Families and substance abuse
Families impacted by substance abuse often face profound and lasting consequences that affect their overall dynamics and well-being. When a family member struggles with substance use disorder (SUD), the challenges extend beyond the individual, impacting relationships, emotional health, and everyday functioning within the family unit. This phenomenon is sometimes described as a "family disease," as the emotional turmoil—encompassing feelings of guilt, anger, and resentment—can disrupt the supportive and nurturing environment that families ideally provide.
Various factors contribute to the onset of SUD, including genetic predisposition, family history, and environmental influences. As substance misuse becomes more prevalent, the likelihood of familial impact increases. Families may exhibit distinctive responses, such as codependency, confrontation, or collaboration, influencing their collective ability to cope with the challenges posed by SUD. Treatment options are available not only for the individual suffering from SUD but also for family members who need support and guidance in navigating their complex feelings and behaviors. Programs like Al-Anon and Nar-Anon, along with professional mental health support, can help families heal and develop healthier dynamics as they address the implications of substance misuse together.
Families and substance abuse
DEFINITION: A family with a member who is misusing a substance, or with substance use disorder (SUD), often experiences long-lasting, deleterious consequences from that misuse. An individual member’s substance abuse or misuse becomes the family’s substance abuse or misuse. Addiction and SUD have been said to be a family disease. Self-pity, hatred, resentment, guilt, and anger disrupt family life that, while never perfect, should ideally be health-promoting, protective, supportive, and positive. Powerful and dangerous emotions intoxicate and ruin the functional life of the family. Treatment, however, is available for family members and for the member with SUD.
Causes
While initial substance and chemical use is often voluntary, many other factors come into play, depending on the substance the person is using, their purpose for using it (medical or nonmedical, or recreational), and the duration of use. As prescription drugs became more prevalant and available, and as recreational drugs and alcohol also became popularized and legalized (as in states legalizing marijuana), the rates of SUD rose as well. As of 2020, over 37 million people twelve and older actively used illicit substances.
Continued drug use produces 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 then in control.
Substance misuse 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 varied, they all produce the same overt response in the person using them: 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 individual experiencing SUD becomes emotionally cut off from family, friends, and coworkers. The quest to satiate the next urge controls the person's mental state.
Those struggling with SUD can experience legal troubles and may use substances in dangerous situations (such as driving under the influence). The inability to resist the impulse to take the drug overtakes self-control, and people are left helpless, often beyond the assistance their families and friends can provide.
Risk Factors
While vulnerability to SUD 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 SUD is more likely to have been raised in a family free of substance and chemical misuse.
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 persons exposed to drugs.
One in four families has one or more members who either misuses drugs or has a dependence on drugs. This can be explained in part by research that shows that substance misuse occurs 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 misuses or is dependent on drugs.
Having a behavioral or mental problem or illness, even common ones like anxiety and depression, also increases the odds that one will develop SUD. Also more likely to become dependent 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 dependence. Snorting and intravenous injection are the most dangerous methods that can lead to SUD.
Impact on the Family
Persons do not intend to become substance misusers. 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.
Occasional use can become frequent use, and frequent use increases the odds of SUD. Episodes of misuse, in turn, increase the odds that SUD will overcome the person’s state of mind and being.
Having a family member with SUD 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 denotes a pattern of unhealthy learned behaviors whereby the nonaffected family member focuses completely on the habits, behaviors, and day-to-day living of the family member with SUD, 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 dependence 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 person with SUD 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 abuse and misuse is not being treated, its remission is brief; when it resurfaces, it will again be met by family outrage. The family member suffering from SUD 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 disease, try to control the dependence, and find a cure for the SUD.
Engagement initially requires the emotional and psychological detachment from the affected family member 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 a person'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 SUD and delay treatment, families experience extreme emotional dissonance and self-doubt. Families become confused about whether they are tolerating their family member's behavior and actions, enabling them, or just protecting themselves.
At this stage, families are immersed in SUD, and treatment becomes necessary, even if they refuse. Often, family members will employ a strategy of emotional or physical avoidance, a form of denial that parallels that of those with SUD.
For those with SUD and their families, substance misuse is a treatable disease. As families accept the realities of the disease, 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 members with SUD 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 their family member's treatment and recovery processes. Ideally, the family should respond to the disease 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 SUD habits of an individual member. They are facing a family disease, and they should seek help accordingly.
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