ROLE REVERSALS IN FAMILIES OF SUBSTANCE MISUSERS - A TRANS-GENERATIONAL PHENOMENON

Fifty adult methadone maintained opiate misusers were seen with their spouse and/or family of origin in outpatient therapy as part of a Vete rans Administration Research project supported by NIDA. Family treatme nt was offered in an attempt to improve and enhance family relationshi ps/social supports and to aid in the decrease or cessation of drug use . In this study, 42 of the 50 patients had parents who were substance misusers. The subjects were evaluated by constructing a Three-Generati onal Family Tree to define and clarify the nature of problems across t he generations. Success or failure was measured by the Addiction Sever ity Index (ASI) which assessed drug use, problems with family, health, social relationships, legal difficulties, and employment as well as p sychiatric symptoms. A recurrent problem of the ''absent father'' was identified across both generations studied. Thirty of the 50 opiate mi susing men had absent fathers (usually due to alcohol or other drug mi suse) and 27 of these 30 became absent fathers (also usually due to su bstance misuse) when they had children of their own. The absence of a father produced major developmental problems seen in these families. P articularly important was the ''Parentified Child,'' forced to prematu rely assume adult responsibilities. This age inappropriate role assump tion was common in both the patients and their children, and was seen as a contributor to the initiation of drug misuse. A structured clinic al intervention is described using the three-generational family tree to bring out these relationship issues, followed by supportive family therapy to restructure wounded family relationships from the family of origin and to bring about appropriate role expectations in the marita l families. The findings suggest an improvement in legal difficulties, drug use, and psychiatric symptoms.