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The International Journal of the Addictions, 7(1), pp. 97-107, 1972

The Family of the Addict:

A Review
of the Literature
Nathan E. Seldin
Deputy Chief,
Education and Training
NlMH Clinical Research Center
Lexington, Kentucky

It is generally conceded in the field of drug addiction treatment that

enlisting family participation is a monumentally discouraging task. Yet we
cannot ignore the significant others in the life of the addict. To induce
further reflection on this problem area we should first acquaint ourselves with
material from the disciplines of psychiatry, social work, psychology, and
sociology. But it should be stressed that the clinical data herein refers to the
so-called visible addict, the one known to treatment agencies.

SOClO LOGY
There is more literature devoted to the family of origin than to the
marital life of the drug addict, although even the former is sparse. On the
other hand, we do not have t o search very hard to find significant works
related to the generic concepts of family.
In the discipline of sociology, Goode (1959) as well as others indicate the
classical functions of family, reproduction, status placement, biological
maintenance, socialization, and sexual controls. These functions are generally oriented toward producing an active individual; thus they can be viewed
as being in the service of society. To the above functions Goode adds
97
Copyright 0 1972 by Marcel Dekker, Inc. NO PARTof this work m y be reproduced or
utilized in any form or by any means, electronic or mechanical, including xerography,
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emotional maintenance, which has become of particularly strategic

importance to the urban individual as other avenues of emotional redress have
become extinct. This is viewed by many analysts of family as a key factor in
urban family disorganization. It denotes family dysfunction, particularly its
inability to sxialize its offspring and provide for them emotionally.
McCord (1965) associates this family disorganization with drug addiction.
He states that 97% of youthful addicts come from families affected by
divorce, desertion or open hostility between their members. The frequency
of such disorganization is also higher among deprived ethnic groups. From a
conditioning standpoint, this type of family inadequately prepares the
youthful family member for healthy emancipation through a motivation for
building his own family group.
Kingsley Davis (1964) offers a sociological view of parent-youth conflict
which he relates to urban versus rural growth. He sees in our culture rapid
social change, complex social structures, uneven integration, and the velocity
of vertical social mobility as malefactors in producing conflict between parent
and youth. Most of our illegal drug addiction takes place in large cities where
youth dramatize their conflict with parental authority by joining a gang
which then becomes the preferred group. The psychological significance of
this will be discussed more fully when we look at the drug addict and the
street.
The statistical data provided by Ball (1965) verifies the greater involvement of urban youth in addiction. He found upon statistical analysis of 3301
male patients discharged from the U. S. Public Health Service Hospitals in
Lexington, Kentucky and Ft. Worth, Texas that the urban heroin addict was
eight years younger than the average addict recorded in Pescors much earlier
study of 1937. Parenthetically, Ball corroborated that for the urban addict
heroin far surpassed the earlier use of morplune; also the youthful urban
heroin addict is typically a minority group member and is from a northern
city.
Clinard (1963) ascribes drug addiction to extrafamilial factors. He prefers
to blame peer group associations. It is part of a learning pattern that involves
supply and demand within a particular subculture. This is the differential
association view introduced by Sutherland, additionally emphasized by
Cressey, Merton (anomie), and developed in Cloward and Ohlins reference
(1960) to the differential between goals and opportunities. The subculture
instructs the initiate in the illegal use of drugs. There is an arcane language
that develops as part of this subculture, and use of this esoteric jargon helps
to provide a sense of belonging. My own clinical experience suggests that this
particular subculture evinces little cohesion, since the typical addict has

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difficulty supporting interpersonal relationships over a long period of time.

He is more the loner than the joiner. His associations with other addicts
become increasingly opportunistic; in contrast with the momentary partnership for the boost, there are frequent experiences of beating each other
out for the drugs. The addict rationalizes this behavior for himself and his
fellow addicts as part of the game; when youre strung out, that is, really
addicted, you cant be blamed for antisocial behavior.
Lindesmith (1947; 1966) disagrees with the position of such theorists as
Clinard, Cloward, and Ohlin. He doesnt believe the addict is satisfied with
the life of addiction as an alternative to failure in achieving legitimate goals
via legitimate means. He also disputes any theory of an addiction-prone
personality.
Mowrer (1942) enjoins the field of sociology to look beyond sociological
theory for an understanding of addiction to alcohol. By inference this is
applicable to drug addicts in general. Mowrer ascribes to the family a central
role in the creation of personality. The pan-discipline approach is the only
basis for dealing with the multicausal background of addiction. Some addicts
can be produced by purely sociological factors and others by purely
psychological ones but these are the polar possibilities. In between are the
many who represent a convergence of anomalous factors, sociological and
psychological; polemics regarding whose theory is most comprehensive is
wasteful and obfuscating.
One of the sociologists who amalgamates sociological and psychological
theory is Talcott Parsons (1964). His structural-functional view of family
combines the psychoanalytic concept of psychosexual development with role
theory. The developing child relinquishes oedipal attachments as he perceives
his future role as a parent in his own right. This is seen as a normative pattern,
and we can infer that the drug addict deviates from it. He usually evades
assumption of familial roles which require that he provide for others.
Pollak (1965) is another theorist who bridges the formal disciplines. In
quest of family treatment and diagnosis as the basic approach to dealing with
deviant behavior, his interest is strongly prescriptive. Social system theory is
woven into the psychoanalytic; there is emphasis upon interactional dynamics
and how they influence the individual. Applied to the drug addict, we are
caused to think of his passivity. He does not engage in a mastery of power.
Fromm (1941) would suggest powerlessness, and a need to submit to the
authority of others. I believe this is portrayed sadomasochistically in the
addict. He appears to be antiauthority at the sadistic peak, but is actually
demanding of authority that it take charge, care for him, as in a prison where
responsible decision making, the hallmark of the emancipated and free, is

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drastically reduced. Here again we cant be guided simply by what the drug
addict says but rather by what his behavior tells us. The hapless way many
drug addicts get arrested and give up their freedom is in itself a provocative
item.
ODonnell (1969) offers some pertinent material in his study of a
stratified sample of 266 addicts who were treated at the U. S. Public Health
Service Hospital in Lexington, Kentucky. Among other factors, ODonnell
has measured those pertaining to marital history, particularly mate selection
and transmission of addiction. He found that his male subjects tended to
marry mates who were addicted or in other ways deviant. There was an even
greater tendency on the part of the male subject to cause his wife to deviate,
following marriage, especially in the practice of addiction. Among the males,
almost twice the anticipated number never did marry. The male and female
subjects who did marry engaged in more multiple marriages than is reflected
in the baseline Kentucky population; most of these marriages terminated in
separation or divorce.

PSYCHO LOGY
Chein (1964) studied personal and community aspects pertaining to
young male addicts. He wanted to understand why certain individuals raised
in the same marginal communities as these addicts did not succumb to drugs.
He believes the critical factor is the degree of family emotional health, with
the mothers relationship especially crucial. In the case of the addict she is
often seductive and emasculating. Of particular interest is the finding that the
male addict may attempt flight into marriage but usually returns, defeated, to
mother. The father is morally vague, pessimistic about life, easily swayed, has
a poor job history. As a male model he is easily faulted by the addict. The
family process is inconsistent-overindulging, as well as overdenying. The
process is arbitrarily determined by mood swings, and standards are not
always stressed.
Rosenfeld (1962), who worked with Chein, has also studied the family of
the drug addict. She reports many families broken by death, divorce, or
desertion. The typical family is not very cohesive. She too describes the
mother as an immature parent who vacillates between possessiveness and
frank rejection. The father, again, is a remote, detached figure. The male
offspring in this family does not receive validation of himself as an individual
and a man. This same family picture can be found in most cases of
delinquency but Rosenfeld believes it is more marked in regard to drug
addicts.
The stimulus-response or operant conditioning position in regard to drug

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addiction is perhaps best illustrated in the work of Hill (1962). He first

delineates a background that inclines toward addiction, with reference
primarily to poor family conditioning. The addict comes to the drug,
narcotic, or alcohol with a socially deviant personality. He is variously
described as psychopathic or sociopathic. The important fact is that
frequently his values do not coincide with those of society. He is unable to
delay gratification and is more responsive to states of euphoria. Alcohol is
more available and more accepted by society but does not appeal to narcotic
addicts since they are, generally, more disturbed about the aggression released
under alcohol. The antecedents for creating addiction do not require a slum
environment, but in this environment more illegal drugs are available. In
addition to availability there is reinforcement in the psychological and,
subsequently, the physical aspects of the drug. Through learning, the addicts
behavior with drugs takes on a goal directiveness that makes securing the drug
through whatever means most paramount and most meaningful as a raison
detre.

PSYCHIATRY AND SOCIAL WORK

In the field of psychiatry Ackerman (1958) is a leading proponent of
family diagnosis and treatment. He views the orthodox Freudian model as too
biologistic or instinct-laden and seeks to modify it by adaptation of
interpersonal relationship theory. The family is the basic socializing unit, the
soil for good or poor emotional health. Like Parsons and Chein as well as
other theorists, Ackerman endorses the proposition that social roles begin in
the family process. This process involves basic communication that makes
individual needs evident. The family is guided by a rational desire for
stability; its behavior can be viewed as homeostatic since it readjusts itself and
continues despite reverses.
Ackerman devotes particular attention to adolescent psychopathic
conduct, which is of interest to us as we look at the young male drug addict.
He visualizes this type of behavior, which comes under various other labels
like sociopath or perverse personality, as contagious in a social sense, since
like organic diseases it can spread. The germ of psychopathy can be found
in the family and the community. This, by the way, is why Ackerman deems
it necessary to treat the character disorder together with family and
community. Weech (1966) describes the psychological importance of the
street, a term frequently employed by drug addicts. The street is a refuge
from family hurt and disappointment. Weech stresses the need to know as
much as we can about this refuge if we wish to help the addict.
Adolescence is a crucial state, during which the young persons identity is

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undergoing pressure. He is frequently in conflict between familial and

extrafamilial loyalties. Rasor (1959) refers to this as the most vulnerable
period for engaging in drug addiction. He too describes the deficiencies in the
drug addicts family for meeting emotional needs.
Erikson (1963) devotes brief attention to the drug addict as he discusses
his 5ody zone modal theory. In an orthodox psychoanalytic manner he
describes the infants oral phase of psychosexual development and the
addicts fixation here which causes him to seek a restoration of the
pleasurable feelings of infancy. To achieve this the addict resorts to
incorporation by mouth or skin of substances that will satiate him. Rado
(1933) referred as well to the oral regressiveness in narcotic abuse. The addict
is not conscious of his desire to return to an infantile state and acts this out
only when he meets adversity. This type of theorizing coincides with the
addicts psychophysical reactions to heroin. He first feels high, sated, and
oblivious to stimuli or basic needs like food (as though he has been fed), then
he goes on the nod as the narcotizing effect of the drug takes hold of him.
One addict has described a feeling of internal warmth and blissfulness which
he likened to being cuddled to sleep by a devoted mother. Such investment in
the recapture of infantile states reveals the suspected underlying motivation
when the typical male drug addict chooses a wife. Clinical histories cite cases
where addicts have left drugs just before marriage only t o return to them
after a child is born of the union.
Fort (1954) whose psychiatric experience includes direct treatment
activity with drug addicts, agrees with the observations already cited, namely,
that the young male addicts character is essentially oral and narcissistic. He
found strong ambivalence toward the mother and usually other females.
Heroin served the need of takmg away sexual urgency thereby removing a
challenge to manliness. Despite this, Fort views the male addict as someone
who constantly needs association with females. This has some research
support in the study recently done by Vaillant (1966). He did a follow-up
community study of 100 male New York City addicts who had been
hospitalized in the U. S . Public Health Service Hospital at Lexington,
Kentucky between August, 1952 and January, 1953. Vaillant found a high
percentage of the addicts had remained with their mothers, or another female
blood relative, as late as age 30. He comments, The findings underscore in
concrete terms the fact that adult addicts remain unusually dependent upon
their family of origin. Unlike the youngster who runs away from family
tension to join the circus or enlists in the armed forces, and quits the
family forever, I would add that the drug addict seems to have a compulsive
need t o return, as it were, to the scene of the crime and remain within
provoking view of the family .*
*Self-help organizations, such as Synanon, seek to interdict the return to family which is
perceived as injurious to the addicts growth. The organization actively assumes a strong,
disciplined parenting role that will lead to the addicts rebirth. Recently such

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Some psychiatrists have taken a more penetrating look at mothers of drug

addicts. Nyswander (1956) refers to mother fixation, a very close and
over-protective relationship that makes the addict extremely sensitive to the
suffering caused the mother, but not the father. The patient receives his
evaluation of father from the mother and this is usually an emasculated
image, used by the addict to condemn the father.
Mason (1958) made some effort to include the mother in his treatment of
young male addicts. He too found the mother the dominant family figure; the
responses of the addicts indicated a marked preference for her. Some of the
mothers sabotaged the efforts of clinical staff. One mother insisted that she is
the only one who knows what her son needs. Most of the letters written by
these mothers to their sons were effusive and infantalizing; they also evinced
ambivalence since they contained hostile remarks. Mason felt the efforts at
reaching the mothers involved were unrewarding; most of them refused
treatment. In summing up, he depicts these mothers as hostile, controlling,
unhappy, and guilt-ridden.
Mother manipulation has also been described by Gerard and Kornetsky
(1954). They suspect that the mother of the addict provokes deviant behavior
in children and then proceeds to disapprove in a sanctimonious manner. This
betokens the Adelaide Johnson (1960) thesis of superego lacunae, which
results in a transmission to offspring of a faulty value system, with acting out
against society. The mother, without being intellectually aware, bids the child
to aggress against a social system in which she finds herself disadvantaged.
Consistent with the above, Hirsch (1961) believes that most mothers of
young male addicts see them as narcissistic extensions of themselves. They
give really to gratify their own needs; there is very easy capitulation to the
conning behavior of the addict. The mother frequently endured the same
type of relationship with her own mother and wants from her offspring the
affection and warmth that was denied her. The child and mother become
intertwined in a sticky relationship that gives no sustenance to either of them.
Hirsch also mentions that the parents of the drug addicts he treated were
unhappy in their marriages, a negative conditioning factor for the young male
addict contemplating marriage.
If any single profession is clearly charged with the responsibility of
treating the family it is the profession of social work. Rasor (1959) refers to
the psychiatric social worker as an integral member of the team that treats
drug addicts in a hospital setting. He is the principal liaison between the
hospital and the patients family and community, and a number of social
workers have examined the family characteristics of addicts.
Larner and Tefferteller (1964) tape recorded interviews with four addicts.
The interviews were conducted in a community settlement house in which
organizations have conceded the need to bring family and the general public into their
sphere of influence.

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the addicts had earlier established a relationship as youngsters. Larner refers

to the emancipation problem of the addict vis-a-vis his family. Overcrowded
slum living conditions and the boredom of adolescence provide some of the
background for escape through drugs. He sees a defective family in each case,
particularly a father who is either distant or insensitive. Two of the mothers
involved were recorded. They exhibited marked psychic pain regarding their
addict offspring. In juxtaposition with the protective concern were death
wishes at times openly expressed, and some suicidal thoughts that would
point to the addict child as the killer. One mothers constant concern was
with feeding her addict son, putting weight on him. When he ate her food she
tended t o see him as improved even though he was still on drugs.
Most of the male addicts in this small group evaded marriage although
they lived with a number of females, usually addicts as well. In all four cases
they constantly returned to the mother, and it is interesting to note that
when their mothers exhibited conclusive rejection they refused to accept it.
They persisted in efforts to evoke pity and kept returning to the mothers
home in an unending cycle.
The mother of the drug addict is so baffling that stress is often placed
upon the need for community treatment that includes family members.
Berliner (1966) as well as other have given this special emphasis, in regard t o
aftercare following treatment in such hospitals as the federal institutions at
Lexington, Kentucky and Fort Worth, Texas. He laments the fact that
families are usually not available to the social workers at these hospitals
because of physical distance.
Frazier (1962), who has treated young male addicts in a correctional
institution, remarks as well the oral, hostile, and immature behavior of the
addict. He too finds that the young addict attacks his father readily but
believes this is really a smoke screen since his real target of hostility is
mother. Hostility cannot coexist with his passivity so narcotics serve to keep
this affect beneath the surface. Frazier describes the typical mother of the
young male addict as a lonely and emotionally isolated person. She produces
a replication of herself in her addict son as she finds herself unable to help
him mature, much as her own mother has been unable to achieve this for her.
The addicts demands upon mother give us a glimpse of what his relationship
with a wife will be.
Wolk and Diskind (1961) wrote a brief but interesting article about their
clinical experience with the mothers and wives of male addicts. They suspect
that in most instances the mother is emotionally ill and fosters a parasitic
dependence in the addict-cluld. This ties the child to her, a state she desires,
despite outward complaints. Some mothers support the sons addiction in

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order to keep him dependent. The authors believe that in like fashion many
wives of addicts choose them out of a wish t o dominate, and those who stick
with them perform in the sick motherly fashion described. Instances are cited
where wives have sabotaged the addicts return to health. Because of these
contaminations the authors stress the need for treating the mother, or wife, as
well as the addict. If the addict is hospitalized it is wise to engage the female
he is returning to in casework to insure the gains he may make.
In a study of 16 married couples in which the husbands are drug addicts,
Osnos, Taylor, and Wilbur (1966) found the wives attracted to the
weaknesses of their addict spouses. These wives wished to dominate their
males and preferred the fewer heterosexual demands made of them. It is
interesting that most of these wives came from families where drug abuse was
a problem and featured a dominating mother paired with a weak, inconsequential father. The wives in this study failed to help their marital conflicts
because they could focus only on the spouses addiction as a problem and
could not bring their own personality gaps into discussion as well.
Seldin (1965) adds that since the average male addict has undergone an
early rupture with his family group, and we have already referred to the
abortive and ambivalent nature of this, he seeks out the company of others
who provide a consensus of sociopathic values. When he later marries a
woman who is not in the life, he finds his antisocial values challenged. His
wife and then his chiIdren present him with role expectations (for example,
breadwinner) which he cannot meet. The marriage deteriorates within a very
brief period of time. The passive child-like quality of the addict, which may
have attracted his wife to him in the first place, usually keeps the wife from
remaining hostile and retributive.

SUMMARY
The literature from various disciplines on the visible male drug addict
emphasizes his immature personality development. Whether viewed from
learning or psychoanalytic theory, the family plays a crucial role in the
formation of his personality.
The family of the addict, typically, provides an unstable environment for
emotional growth. The mothers relationship with the addict is particularly
critical. The father is detached and uninvolved while the mother, who
dominates the family, is viewed as emotionally immature, conflicted, and
ambivalent about her family role. This provides poor conditioning for the
addict in his own assumption of the roles of husband and father. In marriage
there is likeliliood of a replication of the original family dynamics-a

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106

dominating, psychosexually ambivalent wife who perpetuates the male

addicts immature behavior patterns.

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