Family and substances use in adolescence: Vulnerability and adaptation factors

This literature review synthesizes what is known about family vulnerability and adaptation factors towards substance use in adolescents. The introduction resets individual risk factors, such as aggressiveness, impulsiveness, sensation and novelty seeking, and psychopathological comorbidity frequently associated with addictive disorders (anxiety and depression). Peer influence plays an important role in drug experimentation and consumption in adolescence. The context of protective family dimensions is also described. Thus, parental supervision of the young, clear family rules, low levels of family conflict, as well as good communication between the young and his parents are protective dimensions with respect to substance consumption. The first part of this paper deals with family vulnerability factors involved in the development of addictive behaviors. There seem to be structural and functional differences in consumer families. Teenagers living in a single-parent family, or with divorced parents, or sharing the daily life of a parent dependent on psychoactive substances, seem more attracted by substances. Family dynamics may be dysfunctional, with problems noted including low levels of cohesion, poor adaptability and poor communication between family members. A low level of cohesion implies low attachment bonds between members. Low adaptability seems to be a strong predictor of teenagers' addictive behaviors. The nature of relationships between family members is problematic: we can note the presence of "intergenerational coalition", "perverse triangulation" and often a poor quality relationship with the fathers. These families also show difficulties to elaborate the process of separation and individuation, behavior allowing the teenager to aspire to independence, even if dependence to the family remains. Communication skills of consumer families seem to be poor and associated with high intensity conflicts. Mothers of dependent patients would express more hostile feelings towards consumers. To date, studies of families that have adolescents with drug problems have focused on family vulnerability factors, involved in the development of addictive behaviors, but few researchers have assessed the impacts of a consumer's addiction on his relatives. Therefore, the second part concerns the cognitive, emotional and behavioral impacts of a consumer's addiction on his relatives, and presents the different coping strategies used by relatives. Addiction causes chronic stress to the environment that could be a source of physical (e.g. sleep or appetite disturbances) and psychological (anxiety and depression) disturbances, as well as a feeling of burden. On the emotional level, negative valence feelings prevail (e.g. shame, fear, anger, sadness, guilt...). Faced with this aversive situation, relatives try to adapt by using coping strategies. There are different types of coping and some seem more appropriate, allowing an increase in physical and psychological well-being. Efficiency of coping seems to depend on the relatives' understanding of the addiction, namely that addictions are complex, uncontrollable and joining on the long term. This review opens new research perspectives related to the practice of clinical psychologists in families that have an adolescent with substance use disorders. We could investigate individual parental coping in a multidimensional and situational prospect. Moreover, further studies could examine the couples' adaptation strategies by investigating dyadic coping. Coping efficiency could then be analyzed and discussed with regard to family dynamics and the psychological distress perceived by the parents. (C) 2016 Elsevier Masson SAS. All rights reserved.