Recently, Lily Schmelzle, The Buttery’s Family Support Program Manager, gave a moving, nuanced and evidence-based presentation to Buttery staff titled:  Developmental Processes and how it plays out in addiction within families.

We thought it would be valuable for anyone with a loved one experiencing drug misuse.

Lily Schmelzle: The Buttery’s Family Support Program Manager

 

Co-dependence is frequently a word used in therapy and AOD circles as a way of describing unworked out needs and poor boundaries that are played out with family, partner or friends. Although there is nothing wrong with the co-dependence model and it is good shorthand language to describe a set of behaviours, it may lack the understanding and depth of attachment, developmental and trauma models. I want to present a short paper that describes how addiction can developmentally cut across the process of separation and increase both physical and psychological dependency and leave the one struggling with addiction in much younger states of development. This process leaves the family in a very difficult place as the destruction of the addiction pathway takes hold they are left dealing with issues of risk, safety and survival. Often the way the family responds is a sane response to the insane and highly stressed pattern of addiction

These ideas are based on a conglomeration of many different families’ experiences that I have worked with. I have focussed on adolescences who begin using experimentally and develop addiction pathways and how that plays out in the family. But there are many different stories that lead to addiction. I am also aware that I have simplified complex processes in order to frame my ideas.

One of the roots of addiction may lie in issues of unworked out dependency that are played out in different attachment styles

Secure                  Secure
Avoidant              Anxious –pre-occupied
Ambivalent          Dismissive-Avoidant
Disorganized        Fearful-Avoidant

There is a multitude of factors that could affect the early bonding and attachment process in a family:

  • The lineage of the parents own history
  • Trans-generational Trauma
  • Implicit memory
  • How much support there is for the mother/family
  • Absent Fathers
  • The match of parents with baby (Infant Obs)
  • Stress/Trauma/Grief and Loss

And these factors can all play a part in the stages of separation like crawling, walking, going to school etc – all psychological milestones.
A 7-year-old is different from a 5-year-0old and a 10-year-old different from a 15-year-old in their needs.

There is a dance between connection, support, and holding, and individuation;  the development of a separate self.

In adolescence, this dance becomes very strong. There is a need to have more control and independence but at the same time, they don’t take responsibility, like cleaning their rooms etc. They can withdraw, not so open, be on the phone, not talk to you, and depending on their age, be often out with friends.

Experimental use of drugs and alcohol can often come in much earlier than in the past. Although not recommended, it can be still manageable but it becomes a different story when the purpose of the use is not just experimental or recreational, but to self-medicate anxiety, depression, trauma or feelings in general that are unbearable, and an addiction pathway rapidly develops.

There are factors that can make young people more vulnerable:
Sensitivity, genetic, attachment style, family separation, bullying, trauma, grief and loss.

Addiction cuts across an already complex continuum of movement between dependency and separation. Initially, it may not be as obvious, as the loved one is using experimentally and there are not big behavioural changes. Many parents talk about not recognizing the early warning signs of substance misuse developing as they thought it was normal teenage behaviour.

When the loved one becomes more withdrawn, angry, and reactive with mood swings, going out all the time etc it takes parents by surprise and they realize later it was addiction/self-medication taking hold.

The dynamic on the surface seems to be they are very independent, unavailable, not coming home. Actually, the dependency on their drug of choice is also mirrored by the underlying dependency played out in the relationship.

As the loved one becomes more fused with the substance they are using they become more undifferentiated and begin to lose more of their developing adult self. Through addiction, their neediness becomes greater not only for the drug but also to have someone clean up their mess. I wonder if they fall deeper into their unworked-out dependency as they fall deeper into their dependency on drug use.

Emotionally they are not developing independence. As time goes on they don’t manage work, rent, food, or money. With addiction pathways the loved one does not go through developmental milestones. They don’t deal with life on life terms. They are unable to bear and tolerate feelings, stress, and relationship break-ups. The Adult part that manages the world and keeps an overview is not developing.

Families step in and pay their rent, food, fines etc. Families don’t want to be caught up in this cycle but also have a lot of fear of what will happen if they step back. Homelessness and dying are very real fears that play out in the parents’ mind — as Tony Trimingham, the founder of Family Drug Support, could tell you, as he lost his son to a drug overdose.

I think there are multi-layered forces of protection and dependency that are played out in the family and which undermine the development of adult independence.

Just at a time when the family is gearing towards graduation to young adulthood, leaving home, having a girlfriend etc the complexity of addiction throws a spanner in the works.
As the loved one’s dependency on substances grows so does the relational dependency on their parents. They step in and clean up messes, give money, organize psychologists, counsellors and rehabs.

Mothers can often be the last person standing in the family. They will hang in there to the bitter end and stand by their child. And rightly so. The only thing that may be useful is how they hang in there. I often talk about the umbilical cord connection with the loved one; the deep maternal instinct to protect. Separation can also be complicated by the mother’s own unconscious process in how she deals with separation and how it was dealt with in her own family. Then add the messiness of addiction. This can completely cut across the mother’s capacity to separate from her child as the increased concern for their welfare moves her back into the dependency process/ the caretaker role/being responsible for the other.

At a time when the loved one is a developmental stage of separation and moving towards independence, a dilemma arises in the mother whether to move towards or move back. It is very difficult for the parent not to step in when their protective survival instincts are triggered as they see the potential risk and harm.

I had been working with families for a few years before I began to realize that the behaviours in addiction that we take for granted as AOD counsellors are so similar to the behaviour of a 2-year-old.

  • Lack of consequential thinking
  • Instant gratification
  • Poor Impulse control
  • Reactive Behaviour
  • Centre of the Universe/Self Absorbed
  • No sense of other
  • Lack of observer

I often talk to families about an idea that addiction mimics the state of a 2-year-old.

When I say this to families, very respectfully suggesting that this is a description only, it makes a lot of sense to them. They have been trying to relate on a sensible adult level but the Adult is often off-line. They think they have a developing young adult that they are relating to but instead what they get is denial, reactivity and poor impulse control and someone who cannot see the effect they are having on others or the consequences of their actions.

Other family members, friends and professionals often use cliques like co-dependence, needing to hit rock bottom, kick them out, not realizing that someone’s rock bottom can be death or homelessness. This is not useful to the family member. In fact, what happens is that they shut down and don’t share what is happening to them as they often feel judged.  It also feeds into the guilt and responsibility and a general sense of badness that the family member carries for their loved one using.

Over the years of working with family members, I have realized that they need to feel that they have done everything in their power to help so that if anything happens to their loved one they know they have done their best.

From control to acceptance

Family drug support has developed a stages-of-change model in which there is a movement from control eventually to acceptance but it takes families time to get to this.

Often families are facing impossible moral dilemmas and ask me what to do. I don’t know the answer either and I say there is often not one right answer and support them to find what is the best way through for them in this situation. I often tell them that they are the parent and this is their child and they need to do what feels right for them at the moment.

I have families who have loved ones who are in the early stages of addiction and beginning to be concerned about. I also see family members who are dealing with reactive behaviour, verbal and sometimes physical abuse have had to take an AVO out on their child.  I know families that have had to run and hide as they have feared for their safety and also those have been put under pressure to give money so their loved one can use. Often their kids have high anxiety and also trauma in combination with out of control substance use. To me, it seems like their nervous systems are rampaging in fright flight. The parent is placed in a position to do something to help contain their child’s out of control stress, trauma, anxiety and withdrawal. A decision that may have been a textbook no-no can lead to unexpected places.

Sometimes a response that is not in the textbook can lead to positive results and clearer boundaries or going to rehab.  Over time families do develop better boundaries and learn to step back more and understand that if they constantly step forward it does not help their loved one begin to make their own decisions and step into their own adult more. There are also many good stories of success. Some have loved ones who go to rehab, others have learnt to step back more and their loved one is much more manageable.

I try to help them find a place in themselves where they can support and also hand responsibility back to their loved one. They are able to learn to dance the dance between connection and separation.