{"id":218,"date":"2019-12-04T17:31:06","date_gmt":"2019-12-04T17:31:06","guid":{"rendered":"https:\/\/pressbooks.ulib.csuohio.edu\/substancemisusepart1\/chapter\/ch-2-name-4\/"},"modified":"2020-11-13T20:07:09","modified_gmt":"2020-11-13T20:07:09","slug":"ch-2-name-4","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ulib.csuohio.edu\/substancemisusepart1\/chapter\/ch-2-name-4\/","title":{"rendered":"Ch. 5.2: Family as Social Context"},"content":{"raw":"There is no doubt that substance misuse and substance disorders often seem to \u201crun\u201d in families. We explored genetic models in Chapter 2 and learned that expression of genetic vulnerability or resilience to addiction is heavily influenced by environment and experience. The family system<\/em><\/strong><\/a> is a powerful source of environmental influence to consider. This chapter explores the family as one influential social context of substance use initiation, substance misuse, substance use disorder, and recovery.\r\n\r\nFamily forms a context for a great deal of human development\u2014it is a site where individuals learn behaviors through operant conditioning (reinforcement and punishment of their behaviors) and observational learning (behavioral models), as well as become socialized into their culture, social norms, and social roles. The physical environment established by a family can also influence development and behavior through constraints and opportunities provided to individuals\u2014for example, ease of access to alcohol, tobacco products, or other psychoactive substances. Family social relationships influence a person\u2019s motivation for social conformity or deviance, as well. Family can be a source of stress to which a person might respond with substance use, or a source of resilience and protective factors that reduce the probability of engaging in substance misuse.\r\n

Family Systems Theory<\/strong><\/h2>\r\nNot only do we need to consider how learning, social learning, social norms, and cultural beliefs related to alcohol and other substances operate within families, we also need to consider how family system principles apply to the situation. A prevailing principle in family systems theory concerns families\u2019 conscious or subconscious efforts to establish and maintain a stable state of homeostasis<\/em><\/strong><\/a> or balance. Just like a biological organism (e.g., the human body), family systems tend to develop practices, roles, rules, norms, patterns of communication and behaviors that serve this homeostatic function. Consider, for example, a family \u201crule\u201d about not discussing or tending to minimize a member\u2019s substance misuse. Making the topic taboo might be dysfunctional in terms of getting the substance misuse problem addressed but may serve the family\u2019s need to maintain a stable peace despite the problem. Here is a brief orientation to four facets of the family systems theory as applied to individual members\u2019 substance misuse (see Begun, Hodge, & Early, 2017).\r\n
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  1. The family is a system embedded in other, larger social systems.<\/strong> Just as we saw the individual embedded in micro- to macro-level systems in the social ecological framework, family systems also are embedded in progressively larger social systems. We cannot hope to understand families or their behavior, functioning, and development without understanding their interactions with their ecological contexts\u2014the influences of extended family, neighborhood, social institutions, culture, society, and large-scale political, economic, and historical trends. Consider, for example, the influence of local, national, and global economy on families in your own community.<\/li>\r\n<\/ol>\r\nIn this framework, consider how family contexts might influence individuals\u2019 substance use behavior, treatment seeking, and recovery-related behaviors and the ways that family supports or challenges their substance use behavior or recovery efforts. For example, how might a family\u2019s relationships with religious\/spiritual systems, education or workplace settings, neighborhood, criminal justice system, child welfare system, and others be relevant in preventing substance use initiation or substance use from becoming misuse or a substance use disorder? Individuals are not only a product of (and influence on) interactions with the nuclear family but also of the family\u2019s interactions with extended family\u2014how might extended kin relationships impact the behaviors of an individual family member? Or, for example, how do kin play a role in caring for children when a parent is engaging in substance misuse or working on recovery (as discussed in a chapter about grandfamilies by Mendoza, Fruhauf, and Hayslip, in press<\/em>). A number of interventions for individuals experiencing substance use disorder are designed to involve families and supportive significant others (SSOs) in the process, as well as provide support to these families\/SSOs in their own right (e.g., as discussed in chapters about working with children and families of individuals engaged in substance misuse by Straussner and Fewell, in press<\/em>, and by Petra and Kourgiantakis, in press<\/em>). Considering the neighborhood, organization, and community levels, crime and violence in a neighborhood might be relevant because it affects family stress and distress levels, which in turn may influence substance use at the individual level; access to preventive and treatment interventions in the community are also relevant features of the family\u2019s context.\r\n\r\n\"AAn eco-map<\/em><\/strong><\/a> is a visual assessment tool (originally described by Dr. Ann Hartmann) used in social work to help families identify and express the nature and quality of their interactions with the surrounding systems\u2014what is supportive and what is detrimental, where the energy, emotional, and resource \u201ccosts\u201d to the family are excessive compared to what is gained, and where the \u201cgains\u201d are more favorable than the costs. In some cases, a family eco-map may appear overly sparse, leaving the family under-resourced and socially isolated. At the other extreme, a family\u2019s eco-map may be overly saturated with formal institutions that serve the family but at a high \u201ccost\u201d in effort and energy; even informal relationships are supported at some cost since they typically exist within a set of \u201cgive and take\u201d expectations. Even if the amount and types of ecological relationships may be reasonably balanced, the qualitative picture may be heavily conflict-ridden as opposed to working peacefully or harmoniously. For example, when a family member engages in substance misuse involvement with criminal justice, child welfare, housing, and health care systems may occur, much of which is demanding despite possibly providing needed resources. All of this relates to the degree of stress which the family system is under in its day-to-day existence. Stress is often translated into individuals\u2019 use of substances, according to stress and coping theory<\/em><\/strong><\/a> which emphasizes the stress experienced in contexts characterized by a great deal of social disorganization, distress, and alienation (Moos, 2006).\r\n
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    1. The family system is greater than the sum of its parts.<\/strong> \u201cThe family\u201d has meaning to its members separate from what each individual family member might mean. In other words, \u201cfamily\u201d is more than just a conglomeration of individual members living together. A family has an identity and \u201clife\u201d of its own. In many instances, family members act to further the family\u2019s interests, even at individual expense. When an individual engaged in substance misuse violates this family-oriented expectation it is experienced as a gross violation by other family members. On the other hand, the possible impact on family is one potential protective factor stopping an individual from misusing substances\u2014the impact on their family, not just on themselves. It also may be a motivating factor in someone wanting to engage in treatment and recovery\u2014unfortunately, it can be difficult to sustain this kind of family-focused motivation when substance use clouds a person\u2019s mind and drives individuals\u2019 substance seeking behavior.<\/li>\r\n \t
    2. Family systems are comprised of subsystems.<\/strong> Family systems do not always operate as a whole; many interactions, roles, and functions are enacted within subsystems of the larger family system. These might include a couple subsystem, parent-child subsystems, or sibling subsystems. The possible variants are numerous especially when ex-partner, step-parent, step-\/half-sibling, and extended family subsystems are involved. In families where a member is engaged in substance misuse, it is possible that the person\u2019s \u201crelationship\u201d with the substances themselves functions much like a subsystem. For example, an adult son living with his mother\u2014both of whom experienced active substance use disorders\u2014described their two-person family in terms of there being \u201cthree of us\u201d in the relationship\u2014himself, her, and the drugs (quotingTony from the documentary entitled Foo Foo Dust<\/em>).<\/li>\r\n \t
    3. Change in any part of the system affects the entire system.<\/strong> Family systems are dynamic, changing over time as recognized in the chromosphere aspect of the social ecological model\u2014past, present, and future look different because families are not static or stagnant. It is important to remember that all change\u2014positive and negative in nature\u2014are experienced as stressful, challenging the family system\u2019s hard-earned balance and homeostasis. Consider, for example, how stressful happy family development events like marriage, childbirth, and retirement can be for the system; this adaptive pressure might bewilder families who only expected to be stressed by negative changes such as divorce or the death of a family member. Family system changes are a response to pressures from the outside (contexts), family membership, internal subsystems, and changes in individuals. Some pressures are developmental in nature\u2014the dynamics of parenting young children may be very different from parenting adolescents, for example. It is the nature of systems that change in any part of the family system reverberates throughout the entire family system, sending ripples throughout the system.<\/li>\r\n<\/ol>\r\nDespite individual and family developmental changes presenting periods of stress, which in turn may trigger a transition from substance use to misuse or may trigger a relapse during recovery, it is also possible that family changes can lead to a reduction in substance use (Moose, 2006). For example, the transition to parenthood, while creating stress on the family system, also may lead young adults to adapt their substance use to become more aligned with role expectations of parents\u2014certain adult roles are not compatible with alcohol and other substance misuse and therefore may exert pressure to reduce or cease substance use (Moos, 2006). Adolescents and emerging adults maturing and entering into important social roles often is associated with reduced substance use, perhaps due to greater responsibility and\/or pressure from partners concerning what is no longer appropriate substance use; \u201cmaturing\u201d out of substance misuse is less likely if misuse has progressed to the point of a substance use disorder (Begun, Bares, & Chartier, in press<\/em>).\r\n\r\nRole theory<\/em><\/strong><\/a> also has relevance for how a family member\u2019s substance misuse might be experienced by the family system (Begun, Bares, & Chartier, in press<\/em>). Family members adopt and fulfill roles that function to serve the demands of the social environment, the family as a whole, and the needs of individual family members (Begun, Hodge, & Early, 2017). While specific family roles, tasks, and behaviors vary by culture, context, time, and circumstances, key family functions include (1) obtaining and distributing resources necessary for meeting members\u2019 basic needs for food, shelter, and protection, and (2) socialization of family members into family and societal roles (Begun, Bares, & Chartier, in press<\/em>). Family dysfunction is common when one or more family member, particularly a parent, engages in substance misuse (Straussner & Fewell, in press<\/em>). That individual\u2019s expected roles could be:\r\n