Butler Center for Research / October 2021 Download the Helping Families Cope with Addiction Research Update Addiction affects not only individuals, but the family members and friends of the person struggling with a substance use disorder. Due to misinformation, families may face labeling and may be accused of being enablers, neglectful and abusive.1, 2, 3 Unfortunately, stigma may prevent families from reaching out and getting help, which can contribute to isolation, financial and psychological burden.3, 4 Although understanding the role of family is of utmost importance, past research has mainly focused on the negative impact of substance use on the individual, dismissing the impact on and experiences of family members and their roles in both active addiction and substance abuse treatment.5 Once considered a moral problem rather than a disease, vestiges of the moral model continue to target individuals with addiction and their family members. People with substance use disorders are stigmatized, and for every targeted individual there are differently affected family members. Family members are faced with stigma, judgment and blame by association.6 Unhelpful social attitudes burdening families with addiction include prejudice, labeling and blame (which contribute to social isolation), shame, self-prejudice and treatment avoidance.3 Addiction is a family disease, and including families during treatment can be helpful for recovery of the addicted member and the family's growth process as a supportive family system.7 Although family member recovery is a different process than that of the addicted individual, adaptations to the family system are necessary for relapse prevention and healing for all family members.8 New treatment models aim to empower family members and are now incorporating care models that offer families the possibility of learning about alcohol and drug dependence, which provides them with healthier ways to cope with addiction, prevention strategies and support through recovery. Education and Support for Families When an addiction develops, family members and friends are also often directly impacted by the addiction.9, 10 That is why it is important for family members and friends to have a good understanding of addiction and how to continue to take care of their own health as well. Education can help families escape the blame game. Rather than believing that the person's substance abuse disorder stems from weakness, willfulness or stubbornness, it is helpful to understand how addiction is associated with changes in the brain. It is not always easy to live with or support someone who has an addiction. As research points out, addiction in a close relative can serve as a stressful life situation that persists for years, and that long-term dysfunction can make it hard for families to communicate clearly. There can be a block of mistrust between every member of a family touched by the addiction.11 Connecting with peers can help, such as through a program like Al-Anon or Alateen. The goal of these programs is to provide help for families of those with substance use disorder. They also provide a safe, nonjudgmental space where family members can learn about, discuss and cope with an addiction unfolding in their midst. People attend these meetings for many reasons, but one survey12 found that many participants were drawn to meetings because they were hoping for help with: Finding a better quality of life Having fewer problems with the addicted person Lowering levels of stress Improving psychological health By going to a meeting and listening to other family members, feelings of isolation and doubt may begin to fade. Families may also get the skills they need to better handle the interpersonal problems they are facing. Friends and family members who stay informed and take care of their mental and physical health are better equipped to deal with addiction, support their loved ones and put their family on the path to recovery. Many support groups exist in every region of the United States and around the world to help family members and friends of those who have an addiction. These groups provide education and information to help guide families through the process and can also offer support networks. The table below lists several options. Table 1. Support Groups for Family Members and Friends Al-Anon This is a worldwide support group for family members and friends of those who are addicted to alcohol. Alateen This is a division of Al-Anon that is specifically designed for adolescent family members of alcoholics. Families Anonymous Families Anonymous is a group for relatives and friends concerned about the use of drugs or related behavioral problems. GRASP Grief Recovery After Substance Passing (GRASP) is a support group for people who have lost a loved one due to substance abuse. NAMI The National Alliance on Mental Illness (NAMI) provides a wide range of support options for loved ones of people suffering from symptoms of a mental health condition. Nar-Anon Similar to Al-Anon, this worldwide fellowship helps family members and loved ones of those who are addicted to drugs. PAL Parents of Addicted Loved Ones (PAL) is a Christian based group of parents who help other parents learn how to cope with an addicted child and that allows for both educational and peer-sharing opportunities. SMART Recovery Family & Friends This group is an alternative to Al-Anon that focuses more on science-based and nonconfrontational methods of helping your loved one. Interventions Involving Families in Treatment and Recovery Shumway and colleagues proposed a revised Multifamily Group Curriculum to assess efficacy of family involvement at an inpatient treatment setting.13 The curriculum involved11 different modules in a two-and-a-half-day program addressing family systems education, family therapy, multifamily groups, disease model education, Twelve Step Facilitation and coping skills; outcomes were measured at pre- and post-test and follow-up at 30 days. Results indicate that family involvement can produce positive, short-term effects in family functioning, readiness to change, relationship satisfaction and individual overall health. However, better outcomes were noted between pre- and post-test findings, and would begin to decrease in subsequent follow-up periods when families were no longer in treatment, which seems to indicate that longer family recovery practices are necessary for sustained change.13 Brief Strategic Family Therapy (BSFT) was compared to treatment as usual in eight different treatment settings for adolescent substance use and parent alcohol use.14 Results from this study indicate that involving family members in BSFT can be more effective than individual-based treatment only by reducing parent alcohol consumption and increasing family functioning. In addition, this study demonstrated that adolescents whose parents engaged in substance-using behaviors were more likely to use substances than those families with less-frequent substance using behaviors, which provides more information about the way families' behaviors influence one another and can have an important impact on both addiction and recovery.14 Parent and partner treatment engagement for individuals with alcohol use disorder can support behavioral change.15 Community Reinforcement Approach and Family Training (CRAFT), developed to treat alcohol use disorders, is now implemented to treat addiction to different substances by engaging families who have treatment-refusing individuals.16 Although research is lacking in assessing CRAFT effectiveness, recent updates indicate promising results as seen in more successful treatment engagement for treatment-resisting individuals as well as improvement in physical symptoms, depression and anxiety.16, 17 Training family members to understand and manage overdose is a way to empower and educate families about heroin addiction. Williams and Strang18 implemented a study where 187 family members were distributed in two groups: take-home naloxone (THN) administration training or a basic opioid overdose information-only group. The THN group results included greater overdose knowledge and more positive attitudes than the information-only group. Furthermore, families trained in the THN group were able to administer naloxone to family members. By involving family members in overdose training, family members were able to improve their knowledge and have a greater sense of competence and knowledge to participate in a relative's recovery.18 Conclusion Historically, research has focused on measuring treatment outcomes on individual-based interventions. More recently, treatment programs have begun to expand treatment services to include family education and multifamily groups. There is new evidence to suggest that involving family members in substance use treatment is effective for more positive recovery outcomes. Family involvement can improve knowledge about addiction as a disease as well. Empowering families to improve interactional patterns can benefit not only the family member with addiction but the entire family system. Treatment settings involving family programs can offer additional benefits for an individual's recovery process.