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Addiction as a family disease
July 21, 2016

Why Addiction Is a Family Disease

“Addiction is a family disease.” That’s a common refrain heard in recovery circles and bandied about in the drug and alcohol treatment world. But what does it mean? This article offers a detailed answer, by highlighting key ways in which the unique pathology of drug and alcohol addiction is family-based (and therefore stands to benefit from family-focused therapies and treatment interventions).

Impact of Substance Abuse on Family

One person’s drug or alcohol problem has a painful ripple effect, one that family members living with the addiction are often first to experience. By its very definition, after all, “addiction” entails compulsive use despite negative consequences, and often one’s family of origin bears the brunt of this heavy toll.

An extensive body of research has catalogued how substance abuse places enormous mental, physical, emotional, social and financial strain on families — so much so that researchers at Harvard classified addiction as “toxic stress,” meaning “strong, frequent, and/or prolonged adversity” that elicits a commensurate physiological stress response.

What the researchers also found is that this toxic stress response can cause long-term and even lifelong health repercussions, including greater susceptibility to one or more of the following mental and physical problems:

  • Cognitive impairment
  • Developmental delay
  • Heart disease
  • Diabetes
  • Depression
  • Substance abuse

Another study found a strong link between “Adverse Childhood Experiences” (ACEs) — substance abuse being one of only a few prime examples — and the risk of early death.

The takeaway from such studies is that the disease of addiction directly impacts family members’ health, often in serious ways, causing a lasting generational impact.

Family Dynamics of Addiction

In the presence of a substance use disorder (SUD), family members also develop dysfunctional patterns of coping with and compensating for the ensuing pain and stress. The resulting family dynamics are arguably as unhealthy as the untreated addiction itself, and can follow a similar progression from bad to worse.

The following dynamics are particularly distinctive to families in the grip of substance abuse, and receive more attention in the sections that follow:

  • Codependency
  • Role reversal/distorted roles
  • Emotional disconnection
  • Attachment issues and disorders

What these dynamics look like can also vary with family structure, as the Substance Abuse and Mental Health Services Administration (SAMHSA) chronicles. For example, the spouse of an alcoholic rearing small children may attempt to over-compensate for deficiencies caused by her partner’s substance abuse (in a manifestation of what sometimes goes by the term “codependency”). Or, the child of a parent with a SUD may act as a surrogate spouse to that parent (thereby engaging in what’s called “role reversal/distorted roles”).

Codependency and Role Reversal/Distorted Roles

Codependency and role reversal/distorted roles often occur among SUD-affected family members. For example, a 1988 study found that spouses of compulsive drinkers “tended to be codependent,” showing high levels of “enmeshment” (poor personal boundaries in their marital relationship). More recently, a study that compared family ties of heroin addicts to those of two other populations (schizophrenics and high achievers), found role reversal occurred “significantly” more within families of heroin addicts, on the part of children of heroin-using parents.

Codependency and role reversal share some of the following characteristics, as described by Codependents Anonymous:

  • Denial
  • Low self-esteem
  • Control
  • Compliance
  • Avoidance

Denial, low self-esteem, control, compliance, and avoidance are, at heart, coping mechanisms for dealing with the confusion, tension, and unpredictability that substance abuse inserts into the family environment.

Emotional Disconnection

Another common family dynamic of addiction is emotional disconnection, according to a report endorsed by the National Association for Children with Alcoholics (NACOA). There the clinical psychologist and addiction and trauma expert, Dr. Tian Dayton, describes how SUD-affected families are prone to hiding genuine feelings via “strategies for keeping safe, such as pleasing or withdrawing.”

Dayton writes:

The family becomes organized around trying to manage the unmanageable disease of addiction. They may yell, withdraw, cajole, harangue, criticize, understand, get fed up, you name it. They become remarkably inventive in trying everything they can come up with to contain the problem and keep the family from blowing up. The alarm bells in this system are constantly on a low hum, causing everyone to feel hyper vigilant, ready to run for emotional (or physical) shelter or to erect their defenses at the first sign of trouble.

And in a climate in which doing just about anything to avoid painful subjects is now the norm, avoiding emotional connection altogether is just an outgrowth of that effort at “homeostasis” (keeping things as they are), according to Dayton.

Attachment Issues and Disorders

“Attachment disorders” are a related dynamic in SUD-affected families, but one that carries a formal psychiatric diagnosis — typically pertaining to young children who have had trouble forming an emotional connection with their main caregiver (one or both of their parents, in most cases). Early childhood exposure to substance abuse raises one’s risks of developing an attachment disorder, research shows. For example, infants in families with two parents with an alcohol problem reportedly had “significantly higher rates of insecure attachment with both parents.” And persisting attachment issues are “a predominant feature of adult children of alcoholics (ACOA’s),” according to other findings.