Nursing diagnosis: dysfunctional Family Processes related to abuse of substance(s), resistance to treatment; family history of substance abuse; addictive personality; inadequate coping skills, lack of problem-solving skills
Possibly evidenced by
Anxiety, anger or suppressed rage, shame, and embarrassment
Emotional isolation, loneliness, vulnerability, repressed emotions
Disturbed family dynamics, closed communication systems, ineffective spousal communication and marital problems
Altered role function, disruption of family roles
Manipulation, dependency, criticizing, rationalization or denial of problems
Enabling to maintain drinking or substance abuse, refusal to get help or inability to accept and receive help appropriately
Desired Outcomes/Evaluation Criteria—Family Will
Verbalize understanding of dynamics of enabling behaviors.
Participate in individual family programs.
Identify ineffective coping behaviors and consequences.
Initiate and plan for necessary lifestyle changes.
Take action to change self-destructive behaviors and alter behaviors that contribute to partner’s/SO’s addiction.
Nursing intervention with rationale:
1. Review family history and explore roles of family members, circumstances involving drug use, strengths, and areas for growth.
Rationale: Determines areas for focus and potential for change.
2. Explore how the SO has coped with the client’s habit—use of denial, repression, rationalization, projection, feelings of hurt, and loneliness.
Rationale: The person who enables also suffers from the same feelings as the client and uses ineffective methods for dealing with the situation, necessitating help in learning new, more effective coping skills.
3. Determine understanding of current situation and previous methods of coping with life’s problems.
Rationale: Provides information on which to base present plan of care.
4. Assess current level of functioning of family members.
Rationale: Affects individual’s ability to cope with situation.
5. Determine extent of enabling behaviors being evidenced by family members and explore with each individual and client.
Rationale: People want to be helpful and do not want to feel powerless to help their loved one stop substance use and change the behavior that is so destructive. However, the substance abuser often relies on others to rescue them by covering up own inability to cope with daily responsibilities.
6. Provide information about enabling behavior, addictive disease characteristics for both user and nonuser.
Rationale: Awareness and knowledge of behaviors such as avoiding and shielding, taking over responsibilities, rationalizing, and subserving, provide opportunity for individuals to begin the process of change.
7. Identify and discuss sabotage behaviors of family members.
Rationale: Even though family member(s) may verbalize a desire for the individual to become substance free, the reality of interactive dynamics is that they may unconsciously not want the individual to recover because this would affect their own role in the relationship. Additionally, they may receive sympathy and attention from others—secondary gain.
8. Encourage participation in therapeutic writing, such as journaling (narrative) or guided or focused writing.
Rationale: Serves as a release for feelings such as anger, grief, and stress, and helps move individuals forward in treatment process.
9. Explore conflicting feelings the enabling partner may have about treatment such as feelings similar to those of abuser—blend of anger, guilt, fear, exhaustion, embarrassment, loneliness, distrust, grief, and possibly relief.
Rationale: Useful in establishing the need for therapy for the partner. This individual’s own identity may have been lost, she or he may fear self-disclosure to staff, and may have difficulty giving up the dependent relationship.
10. Encourage involvement with self-help associations, AA or NA, Al-Anon, Alateen, and professional family therapy.
Rationale: Puts client and family in direct contact with support systems necessary for continued sobriety and to assist with problem resolution.