Article review and analysis methods

Drug Abuse and Families

Results from the 2009 National Survey on Drug Use and Health, the latest survey available from the U.S. Department of Health and Human Services, estimated that 21.8 million Americans, ages twelve and up, were current (past month) drug users. The figure represented an increase of .7% over the previous year. Families of substance abusers can find themselves in crisis, experiencing a range of emotions from helplessness to frustration, fear, and anger. "Loved ones struggle with extraordinary questions about loyalty, love, support, and limits" (Denning, 2010, p. 164). There is considerable evidence in the current literature that families are often devastated by drug use and employ various means to cope. The purpose of this paper is to review three articles that discuss the challenges families face when one or more members have an addiction to drugs.

As pointed out by Saatcioglu, Erim and Cakmak, abuse is a family disease and requires joint treatment of family members (2006, p. 125). With respect to family dynamics, there are strong parallels between alcoholism and drug abuse. The authors suggest that many of the treatment approaches involving families of alcoholics may also be applied with families of drug abusers.

Saatcioglu et al. use the system theory to describe the family. There is the basic structural unit as well as subsystems that may consist of individuals, dual groups, triads, or more (e.g., parents, male family members, female family members, siblings). According to the authors, the system has to adapt to stress, such as substance abuse, and transform in a reactional manner. Families react in different ways, either ignoring or rationalizing the problem, or becoming completely dysfunctional and chaotic as a result. In some ways, however, the family dynamics the authors discuss do not wholly generalize to drug abuse. Alcohol is a legal substance for adults. Alcohol is easier to obtain and there may be members of the family who can drink responsibly, while someone else in the same family is an alcoholic. There may be someone in the family who is a high-functioning alcoholic, meaning s/he never misses work because of the disease and functions at acceptable levels in most situations. Using illegal drugs, however, is against the law whether it is a parent or child using them. Still, the system theory can be applied, as families can be in various states of denial, acceptance, and willingness to take action. Whether the abuser uses drugs or alcohol, the substance abuser is the person, according to the authors, who can tip the family balance. The authors suggest that clinicians can apply the same treatment approaches to family systems in drug abuse as they can in alcoholism.

Da Silva, Noto and Formigoni (2007, p. 301) point out that while death is a natural and inevitable process, it can still be devastating for families, even more so when death was caused by a drug overdose. There are social and moral stigmas that may cause family members to feel shame and the need for secrecy and denial, in addition to feelings of anger, helplessness and guilt. To learn about family reactions and coping mechanisms when a drug-related death occurred, the authors interviewed families in Brazil who had experienced this sort of devastating loss. In one group were the families who had been aware of the drug use before their relative died of an overdose; the other group had no prior knowledge of drug use.

The family members who did not know about the drug use described terrible pain and grief. Besides coping with the loss, they were "deprived of information that could allow some kind of action" (Da Silva et al., p. 305). They felt cheated and betrayed. Their sense of loss was intensified by the shock of discovering such an awful secret about a love one.

The families whose loved ones were known drug abusers were prepared for the worst. Although they were greatly saddened by the deaths, they all expressed feeling resigned that it would happen. There was a tremendous amount of anger and guilt; survivors felt as though they should have been able to do something to save their loved one. They also felt guilty for feeling a sense of relief that there was some kind of closure, even a tragic one. Family members said it was painful to worry and wait for something bad to happen. One family reported it was helpful to meet with other families through Narcotics Anonymous and share experiences. Another family felt that therapy was useful. One family reported that the survivors had a better relationship with one another after the overdose because the household was calmer and the stress and tensions removed. Every family attempts to cope in its own way.

Denning (2010, p. 165) states "Being the loved one of a person with an alcohol or other drug problem can be excruciating." Available support groups (e.g., Nar-Anon, Al-Anon) often provide guidelines for practicing "tough love," which Denning states does not work. People with substance abuse problems are complicated, as the drug use itself is complicated. A month in rehab seldom solves the problem. Denning suggests instead that harm reduction principles are put into practice, beginning with an understanding that addiction is not a disease "but rather a maladaptive pattern that has biological, psychological, and sociocultural origins" (p. 166).

The harm reduction family treatment Denning discusses focuses on the family coming to grips with their own reality and the reality of the loved one who abuses drugs. In other words, what can family members do to alleviate some of the worry and pain associated with having a drug abuser in the family. For example, a father decided his daughter could not come in the house because she routinely stole from him. To hold on to a relationship with her, however, he took her to dinner once a week. Another man divorced his wife, while another man decided to stay in his marriage, making arrangement with relatives for care of the children when his wife became high. These people all found solutions that worked for them.