Addiction As A Family Disease

Addiction is a Family Problem

The Process of Addiction for Families

By Kristine Hitchens, PhD, LCSW-C, LCADC, CCDC

What is Addiction?

Addiction is a brain disorder. Basically, when addictive substances are put

into a body, the chemicals in those substances move into the brain and stimulate

the limbic system, the pleasure center of the brain, and enormous sensations of

gratification ensue. This part of the brain is supposed to be balanced out by the

prefrontal cortex, which is responsible for judgment and decision-making. So,

when the limbic system says, “Go, go, go! Those drugs feel good! Get more!” the

prefrontal cortex is supposed to recognize that there are consequences to doing

so and is supposed to be able to say, “Stop.” However, when the brain has been

altered repeatedly by the use of drugs and alcohol, addiction can occur, and the

prefrontal cortex becomes disabled. It can no longer say, “Stop.” Typically, an

addicted person must experience enough consequences from their use to

override the associated pleasure. The desire to end the consequences is often

what leads an addicted person to seek recovery. Recovery builds scaffolding

around the damaged prefrontal cortex so that it can begin to work correctly again

and help the person to make healthy, appropriate decisions.

Addiction is a process, not an event. It is not like a cold. With a cold, you

go to bed feeling fine and then wake up feeling lousy. Your throat hurts, your

nose is running and your face is full of pressure. You know something has

changed; something is wrong. You are sick. Addiction is different. It grows over

time and, because of the relatively slow process, the sickness is harder to

recognize. Addiction is akin to the boiling frog phenomenon: What do you think

happens if you throw a frog into a pot of boiling water? The frog will recognize

that the water is too hot and that he is in danger. Therefore, he does his best to

jump out. But, what happens if you take a pot of lukewarm water, place the frog

in the pot, put the pot on the stove, turn on the gas and slowly over time the

water starts to boil? The frog has difficulty sensing the incremental temperature

change. The warm water dulls the senses and makes the frog sleepy. He does

not recognize the danger, and he boils. Addiction acts in much the same way. As

addicts continue into the process, they become used to the changes. Their

damaged brains do not sense the danger, and they often find themselves in

“boiling water” before they realize, if they realize, that they are in serious trouble.

The Family in the Process

Family members of addicts, witness to the destruction, are part of the

process. When a person loves someone who is addicted to drugs or alcohol, it is

impossible for that person to avoid being affected by the addict’s actions. The

extent to which the impact occurs depends greatly on the family member’s

knowledge of addiction and use of resources. For many family members, it takes

months and years to gather helpful information and related coping skills. In the

meantime, it is easy to personalize the process. For example, many family

members believe that if they had said or done the right thing at the right time,

they would have prevented their loved one’s addiction. Other family members

grow resentful, thinking that if the addicted person truly cared about them, then

that would be enough to stop the addiction. It can be a tremendous relief for

family members to comprehend that they cannot control or cure their loved ones

and to attempt to do so tends to make problems worse for themselves and

others. Family members who are unable to grasp these concepts tend to become

so hurt by the process of addiction that they are no longer able to function as

they once did. Their personalities change. They become victims of the disease.

An Innocent Start

The addiction process begins innocently. Nobody wants to be an addict.

Most are first introduced to alcohol and drugs by another person in some type of

social setting. Perhaps they are spending time with a friend who raided a parents

liquor or medicine cabinet. Perhaps they are at a party. Or, perhaps they are

sitting around the family dinner table and are given a sip or more of wine every

now and then. Rarely, do people start using substances all by themselves.

Moreover, experimentation with alcohol and drugs tends to begin in the teen, or

even preteen, years when the user is ill-equipped to think through these actions.

The prefrontal cortex, the part of the brain that is responsible for weighing

consequences and making good decisions, is not fully functioning and, in

teenagers, is out of balance related to the limbic system (the pleasure center

which develops more rapidly) until the early to mid 20’s. Therefore, teenagers are

less likely to make wise decisions because their brains are still developing. It is

more likely that they will engage in risky behaviors and focus on immediate

pleasures instead of potential consequences. Moreover, the younger a person is

when he or she begins using drugs or alcohol, the more likely it is that he or she

will become addicted. The attraction to and dependency on the substances gets

folded into the developmental process.

Another common way in which people enter the process of addiction is

through doctor-provided prescriptions. People have legitimate reasons for

seeking out a doctor’s help with concerns like chronic pain or anxiety. And,

doctors have legitimate reasons for prescribing drugs to treat these conditions.

Unfortunately, opiate medications (like OxyContin and Percocet) prescribed for

chronic pain can be addictive, as can be benzodiazepines (like Xanax)

prescribed for anxiety. Once a person gets hooked, it is quite common to “doctor

shop,” going from doctor to doctor with the hope of cajoling the doctor into

prescribing a certain type of drug. People get very good at knowing what to say

and how to act to manipulate a doctor into prescribing. Some doctors are savvy

and understand the signs and symptoms of addiction, but many are not, and take

their patients at face value. Of course, it is also possible for people to buy opiates

and benzodiazepines off the street and the internet.

It would be so nice if potential addicts would turn blue the first time they

drank or drugged, to let them know that they need to stop because further use

will lead to addiction. But they don’t turn blue. Typically, they look like everyone

else who does some experimenting with alcohol or drugs or goes to the doctor

with complaints and gets a prescription. The obvious signs of addiction do not

emerge until later.

The Family Enters the Process

People do not continue behaviors for no reason. There has to be a benefit

that reinforces the behavior. So it goes with addiction. People continue to use

alcohol and drugs because they enjoy the use itself or the related effects. Maybe

the substances make a good feeling last longer. Maybe they make a bad feeling

turn into a good feeling. At the very least, maybe they make a bad feeling go

away; it is better to feel nothing than bad. Perhaps the use of the substances

provides a feeling of acceptance or a thrill of adventure. Therefore, our loved

ones make space for the use in their lives. They become preoccupied with the

substances. Of course, the use of substances can be quite time consuming. So,

an ample amount of space must be made in a person’s life to fit this new activity.

And this is often when family members first enter the process of addiction. Many

family members become more and more preoccupied with their loved ones as

their loved ones become more and more preoccupied with their drug of choice.

When someone we love starts to change their habits, their patterns and their

interactions, we know it. We know something is different and it pulls our attention.

Additionally, family members are often negatively impacted by the lifestyle

changes made by their alcohol and drug abusing loved ones. Without a clear

understanding of the phenomenon occurring, family members tend to feel hurt,

angry, frustrated and confused. They wonder why their loved one is acting

differently, withdrawing and failing to handle responsibilities. As such, tension

builds in the family. Some family members become aggressive with their

concerns. Arguments and perhaps physical altercations can ensue as they

confront their loved ones about their unreliability. Some family members are

more passive. They stuff their concerns inside and walk on eggshells. Some

family members are passive-aggressive, and they find ways to “get even” with

their loved ones while pretending that everything is okay.

The Process Continues

Addicts are sick people; they are not stupid people. They know when

tension has entered the family. However, because of the way that addiction hides

itself in the brain they do not consciously understand that their family members

are upset because of behavioral changes that have occurred as a result of their

growing addiction. They just know that things aren’t comfortable in the home. It’s

an uncomfortable feeling, and they’d like this feeling to go away. It is a problem,

and they have trained their brains to handle problems by using more drugs and

alcohol. Of course, the more they use, the more the physical and psychological

hooks of addiction penetrate. Therefore, the user becomes more preoccupied

and less responsible. The tension grows, and the greater the tension the greater

the uncomfortable, guilty feeling. Therefore, the more the user uses, and so on,

in a vicious cycle.

Family members also often find themselves feeling guilty regarding the

changes that have occurred. They may wonder if they caused the problem or feel

that they have failed to fix it. Many family members wish that they had discovered

the drug and alcohol use earlier, said something differently or acted differently,

believing that they have the power and the responsibility to cure or control the

disease. Family members, especially parents, may also feel that they caused the

disease because they failed to protect their loved ones from it. By this time,

everybody’s stress level has increased dramatically. Witnessing someone you

love suffering from addiction is incredibly stressful. As human beings, we have a

very natural reaction to stress; our defenses kick in. In the best case scenarios,

our defenses help us. They ease us into reality when life hits us with shocking

information. However, with addiction, defenses tend to get stuck, and they end

up being more harmful than helpful. The main defenses include denial—an

inability to comprehend that a problem exists; minimization—believing the

problem to be minor and self-correcting; avoidance—removing oneself from

situations in which confrontation is probable; blaming—believing that others are

the cause of any problems that are occurring; and, rationalizing/justifying—

excuse making. The excuse that is most frequently made is some variation of

this: “If you had the job/the life/the family/the trauma that I’ve had, you would

understand I need this/I deserve this/I cannot live without this.” Family members

are also prone to getting stuck in defenses. Family members can live in denial for

months and years. They either do not see the problem or they try to make the

problem about something else, believing that if the other issue can be fixed (e.g.

work troubles, self-esteem issues), the abuse of alcohol and drugs will stop.

Family members also avoid. It is horrifying to watch a person you love progress

into addiction and it can create a terrible hopeless, helpless feeling. Therefore,

family members may pull away from the addict because it hurts too much to be

around them. Family members may also blame, resentful that their loved ones

aren’t seeking help and believing that they cannot feel better until their loved

ones are okay again. Family members will also join in with rationalizations and

justifications. Although, overtime, many family members gain the ability to sense

when their loved one is being dishonest, they are still likely to give the benefit of

the doubt, hoping that their loved one will magically change. By joining in with the

excuses, family members make those excuses stronger.

With the defenses in place, people are no longer tethered to reality.

Therefore mood swings are more common. Addicts will have mood swings

throughout the process because the addictive chemicals create changes within

the emotional centers of the brain. The mood swings tend to get worse over time

as the process unfolds. Family members also experience mood swings in the

form of touchiness, irritability and tearfulness. The late stages can be chaotic;

problems multiply. Areas of life often impacted by addiction include finances,

health, relationships, work and school.

Family members also experience problems in these areas. For example, if

a family member has a joint account with an addicted person and the addict is

having financial problems, so too is the family member. If a family member has

been bailing their loved one out of trouble, they have been impacted financially. If

the family member is supposed to be cared for financially by the addict who is no

longer able to do so, that dependent family member is hurt. Furthermore, stress

takes a great toll on health. It can cause or exacerbate problems related to heart

rate, blood pressure, stomach irritation, muscle tension and the immune system.

Family members also experience problems with their relationships. It is difficult to

know who to trust and how to reach out to others. It is difficult to have time or

energy for other relationships if the addict is the center of attention. This can be

especially troubling if a parent is too distracted to be aware of the needs and the

impact of the situation on their children. In addition, it is difficult to concentrate on

work or school tasks when preoccupied with the addict’s behavior and worries

about what will happen next. Productivity can suffer greatly.

In the end, the pressure of the process must go somewhere. Those who

tend to internalize show symptoms of depression and anxiety. Those who tend to

externalize may become rageful. Those who cannot stand to feel anymore go

numb. This is the late stages of the process. For family members and the

addicted person, the situation has gone from bad to worse once functioning and

personality have changed.

Families Stuck

Family members get caught in the process of addiction and stay caught if

they believe that relief can only come if the addict changes. Thoughts related to

this mindset include:

“I want to fix you because it hurts me to see you this way or live like this. I

don’t want to hurt, so I have to make you better.”

“I want to feel good/happy; I can’t do that if you are going to be sick.” (For

example, “I depend on you to make me feel good.”)

“When I am feeling bad, I blame you. If only you were taking care of

yourself, then I wouldn’t have to feel this way.”

“I feel empty because nothing is getting through to you and I don’t know

what else to do or who to turn to who will understand. I am all alone.”

As a result, family members feel responsible for the addict and try to fix, rescue,

protect and control which leads to exhaustion, anxiety, fear, guilt, anger, rejection

and self-pity. Enabling is also common in this process. Enabling includes

standing between a person and his or her consequences; doing for someone

something he or she should be doing for him or herself; and engaging in actions

that ultimately perpetuate someone’s problematic behavior. Families will enable

their loved ones and keep them from recognizing the seriousness of their

problem by:

• Getting stuck in the defenses

– Denying there is a problem

– Minimizing the problem

– Avoiding discussions about the problem

– Blaming others or lashing out with anger

– Joining in the rationalizations/justifications that the addict creates

– Taking over their responsibilities

– Continuing to provide financial support

– Helping to resolve legal problems

– Promising rewards for abstinence

– Threatening to kick them out and not following through with the

boundaries set

– Provoking arguments/nagging

– Avoiding getting help for themselves

Getting Unstuck

In order to get out of the process, family members must learn to detach.

Detachment becomes possible when families recognize that it is impossible to

control or cure another person and to try to do so makes things worse.

Detachment is not abandonment. With abandonment, family members let go with

hate. They pull away from their loved ones with bitterness and resentment, and

healing is not possible. With detachment, family members recognize what they

can and cannot do. They stop enabling and create boundaries to protect their

safety and sanity. They reach out for support and education. They find ways to

enjoy life again. And, they still have love for the addict. In fact, because of their

improved balance and ability to reality-check, they are able to shine a light of

health onto the situation which can improve communication with and decisions

regarding the addict. A family member who has detached knows, “I can’t control

you. I can only control me. If I am hurt, then I have to take care of me. I have to

get my center back so I can function again. I heal through connections and

balance. Health is here and you are welcome to join me. I take responsibility for

myself and bring the benefits of my healthy lifestyle back into my relationships. I

share myself with other healthy people. You take care of you. I take care of me.

We support each other.” Instead of being responsible for others, family members

become responsible to others meaning they are sensitive, empathetic,

encouraging and able to listen while maintaining necessary boundaries and

confronting behaviors when appropriate. As a result, family members are able to

breathe again. They feel more relaxed, free and aware.

How Do Families Get There?

Many family members find comfort, relief and information through

programs like Al-Anon and Nar-Anon, the Twelve Step programs for family and

friends of alcoholics and addicts. Families also do well by reading books about

addiction and attending educational and therapeutic programs. Individual and

family therapy can also make a great difference. If you know a family in need of

such services, please encourage them to explore their resources. The guidance

of caring professionals can help move families from panic towards serenity.

(Web) www.fathermartinsashley.org (Email) khitchens@fmashley.com

© 2011 Kristine Kitchens. All Rights Reserved.