Transcript SUBSTANCE USE DISORDERS AND THE FAMILY

SUBSTANCE USE
DISORDERS AND
THE FAMILY
Donna L. Londino, M.D.
Medical College of Georgia
Alcohol Medical Scholars Program
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Substance Use Disorders and
the Family

Substance use and associated disorders are
common
• Alcohol 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
drug
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Percentage of U.S. Population (Aged
12 and Over) Who have ever Used Drugs of
Abuse
70
60
50
40
30
20
10
0
Tobacco
Heroin
THC
Cocaine
Alcohol
Source: SAMHSA, National Household Survey on
Drug Abuse, 1998
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Substance Use Disorders and
the Family
Individual
FAMILY
The individual exists in the context
of a larger system - the family.
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Family Influences on
Substance Use
 BIOLOGIC
 PSYCHOLOGICAL
 DEVELOPMENT
 SOCIAL
INFLUENCES
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Biologic Considerations

Alcohol and drug use have genetic influences
• “Novelty seeking” temperament
• Genetic predictors of response, metabolism, risk
of later dependence
• Familial factors in medical consequences to
alcohol use
• Independent psychiatric disorders
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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.
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Family Attitudes Towards
Substance Use
 Cultural
• Khat - Afghanistan, Africa, Yemen
• Ganja - West Indian cultures
 Religiosity
and personal conservatism
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THE ALCOHOLIC FAMILY
 “When
the
appropriate and
sensible use of
substances
merges into
inappropriate and
unsafe use”
 Domestic
violence
 Child abuse
 Impaired family
relationships
 Dysfunctional family
responses
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Domestic Violence

Approximately 80% of spouse to spouse violence is
alcohol related

Physical abuse of children involves 20-30% of
parents who are heavy drinkers

The child abusing parent is often under the influence
of alcohol when the incident occurs
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Family Relationship Issues

Marital conflict - abuse, separation, divorce

Parental attachment

Family of origin

Cross-generational effects
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The “FAMILY DANCE”
 Rituals
- symbolic, self sustaining, self
corrective, anticipatory
Alcohol and substance use can have a highly
disruptive effect on family rituals
“Uncle Tom ruins each Christmas dinner by
becoming intoxicated and belligerent”
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Family Responses
“Sequences of behaviors that emerge as a
response of members in alcoholic families”
 Predictable
 Individuated
response”
to the family - a “family pattern of
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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”

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Effects on Children
 Conduct
and academic problems
 Emotional difficulties
 Potential causal effects on earlier onset
on drinking
1. Biologic
2. Modeling
3. Adaptation to family dysfunction
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Family Influences on
Substance Use

BIOLOGIC

PSYCHOLOGICAL DEVELOPMENT

SOCIAL INFLUENCES
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Social Influences on the
Family
 Crime
 Financial
 Health
effects
 Foster care
 Social interactions - isolation, “shame”
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Family Considerations in the
Treatment of Substance Abuse
Disorders
The Best Treatment Programs are
Comprehensive and Multidimensional
Vocational
Services
Family
Services
Medical
Services
Intake
Screening
Substance
Use
Monitoring
Legal
Services
Support
Groups
Medications
&
Therapy
Educational
Services
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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.

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Family Considerations in the
Treatment of Substance Use
Disorders

Screening - Individual and Family

Support Groups
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Therapeutic Interventions for Family
Members
 Stress
management
 Assertiveness training
 Psychoeducation
 Addressing family communication and
response patterns
 Problem solving tasks
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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

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