ABSTRACT
The family system can play a role in substance abuse treatment, as well as in family circumstances promoting continued alcohol and drug use (e.g., Haugland, 2003; Rangarajan & Kelly, 2006). About 9.4 percent of the total U.S. population of individuals age 12 and above were classified as substance dependent or substance abusive (SAMHSA, 2006). The National Institute on Drug Abuse (NIDA) estimates economic costs of substance abuse around $484 billion per year (NIDA, 2007). The consequences of substance abuse also involve family problems, including communication problems (Fals-Stewart & Birchler, 1998; Kelly, Halford, & Young, 2002), increased detachment (Carroll, Robinson, & Flowers, 2002), verbal aggressiveness (Straus & Sweet, 1992), and physical abuse (Testa, Quigley, & Leonard, 2003; Wekerle & Wall, 2002). Spouses of substance abusers are frequently affected in terms of both physical and mental health (e.g., Hurcom, Coppello, & Orford, 2000). Children of alcoholics are at greater risk for behavioral, psychological, cognitive, and neuropsychological deficits (Johnson & Leff, 1999). Parents of adolescent substance abusers may be perceived as more controlling and less loving (e.g., Pandina & Schuele, 1983), and familymembers may influence continued substance abuse (e.g., Copello, Velleman, & Templeton, 2005; Rotunda, West, & O’Farrell, 2004). While these findings point to the need to study negative effects of substance abuse on
the family, research also documents potential positive intervening effects of family communication on substance abuse. Recovery programs are now incorporating family members in substance abuse therapy and treatment (e.g., Mann, 2003; Osterman & Grubic, 2000), with some treatment programs involving the family throughout the treatment process (Saatcioglu, Erim, & Cakmak, 2006). Research documents positive outcomes from involving family members in treatment. Behavioral couples therapy with alcoholics and remission after individual alcoholism treatment have been associated with improved family functioning in the form of reduced family stressors, improved marital adjustment, reduced domestic violence and conflict, reduced risk of separation and divorce, reduced emotional distress in spouses, and improved cohesion and caring (O’Farrell & Feehan, 1999; O’Farrell, Murphy, Alter, & Fald-Stewart, 2010). Including families in substance abuse treatment can potentially improve health outcomes for family members
and enable a stronger support network to further aid in the recovery process (Morgan & Crane, 2010). Relational effects point to the need to study the reciprocal impact of family members
and continued substance abuse. Family members play a role in initiating alcohol or drug use, in the choice of substances, in the intensity of substance use, and in the decision to use or abstain from substances (Gruber & Taylor, 2006). Family interventions can involve family members promoting substance abusive individuals to participate in treatment, joint involvement of family members in the treatment, and responding to the needs of family members (Copello, Velleman, & Templeton, 2005). This chapter provides an overview of the ramifications of substance abuse on various family members, including spouses, children, siblings, and parents of adolescent abusers. Based on research supporting the Inconsistent Nurturing as Control (INC) theory assertion that significant others (spouses/cohabitors) in relationships with substance abusive individuals unintentionally and subtly encourage substance abusive behavior through their well-intentioned efforts to curtail this behavior (Duggan, Dailey, & Le Poire, 2008; Le Poire, 1992; Le Poire, 1995; Le Poire & Cope, 1999; Le Poire, Erlandson, & Hallett, 1998; Le Poire Hallett, & Erlandson, 2000), this chapter explores the unique communication dynamics in sustaining or deterring family members’ substance abuse.
