Substance use disorders
Written by :TESSA OTTEN B/Mast
Addiction cannot be viewed as affecting only the individual who is struggling with a substance use disorder. Substance use disorders are described as a family disease, owing to one family member’s addiction having a powerful effect on other family members, impacting the entire family system (Levin, 1995). Therefore, family members should be included in the recovery process as well.
The drama triangle
The drama triangle, developed by Stephen Karpman (1968) has added significant value when working with families of the addicted individual. Peter Powis, a specialist in the addiction field, describes how he has found the drama triangle to be “one of the simplest and most powerful tools to both raise new levels of awareness about enabling behaviour, and motivate change in this behaviour” (Powis, 2001). The drama triangle is a strong theory that works well because all of the roles are complementary. Each role described sees in the other what he is unable to see in himself (Taibbi, 2011). This theory also provides a way for health care professionals to understand a situation objectively, as it plots the changes of a sequence of transactions between people (Orriss, 2004).
The 3 Roles
There are 3 roles described by the triangle which include the persecutor, the rescuer and the victim. All three roles operate in order to create the illusion of power amongst each role (Namka, 2004). Each role depicts learned patterns of behaviour and control mechanisms which form dysfunctional bonds within families. All 3 roles demonstrate interdependent, disparaging behaviours that affect each family member (Namka, 2004). The following diagram depicts these roles as laid out by Karpman (1968).
Figure 1: The Drama Triangle
As can be seen in Figure 1, the roles are depicted on an inverted triangle. The persecutor and the rescuer are found at the upper end of the triangle, with the victim at the bottom. Karpman (1968) depicted the triangle in this way in order to express the “one-up” positions, where the roles at the top of the triangle are filled by people who feel superior (Namka, 2004), stronger and more-together than the victim (Forrest, 2008). The victim was placed at the bottom in order to depict a “one-down” position, in order to demonstrate a feeling of being looked down on and helpless (Namka, 2004). The roles as presented are never fixed, as individuals tend to move from one position on the triangle to another. Forrest (2008) describes how no matter where one starts on the triangle, they will end up playing the role of the victim. Forrest (2008) discusses how through these roles, we “unconsciously re-enact painful life themes that create shame”. It is because of this that old, painful beliefs are reinforced which keeps one stuck in a limited version of reality (Forrest, 2008) and keeps one disconnected from true intimacy (Namka, 2004). Whilst individuals move amongst the different roles, it is often found that one role will fit more comfortably than others. This is a result of one’s personality, upbringing and learned ways of coping (Taibbi, 2011).
The roles depicted in the drama triangle are easily seen at a social level through observable behaviour. However, it also works at an internal dynamic level or how the individual is feeling inside (Orriss, 2004). It is because of this that it is possible that an individual may feel like a victim, but be viewed by others as a persecutor, or vice versa. We play out the drama triangle internally, ensnaring ourselves within the triangle with “dishonest and dysfunctional internal dialogue” (Forrest, 2008), which can often result in feelings of anger and self-worthlessness. The roles and behaviours adopted by an individual as well as the beliefs and feelings that accompany them tend to become entrenched and self-perpetuating over time, forming part of one’s identity (Forrest, 2008). Often these roles can become the core of an individual’s identity resulting in them spending most of their lives stuck moving between the different dysfunctional roles.
The drama triangle can help families to identify the roles that they are adopting, why they have been adopted, how these impact their loved one with an addiction and how it may be fuelling the addiction. By creating insight into these roles, the family is empowered to make a change if the need is identified.
The families’ feelings around a loved one’s addiction are generally of a negative nature. This often impacts detrimentally on the way in which they deal with the situation. It is useful for family members to learn to recognise their thoughts and feelings and how these may influence the way in which the circumstances are handled. It is often seen that the family members blame themselves and therefore take the responsibility away from the individual struggling with an addiction. This has a negative effect on one’s recovery, as it can only be achieved if the addicted individual starts taking responsibility for their own behaviour. Whether a family member adopts the persecutor or rescuer role, both result in the victim (or the addicted individual) being left with no responsibility and no consequences for their actions. This allows the addicted individual to continue with their behaviour as they believe that it is not their fault and do not suffer the consequences of their actions.
Namka (2004) discusses how these roles are adopted as an attempt to allow one to feel safe and important while disconnecting from one another. By refusing to take responsibility for oneself, one unconsciously chooses to react as a victim (Forrest, 2008). This often results in feelings of anger, fear, guilt and inadequacy and leaves a person feeling betrayed or taken advantage of (Forrest, 2008). Although the roles portrayed by the triangle are in a constant state of flux, each individual will have a more familiar role which will be their primary role. Although one familiarises themselves with a specific role, the roles are automatically rotated and individuals move around the triangle.
The victim role is typically assumed by the individual struggling with an addiction. This individual is often “stuck in a false sense of being unworthy with defences of feeling sorry for oneself” (Namka, 2004) which can result in passive-aggressive behaviour. This is an easy, manipulative role for the addicted individual to adopt as it gives them an excuse to abuse substances as they see their life as difficult and unfair. The victim does not take responsibility for their own actions and feelings and feeds off the reinforced belief of the other two roles that they cannot take care of themself. However, constantly being “looked down on” can result in the victim building resentment and therefore retaliating, creating a natural progression from victim to persecutor (Forrest, 2008).
The rescuer wants to protect and help the victim as this allows them to feel safe and important. The rescuers feel that they are only valued for what they can do for others (Forrest, 2008). This is commonly accompanied by a false sense of superiority but is defended by seemingly acting unselfishly to help others (Namka, 2004). Ultimately, this role to control others is done in order to avoid their own feelings and problems and build their self-esteem by being seen as unselfish through helping others. The rescuer blames the persecutor for the problems in the family and is highly judgemental of others, believing that they have all the answers (Forrest, 2008). Within families affected by addiction, this creates conflict between the rescuer and persecutor who are ultimately trying to achieve the same goal through different means. This enforces the role of the victim, who makes use of their arguing as an excuse to continue abusing substances, this further entrenches the roles of the drama triangle. By constantly giving, the rescuer may adopt a sense of entitlement. However, the rescuer never receives anything in return which can result in depression and a victim mentality as they start to feel that they are being taken advantage of (Namka, 2004).
The persecutor feels a need to be in control and often uses verbal or physical force in order to stay in power. However, they are generally in complete denial about their blaming tactics. The persecutor feels that their attack approach is necessary for self-protection as they see themselves as the victim wanting to strike before the perceived inevitable attack (Forrest, 2008). The persecutor is highly judgemental of others and is angered by others not doing what they say, they tend to judge others about their weaknesses, denies their own weaknesses and feelings of anger and frustration, which allows them to avoid their own uncomfortable feelings. The persecutor feels a strong need to be right which results in anger when their authority is challenged and does not allow themself to be vulnerable.
It is only through becoming conscious of the dynamics within the drama triangle that we can transform them and move forward on a journey towards “re-claiming emotional, mental and spiritual well-being” (Forrest, 2008). By being mindful of the situation, one is able to notice what is happening instead of reacting to it (Namka, 2004). In order to move off the triangle and towards effective helping roles, it is essential that each individual takes responsibility for their own selves. Individual’s need to be reminded that the roles they have adopted are a result of what they have learned through what was modelled for them. Understanding this can help relieve any feelings of guilt and encourage forgiveness.
Boundaries are needed for both the family members and the addicted individual to protect themselves and each other. By making use of the drama triangle, family members are encouraged and enabled to identify the role that they assume. It is only through recognising the role that one assumes that one can start making changes from a problematic helping role to a supportive helping role. Once the necessary changes to be made have been identified, the family can protect themselves through setting boundaries and taking responsibility for their own actions.
Changing from a problematic role to an effective role seems simple in principle, but in reality, it is much harder to achieve. Becoming aware of one’s role and attempting to make the necessary changes is not quite as simple when working with an individual with an addiction. The addicted individual benefits from adopting the role of the victim, as it permits them to continue with their addiction without any consequences. With this attitude, the individual does not need to take responsibility for themself which enables their drug use. Through rescuing and enabling, the natural aversive consequences of an individual’s actions are interrupted, as is breaking through denial around the severity of their problem.
The individual who adopts the role of the victim needs to transform this into one of a survivor. This needs to be done by solving their problems themselves and taking responsibility for their feelings, thoughts and actions. Accompanying this, the individual needs to challenge beliefs or thoughts around being unworthy and unable to take care of themselves. It is also imperative that the victim stops blaming the persecutor and rescuer and rather focuses on getting out from under their influence (Namka, 2004). By doing this, the victim is able to take responsibility for their own life which results in an empowering attitude of survival.
The individual adopting the role of the rescuer needs to transform into a supporter. To achieve this, the individual needs to set limits when it comes to solving other people’s problems and rather place their energy into solving their own. In order for this to be effective, the rescuer needs to stop rationalizing and justifying their caretaking and enabling behaviour, as well as identify how they are being manipulated into doing things for others (Namka, 2004). When moving off the triangle, the individual needs to sort through their motives and feelings regarding the present situation and become willing to experience uncomfortable feelings. For the rescuer, the most uncomfortable feeling may be allowing others to feel pain or suffering, without rescuing them. When this happens, the individual may be perceived as a persecutor for not fulfilling their primary role, but in truth, they are moving to a supportive role that allows them to protect themselves.
As with all the roles, the persecutor needs to become self-accountable in order to move off the drama triangle and towards an effective helping role. This can be especially challenging for the persecutor as it often results in them blaming themselves, which perpetuates their internal anger which energizes them (Forrest, 2008). An awareness of how the persecutor needs tend to reject, punish or persecute others as a result of their unrealistic expectations of others (Namka, 2004) is a useful start. Acceptance that they do not have all the answers and cannot always be right will allow for a change in their domineering behaviours (Namka, 2004). Learning to accept and feel uncomfortable feelings will lessen anger outbursts that often occur when feeling stressed or threatened (Namka, 2004). By adopting these skills and taking responsibility for their actions, the individual can begin a journey of moving from the role of the persecutor to that of a limit setter, or one who can set boundaries.
TESSA OTTEN
Bachelor of Social Work
Bachelor of Social Science (Hons)
Masters in Advanced Development in Social Work
Reference List
Forrest, L., 2008. The faces of victim. Available at: http://www.lynneforrest.com/articles/2008/06/the-faces-of-victim/.
Karpman, S., 1968. Fairy tales and script drama analysis. Transactional Analysis Bulletin. 7(26):39-43. Available at: http://www.karpmandramatriangle.com/dt_article_only.html.
Levin, J., 1995. Introduction to Alcoholism Counseling: A Bio-Psycho-Social Approach. 2nd Ed. Philadelphia: Taylor & Francis.
Namka, L., 2004. The Drama Triangle: The three roles of victimhood. Available at: http://www.angriesout.com/grown20.htm.
Orriss, M., 2004. The Karpman Drama Triangle. Available at:
http://coachingsupervisionacademy.com/thought-leadership/the-karpman-drama-triangle/
Powis, P., 2001. Drama-triangle. Available at: http://www.breaking-barriers.co.za/wp-content/uploads/2011/03/drama-triangle.pdf.
Taibbi, R., 2011. The Relationship Triangle. Fixing Families. Available at: http://www.psychologytoday.com/blog/fixing-families/201106/the-relationship-triangle
