ELEMENTS TOWARD THE
CONSTRUCTION OF A MODEL
Before presenting our model, certain aspects of it
require clarification. In this section discussion is devoted to the ways
in which our obser-vations led us along a
path toward the formulations from which the model has been constructed.
FEAR OF
SEPARATION
It is commonly recognized
that drug addicts usually present as depen-dent
and inadequate individuals who frequently "screw up.- They seem not to function because they are too
dependent and not ready to assume
responsibility—as if they want to be taken care of. They fear being separate or separated. At the outset of our
work we observed this characteristic
and it was not obvious to us how or whether it fit into the total family
system. On looking further, however, we started to notice that when the addict began to succeed—whether on the job, in a treatment program, or elsewhere—he was in a
sense heading toward leaving the
family, either directly or by developing more autonomy in general. What was
interesting was that at this point some
sort of crisis would almost inevitably occur in the family, such as parents having a fight or a separation, one parent
developing symp-toms, or a sibling
becoming a problem. On the heels of this the addict
Concerning the relation between fear of
separation and the onset of difficulties in adjustment, the addict
does not generally become problematic until adolescence.5'• I 11.9' 19
2"" I t is at this point that he should be expected
to actively engage in heterosexual and other intense outside
relationships. If he does, however, he becomes less available and less
attached to his family. Since he seems to be badly needed by the
family, his threatened departure can cause panic. Consequently, the pressure
on him not to leave is so powerful that the family will endure (and
even encourage) terrible indignities, such as his lying, stealing, and
the public shame he generates, rather than take a firm position in
relation to him. They also tend to protect him from outside agencies,
relatives, and other social systems. Rather than accept responsibility themselves, family
members usually blame external systems, such as peers or the neighborhood, for
the addict's problem. Should the parents
take effective action, such as evicting him, they often undo their actions by overtly or covertly encouraging his return. They seem to be saying to him, in
effect, -We will suffer almost
anything, but please don't leave us.- Thus it becomes nearly impossible for the addict to negotiate his way out
of the family.
CHOICE OF SYMPTOM
If one views opiate addiction not only as a
physiological or biological predisposition but as a family phenomenon, one must ask how these families differ from others with problems.
Questions also arise as to why this particular symptom is chosen, and what
functions it serves.
Comparison with Other Disorders
In some ways families of
addicts appear to be similar to other severely
dysfunctional families. Many types of problem families use a focus on
the child's difficulties to avoid (1) conflicts between the parents, or
(2) other family problems.6i.m•85 However, families
of addicts do seem to differ in a
number of respects, as follows:
1.
There is evidence for a higher frequency of
multigenera-tional chemical dependency, particularly alcohol, among addicts' families, plus a propensity for other
addiction-like behaviors
such as gambling and
television watching.'' '• '8' ft 4-''()L 8{1' 122
124.161.1'9. 198 Such practices provide modeling for children and
can also develop into family
-traditions.-
2.
Addicts' parents' behavior is characterized as
-conspicu-ously unschizophrenic- in
quality.'
3.
Related to the above, several of the authors (noted
in the Preface) have been extensively
involved in therapy research on both
families of schizophrenicssa and families in which an off-spring has a severe
psychosomatic disorder.Rw '"' Compared to these groups, addicts are more likely to form strong outside relationships and to retreat to them, even if only
for a brief period, following family
conflict. In other words, the illusion of independence is greater for addicts because, unlike the other symptom groups, they have a subculture to which
they can relate.
4.
Compared to families of schizophrenics and
psychoso-matic young people, addicts'
families seem to be more primitive and
direct in their expression of conflict.
5.
Alliances among family members and within family
sub-systems (e.g., between an addict and his mother) are often quite explicit in addicts' families and may be confirmed
verbally by members. Addicts'
families often characterize themselves as -close,- showing a good deal of nurturant (even infantilizing) behavior toward each other. On this point, Madanes et al.95 compared the families of addicts, schizophrenics,
and -normals-(high achievers) on a
test in which members were required to indicate
their closeness or attachment by moving cardboard figures representing themselves on a grid of family
structure. Addicts' families were 6 times more likely than the other two groups to place the figures so that they touched
or overlapped each other.
6.
Mothers of addicts show greater -symbiotic"
childrear-ing practices and needs
than mothers of schizophrenics and normals.
Attardoo compared these three kinds of mothers on a
7.
Addicts'
families show a preponderance of death themes and
premature, unexpected, or untimely deaths within the family. These
aspects are discussed more extensively later in this chapter.
8.
The symptom of addiction provides a form of
-pseudo-individuation- at several levels (see below).
9.
Acculturation and parent—child cultural disparity
appear to play an important role in
many cases of addiction. Vaillant[8] 82 raised this possibility based upon his data with heroin addicts. He
discovered that the rate of addiction for offspring of people who immigrated either from another country or from a different section of the United States was 3 times higher than the rate for
the immigrants
themselvei. In addition, he found
that immi-grants' offspring who were
born in New York City were at greater
risk for addiction than either their parents or immigrants' offspring born in the former culture. Rosenberg'12
also found higher rates of drug abuse among children of immigrants.
Follow-ing this lead, Alexander and Dibb2
determined that in a group of 12
families they were treating for drug addictio* the parents in 10 of them (83%) lived more than 200 miles from
their place of birth; most were
immigrants from Europe or the Canadian prairies.
In another Canadian study, Smart et al.139 found less inhalant use among children whose parents were born in North America versus children of parents from other
continents. Finally, Scopetta et at133 compared acculturation scores between Cuban American parents and their problem offspring.
Significantly greater parent-child acculturation gaps were found within drug users' families than within families of
adolescents with nondrug problems; the drug
users were more acculturated, and their parents less so, compared with the psychiatric group.
In an attempt to understand and explain this
phenomenon, Valliant '8' notes the abnormal dependence of addicted mothers on their children. He suggests
that ( I ) immigrant parents are under the additional strain of
having to cope with their new environ-ment, (2) parental migration may be correlated with
parental instability, and (3) the immigrant mother,
separated as she often is from her own family ties, may be less able to meet the needs of
those dependent on her and yet experience greater than average difficulty in permitting her child mature
independence- (p. 538). It might be added that immigrant parents are
also faced both with the "loss- of the
family they left in their original culture, plus their own possible feelings of guilt or disloyalty for having deserted these other members. Thus it is often
worthwhile to examine issues in the
extended family as well as interactions in the nuclear family. In any case, what appears to happen is that many immigrant parents tend to depend on their
children for emotional and other
kinds of support, clinging to them and becoming
terrified when the offspring reach adolescence and start to individuate.
Symptom
Function
Stemming from earlier discussion of the interdependency and fear of separation that addicts' families show, we have
concluded that opiate addiction has
many adaptive, functional qualities in addition to its immediate pleasurable features. Our major
conclusion is that it pro-vides the
addict and his family with a paradoxical
resolution to their dilemma of maintaining or dissolving
the family, that is, of his staying or leaving. Its pharmacological effects, and the
context and impli-cations of its use, furnish solutions to this
dilemma at several different levels, stretching from individual
psychopharmacology to the drug subculture. Some of these functions appear to
be:
1. The individual-pharmacological level. Several
writers have
conceptualized the addict's experience of euphoria as analo-gous to a symbiotic attachment or fusion with the
mother—a kind
of regressed, infantile satiation.85' If so, then while he is in
this state he
can feel -close- to mother or family, and also in some ways appear to them much as he did when he was very young and clearly not autonomous. On the other hand, heroin
blunts the anxiety accompanying
separation and individuation,r95 often causes
drowsiness,26 and in effect allows the addict to be separate, distanced, and self-absorbed while physically
present. Thus we hypothesize that he, and they, can -have it both
ways" by means of the drug. Through
the drug he can be both close or infantile and distanced at the same time.
2.
Aggressive
behavior. Because of the turmoil that ensues when
he improves or succeeds, the family's covert message to the addict appears to be that he should remain
incompetent and dependent. On the
other hand, heroin, like alcoho1,99 has been noted to give a sense of new power, omnipotence, and tri‑
Is,11- 12(,I95
umphant success.- Perhaps more important is the point
made by Ganger and Shugart,” however, that under
the influence of heroin, addicts become aggressive and assertive toward their families, particularly parents. We note that in so
doing they become autonomous,
individuated, and "free.- They appear to stand up for themselves, but not really. This is actually a pseudo-individuation, for their ravings and protestations are discounted.
The drug is blamed. Without it they
-really aren't that way.- Through the
drug cycle the whole family becomes engaged in a repetitive reenactment of leaving and returning in which the -leaving" phase is neutralized through denial
of the possible implications of the
addict's assertiveness. In short, the family is saying, -You don't really hate us—you're just high," and when he is not influenced by drugs the addict
concurs with, -Yes, I don't really hate you, but when I'm on the drug I can't
control myself.-
3.
Heterosexual relationships. Heroin may offer a com-promise in the area of heterosexual relationships.
Addicts have been noted not to have teenage crushes," to be more
likely than average to engage in homosexual
activities,51. 17°' 2°° or to be retreating
from sexuality.50 Scher'29 proposes that intense family ties serve to prevent the addict from developing
appropriate relationships with spouses
or offspring. It may be true that the drug
produces a kind of sexual experience,", "6 which would partially explain the colorfully eroticized
language and loving tenderness that
addicts attach to various aspects of their habit192'1°5;
they seem to be addressing it as a love partner.
Since it apparently reduces the sex drive also, it can in this way
again provide a solu-tion to the addict's dilemma. Through it he can
have a quasi-sexual experience without being disloyal to his
family,'9 and, most obvi-ously, his mother. He does not have to form a heterosexual rela-tionship but can relate sexually to the drug
instead.
4. The drug subculture. Other aspects of drug addiction can help the addict out of his dilemma, especially
those pertaining to extrafamilial
systems. The addict forms relationships among members of the drug
subculture. He -hustles- and makes a lot of money to support his habit. Thus he
has friends or peers and is in this way
grown-up, independent, and "'successful.- Paradoxically, however, this is not the case, for the more heroin
he shoots the more helpless,
dependent, and incompetent he is. In other words, he can be successful and
competent only within the framework of an
unsuccessful, incompetent subculture. It is a limited realm, restricted to people who need help and cannot
really be expected to function
adequately within society. Once again, through his addiction the addict almost has his cake and eats
it, for he seems to be out of the
family, but only in a way that is tolerable to them and keeps him within his assigned role.
5. Abstinence and the addict role. Previously we noted
how
the drug may serve as a problem that keeps the
family together. In this way it transcends its pharmacological
effect; it serves more as a symbol of the addict's incompetence and his
consequent in-ability to leave the family or their inability to release him. Much has been made of the
euphoria in drug addiction, but our ex-perience indicates that
this is of secondary importance to its function within the family. Given appropriate
support, an opiate addict can, for example,
tolerate large decreases in methadone levels.
By far the greatest resistance is in the final step of going from 5 mg, or I mg, to nothing. It is an easy step
to take, pharmacologically, and its
real significance is iymbotic. If he takes it, the addict is no longer
an addict. He is making an assertion against the roles he has played and against his
mantle of in-competence. Should the family still need him in the position of the addicted one, they can
bring almost unbearable pressure to bear. If he cannot withstand it, he slips once
again into the
addictive cycle.
DUNCAN STANTON - THOMAS C. TODD
