EXTRA FAMILIAL SYSTEMS
A variety of extrafamilial factors also can
threaten the family system and trigger the addictive cycle. These might
include the father losing his job or facing retirement, a family member
becoming seriously ill, or a sibling marrying and leaving home. Social
systems, including peers, social agencies, and legal institutions,
can affect the addict directly, and through him, the family. However,
without denying the importance of extrafamilial systems, we believe
that the family's influence is primary, and in fact accentuates or
attenuates the impact of such external forces.
*In this case, iservocontrolled" refers to
an automatic return to a prior be-havioral state, once a specified limit is
reached, such as the end of a time period,
DISCUSSION
The model presented does not deal extensively
with the historical etiology of drug addiction, but rather with
current family functioning. Like most research, these studies examine
families after the drug-abuse pattern is well established, without
necessarily attempting to predict which families will produce an addicted
offspring. We have also not dealt at length with factors affecting the onset of
addiction, although the life cycle stages of
adolescence and leaving home—especially when there is parent-child
cross-cultural disparity—do appear to
be of critical importance. Other factors also may influence the initial addiction experience, such as
prevalence of addiction in the neighborhood,
the prescribing of morphine during hospitalization, occurrence of deaths or losses in the family,
genetic factors, and military service
in Vietnam. Further, it is not clear how our model would apply to addicts raised without families,
including those who grow up in
institutions and become state wards for their entire lives. Whatever the variables affecting onset, however,
in cases with exis-tent families it is
our position that the family is a crucial factor in determining whether someone remains addicted. To this point, it would
be interesting to study people who become addicted but do not manifest the family patterns and structures we have
described. Would it be easier for
them to get off drugs? This issue and others, such as the variables
contributing to symptom choice, await further explora‑
tion.
Most of our discussion has concerned male
addicts. We have had experience with
only a few families in which the primary addicted member was a female. However, it is our impression
that most of the principles set forth
also apply to women addicts. Further, several studies mentioned earlier" '9° indicate that the relationship between the female addict and her parents,
particularly her father, resembles
the male addict-mother pattern. This is a client popula-tion that is receiving increased attention, and it
is our hope that investigators will
not neglect the family variables extant in the treat-ment of female addicts.
It is generally accepted that the addict who -cleans
up'' is sub-jected to pressure from
peers, pushers, and acquaintances in the drug subculture to return to his habit. Conditioning to the paraphernalia and setting itself can also occur.I9' These
influences can be very
strong. We do not see our model as being
inconsistent with condi-tioning
theories, but rather that most such theories are not con-structed to encompass family and interpersonal
systems behaviors. Conditioning
paradigms sit at a different level of integration, and therefore would not readily predict such phenomena
as the be-havioral sequences within
the family homeostatic cycle, or the occur-rence of symptoms or crises with other family members when the addict
abstains. Further, our experience dictates that if change has been effected in the family system, the pull from
conditioning factors can be
resisted. With effective treatment the family can be a source of strength in helping the addict stay off drugs. '2'92'9' 152' 15- We have seen parents take charge of intercepting calls from -junkie- contacts and actively work to support their sons and shield them
from their old ways. This sort of
turnaround can fortify the -withstanding- process long enough for the old relationships and learned
patterns of be-havior to lose their
potency.
Considering the role of the family may help to
understand the successes and failures
of other treatment approaches. For instance, individual therapy places the addict in a position of having to rec-oncile opposing loyalties.19 The therapist becomes
another outsider competing for him,
and the addict usually returns to his primary relationships (i.e., his family) when pressures mount. Furthermore, it is possible that pharmacological substitution
(e.g., the continued administration
of methadone) may actually serve to perpetuate the family cycle because, at
least initially, it tends to promote acceptance of the addict in his role as -sick- and unable to be drug-free.N° In some ways it recreates the family system. '3', ' We
observe that these families show great
tolerance for any treatment program that con-tinues to keep the -patient- label on the addict. This may even occur in a tightly structured drug-free community, where
the addict is treated as a -junkie-
even when he is off drugs. In some families the addict's mere presence in such a program is sufficient to keep the family stable (e.g., the
case in Chapter 7). For others this is not enough and the addict drops out of the program when a crisis develops among other subsystems in the family. We
suspect this to be a major factor
accounting for the unfortunately high dropout rates that occur in so many methadone and therapeutic
community pro-grams.
A fruitful
direction for future research would be to identify the contribution of family factors to those situations in which drug‑
The emphasis here may appear to be on families with
a member addicted only to opiates.
However, we want to underscore that we consider
the patterns we have described, and the conceptualizations we have offered, to be of a much more generic
nature than this. As noted earlier,
our combined experience includes many kinds of drug abusers' families. While we concede that the use
of certain drugs may denote certain
-psychodynamic- differences among abusers at dif-ferent times, we would nonetheless posit that (1) such preferences are also greatly influenced by a complexity of
external, nonindividual factors, such
as availability and costliness of drugs, and (2) the processes and the model described would still apply
to most of them, no matter what
particular substance they compulsively abuse. Indeed, cut-and-dried opiate
addicts may be on the wane, as the majority of chronic abusers in the United States appear to have grown more catholic in their tastes. (In fact, many of the AFP
cases showed such polydrug use.) Consequently, we view the proposed
model—especially in its more general
form—as applicable to most families who have a young person compulsively using drugs.
Not all of the problems that we have ascribed to
addicts' families must be present in a
given case. For instance, many addicts are successful at work or school but live isolated lives in the homes of their parents. Conversely, it is not impossible to
find an addict hundreds of miles from
home, but having an unstable marriage, no secure job, and living in a deviant subculture. Even in these distanced cases, however, the addict may still be intimately
involved in the family, as his
physical presence is not necessarily required in order for him to maintain his function within it. He can
simply check in with them by phone or letter on a periodic basis, or a social
or rehabilita-tive agency (hospital,
police, drug program) can communicate with the family about him. Nonetheless,
whatever the configuration of problems,
it is necessary for all of them to be
overcome as part of the successful
negotiation of this family developmental stage. Specifically, the addict must
(1) cease his dependence on drugs; (2) achieve some measure of separation from his parents, typically
by leaving home; (3) be seen by
parents, himself, and the community as successful in
SUMMARY
The chronic relapsing nature of drug addiction
can be explained from a family systems viewpoint. The addiction cycle is part of a
family pattern involving a complex homeostatic system of interlocking feed-back mechanisms, which serve to maintain the
addiction and, conse-quently, the overall
family stability. The pattern usually involves at least three people and follows a sequence in
which, when the addict improves, the
parental figures start to separate; when he again becomes problematic, they shift focus from their
own conflict and join in directing their attention to him—at least until he
again starts to improve, bringing the process full circle.
Drug taking usually starts at adolescence. It is
related to an intense fear of separation experienced by the family in response to the addict's attempts at
individuation. The family becomes stuck at this developmental stage. The drug provides a solution at
several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits
him to simultaneously be both close and distant, "in- and -out,- competent
and incompetent, relative to his family of origin. This is pseudoindividuation.
An understanding of these concepts, and their integration into a
homeostatic model, can provide the basis for effective treatment.
