The family is our basic primal connection to others. It is a naturally occurring interpersonal system. Unfortunately, the family does not always provide the healthiest support system. Inter-familial dynamics may be unhealthy from the start (often called dysfunctional). This situation, which may or may not include traumatic experiences, can increase the risk for someone developing mental illness or SUD (substance use disorder). When a person is in active SUD, family relations are challenged and, at times, strained or damaged. Trust may be broken. This can result in conflicted relationships, sometimes irreparably. I have known families that have given up and totally separated from their loved one in active addiction in order to save what is left of the family system, and their own health.

Many of us are familiar with the idea that addiction is a family disease. Like other serious chronic conditions, the effects of SUD reverberate throughout the family. Family resources such as time, finances, and emotional stamina may be taxed to the brink of exhaustion. Frustrations are common and may be related to inter-personal conflicts often stemming from lying, stealing, and other addiction related behaviors. This leads to a break down in trust in the family. In addition, there is often stress related to lack of treatment resources, no clear direction or standard of care, and unclear or conflicting recommendations from health professionals. When my son, Tim was in active addiction, his behavior and my frustration with not seeing progress resulted in angry voices, slamming doors and, often, tears. 

Within the family system, members may have their own disparate perceptions and attitudes as to how to respond or react to their loved one’s addiction. Some may blame the individual for what they believe are poor choices and selfishness. They may be frustrated with what they may interpret as an uncaring attitude or lack of motivation on the part of the person with SUD. Parents often struggle with feelings of guilt, responsibility, and inadequacy in not being able to prevent such a problem and then in not being able to “fix” their loved one and protect them from further pain. There may be blame and judgement from within the family and from others in the community, who see inadequate parenting or a moral failing as the reason for the addiction occurring. Others may blame the parents for “enabling.” This term is used to describe behavior that may be result in denying the severity of the problem or actually sustaining the unhealthy  behaviors of addiction. Too often this term is used to blame parents and others who are desperately trying any means they can to help the individual with SUD avoid negative and and potentially lethal consequences.  A family that I know had a daughter in the throes of opiate addiction that was living on the streets and prostituting herself. The parents would at times find her and bring her home for a hot meal and warm bed, knowing that she would return to the streets the next day. They lived with the hope that one day their daughter would decide to stay home and find a way into treatment. Unfortunately she died from medical complications of Intravenous drug use.

Another perspective in the family may be one of sympathy and compassion. This may be manifested in denying or at least minimizing the problem, or in a more healthy and balanced view that the addicted individual is struggling against a seemingly hopeless situation. Understanding that addiction is a medical problem will help the family find realistic strategies to help the individual get on the road to recovery. Family members often have to advocate and insist that their loved one receives proper and comprehensive treatment, at times risking their own financial and emotional resources to make these opportunities available. My wife and I, on two separate occasions, stayed for two weeks with my son, calling treatment centers every single day and hoping for an opening into a treatment program. Few people in active addiction have the emotional stamina to do that on their own for 14 days. 

Recovery is also a family process. The focus is about establishing and/or repairing healthy connections. Many in long term recovery credit supportive relationships as key to ongoing recovery. This can happen in many ways. In addition to family relationships, twelve-step programs provide a place for acceptance and connection, as can a job or other social situations. 

When supportive family relationships can be maintained or repaired this can result in a valuable resource for the person in recovery. Family therapy is recognized as an integral part of a comprehensive recovery program. When this is the case, family can provide 

a safe and supportive environment for the person in recovery to focus on their personal growth and health. Families can help by providing assistance with finances, childcare, housing, and transportation that allows the individual with SUD to focus on their self-growth and sustained recovery. This environment can be a place to repair diminished self-esteem, a refuge from judgement and discrimination, and a place of continued love, acceptance, forgiveness and hope. 

It is obvious that traumatic family relationships can play a significant role in the potential development of a substance use problem. Families with an individual experiencing substance use disorder often struggle with their response and reactions to this problem. In the end, strengthening family relationships as part of a comprehensive recovery plan will improve the chances of success for the individual and the family as a whole.