IN PREVIOUS CHAPTERS it has been made clear that the course of drug addiction is strongly linked to certain
characteristics of family life
experience. Age is one such factor. A drug problem frequently emerges at the
time in life when a passsage is anticipated from the dependency of youth into the self-reliance of
adulthood. The integrity of the
family of origin may be threatened by a member's shift toward autonomy. In such families, the onset of a symptom
that postpones this passage may
constitute a -solution,- postponing or avoiding the
greater family crisis (see Chapters 1 and 4).
An addicted eldest child presents a powerful
example to his younger siblings of the -dangers" that lie
beyond the family circle. On the other hand, should the first child manage the
transition to adulthood responsibly, increased pressure might come to bear on the second and later children.
The youngest child may be forced to travel the hardest route of all,
becoming the final link in making or breaking the future viability of the
family—now reduced to the husband-wife
dyad.
While the age configuration among siblings is an
important factor in determining which child becomes addicted, the effect is mediated by the age of the
parents. Parental age warrants deeper consideration in clinical diagnosis and
treatment than it has received from many family therapists. Any strategy adopted
by the therapist will either support or undermine the plans and
ambitions of the parents for their children, the children for
their parents, the parents for themselves, and the children for themselves.
If the therapist is insensitive to the fact that not only the addict but the entire
family experiences critical life cycle
transitions, his approach may blindly
In contrast to the
extensive clinical material of the other cases in this book, the present
chapter is more narrowly focused. Emphasis is predominently
on issues pertaining to parents who are elderly and the difficulties involved with the addict's leaving
home under such conditions.
Implicitly
or explicitly, parents who are left with an addicted adult child at home
usually indicate discomfort at the prospect of that child's departure, despite his age. The operations of the therapist must give
credence to the parents' hesitancy, without giving them the impression that their reluctance is right or
wrong. While their ex-pressed concern is for their offspring, the underlying
issue is com-monly protection of their
own interests. However, this is usually outside of their awareness and they focus instead upon the addiction. The parents' point of view is that it would be
irresponsible for the child to leave
home before he is fully "responsible- for his behavior.
The parents' position constitutes a contradiction,
or paradox, that severely limits the
child's chances of attaining independence, though it is rarely
recognized as such by any member of the family. In effect, the admonition keeps the child from acquiring the conditions or status needed to exhibit responsible behavior,
or to have the parents perceive it as
such. The addict is in a bind in which it is impossible to leave home responsibly or to demonstrate responsibility at home (see Chapter 1). Therapy with families of
this sort must seek to change the
conditions that keep the child and parent bound in interdependent
positions. The paradox must be broken before a new manner of relating can be established between family members. Following one case through the course of therapy,
we can see how the therapist moved
toward this objective of breaking the paradox, and how the factor of the parents' advanced age was
handled in relation to this task.
CASE EXAMPLE INDUCTION
The addict, Paul, was the only son in this Black,
middle-class family.
He was age 25, had served in Vietnam, and lived at home with his
mother and father. An older sister was not living at home, but had
regular contact with her brother and parents. The
addict had begun drug use as a business venture (i.e., dealing)
after leaving the service. He was successful, and increased his personal use
of heroin. After several years, he began to see the habit as
harmful and tried twice to detoxify, unsuccessfully. He had had several
arrests, one of which was pending trial at the time that therapy began. He said
that he was now motivated to detoxify and intended to enter
school and find a job as
soon as he finished.
In the first interview between the client and
therapist (Peter Urquhart) the client indicated that his home
life was good. He felt his parents were a strong, positive influence on
him, and saw no problem in having them enter therapy. Throughout this
interview the client presented a tone of cooperation. Urquhart did
not attempt to persuade; rather, he conveyed the idea that the
requirements of therapy were few and obvious to both him and the client. These
were: the manage-ment of medication, gradual detoxification, and active
involvement of the family. The therapist's manner dovetailed
with the client's stance of cooperative, responsible participation: there
was no confrontation, no question that the therapy should proceed any
differently than the therapist had described it. Following through on
this continuity, the therapist obtained the client's assurance that
he would be responsible for bringing his parents in for the first family
session—which he did
within the week.*
FIRST FAMILY SESSION
The therapist began therapy with the family by
asking the client to discuss his personal goals (described to the
therapist the previous week). The client specified two goals: (1)
detoxification, and (2) completion of a correspondence course, to obtain
a decent job. In keeping with the earlier spirit of cooperation and
responsibility, the client said that he believed he could finish the
course ahead of schedule and be employed within several months.
At the outset of therapy, then, he was already presenting a fairly specific set of goals. However, means for accomplishing these
goals remained undeveloped at that point. (Getting the client to articulate
such goals will take
possible in the therapy.)
When the therapist asked the
client's father and mother, respec‑
tively, what their goals were for the family,
neither could respond other than to
say that they wanted to see their son -straighten up-and stop "sliding back." They clearly
had not thought or talked about what life on their own would be like after
their son left home. Their attention
had become fixed upon the son and his drug problem. Yet, they had difficulty defining this problem in terms
that could be adapted by the therapist into goals supportive of the client's
own
plans.
Two key transactional
problems were manifested during the
parents' discussion of goals. First, it was learned
that the father had recently retired.
He was presently spending 4 to 6 hours a day in the company
of his son, even driving him to the drug-treatment pro-gram to pick up medications.* Second, the therapist
observed that the mother cut in on
the father's communications with the son (in the session and at home), redirecting it toward the drug problem. The therapist asked the client how he felt about these
tendencies of his parents. The client responded that he saw them as positive—as
signs of concern and caring in a close-knit
family. This clarified that, at least
on the surface of their relationship, the mother, father, and son had evolved a
durable status quo with one another since the onset of the son's drug problem. The son recalled that his
parents had been
steady and helpful all
through his life.
Further inquiry by the therapist brought out that
the household
rules were
set by the mother: both the father and son stated that she permitted no fighting or other bad habits in the
house. The mother confirmed this, and
indicated pride in having maintained order at home. There is an irony implicit in this
statement, given the nature of the
client's drug problem, that became explicit slightly later in the session, when the therapist asked the parents how
they adjusted to life without
children when the son was in the service. It seems that the father at that time
worked two shifts daily. He was almost never at home during the day, and the
mother was quite lonesome. She indicated that the experience was not at all
pleasant. To establish a base for the
client on the issue of leaving home in the future, the
The paradoxical nature of this criticism is
apparent: the son should not be
permitted to take care of himself, says the father, until he is able to take care of himself. Yet, the
father gives no indication of how the son could demonstrate this
competency. Nor does the father indicate
that he should offer guidance to the son in this matter, despite his own wealth of experience.
Mother's statements in this same discussion
revealed further aspects of the
paradox and its function in family relations. When the therapist asked if the closeness among family
members would present a problem in
the client's leaving, she stated that she saw her son's goal as fine, that she would do everything she
could to help him leave: give him
money, food, clothing, and so forth. The strings implict in her -good will- were not apparent to the mother or
the father. The parents revealed that
the client did not presently have to pay them room or board, just -take care of himself- (another facet of the paradox). This arrangement effectively deprived the
client of any opportunity to
demonstrate responsibility: the parents' accommoda-tion of their son was warm and loving, yet it
provided no area where independence
or personal success was sanctioned, and placed no obvious values on
autonomy. So long as the son cooperated with this complacent ethos of the parents, the status quo would remain. Neither he nor they would grow, and the family system would
remain at its
present life cycle stage.
The atmosphere of the discussion changed sharply
when the therapist informed the client that his urinalysis for the past week had
come up dirty (indicating illicit drug use). The parents did not under-stand what this meant and
the therapist asked the son to explain it to them. The client
equivocated—blaming it or, the treatment system. Since his own urines were
surely clean (he asserted in a "cooperative-tone), another patient's
urine specimen must have been confused with his. Here, the theme of
goodness and cooperation, so carefully nurtured elsewhere in the
client's relationship with his parents and
JOHN M. VAN DEUSEN PETER URQUHART
