Yet, substance use disorder affects many more than the addicted individual. Consider this: 30% of the general population knows an addict or alcoholic firsthand, and an additional 10% of the general population currently lives with one (National Council on Alcohol and Drug Dependence). Despite the overwhelming empirical data justifying an aggressive and proactive approach, fewer than 10% of those afflicted with substance use disorder receive proper treatment, and fewer than 5% of those treated for addiction will seek help voluntarily (Join Together Staff Writer).
A closer look at addiction reveals many components of the disease are shouldered by someone other than the addict—most likely members of their immediate family. The grueling task of providing assistance often falls on the people closest to the addict and those most empathetic to their struggles. Often, despite their heroic efforts, the family’s good intentions result in enabling the addict and worsening their disease. These families care about their loved one but contain complex interpersonal relationships which are affected profoundly by the addicted family member. Despite altruistic and sometimes monumental efforts to help, issues of co-dependency, enabling, and lack of education often impede the family support system from being effective.
One major reason why families develop co-dependency and enabling traits is to soften the embarrassment of social stigma associated with addiction. Fear of punitive reactions, societal judgment, and shame are often reported as reasons why assistance is not sought proactively. More importantly, family members and loved ones often fall under the spell of co-dependency and become affected by the disease by proxy. Co-dependency is more than enabling bad behavior; it has been defined “as a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition, most commonly addiction” (Daily). Co-dependency can develop between the addict and a protective spouse, an overly attentive coworker, inappropriately doting parents, or a lax and tolerant employer, to name a few examples. Co-dependency is a significant indication that addiction affects the entire family, not only the person using the substance. As addiction progresses, so too does the co-dependent behavior, dysfunction, and maladaptive behavioral patterns within the family.
These co-dependent roles are subconsciously assumed with the primary objective of maintaining a balanced family social system. The family members’ co-dependent relationships are often gradually revealed only after one person’s addiction is uncovered. Once that happens, changes in family behavior and personalities become easily identifiable. The addicted individual becomes the center of the family’s attention. The balance of the family system is derailed, and the use of the substance becomes the most important aspect of the family’s life. The addict starts to leverage position within the family to garner support through sympathy, guilt, shame, denial, and fear. Individualized manipulation is a significant tactic used by the addict, and through repetition, they begin to lose the ability to maintain behavioral control. If the addicted person is confronted, stories of personal struggles and trauma are used to garner sympathy and dissuade the family from addressing the glaring substance use indicators. These dynamics discourage family members from seeking help for either themselves or their addicted loved one.
Nurturing Healthy Family Systems
As the family system gradually becomes dysfunctional in the wake of addiction, so too can it heal and improve. A healthy family system is one that uses specific boundaries to safeguard the integrity of its members. Learning about substance use disorder and healthy family dynamics, and applying this knowledge consistently, is key.
Well-informed Family Members
All members in the family must be educated and well informed about substance use disorder. This can be achieved through individual and family counseling, 12-Step programs like Al-Anon and other support groups. For those living in remote areas, sheltering from COVID-19, pressed for time, and/or caring for children, virtual and telehealth options make these resources more accessible than ever. Families can also gather useful information by visiting reputable online resources such as the Substance Abuse and Mental Health Services Administration or the National Institute on Drug Abuse. Your local substance use prevention organizations, mental health treatment facilities, and recovery centers will have additional resources.
Enabling Vs. Empowering
Members of a healthy family system must be willing to hold their addicted loved one accountable for their behavior. It cannot be the responsibility of a family or family member to control the addict’s substance use. To heal, the substance user must accept all responsibility for their behavior. To support this, the family must be willing to create, articulate, and maintain reasonable, enforceable boundaries and consequences.
Consistency is Key
Often, an addict will attempt to reach their desired outcome by manipulating multiple members of the family separately. Yet, to ensure the substance user bears full responsibility for their actions, the family must remain united with consistent boundaries and objectives. When family members are all able to respond the same way during a crisis, healing and growth within the family system can continue.
Family Members Need Support Too
Psychotherapy benefits everyone in the family system. Just as the addict needs support to overcome their dependencies, family members need support to learn how to set healthy boundaries and protect their own physical, emotional, and mental health in the face of crisis. Unlearning co-dependency requires commitment from everyone involved, and trained professionals can assist in that process. The prevalence of telehealth therapy options makes attending professional counseling sessions easier and safer.
Improving the future through education, effective intervention options, and emotional support, families can learn how to best care for each other. This benefits not only the substance user but also their loved ones. Addiction is a family disease, and in their own way, all family members can heal and grow with commitment.
“Public Policy Statement: Definition of Addiction. Quality and Practice.” American Society of Addiction Medicine. 2016.
Daily, J. “What Drives Addiction? What Drives Co-dependency? Is the Real Question.” Recovery Happens Counseling Services. 2014.
Join Together Staff Writer. “New Data Shows Millions Of Americans With Alcohol And Drug Addiction Could Benefit From Healthcare.” Partnership for Drug Free Kids. 2010.
“Understanding Addiction.” National Council on Alcoholism and Drug Dependence. 2016.
“Mental And Substance Use Disorders. Behavioral Health Trends In The United States: 2014 Statistics.” Substance Abuse and Mental Health Service Administration. 2014.
Claudia Garcia, MBA, BSN, RN, CADACII, LAC, COO Parkdale Center, Chesterton, IN
Jeffrey A. Coto, DNP, MS, CNS, CCRN Assistant Professor - Valparaiso University, Valparaiso, IN
Adapted from “Addiction: A Nursing Family Affair,” published in Indiana State Board of Nursing Focus, August 2016, Edition 47.