Addiction doesn’t affect only the person who has the substance use disorder. Addiction is a disease that affects every member of the family system as they develop unhealthy coping behaviors to maintain equilibrium in a dysfunctional household.1 Family members may deny or manipulate reality to cope with instability and chaos, and children in the household may act out or withdraw. Family members may unwittingly take on the role of enabler, such as by minimizing the situation or making excuses for their loved one.
What is Addiction?
To understand how addiction and the family system affect each other, it’s important to understand addiction itself. Addiction is characterized by the inability to stop using a substance even though it’s causing problems in your life. It’s a chronic, progressive and relapsing disease of the brain that affects brain function and behavior.
- Chronic means that there is no cure for addiction, but it can be sent into remission for the long-term.
- Progressive means that without professional help, the addiction typically grows worse.
- Relapsing means that using again once in recovery can cause the addiction to return, characterized once again by continuing to use the substance despite the problems it causes.
- Disease means that addiction can be systematically diagnosed, observed, treated and prevented. It has biological and environmental underpinnings like many other chronic diseases such as diabetes and hypertension.
According to Harvard Medical School, addiction develops as the result of brain changes that occur with chronic abuse of a substance.2 Drugs and alcohol affect the reward, pleasure, memory and motivation centers of the brain, causing physical changes in their structure and interfering with normal chemical activity.
As dopamine floods the brain’s pleasure center when you use drugs or alcohol, the brain’s memory center records a memory of that pleasure. Each time the substance is used, the memory of the pleasure and the connection between the pleasure and using the substance become stronger.
With chronic drug abuse, the brain’s pleasure center may begin to communicate with the part of the brain that governs the planning and execution of tasks. Your brain begins to associate liking a drug with wanting it, and the result is powerful, intense cravings that are very difficult to withstand.
These cravings are very similar to the ones that make us want to eat food and procreate for survival, and they’re so powerful that they can motivate someone to seek out drugs or alcohol even if they know that doing so will cause serious problems with their relationships, physical and mental health, finances and legal status. They will continue using drugs or alcohol even though they want to quit or have tried to stop using.
Addiction almost always requires professional treatment to end the cycle of remission and relapse and promote successful long-term recovery.3 Good intentions and willpower are rarely enough to overcome an addiction.
Family Roles in Addiction
In many cases, family members of an addicted individual will develop unhealthy behaviors of their own in order to cope with the many negative effects of addiction. Family roles in addiction may include enabling and codependent behaviors that can allow the addiction to grow worse or keep a loved one from getting help.
Enabling behaviors are those that directly or indirectly support your loved one’s substance abuse. Enabling behaviors to remove the consequences of the addiction in order to keep the peace, ensure your loved one’s safety or help you feel in control of an out-of-control situation.
Enabling behaviors include:
- Using drugs or alcohol with your loved one so that you can keep an eye on things, keep your loved one out of trouble, or make sure he gets home safely.
- Keeping your feelings to yourself so that you don’t upset or anger your loved one.
- Accepting your loved one’s justifications for his substance abuse.
- Minimizing the situation, such as by telling yourself it isn’t as bad as it could be.
- Protecting your loved one’s image—or your own—by minimizing the negative consequences of the addiction, such as by making excuses for his behavior, bailing him out of jail, or taking care of his responsibilities when he fails to do so.
- Going out of your way to make it appear to others that everything is fine at home.
- Feeling guilty when your loved one has to face up to the consequences of the addiction, as though you should have been able to make things better.
Codependency occurs when you develop certain unhealthy behaviors as a result of trying to adapt to increasing dysfunction within the family system. If you’re codependent, you’re likely so concerned with your addicted loved one’s problems that you neglect your own needs and wants.
Codependent behaviors include:
- Worrying obsessively about your loved one’s substance abuse
- Living in denial by lying to yourself or others about your loved one’s substance abuse
- Avoiding contact with people outside the immediate family because you don’t want to have to make excuses or talk about the addiction
- Neglecting your physical, emotional and spiritual needs in favor of focusing solely on your loved one and their addiction
- Reacting irrationally or even violently to events related to the addiction
- Low self-esteem resulting from putting all of your focus on your loved one
- Misplaced anger at your loved one that ends up aimed at others, such as the kids or the pets
- Engaging in compulsive behaviors that are unhealthy but help you cope with the addiction, such as eating, shopping or surfing the Internet
- Basing your mood on your loved one’s mood: If they’re happy, you are too, but if they’re not, it can ruin your day
Why Treatment is Essential for Successful Recovery
Treatment is crucial for overcoming an addiction. During treatment, a variety of therapies are used to address the highly complex issues underlying the addiction, which may include chronic stress, mental illness like depression or anxiety, a history of trauma or a lack of coping skills.
Cognitive-behavioral therapy is a cornerstone of addiction treatment and helps clients learn to evaluate their thoughts, attitudes, and behaviors and replace those that are self-destructive with those that are healthy and productive. Clients develop an arsenal of coping skills and strategies to help them combat stress, manage cravings, deal with other triggers and successfully navigate high-risk situations.
A high-quality treatment program will include a variety of other traditional and alternative therapies that help clients delve deeply into a range of physical, mental or spiritual issues that may be holding them back from fulfillment in life and keeping them mired in addiction. This holistic approach helps to improve self-esteem and increase self-awareness as well as bolster confidence and help clients find purpose and meaning in life.
Family Roles in Addiction Treatment
The Substance Abuse and Mental Health Services Administration stresses the importance of family involvement in treatment.4 Family roles in addiction are complex, and addiction affects family members in a variety of ways. Because dysfunction in the household is a major trigger for relapse, improving the state of the family system is crucial for a better chance at long-term success. Family members often need help understanding the nature of addiction and addressing the effects of the addiction in their own lives in order to fully and appropriately support their loved one in recovery.
Family therapy offers family members a safe place to work through a variety of issues to help restore function to the household, an important factor in successful recovery. The family learns healthy ways of communicating and works on restoring trust and repairing damaged relationships.
Psychoeducational workshops help family members understand the nature of addiction and how it affects brain function and behavior. They learn about enabling and codependent behaviors and develop a toolkit of skills and strategies to best help their loved one navigate recovery once treatment ends.
- It helps to increase motivation during treatment.
- It gives family members a safe place to voice their feelings and concerns.
- It gives the addicted family member the opportunity to understand how the family is affected by the addiction.
- It helps to ensure the highest possible level of family support during and after treatment.
- It helps family members identify and address any mental health issues that may contribute to the addiction.
Once an individual enters treatment, the family is also in recovery. Getting involved in a loved one’s treatment is as much about repairing the family system and helping family members heal as it is about sending the addiction into remission.
Family Roles in Addiction Recovery
Treatment only goes so far in helping family members recover from the effects of addiction, since the focus in generally on the addicted individual and the issues that stem from the addiction. In addition to getting involved in a loved one’s treatment plan, family members should seek outside help to begin working through their own complex issues, directly and indirectly, related to the addiction. The best ways to do this are to enter therapy and join a support group.
Individual Therapy for Family Members
The National Council on Alcoholism and Drug Addiction stresses the importance of individual therapy for family members affected by addiction. Individual therapy can help you sort through your feelings and address any unhealthy behaviors you’ve developed in an attempt to cope with the addiction. It can help you effectively work through anger, resentment and fear as well as address other negative emotions commonly associated with addiction. It helps you understand family roles in addiction and recovery in both the short-term and long-term. Minor children can benefit greatly from individual therapy, which helps to reduce their risk of developing behavioral or substance use problems down the road.
Support Groups for Family Members
Families who participate in a support group are better equipped to offer positive and healthy support to their loved one during and after treatment. Support groups are populated by people who are experiencing similar circumstances with a loved one. They offer a safe place to turn when you need support, and they help reduce feelings of isolation. Support group members share coping skills and strategies and offer practical advice and encouragement.
Five Important Ways to Support Your Loved One in Recovery
Family roles in addiction recovery will evolve as your addicted loved one works through the underlying causes of the addiction and becomes more confident in sobriety. While ongoing therapy and support groups are extremely beneficial to family members even after treatment ends, there are a number of practical, day-to-day ways to support your loved one in recovery. These five are, perhaps, the most important.
- Take good care of yourself. Taking care of your own physical and mental health in early recovery is essential for ensuring the family continues to heal and move toward a higher level of functioning. Staying healthy also helps you cope with the ups and downs of early recovery in a positive way.
- Have fun together. Recovery should be a joyful time, and an important aspect of relapse prevention is helping people in recovery find enjoyment in life without drugs or alcohol. One of the most important family roles in addiction recovery is finding ways to have fun and enjoy the time you spend together as a family. Finding new hobbies that promote a sober lifestyle and developing new family routines and traditions are important cornerstones of recovery.
- Facilitate important lifestyle changes. Crucial to successful recovery are the big and small lifestyle changes that make sobriety easier and more enjoyable. A healthy lifestyle is absolutely essential for ongoing recovery, and family members can help facilitate healthy lifestyle changes by eating healthier food, exercising as a family, keeping drugs and alcohol out of the house and enjoying activities that don’t involve drug or alcohol use.
- Understand triggers. Triggers are events or conditions that make someone in recovery want to use again. Some of the most common triggers include stress, negative emotions, and feelings of isolation and loneliness. By understanding what your loved one’s triggers are, you can help them cope or avoid the triggers altogether. Dysfunction in the household is a major trigger for relapse, and family roles in addiction recovery once treatment is complete should include continuing to work on healthy communication and coping skills within the family system.
- Understand lapse and relapse.Psychoeducational classes will go a long way toward helping you understand the mechanics of relapse and recognize the signs of an impending lapse. A lapse is an instance of using once an addiction is in remission. A relapse is a return of the addiction, once again characterized by the inability to stop using drugs or alcohol despite negative consequences.
Perhaps the most important thing to understand is that setbacks in recovery are fairly common. Relapse rates for addiction are between 40 and 60 percent, similar to the relapse rates for other chronic diseases like diabetes and hypertension.6 It’s important to understand that relapse doesn’t mean that treatment failed. Rather, it’s often a normal part of recovery, and it’s widely regarded as an opportunity to evaluate what went wrong and develop the missing skills needed to prevent another relapse in the future.
How you and your loved one approach a relapse will have a major influence on whether your loved one returns to recovery quickly and stronger than before. Approaching setbacks with a positive attitude is essential for getting back on track quickly and moving forward in recovery.7
The Guiding Principles of Recovery
The Substance Abuse and Mental Health Services Administration has developed twelve Guiding Principles of Recovery that can help families stay on track with recovery goals and keep the big picture in mind.8 These principles include understanding that:
- Recovery has many pathways, and no single treatment is right for every individual.
- A holistic approach to recovery that addresses issues of body, mind and spirit offers the best chances of success.
- Recovery is supported by peers, family members, and allies in the community.
- Recovery emerges from hope and gratitude. Holding onto hope for a better future and expressing gratitude are the foundations of recovery.
- Recovery is a process, not an end. It’s the process of rebuilding your life, improving your physical and mental health and redefining both the individual and the family.
The last principle is the most hopeful of all: recovery happens. It grows stronger with every passing day, and the more engaged the family is in recovery, the better and happier the outcome for everyone involved.
- Family Disease. (2016, February 24). Retrieved from https://www.ncadd.org/family-friends/there-is-help/family-disease
- How Addiction Hijacks the Brain. (2011, July). Retrieved from http://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain
- DrugFacts: Understanding Drug Use and Addiction. (2016, August). Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction
- Substance Abuse Treatment and Family Therapy. (2004). Treatment Improvement Protocol (TIP) Series, No. 39. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64269/
- Drug Counseling for Cocaine Addiction. (1999, September). Daley, D. C., Mercer, D. E., & Carpenter, G. Retrieved from https://archives.drugabuse.gov/TXManuals/DCCA/DCCA10.html
- Drugs, Brains, and Behavior: The Science of Addiction. (2014, July). Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
- Melemis, S. M. (2015, September 3). Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine, 88(3), 325-332. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
- Definition of Recovery. (2015, July 24). Retrieved from https://ncadd.org/people-in-recovery/recovery-definition/definition-of-recovery