Exploring resilience in families living with addiction.

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Exploring resilience in families living with addiction

September 2011 · Journal of Primary Health Care 3(3):210-7

DOI:10.1071/HC11210 Source · PubMed

Project: Applied Research on Communication in Health (ARCH) Group

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Abstract

Information about the impact of addiction on New Zealand (NZ) families is scarce. A good understanding of the nature and extent of family problems is essential to help families become more resilient and minimise the consequences. This study aimed to explore experiences of NZ families living with addiction, identify impacts on non-addicted family members, their coping strategies and barriers to help seeking. Literature and key stakeholder interviews informed the development of an interview schedule for 29 family participants recruited through health and social services. Interviews were recorded for analysis of central themes and critical elements that underpin those. Key stakeholders and informal informants were again consulted to discuss findings and interpretation. Addiction has widespread effects on NZ families. The coping strategies described by the participants in this project lacked the positive connotations of resilience, namely positive adaptation under significant adversity. Family impacts of addiction are complex, and similar family problems arise regardless of the substance(s) involved. This small exploratory study indicates that the implications for NZ families deserve further investigation. Future research is also required to further characterise the impact of behavioural addictions on families, addiction in particular ethnic groupings and the implications of the findings for clinical practice, other social and health services, and for public health and social policy.

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Exploring resilience in families living with addiction

QUALITATIVE RESEARCH

ORIGINAL SCIENTIFIC PAPERS

Helen Moriarty MBChB, MGP, DPH, PGCert HlthSci, PG Dip Tert Tchg; BA Hons (First Class), Maria Stubbe

DipTESL, NZ DipTCHG, MA, PhD; MBChB; Sarah Bradford Sophie Tapper Bee Teng Lim BSc, MB ChB; BA

Hons (First Class) , PG Dip Clinical Psychology, PhD

Department of Primary Health Care and General Practice, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand

CORRESPONDENCE TO: Helen Moriarty Department of Primary Health Care and General Practice, Wellington School of Medicine and Health Sciences, University

of Otago, PO Box 7343, Mein Street, Wellington South, New Zealand helen.moriarty@ otago.ac.nz

J PRIM HEALTH CARE 2011;3(3):210–217.

ABSTRACT

INTRODUCTION: Information about the impact of addiction on New Zealand (NZ) families is scarce. A

good understanding of the nature and extent of family problems is essential to help families become more

resilient and minimise the consequences. This study aimed to explore experiences of NZ families living

with addiction, identify impacts on non-addicted family members, their coping strategies and barriers to

help seeking.

METHODS: Literature and key stakeholder interviews informed the development of an interview sched-

ule for 29 family participants recruited through health and social services. Interviews were recorded

for analysis of central themes and critical elements that underpin those. Key stakeholders and informal

informants were again consulted to discuss findings and interpretation.

FINDINGS: Addiction has widespread effects on NZ families. The coping strategies described by the

participants in this project lacked the positive connotations of resilience, namely positive adaptation

under significant adversity.

CONCLUSION: Family impacts of addiction are complex, and similar family problems arise regardless

of the substance(s) involved. This small exploratory study indicates that the implications for NZ families

deserve further investigation. Future research is also required to further characterise the impact of behav-

ioural addictions on families, addiction in particular ethnic groupings and the implications of the findings

for clinical practice, other social and health services, and for public health and social policy.

KEYWORDS: Qualitative research; addiction; family resilience

Introduction

Addiction prevalence in New Zealand

Alcohol, drugs and tobacco are major contributors to addiction-related morbidity and mortality, and illicit drug use has increased precipitously over

the last few decades.2 The New Zealand Alcohol and Drug Use Survey shows that nearly one in two adult (49%) aged 16–64 years have used

drugs for recreational purposes at some point in their life, and 16.6% have used drugs recreation- ally in the past year (tobacco addiction excluded).

Among these recent drug users, 34.5% reported driving a motor vehicle and 18.5% reported work- ing under the influence of drugs.3

Alcohol recreational use is even higher.4 The

2007/08 New Zealand Alcohol and Drug Use Survey shows that three in five (61.6%) drink- ers have consumed a large amount of alcohol on

at least one occasion in the past year; 6.9% of alcohol users reported harmful effects on their friendships and social lives due to their own alco-

hol use, while 16.0% of adults reported harmful effects on friendships and 8.5% on home life due to someone else’s alcohol use in the past year.5

Behavioural addictions, such as gambling and eating disorders, also create significant issues.

The 2006/07 New Zealand Health Survey found one in 58 adults (1.7%) with either problem (0.4%) or moderate risk (1.3%) gambling6, while the

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210 VOLUME 3 NUMBER 3 SEPTEMBER 2011 • • JOURNAL OF PRIMARY HEALTH CARE

VOLUME 3 NUMBER 3 SEPTEMBER 2011 • • J OURNAL OF PRIMARY HEALTH CARE

QUALITATIVE RESEARCH

ORIGINAL SCIENTIFIC PAPERS

2006/07 Gaming and Betting Activities Survey

found that 9% of adults had gambled to a harm- ful level during the last 12 months.7 Significant social, health and welfare problems can arise out

of both substance use and abuse. 8–9 The social costs of tobacco, alcohol and illicit drug use to New Zealand (NZ), including poor health,

premature death, decreased productivity, drug- attributable crime and accidents, was estimated to be NZD $2.81 to 3.71 billion.10

The role of families

Families have important roles in attracting their addicted family member into treatment and fos- tering supportive environmental change. Family

involvement can also foster better engagement of addicted individuals in treatment.11–14 Communi- ty Reinforcement and Family Training (CRAFT)

is a New Mexico programme to restructure the social, family and vocational facets of an ad- dicted individual’s life to promote and encour-

age abstinence from substance use.15–17 CRAFT reported 74% of previously resistant individuals becoming successfully engaged in treatment,

and a corresponding decrease in physical and psychological symptoms for non-addicted family members.16 That team favourably compared the

engagement six months post-intervention from CRAFT with the family self-help support group Al-Anon and other addiction treatment serv-

ices.18 However, these studies do not address the likelihood that family members may have unmet needs of their own, and the potential to improve

family well being by addressing needs of the family as a unit.

Impact of addiction on families

The number of families living with addiction in

NZ is unknown, but is likely to be significant. International research shows the widespread effects of addiction on families,2,10,19–23 but is

mainly focused on the most visible family phe- nomena such as domestic abuse, foetal alcohol spectrum disorder, drug- and drunk-driving.

Addiction has also been shown to disrupt family relationships, social networks, personal education or work goals, as well as contributing to financial

and justice problems.1, 14 Copello and Orford have identified behavioural impacts of addiction on

families, such as poor parenting, unfavourable role modelling, siblings adopting parenting roles,

socioemotional difficulties and control issues.20 These impacts arise from the disruptive effect of addiction, but can also contribute to the disrup-

tion. The same team24 summarised two decades of family addiction qualitative research. Negative experiences included aggression, deceitfulness

and lying, conflict over money and possessions, uncertainty and worry, threatened home and family life.

The literature identifies some of the help-seeking barriers for families. The Australian National

Council on Drugs reported that family members living with addictions lack awareness of available resources, have problems accessing the services,

but are also aware of and fear social stigma.25 UK research24 reported that some family members have strongly held beliefs about what it means

to be a good parent or a good partner, and the shame of having the addiction known outside the family may prevent help-seeking behaviours, but

sometimes addicted family members themselves may stop them from seeking help.

The role of resilience

The concept of resilience has its origin in the

psychological study of individuals. It refers to an individual’s capability to adapt successfully

WHAT GAP THIS FILLS

What we already know: Prior research has focused mainly on the most

visible and well-known addiction-related family phenomena, such as foetal

alcohol syndrome and domestic abuse, while less visible phenomena such a

mental or physical health or interpersonal problems are largely overlooked.

There is a growing interest in the role of families in the recovery of an indi-

vidual with addiction, with a developing body of international literature sug-

gesting that involving those closest and most concerned about the substanc

user can better engage the user in treatment. Despite substantial literature

about resilience, little is specific to collective groupings such as families, or

about family resilience to addiction.

What this study adds: This project begins to fill some gaps in under-

standing of the experiences of NZ families living with addiction, and the

factors important in their coping and resilience. A good understanding of

the nature and extent of family problems in NZ is necessary to find ways to

negate the impact on family/whanau wellbeing.

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212 VOLUME 3 NUMBER 3 SEPTEMBER 2011 • • JOURNAL OF PRIMARY HEALTH CARE

QUALITATIVE RESEARCH

ORIGINAL SCIENTIFIC PAPERS

emotional bonds, effective communication, intact family belief systems and family tradi-

tions in coping with adversity.28 It is important to understand the protective factors that enable NZ families to adapt positively and function well, or

deter other family members from taking a path to addiction. It is also important to understand how collective family resilience might be measured,

given the individual and interpersonal nature of these characteristics.

The present study

The awareness of the limited information on

the extent and potential impact of addiction on families in NZ provided the impetus for this current study. This was an exploratory study

to start to address knowledge gaps for NZ families living with addiction, in particular the less visible impacts on NZ families living

with addiction.

The project sought to explore the experiences of

NZ families as they support a family member or members through an alcohol, drug or behav- ioural addiction, and to understand some of the

help-seeking barriers for families and the coping strategies employed by family, especially whether these coping strategies had increased family resil-

ience. Traditionally, addiction treatment services have focused on treating the individual with addiction, largely overlooking the family impact.

There are likely to be many more affected family members living with addiction than the total number of addicted individuals.

Methods

Participants

Participants were adults aged 18 years or older,

with one or more family member(s) with an ad- diction. Most participants were recruited from self-help organisations, some through an informal

snowball technique via other participants or ad- vertising. A recruitment poster was displayed at premises of addiction clinics, the needle exchange

and other support services.1 Nineteen family participants (12 females and seven males) were interviewed. Table 2 summarises the characteris-

tics of these family participants.

Table 1. Family interview questions

Family scene setting:

1.

2.

3.

Duration living with a family member with addiction?

How did the family become aware?

How many known family members have addiction problems and the nature of their addiction?

Family-specific issues:

1.

2.

3.

What was the biggest impact on the family (hardest for the family to cope with) and what less so?

How have the issues changed over time?

What has helped the family get through?

Substance-specific issues:

1.

2.

Does a drug-use problem rather than an alcohol problem change the issues for some families?

Has that (substance type) affected how well the family

has coped?

Individual seeking help:

1.

2.

3.

4.

Was help offered to the individual family member(s) with addiction?

Did that person accept their own drug/alcohol problem? Why, where and how?

Did that also help the family or cause more difficulties? How/what?

If the family could give some advice to drug/alcohol treatment services in NZ, what would that be?

Families seeking help:

1.

2.

3.

Did the family seek help for itself or for individual non- addicted members? Why, what and where?

What is good or not so good about the helping services?

If you design a service to help NZ families in this situation, what would it be like and what help would it offer?

Resilience: 1.

2.

3.

What do they see as protective factors for the family?

How did they cope and what helped the individual to get through all this?

What do they see as individual and family strengths as a result of this experience?

despite risk and adversity.26 Resilience is defined as the ability to persist, bounce back and even

thrive, in the face of stressful circumstances.27 The literature mentions resilience of individuals growing up in a family affected by substance use

or addiction, but it remains somewhat unclear whether or how the concept might apply to a col- lective group such as the family unit. It has been

suggested that the concept of family resilience should recognise family strengths, including collective family capacity to resist risk factors.

One possible definition of family resilience is “a dynamic process encompassing positive adapta- tion within the context of significant adversity”.26

Previous research also points to the importance of aspects of family functioning such as strong

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Kunnskapsoppsummering om barn og partnere til personer med rusproblemer

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Citations (38) References (27)

... På den ene siden beskrives det uforutsigbare i den rusavhengiges humør og atferd, som også påvirket den andre voksnes humør (Haugland, 2005;Peled & Sacks, 2008). Barn og voksne må forholde seg til brutte løfter, svik, løgn, bedrag, kontroll og manipuleringer (Lee & Kirsh, 2006; Moriarty, Stubbe, Bradford, Tapper, & Lim, 2011; Peled & Sacks, 2008), og partner opplever å få skylden for ektefelles avhengighet (Peled & Sacks, 2008). Konflikter mellom partnere var vanlig, også vold og krenkelser (Haugland, 2005;Lee & Kirsh, 2006;Peled & Sacks, 2008). ... ... Konflikter mellom partnere var vanlig, også vold og krenkelser (Haugland, 2005;Lee & Kirsh, 2006;Peled & Sacks, 2008). Som partner i denne konfliktfylte situasjonen bruker man mye krefter på å gi inntrykk av at alt er normalt (Lee & Kirsh, 2006; Moriarty et al., 2011; Peled & Sacks, 2008), man prøver å skåne barna for konflikter og går på jobb og later som om alt er ok (Peled & Sacks, 2008). Eller man er hjemmevaerende og sosialt isolert (Lee & Kirsh, 2006). ... ... Situasjonen beskrives som ekstremt vanskelig. De strever med økonomien, og det er liten støtte fra familie og hjelpeinstanser (Moriarty et al., 2011) . Både rutiner og praktisk arbeid i hjemmet, men også jobb ute bidro til å distrahere fra den uholdbare situasjonen med rusbruk (Haugland, 2005;Peled & Sacks, 2008). ...

View Show abstract

... Studies identified themes related to emotional and psychological stress and impact (Butler and Bauld, 2005;Joolaee et al., 2014;Maghsoudi et al., 2019;McCann et al., 2019;Soklaridis et al., 2019). Frequently experienced emotions were: guilt, self-blame, shame (Arcidiacono et al., 2009;Butler and Bauld, 2005;Horta et al., 2016; Moriarty et al., 2011; Richert et al., 2018;Usher et al., 2007), concern and worry ( Arcidiacono et al., 2009;Jackson and Mannix, 2003;Moriarty et al., 2011;Velleman et al., 1993), hopelessness and powerlessness (Horta et al., 2016;McCann and Lubman, 2018;Oliveira and Medonça, 2012;Richert et al., 2018), grief (Richert et al., 2018;Usher et al., 2007), and anger (Horta et al., 2016;Velleman et al., 1993). Also, themes frequently included reference to family conflicts (Oliveira and Medonça, 2012;Van Hout and Bingham, 2012;Velleman et al., 1993), disruptions of daily routines (Butler and Bauld, 2005;Richert et al., 2018), limitations to social and leisure activities (Arcidiacono et al., 2009;McCann et al., 2019), as well as financial consequences of a relative's substance use (Butler and Bauld, 2005;Horta et al., 2016;McCann et al., 2019;Moriarty et al., 2011). ... ... Studies identified themes related to emotional and psychological stress and impact (Butler and Bauld, 2005;Joolaee et al., 2014;Maghsoudi et al., 2019;McCann et al., 2019;Soklaridis et al., 2019). Frequently experienced emotions were: guilt, self-blame, shame (Arcidiacono et al., 2009;Butler and Bauld, 2005;Horta et al., 2016;Moriarty et al., 2011;Richert et al., 2018;Usher et al., 2007), concern and worry ( Arcidiacono et al., 2009;Jackson and Mannix, 2003; Moriarty et al., 2011; Velleman et al., 1993), hopelessness and powerlessness (Horta et al., 2016;McCann and Lubman, 2018;Oliveira and Medonça, 2012;Richert et al., 2018), grief (Richert et al., 2018;Usher et al., 2007), and anger (Horta et al., 2016;Velleman et al., 1993). Also, themes frequently included reference to family conflicts (Oliveira and Medonça, 2012;Van Hout and Bingham, 2012;Velleman et al., 1993), disruptions of daily routines (Butler and Bauld, 2005;Richert et al., 2018), limitations to social and leisure activities (Arcidiacono et al., 2009;McCann et al., 2019), as well as financial consequences of a relative's substance use (Butler and Bauld, 2005;Horta et al., 2016;McCann et al., 2019;Moriarty et al., 2011). ... ... Frequently experienced emotions were: guilt, self-blame, shame (Arcidiacono et al., 2009;Butler and Bauld, 2005;Horta et al., 2016;Moriarty et al., 2011;Richert et al., 2018;Usher et al., 2007), concern and worry ( Arcidiacono et al., 2009;Jackson and Mannix, 2003;Moriarty et al., 2011;Velleman et al., 1993), hopelessness and powerlessness (Horta et al., 2016;McCann and Lubman, 2018;Oliveira and Medonça, 2012;Richert et al., 2018), grief (Richert et al., 2018;Usher et al., 2007), and anger (Horta et al., 2016;Velleman et al., 1993). Also, themes frequently included reference to family conflicts (Oliveira and Medonça, 2012;Van Hout and Bingham, 2012;Velleman et al., 1993), disruptions of daily routines (Butler and Bauld, 2005;Richert et al., 2018), limitations to social and leisure activities (Arcidiacono et al., 2009;McCann et al., 2019), as well as financial consequences of a relative's substance use (Butler and Bauld, 2005;Horta et al., 2016;McCann et al., 2019; Moriarty et al., 2011) . AFMs described feeling stigmatized and blamed (Joolaee et al., 2014;Maghsoudi et al., 2019;Lubman, 2018, 2017;Soklaridis et al., 2019;Van Hout and Bingham, 2012), having difficulties finding support, and being socially isolated (Arcidiacono et al., 2009;Butler and Bauld, 2005;Horta et al., 2016;Maghsoudi et al., 2019;McCann et al., 2019;Moriarty et al., 2011;Richert et al., 2018;Soklaridis et al., 2019;Velleman et al., 1993). ...

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View Show abstract

... In the context of addictions, Park and Schepp (2015), in a systematic review of children of alcoholic parents, considered children's vulnerability and psychological resilience on four levels: the individual level (e.g., age, gender, cognitive and academic abilities, temperament, self regulation and self-esteem), the parental level (e.g., attachment style, parent-child relationship, parentification), the familial level (e.g., family violence, family cohesion, trusted family members and parents' co-morbid mental health conditions), and the social level (e.g., social support, extra-curricular activities, positive relationships later in life). In studies related to addictions, several aspects of family dynamics/environments were found to promote psychological resilience including direct involvement and clear communication (e.g., Wyman et al., 2000), family cohesion and family adaptability (Leys et al., 2017; Moriarty et al., 2011) , effective disciplining, and consistency (Armstrong et al., 2005). Other factors such as hostility, rejection, control and neglect (Lind et al., 2018) as well as invalidation and inconsistent discipline (Hann & Borek, 2001), were linked to reduced levels of psychological resilience. ... ... Taking together various findings on the long-term impact that parental addiction has on children (e.g., Catalano et al., 2002;McPherson et al., 2013), the link between addictions and disruptive family environments (e.g., Barnard, 2007;Catalano et al., 2002;Keller et al., 2002;Testa & Smith, 2009), the link between family dynamics and psychological resilience (e.g. Armstrong et al., 2005;Leys et al., 2017; Moriarty et al., 2011; Wyman et al., 2000), and Leys et al.'s (2017) study which found that psychological resilience fully mediated the link between family dynamics and mental health, we predict that the link between parental behavioural addictions and mental health will be mediated by a disruptive family environment which will be linked to reduced psychological resilience and then to reduced mental health . Based on these findings, we hypothesise that: ...

View Show abstract

... Family members were involved when the victim of substance misuse had serious medical disorders (12,18). A study found that mothers have adapting reaction when managing issues in the youth (26) . They observed an assortment of complex adapting components expressed by the members (27). ...

View Show abstract

... We now know from the last decade of research that in the background of people with addiction is frequently a history of childhood abuse, neglect, loss, and abandonment. [24] Persons with addiction also have problematic marital and family relationships, [25, 26] intimate partner violence, [27,28] and abuse and neglect of their children. [29] In an atomistic view of disease and symptoms, it is difficult to link seemingly remote childhood experiences to problematic relationships in adult lives and addictive and mental disorders. ...

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... In most Ugandan cultures, extramarital relationships are accepted, and polygamous relationships are considered normal in most communities, which explains the high prevalence of extramarital affairs found in our study because most women do not accept these practices is seen as a breach of marital trust. 49 Despite the fact that the majority of the studies about the effect of spouse's addictive substance uses being qualitative, [50][51] [52] this study, one of very few, found a statistically significant relationship between participants' depression and their spouse's use of addictive substances. This can be explained by the previously reported correlation between spouse's substance addiction and extramarital relation -a known risk factor of depression. ...

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