Voices of Loved Ones Indirectly Affected by Substance Use Problems

Continuing to look back at my career in the addiction recovery field and what I have learnt. After reading the excellent book Beating the Dragon: The Recovery from Dependent Drug Use by James McIntosh and Neil McKeganey in 2003, I made the decision to start a research programme involving qualitative analysis of interviews. The first piece of research, which focused on the effects of substance use problems on the family, was conducted by Gemma Salter, a third year undergraduate. Gemma was awarded the prize for the project of the year in my Psychology department.

Gemma’s research involved semi-structured interviews (lasting 42 – 129 minutes) with nine parents and one grandparent (who had assumed the role of parent) of people with a drug and/or alcohol problem. The participants were recruited from West Glamorgan Council on Alcohol and Drug Abuse (WGCADA) in Swansea and Drug and Alcohol Family Support (DAFS) in Blaenau Gwent, South Wales.

Interviews were taped, transcribed and then analysed using a qualitative analysis known as Grounded Theory.

Eight important themes emerged from this analysis, which Gemma termed confusion/lack of awareness; imbalance/pervasion of the problem; heightened negative emotions; family support/ treatment; coping; outcomes; family and other stressors. These inter-related themes, each comprising various concepts, were integrated into a preliminary model describing the impact of substance misuse on the families interviewed and various related matters.

The following summary of Gemma’s findings is based in part on an article I wrote for an early edition of the UK magazine Drink and Drugs News(29 November 2004, p. 12). I have added here quotes from Gemma’s interviews.

Families face a number of difficult issues when one of their children develop a substance use problem. Parents, as well as siblings and relatives, are likely to feel extremely stressed about a whole range of problems—initial confusion about the nature of the substance use, imbalance as the problem takes over, a barrage of negative and contradictory emotions, the stigma associated with substance use, and problems associated with the treatment system.

Confusion arises and increases because parents are not aware of what is going on with their loved one, and because of a lack of knowledge about substance use and its associated problems. Initially, parents are not aware of what substances are being used, the method of administration, and the seriousness of use. For some parents, confusion and uncertainty continue for a long time.

There is usually a gradual process of realisation, as family members witness the consequences of use, rather than a clear-cut understanding of what is going on. Some parents are constantly trying to ‘catch-up’ in order to fully understand new or different stages of their loved one’s addiction or recovery process.

‘I found out within less than a year that he was injecting himself. Purely, I found out because… he had phlebitis in the legs. He had infections there, and ulcers.’

The process of understanding what is going on is often confounded by the user’s deceit and lies, which create an atmosphere of mistrust. Even if they are not deceitful, users can be in denial about their problem. Some parents are also in denial, generally because they don’t know how to deal with the problem. They experience contradictory thoughts and behaviours, particularly towards their loved one. All of these factors add to the ongoing confusion.

‘I seemed to be looking for the good in him…I know he hurt me by pinching [stealing], but he’s family… As a son he leaves a lot to be desired, but he’s still my son, and this is the hard part about it.’

Parents are involved in a learning process about the nature of their loved one’s problem and how it can be overcome. In order to achieve a greater degree of clarity, they must learn about and understand the drug(s) involved, the reasons for use and consequences of use (e.g. drug withdrawal, overdose), the nature of recovery, and what different forms of treatment involve and how they can be accessed. Confusion can be exacerbated by information obtained from questionable sources, such as some elements of the media.

Parents’ lives are knocked off balance, as the substance use problem pervades and dominates the family. This imbalance is characterised by a series of worries, which tend to dominate parents’ thoughts, and cause a significant amount of stress. These worries are either general in nature or specifically relate to fears regarding the user’s safety or health.

‘I was frightened we were going to have a phone call to say he was dead or he was in hospital with an overdose… We were just waiting for a knock on the door to say they’d found him in the gutter or something like that.’

Some parents whose family member is in recovery from addiction worry about them relapsing.

‘You’ve always got that worry that they will relapse and go back, and I think I will always have that. I don’t think I will ever get away from that.’

In the turmoil of worry about their loved one’s health and safety, parents often feel as if they dislike or even hate their child, hoping that they would die or disappear to remove the problem altogether. In most cases, this feeling contradicts concurrent feelings of parental love and obligation and serves to further confuse and stress the parent. Many of the parents also experience other negative emotions, such as feelings of isolation, shame, grief and anger.

The addiction treatment system offers little initial comfort, as parents become frustrated with long waiting times for their loved one.

‘I get annoyed about it, angry and frustrated as well…I think the access [to treatment] is very, very slow, and I think this is where a lot of problems arise. As is the case with my son, they get frustrated, and they get despondent, and they think… what’s the use?… Access needs to be a lot, lot quicker.’

Then comes the stress of stigma and prejudice. Although most parents don’t experience stigma aimed at them directly, they suffer when it’s targeted at their child and often try and conceal the problem. There is a tendency for a parent to feel that other people think the user’s problem is the parents’ fault:

‘You could tell by the tone in her voice that she was pointing the finger. It makes you feel that you haven’t done things right for your family. Where have you gone wrong, is what you say to yourself?’

Part 2 to follow tomorrow.

The photograph used in this blog post was by Marcus Woodbridge and has come from Unsplash, a great resource of free high resolution photographs.