Have you ever heard the saying that ‘addiction is a family disease’? It’s something I’ve so often heard in the context of addictions literature, in therapy contexts and also in 12-step recovery groups. But what does that actually mean?

Well, let’s reconsider what addiction is:

According to the American Society of Addiction Medicine (ASAM) 2011 definition (a very popular definition used worldwide), addiction is a chronic disease of the brain, which affects its functioning of the reward, motivation and memory circuits. This dysfunction leads to biological, psychological, social and spiritual problems in your life as you keep using a substance or behaviour to get pleasure and/or to avoid pain. Addiction is a disease that comes from several factors. Genes, learned behaviour, the environment and personal exposure to stress all play a role in its development. It’s considered a primary disease, meaning it doesn’t necessarily have a cause, such as psychological trauma, as is often assumed.

So what does ‘addiction is a family disease’ mean in this context? It means that first of all, there is a scientifically proven genetic link. If you have it, it’s highly likely that someone in your family has it too. If you google addiction and genes, you’ll find countless references (here is one) that state that having a family member who’s an alcoholic will increase your chances of becoming one by up to 50%! Research has also identified numerous genes that affect the risk for dependence on alcohol and drugs, even though no specific addiction gene has been identified. Just to put this in the context of food addiction, research has also shown that the same genes can be found in obese people, and we know that many obese people (though not all by far) are food addicted.

There’s another important way that addiction is a family disease: If you’re an addict, or you live with an addict, the whole family will be affected by the addict’s behaviour. The Big Book of Alcoholics Anonymous has countless references to how this occurs, including the Chapters To Wives and The Family Afterwards.  There are also 12-step recovery groups dedicated to people whose lives are impacted by addicts, for example Al-Anon and Adult Children of Alcoholics.

In what way, then, would a family member be affected by the addict? Well, the addict is highly compulsive and obsessive, always on edge and usually suffers from highly erratic mood swings and associated inconsistent behaviour. ‘Restless, irritable and discontented’ as they say in AA Big Book. In active addiction, the addict is also very good in lying and rationalising to be sure they can protect their addictive behaviours.

One of the hallmarks of how addiction affects others in the family is codependency. Codependency is an addiction in itself – an addiction to people. The dictionary definition is  ‘a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition (such as an addiction…); broadly: dependence on the needs of or control by another’. I find the following description very helpful, which is from a personal story in the key text of Codependents Anonymous: ‘codependency is a process of manipulating myself to meet others’ expectations, in a futile attempt to control their thoughts and feelings so they’ll not shame and abandon me. Behaving codependently involves being dishonest with myself and others about what I think, how I feel, what I believe – in short, who I am’. A good way of describing it is ‘walking on eggshells’, and being ‘hypervigilant’ to the needs of another.

So, that’s how addiction is a family disease. What’s the solution? Well, learning from my own recovery, I can say that  no one can help the addict who’s still in denial. They have to get to a point of desperation and ask for help before they can be helped. And some never will. The most important thing, in my view, for those of us with addiction we can do for ourselves and our families is to recover, recover and recover. And the most important thing for the people living with or caring for an addict is: Put your own self-care before the care for the addict. Get help outside of the family system.