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Focusing on Family Strengths – Dual Diagnosis and Caretakers

by Gretchen Saari

Last month I got my first passport.  My destination was Newcastle on the Tyne in England where the Addiction and Family International Network had a conference.  The research group that sponsored the event believes in the need for strength based, non-pathologizing support for families.

One of the three people from the U.S. who attended was Jan Ligon, PhD., LCSW, an associate professor at Georgia State University, who made a presentation. Like myself, he understands the problematic emphasis on the “Family Disease Model of Addiction.”  He embraces research-based support for “Concerned Significant Others” of people with a Substance Abuse Disorder (SUD). He supports attention to research-based models, such as Community Reinforcement and the Stress, Strain, Coping, Support Model.

He referenced the SAMSHA statement, “The family disease model looks at substance abuse as a disease that affects the entire family. Family members of the people who abuse substances may develop codependence, which causes them to enable the IP’s substance abuse. Limited controlled research evidence is available to support the disease model, but it nonetheless is influential in the treatment community as well as in the general public (SAMHSA, 2008, p. 5).”

NAMI began with families around a kitchen table.  They were subject to erroneous theory about schizophrenia that blamed “schizophrenic” mothers for schizophrenia. The medical field has dropped references to schizophrenic mothers, but the treatment field for SUD’s(Substance Use Disorders)  hangs on to labels and old theories. The strengths and needs of families are not recognized by many providers.

I hope that NAMI members will sit around tables and talk about their needs as concerned significant others.  The two stigmatizing labels mentioned in the SAMSHA statement are “codependence” and “enabling”. These unscientific and vague labels were all I knew for years, beginning in 1984, when I began my journey to support my sons.  NAMI classes actually helped me break through the stigmatizing labels. I learned that the labels hampered me rather than leading me forward. I learned how I need support and inner strength.

In NAMI Family to Family classes, families are approached as caregivers. In 2015, the American Association of Psychologists, made a “Public Health Directorate” stating that families who have member with a SUD need support as caregivers. 

“Although family members of individuals with addictive disorders frequently have been studied, there has been little recognition in the field of addiction of the caregiver role played by these individuals.
Early theories tended to blame family members for the addictive problems, but later theories acknowledged the stress created by being in a close relationship with someone suffering from an addictive disorder.”APA Public Health Directive

Thoughtful advocacy can transform the ways families are viewed. Families can receive credible support. Families can make positive contributions in this time when substance abuse is a major and rampart health care concern.

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