Have you ever heard someone say about you and a sibling, parent or child that you act in similar ways? Have your mannerisms ever been compared to a member of the family to which you are close and have been for years? Stephen Curry is an NBA star despite the absence of the daunting height and weight of most NBA stars. Stephen Curry grew up watching his father, Dell Curry, play in the NBA. Go figure. Johnny is an alcoholic and, despite his intelligence and health, he drinks alcohol after work to cope with stress. Johnny grew up watching his father drink to cope with stress. Go figure. Had Curry not spent so much time in gyms and basketball arenas, watching his role model and primary caregiver play basketball, he may have never considered or pursued a career in sports. Had Johnny not grown up in a home where alcohol was a coping mechanism, he may have never considered that relationship between alcohol and stress. You might rebuttal that making it to the NBA has a lot do with genes and one would say you are correct and quip that genes play a role in addiction in addition to environment.
Like Father, Like Son
Addiction, beyond alcohol, can be passed through generations due to the presence of a genetic predisposition and simply being in the presence of addiction. Researchers have found that the inhibitory control of a substance abuser can be passed from one generation to the next. Inhibitory control refers to one’s ability to control impulses in the face of a potentially damaging desire (i.e. alcohol) and researchers have found that adults with a substance use disorder and their children have low levels of inhibitory control. In a study conducted on inhibitory control and alcohol dependence it was found that behavioral under control accounted for 40% of the genetic variation for risk of dependence. Additional studies have shown that sons of male alcoholics struggle to control their impulsive behavior, including with illicit drugs or alcohol. The effect of addiction within a family has several effects on child rearing as well. For a parent is a substance abuser, their discipline skills are likely to suffer in ways such as:
- Coercive control
- Lack of follow through on discipline
- Poor implementation of discipline strategies
- Financial issues
- Low quality interactions
- Low engagement
- Low positivity
- Lack of synchrony
The list could go on and on and the fact of the matter is that substance abuse has a negative effect on a parent, their spouse, their children, their extended family, their friends and even their co-workers and their other loved ones. The fact that substance abuse can permeate into other peoples’ lives is both scary and amazing. Suppose Johnny’s father doesn’t show up to work, instead he’s home fighting with his spouse in front of Johnny about how he can go to work with a “buzz” and, when he doesn’t make it, his co-workers are working extra hours to make up for his absence, cursing him, and returning home too late to spend quality time with their loved ones. Something like substance abuse can affect work morale, work productivity, quality of in-home relationships and, if someone drives to work buzzed on alcohol, the safety of innocent civilians. Yes, the same argument can be made about criminal behavior, deforesting, economic hardships, oil drilling and everything else under the sun in that the effects will reverberate to infinity because every action has an equal reaction and in this case, substance abuse can impact not only the abuser but everything he or she directly or indirectly touches. That includes something as random as car insurance because the substance abuser wrecked his or her car in another person’s zip code thereby heightening the risk of other local drivers prompting the insurance companies to raise rates. Substance abuse is like a blender on the highest setting, without a top, whipping a strawberry milkshake all over the kitchen. After your substance abusing loved one squanders all the mortgage money, sending your house into foreclosure, while cleaning the empty house, you’ll find strawberry ice cream stains in spots you never thought to even look at in your kitchen. If relapses and binges were predictable, the efficacy of treatment would sky rocket. No scientist can determine exactly where every bit of strawberry ice cream is going to land.
The Enablers
While there is dependency on illicit substances a secondary dependency can occur within a family system. When someone’s spouse is an alcoholic, they’re at risk of enabling their spouse to continue the cycle in the following ways:
- Excusing his or her behavior
- An enabler’s self-worth can be tied to the drug or alcohol dependent person
- Growing feelings of guilt, embarrassment and anger
Think about that for a second. If you’re involved with an alcoholic, whether you are a spouse, friend, family member, partner, co-worker or the like, aren’t you going to make excuses for that person to avoid negative feelings such as guilt and embarrassment? Enabling doesn’t happen out of thin air. Enabling follows a subtle progression.
- Stage One – Protection: Small tasks are completed for the dependent such as calling in sick, going to court with them or paying their attorney’s fees.
- Stage Two – Controlling: Taking over finances, paying extra to maintain housing or trying to control the dependent’s substance use.
- Stage Three – Super People or Martyr: Enabler receives feedback for “being so strong” or “standing by his or her side”. At this juncture, the enabler has become accustomed to the role.
Why do people enable a substance abuser in their family? It’s possible that taking care of someone’s issues can mask an enabler’s co-dependency because, according to their equally blind or enabling loved ones, they are “fighting a good fight” for their spouse, mother, brother, father, what have you. Maybe the enabler’s father was an alcoholic and the caretaker role is what was asked of the enabler growing up, setting the framework for involvement with another person that needs caretaking in the future. Enabling can become a lifetime role. This isn’t a referendum on the enabler’s though. What’s going on with the substance abusers and what are they affecting in their path?
Effects of Substance Abuse on the Family
According to Drugabuse.gov the following social problems are occurring due to substance abusers:
- Drugged Driving: The National Highway Traffic Safety Administration estimates that drugs are used by approximately 10 to 22 percent of drivers involved in crashes, often in combination with alcohol.
- Violence: At least half of the individuals arrested for major crimes including homicide, theft, and assault were under the influence of illicit drugs around the time of their arrest.13
- Stress: Exposure to stress is one of the most powerful triggers of substance abuse in vulnerable individuals and of relapse in former addicts.
- Child Abuse: At least two-thirds of patients in drug abuse treatment centers say they were physically or sexually abused as children. Approximately 50% to 80% of all child abuse and neglect cases substantiated by child protective services involve some degree of substance abuse by the child’s parents
The overarching concern is that substance abuse does not occur in a vacuum and it can become a family disease. Substance use can push family members to their breaking point, impact the stability of the home and hinder the physical and mental health of the family. There are some helpful programs that can assist a family with breaking the cycle of abuse in a home.
- Al-Anon.org: For family members of alcoholics.
- Nar-anon.org: For family members of addicts.
- coda.org: For co-dependent individuals.
- adultchildren.org: For adult children of alcoholics and addicts.
Just Stop It, Okay?
There are times that a family will use an intervention in an attempt to get through to their loved one. An intervention is a professionally guided process that has a basic framework with several individualized variables depending on the substance of choice, severity and length of use and the strength and willingness of the support system in place. An intervention specialist is hired to do a job and it’s up to the family on how far they’re willing to take it until they feel like they should claim defeat. When they give up the care usually falls in the hands of local hospitals and the justice system. Should a family choose to use an intervention specialist and their loved one agrees to get help, cautious optimism is warranted because the work is just starting. There are times that someone’s substance abuse has gotten to a point where it requires a multimodal intervention that can come in the form of medication, individual therapy, family therapy, vocational rehabilitation, social services involvement and many other possibilities to help support the abuser and prevent a full-blown relapse. For starters, when withdrawing from substance abuse a person, depending on the chronicity, severity and length of abuse may experience mood swings, restlessness, depression, anxiety and physical discomfort. Some drugs used to treat withdrawal effects are:
- Opioid Addiction
- Methadone
- Buprenorphine
- Naltrexone
- Alcohol and Drug Addiction
- Naltrexone
- Disulfiram
- Acamprosate
Let’s Talk About Your Feelings
In addition to drugs to ease the withdrawal effects it is recommended that the recovering abuser engage in behavioral therapy to increase the effects of the medical intervention. Therapy can assist a recovering substance abuser with modifying their attitudes toward substance use and expanding their responses to stress and triggers to include healthy coping skills that have often led to substance abuse. Some of the modes of therapy are listed below:
- Cognitive Behavioral Therapy – seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
- Contingency Management uses positive reinforcement such as providing rewards or privileges for remaining drug free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
- Motivational Enhancement Therapy uses strategies to evoke rapid and internally motivated behavior change to stop drug use and facilitate treatment entry.
- Family Therapy (especially for youth) approaches a person’s drug problems in the context of family interactions and dynamics that may contribute to drug use and other risky behaviors.
The Beginning of the End
It’s unfortunate that, even from birth, certain people are already at risk for substance abuse and it seems unfair that some people have to work harder than others to achieve the same goals. It’s important to be aware of your family history before you start drinking socially with friends even when experimenting with drugs or alcohol in high school. An illicit substance can easily take place of healthy coping skills that are often a cornerstone of someone’s success in life. It’s possible Stephen Curry was going to be an NBA star no matter what and I’m willing to bet Johnny was going to be the same but his dad fell asleep in the recliner after his fourth Jack on the rocks and won’t wake up to bring Johnny to basketball practice.