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Dr. Howard Wetsman on the role of family in addiction recovery

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Next month is National Recovery Month, and while most attention goes to addicts seeking sobriety, it's important to realize addiction is a disease that affects the entire family. Townsend chief medical officer and author of Questions and Answers on Addiction, Dr. Howard Wetsman, discusses the role of family in addiction recovery.

What is addiction, and how does it affect the family of the addict?

Addiction is a largely genetic, chronic brain illness with definable symptoms that exists whether or not the person is using. How the family is affected will vary depending (on the) severity of symptoms, the reward (anything that can be used compulsively to cause a spike of dopamine in the reward center of the brain) to which the person with addiction is attached and who else in the family has the illness. Almost all these are variations on a single problem: The people with addiction are attached to the reward and are unavailable to fill some or all of the roles the family expects of them.

When people say addiction is a family disease, what do they mean?

When one person has addiction, it requires a change in family roles as well. You'd see the same thing in any chronic illness that limits someone's ability to function. As we learn more about the genetics of addiction, the saying "it's a family disease" becomes more literal.

Are there genetic indicators in addicts, even those who might not display their symptoms outwardly?

There is not, nor is there likely to ever be, a genetic test for addiction. Addiction, while a single illness, is one that has multiple pathways to getting the illness. As each of those pathways has separate genetics, there will not be a single genetic test for addiction. It's important to see the symptoms of addiction: inability to enjoy normally rewarding activities, low motivation, poor memory, poor attention and difficulty attaching to anything or anyone that isn't a large source of reward, such as a drug. This normally brings about a picture of "restless, irritable and discontented" and is pretty noticeable.

What can family members do to support an addict's recovery?

The most important thing is to seek your own help. Just like in an airplane when they tell you to put your own oxygen mask on before helping your children, it's important for the family of someone with addiction to get their own help first or at the same time as they get help for that person. So often we become so focused on that person that we forget to take care of ourselves. Al-Anon Family Groups are a great place to start your own recovery, whether or not the person you're focused on wants help for themselves.

What role does the family's recovery plan play in helping the addict stay sober?

A big one, but not the way most people think: Most people think in terms of, "We have to learn a lot because we have to get this right or he won't stay sober." What a family's recovery will teach them is that the family members with addiction will have to get sober and stay sober with help other than theirs. There's nothing to "get right." In fact, one of the greatest lessons of a family's recovery is to stay out of the way to let the person with addiction find his or her own path.

How can 12-step groups help?

They provide social support for someone going through early recovery; they provide a place for the person in full recovery to help others and solidify his recovery process; they provide a program to clear away the "wreckage of the past" so the person can get a fresh start; and they provide a place to build a life that includes spiritual principles, regardless of whether a person has any religion. From my standpoint as a physician interested in the treatment of addiction, I think the most important thing involvement in working the 12 steps does is actually change the brain and increase dopamine receptor density. This helps medications work better, and in some people, can alleviate the need for medication.

Many addicts abstain from other things that may be addictive. For instance, a recovering cocaine addict may abstain from alcohol and gambling. Why is this?

Addiction is a chronic illness and no one gets over it. Because addiction is a brain illness, not a drug illness, it's important to abstain from anything that can be used compulsively. Many people will say, "But alcohol was never my problem. Why should I not drink?" If addiction were just the same as substance abuse that would be true, but addiction is a progressive illness that progresses with age just like any chronic illness. It progresses faster in people who are compulsively using. The reason a person with addiction shouldn't use is that it causes rapid disease progression — the same reason a diabetic should not eat sugary foods. There's no right or wrong about this, no moral lesson — just medicine and common sense.

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