We talk a lot about the impact of substance use disorders (SUD) on individuals, but we sometimes forget the effects it can have on families. Addiction impacts families in too many ways to count. The stress and uncertainty associated with worrying about a loved one permeates every aspect of life and can be incredibly stressful not only on the individual but on the family unit as a whole.
One study found that just under 30% of family members of people living with a substance use disorder were struggling with their own mental health issues compared to 16% of their peers.
All this starts with understanding the nature of addiction and recognizing the roles that family members may play in the course of their loved one’s recovery. This article acknowledges the effects of SUD not only on the individual but on the family unit as a whole, and discusses how family members can most effectively help their loved ones while still taking care of themselves.
How Do We Define A Family Unit?
First let’s define who is part of the family unit. Many people with SUD may be living at home with parents or siblings, or alone, or with roommates or friends. When we discuss a person in recovery’s family, we include all the people who they are close to that are contributing either positively or negatively to their recovery. family members do not have to be blood-related, related by marriage, or living in the same home to be important social supports for someone who is in recovery
6 Common Family Roles Within a Household with SUD
Though there are certainly more than six roles a family member might play within an addicted household, reading about the following six types can be a starting point for a conversation about interactions among individuals within the family unit.
Friends and family may read these roles and immediately identify with one or more of them. Others may find them reductive or too simplistic.
Remember these roles are fluid and malleable. Reading these descriptions might help family members to at least start a discussion about what roles they take on in their family unit. Remember that your family members usually have the best intentions when helping you to recover, and may attempt to help in many different ways.
The Person Living With Addiction
This person is usually the focal point of the family. Many conversations revolve around the effects of their SUD.
This person will often do the following:
- Use substances, including alcohol, to the detriment of their ability to function at work and at school.
- Lie to their family about their use of substances.
- Steal from family members to pay for drugs or alcohol.
- Ignore the needs of others in pursuit of getting and staying high.
- Promise repeatedly to change, to stop using drugs or alcohol, or to make up for past harms.
- Engage in “no holds barred,” emotional behaviors to ensure that they can maintain connections with family members who are helping them to stay comfortable in addiction.
Sometimes called an enabler, this role is played by the person who works hard to keep the peace. With the best of intentions, this person may justify the choices of the person living with addiction, lie or otherwise cover up for them to protect them from judgment, and spend a great deal of time trying to mitigate the repercussions of their actions. While their overall intention is good, they can sometimes inadvertently become the “ally” and enable the SUD to continue to use.
The caretaker may also be the person who really wants to believe that everything is okay and that their loved one is doing their best and not truly living in addiction. They may give them money or other support, believing the person when they say that the money is for something other than drugs or alcohol.
They may also help the person in addiction avoid the consequences of their actions. For example, the caretaker might call their loved one’s boss to say that they’re sick if they are too hungover or under the influence. If they are fired, the caretaker may give them money or buy them things.
“The caretaker” might do the following:
- Disbelieve that their loved one is living in addiction or that the problem is as bad as others think.
- Play the role of martyr, often giving up things they want to help out the addicted person — and not always happily.
- Give the person living with SUD money or other kinds of support that make it easier for them to continue misusing drugs and alcohol.
- Cover for the addicted person with family members, neighbors, bosses, and others who suggest that the person is living with a substance use disorder.
The hero or heroine in the family will take the martyrdom of the caretaker to the next level, going above and beyond to fix the problems caused by their loved one’s addiction. Their goal is always to maintain the status quo and hold everyone together by making sure that the costs of addiction are not felt.
This person may be viewed by others in the family as responsible, the “together” one, independent, and emotionally strong. A critical thinker, they respond effectively in a crisis, but they may also struggle internally with living up to everyone’s expectations and the responsibility of making sure that everyone else in the family is okay.
The hero(ine) may do the following:
- Take responsibility for the problems caused by the person living with SUD even when they are not actually responsible.
- Stay calm in emotional or chaotic situations.
- Seek to portray the family as “normal” to others through overachievement, hyper-responsibility, and type A personality behaviors.
- Consistently attempt to stop the dysfunction at home caused by the SUD.
This person is sometimes called the anti-hero. This person is often a middle child or sibling of the addicted person or a fellow roommate. Because their issues are always overshadowed by the person with SUD, they may feel ignored or underappreciated. They may lash out emotionally, or otherwise seek out attention
The scapegoat may do the following:
- Stay out late, all night, or disappear for days without communication.
- Engage in “shock” behavior to garner attention.
- Be irresponsible with money, their belongings , and in their attention to school or work responsibilities.
- Engage in aggressive or emotionally manipulative behavior.
- Blame others in the home for their choices or problems.
The mascot seeks to divert attention away from the problems associated with the addiction differently than the scapegoat might. Rather than engaging in negative behaviors, the mascot will make jokes or try to lighten the mood in order to keep everyone together.
The mascot may be seeking to regain a sense of control in an out-of-control situation with humor, just as the hero does with intense responsibility or the scapegoat does with negative attention-seeking behaviors. Just as the hero is often the oldest child and the scapegoat may be a middle child, the mascot role often falls to the youngest child in the house.
In roommate situations, it may be the role of one of the roommates if there are multiple. It is rarely the role of someone in a partnership with a person living with addiction or a spouse.
Though the mascot often appears to be upbeat and always on the go, if they ever need to slow down or sit with the uncomfortable reality of the situation, they may become depressed or anxious.
The mascot may do the following:
- Make jokes during heated arguments.
- Note the heavy atmosphere when walking in the room and make light of it.
- Feel anxious if their attempts to make people laugh don’t work.
- Feel depressed if the situation worsens over time.
The Lost Child
The lost child archetype describes a person who is largely uninvolved with the problems created by the person with SUD. They rarely do anything to take part in conversations about their loved one. They do not seek to cover up the situation or divert attention away from it with negative or silly behaviors.
The lost child often stays to themselves, spending most of their time doing things alone, like watching TV, scrolling on their phone, or playing video games. The goal of these activities is often to escape from or disconnect from the tensions within the household.
The lost child might do the following:
- Stay silent in family conversations about the addicted loved one.
- Slip out of the room when conflict develops or conversations get heated.
- Defer answering directly when asked for their opinion.
- Appear to be unaffected by everything going on externally but still might feel deeply affected by these tensions internally
How to Determine Your Role in a Household with SUD?
Just knowing what role you may be playing or recognizing and acknowledging the roles others play in the home is a great first step in helping an individual to recover.  Try doing the following:
- Make a list for each role. As you read through the characteristics of each role above, make a list of the things you regularly do or have done in the past that may put you into one role or another. You may have made choices that could put you into more than one category, and this will be helpful information later on.
- Discuss this with others in the family. Try the above exercise on your own and then go through the process with other family members. They may have insights about your role that you don’t.
- Talk to your therapist or sponsor in a support group about the roles you feel most apply to you. Consider their opinions on the subject. An objective person outside of your family who has spent time getting to know you through therapy may be able to shed some insight.
- Notice how you feel when it is suggested that you may be filling any of these roles. If you feel that none of the roles apply to you or feel defensive about a role another family member associates with you, Instead, reflect on what might be accurate. Remember, everyone’s ultimate goal is the same: to help the person in recovery and protect the family unit.
How to Define Healthy Roles in Your Family
Defining healthy roles for yourself and everyone in the family takes time and patience.
With consistency and persistence as well as a dedication to self-awareness and a sustained focus on the goal of finding personal balance no matter how addiction unfolds, healing is possible.
Some of these steps will aid the healing process:
- Adjust your expectations: The emotional impact of SUD on families can take time to heal. It will take much longer than a couple weeks of detox or 30 days of treatment to return to a state of “normal.” Be patient!
- Open up to possibility. There is no magic cure for addiction, but there are a number of different treatments that can be effective. The people around the person with SUD also need to recover from the trauma experienced as a result of their loved one’s addiction. While it may not necessarily be the exact outcome that is hoped for, the results of treatment for all involved can be beautiful and unexpected in a positive way. =
- Speak with a personal therapist. Working with someone who solely has your interest in mind), and who may offer educated, professional insight and advice is key to the recovery of family and friends.
Additionally, a professional therapist may recognize the signs of trauma and other diagnosable mental health disorders. They can connect you with appropriate medical intervention.
- Work with a family therapist or couples counselor: It can also be helpful to work on individual relationships within the family unit in a therapeutic setting.
For example, couples counseling can help married partners when one member is struggling with a SUD.
Fixing a family that has been broken by addiction starts with recognizing that everyone in the family plays a role in the addiction disorder. It is important to continue to support the member with SUD while still supporting and validating all members of the family unit.
While there is no quick fix for addicted households, healing is possible. With attention to the harm done by active substance misuse, family therapy, and ongoing support and guidance, families can continue to recover together.
By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
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