Study on the intrafamily conviviality of users of alcohol and other drugs in contemporary relationships

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ORIGINAL ARTICLE

VICENTE, Reginandréa Gomes [1], MASONI, Gustavo de Lima [2]

VICENTE, Reginandréa Gomes. MASONI, Gustavo de Lima. Study on the intrafamily conviviality of users of alcohol and other drugs in contemporary relationships. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 11, Vol. 18, pp. 115-148. November 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/psychology/users-of-alcohol

SUMMARY

The use of alcohol and other drugs is a reality in Brazil and in the world, associated with risk factors that may involve beyond the user, the people around them. This research investigates the intrafamily conviviality of users of alcohol and other drugs in contemporary relationships from the point of view of each of those involved. The basis of investigation and analysis was the systemic theory that considers the totality of the contextualized phenomenon. A field research was carried out with the application of a questionnaire of qualitative, exploratory characteristic. Twenty family members and 16 users answered the survey. The results found that family members and users believe that the use of substances is associated with situations of sadness and lack of other repertoires to deal with problems. Users added: (I) recreational use; (II) use to improve mood. Family members (45%) described intrafamily conviviality with good functional communication and 55% described conflict resolution by talking; family relationships were described (40%) as unsatisfactory; the word “Love”, the most associated (15%) to the family concept. Intrafamily contact was described by users (88%), with conflicts due to the use of substances. The family relationship described (88%) as satisfactory, (44%) with functional communication and 88% with satisfactory family support; the words “Mess” (13%) and “Union” (13%) were the most associated with the family concept. This study aimed to clarify the complexity of separating what is a “problem” derived from the use of drugs from the intrafamily relationship itself. If, on the one hand, sorrows and sufferings trigger the desire for the use of substances, on the other hand, a satisfactory life is sought in the family. It is indicated for a next study the intrafamily relationships beyond the blaming of the drug phenomenon.

Keywords: Alcohol-drugs, addiction, co-dependence.

1. INTRODUCTION

The use of alcohol and other drugs is a reality in Brazil and worldwide, it is associated with risk factors that involves beyond the user, all the people around them in various ways. According to the report by the United Nations Office on Drugs and Crime (UNODC, 2016) they carried out a calculation in which more than 200 (two hundred) million people among adolescents and the elderly already used some kind of drug in 2014 worldwide, in this report suggests that there was an increase in the number of people with some type of drug-related disorder , even though there was no large increase in users between 2010 and 2014. Drug use disorders mainly include the spread of STIs (Sexually Transmitted Infections) by injecting drugs, also noting deaths resulting from abuse leading to overdose.

Thus, it is evidenced the democratic character (it is found in every social fabric), universal (there are no borders), and endemic (it is always found anywhere). Thus, it is possible to recognize the timelessness of drug use since antiquity human beings use substances that modify the normal systems of the body, these substances called drugs alter sensations, mood, consciousness or other psychological and behavioral functions.

According to Dias and Pinto (2004), drugs can be classified as natural – those that do not have any kind of remodeling by man – the seemissyntheticones – those that have undergone some kind of alteration by man – and synthetic ones – that were made by man. Humans use these psychoactive substances for different reasons. The action of the drug on the body varies from person to person. They can also be subdivided into different classes such as; Depressors that promote a reduction of brain activities and organic functions in general such as alcohol and opioids, stimulants that increase activity in the central nervous system and autonomic nervous system such as cocaine, nicotine and caffeine; Disturbing (hallucinogenic) that alter perception and sense of time and space such as marijuana, LSD and mescaline; Psychiatric medications that include drugs used in the treatment of chronic mental disorders or not such as antipsychotics, antidepressants and mood stabilizers.

However, it is important to highlight that the view on drugs has changed throughout history, thus modifying the understanding of the use and possible treatments. According to Brasil (2004), drug addiction (mania to consume chemical substances) has already been treated as a spiritual problem, with the family as a collaborator in the process for the removal of the “spiritual entity” that made the individual use a certain substance, so dependence was due to spiritual responsibility and not the individual. Later this concept changed and the user of alcohol and other drugs came to be seen as someone amoral. The treatment of a drug-addicted person should be done from biopsychosocial factors. Systemic vision sees chemical “dependence” as a symptom of family “disease”.

From the systemic paradigm, to understand the use of alcohol and other drugs it becomes necessary to study the family establishing relationships when one or more members of the system are users and the repetition of intergenerational patterns. This research, based on the systemic framework, investigated the family relationships of alcohol and other drug users in contemporary times.

Studies indicate (BRASIL, 2004) that the impact of drugs on the family varies from extrinsic and intrinsic characteristics of each system, such as the instant of the life cycle in which the phenomenon, intergenerational history, sociocultural context in which they are introduced, etc.

According to Steinglass, Bennett, Wolin and Reiss (1997 apud BRASIL, 2004), the issue of dependence on the family system can be a factor of union or rupture, non-user members develop throughout the process a high tolerance to stressful situations and an intense adaptation. For example, alcohol use can lead the family to isolation, fearing that the alcoholic drinks in social and/or festive situations. An important impact to be highlighted is the change in the family’s life routine after they adopt alcoholism as part of the identity, making this idea seem “normal”, attributing fixed changes to family members, often causing their self-esteem to become low, contributing to isolation. In addition, when the alcohol user is the father or mother, it may affect the development of the children, but it all depends on the personal characteristics of each child, the age, the emotional balance of the non-toxic father.

Regarding family relationships, Silva (1997) resumes the concept of codependence. It states that it was first implemented in the United States in the 1930s when mental health institutions realized that the wives of alcohol addicts were of great concern for their partners and with high rates of depression. The term codependence was used more particularly for wives of alcohol addicts. Over the years in the 1950s, there were support groups that established strategies for living with the presence of alcohol. After new studies and the development of systemic approaches in the 1970s, the definitions of codependence are implemented in such a way that all who suffer from the conviviality with drugs and the term codependence does not apply only to drugs, because it may be related to the dynamics of dysfunctional interpersonal relationships that compromise the processes of autonomy and family differentiation and that does not necessarily involve drugs.

It is important to observe the relationships of co-dependence in the family system in which there is some member who uses alcohol and other drugs, because family members can establish a relationship similar to what the user has with the drug, the co-dependent begins to organize his/her life around the user experiencing serious problems resulting from such functioning. The codependent may present low self-esteem; believes that his happiness depends on the other; feels responsible for others; lives a constant oscillation between dependent and independence, having difficulties in establishing relationships of interdependence; constantly denies its reality; cares about controlling and changing things that do not depend on it; he feels constantly dissatisfied and his life is guided by extremes (BRASIL, 2004).

Based on these data, it is emphasized, therefore, how much the use of alcohol and other drugs is a complex phenomenon and as such also requires complex studies that go beyond the cause-effect paradigm, but present the recursion of the phenomenon engendered in the family and social system. These characteristics are further highlighted by the current socio-historical moment, contemporaneity, which similarly predicts complexity by living with diversity and uncertainties. Petuco (2011) presents a reflection on the problems related to drug use in contemporary times, advocates the possibility of a radical listening of the other, this possibility of listening goes beyond normativity, because it really wants to dialogue with diversity. People who use alcohol or other drugs tend to suffer a prejudice because people think they are manipulative. Any professional who comes to work in the area of dependence should always be attentive to the correct use of the words used not to incur this fallacy and reproduce social ideologies.

The same must be thought of when conducting scientific studies that can also lend itself to reproducing certain ideologies without the necessary criticality of the construction of science.

As Goffman (1981) points out, society has always had the means of classifying people and the total of their characteristics considered as frequent or natural for its members. Based on these preconceptions people “demand” something from others, that is, statements are placed on what the other should be. Thus, when evidence of some strange condition emerges, it is considered different from other people, and can be included even as less important, so the person is judged as degenerate and small. Such an attribute is a stigma, particularly when its infamy effect is very large and constitutes a specific discrepancy between the real social identity – it is the category and attributes that the individual proves to possess – and virtual social identity – character imposed on the individual due to his potential retrospect.

Users of alcohol and other substances, as well as their families, can be stigmatized by society in general including discriminatory expressions by professionals in the field, public policies, among others.

This study presents the understanding of the theme from an investigation that adopted “radical listening” of users of alcohol and other drugs and their families favoring the description of the phenomenon by those who live it with its specificities, diversities and possibilities.

2. METHODOLOGY

This investigation was based on exploratory field research with the application of a qualitative questionnaire, including general information and questions associated with the family relationship of users of alcohol and other drugs. Using individuals who use alcohol and other drugs and/or family users, aged 18 years and older. No restrictions were made regarding marital status, socioeconomic or educational level.

A sample was not probabilistic by representative population typicality (MARCONI; LAKATOS, 1999).

The sampling was for convenience, called by the Internet, by the dissemination of the research link among friends of the researchers, through the relationship networks and via e-mail. The procedure called “snowball” was adopted in which friends, colleagues or participants themselves will be asked to nominate others.

In order to avoid that people without access to electronic means be excluded from the sample, the printed version of the questionnaire was adopted that was distributed in person.

Being done for the procedures to build the online form, the Google Drive Tool Form (Google Cloud, Cloud) form feature was used.

Regarding the link forwarded, at the beginning of the page there was a text explaining the academic character of the research, inclusion and exclusion criteria of the population to be investigated, in addition to mentioning the names and contacts of the researchers for any necessary clarification. At the beginning, the estimated time of the research was mentioned that was not more than 25 minutes. Then, the purpose and need for the free and informed consent form and the guarantee of confidentiality of the participants were clarified. They visualized the term, which could be accepted or not, according to the desire to participate.

In the printed version, an envelope containing the questionnaire identical to the electronic questionnaire, a cover letter explaining the objectives of the work, instructions for filling out, the free and informed consent form, the telephone number of one of the researchers for contact, if necessary, was distributed.

3. REESULTS

Forty-one (41) questionnaires were applied, sixteen (16) answered in person and twenty-five (25) online. Of these, five (5) had to be discarded because the collaborators differed from the sample profile, namely, two (2) were under 18 years of age and three (3) reported that they were not users and that they did not have family members who used alcohol or other drugs. Thus, twenty (20) family members and sixteen (16) users answered, it is worth mentioning that the individuals who indicated that they are users and that their family members are also users were considered in this distribution, users. The sample consisted of people aged 18 years and older, with no restriction on marital status, socioeconomic or educational level, living in different locations, such as: regions of Greater São Paulo, Minas Gerais and Rio de Janeiro.

3.1 THE USE OF SUBSTANCES

Because this research has an exploratory character, it was established that the collaborator himself would define himself or not as a user and, at the same time, clarify what were the criteria adopted for the classification.

It was found that whether or not to consume substances was not the only discriminatory factor for people to define themselves as users, but the frequency with which they do so. Thus, criteria of various evaluations were identified, that is, people who defined themselves as users for frequent ly using substances (bids or illicit) or with what they called “recreational mode”.And also, people who defined themselves as non-users but family members of users, although they indicate that they use substances occasionally. That is, except for the polarities use x no – use, there is little clarity in the classification criteria, for example, the idea of social use, appears both to justify not being a user, as well as to be so.

The total sample (16 users and 20 family members) indicated their pattern of substance use, as occasional, that is, use that has no effects on personal life. No employee indicated abuse (large use that begins to harm health and personal life) or dependence (difficulty in stopping or decreasing the use of the substance on their own and having problems related to use).

The twenty (20) family members who use some substance, but do not consider themselves users, specified the frequency of use as, 55% or eleven (11) of which they never use substances, 30% or six (6) reported that they use it once or twice a month, 10% or two (2) reported that they use it weekly and 5% or 1 family reported making monthly use of any substance.

The sixteen (16) users interviewed specified the frequency of its use as, 44% or seven (7) for use once or twice a month, 31% or five (5) for weekly use, 19% or three (3) for monthly use and 6% or one (1) reported using some substance daily or almost every day.

Thus, the results indicate that the fact that the individual describes himself as a user or not and claims to use the occasional substance may have different meanings regarding the pattern of use.

Among the substances used by the sixteen (16) users interviewed, alcoholic beverages are the most used with 59% or sixteen (16), followed by tobacco and marijuana derivatives with 15% each or four (4), finally hallucinogenic drugs, cocaine and stimulants come with 4% or one (1) user each. It is worth mentioning that some users have selected more than one drug.

3.2 THE USE OF SUBSTANCES, ACCORDING TO FAMILY MEMBERS

It was indicated that in 26% of the cases or six (6 participants) the user relative is the father and the same number was indicated when the relative is the uncle.  Then, the index of 17% or four (4participants) appeared indicating the other category, in which they specified the relatives as: paternal grandfathers, grandmother, brother and sister. It has been reported in 13% of cases or three (3 participants) that the child (a) is the person who uses substances, followed by the categories cousin (a) and mother with the same percentage 9% or two (2) for each. It is noteworthy that some relatives reported having more than one relative who used alcohol or other drugs.

According to the twenty (20) relatives who responded to this research, the mode of substance use made by the user relatives is occasional, that is use that has no effects on personal life. Although abuse or dependence was not mentioned in 70% of the cases, family members indicated daily use

Of the twenty (20) family members interviewed, 70% or fourteen (14) reported that the user relative uses some substance daily or almost every day, 20% or four (4) use some substance weekly and that 5% or one (1) use it 1 or 2 times a month or monthly.

Therefore, although most family members recognize that the relatives who use substances daily do not understand that it compromises their personal lives. Or, it can be hypothesized that the terms: abuse and dependence were not considered appropriate to describe the pattern of behavior of the user relatives.

3.3 TRANSGENERATIONAL REPETITION OF SUBSTANCE USE

It is interesting to note that of the sixteen (16) users interviewed, fifteen (15) reported having some relative as a user of alcohol or other drugs. These data suggest a transgenerational repetition of substance use.

Regarding kinship, they indicated that users specified the majority of their parents as their parents, 39% or in nine (9) cases. The (A) uncle (a) then appears with the frequency of 30% or seven (7), with 17% or four (4) appears to the mother, followed by the category “other” with 9% or two (2), in which he was indicated as a user in one case the brother, in the other the brother-in-law. With 4% or one (1) case, prime appears. It is noteworthy that the interviewees selected more than one relative who uses alcohol or other drugs.

The following distribution was evidenced for the type of substance used:

The substance most frequently used by the relatives of users was alcoholic beverages with 46% or thirteen (13) of the cases that make the use, then comes the tobacco derivatives with 34% or ten (10) cases, marijuana comes next with 14% or four (4) cases, finally cocaine with 3% or one (1) case and one (1) case that the user has no relative who makes the use of substances. It is worth mentioning that some users reported having more than one relative who uses alcohol or other drugs and more than one substance.

Note here, the same prevalence of substances listed as those used by users. That is, alcohol, tobacco and marijuana derivatives were indicated by the sample as the main substances used.

According to the users, the frequency with which family members use substances was distributed as well:

Users specified that their relatives make use mostly daily or almost every day, with 63% or ten (10) relatives, followed by 31% or five (5) relatives who make use weekly and with 6% or one (one) relative who does not use alcohol or other drugs.

Users rated the frequency of family use as follows:

Users characterized the use of 50% or eight (8) relatives as dependence, 25% or four (4) as occasional use and 25% or (4) as abuse.

It can be noticed that within the family life family members characterize the use of their family users as occasional, and some use daily and others monthly, while users have classified some relatives as dependent, even if they use alcohol or other drugs monthly or weekly, showing that there is no unique way to see how the person is using alcohol or other drugs. It should be noted that both users and family members when describing their own behavior do not consider themselves dependent on any substance. Here it is possible to open a question about what would lead to the adoption of different criteria for the evaluation of one’s own behavior or the other.

3.4 ABOUT FAMILY CONVIVIALITY

Family members, when asked about the family relationship, answered:

The twenty (20) family members interviewed divided their answers in relation to the family relationship into 40% or eight (8) for an unsatisfactory relationship, 35% or seven (7) for a satisfactory relationship and 25% or five (5) for a neutral relationship.

Among the sixteen (16) users interviewed, 50% or eight (8) reported their family relationship as satisfactory, 44% or seven (7) reported their family relationship as neutral and 6% or one (1) reported their family relationship as unsatisfactory.

Among the justifications for a satisfactory relationship, answers were obtained, such as:

“It is a family with a lot of care, listening, closeness and always with dialogues”(U.F24)

“I consider it satisfactory, because we always try to talk about our problems and solve them together” (F.F31)

The answers that refer to a good family relationship present functional communication as an instrument that enables the family’s ability to welcome and provide emotional support to its members, likewise, reiterates the social expectation that families are this locus of affection.

The collaborators justified family relationships as neutral with arguments such as:

“when he drinks at a family party it gets boring.” (F.F.9)

“Living with my mother is ok, but my father has always been someone very ignorant and absent” (F.F.11)

“It does not hinder conviviality, but generates discomfort” (U.F 14).

Neutral responses provide ambiguity, bring positive aspects of family living unto discomfort.

On the other hand, the collaborators who evaluated family relationships as unsatisfactory used justifications such as:

“Justifying my family relationship, alcohol is not the reason for dissatisfaction.” (U.F16)

“Because I have an alcoholic father, I have a troubled relationship, marked by fights.” (F.F15)

The justifications about the unsatisfactory evaluation of family life brought polarization: On the one hand, a family member pointed out the use of alcohol as the protagonist of family discussions and generator of the worst family stress: “The financial difficulty arising after the emergence of alcohol in the family environment.” And on the other hand, an alcohol user made a point of signaling that the relationship is unsatisfactory, but is unrelated to substance use. Was the use, then, the result of the relationship unsatisfactory? This same collaborator clarifies that no, as much as this reasoning is practically automatic, He says that the worst stressor of his family is “Opinions regarding the way life works within the house and on the issues of respect for “hierarchy” of kinship. “respect the elders” and so on.” Pointing, therefore, to the difficulty of family functioning with regard to the establishment of roles and hierarchy.

The question remains: Could these diametrically opposed answers be the expression of the role that is occupied in this relationship, that is, family members or users?

The twenty (20) family members interviewed described mostly with 45% or nine (9) family members, the communication as “Some hear and understand each other, others do not”; with 25% or five (5) a functional communication was described (i.e., there is reciprocal listening and good understanding of the messages transmitted); with 20% or four (4) family members it was described that communication would be functional if it were not for the use of alcohol or other drugs and with 10% or two (2) family members it was reported that communication is dysfunctional (i.e., no one is heard, no one understands).

It is possible to observe from these results that in 75% of the cases family members identify communication problems in the family, however, only 20% attribute this dysfunction directly to the use of alcohol or other substances.

The sixteen (16) users interviewed described in 44% of the cases or seven (7) users, communication as functional (i.e., there is reciprocal listening and good understanding of the messages transmitted), with 38% or six (6) described the communication as “some are heard and understood, others do not”, with 13% or two (2) users it was reported that the communication would be functional , if it were not for the use if alcohol or other drugs and with 6% or one (1) user it is reported that the communication is described as “Everyone is listened to and understood, except me”.

The perception of a functional communication pattern appeared much more recurrent in the group of users, emphasizing that none pointed out communication as dysfunctional, although in 57% of cases they also recognized communication problems. And it was among the users that a response appeared that seems to indicate that in terms of communication, the individual finds himself part of the family (“Everyone hears and understands, except me”).

Family members describe mostly 60% or twelve (12) that their family’s emotional support is satisfactory (I have security in my family’s emotional support.), 25% or five (5) family members describe the relationship as unsatisfactory (I would like to rely on family support, but I don’t have it) and 15% or three (3) describe emotional support as neutral (I don’t care, I don’t need family support)

The users interviewed mostly answered with 88% or fourteen (14) users that emotional support is satisfactory (I have security in the emotional support of my family.), with 13% or two (2) users reported that emotional support is neutral (I don’t care, I don’t need family support).It should be noted that no user indicated unsatisfactory emotional support.

Using the free association feature, collaborators were asked to list a word that they associated with the term family, the words were obtained:

Among the 20 family members who answered the questionnaire, 15% or three (3) relatives answered that the word that refers to them the idea of family is “Love”, while the other seventeen (17) family members corresponding to 5% each, answered that the associated words were “Friendship”, “Clumsy”, “Good”, “Boring”, “With many problems”, “Companions”, Courage”, Dissupport, fights”, “Disunity”, “Fun”, “Between slaps and kisses” , “Non-existent”, “Nothing”, “Positive”, “Need more union”, “Union”, “Union, safe harbor” remind them of “family”.

Among the 16 users of alcohol or other drugs who answered the questionnaire, 13% or 2 users answered that the word that refers to them the idea of family is “union”. Another 13% resemble the family the word “mess”. The other 12 users each responded differently, bringing the following terms: “base”, “companionship”, “love”, “finances”, “home”, “fear of losing”, “unnecessary opinions”, “problematic”, “protect”, “respect”, “support” and everything”.

Both family members and users cited similar emblematic words associated with the term family pointing to social narratives rooted in the subjectivity of people associating it with love, unity, security and others, at the same time there are answers that indicate the antomy of these values, anyway, having the former as reference.

Of the twenty (20) family members, 55% or eleven (11) reported that the resolution of their family conflicts takes place by talking and negotiating, 5% or five (5) family members reported that conflict resolution occurs with aggressive confrontation and 20% or four (4) family members reported that conflict resolution occurs with denial and postponing the conflict.

Of the sixteen (16) users, 56% or nine (9) users reported that conflicts are resolved by talking and negotiating, 25% or four (4) users reported that conflicts are resolved by denying and postponing the conflict, 19% or three (3) users reported that conflicts are resolved with aggressive confrontation.

Here, it is observed that the majority of respondents referred to conflict resolution through positive conflict management conducts. Like, most family members indicated that there is a presence of conflicts in the family environment due to the use of substances, as can be seen below:

Of the twenty (20) family members, 65% or thirteen (13) answered that there has already been some type of conflict because of the use of alcohol or other drugs. While 35% or seven (7) reported that there were no conflicts because of the use of alcohol or other drugs.

Users confirm the presence of conflicts as a consequence of the use of substances:

Of the sixteen (16) users interviewed, 88% or fourteen (14) reported that there was conflict because of the use of alcohol or other drugs.  Only 13% or two (2) users reported that there was no conflict because of the use of alcohol or other drugs. Such data seem to indicate that the use of substances can be considered a risk factor for family conflicts. And the other way around, would it be true? I mean, would family conflict be a risk factor for consumption? This question was made to the collaborators and the following answers were obtained:

Of the twenty (20) family members interviewed, 55% or eleven (11) family members reported that they do not believe that the use of alcohol or other drugs is facilitated by family conflicts, while 45% or nine (9) family members believe that the use of alcohol or other drugs is facilitated by family conflicts.

Of the sixteen (16) users interviewed, 63% or ten (10) users reported that they do not believe that the use of alcohol or other drugs is facilitated by family conflicts, while 38% or six (6) believe that the use of alcohol or other drugs is facilitated by family conflicts.

According to these data, in this research, family conflicts did not appear as a risk factor for consumption according to the perception of most family members and users.

Establishing the crossing of results between the evaluation of family life, substance use and conflict management, we had the following data:

Considering all family members who answered the survey, 25% or five (5) family members stated that in family life there were conflicts due to the use of alcohol or other drugs that were resolved with aggressive confrontation. Another 25% or five (5) family members admitted that there were conflicts because of the use of some substance that was resolved by talking and negotiating with the user. In 15% of the cases or three (3) family members claimed that within their conviviality there were conflicts generated by the use of alcohol or other drugs, which were solved by postponing the problem and negotiating with users. The last 35% or seven (7) relatives reported that there was no conflict because of the use of alcohol or other drugs and that there was good communication between family members.

Among the sixteen (16) users of alcohol or other drugs in this study, 19% or three (3) users reported that within their family life there were conflicts because of the use being resolved with aggressive confrontation; 50% of users or eight (8) said that there were conflicts because of the use of some substance, which were resolved by talking and negotiating, 25% of users or four(4) report that there were conflicts within family life that were resolved by postponing the problem and negotiating And the last 6% or only one (1) user reported that there was no conflict of any kind , and that there is good communication in your family life.

The users who participated in this research identified almost in its entirety the presence of conflicts due to the use of substances with different ways of administering it. In order to investigate the perception of family members and users about the influence of transgenerational patterns on substance use.

Of the twenty (20) family members interviewed, 55% or eleven (11) believe that the use of alcohol or other drugs is facilitated by customs, habits or traditions. The other 45% or nine (9) family members believe that the use is not facilitated by customs, habits or traditions.

Asked the same question for users the answer was:

Of the sixteen (16) users interviewed, 69% or eleven (11) believe that the use of alcohol or other drugs is facilitated by customs, habits or traditions. The other 31% or five (5) do not believe that the use is not facilitated by customs, habits or traditions.

Most family members and users agree that customs, habits and traditions favor the use of substances, that is, it was considered another risk factor for consumption.

3.5 IMPACTS ON FAMILY ROUTINE AND CODEPENDENCY

The following data were provided to understand possible impacts of substance use on family routine, as well as to identify whether in this sample it would be possible to notice the presence of codependence in family relationships. To this do so, the following questions were asked:

Of the twenty (20) family members interviewed, 55% or eleven (11) reported that they did not have their routines compromised due to the use of alcohol or other drugs of the family user and 45% or nine (9) family members reported that the routine has already been compromised due to the use of alcohol or other drugs of the family user.

Of the sixteen users interviewed, 73% or eleven (11) reported that their routine was not compromised due to the use of alcohol or other drugs, while 27% or four (4) reported that they had their routines compromised due to the use of alcohol or other drugs.

Of this sample, most family members and users did not perceive impacts that compromised their routine due to the use of substances.  As well, they did not report deadlocks regarding giving money or not to the user.

Of the twenty (20) family members interviewed, 60% or twelve (12) reported that there was no impasse between giving money or not to the family member who used other drugs, while 40% or eight (8) reported that there was a stalemate between giving money or not to the family member who used alcohol or other drugs.

Of the sixteen (16) users interviewed, 75% or twelve (12) reported that there was no impasse between giving money or not, while 25% or four (4) reported that there has already been this impasse.

Asked about indebtedness due to substance use, family members answered:

Of the twenty (20) interviewees, 65% or thirteen (13) relatives reported that there was no indebtedness due to the use of alcohol or other drugs of the family user, while 35% or seven (7) family members reported that there has already been indebtedness due to the use of the family user.

Presented the same question to users, they answered:

Of the sixteen (16) users interviewed, 94% or fifteen (15) reported that there was no indebtedness because of the use of alcohol or other drugs, while 6% or one (1) user reported that there has already been indebtedness because of the use.

Although the majority of users and family members deny indebtedness and impasses in relation to giving money to the user to buy alcohol or other drugs, in both groups (family members and users) we have affirmative responses evidencing that these phenomena have some recurrence in family relationships.

Asked about job loss or dismissal (or other similar activity) due to their use of alcohol or other drugs or by the use of a family member, the family members stated:

Of the twenty family members interviewed, it was reported that in 95% of the cases or in nineteen (19) there were no job losses due to the use of alcohol or other drugs, while in only 5% or in one (1) there was a loss of employment because of the use of alcohol or other drugs.

Among users, none of them reported job losses or layoffs due to substance use.

Regarding the fact that he/she stopped expressing himself for fear of the reaction of another person who was under the influence of alcohol or other drugs, the answers below were obtained:

Of the twenty (20) family members, 55% or eleven (11) reported that there was no lack of expression because the other person was under the influence of alcohol or other drugs, while 45% or nine (9) reported that there was already a lack of expression because the other person was under the influence of alcohol or other drugs.

Of the sixteen (16) users interviewed, 56% or nine (9) reported that there was already a lack of expression because the other person was under the influence of alcohol or other drugs, while 44% or seven (7) reported that there was no lack of expression because the other person was under the influence of alcohol or other drugs.

The responses of family members and users showed that, in many cases, verbal expression is resonated due to the interlocutor being under the influence of alcohol or other drugs, which may be an attempt to avoid an aggressive confrontation.

When asked about assaulting or assaulting in a context of alcohol use or other substances, family members gave the following answers:

Of the twenty (20) family members interviewed, 80% or sixteen (16) reported that there was no type of aggression because of the use of alcohol or other drugs, while 20% or four (4) relatives reported that there had already been some type of aggression because of the use of alcohol or other drugs.

Users presented the following:

Of the sixteen (16) users interviewed, 62% or ten (10) reported that there was no type of aggression because of the use of alcohol or other drugs, while 38% or six (6) reported that there has already been some type of aggression because of the use of alcohol or other drugs.

Although the negative responses exceed the positive ones, the presence of situations of aggression was evidenced in the discourse of family members and users.

Family members were asked about their perception of their family’s ability to meet their wishes/needs or not, as follows:

Of the twenty (20) family members interviewed, 60% or twelve (12) reported that their family did not meet their wishes/needs, while 40% or eight (8) reported that their family meets their wishes/needs.

Users replied:

Of the sixteen (16) users, 81% or thirteen (13) reported that their families meet their wishes/needs, while 19% or three (3) users report that their families do not meet their wishes/needs.

The vast majority of users realize that their family meets their wishes and needs.

Some family members admitted that they covered up transgressions of the user relative:

Of the twenty (20) family members interviewed, 60% or twelve (12) reported that there was no cover-up of transgression of the user family member, while 40% or eight (8) reported that there has already been a cover-up of some transgression of the user relative.

Among users, only one employee admitted to having some transgression covered up by family members:

Of the sixteen (16) users interviewed, 94% or fifteen (15) reported that there was no cover-up of family members because of any transgression, while 6% or one (1) had already reported that there was a cover-up of some transgression committed.

When asked about the family’s responsibility to users, the following answers were given:

Of the twenty (20) family members, 50% or ten (10) reported that they do not feel responsible for the user of alcohol or other drugs, while the other 50% feel responsible.

Of the sixteen (16) users interviewed, 62% or ten (10) reported that family members do not feel responsible for them, while 38% or six (6) reported that their families feel responsible for them. It is worth remembering that all users of this sample are of age.

Regarding what would be the worst stressful factor of family life of all thirty-six (36) interviewees, it was reported, mostly, that they are related to conflicts with family members.

(Indicate what is the worst stressor in your family life:) “My father’s lack of responsibility” (F.F12)

(Indicate what is the worst stressor in your family life:) “Mother” (U.F05)

According to the analysis of the questionnaires, it was possible to notice that the conflicts with family members described above as the worst stressors were not directly related to drug use, but rather to issues related to family functioning. Although, in smaller numbers, answers were also found that indicated the drugs as the worst stressor in the family.

(Indicate what is the worst stressor in your family life:) “Drugs” (F.F26)

In the opinion of family members about why someone is using or starting to use alcohol or other drugs, they understand that it occurs due to problems in their lives that generate sadness or depression. They believe that the use takes place in situations of isolation or sadness or even to enter into some social group that have the desire to participate.

(In your opinion, what drives someone to use alcohol or other drugs?) “When they feel alone to anesthetize emotional pain. When they are not very happy” (F.F32)

(In your opinion, what drives someone to use alcohol or other drugs?) “Depression, family quarrels, not being understood.” (F.F35)

The family members pointed out that what people see positive in the use of alcohol or other drugs is the relief of problems, that is, a way to forget the problems of their lives and how negative, they see drug dependence and thus not be able to stop and with that, have the removal of people close to them.

In the opinion of users about why someone is using or starting to use alcohol or other drugs, they state that it occurs due to anxiety or leisure, making use in situations in which they feel stressed and in situations of frustration, such as the loss of some great accomplishment. But also for pleasure or transgression.

(In your opinion, what drives someone to use alcohol or other drugs?) “Many factors: Socialize, escape valve of “reality”, taste a good dose of whiskey, relieve stress, rebellious against those responsible (spring effect), etc. ” (U.U14)

(In your opinion, what drives someone to use alcohol or other drugs?) “When they want to seek pleasure, or relieve feelings or escape from reality, or when dependence develops” (U.U22)

Users pointed out that people see the easy socialization and social acceptance, well-being, recreation and the possibility of forgetting problems, in a negative way, reported excesses, social discrimination and the risks of becoming dependent.

(In your opinion, what do people see positive when they use alcohol or other drugs?) “Recreation, social acceptance and psychoactive well-being” (U.U20)

(In your opinion, what do people see negative when they use alcohol or other drugs?) “Dependence, deleterious effects, the social burden associated with each specific type of drug” (U.U20)

(In your opinion, what do people see positive when they use alcohol or other drugs?) “Facilitated socialization” (U.U19)

(In your opinion, what do people see negative when they use alcohol or other drugs?) “Excesses” (U.U19)

The results found, therefore, that family members and users believe that the use of substances is associated with situations of sadness and lack of other repertoires to deal with problems. Users added: recreational use; use to improve mood.

The results of this research indicate that investigating family relationships and drug use requires understanding the complexity in singularity.

4. DISCUSSION

This study aims to present a relational and contextualized understanding of the conviviality of the user of alcohol and other drugs and family members from the point of view of both. Aiming to understand the intrafamily conviviality of the user of alcohol and other drugs in contemporary times; understand the relationships between alcohol and other drug users in their family environments; to analyze the family relationship from the perspective of the user of alcohol and other drugs; to analyze the family relationship from the perspective of the family of users of alcohol and other drugs.

In this section of discussion, it is intended to respond to these objectives by articulating the description of the participants based on their own experience with the literature studied without the intention of exhausting the theme, but rather to broaden the understanding of family relationships and dynamics in the context of substance use. Because it is a qualitative study, the number of collaborators in the sample was considered adequate, as well as the diversity of its characterization. Although the sample was composed predominantly of young people, it still had some people of middle age and old age. The level of education, family income and place of residence presented diversity, providing the possibility of analysis and comparison of different perspectives in different contexts in the attempt to avoid viese.

The analysis of the results conducted the following categories of analysis: 1- Polysemy when the theme is: substance use 2- Intrafamily conviviality 3- How family members and substance users understand the uses and abuses:

1- Polysemy: when the theme is substance use

The great first evidence and perhaps the most important contribution of this study was to verify that when the subject refers to drugs, there is no homogeneity in language, in evaluation or classification criteria, starting with the very definition of what it is to be a user. The results showed that whether or not to consume substances was not the only discriminatory factor for people to define themselves as users, but the frequency with which they do so. Nevertheless, the frequency was also evaluated with multiple criteria, including, in some cases, the individual used different evaluation and classification criteria when the consumption was his or her family. It is interesting to note that the mode of abuse or depends was only indicated by users in relation to their relatives and in no case in relation to themselves. Arbitrarily, using substances daily, weekly or monthly, can be understood as being or not user, as well as indicate an occasional use, abusive or depends.

In the literature review (BRASIL, 2004; PETUCO, 2011) it was observed that the theme of substance use is imcormic and controversial term “chemical dependence” which is ultimately the corollary of ideological disputes. The present study can clarify that the definitions for users, the frequency allowed for the use of substances and the mode of use are defined from the subjectivity of the subjects, certainly constructed from ideological, moral, experience, self-assessment and self-perception issues.

Thus, it is important to think that in order to establish a dialogue with substance users and/or their families, whether in the field of research, professional practice or public policies, it is important at first to clarify and plan communication, that is, it is necessary to deconstruct the various “dialects”, including technicians, and to build new narratives that are meaningful and with meanings shared among all. Public policies must be designed for everyone and at the same time for each one.

4.1 INTRAFAMILY CONVIVIALITY

The analysis of the results of this research revealed that the majority of the interviewees stated that they had a good family relationship despite the existence of conflicts. They indicated that functional communication is an instrument that enables the family’s ability to welcome and provide emotional support to its members. The survey participants, for the most part, claimed to have security in the emotional support of my family.

On the other hand, some interviewees evaluated their family relationships as neutral, causing ambiguity, brought positive aspects of family experience unfamiliar with discomfort. Furthermore, other collaborators evaluated family relationships as unsatisfactory, not necessarily linked to conflicts arising from the use of substances, but also related to the difficulty of family functioning, especially with regard to the establishment of roles and hierarchy.

Thus, it can be observed that there were diversified responses, as predicted by Brasil (2004) that refers to the impact on the lives of families of drug users in a varied way. As for example, there were family members who described their family life with good communication and absence of conflicts, while other family members described a totally opposite situation, being the same case for users of alcohol or other drugs, who described the family as a support base and others, as a “group of unnecessary opinions”.

Family members (45%) they described intrafamily conviviality with functional communication, although they also identified communication problems in the family, however, only 20% attribute this dysfunction directly to the use of alcohol or other substances.  Still among family members, 55% described the resolution of conflicts by talking; the word “Love”, the most associated (15%) to the family concept.

Intrafamily contact was described by users (88%), with conflicts due to the use of substances. The family relationship described (88%) as satisfactory, (44%) with functional communication. The perception of a pattern of functional communication appeared much more recurrent in the group of users than in the group of family members, there were two cases with reports of dysfunctional communication, although in 75% of the cases they also recognized communication problems. It was among the users that a response appeared that seems to indicate, in terms of communication, that the individual sees himself part of the family (“Everyone hears and understands, except me”).

Substance use was pointed out as a risk factor for conflicts and family quarrels, confirming what is described in the literature (JOHNSON 1987, apud ANTÓN 2003, p.53). As well as, in this sample, the prevalent use of alcohol, tobacco derivatives and marijuana in which it indicates was mentioned. that substance use is high, as described in the report by the United Nations Office on Drugs and Crime (UNODC, 2016) that more than 200 (two hundred) million people among adolescents and the elderly have already made some kind of drug in 2014 worldwide.

It should be noted that family conflicts were pointed out as resulting from the use of substances, inversely, family conflicts were not placed by the majority as a risk factor for the use of substances.

It was observed that the majority of the interviewees referred to conflict resolution through positive conduct of conflict management, namely, talking and negotiating.

Most collaborators understand that substance use can be influenced by family customs, habits and traditions, as well as a high prevalence of transgenerational repetition in substance use (94% of users indicated some relative also a user), that is, family patterns of consumption represent another risk factor for use, as well as studies from Brasil (2004) that report that the impact of alcohol or other drugs on the family varies from extrinsic and intrinsic characteristics of each family system in which there is a member who uses alcohol and other drugs, because family members can establish a relationship similar to what the user has with the drug, the co-dependent begins to organize his life around the user experiencing serious problems resulting from such functioning.

According to this sample, most family members and users did not perceive impacts that compromised their routine due to the use of their own or family members. Only one family member reported job loss or dismissal as a result of a family member’s substance use. Although most users and family members deny indebtedness and impasses regarding giving money to the user to buy alcohol or other drugs, in both groups (family members and users) had affirmative responses evidencing that these phenomena have some recurrence in family relationships. Only one employee admitted to having some transgression covered up by family members, although 50% of the relatives admitted to feeling responsible for the user relatives. Thus, we did not have enough data to be able to affirm whether or not the phenomenon of codependence is present in the relationships investigated.

Understanding the family life described by substance users and by family members of users implied identifying the complexity in separating what is a “problem” derived from the use of drugs from the intrafamily relationship itself and from the family ideas present in our subjectivity. If, on the one hand, sorrows and sufferings trigger the desire for the use of substances, on the other hand, a satisfactory life is sought in the family. Both family members and users cited prototypic words associated with the term family indicating the reproduction of social narratives rooted in the subjectivity of people who see the family as more than an institution, but rather a value. Linking it to the idea of love, unity, security, among others, at the same time there were answers that indicated the anthonny minof of these values, anyway, with the former as a reference.

4.2 HOW FAMILY MEMBERS AND SUBSTANCE USERS UNDERSTAND THE USES AND ABUSES

The results found that family members and users believe that substance use is associated with situations of sadness and lack of other repertoires to deal with problems. Users added: recreational use and use to improve mood.

Respondents, both family members and users, reported in the vast majority that someone is led to use alcohol and other drugs because of some unhappiness, such as the daily stress resulting from fights, depression and some sadness installed because of some social context in which the person lives, therefore, the use of drugs serves to mitigate or eliminate this sadness and / or to try to forget these problems, that is, a relief for their pain, as described by Pratta and Santo (2009). Another factor that the interviewees reported was that the use is made by social influences as well as signaling Botvin and Botvin (1994, apud ANTÓN, 2000).

Most of the family members who use alcohol or other drugs are predominantly male, with a father or uncle, which is in line with the research of Bortolon et al. (2015) who report that the socialization of males seems to cooperate with the higher prevalence of use among them.

Johnson (1987, apud ANTÓN 2003) and Jessor (1982, apud ANTÓN 2000) bring in their works that emotional stress, low self-esteem, negative self-image or depression are factors that can lead an individual to use alcohol and other drugs, creating a false illusion that they are in control of the situation without risk of becoming users of alcohol and other drugs. In this research, no data were collected that would allow inferences about the employees’ self-esteem or self-image, however, stress and depression were cited by both users and family members as risk factors for substance use. Family members tended to identify the use of substances predominantly linked to the function of “medicine”, as already mentioned, relief for pain. On the other hand, users add pleasure and leisure in a preponderant way. Use as transgression was also mentioned.

The use of substances still appeared tied to people who need to have pleasure or avoid pain in the face of the adversities of adulthood, as indicated by Bortolon et al. (2015), as well as some interviewees report the use of alcohol or other drugs for this purpose.

(In your opinion, what drives someone to use alcohol or other drugs?) “Unhappiness, unemployment, lack of money…” (F.F26)

(In your opinion, in what situations do people use alcohol or other drugs?) “Sadness” (F.F26)

(In your opinion, what drives someone to use alcohol or other drugs?) “Depression, loneliness, attempt to escape from reality” (U.F12)

(In your opinion, in what situations do people use alcohol or other drugs?) “Stress, sadness” (U.F12)

It is concluded that the understanding of the uses and abuses of substances has different meanings, transitioning between pain relief, pleasure, social insertion, social transgression, among others. Thus, as Petuco (2011) warned when he presented his reflection on the problems related to drug use in contemporary times, he advocates the need for a radical listening of the other, going beyond what is being placed as normative, indicating the need to dialogue with diversity. Thus, professionals who work or work in the area must always start from the meanings that can emerge from the dialogue with those assisted whether users and/or family members, thus avoiding, from incurring collective monologues or being exclusively at the service of the reproduction of social ideologies.

5. CONCLUSION

Based on what was presented in the present study, it can be concluded that the study on the intrafamily relationship with users of alcohol or other drugs met what was proposed, since it was possible to broaden the understanding of the experience of family members and substance users about family life. The description of the two groups was similar with regard to family life, both consider it positive and as a source of emotional support. On the other hand, when they were asked to speak generically about what generates substance consumption, the social discourse that commonly ties the use to family conflicts and/or a family member who is not responsive, physically or emotionally absent arose.

Thus, a gap between the perception of one’s own family relationship and the view of other families that also have members who use substances are open.  However, it should be noted that this sample was composed of people who considered their own use or the use of the family member as occasional (even if some indicated frequency of daily use), that is, perhaps this sample did not contemplate the use that even compromises family life or personal life. Thus, it is recommended that in a next study, individuals who consider themselves dependent on substances as a selection criterion are used as a selection criterion, so that conviviality can be understood in this context. Moreover, it would be interesting to investigate users and their respective families in a next study in order to establish a direct relationship between the narratives of both.

Family members and users also converged on the perception of the presence of intrafamily conflicts due to the use of substances, as well as, they were one-off in stating that they manage conflicts predominantly positively without resorting to aggressive confrontation. This data demystifies the usual perception that the family dynamics of substance users is permeated by violence. Functional communication was indicated as the instrument that guarantees satisfactory family relationships.

Regarding the interpretations of uses, abuses, definitions about frequency evaluation and modes of use, the responses of users and family members converged on diversity and arbitrariness. Regardless of whether they were a user or family member, they met a particular pattern to each individual and often differed from the normative standards established by health agencies, such as the World Health Organization (WHO). This divergence makes it possible to understand why so often the communication between users, family members and professionals working in the area of drug addiction is dysfunctional and frustrating to all interlocutors.

An important point to be taken into account for future research is about the view of people who are outside the context of alcohol or other drug use on people who are users, because there are a number of prejudices and stigmas that focus on the latter, which ends up giving them low self-esteem and the tendency to move away from people , consequently, they are often seen as non-sociable people. Thus, the feeling of social exclusion and the tendency to search for the group of equals often emerge, thus forming a cycle in which substance users are socially segregated. In the family group, it was noted that each family functions as a different and unique system.

The use of alcohol or other drugs can be understood in different ways because in many families the transgenerational repetition of substance use has been noted, giving them a way of dealing with the sui generis situation, some as part of a family tradition, others with total naturalization on the phenomenon or even, with roles and functions very well demarcated in the face of substance use. On the other hand, as shown in the questionnaires, some families have placed that there is a strain on the family system due to the use of alcohol or other drugs, and a certain perplexity in its management. Another point that deserves further investigation are the treatments aimed at people who use alcohol or other drugs and their families. As controversial as the definitions about being a user or it would not be appropriate to listen to users and family members about how they evaluate the various treatments: from hospitalization to harm reduction. In any case, for the treatments of these people who use alcohol or other drugs and their families, it is necessary that there are trained professionals capable of developing care strategies that privilege the singularities of each individual, and thus, the identification of the best indicated treatment for each case.

Research and interventions on substance consumption is of the utmost importance considering the recursive impacts on the personal life of the individual, on his family system and on society as a whole. Distancing itself from the idea of demonization of drugs, this study aimed to clarify the complexity of separating what is a “problem” derived from the use of drugs from the intrafamily relationship itself. As is typical in contemporaneity, feelings and values, often antagonistic, overlap and coexist. If, on the one hand, sorrows and sufferings trigger the desire for the use of substances, on the other hand, a satisfactory family life is sought.

In conclusion, this study is intended to encourage further research that expands knowledge on the theme and especially about intrafamily relationships beyond the blaming of the Drug phenomenon.

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[1] Guidance counselor. Graduated in psychology, improvement in clinical psychology, master’s degree in clinical psychology.

[2] Graduation in progress in Psychology.

Sent: May, 2020.

Approved: November, 2020.

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