1. Copyright Alcohol Medical Scholars Program1 SUBSTANCE USE DISORDERS AND THE FAMILY Donna L. Londino, M.D. Medical College of Georgia Alcohol Medical Scholars Program

2. Copyright Alcohol Medical Scholars Program2 Substance Use Disorders and the Family  Substance use and associated disorders are common Alcohol is one of the most commonly misused substancesAlcohol is one of the most commonly misused substances The majority of people in Western societies are current or past users of at least one psychoactive drugThe majority of people in Western societies are current or past users of at least one psychoactive drug

3. Copyright Alcohol Medical Scholars Program3 Percentage of U.S. Population (Aged 12 and Over) Who have ever Used Drugs of Abuse Source: SAMHSA, National Household Survey on Drug Abuse, 1998

4. Copyright Alcohol Medical Scholars Program4 Substance Use Disorders and the Family Individual FAMILY The individual exists in the context of a larger system - the family.

5. Copyright Alcohol Medical Scholars Program5 Family Influences on Substance Use  BIOLOGIC  PSYCHOLOGICAL  DEVELOPMENT  SOCIAL INFLUENCES

6. Copyright Alcohol Medical Scholars Program6 Biologic Considerations  Alcohol and drug use have genetic influences “Novelty seeking” temperament“Novelty seeking” temperament Genetic predictors of response, metabolism, risk of later dependenceGenetic predictors of response, metabolism, risk of later dependence Familial factors in medical consequences to alcohol useFamilial factors in medical consequences to alcohol use Independent psychiatric disordersIndependent psychiatric disorders

7. Copyright Alcohol Medical Scholars Program7 Family Perspectives and Beliefs Families develop patterns of use which become integrated into the family structure. These can be modeled and passed on to future generations. Families develop patterns of use which become integrated into the family structure. These can be modeled and passed on to future generations.

8. Copyright Alcohol Medical Scholars Program8 Family Attitudes Towards Substance Use  Cultural Khat - Afghanistan, Africa, YemenKhat - Afghanistan, Africa, Yemen Ganja - West Indian culturesGanja - West Indian cultures  Religiosity and personal conservatism

9. Copyright Alcohol Medical Scholars Program9 THE ALCOHOLIC FAMILY  “When the appropriate and sensible use of substances merges into inappropriate and unsafe use” è Domestic violence è Child abuse è Impaired family relationships è Dysfunctional family responses

10. Copyright Alcohol Medical Scholars Program10 Domestic Violence l Approximately 80% of spouse to spouse violence is alcohol related l Physical abuse of children involves 20-30% of parents who are heavy drinkers l The child abusing parent is often under the influence of alcohol when the incident occurs

11. Copyright Alcohol Medical Scholars Program11 Family Relationship Issues  Marital conflict - abuse, separation, divorce  Parental attachment  Family of origin  Cross-generational effects

12. Copyright Alcohol Medical Scholars Program12 The “FAMILY DANCE”  Rituals - symbolic, self sustaining, self corrective, anticipatory Alcohol and substance use can have a highly disruptive effect on family rituals Alcohol and substance use can have a highly disruptive effect on family rituals “Uncle Tom ruins each Christmas dinner by becoming intoxicated and belligerent” “Uncle Tom ruins each Christmas dinner by becoming intoxicated and belligerent”

13. Copyright Alcohol Medical Scholars Program13 Family Responses Family Responses “Sequences of behaviors that emerge as a response of members in alcoholic families” “Sequences of behaviors that emerge as a response of members in alcoholic families” u Predictable u Individuated to the family - a “family pattern of response”

14. Copyright Alcohol Medical Scholars Program14 Response Patterns Response Patterns  Role changes and reversals  “Family energy” surround the substance use and its sequelae  Family defenses of ambivalence and denial  Social withdrawal and isolation  “Fear of shame”

15. Copyright Alcohol Medical Scholars Program15 Effects on Children  Conduct and academic problems  Emotional difficulties  Potential causal effects on earlier onset on drinking 1. Biologic 1. Biologic 2. Modeling 2. Modeling 3. Adaptation to family dysfunction 3. Adaptation to family dysfunction

16. Copyright Alcohol Medical Scholars Program16 Family Influences on Substance Use  BIOLOGIC  PSYCHOLOGICAL DEVELOPMENT  SOCIAL INFLUENCES

17. Copyright Alcohol Medical Scholars Program17 Social Influences on the Family u Crime u Financial u Health effects u Foster care u Social interactions - isolation, “shame”

18. Copyright Alcohol Medical Scholars Program18 Family Considerations in the Treatment of Substance Abuse Disorders The Best Treatment Programs are Comprehensive and Multidimensional The Best Treatment Programs are Comprehensive and Multidimensional Vocational Services Support Groups Legal Services Medical Services Medications & Therapy Educational Services Family Services Intake Screening Substance Use Monitoring

19. Copyright Alcohol Medical Scholars Program19 Treatment Can be Effective  Drug treatment reduces drug use by 40-60%  Treatment does not have to be voluntary to be effective.  Family influences can help facilitate entry and engagement in the treatment process  Lack of family support has been implemented in poor compliance with treatment recommendations.

20. Copyright Alcohol Medical Scholars Program20 Family Considerations in the Treatment of Substance Use Disorders  Screening - Individual and Family  Support Groups

21. Copyright Alcohol Medical Scholars Program21 Therapeutic Interventions for Family Members u Stress management u Assertiveness training u Psychoeducation u Addressing family communication and response patterns u Problem solving tasks

22. Copyright Alcohol Medical Scholars Program22 Conclusions  Family considerations in substance use disorders include biologic, developmental, and social contributants  It is difficult to establish cause and effect - easier to note correlations  The family should be an integral part of a multidisciplinary treatment approach