Death Of A Family:An older woman with red rimmed empty eyes sat by the bed of the 40-year-old patient in 14B. I knew those eyes. I have had those eyes, those mother’s eyes, sitting by my son, in another hospital on the other side of the country. Lowering her grieving eyes, the woman quickly left her son’s room.
My position at a major metropolitan hospital was to conduct addiction medicine consults on patients admitted for diagnoses that could potentially be brought on, or exacerbated by, drug and/or alcohol use. Using the evidenced based practice of Motivational Interviewing (MI); I approached patients with respect, exploring ambivalences in order to potentially facilitate change in destructive behaviors. When a patient is in a hospital bed with the probable cause stemming from substance use and/or abuse, change is often sought.
Mr. 14B reported that he currently lived with his 72 years old mother, his father left his mother 6 years ago and his only sibling, three years younger than he, was an attorney.
“I moved in with mom after I lost my last job. ‘Bout 6 months ago. She said I could stay ‘til I get another job but I’m trying to get on disability.”
“What’s your disability?”
Mr. 14B reported that he had “figured out” his diagnosis on line and that he was trying to find a doctor to do the paper work so he could “get SSI.” The Internet can be a helpful tool, but it can be extremely dangerous in the hands and minds of the psychologically untrained.
“What do you use?” I asked.
“Oh, when I was younger I used the usual–crystal, crack, a little heroin. Mostly I just drink now, use a little coke, some benzos when I can get ‘em.”
“So the crystal or crack hype you up and the heroin or benzos or alcohol bring you down, is that how it works?” (In the field of addiction, Benzodiazepines–Xanax, Klonopin, Ativan, etc.–are considered alcohol in a pill).
Bipolar disorder mimics this type of drug use. The patient is up, then down. He may be irritable in either phase, talk too fast, experience changes in sleep or eating patterns and may be suicidal. These can also be symptoms of drug and alcohol abuse. If properly diagnosed by a trained professional, bipolar disorder can be treated with medication and behavioral therapy.
“Tell me about your father. Does he drink? And your mother, sister?” I asked, seeking a possible biological link to the patient’s substance dependence in the Biological-Psychological-SociologicalModel of Addiction.
“Only a little, all of ‘em. My dad just thinks I’m a loser. He told my mom that she’s crazy and left her. He always wanted to kick me out and mom was afraid I’d die. My sister’s the good kid, I’m the loser.”
When a child dies, an estimated 80-90% of the parents divorce. The pain is too personal, too unbearable, often driving a wedge between the parents. Death is the one way to lose a child. Losing a child to addiction is another.
Friction in the family centers on how to pay for treatment and what type of rehab to seek. There are heated debates over what treatment really works and how much emotional support and involvement the family should give the addicted member. Then of course there is the blame game—who’s fault is it that an offspring has become an addict?
The “other child” often tries to be the perfect one, attempting to make up for the trouble and heartache caused by the addicted sibling–trying to make up for the hole in the family where the addict once dwelled.
She may be terrified, fearful for her sibling’s life but also tired of repeated relapses and broken promises. Searching the streets, the beaches, the fields for their runaway brother or sister can create a seething anger as well. Some experts believe family members of an addict may actually suffer from Post Traumatic Stress Syndrome from the repeated assaults on their sense of safety and the enormous, mostly self induced but still very real, pressure to make up for what the parents lost by having an addicted child, or the helplessness that comes with loving an addict.
“I know you guys love me, I can see it in every move you make. But I’ll never be everything because the bottom line is, there’re two kids and one of them is missing,” my daughter said of her heroin addicted brother.
When I left my position at the hospital, I became a certified personal coach, believing that the coaching model works well in families as opposed to the disease model that can leave family members feeling as though they suffer from a psychological disorder. In addition, coaching the addict on his road to recovery can be beneficial in any follow up treatment plan. With my background in clinical psychology if I detect pathology, clients are referred to appropriate professionals.
In my practice, I often see “scapegoating” the one who is dependent on drugs, making the addict feel he is to blame for all the problems in the family. This may or may not have any merit, but it does become an easy copout for other family members who do not want to face their own possible dysfunctions. In the example of Mr. 14B’s family, he may be the scapegoat for the family dysfunction.
Triangulation is another symptom I often see in families of addiction. The term triangulation is most closely associated with the work of Murray Bowen who theorized that a two-person emotionally unstable system forms into a three-person system or triangle under stress. (Bowen, Murray (1985). Family and Therapy in Clinical Practice. p. 478.) For example in Mr. 14B’s family, the father may have substituted his daughter to communicate dissatisfaction with the mother and discuss how to solve her brother’s addiction. The daughter is thrust into the role of a third party, even a “surrogate spouse,” thus triangulating the relationship with the mother. Aligning with her father may serve to solve the daughter’s ambivalence towards her brother however; it may alienate her from her mother.
Death is sadly the outcome in the life of those with substance dependence. The secondary death is often the family unit, destroyed in the firestorm of a loved one’s addiction.
Galen Morgan Cooper, Ph.D., is a specialist in addiction psychology. As a certified coach, Dr. Cooper helps families navigate their lives when addiction strikes as well as helping those with addictive behaviors focus on their goals. Dr. Cooper is the author of the book, A Turmoil Called Home: My Family’s Journey into the Hell of Addiction and a play of the same title, based on her memoir. Dr. Cooper speaks at community venues and universities, appears as an expert on television, and presents her play nationally and internationally to raise awareness on addiction.