Knowledge about the effects of addiction on families and the family recovery process has grown exponentially as a result of scientific studies and cumulative clinical experience. Among the most important conclusions to date that can be drawn from this body of knowledge are the following.
1. Alcohol and other drug (AOD) problems spring from diverse influences; unfold in widely varying patterns of severity, complexity, and duration; and are resolved through multiple pathways and styles of personal and family recovery.
2. The effects of addiction (a generic term used for the most severe patterns of AOD problems) on the family are influenced by the role of the addicted person within the family, the timing of addiction within the family life cycle, the degree of co-occurring challenges faced by the family, the cultural context within which the family is nested, and the resilience resources and recovery capital available to the family.
3. Addiction can be transmitted intragenerationally and intergenerationally via multiple, interacting mechanisms. These mechanisms include the following: a) genetic and neurobiological influences (e.g., those with family histories of addiction are at increased biological risk of developing a substance use disorder), b) assortative mating (i.e., the propensity of individuals to select intimate partners with shared family and developmental experiences) intensifies both biological risk and substance use as a preferred coping mechanism), c) parental/sibling/spouse modeling (i.e., substance use as a learned behavior and one potentially initiated and coached through the influence of other family members), d) adverse childhood experiences with multiple traumagenic factors (e.g., early trauma, multiple episodes and duration of trauma, more boundary-invasive forms of trauma, multiple perpetrators, perpetrators drawn from family or trusted social network, failure of belief and protection when trauma is disclosed), d) historical trauma (e.g., such as that experienced by Native American tribes), e) early onset of AOD use (early onset increases risk of addiction, greater problem severity, more rapid problem progression, and a longer course of problem resolution), and f) environmental factors (e.g., drug-saturated neighborhoods, social promotion of excessive AOD use). In short, the addiction of one family member increases the risks of addiction in other family members; addiction in past and present generations increases the risks for addiction and related problems in future family generations.
4. Family roles, rules, rituals, and relationships; the frequency and quality of family interactions with kinship and social networks; and the global health and functioning of family members are all severely disrupted by addiction. These effects can be far-reaching, with effects on children carrying into their adult development, including their future intimate and family relationships. (See interviews with Claudia Black, Stephanie Brown, Sharon Wegscheider Cruse, and Jerry Moe)
5. The adaptations families make to survive the immediate threats of addiction enhance short-term safety and emotional survival of family members and lower threat of family dissolution, but also constitute roadblocks to long-term personal and family recovery.
6. With proper coaching and support, families can play a catalytic role in recovery initiation and maintenance of the addicted family member and the family as a whole. (See interview with Robert Meyers)
7. The recovery of affected family members can begin prior to the initiation of recovery by the addicted family member. The improved health of affected family members increases pressure for change in the addicted family member. Strategic actions can be taken by families that increase opportunities for recovery initiation.
8. Family-focused addiction treatment and recovery support services generate recovery outcomes superior to treatment focused solely on the addicted person.
9. Recovery can destabilize family relationships if families are not provided ongoing support through the recovery process. According to the research of Dr. Stephanie Brown, addiction-affected families in recovery need “scaffolding” of support to manage the transitions from active addiction to stable recovery. Lacking such support, families that absorbed and survived every addiction-related insult may be fractured (i.e., family dissolution) during the recovery process.
10. With support, families can achieve a level of health and functioning superior to that which existed before the family was impacted by addiction. Addicted individuals and their families have the potential to get “better than well.”
11. With support (including the options of peer and professional support services), families can heal and break intra- and intergenerational cycles of addiction and related problems. (Recovery of one family member increases the probability of successful recovery of other family members. See Here.) Families that lose a family member to addiction also need a recovery process—a process that can be enhanced through peer support and professional guidance.
12. Individuals and families in recovery can play a larger role in healing communities wounded by addiction via their support of others affected by addiction, their recovery advocacy activities, and larger service to their communities.
It is time—no, past time—that the basic unit of service within recovery support service settings shifted from the individual to families and kinship networks. Making that shift will require substantive changes across the addiction treatment and recovery support service continuum.
Coming Soon: Couple Recovery
William (“Bill”) White
Emeritus Senior Research Consultant at Chestnut Health System
Read all of Bill White's Blog Posts on his website here www.williamwhitepapers.com