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Journal of Psychoactive Drugs, 44 (2), 173–185, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 0279-1072 print / 2159-9777 online DOI: 10.1080/02791072.2012.685408

Familial Risk Factors Favoring Drug Addiction Onset

Jadranka Ivandić Zimić, Ph.D.a & Vlado Jukić, M.D., Ph.D.b

Abstract — This study, primarily aimed at identification of familial risk factors favoring drug addic- tion onset, was carried out throughout 2008 and 2009. The study comprised a total of 146 addicts and 134 control subjects. Based on the study outcome, it can be concluded that in the families the addicts were born into, familial risk factors capable of influencing their psychosocial development and favoring drug addiction onset had been statistically more frequently encountered during childhood and adolescence as compared to the controls. The results also indicated the need for further research into familial interrelations and the structure of the families addicts were born into, as well as the need for the implementation of family-based approaches to both drug addiction prevention and therapy.

Keywords — drug addiction, family, risk factors

Drug addiction represents a global health and social challenge faced by the modern world, with ongoing prob- lems for all parties involved; this is true especially for the members of the addict’s family, who often have to admit their inability to cope in an efficient manner. The ever-growing prevalence of opiate drug abuse has eventu- ally led to crises in modern society and traditional family ways; it has jeopardised fundamental social virtues and values and led to a rise in criminal behavior. Therefore, drug addiction issue should be viewed as a multidisci- plinary phenomenon whose causes are to be sought in the interplay between biopsychological, familial and social factors, and in the interplay between risk and protective factors (UNODC 2009; NIDA 2003). Nevertheless, a fam- ily can‘t be viewed as an isolated entity, but rather as an integral part of the broader community, so that a family and society are in constant interaction that strongly affects

aSenior Adviser to the Government and to the Governmental Office of the General Programs & Strategies Department, Office for Combating Drug Abuse of the Government of the Republic of Croatia, Zagreb, Croatia.

bHead of the Hospital, Psychiatric Hospital Vrapče, Zagreb. Please address correspondence to Jadranka Ivandić Zimić,

Ph.D., Office for Combating Drug Abuse of the Government of the Republic of Croatia, Preobraženska 4/II 10000 Zagreb, Croatia; phone: +385 1 48 78 130; fax: +385 1 48 78 120; email: jadranka.ivandic@ uredzadroge.hr

not only individual behavioral patterns, but the society as a whole (Georgas 2006). It has been well recognised that, aside from familial risk factors, addiction onset can also be influenced by other cultural-social factors, personal- ity features and genetic predispositions working together (NIDA 2003). While discussing the fundamental functions of the family, the American sociologist Talcott Parsons has mentioned primary and secondary socialisation, the for- mer defined as going on within the familial frame during an early childhood, and the latter as taking place outside family boundaries and developing as a result of social influences stemming from peers, school and immediate surroundings (Georgas 2006). Familial sociopathology in terms of alcohol abuse, domestic violence and especially child molestation and neglect have adverse effects on the child’s healthy psychological development and are fre- quently seen as the primary cause of psychological issues and risky behaviors, including addiction (Bry et al. 1998; Haddad, Barocas & Hollenbeck 1991). Studies devoted to addicts’ families, carried out in Philadelphia, have demon- strated that the nature of chronic heroin addiction may be explained by family structure and intrafamilial relations (Stanton et al. 1978). In several of their studies, Stanton and colleagues have described the male addict prototype characterized by a highly involved and considerate, over- protective mother, indulgent when it comes to the addicted

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child or even favoring that child over the others. The father of the male addict, on the other hand, is pictured as sepa- rated, uninvolved, weak or distant, or aggressive and brutal, many among them being alcoholics as well.

Peak incidence for addiction occurs in adolescence although other forms of addiction may manifest later in life (NIDA 1999; Nikolić, Klein & Vidović 1990). NIDA studies have pointed towards poor parental surveillance and parent-children conflicts as strong predictors of drug addiction onset (NIDA 1999). Studies have also found that in retrospect addicts very often viewed their mothers as more functional than their fathers in terms of involvement, responsibility and attachment (NIDA 1999. According to numerous theories, an inadequate fulfilment of the parental role, the lack of parental surveillance included, can even- tually result in deviant behavior onset (Stattin & Kerr 2000; NIDA 1999). One study concerned with the relation between bad parenting and delinquency (often associated with drug consumption) revealed the delinquents to have markedly poorer communication with their parents, to lack trust in them, and to be much less bonded to them as compared to nondelinquents (Stattin & Kerr 2000).

Parental alcohol abuse, especially that of the father, can be responsible for children’s issues such as behav- ior problems, delinquency, toxicomania, school issues or school quitting, and issues of a psychological nature like sleep disorders, anxiety and depression (Vitaro, Tremblay & Zoccolillo 1999; Haddad, Barocas & Hollenbeck 1991). Numerous studies have shown that poor interparental rela- tions adversely impact child’s psychological development, since marital conflicts are linked to a child’s incapacity for social adjustment and his/her harsh upbringing reg- imen, later on closely related to risky behavior patterns including addictive substance consumption (Goddman & Brand 2009; Haine et al. 2008; Ferić Šlehan 2004; Vukšić Mihaljević & Grubeša 2004; NIDA 2003; Stanton et al. 1978). Given the hypotheses quoted above, drug addic- tion may certainly be analysed from the familial dynamics standpoint, as well as from the standpoint of family struc- ture and intrafamilial relations (NIDA 1999; Stanton et al. 1978).

In line with the foregoing, this study primarily aimed at investigating the familial risk factors favoring drug addic- tion onset, taking into account developmental, interaction and social aspects, so as to ultimately be able to determine the existence of certain specific familial characteristics and a profile of family relations typical of drug addicts that might be shed light on as risky familial environments causing some children to be more prone to drug addiction.

DEVELOPMENTAL THEORIES ADDRESSING ADDICTION ONSET

The most renowned developmental theories address- ing drug addiction onset are psychoanalytical theories that

view the family as the key factor responsible for personality shaping. These theories have pointed towards several famil- ial factors considered of importance not only for the onset of addiction, but other psychological disorders as well. Among these factors, those indicated as the most important are early separation from the parents, unfavourable percep- tion of the father figure or his absence from the family, and conflicting, cold and distant relations with the parents (Oslen 2004; Nikolić, Klein & Vidović 1990).

The family, defined as a core community primarily responsible for the upbringing of its offspring and expected to show continuous care for children’s psychophysical development, may be considered essential for personality shaping and viewed as a primary social group playing a crucial role in the upbringing and socialisation of future generations (Janson 2007). In its efforts to fulfil this role, a family gets to witness and deal with various emotional relations and interactions, the dyadic relation between the mother and the child being the fundamental one (Rudan 1995). According to the psychoanalytical theory, child psy- chological development runs through psychosexual devel- opmental stages (oral, anal, oedipal, latency, and adolescent stages). Should the first three stages run smoothly, i.e. free of major frustrations and traumas, and under favourable cir- cumstances, the latency and adolescent stages are likely to be far less painful (Nikolić, Klein & Vidović 1990). These theories have also suggested the importance of parental presence in early childhood, since separation from the par- ents can be the origin of anxiety and infinite psychological trauma. Early separations from the parents affect the qual- ity of relations with the object of affection (the parent/the parents) and may profile the entire course of the child’s further psychological development. Traumatic experiences witnessed in early childhood may compromise ego devel- opment (Rudan 1995; Klein 1992); separation from the parents definitely falls into the category of such experi- ences, since it can induce an overdue defence mechanism utilisation, personality splitting and projection. Premature separation from the parents may cause stress and psycho- logical trauma that become a source of anxiety, which, in turn, may trigger drug consumption so as to bring “relief” and “alleviate” psychological symptoms arising due to traumas and stresses witnessed in the early child- hood. Psychoanalysts are of the opinion that the quality of upbringing and well-balanced relations with both parents are a prerequisite for a healthy and normal development of a child (Nikolić 1991). Relations with the parents, built in early childhood, mirror the relations established in the adolescence. Close emotional relations with the parents are largely conditioned by emotional relations established in the first three developmental stages, and close emotional relations (intimacy) with the parents, established in early childhood, act as a protective factor hindering drug addic- tion onset during adolescence (Nikolić, Klein & Vidović 1990; Goddman & Brand 2009).

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Drug addiction onset is closely linked to adolescence. By definition, adolescence is the time of crisis in the life of virtually all individuals; however, children com- ing of age under unfavourable conditions compromising their emotional development are far more endangered. Psychoanalysts have taken the position that adolescence can be best described as the period characterised by a number of psychological phenomena and issues that an adolescent needs to resolve. One of the major issues to be resolved is the oedipal conflict; its final resolution should be followed by the assumption and the embracing of sex roles. Major task number two, pending resolution, is social affirmation in the local milieu and the assumption of social roles. From where the psychoanalysts stand, definite ful- filment of these tasks and ultimate resolution of these conflicts depend on relations established in the primary childhood (Rudan 1995). Furthermore, since one has to prove and promote himself/herself within the local com- munity, the role of peer groups, and their influence on values an adolescent chooses to adopt and observe, is of the utmost importance; therefore, such peer groups may often be directly involved in drug addiction onset. In light of the foregoing, it is highly likely that a certain number of adolescents, whose early psychological development was rich in difficulties and frustrations, would try to resolve an otherwise normal adolescent crisis by virtue of drug consumption.

INTERACTION THEORIES—FAMILIAL RELATIONS AND FAMILY STRUCTURE AS

FACTORS IMPLICATED IN ADDICTION ONSET

Symbolic-interaction theories addressing the role of a family have acknowledged the importance of communi- cation between family members not only for the proper family functioning, but for its survival as well. Marriages and families are essentially built of individuals having a long-term mutual interaction (relations), the latter being dependent on the roles assumed by an individual family member at a given point (Plunkett 2011: Janković 1994). Interaction theory greatly resembles conflict theory, which states that a conflict represents the foundation of each and every social relation, familial relations included, such conflict stemming from a desire to assume as powerful familial role as possible in order to protect one’s interests (Janson 2007; Farrington & Chertok 1993). This conflict arises on the grounds of controversial wishes and desires of two or more groups, or on the grounds of a limited supply of the objects concurrently targeted by various indi- viduals or groups. This theory argues that such conflict represents the basic ingredient of not only the social life of an individual, but the development and progress of the society on the whole (Farrington & Chertok 1993). Studies of the birth families of addicts by Stanton and colleagues (1978) showed that the causes and nature of chronic heroin

addiction may be explained by analysis of familial rela- tions, i.e. the analysis of familial interactions and family structure. These studies attempted to find out the differ- ences between families dealing with addiction and families dealing with similar issues. The comparison revealed some phenomena seen across addicts’ families to be very similar to those encountered among other disorderly and dysfunc- tional families and/or families dealing with issues of other nature. In addition, it was found that the family of an addict has distinctive features and specificities. For instance, such families are characterized by high substance (in particular alcohol) addiction prevalence rates seen across generations, as well as by a frequent predisposition to other forms of addiction, for instance pathological gambling disorder. Of note, other studies carried out within 1975–1979 time- frame yielded similar results, even though it should be pointed out that the focus of the later studies devoted to this problem had mostly been shifted from familial factors, in particular familial relations favoring drug addiction onset (Coleman & Stanton 1978; Harbin & Maziar 1975).

Numerous later studies have demonstrated that the consumption of drugs and other addictive substances can be associated with familial surroundings characterised by an insufficiency or lack of parental support and by little parental knowledge about the persons their adolescent is associating with. NIDA studies have revealed poor parental surveillance and parent-child conflicts to be strong predic- tors of drug addiction onset (NIDA 1999). This research has suggested the importance of a strong emotional rela- tionship with the parents and parental support as protec- tive factors hindering drug abuse. As opposed to that, parental addiction, parent-child conflicts, a local milieu favoring drug abuse, and positive peer group attitudes towards drug consumption are risk factors facilitating drug addiction onset. According to numerous theories, inade- quate parental practices, the lack of parental surveillance included, can ultimately lead to deviant behavior onset (Stattin & Kerr 2000). These theories support the thesis that adequate parental surveillance is capable of prevent- ing deviant behavior including addiction. A study that dug deeper into the association between poor parental practices and delinquency showed that delinquents have a far poorer communication with their parents as compared to non- delinquents; they have little faith in, and loose bonds with, their parents (Cernkovich & Giordano 1987). The results of the research study “The System of Values Observed by the Young Ones and Social Changes Witnessed in Croatia” carried out by the Institute for Social Research in Zagreb, Croatia on the sample of 17,000 young indi- viduals aged 15 to 29 recruited throughout Croatia showed that young drug and alcohol addicts express their dissatis- faction with the quality of their parents’ marital life and come from structurally impaired families far more often than their counterparts (Bouillet 2004). In addition, these young addicts were of the opinion that their family is

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of virtually no relevance for their attitudes and beliefs. In conclusion, numerous studies have shown that the con- sumption of drugs and other addictive substances can be related to familial surroundings characterised by a poor parental support and little parental knowledge about the persons their adolescent is associating with. An overview of studies dealing with maladjusted behavior came to the conclusion that relationships with parents play a key role in drug addiction prevention, largely due to opened chan- nels of an intrafamilial communication (Tokić 2008; Berger & Sather 2007). A number of other studies also have stressed the importance of favorable interfamilial com- munication and close emotional relations between parents and their offspring in the prevention of behavioral disor- ders including addiction (Ferić Šlehan 2004; NIDA 2003; Glavak, Kuterovac Jagodić & Sakoman 2003; Kerr et al. 2003; NIDA 1999). Favorable and supportive intrafamil- ial communication allows family members to express their needs, and creates a democratic environment full of trust and warmth in which closer and more cordial relations between the parents and their children can be established more easily. In creating such an environment, the roles of parents and adolescents are equally important; parents, on one hand, should be warm and supportive and have faith in their child/children, while children, on the other hand, should be willing to establish open and sincere communi- cation with their parents and have faith in them, too (Kerr et al. 2003).

SOCIOLOGICAL THEORIES—SOCIAL FACTORS AND FAMILIAL SOCIOPATHOLOGY AS RISK

FACTORS FAVORING ADDICTION ONSET

When discussing a family, it should be borne in mind that neither any given family nor any given person can be profiled independent of the entire social context. A fam- ily can be described as an ever-changing structure whose functioning, as well as the pathology potentially witnessed in the later stages, depend on a number of social deter- minants such as familial financial standing, cultural and religious values, level of education, migrations, and social isolation or adaptability, as well as on various larger-scale events witnessed by the local community—war operations, economic crises and criminal offences being the most striking among them (Georgas 2006; Čudina-Obradović & Obradović 2002; NIDA 1999). The onset of addiction, which nowadays poses as a global problem, also depends on a number of psychological and sociological factors whose interplay eventually triggers an individual drug addiction onset (Klarin 2002; Kušević 1987). It has been well established that drug addiction onset can be closely linked to adolescence—an age in which young people face numerous, extremely dynamic and intense changes. It is not uncommon for certain young age groups to express their rebellion against the culture dominating their local

communities by following novel trends in music, culture and leisure time spending. By doing so, they also rebel against parental authority as the primary factor respon- sible for their socialisation. One of the most prominent social factors responsible for drug addiction onset is the ever-growing drug availability (Perasović 2000). Clearly, should a drug be hard to obtain, it will be sought by individuals prone to antisocial behavior and rejection of all social values, as well as by individuals coming from turbulent or dubious familial and social environments. Nonetheless, ever-growing drug availability increases the chances for consumption by young people across all social strata regardless of presence of risk factors. The social devi- ation theory views drug addiction as a phenomenon typical of social environments in which drugs are easy to obtain, as well as a phenomenon typical of criminal milieus and environments prone to accept deviant behavior in general (Hill 1980). Therefore, drug abuse issue witnessed across young population can not be resolved by virtue of separate interventions, but rather by virtue of targeted interven- tions aiming at three psychosocial impact factors: behavior, personality and surroundings, familial one in particular (Milkman & Wanberg 2005).

Under the influence of social developments, a fam- ily may witness changes during which traditional patterns of its functioning are gradually perishing and new, mod- ern attitudes and family and marital values are substi- tuted. The proportion of employed women is constantly rising, while, at the same time, the traditional institu- tion of marriage steadily loses its relevance, so that the number of people determined to establish informal, extra- marital relations is growing by the day; in turn, attitudes towards family and children are undergoing changes as well (Čudina-Obradović & Obradović 2002). The tradi- tional family featuring a stable group of characters is gradually decreasing, while an ever-growing number of young people tend to embrace different trends more attuned to their generation. In addition, influenced by various global trends, younger generations gradually establish their own values, substantially different not only from those observed by adults but from those socially favorable and/or acceptable as well (Williams 2003). Lack of public aware- ness together with the lack of high-quality, well-organised preventative and therapeutic programmes, in particular those that are family-oriented, are factors in the con- stant increase in the number of addicts seen in certain societies.