When working with families struggling with addiction, it is common to hear family members say, “I wish my loved one would get sober so that we can get back to normal!” This comment makes sense, as families view the period when a loved one is using as an anomaly and inconsistent with how they functioned without the active addiction. They believe that the person with the addiction is the person with the problem, and they cling to the belief that their own struggles are only transient realities that will go away when their loved one achieves sobriety. They attend family programming to better understand their loved one’s problem, to support their loved one’s recovery and to facilitate their family’s journey back to normal.
Unfortunately, many addiction professions hold this same notion. They believe the value of family participation in the treatment process lies in supporting their clients’ recovery efforts. They fail to recognize the significance of the family disease process on addiction formation and addiction resolution. While a supportive family becomes a valuable asset to the treatment process, it falls far short of treating addiction as a family disease.
If addiction is to be treated as a family disease, with genetic and transgenerational transmission, we must accept that the illness affects every member of the family. It also affects how current and future generations either inhibit or support addiction and recovery. As one generation after another is affected by epigenetic influences, childhood trauma and dysregulation of the autonomic nervous system, normal family functioning becomes skewed by family members' unconscious coping with the elephant in the room.
With each new generation, family members are predisposed to addiction long before their first drink or drug. Therefore, treatment providers must recognize that each family member’s experience of normal functioning is influenced as much by personal and family history as it is by their current struggles with a loved one’s addiction.
Understanding a normal family experience
The concept of organization is important to understanding how families perceive what is normal. From the time we were born, our family leaders established rules, roles, boundaries and routines that created repetitive, consistent and patterned interactions. These organizing principles created stable thoughts, feelings and behaviors that allowed the family to live within a desired value system and to achieve desired goals.
Family organization is shaped through a process of positive and negative feedback. On a day-to-day basis, family leaders reinforce or extinguish thoughts, feelings and behaviors, through consistent patterns of verbal and nonverbal parental interventions. Parental interventions are influenced, positively and negatively, by relationships with authority figures within their own family of origin. Primary family relationships set the foundation for establishing the stable patterns that promote family values and goal achievement.
Rules can take the form of overt and covert communication patterns, allowable limits to emotional experience and expressions, obedience to leader authority, conflict management and resolution, and rule flexibility to meet age-appropriate developmental needs and growth. Roles may include expectations for child care, financial management, chauffeur duties and enlistment of older siblings to manage younger siblings while family leaders are engaging in other role-determined behaviors. Boundaries govern the flow of information within the family system and with the outside world. They can take the form of family subsystem boundaries that shield children from parental relationship issues and prevent the triangulation and parentification of children. They often include limits to time spent with friends or with the television and computer, and also the holding of family secrets. Rituals take the form of religious or spiritual practices, participation in birthday celebrations, and time spent with extended families. Over time, stable patterns evolve into routines, which in turn become a hard-wired and mostly unconscious organizational system that feels normal to each family member.
As family members leave the nest, these same organizational negotiations take place in the formation of new families. New family leaders utilize the organizing principles from their own families of origin as templates for negotiating desired stable patterns for their newly forming family. Within this process, rules, roles and boundaries will evolve. Some will be similar to those of one family of origin and others to the other family of origin. Over time, the new family will evolve hard-wired stable patterns that create a hybrid organization that once again will become the lens for what is normal.
Family stress, problems and crises
Family stress theory defines a problem as any stressor that requires the family to initiate an existing coping strategy and to expend existing resources to solve the issue. A crisis is defined as any problem for which a family does not have a coping strategy or appropriate resources to resolve. Until a family either identifies a new understanding of the problem or develops new resources, it is forced to expend resources consistently to solve the problem, while living with the consequences of the unresolved crisis on a daily basis.
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