The Impact of Addiction on the Family

Michael Calderon is a Licensed Clinical Social Worker and Licensed Clinical Alcohol and Drug Counselor who has been practicing clinically for nearly eight years. Michael’s clinical work includes working with adults and youth experiencing a wide spectrum of mental health disorders, couples, families as well as individuals who are dually diagnosed with substance use disorders. Additionally, he has worked as a substance use navigator for Somerset, Hunterdon and Warren Counties where he provided education to professionals and the general public about mental health and substance use disorders impacting youth, provided information and referrals for youth to receive substance use treatment and provided recommendations to increase opportunities for youth who are in need of substance use services to receive treatment.

He is also a voting member on the Local Advisory Committee on Drugs and Alcohol for Warren County, the president of the Hackettstown Stigma-Free Taskforce in Warren County, New Jersey and Alliance Coordinator for Hackettstown. Prior to his career as a psychotherapist, Michael was a special education teacher who taught students with behavioral disabilities, learning disabilities and severe mental health diagnoses.

Welcome to the Community Education Series, hosted by The Recovery Village and Advanced Recovery Systems.

Hi everyone. I am so happy to see so many of you from all over, but I am Jordan Katz. I’m a licensed social worker and clinical outreach specialist for The Recovery Village Cherry Hill at Cooper, right here in Cherry Hill, New Jersey. We offer the full continuum of care for adults struggling with substance use disorders and co-occurring mental health disorders, including detox, residential and outpatient programs. I’m going to put my phone number in the chat, so if anyone has any questions, feel free to reach out to me.

I have the pleasure of introducing Michael today. Michael Calderon is a licensed clinical social worker and licensed clinical alcohol and drug counselor who has been practicing clinically for nearly eight years. Michael’s clinical work includes working with adults and youth experiencing a wide spectrum of mental health disorders, couples, families, as well as individuals who are dually diagnosed with substance use disorders. Additionally, he has worked as a substance use navigator for Somerset and Warren Counties, where he provided education to professionals and the general public about mental health and substance use disorders impacting you, provided information and referrals for youth to receive substance use treatment, and provided recommendations to increase opportunities for youth who are in need of substance use services to receive treatment. He is also a voting member on the local advisory committee on drugs and alcohol for Warren County, the president of Hackettstown Stigma-Free Taskforce in Warren County, New Jersey, and alliance coordinator for Hackettstown. Prior to his career as a psychotherapist, Michael was a special education teacher who taught students with behavioral disabilities, learning disabilities, disabilities and severe mental health diagnoses. Welcome, Michael. We are so excited to have you speak for us today. Thank you.

Michael:
Thank you. I see we have people from all over here. That’s terrific. Welcome, everyone. I’m here to talk to you about the impact of addiction on the family and family system.

I did just want to add — everyone, if you scroll up in the chat, I did throw the PowerPoint in there so you are able to view it on your own screen as well as viewing Michael’s.

Great. Alright, so what I’m going to start with is kind of discussing what family systems is. That comes from the family system theory, and it suggests that the behavior of individuals cannot fully be understood unless you look at the system in which the behavior is occurring. In this case, we’d be talking about the family system, and each system would, as far as if somebody was at work, they may behave differently. So, we have various systems; we’re focusing, of course, on the family system, and you need to observe to really get an idea about the individual. You observe their behavior and the emotional unit to understand that all families maintain an order. They have to maintain order through structure, boundaries and roles for each family member in the system. Each family member tends to function in a way that keeps the family system in balance and maintains the status quo, or what we would call homeostasis. So, it’s this functional thing, but what happens is if somebody changes that behavior or a behavior, it will impact the system and change how the system is functioning, which often causes some emotional discomfort among other things within that system. It’s important to identify how various parts interact with one another, and understanding how they interact can help us to understand how the system breaks down.

The one thing that I wanted to just talk about too is, what is addiction? A lot of people have different ideas about addiction. Addiction is a brain disease, and it’s marked by uncontrollable as well as compulsive substance-seeking and use, despite experiencing severe medical or physical consequences as well as social consequences. In addition, the person becomes addicted emotionally and/or physically, depending on the substance of use. They are both equally addictive, but in different elements. When we talk about physical addiction, we talk about that withdrawal, where people exhibit withdrawal symptoms. For example, somebody who has a severe alcohol use disorder may withdraw having DTS, or delirium tremens, and that’s important to know we’re talking about a disease of the brain. This is it — anything else, I like to compare it to diabetes. We’re not necessarily born with diabetes, but people sometimes are very susceptible to diabetes. Other people will eat poorly and eventually develop diabetes. An addiction to drugs or alcohol does develop from use. However, the person that’s doing that — it’s not their intention. It never is their intention. It’s something that eventually can happen, and it can happen more or less quickly, depending on the individual. So, it’s a disease — that a brain obtaining and using the substance becomes the individual’s primary goal, which is usually to the detriment not only of themselves, but other people within their system. Their family system, in particular. And it can impact, in a pejorative manner to signify, the goals and responsibilities of everyone who is involved with them.

So, effects. The effects on the relationship. It impacts every member of the household. What we talk about is there’s different phases, so the first phase is the learning phase. This is where it first starts. The members of the household, they often become aware that there’s emotional tension within the family. People aren’t getting along as well, fuses are a little shorter and relationships become strained. The communication decreases, and arguments tend to increase disagreements. People will be short with each other; they’ll assume what’s being said to them and react rather than hearing what it is and kind of staying calm about it. Relational boundaries become inconsistent and undefined, so what may have been okay today is not okay another time. And then the emotional connections to the family unit are weakened, so this time in the phase is when you’re most susceptible to the possibility of domestic violence. Because what ends up happening is the frustration, the anger, all these different things start to increase. As those things increase, it also impacts the person using the substances. Their emotionality increases, and that’s when we can start to see some abuse, whether it’s child abuse, domestic violence, occur.

So, the harmful phase: The trust for the substance user starts to diminish. Before they’re using, we kind of can see a problem, but it may not be identified or spoken about. Other people within the family may be just kind of rationalizing. “No, this is normal. This is what people do or kids do. They don’t have a problem. It’s not a big deal. It’s a phase.” I’m now in a harmful phase; as it goes on, we are now starting to see this lack of trust. Family members tend to exhibit hypervigilance towards the substance users. What that may look like is they are on top of them, wanting to control what they’re doing. “Where are you going? Who are you with?” Things like this. “What are you doing?” Trying to see how much money they’re spending. They take on greater personal responsibility and reduce expectations of substance users. What that may look like is now all of a sudden, they’re blaming themselves, or, “If I’m not constantly checking in with this person, this person is going to slip and they’re going to start using again, or they’re going to do something stupid and get themselves in trouble, so I have to take care of that.”

Whoever the person is that feels that way, they become defensive in their thinking and behavior. Very sensitive to criticism about what they’re doing or how they’re interacting. That can be both family members, as well as the substance user. They experience feelings of blame, resentment, anger, and/or fear towards a substance user. These are the people in the family. As we start to see, it’s a problem. Now that could be, “Well, you know, your problem is harming everybody. It’s changing everything. I’m not getting the attention I need.” Or somebody else — it’s impacting their work schedule because they’re having to leave work to take care of certain things due to substance use. But at the same time, people often will feel guilty about it.

Now, they feel guilty about being angry with the individual, or they feel guilty as if — often, you’ll see parents’ guilt where, “If I did something better… what did I do wrong? My kid wouldn’t be using.” Even children can feel that way if their parents are using. “If I behave better, my parents wouldn’t need to drink or use drugs.” So there’s a lot of conflict, a lot of emotionality going on during the harmful phase. Also, there’s often financial instability at this time, and what that means is that the substance user often will — their behavior, their substance use may impact the way they’re working, so it could cause problems at work. Should it cause them to get fired, they would then — if they’re the primary income — that could cause a lot of problems financially. It also caused them to lose health benefits for the entire family. Also at this time, the substance user often will take things or steal things often from family members, whether it’s money or objects, to try and trade or sell to get money for their addiction.

And then we go from the harmful phase to the escape phase. And during this time, this is kind of the last phase family members experience — overwhelming feelings. They just feel drained. They’re tired or overwhelmed. They’re tired of it. They’re tired of what’s going on. They often don’t know how to help themselves, and they look for means to emotionally escape the circumstances which develop in his or her lives due to substance use. At this time, you see sometimes where, in a married couple, there may be an affair outside of the marriage to escape. Even if it’s not the other parent who’s using — if it’s another family member, you might see some escapes by using drugs or alcohol themselves as a way to self-medicate. They’re just looking for a way to just take off some of the tension one way or another to lessen what they’re experiencing. And then family members tend to emotionally withdraw from social activities as well as friends and extended family. They pull back, oftentimes. They’re just not interested in doing any of that, and often, we see withdrawal and signs of depression as well. And oftentimes people are depressed during this, within the family. I’m sorry. It wasn’t the last phase.

So, the family denial phase — that is the last phase. I apologize, I think I said the last one was earlier. During the family denial phase, the user begins to experience consequences, which results in a shift in their thinking. When we talk about stages of change, for those of you familiar, you know the first stage is precontemplation, which means, “Maybe I have a problem, but I’m not really ready to do anything about it,” or they don’t even acknowledge that they have a problem. “No, everything’s fine. This is temporary. I don’t do that much.” They rationalize. And then we talk about contemplation. When they get into contemplation, now there’s this idea. “Well, maybe I need to do something about it. I think this is a problem.” And there’s a formulation of some ideas on how to go about solving the problem.

And then when we get into the prepared stage now, they’re starting to do things. They’re starting to do things now — get into recovery, in this case. “Where do you want to stop using?” They’re coming up with a plan and they’re starting to practice the plan that they’re coming up with. And then when we get to the action stage, they are actually doing — consistently — all the things that they need to do to recover. So, as somebody starts to move towards contemplation from precontemplation, there’s no problem identifying that, “There is a problem and I need to do something.” There’s a shift that starts to occur within the family, and during that shift, what’s going to happen is we are changing — again, the status quo — to homeostasis. By doing so, it creates discomfort within the family, and what often happens is there’s conflict with the family. They don’t consciously say this to themselves, but they think, “Okay, we want everything — we want this person to be healthy. We want them to be better. But now because they’re better, it’s changing a lot of other things, and I’m not really comfortable with that.”

So, it is a resistance that may occur, and then it is a denial phase that there is a problem. Now it’s like, “Oh, it wasn’t that big of a problem.” They experienced an immediate need to maintain homeostasis to try and bring things back. Emotionally stabilizing the individual as well as a family unit as a whole — that’s by bringing it back to the homeostasis in an attempt to do that. And there’s feelings of failure in his or her family role for the person that’s feeling this way, or they may assume responsibility to the substance user to overcompensate for personal feelings or failure and guilt. One of the things that often happens to, let’s say, a person in recovery — they’re doing well. They haven’t — let’s say it’s alcohol — they haven’t drank in a month or two, and so maybe for a family member to say, “Hey Joe, why don’t you have a beer? It’s a holiday,” and they’re like, “I’m not drinking anymore.” “Oh, one won’t kill you.” And you talked to somebody like that in early recovery — all of a sudden, the brain starts thinking, “Well, maybe I could have one,” and then we’re right back to where we were.

Inadvertently, there’s this attempt at sabotage, in a way. I don’t think people are intentionally doing that, but they’re wanting things back — kind of normal. They want the person to be normal and maybe everything to go back where it was but the person to be healthy, and it can happen both ways. So, it was a real struggle. And during this phase, the family members’ behaviors are often intended to help the substance user through those behaviors, which tend to be harmful. They’re trying to help, but they’re not doing a great job of helping, often. Children suffer consequences, in particular, when their parents are using. It really impacts the caregiver-child relationship. It decreases/increases risk for child abuse, and we’re talking about emotional, physical — as well as sexual. Abuse is drastically increased.

When a parent has a problem like this, there’s a tendency to really not look at things globally. They look at it from their perspective — what their wants and needs are — so they have a lower tolerance. There’s less ability to tolerate discomfort of any kind, emotional or anything else. And then there’s also — as we all know, when you use drugs, it definitely has an inhibition there. We’re more likely to do things that we wouldn’t normally do, and also drastically increases the possibility of children being neglected by their caregivers, where even their basic needs may not be provided for. So, children in the family, they kind of — this phenomenon that’s called — they become parentified. What that means is they now assume the role of the parent. Typically, the child that typically would assume this role is the eldest child, and what they ended up becoming is they are now assuming the role — age-inappropriate for them — as a caregiver of a parent. This could even occur where they’re parenting the parents.

I’ll give you an example. A woman I had worked with — at age eight, her parents were both alcoholics, and she would have to come home from school. She would have to make sure her siblings were cooking, they were doing their homework, and keep them on task. She cleaned the house. She would cook dinner. She would actually have to go food shopping oftentimes ‘cause there wasn’t any food in the house, and she would have to, at times, go to the bar and actually tell their parent or parents it was time to come home because they didn’t have money for food or whatever and she needed to go. And they would bring her to the food store, but they wouldn’t even shop. They would send her in and wait for her. So, I mean, she was doing all the roles of the parent at eight years old, which is certainly an inappropriate age. They learn to parent themselves as well, so they have to learn how to suit themselves, how to make themselves feel better, how to provide for the family, and have to learn how to take care of themselves at a lot quicker rate than they’re ready for. Oftentimes, parentified children tend to be more prevalent in single-parent homes. One of the reasons is, a lot of times, apparent with the substance use problem. Working, then after work, they’re unavailable because they’re using, whether they’re at home or just not actually mentally available. So the eldest child, once again, will tend to take over that.

Some other consequences — what we call negativism. Communication tends to be based on complaints and criticism, which contributes to a negative, harmful environment. So, the parent is constantly criticizing the child. In turn, depending on age and child temperament, they may start criticizing the parents as well. And then this becomes the norm and the dynamic of their relationship. Negative attention is rewarded by the parents. So, when a parent has a substance use problem, oftentimes, the child has difficulty getting the parents’ attention, and what they tend to do is then they act out. The parent has an intolerance for acting out, and now they’re getting the attention they need. So, you’re rewarding bad behavior. What do we know about rewarding any behavior? We can expect more of it the more it’s rewarded. So rather than the appropriate behavior being rewarded — because a negative behavior is something that causes some discomfort — they’re rewarding that by constantly paying attention to that. Parents tend to be inconsistent with household rules and boundaries, so this can create anxiety within a child. Children need boundaries; they need household rules or expectations that are clearly enforced and defined so they know what they can and cannot do. When they aren’t, it becomes very confusing. There’s a feeling that people don’t care. They don’t love them, the child. Because if they’re allowed to do certain things one day, they may do something the next day — it may not be allowed. It just creates a lot of angst for a child in this situation.

Then we have parental denial. Parents misusing substances often will minimize, or they’ll rationalize the use of substances. Like, “Oh, everybody has a couple of beers after work. It’s a way to relax,” or they deny it. They’ll say, “I don’t really do it that often,” or, “I don’t do it at all,” when in fact, they are. Then another dynamic happens when we have a child who’s using substances. Often, parents will deny or minimize their children’s use, and one of the reasons for this is nobody wants to think, “That’s our child that’s using drugs or alcohol, having a problem,” so that’s one reason. Another is, “Everyone’s going to think I’m a bad parent if they’re using something,” so they go into denial mode. It’s an involuntary thing. It’s not something that they say on purpose, like, “Oh, I’m just not going to recognize it,” but it’s a defense mechanism that their brain invokes, and now they’re denying it because, “I can’t even consider that I’m a poor parent.” Just because a youth is using substances, doesn’t make someone a poor parent, but that tends to be the perception of the parent — or worried about what the neighbors or the school or anyone else might think. So they minimize or they deny it’s happening.

Also, by accepting it and moving forward, now there’s an accountability. Now, “I have to do something,” and sometimes, parents don’t know. “If I acknowledge it now, where do I go? I don’t even know what to do. How do I do this? My kid has a problem. I don’t even know what the first step to take,” you know? Savannah and Jordan can tell you, it was like me with the technology today. They’re trying to explain some things and I’m like, “You got to give it to me in very simple terms because I’m not great with technology. So if something happens with my technology, I don’t even know how to help myself. I have to call someone, and if they’re not available, I’m stuck.” Parents often feel that way when their child is using substances. In both circumstances, the substance use continues with little to no resistance, and often, other children and adult family members feel invalidated. So, if you have somebody else in the family who is recognizing it and it’s being minimized or denied, they feel like their opinion — their view — doesn’t even matter. Their concern doesn’t matter.

Some of the things that happened — as far as in the relational dynamics, especially with the parent/child — there’s miscarried expressions of anger. I touched on this before; family members develop resentments regarding the environment, each other, substance user, and at times, others in society. So, what that means — there’s tension in the household. Because of the attention, it could really ignite some emotions, and other members of the family may be short with each other and develop resentment to each other. If other members have a different perspective or a different opinion of what’s happening and then they don’t agree again, that can cause strife within a relationship — tension. Resentment is often resentment for the substance user, but there could be resentment from the substance user towards family members as well. As far as resentment or frustration with others in society — a lot of times, what’ll happen is, we never know what happens behind closed doors in someone else’s house. We’ll think of somebody who’s having the perfect life. In a good way to kind of put a picture to this, if you’re feeling depressed, don’t go on Facebook because you’re going to go on all your friends on Facebook and you’re going to see them at the beach. They always have a smile. They’re always doing something fun.

This is what they choose to present to us, but we’re like, “Oh my God, they have the perfect life. And look at the hell I’m in,” so we tend to have resentment. When we see somebody in society who seems to have it all together — their family seems to be the perfect family — we actually get angry and resent them if we’re dealing with something like this. Not everyone, but it can happen, because it’s like, “Why do they get to have this great family and I have this disaster on my hands?” Or, you know, whatever it is. They’re often afraid and reluctant to express individual feelings within the family, and then may misuse substances, as I said before, to manage repressed feelings as self-medication. So, if one person is really looking at what’s happening and deciding something has to happen in the rest of the family, they may not say anything because they’re going to get a lot of static and resistance from the other family members. There’s going to be a lot of anger. It’s going to cause a lot of conflict. And again, to avoid all of that, they may not bring it up and they may be villainized, like, “Oh, you’ve always been jealous of them,” or say something else to this individual who’s bringing it up within a family.

Unrealistic parental expectations parents often will experience. They’ll want things too high for a child, so set unreachable goals. Again, think about it — when someone’s addicted to substances, they definitely have a distorted point of view. They may think, “My child should get straight A’s,” and maybe that child’s not capable of straight A’s, and then if they don’t get straight A’s, now there’s consequences for it. Or, “You need to be playing varsity sports at a sophomore level,” and they’re just not really — they may have some sports talent, but they may not be developed enough for that. It may be this unreasonable goal that they cannot reach, or it’s a goal that will just take so much effort to reach that it’s not realistic to expect that of a child. Then on the other side of the coin, we see where parents will set the expectations too low. “You know what? They’re going to school. Whatever their grades are, at least they’re going,” Or they’ll actually be negative towards their child. They’ll tell their child they are stupid.

Now we have the self-fulfilling prophecy, where the child now believes that they’re not capable of more — that they’re only capable of what they’re being told by their parents or what their parents are behaving like, ‘cause sometimes, our behavior even sets expectations. And they learn to expect failure from themselves. Not only that, but when you think about it, one of the most important ways of learning is modeling. And when you have somebody — a parent or both parents — that have addiction, they are not modeling the kind of behavior that’s going to result in a child excelling or succeeding or meeting or exceeding expectations in what they’re doing. The drugs and alcohol often take precedent, especially when it’s a problem and other people are not able to excel. And even if they’re excelling in one area of their life, they are not excelling in all areas. Other areas have taken a hit because the substance has become the most important thing in their life, and something has to be sacrificed for that. They have to find a place for it.

Also what happens is codependency, which is a term that can be a little controversial — to call somebody codependent — but I’m going to just use this in the general sense. And basically, what it is is family members attempt to control the substance user because they feel the substance user is incapable of taking care of him or herself. So, what does that mean? They tend to do it. “I don’t want you upset, I’ll do it,” whatever it is. Or rather than having somebody be accountable to call for work, maybe their wife will call them out for work and say they’re sick so that they don’t have to face it. It’s a way of doing things that actually tends to limit the consequences or the accountability for the one using the substances and then, in effect, what they don’t realize is it actually helps that person continue. They’re not receiving the consequences or all the consequences, so it takes away from the impact it would be if they had to face those consequences, which enables them to keep using. And the family member experiencing the codependence of his or her feelings often needs to intensely focus on the substance user’s.

What we mean by that is, rather than looking at a mirror and cleaning up my end of the street — if it’s me that’s the codependent — and say, “In order for this to get better, I have to do this,” it’s a lot easier to put all my focus on someone else than to look in the mirror. That’s a hard thing to do, especially when you feel like you’re contributing to something negative. So, there’s a tendency that they feel that they’re doing good. They’re telling themselves, and they believe in their mind, often, that they’re doing good by focusing on the substance user intently and trying to protect them and trying to minimize their consequences. And at the same time, they think they’re going to get them to stop using the drugs or alcohol that they are. But this is a bit distorted thinking. That’s not what’s going to happen. Here’s why codependency is — we call it a stigmatizing term — a little bit controversial: Because we were labeling the person as somebody who’s doing harm, but really, the person believes that they’re doing something good, usually.

Also what we have is historical and intergenerational trauma which occurs. So, what we mean by that is — as a therapist, I use, at times, genograms. It’s a tool that I will use to take a look at different patterns that develop within families. Basically, it’s a family tree, for any of you who may not know. They not only display the names and ages and all that, but it also displays all the issues within the family. We have symbols to depict each thing, as well as some of the good things, but a lot of times, more focused on the negative because, as therapists, we’re looking to help them improve those areas that are life. And what you can often see is you can see a pattern within the family of substance use. And I don’t just mean substance use, but sometimes, you’ll see a pattern, like — for instance, “Wow, it’s really interesting for five generations, every female in the family who became a mother actually had an alcohol use disorder.”

These things tell us things that we can use to help the family understand what’s happening and change those dynamics. This is what we call historical or intergenerational trauma. We can see things like that also with child abuse as well as domestic violence. It’s amazing how you can watch a pattern develop and repeat, and it’s a collection of emotional and psychological injury over an individual’s lifetime and across generations. Again, that pattern I was talking about — these detrimental behaviors that tend to be replicated with each generation, which create fixed patterns of harm. So, we tend to do what we learn. A lot of times, we tend to enact ourselves. So, if someone has been abused, there’s a higher risk that they’re going to go on and abuse their child, and then so on and so on.

Also to note, oppressed populations are at a higher risk for intergenerational trauma. I’ll give you an example: Native Americans or African-Americans, undocumented immigrants, they do have a higher risk of this because of their experiences and what they go through. People who are undocumented — some of the awful conditions they have to go through to get to the country and things that have been done. And then there could be a tendency, especially if they had that done as a child, where that abuse can change the way your brain is developing and raised. You could end up going on to abuse yourself. I don’t want to get too deeply into that, but even those experiences can be influential. There’s books that have described different oppressed societies with some of the things that have been done to them by society itself and have then been also instituted within their own families, because that’s what they’ve learned — and that’s my point. That puts them at a higher risk for this kind of thing.

Alright, intergenerational cycles of trauma — again, the developmental influences. What we look at here is what we call ACEs, which is adverse childhood experiences. Actually, if you go online and you were to look it up, there’s a questionnaire with 10 questions to determine the level of ACEs. The more ACEs a person has, the more likely that they are to have had trauma and have it impact them in a negative way. So, when people have ACEs, this is definitely impacted, and the more ACEs we see through generations, the more we see those behaviors repeated. It also often occurs as a result of parental mental illness. So, if somebody has a severe mental health diagnosis, oftentimes, they’re not good at regulating their own behaviors or even having insight about the impact of their behaviors, so that can impact a child. Parental substance misuse — again, we talked about that — and then also being a victim of or witnessing child abuse. Whether it’s emotional, physical or sexual, the risk increases significantly when parental substance misuse is present. So, the abuse has increased, but also, that increases the ACEs. Again, if these things are happening through generations — some of these behaviors — we can see that pattern again. And then historical or intergenerational trauma is maladaptive patterns of thinking and behaving. I’m sorry, I should have defined that first — it’s maladaptive patterns of thinking and behaving that’s passed from generation to generation. That’s why we see some of these things repeating.

So, what are the effects of this trauma that occurs through generations? It negatively alters the family structure and organization of the family. All family members’ behaviors tend to go to extremes, meaning that often — when we talk about extremes — we’re seeing a very high level of emotionality. And when we have addiction within a family, those families have, typically, a high level of emotionality there. They don’t regulate their emotions very well. There’s a lot less logic being used and a lot more emotions. Communication and boundaries are inconsistent and unhealthy, and that’s something that if you grow up in a household with no boundaries or very limited boundaries, there’s a tendency that you will then have a household yourself — if you have children — with limited and unhealthy boundaries. Interfamily relationships are unhealthy, strained and are fractured.

When we look at the unhealthy part, we’re looking at how they communicate, how they interact with each other, the regard they hold for one another. Again, if there’s abuse in the family, social relationships are reduced and kept at an emotional distance. That’s kind of typical, right? If something’s happening — when we think about, say, addiction, that’s a big secret. We don’t want everyone to know, so one way that we keep that a secret is we kind of withdraw. We stay within the family; we stay close to the chest with it and we don’t talk about it. We’re told — and this happens intergenerationally too — oftentimes, family members are told that it’s not to be spoken about. “We’re not going to talk about your uncle’s drinking. You don’t talk about that outside of the family.” The entire family often experiences societal stigma. So if one person has — or if there’s a history of the family having substance — that family often gets labeled in a very negative way. My last name is Calderon — I’ll just use mine so I don’t offend anybody. “Oh God, those Calderons, man. You want to stay clear of them. They’re all a bunch of drug users, even going way back to their grandfather when they were in this town. He was the town drunk. Just stay away from that.”

We stigmatize them and, all of a sudden, everybody connected to the family. Now, it has this negative connotation, and we forget all about the person and we just label them based on one or a couple of family members’ use of substances. All family members are at risk for, in this instance, depression, anxiety and other mental health disorders. They have difficulty recognizing, expressing and regulating emotions. As I said, there’s a lot of self-destructive behavior and very low self-esteem among the members that go through this intergenerational cycle. Post-traumatic stress disorder is common. Self-destructive behavior, we mentioned. We talked about self-destructive behavior; that could be overspending. That could be physically self-harming. That could be a variety of things that we’re looking at. Substance misuse happens, poor physical health and/or outcomes and a high rate of suicide in families that have experienced this.

The family disease, which is boundaries. Most of you I’m sure know, but I’m going to define boundaries for you. Boundaries are building blocks of all human relationships, and it gives us an idea of what’s acceptable and what limits we have and what’s not acceptable. So, give me a quick example of a boundary. We all seem to have an acceptable — well, with COVID, it may change in the future — but an acceptable distance to speak, right? If someone’s too close to you, you’re going to step back, maybe put your hand up. People generally know that boundaries, and society will have these same kinds of boundaries with what the expectations are. Behaviors and roles and set limits, which establish reasonable, safe and permissive ways for others to see and interact with each other. Boundaries are enforced. Therefore, boundaries include a response when personal boundaries are violated, which notify the other party of the problem and reset or redefine the acceptable boundaries. Again, somebody’s talking too close, we might put our hand up. We might step back or lean back. That’s a way for us to let them know they’re invading our space, which means they’re actually violating our boundaries.

Families maintain boundaries with other systems outside of the family’s influence. A good example would be school. With the schools, they maintain a certain level of boundaries. Individual family members’ interaction with the outside world — the way the family, as a whole, interacts with the outside world. These are all the different systems I was talking about. How does the family or individual in the family system interact within these families or these other systems, like school? It could be work, social gatherings. It could be community sports — whatever it is, the boundaries are all there, and we all interact differently with those boundaries and try to find what’s acceptable. But also what guides us is our families and what’s acceptable within those boundaries.

Family boundaries are very based on how open or closed the family is to non-members and systems outside of family unions. So, if it’s a closed family, they’re not bringing anybody inside. I’m half Italian. You think of the tight, “You keep that in the family, we don’t share that, that stays in the family.” Very private, right? So, that’s closed. They may be open in other ways, but that’s closed. So, keeping everything very, “We’re not talking about family issues with anyone else.” And open family — they’re more open and it’s like they’re willing to share, which means that they’re more open to having different types of relationships and closer relationships outside of the family. Close family, they tend to stay very tight-knit and their close relationships tend to be within the family.

So, when I look at a family disease, there’s roles that tend to happen. I don’t have time to get into that today, but what we can talk about is the family rules. When we’re talking about a family who has addiction within the family, the rules dictate the behavior in the home and, to a point, outside the home, as far as what’s shared. So, these are the typical rules, right? “It’s a secret we want to keep. Don’t think for yourself, don’t name, don’t challenge, don’t trust, don’t feel, don’t ask for change.” These are all ways to keep things as they are, which is comfortable. These are all unwritten rules. It’s not like a family puts it on the refrigerator: “You can’t do these things.” But in a family with addiction, there is a tendency — especially if they’re in one of the earlier phases that I discussed — there is the tendency that you will get some kickback and some resistance and some anger and resentment because you are moving the homeostasis and they don’t want you to do that. So, “family problems should stay in a family,” which influences how family members do or do not reach out for help. It is discouraged, typically, within the family to reach out for help. That’s not something that often happens. Somebody may reach out for help, but typically, the family unit has a tendency to try to prevent that from happening because it’s going to change the dynamic within a family.

What can somebody do who finds themselves in this situation, or what can you do if you have a family member that is struggling with substance and family members that are struggling as part of that system? Well, the first thing you do is maintain fair, firm and consistent boundaries and expectations. What that means is they’re fair, they’re meeting expectations and boundaries. They know what is expected. It’s very clear. You’re sticking to it and consistent. You’re always enforcing those, especially with somebody who does have a substance use disorder. Consistency is so important; if you want to help that person, they need these boundaries.

You also want to promote healthy and appropriate emotional expressiveness. Promote healthy and appropriate emotional expressiveness. So, we want to reduce the emotionality. We also want people to actually talk. We want to help them to not criticize one another. How can we speak? How could you express yourself in a way where you could say, “I am not comfortable,” or, “I don’t like what’s happening,” without criticizing the other individual? Often, we suggest using “I” statements, meaning you start the sentence with, “I feel this way when this occurs.” We want to validate each person’s feelings with frequency whenever it’s possible. Validation is a powerful tool, and it’s interesting — you can validate somebody, even when you think they’re completely inappropriate and out of line.

If you’ve got somebody that’s an adult throwing a tantrum like a child, and you’re thinking to yourself, “This is ridiculous,” there’s one way to validate that person that can get them to drop their guard. Lower their emotion just a little — maybe enough to be able to process what you’re saying. What I like to say to those people is, “I can see how extremely upset you are.” I am validating your feelings, but I am not validating their behaviors, okay? I’m not suggesting it’s okay. I’m simply validating that I can see how upset you are about what’s happening. I may not think they have a good reason to be upset, but I can still validate what I see. And that is a powerful tool that often gets people to calm down because they’re like, “Yeah, you kind of get it.” And then you may be able to get what you need from them or to speak to them in a way that maybe can lower their guard and their emotionality further.

We also want to utilize protective factors, which is to identify strengths and resources within the family. Every family has a strength; it could be resiliency. It could be, you know, whatever. Whatever that strength is, we want to look at it and build off of the strength. There may be strong leadership from somebody within the family that we can kind of look to to lead through this, and someone that the other family members look to as a leader, so they’re more apt to follow them. If we can help them with healthy communication and healthy behaviors, that may be a way to help the rest of the family. We want to build off whatever the strengths are. We want to confront each other without being confrontational. So, what does that mean? We want to focus on the issue. You confront it, but you don’t have to come at them in an emotional way. Again, you can use the “I” statements: “I was very disappointed or very hurt by your behavior when you did this.” I’m confronting them in an inappropriate way. We can encourage open communication and active listening. What we mean by active listening is that you’re participating. If someone’s saying something you agree with, there’s a head nod. There may be some questions. Maybe you add to what they’re saying — appropriately — and then we can maintain a safe and nurturing space.

After that, we have some resources on the sides for you — for families and for individuals. Children’s System of Care. I’ll let you guys look at this ‘cause I realize we have 10 minutes for questions here. Some other resources — I apologize, these are some of the counties from where I used to work. I actually wasn’t even aware that there were gonna be so many out-of-state people, so forgive me for that. These, again, are county resources. These are some very basic resources for anyone — for families. And then my references. I’ll go back to that one, and those are some other websites and resources. So, thank you for your attention. Thank you for coming. Does anyone have any comments or questions?

It is 3:00 p.m. and I don’t see any other questions in the chat, so I’m just going to go ahead and throw my email in there. If you have anything you would like to follow up on, please feel free. Michael, if you’d like to do the same. Any additional questions, you can throw them his way. But I just wanted to say thank you so much for joining us again today. We host these events every Wednesday from 2:00 to 3:00 p.m. This Friday, we also have a continuing education event, so be sure to join us for that. But thank you, everyone. Hope you have a great rest of your day, and hang on for Michael’s email. Thank you.

Thank you for watching this video. We hope you enjoyed the presentation.