Drug Use and the Family

Michael Centore

S E R I E S C O N S U L TA N T SARA BECKER, Ph.D. Brown University School of Public Health/Warren Alpert Medical School

Drug Use and the Family D R U G A D D I C T I O N A N D R E C O V E R Y


Alcohol and Tobacco

Causes of Drug Use

Drug Use and Mental Health

Drug Use and the Family

Drug Use and the Law

Hallucinogens: Ecstasy, LSD, and Ketamine

Intervention and Recovery

Marijuana and Synthetics

Opioids: Heroin, OxyContin, and Painkillers

Over-the-Counter Drugs

Performance-Enhancing Drugs: Steroids, Hormones, and Supplements

Prescription Drugs

Stimulants: Meth, Cocaine, and Amphetamines


Drug Use and the Family

Michael Centore

S E R I E S C O N S U L TA N T SARA BECKER, Ph.D. Brown University School of Public Health Warren Alpert Medical School


Mason Crest 450 Parkway Drive, Suite D Broomall, PA 19008 www.masoncrest.com

© 2017 by Mason Crest, an imprint of National Highlights, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, taping, or any information storage and retrieval system, without permission from the publisher.

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Designer: Annemarie Redmond Copyeditor: Peter Jaskowiak Editorial Assistant: Andrea St. Aubin Series ISBN: 978-1-4222-3598-0 Hardback ISBN: 978-1-4222-3603-1 E-Book ISBN: 978-1-4222-8247-2

Library of Congress Cataloging-in-Publication Data Names: Centore, Michael, 1980– author. Title: Drug use and the family / by Michael Centore. Description: Broomall, PA : Mason Crest, [2017] | Series: Drug addiction and    recovery | Includes index. Identifiers: LCCN 2016003948| ISBN 9781422236031 (hardback) | ISBN    9781422235980 (series) | ISBN 9781422282472 (ebook) Subjects: LCSH: Drug addiction—Juvenile literature. | Children of drug addicts— Juvenile literature. | Drug addicts—Family relationships—Juvenile literature. | Family psychotherapy—Juvenile literature.

Classification: LCC RC564.3 .C463 2017 | DDC 362.29—dc23 LC record available at http://lccn.loc.gov/2016003948

Printed and bound in the United States of America.

First printing 9 8 7 6 5 4 3 2 1

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Series Introduction . . . . . . . . . . . . . . . . . . 6 Chapter One: A Family Disorder . . . . . . . . . . . . . 11 Chapter Two: When a Parent Uses . . . . . . . . . . . . 25 Chapter Three: Teen Use and the Family . . . . . . . . . . 37 Chapter Four: Family Therapy . . . . . . . . . . . . . 49 Further Reading . . . . . . . . . . . . . . . . . . 58 Educational Videos . . . . . . . . . . . . . . . . . 59 Series Glossary . . . . . . . . . . . . . . . . . . . 60 Index . . . . . . . . . . . . . . . . . . . . . . 61 About the Author . . . . . . . . . . . . . . . . . . 64 About the Advisor . . . . . . . . . . . . . . . . . . 64 Photo Credits . . . . . . . . . . . . . . . . . . . 64

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Many adolescents in the United States will experiment with alcohol or other drugs by time they finish high school. According to a 2014 study funded by the National Institute on Drug Abuse, about 27 percent of 8th graders have tried alcohol, 20 percent have tried drugs, and 13 percent have tried cigarettes. By 12th grade, these rates more than double: 66 percent of 12th graders have tried alcohol, 50 percent have tried drugs, and 35 percent have tried cigarettes. Adolescents who use substances experience an increased risk of a wide range of negative consequences, including physical injury, family conflict, school truancy, legal problems, and sexually transmitted diseases. Higher rates of substance use are also associated with the leading causes of death in this age group: accidents, suicide, and violent crime. Relative to adults, adolescents who experiment with alcohol or other drugs progress more quickly to a full-blown substance use disorder and have more co-occurring mental health problems. The National Survey on Drug Use and Health (NSDUH) estimated that in 2015 about 1.3 million adolescents between the ages of 12 and 17 (5 percent of adolescents in the United States) met the medical criteria for a substance use disorder. Unfortunately, the vast majority of these IF YOU NEED HELP NOW . . . SAMHSA’s National Helpline provides referrals for mental-health or substance-use counseling. 1-800-662-HELP (4357) or https://findtreatment.samhsa.gov SAMHSA’s National Suicide Prevention Lifeline provides crisis counseling by phone or online, 24-hours-a-day and 7 days a week. 1-800-273-TALK (8255) or http://www.suicidepreventionlifeline.org


When pro- and anti-drug information sit side-by-side online, it can be hard for kids to separate fact from fiction.

adolescents did not receive treatment. Less than 10 percent of those with a diagnosis received specialty care, leaving 1.2 million adolescents with an unmet need for treatment. The NSDUH asked the 1.2 million adolescents with untreated substance use disorders why they didn’t receive specialty care. Over 95 percent said that they didn’t think they needed it. The other 5 percent reported challenges finding quality treatment that was covered by their insurance. Very few treatment providers and agencies offer substance use treatment designed to meet the specific needs of adolescents. Meanwhile, numerous insurance plans have “opted out” of providing coverage for addiction treatment, while others have placed restrictions on what is covered. Stigma about substance use is another serious problem. We don’t call a person with an eating disorder a “food abuser,” but we use terms like “drug abuser” to describe individuals with substance use disorders. Even treatment providers often unintentionally use judgmental words, such as describing urine screen results as either “clean” or “dirty.” Underlying this language is the idea that a substance use disorder is some kind of moral failing or character flaw, and that people with these disorders deserve blame or punishment for their struggles.


And punish we do. A 2010 report by CASA Columbia found that in the United States, 65 percent of the 2.3 million people in prisons and jails met medical criteria for a substance use disorder, while another 20 percent had histories of substance use disorders, committed their crimes while under the influence of alcohol or drugs, or committed a substance-related crime. Many of these inmates spend decades in prison, but only 11 percent of them receive any treatment during their incarceration. Our society invests significantly more money in punishing individuals with substance use disorders than we do in treating them. At a basic level, the ways our society approaches drugs and alcohol— declaring a “war on drugs,” for example, or telling kids to “Just Say No!”— reflect a misunderstanding about the nature of addiction. The reality is that addiction is a disease that affects all types of people—parents and children, rich and poor, young and old. Substance use disorders stem from a complex interplay of genes, biology, and the environment, much like most physical and mental illnesses. The way we talk about recovery, using phrases like “kick the habit” or “breaking free,” also misses the mark. Substance use disorders are chronic, insidious, and debilitating illnesses. Fortunately, there are a number of effective treatments for substance use disorders. For many patients, however, the road is long and hard. Individuals recovering from substance use disorders can experience horrible withdrawal symptoms, and many will continue to struggle with cravings for alcohol or drugs. It can be a daily struggle to cope with these cravings and stay abstinent. A popular saying at Alcoholics Anonymous (AA) meetings is “one day at a time,” because every day of recovery should be respected and celebrated. There are a lot of incorrect stereotypes about individuals with substance use disorders, and there is a lot of false information about the substances, too. If you do an Internet search on the term “marijuana,” for instance, two top hits are a web page by the National Institute on Drug Abuse and a page operated by Weedmaps, a medical and recreational


marijuana dispensary. One of these pages publishes scientific information and one publishes pro-marijuana articles. Both pages have a high-quality, professional appearance. If you had never heard of either organization, it would be hard to know which to trust. It can be really difficult for the average person, much less the average teenager, to navigate these waters. The topics covered in this series were specifically selected to be relevant to teenagers. About half of the volumes cover the types of drugs that they are most likely to hear about or to come in contact with. The other half cover important issues related to alcohol and other drug use (which we refer to as “drug use” in the titles for simplicity). These books cover topics such as the causes of drug use, the influence of drug use on the family, drug use and the legal system, drug use and mental health, and treatment options. Many teens will either have personal experience with these issues or will know someone who does. This series was written to help young people get the facts about common drugs, substance use disorders, substance-related problems, and recovery. Accurate information can help adolescents to make better decisions. Students who are educated can help each other to better understand the risks and consequences of drug use. Facts also go a long way to reducing the stigma associated with substance use. We tend to fear or avoid things that we don’t understand. Knowing the facts can make it easier to support each other. For students who know someone struggling with a substance use disorder, these books can also help them know what to expect. If they are worried about someone, or even about themselves, these books can help to provide some answers and a place to start.

—Sara J. Becker, Ph.D., Assistant Professor (Research), Center for Alcohol and Addictions Studies, Brown University School of Public Health, Assistant Professor (Research), Department of Psychiatry and Human Behavior, Brown University Medical School



coping mechanism: a behavior a person learns or develops in order to manage stress. dysfunctional: not working as it should; impaired. environment: one’s physical, cultural, and social surroundings. family structure: one of the various types of relationships or combinations of relationships that creates a family. genes: units of inheritance that are passed from parent to child and contain information about specific traits and characteristics. intoxicant emotions: emotions family members feel that are linked to a user’s behavior. repression: holding something back, such as an emotion.



We often think of addiction as a personal problem. After all, drugs and alcohol can harm someone’s physical, mental, and emotional health. But rarely do we consider how misuse affects the people who are close to the user. Friends might get hurt, because people struggling with addiction might act in ways they normally wouldn’t in order to cover up their use. Relationships with teachers can suffer, especially if the user stops caring about attending school or doing homework. Above all, the person’s family might suffer, because they are the ones closest to the problem. Whether the user is a parent, teen, relative, or spouse or partner, addictive behavior can change the entire family dynamic. For example, if the person tells lies to cover up an addiction, it can create feelings of distrust and distance. Heightened emotions can disrupt a family’s sense of balance. Family members may find themselves covering for the user, lying to themselves and to others to protect the family’s reputation or



Substance use disorders might feel very solitary, but they affect the user’s entire family in many ways.

to preserve the illusion of a “normal” life. Fortunately, there is help for families dealing with the stresses that come from living with addiction.


Two major factors determine whether someone might be prone to addiction: genes and environment . Both of these relate to the family. Genes are units of hereditary information passed from one generation to the next. They determine your outward appearance, including such things as the color


of your hair or how tall you are, but they also contribute to your chances for addiction. In fact, about half of your chance of developing an alcohol addiction can be traced to genetics, and slightly more with other drugs. It’s important to keep in mind that you don’t inherit a substance use disorder; you inherit a vulnerability to it. That means you are more at risk of having problems with substance use than someone else. There is no single “addiction gene.” Instead, a combination of genes influences your chance of having substance use problems. Some people have a genetic makeup that allows them to drink without getting hungover, while others have a couple drinks and feel the effects the next day. Some use drugs and immediately feel an intense high, while others don’t feel much at all. Some can try drugs for a while and then stop fairly easily, while others have horrible withdrawal symptoms. Some might be drawn to drugs because they often feel depressed or anxious, while others might not experience these emotions as frequently.

Substance use disorders are said to “run in families.” This means you can inherit a vulnerability to that disorder. But it does not mean you will definitely have it.



Genes and environment interact in complicated ways. If addiction genes run in your family, it is more likely that other family members will use drugs. That means that you are more likely to be around drugs, which makes it easier for you to get them and easier to become addicted. If your parents use drugs, they are also likely to have a harder time monitoring what you are doing. This means it’s easier for you to get in trouble or develop an addiction. In contrast, a healthy home environment is one of the best defenses against addictive behaviors. A healthy home doesn’t make a person immune to substance use disorders—anyone can develop one. In fact, many teens who grow up in healthy home environments develop serious problems. But if you grow up in a healthy home without addictive substances around, you have a lower risk of developing a substance use problem than someone who grows up in an unhealthy home surrounded by substance use. And it takes more than being substance free to count as a healthy home environment—a healthy home is one that is stable, supportive, and filled with positive relationships. These types of environments aren’t created automatically; they take a lots of work. Fortunately, counselors can help give parents the tools to begin creating a more positive home environment. The good news The effects of addiction on a child can carry on well into the person’s adult years. For example, if a young girl grows up with an addictive parent, this can influence her future parenting style in a number of ways. She might become overly strict, fearing that her kids will wind up as users, too. Or she might become overly permissive, because she lacks confidence after years of dealing with an aggressive, unpredictable parent. The ways that a person’s addiction influences the family member’s behaviors over time are known as “intergenerational effects.”

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