Families and Drug Use

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Families and Drug Use

Have you ever questioned which came first: the chicken or the egg? That age-old question is much like the dilemma experts grapple with: Do problems in family life lead to drug addiction, or does drug addiction lead to problems in families? Professionals who work with drug abusers take different sides in this debate. Some counselors focus on treating the individual. Others believe that to treat drug addictions one must work with families in order to create more healthy environments. In the early twenty-first century, treatment of adolescents with drug problems tends to take the approach of treating the family.

The American family has changed significantly since the mid- twentieth century. At that time, the standard view of a family was two parents and their children, with the father as the wage earner and the mother as the homemaker. Since then, different forms of families have steadily gained acceptance. Divorce, single-parenthood, childlessness, and living alone have become common, as well as more accepted. Attitudes toward the roles of men and women have also changed. Women are no longer expected to stay home with children, and fathers are expected to participate more fully in parenting.

In the 1980s and 1990s the changing face of the American family became commonplace. By 1987 a quarter of all children under 18 years of age no longer lived with both of their parents. Is there a connection between these changes in the family and trends in drug abuse? Determining the role of the family in drug abuse is a continuing subject of research. One answer may be that the instability of families leads to stresses upon individuals and society, and that those stresses open the way toward drug and alcohol use. Family stability may provide more secure environments for individuals, who may then be able to cope with life's challenges without abusing drugs. Other evidence suggests that an individual's drug addiction may be a form of illness passed from one generation to the next.

Every year, 100,000 Americans die as the result of drug abuse. Needle use among drug users also causes further deaths from AIDS. Alcohol, nicotine, and illicit drug abuse are serious health problems, especially among the young. Life expectancy has steadily risen in all age groups except for youth aged 15 to 24. However, the death rate in this age group has increased because of injuries and disappearances related to drug use. Long-term substance abuse also results in depression, hostility, malnutrition, lower social and intellectual skills, broken relationships, mental illness, economic losses, and growing crime rates. Together, these take a huge toll on individuals and society as a whole. To prevent individuals from turning to drugs, we must understand the relationship between substance abuse and family dynamics, or in other words, how family members deal with one another.

Family Predictors of Drug Abuse

Three factors that help predict drug use are family structure, family history, and family relationships.

Family Structure. Family structure refers to the composition of the family, such as single- or two-parent families, the number of children, the number of years between siblings, birth order, and whether the family members are males or females. Research on drug abuse has looked at single-parent, disorganized families, in which the parent is unable to clearly play the role of the head of the family in terms of caregiving, rule making, and consistent discipline. Children in these single-parent, disorganized families tend to try drugs and alcohol at an earlier age than do children in traditional nuclear families (those in which two parents are present). Drug and alcohol abuse is also more common among these children. Of course a great number of single-parent families are as secure as two-parent families, and in such cases there is no link between the single-parent structure and adolescent drug use.

Children who have no siblings appear to be at least risk for drug abuse, while children from families with six or more siblings are at greater risk. There seem to be fewer cases of drug abuse involving first-born children compared with the number of cases involving subsequent, especially last-born, children.

Some researchers argue that family structural factors do not add much to the understanding of drug-abuse behavior. More important risks for children, they suggest, lie in how the family operates and the quality of life within the family. For example, in a family where the husband and wife have hostile feelings for each other, divorce may be a healthy way to end the conflict and tension. If the divorce does not disturb the child's development—the natural steps a child takes in the process of growing up—then the parents' breakup may lead to better overall family relations. In such a case, divorce alone does not have a negative impact in terms of a child trying and using drugs.

Following divorce, most children experience a brief period of adjustment. The age of the children, the gender, the parent with whom they live after the divorce, and the quality of life in the home after the divorce all affect how well and how quickly children adjust. Depending on family relationships, children being raised in single- parent households can be expected to cope with problems as well as children from two-parent households.

Family History. Family history refers to patterns of behavior among various generations. For example, if an individual abuses drugs as an adult, therapists will examine whether that person's parents abused drugs during his or her childhood. Some well-established evidence indicates that when the parents or siblings of an adolescent use drugs, the adolescent is more likely to use drugs also. This may be the direct result of a genetic (biologically inherited) link, especially in the case of alcohol use among male members of the same family. However, many researchers think that a person's biology or genetic makeup cannot fully explain why some adolescents use drugs and others do not. The attitudes and values of parents are key factors affecting adolescents. When parents use drugs such as cigarettes and alcohol, children receive a clear message that such use is expected—or at the very least tolerated—in the family.

Heavy drug use in the family, especially by parents, also disrupts family functioning. Drug-abusing parents are less able to give care and support. In such a family environment, other members of subsequent generations are more likely to take up drugs themselves. A parent on drugs is less able to supervise his or her children, thus allowing their children to mingle with peers who abuse drugs frequently. Parental drug use also interferes with communication between parent and child. These parents may lack patience or fail to take the time needed to develop a healthy relationship with their children. Not only do drug-using parents set a bad example for their children, their drug use prevents them from instilling positive values. Parental drug use is also associated with child neglect and all kinds of child abuse: emotional, physical, sexual.

Family Relationships. Family relationships refers to the dynamics among individuals, such as the quality of a marriage and how well parents and children or siblings get along. Every family has its own way of offering support to each other—giving acceptance, encouragement, security, and love—and also of controlling each other through establishing rules and practicing discipline. Concerned, involved parents can help prevent delinquent behaviors in children and adolescents. Supportive parents provide encouragement and praise, are physically affectionate, and enjoy the companionship of their children. Evidence shows that a rewarding parent-child relationship can help prevent substance abuse during childhood and adolescence. Families in which parents praise and encourage their children, offering closeness, trust, and help with personal problems, are typically families of abstainers, or people who do not use drugs. Children who feel rejected by their parents or overly controlled by them, and whose family life is marked by a great deal of conflict, are more likely to try drugs at an early age and to continue using them.

The subject of control is more complex than the subject of support. It is important to distinguish between authoritative and authoritarian controls. Authoritative control combines warmth, supervision, and the opportunity for children to voice their own feelings. Children accustomed to this type of control are more likely to abstain from using drugs or to experiment only rarely with "soft" drugs. Authoritarian control, on the other hand, is based on force, threats, and physical punishment. This type of control is more typical of the families of dependent drug users, and resembles bullying more than parenting. In such families, sexual abuse and physical abuse are also more likely to occur.

Conclusive evidence shows that families with inconsistent or no clearly defined rules also have adolescents who abuse drugs. The constantly changing rules in some families threaten the parents' ability to monitor and supervise children. The children do not know what their parents expect, creating confusion. These families have not developed clear expectations for good behavior, nor clear limits regarding misbehavior.

Another important element of family dynamics is the way family members communicate with each other. Communication is the essential feature of all family relations, from expressions of support to the enforcement of the rules. Good communication involves understanding the other person's point of view. In a family where drug use is prevalent, family members often misunderstand each other to the point that communicating becomes a negative experience.

Peer Groups and School

When adolescents are involved in drug abuse, not only their family but their peer group and school play important roles. Parents are with their children for limited periods of time. Adolescents pick up many of their values, attitudes, and behaviors from friends and school.

Peers introduce most new drug users to drugs. Peers also help new users continue to experiment, leading them to develop regular patterns of use, including greater dependency. Researchers find consistent evidence of the relationship between drug abuse and dropping out, poor performance and underachievement in school. A low grade-point average and dropping out of school are strongly associated with a young person's involvement with drug-abusing peers, according to some research. Parents' involvement in schoolwork and activities reduces the chances of a child being seriously involved in drug use.

Family Violence and Substance Abuse

Substance abuse in families tends to lead to increased physical abuse. In 1994 it was estimated that about 10 million American children lived in households with a substance abuser. A minimum of 675,000 children per year are neglected or abused by drug- or alcohol- dependent caretakers.

Drug abuse can disrupt family dynamics among the rich, the middle class, and the poor and in any ethnic group. Research shows that people whose parents were substance abusers are more likely to have marital problems and psychiatric symptoms, especially if they had experienced physical and sexual abuse. It has also been found that domestic violence commonly occurs when the violent individual is also an alcohol abuser.

Studies have shown that substance abuse can lead to child abuse. Whether it does depends on family factors such as education, income, and the parents' own histories of substance abuse, neglect, and physical abuse. Moreover, physical abuse is not the only kind of abuse. Parents who use drugs or alcohol are typically unable to fulfill some aspects of their children's emotional or physical needs. One common factor in the family lives of substance abusers is the absent father. When the father leaves, his role in family life must be filled by someone else. Often a child must assume responsibilities inappropriate to his or her age, such as caring for younger children in the family. As a result, that child's own needs may never be met.

Domestic violence can occur when a drug abuser in the family is desperate to obtain more drugs. For example, if the drug abuser needs money to buy drugs, and a family member tries to prevent him from taking money, the drug abuser may become violent. A drug abuser might also become suspicious that a partner is informing on him or her to the police and respond violently. Some women are involved in prostitution to obtain drugs for themselves or their partners, so their risk of exposure to violent behavior is increased substantially.

Studies of couples have shown that when both partners have substance abuse problems, they are more likely to become violent against each other. Alcohol problems most strongly increase the likelihood of violence. Studies have also shown that the combined use of alcohol and drugs, particularly cocaine, is extremely dangerous in terms of violent behavior.

Family Treatment

Treatment or intervention programs can help prevent drug addiction from being passed down from one generation to the next. Until the mid-1980s, very few drug treatment programs directly involved spouses, parents, or other family members in their treatment of the patient. After that time, family therapy became the treatment of choice for most drug abusers, especially in the area of alcoholism treatment. Family-centered drug interventions are very effective in getting family members off drugs and keeping them off. In contrast, if adolescents are treated individually and their family system has not changed, they often return home to resume the same behaviors that had earlier led them toward addiction.

Including other family members in an adolescent's drug treatment makes the treatment more complicated. But it also allows the family therapist to help the drug abuser maintain family love and relationships. Strengthening family relationships may eliminate an individual's addictive behaviors.

Successful alcoholism treatment is currently based on family systems. For instance, research has revealed that the spouses of alcoholics often support their spouse's addiction in ways they themselves do not understand. Helping the spouse of the alcoholic to change his or her behavior can help the alcoholic overcome his or her addiction.

Family therapy is also helpful for young adult heroin addicts. Researchers found a significant decrease in heroin use by young adults when family-focused therapy was employed. A study over several years of 136 adolescents also supports the effectiveness of a family therapy program when compared to individual counseling combined with a family education program. In this study, family therapy intervention significantly reduced drug use for 54.6 percent of the adolescents.

The best drug treatment, however, may be a combined treatment. The individual should receive treatment that teaches social skills and strategies for coping with stress. The family should receive treatment in which family members learn how to nurture each other. Combining the two approaches offers creative solutions to the problem of drug abuse in the young.