Heroin is an opioid drug and is a major downer because when the drug enters the brain rapidly it results in both long-term and short-term side effects such as, drowsiness for a few hours, slowed down breathing, slow heart-rate, insomnia, vomiting, cold flashes, restlessness, etc. (National Institute on Drug Abuse (NIDA), 2018). Although heroin is a powerful pain reliver, it can also act to stimulate the pleasure centers of the brain, which makes it one of the world’s most addictive substances (LeVert, 2006). According to Addiction Treatment: A Strengths Perspective, side effects can be in terms of euphoria, drowsiness, dizziness, confusion, nausea, addiction, fatal overdose, etc., the list continues (Van Wormer & Davis, 2018). In, The Facts About Heroin, it states that “According the United Nations International Drug Control Programme, also known as UNDCP, about 9.8 million people use heroin” (LeVert, 2006, p.7). The addiction of heroin does not just affect the individual but the family and those surrounding the user as well. It is important to know that this is a disease and affects nearly 80% of Americans. Prescribed opioid misuse is a leading factor to heroin use, showing that less than 4% of people who have misused prescribed pain medications started using heroin within 5 years (National Institute on Drug Abuse (NIDA), 2018). Some families may stay together whereas others have separated due to the stress that it may have caused. There are a lot of stressors that are put on the family members and individual that may cause distress amongst everyone. Not only does the addict need treatment, but it is beneficial to the family to seek treatment as well. This disease does not just affect the user but the relatives of the user and sometimes people do not know how to cope with this turmoil.
Stressors, Roles, and Emotions of Family Members
When a family member abuses a substance, this doesn’t only affect the user but can affect the family as well. Depending on the family dynamic, depends on how the addiction will affect the family. For family members there are a lot of concerns, emotions, and decisions that they have to face and deal with. Many stressors can be apparent when coping with a drug problem in the family. The stress can be both physical and psychological and may result in creating household stabilities, neglect or even abuse. The amount of money that a user spends on the drug as well as the cost for rehabilitation centers can add up resulting in stress on the family members if they are willing to help. Lack of care amongst other family members may start to occur, such as lack of feeding or cleaning (Barnard, 2007). It is common for relatives to show signs of rejection, aggression, neglect, criticism, insensitivity, etc. However, this is not to say that every family shows those types of reactions, some are understanding, helpful, supportive of the user. With families of addiction, the members take on roles surrounding the affected person who has now become the main focus of the family. Those members change their behaviors and reactions in a slow insidious process (Black, n.d.). The roles are the family hero, who is the responsible one, the placater, the people pleaser, scapegoat, the one who acts out, the lost child who becomes the adjuster to the situation and lastly the mascot, becomes flexible to the situation. Each member may take on one of those roles when the addict becomes the focus of the family.
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When a member of the family is an addict, the other members become affected in numerous ways as mentioned. The healing process becomes harder to begin because at some point the addiction has affected themselves. Families are important in the many treatment processes of substance abuse. The family also has a fear of relapse which can become the center of attention for the families concern and well-being. If the addict is sober, the family is still concerned and focuses their attention on the individual. For all family members, addiction puts a pressure and a can change the dynamic of the family members. Some family members may choose to cut ties with the addict and some may focus on helping the addict anyway they can. There are the family members who are in denial that a family member could be an addict.
How Relapse Impacts the Family
A relapse can be hard for the user as well as the family. Families should be hopeful for the user but know that there is always the possibility of a relapse and to be supportive. Relapse can cause an added layer of emotional distress, causing a setback in one’s recovery from the addiction. In addition, relapse can have the individual moving backwards in their recovery ending up in a vicious cycle. In the book, Everything Changes: Help for Families of Newly Recovering Addicts, it explains that relapse is like a cycle through the various stages, sometimes you move up, sometimes you fall back, until eventually, the change is finally achieved (Conyers, 2009). For the families, when an addict faces relapse, it is hard because you don’t want to ignore the situation and have the user revert back to old ways, but the family members don’t want to monitor every move the addict could make. It is hard to see someone relapse, but it is important to be aware that relapse is part of the process of recovery. According to Sharma, Upadhyaya, Bansal, Nijhawan, & Sharma, (2012), higher accounts of relapse occurred when there was a decrease in social support. Social support of family members can decrease relapse occurrence, however if there is a lack of social support amongst the addict, relapse is more likely to occur. If family members show their support, the likelihood of a heroin addict relapsing is less common, therefore social support is important.
Parent – Child Relationships
Families of adolescent addicts are more reluctant to go to therapy than families of adult addicts. According to Drug Addiction and Families, “Although physical neglect of children has been strongly associated with parental drug use, it is also the case that drugs negatively affect the establishment of strong emotional bonds with parents (Kerwin 2005).” (Barnard, 2007, p.18).The use of drugs as stated can negatively affect the relationship between parent and child and change the strong bond they once had to a weak, untrusting bond instead. According to Barnett (2016), family members don’t realize the impact in which the addiction has affected their thinking, their behavior, and their relationships. However, it can make it hard to know how to begin healing, even if the addict has stopped using (Barnett, 2016).This is often true for most families. While in treatments including both the young adult and the parent, it is important to help them learn to create constructive dialogue between them.
Substance use can also be related to the less parental monitoring, more exposure to stress from the family, financial struggles, conflicts or violence. Through several treatments with both the family members and the user it has been addressed that the parental overprotection and the over-involvement are factors in limiting the parent-child relationship interaction. Living with heroin-addicts, specifically a child, can be stressful for the members of the family, leading to anxiety, burden and negative feelings towards the addicted person. An article by Pomini,Gournellis, Kokkevi, Tomaras, Papadimitriou, & Liappas (2014), reported that relatives of heroin users think that in order for the child to get better is up to the individual’s control. This thought could increase the blame that the relatives place on the addict, and the addict may feel guilty leading to an increase in substance abuse thus creating a cycle. Also, rejective attitudes towards the user are another way of coping with the addiction of the family member. When a family is experiencing this situation, it tends to have the members come to reality of feeling unprepared and are all affected.
For children, when either one parent or both parents are addicts can result in the child not being able to form trustworthy relationships with people. Some emotions may start to form for the children and may cause anxiety, depression, guilt, shame or they need to keep a secret about their parent’s substance abuse (Lander, Howsare, Byrne, 2013). As mentioned, a parent may be neglectful of the child ultimately affecting the child’s development in certain areas of life, such as education, health, etc.
It is important to realize that not only does the addict need help, but the partner of the addict as well can benefit from receiving help. Another form of relationship is spousal relationships, which can also be affected if one of the spouses is an addict. Marriages can be tested if one is an addict, they might be having communication problems or could be confused how to support the spouse. Couples counseling if it is a partner who is an addict is beneficial so that the counselor can help the couple repair their relationship (Barnett, 2016). Methadone maintenance programs are capable of offering immediate social rewards for the addict living with this family. This program also relieves family strains and improves family relationships (Clark, Capel, Goldsmith, & Stewart, 1972). Married addicts whom are a part of the methadone maintenance programs result in creating changes in one’s behavior. If both spouses are addicts with children, other family members or friends/neighbors tend to take on the role of caregiver. The children may assume roles as mentioned earlier, may experience negative consequences, or may respond and cope better than others.
Family Focused Therapies
Not only does the addict need support but when a family is affected by the addiction as well, they also require support. Therapy can be extremely helpful and beneficial for the whole family. As opposed to a treatment specifically for the addict, there are treatments that are specific for families of addicts. For family members of different types, other than couples, such as extended families, immediate families, etc., different treatments are available to them as well. Family-based therapies are some of the most effective treatments that are provided. One common therapy that families of addicts’ resort to according to Substance Abuse Treatment and Family Therapy, is called family therapy. The goal of family therapy is to meet the needs of all family members as well as address family relationships and determine how certain relationships affect the identified patient and other family members health. In family therapy, another goal is to make a change amongst the whole family. This is different than family-involved therapy, where the focus is to educate families about the relationship patterns that can contribute to the formation and continuation of substance abuse (“Substance Abuse Treatment and Family Therapy,” 2004)
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Another treatment that can be used called Brief Strategic Family Therapy (BSFT), focuses on one member’s problem behaviors and how that stems from unhealthy family interactions. This treatment consists of 12-16 sessions and the counselor observes how each member interacts with one another helping them to change their negative interaction patterns into positive, healthy interactions. Strengthening the family interactions that can be associated with the adolescent’s drug use and related problem behaviors is what makes up the model of this therapy. In order to create the change, a therapist will work the family to increase motivation to change behaviors and reduce concerns about changing. According to Szapocznik, Zarate, Duff, & Muir (2013), the most important innovation of this approach is the belief that any challenges the families discuss in treatment are the same problems maintaining the adolescent’s problem behaviors.
According to “Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide”, there are several known treatments for families and the user such as Family Behavior Therapy (FBT), Functional Family Therapy (FFT), and Brief Strategic Family Therapy (BSFT). With FBT treatment, the therapy focuses on combining the behavioral contracting with contingency management to address both the substance abuse and other behavioral problems. In the therapy is the user and at least one participant where they choose a specific intervention to encourage the family members to use behavioral strategies that they have been taught and apply them to improve their home environment. Functional Family Therapy (FFT) combines family functioning with behavioral techniques to improve communication, problem-solving, conflict resolution, and parenting skills. In treatment is important to engage the families in the treatment process to learn behavioral techniques to improve their relationship with the user (National Institute on Drug Abuse (NIDA), n.d.).
Multidimensional-family therapy is an early intervention approach that is a drug abuse prevention and intervention of families. This approach works on intrapersonal aspects of the adolescent, the parent(s), and other family members that could lead to the development and continuing of the drug use and related problems that arise (Liddle, Rowe, Dakof, Ungaro & Henderson, (2004)). In this specific study, the parents work to improve their relationships with their child. With this treatment, families were able to better their relationships by developing better communication patterns and addressing family problems (Liddle, et al., (2004)).Multi-family therapy incorporates other treatments that are used with families of addicts, such as group therapy, family counseling, psychodynamic practices as well as attachment theories.
According to (Garrido-Fernandez, Marcos-Sierra, Lopez-Jimenez, & Ochoa de Alda, (2017)), a study done about combining the reflecting team with the multifamily treatment, found the self-reflective capacity will allow the individuals to analyze their experiences as well as think about their own thinking processes. The study found that multi-family therapy combined with reflecting team does in fact reduce the addiction severity to some degree. It also showed that with this treatment, several areas were improved such as, employment and support, drug use and psychiatric condition of the individual. The importance of this study was involving the families in the treatment process which then allows them to share their problems and improve their communication processes. The presence of the family positively promotes the drug addict’s rehabilitation process. Specifically, in this article, the multi-family therapy focused on the illness, the patients and their families experienced and related to the illness and how it occupied their lives(Garrido-Fernandez, et al., (2017). The importance of addressing these issues in the therapy sessions allows for the families to understand one another and make an understanding of how the illness may have affected/changed their lives. The goal is to strengthen their family ties by learning from one another and improving their communication skills. With multifamily psychotherapy, combining that with a reflecting team, allows for alternative perspectives.
Although isolation and abandonment are coping strategies that most family members tend to have, it is found that this way of getting distance from the problem actually helps them deal with the situation while regaining their own lives. It is also found that religion and spirituality are common ways to deal with the problem for the family members (Horta, Daspett, Egito, & Macedo, (2016). Similar to the addicts searching for a higher power in their 12- Step Program, the relatives of the addict need to emerge themselves in their religion and or spirituality. Emerging in religion or spirituality can help decrease stress and find strength to cope with this situation (Horta et al., 2016).
Finding family support groups can be one-way families cope, one well-known support group is a 12-Step program such as Nar-Anon Family Groups is a spiritual program, meaning the Higher Power is to help solve one’s problems and become at peace. A Twelve Step fellowship is offered for both the addict as well as those who know the addict and need support. Nar-Anon Family groups, allows for individuals who either know or have known a feeling of desperation concerning the addiction problem of someone close to you (“What’s Nar-Anon?,” 2018). By using Twelve Steps, it can help find a solution to any problem one may be facing regarding addiction. These meetings show support from other individuals facing the same situation, such as relatives or friends of addicts who have been affected by an addict. In Addict in the House: A No-Nonsense Family Guide Through Addiction and Recovery, the importance of the steps helps the members to find their own higher power that is greater than themselves (Barnett, 2016). No single treatment is right for everyone, just like for their families. Depending on the individual, a specific and effective treatment plan is created for the patient’s needs.
The overall focus and goal of these family-based therapies is to create change amongst the whole family, including the user. Focusing on increasing a stronger relationship and better communication tools are tools that the families can learn in these treatments. Depending on the family and user, the treatment that fits them and will benefit them the best is personal. The treatments mentioned are useful when working with families of addicts, including the addict.
Overall Importance (change title)
As mentioned, family-based treatments are effective such as brief strategic family therapy, family behavior therapy, functional family therapy, and multidimensional-family therapy. Other treatments beneficial for families of addicts are family therapy and a 12- Step program such as Nar-Anon meetings. Each family will be able to find a treatment or therapy that works well for them and can benefit them. Relapse is common in addiction, but the family members should know that relapse will occur and the best thing they can do is be hopeful and supportive. Knowing that it will happen and becomes a vicious cycle, is important to be aware of if you know someone who is addicted. A lack of social support can lead to the addict relapsing more likely. However, social support of family members can decrease the relapse occurrence.
Not only should the addict to seek treatments, but it is vital for the family seek treatment as well. Treatments will help relieve the stressors and confusion that individuals may be facing. Children of those whose parents are addicts have taken on other roles, need support in order to cope with the stressors of a parent being an addict as well. The important thing to know is that just like the addict needs therapy and treatment, it is vital that those family members or friends who may have been affected need therapy and treatment as well. There are options for additional support for both the addict and families affected. Not only is the addiction affecting the user but those who are around the user, therefore the importance of support is crucial for all affected.
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- Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage Learning.
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