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ADDICTIONS IN THE FAMILY: FAMILY AT RISK

Spouses, children, parents, siblings, and others – everyone in the family suffers when a loved one is an addict and the problems can be severe and long lasting.  Fortunately, “family members” do not have to remain in the grip of alcohol or drugs; once they realize that their lives are in crisis, they can find help and break the vicious cycle.


Addiction is a process, in an attempt for the addict to control natural cycles of life, through the introduction of harmful chemicals into their systems to produce a desired mood change, thereby perpetuating uncontrollable cycle in their lives and the lives of the family support unit.

An addict truly believes that they can use a substance on the most basic level to fulfill the desire for “happiness” and control the inner demons of unnatural life cycles that they experience on a daily basis

. Addiction must be viewed as a process that is progressive and an illness, not a disease, which undergoes continuous development from a starting point to an ending point.

According to Craig Nakken in his book, The Addictive Personality: Understanding the Addictive Process and Compulsive Behavior, “we must first understand what all addictions and addictive processes have in common: the out-of-control and aimless searching for wholeness, happiness, and peace through a relationship with an object or event. No matter what the addiction is, every addict engages in a relationship with an object or event in order to produce a desired mood change or state of intoxification. [1]

The crucial crux of the situation is that the addict will not recover unless he or she wants to recover regardless of any intervention!  An addict has been too long on too many drugs.  Even young, otherwise healthy bodies fight back. The vibrations of an addict are of a very specific sort – they ricochet out of control, mostly out of reach. 

The energy called up the drug quickly disperses, leaving a void, a nothingness.  Nature abhors a vacuum, so negative forces rush in, take up residence.  The only immediate relief is more narcotics.  This is the vicious cycle of addiction for an addict.

In days past, when society spoke of “family,” it was typically referring to Mom, Dad and the kids, plus grandparents and aunt or uncle. Family structures in America have become more complex—growing from the traditional nuclear family to single‐parent families, stepfamilies, foster families, and multigenerational families.

Therefore, when a family member abuses substances, the effect on the family may differ according to family structure.[2] A growing body of literature suggests that substance abuse has distinct effects on different family structures.

For example, the parent of small children may attempt to compensate for deficiencies that his or her substance‐abusing spouse has developed because of that substance abuse.

Frequently, children may act as surrogate spouses for the parent who abuses substances.[3] Because that option does not exist in a single‐parent household with a parent who abuses substances, children are likely to behave in a manner that is not age‐appropriate to compensate for the parental deficiency. [4]

Empirical studies have shown that a parent’s alcohol problem can have cognitive, behavioral, psychosocial, and emotional consequences for children. Among the lifelong problems documented are impaired learning capacity; a propensity to develop a substance use disorder; adjustment problems, including increased rates of divorce, violence, and the need for control in relationships; and other mental disorders such as depression, anxiety, and low self‐esteem. [5][6][7]

The consequences of an adult who abuses substances and lives alone or with a partner are likely to be economic and psychological. Money may be spent for drug use; the partner who is not using substances often assumes the provider role.

Psychological consequences may include denial or protection of the person with the substance abuse problem, chronic anger, stress, anxiety, hopelessness, inappropriate sexual behavior, neglected health, shame, stigma, and isolation.

Alternately, the aging parents of adults with substance use disorders may maintain inappropriately dependent relationships with their grown offspring, missing the necessary “launching phase” in their relationship, so vital to the maturational processes of all family members involved.

When an adult, age 65 or older, abuses a substance, it is most likely to be alcohol and/or prescription medication. The 2012 National Household Survey on Drug Abuse found that 12.5 percent of older adults reported binge and 6.4 percent reported heavy drinking within the past month of the survey.[8]

Veteran’s hospital data indicate that, in many cases, older adults may be receiving excessive amounts of one class of addictive tranquilizer (benzodiazepines), even though they should receive lower doses. Further, older adults take these drugs longer than other age groups.[9]

Older adults consume three times the number of prescription medicine as the general population, and this trend is expected to grow, as children of the Baby Boom (born 1946–1958) become senior citizens.[10]

It is interesting to note that many people who abuse substances belong to stepfamilies. Even under ordinary circumstances, stepfamilies present special challenges. Children often live in two households in which different boundaries and ambiguous roles can be confusing.

Effective co-parenting requires good communication and careful attention to possible areas of conflict, not only between biological parents, but also with their new partners.[11] Experts believe that the difficulty of coordinating boundaries, roles, expectations, and the need for cooperation, places children raised in blended households at far greater risk of social, emotional, and behavioral problems.

Children from stepfamilies may develop substance abuse problems to cope with their confusion about family rules and boundaries.[12] Substance abuse can intensify problems and become an impediment to a stepfamily’s integration and stability. When substance abuse is part of the family, unique issues can arise.

Such issues might include parental authority disputes, sexual or physical abuse, and self‐esteem problems for children. Substance abuse by stepparents may further undermine their authority, lead to difficulty in forming bonds, and impair a family’s ability to address problems and sensitive issues.

Clinicians treating substance abuse should know that the family dynamics of blended families differ somewhat from those of nuclear families and require some additional considerations. The effects of substance abuse frequently extend beyond the nuclear family.

Extended family members may experience feelings of abandonment, anxiety, fear, anger, concern, embarrassment, or guilt; they may wish to ignore or cut ties with the person abusing substances. Some family members even may feel the need for legal protection from the person abusing substances. Moreover, substance abuse can lead to inappropriate family subsystems and role taking and the effects on families may continue for generations.

Intergenerational effects of substance abuse can have a negative impact on role modeling, trust, and concepts of normative behavior, which can damage the relationships between generations. For example, a child with a parent who abuses substances may grow up to be an overprotective and controlling parent who does not allow his or her children sufficient autonomy.[13]

Neighbors, friends, and coworkers also experience the effects of substance abuse because a person who abuses substances often is unreliable. Friends may be asked to help financially or in other ways. Coworkers may be forced to compensate for decreased productivity or carry a disproportionate share of the workload. Consequently, they may resent the person abusing substances.[14]

In cultures with a community approach to family care, neighbors may step in to provide whatever care is needed. Sometimes it is a neighbor who brings a child abuse or neglect situation to the attention of child welfare officials. Most of the time, however, these situations go unreported and neglected.[15]

People who abuse substances are likely to find themselves increasingly isolated from their families. Often they prefer associating with others who abuse substances or participate in some other form of antisocial activity. These associates support and reinforce each other’s behavior.

Different treatment issues emerge based on the age and role of the person who uses substances in the family and on whether small children or adolescents are present. In some cases, a family might present a healthy face to the community while substance abuse issues lie just below the surface. In any form of family therapy for substance abuse treatment, consideration should be given to the range of social problems connected to substance abuse.

Problems such as criminal activity, joblessness, domestic violence, and child abuse or neglect may also be present in families experiencing substance abuse. To address these issues, treatment providers need to collaborate with professionals in other fields. This is also known as concurrent treatment.

Whenever family therapy and substance abuse treatment take place concurrently, communication between clinicians is vital. In addition to family therapy and substance abuse treatment, multifamily group therapy, individual therapy, and psychological consultation might be necessary.

With these different approaches, coordination, communication, collaboration, and exchan ge of the necessary releases of confidential information are required. With concurrent treatment, it is important that goal diffusion does not occur. Empowering the family is a benefit of family therapy that should not be sacrificed. 


[1] Nakken, Craig. The Addictive Personality: Understanding the Addictive Process and Compulsive Behavior. (Center City, Minnesota: Hazelden). 1996.  Pg. 3.
[2] Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 2 Impact of Substance Abuse on Families. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64258/  
[3] Brown, S. and Lewis, V. The Alcoholic Family in Recovery: A Developmental Model. (New York: Guilford Press), 1999, pgs. 100-101.
[4] Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series. Rockville, MD: Substance Abuse and Mental Health Services Administration, in development e.
[5] Giglio J.J., Kaufman E. The relationship between child and adult psychopathology in children of alcoholics. International Journal of the Addictions. 1990;25(3):263–290. [PubMed: 2228336]
[6] Johnson J.L., Leff M. Children of substance abusers: Overview of research findings. Pediatrics. 1999;103(5 Pt 2):1085–1099. [PubMed: 10224196]
[7] Sher K.J. Psychological characteristics of children of alcoholics. Alcohol Health and Research World. 1997;21(3):247–254. [PubMed: 15706777]
[8] Office of Applied Studies. Results from the 2012 National Household Survey on Drug Abuse: Vol. 2. Technical Appendices and Selected Data Tables. National Household Survey on Drug Abuse Series: H‐18. DHHS Publication No. (SMA) 02‐3759. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012d.
[9] National Institute on Drug Abuse. Prescription Drugs: Abuse and Addiction. National Institute on Drug Abuse Research Report Series. Rockville, MD: National Institute on Drug Abuse, 2001. Updated in 2012. http://www.nida.nih.gov/PDF/RRPrescription.pdf
[10] Bucholz, K.K., Sheline, Y., and Helzer, J.E. “The epidemiology of alcohol use, problems, and dependence in elders: A review”. In: Beresford, T.P., and Gomberg, E., eds. Alcohol and Aging. New York: Oxford University Press, 1995. pp. 19–41.
[11] Anderson, J.Z. “Stepfamilies and substance abuse: Unique treatment considerations”. In: Kaufman, E., and Kaufmann, P., eds. Family Therapy of Drug and Alcohol Abuse. 2d ed. Boston: Allyn and Bacon, 1992. pp. 172–189.
[12] Popenoe D. “The American family crisis”. National Forum. 1995;75(3):15–19.
[13] Fields, J., and Casper, L.M. America’s Families and Living Arrangements: March 2000. Current Population Reports, P20‐537. Washington, DC: U.S. Census Bureau, 2001.
[14] Fishman, H.C. Intensive Structural Therapy: Treating Families in Their Social Context. (New York: Basic Books).  1993. Pgs. 67-98.
[15] IBID.
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