In the field of substance use disorder care counselors like myself work diligently in support of those nearest to the patients we treat. Whether it is a traditional family member, an elected family member or anyone that shares an emotional bond with the patient, their health and the health of the system they inhabit can be an asset in all measures of patient care. It is vital to have a sound understanding of how the disease of addiction impacts those around the chemically dependent individual. I would like to add a bit to this conversation.
First, it’s important to understand that the evolving methods of compensation that family members and friends create in their efforts to live with someone with substance abuse disorder are mechanisms for survival. Secondly, it is vital to recognize these evolving methods as pre-contemplative; that is to say the individual is not completely aware that they are living in a manner that is all that different. Once the progression begins, previously unthinkable actions or activities come slowly into conception, ultimately working to become acceptable and even commonplace. Without understanding this process it is easy to blame a family member or loved one for “enabling” the behaviors of those with a substance use disorder.
The impact of the disease of addiction is progressive. So, just as an individual with a substance use disorder will become increasingly ill, so too will family members or other loved ones if they remain in proximity of the substance user without intervention. In addition, as clinicians have noted for some time, since the social structures in which family members reside and the physiological responses they have are so similar this progression can be qualified and even quantified to substantiate the level of impact endured. Let’s explore this reality.
Spirituality/Values: At the outset you will see the genesis of this progressive influence on value systems; the impacted family member or other loved ones spiritual nature begins to erode. He or she begins to doubt their own judgment, abilities and senses. They begin to accept violations as to how they might wish to live, or how they are treated. Similarly, a parent, spouse or other loved one begins to feel lost, confused or uncertain and subsequently begins to acquiesce to the previously unacceptable.
Mentally/Rationality: These low-grade violations spark the use of defense systems, or active methods of compensation. The affected family member begins to intellectualize, justify, or minimize what he or she sees and/or how they are now living. Rationalizations become commonplace: “All kids experiment right?” . . . it is just a phase . . . she is just stressed with work . . . it is only weed . . . everything will be better after the holidays . . . and the list goes on. Although these defenses can be quite productive in decreasing discomfort or stress short-term (try saying the word “only” aloud… comforting right?), long-term they add to the mounting violations of self.
Emotionally: Emotions begin to be more high-risk as family members live constantly in fear for the safety and wellbeing of someone they care so much for. They look for control and begin demanding change, and attempt to orchestrate stability. As their confusion and disbelief grows they become angry or dreadfully sad. “How did we get here?”, “why are they doing this?” Members may become defensive and jealous of those not struggling as they are. They begin to feel unsafe in their own home, often consumed with resentment. They can find little hope in most of what is around them and find themselves wishing desperately that things would just change.
Physically/Behaviorally: The substance user and family members have begun to live much differently now; isolating themselves, declining social engagements. As family members grasp for order they become an unwitting detective in their own home, searching for evidence, attempting to fill up the hole that has been created in their heart. They begin to hide valuables, lock rooms; perhaps purchase a safe, or take doors off of hinges. They might sleep on the couch waiting, or drive to a location to see if their loved one got there as they didn’t believe they would, yet could not say “no” to their request. As this progression begins to run full steam family members move into physical distress. They have become hypersensitive to their environment, jumping at sudden noises like when the phones rings or a door slams. Stress responses have led to sleep disturbances in which they might wake hourly, or wake early before the alarm goes off, staring at it each morning as getting out of bed is now a laborious chore. They may even note they have stopped dreaming vividly as they now tend not to enter into REM sleep. Their appetite is diminished, accompanied by other stomach alignments. Finally they might find they are experiencing muscle twitches in their legs or the corner of their eyes, or hair loss, and dry skin. They may notice they are clenching or grinding teeth at night, or biting nails. Breathing is consistently shallow and it feels like a weight is constantly on the chest. Overall they feel sad and unmotivated, have racing, anxious thoughts and forget things easily. Relaxation is a long lost friend as is self-worth and esteem. And yet in spite of the profound impact, in the back of their mind, the thought still remains— “if I could just get them to stop all would be well… “
Those of us who traverse this terrain know well that affected family members and loved ones require and deserve the healing and comfort that accompanies personal recovery. And though not yet its own substantiated diagnosis I believe practitioners should continue to critically evaluate the reality of addiction as a Family Disease and work to classify symptom progression to better support the care we provide clinically.
Jerry Blackburn M.Ed., CDP
If you or a loved one is struggling with a substance use disorder or its impact please seek help.