Introduction

Let’s Talk About... Kids, Health & HIV, Sex, and Interpersonal Violence

There are a number of topics people, and society in general, think of as ‘taboo’ and thus, feel very uncomfortable talking about. These appendices take a look at four of those topics:
(1) The effects of substance use on kids,
(2) the health implications of substance use and HIV,
(3) sex, and
(4) interpersonal violence.

Most people perceive the consequences of their behaviors as only affecting themselves, not extending into interpersonal relationships. Often, these issues are overlooked or avoided due to their inherent sensitive and provocative nature; they are the ‘family secrets.’ However, it is imperative that these issues are discussed.

Moreover, it is crucial that the impact of substance-abusing behaviors on children and interpersonal interactions is not underestimated.

Presenting the facts about these issues can help to increase people’s awareness of the far-reaching effects of substance-abusing behaviors, and provide alternative choices that can assist people in engaging in behaviors that have the potential to change negative outcomes and improve overall individual and family functioning.

Appendices A through D will provide the reader with important information on these critical subjects.

APPENDIX A

Let’s Talk About... the Impact of Substance Use on Kids

While the abuse of alcohol and drugs has serious consequences for those who use them, children who live with alcohol- and drug-abusing parents are also victims of the unhealthy environments created by their parents.

• Children who have a parent who abuses or is dependent on alcohol 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 parent1.

• There are between 6 and 12 million children living in homes with at least one parent who has used illicit drugs2.

A number of investigations have provided critical insights into the overall functioning and well being of children living with alcohol- or drug-abusing parents. In general, children living where at least one parent abuses substances, experience a number of psychosocial problems, as compared to children who have not been raised in homes with alcoholic or drug-busing parents.

It has also been reported that these children experience:
• Increased physical complaints, internalizing behaviors (depression, anxiety), externalizing behaviors (conduct disorder, substance use), and lower overall academic achievement3.
• Similarly, COSAs will often display problems with attention, emotional and school difficulties, and have an increased incidence of psychiatric and psychological problems4.

Fals-Stewart and colleagues5 have identified some factors about COSAs that indicate these children have 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, occurring in front of the children.
• Higher levels of psychiatric distress.

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. These activities are fully explained throughout this workbook.

Some skills and activities that are directed specifically at children and families are located in the section titled: Increasing Positive Interactions: Couple & Family Activities. The section titled Family Based Views of Alcoholism and Drug Abuse provides family specific information on treatment.

Learning to use positive and healthy communication skills can have wonderful benefits for children, including:
• Reducing their stress.
• Improving future success.
• Reducing the likelihood of using substances as adults.

Skills that can help parents communicate more effectively and that can be used with children are located in the section titled: He Said – She Said: A Discussion on Communication Barriers & Skills for Successful Communication.

Furthermore, substance-abusing families can initiate personal changes that will positively benefit their children including:
• Achieving and maintaining abstinence.
• Attending self-help.
• Complying with medication regimens.
• Planning family time and fun activities.
• Attending treatment.
• Engaging in behaviors that highlight effective communication.
• Stopping behaviors that are damaging to the family as a whole including violence.

These topics are addressed throughout this package. Please refer to the sections titled Building Support for Abstinence; Increasing Positive Interactions: Couple & Family Activities; He Said – She Said: A Discussion on Communication Barriers & Skills for Successful Communication; and Family Based Views of Alcoholism & Drug Abuse.

For more information refer to:

1 Eigan, L.D., & Rowden, D.W. (1995). A methodology and current estimate of the number of children of alcoholics in the United States. In S. Abbott (Ed.), Children of alcoholics: Selected readings. Rockville, MD: National Association for Children of Alcoholics.

5 Fals-Stewart, W., Kelley, M.L., Cooke, C.G. & Golden, J. (in press). Predictors of the psychosocial adjustment of children living in households of parents in which fathers abuse drugs: The effects of postnatal parental exposure. Addictive Behavior.

4 Luthar, S.S., Cushing, G., Merikangas, K.R., & Roundsaville, B.J. (1998). Multiple jeopardy: Risk/protective factors among addicted mothers’ offspring. Development and Psychopathology, 11, 117-136.

3 Johnson, J.L. & Leff, M. (1999). Children of substance abusers: Overview of research findings. American Academy of Pediatrics, 103, 1085-1099.

2 U.S. Department of Health and Human Services. (1994). Substance abuse among women and parents. Washington D.C.: National Institute on Drug Abuse and the Office of the Assistant Secretary for Planning and Evaluation.
 
APPENDIX B

Let’s Talk About... the Health Implications of Substance Abuse

At moderate doses, the effects of alcohol or drugs are perceived as being beneficial and pleasant. However, at higher consumption levels, the harmful consequences on the body can be quite serious. It is important to note that many drugs are legally and medically prescribed, while others are not. This section describes the effects on body systems as a result of alcohol or drug abuse.

Some physical symptoms of heavy drinking include:
• Elevated uric acid and liver enzyme counts
• Inflammation of the liver, pancreas, and muscles
• Hepatitis
• A decrease in immune system fighting capabilities
• Nerve damage
• High blood pressure
• Anemia
• Specific to women, a change in menstrual cycles

Stimulants, such as cocaine and crack, may result in:
• Elevated blood pressure
• Increase in cardiovascular problems
• Decreased output of serotonin (a natural, healthy, brain-produced chemical)

Depressant abuse may result in:
• Sleep problems (i.e., insomnia)
• Mood changes (i.e., panic and paranoia)
• Overdose potential when not used properly

If depressants are used and stopped abruptly, severe withdrawal, including seizures, can occur. Use of depressants at toxic levels can result in a decrease in cardiac and respiratory functions, and even death.

ALL MEDICATIONS SHOULD BE PRESCRIBED AND MONITORED BY A LICENSED PHYSICIAN!

Please refer to the sections titled: Alcohol & Other Drugs: The Basics; and Building Support for Abstinence for more information on medically prescribed drugs and drugs of abuse. Also, refer to: Schuckit, M.A. (1989). Drug and alcohol abuse: A clinical guide to diagnosis and treatment, 3rd Edition. New York: Plenum Medical Book Company, for a detailed explanation of all drug categories.

Let’s Talk About HIV

Human Immunodeficiency Virus (HIV) is the virus that causes AIDS. This virus can be passed from one person to another through blood-to-blood and sexual contact. HIV is present in semen, blood, vaginal fluid, and breast milk. It is a sensitive and alarming social health problem in the United States.

The Center for Disease Control and Prevention (CDC) estimate that 650,000 to 900,000 U.S. residents are living with HIV infection, of whom more than 200,000 are unaware of their infection.  This is an alarming statistic because of the potential for unknowingly infecting others.

Because of various behaviors engaged in by both substance- and non-substance-abusing partners, there is additional risk for contracting HIV.  Since the epidemic began, injection drug use (IDU) has directly and indirectly accounted for more than one-third of AIDS cases in the United States.  This disturbing trend appears to be continuing.  Of the 42,156 new cases of AIDS reported in 2000, 11,635 (28%) were injection drug user-associated (i.e. injecting drugs, their sexual partners and their offspring).

One of the easiest risks to identify in this particular population involves the substance-abusing partner’s potential for unsafe needle practices (e.g., needle sharing, using unclean syringes).
• Non-injection drugs (such as “crack” cocaine) also contribute to the spread of the epidemic when users trade sex for drugs or money, or when they engage in risky sexual behaviors that they might not engage in when sober.
• Drug-abusing individuals tend to inhabit communities and settings where the prevalence of
HIV is more highly concentrated (e.g., shooting galleries, crack houses).

Thus, the potential sexual partners for these individuals are more likely to have HIV than individuals in the general population.

In contrast, the non-substance-abusing partner has a greater chance of indirect exposure to HIV.  Most married or cohabiting individuals report they do not use condoms while engaging in sexual relations with their partner. 

Therefore, if the spouse/partner engages in risky needle practices or unprotected extramarital sexual relations, the non-substance-abusing partner is at increased indirect risk for HIV infection, because there is an exchange of potentially infected bodily fluids.

Education and communication about this growing epidemic can reduce the risk of HIV
exposure. Listed are a number of risk factors:

Unsafe Needle Practices:  IV drug users who engage in unsafe needle practices, like needle sharing and using unclean syringes, are at a greater risk of HIV infection.

Getting ‘Stuck’ with a Dirty Needle:  Drug users, in general, may be more likely to be in situations where other people are using IV drugs and may accidentally get ‘stuck’ with a dirty needle.

Having Unprotected Sex:  Another risk behavior for HIV infection is unsafe sexual practices, like having sex without condoms when not knowing a partner’s HIV status.

Indirect Exposure:  This is a situation where one partner puts the other partner at risk because of his or her behaviors outside of the relationship.  This is especially likely if a partner is not using condoms in his or her primary relationship and has been exposed to HIV through one of the ways previously mentioned.

Receiving blood from an infected person.

From mother to child during pregnancy, the birth process or by breastfeeding.

Important information about lesser-known ways to be exposed to HIV:

Alcohol and Non-IV Drug Use: Abusing alcohol and other drugs can still increase the likelihood of exposure to HIV because:
- People often have more sex when they use alcohol and drugs, and they often forget to wear latex condoms or to ask their partner to wear a condom.
- Some people sell sex to get alcohol and drugs or to get money for alcohol and drugs. This may mean they have more sex or unprotected sex.
- Alcohol and drugs may weaken the immune system, making it easier to contract HIV and other STDs.

Oral Sex:  People often assume that HIV and other STDs cannot be transmitted through oral sex.  As with any activity that involves the exchange of bodily fluids, oral sex does involve some risk. The level of risk depends on several factors including:
-    Oral sex without latex barrier (condom or “dam”).
-    Cuts or sores in the mouth, damaged or bleeding gums.
-    Presence of other STDs which cause ulcers on the genitals or mouth.

HIV Risk Reduction Strategies: There are a number of strategies that individuals can use in order to reduce the risk of HIV exposure.
- Getting the facts about HIV and HIV transmission.
- Knowing own and partner’s HIV status.
- Receiving education on safe sex practices and incorporating those practices within the relationship.
- Abstain from sex outside of the marriage/relationship.
- If there is continued substance use:
  o Use clean needles and other paraphernalia.
  o Use condoms with sexual partners outside of the relationship.
  o Use condoms within the relationship.
  o Get tested for HIV.

‘Safe Sex’ & Condoms:

Male condoms:
• Must be worn correctly and must remain on throughout intercourse to help prevent the spread of HIV, Hepatitis and STDs.
• Condoms must be latex. Condoms made of lambskin, sheepskin and other natural materials do not protect against HIV, Hepatitis, and STDs.
• Only use water-based lubricants with condoms.
• For oral sex: men should use non-lubricated latex condoms and women should use dental dams or a barrier such as plastic wrap without holes.
• Spermicides, such as jelly or sponges do not kill HIV and should not be used in place of condoms.

Female condoms:
• Reduce the risk of pregnancy and exposure to STDs.
• Male and female condoms should never be used at the same time.
• Used only once and must be thrown away after each sexual act.

HIV Testing: Anyone engaging in any high-risk behavior should strongly be encouraged to get HIV testing.  The decision to have an HIV test is voluntary. Testing is confidential (test results become part of the medical record) or anonymous (if results are positive, the test results can be changed to confidential and become part of the medical record). Positive results are reported to the Health Department to help with tracking and prevention.

State laws vary on mandated partner notification. The National Institute on Drug Abuse1 suggests that individuals with positive results should receive counseling to inform their primary partner and
other drug and sex partners, if possible, about potential risk of infection and the importance of getting tested and counseled for HIV.

Individuals who test positive should be encouraged to seek medical treatment for HIV and to follow recommended practices with regard to obtaining and adhering to medications to slow or prevent the onset of HIV symptoms.  Furthermore, these individuals should also be advised to get off and stay off drugs, and to maintain overall health through proper nutrition, rest, and exercise.

For more information refer to: www.cdc.gov/hiv/dhap.htm
1 National Institute on Drug Abuse. (2000). The NIDA community-based outreach model: A manual to reduce the risk of HIV and other blood-borne infections in drug users. National Institute on Drug Abuse, U.S. Department of Health and Human Services, National Institutes of Health. NIH Publication Number 00-4812.

For testing locations in your area: 1-800-342-2437 (English) or 1-800-344-7432 (Spanish)

APPENDIX C

Let’s Talk About... Sex

When one or both partners have a substance use problem, it is not uncommon for couples to report that there has been a change in the frequency and quality of their intimate interactions. In addition, the
topic of sex is often avoided between partners and/or overlooked by those who are working with couples who report distress in their relationships.

Alcoholic couples report:
• Sexual intercourse occurs less frequently.
• Less sexual satisfaction.
• More disagreements about their sexual relations (frequency, quality).
These reports occur more frequently in couples where a partner is abusing substances than couples who do not report relationship distress1.

Alcoholic men may experience impotency problems, while alcoholic women may experience a decrease in the frequency of sexual relations as their alcohol problems increase in severity. In addition, women have often stated that the use of alcohol helps them function in their relationships, be more assertive, and meet the demands of their partners2.

‘Sextasy’ and the cocaine-sex connection refer to the perceived interaction between the use of a certain drug and enhancement in sexual performance and experience.

‘Sextasy’ refers to the use of ecstasy and viagra together. While ecstasy is often referred to as the ‘love drug,’ it can reduce sexual drive and cause loss of erection. Therefore, men will often take viagra in combination with ecstasy in order to achieve erection and to increase sexual stimulation and pleasure.

Cocaine users will often report the strong connection between the use of cocaine and the frequency and quality of sexual relations; specifically that frequency increases, as does the perceived quality of the sexual experience. It is not uncommon for cocaine abusers to have concerns regarding sexual drive and the quality of sexual relations when they are working towards abstinence.

While these drugs may actually enhance physical sensation and perceived emotional connection between partners, the truth is that the levels of satisfaction and happiness in the relationship often determine the quality and frequency of sexual intercourse. If a couple is in distress, the use of drugs can actually help to decrease negative feelings, decrease inhibitions, and increase desire, allowing for sexual relations between them.  Individuals who use these substances will equate sexual satisfaction with the use of these drugs.

It is vitally important to work on relationship enhancement, address medical problems in a medically appropriate fashion, and for partners to discuss how they feel and think about their sexual relationship. Often, substance abuse, poor communication, lack of positive feelings, and blaming, are precursors to poor sexual relations. Skill building in these areas is key to addressing the difficult issue of problems with sexual intimacy.

Refer to He Said – She Said: A Discussion on Communication Barriers & Skills for Successful Communication; Increasing Positive Interactions: Couple & Family Activities; and Building Support for Abstinence for information and skill building tasks to help increase couple satisfaction and happiness.

For more detailed reports, refer to:
2 Lammers, S.M.M., Schippers, G.M., & van der Staak, C. (1995). Submission and rebellion: Excessive drinking of women in problematic heterosexual relationships. International Journal of addiction, 30(7), 901-917.
1 O’Farrell, T., Choquette, K.A. & Birchler, G. (1991). Sexual satisfaction and dissatisfaction in the marital relationships of male alcoholics seeking marital therapy. Journal of Studies on Alcohol, 52(5), 441-447.
 
APPENDIX D

Let’s Talk About... Interpersonal Violence

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 couples1.
• According to Fals-Stewart and colleagues2, 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 violence3.

IT IS NEVER OK TO PUSH, SHOVE, HIT, VERBALLY ABUSE OR THREATEN ANOTHER PERSON!

Couples who engage in violent behaviors often lack skills that promote 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.

“Violence is a dance” refers to violence as an active exchange of behaviors between two people, like that of a dance. Often, couples will report that they were both yelling or pushing each other; like dance steps, the violence takes on its own form and ends with hurt feelings, physical and/or emotional wounds, and a lack of resolution to the issue that began the conflict.

ALL FORMS OF VIOLENCE HURT THE VICTIM!

There are a number of tactics that one can use to reduce the occurrence 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.

- Refer to Couple Promises. No angry touching at any time! When couples make this promise, they encourage each other to use 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 priority number one. If one or both parties fear that violence may occur, there are a number of strategies that can be implemented to ensure safety:

o Call 911: VIOLENCE HURTS EVERYONE.

o 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.

o 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.

o Get Help: There are programs available that specifically address domestic violence. In addition, 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.

For more information refer to the sections titled How Do You Know if You or Someone You Love Needs Help?; Building Support for Abstinence; He Said – She Said: A Discussion on Communication Barriers & Skills for Successful Communication; It Takes Two: Seven Dimensions That Influence Couple Functioning; and Increasing Positive Interactions: Couple & Family Activities.

For a more detailed review:

2 Fals-Stewart, W., Birchler, G., & O’Farrell, T. (1999). Drug-abusing patients and their intimate partners: Dyadic adjustment, relationship stability, and substance use. Journal of Abnormal Psychology, 108(1), 11-23.

3 O’Farrell, T. J., Fals-Stewart, W., Murphy, M., & Murphy, C.M. (2003). Partner violence before and after individually based alcoholism treatment for male alcoholic patients. Journal of Consulting and Clinical Psychology, 71(1), 92-102.

1 Straus, M.A. & Gelles, R.J. (1990). Physical violence in American families: Risk factors and adaptations to violence in 8,145 families. New Brunswick, NJ: Transaction Publishing.

GLOSSARY OF TERMS

7 Cs: Seven factors that represent areas of personal and interpersonal functioning as seen in a relationship.

12 Steps: An outline of practices designed to be helpful in gaining and maintaining abstinence.

12 Traditions: Documented principles that are the foundation and framework for self-help programs.

Abstinence Violation Effect: The belief that once substance use has occurred abstinence was “blown” or that the user is ‘doomed’ to a life of substance use.

Abstinence: The act of refraining from use of alcohol or drugs.

Abstinence Trust Discussion: A brief, daily discussion between partners that promotes trust, conveys support for continued abstinence, and decreases negative interactions.

Abuse: An unhealthy pattern of substance use that results in significant negative consequences.

Addiction: A pattern of behavior that is compulsive and progressive, lacks control, and continues despite experience of negative consequences (e.g., alcohol, sex, eating, gambling, drugs, shopping, etc.).

AIDS [Acquired Immune Deficiency Syndrome]: A disease that slowly destroys the body’s immune system; caused by the HIV virus.
 
Alcoholism: A chronic problem with alcohol characterized by cravings, loss of control, and physical dependence and tolerance.

Caring: A person’s ability to express behaviors that promote emotional and physical intimacy.

Catch Your Partner/Child: An exercise that encourages couples/parents to notice, acknowledge and express appreciation for each other.

COAs:  Children of Alcoholics.

COSAs: Children of Substance Abusers.

Codependency: Any relationship when one person is psychologically dependent, in an unhealthy way, on someone who is engaged in self- destructive behavior; can be reciprocal; helps maintain balance.

Contract: An agreement between two or more persons (i.e., marriage).

Coping: Strategies used to deal with difficulties; overcome obstacles.

Craving: A strong need or urge to use alcohol or drugs.

Dependence: Characterized by physical, psychological, and cognitive symptoms that are a direct result of using alcohol or drugs despite significant problems in these areas.

Detoxification: A process in which poisons are cleansed from the body; goal is to provide safe process while person is experiencing withdrawal from a substance.

Enabling: A set of behaviors that support substance-using behavior.

Empathizing: To identify and understand another’s feelings, thoughts, or motives.

“I” Messages: A communication skill designed to help the Speaker deliver a positive or negative message clearly and directly.

IDU [injection drug-user]: A drug-using person who uses a needle as the tool to take a drug(s).

Inpatient: A type of treatment program that requires a person to live at the facility during this treatment phase.

Interpersonal Violence [IPV]: Repetitive verbal or physical acts between two people that harm, intimidate, damage, or violate the other person.

Joining: A technique used by a therapist to promote a favorable working relationship between him or her and the family.

Lapse: A single act of substance use after a period of abstinence.

Mirroring: A skill requiring the Listener repeating the words and feelings of a Speaker’s message(s).

Monogamous: Being married to or having only one partner at a time.

Outpatient: A type of treatment attended 2-3 times per week; depending on the program and needs of the individual/couple/family.

Physical Aggression: The act of physically harming another person; can include hitting, slapping, biting, choking, pushing, threatening or harming with a knife or gun, etc.

Positive Specific Requests: A communication skill that provides a clear and direct forum to express a desired change or need.

Recovery: A process by which an individual works toward achieving and maintaining abstinence.

Relapse: To fall back into old behaviors (i.e., drinking) after a period of getting better.

Restructuring: A therapist technique used to alter family patterns in order to establish new and healthier functioning patterns.

Safety Plan: A plan designed to avoid or minimize harm in a violent situation; clothing and money packed and hidden away, a place to stay, someone to call for help, etc.

Self-help: Peer organized and driven meetings that are designed to help people work on a specific problem with the support and assistance of others; AA, NA, Al-Anon.

Shared Rewarding Activities: Spending time together as a couple or family doing fun, positive activities together; designed to put the fun back into the relationship/family.

Sobriety: Abstaining from drinking alcohol or using drugs.
 
Sobriety Medications: Designed to help minimize withdrawal, help achieve abstinence, reduce cravings, and provide stability; helps individual return to normal functioning; examples include naltrexone, methadone, antabuse, etc.

Sponsor: Someone of the AA, NA membership the substance user asks to support in his or her recovery; helps ‘work’ steps, attends meetings with, or someone to call when needed.

Sexually Transmitted Diseases [STDs]: Infections that are passed person-to-person through sexual contact; herpes, Chlamydia, AIDS, etc.

Timeout: A 5- to 10-minute break during a conversation or disagreement; goal is to provide time for those involved to calm down separately; both people return to the discussion when calmer and more willing to discuss a solution.

Triggers: Any situation, person, place, event, mood, etc. that results in urges, cravings, or use of a substance.

Validating: Expressing understanding of the thoughts, feelings, or beliefs of another person as he or she states.

Verbal Aggression: The act of harming someone through yelling, name calling, blaming, insulting, etc.

Vicious Cycle: Describes the relationship between relationship distress and substance use as contributing factors to the other; progressive and destructive.

Withdrawal: A physical, psychological and emotional response to having stopped drinking alcohol or taking drugs.

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See more of this publication: Sobriety: A Couple’s Workbook

Learning Sobriety Together: A Couple’s Workbook is also available as a pdf download – see list of manuals on the Addiction and Family Research Group site
http://addictionandfamily.org/