It is not uncommon for couples to report confusion over some of the terms used to describe substance-using behaviors. It can also be relatively unknown what the rates of substance use are within the United States, and moreover, the relationship of substance using behaviors on family members and partners. In addition, substance abusers and their partners may experience episodes of depression as a result of dealing with the myriad of issues that are present where substance abuse issues exist. You may have even asked, how do I know if there is a drinking problem? How does all of this affect my kids and what can I do about it?

The intent of this website section is to help you answer these questions.

How do I know if someone may have a problem with alcohol?

This set of four questions can help to indicate whether there is a drinking problem:

1. Have you ever felt that you should cut down on your drinking?
2. Have you ever felt bad or guilty about your drinking?
3. Have others annoyed you because they criticized your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to try to get rid of a hangover?

Answering 'yes' to one of these questions may indicate that there is a problem with alcohol. If you answered 'yes' to more than one, there is a great likelihood that drinking is a problem. An affirmative answer to any of these questions should prompt some investigation, either with a doctor or a treatment provider, who can help assess if there is an alcohol problem and provide recommendations for appropriate intervention.

What are the differences between abuse, dependence, alcoholism, and addiction?

Abuse and dependence are diagnostic terms used to describe the pattern of use and life consequences attributed to drinking and substance use. There are two terms that are often used to describe the behavioral pattern of alcohol and substance dependence: alcoholism and addiction.

a. Abuse: The essential feature of Substance Abuse is an unhealthy pattern of problem use leading to significant negative consequences. This includes one or more of the following:

1. failure to fulfill major social obligations in the context of work, school, or home;
2. recurrent substance use in situations that creates the potential for harm (e.g., drinking and driving);
3. recurrent substance-related legal problems; and
4. continued substance use, despite having persistent social or interpersonal problems caused or exacerbated by the effects of the substance.
   

b. Dependence: Substance Dependence is marked by a cluster of cognitive, behavioral, and physiological symptoms, indicating that the individual continues to use a given psychoactive substance despite significant substance-related problems. To meet criteria for dependence on a psychoactive substance, an individual must display at least three of the following seven symptoms:

1. physical tolerance;
2. withdrawal;
3. unsuccessful attempts to stop or control substance use;
4. use of larger amounts of the substance than intended;
5. loss or reduction in important recreational, social, or occupational activities;
6. continued use of the substance despite knowledge of physical or psychological problems that are likely to have been caused or exacerbated by the substance; and
7. excessive time spent using the substance or recovering from its effects.
   

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, Fourth Edition (DSM-IV). Washington D.C.: Author.

c. Alcoholism: The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime, it usually follows a predictable course, and it has symptoms:

• Craving: A strong need or urge to drink.
• Loss of control: Not being able to stop drinking once drinking has begun.
• Physical dependence: Withdrawal symptoms such as nausea, sweating, shakiness, and anxiety after stopping drinking.
• Tolerance: The need to drink greater amounts of alcohol to get "high."
  

d. Addiction: Addiction is viewed as a complex, progressive behavior pattern having biological, psychological, sociological, and behavioral components. What distinguishes this pattern of behavior from others is the individual’s overwhelming pathological involvement in, or attachment to, subjective compulsion to continue, and reduced ability to exert control over the substance use. The behavior pattern continues despite its negative impact on the physical, psychological, and social functioning of the individual. The term addiction is a broad descriptor for a behavior someone may lack control over, feel a compulsive need to continue, and an overwhelming attachment to (e.g., gambling, sex, drugs, alcohol, food, shopping, etc.).

What is the rate of alcohol use in the United States?

• Roughly 50% of Americans report the use of alcohol in any given month.
• Approximately 15% of Americans report binge drinking (5 or more drinks on a single occasion).
• There are roughly 15% of Americans with lifetime rates of alcohol abuse and dependence.
• Between 5-10% of American men demonstrate alcoholism in their lifetime.
• 90% of teenagers are "drinkers" by the end of high school.

What is the rate of drug use in the United States?

• 35% of Americans (12 and older) have used an illicit drug at least once in their lifetime.
• 11% of Americans use an illicit drug at least once in any given year.
• Approximately 6% of Americans have suffered from drug abuse or dependence in their lifetime.

What is the relationship between alcohol and drug use and relationships?

• 25-30% of adults entering treatment for alcohol/drugs are married or in stable relationships.
• Alcoholics and substance abusers are just as likely to marry, but more likely to divorce/separate.
• Exhibit high levels of relationship distress and dissatisfaction.
• Poor communication skills.
• Decreased expressions of caring behaviors.
• Distress and health concerns in spouses and children.
• Increased risk of interpersonal violence.

What happens to relationships when substance use is a problem?

The relationship between problematic drinking and relationship problems is not unidirectional, with one consistently causing the other, but rather each can serve as a precursor to the other, creating a “vicious cycle” from which couples that include a substance-using partner have difficulty escaping. For example, there are several familial antecedent conditions and reinforcing consequences of substance use. Marital and family problems (e.g., poor communication, deficient problem-solving skills, arguing, financial stressors, etc.) often serve as precursors to excessive drinking or drug use, often as a method of affect regulation. In turn, resulting family interactions can inadvertently help to maintain these behaviors once they have developed. Drinking provides more subtle adaptive consequences for the couple or family, such as facilitating the expression of emotion and affection (e.g., caretaking when a partner is suffering from a hangover) or regulating the amount of distance and closeness between family members. Such consequences can inadvertently serve to reinforce substance use. Our couples programs are used as a vehicle to break the “drinking-relationship distress cycle” for these couples.

What is codependency?

Alcoholism and drug abuse are viewed as not only affecting the substance abuser, but also members of the family. From this perspective, family members suffer from “co-dependency,” which can be characterized by control issues, dishonesty, frozen feelings, fear, denial, anxiety, depression, stress-related illnesses, care-taking, and self-centeredness. This is not to say that all of these characteristics are present or that they are ‘bad,’ but they can result from living with a substance abuser. Family members may develop these characteristics in an effort to combat the degree of impact the substance abuse has on them.

I’ve heard the term “enable.” What does this mean?

The hallmark of co-dependency is enabling, which is defined as a set of behaviors that support substance abusing behaviors. Some enabling behaviors may be calling in to work for the substance abuser because he/she are hung-over, giving the substance abuser money knowing he/she will buy alcohol/drugs, or making excuses to extended family members when the substance abuser does not attend a family function.

What can I do to help my partner and my relationship?

Learn more about alcoholism and drug abuse and how relationships can be affected by these behaviors. Conducting your own research by visiting websites like this one, reading books, talking to counselors and supportive others, and attending self-help meetings are all steps that can take you in the right direction. Connecting with others who have similar experiences can help validate your concerns and provide you with support. Also, there are a number of different treatment options that are available for you and your family. There are 5 types of treatment that are currently available for substance abusers and their families. It is not always necessary to participate in all of these programs, although some individuals might do so.

1. Detoxification: A process in which there is a clearing of toxins from the body. The goal of detoxification is to provide safe withdrawal from a substance(s).
2. In-patient Treatment: Requires the person to live on-site at the recovery program. The setting could be that of a hospital or a residential center. The substance abuser is exposed to a variety of recovery tools including group discussions and processing, individual sessions, access to and participation in 12-step programs, psycho-educational programs, as well as access to medical, legal, family, and psychiatric care. The length of stay varies based on program structure, managed care, and compliance with program regulations. Many in-patient sites also may offer detoxification services so that there is a continuity of care.
3. Out-patient Treatment: These programs allow the substance abuser access to group processing, individual sessions, and psycho-education, as well as linkage to self-help programs and referrals for legal and medical assistance. Some also provide vocational assistance. Daily participation is not required, although many people will attend 2 groups per week, 1 individual session weekly or bi-weekly, and will fill in the rest of their days with attendance at self-help meetings.
4. Couple/Family Treatment: Traditionally, treatment clinics and providers have focused on working with substance abusers on an individual basis. However, working with the substance abuser and his/her partner or family can result in very positive outcomes for everyone involved. These programs focus on building relationship trust, increasing support, caring, and positive interactions within the family system, increasing and promoting behaviors that are supportive of abstinence, improving relationship satisfaction, and teaching and practicing effective communication skills.
5. Self-Help: These programs are available in every state and virtually every country. There are meetings available daily in most cities. They may be held at churches, community centers, or libraries. They are peer organized and peer driven. Some meetings are geared specifically towards the substance abuser (AA, NA), while others are for family members or friends who are struggling and seeking support of their own (Al-Anon).

What do we know about interpersonal violence and abuse?

Intimate Partner Violence (IPV) is a public health concern of alarming proportions. Approximately 8.7 million U.S. couples report at least one incident of violence each year; that is 1 in every 5 couples (Straus & Gelles, 1990). According to Fals-Stewart and colleagues (1999), male-to-female aggression is 8 times more likely to occur on days when there is drinking compared to days when there is no drinking. Violence destroys relationships and destroys families. Violence is never a solution to any problem. Efforts that are aimed at improving relationship satisfaction and reducing or eliminating substance abuse have been shown to have benefits in the reduction of partner violence (O'Farrell et al., 2003). It is important to note that IT IS NEVER OK TO PUSH, SHOVE, HIT, VERBALLY ABUSE, OR THREATEN ANOTHER PERSON! Couples who engage in violent behaviors often lack skills that are conducive to the healthy exchange of ideas, feelings, and beliefs that are beneficial in problem solving efforts. There are two main forms of aggression: verbal and physical. Verbal aggression includes blaming, yelling, and name-calling. Physical aggression includes hitting, slapping, biting, pushing, choking, and threatening or using a knife or gun on someone.

ALL FORMS OF VIOLENCE HURT THE VICTIM

What are some strategies that one can use to reduce the risk of violence?

Do NOT argue with someone who is drunk or on drugs. The person who is intoxicated will not be capable of engaging in a healthy, productive conversation. The likelihood of increasing the chance of violence occurring, however, does increase. According to the National Clearinghouse for Alcohol and Drug Information, alcohol is present in more than 50% of all incidents of partner violence.

Do NOT hit someone who is drunk or intoxicated. Instigating any physical contact with an intoxicated individual, particularly if there is already a problem and verbal aggression has occurred, will only make the situation worse and increase the risk of experiencing violence.

Make a promise. No angry touching at any time! When couples make this promise to each other, they encourage each other to initiate alternative solutions to their issues, thus decreasing the likelihood of a violent interaction.

Use a ‘timeout.’ If a discussion may be leading to a destructive argument and either partner begins to feel uncomfortable, they have the option of implementing a 5-minute timeout. At that time, partners may go to separate rooms, practice deep breathing, try to stop thinking about the argument, and focus on staying calm and identifying a healthy solution. After the 5 minutes, or after both partners feel calm, the couple can re-start the discussion if that is what they both want to do. If another timeout is needed, the discussion should stop and another time should be identified when both people are calm and clear-headed to address the issue.

Safety Considerations. Personal Safety is number one. If one or both partners fear that violence may occur, there are a number of strategies that can be implemented to ensure safety:

• Call 911: VIOLENCE HURTS EVERYONE.
• Develop a Safety Plan: Pack clothing and necessities in a small bag, have a stash of money, identify someplace to go, someone to call or talk to, and identify local shelters that are available. If children are involved, a plan must be developed that will provide for their personal safety as well.
• Leave: It is ok to leave in the middle of a heated debate. Leaving the house, going for a walk, grabbing the safety pack, and going to a safe place are all safe options.
• Attend treatment: There are programs available that specifically address domestic violence. There are programs for men and for women that address issues specific to education on the many types of violence and aggression, alternative ways to manage anger and negative feelings, identifying and linking with support, and identifying and implementing healthy conflict resolution skills.

How does all of this affect my kids?

While the abuse of alcohol/drugs has serious consequences for those who use them, children who live with alcohol- or drug-abusing parents are also victims of the unhealthy environments created by their parents. Children who have a parent who suffers from alcoholism are referred to as COAs, or Children of Alcoholics. Children whose parents abuse drugs other than alcohol are referred to as COSAs, or Children of Substance Abusers. There are nearly 8 million children living in homes with an alcoholic parent (Eigan & Rowden, 1995), and between 6 and 12 million children living in homes with at least one parent who has used illicit drugs (USDHHS, 1994).

It has been noted that children living in these homes, in general, experience a number of psychosocial problems, as compared to children who have not been raised in homes with alcoholic or drug-abusing parents. For example, it has been reported that these children experience increased somatic complaints, internalizing behaviors (depression, anxiety), externalizing behaviors (conduct disorder, substance use), and lower overall academic achievement (Johnson & Leff, 1999). Similarly, COSAs will often display problems with attention, emotional and school difficulties, and have an increased incidence of psychiatric and psychological problems (Luthar et al., 1998). Fals-Stewart and colleagues (2003) have identified some factors that are indicative of COSAs having greater emotional and psychological adjustment problems compared to COAs, including lower levels of parental monitoring or supervision, higher levels of violence and marital conflict between parents and occurring in front of the children, and higher levels of psychiatric distress.

What can I do as a parent?

All parents can introduce and practice a number of skills and activities that have the potential to improve overall functioning and well being of their children. Pick a day and do something special together. Take the time to notice the positive behaviors that your child displays. Encourage your child to attend school. Express caring and love toward your child. Learning and utilizing positive and healthy communication skills can have wonderful benefits for children, including reducing their stress, improving future success, and reducing the likelihood of using substances as adults. Furthermore, you can initiate personal changes that will positively benefit your child including achieving and maintaining sobriety, attending self-help, complying with medication regimens, planning family time and fun activities, attending treatment, engaging in behaviors that highlight effective communication, and stopping behaviors that are damaging to the family as a whole, including violence.