Family Involvement and Influences in Substance Use Disorders
This paper details the influences and involvement of family members in clients with substance use disorders, and the importance of psychoeducation for family members of clients who struggle with addiction. Research studies mentioned will describe the influences on children (typically adolescents) from how parents approach and view substances, parents’ personal use of substances, parental control and attachment with their offspring, biological, psychological, and genetic factors, and how clients’ family interactions affect the development and perpetuation of substance use and substance use disorders. The family members’ ideas of the causes and solutions for substance use disorders will also be included in this paper, and how it affects the clients’ perceptions of their own addiction, treatment, and progress. This paper will also discuss the implications of these findings on treatment for clients that involves family members, and potential areas of research that current have little prominence and would benefit from an increase in studies.
In the field of substance use disorders and addictions counseling, no matter what approach is taken, familial contact and interaction continues to serve as a significant, multifaceted component of a client’s life (Chassin & Handley, 2006). Varying theories may each have a different way to describe the impact of family members on an individual depending on the emphasis placed on family influences throughout a person’s life; but the fact that there is a connection between family interaction (or lack thereof) and the development of the behaviors and mindset of an individual who begins to use substances or has a substance use disorder, is quite clear.
How it works
It is important to note that this influence may also be bidirectional (Schuck, Otten, Engels, Barker, & Kleinjan, 2013), as children are capable of influencing family interactions and relationships as well. Parents and their children engage a significant amount time in modeling and imitation, whether this is conscious or not, and this behavior does not apply only to learning how to make certain faces or say specific words. Parents and children can very much be influencers and therefore perpetuators of each other’s substance use behavior, in a circular concept of children seeing parents engaging in substances and proceeding to imitate or model that behavior, which in turn affects the continual behavior of parents in their personal use of the substance. In this study, the behavior of smoking behaviors was looked at within the context of bidirectional influence between parents and their children, with results supporting the concept of influences towards substance use flowing in both directions.
Even though the study specifically looks at parents, older siblings and other family members could also serve as bidirectional influencers. Furthermore, this does not limit itself to biological family members (Newman & Roberts, 1993), as family units tend to act as a complex system involving both biological and psychological, proximal and distal members as sources of changes in behavior and perceptions of substance use.
Studies looking at the role of parents specifically, have shown that there is a large scope of influence on children relating to substance use, by influencing their global perception of self-worth, their risk of using substances, their view of peer pressure as a factor in use of substances, and their perception of substance use in general (Bijttebier, Goethals, & Ansoms, 2006). When studying the level of attachment of children to parents, and parental control of the family unit, parents who were alcoholic drinkers had lower family cohesiveness (families were less organized, and their attachments were not as stable), and their children viewed themselves as having lower self-worth than children of non-alcoholic parents. Having a lower sense of self-worth may influence a person’s decision to engage in negative behaviors and peer pressure in order to raise that self-worth by finding acceptance with others. The study also showed that children of alcoholic drinkers’ perceptions of drinking and smoking were influenced by the use of such substances by their parents, indicating that the parental relationship with substances may place the child at risk for psychopathology.
This is important because when it comes to treatment of individuals with substance use disorders, the amount of involvement and moral support from families can have a significant positive (or negative) effect on the success of clients, not just with treatment in general, but with other members of the therapeutic community (Adejoh, Temilola, & Adejuwon, 2018). Some clients want their families to be very involved, and others do not want to have any family involvement due to a history of inappropriate or complete lack of a familial relationship in general. This situation becomes more complicated when family members desire a different level of involvement than the client. They may decide that they want to be involved even though a client does not want them involved; or a client may want family members involved, but family members may not want to be involved with clients due to being “burnt out” or cognitively and emotionally stressed from previous attempts to help either their child or themselves reach some level of sobriety. The relationship that is built over time with family members affects the client’s development of their substance use and potentially their disorder, based especially on how the parents might approach their relationship with the clients and their ability to be open, agreeable, and conscientious (Hojjat et al., 2016). A parent who imposes larger amounts of stress and strain on an adolescent, for example, especially where genetic predispositions have been established in the client, may place that child at a higher of engaging in substance use with peers.
Genetic factors have also been established as passed on between parents and children who are substance users, indicating that there are biological predispositions of substance use (Agrawal & Lynskey, 2008). Risks associated with genetic disposition are moderate to high for using substances, especially when mixed with environmental factors that are less than ideal. This is important because it could be helpful when educating family members and clients about their substance use, in order to decrease denial, and feelings of blame and guilt from either the family members or the clients. Having the knowledge that substance use disorders have biological ties allows clients and their family members to address the factors that are out of their control, and therefore be able to identify factors within their control, such as their relationships with each other, the environment they are in, and other factors such as socioeconomic status and even health issues. Clients’ family members may also have a better understanding of their own role in influencing their children and may be encouraged to seek treatment for themselves.
Silberg, Rutter, D’Onofrio, and Eaves, (2003) conducted a research study of the genetic influences on substance use behaviors, depression, and conduct disturbance on young boys and girls. The results of the study maintained the idea that there was a moderate genetic link between substance use and depression and conduct disturbance, even though the genetic factors were linked to a greater level for girls, with environmental factors having a greater influence on boys’ use of substances. This study is particularly important because it highlights the comorbidity of substance use, depression, and conduct disturbances. Substance use and its disorders are usually characterized by the increase of deviant behaviors in individuals; and when it comes to treatment, a holistic approach addressing the various outcomes and co-occurring issues in clients’ lives may bring greater results (Polimeni, Moore, & Gruenert, 2010).
Based on the diverse and significant amount of research showing how central family relationships, especially parental interaction, influence and affect the involvement of their children in substance use, it’s imperative that families be included in substance use treatment, whenever this is beneficial (McLaughlin, Campbell, & McColgan, 2016). Bertrand et al. (2013), conducted a study that followed the treatment of adolescents and looked at the involvement and effects of family inclusion in treatment on the outcome of the family relationships, perceptions of “parental warmth” (interest from parents in the lives of their children) and maternal mental health from the adolescent’s perspective; and the overall effects on the adolescent’s risks regarding future substance use. The study revealed that after a six month lapse of time where parents used rehabilitation resources provided by the facility and were involved and educated about their children’s treatment, adolescents perceived their parents as being more mentally healthy, showing more positive interest in the adolescent’s lives, and the adolescents actually increased their self-disclosure in sessions. Resulting from closer familial ties and increased self-disclosure, the adolescent’s future use of substances decreased.
Bertrand et al. (2013), reports that a significant factor in the results of the study was the availability and use of resources and groups for parents to learn constructive parenting skills, improvement of communication, and a greater understanding of their children’s lives and processing of addiction. These materials serve as a way to build (or rebuild) trust in the relationships, allowing for the adolescents to feel more able to confide in their parents, moreover facilitating improved parental control and an overall decrease in substance use and deviant behavior. As an added bonus, the study showed that maternal overall psychological distress decreased as a result of the courses and skills gained in parenting styles and improved communication with their children.
To current knowledge, no research was found specifically addressing the effects of parents’ and family members’ thoughts and perceptions of substance use on the substance use of their children, although influences from parents’ behaviors and parenting styles did appear in many research studies. Being that parental involvement, parental use of resources, and parental personal substance use all contribute to the development and risk factors of children using substances, it would be interesting to see if parental perception of substance use has any correlation to their children’s decision to use, whether directly or indirectly.
Another area with limited research in regards to the involvement of family in substance use and substance use disorders is the involvement of siblings. Although some research was found that specifically mentions how sibling relationships may affects substance use, most research was geared towards general family involvement, or sibling perceptions in problem behaviors as a whole. Increased research in this area may allow for improved family involvement by understanding how best to involve siblings of all ages in helping both the client and the family as a whole in the substance use dilemma.
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