Addiction/Recovery as a Family Tradition?
When that doctor asked me, ‘Son, how did you get in this condition?’
I said, ‘Hey sawbones, I’m just carrying on an ole family tradition.’
–Hank Williams, Jr., Song Lyric, Family Tradition.
The intergenerational transmission of addiction and related problems has been documented for more than two centuries. Put simply, the children of alcohol and other drug (AOD) dependent parents are at increased risk of developing such problems, even when raised in alternative environments. Risks are amplified when combined with other factors, e.g., adverse childhood experiences, early age of onset of drug use, co-occurring medical or psychiatric disorders, enmeshment in drug-saturated social environments, and limited problem-solving assets.
In earlier publications, my co-authors and I have addressed the sources of such risks as well as potential strategies for breaking intergenerational cycles (e.g., see HERE and HERE). The challenge we faced in proposing potential solutions is linked to a much larger issue. The AOD research establishment has historically focused on illuminating the psychopharmacology of intoxicating substances, cataloguing the pathologies of acute and chronic drug consumption, and describing and evaluating the short-term effects of educational or clinical interventions designed to alter the course of substance use and substance use disorders (SUD). Absent from this research agenda have been rigorous studies to elucidate the prevalence, pathways, styles, and stages of long-term personal and family recovery across cultural contexts. Without such a recovery research agenda, some of the most important questions facing individuals, families, and communities remain both unasked and unanswered.
If, for example, we followed a large community and clinical sample of parents meeting diagnostic criteria for a substance use disorder (SUD) and examined the prevalence of AOD use, risky use, and SUD among their children, what would we discover with regard to the following five questions?
- Does recovery of a parent reduce the likelihood of that parent’s children developing a SUD compared to parents who have not achieved recovery?
- Does parental recovery increase the likelihood of recovery for any of their children who experience a SUD compared to children of parents who have not achieved remission?
- Does parental involvement in professionally-directed addiction treatment or a recovery mutual aid group affect the intergenerational transmission of SUDs and the recovery prognosis of their children?
- Does the participation of a child in his or her parent’s addiction treatment or in a family-focused peer recovery support group affect that child’s future vulnerability for experiencing or recovering from a SUD?
- For parents who have experienced a SUD, are there parental actions associated with lower SUD risks for their children?
These are not obscure academic questions—the addictionologist’s equivalent of how many brain cells can dance on the head of a pin. They are instead questions of enormous concern to every parent who has experienced an alcohol or other drug problem and to every parent in recovery. It is time, no, past time, for such questions to be answered. If even partial answers to these questions are available, why have they not been widely disseminated to those most directly affected? Is anyone at the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism listening?
Apparently so. McCutcheon and colleagues have just published a NIAAA/NIDA-funded study in the renowned journal, Addiction, that is among the first to explore the questions raised above. The study examined whether the odds of remission from an alcohol use disorder (AUD) increased depending on the existence of relatives in AUD remission. The likelihood of remission was more than three times greater for those related to someone in AUD remission compared to those related to someone with persistent AUD. What remains unclear is whether this remission advantage is a function of heritable traits that increase remission probabilities (i.e., a form of biological recovery capital) or whether this advantage springs from social contagion (e.g., the influence of one family member in recovery upon another family member in need of recovery.) This is the most definitive report to date on the intergenerational transmission of increased odds of recovery from addiction. We have long known that the risk of addiction runs in families; there is now preliminary evidence that this is also true of addiction recovery. Future research may illuminate how the odds of transmitting such resilience may be increased.