DYSFUNCTIONAL FAMILY PROCESSES:
Psychosocial, spiritual, and physiological functions of the family unit
are chronically disorganized, which leads to conﬂict, denial of prob-
lems, resistance to change, ineffective problem solving, and a series
of self-perpetuating crises
• Alcohol abuse; agitation; blaming; broken promises
• Deﬁcient knowledge about alcoholism
• Denial of problems; difﬁculty with intimate relationships
• Enabling to maintain alcoholic drinking pattern
• Rationalization; moodiness; rejection; tension
• Triangulating family relationships
• Marital problems; ineffective spousal communication
• Abuse of alcohol
• Family history of alcoholism
• Addictive personality
• Family history of resistance to
• Biochemical inﬂuences
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Values and beliefs
Family members will
• Acknowledge there is a problem with alcoholism within the family.
• Sign contracts stating they will not engage in abusive behavior.
• Communicate their needs, using “I” statements.
• Discuss problems in an open, safe environment.
• Acknowledge their strengths and progress in resolving problems.
• State plans to continue to seek counseling and attend appropriate
support group meetings.
SUGGESTED NOC OUTCOMES
Family Coping; Family Functioning; Family Normalization; Role
Performance; Substance Abuse Consequences
INTERVENTIONS AND RATIONALES
Determine: Assess drinking pattern; use of other substances; patterns
of withdrawal; ability of alcoholic member to function in
occupational and familial roles; ability of family members to func-
tion in their roles; family health history; afﬁliation with a religious
group and religious practices. Assessment factors will assist in identi-
fying appropriate interventions.
Perform: Create an environment in which family members feel free
to express themselves honestly about the present situation to
decrease their anxiety and help family members develop conﬁdence
in their ability to resolve problems.
Inform alcoholic family member that he will have to acknowledge
his alcoholism before progress can be made in rebuilding family
relations to establish abstinence as a basis for treatment.
Inform: Teach family members to communicate their needs
assertively. Have them practice using “I” statements to express feel-
ings to help them get in touch with their feelings.
Inform patient and family about the symptoms and effects of addic-
tive behaviors on both the patient and the family to help them under-
stand the role they play in both the disease and the recovery process.
Do interactive planning and role-playing with the patient and
family to help them gain the skills needed to effect necessary
changes in communication patterns in the family. Role-playing helps
create a realistic view of the behaviors that reinforce behaviors in
themselves and the patient.
Attend: Encourage family members to acknowledge that alcoholism is
a problem within the family in order to break through family denial.
Ask alcoholic family member to sign a contract stating he will
abstain from alcohol to help him take responsibility for his own
Help family members evaluate the consequences of abusive and vio-
lent behavior. Inform them that any suspected abuse will be reported.
Ask family members to sign contracts so they will not continue to
abuse one another to make them take responsibility for their behavior.
Being able to identify strengths provides the conﬁdence the family
needs to continue working toward a positive outcome for both
patient and family.
Assist family members to identify their strengths and talk about
progress they have made in resolving problems associated with alco-
holism or living with a family member who has alcoholism.
Provide additional emotional support to the head of the family
about altered role and additional responsibility to build self-esteem.
Manage: Refer family for continued family therapy so they can con-
tinue the process of restructuring their lives.
Refer patient and family to AA, Alanon, or other appropriate sup-
port group to establish the importance of abstinence.
SUGGESTED NIC INTERVENTIONS
Coping Enhancement; Family Process Maintenance; Family Support;
Substance Use Prevention; Substance Use Prevention
Fowler, T. L. (2006, July). Alcohol dependence and depression: Advanced
nursing interventions. Journal of the American Academy of Nurse
Practitioners, 18(7), 303–308.