LITERATURE REVIEW

2.1 Introduction
A literature review is a comprehensive summary of previous research on a
topic. The review should enumerate, describe, summarize, objectively evaluate
and clarify this previous research. It should give a theoretical base for the
research and help you (the author) determine the nature of your research. A
literature review discusses published information in a particular subject area,
and sometimes information in a particular subject area within a certain period.
A literature review can be just a simple summary of the sources, but it usually
has an organizational pattern and combines both summary and synthesis. The
literature review is a written overview of major writings and other sources on a
selected topic. Sources covered in the review may include scholarly journal
articles, books, government reports, Web sites, etc. The literature review
provides a description, summary and evaluation of each source.
In the present study, a researcher identified several kinds of literature and
reviewed pertinent to the proposed research theme from both Western and
Indian sources and presented the same based on the objectives of the study.

The World Health Organization (WHO) defines Substance abuse as ‘‘Harmful

or hazardous use of psychoactive substances, including alcohol and illicit
drugs’’. According to Kulkarni & Biradar (2018). Repeated use of these
substances can lead to dependence syndrome cluster of behavioural, cognitive,
and physiological phenomena which involves a strong desire to take the drug
and difficulties in controlling its use. Drug dependence poses not only an
economic burden through rising healthcare costs but also social costs in the
form of loss of productivity and family income, violence, security problems,
traffic and workplace accidents. Substance abuse is a complex and
multidimensional problem. The problem is not merely that of an individual
and a drug or a community but of the interaction between the triad. In India,
traditional drugs like opium, charas, bhang and ganja were used by sections of
society partly as leisure time activity and partly as part of the religious
ceremony. Therefore, their consumption did not invite much negative sanction
from society. Abuse of alcoholic beverages and tobacco is endemic in many
societies, whilst the abuse of other psychoactive substances present in
epidemic features and drug abuse is transmitted from person to person like an
infectious disease. In the National Household Survey of Alcohol and Drug
Abuse (2003) 21.4% were reported to be current users of alcohol (used in last
30 days). Health problems for which alcohol is responsible are only part of the
social damage, which includes family disorganization, crime, and loss of
productivity.

Mohandas, Venugopalan & Sarada (n.d) Alcohol is considered a social

symbol for many in the population. However, alcohol consumption contributes
to 3 million deaths each year globally as well as to the disabilities and poor
health of millions of people. Harmful use of alcohol is responsible for 5.1% of
the global burden of disease. It is accountable for 7.1% and 2.2% of the global
burden for males and females respectively. Globally alcohol consumption is
the seventh leading risk factor for premature death and disability. In India
around 20-30% of adult males and 5% of females use alcohol. While alcohol is
used traditionally by men, its use by women is now on the increase. Issues of
concern include pay-day drinking, domestic violence, alcohol’s contribution to
poverty, illicit and home-brewed alcohol, and reduction in the average age of
initiation. The health problems for which alcohol is responsible are only a part
of the total social damage which includes family disorganization, crime and
loss of productivity. Alcohol abuse is one of the main killers of young men in
India today. However, its real impact is on the social and family dynamics that
underlie its communities. In India, household expenditure on alcohol varies
between 3% to 45% of income. Domestic violence and an exacerbation of
poverty have made alcohol abuse the single most important problem for
women in India. With one in three people in India falling below the poverty
line, the economic consequences of expenditures on alcohol attain special
significance.

According to Copello, A & Velleman, R (2005). The family plays a key part
in both preventing and intervening with substance use and misuse, both
through inducing risk and/ or encouraging and promoting protection and
resilience. The use and misuse of alcohol and drugs is widespread
amongst young people. Substance misuse by these young people, or by anyone
else in the family, can result in harm to the individual and the wider
community, as well as having a seriously negative impact on other family
members. There are many terms in this field that are often used confusingly.
We will generally refer to, and try to distinguish between, substance use and
substance misuse (‘use’ meaning any use including experimentation; ‘misuse’
referring to problematic or very heavy use; ‘substance’ referring to alcohol,
illicit drugs, and volatile substances). Recent data from the United States [1]
indicate that approximately 9% (just under 20 million people) of the total
population aged 12 years or more in the USA, and nearly 12% of young people
aged 12–17, are current (last month) users of illicit drugs. These data also
show that half the population (119 million) are current alcohol users, nearly a
quarter are binge drinkers, and around 7% are ‘heavy drinkers. The highest
rates in the latter two groups are seen in young people 18–25 years.UK
estimates suggest that about six million people
drink above the recommended daily guidelines with almost two
million more drinking at harmful levels [2,3]. Other UK figures [4] indicate
that over a third of the population aged 16–59 has ‘ever’ used an illegal drug,
and currently, there are estimated to be about four million users of illicit drugs
in the UK, based on figures of 12% of 16–59 years olds reporting that they had
taken an illegal drug in the last year.

Addiction is a family disease; the whole family is in recovery when a loved

one seeks help for an addiction. Family involvement in the recovery process is
crucial for the best possible chance of successful long-term sobriety because
dysfunction in the household is a major relapse trigger. The more the family
can do to restore function to the family system and heal individually, the better
the chances of beating the addiction. According to Murmu, Singh, Sengupta
& Dawn (2017). In the present study alcohol is found as the most prevalent
substance used by the addicts of Kolkata, followed by cannabis, tobacco & the
most susceptible age for initiating alcohol use in India is during adolescence
and early adulthood (ages 10- 18). In a study from Ahmadabad, 70.2% of the
patients were addicted to alcohol which is similar to our study findings. The
global burden of disease attributable to alcohol and illicit drug use amounts to
5.4% of the total burden of disease. The National Family Health Survey
(NFHS-3) data from India showed that in the age group of 15–24 years, the
prevalence of alcohol consumption was 1% among females and 19% among
males. As per the World Drug Report, Cannabis is the most widely used illicit
drug followed by Amphetamine-type stimulants, opioids, and cocaine.
However, there is a lack of information regarding the use of illicit drugs in
countries such as China and India, as well as in emerging regions of
consumption. In 2002, the World Health Organization estimated that around
140 million people were alcohol dependent and another 400 million suffered
from alcohol-related problems. Although most of the substance abusers are
admitted for drinking alcohol, almost all of them (95%) are poly-addicts. they
have abuse other substances also than their chief substance of abuse. Smoking
or chewing tobacco is the most common associated addiction (59%). Most of
the substance abusers admitted in different de-addiction centres of Kolkata
belong to the age group 19-30 years, followed by the age group of 31-45.
73.16% of addicts belong to the productive age group of 18-45. Studies from
Pakistan and India have reported similar observations in this regard. A study
from Ahmadabad, India observed 46% of patients to be below 20 years of age.
The draft India Drug Country Report, 1995 revealed that most substance
abusers were 16-35 years of age although abuse was more predominant in the
18-25 age group. The rate of current abusers is low in early adolescence (12-
13 years), rises steeply into the late teenage years, and remains high during the
early 20s. When we look at the family pattern of the addicts, an overwhelming
57.6.% of substance abusers belong to the nuclear family. Whereas, substance
abusers belonging to the joint family are much lower. Only 1.34% of all
addicts belong to extended nuclear or three-generation families. No significant
association is found between family patterns and family history of addiction.
Researchers (50) supported this observation in contrast to others (51), which
showed nuclear families to be a greater risk factor. More research is needed to
arrive at a consistent conclusion.

2.3 Role of family members in the recovery of alcohol addiction.

Addiction is a family disease, meaning that it’s not just one member’s issue,
it’s the dynamic of the whole family. Family involvement is necessary for a
loved one’s recovery. According to Sathyamurthi (2022). The spouse of an
addict or alcoholic can play several different roles not only during the active
substance abuse and addiction stage but also during recovery. In many cases,
the spouse completely takes care of the addict and is directly responsible for
getting them into an appropriate treatment program. Whatever the cause may
be, the spouse of a dependent drug user or alcoholic can sometimes make or
break a recovery program because they are such a critical part of the patient’s
life. Therefore, understanding the role of a spouse in addiction and recovery is
essential to developing a treatment plan for the users.

Families are intimately involved in the dynamics of the alcohol/other drug

problems of family members with these problems. Their adaptations to a
baffling and devastating disorder of loved ones are viewed as normal and not
in terms of psychopathology. Recovery resources for family members are
examined, together with the need for advocacy on the part of families,
expressed in the new recovery advocacy movement. According to White, W.,
& Savage, B. (2005). The belief that alcoholism was a product of heredity and
parental example grew throughout the nineteenth century and added fuel to a
rising eugenics movement that called for the mandatory sterilization of
alcoholics and addicts (in addition to the mentally ill and developmentally
disabled). The passage of these laws was based on the belief that social
problems such as alcoholism were a product of bad breeding and could be
eliminated by weeding degenerate families from the culture. The American
Temperance Movement was filled with graphic images of the impact of
alcoholism on the family. Reformed drunkards filled temperance pulpits,
sharing wrenching stories of the pain and havoc they had wreaked on their
families. Temperance plays such as The Drunkard, One Cup More, and The
Doom of the Drunkard portrayed alcohol-related violence, economic hardship,
and abandonment. Women and children played important roles in the
Temperance Movement. Bordin (1990), in her study of Woman’s Christian
Temperance Union membership, noted that many women within the American
Temperance Movement had experienced the tragedy of alcoholism in their
families. Local temperance society meetings served as therapeutic functions
for the daughters, sisters, 2 wives, and mothers of alcoholics, and provided a
vehicle through which personal pain could be transformed into political
advocacy. Beginning with the founding of the Martha Washington Society in
1842, America’s early recovery mutual aid societies created auxiliary societies
for wives and junior auxiliaries for children. The “Women’s Crusade” and
“Children’s Crusade” of the 1870s and 1880s brought an unprecedented
number of family members into leadership roles in rescue work with
alcoholics and the drive for legal prohibition of alcohol.

AA meetings are generally open, which means you can attend with your loved
one. These meetings offer a great deal of support and advice on living with
someone who has a drinking problem. According to Kelly, Margill & Stout
(2009), Many studies have examined cognitive (e.g., self-efficacy, motivation
for abstinence) and behavioural changes thought to be important to recovery
regardless of the treatment received, but that has been more explicitly
implicated in treatments other than 12-step approaches. Self-efficacy
accounted for a significant reduction in the direct effect of AA participation on
later drinking, and this mediational effect was held in both the outpatient and
aftercare samples and across treatment conditions. The effect of self-efficacy
was maintained at a 3-year follow-up and showed that AA step-work in
particular was related to perceived confidence to avoid drinking in social
situations and when experiencing negative affect. Thus, one way that AA
appears to work is by boosting confidence in participants’ perceived ability to
handle common relapse-related situations or circumstances. In both of these
studies, greater alcohol use severity was associated with more AA
participation. The benefit of AA for these patients appeared to be at least
partially explained by changes in beliefs in their capacity to abstain from
alcohol. In an adolescent sample, examined self-efficacy, motivation for
abstinence, and coping as mechanisms of the effect of AA attendance in the
first 3 months following inpatient treatment on subsequent 4 to 6-month
substance use outcomes. Here, the only motivation for abstinence mediated the
effect of AA, and similar to the finding among adults receiving more severely
substance-involved patients attended AA more frequently. In a follow-up
study, active AA involvement (e.g., talking with a sponsor, group service,
step-work) was shown to be a more important predictor than attendance alone,
and the central mediating role of motivation for abstinence remained
consistent. Thus, similar to adults, baseline alcohol use severity in adolescents
is a predictor of AA attendance and affiliation, and both age groups show
increases in common therapeutic factors of self-efficacy, motivation, and
active coping. However, in younger patients, the only motivation for
abstinence mediated the effect of 12-step involvement on outcome, suggesting
AA-derived therapeutic benefits may differ developmentally.

Addiction is a family disease. One person may use it, but the whole family
suffers. According to McCrady, & Flanagan. (2021). Alcohol use disorder
(AUD) and family functioning are inextricably bound, and families are
impacted negatively by AUD, but families show substantial improvements
with AUD recovery. Family members can successfully motivate a person with
AUD to initiate changes in drinking or to seek AUD treatment. During
recovery, family members can provide active support for recovery. Several
couples- or family-involved treatments for AUD have been developed and
tested in rigorous efficacy trials. Efficacious treatments based on family
systems theory or cognitive behavioural approaches focus on the concerned
family member alone, or they engage the couple or family as a unit in the
treatment. It is almost axiomatic that alcohol use disorder (AUD) and the
family are inextricably bound. AUD harms individual family members and the
functioning of the family as a whole, and family members’ actions may
exacerbate problematic drinking. Conversely, families play a key role in
recovery from AUD, and recovery has a positive impact on family members
and family functioning. Families and other members of the social network of
persons with AUD also play an important role in supporting successful
changes in drinking. Although the scientific literature is limited to specific
family behaviours that facilitate and support successful recovery from AUD,
there is evidence that active partner coping predicts positive outcomes.
Specific types of active partner coping that support successful change include
(a) decreasing negative or controlling behaviours that serve as antecedents to
drinking; (b) increasing supportive and problem-solving communication; (c)
reinforcing positive behaviour change by the partner with an alcohol problem;
(d) increasing shared positive activities; and (e) reducing family member
drinking behaviour to support changes in the drinking of the person with AUD.
Although awareness of diversity in family functioning among different racial
and ethnic groups, socioeconomically challenged populations, sexual and
gender minorities, and veteran populations are increasing, the specific
associations between alcohol use, AUD, family functioning, and AUD
recovery have not been studied. Future research needs to focus on developing
a more nuanced understanding of family structure and function around AUD in
diverse populations to develop effective family-engaged treatments and
disseminate of knowledge of effective practices to support recovery for these
populations.

Supporting a loved one through addiction and recovery is a process that calls
for a combination of patience, understanding, and constant. According to
Sathyamurthi (2022), The spouse of an addict or alcoholic can play several
different roles not only during the active substance abuse and addiction stage
but also during recovery. The study on substance use done by Sathyamurthi et
al (2020) aims to know the usage and it’s on individuals, families, and the
community at large and to suggest an appropriate social work intervention
method for adolescents to cope with their dependency on substances. More
than one-third (72 per cent) of the respondents have not shown any proof of
age while buying cigarettes, One third (38 per cent) of the respondents use
both chew and snuff types of tobacco, More than one-third (72 per cent) of the
respondents have a habit of consuming alcohol, One third (38 per cent) of the
respondents started consuming alcohol at the age of 15 years, two third (66 per
cent) of the respondents have not tried marijuana, Majority (86 per cent) of the
respondents have not tried Cocaine, Majority (74 per cent) of the respondents
have not sniffed glue or spray cans, Vast Majority (94 per cent) of the
respondents have not used steroids. (Sathyamurthi & Kumar, 2020). In many
cases, the spouse completely takes care of the addict and is directly responsible
for getting them into an appropriate treatment program, while other times a
spouse can be an enabler of the addiction. Whatever the case may be, the
spouse of a dependent drug user or alcoholic can sometimes make or break a
recovery program because they are such a critical part of the patient’s life.
Therefore, understanding the role of a spouse in addiction and recovery is
essential to developing a treatment plan that addresses both the harmful and
beneficial impact that the spouse has had – and may or may not continue to
have – on the recovering addict. All the factors including family, school,
media, and proper social work intervention can make a lot of difference in
improving the emotional intelligence of adolescents. (Shefali Mohanty, 2019).
Support System for Spouses Affected by Addiction Spouses and other
committed partners of addicted individuals often find themselves serving as a
buffer between the addict and the rest of the world, including other family
members. They alternate between enabling the addict and attempting to control
his or her behaviour. Their emotions can swing from one opposite to another,
as they lash out in anger and then retreat into depression. Some spouses feel a
deep sense of guilt, believing that they have failed the family. Substance abuse
by the respondent’s family members. More than half per cent (51.7) of the
respondent’s family members use alcohol for substance abuse, more than one-
third per cent (41.7) of the respondent’s family members are not abusing any
drugs for substance abuse and negligible per cent (6.7) of the respondent’s
family members use both tobacco & alcohol for substance abuse.
(Sathyamurthi & Kumar, 2020). Recovery for the spouse shares characteristics
with the recovery process for an addict, as both depend on acknowledging the
problem, learning about the disease that helped create the dysfunction, and
adopting new coping skills. Support groups can be instrumental in giving
spouses a safe place to express their fears, find comfort, and discover new
ways of interacting with family members.

According to Saatcioglu, Erim, & Cakmak, (2006). Abuse is a family

disease, which requires joint treatment of family members. Family is an
important part of the diagnosis and treatment chain of alcohol and substance
abuse. Abuse of alcohol and substances is a response to fluctuations in the
family system. In consideration of interactions within the system, it seems an
important requirement that the clinician involves, and maintains the presence
of, the family in its entirety in the treatment process. A family often needs as
much treatment as a family member who is the abuser of alcohol or a
substance. In this regard, participation of the family in the treatment process as
group members and assuming a supportive role are assets in terms of
preventing relapse and extending clean time, and also very important for
solving conflicts that give rise to abuse of alcohol or substances. Accordingly,
it is important to know the family structure and its role in the treatment
process. Alcoholism has the greatest impact on the family depending upon the
type of family system (i.e. Upwards, as in the case of parents and
grandparents; or downwards, as in the case of children). Alcoholics suffer
from intense problems such as exploitation of spouses and children, and
domestic violence in their marriage and family structures. Crises in the family
may lead to catastrophic disorder in the system and organization of families.
Economic, psychological, emotional, and physical consequences of alcoholism
emerge, and it is not possible to know how a healthy adaptive response would
appear within the family system. At the same time, this kind of family tends to
construct harsh external boundaries whereas internal personal boundaries are
scattered and crushed.

According to Copellow, A (2009). Alcohol and drug problems affect not only
those using these substances but also family members of the substance user. In
this review evidence of the negative impact substance misuse may have upon
families is examined, following which family-focused interventions are
reviewed. Several family-focused interventions have been developed. They
can be broadly grouped into three types: (1) working with family members to
promote the entry and engagement of substance misusers into treatment; (2)
joint involvement of family members and substance-misusing relatives in the
treatment of the latter; and (3) interventions responding to the needs of the
family members in their own right. The evidence base for each of the three
types is reviewed. Despite methodological weaknesses in this area, several
conclusions can be advanced that support the wider use of family-focused
interventions in routine practice. Future research needs to focus on pragmatic
trials that are more representative of routine clinical settings; cost-
effectiveness analyses, in terms of treatment costs and the impact of
interventions on costs to society; exploring treatment process; and make use of
qualitative methods. In addition, there is a need to define more clearly the
conceptual underpinnings of the family intervention under study.

A functioning family offers an environment that provides for the successful

development and protection of its members. According to Graber, K.J.&
Taylor, M.F. (2006). This outcome reflects a secure, cohesive, and mutually
supportive family environment–one that is characterized by appropriate roles,
effective communication, and routine expression of positive affect, and one
that is based on a shared set of cultural norms and values. Family members
must be emotionally involved with each other and able to influence each
other’s behaviour as it relates to the functioning of the family (Moss, Lynch,
Hardie, & Baron, 2002). In the substance-affected family, functional family
roles are often distorted or missing. For example, children of alcoholic parents
may be parentified and take on parenting and adult responsibilities that may
preclude them from age-appropriate activities or peer group socialization
experiences (Haber, 2000). The family unit can be conceptualized as a system
with interdependencies among its members. This perspective implies that
when one part of the system changes or is “damaged” it impacts other parts of
the system. Another implication is that as a system the family may adapt to
protect and accommodate the substance user resulting in accommodating
dysfunctional family relationships. This adaptation often includes denial and
subterfuge to avoid addressing the issue, and the implementation of family
rules and behaviours that mask family member dependency behaviour
(Stevens-Smith, 1998).

The study conducted by Watters and Byrne (2004) The first of these is
therapeutic interventions (TI). Family support is by nature synonymous with
therapeutic interventions even though they are not naturally assumed to fall
within the ambit of family support. However, McKeown points out that the
purpose of family support is to help children, young people, couples, and
families overcome problems that they experience in their lives. In family
support, TI takes the form of counselling and/or supportive listening and by
implication is a form of therapy. The evidence suggests that therapy is
effective in over 70% of cases. However, its effectiveness is affected by
factors such as client characteristics and social support, therapeutic client
relationship, client hopefulness, and therapeutic technique30. In the present
context, McKeown notes that issues like drug use and addiction and prolonged
or multiple problems in families can impact the effectiveness of therapy. In
terms of family support, psychotherapy, marital therapy, family therapy,
elements of social work, counselling, etc, comprise this type of intervention.
The second family support intervention is parent education (PE) programs.
Parenting programs aim to offer parents skills and knowledge in parenting,
which assist them to promote their children’s physical, emotional, and
intellectual development (French, 2000). The content of parent education is
normally based on one or more of the following dimensions: information
sharing, skill building, improving self-awareness, and problem sharing
(Rylands, 1995). These programs take place outside of the home and on a
group basis. The benefits of parent education are effective; however, it is not,
like all family support interventions, effective in isolation and in cases where
more extreme problems such as poverty are also present. Parent education is
therefore one of the ranges of family support interventions that can be
provided across a corresponding range of problems that families present with.
The third category of family support, home-based parent and family support
(HBFS) programs, can be universal, such as the public health nurse system, or
selective, where they specifically target at-risk families. The latter set of
services is the focus of family support-type interventions. McKeown cites
research, that suggests that home-based family support provides for the
following: brings hard-to-access services – through transport, childcare, etc. –
to families in need; social support to families; a hands-on focus to the needs of
families; and assistance in responding to family difficulties at the earliest
opportunity. Family support in the home includes assistance with practical
home tasks such as housework, making and keeping appointments,
information giving, and providing advice and support in addition to more
focused therapy. In Ireland, the most obvious type of service falling under this
intervention category is the Community Mothers Programme, run in the
eastern health region. Other home-based family support includes health board
family support workers, public health nurses, and dedicated family support
projects such as Springboard, that may include elements of home visitation.
The family support intervention identified by McKeown is
community development (CD). Community development, in the broadest
sense of the term, refers to the enhancement and progression of communities
of one sort or another. However, the understanding of community
development differs depending on the context in which it is applied or who is
using it. One of the key debates in community development is that between the
product and/or process of CD. The Combat Poverty Agency (2002)
understands CD as “people working together to clarify their needs, gain
greater power and have more influence in the decision affecting their lives”. In
the context of family support, one recent comment highlights the importance
of CD: “In tackling the exclusions and risks associated with contemporary
society it makes decreasing sense to view young people and families in
isolation from the wider societies in which they live” (McGrath, 2003). This
account observes therefore that one of the strengths of community
development may be, apart from identifying the need for and the provision of
services, its support to children and families in voicing their concerns and
advocating on their behalf in respect of the processes and policies that
negatively impact on their lives (McGrath, 2003). Alcohol use disorder (AUD)
and family functioning are inextricably bound, and families are impacted
negatively by AUD, but families show substantial improvements with AUD
recovery. Family members can successfully motivate a person with AUD to
initiate changes in drinking or to seek AUD treatment. Alcohol use disorder
(AUD) and family functioning are inextricably bound, and families are
impacted negatively by AUD, but families show substantial improvements
with AUD recovery. Family members can successfully motivate a person with
AUD to initiate changes in drinking or to seek AUD treatment.

Alcohol use disorder (AUD) and family functioning are inextricably bound,
and families are impacted negatively by AUD, but families show substantial
improvements with AUD recovery. Family members can successfully motivate
a person with AUD to initiate changes in drinking or to seek AUD treatment.
According to McCrady, B & Flanagan, J (2021). During recovery, family
members can provide active support for recovery. Several couples- or family-
involved treatments for AUD have been developed and tested in rigorous
efficacy trials. Efficacious treatments based on family systems theory or
cognitive behavioural approaches focus on the concerned family member
alone, or they engage the couple or family as a unit in the treatment. families
play a key role in recovery from AUD, and recovery has a positive impact on
family members and family functioning. Sciatic research to understand the
interrelationships between drinking and family functioning began in the early
1900s, and treatment models that address both drinking and family functioning
have been developed and tested for close to 75 years. This article reviews the
conceptual and empirical literature on the impact of AUD on families, the role
of the family in recovery from AUD, and the role of family-involved treatment
in fostering recovery. Families may play a key role in fostering the initiation of
recovery. Although popular literature and 12-step mutual help groups for
families, such as Al-Anon emphasise detachment for family members and
empirically supported interventions for families, such as Community
Reinforcement and Family Training (CRAFT), it has been found that family
behaviour can increase the probability that an individual will seek help for
AUD. Families and other members of the social network of persons with AUD
also play an important role in supporting successful changes in drinking.
Knowledge of the impact of AUD on families has led to the development of
family-engaged treatments. Considerable research has focused on the
development and testing of these family-engaged treatments to foster recovery
from AUD. These treatments have focused on the role of the family in the
initiation of help-seeking, initiation of change, and maintenance of long-term
change. The following sections describe and review treatments for affected
family members in their own right, and as a way to help effect change in the
identified individual with AUD. The existing literature suggests that families
play a key role in motivating persons with AUD to recognize the need to
change, providing support for change, and supporting long-term recovery and
that AUD recovery is good for families.

Family …. a group experience of love and support. According to Daley D. C.

(2013). Family interventions can help the family influence or pressure the
member with the SUD to enter treatment and get help, address the impact of
the SUD on the family system and members, help the family support the
member with the SUD, and help the family address their reactions and
problems associated with their loved one’s SUD. The latter may involve
participation in treatment, family support programs, or both. There is
considerable literature supporting couples and family approaches to SUD.
These may reduce the emotional burden for family members and enable them
to cope more effectively with the affected family members. The following are
strategies adapted from the literature on engagement, treatment, and recovery
to help families. I Engage the family in care: When possible, engage the family
in the assessment process and early in treatment. Outreach efforts may be
needed to engage families in treatment. Many effective interventions have
been used with families to increase their rates of involvement with the family
member with SUD in treatment. II Provide education: Families benefit from
education on SUDs (symptoms, causes, effects), treatments (including
medication-assisted treatments), recovery challenges for members with a SUD,
relapse, mutual support programs, the impact of SUDs on families and
members, and professional services and mutual support programs available for
families. III Provide or facilitate family treatment: Couples or family sessions
can help families address their questions and concerns, change how they
interact within the family system and improve communication. Families can
also benefit from addressing their emotional burdens and behaviours that can
interfere with the recovery of the member with the SUD. Treatment can be
provided in sessions with the individual family or in multiple family groups,
which provide a supportive environment for families to share their common
experiences and concerns. Families can form bonds with each other and learn
what has worked for others. Families can help their loved one in several ways:
facilitate their involvement in treatment; attend sessions together to address the
SUD and recovery needs; engage in ongoing discussions about recovery, and
what can and cannot be done to help the member with the SUD; point out early
warning signs of relapse that their loved one may ignore; and help them
stabilize from a relapse should one occur.
Family is not an important thing. It’s everything. According to Tsounis.A
(2013). The family is a dynamic and complex system of ideas, emotions and
behaviours, whose parts interact and have a great hold on each other. Its
internal changes have a great impact both on the individual and on the entire
family while going through its life cycle. A family with totally open
boundaries accepts all members who want to get into the system and each new
idea. Although this fact widens the context and the potential for mental,
emotional and social development, in its hypertrophic version leaves the
members unprotected and carries the risk of confusion and lack of
understanding of roles The significant role that the family plays in the
installation and maintenance of addiction has been the subject of many
researches. Most of them appear to converge in the ascertainment that drug-
addicted personalities can be found even in the most different types of familial
structure. Without therefore overlooking that each family, as each personality,
is unique, it is important to focus on the elements that characterize the families
of drug-addicted people, without falling into the trap of a typological
perception of inflexible models Nevertheless, the approach of this data is
particularly useful for the development of the theory, in an attempt to
understand the particular role that family plays in the installation of addiction.
Above all, it is useful towards defining specific interventions focusing on the
family, both in terms of prevention, treatment and social reintegration.
Certainly, family therapy is not enough to change the behaviour of the
addicted person, since it is under the effect of a multitude of factors,
psychological, social, economic etc. However, the intervention in the family is
essential for three reasons: firstly, for causing changes in drug behaviour,
secondly, for bringing changes to the behaviour of the rest of the members of
the family as well as for interrupting behaviours that directly or indirectly
enhance dependence and thirdly, for amending the overall dynamic that had
been developed within the family, which has brought negative effects on all of
its members.

Families may promote and support recovery by adopting positive roles and
behaviours. According to Parisi, T (2019). An alcoholic is a term commonly
used to describe someone with an alcohol use disorder (AUD). This disorder
involves a pattern of alcohol consumption characterized by difficulty
controlling one's drinking, preoccupation with alcohol, and persisting in its use
despite experiencing personal and professional consequences. AUD is a
medical condition that can range from mild to severe, and it may require
professional treatment and support for individuals to manage or overcome
their alcohol-related challenges. When approaching a conversation of support
and concern with a family member, it is crucial to ensure that the individual is
sober. This condition allows them to be coherent and fully engage in the
conversation, comprehending your concerns effectively. Substance use can
impair judgment and communication, so having a discussion when the person
is sober maximizes the chances of meaningful communication. Selecting an
appropriate location for the conversation is equally important. opt for a quiet
and safe space where you and your family members can have privacy without
distractions. A calm environment fosters a conducive atmosphere for open and
honest dialogue. This setting helps to create a sense of security and allows for
a more focused and productive conversation about the challenges or issues at
hand. By being mindful of your loved one's sobriety and choosing the right
setting, you enhance the likelihood of a successful and supportive conversation
that promotes understanding, empathy, and constructive problem-solving. It is
also emphasizing the importance of approaching a family member with
empathy, compassion, and understanding when addressing issues like
addiction or mental health. It encourages providing reassurance of support and
sincerity in helping them. The ultimate goal is to have the family member
agree to enter treatment, and offering a list of residential treatment options is
suggested. If the loved one agrees to make changes, it emphasises the need for
sincere commitments, followed by consistent follow-ups to ensure
accountability. The key message is that actions, not just words, are vital in
facilitating positive change and support for your family members.

When trouble comes, it’s your family that supports you. According to Watson,
S (2019). Watching a family member, friend, or coworker with an alcohol use
disorder can be difficult. You might wonder what you can do to change the
situation, and whether or not the person even wants your help. Before you do
anything, it’s important to know whether your friend or loved one has an
alcohol addiction. Alcohol use disorder, or alcoholism, is more than just
drinking too much from time to time. Sometimes alcohol as a coping
mechanism or social habit may look like alcoholism, but it’s not the same. Let
the person you care for know that you’re available and that you care. Try to
formulate statements that are positive and supportive. Avoid being negative,
hurtful, or presumptuous. Choose the right time to have this important
conversation. Have the conversation in a place where you know you’ll have
quiet and privacy. You’ll also want to avoid any interruptions so that you both
have each other’s full attention. Make sure your person is not upset or
preoccupied with other issues. Most importantly, the person should be sober.
Tell your loved one that you’re worried they’re drinking too much, and let
them know you want to be supportive. Be prepared to face a negative reaction.
Try to roll with any resistance to your suggestions. The person may be in
denial, and they may even react angrily to your attempts. Do not take it
personally. Give them time and space to make an honest decision, and listen to
what they have to say also an intervention may be the course of action if the
person is very resistant to getting help. During this process, friends, family
members, and co-workers get together to confront the person and urge them
into treatment. Interventions are often done with the help of a professional
counsellor.

Family should always come first, but choosing alcohol over them will only
lead to regret. According to Gruber K, J & Taylor M, F (2002). While
substance abuse has historically been seen as a problem of the individual,
substance abuse frequently affects the entire family. The role of family and its
dynamics play a crucial role in the incidence and occurrence of substance
abuse. Family can influence an individual's susceptibility to substance abuse in
various ways. Factors such as family environment, communication patterns,
parenting styles, and genetic predispositions can contribute to the development
of substance abuse issues. A functioning family is characterized by an
environment that fosters the successful development and protection of its
members. This outcome is achieved through the establishment of a secure,
cohesive, and mutually supportive family environment. Key elements of a
functioning family include appropriate roles, effective communication, routine
expression of positive emotions, and a shared set of cultural norms and values.
In a functioning family, members play roles that contribute to the overall well-
being of the family unit. Effective communication is essential for
understanding each other's needs and concerns, and positive emotions are
regularly expressed, creating a nurturing atmosphere. The family operates
based on shared cultural norms and values, providing a common ground for
understanding and interaction. Emotional involvement among family members
is crucial, allowing them to influence each other's behaviour in ways that
contribute to the overall functioning of the family. This mutual influence helps
maintain a supportive and harmonious family dynamic, contributing to the
successful development and protection of its members. The importance of
addressing family issues in a comprehensive treatment program is widely
recognized in the literature. Family involvement is considered crucial because
it plays a critical role in multiple aspects of the addiction treatment process.
Research by various scholars (Craig, 1993; Kelley & Fals-Stewart, 2002;
McIntyre, 2004; Straussner, 2004) has highlighted the significance of family
engagement in getting individuals into treatment, encouraging participation in
aftercare, and preventing relapse while maintaining recovery. Several studies
(Costantini et al., 1992; Gruber & Fleetwood, 2004; Knight & Simpson, 1996;
Margolis & Zweben, 1998; McCrady et al., 1998; Ossip-Klein & Rychtarik,
1993; Stevens-Smith, 1998) demonstrate that family involvement is associated
with positive treatment outcomes. Parent and family-oriented intervention
programs are found to be effective in preventing and reducing youth substance
abuse (Lochman & Steenhoven, 2002). Additionally, support from partners or
spouses is identified as a significant factor in the success of addiction
treatment, particularly for women (Knight et al., 1999; Gutierres et al., 1994;
Weiss et al., 1997). This collective evidence underscores the importance of
integrating family-focused strategies into substance abuse treatment programs
for more comprehensive and successful outcomes.

According to Piat, M., Sabetti, J., Fleury, M. J., Boyer, R., & Lesage, A.
(2011). The recovery paradigm in mental health emphasizes the importance of
acknowledging families as crucial participants in the process of recovery for
individuals with psychiatric disabilities. Families often serve as the primary
support networks for individuals, playing a significant role in their social
worlds. While much research has focused on the role of families in the
recovery of individuals living at home or independently in the community,
there has been limited attention to the role of families in the recovery journey
of those residing in structured residential care. Over the past five decades,
various types of housing supervised by mental health professionals have been
developed to cater to individuals with psychiatric disabilities in countries like
Canada and the United States. This continuum of housing options includes
highly structured and professionally staffed environments, such as hostels and
group homes, as well as more autonomous arrangements like foster homes and
supervised apartments. Understanding the role of families in the recovery
process within these structured residential care settings is essential for
developing comprehensive and effective mental health support strategies.
Families often play a central role in protecting the person’s sense of self,
countering negative messages experienced in treatment settings, and building
the person’s confidence. Family members also stayed involved by giving
advice, participating in decision-making, keeping up informal surveillance
over the residences, and advocating on behalf of residents with mental health
providers. Families advised several areas. The recent emphasis on families as
crucial supporters of recovery in the context of mental health is not surprising
for social workers, given that family has traditionally been a central aspect of
their practice. However, it is noteworthy that mental health providers,
including social workers, have often overlooked the role of families in
planning and decision-making regarding housing for individuals with serious
mental illness. Despite families being dedicated to the recovery process, there
is a potential for them to benefit from further education on the significance of
housing in the recovery journey. For social workers responsible for
transitioning residents towards more independent living, stable families
represent a valuable resource and an additional connection to the broader
community. Social workers are uniquely positioned to engage and leverage the
interest and commitment of families. To effectively support individuals with
serious mental illness, social workers must develop comprehensive strategies
that recognize and address family concerns. This involves facilitating
communication between families and the mental health system, as well as
actively involving them in the planning process for independent community
living in collaboration with their loved ones. By doing so, social workers can
enhance the overall support system for individuals with mental illness and
contribute to their successful recovery and integration into the community.

Recovery is a gradual and ongoing process, especially in the context of

overcoming challenges such as addiction, illness, or mental health issues.
Having a strong support system, particularly from family, is crucial during this
journey. Family support offers love, understanding, and stability, which are
essential elements for individuals navigating through uncertain times.
Emotional backing from family members can contribute significantly to the
resilience and motivation needed for a successful recovery. It helps create a
nurturing environment where individuals feel encouraged and secure as they
work towards regaining their physical and emotional well-being. According to
Baum, E. (2022). When family members are supportive, it can make all the
difference in a person’s ability to stay sober. Research has shown that people
who have strong family support are more likely to stay in recovery and avoid
relapse. Because of family support's importance, addiction recovery is a team
effort. Recovery from addiction is a challenging and ongoing process that
involves both good and bad days. Having a support system, especially from
family, is crucial throughout this journey. Family support in recovery refers to
the positive and understanding attitudes that family members adopt to aid their
loved one's progress. Supporting a loved one in recovery involves various
aspects. Firstly, education is key; understanding the nature of addiction, its
triggers, and the recovery process can help family members offer informed and
empathetic support. Open communication is vital, creating a safe space for the
individual to express their feelings, challenges, and successes. Being actively
involved in the recovery journey includes attending support meetings, therapy
sessions, or family counselling. This participation demonstrates commitment
and helps build a stronger connection between the individual and their family.
Setting healthy boundaries is another important aspect. While providing
support, it's essential not to enable destructive behaviour. Encouraging and
reinforcing positive habits and choices helps create an environment conducive
to recovery. Additionally, practising patience is crucial. Recovery is a gradual
process with setbacks, and family members need to remain supportive and
understanding during difficult times. Celebrating milestones and
acknowledging progress, no matter how small, contributes to a positive
atmosphere. Ultimately, family support in recovery involves fostering an
atmosphere of understanding, patience, and encouragement. This collective
effort significantly increases the chances of a successful and lasting recovery
for the individual grappling with addiction.

According to Nirmala (2005). The family's involvement and encouragement

play a crucial role in supporting an individual undergoing active treatment for
substance abuse. However, families often face distress and depletion of
resources, necessitating substantial assistance and encouragement to
effectively support their loved one in treatment. A person with a substance
dependency may manipulate family members, inducing guilt in various ways.
Examples include complaining about the treatment quality, asserting that they
will die without the drug, or threatening suicide unless removed from the
treatment centre. Some family members may succumb to the pressure,
clandestinely providing the substance to the person in treatment. In such
situations, building a trusting relationship with the family becomes essential.
Offering support, educating them about withdrawal-related behaviours,
assisting in decision-making, and helping with problem-solving and
communication are crucial steps. Transformation within the family is
necessary before they can effectively support the individual in treatment.
Addressing denial and enabling behaviours is vital, requiring open discussions
with the counsellor. Establishing trust helps families recognize denial, discuss
it openly, and learn to accept it. Discussions about enabling behaviours aid in
modifying them, enabling the family to shift responsibility for the
consequences of substance use onto the individual struggling with addiction.
Overall, engaging the family in the treatment process and guiding them
through these challenges is a significant aspect of comprehensive addiction
treatment.

According to McDonagh and Reddy (2015). The transformation of support

services, particularly in countries like Ireland, has seen a shift towards
preventative interventions that merge welfare, treatment, and protection for
families in need. Family support interventions are now integrated programs
involving various agencies and organizations, both statutory and voluntary, to
promote and protect the health, well-being, and rights of children, young
people, and their families. Recognizing the impact of substance misuse on
families, policies like the National Drugs Strategy 2009–2016 emphasize the
importance of greater collaboration between service agencies working with at-
risk families. This involves forging better partnership links, particularly
between statutory and community/voluntary agencies, to provide
complementary services. Key agencies include a Garda Síochána, the Office
for the Minister of Children and Youth Affairs, the Health Service Executive
(HSE), and relevant voluntary and community organizations. The strategy
underscores the need for well-developed inter-agency working, with clear
roles and awareness of each other's functions. Assessing risk involves
considering various factors such as individual development, parents, peers,
school, and community. Research supports the inclusion of family members in
substance misuse prevention and treatment programs, with family support
being identified as a significant predictor of positive outcomes for children and
adolescents at risk. Recommendations include incorporating strong family
support in treatment programs for substance-misusing parents, addressing not
only the substance problem but also the various risk and protective factors
influencing the lives of affected children.

According to Staff (2023). Alcoholism can have severe consequences on

various aspects of an individual's life, including relationships, family
dynamics, and financial stability. Treatment is crucial to address alcohol
misuse and alcohol use disorders, and there are patient-focused options such as
detox, outpatient, inpatient, and aftercare programs. However, recognizing the
significant role of the family in the recovery process, family therapy has
emerged as a valuable treatment approach. Family therapy, as recommended
by the Substance Abuse and Mental Health Services Administration
(SAMHSA), is designed to involve the entire family in the treatment process.
This approach aims to facilitate interpersonal, intrapersonal, and
environmental changes within the family unit that can positively impact the
individual struggling with alcohol misuse. Moreover, family therapy is geared
towards preventing the recurrence of alcohol and substance misuse. Research
indicates that when one family member misuses substances, the risk of other
family members developing similar issues increases. Family therapy serves as
a preventive tool, addressing the root causes and dynamics that contribute to
substance misuse within the family. By involving all family members, the
therapy seeks to break the cycle of addiction, preventing the spread of
substance use issues from one generation to another.

According to Saatcioglu, Erim and Cakmak (2006). Abuse is a family

disease" refers to the idea that alcohol and substance abuse are often
influenced by and influence the dynamics within a family. The family is
considered a crucial component in both the diagnosis and treatment of
individuals struggling with addiction. Substance abuse is seen as a response to
disruptions within the family system. In addressing substance abuse, involving
the entire family in the treatment process is deemed essential. The clinician
should not only focus on the individual with the addiction but also recognize
the interconnectedness of family members. The family is viewed as requiring
treatment as much as the individual facing substance abuse issues. The
participation of family members in the treatment process is seen as beneficial
for various reasons. It helps in preventing relapse, extending periods of
sobriety, and plays a crucial role in resolving conflicts that may contribute to
substance abuse. The family's role and structure are considered important
factors to understand for effective treatment. Overall, a comprehensive
approach that includes the entire family is seen as essential for addressing the
complexities of substance abuse within the family system.

According to Reinaldo MAS, Pillon SC (2008). Latin America is a region

where families play a crucial role in providing support for their members.
They are actively involved in the conception, development, execution, and
monitoring of social programs. Changes in family members' social roles can
impact public policies, and the relationships within families can have positive
or negative effects on society. Alcohol abuse poses significant problems in
Latin American families, contributing to interpersonal conflicts, domestic
violence, parental inadequacy, child abuse, neglect, separation, divorce,
financial and legal difficulties, and clinical issues related to alcohol abuse.
Children raised in families with substance abuse issues are at a high risk of
physical and sexual abuse. Families with members suffering from drug-related
disorders often exhibit a pattern of transmission of drug abuse and associated
psychiatric disorders across generations. Pathological behaviour in family
members is a risk factor for the development of psychiatric and clinical
disorders. High levels of social and cross-cultural stress contribute to the
development and perpetuation of substance abuse disorders. Living with an
alcoholic is challenging, and the difficulty lies in convincing the family and
the general population that alcoholism is a disease. The authors note that each
individual's experience with alcoholism is unique but shares common
difficulties. Family disbelief in treatment and abstinence maintenance is
common, as it is challenging for patients to acknowledge their illness and stay
sober. Overcoming these challenges requires family support, a positive social
environment, and well-structured services that foster successful treatment.
Despite the adversity, individuals struggling with alcoholism have defence
mechanisms and motivation to recover, emphasizing the importance of holistic
support systems in the treatment process.

According to the U.S. DEPARTMENT OF HEALTH AND HUMAN

SERVICES Getting a loved one to agree to accept help, and finding support
services for all family members are the first steps toward healing for the
addicted person and the entire family. When an addicted person is reluctant to
seek help, sometimes family members, friends, and associates come together
out of concern and love, to confront the problem drinker. They strongly urge
the person to enter treatment and list the serious consequences of not doing so,
such as family breakup or job loss. This is called “intervention.” When
carefully prepared and done with the guidance of a competent, trained
specialist, the family, friends and associates are usually able to convince their
loved one – in a firm and loving manner – that the only choice is to accept help
and begin the road to recovery.
According to James. In Barnard's work from 2005, recommendations for
supporting families affected by drug use are extended to potentially apply to
those dealing with alcohol problems. The suggested strategies involve
officially recognizing and financially supporting locally operated self-help
family support groups. These groups are reported to be beneficial and
supportive, as indicated by respondents in Glasgow during the author's
research. However, Barnard acknowledges the need for further investigation
into the effectiveness of such a provision. One concern raised is the reliance on
volunteers for self-help groups, which could lead to instability if the
organizer's interests shift, emphasizing the need for sustained research to
evaluate the long-term viability of these support mechanisms.

According to Moos, R. H., & Moos, B. S. (1984). This study focused on

comparing the family functioning of recovered alcoholic patients, relapsed
alcoholic patients, and sociodemographic ally-matched families of community
controls. The research was conducted two years after the completion of
residential treatment for alcoholic patients. Three key aspects of family
functioning were assessed: role functioning, family environment, and husband-
wife congruence. Results indicated that families of recovered patients were
functioning similarly to families of community controls, suggesting positive
outcomes post-treatment. However, families of relapsed patients exhibited
differences in cohesion, expressiveness, and recreational orientation compared
to both recovered patients' families and community controls. Additionally,
relapsed patients' families reported lower agreement about their family
environment and more family arguments than families of recovered patients.
The study also highlighted altered role functioning in families of relapsed
patients, with the non-alcoholic spouse taking on more household tasks while
the alcoholic partner performed fewer. The overall functioning of the family
was found to be influenced by the alcoholic partner's adaptation, as well as by
life events, stressors, and the non-alcoholic spouse's level of dysfunction.

According to Billings, A. G., & Moos, R. H. (1983). The paper outlines a

research program that examines the impact of additional factors beyond
standard treatment on the recovery and relapse of alcoholic patients and their
families. Adopting a systems perspective, the study finds that patients who
successfully controlled their drinking demonstrated improvements in various
aspects of their lives, and their families also experienced better adjustment.
These recovered families exhibited post-treatment functioning comparable to a
non-alcoholic community group. Conversely, those who relapsed faced
multidimensional impairments, affecting both the alcoholic individuals and
their families. The paper emphasizes the importance of extra treatment factors,
such as environmental stressors, coping responses, and social resources, in
influencing the recovery process. These factors were found to be as influential
as the patients' treatment experiences. The authors introduce new methods for
assessing these extra treatment factors and discuss how clinicians and
researchers can use this information to enhance treatment outcomes and
improve the specificity of program evaluations. Overall, the research
underscores the significance of considering a broader range of factors beyond
traditional treatment approaches when studying alcoholism and its impact on
individuals and their families.

2.4 Challenges of the family members in taking care of alcohol addicts

during their recovery.

The family is the basic unit in society and the first agent of socialization. The
role of the family makes an individual learn, perceive, and value several things
consciously and unconsciously. According to Matthew KJ, Regmi, B &
Lama D, L (2018). The family’s morals, ethics, rituals as well as behaviours
like how to react to a particular situation and the coping strategies make an
imprint on the individual. Substance use may be considered appropriate or
inappropriate by the family as it is decided by the sociocultural influences and
attitudes of the members. The individual may be learning substance use as a
usual family pattern or as a response to various mismatches in the family
environment and the system. In this way working close to the family along
with the person addicted to substances is important. Any problem in the family
dynamics found to be increase the chance of relapse. Problems like family
boundary issues, communication problems, lack of cohesion, role
dysfunctions, and behaviour problems may contribute to relapse and
appropriate management of such issues may lead to recovery. Due lack of
open interaction and communication between patients and family members
increases the risk of relapse (Turner et al, 1993; Flora & Stalikas, 2013).
Strong social support combined with self-efficacy was found to be a strong
indicator of recovery from addictive disorders. Social support is a combination
of diverse supporting forces. Simply staying together may not always provide
the support needed. Poor parent-adolescent communication, poor family
management skills, lack of parental warmth, affective response, lack of
parental involvement, and absence of parents due to divorce, or death all are
found to be associated with the risk of relapse (Dodgen & Shea, 2000; Fraser,
2002). There is good evidence to show that family interventions are efficient in
cases of addictive behaviours. These therapies address the dysfunctional
family domains concerning unhealthy thoughts, attitudes, and behaviours.
Productive change comes through improving communication skills, exploring
relationship barriers, enhancement of trust, and dealing with other co-
morbidities. These factors enhance compliance which can result in good
response and play a very vital role in the recovery of addictive disorders.
Giving proper psychoeducation is also found effective as it enables family
members to know the addictive disorders in a very holistic way concerning
physical, psychological, and social domains. This line of therapy can also
focus on support from the family members, healthy coping styles, teaching the
difference between enabling behaviour and supportive behaviour for recovery,
and the importance of effective communication and boundaries.

Physically, psychologically, and socially, individuals build the first bonds with
their families. According to Kahyaoglu1, Dinc, M, Isık, S & Ogel, S (2020).
Addiction causes various problems in these bonds, and a vicious circle is
created when these problems affect the family members (Hashemi et al.,
2010). Although studies have mentioned the negative effects of drug and
alcohol use, addiction is a disease that affects the whole family (Lander,
Howsare, & Byrne, 2013; Choate, 2015). It has been observed that spending
large amounts of money, behaving violently, and running away from home
leads the family to experience physical or psychological problems (Svenson et
al., 1995). Living with a person with addiction increases the biopsychosocial
stress within the family and impacts their physical and psychological well-
being (Velleman, 1993 Brisby et al., 1997). The family cannot effectively cope
with the person with addiction. Therefore, involving only the individual in the
treatment plan can limit addiction treatment. According to the literature,
multiple findings have demonstrated the importance of the family factor in
addiction treatment that has a positive effect on treatment (Orford, 1994;
Copello et al., 2005; Lochman & Steenhoven, 2002). In individuals who are
reluctant to treat their alcohol and drug addictions, family is considered a
mediator factor that provides the person’s integration with the treatment. For
instance, individuals with addiction problems continue to be influenced by
their families more than law enforcement in deciding to start the treatment
(Marlowe et al., 2001). Furthermore, it is suggested that not only the initiation
of the treatment but also the family’s approach to the person with addiction
during the treatment plays a decisive role. Richardson (1999) indicated that if
the family members socially interact with the person with addiction for a year
after the detoxification process, the individual continues the abstinence period
and maintains it longer. However, parents who have developed a democratic
parenting style instead of an authoritarian one and have a supportive attitude
are considered protective factors against substance use (Patterson et al., 1992).
In this context, when various family-oriented therapies are examined, it is
necessary to support the family and educate and inform them about parenting
skills and attitudes. It has been demonstrated that it affects the treatment
positively in many ways, such as starting and continuing the treatment or
reducing the amount of substance used (Copello et al., 2005). Even when a
person with addiction refuses to engage in the treatment, studies have shown
the effectiveness of working only with family members. For instance, Thomas
et al. (1987; 1993) suggested that working only with family members can lead
to a change in the behaviour of those with addiction. It was observed that a
change in the attitude of the family changed the behaviour of the person with
the addiction. According to a study conducted with the families of people with
alcohol addiction, the amount of alcohol consumption decreased in 53% of the
people whose families participated in this program than in the control group,
and eventually some of them also engaged in the treatment. Therefore, when
family members participate in addiction treatment, the effectiveness of the
treatment increases, and it is claimed that working with the family is effective
in people with addiction problems. Therefore, it is observed that treating
addiction should not only involve the individual affected but also the family,
which will have a positive effect on the treatment of the individual.

According to Matthew KJ, Regmi B & Lama LD. (2018). Any problem in
the family dynamics found to be increase the chance of relapse. Problems like
family boundary issues, communication problems, lack of cohesion, role
dysfunctions, and behaviour problems may contribute to relapse and
appropriate management of such issues may lead to recovery. Due lack of
open interaction and communication between patients and family members
increases the risk of relapse (Turner et al, 1993; Flora & Stalikas, 2013).
Strong social support combined with self-efficacy was found to be a strong
indicator of recovery from addictive disorders. Social support is a combination
of diverse supporting forces. Simply staying together may not always provide
the support needed. Poor parent-adolescent communication, poor family
management skills, lack of parental warmth, affective response, lack of
parental involvement, and absence of parents due to divorce, or death all are
found to be associated with the risk of relapse (Dodgen & Shea, 2000; Fraser,
2002). There are good shreds of evidence to show that family interventions are
efficient in cases of addictive behaviours. These therapies address the
dysfunctional family domains for unhealthy thoughts, attitudes and
behaviours. Productive change comes through improving communication
skills, exploring relationship barriers, enhancement of trust and dealing with
other co-morbidities. These factors enhance compliance which can result in
good responses and play a very vital role in the recovery of addictive
disorders. Giving proper psychoeducation is also found effective as it enables
family members to know the addictive disorders in a very holistic way to
physical, psychological and social domains. This line of therapy can also focus
on support from the family members, healthy coping styles, teaching the
difference between enabling behaviour and supportive behaviour for recovery,
and the importance of effective communication and boundaries. Activities that
generate a sense of collective responsibility and feeling such as solving family
problems, taking over responsibility if the situation requires, or doing activities
together, for example cleaning the house, having dinner, going for picnics etc.
are usually encouraged (Nattala et al 2010; Arria et al, 2013). It is very
common for the family members to ask the individual for treatment to stop
their habits but continue with their habits. The family often fails to understand
the importance of collective responsibility and keeping away the patient from
temptation. The addictive behaviours like others can be learned and unlearned.
The unlearned behaviour may be learned again and can be relapsed by the
influence of continuous substance use by other family members (Marlatt &
Gordon, 1985). Relapse of adolescent substance abuse was found to be
associated with rejection by parents, parental and sibling substance use,
divorce in the family and conflict in the family. It is also seen that substance
abusers are more liable to report a poor relationship with their parents
compared to non-users (Cattarello et al, 1995; Fraser, 2002; Van Der
Westhuizen, 2007).