My Partner Is Alcoholic.  What Can I Do? 

Many problem drinkers are unable to admit to this problem. The cry for help may therefore come from someone close who suffers as a result. The cry often comes at a time when he or she is unable to cope any longer with the drinker. As such, the drinker may self-righteously feel they do not have a problem as they had been drinking like this for years. They may resist treatment and often blame others for their problems. Many marriages fail at this point. One spouse can no longer tolerate the alcohol and the alcoholic refuses to take responsibility. This makes treatment of alcoholics extremely difficult. 

It is important for people to understand the stages of recovery and that each stage carries challenges that some alcoholics will struggle for a long time to overcome. Five stages of recovery are discussed: precontemplation, contemplation, preparation, action and maintenance.¹
 
The Five Stages of Recovery
 
In the precontemplation stage, the alcohol problem has not yet been identified let alone accepted by the alcoholic. During this stage, their defences, most notably denial, are strong. They actively reject any notion of alcohol problems and show anger towards anyone suggesting a problem. They reject treatment and may rely on the support of their drinking buddies to affirm that they do not have a problem. 

In the contemplation stage, the alcoholic toys with and finally accepts that they have a problem with alcohol. This acceptance can be overwhelming, at times leading to depression and/or anxiety. These intense feelings must be expected and planned for as part of a treatment process.  

In the preparation stage, the alcoholic learns what treatment is necessary in order to recover. Depending on the severity, this can include detoxification, inpatient or outpatient counseling and marital and/or family therapy and possibly even prescription medications. 

The next stage, action, is when the treatment plan is implemented and activities are undertaken to address the alcoholism. The support of family and sober friends is crucial here as alcoholics learn to defend themselves, not from admitting alcoholism, but from being pulled back towards drinking by former drinking buddies. Also crucial at this stage is developing an understanding of one’s own family history that may have contributed to their drinking problems. 

The final stage involves relapse prevention and is referred to as maintenance. This stage is life-long. One of the best-known maintenance programs is Alcoholics Anonymous (AA). This program is based upon self-help, group model. Members meet regularly to manage the challenges of sobriety.
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Incest Warning Signs
Q&A With Incest Researcher and Social Worker Leslie Beth Wish, Ed.D, MSS

Dr. LeslieBeth Wish, MSS is a social worker based in Sarasota, FL. She has been a speaker for non-profit, corporate and university organizations. Dr. Wish offers sound, research-based relationship advice that makes sense — specializing in issues such as smart dating, women’s relationship advice, career coaching, healthy families, sexual dysfunction, and leadership training.

Dr. Wish is the author of Incest, Work and Women: Understanding the Consequences of Incest on Women’s Careers, Work and Dreams.

Q.  Actress Mackenzie Phillips announced that she had incestuous relationships with her father John Phillips.  How common is this situation?  Do most of these relationships involve father-daughter rather than mother-son?

A:  Although childhood sexual abuse includes mother-child incest, more men commit child-family member sexual abuse.  The most frequent male family offenders are step-fathers, fathers, uncles and grandfathers.

Q.        What are the warning signs?

A:  From a child’s perspective, warning signs include sudden or increased physical contact that might pass as acceptable with a family member.  For example, suddenly Grandpa wants you to sit on his lap more often.  Or, an uncle wants to caress a child’s hair or cheek more often.

Other forms of physical contact are more blatantly sexual, such as Mackenzie Philip’s intercourse with her father.  Childhood sexual abuse can also include fondling of breasts, rubbing up and down against a child and sexual comments.  Children often have a good sense that something is “wrong,” but they may not tell anyone about these sexual experiences.   Children learn rather quickly that the sexual activity with a family member is not normal.

Some offenders make it very clear that if a child reveals their “secret,” the offender will harm the child and/or the family.   Children also come to realize that telling someone puts the family in terrible jeopardy.  What, for example, would Mom do if she knew about it?  Would the family break up?  How would the family get along without Dad?  A great deal is at stake, and no child wants the responsibility of causing a crisis in the family.  If a child does reveal “the secret,” it is not uncommon for other family members to deny or not accept that sexual abuse occurred.

Some siblings, for example, side with the offender, saying that no evidence or hints of abuse exist.  To be fair to these supportive siblings—and even spouses—it is highly possible that the offender kept the secret very well-hidden.  Often, the abuser selects one or two favorite children for sexual and emotional gratification and never violates the other siblings.  As a result, the other siblings never experience or even suspect that abuse is occurring.

Finally, when a family member abuses a child sexually, the abuse is not solely about sex.  Offenders are often looking for comfort, closeness and approval from someone whom, in the mind of the offender, offers an opportunity for unconditional love.  The closeness and need for comfort can rapidly become sexualized.  Many offenders are, however, also looking for sexual gratification, power and control.

Q.        What can be done to protect the child?

A:  All parents and caregivers should talk with each child about sexual behavior that is “wrong.”  Children should be taught early about unwanted touches.  Parents and caregivers should let children know that they want to know about any kind of touching or interaction with someone who makes them feel uncomfortable physically and emotionally or who touches them.

When parents set the emotional rules and establish an environment of care, children are more likely to let a family member know.  Parents can also tell a child that if they are afraid to tell a family member that they can tell another adult whom the child trusts such as a teacher, minister, etc.  (And no jokes, please—yes these two groups have a history of being sexual predators, but there are still good teachers and religious leaders who can help a child in need.)

Q.        What is the likelihood that an incest victim will eventually seek counseling?  Also, when victims seek help do they immediately admit the incest or rather do they come to treatment for issues like alcohol or drug abuse which they’ve sought to cope with the pain of the incestuous relationship?

A:  Statistics can vary about the incidence of abuse, but roughly one in twenty-five women will experience some kind of sexual abuse by the time she is 18.  For men, the numbers are about one in seven or eight.  Since sexual abuse carries such a high degree of shame, it’s highly likely that clients will not mention it.  Substance abuse, as well as suicide attempts, is a failed effort to manage the emotional pain of sexual abuse.

Q.   What type of therapy/counseling is typically used in these cases?

A:  There are many therapeutic treatments, including medication for depression, cognitive therapies and emotional reprocessing therapy where the client learns to come to different conclusions and understandings about the self and the experience.  There are excellent training programs for therapists to learn about these therapies.

Q.   What sort of therapy/counseling is typically used in these cases?

A:  Every person is different, but common, long-term effects include suicide attempts, depression, substance abuse, fear of both emotional and sexual intimacy, promiscuity, prostitution and runaways, lack of career identity, inability to function at work.

Introduction
The question of why women stay in abusive relationships has been studied from many perspectives including the impact of the abuse on the women, the severity of the abuse on the decision to leave, and the types of coping used by women in abusive relationships. Some women leave or request help after an initial incident while others experience repeated beatings before involving social institutions or leaving the relationship. Some never leave, rarely revealing the incidents and don’t involve social institutions. One prominent researcher in the field found that the more severe the abuse, the more likely were the women to seek some form of intervention with divorce or separation being the most likely result as opposed to police intervention or going to an agency. Women who were hit more frequently were more likely to call police. Women who were hit less often but more severely were more likely to leave.

Rationalization and Denial
Battering is seen as a victimization of the woman and her responses often parallel those of victims of violent crimes. However, abused women are different from other victims of violent crimes in that the assailant is an intimate and previously trusted partner. The psychological repercussions include loss of a sense of trust and safety and intense feelings of helplessness. There is confusion as the woman attempts to absorb the impact of being hurt by someone who was thought to be caring and protective. High anxiety, passivity and/or apathy often characterize the woman’s response. The women who are more likely to remain in the relationship are believed to engage in a process of rationalization which denies the reality of the situation, the options available, the truth about the victimizer and the victimization, and the causes of the violence.

Profound Consequences
If the woman remains in the situation without taking any action, the abuse is likely to increase in frequency and severity. She may experience something similar to post traumatic stress syndrome. She begins to identify with the aggressor, becomes brainwashed, may cling to her husband or lover and behave in irrational ways. The long-term psychological effects include a profound sense of betrayal of trust, depression, suicidal ideation, guilt, shame and feelings of inferiority. The woman may be extremely afraid for her personal safety. The psychological consequences of battering are, therefore, profound. They cluster around physical symptoms and mixed anxiety/depressive symptoms.

Women who have been beaten and abused are also more likely to attempt suicide.  Women in an abusive relationship use self-blame which imposes meaning on the situation and gives them some semblance of perceived control. Battered women ask the question, “Why now?” They blame themselves for causing the husband to act violently in order to feel as if they have some control over what has happened. But as the violence continues, they begin to blame themselves more and more for not being able to modify it or for tolerating such behavior.

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By Ms. Sandy Yakim of Morgantown, West Virginia

People begin gambling for different reasons. Perhaps the most common reason is for the entertainment aspect. Many of us who have developed an addiction started just that way. But then for different reasons the entertainment value goes astray, and in my case gambling became a distraction and a way to hide, relax and numb myself to the challenges of everyday life.

I had a great childhood. I grew up here in Morgantown, West Virginia, and after my family moved on, I stayed here to teach school and raise my daughter Erin. Being a West Virginia teacher (where the salaries are low) , I have always had to watch my finances and work extra jobs to get my daughter through college and have a little extra money.

First Experience Gambling

I had never gambled …ever, until I took a trip to Reno, Nevada with my mom to visit my aunt and uncle. They live in Reno, and part of their entertainment is to go to the local Peppermill Hotel Casino and gamble. This was about four years ago. I saved a little money to play and that was all I spent.

Then over the next few years I would visit Atlantic City on the way to my sister Nancy’s in Cape Cod, or stop off at Foxwood Resort Casino in Connecticut, once, for an hour to check it out.

Family Issues

Somewhere in the midst of these years my step-dad died of cancer and my father died suddenly. I helped the family out in both situations by helping plan the funerals and speaking at the services.

Over the next few years my mom had a broken leg, a blocked artery, gall bladder surgery, and a perforated hernia. As a relaxation activity from school and running up and down the road to Charleston, West Virginia, I walked into one of the little casinos here in Morgantown. It wasn’t hard; it was over on University Avenue as are many, many other little gambling spots.  Video poker machines started appearing up in 2000 and can now be found in 99 local establishments.

I started on the weekends after returning from my mom’s, and would just play for an hour and go home, always limiting the amount of money I spent to $20 to $40. Then I started stopping in during the spring of 2004 after school and on the weekends. I would drive around and visit some of the other places here in Morgantown and Westover, West Virginia.

The Big Fall

My big fall into the pit came with the onset of summer 2004. I started out by visiting some of the local places each day. I actually took a class that lasted a week in the middle of all of this, and at that point at least I would like to say that the gambling didn’t interfere with my school responsibilities. I kept it as an after school and weekend activity.

I started playing for fun, a chance to relax, and visit with new people who had similar interests. We discussed wins and losses, family, travel, our health. Everything! It was so much fun. But soon I was out of control.
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By Katherine van Wormer, PhD, MSSW

Introduction
In 1980, in response to the veterans of the Vietnam War and the militancy of the antiwar movement, the American Psychiatric Association (APA) acknowledged the symptoms of Post Traumatic Stress Disorder (PTSD). The diagnosis of PTSD was then included in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The feminist movement was influential in this development as well due to their advocacy for a diagnosis in recognition of the trauma of rape.

The DSM IV-R (2000) describes PTSD, in short, as the “re-experiencing of an extremely traumatic event that the person has experienced or witnessed, accompanied by symptoms of increased arousal (such as sleep disturbance, irritability, hypervigilance, difficulty concentrating) and by avoidance of stimuli associated with the trauma and numbing.”

Post Traumatic Stress Disorder Related to Combat
After the war in Vietnam was over, some 30 percent of Vietnam combat veterans suffered from PTSD; flashbacks to horrible near-death situations were common. A study conducted in 2003 involved 6,200 soldiers who had served in Iraq and Afghanistan several months before. Research was conducted by a team of social scientists at the Walter Reed Army Institute of Research.

Results showed that one in six of the veterans displayed symptoms of PTSD, major depression, or anxiety; 12 percent had symptoms of PTSD alone. (These figures are an underestimate as the study was done before the far more brutal urban combat efforts got underway.) The risk of developing trauma rose in proportion to the number of instances of combat in which the soldier had engaged.

According to a more recent Post-Deployment Health Reassessment, which is administered to all service members, 38 percent of regular soldiers and 31 percent of Marines report psychological symptoms. Among members of the National Guard, the figure rises to 49 percent. Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great.

The exact rate of PTSD in women veterans is unknown. Studies conducted after the Gulf War  concluded that female service members were more likely than their male counterparts to develop PTSD. This is consistent with the 2 to 1 ratio of female to male PTSD sufferers in the general population.

Males with psychological symptoms from battle, however, are three times more likely to be given a diagnosis of PTSD than females, according to the Pentagon Task Force report.

One explanation for this may be cultural expectations that make it difficult for society and mental health providers to recognize women as combatants. Additionally, there is a tendency to diagnose women as having depression, anxiety and borderline personality disorder instead of combat-related PTSD.

For several reasons, the impact of the Iraq and Afghanistan wars is expected to be more severe than the impact of previous wars. (1) The experience of combat, engagement in gun battles, and handling the bodies of dead comrades is a constant in these wars, (2) the experience of killing people at close range is a frequent occurrence, (3) extended lengths of service with only short periods of rest and recuperation in between are taking a psychological toll on soldiers; and (3) many of the injuries in this war are to the brain.

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