What is the relationship between families and substance abuse?

Causes

Initial substance and chemical use is almost always voluntary, as the person decides to consume or not consume a substance; if they do consume, they decide how much. The person is in charge of the choices he or she makes.

Continued choices to use a drug produce chemical and structural changes in the brain that result in involuntary, compulsively driven needs to have the drug. This action compromises the functioning of the areas of the brain involved in the inhibition of drives. The urge is never more than temporarily satisfied, however. The substance, not the person, is in control.

What often starts as an experience of recreation, relaxation, excitement, experimentation, social bonding, or isolated escape from life’s challenges becomes a need to satisfy and resupply. Users are now abusers, and abusers often become addicts of the substances they are using.

Substance abuse can involve any chemical, but more often it involves commonly used and legal substances such as tobacco (the nicotine in tobacco is addictive) and coffee or tea (the caffeine in coffee and tea is addictive) or illegal chemicals such as cocaine, heroin, and marijuana. Substances of abuse also include legal medications, such as anti-anxiety and pain medications, which require a physician prescription to obtain, and over-the-counter medications.

Although these substances are chemically quite varied, they all produce the same overt response in the abuser: an unrelenting need to achieve the next altered state of consciousness, be it a high, sleepiness or relaxation, or excitability. Satisfying the need becomes a priority over responsibilities with family, friends, or work. The addict becomes emotionally cut off from family, friends, and coworkers. Addiction and the quest to satiate the next urge control the addict’s mental state.

Those struggling with addiction often have legal troubles and frequently use substances in dangerous situations (such as driving under the influence). The ability to resist the impulse to take the drug overtakes users’ self-control, and they are left helpless and often beyond the help that their families and friends can typically provide.

Risk Factors

While vulnerability to substance addiction can come about for many reasons, the most common involve a prior history of substance abuse in one’s family, which is dually suggestive of being exposed to and learning how to use substances (imitative, learned behavior) and a genetic predisposition to responding more strongly to drugs than might be true for the average person. The average person without an addiction is more likely to have been raised in a family free of substance and chemical abuse.

Geneticists are moving closer to identifying several genes and gene clusters that promote a much stronger pleasure response to certain substances than is typical in the average person. Neuroscientists, similarly, are increasing their focus on areas of the brain that become highly excitable in addicted persons exposed to drugs.

One in four families has one or more members who either abuses drugs or is addicted to drugs. This can be explained in part by research that shows that addiction and substance abuse occur more readily in persons with a family history in which a first-order relative is chemically addicted and in which there exists a genetic loading for an unusually pleasurable response to drugs and other substances. This extrapolates to one of every two families having to cope in a major way with a relation or close friend who abuses or is addicted to drugs.

Having a behavioral or mental problem or illness, even common ones like anxiety and depression, also increases the odds that one will develop an addiction. Also more likely to become addicted are persons who were neglected or physically or emotionally abused as children. Research also shows that even the delivery system employed, that is, how the drugs are ingested, puts someone on a faster track to addiction. Snorting and intravenous injection are the most dangerous methods that can lead to drug addiction.

Impact on the Family

Persons do not intend to become addicts or substance abusers. People most often use substances to change an emotional state, to enhance a state of feeling good, or to combat a state of feeling bad.

Use easily becomes frequent use, frequent use increases the odds of abuse; episodes of abuse, in turn, increase—and almost guarantee—the odds that addiction will overcome the person’s state of mind and being. They live the life of addictive preoccupation; nothing else matters.

Having a substance-abusing member in a family has long-lasting, deleterious effects that take from the energy, bonds, and nurturance that characterize the traditional family group. The social dynamic in families is that each member reacts to all other members. Mothers react to spouses and their children. Fathers react to spouses and their children. Children react to each parent and their siblings. This mesh of reactions results in a long-term, developmentally progressive, complex social system that has its own lifecycle. A substance-abusing family member has an impact on this cycle, usually in one of three ways. Family members can respond to the substance abuse in a similar fashion.

The most prevalent of these three reactions is the desire to stay engaged with the substance abuser, and to advise, counsel, support, reason with, and show disappointment in the abuser while seeking the promise of abstinence and reform. This response by family members who love and are committed to each other is rarely effective, but nonetheless may last for decades. This relationship is referred to as codependency and d a pattern of unhealthy learned behaviors whereby the nonaddicted family member focuses completely on the habits, behaviors, and day-to-day living of the substance abuser, often at the expense of the nonaddicted family member's health, happiness, and general well-being. Engagement often produces depression and hopelessness in the family, which can then produce guilt and shame in the abuser. The pain of the guilt and shame is more than the abuser can withstand, and the negative emotions may drive him or her back to the substance of abuse.

The second most prevalent reaction, confrontation, usually arises some time after the addiction is accepted as a real problem, both for the family member and for the family. Confrontational responses generally have rapid onset with a short half-life. Most people cannot sustain high levels of intense anger and outrage. The addict often recoils in the face of such an emotional onslaught and will nervously try to avoid the drug or not get caught taking the drug. Inevitably, because the addiction or abuse is not being treated, its remission is brief; when it resurfaces, it will again be met by family outrage. The addict will then respond as before: recycling the pattern of abuse.

The third reaction, collaboration, can move family members from being contributors to and enablers of the problem to recognizing that, in the face of the disease, the family has become diseased itself; symptoms are often manifested in a long and varied series of unhelpful, maladaptive, dysfunctional responses that attempt the impossible: Remove the cause of the addiction, try to control the addiction, and find a cure for the addiction.

Engagement initially requires the emotional and psychological detachment from the addict and his or her disease. Genetic loading and family history notwithstanding, family members (often slowly) come to understand that they did not cause the disease, that they cannot (and have never been able to) control the disease, and that they cannot cure the disease.

Treatment for Families

Just as families have primary ways of reacting to their drug-abusing members, they also have fairly predictable developmental stages in reacting to these members. In the beginning, as an addict’s behavior becomes harder to hide, family members begin to notice that something is wrong.

Family members will feel concerned and worried and will begin genuine attempts to look out for the troubled member’s welfare. Families ask, remark, comment, suggest, and obtain promises of reduced or controlled use. Families will protect, make excuses, and try to carry on their normal lives. Slowly, as these efforts only prolong the addiction and delay treatment, families experience extreme emotional dissonance and self-doubt. Families become confused about whether they are tolerating addiction, enabling addiction, or just protecting themselves.

At this stage, families are immersed in the addiction, and treatment becomes necessary, even if the addict refuses. Often family members will employ a strategy of emotional or physical avoidance, a form of denial that parallels that of addicts.

For addicts and their families substance addictions are treatable diseases. As families accept the realities of the addiction, they can begin to make real changes. For many families, the treatment of choice will be a family-centered, twelve-step program such as Al-Anon or Nar-Anon. Individual family members may get their own treatment by meeting with a mental health specialist skilled at recognizing common dysfunctional family responses. As the family tends to its own health, it gets healthier. With the right kind of help comes healing, and the family can start to return to a normal way of life.

Family life involves intense emotions (good and bad), so it is almost impossible for families to have an engaged response without outside guidance, direction, and support. Help for families coping with addicted members is wide ranging. It comes in the form of twelve-step groups such as Al-Anon and Nar-Anon. Also available are licensed behavioral health care professionals who specialize in substance abuse treatment or specialized treatment centers or programs.

In addition to being an example of those invested in their own recovery, families can be huge catalysts for aiding the addicts’ treatment and recovery processes. Ideally, the family should respond to the addiction with support and noninterference.

The role of the family is critical; its reactions will either promote health or enable disease. Though they may never have abused substances themselves, family members should accept that they are coping with more than the substance abuse habits of an individual member. They are facing a family disease, and they should seek help accordingly.

Bibliography

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Foote, Jeffrey. Beyond Addiction: How Science and Kindness Help People Change. New York: Scribner, 2014. Print.

Friel, John C., and Linda D. Friel. Adult Children Secrets of Dysfunctional Families: Secrets of Dysfunctional Families. Deerfield Beach: Health Communications, 1988. Print.

Hayes, Steven, and Michael Levin. Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions. Oakland: New Harbinger, 2010. Print.

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Rusnáková, Markéta. "Codependency of the Members of a Family of an Alcohol Addict." Procedia-Social and Behavioral Sciences 132 (2014): 647–53. Print.