Many American families find themselves dealing with what seems like an unstoppable force for destruction. Addiction plagues many families and significant others on a daily basis. Many families lack the knowledge or understanding of how addiction impacts a family unit. Often, once chaos, financial burden, and hardship plagues a family, due to a family member suffering from addiction the family is left wondering how, why and what contributed to their loved ones’ situation. Often, many family members and marriages are torn apart by the devastating and long-lasting impact that addiction leaves on a family. Families wonder what they could have done better and what they could have changed. This article will discuss why addiction is more than a mere individual issue and will help educate families about why and how they can make lasting changes in their loved one’s life, and for themselves. The family unit is a system. The famed clinician, Dr. Murray Bowen, researched family dynamics and pioneered the treatment and model of Family Systems Theory. This approach is useful when trying to glean an understanding of addiction. In fact, Dr. Bowen’s first research into family systems focused in large part on analyzing alcoholism. Alcoholism is often a trait that is passed down both through heredity, and also due to systemic dynamics observed and practiced within a family system. Looking at a family through a lens of a system is like looking at a car with all its interworking pieces. Without a steering wheel or tires, a car could not operate. Similarly, when a family system is broken or dysfunctional, such as in the case of a parent with an addictive disorder, it leaves the entire system out of balance, and sometimes inoperable. Additionally, when one part of a system is dysfunctional, other parts of the system often over-function in order to keep up. This can be called homeostasis and often poor coping mechanisms, poor communication, and faulty defense mechanisms begin to be the norm. This leads to repeated patterns of behavior that sometimes lasts generations.
Many families dealing with a family member with addiction have heard the term “enabling.” Enabling by definition is giving permission to another to do something. In most addiction cases, family members often knowingly or unknowingly “give permission” to a substance user within their family. Often the family outwardly says they want their loved one to change or stop their addictive behavior, but because of ingrained patterns or faulty systems behavior, and overcompensating, many family members indirectly support continued addictive patterns, despite their words and best intentions. This is what enabling is all about, and it can be often found in dysfunctional family systems. The term enabling grew out of the Al-Anon peer support group, a 12-step group created for family members dealing with an addicted loved one. It also is referred to in more clinical models such as Family Systems Theory. Enabling has many keys factors, but the primary concept from a family systems perspective is that due to emotional stress or dysfunction, some key people in a family system begin making excuses or attempt to overcompensate for another member. This is usually the addicted family member. Often, fear that the addicted family member will die, get in legal trouble, or further hurt the function or reputation of the family, leads members to make repeated attempts to gain control of the faulty behavior. These attempts usually fail and fail again. The system becomes strained, there is yelling, crying, bargaining between family members and the one using. This leads to emotional fusion and a decrease in “differentiation” or healthy interdependent behavior within a family. Often it looks like grown adults trying to parent grown adults, which is never a pretty picture.
In addition to generational transmission, a process of behavioral teaching and practicing that lends itself to generations of addiction and dysfunctional behavior, families often must realize the underlying genetic factors can play a role in addiction within a family. Modern research has opened the door for understanding family addictive process on a broader level. While there is no specific gene that codes for addiction, it has been researched and found that many aspects of behavior associated with addiction are passed on. So, what does this look like? If both parents are alcohol dependent, the offspring will be significantly more likely to develop the same malady. This has also been shown with biological twins. The good news is that there are many children of substance abusers that do not end up addicted. While this may be true sometimes, system theory looks at historical and genealogical patterns to illuminate potential problems. Genetics plays a role, in impulse control, reward circuitry of the brains, as well as with depression and anxiety, a large factor for self- medicating and ending up with an addiction problem. Genetics also plays a role in personality and how well stress is tolerated. In general, the less someone tolerates stress, the more prone they can be to fall into addictive patterns. This process of poor stress tolerance is one that is directly hinged on genetic factors. In short, if parents do not tolerate stress well, the children will be at risk for the same. Much in that same way that addiction to substances can come from genetic factors, so can controlling and enabling behavior. Personality, while hinged on both environmental and genetic factors, it is widely agreed that genetics often plays the primary role. Couple this with learned behavior, and it is no wonder why generations of dysfunctional alcoholic families can be seen and studied. If one wants to understand addiction within the family, doing a good look over the family tree can provide a good starting place. Often clinicians will use a genogram, which is a clinically developed “mapping” technique that looks at various components of family trees, such as addiction. After looking at both systemic issues and genetic components to addiction within a family, it is crucial to look at treatment for the entire family. Attempting to treat an individual without treating a family unit will often lead to relapse or failure. This is because any system that does not require function of all parts, will inevitably return to the previous dysfunctional pattern that occurred before. This is why family treatment is such a crucial part of treating any one person with addiction issues. Only with simultaneous treatment of the family and couple system, will allow for a marked change with that system, allowing both the addicted patient and family to change to a more optimal behavior pattern. So, what does the family treatment of addiction look like? It is really quite simple, any treatment or detox program for any addictive individual, should also offer some sort of family therapy program. These programs often differ from program to program. Traditionally 12-step programs would recommend that spouses, family members and children of addicts should attend Al-Anon or Alateen. This model should not be confused with actual family therapy or treatment. While the 12-Steps can provide family members with needed support and some spiritual philosophy, it fails to do offer two critical components. One, it does not provide actual therapy, or a process of clinically trained individuals working to assist in the counseling of the family process. This is necessary for learning communication skills, as well as to work through hurt from both sides of the family. Two, it does not allow for integration with the addicted patient, who has been diagnosed with addictive use disorder. So often during the course of experience for a family dealing with addictive illness, many emotional wounds, lack or trust, and failure to communicate has been at play for sometimes decades. It is crucial that families attend therapy together to repair and restore needed attachment bonds in a new healthy way to improve a family’s and individual’s outcome.
Family therapy and specifically family systems therapy, allows both an addicted patient and their family to work through much of the dysfunction that preceded treatment. Family therapy also allows people to share their needs, ideas, and what works for them, getting away from the lopsided and over-functioning behavior that often allows addictive problems to continue and grow. Finally, it allows a needed conversation about what life will look like for the family and individual after treatment is finished. Families must understand that every member must learn new ways to function healthier and more productively if the system is to grow and change for the better. It is also crucial for an addicted patient to understand what boundaries and expectations family members have of them moving forward. Conversely, it is crucial that family members understand that a person that has worked through substance use disorder has a new way of thinking. Often this is a struggle for family members. Even though they always dreamed and hoped for recovery and abstinence, dealing with a family member that used to hide out, be passive, not communicate is often very different and challenging from a healthier adult person who sets boundaries and requires family members to have respect for their new ways of handling their situation and recovery. In summary, addiction affects the entire family. This maladaptive pattern can lead to years of systemic dysfunction. Often, despite best intentions, advice, and attempting to control an addictive family member, a family becomes disengaged, angry and hostile. All members are left in a state of stress that leads to further dysfunction. Reasons for this family behavior and addictive illness within families are multigenerational processed and encompass both learned behavior and genetic factors. These deeply ingrained traits that are inherited as well as repeated within families, lead to cycles where it is impossible for both individuals with addiction, as well as their family members to function without professional help. While there have been traditionally 12-step peer support groups, they fail at targeting more important factors that are required to get a system functioning healthy again. This is why it is crucial for families to be treated in conjunction with any one specific family member that struggles with addiction. Furthermore, it is important that any family or individual seeking substance abuse treatment does not do so without making sure the family as a whole seeks out family therapy. Family Systems Therapy is one such model that was created out of evidence-based research by Dr. Bowen, who studied alcoholism within families. Working on differentiation with family members, as well as supporting direct communication, leads to improved outcomes for both the family and the newly sober patient. Only with this type of help, will a system be able to avoid a return to the pitfalls of homeostasis or repeated addictive behavior. At APEX Recovery, we help you identify motivating factors for long-term change, develop necessary skills to maintain recovery and include your loved ones in your recovery. We treat individual patients and their unique needs through a model that we recognize is not a “one size fits all”. Our admissions coordinators are available 24 hours a day to give you the support you need to make positive changes. Call APEX today.