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Key points
- A family is a system, and what happens to one member happens to the whole.
- Each family copes and responds differently to a substance use disorder.
- However, there are common patterns in families' responses, including taking time to discover the problem, living with it, and separating from it.
On a family road trip, our adventurous driver wondered what would happen if he put the car into reverse while we were coasting downhill. Long story short, we ended up in Nowhere, Utah, stranded for several hours, waiting for a tow truck. Unsurprisingly, the vehicle—which is designed as an efficient, coordinated system—needed several repairs because once one part was thrown into chaos, other systems went awry as well.
Families, like vehicles, are similarly coordinated systems, with each person relying on others to make sure everything functions and everyone is taken care of. When an individual struggles with a substance use disorder (SUD), oftentimes, treatment is focused only on that one individual as if that person is the only one impacted.
But family members can feel great pain over a loved one’s SUD and are left to grapple with the consequences and the added stress all on their own. As a result, those with loved ones who struggle with a SUD often have to guess about how to manage their own emotions as well as added responsibilities and other practical consequences of the afflicted person’s impact on the family.
In this two-part series, we will elaborate on the potential impact that a SUD can have on a family, as well as tips for families struggling with a SUD.
Impact on the family system
Substance use leaves its mark on any family that encounters it, though each family’s experience with SUDs is unique. One research group termed their model of how SUDs affect families the Stress-Strain-Coping-Support Model, which is a broad-based model for describing how SUDs impact a family system. The group suggests that families suffering from SUDs tend to have the following experiences:
- Stress: Both individual family members and family life tend to suffer when there are struggles with a SUD. Stress levels in the family increase due to the negative impact of the SUD on them.
- Strain: Members of families with a SUD begin to show their strain through increased physical or mental health problems of their own.
- Coping: Family members are often forced into the dilemma of determining what course of action is best. This is usually a fraught process that can bring up conflicts among family members, even when those family members are not struggling with SUDs themselves.
- Support: Families attempt to understand what is happening and why; in this process, families typically seek out resources and information to develop an understanding of SUDs. At these times, families are often at the mercy of the resources available to them and how others in their circles react to the problems at hand.
While not every family struggling with a SUD will go through these experiences, the model demonstrates the general difficulty that SUDs pose for families. It is easy for family members to feel guilt, shame, stigma, or blame for the presence of a SUD, and these types of responses tend to compound an already stressful situation. It is important for family members to know that the process of “coping” or deciding what the best response is may be conflictual, confusing, and complicated. It is normal to have different responses at different times and to have different opinions than other family members. While it is hard to have patience, to tolerate “what if” fears, and to take others’ perspectives, ultimately, the stance of listening first is what will best support the family in the long run.
Common patterns in families with SUDs
Adapting to a family member’s substance use is a family’s way of trying to stay interconnected despite the disruptions caused by the presence of a SUD. Through close examination of families with one or more members with a substance use disorder, one researcher noted three common ways that families try to adapt to substance use in the family:
- Discovery: Because the SUD is often hidden, it takes time for families to recognize that another member is suffering from a SUD. Families may initially notice only small changes—physically, emotionally, or behaviorally. The fear of “what ifs” can sometimes cause panic. Because of shame or stigma, families may try to manage the SUD themselves without seeking professional or needed support.
- Living with the SUD: Oftentimes, family members find themselves in a long-term, increasingly stressful dynamic with a loved one whose SUD begins to damage family relationships. Even still, family members feel compelled to try to protect their loved ones from physical harm or death as much as possible. Sometimes this means family members can become involved in the struggling member’s life (or substance use) in uncomfortable and unwelcome ways in order to do damage control.
- Expulsion (separation): In circumstances when SUDs have had a significant negative impact on family members, families may come to a point at which they feel they must separate themselves from the loved one with a SUD or set strict guidelines for contact. Such a decision is often made knowing the member with a SUD will be placed at higher risk. Such an effort is typically made after many years of struggle when family members feel they have no other recourse. Similarly, this may be an effort for family members to preemptively protect themselves against the fear of their loved one’s death. Under the best circumstances, this type of decision would be made after efforts to get the family member who has the SUD (and the family) professional treatment and with the support of a mental health professional.
Every family’s experience is different, yet most families make efforts to remain connected—and to continue to be a functioning system—even when a SUD is brought into the family. Not all efforts are successful, but families undoubtedly experience increased stress, distress, and conflict as they attempt to adapt to a person with a SUD. It is imperative that at such times all family members seek care and support to maintain each person’s well-being as much as possible.
In our next blog post, we will discuss possible ways for family members to pursue their own well-being in the midst of the chaos that a SUD can create.
About the Authors
Elizabeth Laney, Ph.D., is a staff psychologist at The Menninger Clinic. She has a doctorate degree in clinical psychology from the Rosemead School of Psychology at Biola University. Dr. Laney’s clinical interests include training of psychologists, psychoanalytic treatment of trauma and attachment trauma, psychodynamic treatment of personality disorders, as well as motherhood and women’s issues.
Wendy Jamison, LPC, LCDC, earned a master’s degree in clinical psychology from the University of Houston-Clear Lake. She has experience working in psychiatric facilities, a corporate employee assistance program, and as a coordinator of a chronic pain recovery service. She has been working with people who struggle with substance use disorders since 2005.
