Psychology Corner

There are many addiction models give a brief explanation about addictive behavior, especially in drug addiction (also applied to alcohol), such as the disease models, psychoanalytic models, conditioning models, cognitive models, family system models, socio cultural models, and also bio-psychosocial models which I think more comprehensive and complete in explaining about drug addiction. Because I’m interested to know more about family and drug addiction, so I want to review the addiction model by focusing on family system. Moreover, in Indonesia, family has the most influence on individual’s development, not only until adolescence stage, but even at late adulthood. We can see that in Indonesia, individual is still strongly attached to their family (father, mother, and siblings) though they have been living with their spouse and children.   I have two real cases (my clients) to be discussed here, both of them are young adult recovering heroin addicts of the same age, about 29-30 years old. They are clean now but it took many years to reach that point, and surely still have to watch step for the rest of their life to be sober.

Van Wormer _[3] noted that the family is a system composed of members in constant and dynamic interaction with each other. Patterns of interaction get established: who interacts with whom, who talks and who listens, who has the authority and who is the controlling force behind the scenes. The family has a pattern, a rhythm that is more than the sum of its parts. Thus, in family system models, we have to give attention to the interdependence of all the members and the wholeness of the system. There’s a “rules of interaction” or the methods of how relationship between the family members function. We can call it “boundaries”. Thombs _[3] explained about the boundaries in the continuum below :

• Very diffuse: relationships are enmeshed. No flexibility, no room for individual differences. Individual are too close. Loss of self- identity.
• Very rigid: Relationships are distant. Little intimacy, much isolation. There is little sharing of positive emotions. No connectedness.
• Clear (optimal relationship): Allow for individuality yet maintain intimacy, they are based on mutual respect, genuine love, and concern for one another without attempting to control, freedom, flexibility,  and communication patterns are clear and direct.

In addict families, boundaries may be rigid or disengaged. Addict may be isolated, and the entire family may be isolated too from the community. Lawson and Lawson _[1] said that addict families have three rules :

1. “do not talk about the addiction”
2. “do not confront addictive behavior”
3. “protect and shelter the addict so that things don’t become worse.”

But actually such rules enable an addict to keep using drug and contribute to the progression of addictive behavior. When one spouse is an addict, the marital relationship may be disengaged. The addict may spend much time in drug-using rather than at home. The non addict spouse may carry the full parenting load and children may feel rejected and unloved.

Families usually have rules governing the manner in which different emotions are expressed. In some families, anger is not allowed, whereas in others shouting is permissible. I also saw in some families affection is demonstrated with hugs and kisses, while in others physical contact is limited. In addict families, it is usually prohibited to talk openly about the drug abuse.

If we take a look at the cases, let’s say their names are Andri and Bobby (of course not their real names). Andri comes from diffuse mother-child relationship, while Bobby from rigid one. Andri can express and talk about himself openly to his mother, yet not to the other member of the family. Whereas Bobby  is usually  silent and limits his conversation with his family. But it’s not weird for Andri’s family. The similarity of them is showed by their relationship with their mother. Their mother always give what they want (e.g., money). After denial for some years about their children problem, which is drug abuse, by not listening the second opinion about their children issue or not finding out the answer of ‘do their children abuse drug?’, finally they ‘could’t runaway’ again because their children then decided to tell the truth that they are addicts. Then when their denial about their children drug abusing stopped, they shifted to another denial, which is they denied the symptoms of their children’s relapse.

One of the concepts in system theory is homeostasis. It explains the family’s tenancy in holding onto existing behavioral repertoires, resisting change, and exerting pressure to minimize or reverse change when it occurs _[2]. Drug addiction may be thought of as an effort to maintain family balance but unfortunately it’s a pathological equilibrium_[3], e.g., if the addict is stopped or go to recovery, it may cause neighborhood or big family recognizes about the family problem then they would feel embarrassed, or if the addict father go to rehab then his family lose their head and economically disturbed. Because of this false thought, then family decide not to take the addict to recovery and prefer to let the addict stays at home using drug.

In case of Andri, her mother permitted him to use heroin at home. She thought it would be better than her son used it outside and looked by neighbors or caught by the police and under arrested. While Bobby’s mother also let her son use heroin with a bit different reason. She wants to hinder the conflict between her and Bobby. She didn’t want to make Bobby hates her and want to ease the family atmosphere. She also can’t stand saw her son suffering from withdrawal syndrome. But unfortunately they were in the wrong way.

Family that usually have rigid rule of interaction should improve the rule when their member as the addict come to recovery. The program demands them to show more intense interaction. Then when the addict comes back to their family and has shown good progress after several months of abstinence and frequent involvement on Narcotic Anonymous (NA) or fellow addicts, the spouse may return to rigid stability by complaining that he or she looks too busy with that recovery things then forget about family or in other case, the non addict spouse protest about how unfair for them to take over the family load. Often they have ambivalent feelings about the behavioral and personality changes of the addicts after recovery. They may feel that their mates are now too quiet, less sociable, less energetic, “kind of boring” than when they were abusing drug.

All of it can be a crisis for the family then provoke the addicts to relapse again. The dynamic of relapse often go unrecognized and that those who relapse are labeled “unmotivated” or perhaps “emotionally unstable”. They overlook that relapse prevention should include intervention from the family (to improve various forms of repetitive, consistent, and predictable displays of behavior which is maladaptive) rather just pushing the addicts to fix their intra psychic factors. In case of Bobby, at the moment he had finished from his recovery program then went to home, Bobby said that he felt empty amongst his own family members. His family kept showing the old pattern, which is cold, silent, and distant. Bobby who had used to get ‘love’ from heroin, then he felt unloved at all because his family didn’t know how to fill the hole inside and didn’t change their very rigid pattern to be optimal. So Bobby relapsed again. Hence, family can’t be substituted even by recovery program.

Triad

Bowen_[3] stated that dysfunctional families form triadic patterns of interaction which contribute to the development of addiction in children. Triads are family subsystems that consist of three members. In addict family, it involves a young adult (or adolescent) addict and the parents. In the most common triad, one parents is intensely involved with the addict while the other parent is under involved and perhaps punitive. The triad forms as a means of protecting the marriage and the family by distracting the parents from their own marital difficulties. The drug problem gives them a reason for remaining together. That’s why in many cases, when the addiction of their children is over, their marriage is also over.

The real marital problem of Bobby’s parents was never discussed by both. Bobby’s mother used to be ‘a savior’ for her son, while the father became ‘an enemy’.  They were busy with Bobby’s addiction and in fact, it made their relationship and marriage worse. They blamed each other and never talk heart to heart about the real conflict they buried. In Bobby case, it truly happened. When he stopped using drug, his parents divorced.

Codependency

Subby & Friel _[3] defines codependency as unhealthy pattern of relating to others that results from being closely involved with an addict. Their relationship is enmeshed and problem filled. The problems provide endless opportunities for the codependent to be preoccupied with the addict. They also find it very difficult, if not impossible, to leave dysfunctional relationships. As the result of this emotional enmeshment, the codependent tends to lose all sense of self or identity, and to become emotionally dependent upon the addict. The addict’s mood dictates the codependent’s mood. The codependent often protects the addict from the natural consequences of drug abuse. Such behavior is referred to as “enabling”. Examples include giving the money for the addict to buy drug out of pity seeing the addict suffered from withdrawal syndrome.  Hence, codependency is considered an unhealthy relationship pattern. That the codependent may purposely isolate himself/herself (and the family) from the extended family and friends, in order to keep the “family secret” and save the family from the embarrassment_[3].

Chief Characteristics of codependents _[3]:

• Poor self-esteem
• Need to be needed
• Strong urge to change and control others
• Willingness to suffer
• Resistance to change
• Fear of change

The mother usually becomes codependent. Maybe because ‘whose mother wants to see her children suffer?’. Yet, actually she has to show tough love to help her children safe from addiction. She must understand that enabling is a destructive pattern and moreover will take her children further from recovery.

Role Behavior

Family therapists have created a variety of schemes for classifying the types of role behavior in the addict family. The roles born because the needs to reach equilibrium. The players in this scheme are_[3] :

The addict

The addict also play a role which is to act irresponsibly. He/she is also emotionally detached and show abandonment to the family. Drug using becomes the priority and may be the only thing he/she cares about.

The enabler

The enabler shows behavior that support the addiction process by helping the addict avoid the natural consequences of irresponsible behavior. The enabler may reduce tension in the family by “smoothing things over” but he or she is unaware that the enabling behavior is contributing to the progression of drug addiction. Enablers believe that they are simply being helpful and acting to hold their family together. Though their efforts often have destructive long-term consequences for the addict.

Bobby’s mother : “I had dedicated my years for Bobby. Each time I cried, I bleed, it was for him. In his now age, he should have been an independent son who support and take care of me, but the fact is the reverse.”

The hero

This role attempts to do everything right. The hero often takes on parental responsibilities that the addict parent gave up. The enabler parents usually doesn’t have time to their chores because her/his time is fully booked for the addict. They are the family’s high achiever and the source of pride for the family so the family member can say to themselves, “ We’re not so bad after all’.

Bobby’s old daughter : “As the old daughter, I have to take care of my young sister and brother. I don’t want to make my parents disappointed because Bobby has done that. “

The scapegoat

The scapegoat does very little right and is quite rebellious  or even antisocial. The scapegoat typically feels inferior to the family hero. He/she is the object of the addict parent’s misdirected frustration and rage. This also shields the addict from some blame and resentment that would have been directed at him/her, this process of diversion allows the addiction to progress further.

Bobby’s father : “Why do they (Bobby and his wife)blame on me? Why everything I do as a father seems to be always wrong?”.

The lost child

The chief characteristic of the lost child is seeking to avoid conflict at all costs. Such children tend to feel powerless, very quiet, depressed, isolated, withdrawn, and so on. These person tend to be forgotten, as they are very shy. They are follower or show great deal of insecurity. The lost child helps maintain balance in the family by simply disappearing or not requiring any attention. In the extreme, the lost child will think, “If I killed myself, Mom and Dad would have one less thing to worry about.”

Bobby’s Youngest sister : ” I want to do something but I’m confused about how and what I can do . My brother and my parents are in trouble, I just don’t want to cause more problem.”

The Mascot/The Clown

Everyone in the family likes the mascot and is comfortable with having him/her around. The family usually views the mascot as the most fragile and vulnerable; thus tends to be the object of protection. The clownish behavior acts as a defense against feelings of anxiety and inadequacy. Mascots often have a dire need for approval from others. The mascot becomes a counterbalance against the tension that is so oppressive in dysfunctional families. He/she maybe the one family member about whom no one has a complaint.

Suggested Readings :

[1] Lawson, A., & Lawson, G. (1998). Alcoholism and the family : A Guide to treatment and prevention (2^nd ed.).  Gaithersburg, MD: Aspen.

[2] Pearlman, S. (1988). Systems theory and alcoholism. In C.D. Chaudron & D.A.Wilkinson (Eds.). Theories on Alcoholism. Toronto: Addiction Research Foundation.

[3] Thombs, Dennis L. (1999). Introduction to Addictive Behaviors (2^nd edition). New York : The Guilford Press.

[4] Van Wormer, Katherine. (2008).  : Counseling Family Members of Addicts=Alcoholics: The Stages of Change Model. Journal of Family Social Work, Vol. 11(2). Iowa : The Haworth Press. Available online at http://jfsw.haworthpress.com