Abstract
Substance use disorders (SUDs) are associated with numerous medical, psychiatric, psychological, spiritual, economic, social, family, and legal problems, creating a significant burden for affected individuals, their families, and society. This paper focuses on the effects of SUDs on family and social problems and emphasizes the need for clients in treatment to address these domains in their ongoing recovery. Individual, group, and family interventions to address these issues for clients with SUDs and their families are reviewed.
Keywords: family, social, treatment, recovery, addiction
1. Effects of Substance Use Disorders on the Family
Many studies and reports document adverse effects of substance use disorders (SUDs) on the family system and individual members, including children [1–8]. These disorders clearly affect many people in addition to the individual with the problem, often creating a burden for the family and its members. These effects on the family may include:
Emotional burden. Members may feel anger, frustration, anxiety, fear, worry, depression, shame and guilt, or embarrassment.
Economic burden. This may be caused by money spent on substances, or money problems associated with the loss of jobs or reliance on public assistance.
Relationship distress or dissatisfaction. Families may experience high rates of tension and conflict related to the SUD and problems it causes in the family.
Family instability. This may result from abuse or violence, or family breakup due to separation, divorce, or removal of children from the home by Children and Youth Services.
Effects on the developing fetus and children. Alcohol use during pregnancy can harm fetal development causing birth defects and problems in child development. Infants born to opioid-dependent mothers are at increased risk for neonatal abstinence syndrome, which can contribute to developmental or cognitive delays. Children of parents with SUDs are at increased risk for abuse or neglect, physical problems, poor behavioral or impulse control, poor emotional regulation, conduct or oppositional disorders, poorer academic performance, psychiatric problems such as depression or anxiety, and substance abuse.
Effects on parents. Mothers with SUDs may show less sensitivity and emotional availability to infants. Parents of a child with a SUD may feel guilty, helpless, frustrated, angry, or depressed.
The effects of a SUD on a specific family or concerned significant other are determined by the severity of the disorder, the presence of other serious problems such as psychiatric illness, behaviors exhibited by the family member with an SUD, support available for the family, and the family members’ coping strategies. Some family members are more resilient than others and less prone to the adverse effects of the SUD.
2. Social Effects of Substance Use Disorders
SUDs impact the social functioning of individuals and create a burden for society as well. These disorders contribute to medical or psychiatric conditions, disability, and death as a result of accidents or diseases caused or worsened by substance use, or higher rates of suicidality, all of which affect society. Other social problems associated with SUDs include housing instability, homelessness, criminal behaviors (victim or perpetrator) and incarceration, the transmission of HIV due to IV drug use or high-risk sexual behaviors, and unemployment or dependence on welfare. The costs associated with these social problems are staggering, creating an economic burden for governments or payors who spend considerable sums of money on treatments for addiction, medical or psychiatric disorders, and other related problems such as those associated with welfare dependence, unemployment, or involvement in the criminal justice or social service systems.
3. Interventions for Social or Family Problems
Components of comprehensive treatment for SUDs include a continuum of professional addiction and related services (assessment, detoxification, rehabilitation, counseling or therapy, continuing care, substance use monitoring, medications, case management, and mutual support programs) [9]. Social, family, and other problems can be addressed through the use of family, child care, vocational, mental health, medical, educational, HIV/AIDs, legal, financial, housing, and transportation services in addiction treatment agencies or within the community.
Many individual [10–13] and group treatments [14–19] for SUDs address social recovery issues in recovery, as these have implications for relapse and quality of life. These interventions may address issues such as how to: avoid or minimize contact with high-risk people, places or events; resolve relationship problems; develop new friendships; develop a recovery network of sober friends and supportive people; resist social pressures to use substances; improve communication or assertiveness skills; ask for help and support from others; engage in substance-free social activities; engage in mutual support programs; and/or make amends to those harmed by one’s SUD.
Family interventions can help the family influence or pressure the member with the SUD to enter treatment and get help, address the impact of the SUD on the family system and members, help the family support the member with the SUD, and help the family address their own reactions and problems associated with their loved one’s SUD. The latter may involve participation in treatment, family support programs, or both.
There is considerable literature supporting couples and family approaches to SUDs [5, 9, 20, 21]. These may reduce the emotional burden for family members and enable them to cope more effectively with the affected family member. The following are strategies adapted from the literature on engagement, treatment, and recovery to help families.
Engage the family in care
When possible, engage the family in the assessment process and early in treatment. Outreach efforts may be needed to engage families in treatment. A number of effective interventions have been used with families to increase their rates of involvement with the family member with the SUD in treatment [8, 9, 22].
Provide education
Families benefit from education on SUDs (symptoms, causes, effects), treatments (including medication-assisted treatments), recovery challenges for members with a SUD, relapse, mutual support programs, the impact of SUDs on families and members, and professional services and mutual support programs available for families.
Provide or facilitate family treatment
Couples or family sessions can help families address their questions and concerns, change how they interact within the family system, and improve communication. Families can also benefit from addressing their own emotional burden and behaviors that can interfere with the recovery of the member with the SUD. Treatment can be provided in sessions with the individual family or in multiple family groups, which provide a supportive environment for families to share their common experiences and concerns. Families can form bonds with each other and learn what has worked for others.
Reduce the emotional burden of the family
Family members experience a wide range of emotions such as anger, fear, anxiety, and depression. The burden experienced by the family can be reduced as they learn about specific disorders, get support and help for themselves, identify with other families experiencing similar problems, and share their own feelings and concerns. As families feel empowered by learning information and acquiring new coping skills, their emotional burden often lessens.
Help the family support the member with the SUD
Members can attend sessions together to learn ways to help the member with the SUD without “enabling” this individual. Learning about potential relapse warning signs or actual episodes of substance use and how to intervene early in the relapse process can empower family members. So can participating in discussions of a continuing care plan following completion of a rehabilitation program.
Help family members engage in recovery to meet their own needs
Families often benefit from mutual support programs like Al-Anon or Nar-Anon, which provide them the opportunity to learn from others affected by a loved one’s SUD. These programs mainly aim to get family members to focus on themselves and what they can do to make positive changes. Initially, it is common for families to focus most of their attention on the member with the SUD. However, these programs aim to get families to focus on their own needs and engage in recovery to address these needs.
Focus on children
Families can be helped to understand the impact of SUDs on children and examining how their own children may have been harmed by the SUD in the family. Parents with SUDs can be encouraged to talk with their children about their impact on their family and the children, and maintain an open dialogue with kids to address their feelings, questions, or concerns. They can help kids learn about SUDs, treatment, and recovery. Establishing normal routines and rituals in the home, taking an active interest in the child’s life, engaging them in family activities, and facilitating an evaluation for a child with a psychiatric or substance use disorder are other ways of helping the family.
4. Conclusions
SUDs are associated with many social and family problems. These problems create challenges for the member with the SUD in treatment and/or recovery, the family, and society. There are many effective interventions and treatments, and mutual support programs, to help individuals with SUDs and families address these issues.
Families can help their loved one in several ways: facilitate their involvement in treatment; attend sessions together to address the SUD and recovery needs; engage in ongoing discussions about recovery, and what can and cannot be done to help the member with the SUD; point out early warning signs of relapse that their loved one may ignore; and help them stabilize from a relapse should one occur.
Families can also help themselves by discussing their experiences with the member with the SUD, examining their own behaviors and emotional reactions, and dealing with their own reactions. This can be accomplished by involvement in treatment, mutual support programs, or other programs. While family members often enter treatment and/or mutual support programs initially to help their loved one, they often discover that they need emotional support and help themselves since SUDs can have many effects on them.
Acknowledgments
The preparation of this paper was supported in part by NIH NIDA grant U10DA020036.
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