FAMILY MEMBERS FRIEND OR FOE?

Addiction and recovery issues fill self-help books, research agendas, and popular media. Numerous treatment centers are focused on the needs of the substance-dependent person. Unfortunately there is a paucity of information about family members’ experience and recovery from their loved one’s addiction. A study at Rutgers’ Center of Alcohol Studies revealed that of 873 studies of alcohol education materials, only 38 of those dealt with the effects of the addiction on the family. The majority of those 38 that did deal with the family were pamphlets circulated by the Al-Anon Family groups.

In the late 1970’s Judith Woititz emphasizes that there are over 10 million alcoholics in this country, and each alcoholic profoundly affects the lives of at least 6 other people. Other more recent work shows that alcohol abuse and dependence is among the most prevalent mental disorders in the US. Persons in close relationships with those who become addicted to substances also become affected by the disease. It is hypothesized that the closer an individual is to the person who becomes addicted, the more symptomatic that individual becomes

Addicted patients have a greater chance of recovery and stability within a recovering family system. When spouses of alcoholics change their behaviors, the alcoholic has an 80 percent better chance to achieve sobriety. Given the importance of families in recovery, it is puzzling that attention to them is limited. They tend to be credited as the cause or as the source of maintaining the addiction. Family process information is often limited to family role labels such as Hero or Scapegoat. When professionals misunderstand the complementarity of behaviors in a family system, and the impact of addiction on the lives of those around the addict, they undermine the family relationships.

Initially, it can be more challenging to work with families in recovery than the individual alone. During the disease process family members experience trauma, loss, and fear. Early in the recovery process they have needs which must be recognized and addressed. Misunderstanding family dynamics, and the potential for blame that comes with such misunderstandings, causes further injury in the family system and reduces the potential for assisting the patient and the family in their recovery.

Family Members’ Experience

The threat of loss of a relationship creates fear and sadness. Parents, spouses, children, friends, and extended family are sources of social relationship that provide contexts within which to maintain balance. To prevent loss people engage in controlling behaviors, hyper-vigilance, and manipulation. Attempts to maintain attachment with people who are needed, or who have moved from available to unavailable, is normal. Pathologizing that reaction is harmful. The normative reaction to loss is grief, and in the case of addiction it is complicated by the ambiguous nature of the loss. If a person dies, loss is unambiguous: the social role the deceased played is no longer occupied and the deceased cannot fulfill obligations or promises. The spouse who becomes addicted to mind altering substances often ceases to fulfill obligations or promises, but physically is present. The interactions that were developed in these close relationships become unsuccessful yet are vigorously pursued because members of the network have not yet identified, understood, or grieved their losses. To manage the negative reactions professionals may experience from family members (e.g., denial, anger, frustration, fear, sadness), the family’s obstacles need to be assessed: they may lack an understanding of addiction, they may be embarrassed about what is happening in their family, they may fear that they caused the addiction, and there may be fear of change. The three tasks for persons with emotional attachment to those who are addicted are: (a) recognize the loss of the role that the addicted person can no longer fulfill, (b) grieve the loss of the original relationship, and (c) reorganize such that the addicted person is no longer central to the member’s well being. Normalizing, identifying, and grieving are the key treatment issues. A psychoeducational approach to understanding addiction, its process and physiological basis, delivered with empathy and respect provide an important step in inviting the family onto the recovery team. When the education is successful, family members can: (a) detach with love, (b) recognize the limits of the relationship with the addicted person, (c) set limits for their own well-being, and (d) care without obsessing.

Families become ill one step at a time, and they become well by learning a different step, one step at a time. It is ineffective to undermine family relationships when an individual has a chronic disease like diabetes or asthma, and it is equally unwise to undermine that relationship when the disease is addiction. When families are seen as hurting rather than broken, and worried rather than enabling, they will be embraced in the journey of recovery.