Family functioning in families with alcohol and other drug addiction.

• Author: Schafer, Gabriele
• Position: Report

Abstract

Alcohol and other drug addiction, a societal problem that is steadily growing, contributes to the destruction of families and communities. Research has identified a strong connection between disrupted family relationships and alcohol and other drug addiction. Individual in-depth interviews were undertaken with 12 participants who were residents and ex-residents in the Higher Ground Alcohol and Drug Rehabilitation Trust, Auckland, New Zealand. These interviews were analysed using a qualitative framework. The findings are discussed in the context of a broad range of academic research on addiction and its effects on families. The results show that the majority of participants had experienced painful and traumatic childhoods in their families of origin, which contributed to their subsequent addictive behaviour and which they felt had affected their current familial relationships. All participants and their families had suffered from various forms of family disruption, such as loss of custody of their children, loss of employment, marital breakdown, physical and psychological abuse, depression and ill health. Some participants had also committed drug-related crimes and experienced accidents as a result of their addictions, which also affected their relationships with their families.

INTRODUCTION

Alcohol and other drug misuse is an increasing social problem that contributes to the destruction of individuals, families and communities (see Rossow 2001, Vetere and Henley 2001). National statistics in the United States show that between 18,000 and 19,000 automobile fatalities each year can be traced to alcohol consumption (Brake 1994), and a disproportionate number of deaths from drowning, fires, violent crimes, and suicides are alcohol-related (Brake 1994, Rivers 1994). It is estimated that there are about 1 million heroin addicts and about 2.4 million crack and cocaine addicts in the United States (Holloway 1991).

Substance abuse results in enormous costs to the abuser, his or her family and the community. With respect to the New Zealand situation, the social costs of alcohol misuse have been estimated as being between $1.5 billion and $2.4 billion annually. This estimate includes direct costs such as hospital expenses, accident compensation payments and justice system costs. Indirect costs include lost production resulting from premature death and illness, lost working efficiency and excess unemployment (ALAC and Ministry of Health 2001). Jones and his colleagues (1995) estimated that alcohol-related lost productivity among the working population of New Zealand amounted to $57 million per year. Each year between 7,000 and 22,000 alcohol-affected patients are treated at each of the country's three busiest emergency units--Auckland City, Middlemore and Christchurch hospitals. Hospital emergency departments estimate that 10 to 30% of their work is alcohol related. (2)

According to Rutter (2002), the pathway to drug misuse is complex and determined by multiple biological, psychological, cultural and environmental protective and risk factors that interact with each other and change over time, from conception to adulthood. One of the most popular theories of alcoholism, and addiction in general, has been termed the disease model. (3) This conceives of alcoholism and other drug addiction as a progressive and predictable disease (Chan 2003). However, according to Chan, over time a fundamental transformation has taken place whereby the focus on the individual as the identified person with the addiction continued, but the family began to be seen as either being the cause of alcoholism or as partly responsible for its maintenance. A large body of research suggests that family members often play an important role in the lives of those who abuse alcohol and other drugs (see Berry and Sellman 2001, Blum 1972, Coyer 2001, Kaufman 1985, O'Farrell and Fals-Stewart 1999, Rossow 2001, Stanton 1985, Velleman 1992, Velleman et al. 2005, Vimpani 2005).

Researchers focusing on the role of family relationships in the creation and maintenance of alcohol and other drug-related problems have identified a strong connection between disrupted family relationships and alcohol and other drug addiction (Stanton et al. 1984, Stanton and Shadish 1997, Velleman 1992). Some research highlights the potential relations between alcohol-related coping behaviours and both psychological and relationship distress (Kahler et al. 2003). Issues related to alcohol and drug abuse colour all behaviour within a family system (Lederer 1991). Lederer suggests some markers that distinguish alcoholic families from other families, including reciprocal extremes of behaviour between family members, lack of a model of normalcy, and power imbalances in family organisation. According to Nace and his colleagues (1982), some psychological factors that affect the alcoholic and their family include the stigma associated with alcoholism, emotional withdrawal, guilt and craving. Velleman (1992) also writes about the impact of drinking on family roles, communication, social life and finances; for example, finances that are limited through expenditure on alcohol, family gatherings that are spoiled because of drunken behaviours, and roles that have to be allocated because the addicted family member is unable to carry out daily tasks.

This study explores the effects of alcohol and other drug addiction on the family system for people with severe substance use disorders who were residents or ex-residents of Higher Ground in Auckland, New Zealand. Higher Ground was established in 1989 in Auckland and provides a 25-bed, four-month residential therapeutic community for people with severe substance dependency on drugs and alcohol. The disease model and the 12-step philosophy of Alcoholics Anonymous are used in individual as well as group therapy throughout the treatment.

METHODOLOGY

One of the purposes of this research was to find out what kinds of family dynamics operate in families with alcohol and other drug addiction. The University of Auckland Human Subjects Ethics Committee and the Auckland University of Technology Human Ethics Committee approved the study. All names and other identifiers have been changed to ensure confidentiality of participants and people referred to in the interviews.

The Participants

Three women and nine men who identified as New Zealanders of European descent participated in the study. (4) The women and six of the men were current residents of Higher Ground; the remaining three men were ex-residents. All participants were part of the Multiple Family Group (MFG) treatment programme in Higher Ground, whereby residents and their families come together on a weekly basis for group family therapy sessions. During July to August 2001 the staff members facilitating the MFG alerted participants in the MFG to the research project. Higher Ground also arranged a poster at strategic places at the facility, inviting participants to contact the researcher. Apart from the ex-residents, who were approached and invited to participate in the research, all of the residents approached the clinical director and let him know that they wanted to take part in the study. The ages of the participants ranged from early 20s to early 50s.

Data Collection and Analysis

The research took the form of in-depth semi-structured interviews of approximately one hour. With the permission of the participants, the interviews were recorded on audiotape and transcribed. It was my aim to understand the connections between family interactions and experiences of addiction. The interview material discussed here does not claim to be representative of a wider population.

With respect to the qualitative analysis, once the interviews had been transcribed, the resulting data were processed via a descriptive thematic analysis technique with an emphasis on the qualitative evaluation of the data (see Glesne and Peshkin 1992). "Thematic analysis is a method for identifying, analyzing and reporting patterns (themes) within data" (Braun and Clarke 2006:79). This involved multiple readings of the data and identifying connections, patterns, and themes. Braun and Clarke discuss what constitutes the prevalence of a theme and emphasise that there is no right or wrong method for determining prevalence, but that authors need to let the reader know how they analysed their data. In this study prevalence was counted across the entire data set. Each theme consists of accounts of the majority of participants, but only a few representative extracts are presented. The findings, which are presented in the results section, are then discussed in the context of a broad range of academic theories and research about addiction and family functioning.

RESULTS

Four main themes were identified in the interview data. The most salient finding of the research was that all participants felt they had been unable to develop functional relationships with either their family of origin or their current family members. They identified a strong connection between these dysfunctional family relationships and their substance use.

Theme 1. Traumatic Childhood and Adolescent Experiences

The majority of the resident participants had experienced physical and sexual abuse and personal neglect in their childhood and said they had tried to cope with these experiences by taking alcohol and other drugs. In some cases the parents had left home and abandoned them to others' care, and some had never met either their mother or father. The majority of participants said that their parents were addicted to alcohol and other drugs, and they had some belief that this caused them (the participants) to be addicted to alcohol and other drugs as well.

Female resident B: And I come from a long line of addicts, so I have a strong addictive trait. I sort of grew up with a lot of resentment from my siblings. I woke up when I was eight years old one morning...