Helping Families

Of Drug Abusers

By

Riffat Sadiq Ph.D

A Publication Of Drug Free Nation

www.drugfreenation.org

A G

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Dedicated to

All family members of drug abusers with

great sympathy and sincere feelings

Drug Free Nation © 2013-2014

Contributors

Bill Cameron

President,

Drug Free Scotland

Grainne Kenny

Hon. President, Europe Against

Drug Abuse

Haider Ali

President

Drug Free Nation

Safia Umer

Program Manager,

Drug Free Nation

Rabia Riaz Ph.D.

Assistant Professor,

Department of Psychology,

University of Karachi

Preface

Family members of drug abuser are kept hanging for unlimited

time along with their addicted patients. Entire family environment,

especially in South Asian Societies, becomes a torture cell for non-

addicted members. Associated behavioral problems of drug or substance

abuse do not let rest of the family members take sigh of relief until

addicted family member recovers.

Entire family falls in the swamp and undergoes the severe stress.

They are vulnerable to various psychological problems. With impaired

mental health, they could not help their patients as they must.

Codependency, social stigma and economic destruction, in turn, make

them dysfunctional members of society.

Mental health and other professionals treating drug abusers must

be equally attentive towards the psychological issues of all family

members of their patients. Only conducting family support group and few

sessions of family counseling can never be effective. A comprehensive

treatment program needs to be followed in order to make the entire

family psychologically healthy enough to be effective supporter of their

drug abuse family member. The current book has been written to guide

the professionals affiliated with drug abuse treatment and rehabilitation

centres. Therapeutic techniques have not been described in details. Only

purpose is to make professional aware of preparing comprehensive

treatment plan exclusively for families of drug abusers.

Riffat Sadiq

S.No Content Page 1. Chapter 1

Introduction

Drug Abuse Scenario in South

Asian Countries

Impact of drug abuse on families

1

2. Chapter 2

Family and its Functions 7

3. Chapter 3

Impact of Drug Abuse Problems on

Family Functions

15

4. Chapter 4

Professional Services for the Families

of Drug Abusers

27

5. Chapter 5

Individual Psychological Counseling 35

6. Chapter 6

Family Counseling 40

7. Chapter 7

Life Skills Training 44

8. Chapter 8

Conducting Family Support 48

9. Conclusion 54

10. References 55

Content

Chapter 1

Introduction

Drug Abuse Scenario in South Asian Countries

Impact of drug abuse on families

1

Introduction

Drug Abuse Scenario in South Asia Countries

The term “drug abuse” has been known to all of us for centuries and people

have been abusing drugs since ancient times. With the passing of time, a variety of

drugs along with their modes of intake have been variously introduced. Culturally,

people define drug abuse differently. For instance; some communities use alcohol as a

part of recreational activity; smoking of opium is still treated as a traditional practice in

the region of South Asia, so in different circumstances, drug abuse is given different

meanings (Voses, 1982, as cited in Muhammad, 2003).

Health professionals have categorized drug abuse as a separate chronic disorder

due to its pernicious effects on user’s health. Drug abuse refers to a compulsive

behavior of using drugs that leads to physical, psychological and as well as social

problems for the users.

World Health Organization defines drug abuse as, “a consumption of a drug

apart from medical need or in unnecessary quantities

In Diagnostic and Statistical Manual (DSM-IV) "psychoactive substance

abuse" is defined as "a maladaptive pattern of use indicated by ...continued use despite

knowledge of having a persistent or recurrent social, occupational, psychological or

physical problem that is caused or exacerbated by the use [or by] recurrent use in

situations in which it is physical1y hazardous".

Drug abuse has become a global concern because of its detrimental effects on

the individual, family, society and economy of the country as well. The global

prevalence rate estimated by United Nation Office on Drug and Crime (UNODC)

pertaining to drug abuse was 3.3% to 6.1% till 2009. About 149 to 272 million people

between 15 to 64 years of age in all over the world abused illicit drugs. About 153 to

300 million people used illicit drugs in the year of 2010.

Chapter 1

2

South Asian countries in particular have been entangled in drug abuse

problems since 1970 (Spencer & Navaratnam, 1981) with cannabis being the most

common drug. According to the survey report of Pakistan Narcotic Control Board

(PNCB, 1993), there were 3 million drug abusers in Pakistan and amongst them 51%

were addicted to heroin. National assessment on drug abuse problems in Pakistan

(2006) depicted that there were 628,000 opiate users and amongst them 482, 000 were

abusing heroin. The prevalence of drug abuse in Khyber Pukhtoonkhua was 0.7%, in

Punjab was 0.4%, in Sind was 0.4% and in Baluchistan was 1 %. At country level,

prevalence of drug abuse was 0.7%. United Nation Office on Drug and Crime

(UNODC, 2002) reported that there were 5000,000 chronic heroin users in all over

Pakistan. A survey report indicated a higher prevalence of alcohol, tranquilizers and

psychedelic abuse among medical students. The prevalence of these drugs among

students was 5 %, whereas among doctors was 3% (Shafiq et al, 2006). In a study,

Khan and Colleagues (2004) found the highest prevalence of drug abuse among people

falling between the age ranges of 21 to 30 years, and married. Most of them were

heroin addicts claiming to use drugs due to peer pressure. About, 5% of the population

was abusing one or more than one type of drug.

Drug reports in South Asian Countries (2009, as cited in INCP, 2011) revealed

that in South Asia, cannabis is the most commonly abused substance. About 3.3% and

1 % population use cannabis in Bangladesh and in Sri Lanka respectively. The

prevalence rate of opiate abuse in Bangladesh is 0.4 % and in Sri Lanka is 0.1%.

Population of other South Asian countries such as; Bhutan, India and Nepal also have

been addicted to opiates. The use of opium is highest in India. The trend of abusing

drugs by injection got higher in Bangladesh, India (0.02%) and in Nepal (0.01%). In

Maldives, mode of injection also has been increased. Heroin and buprenorphine are

the most preferred drugs via injection in these countries. Other drugs, for example

opioids or a combination of buprenorphine and antihistamines or sedatives (mostly

benzodiazepines) have become choice of drugs among most of the drug abusers in this

region. Furthermore, a trend of poly drug abuse has increased in South Asian

countries.

Chapter 1

3

Chapter 1

According to United Nation Office on Drug and Crimes (UNODC, 2009) the

prevalence of opiate abuse in Afghanistan was among the highest in the region where

prevalence of drug abuse reached to 53 %, 230,000 during four years. There are 120,

000 were heroin addicts. The annual prevalence of opiate use was estimated to be 2.7%

of adult population. The estimated prevalence of opium use was 1.9% of adult

population. Heroin prevalence was 1.0% of adult population, the prevalence of adult

drug users was equal 1 million (940,000). They all were falling between the age ranges

of 15 to 64. Opium, cannabis and heroin were was most common drug abuse among

men and young users. About 60 % drug abusers used opium in their life. Opium,

cannabis and heroin were commonly used by young women, opium, cannabis and

tranquilizers (painkiller) used by women, whereas cannabis, opium and heroin were

most commonly used by adolescents. Opium, cannabis and tranquilizers were used by

children. Drug abusers spend 300 million dollars on their drug habit every year.

4

Drug Abusers and their Families

Drug abuse has significant effects on the health and happiness of individuals,

families and communities (Muhammad, 2003). And these effects carry severe penalties

in economy, politics and international relations. Poor health, decline in income and

social isolation further damage the individual functioning and as well as impede the

family’s growth. The annual estimated rate of drug abusers is equivalent to 100,000 in

Pakistan that bring psychological, social and economic harm to 20 million abusers and

their family members.

In India, a drug dependent expends 13 dollar per week on buying drugs and

total expense are 250 to 25,000 dollars. That leads to poverty and other family

problems (as cited in Sharma, 2009). About 58% of family members of drug abusers

reported bad feelings; 2/5 reported anger and annoyance, whereas 22% reported to

have the feelings of hopelessness, shame and non-supportive attitude for their drug

abuse family member. Unwanted behaviors were observed in 36% drug abusers,

whereas domestic violence was reported among more than 80% drug abusers.

There was a strong association between drug abuse and disintegration of

family. The consumption of heroin and psychotropic substances leads to breakdown in

family cohesion (Spielmann, 1994) in Thailand. Drug abuse destroys the family

functions (Sadiq & Umer, 2013). Families of drug abusers suffer from financial

constraints, lack of protection and affection. Family prestige is also at great risk of

severe destruction. Eventually, family reacts to drug abuse by denying, blaming,

suppressing anger, depression and co-dependency (Sharma, 2009). Drug abuse family

member becomes the source of pain and stress for rest of the family members.

Eventually, family becomes emotionally dependent on drug abusers. In such situation,

the family gratifies the abuser’s need for drugs in order to overcome pains associated

with drug abusive behavior and to protect the entire family from further harm. Family

itself becomes dysfunctional and co-dependent. A significant distress has been

observed among parents, specifically mothers of drug abusers (Andrade, Sarmah &

Channabasavanna, 1989).

Chapter 1

5

Chapter 1

Wives of alcoholics reported the coping behaviors of avoidance, indulgence

and fearful withdrawal in response of drug abuse problems in their partner

(Chandrasekaran & Chitraleka, 1998). Delusional jealousy and violent behavior on the

part of drug abusers are causing factors of suicidal attempts among spouses

(Ponnudurai, Uma, Rajarathinam & Krishnan, 2001 ). Families of alcoholics suffer

from guilt, stigma and emotional withdrawal (Nace et al, 1982). Family finances,

gatherings, communication, roles and social life are spoiled due to alcoholic behaviors

(Velleman, 1992). Family relationships are also impaired due to the drug-related

crimes and accidents (Coleman & Strauss, 1983).

United Nation Office on Drug and Crime (UNODC, 2002) has reported that

family members provide money to drug abuse family member due to coercion and

desperation. Some of them had to pay loans on behalf of their drug abusing family

member. Female family member face a huge burden of bearing household expenses

along with burden of blame. She herself becomes the victim of both drug abuser and

society. All these factors result in feelings of guilt, shame, embarrassment, depression,

anxiety, isolation and suicidal thoughts. At this stage, family members of drug abusers

themselves need professional help to be come out from their own psychological

problems and extreme emotional dependency on drug abuse family members.

6

Chapter 2

Family and its Functions

Functions Of Family

Economics

Prestige and Status

Education

ProtectionReligion

Recreation

Affection and

Procreation

7

Chapter 2

Family and its Functions

Defining Family

Family is described as a basic unit of society. From biological perspective, a

man and woman come into a legal sexual relation to produce future generation.

Formally, a family comprised of father, mother and a child.

Sociological perspective takes into account the social needs of family and its

role in running social institution. Family, for sociologists, refers to a social group,

social institution and social system. The function of family is beyond the production

of children and including upbringing the children with the aim of developing a sense of

socialization so that they benefit the social system or vice versa. Different families

make a social system giving various flavors in form of race, class etc.

Benekraitis (1996) has defined family in traditional way. Two or more persons

make family based on blood relation, marriage or adaptation. They live together being

an economic unit besides raising children.

In the view of Nimkoff and Ogbum (1985), “family is a socially sanctioned

group of persons united by kinship, marriage or adaptation ties that generally share a

common habitat and interact according to well-defined roles”. Functional

Perspective (Doherty et al., 1993) deems family as a subsystem of society because

society’s growth largely depends on family.

Religious perspective of family discusses the combination of both biological

and social need of the family. Two persons make the foundation of family by tying the

knot following their cultural and religious norms. In all religions, family is deemed as

a source of personal and social satisfaction. Each religion discourages the involvement

in illicit sexual activities and family violence. Religion bounds all family members to

fulfill the basic needs of each other. Family members are also responsible to exhibit

care, love and affection in order to create a healthy family environment.

8

Psychologists put reflection on those factors that may positively or negatively

affect the family environment. Besides investigating the determinants of family well-

being, the significant effects of family environment on individual also have been under

their debate. Parental attitude, socioeconomic factors, family structure, process and life

style play vital role in developing psychopathologies and delinquent behaviors among

family members.

Axiomatically, family is a combination of sexual, social and psychological

needs of a person. Healthy family provides physical, mental and sexual satisfaction

which diminishes the probability of delinquent behaviors towards the promotion of a

civilized society.

Chapter 2

9

Seven Functions of Family

William Ogburn in 1930 suggested seven functions of a family which are

as follow;

Chapter 2

1. Economics:

The first and essential function of family is to

produce economic sources to gratify basic needs of

the all of the family members.

2. Prestige and Status:

Each member of family is recognized by his

family name in the society. A person is valued or

devalued on the basis of his or her family’s reputation

in the community. Therefore, family must provide

prestige and status to its all members.

3 Education:

The family is also responsible for providing

education regarding domestic services, needs and as

well as searching educational opportunities for family

members especially children which are needed to

compete the society.

4. Protection:

The forth function of the family is to gratify

the need of security. Elders are responsible to provide

physical, social and as well as economic protection to

younger family members.

10

Chapter 2

6. Recreation:

A family also needs to arrange recreational

activities within family not merely relying on the

community and schools etc.

5. Religion:

A family must follow the religious values by

arranging religious gathering, arranging religious

prayer along with acquiring religious education

through the use of Holy books and other scriptures.

7. Affection and Procreation:

The family members also need affection

from each other. The family provides adequate

affection to family members besides emphasizing on

procreation.

11

Chapter 2

Winto (1995) had examined following functions of the family

To provide replacements for dying members of society:

All human beings coming into the world have to go back. Human

beings are being replaced by one and other. Therefore, family is basically

formed to reproduce human beings to continue the system given by

nature. A couple is blessed with a child as a member of society. Later on,

he or she makes his family, gets married and produces a child. At a stage,

his parents go back to eternal place. The entire world is based on this life

cycle

To produce and distribute goods and services:

Provide goods and services for the support of the members of the

society is the second function of the family. Family puts effort to meet

the basic needs of its members as good as possible.

To accommodate conflicts and maintain order internally

and externally:

Certain conflicts are expected to occur within family and

between family members and society. Function of family is to resolve the

conflicts, to reduce internal and external problems and to build the

potentials among family members so that they could resolve the conflicts

themselves

Family Function

Provide Replacements

Produce And Distribute Goods And

Services

Accommodate Conflicts And

Maintain Order

12

Chapter 2

Ghani (2000) also discussed various functions of family which are more or less

similar to the seven functions proposed by Ogyum (1930). Following are the eight

functions of family;

1. Reproduction of perpetuation of human race:

Family is responsible for the reproduction of humanity as nature

demands from all human beings.

2. Sexual Regulation:

Family promotes legal way to satisfy sexual needs and regulate the

sexual behavior.

3. Imparting religion and values:

Each family and society has its own values and religious norms. Family

is responsible to impart religious education and social values/norms to the all

family members.

4. Socialization:

Family also strives to be socialized by producing socially adaptable

family members. Family makes tie with other families in the society.

5. Economic Function:

Family has to explore economic opportunities available in the society, to

plunge into competitive environment and to utilize all capabilities to be

economically flourished.

13

Chapter 2

6. Affectional and emotional security:

Family provides affection and emotional security to all family

members. Gratification of needs for love and care are first take place

in the home.

7. Education:

Making family members educated and knowledgeable to

survive in the community is another important function of the family.

Religious and other educational opportunities need to be provided to

entire family.

8. Recreation:

Family also needs to be involved in re-creational activities

apart from striving for economical and educational resources.

Recreation contributes to healthy growth of family.

Family Functions

Reproduction Of

Perpetuation Of Human

Race Sexual Regulation

Imparting Religion And

Values

Socialization:

Economic Function

Affectional And

Emotional Security

Education

Recreation

14

Chapter 3

Impact of Drug Abuse Problems on

Family Functions

15

Impact of Drug Abuse Problems

on Family Functions

Destruction of Family Functions

Chapter 3

1. Destruction of Economic Resources:

Drug abuse, at first, results in destruction of family economy.

When earning member of family get involved in delinquent behaviors such

as; they become unable to produce sufficient economic resources that lead

to deprivation of basic needs.

According to Dean (1984), when an earning member of a family

indulges in addictive behavior, his wife and children have to be dependent

on others, such as their parents and grandparents for the gratification of

their basic needs. As a result, they deprived of food and good education. In

last, they feel no sympathy and emotional attachment for drug abuse

family member and consider him responsible for this worst situation.

Lower and middle class families suffer a lot. Drug abusers sell

home appliance and other needy materials. Sometimes, families have to

pay others for things stolen by their drug abuse family members for buying

drugs. Many children of drug abusers have to work in factories and shops

to bear household expenses. Mothers in old age, wives and even young

sisters have to go out to earn money. Drug abuse, instead of providing

economic resources to family, himself becomes dependent on them. He

also destroys family’s wealth for drugs (Sadiq & Umer, 2013).

16

Chapter 3

Case Study

Razia is a mother of three addicted sons. Two of them are married and

having children. Razia’s husband has passed away and she is fully

dependent on their sons who are chronic drug abusers. They have been

rehabilitated many times but got relapsed. Their indulgence drug

destroyed family finances. As a result, Razia in her old age has to work

to meet household expenses. She also used to beg for money under

severe economic crises. All of the responsibilities of grandchildren and

daughters-in-law are on her shoulders. She keeps weeping and says

nothing.

17

Chapter 3

2. Destruction of Prestige and Status:

Drug abuse brings harm to family’s prestige and status. A

large body of research evidences reveals the association of drug

abuse problems with criminal behavior. Robbery, pick pocketing,

stealing are drug abuse related crimes (Sadiq, Umer & Ali, 2013).

Involvement of drug abuse family member in such crimes, has

detrimental effects on family’s reputation. According to Ogyum

(1983), each member of family is recognized by his family name in

the society. Unfortunately, family members of drug abusers develop

feelings of shame and guilt because of drug abuse family members.

They also perceive rejection from society; as a result, they socially

restrict themselves. Even, in sub-continent, people do not like to tie

the knot with the girl belonging to drug abuse family members.

Case Study

Saima’s brother is a heroin addict. He is also involved in crimes and

has been arrested twice. Saima is 24 years old and her parents want

her to be married as soon as possible. But, they have no suitable

proposal for their daughter because of their addicted son and his

involvement in drug related immoral activities. Even, Saima’s

paternal aunt did not like to make her daughter-in-law. Saima has

developed feelings of rejection and inferiority. All of her age fellow in

family and community got married. She blames her brother for her

misfortune..

18

Chapter 3

3. Destruction of Education:

As mentioned earlier that family is also responsible to provide

educational opportunities for family members specially children to be

survived. Drug abusers do not remain capable for arranging educational

resources to their children and other family members. The most pitiful aspect

is that children of drug abusers have to go to work and jettison their dreams to

be educated. The drop out of children of drug abusers from school is common

(especially in lower class).

When elder family member spends all of family’s wealth on drugs

leaving nothing behind for any one then, children and younger family

members have to sacrifice their needs. Many children of drug abusers have

been seen doing labor work.

Case Study

Ali’s father is a drug abuser and involved in gambling. He needs more

money for gambling and taking drugs. Ali used to study but he had to give

up his studies since his father became drug abuser. Ali’s mother is not

educated enough to do a job. She sells vegetables but could not earn

sufficient amount to run her kitchen. Ali is 14 years old and eldest among

four siblings. He started working as a mechanic in an auto repair shop. He

works for more than 7 hours and do not find time to study. He and her

mother are working hard to be survived. Ali’s father addiction shattered

Ali’s dream of becoming educated person.

19

Chapter 3

4. Destruction of Protection:

Head of the family is responsible for providing physical, social,

emotional and economical protection to children and younger family

members. Drug abusers could not provide emotional, social and physical

security to their family members. The need for love and affection remains

ungratified - this impedes the process of smooth emotional growth of children.

Moreover, they have to face rejection from society. Feelings of guilt, shame

and deprivation result in psychological problems family members.

Case Study

Rukhsana’s husband is an alcoholic. She is mother of two children.

Rukhsana is a school teacher in a government sector. Although, she is not

having financial problems but her husband’s alcoholism disturbs the family

environment. Being intoxicated, he quarrels and uses abusive languages with

family members. He also beats Rukhsana in front of his children. Due to this,

Rukhsana and her both children remain fearful. Many times, she decided to

break her marital relation but due to some family obligations, she did not

take any step. In normal condition, Rukhsana’s husband behaves well with

her and children as if he is very caring and loving. Every time, he justifies

his misbehavior. He brings gifts for children and wife. Despite that

Rukhsana and her both children do not feel to be secured in their own home.

20

Chapter 3

5. Destruction of Religious Rituals

Another adverse impact of drug abuse is on the religious functioning of the

family. Though, family is responsible for providing religious education, teaching

religious values to be followed but drug abuse problems impair spiritual health of

people. Drug abusers themselves could not perform religious rituals properly that may

affect the other family members in terms of their daily routines. Family members

become co-dependents, developed psychological problems which further impair their

daily functioning, even their ability to perform religious values. They remain

disturbed all the day because of drug abuser family members.

Case Study

Khalid belongs to a religious family. After becoming drug abuser, he deviated

from religious and social norms. All of his attention is on drug intake. He

frequently tells a lie and cheats family members. Drug abuse has destroyed his

sense of right and wrong. His misbehavior and drug related acts have made his

wife depressed and hopeless to the extent that she attempted suicide twice. She

seems to be cursing her fate and prefers death over life. She is compelled to go

out to work to run her kitchen. She does not have sufficient time to teach her

children religious rituals. She and her children also avoid social gatherings

including religious and recreational activities.

21

Chapter 3

6. Destruction of Recreational Activities Recreational activities are essential to grow healthy family.

Involvement in recreational activities provides sound effects, release tension

and make mentally and emotionally healthy. Families of drug abusers are

usually deprived of recreational activities. The entire family environment

becomes stressful. Due to the destruction of economic resources, their interest

is limited to meet household expenses. Indulgence of one family member in

addiction makes rest of the family members frustrated and hopeless. These

feelings further diminish the desire for participating in recreational activities.

Case Study

Usman is 15 years old school going boy. His father is a heroin abuser. He is

having two younger daughters who also study in the same school. His

mother is a factory worker and is working hard to make their children

educated despite her husband’s addiction. Whatever she earns is spent

within a month. Her income merely meets household expenses and her

children education. No extra amount is available for recreational activities.

Usman’s mother goes out of her home early in the morning and come back

in the evening. At home, she has a lot of work to do such as; preparing meal

for children and herself, cleaning and dusting etc. Usman, his mother and

both sisters are leading a life as a machine.

22

Chapter 3

7. Destruction of Affection and Procreation: The seventh function of the family is to fulfill the need of affection and

love of family members. All family members are dependent on each other for

the gratification of their need for love. If need for love and affection remain

ungratified that will impede the process of smooth emotional growth of

children. Not only children but adult also need love being part of family. Drug

abusers need drugs at any cost. Their craving for drugs does not let them to

pay attention to what their family members need from them. Procreation does

not seem to be influenced too much but emotional growth remains at great risk

due to drug abuse. Drug intake during pregnancy may affect the smooth

process of procreation.

Case Study

Jamila’s husband is taking drugs for last 6 years. She is having two

children. She belongs to lower class. She prepares meal at home and

supplies to factory workers. She earns enough money to fulfill basic needs

of her family. Due to her husband’s addiction and drug related activities,

she deliberately underwent the surgery of removing her uterus. On

inquiring, she justified that she had to do it because of her husband. He is

addict and could not fulfill his responsibilities. She did not want to deliver

more babies of an addicted man who is unable to support his family.

23

Chapter 3

Consequences of Family Dysfunction

Destruction of seven functions of family of drug abusers brings dire

consequences in terms of psychological and social problems.

1. Psychological Consequences:

Psychological health of family members of drug abusers is at great risk.

Research based evidences proved that drug abuse affects the psychological health

of family members because of their drug abuse family members. Wives of

substance/drug abusers suffer from somatic complaints, anxiety, social dysfunction,

depression, anxiety and hostility (Ali & Sadiq, 2011), chronic cough, weight loss,

depression, anxiety, aches, pain and irritability (Mehra, 2002, as cited in UNODC,

2002) and suicidal risk (Manohar & Kannappan, 2010).

In a study, Farhat (2003) found that adult children of substance abuse fathers were

suffering from depression, psychasthenia, paranoia, hypomania and psychopathic

personality disorders. They also appeared to be more socially introvert and

aggressive than adults children of non addicts. Alcoholic problems in parents lead

to cognitive, behavioral and emotional problems in children. They, in later life,

suffer from adjustment problems, violence, depression, anxiety and low self-esteem

and substance abuse problems (Johnson & Leff, 1999).

24

Chapter 3

2. Social Consequences:

Social problems are integral part of drug abuse problems. Family has to pay a

huge cost because of their drug abusing family member in terms of social

problems. Family members develop feelings of abandonment, fear, embarrassment

and guilt. In South Asian countries; Pakistan, India, Bangladesh, it is not easy to

cut ties with drug abusing family members. Parents go a long way to save their

addicted children. Sometimes, they embrace their death taking the pain of addicted

children.

At social level, families of drug abusers are rejected and devalued. Most of the

sisters and daughters of drug abusers seem to be complaining of not having suitable

marriage proposal because of social stigma. They are labeled as sisters/daughters of

drug abuser. Even, close relatives do not like to accept them for their sons.

Sometimes, family has to hide or lie about the abusing patterns of addicted member

so that they could arrange their daughter’s marriage. The situation becomes more

pathetic in case of alcoholics. Families of alcoholics are disliked at community

level due to religious and social norms. Usually, neighbors and relatives do not like

to visit these families. Parents and elder brothers do not allow their girls to make

friendships with the girls whose family member drinks.

25

Chapter 3

3. Family Abuse

Family has to counter abuse as a consequence of drug abusive behavior of

one of the family member. Variety of family abuse has been committed at the

hands of drug abusers such as; stealing money and things, snatching money from

family members, using abusive language, beating and quarrelling with family

members.

Alcoholics were found to be involved in domestic violence (Kahler,

McCrady & Epstein, 2003). Approximately, 87% drug addicts violently behaved

with their family members (Shankardass, 1998, as cited in UNODC, 2002).

Drinking problems among husbands results in death of female partner (Sharp et al,

2001). Drug abusers were more involved in quarrelling, threatening and using

abusive language with their family members (Sadiq & Umer, 2013). Alcoholism

predicts physical and emotional violence within family environment (Guebaly &

Offord, 1997).

26

Chapter 4

Professional Services for

the Families of Drug Abusers

27

Chapter 4

Professional Services for the Families of

Drug Abusers

Need of Professional Services for Families

Families of drug abusers also need similar attention as drug abusers are

given. Families become co-dependent due to their drug abusing family members.

Drug abuse is associated with social problems such as; crime, unemployment,

violence, family abuse, social rejection and stigma. Feelings of shame, guilt and

social isolation make them mentally sick; as a result, they remain unable to support

the addicted family member. The treatment of drug abusers requires long term

support and cooperation on the part of families in order to keep the drug abuser in

recovery.

Many times, families have been found to be the cause of relapse. It all

happens unconsciously, because the family also is suffering from emotional and

behavior problems. In order to avoid further harm, they give money to the drug

abuser for buying drugs. Under the shadow of multiple problems, they incorporated

dysfunctional personality patterns. These patterns further make the environment

stressful in which the entire family feels insecure, deprived and helpless.

Specifically, intense feelings of insecurity are developed in children.

Therefore, the family itself requires equal attention from health professionals along

with the drug abusing family members. Family members must be alive with mental

harmony whether their addicted family member recovers from drugs or not.

There are four ways to provide professional services to the families; 1)

individual psychological counseling, 2) life skill training, 3) family counseling, 4)

family support group. Effective treatment is the mixture of all of the four services.

28

Chapter 4

Professional Services

Individual Counseling

Family Counseling

Life Skills Training

Family Support Group

Individual Psychological Counseling

Individual psychological counseling involves one to one session to directly

direct the psychological problems family members are suffering from. The number

of sessions depends on the severity of problems. Variety of therapeutic techniques

can be applied with patients like; supportive techniques, client- centered

therapeutic techniques, crises intervention and cognitive-behavioral interventions.

Individual needs of family members of drug abusers are attended in

individual psychological counseling. Family member learns to shift from negative

behavioral and communication patterns to positive one. He or she also learns to

rebuild his or her coping skills to combat environmental problems. His or her

coping skills and sense of positive self-image also help in the treatment and

rehabilitation of drug addict family member.

29

Chapter 4

Family Counseling

Family counseling is conducted to empower the family members of

drug abusers who are affected by drug related issues. Treatment plan is

followed with the collaboration and mutual understanding of both families

and their patients. Therefore, family counseling is an integral part of drug

treatment and rehabilitation. Family therapy/counseling gave better results

as compare to family education groups and other family services in the

context of substance abuse disorders (Stanton & Shadish, 1997).

Family counseling helps family members to evaluate their own

dysfunctional patters and nature of co-dependency which, somehow,

contribute to drug abuse problems and relapse. They also learn to

communicate with each other in a positive way and develop functional

behavioral patterns. A collaborative attitude is developed in the entire

family towards the solution of drug-related problems. Sessions go side by

side with the treatment of their addicted family member.

30

Chapter 4

Life Skills Training

Life skill training is provided to enhance the skills of people to cope with

daily life problems. Families of drug abusers need to be skilled enough to combat

with social and psychological problems along with seeking treatment for the drug

abusing family members. Life skills make them able to handle stressful situations

and find alternative ways for a particular problem.

Though, drug addiction is not a problem of an individual but of the entire

family, therefore, several problems are expected to be destroying the entire family

environment. Stressful family environments make family members co-dependents

in terms of emotional and behavioral problems and deteriorated coping skills.

Through life skills training, their deteriorated skills are rehabilitated such as; skills

to manage stress and anger, skills to solve problems and skills to communicate and

socialize with others.

31

Chapter 4

Family Support Group

Family support groups are held to provide a platform for family members of

drug abusers where they express their feelings, share experiences and learn from

other families of drug abusers. They gain relevant information, learn from other

experiences and develop skills to listen to others as well as contributing in making

social networks.

Family support groups provide supportive and sympathetic environment to

family members to express their feelings of shame, guilt and resentment. Each

member in the group carefully and sympathetically listens to person sharing his or

her emotional pain. The rest of the members give suitable advice and recommend

strategies to overcome emotional pain and problematic situation.

32

Chapter 4

Stages of Providing Services to Families

Professional services are provided to families in sequences to have long

lasting benefits. Individual counseling is essential if a family member is suffering

from psychological disorder. He or she must be attended as an individual client

rather than a relative of a drug abuser. Drug related psychological issues appear in

form of hopelessness, aggression and feelings of guilt and shame. At this point,

merely advice will not be effective. A Counselor, being an empathetic, supportive

and good listener, will remove the blockage existing in expressions of their feelings

and emotions.

Having attended individual counseling sessions, family members come out

of their own psychological problems and start realizing the reality of drug abuse

problems. Then, they move to the second stage of their treatment, that is family

counseling along with life skill training. In family counseling sessions, he or she is

given awareness of dysfunctional family patterns that cause a gap among family

members. He or she also learns to play a positive role in the treatment of the drug

abuse family member. In family counseling, joint sessions are also conducted.

After individual and family counseling sessions, life skills training can be given to

them so that they rebuild their coping skills to fight in the battle of daily life stress

created by drug abusing family members. Problem solving abilities, improved self-

esteem and communicative skills make them able to handle not only drug abusing

family members but also their own self.

At the third stage, they are referred to family support group. Where, they

are exposed to others suffering from similar kinds of problems. They are ready to

learn from other experiences. They come to know that there are many others who

are facing the problems like them. Family support group also helps in building a

sense of socialization. Their need for being socialized deteriorated due to the drug

abusing family members. But they are given an opportunity to relive again with

enthusiasm.

33

Chapter 4

Stage 1

•Providing psychological counseling sessions to family members (individual or family counseling sessions or both)

Stage 2•Arranging life skill training for family members

Stage 3•Conducting family support group

34

Chapter 5

Individual Psychological Counseling

35

Chapter 5

Individual Psychological Counseling

Description

Individual psychological counseling is one to one relationship between

counselor and client. A supportive and positive environment is provided to a

person suffering from any kind of emotional pain or stress. In individual setting, a

psychological counselor, by applying therapeutic interventions, helps the family

member of drug abusers in dealing with stress and pain associated with drug

abusing family member. Psychological counseling also helps in increasing the

sense of well-being. Different therapeutic techniques can be used to treat the

emotional and behavioral problems among family members of drug abusers such

as; supportive therapy, cognitive-behavioral therapy, crises intervention etc.

Objectives of Individual Psychological Counseling

To provide the opportunity to family members to express their feelings

associated with drug abuse family members

To target their psychological problems (i.e, anger, depression, anxiety and

so forth)

To get them back from co-dependency

To develop coping skills to handle drug abuse related problems

To improve their psychological health so that they perform their role

positively in the treatment and recovery of their drug abuse family members

36

Chapter 5

Qualities of Psychological Counselor

Following are the qualities to be a good psychological counselor

Good listener

Empathic

Non-judgmental

Open-mind

Flexible

Genuineness

Discipline and Firmness

Fortitude and Sensitivity

Caring of professional ethics

Phases of Individual Psychological Counseling

There are three phases of psychological counseling for families of drug abusers

Phase I: Rapport building and catharsis

Initially, Psychological counselor needs to build rapport with the clients by

providing them with the opportunity to express their feelings and emotions

associated with their drug abusing family member. A supportive and positive

environment is provided for catharsis. This phase facilitates the assessment of the

nature of the problem. Techniques from supportive therapy and client-centered

therapy are useful for rapport building and catharsis.

Phase II: Assessing the problem

Psychological counselors needs to examine the nature of the problem

Through probing and using structured questionnaires, counselor assess the impact

of drug abuse problems on the psychological and social health of the family

member with whom he or she is sitting right now. Type of problem, factors

involved in the problems will be thoroughly examined. The counselor may also use

questionnaire or projective techniques to determine the type and level of

psychological, social and family problems. After in-depth analysis of the problem,

a treatment plan is prepared to treat targeted symptoms.

37

Chapter 5

Treatment Plan

Name:_______________ Gender:______________ Age:_________

Educational level:_____________ Relation To Drug Abusers:____________

Diagnosis: _____________________________________ Date:__________

Identified

Problems

Targeted

Symptoms

Interventions Number Of Sessions

Required

Prognosis: Note: This is a sample of treatment plan. Counselor can make treatment plan according to need

38

Chapter 5

Phase III: Using Appropriate Interventions

After making diagnosis, family counselor uses different therapeutic

interventions to treat psychological problems of family members. Supportive therapy,

cognitive-behavioral therapy, crises interventions can be applied with them.

Homework assignments can also be given to the clients. Selection of therapeutic

techniques depends on the diagnosis, its etiological factors and client’s variable

(demographic characteristics, family background, social and religious values/beliefs,

personality traits etc). Number of sessions also depends on the intensity and duration

of the problem.

39

Chapter 6

Family Counseling

40

Family Counseling Description

The core objective of family counseling is to strengthen relationships among

family members in order to promote healthy family environment. The family

environment of a drug abuser is stressful and causes detrimental effects on the

mental health of all family members. Anger, frustration and other psychological

problems are obvious among them. As a result, relationships among the rest of the

family members of drug abusers also get impaired. Family counseling not only

removes the hurdles between drug abuser (under treatment and rehabilitation) and

their families but also works on interaction patterns existing among family members.

Family counselors may take into account the problems of the entire family,

specifically the effects of drug abuse. Communication patterns also are improved.

Family members learn to use more positive ways of communication to handle family

problems.

Objectives of Family Counseling

To help family members to understand each other’s feelings

To convert dysfunctional family patterns into functional one

To enable them to handle family issues

To enhance their communicative skills/patterns

To reduce gap among family members

Qualities of a Good Family Counselor

Empathic

Good listener

Compassionate

Flexible

Non-judgmental

Organized

Chapter 6

41

Chapter 6

Steps involved in Family Counseling

1. Rapport building and Catharsis

2. Assessing the nature of the problems

3. Using therapeutic techniques

4. Providing psycho-education in the context of drug abuse

5. Providing information about relapse prevention

6. Providing information about the maintenance of drug free life style

1. Rapport building and Catharsis

Initially, the family counselor builds rapport with client by attentive

listening and showing empathy. Rapport building is indeed a way of catharsis.

Family members are encouraged to express their suppressed emotions and

feelings. Rapport building and catharsis build a long term trustworthy

relationship between counselor and client that helps in assessing the nature of

problem.

2. Assessing the nature of the problems

A Family counselor tries to assess the problems in detail in the context

of a drug abusing problem. Causes and effects of drug abuse problems are

thoroughly analyzed. More than one family member can be taken into session.

Sometimes, the entire family may attend along with the drug abuser in order to

make connection in obtaining information. The family counselor can use

assessing tools, psychological/personality tests to diagnose the problem.

3. Using therapeutic techniques

In case of identifying a psychological disorder, the family member is

referred for individual counseling. Family members with mild depression,

helplessness, anger and worries are treated by applying different therapeutic

techniques in family counseling. Techniques from client-centered therapy,

cognitive-behavior therapy, supportive therapy and reality therapy can be used.

Selection of techniques depends upon nature, intensity and duration of the

problem, client’s variable (age, educational level, personality traits and relation

with drug abuser). Joint sessions are also held.

42

Chapter 6

4. Providing Psycho-Education In The Context Of Drug

Abuse

After assessing the problem, psycho-education is provided to family

members regarding drug abuse and its impact on mental health on drug users

and their family. Counselor explains the way family’s well-being is impaired

and how drugs make the family dysfunction. Family members develop

psychopathologies and social problems. Co-dependency and its role in drug

abuse problem are also explained to them. The family counselor explains the

dynamics of co-dependent behaviors in relation to drug abuse problems.

5. Providing Information About Relapse Prevention

Very few know that relapse is a part of treatment. Families usually lose

their heart when their patient relapses immediately after treatment.

Relapsing again and again increases hopelessness in family. It is a common

belief of people in South Asian countries that drug abuse is an incurable

disease. The family counselor makes them aware of the reality that drug

abuse is difficult to be treated but it is curable. Chances of relapses are

always there. Information regarding warning signs of relapse and factors

responsible for relapse is provided to them.

6. Providing information about the maintenance of drug

free life style

Sustaining recovery demands life time abstinence from drugs.

Abstinence is not possible without healthy life style. Healthy life styles

means proper sleeping and eating habits, engaging self in creative activities,

taking occupational responsibilities and attending the meetings of Narcotic

Anonymous (NA). The family counselor provides information to families

about the maintenance of recovery. Only treatment is not enough to keep the

patient away from drugs. The family needs to prepare daily plans and

encourage the patient to change life style. Daily plans are prepared sitting

with family counselor. Both patient and his family take part in deciding

which activities are suitable for leading a sober life.

43

Chapter 7

Life Skills Training

44

Chapter 7

Life Skills Training

Description

A life skills training program should also be conducted in order to

enhance coping skills among family members to deal with stress and other

problems in daily life. Families go through continuous stress due to drug

abusing family member and gradually they become co-dependent. Their ability

to solve problem, managing stress and anger is also adversely affected. For

these reasons, besides providing individual counseling sessions, they must be

provided with proper training to build coping skills. The core objective of life

skills is to promote healthy life styles rather just focusing on present symptoms.

Activities should be done considering cultural differences, family, social and

religious values and as well as demographic characteristics of the participants.

Socioeconomic status and education count a lot. Going for jogging is not as

easy for a person belonging to lower or middle class than a person coming from

upper class. Activities should be modified taking into account above mentioned

factors

Following Skills Can Be Taught To Them Via Training;

Stress management

Anger management

Problem solving skills

Communicative skills

45

Chapter 7

Standards for Conducting Life Skill Training Program

The group size will be between 5 to 10

The duration should not exceed from 90 minutes

Frequency of training sessions will depend on the nature of the problem.

It can be conducted on a daily basis.

A comfortable and well-equipped room with adequate light, proper

ventilation, required stationeries should be available

Characteristics of a Group Facilitator

A good leader

Supportive

Honest

Non-judgmental

Keen observer

Firm

Goal directed

Steps Involved in Conducting Life Skill Training Program

1. Arrange the comfortable room with all needed stationeries

2. Arrange chairs in circles for the participants

3. Decide the type of skill that is to be taught

4. Determine the duration of activity and group size

5. Determine the frequency of activities to teach a skill

6. Brief the rules of participation in the activity

7. Do the activity with the help of participants

8. Use process questions in the end

46

Chapter 7

Skill # Personal Skill Time: 30 minutes Additional Resources: Flipchart and pens

Objectives For Participants

Knowledge

Learn new methods of coping with stress

Attitudes/Values

Reduction of stress through conscious efforts

Skills

Identifying specific method to deal with individual stressors Group activity 1.Write the following headings on the white board

o Personal o Interpersonal

2. Participants have to work individually. They have to identify methods they have tried to reduce stress

o After writing a list of methods, they work with the group. Each one has to say two or three methods to reduce stress. They also have to identify which category they belong to environmental, personal and interpersonal

3. For example: Personal

o Jogging o Long walks o Taking care of family members o Look good

Interpersonal o Sharing problems with empathetic person o Joining social service organizations to help others

Notes

This activity helps participants to identify a wide range of method to deal with stress

Process Questions?

What did we do?

How did we learn?

Why did we do this activity?

How would you use this?

Note: This activity has been taken from a manual of Life Skill published by Colombo Plan, Drug Advisory

Program (DAP) as a sample.

47

Chapter 8

Conducting Family Support

48

Chapter 8

Conducting Family Support

Family Support Group

Family Support Group is a group of concerned relatives and friends

whose lives have been adversely affected by a loved one’s addiction to alcohol

or drugs.

Objectives of Family Support Group

To raise family awareness about drug abuse problem as an illness also

it’s psychological, social and economic impact on families.

To make them learn from others facing similar problems

To make families of drug abuser aware of their own feelings , and

reasons for being co-dependents

To teach the method of dealing psychological and social problems

associated with their drug abusing family member through discussion.

To make the families of drug abusers aware of the signs of relapse and

factors involved in recovery process in indirect way.

Who Can Attend Family Support Group?

Any close relative of drug abuser who has been affected in terms of

economical, psychological, social and spiritual problems due to the drug

abusing family member. Parents, siblings, spouse, children, uncle, aunts,

cousins or other relatives, with whom a drug abuser is living, can attend family

support group. Not only do they learn to deal their own problems but they also

get information regarding the factors involved in relapse and recovery process

of the addict.

49

Chapter 8

50

Twelve Steps

Family Support Group is based on the 12 Steps which are as follows

1. We admit to ourselves that we are powerful and that we can have

control over our homes when our guard member is away.

2. We know that by coming to have knowledge of our own power, we can

maximize decision making, gain control and maximize peace and joy

within our homes.

3. We make the decision to start now towards the path of Readiness and

educate our children and other family members as to our role in a

National Guard Family.

4. We will seek to gain an understanding of the overall mission of the

National Guard in order to better support our guard member.

5. We will express to others, and ourselves, our fears of military separation

which will allow us to gain power over them.

6. We know that by being Ready we can remove the fears that

compromise the well-being of ourselves and of our family.

7. We understand that we may not always be able to handle every situation

and that it is OK to ask for assistance.

8. We know to make a list of things that need to be taken care of and have

a willingness to work at each one individually.

9. We know that, although we sometimes may think we cannot manage on

our own, there are others who are willing to help, guide, train and

support us.

10. We understand that we may make wrong decisions but will not let them

hold us back in achieving our mission of READINESS.

11. We seek to improve our state of readiness by sharing our knowledge

and working together as a purple program. WE will not turn a cheek to a

National Guard family that is in need of our support and assistance.

12. We know that through our volunteer service to other National Guard

families we can carry this message and help them be as Ready as we.

Chapter 8

Standards for Conducting Family Support Group

Following steps should be kept in mind before conducting family support group

o The group should be comprised of 8 to 12 members

o Duration will be 1 ½ hours

o Well-equipped room with adequate light, comfortable chairs must be

arranged.

o There should be no distraction such as; noise

o Sitting arrangement will be U-shaped.

o Participants will be selected controlling their demographics. Moreover,

type of drug abuse and associated problems must also be taken into

account in this regard.

o Group will be conducted in native language

o Topic will be selected according to the need of the participants.

o Use neutral words and avoid biased, sexy language

o Maintain equality among all participants ignoring their religion, ethnicity

or race

o Group will be conducted by a single facilitator

Process of Family Support Group

o Family support group will be conducted in the following ways

o First facilitator will introduce himself to the group

o Facilitator will encourage the participants to join him in Serenity Prayer

o Facilitator will brief some rules for participating in family support group

o Will introduce the topic of today

o Encourage the participants to share related to the topic

o Encourage the participants to share their personal experiences related to the

topic

o Close the session by saying some positive words

o Again encourage the participants to join him in Serenity Prayer

51

Chapter 8

Conducting Family Support Group

Following are the steps that a facilitator needs to take to conduct family support

group;

Step 1: Introduce yourself to the participant

o Salam/hello to all

o Welcome to all for coming to attend the group

o Please join me in Serenity Prayer

52

Chapter 8

Step 2: Telling Rules for Attending Family Support Group

Here are some rules to attend the family support group

o Please turn your mobile off

o Listen attentively to others

o Let others complete their words

o Raise your hands if you want to share something

o Try to avoid non-verbal communication

o Share only your own feelings and experiences not the addict

Note: Explain rules in positive way (i.e, please do this, rather than don’t do this)

Step 3: Explaining topic and discussion about it

o Topic of today is --------------.

o My opinion about the topic is …………………………………

o Would you like to say something about this?

o Who would like to share personal experience/feelings?

o How did you handle that problem?

o Would any one among you like to add something to this?

o Now we close the today meeting with the same prayer which we read

in the beginning

o Please join me again in Serenity Prayer

God grant me the serenity to accept the things I cannot change

Courage to change the things I can And the wisdom to know the

difference between them Amen

Note: Being a facilitator you will have to provide an opportunity to each

participant of the group to share his or her personal experience and feelings. Try

to find a suitable solution of the problem with the help of all participants.

Sentences used above in the step 3 are examples and you can change words

during discussion. Try to use neutral words so that no one gets hurt.

53

Conclusion

54

Conclusion

The essence of the information provided in the whole book is that

families of drug or substance abusers suffer from unlimited miseries which

profoundly impair their personalities and coping skills. Dysfunctional patterns

and emotional problems further impede their adjustment in the society.

Empirical evidences have confirmed that children and younger family members

of drug abusers develop severe behavioral and emotional problems. Female

family members, in any role, are also leading the life of silent sufferers of society

due to addicted family members.

Keeping all these facts in mind, exclusive treatment should be

provided to entire family members of drug abusers. Families can be helped by

giving quality of psychological counseling sessions (individual and joint),

conducting life skill training and family support groups. They need to be aware

of their emotional turmoil resulted as a consequence of drug abuse and

associated problems in their family member. Enhancing their coping skills to

fight with daily stress, social and economic problems they are overwhelmed

with, is equally important. Families of drug abusers are in great need of help

from government and non-government agencies and as well as from health

professionals.

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A Publication Of Drug Free Nation www.drugfreenation.org