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Understanding Addiction: A Guide for Families

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If your family member is struggling with drug or alcohol addiction, you may feel a range of emotions such as anger, frustration, or sadness. You may want to help, but not know how.

The challenges of supporting a family member with addiction can feel overwhelming at times, but you’re not alone. Many people struggle with addiction each year in the U.S. In 2019, 14.5 million Americans aged 12 and older had an alcohol use disorder (AUD), while 8.3 million aged 12 and older had an illicit drug use disorder.1

If you’re looking for ways to support a family member struggling with addiction, this article will help you:

  • Better understand addiction.
  • Recognize the signs of substance misuse in family members.
  • Understand the impact of addiction on families.
  • Learn what enabling is and how to stop it.
  • Encourage loved ones to seek help for their addiction.

What is Addiction?

According to the National Institute on Drug Abuse (NIDA), addiction is a chronic, relapsing medical disorder that involves compulsive drug- or alcohol-seeking and continued use of drugs and alcohol despite negative consequences. Addiction changes the brain and behavior in ways that can be long-lasting, making it difficult for someone to stop using, even if they want to.2

Medical and mental health professionals do not use the term “addiction” as a diagnosis, but rather, the term substance use disorder (SUD). This is the diagnosis that people receive when they meet criteria laid out by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). There are 10 different categories of SUDs, including:3

  • Alcohol Use Disorder.
  • Caffeine Use Disorder.
  • Cannabis Use Disorder.
  • Hallucinogenic Use Disorder.
  • Inhalant Use Disorder.
  • Opioid Use Disorder.
  • Sedative, Hypnotic, or Anxiolytic Use Disorder.
  • Stimulant Use Disorder.
  • Tobacco Use Disorder.
  • Other, or Unknown Substance Use Disorder.

Substance use disorders are thought to develop in association with the effects of repeated substance use on the brain and behavior. While it’s not yet completely understood, researchers believe that almost all addictive substances directly or indirectly increase activity in the brain’s dopaminergic reward system.2

Dopamine is a neurotransmitter thought to play a role in motivation and reward, and helps to encode behavior, learning, and decision-making. Researchers believe that dopamine is a key player in reinforcing the desire to use. More simply put, people want to repeat pleasurable experiences; so, when they use a substance that elicits pleasurable feelings, they may be driven to keep using.4

Repeated substance use can lead to tolerance, where a person needs to use more of a substance to experience previous effects. It can also lead to dependence, a condition where the body and brain have adapted to the presence of the substance and the person needs to use it in order to feel normal, to function, and/or prevent withdrawal symptoms.2 These adaptations can result in further motivation to use, particularly in the avoidance of uncomfortable withdrawal symptoms that can occur if a person stops using.

What Are Signs of Drug Abuse in Family Members?

The signs of substance abuse aren’t always obvious, and they can vary depending on the person and the substance. A SUD is diagnosed by a doctor or qualified mental health professional. They rely on DSM-5 criteria to diagnose someone with a SUD.

The criteria listed below apply to all the diagnostic categories for SUDs, except caffeine.3 Knowing the diagnostic criteria may help identify a family member who is struggling with addiction, but a formal diagnosis should be made by a medical professional.

If a loved one has exhibited at least 2 of the following diagnostic criteria over the past 12 months, they may be struggling with a SUD and need the support of treatment professional:2

  • Taking the substance in higher quantities or for a longer period of time than they originally intended.
  • Being unable to cut down or stop substance use even if they want to.
  • Spending a lot of time obtaining, using, and recovering from the effects of the substance.
  • Experiencing cravings, or intense urges to use.
  • Failing to meet obligations at home, work, or school due to substance use.
  • Continuing substance use despite having social or relationship problems.
  • Giving up or reducing activities the person once enjoyed in order to use the substance.
  • Using the substance in dangerous situations, e.g., driving or operating machinery.
  • Continuing to use the substance despite having a physical or mental health problem that the person knows is likely due to the substance.
  • Tolerance, or needing to use larger doses (or using with increased frequency) to feel the desired effects.
  • Dependence, or experiencing withdrawal symptoms when stopping or significantly reducing the amount of a substance.

How Does Addiction Affect Families?

Addiction can affect families in numerous ways based on the family structure, interpersonal dynamics, the substance used, and other factors. Addiction’s impact on families can include psychological, physical, social, and financial effects. Addiction can also have a detrimental and long-lasting impact on children who live in the same household as people struggling with substance abuse.5

Psychological Effects of Addiction

The mental health of families can be impacted in different ways depending on many factors, particularly for partners or people who live with the family member who is struggling. Psychological effects may include: 6

  • Denial.
  • Chronic anger.
  • Stress.
  • Anxiety.
  • Hopelessness.
  • Inappropriate sexual behavior.
  • Shame.

Physical Effects of Addiction

Family members can experience a variety of physical effects when living with and/or supporting a loved one with addiction, including neglecting their own physical needs. 6 These physical effects may include:5

  • Decreased physical intimacy.
  • Feeling a lack of physical safety.
  • Experiencing physical or sexual abuse.

Social Effects of Addiction

Social effects of addiction on families can include feeling isolated from others, even their own family, friends, or community. They may feel stigmatized because of their family member’s addiction.6 Families may experience a range of other social problems related to substance abuse such as criminal activity, joblessness, domestic violence, and child abuse or neglect.6

Financial Effects of Addiction

The financial consequences of addiction on families can include:6

  • Dealing with joblessness or homelessness.
  • Needing to provide direct financial assistance to the family member.
  • Asking other family members for money.
    Taking out loans to help pay for treatment for the family member.
  • Dealing with the cost of theft or legal issues.
  • Indirect monetary contributions in the form of time spent taking the person to appointments, doing housework and shopping, or providing childcare if the person is unable to do so themselves.

How Addiction Affects Children

Addiction can take a serious toll on children who live with someone with substance abuse issues, and especially if that person is their parent or primary caretaker.

Emotionally, children can suffer from a lack of a secure attachment to the parent or caretaker. They may not feel that they have a safe home environment, which can cause developmental and emotional issues. For example, they may not learn healthy ways of communication and may experience chronic emotions like:5

  • Anxiety.
  • Fear.
  • Depression.
  • Guilt.
  • Shame.
  • Loneliness.
  • Confusion.
  • Anger.

Children and teenagers who internalize their emotions can develop psychological problems such as depression, anxiety, substance abuse, and other issues. If they externalize their problems, they can develop issues like:5

  • Opposition.
  • Conduct problems (often in the form of stealing, lying, and truancy).
  • Anger outbursts.
  • Aggressive behavior.
  • Impulsivity.
  • Substance abuse.

Children with parents or caretakers who have substance use issues can have a higher risk of suffering from physical and sexual abuse or neglect. They may be involved with or even physically removed from their homes, if necessary, by Child Protective Services.5

The lifelong consequences of growing up with a parent who had an addiction can include:5

  • Impaired learning capacity.
  • An increased likelihood of developing a substance use disorder.
  • Adjustment problems, including a higher chance of divorce, violence, and the need for control in relationships.
  • Higher risk of other mental health problems such as depression, anxiety, and low self‐

How to Stop Enabling a Family Member

Enabling involves behaviors that seek to protect or prevent a family member with addiction from experiencing consequences related to their substance abuse.5 An example of enabling might be bailing out an adult child from jail due to repeated drug offenses. The parent thinks they are helping, but by bailing them out, they prevent their child from dealing with the consequences and making changes.5

Family members may feel responsible for helping their loved one or fixing their problem, but this enabling behavior can potentially lead to a person neglecting their own wellbeing in favor of ensuring the wellbeing of others.5

Potentially enabling behaviors can include:9

  • Justifying or agreeing with the person’s substance abuse, such as by saying they deserve a drink because they had a stressful day.
  • Minimizing the problem, such as by saying “It’s not so bad.”
  • Using with the person or allowing them to use at home, with the justification that at least they’re not out on the street if they’re at home.
  • Taking on the person’s responsibilities, such as doing their chores if they’re hungover.
  • Calling in sick to work for them when they’re hungover.
  • Feeling superior by treating the person like a child or like they cannot handle things without your help.

Setting limits and establishing boundaries can help protect you and, in the end, may help your loved one because it encourages them to take responsibility for their actions. Boundaries can help to define what’s your responsibility and what’s someone else’s. Boundaries can be:14

  • Spiritual.
  • Social.
  • Sexual.
  • Physical.
  • Emotional.
  • Intellectual.

If you feel angry or resentful, it may be a sign that you are enabling and need to set healthier boundaries.10 It’s not an easy process, and you may need to reach out to a mental health professional to discuss exactly how to set appropriate boundaries with a loved one. Some basic tips about setting boundaries include:11, 14

  • Establishing clear rules so that the person knows what you will and will not tolerate. For example, letting them know you will no longer allow them to stay home from school if they are hungover or that you won’t call in sick to work for them.
  • Recognize your own feelings. For example, if you’re feeling angry or guilty, you may need to consider setting boundaries.
  • Stick to your boundaries.
  • Consider boundaries outside of an immediate conflict so you are not influenced by others.

Take Care of Yourself

Self-care is critical when dealing with a family member who has an addiction. If you don’t take care of yourself first, it may be more difficult to cope or help them, and you can feel increasingly drained and resentful. Make sure to take care of your needs, such as eating a healthy diet, getting enough sleep, reaching out for social support, and making time to relax and destress each day.

Support groups for family members of people with addictions can helpful. You may consider groups like:

  • Al-Anon, a 12-step group for families and friends of people with alcohol addiction.
  • Nar-Anon, a similar group for those with loved ones who have drug abuse issues.
  • CoDA, or Codependents Anonymous. Codependent behavior can be common in families dealing with addiction and typically involves caretaking, denial, low self-esteem, compliance, control, and avoidance.12

Encouraging Family Members to Seek Treatment

It is not always easy to support, love, and help a person struggling with addiction. Even if you want to help, you may feel caught in a cycle and not know where to turn. While you can’t force a person to seek treatment, you can provide encouragement, support, love, and appropriate family behavior that may encourage loved ones to get help. These behaviors include:15

  • Ignoring behaviors related to using drugs and/or alcohol.
  • Reinforcing positive behaviors related to seeking help for addiction.
  • Letting the person experience consequences related to their substance use.
  • Making specific, yet positive requests for the person to change their behavior (e.g., seeking treatment or reducing use).

Suggesting a conversation with a family doctor may be a good place to begin because some people feel it’s a relatively safe setting. A doctor can provide an evaluation and refer your family member to treatment. You can also search treatment facilities around the country on the Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locator.

Treatment for substance use disorders is delivered in many different settings using a variety of behavioral and pharmacological approaches. Treatment is most effective when personalized and tailored to your loved one’s needs, which will take into account the type and extent of your loved one’s addiction, their physical and mental health history, prior experience with substance use treatment, and other factors.13 Generally and broadly speaking, treatment for substance use disorders includes the following:16

  • Detox, or medically managed withdrawal. Often considered the first step in the treatment of substance use disorders, detox or medically managed withdrawal helps a person safely clear their body of substance(s). It includes managing the acute and potentially dangerous physiological effects of stopping substance use, but alone does not address other social, psychological, and behavioral problems related to substance use. Detox may occur in inpatient, residential, and outpatient facilities.
  • Inpatient or residential treatment. A person lives at a hospital, medical, or non-hospital rehab facility for the duration of their treatment, which may include pharmacological treatment and typically includes behavioral therapy.
  • Outpatient treatment. A person lives at home but travels to a rehab facility or medical office several times per week to receive treatment services, which may include pharmacological treatment and typically includes behavioral therapy.
  • Aftercare, including peer support or mutual-help groups and post-treatment therapy. This may include participating in 12-step peer support or mutual help groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), secular mutual help groups such as SMART Recovery, or individual and group therapy sessions led by therapists at a rehab facility.

If you’re not sure how to help someone with addiction or you want to learn more about treatment options, don’t hesitate to reach out for assistance. American Addiction Centers offers a free and confidential helpline that you can call 24/7 at (877) 978-2033 to talk to a caring admissions navigator about the treatment options that may be best for your loved one.


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Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series of in-depth articles on Community Paramedicine programs across the country that go beyond transporting patients to emergency rooms and connects specific patients, such as repeat system users, the homeless and others with behavioral health issues and substance use disorders, to definitive long-term care and treatment. In his current capacity as Medical Editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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