When one family member is addicted, everyone in the family knows what’s going on, but nobody wants to address it. While this may not be the case to begin with, as the addiction progresses, there’s no hiding the damage from the consequences that pile up. More than likely, others outside the family are aware there’s a problem as well. Still, many people choose not to get involved. But the crux of the problem, and the solution, lies directly within the family. It is necessary to acknowledge the elephant in the room before any progress can occur. Ignoring the problem of addiction in the family can be deadly.

Family Dynamics Shift

Over time, as family members of the addict go about their daily lives, their roles begin to shift. This happens subtly and without conscious thought, in most instances, as a means to simply get by. What may be obvious addictive behavior to an outsider becomes a tolerated every day event within the family. One or more family members cover up, make excuses, rationalize, justify, deny or ignore the real issue: Addiction is a disease and it doesn’t go away by itself. In the process, the addict’s family members become co-dependent. They, in fact, enable the addict to continue his or her self-destructive path.

Here’s how some of the roles shift. Of course, there’s the addict, who becomes, in effect, the center of the family universe. Sooner or later, everything seems to revolve around the addict and his or her needs. There’s the need to tend to the consequences that occur as a result of the addiction and the necessity to tiptoe around the addict’s wildly unpredictable, unrealistic, and/or violent behavior. The addict is the tyrant, the dictator, destroying the fabric of normal family life – all as a result of the addiction.

Addiction counselors identify several roles in the co-dependent family members. In smaller families, one or two individuals assume the various roles as circumstances demand, while in larger families the roles are more clearly defined. In all cases, the roles are unhealthy and only serve to perpetuate the behavior of the addict.

• The Joker – Making light of the situation is the province of the joker. This person tries to use humor, at times light, other times biting and cruel, to inject levity into the situation. Often, the joker experiences profound embarrassment, shame, and anger about the family situation. Who wants to deal with the depressive state that surrounds addiction? Something has to deflate the lead cloud in the home. The joker serves this part well, but this behavior does nothing to alter the circumstances and only further complicates any hope of recovery – for the addict or the family.

• The Savior – Sometimes called the hero, the savior does everything in his or her power to cast the family in the best possible light. We’re a normal family. We don’t have a problem, everything’s just fine. The savior, who is also often a perfectionist, talks about things and goes on about life as if the addiction simply doesn’t exist. Underneath, the savior feels intense guilt, shame, and fear that others outside the family will find out.

• The Sad-Eyed Child – This family member remains silent most of the time. Usually, it’s a child, although it can be an adult family member as well. The characteristics of the sad-eyed child are that he or she will never speak about the addiction, never refer to it in an overt way. Often ignored, shunted to the side as a result of the necessity to cater to the needs of the addict, the sad-eyed child suffers greatly and stays out of the way of the addict. With none of his or her own needs met, the sad-eyed child can’t grow. Inside, however, intense feelings of loneliness, neglect, guilt, and anger are festering.

• The Enabler – Often a female family member, the enabler, also called the caretaker, is the chief co-dependent, the person that makes the roles of the other family members possible. The enabler puts on the positive face to everyone outside the family and never brings up the issue of getting treatment. Instead, all the bad behavior and consequences that ensue from the addict are glossed over, denied, or excused by the enabler. Furthermore, the enabler’s driving ambition is to keep the family from talking about the addiction, to operate in a vacuum where addiction, treatment or recovery doesn’t exist. Everything’s fine. We’re okay just as we are – one happy family. The enabler, however, has mounting fear, helplessness, and a sense of inadequacy.

Things Go From Bad to Worse

In the whirling turmoil of family addiction, just getting by becomes more and more difficult. Depending on the extent of the addiction, how long it has gone on, what substances are involved, and whether or not there are underlying medical or psychological conditions present, the family situation can deteriorate slowly or much more rapidly.

There may be profound consequences that occur as a result of the progression of the addiction that need to be dealt with. These may be financial, social, or legal problems. The addict may be the breadwinner in the family and, when he or she loses their job, loss of the family home and other financial losses may threaten disaster. If the addict has had a motor vehicle accident while under the influence of alcohol or drugs, there may be liability claims, injuries or death as a result. There certainly will be mounting legal expenses, fines, increased insurance costs, and possibly jail time.

The risk of family violence increases as addiction progresses. So do drowning, fights that may turn deadly, and crimes committed to finance the addict’s habit which may end in murder.

Medical problems start to crop up for the addict, including stomach ulcers, hepatitis, HIV/AIDS, cirrhosis of the liver, kidney failure, heart disease, stroke, neuritis, brain damage, dementia, and ultimately even death. Overdose death is an increasing risk, particularly for heroin and methamphetamine addicts, but also from acute alcohol intoxication. Some drugs such as MDMA or ecstasy, also referred to as party drugs, cause problems with fluid balance – too much water or dehydration. Hyperthermia or overheating often results. This is a very dangerous condition that can cause permanent brain damage or death.

But it isn’t just the addict that suffers as the addiction progresses. Everyone in the family is impacted. The roles so carefully maintained just to get by no longer insulate family members from the consequences of the addict’s behavior. Stresses mount up. Frequent outbursts of anger, tears, recrimination and blame start to occur as the family dynamic continues to unravel.

At some point, something has to give. It’s at this point where one of the family members may bring up the topic of treatment.

Turning It All Around

When the recognition of the problem begins to dawn on family members – or at least with one of them – this is the critical turning point. Without recognition, there can be no hope of recovery. Someone has to bring up the subject, directly or indirectly. One method that is helpful, particularly in families where nothing else has worked, is intervention.

In an intervention, which is conducted by an intervention professional, family members and friends confront the addict and encourage him or her to admit they have a problem and to commit to going to treatment to overcome it. The conclusion of the successful intervention is that the addict is escorted by the interventionist directly into treatment. Of course, not all interventions are successful, since the addict has to be willing to undergo treatment for the best potential outcome. But many are, hence their popularity as a mechanism to get the addict into a program where the disease can be treated.

It is important to note that denial of the problem by the addict is the chief hurdle the intervention seeks to overcome. The addict usually says that he or she will go to AA or some other 12-step group meetings. Promises of quitting or cutting down are also common. But these are just words, and words have no teeth against addiction.

The reason so many interventions are successful lies in the power of the group support, encouragement and love displayed by family members and close friends. It isn’t an issue of ganging up on the addict. Rather, it’s the supportive environment where all concerned talk about what the addict’s behavior has done, how it hurts each person, how they feel about the situation, and how they want the addict to get help.

There’s actually nothing more powerful than such group support, especially when it ends in the addict agreeing to enter treatment – and actually going. It needs to happen immediately, not tomorrow or next week. All the arrangements are made ahead of time, all the paperwork and financial agreements concluded, so that when the addict says, “Okay, I’ll go,” he or she leaves the home (or wherever the intervention is held) and goes right into treatment.

Some families may not have insurance that covers treatment. While this could complicate getting the addict into treatment, there are alternatives. The most successful treatment for some chronic, long-term addictions is a residential treatment program. These entail a minimum of 30 to 60 days, and can last longer, depending on the individual’s needs. Many residential treatment facilities have pay-as-you-go or sliding-scale payment plans, in addition to insurance that may pay for some part of the treatment. Others offer special financing, or provide scholarships or grants to help cover the treatment. The key is not to let finances deter families from seeking treatment for their addicted loved one. There is always a way to get help. It may take a bit of research and asking a lot of questions, but it can be done.

Treatment for the Family

Addiction is a family disease. So it’s more than just the addict that needs to get treatment. No, this doesn’t mean that the other family members go into a facility for one or two months. What it does mean is that the family members are actively involved in various aspects of their loved one’s treatment program. The treatment staff will invite the family members in for different aspects of the plan. This often involves regularly scheduled individual and/or group counseling, educational meetings and recreational or social interaction with the addict and others at the facility.

Some facilities have intensive couple’s seminars of varying lengths – weekends, 4 to 7 days, or longer – consisting of educational and clinical activities to promote forgiveness, understanding, and acceptance. At the same time, such seminars or workshops focus on working through the years of accumulated shame, anger, resentment, bitterness, and fear. Coping strategies and development of healthy behaviors are taught.

Aftercare is another critical part of recovery, both for the addict and the family members. Continuing individual and group counseling is essential, as is attendance and participation at 12-step support group meetings. For the addict, these may include Alcoholics Anonymous, Cocaine Anonymous, Narcotics Anonymous, Crystal Meth Anonymous, Gamblers Anonymous, Overeaters Anonymous, Debtors Anonymous, Marijuana Anonymous, Sexaholics Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexual Compulsives Anonymous, and Workaholics Anonymous.

Support groups for family members include Al-Anon/Alateen, Adult Children of Alcoholics, Co-Anon Family Groups, Co-Dependents Anonymous World Fellowship, COSA, Gam-Anon, Nar-Anon Family Groups, and S-Anon International Family Groups.

A family wellness program helps educate family members about the disease of addiction, encourages them to examine their roles within the family, and provides strategies for identifying and addressing addictive behavior. Understanding what behavior is helpful and what is harmful to a substance abuser is also a key part of family treatment. Each family member needs to learn tools and strategies to use in order to remain healthy while their loved one is in treatment and then in recovery. Even if the loved one rejects treatment, or suffers a relapse, family treatment is vitally important.

How long does such family treatment and counseling take? It varies for each family and individual. The focus shouldn’t be on how long it takes but how effective it is in helping family members. Healing is a process, and it takes as much time as each person needs.

In the final analysis, it is only when the elephant in the room is recognized that family members can take the appropriate steps to help themselves – and the addict – find their way into recovery. Although it seems hard to believe for those who are deeply immersed in the effects of family addiction, recovery is not only possible, it may mean the beginning of a highly productive and successful life. It begins, as always, with the first step: the desire to make a change.