Alcohol Use Disorder is Not a Spectator Sport; Eventually the Whole Family Gets to Play

When a person has alcohol use disorder (AUD), also commonly referred to as “alcoholism,” their urge to drink can be as powerful as a human’s need for air and water. The brain disease and the erratic behavior it can produce can affect loved ones just as much as the person with the health condition. Whether it’s a parent, roommate, brother, spouse, child, or friend, if you’re struggling with someone who is struggling, you know how hard it can get.

In the U.S., one in 10 children currently live with a parent or caregiver with AUD (SAMHSA). Think of the family system as a mobile: when one part in a hanging mobile moves, this affects all parts of the mobile but in different ways, and each part adjusts to maintain a balance in the system (National Institutes of Health).

“Mental health and substance use disorders overlap quite a bit,” said Ellie Carpio, LPC, LAC, NCC, assistant program manager at WellPower. “75% of individuals with a mental health diagnosis also have a substance use disorder diagnosis. There is a myth that the individual needs to get sober first before they can work on their mental health. This couldn’t be further from the truth.”

Impacts of Alcohol Use on Family Members

The negative impacts of parental substance use disorders on the family include disruption of attachment, rituals, roles, routines, communication, social life and finances. Families in which there is a parental substance use disorder are characterized by an environment of secrecy, loss, conflict, violence or abuse, emotional chaos, role reversal and fear (SAMHSA).

“Families cope in different ways,” said Carpio. “Sometimes they enable – like cleaning up after their loved one or making excuses for them. This isn’t designed to justify the drinking, but to cope.”

Children can inadvertently take on distinct roles in the household. Often the oldest child can morph into the “hero” of the family. Their successes (school, sports, music, etc.) are highlighted so the focus is not the parent or caregiver with AUD. Another typical role is the “clown” where one child in the family tries to be as funny and silly as possible to lighten the mood in the household and serve as a pressure valve for the family. Finally, some children take on the role of “black sheep.” As an opposite to the “hero” role, the failures of these children are highlighted as a distraction from what is really going on with the parent or caregiver with AUD.

For these children, there is also an increased risk of developing a substance use disorder themselves. Adolescents whose parents binge drink have a four times greater chance of drinking alcohol themselves compared to adolescents whose parents do not binge drink (Journal of Adolescent Health).

How to Get Help: Recommendations for Family Members of People with AUD

“We see a lot of people who believe they have to work on themselves separately, with individual treatment first, whether it’s their addiction or mental health,” said Carpio. “The research tells us that if we pursue family and/or couples therapy in tandem with individual treatment the results are better. Humans are relational creatures; we are interdependent on one another and cannot ignore this in the recovery process.”

If you are struggling with a loved one who is struggling, here are some support recommendations:

Educate Yourself – Knowledge is power and key when dealing with alcohol use disorder. The more you understand about this brain disease, the easier it might be to understand what is going on with your loved one. Here are some of our favorites:

Set Boundaries – The purpose of having boundaries is to protect and take care of yourself. Everyone’s situation is different and depending on your relationship, setting boundaries might be difficult. Setting boundaries can mean tough love or setting limits and enforcing them. Letting the person experience the consequences of their drinking can be a powerful motivator to enter treatment. WellPower’s TherapyDirect program can provide support for you to do this. TherapyDirect lets you connect directly to a professional counselor in minutes. No appointments or scheduling – just hop on your phone, laptop, or tablet for a 100% secure and confidential video call. Insurance is not required, and there are no program fees. Monday – Friday, 9 a.m. – 5:30 p.m.

Al-Anon and Alateen – Most people have heard of Alcoholics Anonymous, or AA, a free and confidential 12-Step support group for anyone who might have an issue with alcohol or drugs. This same concept applies to friends and families of people with substance use disorders. Based upon the 12-Steps of Alcoholics Anonymous, Al-Anon Family Groups (which includes Alateen for adolescent members) provides non-professional, free and confidential support. NAMI (National Alliance on Mental Illness) also offers excellent support groups for loved ones. Carpio notes that you may need to try a couple of different groups until you find the best fit.

“It’s ok not to know what to do,” concluded Carpio. “No one chooses to struggle with alcohol use disorder and their addiction is not your fault.”