TABLE 1.

Impact of SUD on Family Life Cycle Stages

Stage	Developmental Tasks	Impact of SUD on Developmental Tasks	How Social Work Can Help
Married without children	Establish healthy marriage with boundary from family of origin.	Poor communication, impairment of emotional and physical intimacy, increased conflict.	SUD counseling, couples counseling, referral to AA/NA, Al-Anon, Nar-Anon.
Childbearing families	Create safe, loving home for infant and parents. Establish secure attachment with child.	Home not physically or emotionally safe due to impairment and labile mood. Insecure attachment with infants.	Assess safety for children and spouse, SUD counseling, couples counseling, referral to AA/NA, Al-Anon, Nar-Anon.
Families with preschool children	Adapt to needs of preschool children and promote their growth and development. Cope with energy depletion and lack of privacy.	Inconsistent parenting, possible abuse, neglect, Child Protective Services involvement, removal of children, marital conflict.	Assess safety for children and spouse. Provide parenting skills, SUD counseling, couples counseling, referral to AA/NA, Al-Anon, Nar-Anon.
Families with school-age children	Fitting into the community of school-age families. Encourage children's education.	Educational needs of children not met. Possible domestic violence, conflict at home.	Collateral contact with school, SUD counseling, couples counseling, referral to AA/NA, Al-Anon, Nar-Anon.
Families with teenagers	Balancing freedom with responsibility. Establish healthy peer relationships. Develop educational and career goals.	Teens may follow model of parent with SUD. Children have difficulty forming healthy peer relationships due to impaired early attachment. School/legal problems and family conflict. Anxiety, depression, or oppositional disorders.	Family therapy, Teen Drug Court, collateral contact with school, vocational training, referral to AA/NA, Al-Anon, Nar-Anon, Alateen.
Families launching young adults	Release young adults with appropriate assistance. Maintain supportive home base. Young adults develop careers.	Failure to launch due to adult children being unable to support themselves, relationship conflict.	Family therapy, vocational training for young adult, referral to AA/NA, Al-Anon, Nar-Anon.
Middle-age parents	Rebuild the marriage. Maintain ties with younger generations.	Marital conflict, adult children may disconnect from parents and not want them to be around their young children.	Couples counseling, connect with community activities, referral to AA/NA, Al-Anon, Nar-Anon.
Aging family members	Coping with bereavement and living alone. Closing the family home or adjusting to retirement.	Isolation, depression can lead to SUD or vice versa.	Individual therapy, collateral contact with adult children, help get elderly connected to senior community to reduce isolation.

Note. This table has been adapted from Carter and McGoldrick's (1989) model of the stages of the family life cycle. Modifications have been made to Column 2 to identify concepts relevant to the family with a SUD, and Columns 3 and 4 are contributions of the authors of this article.

SUD = substance use disorder; AA = Alcoholics Anonymous; NA = Narcotics Anonymous.