This was a presentation to social workers based upon requests to know more about substance abuse and dysfunctional families.

So How Does Substance Abuse Cause Changes In the Family?

Drugs and alcohol are substances that alter people by producing changes in:

• Aggression – Research shows that substance abuse is not a risk factor for many factors in and of it self; however, substance abuse can strength other risk factors. Where there is a risk for violence and child abuse, substance abuse can increase the risk by causing loss of control, decreased inhibitions, and impaired judgment memory and attention.
• Abusers often neglect children, both with regards to physical needs, as well as emotional and cognitive needs. Research has shown that children with heroin addicted parents show the same pattern of cognitive delays regardless of whether the mother or father used sex.
• Substance abuse often changes sexual relationships. Sometimes performance decreases, or marital rape occurs, or previous inhibitions are temporarily lost. People in general are more often willing to excuse actions committed under the influence of alcohol (“It wasn’t him, it was the alcohol…”) verbal interactions.
• Substance abusers are often more prone to engage in conflict, to be emotionally abusive mood.
• Substances alter moods, and can result in increased depression, anxiety, and paranoia. This is relevant not only to the abuser, but also the partner. Research shows that the partner of the abuser is often at the greatest risk for psychopathology.
• Sleep/wake patterns, eating patterns, and personality characteristics can all change when abusing substances. Imagine having two parents; the sober dad who is verbally abusive, and the drunken dad who is emotionally expressive and loving.

How Is Substance Abuse Maintained?

Internal Forces Stabilize the Family

• One partner abuses and the other overcompensates and manages the addiction (“Don’t upset Dad, he’s drinking again”)
• One partner uses and the other becomes functional for a time, then relapses into depression or anxiety and forces the abuser into short-term sobriety
• The parent uses and the children engage in role reversals, becoming parents to each other and the parent
• The family suffers multiple losses due to death by substance abuse, accidents, and crime; the family continues abusing and tolerating, and focuses instead on how much pain they have suffered without addressing the cause

The Family Teaches Its Ways To the Children

• Denial is a well-established pattern:
  • Denial over the seriousness of the children’s acting out, running away, staying out late, sexual activity can cause small problems to become bigger ones before the family addresses them
  • Sometimes the Grandparent becomes Parent. Since they don’t understand their role in the substance abuse of the Parent, they continue parenting the same way, and allow substance abuse to develop in the Child.
  • The Parent has a Grandparent that uses. The Parent may have learned denial, and when the Grandparent’s use increases, Teen starts using and the Parent ignores out of habit
• Unstable discipline is seen. Parents may use very rigid and over-reacting styles, and then at other times ignore the behavior all together.
• Problem-Solving is impaired:
  • Solutions are short-term focused, and often won’t work in the long run. They are also designed only to stabilize the system. For example, if Dad drinks after work and the kids are home alone, Dad may force the 14 year old to serve as disciplinarian. This may work in the short run, but will create more problems than it solves.
  • Whatever behaviors or structures are put into place, they may be abandoned when the crisis is over and the high level of affect returns to normal.
  • Solutions are marked by high affect. If a problem doesn’t stir intense feelings, it isn’t a problem. Members may avoid dealing with minor problems in order to “save up” their strength for the next drinking binge.
• Structure – Patterns of chaos and disorganization continue:
  • Daily routines are not stable, and kids don’t have stable wake up and bed times, meal times, homework schedules, weekend activities, etc…
  • Family routines are not held, one night they eat dinner together, but the next night have to fend for themselves because the parent is abusing; one night the teen is a teen and is under the parent, the next night the teen is asked to go bring the parent home from the bar.
  • Family rituals maintain abuse:
    • During the holidays, the family drinks and the lines between use and abuse are blurred…
    • The children hang out with a substance abusing relative or the parent and are exposed to the abuse again…
    • Parents’ spend gift money on drugs and Christmas is ruined again…
    • Transitions from child to teen to adult may be blurred and children don’t grow up in stages…
• Communication – Communication patterns include substance abuse
  • Family members are shown affection when user is drunk, so being drunk isn’t so bad.
  • Family members give co-dependent advice, like staying with an abuser because he will grow out of it, or it’s not a serious problem, you can’t change them until they want to change themselves.
  • Mom may be more manageable after a few drinks, so dad lets her drink before bringing up problems.
  • “Schizophrenic Communication” develops and the family teaches the children not to talk about abuse, not to direct frustrations to their source, not to raise painful issues to avoid provoking binge, or that problems are associated with intense anger and emotional explosions.
  • Family Values get communicated:
    • Some are that abuse is ok.
    • Some are that codependency is ok.
    • Some are that deviant behavior is ok.
• Empathy – Substances may play a role in closeness and distance.
  • Relatives may share substances to be close and soothe each other. Joining in may be a way to move up in the family hierarchy or move to the next developmental stage.
  • Parents can’t help children label emotions and can’t validate them because they feel the same way and don’t want to label and experience their own emotions. They teach the children to deny and repress.
  • Teens may start using
    • Out of expectations that it’s normal.
    • As reactions to the stress in the family. Denial may come into play here too. You react to Dad’s drinking binges by smoking marijuana to calm down.
    • Or may refuse to use but sell instead. Likely looks down on users and sees selling as a way to gain control over the helplessness they felt as a child under abusing parenting

How Is Substance Abuse Transmitted Across Generations?

• Boundaries – The family deals with issues such as:
  • Where do new romantic partners, new Parent figures, other Grandparents, and half-siblings’ Parent fit in? Parents may see no problem in the new partner caring for the Child despite an alcohol problem. Having too flexible boundaries means you bring in to the family new problems.
  • What do we reveal? The Grandparent may believe that the Parent has relapsed but hide this from the social service agency. Rigid boundaries hide problems in the family.
  • Who is a capable Parent? The Parent may believe it is ok for the Grandparent to raise the child, especially if the Grandparent did not raise the Parent. The Parent may feel the Grandparent can not raise the Child well, but may hide this from worker and agency to avoid losing the Child.
• Developmental Themes – The Parent and the Grandparent work with various assumptions about the Child
  • The parent may be thinking “I had a child too soon, so this Child will not make my mistakes but will do what I wished I had done”
  • The Grandparent may be thinking, “I didn’t do so good a job raising my own Child, but I will redeem myself with this Child” or “I will prove myself with this Child.”
• Differentiation may be upset
  • This is seen when the Parent has unresolved issues toward The Grandparent, but must interact well with the Grandparent to visit the Child, or when the Parent and the Grandparent bond over codependent issues.
• Subtle Sabotage
  • The Grandparent may have labeled the parent as a failure, and break down Parent’s resolve and resistance to relapse.
  • Other people in family may have grown used to Parent’s binges as ways to avoid problems in the family or to be affectionate, and may have increased anxiety now.
  • The Parent may lack money management, discipline, housekeeping, and stress management skills because they used to rely on substances for all this.
• Values – This topic covers ideas about work and education, religion and morality, family loyalty, conflict resolution, how the world treats you, and how problems will be solved…

So What Do You Do?

• Treatment for sobriety and a period of time sober to experience life
• Individual therapy to begin to change dysfunctional dynamics, rectify skill deficits, and uncover problematic issues in the family of origin that impair “living life on life’s terms”
• Family therapy to mend broken bonds, learn new ways to be close and distant, spot ways the family may sabotage, and to “purify” family rituals of alcohol and drug abuse.
  • Treatment of the family will involve identifying their type of family — an Alcoholic Family or a Family with an Alcoholic. The difference is that the Alcoholic Family is participating in the alcoholism and needs treatment, while the Family with an Alcoholic can exclude the abusing member and avoid or limit further trauma to the family.
  • Therapy may also have to address couples work. The 12 Step model includes that partners should not go to groups together, as it should be Anonymous and individual because the problem is only solved on an individual and even day by day basis. However, a couple may spot each others’ triggers, and may sense when the other is about to relapse. One partner may become weak, and “unintentionally” trigger the sober partner to relapse. This kind of dynamic is even more likely if the couple has used alcohol or substances as a way to manage closeness and distance, and a way to connect them. Unresolved resentment can also make your partner into your worst nightmare when it comes to maintaining sobriety.
  • Treatment will also entail identifying the family’s stage in addiction.
  • The Early Phase family doesn’t recognize a substance abuse problem. They recognize the symptoms of the problems as problems themselves and do not understand that they are symptoms of a deeper issue they have not faced.
  • The Middle Phase family does recognize the problem as a substance abuse issue, but have just come to terms with dealing with it head on. The prompt may be a change to a new transition in their lives and a recognition that they are not ready now, or an anticipatory anxiety over the probably shift to a new stage.
  • The Late Phase family may be beyond help. The abuser may never change, and the focus of family therapy may well be to help the children in the family disengage from the dysfunctional aspects of the family, recover themselves, and form new and healthy families to join with.