Professional Documents
Culture Documents
Family and Social Aspects of Substance Use Disorders and Treatment
Family and Social Aspects of Substance Use Disorders and Treatment
ScienceDirect
Dennis C. Daley*
Addiction Medicine Services, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
abstract
Keywords: Substance use disorders (SUDs) are associated with numerous medical, psychiatric, psy-
Addiction chological, spiritual, economic, social, family, and legal problems. These problems create a
Family significant burden for the affected individuals, their families, and society. This paper fo-
Recovery cuses on the effects of SUDs on family and on social problems and emphasizes the need for
Social clients in treatment to address these domains in their ongoing recovery. This paper also
Treatment reviews individual, group, and family interventions that address these issues for clients
with SUDs and their families.
Copyright ª 2013, Food and Drug Administration, Taiwan. Published by Elsevier Taiwan
LLC. Open access under CC BY-NC-ND license.
1. Effects of substance use disorders on the (4) Family instability. This may result from abuse or violence.
family Family breakup may occur because of separation, divorce,
or removal of children from the home by Children and
Many studies and reports document the adverse effects of Youth Services.
substance use disorders (SUDs) on the family system and on (5) Effects on the developing fetus and children. Alcohol use
individual members, including children [1e8]. These disorders during pregnancy can harm fetal development thereby
clearly affect many peopledin addition to the individual with causing birth defects and problems in child development.
the problemdand often create a burden for the family and for Infants born to opioid-dependent mothers are at increased
each family member. These effects on the family may include risk for neonatal abstinence syndrome, which can
the following: contribute to developmental or cognitive delays. Children
of parents with SUDs are at increased risk for abuse or
(1) Emotional burden. Family members may feel anger, frus- neglect, physical problems, poor behavioral or impulse
tration, anxiety, fear, worry, depression, shame and guilt, control, poor emotional regulation, conduct or opposi-
or embarrassment. tional disorders, poorer academic performance, psychiat-
(2) Economic burden. Money spent on substances or the loss ric problems such as depression or anxiety, and substance
of jobs or reliance on public assistance may cause an abuse.
economic burden. (6) Effects on parents. Mothers with SUDs may show less
(3) Relationship distress or dissatisfaction. Families may sensitivity and emotional availability to infants. Parents of
experience high rates of tension and conflict related to the a child with a SUD may feel guilty, helpless, frustrated,
SUD and the problems it causes in the family. angry, or depressed.
* Addiction Medicine Services, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, USA.
E-mail address: daleydc@upmc.edu.
1021-9498 Copyright ª 2013, Food and Drug Administration, Taiwan. Published by Elsevier Taiwan LLC. Open access under CC BY-NC-ND license.
http://dx.doi.org/10.1016/j.jfda.2013.09.038
S74 j o u r n a l o f f o o d a n d d r u g a n a l y s i s 2 1 ( 2 0 1 3 ) s 7 3 es 7 6
The effects of a SUD on a specific family or a concerned help, address the impact of the SUD on the family system and
significant other are influenced by the severity of the disorder, members, help the family support the member with the SUD,
the presence of other serious problems (e.g., psychiatric and help the family address their own reactions and problems
illness), the behaviors exhibited by the family member with an associated with their loved one’s SUD. The latter may involve
SUD, the available support for the family, and the family participation in treatment, family support programs, or both.
members’ coping strategies. Some family members are more There is considerable literature that support couple and
resilient than others and are less prone to the adverse effects family approaches to SUDs [5,9,20,21]. These approaches may
of the SUD. reduce the emotional burden for family members and enable
them to cope more effectively with the affected family
member. The following strategies to help families are adapted
2. Social effects of substance use disorders from the literature on engagement, treatment, and recovery.
Substance use disorders impact the social functioning of in- 3.1. Engage the family in care
dividuals and create a burden for society. These disorders
contribute to medical or psychiatric conditions, disability, If possible, engage the family during the assessment process
death resulting from accidents, diseases caused by or wors- and early in the treatment. Outreach efforts may be needed
ened by substance use, and higher rates of suicidalitydall of to engage families in treatment. Numerous effective in-
which affect society. Other social problems associated with terventions have been used with families to increase their rate
SUDs include housing instability, homelessness, criminal be- of involvement with the family member with the SUD in
haviors (as a victim or as a perpetrator) and incarceration, treatment [8,9,22].
transmission of human immunodeficiency virus (HIV) asso-
ciated with intravenous drug use or high-risk sexual behav- 3.2. Provide education
iors, and unemployment or dependence on welfare. The costs
associated with these social problems are staggering, and Families benefit from education on SUDs (e.g., symptoms,
create an economic burden for governments or payors who causes, effects); treatments (e.g., medication-assisted treat-
spend considerable sums of money on treatments for addic- ments); recovery challenges for members with a SUD; relapse;
tion, medical or psychiatric disorders, and other related mutual support programs; the impact of SUDs on families and
problems (e.g., welfare dependence, unemployment, and members; and professional services and mutual support
involvement in the criminal justice system or social service programs available for families.
system).
3.3. Provide or facilitate family treatment
3. Interventions for social problems or Couples or family sessions can help families address their
family problems questions and concerns, change how they interact within the
family system, and improve communication. Family mem-
Components of a comprehensive treatment for SUDs include bers can also benefit from addressing their own emotional
a continuum of professional addiction services and addiction- burdens and behaviors that can interfere with the recovery of
related services (e.g., assessment, detoxification, rehabilita- the member with the SUD. Treatment can be provided in
tion, counseling or therapy, continuing care, substance use sessions with the individual family or in multiple family
monitoring, medications, case management, and mutual groups, which provide a supportive environment for families
support programs) [9]. Social, family, and other problems can to share their common experiences and concerns. Families
be addressed through family, child care, vocational, mental can form bonds with each other and learn what has worked
health, medical, educational, HIV/AIDs, legal, financial, for others.
housing, and transportation services within the community or
in addiction treatment agencies. 3.4. Reduce the emotional burden of the family
Many SUD programs for individual treatment [10e13] and
group treatment [14e19] address social recovery issues during Family members experience a wide range of emotions such as
recovery because these issues have implications for relapse anger, fear, anxiety, and depression. The burden experienced
and quality of life. These interventions may address issues by the family can be reduced as they learn about specific
such as how to avoid or minimize contact with high-risk disorders, get support and help for themselves, identify with
people, places, or events; resolving relationship problems; other families experiencing similar problems, and share their
developing new friendships; developing a recovery network of own feelings and concerns. The emotional burden often
sober friends and supportive people; resisting social pressures lessens as families feel increasingly empowered by learning
to use substances; improving communication or assertiveness information and acquiring new coping skills.
skills; asking for help and support from others; engaging in
substance-free social activities; engaging in mutual support 3.5. Help the family support the member with the SUD
programs; and/or making amends to people who have been
harmed by an individual’s SUD. Members can attend sessions together to learn ways to help
Family interventions can help the family influence or the member with the SUD without “enabling” the individual.
pressure the member with the SUD to enter treatment and get Family members can be empowered by learning about
j o u r n a l o f f o o d a n d d r u g a n a l y s i s 2 1 ( 2 0 1 3 ) s 7 3 es 7 6 S75
[15] National Institute on Drug Abuse (NIDA). A group drug [19] Wenzel A, Liese BS, Beck AT, et al. Group cognitive therapy
counseling approach to treat cocaine addiction. Therapy for addictions. New York, NY: Guilford Press; 2012.
manuals for drug addiction, Manual Number 4. National [20] National Institute on Drug Abuse (NIDA). Brief strategic
Institutes of Health Publication Number 02-4381. Rockville, family therapy for adolescent drug abuse. Therapy manuals
MD: U.S. Department of Health and Human Services; 2002. for drug addiction, Manual Number 5. National Institutes of
[16] Substance Abuse and Mental Health Services Administration Health Publication Number 03-4751. Rockville, MD: U.S.
(SAMHSA). Counselor’s treatment manual: matrix intensive Department of Health and Human Services; 2003.
outpatient treatment for people with substance use [21] Stanton MD, Shadish WR. Outcome, attrition, and
disorders. Rockville, MD: U.S. Department of Health and familydcouples treatments for drug abuse: a meta-analysis
Human Services; 2007. and review of the controlled, comparative studies. Psychol
[17] Sobell LC, Sobell MB. Group therapy for substance use Bull 1997;122:170e91.
disorders: a motivational cognitive-behavioral approach. [22] Smith JE, Meyers RJ. Motivating substance abusers to enter
New York, NY: Guilford Press; 2011. treatment: working with family members. The CRAFT
[18] Velaquez MM, Maurer CG, Crouch C, et al. Group treatment Intervention Program. New York, NY: Guilford Press; 2004.
for substance abuse: a stages-of-change therapy manual.
New York, NY: Guilford Press; 2001.