A Call to Revise Family Roles in Addiction: Treating Individuals First

A call to clinicians to re-think how we work with individual family member’s struggles and needs during treatment. Why not drop preconceived expectations to see the person in front of us? Would that help us work with them more effectively? An exploration here.

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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:

“Weak-willed” and
“Self-inflicted problem”

…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.

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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:

  • Spouses
  • Partners
  • Children
  • Teens
  • Adult children
  • Parents

…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)

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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.”

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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.”

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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?”

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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
Program 2004.

Reference Sources:
1.DeSantis, Richard P, PhD, Manney, Gerald J, MS, Parental Distress: Moving from Reaction to Response,
Adolescence, July 1993, p 29-31.
2. Manney, Gerald, J, MS, LADC I, Partnering with Parents, EAP Digest, Spring 2010. p 24-26.
3. 2007 Joint Meeting on Adolescent Treatment Effectiveness (JMATE) Washington, DC, SAMHSA, CSAT,
NIAAA, NIDA, Robert Wood Johnson Foundation.
About the Author: Gerald “Jerry” Manney MS, LADC I, has over 35 years experience in the addiction field. He has presented at three of the first four Joint Meetings on Adolescent Treatment Effectiveness (JMATE) in Washington, DC. He has taught graduate and undergraduate courses on addiction and the effects of addiction on families. He has also authored numerous articles for professional publications and is currently working on his second book, You Don’t Have To Go To Every Argument You Are Invited To. Follow Jerry’s blog www.communicatemoreeffectively.com and on twitter @jerry_manney
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.


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  1. Thank you Peter. I also read your review on amazon.com of Olivia Curtis’ C.D. is a Family Affair. Very eloquent. However, I continue to hear these misconceptions repeated among too many addiction professionals as well as members of twelve-step programs, including those for families of alcoholics.

  2. In the 1980’s , popular writers on addict took classic family systems theory that applied to all families, or stressed families, and applied it to families with an addicted member. They did not cite the previous work by Adler, Minuchin, Satir, etc. People self identified with the roles such as scapegoat, family hero, and lost child. Families were said to be as sick as the addicted member. Luckily, this has to a great extent blown over. See my review of Curtis Chemical Dependency A Family Affair, on Amazon, which someone cut and pasted from the Journal of Teaching in the Addictions.

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