ABSTRACT
Addiction is a family disease. Adult children of alcoholics (ACOA) develop in dysfunctional families. Shame, control, trust, responsibility, intimacy and self-worth are central challenges for those affected by the family disease of addiction. Sullivan’s interpersonal theory is consistent with understanding addiction as a family disease where a mental disorder is not embedded in a person but anchored in dysfunctional family relationships and systems. The functional use of projective identification, where parents project importance, esteemable qualities and other affirming characteristics onto the child, is impaired in the addicted family. Denial of addiction creates vulnerability to projecting fear and shame through using verbal criticism, humiliation, guilt, contempt and physically threatening behavior. The expression of feelings such as hurt, anger, fear, sadness or loneliness is suppressed.
Relapse is an inevitable part of the recovery process, which requires a flexible and mutually negotiated approach. An “all or nothing” approach that characterizes some abstinence-based treatment may reenact the rigid dynamics of the dysfunctional family. Pharmacological interventions such as the use of buprenorphine for opiate addiction may be integrated into group psychotherapy for this population.
Working virtually with families affected by addiction presents both opportunities and challenges. Behavioral addictions are also more successfully treated as family diseases.
