Tuesday July 22nd 2014

Family dynamics of addiction

The importance of context

It is impossible to decipher meaning unless we put events into context.  For example, I recently drove by a very emotional scene on my way home from work.  What looked like two separate families were congregated outside a home and a young girl, who appeared to be about 12 years-old, stood sobbing in the middle of the group.  All the women folk were giving comfort and the men stood off to the side.  I witnessed about five seconds of the drama as I passed by and was left wondering what was going on.  Were they tears of anguish because she was going away or tears of joy because she just arrived?  Who was she and what was her story?  Was she a daughter, a sister, a friend?  I had no idea because I didn’t have the necessary information to put the scene into its proper context.

Addiction does not arise in isolation.  It must also be put into context if we are to understand its origins, impact, and recovery.  How can we begin to understand such a powerful and destructive dynamic unless we examine the context in which develops?  An addict is born into a particular culture, socio-economic class, geography, historical era, and gene-set.  Events like divorce, relocation, and loss often occur during delicate developmental periods.  Is the addict innately introverted or extroverted?  How did she navigate the pressures of school?  Was there abuse?  Who was there for her?

Addiction and family

Over the past three years, I have led a collaborative project developing a program to treat addiction in the context that best addresses these questions – namely, the family.  Family-focused treatment assumes that because addiction arises within the family unit, and in many ways is a family problem rather than just a problem for the individual, treatment should – whenever possible – also include the family.  The individual is no longer viewed as the client, rather the family is.

The program, called Denver EFFECT (Entire Family-Focused Comprehensive Treatment), actively recruits members from the family to participate in the intervention.  It begins with the addict and family members meeting with a family therapist to complete a genogram, which is a diagram detailing family relationships.  This process may take several sessions to complete – depending on the size and complexity of the family and is the first step in placing the person’s addiction into context.

The genogram can be quite illuminating for the family as they examine in detail (often for the first time) their own history.  It lays a foundation of understanding that provides direction for treatment.  After the genogram is completed family therapy starts in earnest.   The addict is given the opportunity to explore how the family impacted the course of her life and the family is allowed to express their feelings related to the addiction.  It helps them work through old recriminations and current conflict.

In addition, the addict and family participate in multi-family groups that bring members of many families together for education and support.  These groups explore issues like boundaries, human development, communication styles, etc.  It is an opportunity for families to share their stories and to see that they are not alone.  They learn from each other.  What should the family member do, for example, if their loved-one is pounding on their door at 3:00 am drunk?
Relapse prevention therapy

The addict also participates in traditional relapse prevention groups and individual therapy.  This is an opportunity to process feelings and ideas brought up by the family work.  There is usually a lot to talk about.

Family substance abuse treatment

Formal family-focused programs are just starting to develop and are not yet widely available.  However, families impacted by addiction do not have to wait for them to come to their area.  If your local treatment center does not offer family work then seek out a competent family therapist with some experience in the field of addiction in order to add this powerful component to your program.  Having a supportive family educated in the dynamics of addiction is one’s best hope for sustained recovery.

Photo credit: Sam Frederick

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About Nachshon Zohari, LCSW

Nachshon Zohari is a licensed clinical social worker and the Program Administrator for Mental Health and Substance Treatment in a major U.S. city. His private practice includes individual, couples and family counseling; parenting classes; substance abuse education and treatment; and individual and group clinical supervision. He is an expert in the holistic practice of family focused addiction treatment.