Family Members Coping with Substance Use, Mental Health and Stigma
By Eva Ingber, M.S.W., RSW
evaingber.com
Imagine what it would be like if you woke up tomorrow and there was no such thing as stigma and discrimination towards people with addiction and mental health issues. As a family member coping with a loved one with addiction and mental health issues, how would you feel, how would your behaviour change? Would you include more people in your support system without fearing judgment?
“At least 25% of the population is part of a family that is affected by an addiction disorder in a first-degree relative. The data also suggests that up to 90% of actively addicted individuals live at home with a family or significant other” (Principles of Addiction Medicine, Fourth Edition, Lippincott Williams & Wilkins, 2009, page 858.).
As family members whose loved ones struggle with substance misuse and mental health issues, there is often a code of silence. People learn to support partners, parents and children, and often find themselves isolated.
A woman in her sixties began participating in counselling to cope with living with her husband’s ongoing alcohol use. She socializes outside of her home when she goes to work, attends dance classes and sees friends in their homes. She has so many strengths and carries a lot of emotional pain. She has not felt safe to bring home friends in thirty years for fear of them seeing her husband intoxicated and being verbally abusive. This woman takes care of her husband’s physical and health challenges, and tries to cope as best she can. Women caregivers often suffer alone. Women often stay with men who are drinking or using substances, while men are more likely to leave women who are using if they are not using themselves.
Being a family member also makes you a client in many systems, trying to figure out how to navigate the treatment system and find treatment options and services that are a fit. As a family member, you may find yourself ignored and silenced at times. In a hospital where people seek help to address addictions and mental health issues, some family members have said that the cleaning staff is sometimes the most friendly and welcoming to families, always saying hello. Families may feel blamed for their children’s problems. It was once believed that mothers were at fault for their children developing schizophrenia due to “being enmeshed with their children”. This theory has been proven wrong, and was destructive to mothers and family members. Parents worry terribly if there has been substance use and alcoholism in their own families, hoping that their children will not develop these problems.
There are often many barriers in the system when trying to find support. Helping professionals may not feel comfortable or properly educated to work with people using substances. Recently when seeking out a psychiatrist to assess a man with ADHD and substance use issues, the response was, “please, I only want nice clients, not people using substances.” Consequently when seeking out help, it is especially important to ask questions. Some helping professionals may not assess for substance use and be surprised to find they are prescribing medication to someone using other substances, possibly putting the person at further risk. When helping professionals don’t ask about substance use, people may feel uncomfortable to disclose that they are using. It is important that the helping professional conducts an assessment around substance use, exploring how substance use and mental health issues may be interconnected. It is important to ask about a helping professional’s knowledge and comfort in working with people misusing substances. Helping professional need to also recognize the discrimination and stigma that exists that can prevent people from getting the needed help.
Substance use is a coping strategy that people commonly use to deal with physical or emotional pain, past and current trauma, and mental health issues, such as depression and anxiety. It is obviously not a healthy coping strategy, but it often helps to remember that people are doing the best that they can at this time, and to understand that these self-harming behaviours are a combination of often learned behavior, in addition to genetic influences.
As family members, how do you work on accepting the person, and their behaviours, while at the same time, work on change? One of the challenges for the family member may be to stay hopeful during the challenging times when there are slips or relapses.
Setting boundaries, and focusing on one’s self-care is something that needs to be practiced. Family members often struggle with how much support to provide for their loved ones financially and emotionally.
It is important to consider that a loved one may not be ready to make change or know how to start taking care of him/herself without using. In addition, when some people stop using, they may start to feel better, while other people may notice that their emotions are overwhelming to them. Learning to cope with emotions and daily challenges without using is an important part of the recovery process. When there are also mental health issues, these symptoms may be more noticeable when a person is no longer using substances. When a person stops using, a helping professional may more easily assess and diagnose mental health challenges. People who are in treatment for substance use problems have higher rates of mental health problems than people in the general population (Health Canada Guidelines on Concurrent Disorders, 2001).
In a women’s group for family members, women support one another by sharing resources, connecting, setting boundaries, expressing their loses, and stepping back from their pain, while laughing and rejoicing around their individual strengths and wisdom.
It is helpful to connect with others who share similar challenges and coping strategies. There are self-help support groups and educational/counselling groups that help decrease the isolation, ultimately decreasing the guilt and shame that people often carry. Some people seek individual counselling to work on their self-care and boundaries.
No one wants to be defined by their challenges and the labels that they learn to carry. As family members, it is important to think about the person’s strengths, their passions, goals, contributions and dreams. As family members it can sometimes become a pattern to worry, or focus on problems, missing out on opportunities to connect on joint interests and activities together, such as simply going to a movie. A person’s journey with recovery may likely involve many slips, and is ultimately the responsibility of the person taking the journey. Slips and relapses are learning opportunities for the person to consider what they would do differently the next time. The mental health recovery movement has a slogan “Nothing about us, without us.” This powerful statement can help family members reflect on how does one work in partnership with a loved one, and sometimes just step back, observe one’s judgments, and let the person take responsibility for their own path.
Below are two books for family members:
“Get Your Loved One Sober, Alternatives to Nagging, Pleasing and Threatening,” by Drs. Robert J. Meyers and Brenda L. Wolfe, Hazelden, 2004 (available at book stores)
“A Family Guide to Concurrent Disorders,” By Caroline P. O’Grady and W. J. Wayne Skinner, published by CAMH. This resources includes an understanding of recovery, relapse, negotiating the treatment system and stigma. This resource can be found on the website at the Centre for Addiction and Mental Health.
