Dual Diagnosis and the Family

The impact on the family unit of a member with a dual diagnosis of psychiatric disability and either a substance abuse disorder or a developmental disability can be complex. (The topic of dual diagnosis, mental illness and substance abuse, is given more thorough treatment in chapter 8.) Depending on the severity and duration of the person's disabilities, the family may have expended considerable emotional and financial resources in coping with the situation. All areas of family functioning may be affected by the presence of a dual diagnosis in a family member, including the general atmosphere, the ways family members communicate with each other, and the relationships, roles, and responsibilities that family members assume or are assigned (Daley, Moss, & Campbell, 1993). Likewise, families affect the family member with a disability. In their attempts to "control the uncontrollable," some family members may become overinvolved or enmeshed. Others become completely shut off or "disengaged" from their family member with a disability (Evans & Sullivan, 1990). In the case of a substance abuse disorder, sometimes well-intentioned behavior on the part of caring family members has the unintended effect of enabling the person to continue to abuse substances. For example, money given to the individual for living expenses or rent may actually be spent on alcohol or drugs (Evans & Sullivan, 1990).

Nevertheless, families have often developed skills and strategies for coping with a very difficult situation and services to families should build on those strengths. Evans and Sullivan (1990) address the need for families dealing with substance abuse and mental illness to enter a recovery process of their own. Education about chemical dependence and psychiatric disability, support groups such as Al-Anon, the 12-step program for families, and skill development in problem solving, negotiation, and communication are all services that are helpful to families in recovery (Evans & Sullivan, 1990). The concept of family recovery is addressed in more detail later in this chapter.

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