|Year : 2016 | Volume
| Issue : 1 | Page : 15-16
Role of family in substance use disorders: Can they contribute constructively?
Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||22-Dec-2015|
Department of Psychiatry, Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ghosh A. Role of family in substance use disorders: Can they contribute constructively?. Med J DY Patil Univ 2016;9:15-6
Family is the subunit of the larger, encompassing society. Family members not only transmit the biological traits but also shape up the social-moral-attitudinal characteristics of an individual. Understandably, the influence of family on the individual is inevitable and undeniable. Despite dissents, it would not be imprudent to consider addictive disorders, like any other psychiatric disorders as not purely medical in nature. Barring the genetic contribution which an individual acquire by default and is unmodifiable, among the multitude of other risk factors for substance use disorders, the family is posited to be a significant one. Studies among the children of alcoholics (COA) have demonstrated both alcohol specific influences which selectively predict future alcohol problem and nonspecific factors which are predictive of various mental health problems including alcoholism.  Modeling of drinking behavior and positive expectancies from alcohol use predispose COA for alcoholism. Whereas, parental psychopathology and cognitive impairment, exposure to aggression/violence, low cohesion, high conflict in the family, and poor problem solving skills which are among the nonspecific factors, predict emotional or behavioral dysregulation in COA, and in turn predispose for alcohol use disorders. In addition to its role in the development of substance use disorders, the contribution of family in maintaining the problem is also well-known. , In addition to this family-related predisposing and maintaining factors, the effect of substance use on the family members has been alluded to in the review published in this issue of the Journal. 
Although the literature is replete with evidence of addictogenic family environment, the family can also provide resilience or protection against substance use disorders. While risk factors place the COA greater than average risk for substance use, protective factors buffer the initiation and continuation of substance use. Positive bonding among family members and positive parenting with an optimal level of control and warmth are found to be protective.  These positive attributes have been the focus of intervention in various preventive programs directed toward family members. Creating lasting connections, one of such prevention program designed to work with both family system and the community and aimed at identifying high-risk youth and increasing family resilience observed to be effective in reducing alcohol and drug use, delaying the initiation, and increased communication and bonding between the parents.  Another such program, family advocacy network club designed to strengthen the bond between parents and the child, reducing maternal isolation, providing opportunities for families for participating in fun activities together, and helping parents to influence their children in a drug free life, was found out to improve the ability among the youth to refuse alcohol and drugs, and increase the knowledge about health consequences of substance use.  However, it is needless to say that an isolated focus on the family barring the school, peer group, and the community would not be able to produce the desired optimal result as it is the complex interplay between the individual and the context in which the individual lives determines the final substance use behavior. 
In addition to the prevention of substance use, the family might play a key role in the actual treatment process. Although the authors in their review have selectively focused on the role of the family in bringing a "unwilling" individual in treatment net, family could also be an integral part throughout the entire course of the treatment of substance use disorders. Family systems therapy which has its focus on dysfunctional interaction pattern among the family members and is aimed first to establish a family alliance and then to restructure the existing pattern to accomplish the objective of reducing substance use behavior. Family systems therapy has been found to be effective in adolescent substance use.  However, the strongest evidence for treatment involving family members comes from behavioral couples therapy (BCT) which targets both abstinence of the substance using partner and improvement in the interpersonal relationship and communication pattern between the couples. BCT produces more abstinence, improves treatment compliance, improves relationship; reduce the divorce rate, and domestic violence. In addition, BCT is found to be effective in improving relation of couples with children and functioning of children in the year after parent's treatment.  Another specific form of therapy involving family (or friends) from the very outset and at regular interval during the treatment to support patient's recovery by ensuring sobriety, treatment compliance, and improving integrity of social network is known as network therapy. Although preliminary data suggest efficacy, network therapy has not investigated as extensively as the other forms of therapy mentioned earlier. 
Finally, the time has come to think beyond the mere psychosocial influence of the family. Integrative research strongly suggests that childhood abuse and neglect resulting into maladaptive cell assemblies and synaptic connections in the limbic region of the brain during the early developmental phases might and this could affect the future manifestation of negative emotions, conflictual attachment, and maladaptive behavior.  Future research could endeavor to explore the possibility of reversing the brain changes following enhancing family resilience. From the trap of an addictogenic family to a steady, unfaltering and thorough transition toward a healthy family is what that we must be striving for.
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