Guide for Families

Part I: The Addiction Problem and Approaching It

Guide for Families Part I: The Addiction Problem and Approaching It

INTRODUCTION

Family can be one of our greatest sources of physical security and emotional support. But family environments can also foster destructive emotions and behaviors, including substance abuse and addiction. The genetic ties that make blood relatives so close can also hold the seeds of compulsive or addictive behaviors, and the self-harming actions that children observe in their parents can become habits that affect their own lives as they grow. Partners or spouses may feel deeply betrayed or abandoned if the person they love turns to alcohol or drugs. Understanding the nature of addiction and the options for treatment can help family members avoid the cycle of addiction or remain close if substance abuse affects their lives.

No matter how much an individual knows about addiction, it can still come as a shock to find out that a relative has a substance abuse problem. While facing the reality that a loved one is addicted can be heart-wrenching, it is easier to confront that reality with the support of professionals and experts who understand the disease of addiction. Substance abuse counselors, family therapists, marriage counselors, spiritual leaders, school counselors, and intervention specialists are a few of the guides who can help families cope with the effects of addiction and mend broken bonds. Learning about the experiences shared by families struggling with substance abuse, and the resources available to cope with those experiences, can make it easier to overcome this all-too-common disease.

Substance Abuse: How Big Is the Problem?

In popular cultural stereotypes of the American family, drugs and alcohol are not part of a happy household. Yet statistics indicate that the problem of substance abuse affects people from all walks of life, including parents, children, spouses, and partners living in otherwise “normal” homes. According to the National Survey on Drug Use and Health (NSDUH) of 2014, one out of 10 Americans age 12 and older used an illicit drug in the past 30 days — a number higher than any year since 2002. The primary reasons for this increase include the rise in abuse of marijuana and nonmedical use of prescription drugs, especially narcotic pain relievers like OxyContin, Percocet, Vicodin, and fentanyl.

Alcohol abuse is also prevalent among American households. Out of the 139.7 million Americans age 12 and older who reported drinking alcohol in 2014, 16.3 million defined themselves as “heavy drinkers,” and 60.9 reported that they were “binge drinkers,” according to the NSDUH.

Underage Drinking

Although alcohol abuse has declined among young adults age 12-20, the NSDUH indicates that underage drinking is still a problem in the US:

  • Current alcohol use was reported by 22.8 percent of underage Americans.
  • Binge drinking was reported by 13.8 percent of this group.
  • Heavy drinking was reported by 3.4 percent.
  • In total, approximately 30 percent of underage Americans engaged in binge drinking, and over 10 percent engaged in heavy drinking.
underage drinking

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the consumption of 4-5 drinks in a two-hour period, while heavy drinking is defined as the consumption of five or more alcoholic beverages on five or more days within the past month.

Substance Use Disorder

When use of drugs or alcohol causes impairment in one or more areas of an individual’s life, this condition is known as a substance use disorder. Substance use disorders are widespread in the US, as the following 2014 statistics show:

  • Approximately 21.5 million Americans age 12 and above had a substance use disorder.
  • Out of this number, 17 million abused alcohol.
  • About 17.1 million abused illicit drugs.
  • Approximately 2.6 million had both an illicit drug and alcohol disorder.

These numbers become even more significant when the families and partners of these individuals are taken into consideration. Each individual who abuses alcohol or drugs touches the lives of a child, parent, sibling, spouse, or partner. Estimates from the Child Welfare Information Gateway indicate that 12 percent of American children live with at least one parent who abuses alcohol or drugs or who has a substance use disorder. Children of substance-abusing parents are at an increased risk of neglect, poverty, and mistreatment, as well as a higher risk of developing a substance use disorder themselves. Up to two-thirds of cases of child abuse involve chemical dependence in some form, and over 30 percent of children removed from their homes by Child Protective Services in 2012 were removed because of parental drug or alcohol abuse.

There is no doubt that parental substance abuse interferes with the physical and emotional development of children, yet addiction also affects the health of the family as a whole. In order for all members of a household to have rewarding relationships and healthy lives, substance abuse treatment must address everyone in the family, not just the individual who uses drugs or alcohol, notes Social Work in Public Health. When researching the resources available for families affected by addiction, it is important to consider the emotional, psychological, and physical needs of all individuals who occupy the home.

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Detecting the Signs of Substance Abuse

No matter how well we think we know the people we share our homes and hearts with, every individual is capable of keeping secrets. Addiction, by its nature, drives the individual to suppress painful emotions and harmful behaviors in order to fuel episodes of drinking or using drugs. The signs of addiction can range from obvious to subtle, revealing themselves in an individual’s appearance, behavior, moods, mental function, occupational status, or finances.

Perhaps most importantly for families, addiction can affect the quality of interpersonal relationships. Addiction can undermine formerly strong relationships, creating an atmosphere of distrust and provoking feelings of betrayal. The following checklist can help family members identify the potential signs of addiction in the early stages of the disease.

When looking for the potential signs of addiction, remember that substance abuse affects many areas of an individual’s life, and one or two changes in habits or appearance do not necessarily prove that a loved one is abusing drugs. These changes may also be caused by conditions such as depression, personal loss, job stress, or a difficult life transition. A mental health professional or addiction counselor can help to determine whether the changes in the person’s life can be attributed to chemical dependence or abuse.

Changes That May Point to Substance Abuse: A Checklist for Families

PHYSICAL HEALTH OR APPEARANCE

  • Poor grooming or disheveled clothing
  • Unwanted weight loss or gain
  • Pale, cool skin
  • Facial flushing
  • Puffiness or bloating
  • Wearing dark glasses at inappropriate times
  • Tremors
  • Drowsiness at inappropriate times of day

MOOD OR EMOTIONAL BEHAVIOR

  • Irritability
  • Mood swings
  • Unjustified outbursts of anger
  • Tearfulness or sadness
  • Expressions of hopelessness
  • Giddiness or irrational laughter
  • Social isolation

PSYCHOLOGICAL CHANGES

  • Confusion
  • Unexplained memory loss
  • Paranoia
  • Delusional thinking
  • Hallucinations

OCCUPATIONAL OR EDUCATIONAL STATUS

  • Poor performance at work
  • Job termination
  • Decline in grades at school
  • Neglect of favorite school activities
  • Absenteeism at work or school

If you’ve checked off at least one of these characteristics from two or more categories, and your loved one has displayed a habit of using alcohol or drugs, it is likely that they have a problem with substance abuse. It can be tempting to mask the problem by attributing it to outside circumstances (“She’s going through a rough time since she got divorced,” or “He’ll stop drinking once he’s done with this stressful project.”). However, a pattern of destructive use of drugs or alcohol indicates that the person involved, as well as the entire household, needs help and support in order to recover from this disease.

How Addiction Affects the Family

Substance abuse affects a family on every level: emotional, psychological, financial, and social. A parent’s preoccupation with getting drunk or high can lead to neglect or abuse. The use of alcohol and drugs can lead to financial hardship, poverty, or bankruptcy. Shame and embarrassment over a family member’s intoxicated behavior can lead to social isolation and the avoidance of friends or relatives outside the home. These factors can create a destructive cycle in which substance abuse leads to emotional pain or mental instability, which triggers an even greater craving for alcohol or drugs.

Worst of all, addiction undermines the loving, trusting relationships that sustain a healthy family. Children may be forced into a parental role for parents who can no longer function independently. Spouses may hide their addictions from their partners, lying about their actions or expenditures. Parents of addicted children may go to great lengths to rescue a son or daughter from a destructive lifestyle, only to experience the heartbreak of seeing their child return to that lifestyle again and again. Restoring those relationships, which were often damaged long before the substance abuse began, requires time, patience, and the support of knowledgeable addiction professionals.

Approaching the Problem

It’s never easy to bring up the subject of substance abuse with a family member, but in most cases, the person with the problem will not be the one to initiate this conversation. Whether your loved one is your child, parent, or partner, there are certain techniques you can use that will help to make this difficult discussion a little easier and less painful. By the same token, there are approaches and attitudes that should be avoided in order to reach your goal of getting help for your loved one.

Approaches to Talking to Loved Ones about Addiction

PRODUCTIVE

  • Ask sensitive questions. “How do you feel about your life these days? I’ve noticed you’re drinking more than usual.”
  • Use the pronouns “I” or “we.” “I feel frustrated and sad when I can’t talk to you after you’ve been drinking.”
  • Have a clear treatment plan ready. “We’ve found a good rehab program close to home; we want you to get outside help.”
  • Stay calm and compassionate. “I know this is hard. I’m here for you.”
  • Seek support from others. “Your brothers and sisters are here for you too, and we’ve found a counselor who can help all of us.”

COUNTERPRODUCTIVE

  • Make angry accusations. “You never spend any time with the kids anymore; you’re too busy getting high.”
  • Use the pronoun “you.” “You don’t listen to me when you’re drunk!”
  • Make bargains that allow substance use to continue. “If you cut off your drinking by 7 p.m., I’ll give you one more chance.”
  • Act judgmental or outraged. “You’re being weak and inconsiderate; using meth is a crime, you could stop if you really wanted to!”
  • Try to tackle the problem alone. “I can’t handle this by myself. You and your drugs are too much for me to deal with.”

For many families, the prospect of approaching substance abuse is so daunting that they would rather hide the problem than confront their loved one. It’s important to remember that while it may be uncomfortable, facing the problem actually provides a path to healing and reconciliation. Denial only sets up further barriers to recovery.

Seeking Outside Intervention

Even when families approach the subject of addiction with a compassionate, nonjudgmental attitude, there are times when the best attempts to help a loved one fail. Addiction is a chronic disease of the brain that can distort reality, making the individual feel that change is impossible. When a person is caught in the cycle of addiction, the brain’s overwhelming need for chemical gratification can overpower their sense of reason. If confronted by family, the loved one may lash out in anger, turn inward, or even become violent. Communication may seem impossible, and parents or partners may be left feeling helpless.

When communication breaks down among family members, it could be a good time to seek help from a professional who understands the effects of substance abuse. Some of the best sources of professional guidance in an addiction crisis include:

Substance abuse counselors: therapists or social workers with specialized training in addiction treatment

School counselors or psychologists: professionals with experience working with children and adolescents

Spiritual leaders: pastors, rabbis, priests, or other religious guides

Marriage and family therapists: licensed therapists with advanced degrees and certification in family therapy and couples counseling

Professional interventionists: therapists, counselors, psychologists, or social workers who specialize in overcoming the barriers that prevent persons with substance use disorders from seeking treatment

An experienced professional can help a family break through the resistance that blocks the way to treatment. This process often occurs through a formally structured intervention. An intervention is a prearranged meeting with the loved one who is using drugs or alcohol, in which concerned family members, friends, or coworkers of the individual gather to discuss the problem and attempt to persuade the individual to seek treatment.

During the meeting — which may or may not be arranged with the individual’s knowledge of the reason for the discussion — the specialist gathers with the concerned family members to talk about the problem and present a solution. The two primary goals of an intervention are (1) to help the person with the problem see the relationship between substance abuse and the problems in their life, such as job loss, failure in school, relationship conflicts, or financial problems, and (2) to persuade the person to get into treatment. Many interventionists recommend presenting the person with a contract that clarifies the family’s expectations and clearly states the consequences that will occur if the individual does not meet these expectations or refuses treatment. Expectations might include making changes in behavior or stopping certain activities, as well as agreeing to go to detox and rehab. Sample expectations and consequences are listed below:

EXPECTATION

CONSEQUENCE IF NOT MET

Jeff will not take the car without his mother’s permission.

Driving privileges will be removed.

Amy will come home from school by 4 p.m. unless she has a prearranged school activity.

Amy will not be allowed to go to social events on the weekends.

Bill will attend at least one AA meeting per day for the next 90 days, as recommended by his sponsor.

Bill’s employer will suspend him from his job.

Melinda will enroll in an outpatient drug rehab program that begins tomorrow.

Melinda’s partner will make arrangements for a temporary separation.

Doug will pay his child support on time every month

Doug’s custody privileges will be revised or revoked.

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Intervention Success

According to the National Council on Alcoholism and Drug Dependence, interventions are successful 90 percent of the time when they are conducted with the help of a trained professional. However, family members who participate in an intervention must be prepared to follow through on their expectations and consequences; otherwise, the individual is likely to return to their destructive behavior.

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