SUBSTANCE MISUSE AND THE FAMILY: The exploration of relationships in the family system within sibling narratives

Substance misuse affects many families, resulting in social, economic, and health difficulties, which has implications for wider society. Due to these difficulties, drug and alcohol services and health services are often accessed, with great cost to the National Health Service (NHS). Despite the growing body of research suggesting family members have an impact on recovery and are negatively affected themselves, treatment continues to focus on abstinence of those with substance misuse issues, with little support available for families. Research also highlights the important contribution our siblings make to our development. However, research into families and substance misuse focuses on the experience of partners and parents, which is also reflected in service provision. As such, siblings are left without a voice or support, and their perspective is not considered.
The stories of six siblings who identified as having a sibling with substance misuse issues were collected, and these interviews were analysed using narrative analysis, underpinned by a constructionist epistemology. The research sought to gain insight into the experience of these siblings, considering how they made sense of the experience, and how it shaped their identity and relationships with others.
Participants struggled to place themselves in their experience, feeling both like an insider and an outsider. Polarisation often emerged in their narratives, with the sibling seeing other family members’ actions as bad or good. Siblings often seemed to adopt a ‘hero’ type role, in an attempt to rescue the family from the difficult situation, in which everyone felt helpless. They struggled to differentiate between whether their ‘using sibling’ had an illness or if the substance misuse was in their control. The siblings often felt there was a lack of boundaries present, and so tried to create them. Guilt was evident, and at times, seemingly due to feeling they had escaped having substance problems themselves, the participants often felt blame and shame.
The study highlights the distress experienced by siblings, and the need for more support for siblings and their families. It advocates the need for professionals to reconsider treatment options for substance misuse, perhaps including family in the treatment, using more integrated or family-based models. This study argues that the sibling experience should be included in the discussion about substance misuse, and that professionals should seek to understand it further, to help provide adequate support.