As part of my series on addictions and families, guest writer Jeffrey D. Roth, M.D. explores more deeply how depression and anxiety are symptoms for both the person with the addiction and for members of her or his family. Last week, my post looked at my own experience with the family disease and other examples. I wrote about how in my family, alcohol and sugar addictions often went together and were accompanied by anxiety and depression. I also provided examples of how addictions can manifest over several generations in families and why the family disease is often untreated.

Dr. Roth is a leading practitioner and advocate for attention to and treatment of the full impact of addictions on individuals and their families and friends. He is a Distinguished Fellow of the American Society of Addiction Medicine and practices in Chicago. He is the author of Group Psychotherapy and Recovery from Addiction: Carrying the Message.

As an addiction psychiatrist, I am often consulted by people who have been treated for depression and anxiety by colleagues who are not well-versed in the diagnosis and treatment of addictions.  There are two patterns I observe from this practice.

First, I and other colleagues have seen first-hand the limited results from trying to help someone who is addicted deal with depression or anxiety before the addiction is treated and the person is engaging in a process of recovery. A person who is addicted may be looking to medicate uncomfortable emotions. The addictions often involve the use of mood-altering substances such as alcohol, nicotine, marijuana, cocaine or opiates.  Other strategies include the use of food, money, sex and other processes to avoid uncomfortable emotions.  Even those colleagues who might recognize the signs and symptoms of chemical intoxication and dependence may attempt to treat anxiety or depression while the person being treated continues to use mood-altering substances.  This process often results in a treatment stalemate.

That the use of alcohol and other chemicals which suppress anxiety may cause central nervous system depression is not surprising.

What may not be generally appreciated by mental health professionals and most non-professionals is the high prevalence of problem drinking and substance misuse in the population of people who seek help for their “depression.”  The attempt to treat this depression, either with medication or psychotherapy or both, while the person is still using alcohol or drugs, is often a self-defeating process where any salutary effect of treatment is offset by the impact of the addiction.

More frequently, and relevant to this series on how addiction is a family disease and Al-Anon’s 70^th anniversary, is that the people struggling in a close relationship with someone who is using mood-altering substances are not considered to be suffering from the family disease of addiction, i.e., their depression and anxiety and the quality of their relationship with the addicted person is ignored in the treatment. The focus is too often solely on the addicted person.

Incorporating the concept of addiction as a family disease opens treatment options that utilize systemic psychosocial interventions rather than relying exclusively on pharmacologic or isolated cognitive-behavioral changes. 

The most well-developed psychosocial intervention for addiction as a family disease is available in the Twelve Step fellowships.  The first such fellowship, Alcoholics Anonymous (AA), has been in existence for more than eighty-five years. AA has inspired a growing number of other Twelve Step fellowships, each one specific to a particular addiction or compulsive behavior. For the first twenty years of AA’s existence, the family members and friends of problem drinkers would attend open AA meetings to learn about the disease. Seventy years ago, these family members and friends formed their own fellowship of Al-Anon to recover from the symptoms of their version of the family disease.

As noted above, often ignored is the prevalence of anxiety and depression in the family and friends of problem drinkers and addicts.  These family members and friends are usually embroiled in overt and/or covert power struggles with the problem drinker or addict that saps their energy (depression) and generates substantial anxiety. Treating such depression and anxiety while the person continues in the power struggle may yield as little progress as does similar treatment with the alcoholic or addict. In other words, recovery from addiction while practicing the addiction or from the effects of addiction on family members while the family members are focused on controlling or stopping the addictive behavior may present formidable challenges

Fortunately, the Twelve Step fellowships offer a reliable path to recovery from both the anxiety and depression that are symptoms of the family disease of addiction.  Family members who have accepted chronic anxiety and depression as the price they need to pay in order to maintain the illusion of keeping their friend or family members out of trouble will not be prevented from continuing their pattern of fixing, managing and controlling others.  Participation in the fellowship of Al-Anon offers the experiential opportunity to engage with other family members and friends who support each other in detaching with love may interfere with their illusions.  Similar to the alcoholics and addicts who let go of medicating their feelings with substances, family members may let go of medicating their feelings with the illusion of control.  Recognizing the frequent connection between depression and anxiety with addiction both for the person with the addiction and those close to her or him increases the likelihood of recovery through Twelve Step programs and other professional help as needed.

This post was published on Recovery Speakers on May 17.