Family culture and behaviour will usually adjust to cope with the distressing presence of addiction, often twisting itself out of shape in the process; even establishing new (unhealthy) norms of behaviour, long before anyone in the family is aware of what is happening. Coping with addiction becomes the organising dynamic of family life. Everyone slots in to some sort of role in relation to (the person with) the condition. Some of the coping strategies end up neither helping the addicted person nor the rest of the family, individually or collectively. Suffering is perpetuated as a result.

Family members don’t always cope with addiction in the same way. Those differences will also be apparent in how they approach the treatment of a family member. Some succumb to a controlling reflex based on fear and the desperate hope of finding a way to get the loved one to stop and change. Another approach is to deny the reality of what is happening while trying to carry on “as normal”. Another might be a blaming, punitive, rejecting attitude. Some will effectively hand over their relative to be “fixed” by the treatment centre — as they would a car that needs repair — staying detached until the job is done. Such family members generally don’t look to involve themselves in the treatment process, while anxiety may cause others to hover intrusively over the treatment of their relative.

It used to be that the addicted person was the sole focus of the family and, almost by extension, the treatment centre. There was a tendency to think that everything would come good if only the patient got well. Nothing else and no one else had to change. It’s not hard to understand why something so apparently straightforward might be the hope. However, that perspective has long since been overtaken; and for good reason. For decades, evidence has been mounting to indicate that a systemic understanding and therapeutic approach is more effective. It would be foolish to ignore this.

Defined by its purpose (such as being a family), a system functions according to the weave of its internal relationships. There are interrelated parts that make up the whole. Each depends on and is affected by the other. If one part of the system changes the rest is inevitably challenged. If something affects the whole it will have an impact on the parts. So when addiction emerges in a family, we now look to help all parts of the system: individual family members (whether addicted or not) as well as the family as a whole. If changes only occur in one part of a family system that has adapted to the presence of addiction while the other parts try to stay as they now are, the chances of recovery diminish.

It all comes down to what stands the best chance of achieving the outcome everyone in the family apparently wants: a recovering family member and a restored family. We again turn to research for guidance. The evidence there tells us that engaging the whole family affected by addiction during the treatment of a family member makes a positive outcome more likely. This engagement needs to include the following:

1. Identifying and making sense of potentially helpful and unhelpful ways of relating to the addicted individual and to each other; supporting the former and addressing the latter during and after treatment
2. Increasing understanding of addiction and its impact on family functioning
3. Given the significant stress suffered by families in living with addiction, recognising and accepting their need for help and support in their own right, rather than just in relation to the addicted individual in treatment

So, how can I, as a family member, help? The answer: Respond positively to invitations to become involved.  Look to improve your understanding of addiction and how it impacts families, including yours.  Resist any urge to control the outcome. Respond openly and honestly to such questions as “How are you?”; as opposed to focussing exclusively on the patient. Accept and engage proactively with the support offered, even if you feel anxious or reluctant at first. Family members who do so generally experience considerable benefit, including a sense of relief

Redefining “holistic treatment” to include Family Support

There is convincing evidence to indicate that family involvement is likely to help improve outcomes.  When it comes to addiction treatment, the terms “holistic” and “integrative” need to be redefined to ensure that they encompass high quality support for families, both in relation to their addicted family member undergoing treatment as well as in their own right. Family members have been shown to experience high levels of stress and related mental health problems, partly as a result of co-dependent approaches to living with addiction. The harmful effects of anxiety and associated counter-productive behaviours, can be ameliorated quite quickly with the right help.

New perspective on addiction in the family

Until comparatively recently, everyone, including the addiction treatment provider and the family, tended to focus almost exclusively on the person with the evident problem. Mistakenly, treatment services often saw the family as being of only peripheral importance. Meanwhile the family co-dependently staked all its expectations and hopes for its own improved wellbeing on the recovery of the addicted family member.  Given the often alarming state of their loved one’s mental and physical health, this was hardly surprising.  However, such a unifocal approach failed to take account of the family context and its influences upon the individual. While everyone was worrying – sometimes obsessively – about the person with the overt signs of addiction, no-one turned to the other members of the family to ask simply, “And how are you?” 

A systemic approach

The much needed shift to a more systemic perspective took place. Consequently, practitioners began to help families change their point of view.  They were now invited to recognise addiction as having emerged in the family through one of its members, affecting them all as a result. This approach also helped to defuse moral judgements and the impact of stigma.   The solution was now to be found in the family taking responsibility individually and collectively for the recovery of one and all. 

Family Recovery 

This work can begin in the treatment service where skilled therapists can facilitate family meetings that include the person undergoing treatment.  The family dynamics determined by addiction can be understood and a range of feelings can be explored, while healthier personal strategies are identified.  A great deal of education about addiction, its influence over family functioning and the steps that can be taken to release its hold, is generally required. Together, the family can work to recover from addiction and co-dependency and to build a degree of individual and collective resistance to their return.

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