Substance Abuse And Family Life

It has been estimated that abuse is associated with psychological disorders in about 20 percent of cases (Stark & Flitcraft, 1988). The family plays an important role in factors relating to the development, maintenance, and treatment of substance abuse. The fundamental significance of families as dynamic systems has been recognized and studied (Wolin et al., 1980). Today, treatment plans for substance abusers typically involve family members or significant others. The disorganizing impact of alcoholism on families is perhaps the addiction that has been best delineated, but information about the impact of other drug use is increasing (Kosten, Rounsaville, & Kleber, 1985; Bernardi, Jones, and Tennant, 1989).

Disrupted family dynamics can occur irrespective of socioeconomic status and ethnic group membership. Research involving a large cross-sectional sample found that offspring of substance abusers were more likely to experience marital instability and psychiatric symptoms, especially if they had experienced physical and sexual abuse (Greenfield etal., 1993), and it has also been found that alcohol abuse often co-occurs with domestic violence (Fagan, Barnett, & Patton, 1988; Dinwiddie, 1992). Construction of "family trees,'' or genograms, are now in common use as clinical tools to depict the degree to which abuse of various substances has had effects on several generations in a family, the extent that support is available from family members, and the emotional "valence" of kinship relationships (Lex, 1990). Background factors significant for women include childhood violence experiences, violence from a cohabiting partner, and presence of concurrent antisocial and/ or borderline personality disorders (Haver, 1987).

Substance abuse and child abuse may co-occur under similar family conditions and dynamics, or substance abuse can lead to child abuse (Kelley, 1992). Mediating factors, such as social support and education, income, alternative sources of nurturing, and parents' own histories of familial substance abuse and histories of neglect and abuse are important. It is likely, however, that when mothers who use drugs or alcohol are primary caregivers, they will be unable to fulfill some aspects of their children's emotional or physical needs (Tracy & Farkas, 1994).

One typical factor in family lives of substance abusers is the absent father, who usually is affected in some way by substance abuse and whose familial role has had to be reallocated among other relatives (Bekir et al., 1993; Hayes & Emshoff 1993). Often this pattern is transmitted from the grandparental generation to the parental generation. Involuntarily or out of necessity, the missing role is frequently assigned to a child, who has to assume responsibilities inappropriate to his or her age and generation (that is, to act as a spouse or parent). Some children recall having had to raise themselves, since their parents neglected to nurture them or abused or scapegoated them or controlled their activities excessively. Children's responses can include acting out through anger, antisocial behavior, and estrangement, or compliance and assumption of housekeeping, care for siblings, and other domestic tasks. In adulthood, resentment because of the burdens of these childhood role reversals can promote depression in individuals and affect their adjustment to adult roles, and it can, in turn, damage their relationships with their own offspring. In some cases, the onset of substance abuse in children occurs at the age or life-cycle stage when a parent began substance abuse. Substance abusers often appear to expect parental unconditional love from their spouses that includes unquestioned acceptance of their substance abuse and irresponsible behavior (Bekir et al., 1993). Unstated expectations and other communication difficulties occur when the moods and behaviors of substance abusers are closely tied to those of family members (McKay et al., 1993). ''Low autonomy'' (emotionally dependent) substance abusers, however, appear to respond well to treatment if family members provide more nurturing and support. Conversely, male substance abusers whose attitudes and actions are independent and detached from family concerns seem to exhibit a pernicious individualism that is associated with a poor outcome in treatment.

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