We have looked at the neuroscience and culture of addiction.  Today we look at how substance abuse affects the families of those involved.

Often in the early stages, the family has no idea that the changes they see in their loved one are drug-related.  They may view them as typical teenage moodiness or rebellion.  According to William Moyers, those involved in substance use become masters of manipulation, covering their behavior, using fear, guilt and pity as they exploit others.  “Nobody sees what’s happening because that person is deft at conniving, scheming or outmaneuvering the world on the way to another drink or drug.”

As the loved one begins the downward path into substance abuse, the signs are easy to hide.  Families are often in denial about the reality of their loved one’s addiction, wanting to believe drug use is not the cause.  The loved one will offer explanations of their behavior or symptoms, blaming it on allergies, tiredness, or stress.  If pressed, the loved one may become defensive and begin verbal attacks on the person asking the questions, insulted by the questions or conversation.  They may blame the family for the symptoms, deflecting and denying.  There may be accusations of violating privacy or lack of trust, causing the parent/family member to question their original fear.  The emotional intensity of the response may be out of proportion to the level of questioning.  The excessiveness of the reaction may be an indication of how close the questioner is to the truth.

The family may find itself treading more and more carefully around the loved one to avoid setting him off.  Family dynamics may shift as the rest of the family tries to maintain normalcy and balance.  They may find themselves covering for their loved one, making excuses, providing a safety net and rescuing him from consequences as they try to navigate the lies, deceptions and manipulations.  The family may gradually change as they attempt to maintain balance in the constantly shifting behavior and mood of their loved one.   They may have a sense that something is not right, but be unsure what is really going on.

A local mother of an adult, addicted child reported “until they go off to rehab or jail, you don’t realize just how dysfunctional your life has become.”

Another mom stated “addicts have an inability to face pain.  Opioids help them get through their own pain.  Then, it helps them avoid the consequences of how they have hurt the people around them.”

Families suffer right along with the person involved in substance use.  There is a constant sadness and mourning for the way the loved one used to be.  There is the worry and anxiety of where they are, what they are doing, whether they are dead or alive.  Some family members have expressed relief when their loved one is arrested.  “At least I know she is safe and being fed when she is in jail.”  Families often work harder at helping their loved one than the person who is actually using.  Families can become angry, frustrated, resentful and depressed.  They may disagree on the best way to deal with the problem.  Other relationships may become strained as friends and family feel abandoned and neglected by the amount of time, attention, and energy the addicted one is consuming.  The constant roller coaster of hope and despair is exhausting and draining.
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 Next time: How can a family cope?

William White is a pioneer in the field of addiction treatment and recovery.  He has written several books on the subject, been recognized with multiple awards for his work, and maintains a website: williamwhitepapers.com
His book  Pathways from the culture of Addiction to the Culture of Recovery (1996)  gives clinicians and family members a picture of  the world of addiction, the culture that that addicts  live in and how treatment must address and replace all these elements to move people into a life of recovery. 

White gives a very vivid picture of this culture, its values, and the mind of those involved in addiction. He believes that those involved in addiction constantly change their words and actions  based on who they are with and where they are, to maintain their drug supply and deny  the seriousness of their addiction.  The life of  addiction is a ‘predatory lifestyle’ where survival depends on the ability to respond to the continually shifting environment of danger, threats and drama.  The addict believes that everyone and everything in his environment is working to keep him from what his brain really needs (drugs) and make him face a reality is trying to avoid.  He lie to his family, steals from a loved one, manipulates and cheats. As the addict continues down the path of addiction, these become easier and easier to do without remorse.  Nothing is sacred or safe in the endless pursuit of drugs.  His brain is telling him that his only focus and motivation is to obtain and secure a drug supply at any cost.

White states that in this endless cycle of addiction, ‘drug users seek out and build relationships with other people whose drug use mirrors their own, nurturing the rituals of drug use,  becoming a fully organized culture of drug use  constituting a powerful stimulus promoting excessive drug use.‘   This culture separates those in addiction from those who are not.  Values and priorities change from those not involved in drug use.  Heroes of the drug culture are those who have learned how to manipulate and take advantage of others to promote their own drug use. Stories of avoiding arrest, maintaining a drug supply, obtaining money, working a hustle,  aggression, violence, and surviving danger, glorify drugs and help others justify and minimize their own use.  The more excessive and outside of societal norms, the more valued the experiences are.  Those outside the drug culture are viewed as mockable, easy targets to be used and discarded when no longer useful. The culture of addiction  separates people who are “in the life” from those who are not, providing acceptance and perceived value for those who may have never felt accepted and valued in normal society.
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I hope you are getting a sense of everything that must be overcome to enter into long-term recovery: attitudes, priorities, values, activities, friends, language, dress and appearance, etc.  In addition to addressing the physical and psychological aspects of addiction, treatment must immediately provide ways to meet the needs filled by the addiction culture with another lifestyle.   Any unmet needs can be a stimulus/trigger for relapse.  Those in recovery say they have to replace their playmates, playthings and playgrounds.  In other words, a whole new life must be adopted and embraced. 
Although it is a daunting task, there is hope.  Treatment works.  Recovery is possible!