Interventions with alcoholics and their families.

Different types of alcoholism seem to exist, but all alcoholics progress through predictable stages. At any stage, interventions can be made by the nurse. The most effective, though unorthodox, interventions include the use of reversals (encouraging more of the same behavior) and the use of leverage (requiring treatment). These interventions focus upon the alcoholic. Family intervention, however, is a necessary condition for the complete recovery of the alcoholic and his family. The family system is a more powerful force than the addiction itself and has great potential for overcoming or sustaining the alcoholism. Using Bowen's family systems theory, the alcoholic family system was explained along with appropriate interventions for it. The major interventions included coaching the co-alcoholic to differentiate a self in the family system, to modify the habitual overfunctioner and pursuer roles, to bridge cutoffs, and to de-triangle oneself as the anxiety and tension rise in the family system. This article focuses on the alcoholic and the family system during the period of active alcoholism. Work on the family system is equally necessary and rewarding to family members once abstinence and sobriety are established. Families with alcoholism require several years of such work before the family system reaches an optimal level of functioning. Family systems work is a powerful, therapeutic adjunct to alcoholism treatment for the alcoholic and the participation of family members in Alcoholics Anonymous, Al-Anon, Ala-Teen, and Adult Children of Alcoholics is quite useful. Work with the alcoholic family system introduces a note of optimism for the future. As high levels of anxiety are reduced, opportunities are provided for differentiating a self in the family system, and triangling in of children becomes less necessary. The transmission of alcoholism and its effects are thereby lessened for future generations of children of alcoholics.