Edition 2

Helping Families of Drug Abusers

By
Riffat Sadiq

A Publication of Drug Free Nation

Title: Helping Families of Drug Abusers

Author: Riffat Sadiq, Ph. D

Edition : 2

Quantity: 500

Price: Rs.150/-

Year of Publication: 2019

Composed by: Haider Ali Meher

Published by: Drug Free Nation, Pakistan

Published in: Pakistan

Coypright 2019 Drug Free Nation Faisalabad, Pakistan

Cell: 03346307777
www.drugfreenation.org

Rights Reserved

No part of this book can be reproduced, copied, printed

in any form, electronic/mechanical, without permission
in written from author and publisher. In this regard, all
queries are answered by publisher.
 Dedicated to

Families of drug abusers with great sympathy and

sincere feelings
 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
nothelp 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
implemented in order to make the entire family
psychologically healthy enough to be effective supporter
of their drug abuse family members. The current book
has been written to guide the professionals engaged in
rehabilitating drug abusers. Therapeutic techniques have
not been described in details. The only purpose of
writing this book, herein, is to guide professionals in
preparing comprehensive treatment plan exclusively for
families of drug abusers.

Riffat Sadiq Phd

 Introduction
1.1. Drug Abuse Scenario in South Asia Countries:
Unsurprisingly, the problem of drug abuse entangled the
world populace since ancient times. Thenceforth, a
variety of drugs along with routes were variously
introduced. However, a paucity of consensus is seen
when the point is to conceptualize the problem of drug
abuse. Still not all concur to embrace the disease model
of drug abuse as it is also considered a moral deed.

Culturally, people delineate drug abuse differently. For

instance, some communities use alcohol as a part of
recreational activity; smoking opium is still treated as a
traditional practice in the region of South Asia. Hence, in
different circumstances, drug abuse is given different
meanings (Voses, 1982, as cited in Muhammad, 2003).

Health related agencies like World Health Organization

(WHO, 2019) view the problem of drug or substance
abuse as,

“Drug or substance abuse is the harmful or

hazardous use of psychoactive substances including
alcohol and illicit drugs”

National Institute on Drug Abuse (NIDA, 2018)

conceptualized drug abuse or addiction as,

2
 “a chronic, relapsing brain disease that is
characterized by compulsive drug seeking and use,
despite harmful consequences”.

Health professionals categorized the problem of drug

abuse as a separate chronic disorder noting its pernicious
effects on user’s health. In Diagnostic and Statistical
Manual (5th ed.), substance use related problems have
been elucidated in terms of cognitive, behavioral and
physiological symptoms resulting in personal, social and
occupational dysfunctions. This category of disorder
contains 10 classes of drugs including: alcohol, cannabis,
caffeine, hallucinogens, inhalants, opioids, sedatives
/hypnotics/anxiolytics, stimulants, tobacco and other
unknown substances.

Compulsive use of drugs causes physical, psychological

and social complications for the users. In fact, drugs or
substances bring significant changes in brain circuits
leading behavioral deficits. These brain changes may
make the ground for relapse whenever user is exposed to
drug related environment (DSM-V, 2013).

Drug abuse has become a global concern because of dire

consequences for individual, family, society and
country’s economy. Rapid upsurge of drug abuse has
escalated tensions for entire world. Increase in the size
of illicit drug users was largely noted since late 1990.

3
The global prevalence of drug abuse was 3.3% to 6.1%,
(UNODC, 2009). About 149 to 272 million people
between 15 to 64 years of age in all over the world
abused illicit drugs. Around 153 to 300 million people
used illicit drugs in the year of 2010, as (UNODC, 2010)
estimated.

South Asian countries, in particular, have been severely

affected with drug abuse problems. Drug reports from
South Asian Countries (INCB, 2011) discovered
cannabis as the most commonly abused substance. About
3.3% and 1 % population used cannabis in Bangladesh
and in Sri Lanka respectively. The prevalence rate of
opiate abuse in Bangladesh was 0.4 % and in Sri Lanka
was 0.1%. Populace of other South Asian countries (i.e,
Bhutan, India and Nepal was also addicted to opiates.

4
The use of opium was highest in India. The trend of
abusing drugs by injection got higher in Bangladesh, in
India (0.02%) and in Nepal (0.01%). In Maldives, mode
of injection was also increased. Heroin and
buprenorphine were 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 the choice of drugs among most of the drug
abusers in this region.

Moreover, a trend of poly drug abuse has drastically

increased in South Asian countries. In India, the
prevalence of substance dependence was 4.65% (Avashti
et al., 2017). About, 1.53% people were addicted to
opioids and 0.52% to cannabisnoids, while 0.015%
populace was using sedative hypnotics. The prevalence
of 0.91% was observed for injectable opioids. It was also
noteworthy that the most common used opioid was
injectable buprenorphine following bhukhi/doda/opium
and heroin.

According to United Nation Office on Drug and Crimes

(UNODC, 2009), the highest prevalence of opiate abuse
was estimated in Afghanistan where, during past four
years, the ratio of drug abusers reached to 53 %
(230,000). The prevalence of adult drug users was equal
to 1 million (940,000). The annual prevalence of opiate

5
and opium use was 2.7% and 1.9% in adult population
respectively. Heroin prevalence was 1.0% for adult
population. Opium, cannabis and heroin were the most
common drugs being abused by men and young users.
Almost, 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 being commonly used by adolescents.
Opium, cannabis and tranquilizers were used by
children. The prevalence of 11.1%, equal to 2.92 and
3.57 million, was estimated for total population. While,
the estimated national drug use rate was 7.3%, equal to
2.01 million and 2.46 million people, as mentioned in
Afghanistan Drug Report (2015).

In 1993, Pakistan Narcotic Control Board had reported 3

million drug abusers in Pakistan and amongst them 51%
were only addicted to heroin. According to United
Nation Office on Drug and Crime (UNODC, 2002),
there were 5000,000 chronic heroin users in all over
Pakistan. A National Assessment Survey (2006)
documented the existence of 628,000 opiate users in
Pakistan 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,
estimated prevalence of drug abuse was 0.7%.

6
 Khan et al. (2004) found the highest ratio of drug abuse
among people falling between the age ranges of 21 to 30
years, and married as well. Most of them were heroin
addicts. In another report, nearly 55% university students
were described as drug abusers. About 36.5% abused
cannabis, 27.5% used alcohol, 26% used all kinds of
drugs, whereas 15% abused drug at least once in life
(Khattak et al., 2012)

Other scientific literature from Pakistan (Malik et al.,

2012) showed the problem of substance abuse prevailing
in lower and lower-middle classes. A report from
Pakistan highlighted 6.7 million people abusing
substances including prescribed drugs. Approximately,
860,000 (0.8%) people were heroin user, 320,000 (0.3
%) were opium users and 1.06 million people (1.0%) of
total population were opiate users (UNODC, 2013).
Stimulants, opioids, and benzodiazepines, antihistamines
and LSD were the most common form of drugs being
abused by students. Male students were more involved in
drug abuse than female counterparts (Zaman et al.,
2015).

1.2.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.

7
Poor health, decline in income and social isolation
jeopardize the individual functioning. Only in Pakistan,
the annual estimated rate of drug abusers is equivalent to
100,000 causing psychological, social and economic
harm to 20 million abusers and their families.

In India, a drug dependent expends 13 dollar per week

on buying drugs, whilst total cost is equal to 250 to
25,000 dollars resulting in poverty and other family
problems (Sharma, 2009). Approximately, 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.

A strong alliance also existed between drug abuse and

disintegration of family. The consumption of heroin and
psychotropic substances led to breakdown in family
cohesion in Thailand (Spielmann, 1994). Drug abusers
destroy the family functions (Sadiq & Umer, 2013).
Families of drug abusers encounter financial constraints,
lack of protection and affection as well. Family prestige
is also at great risk of massive destruction. Eventually,
family reacts to drug abuse by denying, blaming,
suppressing anger, depression and co-dependency
(Sharma, 2009). Families of alcoholics suffer from guilt,

8
stigma and emotional withdrawal (Nace et al, 1982, as
cited in Schafer, 2011).

Significant distress was seen among parents, specifically

mothers of drug abusers (Andrade, Sarmah &
Channabasavanna, 1989). Wives of alcoholics exhibited
avoidance, indulgence and fearful withdrawal in
response to drug abuse problems in their partner
(Chandrasekaran & Chitraleka, 1998). Delusional
jealousy and violent behavior on the part of drug abusers
are triggering factors of suicidal attempts among spouses
(Ponnudurai, Uma, Rajarathinam & Krishnan, 2001).
Wives, sisters and daughters of drug abusers suffered
from depression and anxiety due to caregiver stress,
perceived stigma and quality of life (Rafiq, 2017).

With such psychological turmoil, families, instead of

taking care of patients, become emotionally dependent
on their addicted member. In this precarious situation,
family is compelled to gratify the abuser’s need for drugs
to be saved from further psychosocial harm. 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
patients. Female family member faces a huge burden of
bearing household expenses along with burden of blame.
She herself becomes the victim of both drug abuser and

9
society. Besides, she is supposed to be primary caregiver
for her addicted male member. Caregiving of drug
addicts is too rigorous and is the big source of physical
and emotional tensions/stress for caregivers. This
caregiving related stress seems to influence quality of
life, physical health, psychological health, better
environment and social relationship of female family
members of poly drug abusers (Rafiq & Sadiq, 2019).
Additionally, family finances, emotional support,
relationships with relatives were spoiled as the functions
of substance abuse (Ponnudurai et al., 2001). Drug-
related crimes and accidents also ruin the family
relationships (Schafer, 2011).

In the light of scientific literature, it is suffice to say that

imprudent behavior of drug abusers is troublesome for
entire family. Socio-economical and psychological
health status restrains family to play its effective role in
the treatment of drug abusing member. At this stage,
families need professional help to be come out from their
own psychological pain and extreme emotional
dependency on their patients.

10
 Family and its Various Functions

2.1. Defining Family:

Family is described as a basic unit of society. 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.
Different families make a social system giving various
flavors in form of race, class etc. Family, for
sociologists, refers to a social group, social institution
and social system. The function of family is beyond the
production of children but is upbringing the children
with the aim of developing a sense of socialization so
that they benefit the social system or vice versa
(Eshleman, 1997).

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.

12
 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 approach of family discusses the combination

of both biological and social needs of the family. Two
persons make the foundation of family by tying the knot
following their cultural and religious norms. Almost in
all religions, family is deemed as a source of personal
and social satisfaction. Each religion deters 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.

Islam also stressed upon the rights and duties of all its
members in order to strengthen family system (Islahi,
1998). Fulfillment of duties while mixing the taste of
sincerity, love, enthusiasm and tolerance is the sign of
functional family.

13
Psychologists put reflection on those factors that may
positively or negatively affect the family environment.
The way a family operates its functions encompassing
decision making, relationship commitment, expression of
feelings/opinion, sharing and transferring information
count a lot (Silbrun et al., 2006; Zubrick, Williams,
Silbani & Vimpani, 2000, as cited in Kausar, 2014).
Parental attitude, socioeconomic factors, family
structure, process and life style are pivotal in constituting
mental and social well-being of all 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 psychopathologies and
delinquent behaviors towards the promotion of a
civilized society.

2.2. Seven Functions of Family:

Ogburn in 1930 suggested seven functions of a family
which are as follow:
2.2.1. Economics:

The first and essential function of

family is to produce economic
. sources to gratify basic needs of the
all of the family members

14
2.2.2. Prestige and Status:
Each member of the family is recognized
by his family name in the society. A
person is valued or devalued, in his/her
community, on the basis of his or her
family’s reputation. Therefore, family
must provide prestige and status to its
all members.

2.2.3. Education:

The family is also responsible for

providing education regarding domestic
services and needs besides searching
educational opportunities for especially
children who are required to get along
with competitive world in future

2.2.4. Protection:
The forth function of the family is to
gratify the need of security. Elders
are responsible to provide physical,
social and economic protection to
younger family members.

2.2.5. Religion:
A family must follow the religious values
by arranging religious gathering, religious prayer along

15
with acquiring religious education through the use of
Holy books and other scriptures.

2.2.6. Recreation:

A family, autonomously, needs to

arrange recreational activities within
family not merely relying on the
community and schools etc.

2.2.7. Affection and Procreation:

The family members also need

affection from each other. The family
must deliver adequate affection to
family members besides emphasizing
on procreation.

16
Three Major Functions of a Family:

Winto (1995) had categorized family functions in

following three ways:

2.2.2. To provide replacements for dying members

of society:

All human beings who are coming in the world have to

go back. They are being replaced by one and other. Thus,
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
this stage, his parents go back to eternal place. The entire
world is based on this life cycle.

2.2.3. 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 a
family. Family puts effort to meet the basic needs of its
members as good as possible.

17
2.2.4. To accommodate conflicts and maintain order
internally and externally:

Certain conflicts are expected to occur within and

between family members and society. The third vital
function of family is to resolve these conflicts, to reduce
internal and external problems and to build the potentials
among family members so that they could resolve the
conflicts themselves.

2.3. Eight Functions of a Family:

Ghani (2000) also elaborated various functions of

family, like Oygum (1930), as described below:

18
2.3.1. Reproduction of perpetuation of human race:

Family is responsible for the reproduction of humanity

as nature demands from all human beings.

2.4.2. Sexual Regulation:

Family promotes legal way to satisfy sexual needs and
regulate the sexual behavior.

2.4.3. 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 all family
members.

2.4.4. Socialization:
Family also strives to be socialized by producing socially
adaptable family members. Family makes tie with other
families in the society.

2.4.5. 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.

19
2.4.6. 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.

2.4.7. 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.

2.4.8 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.

20
 Impact of Drug Abuse Problems on
Family Functions

3.1. Destruction of Family Functions:

3.1.1. Destruction of Economic Resources:

Drug abuse, at first, results in destruction of family

economy. Being enmeshed with drug abuse, one could
not produce sufficient economic resources resulting in
deprivation of basic needs of whole family.

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 addicted members for buying drugs. Many
children of drug abusers have to work in factories and

22
shops to bear household expenses. Mothers, in their old
age, wives and young sisters have to go out to earn
money. Drug abuse, instead of providing economic
resources to family, himself becomes dependent on
them.

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 her sons
who are chronic drug abusers. They have been
rehabilitated many times but got relapsed. Their
indulgence in 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.

23
3.1.2. Destruction of Prestige and Status:
Drug abuse harms 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 abusing
family member in crimes is perilous for 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 in response to perceived
stigma and rejection from society. Resultantly, they
socially restrict themselves. Even, in sub-continent,
people do not like to tie the knot with the girls belonging
to drug abusing family.

Case Study
Saima’s brother is a heroin addict. He was arrested
twice owing to being involved in drug-related crimes.
She 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. Even, Saima’s paternal aunt did not like to make
her daughter-in-law. She 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.

24
 Destruction of Education:

As mentioned earlier that family is responsible to

provide educational opportunities to all of its members.
But drug abusers are not capable enough for arranging
educational resources for their children and siblings. The
most pitiful aspect is that children of drug abusers have
to work while putting aside their dreams of being
educated. The drop out of children from school is
commonly observed in addicted families (especially in
lower class). When elder family member spends
family’s wealth on drugs leaving nothing behind for
anyone else, then, children and younger family members
have to sacrifice their needs. Innocent children of drug
abusers do labor work at the expense of their education.

Case Study
Ali’s father is a drug abuser and also involved in
gambling. He needs more money for gambling and
drugs. Ali had to give up his studies since his father
became drug abuser. His 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 does not find sufficient time to study. He
and her mother are working hard to be survived. Ali’s
father addiction shattered his dream of becoming
educated person.

25
 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, in case of
being head of the family, fail to make necessary
arrangement for emotional, social and physical security
of their families. Moreover, families are at the target of
social rejection and vilification that further cultivates the
feelings of guilt, shame and deprivation.

Case Study
Rukhsana’s husband is an alcoholic. She is mother of two
children. She 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 her in front of his
children. Consequently, she and her both children
developed fears. 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
secured in their own home.

26
 Destruction of Religious Rituals:

Religious functioning of the family is highly influence

by drug abuse problems. Family must ensure the
provision of religious education and values to be
followed. Diminished sense of right and wrong, in drug
users, exacerbates the daily performance of religious
rituals. On the other hand, family members with co-
dependency and mental distress could not concentrate in
their prayers as requisite to have spiritual effects in
return. Sometimes, their feelings of hopelessness and
frustration are beyond of their control resulting in
suicide.

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 as well.

27
 Destruction of Recreational Activities:

Recreational activities are indispensable to grow healthy

within family. Involvement in recreational activities
gives sound effects, releases tension and boosts
emotional health. Families of drug abusers are usually
deprived of recreational activities because of scant
economic resources. Hence, their interest is confined to
meeting household expenses. Indulgence of one family
member in addiction makes rest of the family members
helpless diminishing their desires to be the part of any
recreational activity.

Case Study
Usman is 15 years old school going boy. His father is a
heroin abuser. He is having two younger sisters who
also study in the same school. His mother is a factory
worker who is striving to make her children educated
despite her husband’s addiction. Whatever she earns, is
utilized 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 comes back in the evening. At home, she
has a lot of work to do that includes: preparing meal for
children and herself, cleaning, dusting, etc. Usman, his
mother and both sisters are leading a life as a machine.

28
 3.1.3. Destruction of Affection and
Procreation:
Love and affection are necessary strands of a functional
family. All family members are dependent on each other
for the gratification of their love need. Ungratified need
for love and affection will impede the process of smooth
emotional growth of an individual. 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
owing to drug abuse problem. Nevertheless, 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 an 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.

29
 3.2. Psychosocial Consequences of Family
Dysfunction

Destruction of family functions brings dire

consequences in terms of psychosocial problems for
affiliated members.

3.2.1. Psychological Health Consequences:

Family members of drug abusers are always prone to

develop various psychological upheavals. Research
based evidences espoused the pernicious effects of drug
abusers on the psychological health of 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). Mental
health of female close relatives (wives, sisters and
daughters) of drug addicts was affected by caregiver
stress and perceived stigma (Rafiq & Sadiq, in press).

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

30
socially introvert and aggressive than adult children of
non addicts. Alcoholic problems in parents lead to
cognitive, behavioral and emotional problems in
children. They, in later life, develop maladaptive
behaviors and prone to be alcoholics (Johnson & Leff,
1999).

3.2.2. Social Health Consequences:

Social problems are always on the way of families of

drug abusers. Family has to pay a huge economic cost
leading feelings of abandonment, fear, embarrassment
and guilt. In South Asian countries, it is not easy to cut
ties with drug abusing family member. Parents go a long
way to save their addicted children. Sometimes, they go
back from the world taking the pain of their illness.

31
 At social level, families of drug abusers are rejected and
devalued. Sisters and daughters of drug abusers are
found to be complaining of not having suitable marriage
proposal because of social stigma. They are labeled as
sisters/daughters of drug abusers. Even, close relatives
do not like to accept them for their sons. At times, family
has to hide or lie about the abusing patterns of addicted
member so that they could arrange their daughter’s
marriage. The situation seems more pathetic in case of
alcoholism. Families of alcoholics are disliked at
community level associating it with 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 other girls
whose family member drinks.

3. 2.3. Domestic Violence and Abuse

Family has to counter abuse as a consequence of

addictive behavior of any one of the family member.

32
Different forms of family abuse were 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.

Scientific endeavors also evinced drug abusers

perpetuating violence at homes. Approximately, 87%
drug addicts violently behaved with their family
members (Shankardass, 1998, as cited in UNODC,
2002). Drug abusers were more involved in quarrelling,
threatening and using abusive language with their family
members (Sadiq & Umer, 2013). Alcoholism was
associated with domestic violence (Kahler, McCrady &
Epstein, 2003), physical and psychological violence
within family (Manohar & Kannappan, 2010) and death
of female partner (Sharp et al, 2001).

33
Part 4
Professional Services for the Families of
Drug Abusers

4.1. Need of Professional Services for Families

Families of drug abusers also need similar attention as

drug abusers are given. In fact, the treatment of drug
abusers entails long term support and cooperation on the
part of family members to sustain their recovery from
drugs. Unfortunately, families become co-dependent as
the function of drug related problems, for instance,
crime, unemployment, violence, family abuse, social
rejection and stigma. In continuation of this, feelings of
shame, guilt and social alienation impede the successful
provision of support for patient.

Many times, families were found to be the actual cause

of relapse. It all happens as family members themselves
are overwhelmed by psychosocial issues. In order to
avoid further harm, they give money to patients for
buying drugs. Under the shadow of multiple problems,
they incorporated dysfunctional personality patterns.
These patterns are devastating for living environment in
which the entire family feels insecure, deprived and
helpless. Specifically, intense feelings of insecurity are
developed in children.

35
So, the family itself requires professional help besides
accessing treatment services for drug users. Family
members must feel alive, energetic and rejoice mental
harmony whether their addicted family member recovers
from drugs or not. For these reasons, a comprehensive
treatment is essential for the blossom of family health.
Comprehensive and effective treatment is the mixture of
following four types of services to heal families of drug
abusers:

1. Individual Psychotherapy
2. Group Therapy
3. Life Skill Training
4. Family support group.

Individual
Psychotherapy

Life Skill Professional Group

Training Services Therapy

Family
support
group

36
 4.1.1. Individual Psychotherapy:

Individual psychotherapy involves one to one session

that directly targets the psychological problems.
However, the number of sessions depends on severity
and nature of the problems. Variety of interventions can
be applied to heal the patients including supportive,
client-centered, existential, gestalt and cognitive-
behavioral therapeutic, etc.
Individual needs of family members are attended in
therapeutic sessions to relieve distress. Under the
professional guidance, they set new goals for relearning
and personal development. Psychotherapy, not doubt,
works to correct negative emotions, amend maladaptive
behaviors and motivates to confront life challenges.

37
 4.1.2. Group Therapy:

The purpose of group therapy is to heal a group of

people at once. Group therapy is evident to be effective
in bringing emotional, cognitive and behavioral changes
in patients. While devising the treatment plan, this form
of therapy could be the choice of treatment to target
emotional and behavioral problems families are suffering
from. .
It works following different theoretical approaches
including psychodynamic, humanistic and cognitive-
behavioral and so on. Family members learn to
overcome their social deficits, unfold wishes/ desires and
move towards personal growth and development.

38
 4.1.3. Life Skills Training:

Life skill training is provided to rebuild or enhance the

personal skills to cope with daily life problems. Life
skills work as additive to handle stressful situations and
find alternative ways for a particular issue.

Though, drug addiction is not a problem of an individual,

therefore, several worries are expected to be destroying
the entire family environment. The problems of co-
dependency, emotional/ behavioral disturbances and
poor coping skills revolve around the family of drug
abusers. Thus, family members need to be skilled
enough to take stand against psychosocial complications.
Through this training, they acquire personal skills to
combat with environmental hitches. Their coping skills
and sense of positive self-image facilitate the
rehabilitation process to cure their patients

39
 4.1.4. Family Support Group:

Family support groups are held to provide a platform for

family members of drug abusers where they actively
express their feelings and share emotional experiences.
They also gain relevant information, learn from other
experiences and develop insight as to basic mistakes a
family commits while handling addicted member.

Feelings of shame, guilt and resentment are also

explicitly discussed. Every 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
their grief and problematic situation as well. Family
support group is also important in promoting social
networks of the families of drug abusers.

40
 4.2. Process of Providing Services to Families

Professional services are provided to families in

sequences to have long lasting benefits. Individual
psychotherapy is essential if a family member is
suffering from psychological chaos. 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, depression, anxiousness,
aggression and feelings of guilt and shame. At this point,
merely advice will not be effective. A psychotherapist,
being an empathetic, supportive and good listener, will
remove the blockage existing in the expressions of
painful feelings and emotions. Having attended
individual therapeutic sessions, family members come
out of their own psychological tensions and start
realizing the reality of drug abuse problems. During this
stage of treatment, family members can also be provided
group therapy to lessen emotional and behavioral
distress.

After individual and group therapeutic sessions, they

move towards the second stage of treatment. At this
stage, life skills training program is introduced to
strengthen their coping skills to fight in the battle of
daily life difficulties created by drug abusing family
members. Problem solving abilities, improved self-

41
esteem and communicative skills make them able to
handle not only their patients but also their own self.

At the third stage, family members are referred to family

support group where they interact with people suffering
from similar kind of problems. Family support group
urges members to learn from each other experiences.
They come in the contact with those who are facing the
crisis like them. Family support group also helps in
building a sense of socialization that was deteriorated
due to addicted member. But, through this platform, they
are given an opportunity to relive again with enthusiasm.

• Providing individual and group

Stage 1 psychotherapy

• Conducting life skill training

Stage 2

• Conducting family support

Stage 3 group

42
 Individual Psychotherapy
5.1. Individual Psychotherapy:

Individual psychotherapy is one to one alliance between

therapist and patient with the purpose of eliminating
emotional aches. It is a systematic procedure of
changing emotions, cognitions and behaviors of the
person experiencing emotional crisis. In individual
setting, a therapist, by applying therapeutic interventions,
helps patient to achieve insight and defy the life hurdles.
A supportive and positive environment is created to
facilitate the release of repressed material presumably is
reflected in the form of psychological disorders. The
prime responsibility of psychotherapist is to deal with
expression of emotions/feelings to utilize it to amend the
patient’s attitude, beliefs and behavior. Psychotherapy is
expedient in resolving specific snags.

44
5.2. Objectives of Individual Psychotherapy:

The core objectives of individual psychotherapy are as

follow:
 To facilitate the process of catharsis (release
of emotional tension)
 To develop insight as to drug abuse and its
aftermaths
 To resolve the problem of emotional nature
 To get family back from co-dependency
 To strengthen the sense of well-being
 To promote personal growth and
development

45
5.2. Qualities of an Effective Psychotherapist:

Following are the qualities necessary to be an effective

psychotherapist for the families of drug abusers:

 Good listener
 Empathic
 Non-judgmental
 Open-minded
 Flexible
 Competent
 Genuineness
 Caring
 Supportive

46
5.3. Phases of Individual Psychotherapy

Virtually, individual psychotherapy can be applied in

following three different phases:

5.3.1. Phase I: Rapport Building and Catharsis:

At the beginning phase of the treatment, psychotherapist

needs to build rapport with clients while exhibiting
warmness, care and support during therapeutic sessions.
Rapport is vital for the active expression of emotional
experiences and as well the release of emotional tensions
(generally is referred to as catharsis). The use of
empathy, unconditional positive regards and geniuses is
beneficial in facilitating therapeutic relationship and
release of hidden emotions/feelings.

5.3.2. Phase II: Assessment of the Problem:

This phase is
related to the assessment of nature and severity of the
problem. Via intensive probing and structured
questionnaires; therapists assess the psychosocial
consequences of drug abuse problems for the person who
is waiting for help. The therapists may use projective and
non-projective techniques to determine the type and level
of psychological disruptions. Having done the in-depth
analysis of the problem, a complete treatment plan is
prepared to treat targeted symptoms.

47
5.3.3. Phase III: Using Appropriate Interventions:

After confirming the diagnosis, psychotherapist may use

specific or combination of therapeutic interventions to
resolve emotional/behavioral issues. Variety of
therapeutic interventions is available to cure the patients,
for example, cognitive-behavioral therapy, existential
therapy, reality therapy, gestalt therapy, brief
psychodynamic therapy and so on. Selection of specific
therapeutic technique is largely depends on the
diagnosis, its etiological factors and patient’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 psychological sufferings.

48
49
 Group Therapy
6.1. Group Therapy:

Group therapy is one form of psychotherapy used to

unfold emotional experiences and pain towards the
positive emotional growth and development. Group
therapy is really influential in transforming dysfunctional
thoughts, feelings and attitude. Participants of group
assist each other to focus on what they require for their
survival and solutions of significant issues related to
behavioral and emotional dyregualtion (Reading &
Weegmann, 2004). Family members of drug abusers, in
a group, also learn more positive ways of communication
to handle family matters. Besides, they learn to accept
what others feel and think.

In this regard, a therapist may conduct following groups

considering the nature of problem and patient’s
characteristics to ensure great success:
 Analytic group psychotherapy
 Cognitive-behavior group therapy
 Humanistic group therapy
 Art group therapy

51
6.2. Objectives of Group Therapy:
Objectives of group
therapy can be better understood in the light of following
factors as suggested by Ballinger and Yalon (1995):
 Instilling hope
 Universality
 Imparting information
 Altruism
 Corrective recapitulation of problems
from the person’s original family
 Developing social skills
 Imitating others
 Emotional processing and cognitive
reflection
 Interpersonal learning
 Group cohesiveness

52
6.3. Standards of Group Therapy:

Following standards are required to be followed by

group therapist before initiating the activity:

 Number of participants may range from 5 to 12

 Frequency of sessions depends upon the needs
and nature of the problem
 Duration of sessions may be 1 hour but
sometimes it exceeds considering the strength
and objective of the group
 Seats of participants/group members may be
arranged in circle or U-shape
 Group activity will be done following theoretical
boundaries of selected group therapy
 Language used for group session must be fully
understood and spoken by every participant
 Matching among participants should be done
while taking into account the nature of problem
and demographic characteristics

53
6.4. Procedure of Group Therapy:

Session of group therapy will be held in the following

ways:

 Select the participants for group

 Select the type of group therapy
 Decide the activity to be done in a group
(specific technique to target specific symptom)
 Set the duration of group
 Set the rules for participation in a group
 Brief rules to all participants before initiating
the activity
 Use required materials for activity (board,
paper/pencil, colors, audio/video, computer,
etc)
 Introduce yourself to participants
 Let all participants to introduce themselves one
by one
 Brief rules to all participants before initiating
the activity

54
Introduce the nature and purpose of selected activity to
be done
 Pay attention to all participants
 Create warm and supportive environment for
all
 Provide chance to every participant to express
personal opinion and experiences
 Provide feedback to participants when it is
essential

Note: Standards and procedures of group therapy may vary with

the difference of group activities

55
 Life Skills Training
7.1. Life Skill Training:

Life skills training program is applied to enhance coping

skills required in response to daily life stress and other
important concerns. Families undergo continuous stress
due to drug abusing family members resulting in co-
dependency and impediment of skills. For these reasons,
families must be provided proper training to re-build
their coping skills. Here, the core objective of life skills
program is to promote healthy life styles rather than
focusing on illness.

Activities included in life skill training should be done

considering cultural differences, familial/social/ religious
values and as well as demographic characteristics
(specifically, socioeconomic status and education level)
of the participants. Going for jogging is not as easy for a
person belonging to lower or middle class than a person
hailing from upper class. Facilitators need to modify
activities accordingly.

57
7.2. Focused of the Training:

Following skills are focused during life skills training

program:

 Stress management
 Anger management
 Problem solving skills
 Communicative skills
 Boosting self-esteem

58
7. 3. Standards for Life Skill Training Program:

Good facilitator needs to hold the group following some

standards as mentioned below:

 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 daily basis.
 A comfortable and well-equipped room with
adequate light, proper ventilation and
stationeries is required.

7.4. Qualities of an Effective Group Facilitator:

Following are some of the characteristics which make a

group facilitator effective enough to benefit the
participants:

 A good leader
 Supportive
 Honest
 Non-judgmental
 Keen observer
 Firm
 Goal directed

59
7.5. Steps Involved in Conducting Life Skill Training
Program:

Following steps must be taken by group facilitator

before starting the group activity:

 Arrange the comfortable room with all

needed stationeries
 Arrange chairs in circles/U-shape for the
participants
 Decide the type of skill that is to be taught
 Determine the duration of activity and
group size
 Determine the frequency of activities to
teach a skill
 Brief the rules of participation in the
activity
 Do the activity with the help of participants
 Use process questions in the end

60
 Family Support Group
8.1. Family Support Group:

Family support group is a group of closed relatives of

drug abusers whose lives have been adversely affected
by a loved one’s addiction to alcohol or drugs. This
special kind of forum encourages family members to
express their painful feelings and emotions developed
owing to drug abuse related aftermaths.

8.2. Objectives of Family Support Group:

Family support group is held to meet the following

objectives:
 To develop insight regarding drug abuse
problem and its psychological, social and
economic impact on families

62
  To learn from other experiences
 To understand the nature and causes of co-
dependency
 To learn how to solve the problems in order to
overcome psychological anarchy
 To understand the role of family in treatment
and sustaining the recovery of drug abuser
 To understand the signs and symptoms of
relapse and how to work for relapse prevention

8.3. Who Can Attend Family Support Group?

Any close relative of drug abuser who encounter

economical, psychological, social and spiritual problems
as the consequences of drug abuse. Parents, siblings,
spouses, 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 of risk and
protective factors involved in relapse and recovery
process of drug abusers.

63
8.4. 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.

64
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.

65
8.5. Standards for Conducting Family Support
Group:

Following standards should be kept in mind before

conducting family support group

 The group should be comprised of 8 to 12

members
 Duration will be 1 ½ hours
 Well-equipped room with adequate light,
comfortable chairs must be arranged.
 There should be no distraction such as; noise
 Sitting arrangement will be U-shaped/circle
 Participants will be selected controlling their
demographics. Moreover, type of drug abuse
and associated problems must also be taken
into account.
 Group will be conducted in native language
 Topic of discussion will be selected according
to the need of the participants.
 Use neutral words and avoid biased, sexy
language
 Maintain equality among all participants
ignoring their religion, ethnicity or race
 Group will be conducted by a single facilitator
whose family member, either, must be a drug
abuser or recovering drug abuser.

66
8.6. Steps Involved in Conducting Family Support
Group:

Following are the steps taken by facilitator to conduct

family support group:

Step 1: Introduce yourself to the participant

 Salam/hello to all
 Welcome to all for coming to attend
the group
 Please join me 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

Step 2: Telling Rules for Attending Family Support

Group:
Here are some rules to
 Attend the family support group:
 Please turn your mobile off
 Listen attentively to others
 Let others complete their words

67
  Raise your hands if you want to
share something
 Try to avoid non-verbal
communication
 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

 Topic of today is --------------.
 My opinion about the topic is
…………………………………
 Would you like to say something
about this?
 Who would like to share personal
experience/feelings?
 How did you handle that problem?
 Would anyone among you like to
add something to this
 Now we close the today meeting
with the same prayer which we
read in the beginning

68
 Chapter 8

 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:
 The procedure and standards were extracted from already
exiting material related to family support groups.
 Sentences used above in the step 3 are examples and
facilitator can change words during discussion. Try to use
neutral words so that no one gets hurt.

69
 Family Counseling
9.1. Family Counseling:

Family members are interconnected with each other

owing to being an emotional unit (Bowen, 1966, 1978),
as described by Kerr (n.d). If infers that the presence of
psychological problem in one member aggravate the
health of rest of the family members. Accordingly,
families could not adapt to change, communicate well
and cope up with a crisis. While experiencing the crisis
of drug abuse, most of the families are inept to identify
the origin of their emotional wounds.
Hence, family counseling is recommended to alleviate
stress, strengthen family relationships and to modify
dysfunctional communication patterns. Family
counseling benefits in gaining insight of problems
emanated from addictive behavior. It further assists in
removing the obstacles expected to be occurred during
rehabilitation of drug abusers.
Motivational counseling is type of counseling that,
specifically, aims at motivating the families to be ready
for giving maximum input in the treatment of drug
abusers. Families develop understanding concerning
warning signs and symptoms of relapse to ensure
productive contribution in maintaining the recovery of
their patients.

71
9.2. Qualities of an Effective Family Counselor:

To have maximum output from counseling process, a

family counselor must possess following qualities:

 Empathic
 Good listener
 Flexible
 Non-judgmental
 Open to change
 Passionate

72
9.3. Procedure of Family Counseling
9.3.1. Rapport Building and Catharsis

Initially, the family counselor builds rapport with client

being empathic and effective listener. Rapport building
is indeed a road to catharsis. Family members are
emboldened to express their suppressed emotions and
feelings. A long term trustworthy relationship between
counselor and client helps in the exploration of facts
related to drug abuse and related outcomes.

9.3.2. Assessing the Nature of the Problems

A family counselor involves in assessing and analyzing

the consequences of drug abuse for families. Besides,
family counselor also assesses how families
conceptualize the problem of drug abuse and what
coping resources available to counter the existing issues.
More than one family member can be counseled in this
regard. The entire family may be attended to make
connection in obtained information for problem
identification. The process also involves the use of
psychological tools, observation and mental status
examination.

73
9.3.3. Using Counseling Techniques

In case of identifying a psychological disorder, the

family member is referred for psychotherapy to eliminate
the problems from roots. The problems of co-
dependency, dysfunctional communicative patterns and
family pain are entertained by family counselor. For the
resolution of detected problems, family counselor may
choose the counseling techniques derived from client-
centered, cognitive-behavior, psychodynamic,
humanistic and integrative approaches. Selection of
counseling techniques would be done considering
client’s variable (ie, age, educational level, personality
traits and relation with drug abuser, etc). Joint sessions
may also be held.

74
9.3.4. Providing Psychoeducation:

Psychoeducation is an earliest form of family therapy

(Hecker & Thorpe, 2005). Distorted communicative and
living patterns are basically the result of drug abuse.
Thus, counselor makes family aware of how family’s
well-being is impaired by drug abuse problem.
Counselor also enables the family members to overcome
their co-dependency and to be thrive despite living in
disturbing environment

9.3.5. Providing Information about Relapse

Prevention

It is known to very few that relapse is a part of treatment.

Families easily get frustrated when their patient takes
drug again, even provided treatment on time. No doubt,
relapsing again and again is devastating for the families;
rather they start believing the problem of drug abuse as
an incurable disease. For this reason, psychological
counselor must logically convince the family that drug
abuse is difficult to be treated but is curable. Chances of
relapses are always there. Therefore, information related
to warning signs and trigging factors of relapse must be
timely provided to them.

74
9.3.6. Providing Information for the Maintenance of
Drug Free Life Style

Sustaining recovery demands life time abstinence from

drugs. Abstinence is not possible without healthy life
style that entails healthy sleeping and eating habits,
engaging self in creative activities, taking occupational
responsibilities and attending the meetings of Narcotic
Anonymous (NA). The family counselor briefs the
methods necessitate for the maintenance of recovery
from drugs. The family needs to prepare daily plans and
encourage its patient to change his/her life style. Family
counselor, family members and patients mutually decide
the activities seem suitable for leading a sober life.

Note: Family counseling is not the part of treatment plan

as suggested for treating families of drug abuser.
Notwithstanding, it can be a choice of treatment for
families while rehabilitating their patients.

75
 The essence of the present endeavor is that the families
of drug or substance abusers suffer from unlimited woes
which profoundly impair their mental health and coping
skills. Poor mental health and dysfunctional patterns
further impede their adjustment at personal and social
level. Empirical evidences have confirmed the presence
of severe emotional/behavior problems in children and
younger family members. Females, in any role, are silent
sufferers of various psychosocial issues.

Keeping all these facts in mind, exclusive treatment

must be offered to cure families of drug abusers.
Provision of individual/group therapy, life skills
program, family support group and family counseling
can heal their wounds to great extent. Professional
assistance accentuates on developing insight of
emotional turmoil as a consequence of drug abuse and on
rebuilding coping skills for effective dealing with daily
life problems.

77
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