Ask a Psychologist: When a Family Member Is Struggling with Addiction

How to ask for help, and how to move forward

Q:Hey APW,

I’m getting married in August (yay! yikes!) and am seriously struggling with a family conundrum. My older brother is an addict and has been in and out of relapse over the last four years. It has been an extremely difficult time for my family, as like most addicts he has repeatedly lied to us and done other unspeakable things to lose mine and my parents trust. In the last month or so things have taken a turn for the worse and he continues to lie and likely use drugs. He’s always been on the invite list, because, well, he’s my brother. However, the closer it gets to the wedding the more anxious I become about the situation and the more stressed out my mother gets. It is problematic because if I uninvite him—which I wouldn’t even begin to know how to do, or have the guts to do, then my parents will be stressed about what to tell extended family members and friends when they ask why he isn’t there. On the other hand, what if he comes and is strung out and makes a scene? With only six weeks before the wedding I realize I’ve got to figure it out soon. Do I make ultimatums to him that he has to have a clean drug test in order to come to the wedding? Do I sadly hope that he can’t get it together financially to make it from the West Coast to the East Coast? Do I flat out tell him he can’t come?

Yours,
Desperately seeking advice from APW families with substance abuse issues

A:Dear Desperately Seeking Advice,

Addiction can be a devastating disorder for the people who struggle with it, as well as for their families. It’s not easy to manage this in the midst of preparing for your wedding. But substance abuse also affects a large number of people, which means that there is a tremendous amount of information out there about how people and their families can recover from addiction. And there are many stories of success in recovery. You are already handling this well in asking for help, and in thinking about different ways to move forward.

Addiction is a biologically based illness that significantly changes the brain, particularly in terms of its reward center, as well as its ability to think clearly, make decisions, and control impulses. As the National Institute on Drug Abuse website points out, anyone can become addicted to drugs. And as tolerance and dependence develop, the drug is craved not just to achieve a high, but to avoid the severe withdrawal symptoms. So, a person’s life can quickly become organized around obtaining and using the drug. This is important to keep in mind, because it helps to gain perspective on the challenging behaviors that often accompany addiction and negatively impact relationships, including becoming unreliable, lying, and stealing. These behaviors can wreak havoc on families’ lives, but they are rooted in a biologically based disorder, which needs psychological treatment and/or medical care.

Like recovery from many illnesses, recovery from addiction requires people and their families to balance responsibility and acceptance. In planning your wedding, you are responsible for thinking about what you want and need to feel comfortable and happy on that day, while also staying realistic about potential obstacles. So, first of all, make sure that you are taking care of yourself. This might mean seeing your own therapist, going to a self-help group for families of people with addiction (by yourself or with family), or trying family therapy. Remember that addiction is a common disease, that you are not alone in having a family member struggling with it, and that there are many resources out there to help.

To help answer your question, I talked to my colleagues, Romy Reading, Ph.D., and Nora Moore, Psy.D., New York City psychologists with expertise in addiction. Weddings are wonderful celebrations, and they also create family pressure, both of which can trigger relapse, explain Moore and Reading. If your brother is going to attend the wedding, Reading and Moore suggest creating a safety plan. You, friends, or family can set parameters in advance to plan for potentially challenging situations on the wedding day. For example, you might assign someone who knows your brother well to support him and escort him out if necessary, or you may decide what information you want to share, and with whom. If you do decide that your brother should not attend the wedding, Reading recommends that you talk to him about it as soon as possible, and that you continue to have an ongoing, collaborative family dialogue, rather than focusing on ultimatums or obtaining drug testing.

While you’re thinking about the wedding day, don’t forget to also think more long-term about the future and your family relationships. Your brother needs help. If he is already in treatment, he may need a more intensive setting. And he may also be able to recover. “A wedding is a special day, but it is just one day out of your life,” notes Moore. “Think about what kind of relationship you want with your brother, and start there. Have you talked to him about your concerns? Can you work with him to come up with a plan so that, should he come, both of you will feel comfortable? It’s possible that you decide together that it’s best for him to not come, not because you don’t trust him, but because you are a sister supporting her brother in his struggle to recover from addiction.”

In the comments section of my July post about coping with a parent’s depression, there was an interesting discussion about stigma toward mental illness, but not towards medical illness. Moore agrees, “If your brother had a medical condition that prevented him from coming, would it be as stressful to explain? Addiction is not a failure in character, but an illness, and focusing on keeping up appearances can have negative consequences.” So, as for the question of what other people will think, choose what you want to explain, and to whom. Lean on the people you are closest to for support. Choose how much energy you want to put into worrying about what everyone else thinks (recommendation: none). And honor your wishes to create a beautiful, meaningful wedding day for you, your partner, and your families.

For more information on treatment, research, and resources for people with addiction and their families, visit the National Institute on Drug Abuse website and Faces and Voices of Recovery.

The information provided in Ask a Psychologist is intended by Dr. Brofman and APW to serve as general advice and guidance for all readers. The advice herein does not constitute a clinical recommendation or relationship, and Dr. Brofman and quoted mental health professionals do not take clinical responsibility for this information. Ask a Psychologist does not take the place of a confidential clinical consultation with a trained mental health professional.

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