Family Dynamics of Addiction and Life After Rehab

“No man is an island,” the author Ernest Hemingway once observed. The same might be said of those who struggle with addiction: one person’s substance abuse problem affects those around them, and in a great number of cases, those most affected are immediate family members—the parents, spouses, siblings or children of that loved one.

The resulting family dynamics can, in turn, feed a cycle of addiction, by setting into motion certain forms of dysfunction, the systemic treatment of which is critical to successful recovery. The more information individuals and families have about these dynamics and how they affect the whole family system, the better prepared they will be to seek help for an addiction and navigate the challenges of family life after rehab.

Family Dynamics of Addiction

Studies of families with substance use disorders (SUDs) have revealed some shared patterns of dysfunction. They include the disruption of:

• parent-child attachments, and, in turn, a higher rate of “attachment disorders”
• family roles
• rituals and routines
• communication
• social life
• finances

Such disruptions to the family system typically arise within and give shape to a home environment characterized by the following attributes:

• secrecy
• loss
• conflict
• violence or abuse
• emotional chaos
• role reversal
• fear

The Generational Impact of Addiction

The generational impact of addiction can in turn manifest itself in a number of ways, starting with the most vulnerable members of a family: children. In America, more than 8 million children younger than age 18 reportedly live with at least one adult who has a substance use disorder (SUD). That translates to a rate of more than one in 10 children whose early development in the presence of an SUD raises the risks of emotional, behavioral and substance use problems later on in life.

The majority of these children are under the age of five, according to the U.S. Department of Health and Human Services (HHS). That’s important to note, because children whose exposure to an SUD starts at a young age may experience that exposure over a greater length of childhood and in the most formative years. For these children, the price of a parent’s addiction may be even higher.

Effects of Substance Abuse on Families

The longer it goes untreated, a parent’s addiction raises a child’s risks of experiencing one or more of the following effects of substance abuse on families:

• a devastating family tragedy (in the form of a parent’s early death from an accidental overdose or drunk driving accident that results in severe injuries and/or death to the parent, child or other family members)
• a disruptive home environment, marked by discord and domestic violence between parents
• the extended absence of one or more parents because of an SUD (because one or more parents may be in prison for a drug-related crime or on the streets)
• financial problems and poverty that can mean the loss of a home or eviction, restricted access to educational and other opportunities, and the denial of even basic health and nutritional needs
• the challenge of also living with a parent’s dual diagnosis (a co-occurring mental illness that accompanies roughly half of all diagnosed SUDs)
• parental neglect
• physical and sexual abuse
• high levels of stress associated with all of the above
• more health problems and higher rates of morbidity

The Link Between Addiction, Child Abuse and Parental Neglect

Child abuse and parental neglect are the most under-reported effects of substance abuse on families, when in fact the link between addiction and child maltreatment is “compelling and undeniable,” a report by HHS testifies. The same report goes on to document in stark terms how children of parents with SUDs are three times more likely to be physically or sexually abused and four times more likely to experience parental neglect. These children are also, in turn, more likely to end up in foster care and to remain there longer than children from families not affected by substance abuse.

Long-Term Impact of Substance Abuse on Children, Family Members

An experience of abuse or neglect at the hands of a parent abusing drugs or alcohol makes children more vulnerable to other long-term negative consequences of addiction in their adolescent and adult years. Childhood exposure to substance abuse can cast a long shadow, in other words. For example, children abused by a substance-abusing parent are:

• more than 50 percent more likely to be arrested as juveniles
• 40 percent more likely to commit a violent crime
• as susceptible to health problems and morbidity as a drug-abusing parent—this by extension from at least one study that found this trend applied to family members in general, whose rates of diagnosis and needs for healthcare are comparable to those of the chemically dependent loved one

Life After Rehab and Living Sober

The family dynamics of addiction and their potential long-term impact, if left untreated, only strengthen the case for getting a loved one with an SUD into treatment as soon as possible. Equally critical are the implications of these dynamics for family life after rehab. One very clear implication is the central importance of family involvement in the recovery process.

A number of studies have underlined just how important this element is in boosting recovery outcomes. Family involvement in substance abuse treatment increases engagement rates for entry into treatment, decreases dropout rates during treatment, and predicts better long‐term outcomes, according to research-based treatment recommendations from the Substance Abuse and Mental Health Services Administration (SAMHSA). Among the many research findings is the following example: that group therapy—and, in particular, family group therapy—can be a more effective therapeutic intervention than individual therapy.