Addiction is often conceived of as a problem that an individual has. To an extent, this is true. However, in many cases, the problem of addiction is much larger and more complicated than this. No person exists in a vacuum; everyone has friends, family, and loved ones impacted by their choices. This is true, even when someone is at odds or separated from their family. In many cases, substance abuse issues can cause great rifts or pain in the relationships the addicted individual has with others.
This can look different in different situations. In some cases, individuals struggling with addiction may live with family members, spouses, and/or children in their homes. The relationships of the addicted person with those in the home can become problematic very quickly. Even when someone lives alone or with friends, the relationships with those around him are important.
When we talk about “family” here, it is useful to understand that this does not just refer to those related by blood. For family addiction therapy, the term “family” can refer to immediate and blood-related family members, close friends, mentors, in-laws, or anyone else who has a familial relationship with the addicted person.
When it comes to addiction and the family, some behaviors or patterns are very unhealthy or dangerous, most notably codependency and enablement.
Codependency: The behavior of codependency occurs when the addicted individual and someone close to them has adapted their relationship in a dysfunctional way in response to addiction. Sometimes this will manifest as constant fear or worry by the loved one for the addicted individual to the point that it disrupts the loved one’s life; this can also manifest in the form of denial, low self-esteem, unhealthy behavior such as over-eating or shopping; additionally, this may show up as changes in mood that are dependent on the addicted individual.[i]
Enablement: When it comes to these behaviors, it can sometimes be difficult to distinguish between enabling and helping. In many cases, it may not be unclear. In general, enabling relates to assisting someone addicted to things that they would normally do for themselves or allowing them to avoid consequences that they would normally receive. Helping, on the other hand, generally relates to things the addicted individual with things they would not or could not do by themselves. The line between these is difficult, and it can often be helpful to consult a counselor or wise family and friends for assistance in making significant decisions.[ii]
Benefits of Family Therapy
Improved Communication: Communication between one who is addicted and their family can be a difficult process. Addiction can cause each person to say and do things differently than they would otherwise. Family therapy provides a safe context in which healthy communication can happen. The counselors who lead family therapy sessions are trained to facilitate and encourage honest but loving communication between those struggling with substance abuse and their loved ones.
Awareness of Family Dynamics: In many cases, the dynamics and relations between the person addicted and their family can go unnoticed. Changes in the ways people relate can happen subtly and quietly. In the context of family therapy, however, there is an opportunity for the nature of the relationships and the family dynamics to be more clearly revealed. Sometimes there are unhealthy ways of relating, including codependency or enabling tendencies that neither is aware of initially.
Clarification of Ways to Get Help: Family therapy can also provide a place for both the addicted and their family members to receive help and find ways of receiving help. Many of the struggles relating to healthy relationships involve both persons needing help and either not getting it or not knowing how to get it. The person addicted may know they need help but will often be wrong in understanding what and how they need help. Many times, family members and loved ones desire to help and support the addict, but they do not know-how. Even more unnoticed, however, is that often the family members themselves need health. There will be physical and mental exhaustion, among other consequences, that come with supporting and dealing with someone who is addicted.
Establishment of Boundaries: Beyond these things, family therapy is beneficial for helping those addicted and their families as they set to establish effective and useful boundaries. This is important to help avoid the negative behaviors of codependency and enablement. When boundaries have not been set appropriately, the result is negative for both parties. Boundaries can sometimes feel restrictive or feel like we are not helping our loved ones who struggle with addiction, but the reality is that the boundaries are for the good of the addicted. There is a difficult but important balance that must be found between having empathy, loving, and supporting the addict and allowing them to continue in their behavior without experiencing the natural consequences.
Opportunities to Safely Share Feelings: Because of the difficult nature of substance abuse and the guilt and shame it often brings with it, addressing feelings can be extremely challenging. For the one who is addicted, often the feelings may be repressed or avoided. When they are not avoided, they can surface as overwhelming shame and embarrassment. When confronted, this guilt and shame can manifest by anger and hurt, sometimes including making the one confronting the addict feel guilty for bringing it up. These are natural but harmful things. For the family member trying to help a loved one, there are often feelings of being taken for granted, of exhaustion from constantly supporting the loved one or providing for the home without the loved one. Addressing this with someone in the midst of addiction is, at the very least, difficult. Family therapy can help in these situations by providing a safe context and a wise, trained professional to guide and support the discussion.
Chances to Build Trust: Finally, family therapy can provide opportunities to build trust. The reality is that addiction causes a lot of fractures in relationships, and trust is often eroded and damaged very quickly. For obvious reasons, this is not the place where we want relationships to stay. The hope is for restoration and reconciliation. This requires the rebuilding of trust. Family therapy, often by addressing the things listed above, can help begin this process of building trust and restoring relationships.[iii]
Most people don’t get addicted to drugs or alcohol because they have nothing better to do with their lives. There is almost always a driving force that causes them to turn to substance abuse to cope with personal issues.
Sometimes, drug users are simply trying to mask mental health issues. In other cases, it is a matter of the drug user looking for ways to cope with everyday life against what seems to be insurmountable odds. We submit to you that family issues will often play a role in someone turning to drugs and alcohol.
How Family Interactions Can Lead to Addiction
For the most part, we all count on our family and friends to provide us with a safe environment to navigate everyday life. When things are good within the family unit, our families are a great source of support and care through tough times. Unfortunately, family members can also become a primary source of strife and stress in our lives.
To be clear, every family has its own way of dealing with each other. There are usually two or three family members that dominate the family unit, while the rest of the family members tend to be followers. Therein lies the potential problem.
More often than any of us would like to admit, we fall out of grace with our dominant family members when they start giving off negative vibes. They might be trying to drive or manipulate us to do as they dictate. Sometimes, they choose to pour their unhappiness into our laps and the laps of other family members, which almost always leads to family issues.
As we indicated above, it’s the submissive family members that usually end up turning to drugs or alcohol. They are the ones who feel overwhelmed by their more aggressive family members, seeing drugs or alcohol as the best way to cope with ongoing family issues.
When family members become part of the addiction problem, the entire family unit tends to suffer. Of course, it starts with the addiction sufferer who is left to struggle within the cycle of addiction. In time, their addictive behavior will start to permeate the family unit.
When addiction strikes, family members could be subject to:
Being victimized by their loved ones addictive behavior (stolen money, involvement in a DUI accident)
Becoming upset, causing isolation among family members and the addiction sufferer
Becoming codependent and supportive of the addictive behavior
No matter how badly the family gets fragmented due to an addiction issue within the family unit, there is always a way for the family to come back together. It is called communication. The best source for getting family members to communicate again is almost always family therapy, which we heavily promote.
When an addiction sufferer enters our rehab, they spend a good deal of their time working with a therapist as an individual. When family issues seem to be playing a role in the addiction sufferers addiction, the addiction sufferers therapist will usually suggest family therapy.
As part of family therapy, key family members are invited to come into our rehab facility for open and honest discussions. It is incumbent on the therapist in charge to watch the family interact. They would typically rely on their experiences to identify the potential sources of addiction sufferers’ family problems.
Ultimately, the therapist wants to help family members do three things.
Mend Fences: Family therapy is a good environment for family members to get thoughts and feelings out on the table. When communication among family members starts to improve, healing can start.
Learn the Truth About Their Loved One’s Addiction: Family members aren’t always aware of the extent or the reasons behind their loved one’s substance abuse issues. After learning about what drives the abuse, family members will often use that understanding to the basis for forgiveness and empathy.
Learn How to Support Their Loved One in Recovery: After rehab, clients will need all the support they can get as they navigate recovery. If a lot of that support can come from family members, both the addiction sufferer and their family members would stand to reap great benefits in terms of bringing the family closer together.
If you come to us for treatment, we can assure you we will be looking at how your family might be playing a role in your addiction. If warranted, we might suggest family therapy as a way to get the family back on track. We often take this position because we know how important family is in all of our lives.
Awareness of a problem can happen in many different ways and over different amounts of time. There is a mistaken notion that knowledge is simply a matter of knowing the right words. This is not always the case. There are often cases where we may know someone is trustworthy or a situation is safe, yet we still have a hard time trusting and unafraid. Knowing the words “This is a safe situation,” sometimes even when you know there are good reasons to believe it, does not mean that you can fully latch on that knowledge. It may take time and reinforcement before those words sink deep within you as true.
The same is often true in cases of addiction and substance abuse. There may be early points in substance usage where someone mentions that there might be a problem or a thought in the back of the mind that something may be heading in the right direction. But it might take time before this becomes realized and reflected upon. In some cases, these realizations and believing the words “You have an addiction” may not happen until a crisis brings the truth home suddenly and harshly.
The Transtheoretical Model
When thinking about recovery, the Transtheoretical Model, which characterizes recovery in five stages, seeks to capture the intentional and multi-faceted nature of progress in recovery. The five stages are known as Precontemplation, Contemplation, Preparation, Action, and Maintenance.[i]
The first stage of recovery on this model is contemplation and is at the stage at which an individual would be considered “not ready.” When it comes to an understanding ourselves, it is important to remember that we are not transparent. What that means is that we do not always fully realize the motivations for our actions or fully understand ourselves. If you have ever done something and then later sat back and wondered why then you understand this. In many cases, especially in the fast-paced world of the “West,” this happens because we are not taking time to think about ourselves and our lives. We are swept up at the moment, in responsibilities, in trauma from the past, in social media and television, or anything else. Not to say that all of these things are wrong, but it can be easy to miss what is going on within our heads if we do not consider ourselves.
The point at which we do begin to reflect is known as contemplation. This can be thought of as an exploratory phase. We begin to think about “if”; if there is a problem, if we can change, change, and so forth. This stage may take some time, as it can sometimes be difficult to tell the nature and extent of a problem. We may also become acutely aware of the consequences. There may be fear of judgment from family, friends, or society and simply a desire within not to give up the pleasure of the substance. The perceived enjoyment of drug use may not seem outweighed by the negative consequences in life.
There will often come the point, though, where a decision is made to change. In most cases, this does not immediately result in doing something but rather in preparing. This means getting a plan for addressing problems and discussing the details with those around you. Even when you have decided you want to make a change, actually moving forward with it can be intimidating and difficult. This is okay as long as you face it directly and do not let the fear and difficulty derail you.
This is the stage in which clear steps have been taken to change one’s life. In most cases, when we think of individuals in recovery, this is the step we think of because it is most visible. While this is a misunderstanding of the journey to recovery, it is important and helpful that this stage is visible. Seeing change and progress, steps begin taken, can be a rewarding and encouraging experience. This may mean a measurable decrease in substance usage, lifestyle changes in nutrition and exercise, beginning a treatment plan with a doctor or treatment facility, or any other steps.
While the Action stage can be exciting and invigorating in its measurable progress, this excitement and satisfaction can decrease over time. The sensation of progress and feelings of seeing recovery in action is not permanent. Maintaining the progress can be a significant challenge, especially as withdrawal can sometimes last years, and cravings may continue to appear even longer than this. Most researchers have suggested that the maintenance stage is often around six months to five years in length.[ii] This may seem disheartening, but it is simply the reality of the situation. It is important to realize this so that individuals can mentally prepare for the experience.
One of the most important things to keep in mind when reading about the transtheoretical model is that recovery is much more than the “Action” stage. Those who are currently struggling with substance abuse realize that all of the steps are part of the process. You cannot force these things. Knowing what it means to say “I have a substance abuse problem” is not easy. It will take reflection and contemplation; it will require you to come face to face with the reality of who you are, what you have done, and how you can respond.
Another grouping of words can be hard to fully believe and own for yourself as knowledge and truth: There is hope. It is so easy to discount these as meaningless and untrue, especially when you’re in the midst of the deepest darkness. It may seem like all hope is lost, like this is beyond your power like nothing will ever change. It will be easy to despair.
I often find strength in thinking about the dawn. Every single day, the sun goes down, and the world gets increasingly dark. It becomes difficult to see, and it becomes easier to get lost. There comes the point where it the darkest in the night. And then the sun begins to rise. Gently, along the horizon, little flickers of light and color, growing and growing. The sun rises, dawn arrives—a new day.
Trauma-informed care is an important part of therapy for many drug treatment clients. Whereas many treatment centers focus on using and addiction, there are many benefits of trauma-informed care. Many people come to recovery and treatment with unresolved issues related to something traumatic they have experienced in their life.
Some people may have anxiety or PTSD, which are both mental health disorders that are treatable and often require medication and talk therapy. For others, the effects of trauma may not be as noticeable but can often reveal themselves during therapy or recovery work.
Trauma and Coping Behaviors
In recovery, people often “peel back the layers” of their life and discover that their past trauma is a trigger to continue to use alcohol or drugs. They may learn that their poor coping behaviors were a result of dealing with trauma.
Oftentimes, an individual may have developed coping behaviors that worked well while in crisis but now need to be changed to live a happier, healthier life.
Post-traumatic stress disorder is one way a person’s life can change when they have survived a traumatic experience. Professionals will often describe this mental health disorder as a “normal reaction to abnormal circumstances.” The brain often creates different ways of thinking as a result of a person’s life experiences.
Coping with trauma can change how a person acts, feels, and thinks, as they often go into “survival mode,” and their mind continues to return to that mode after the threat has passed. Trauma-informed care can help treatment providers address both addiction and triggers resulting from traumatic experiences.
Addiction is common among people who have experienced trauma. People who have been to war or survived sexual assault often are diagnosed with PTSD and other issues. It’s widespread for people who have unresolved or unexplored traumatic experiences in their past to self-medicate, especially during the holidays or even anniversaries of the event that caused them so much pain.
Addiction can make a bad situation much worse and puts further strain on your mental health.
Getting Help for Addiction and Trauma
Getting help for resolving past trauma and caring for mental disorders can help a person become more healthy and cope with their life instead of using substances.
At Cycles of Change Recovery Center, trauma-informed treatment helps us meet our clients where they’re at. Trauma-informed care encompasses a treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma.
Through this trauma-informed approach, we can help our clients by emphasizing physical, psychological, and emotional safety. This approach helps trauma survivors rebuild a sense of control and empowerment in their lives and provide new coping skills.
Unlike physically addictive drugs like alcohol and heroin, cocaine is psychologically addictive. In fact, aside from methamphetamine, cocaine is considered to create the most significant psychological dependence of any drug. CESAR (the Center for Substance Abuse Research) classifies cocaine as “highly addictive,” particularly when processed into the crack and smoked. According to CESAR, “A person can become addicted after his or her first time trying crack cocaine.”
Cocaine: The Basics
Cocaine is a stimulant drug made from the coca plant leaves native to South America and is considered illegal. As a street drug, cocaine looks like a fine, white crystal powder.
People use the drug in a few ways: they snort cocaine powder through their noses or rub it on their gums. Some mix it with water or heroin and inject it into the bloodstream (the combination of cocaine and heroin is called a speedball). Others smoke cocaine that has been processed into a crystal (crack cocaine).
When you use cocaine, it affects the brain almost immediately. You’ll have feelings of intense well-being and be very talkative, energetic, and confident (hence, it is often referred to as a party drug).
But the high you get from consuming cocaine only lasts a short while (about 15-30 minutes). That’s why so many people take it in binges, using it multiple times in a small window while increasing doses. Many people wonder, “is cocaine physically addictive?” which it indeed can be with heavy use.