how to do anything but fly under the radar. So it's this whole new scary world. There's not all the dysfunction but they don't know how to function in a functional society. They recognize the way to avoid attracting critical attention is just to keep to themselves. They're out of sight and out of mind. How horrible must that feel for a child to know that, you know, no news is good news. If they don't see me, they don't call on me, then, you know, that's better than if they do but nobody would know if I was alive or dead. Underline feelings, guilt, loneliness, neglect, shame and anger. You can imagine a kid would feel pretty resentful if they believed that their parents wouldn't even know if they were alive or dead. So there are dysfunctional traits that occur within the addicted family as well. Now we talked about the family roles but the dysfunctional traits kind of refer to a behavior pattern. There's the clown and you're going to think of that more as the mascot. There's the rescuer. You're going to think of that as more of the enabler. But then there's the troubled person who may be the scapegoat. The people-pleaser, the socially conscious one that's going to do all the right things all the time and then the non-feeler that just kind of drops out of the way, the lost child. These are all behaviors at one point or another that people in an addicted family will try out and they probably have more than one of these behaviors. My question to a lot of clients who grew up in dysfunctional families is how are you doing that now? You know, tell me about who was the addict in your family? Who was the scapegoat in your family? What did they do that made them that? How did they embody that role? How did you feel towards them? We talked about that for a little while then out of the clear blue. I'm like, alright, now who's the scapegoat in your current situation? And make some think. So interventions. This is not a family therapy presentation overall so we're not going to go into how to deal with these. But one of the things you can do to start figuring out where to start is to take stock of the current situation, the status quo and potential treatment or recovery and each person needs to identify what are the benefits of the status quo to me and what are the drawbacks. Drawbacks are probably pretty obvious. Then looking at the benefits of recovery. If the person in who is the identified patient gets recovery, is in recovery, what are the benefits to that and what are the drawbacks? And I should have put three columns. If I am in recovery, despite the person with the addiction, you know, they're going to do what they're going to do. If I'm in recovery, what are the benefits and what are the drawbacks? Because it's really scary if people in the family unit start to move on and get healthy and the addict doesn't. What does that mean to them? They're afraid of abandoning the addict. They're afraid of being rejected by the addict. There's a whole lot of issues if you're changing how you interact with one another. What issues of anger and resentment are you afraid of or might come up if you maintain the status quo, how you're currently behaving? What kind of anger and resentment issues are you going to have or going to have to face when you get into recovery? I mean you may still be angry that the addict is choosing the addiction over you. And that's, you know, those are treatment issues that we don't have time to go into here. We want to look at guilt. Guilt for, you know, the way things are right now. What do you feel guilty about? But if you recover, what are you going to feel guilty about? A lot of times it comes down to I feel like I'm leaving the sick members of my family behind. We need to talk about grief, grieving the losses of growing up in an addicted family. You know, you didn't have beaver-cleaver childhood. You didn't have the childhood you thought you should have. So, you know, we need to grieve that and deal with that and figure out what you're going to do with it. We need to talk about fear issues. You know, fear came up with each of those family roles. Fear of rejection. Who's going to reject you? Why do you fear their rejection and what can you do about it? Isolation. You know, if you start to recover, yeah, you're going to have to change people's places and things probably. What does that mean to you? What parts of that are scary? What parts of that are exciting? And what is this new environment going to look like? Loss of control. Now, this is an interesting one because a lot of people, when they come into treatment, appear to be control freaks. They're trying to hold on to control of everything so incredibly tightly. In reality, they have control of absolutely nothing. Their world is spinning out of control. So, we talk about what do you fear losing control of if you start to recover? And, you know, what do you do about it? Is that something that you're really all that concerned about? Because you're going to lose control of the addict, but guess what? You don't have control of him or her right now. And failure. What do you fear failing at? Do you feel fear failing at recovery? They're sponsor in the road. You know, most people don't have a completely smooth recovery period. The hiccups are what we as therapists are there for. What are the things that you fear? What are the things that you fear finding out in recovery? These are all questions that you can put on a piece of paper and have clients fill out between sessions, between the first intake session and the treatment planning session in order to get an idea of, you know, where their motivations are, what they're willing to work on, and what might hold them back because those are the things that you're going to have to address early on, at least from a motivational perspective. So, identifying family roles in the past and present. Who was the enabler in your family and what did he or she do that made him or her an enabler? And then like we were talking about earlier, who in your current life is the enabler and what does he or she do that makes him or her an enabler? How did you feel about that enabler and your family of origin and why? And this is a really scary topic for people in an addicted family or who come from one because you don't talk, you don't trust, you don't feel. So, airing the family secrets is bad enough but then saying that you were angry or you resented that person or whatever the negative feelings might be, that's terrifying. Even if you're not saying it to that person, actually hearing it come out of your mouth is absolutely terrifying. So, encouraging people to start looking at how did you feel about that person and then how do you feel about the enabler in your current family and why? And the person you're working with may be the enabler. Remembering that a lot of patients who come from dysfunctional families repeat this behavior. A is because it's what they know. They may not even be trying to fix it. It's just they know dysfunction so they kind of repeat dysfunction. I wish I could say it wasn't the case but we see it over and over again. Once they become aware of how they're repeating old patterns, then they can make a conscious choice of is this something I want to do again. Ask the person what was the benefit of these behaviors to the enabler? You know, we ask them what behaviors made them enabler, made them an enabler. Now we want to back up and say, okay, what was the benefit to those behaviors? Helping people see that everything we do and everything everybody else does is a balance between what's more and less rewarding. And finally, how can you deal with the enabler in a healthier way? Even if you are dealing with the enabler as the patient, being kind and compassionate is usually the first thing. If you're dealing with another enabler, the person that you're seeing is not the enabler, helping them figure out how to set boundaries because the enabler in the family has always been very controlling to try to hold that family together. So how can you set some boundaries in order to be able to have your own feelings and have your own thoughts and maintain physical and emotional safety? Going through this for each family role to help people see how they're recreating their family of origin, but also to help them identify transference issues. So they can see, you know, my cousin was always the black sheep of the family. And, you know, we always focused on whenever we got together for family get-togethers, we would always focus on, you know, what cousin so-and-so was doing. And today, we always focus on what the black sheep of the family is doing. It's something to focus on besides what's going on here. So you can see how you repeat patterns in your family. You can see how maybe you tend to rescue other people or you fear abandonment from certain people. So thinking about all of these family roles and thinking about the patients that you've worked with and the problems that they've brought up, I encourage you to think and not be as rigid in your thinking about addiction as just alcohol or drugs because a lot of people have behavioral addictions and it may not be to the same, the dysfunction may not be to the same extent as you would see maybe in someone who's a heroin addict, but you do see some of the dysfunction in the family. So I encourage you to look and see if there are any hints of these family roles that are playing out in your current client situation, not only at home but at work. Sometimes we get in situations and work where we actually create that family of origin all over again because we spend a lot of time there. So you may create a replica if you will and if people are having difficulty at work, they have this boss that's overbearing or they have this person who they work with who never does anything and they're always rescuing them. Let's talk about whether that's actually what's going on and if it is, how can you deal with it in a healthy way and why haven't you dealt with it in a healthy way up until now? And it may come back to well, that reminds me of such and such from my past and it just wasn't safe to do it back then or I saw that pattern back in my family of origin but we never learned how to deal with it because nobody ever confronted that. That was off the table. You just knew it existed and you went back into your room. Addiction and mental health disorders impact the entire family unit and it's not just that one generation because the things that are broken in that family continue to be broken as they form their own families and they pass on that pathology until they start identifying exactly what's going on and make a conscious choice about whether they want to keep doing it or not. As the identified patient begins to recover, family members need to interpret behaviors from a different perspective. Not always assume that we're going down that road again. They need to explore what it means to them if the identified patient recovers and address their own issues related to the identified patient's illness and recovery. Maybe they blame themselves. Maybe they're angry at the person. We just have to ask them, what does it mean to you if this person recovers and what do you have vested in their recovery or their illness?