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Addiction, The Ties That Bind (the entire family)

Addiction: A Family Affair


When the addiction finally reveals itself in the workplace it is often asked:

“Why didn’t anyone say something sooner?”  After a more careful analysis,

it is apparent that the talons of addiction are not only embedded in

the addict, but also the co-workers that unknowingly enable their behavior.



According to the American Society of Addiction Medicine (2015), substance use disorder (addiction) is characterized by the inability to consistently abstain from controlled substances, impairment in behavioral control, continued cravings, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Conservative estimates state that nearly 10% of the general public and as high as 15% of health care professional is currently or will be addicted to drugs or alcohol in their lifetime (SAMHSA) (2).  To illustrate the point that substance use disorder affects many more than the individual addicted, consider the following; 30% of the general population knows an addict or alcoholic first hand and an additional 10% of the general population currently lives with one (National Council on Alcohol and Drug Dependence)(3).  The culmination of these startling statistics would indicate that someone addicted to drugs or alcohol directly affects 50% of the population.  This does not take into account the countless numbers of patients, consumers, or unsuspecting people that fall under their direct care.  Despite the overwhelming empirical data identifying a justification for an aggressive and proactive approach, less than 10% of those afflicted with the disease receive proper treatment and less than 5% of those treated will seek help voluntarily (Drug Free) (4).  Most, nearly 95% will be required to enter treatment only after “getting caught”. 


A closer look at addiction reveals many components of the disease that are propagated by someone other than the addict. In particular the problem lies with the inability of the addict to recognize ones own behaviors or in their maladaptive responses to good-intentioned support systems attempting to intervene.  In the case of the addict it is likely their family, in the case of the addicted nurse it may also be their “hospital family”. This arduous task of providing assistance often falls on the people that are closest to and are empathetic to the struggles of the addict. Most often and despite heroic efforts, the family’s good-natured attempts result in enabling the addict and worsening the disease.  In the nurse’s case, there are two families enabling the addiction, the nurse’s immediate family (spouse, children, parents) and the family at the healthcare institution (co-workers, peers, supervisors). Both “families” share similarities in that they both care about the individual, both contain complex interpersonal relationships within the family system, both area affected profoundly by the addicted family member, and both families experience the stages of loss and grief when outcomes are less than ideal.  It is because of these similarities that intervening and assisting the nurse while they are in the throws of the addiction can be challenging.  Despite altruistic and sometimes monumental efforts to help, issues of co-dependency, enabling, and lack of education often impede the family system from being effective with their attempts to render assistance.


One major reason why families develop codependency and enabling traits is to help soften the embarrassment of social stigma associated with addiction. Fear of punitive reactions, societal judgment, and shame are often reported as to why assistance is not proactively sought.  More importantly, family members and loved ones often fall under the spell of codependency and become affected by the disease by proxy. This is true for both the immediate family and the nurse’s family at work.  Codependency is more than enabling bad behavior; it has been defined  “as a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition, most commonly addiction” (Daily, John)(5).  It is this psychological condition that can be directly correlated to the addicted counterpart in the relationship.  This is a significant indication that addiction affects the entire family, not only person abusing the substance.  Codependency can be a protective spouse, and overly attentive coworker, inappropriately doting parents, an accommodating supervisor, or a lax and tolerant employer.  As addiction progresses, so too does the codependent behavior and the dysfunction and maladaptive behavioral patterns within the family. 


Family Roles


The different family member’s roles are subconsciously assumed amongst both the immediate and work family with the primary objective to maintain a balanced family – social system. The family members codependent role is portrayed only after the person’s addiction is introduced into the family system. This introduction is a gradual development and often unnoticed for a period of time. Once the addiction is unmasked changes in family behavior and personalities become easily identifiable. First, the addicted individual becomes the center of the family’s attention.  The balance of the family is derailed and the use of the substance often becomes the most important aspect in the family’s life.  The addict starts to leverage position within the family to garner support through sympathy, guilt, shame, denial, and fear.  Individualized manipulation is a significant tactic used by the addict and through the lack of consistency, starts to lose the ability to maintain behavioral control. Within the work family, the addicted nurse is often portrayed as experiencing burnout syndrome, workload fatigue and emotional exhaustion. These are all signs that may indicate substance abuse and addiction. Co-workers may recognize the signs but yet enable the individual buy helping out “extra” during shifts, covering the individual’s unplanned absences, providing cover for work site discrepancies, failing to report suspicious activity, endorsing unwittnessed narcotic waste medication, and falsifying records all with the attempt to protect the nurse. When the addicted nurse is confronted, stories of divorce, victimization, personal struggles, abusive relationships or recent family deaths garner sympathy and dissuade the co-worker from reporting the glaring substance use indicators.


Similar to the traditional family, the work family members subconsciously assume one of a few roles.  These roles are an attempt to bring homeostasis to the family but also impede healing.  The “Care-Taker” is the co-workers that make excuses for the addict.  They may use terms like “He is just having a really hard time at home” or “ She is nodding off because she is going through a difficult time right now”.  Although the intention is to protect the nurse, the enabling is maladaptive.  The “Lost Child” co-worker knows that something is wrong but for fear of making things worse, choses to remain silent.  They hope that the situations will self resolve and no one will be reprimanded.  This co-worker often feels great amounts of anxiety and angst.  The “Hero” co-worker will work diligently to pick up the slack. This nurse will come in early, stay late, double check on the addict nurses patients and attempt to maintain stability in the workplace, often at the expense of their personal well-being.  Lastly, the “Mascot” co-worker attempts to maintain workplace stability by deflecting away from the addicted nurse.  They often use humor, story telling, and self-disclosure of personal information.  They will attempt to engage in many conversations to direct the attention from the addicted nurse.  Once the addiction is revealed they are often left with a feeling of guilt and self-blame because they didn’t do enough to help.