Being a part of a family is unlike any other relationship you ever have in your life. There’s something different about the relationships we have with our siblings and parents, something that we don’t find in other types of relationships. For the most part, we don’t get to choose our family, yet, it is very difficult to escape the “orbit” of your family relationships, even in adult life. Even for those that are estranged from their family, the absence of that family member can still have a very profound impact on areas of their life. When someone in a family unit struggles with addiction, the effects of addiction spread quickly through the family and, without careful attention, can make the addiction both last longer and have more serious consequences.
The interconnectedness of a family system is why treatment professionals say that we treat families in our line of work, rarely individuals. This is fairly obvious in the treatment of adolescents, who, by and large, still live under their parents’ (or parent figures’) roof; however, it is vital in the treatment of adults as well. Rarely do we work with someone who has no contact with or feelings about family. Even if the relationship with a mother, husband, wife, brother, etc. is fractured, creating a plan to progress in that relationship is a major component of treatment. While there is always some individual work to be done on the part of the person in treatment, there is almost always some family work to be done as well. With families, the most common things that we work through are to resolve the immediate consequences of addiction, discover and change the addiction-reinforcing behaviors, and to make meaning out of the addiction itself.
Addiction is a destructive disease, and no one feels the brunt of that destruction more than the immediate family of the person who is struggling with addiction. Perhaps a sudden job loss after a failed drug test has left the entire family on the precipice of financial disaster; maybe a partner has left after too many nights of sleeping alone while the other was out using, or maybe a confrontation about substance use has left an important relationship fractured and in disrepair. Whatever the case may be, a core feature of addiction is self-destruction. Often, as someone begins their journey on recovery, they are recovering from a recent “disaster,” and this disaster also has very real consequences not just for the addict, but their family as well. The family (usually rightly, at this point) does not have any degree of trust in the addict’s ability to move forward in a productive direction and will resist the addict’s involvement in creating a plan to move forward. They may be open to involving the person, but they’ve heard “it’s different this time” one too many times. As difficult as it is, one of my main duties as a clinician at this point in the recovery journey is to help people put aside feelings about past problems and focus on working together in the present situation. I try to empower the person in recovery to take control of some of the things he can handle, and accept that they will have to release control of some of the other things to their family to begin to establish a working relationship. It can be helpful for both parties to view the gain of a working relationship as more valuable than the actual action steps they may take together to solve the problem. Maybe a solution will work better for the family at some expense to the one in recovery—but that’s easier to tolerate if a tangible win from the plan is gaining some of their family’s trust back.
As the family begins to gain some traction on the most pressing problems, space starts to open up to begin having discussions about the things that people have done to hurt each other. When I say “open up,” maybe that’s putting it a bit lightly—while needing to scrape together a few dollars to pay off the overdue bills can push people together for a bit, but eventually the tension brought on by the things each side has done comes crashing through. The family behaviors surrounding addiction can be a destructive cycle. The family member is anxious, so they use drugs to ease their anxiety. Then, the rest of the family discovers the substance use and reacts to it by trying to “fix” the situation—maybe giving a curfew, pressing the family member to “fix” the problem. These things cause more anxiety, which makes more drug use more likely, and the cycle repeats. Divides can become deep, as family members begin blaming each other and seeing each other as the cause of their anger/sadness/frustration/whatever. It is important for a family to begin to—safely—share some of the things that are driving behaviors that push the other away. As the family talks through the things that reinforce each person’s negative behaviors, they begin to learn and practice positive behaviors as well—taking appropriate space from each other, learning the best ways to cope with their stressors, and supporting each other in coping positively.
Finally, as the problems caused by the addiction subside, and the behavior that reinforced the addiction stabilizes, the family starts to work to make meaning out of the addiction. This helps people avoid, as best they can, emotional traps when a sudden emergence of unhelpful behaviors happen. This helps move people away from the mindset of “I’m a failure of a parent because my son used crack” or “my wife loved drinking more than me.” There are tons of value judgments surrounding addiction, and, to build the best base for stable and long-term recovery, each person in the family unit needs to integrate the experience of walking through an acute addiction into their beliefs about themselves, their world, and their hopes of the future. The more a person can move from a meaning resembling “my family member was weak and caused me suffering” to one like “our family has endured and overcome a lot, and the struggle with addiction has made us stronger,” the more stable their recovery is likely to be. It is in this aspect that self-help groups, faith groups, and other supportive social networks are invaluable to the process. While individual and family work that clinicians do prepares a family to get to this point and helps accelerate the process of finding meaning, I have found that the issue of making one’s meaning of the way addiction has touched their lives is a conversation uniquely suited to peer support groups. While meaning is a longer-term issue that may begin in clinical sessions, the meaning is often truly made in community with others.