Addiction is a Family and Community Event

In memoriam Philip Seymour Hoffman and the many other addiction casualties unknown to the public.

Many of us are deeply affected by the tragic death of Philip Seymour Hoffman (46) on Sunday, February 2, apparently from an overdose of heroin. His mother, his long-term partner and their three young children are “devastated”. Hoffman had spoken candidly about his decades long struggle with addiction during an interview in 2006. More recently, he had been in a rehabilitation center during 2013. It’s impossible to fathom the pain this brilliant actor must have endured during so many years. (“I cannot accurately convey to you the efficiency of heroin in neutralizing pain.” Russell Brand, s. below.)

For me this event illuminates the enormous power of addiction. But Hoffman’s death also highlights the fact that alcohol, substance abuse, gambling, and other addictions never affect only the addicted person. Addiction is a family and community event!

At Princeton Family Institute we encounter people who are in the throes of addiction or at different stages on their path to recovery. We also consult with members of their families and with their friends and enlist their support. The following guidelines gleaned from our therapeutic practice are meant primarily as an orientation for those who are looking for help because they are worried about a loved one who is fighting with the demons of addiction.

Guideline 1: You should connect with others who also care about the person struggling with addiction.

Nobody can be successful in the complex and arduous work of recovery from addiction by herself or himself alone! This is true in regard to the individual struggling to overcome addiction. And that is why we have all kinds of self-help groups such as Alcoholics Anonymous. But it is also true for the family member or friend who cares about the addicted person.

An open conversation with another family member or a friend who cares about your observations and worries may be your very first step. It will contribute to regaining some hope, which is so necessary for healing. And you will begin to learn and accept that the recovery of the family member or friend you are worried about is foremost the responsibility of that individual, even so what you do can be critically important.

Family members or friends of a substance abusing loved one frequently hesitate to invade another person’s domain. And people who are addicted often feel great shame, especially in relation to family members or friends, i.e. the people they care about the most. Such hesitation and shame trigger secretiveness and isolation, which increase the power of the drug of choice and decrease the strengths of others who want to help.

It is not only the person struggling with addiction who is experiencing shame. Family members also do not want to reveal to close friends their pain, anger, and perplexity with their adolescent’s or young adult’s addictive behavior and the resulting destructive consequences. They feel ashamed that they’ve somehow failed to raise successful kids. But, overcoming shame and socially sanctioned hesitation to intrude into someone else’s life is the kind of change process family members and friends have to go through in order to eventually make a difference for a loved one.

Most importantly, of course, parents need to speak to each other candidly about the adolescent or young adult in their family whom they see in trouble through addictive behavior or full-blown alcohol and drug abuse. After they were able to arrive at a joint point of view they need to map out a strategy how to proceed.

Equally, a spouse whose partner struggles with alcohol or substance abuse or can’t stop gambling needs to reach out to trustworthy family members. The strength to remain persistent and walk the difficult path lying ahead originates in the relationships that concerned family members or friends can activate as their ongoing support.

Guideline 2: Get a consultant, aka psychotherapist, to facilitate and mediate the process of your group

A therapist, preferably a family therapist, is an invaluable asset for those who are worried about a drug addicted family member or friend. The therapist needs to be trained and skilled to orchestrate the process of a ‘family and friends’ support group for the addicted family member and to work with the conflicts that may come up within that network.

Particularly, the therapist can assist parents of a teenager or of a young adult struggling with addiction issues to arrive at and agree on a set of specific strategies that, hopefully, will motivate their daughter or son to seek professional help, individually and as a member of the family. To agree on a strategy and to abide by it while at the same time not running the young person’s life can be extraordinarily difficult for parents. It may feel harsh or heartless to insist on certain conditions for their son or daughter to continue to live at home. As motivation for such an overall structure it may be freeing for parents to be able to say: ‘Because we love you, we will not allow you to harm yourself or to die in front of our eyes!’

Similarly, a spouse may have to lay out in front of her partner the choices he has of either giving up substance abuse, gambling, or drinking and seek help or face the fact that she will leave him together with the children. Again, that is experienced as a horrible choice and, yet, often the only way to save the partner and the relationship. That is why the support of other family members and close friends is so essential in this process.

The therapist does not need to be a drug and alcohol addiction counselor, but should be trained and skilled in working with relational systems. She or he needs to be able to bring together professionals from various disciplines to collaborate with each other, i.e. an addiction specialist, a psychiatrist, a primary care physician, an emergency room doctor or school personnel. Together they can recommend a rehabilitation center that fits the need of the addicted individual. The best centers are those that also work intensely with family members (and close friends) during a residential stay.

One other quality of the therapist is an essential requirement: She or he must be humble and curious enough to privilege the expertise of the ‘family and friends’ group, i.e. respect their intimate knowledge of the person they care about, respect the culture and uniqueness of this specific family and their traditions and values. The entire recovery process needs to be led by the extended ‘family and friends’ group and will succeed only, if it is collaborative.

Guideline 3: Look toward the future! Do not get stuck in the past; you do not have to forget, but you do have to step out of the past into the future.

Family members, especially parents and spouses, but also friends frequently come to see us carrying a huge amount of guilt and self-blame. “What did we do wrong?” They feel the addiction of their loved one and so much of the predicament of the family is their fault. If only in the past they would have said or done something else… Yes, “The past is never dead. It’s not even past.” (W. Faulkner). And you may need a therapist who can assist you in coming to terms with your past without forgetting it.

Other family members are full of anger (and hurt): “How could he do this to us?” Or: “How irresponsible for her to drive drunk with our small children in the car!” Or: “How could he gamble away everything he had and leave our children and me destitute?”

But guilt, anger, self reproach are issues that do not steer you in any useful direction if you want to help. Rather, when you care about a drug addicted family member the crucial questions to ask are:

  • How can we leave self-blame, guilt, anger and hurt behind us? How can we free ourselves up from the overpowering intensity of emotions that keep us paralyzed and confused about how to act? In other words, the people who care about the person with the addiction need to do some emotional work for themselves before they can firmly set their feet on to a path toward the future.
  • How do we proceed from now on forward and institute changes in our interaction with the loved one? As concerned relatives or friends how can we position ourselves in relationship to the individual stuck in addiction in such a way that we can make a difference in that person’s life? In other words, the relationships have to change so that family members or friends support the recovery of a loved one instead of unwittingly enabling the drug habits.

Guideline 4: Activate the community at large At this time there certainly is a crisis around drugs, especially heroin, in New Jersey. I cannot now go into the enormously diverse social and cultural situation in local communities or into the broader political issues. Yet, in honoring the memory of so many, particularly young addicts who died of a drug overdose and remain unknown to the public, I strongly suggest that you familiarize yourself with the extent of the drug problems in NJ by reading one recent report.

As a background for conversations among people with whom you are networked personally and professionally about the current drug epidemic and what to do about it you may want to read these three thought provoking essays:

addiction, alcoholism, substance abuse, heroin, overdose