Families and addiction Addiction and substance abuse and dysfunction in the family system Family roles interact with substance abuse and addiction in mutually responsive ways that create dysfunction in the family systems and the lives of the members. The roles for each member become comfortable for the member and through the use of feedback loops become the primary way in which the family maintains homeostasis and cohesion within its structure. These roles further define the members in terms of hierarchy, rules, subsystems, and boundaries. All of these serve to keep the family functioning at levels appropriate for survival. Each member of the family finds their way within the definitions of their roles and acts within the confines and expectations of these roles in order to present a unified front to the world and continue to transmit the family’s value system to each generation(Stevens & Smith, 2009). Specifically, the hero role is usually adopted by the oldest child caught in the addictive family. This child feels responsible for the family pain, and develops ways to anticipate the needs of each family member. As a result of this hypervigilance, the hero becomes quite adept at perceiving and reacting to the needs of others. This caretaking aspect of the oldest child’s personality is based on a performance model of self-esteem and causes this child to be forever responding to the needs of others at the expense of their own. Now, because the family cannot predict when the primary user is going to abuse a drug and create havoc in the family system, the members of the family involved in this abusive cycle must remain hypervigilant to detect when the primary user will be acting out their emotions on the family. This constant requirement to remain vigilant causes the development of an inability to trust the primary care givers and impacts the family member’s future ability to trust others in their world. Finally, the family member constantly reacting to the primary abusive actor causes them to mask or shut their emotions down completely. The hero personality trait is associated with the hypervigilance in the addictive family process in that each has their own emotions exhausted and must remain ever cautious of others(Stevens & Smith, 2009). Again, consider the fact that families create subsystems. These subsystems further define the individual roles and expectations of the family members. One of the subsystems created by a family is the role of the marital dyad. The marital dyad may consist of one abuser or both partners may be abusing substances. Each partner is about the business of maintaining control in the relationship, but each person is limiting the amount of chaos for their own purposes. These attempts at control are often done with anger and hostility. Codependency and enabling develop as mechanisms to limit confusion, maintain inner equilibrium, and present a unified front to society(Stevens & Smith, 2009). One of the sad realities of drug dependency and abuse in families is the impact the abuse has on children. Children of Alcoholics (COA) begin to demonstrate pathological development at early ages and research has shown issues with conduct disorders, immaturity, low self-esteem, minimized social skills, and a high percentage develop drug dependencies. The addicted family environment is often characterized by confusion, chaos, indecision, lack of stability, and meaningful, authentic interaction between the individual members. Because of this constant emotional chaos, the child of an alcoholic is at risk to develop antisocial personality traits and spatial learning deficits(Stevens & Smith, 2009). Specifically, in work done recently in assessing the effect of alcohol on higher order mental processes such as spatial learning, the research indicated that spatial learning is impacted negatively by alcohol consumption long after the user has reached the subjective experience of being sober. The alcohol remains in the hippocampus, where most spatial learning processes are conducted and is diminished in its capacity to remember spatial information(Cromer, Cromer, Maruff, & Snyder, 2010). This impact of alcohol on the spatial learning has a future effect on the COA’s ability to function in school and process cognitive information. Of particular interest is the work done in 1985 by Kaufman who has been successful in defining four types of addictive families. Use of these categories of addictive development within the family structure can be useful during the initial testing and assessment phase of the counseling process and also useful as an ongoing barometer by which to assess the progress or lack thereof during counseling phases. It is important to note that the categories must never become a “cookbook” by which families are compartmentalized, but they must be used as a tool by which characteristics can be pointed out and used as a measure of development along with a means by which a treatment plan may be developed for counseling success. The functional family is typically at the beginning experience of drug abuse by one or more of its members and is beginning to express concern while still maintaining higher order functioning at an interpersonal level and socially. The neurotically enmeshed family usually demonstrates role reversals in that the child becomes the parent to the using adult and roles are reversed. Chaos rules the environment, unpredictability is the norm, and control is maintained by feedback loops of codependency. A family in the disintegration phase has been broken and members are separated from one another. In the last phase, known as the absent family, the family is completely separated either as a result of personal decision or court order. This understanding of the phases a family may undergo in the addictive process will be helpful in work done with the adolescent male population currently being worked with in a group home. Each adolescent male fits into a particular family that demonstrates each of these levels of addiction and position in Kaufman’s hierarchy(Stevens & Smith, 2009). One legal concern that presents itself when entering into and maintaining a counseling relationship with addictive families must be confidentiality and the limits of that confidentiality. Section 4.01 and 4.02 give the guidelines for both maintaining confidentiality and the limits of that confidentiality(APA.org, 2010).  Basically, counselors must maintain confidentiality of all spoken and written communication unless presented with a court order, presented with a scenario in which the individual is going to harm themselves or others, and in a medical emergency. Limits of confidentiality must be presented to the client at the outset of professional care and an explanation of how the information gained through the counseling relationship will be used must be tendered. In the present milieu in which counseling takes place, the adolescent males in the group home are told of the limits of confidentiality upon entering the program and strict confidentiality is maintained throughout their stay in the home. A possible scenario to illustrate confidentiality and its limits involves the parents of these males and the extended family they sometimes have as key players in their lives. Only immediate family members are allowed to know the behavior and progress of the consumer within the group home and not the extended family members. The client in the group home is informed of information that may be revealed to parents as a courtesy. Since all of the work done in the group home where my employment takes place, section B.4.a. of the ACA code of ethics appears salient. This ethical code declares that counselors must clearly explain the importance and parameters of confidentiality for the specific group being entered(ACA.org, 2005). In the group home, the clients are told that everything is confidential as a beginning rule of the house and organization. However, there are limits to this confidentiality if they state they are going to hurt themselves, others, or are having a medical emergency. It is also explained to them that all contents of their permanent records are confidential unless a court order or subpoena is received. They are also made aware of who within the staff will have access to their records. Addictive cycles, feedback loops, characteristics and traits of addictive families are interesting. Knowing the roles, rules, and ethics that guide the work with this group will help in being of service.