Family and Other Social Influences on Addictive Behaviors

1. Family and Other Social Influences on Addictive Behaviors • How can one’s family help, but also harm, substance abuse treatment efforts?

2. In general, substance abusers have restricted social networks • Friends and family create distance • Marriages or other romantic relationships dissolve • Wives more likely than husbands to remain with drug abusing partner • Substance abusers gravitate to others abusing substances-relationships are less stable • This becomes an issue when attempting to initiate behavior change, as one must distance oneself from one’s peer group • Catch 22 situation given that social support can be an important part of the recovery process

3. In terms of adolescent substance use, parental factors can play a critical role • It is important that parents understand that their attitudes and behaviors do matter, despite what they might think • Core social learning theory component • Parental disapproval of drug use is a strong protective factor • In contrast, indifference or approval is a strong risk factor • Four relatively straightforward parental behaviors that can limit adolescent drug use: • Consistent supervision • Consistent discipline • Clear family values toward use • Reward non-use

4. Ways that families can exacerbate drug use • Coercive communication strategies (e.g., nagging, verbal abuse) • Protection from consequences of use • What are some examples? • “Natural” reaction of family members, but at what cost? • In contrast, appropriate encouragement can increase likelihood of treatment • Women more likely than men to encourage treatment-why???

5. Broader family factors associated with substance use: • Protective factors (exceptions to all, though) • Intimate relationship (esp. with partner who has clear values against substance abuse) • Cohesive family • Larger social network • Supportive friends • Strong attachment • Risk factors (exceptions to all, though) • Marital dissatisfaction • Emotional labile families • Romantic partner who tolerates or encourages use • Having friends who use similar substances

6. Barriers to family support of change • Alteration of family roles (e.g., disregulation of a system) • Desire of family to engage in certain behaviors • Imagine, for example, an alcoholic in a family of “normal” drinkers • Mistrust of the substance abuser • Family interventions thus tend to be rather broad and include multiple components • Improving relationships • Improving communication • Improving parenting skills

7. Unilateral family treatments involve efforts to help the family members convince someone else to attend treatment • Family members are taught communication skills and how to provide others feedback regarding the consequences of substance use • Also taught ways to cause the substance abuser to experience negative consequences as a result of use • Families taught how to take care of self as well • In some cases family interventions are not warranted • Domestic violence issues • Situations that are overly toxic

8. Broader social influences on substance use • Social control theory • Strong bonds with “conventional” societal groups (family, school, religion, etc.) serve as protective factors against substance use • The stronger these bonds, the less likely the individual will engage in “irresponsible” behaviors • Social disorganization and inadequate monitoring weaken these bonds • Behavioral economics/choice • Social learning theory • Substance use is influenced by the behaviors of models in our environment • Highlights the importance of parents and peers, but also larger societal images (movies, TV, etc.) • Stress and coping theory • Substance abuse results from desire to cope with stressful social environments

9. Social role transitions can reduce substance use • Essentially, substance abuse can change when social expectations regarding use changes • Getting married • Getting a job • Parenthood • In many cases a reciprocal relationship exists, though • Some abusers self select into situations that will maintain ones use (and vice-versa)

10. In general, perceived norms can play an important role in substance abuse • Descriptive vs. Injunctive Norms • Peer Norms • Family Norms • School or community norms • Implications for interventions?

11. Negative relationship between being employed and substance use in adults-opposite in adolescents • Why?