From: Chapter One, "Theories of Addiction and Implications for Counselling" by Alan C. Ogborne, in Susan Harrison and Virginia Carver eds., Alcohol & Drug Problems: A Practical Guide for Counsellors (© 2004 CAMH)
Many social and other environmental factors have been cited as contributing to the onset and maintenance of substance use and to relapse. However, no one factor has been shown to be either necessary or sufficient for use or relapse to occur. Thus, like other factors that influence substance use, social-environmental factors exert their influence in the context of a complex, dynamic multi-factor system.
The availability and cost of alcohol and other drugs clearly influence overall patterns of use (Single, 1988; Godfrey & Maynard, 1988) and can contribute to use and relapse. We have already noted that, at least in the laboratory, price manipulations can influence the drinking behaviour of “alcoholics.” There is also evidence that price influences people who drink heavily in the community. Some clinicians have contracted with clients to increase the cost of alcohol and other drugs to deter relapse. Clients agree that if they drink or take other drugs, they will make a donation to a despised cause or forfeit a returnable deposit.
The substance use culture of the dominant society, and especially of clients’ peers and family, can contribute to continuing substance use and relapse. This is especially so in cultures that promote heavy or illegal substance use, or substance use to solve problems.
Many other aspects of family life may also contribute to substance use and relapse. Family members may present models of substance use that are emulated by children. Childhood experiences within distressed or dysfunctional families may leave children vulnerable to substance use and a variety of other problems as adults. Family-related factors that can contribute to the onset and maintenance of substance use (and possibly to relapse) include:
- membership in a group devalued by the larger society
- alcohol or other drug problems among family members
- parental abuse and neglect
- parental separation
- low cohesion
- low mutual support (Goplerud, 1990).
Systems theory has drawn special attention to the influence of other family processes (Pearlman, 1988). This theory views individuals’ behaviour as being determined and sustained by the dynamics and demands of the key people with whom they interact. (This proposition is compatible with social learning theory, described above.) Further, systems theory proposes that behaviours have functions within dynamic systems, even when the behaviours and their supporting systems cause problems for those involved. The theory draws attention to ways in which a substance user’s family copes with and possibly reinforces substance use, and the implications for the family if the person changes his or her behaviour.
Systems theory proposes that families and other social networks develop “rules” of interaction that can sustain pathological behaviours (e.g., the family implicitly agrees never to plan family events on Friday nights because that is when father goes out to get drunk with his friends). Family members also assume roles, such as “enabler,” “martyr” or “sick person,” that maintain the homeostasis within the family).
The notion that some family members have “codependency” needs that help maintain a dysfunctional homeostasis has been widely and uncritically embraced by the recovery movement. In addition, popular recovery literature and Web sites often refer to codependency as a disease. However, there is little relevant research on this topic, and the concept of codependency has been challenged by feminist academics (e.g., Babcock & McKay, 1995).
In Alcohol and Drug Problems: A Practical Guide For Counsellors