A Call to Revise Family Roles in Addiction: Treating Individuals First
By Gerald “Jerry” Manney MS, LADC
Why Do Families of Substance Abusers Act the Way They Do?
To truly understand this, one needs to first think about the impact words like:
…have upon people with substance use disorders as well as their loved ones. After all, there must be something very wrong with someone who would choose to be with “those kinds of people.”
Families cannot be generalized or stigmatized
By the mid 1960’s the American Medical Association and the American Psychiatric Association, recognized alcoholism as an illness. Yet many of us, myself included, working in the field of addictions who advocated treating people with the brain disease of addiction with Individualized Treatment Plans, often continued to approach family members in a more generalized manner. Terms such as “roles” of families of alcoholics/addicts, “characteristics” of adult children of alcoholics, and other such terms tended to list only negative attributes to every family member.
Searching the Literature
In the late 1980’s, I began a search of the literature, with Richard P. DeSantis, PhD, Professor Emeritus, Keene State College, to understand how family members were affected by other major chronic illnesses and conditions of loved ones. Other major chronic illnesses and conditions, as well as addictions, significantly impact not only the patient but also:
- Adult children
…and others. Our initial attempts to communicate to college students and professionals the commonalities between distress responses of families of substance dependent persons and families distressed by other major diseases or disabilities of loved ones were usually met by comments reinforcing stereotypes mentioned earlier in this article.
Starting to Listen to Family Member’s Needs
During this time I was Director of Family Services at Beech Hill Hospital in Dublin, NH and was looking to gain additional insights to help parents of patients in the then new Beech Hill/Hurricane Island Maine Outward Bound Adolescent Substance Treatment Program. Dr. DeSantis and I went about developing for discussion purposes The Parental Distress Response Survey.1 An updated version is presented here.
One of the following quotes or statements is made by a parent of an adolescent with a severe marijuana abuse disorder. The other responses are in reference to other chronic illnesses or conditions of a child or teen. Which illness or condition does each pertain to? (answers are at the end of the article)
PARENTAL DISTRESS RESPONSE SURVEY2
A “It was a long time before I could say that sometimes I hate her for all the problems she presents. I often feel as if I am bled dry.”
B. “As a parent, you may blame yourself for her illness or for not having noticed it earlier.”
C. “Disappointment that a child is not perfect poses a threat to many parents’ egos and a challenge to their value system.”
D. “I’m going crazy. People treat me like I’m a bad parent. I feel violated.”
A Normal Response to Any Serious Illness
I have presented this survey, or an earlier version of it, at the 2007 Joint Meeting on Adolescent Treatment Effectiveness (JMATE)3 in Washington, DC as well as in graduate and undergraduate level courses I have taught. When I would ask the participants or students to respond to each of these statements, someone always comments, usually by the second or third quotation, that each statement, “could be in response to almost any serious illness.”
That is the main point of this survey.
When we listen to each individual family member’s struggles and needs without preconceived impressions or expectations, we can see the person in front of us and work with them more effectively.
Family or Parental Distress: The Heart of the Question
Family or parental distress is a state where individual and/or family resources are stretched to or beyond apparent limits. These resources may include emotional, physical, financial, social supports and others.1 So, why do families of substance abusers act the way they do? At the Heart of the Question is that they respond in ways similar to family members of those who are affected by other major so-called socially accepted diseases.
A more appropriate question is: “How can we more clearly understand each individual with the brain disease of addiction as well as those who are also distressed by their loved one’s disease?”
Finally, how can we supportively respond as we would with any other major disease?
Answers to the Parental Distress Response Survey2
A. Cerebral Palsy: The Resilient Family, Power, Paul W., ScD, Dell Orto, Arthur, PhD, Sorin Books, Notre
Dame, Indiana, 2003
B. Diabetes: Living with Diabetes www.diabetes.org.
C. Head Injury: Lezak, Muriel, PhD, “Brain Damage Is a Family Affair,” Journal of Clinical and Experimental
Neuropsychology, Vol. 10. 1988.
D. Marijuana Dependence: father of a 16-year-old son, stated during LUK, Inc., Fitchburg, MA, Parent