FAMILY SYSTEMS AND THE
IMPACT OF SUBSTANCE ABUSE
Impact on Family
Developmental Stages
Early Phase
Chemical dependency emerges and proves
powerful in the family, that all other issues are
ignored.
Individuals are powerfully influenced by their
families of origin
Chemical dependency affects family identity
formation in two instances
I. Family enters the early phase with an already
established problem of dependency
II. Chemical dependency arises while the family is
working out its identity issues
Brooks/Cole, Cengage Learning, 1999
Impact on Family
Developmental Stages
Middle Phase
Committing to set of family norms that will ensure
stability is the major task for the middle phase of
development.
The chemically dependent family builds:
I. Maintenance activities around a core of alcohol
II. Drug-related behaviors
Family development , because of chemical dependency
invades the family regulatory behaviors and becomes
altered.
During the middle phase the seeds of generational
transmission of chemical dependency are being sown.
Brooks/Cole, Cengage Learning, 1999
Impact on Family
Developmental Stages
Late Phase
The family’s identity is firmly established in this stage and the
major task is recognizing and stabilizing as it plans for the
future.
Generational transmission of alcoholism or addiction is clearly
noticed:
I.
Transmission of beliefs and values regarding the use of
alcohol or drugs
II. Perspective of family culture is incorporated and then
transmitted into the children
The family is now forced to make an explicit statement about
chemical dependency. The nature of that statement
determines which possible options or pathways the family will
follow.
Brooks/Cole, Cengage Learning, 1999
Impact on Family Developmental
Stages
The four different
pathways or options
the alcoholic family is
directed include;
The Stable Wet
Dependent Family
The Stable Wet or
Controlled Use
Nondependent Family
The Stable Dry
Dependent family
The Stable Dry
Nondependent Family
Impact on Family
Developmental Stages
The Stable Wet Dependent family:
I. Evidence of an accommodation of the family to
the chemical dependency and its related
consequences
II. The family has taken a firm stance
III. Family members periodically challenge and
question the wisdom of this way of life
IV. Family members may also threaten to leave
unless change occurs
V. The family seems to have lost its ability, but its
will to change
Brooks/Cole, Cengage Learning, 1999
Impact on Family
Developmental Stages
The Stable Wet or Controlled Use
Nondependent Family:
I. Although drinking or drug use may not stop,
movement strives away the dependency as
a core development or identity issue
II. The reduction of consumption from time to
time
III. Drug use is no longer a controlling factor in
the family regulatory behavior
Brooks/Cole, Cengage Learning, 1999
Impact on Family Developmental
Stages
The Stable Dry Dependent
family:
I.
The family has
successfully negotiated a
conversion to no use by
the dependent
II.
There is no movement
away from the dependent
family identity
III.
Behavior patterns that
has been established
around the dependent
continue to dominate
family life
The Stable Dry Nondependent Family:
I.
The drug use has stopped, but
the family has given up its
preoccupation with drugs and
drug-related issues
II.
Some families make no
particular commitment to
reorganize the family, just no
longer focus on drug-related
behavior
III. This stage does not resolve
issues related to the dependency
but also involves major family
reorganization and
transformation of individual
members
Brooks/Cole, Cengage Learning, 1999
Critical Issues in Chemically
Dependent Families
The most vulnerable members of any family are
children. The impact of chemical dependency on
the family’s regulatory structure and international
patterns can in themselves create adverse
outcomes for developing children.
Rules and disciplinary inconsistencies;
I. Projection of blame
II. Extreme rigidity or lack of boundary definition
III. Lack of trust
IV. Role confusion
Brooks/Cole, Cengage Learning, 1999
Critical Issues in Chemically
Dependent Families
Alcohol and drugs serve as a disinhibiting factor in
many cases of child sexual abuse and domestic
violence.
Some factors that contribute to domestic violence
include;
I. Child abuse, examples are;
a) Physical sexual abuse, any kind of touching in a
sexual way ranging from sexualized hugging or
kissing to actual intercourse
b) Emotional sexual abuse, involves a parent’s
inappropriate bonding with a child to get his or her
emotional needs met
Brooks/Cole, Cengage Learning, 1999
Critical Issues in Chemically
Dependent Families
Factors that contribute to domestic violence
continued;
I. Shame, a defined factor that is associated with
chemically dependent systems
Shame differs from guilt.
Shame is an intensely painful feeling about one’s self as
a person and can seriously damage emotional growth
Guilt constitutes regret for an action and presents the
opportunity to assert personal values, make amends,
and to grow from the experience
Shame-bound families operate according to rules that
demand control, perfectionism, blame, and denial
Brooks/Cole, Cengage Learning, 1999
Critical Issues in Chemically
Dependent Families
The Families,
 Every year, more than 3 million children witness domestic
violence in their homes.
 Children who live in homes where there is domestic violence also
suffer abuse or neglect at high rates (30% to 60%).
 A 2005 Michigan study found that children exposed to domestic
violence at home are more likely to have health problems,
including becoming sick more often, having frequent headaches
or stomachaches, and being more tired and lethargic.
 A 2003 study found that children are more likely to intervene
when they witness severe violence against a parent – which can
place a child at great risk for injury or even death.
http://www.safehorizon.org/index/what-we-do-2/domesticviolence--abuse-53/domestic-violence-the-facts-195.html
Critical Issues in Chemically
Dependent Families
Family Survival Roles:
I. The Chemically
Dependent person
II. Codependent
III. Family hero
IV. Scapegoat
V. Mascot
VI. Lost Child
Critical Issues in Chemically
Dependent Families
The Chemically
Dependent Person;
Process of projection
Attempting to place on
others the responsibility
for using and for the
family’s problems.
Codependent; this role is
taken on by the enabler
Enabler is characterized
as a person who reacts, in
such a way; as to shield
the dependent from
experiencing the full
impact of the harmful
consequences, of the
disease
Critical Issues in Chemically
Dependent Families
Family Hero;
Generally the oldest child in
the family and works in
close alliance with the
codependent to maintain
the family homeostasis
The hero is likely to grow
up to marry an alcoholic
and assume the role of
enabler
Scapegoat;
The problem child, with
disruptive behavior that
demands urgent, fast
attention
The scapegoat is keenly
aware of the manipulative
communication of the
enabler and the hero with
chemically dependent
person
Brooks/Cole, Cengage
Learning, 1999
Critical Issues in Chemically
Dependent Families
Mascot;
The member who at least tries
to bring some fun and humor
into the family and usually
functions as the family pet
Characteristic defensive
behaviors are hyperactivity,
charm, being super cute, and
doing anything to get a laugh or
be the center of attention (the
joker)
Brooks/Cole, Cengage Learning,
1999
Lost Child;
The lost child has much in
common as the scapegoat. Both
feel insignificant and
unimportant within the family
and learns quickly that the
family spends its prime energy
and creativity in protecting the
dependent person
The role of the lost child lays in
being overweight, physical and
emotional distances,
promiscuity, sexual identity
problems or sexual dysfunction
Critical Issues in Chemically
Dependent Families
A wide range of services is available for those who have experienced
violence in their homes or in dating relationships. They include:
 Individual counseling for survivors of abuse, and children and teens who
have witnessed abuse.
 Family counseling for children and their non-abusive parents.
 Group counseling for women, children and teens.
 Men's groups for men who have used abusive behavior in intimate
relationships.
 Case management and advocacy services, including help acquiring
public assistance, orders of protection, housing and shelter as well as
referrals for other services when necessary.
http://www.childrensaidsociety.org/family-support/domestic-violence-preventionintervention-services
Critical Issues in Chemically
Dependent Families
Adult Children of Alcoholics: Characteristics
 guess at what normal is....have difficulty in following a
project through from beginning to end.
 ...lie when it would be just as easy to tell the truth.
 ...judge themselves without mercy.
 ...have difficulty having fun.
 ...take themselves very seriously.
 ...have difficulty with intimate relationships.
 ...overreact to changes over which they have no control.
 ...constantly seek approval and affirmation.
 ...feel that they are different from other people.
 ...are either super responsible or super irresponsible.
About.com Alcoholism, 2013
Critical Issues in Chemically
Dependent Families
West and Prinz (1987) also consider that other
factors may increase the probability that short
and long term psychological, social and physical
problems may ensue for children raised in
chemically dependent homes.
Other factors may include; higher divorce rates
more family conflict, more parental
psychopathology, economic factors, physical
abuse and neglect, and birth complications
Brooks/Cole, Cengage Learning, 1999
Family Assessment
The purpose of conducting a chemical
dependency assessment is to determine the
severity of the clients problems based on
symptoms and longevity of symptoms in order
to determine the best interventions.
When conducting an assessment of someone’s
alcohol or drug use, it is helpful to understand
the clients goal for seeking professional
services. The clients answer should be a part of
your clinical consideration.
Martha St. Enterprises, Inc. 2009
Family Assessment
Common reasons to seek help include:
I. To stop use due to the progression of
consequences
II. To stop use because of potential consequences
III. To stop or limit use to get someone off their
back
IV. To limit use to not accumulate consequences
V. To decide if the person actually has a problem
with alcohol or drugs
Martha St. Enterprises, Inc. 2009
Family Assessment
Substance Abuse Assessment questions may include;
 1. How much are you using?
 2. What is the frequency of use?
 3. Have there been any changes in frequency or amount of use? If
not, how long has this amount and frequency of use been for?
 4. What is your drug of choice?
 5. Any history of poly substance use?
 6. When was first use?
 7. What has been the longest period of no use?
 8. Have you ever tried to change the amount or pattern of your
use in the past? What did you do?
 9. Any family history of chemical dependency?
 10. Have you ever been in formal treatment?
 11. Are others concerned about your use?
 12. Are you concerned about your use?
Family Assessment
Substance Abuse Assessment questions continued;
 13. Have you experienced tolerance – the need to use more of the drug
to create the same effect?
 14. Do you ever experience withdrawal when not using?
 15. When you come down from the drug, do you ever experience
thoughts of wanting to hurt yourself? Have you ever done so?
 16. When was your last physical exam, where there any problems?
 17. Consequences fall into five categories. I’ll describe the category and
you tell me if you have ever experienced problems in this area of your
life due to your use.
 a. Health
 b. Financial
 c. Relationship
 d. Work/school
 e. Legal
 18. What do you want to do differently, if anything, about your use?
Martha St. Enterprises, Inc. 2009.
Working With Chemically Dependent
Families
To work effectively with
chemically dependent
families, counselors need a
conceptual framework that
acknowledges all the
complexities involved.
Framework views the
family as a social unit
Brooks/Cole, Cengage
learning, 1999
Working With Chemically
Dependent Families
There is one simple fact when working with families in
addiction treatment: family participation greatly increases the
person's chances for recovery.
Goals of The Family Treatment
 Provide factual information on addiction and families.
 Decrease the family’s response to the chemical
dependency.
 Encourage family members to gain their own sources of
support.
 Assist families in learning healthy ways to support their
loved one’s recovery.
St. Christopher's Addiction Wellness Center, 2009-2013
Working With Chemically
Dependent Families
In addition in working with chemically dependent families, there are down
falls that necessarily won’t be effective. Such as;
1. When too much data is given by the family members at once, not
enough time is available for the deeper exploration necessary for
effective counseling. The counselor needs to place the focus more on
the process of what is occurring in the family, than on the content of
the complaints.
2. A counselor’s reluctance to encounter resistance can result in not
meeting issues head on. Upsetting the family balance and risking
possible outbursts are often necessary to promote change.
3. A counselor eager to see quick results may attempt to push change
before the parties are ready
4. The counselor, for whatever reason, may be unable to maintain a
basic respect and caring for the family members or may tend to side
with one family member against another.
Brooks/Cole, Cengage Learning, 1999
The Family Recovery Process
Pretreatment Stage
This stage encompasses the
motivational crisis that brings
the family or individual family
members into treatment
Stabilization Stage
This primary task of the
stabilization stage is the
family members’ recognition
that they did not cause the
addition, but are responsible
for their own contributions to
the problems and
dysfunctions
The Family Recovery Process
Early Recovery Stage
In the early recovery period,
the family members begin to
emotionally and cognitively
process their own
motivational crisis or crises
Middle Recovery Stage
Within the middle recovery
stage, the family begins to
rebuild self-image and selfesteem and establishes a
personal structured recovery
plan
The Family Recovery Process
Late Recovery Stage
During this stage, the family
members must begin to
identify and resolve longterm life problems and to
work on issues of the family
of origin and identity
Maintenance/Remission Stage
This stage of necessity,
requires a full acceptance by
each individual for the need
for life-long recovery through
continued personal growth
In Conclusion
The Treatment Improvement Protocol explains that
family therapy in substance abuse treatment can help
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 and to ameliorate the
impact of chemical dependency on both the patient
and the family. Family therapy, the treatment
improvement protocol says, can help families become
aware of their own needs and aid in the goal of keeping
substance abuse from moving from one generation to
another. It is very crucial that any counselor be
educated in the treatment process and further proper
training and licensing, but they should know enough to
determine when a referral is indicated.
About.com Alcoholism, 2013
References:
1) Chapters 7 - 12 of Chemical Dependency: A Family Affair
2) PowerPoint presentation on concepts associated with
substance use disorders and family treatment
3) Read research article titled ,The Psychological
Characteristics of Children of Alcoholics.
4) http://psychcentral.com/lib/recovery-from
codependency/00014956
5) http://alcoholism.about.com/cs/adult/a/aa073097.html
6) http://www.adultchildren.org/lit/Problem.s
7) http://www.become-an-effectivepsychotherapist.com/Chemical-DependencyAssessment.html
8) http://www.addictionwellness.com/Family_Program.html
9)http://alcoholism.about.com/od/fam/a/blsam041004.html
10)http://www.draonline.org/chemical_dependency.html