Hi XXXXXXX

As you have rightly mentioned, family roles and addiction go hand in hand. Other family members play a significant role in one of the member’s addiction to either alcohol or drugs. When a family is dysfunctional, each member assumes different roles to cope. Although it is not determined that the family itself causes addiction, the family members and their roles contribute either to the wellness of everyone in the family or the deterioration of the relationship among the members. Usually, a family that takes on certain roles suffers from some form of addiction, like drug and alcohol abuse.

In a systems approach, the roles of the family must be determined so that the appropriate action will be taken to make sure that everyone in the family can contribute to a creating positive therapeutic environment for the client with the substance abuse problem. I have discussed below some of the important dysfunctional family roles / states which need to be addressed in therapy.

One of the well known phenomena observed in a majority of families where one person is addicted is “Co-dependency”. Co-dependency happens when one or more family members are preoccupied by the addict’s behaviour. They feel unnecessarily guilty when they do not take care of that person’s needs. The co-dependent member or members do not consider their feelings important, do not feel that they are good enough, do not feel that they are lovable and deserving of love, and do not think that it is acceptable for them to have problems. They do not think that they have the right to have fun. They feel utterly responsible for a significant other’s behaviour.

Another important contributing family factor for the development of addiction is “Modelling”. Alcoholics usually develop their alcoholic behaviours from people around them. In alcoholic families, there is usually an alcoholic parent, or both.

Yet another well-known family factor which can play a significant role in addiction is “Enabling”. The ‘enabler’ can be in the form of a parent, a spouse, a sibling, or even a friend who tries to help the addict. The enabler constantly makes excuses and denies that the addict has a problem with his addiction. He ends up helping the addict obtain more drugs or alcohol, or both, without realizing that what he does makes the addiction worse. Even in himself, the enabler denies that his loved one is stricken with an addiction that is hard to overcome. An enabling behaviour exhibits efforts to keep the family in balance, making sure that everyone is alright, even if it means blocking out the real issue of addiction in the family. Enabling behaviours are those that try to control the situation by doing some things that the addict approves of. These enabling behaviours try to appease or satisfy the addict.

So, prompt identification of such dysfunctional family roles will help a great deal in treating or preventing substance abuse. Family interventions in substance abuse treatment can help in the following ways:

1.     By using the family's strengths and resources to find ways for the person who abuses alcohol or drugs to live without substances of abuse

2.     By ameliorating the impact of chemical dependency on both the patient and the family.

3.     By making families become aware of their own needs and aid in the goal of keeping substance abuse from moving from one generation to another.

In a systems approach, family interventions can be incorporated at various stages of addiction treatment:

1)     Prior to substance abuse treatment and intervention – this will aim at improving family communication so as to encourage and move the client towards treatment. This type of positive family involvement can also help lead the rest of the family toward a journey of recovery and self-discovery.

2)     During a patient’s substance abuse treatment program – this will aim at involving and working closely with the family members, so that unhealthy family dynamics, enabling behaviours and other counterproductive relationships are addressed. The positive aspects of emotional and moral support and positive motivation from the family are utilized to the fullest potential.

3)     After a substance abuse treatment program - there truly is no clear-cut “end” to the addiction therapy process. Families struggling with the effects of their loved one’s addiction are encouraged to involve in therapy on a regular basis to continue a constructive program of support, ongoing education and motivation.

However, like I had mentioned in the previous answer, inculcating such family-based interventions in a systems approach can have certain risks involved, like:
-     Ethical concerns with issues like individual rights and confidentiality
-     Over involvement of certain family members, with vested interests
-     Power struggles during decision-making processes
-     Challenges in dealing with unorthodox family set-ups or cultural variations in family dynamics
-     Therapists who are not specifically trained and experienced in such family-based therapies can jeopardize the effectiveness of therapy or sometimes, even make it counter-productive.

So, it is important that well trained, culturally sensitive and confident therapists are able to utilize the strengths and protective factors of the family-based interventions, and at the same time be able to keep the client’s therapeutic needs in the forefront.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist

---