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Representations of family: a review of the alcohol and drug literature
International Journal of Drug Policy 15 (2004) 347–356
Representations of family: a review of the alcohol and drug literature Judith C. Barkera,∗ , Geoffrey Huntb,1 a
Department of Anthropology, History and Social Medicine, University of California, 3333 California Street, Suite 485, San Francisco, CA 94143-0850, USA b Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501, USA Received 2 February 2004; received in revised form 27 June 2004; accepted 1 July 2004
Abstract Family has a central role in youth socialisation, including substance use. Family is both the genesis of alcohol problems (through parental consumption or supportive attitude) and a solution, via family therapy. In contrast, family is not the primary unit of direct socialisation to drug use. Rather, attributes of family (such as structure, sentiment, and activity) lead to youth delinquency, which results in drug use. These representations of family are based on taken-for-granted notions supporting a Parsonian-style structural-functionalism, highly influenced by Freudian psychoanalytic ideas. This theory of family, permeating and uniting otherwise separate literatures on alcohol and drugs, reduces complex concepts to simple, easily measured static attributes rather than developmental or social processes; uses a limited repertoire of predominantly quantitative methods; imposes unwarranted normative assumptions; and has investigated a truncated selection of topics. A call is made for expansion of the epistemological, theoretical and methodological bases, to include contemporary social theory, such as post-modern, practice theory or Foucauldian ideas, and a range of qualitative approaches when studying family and substance use. Pluralistic, flexible, contingent, contradictory, partial and fluid depictions better represent family life in a context of rapid societal transformations, often with unpredictable outcomes, occurring via globalization, information transfer/communication and commodification. © 2004 Elsevier B.V. All rights reserved. Keywords: Family; Alcohol; Drugs; Social theory; Epistemology; Methods; Deviance; Structural-functionalism
Politicians, policy analysts, the media, researchers, health practitioners, social service providers, educators and the general public share two views about family: that it is a crucially important societal foundation, and that it has a central role as an institution of primary socialisation. They also share a perception that dysfunctional families create social ills that can and must be addressed, substance use or abuse being one such undesirable outcome (Boyd, 1999; Skolnick, 1979; Waldron & Slesnick, 1998). Within the vast empirical literature on family and substance use, few studies exist on how precisely the family has been theorized. Consequently in this paper, we review, ∗
Corresponding author. Tel.: +1 415 476 7241; fax: +1 415 476 6715. E-mail addresses: [email protected] (J.C. Barker), [email protected] (G. Hunt). 1 Tel.: +1 510 865 6225; fax: +1 510 865 2467. 0955-3959/$ – see front matter © 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2004.07.002
evaluate and comment on the concepts, theories and assumptions about family which regularly appear in the alcohol and drug arenas. We critique the single, stolid vision of family that dominates and permeates that literature, and argue that a broader range of epistemological stances and social theories, more appropriately tailored to the exigencies of contemporary family life would enhance understanding, as well as education, prevention and intervention efforts. Most of the literature on which we draw is written in English and derived from studies based in the United States (US) which dominates the amount of funding provided for substance research (Hunt & Barker, 2001; Klingemann & Hunt, 1998). With notable exceptions (e.g., Bourgois, 1996b; Ulin, 1996), this literature has focused firmly on consumption of psycho-active substances while being largely inattentive to family in the production or distribution of alcohol or drugs. Our comments reflect this focus on consumption.
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Family in alcohol and drug studies: divergent yet . . . At first glance, work on family in the alcohol and drug arenas is more different than similar. Not only is the literature on alcohol more extensive than for drugs, but it also had quite distinct disciplinary starting points and underpinning premises, with vastly different impacts on subsequent conceptualisations, intellectual outcomes, and investigations of the genesis and management of social problems (see also Barker & Hunt, forthcoming). Alcohol The study of alcohol and family aimed at understanding alcoholism, came out of medicine and diverse psycho-social approaches to studying family life. A largely unexplored under pinning is that controlled alcohol use is normative and pleasurable (Heath, 1981, 1985, 2000; Hunt & Barker, 2001; Peele & Grant, 1999; Room, 1984). Most alcohol consumers are neither dependent nor likely to become so. Consequently, abstinence is not the only way to prevent the development of alcohol-related problems. Alcoholism is either (a) a disease manifest by particular, susceptible individuals, whence, bio-medical science exploration of genetics, especially gene–environment interaction (Anthenelli & Schuckit, 1997; McGue, 1994; Troost & Filsinger, 1993); or (b) a result of socialization – or its failure – within the family. Thus, a major focus is the ways family shapes alcohol-related behaviour, including, for example, what and how one drinks appropriate to gender, age, ethnicity, socio-economic class, occupation, or regional setting (Jacob & Leonard, 1994; Orford & Harwin, 1982; Peele & Grant, 1999). Family is viewed as both the genesis/locus of alcohol problems as well as a source of solutions (Doherty, Boss, LaRossa, Schumm, & Steinmetz, 1993; Waldron & Slesnick, 1998). Abuse of alcohol hinders proper functioning by severely disrupting family rituals and cohesiveness (Bennett, 1987; Bennett & McAvity, 1985; Bennett, Wolin, & Noonan, 1977; Wolin, Bennett, Noonan, & Teitelbaum, 1980). Alcohol-related behaviors can become “central organising principles” (Steinglass, 1999; Steinglass, Bennett, Wolin, & Reiss, 1987: 47), with wives deemed co-dependent enabling their alcoholic husband’s problem consumption (Schaef, 1991; compare with Fillmore, 1984). Therapy involving the whole family can become necessary (Waldron & Slesnick, 1998). While alcoholism resulted in non-normative, different, undesired or disvalued outcomes, it was not classed as criminally deviant behaviour, and a family member’s errant behaviour was often remarkably well tolerated. Drugs The literature on family and drugs is not a simple parallel to that on alcohol. Investigation of drug use derived primarily from criminology and its concept of deviancy, and aimed at explaining criminal drug behavior. Virtually absent, until
very recently, is any idea that the use of illicit drugs, ‘soft’ or ‘hard’, could be controlled or normative (Klingemann et al., 2001 on natural recovery; Pearson, 2001). So, only total abstinence from use is acceptable. Family is not conceived to be the primary unit of direct socialisation to drug use. Characteristics and activities within the family are said to lead first to delinquency, consistent with a criminological definition of deviancy and its intense attention to youth deemed vulnerable. Delinquency results in drug use (along with other socially undesirable attitudes and behaviors). In other words, drug use is an indirect or secondary effect of family socialisation. Moreover, family is presented as unable or unwilling to tolerate members who continue to use drugs or whose dependence becomes disruptive. Offending members are expelled. Rarely, however, is there actual discussion of family life, even though many substance users maintain ties to parents, siblings, and offspring. A fledgling discourse is arising, however, about drug-using women and parenting (Banwell, 2003; Murphy & Rosenbaum, 1999; Rosenbaum, 1981). Generally, though, the drug user is presented as a passive, isolated individual, lacking in agency and essentially leading a solitary life. Other divergences These differences also create a fracture between alcohol and drug research, a split that has deleterious intellectual consequences for understanding ingested substances in general in both family and social life (Hunt & Barker, 2001). The creation of two largely distinct literatures is bolstered by the socio-political organisation of the investigative, regulatory enterprises (Bourgois, 2000; Courtwright, 2001; Hunt & Barker, 2001). For example, researchers classify themselves as either alcohol or drug investigators, with allegiances to distinct disciplinary training, professional associations and conferences, and publish in different journals. Distinct funding streams exist (the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse being separate institutes of the U.S. National Institutes of Health). Diverse governmental agencies are charged with preventing, monitoring and controlling access to various substances, and of related divergent policies regarding the policing, legalization, taxation, and commercial exploitation of specific products. Moreover, alcohol and drug researchers tend to employ different research methods, with ethnographic investigation of the ‘lived experience’ of consumers being more prevalent in drug than alcohol studies. This has a curious though unintended effect—of being a form of ‘Othering,’ of exoticizing drug users compared to alcohol consumers, an alienation subtly fostered by the image of drug users as passive, apathetic, asocial individuals, ostracised by family and society. Discussion of “shooting galleries”, drugs-forsex, poverty, persistent homelessness, ravaging diseases, and other vulgarities presented as an inherent part of a “drug lifestyle” (Bourgois, 1996a, 1996b, 1998; Singer, 2000) are not matched in the alcohol literature. Even the literature on
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alcohol-inflamed domestic violence seems subdued in relation to many ethnographic depictions of the deprivations and horrors of life for (injection) drug users. Without any scholarly attention being paid to normal drug use, however, it is impossible to situate these accounts properly, to know if they represent the extremes of a continuum or are indeed inevitable and typical of a lifestyle resulting from use of certain drugs. . . . A basically similar view Despite these differences in the fundamental assumptions of the alcohol and drug arenas, a remarkable and intransigent uniting feature is the extent to which the basic conceptualisation and theoretical depiction of ‘family’ is identical, invisible, and ignored. An entrenched perception that current conceptualisation of the family is non-problematic, not in need of further theoretical development or exploration. Classic structural-functional theory In general, both the older and more contemporary literature on family and substance use is mired in classic or modernist theory, essentially unchanged since its development (Doherty, 1999). The alcohol and drug field is bogged down in a social-psychological theory of family developed in the 1930s to 1950s and unchanged since then. A notion of family derived from Parsonian-style structuralfunctionalism, highly influenced by Freudian psychoanalytic ideas (Cheal, 1991; Gubrium & Holstein, 1990; Parsons & Bales, 1955), which “emphasised the importance of harmony of goals and functions between families and societies” (Doherty et al., 1993: 10). As such, families are conceptualised as ahistorical, bounded, functioning small groups or social systems, with interdependent, self-regulating parts, a set of well-defined roles, based on gender, age, and social position, and a commonly accepted set of behavioural norms and values widely shared throughout a homogeneous population. Within this framework, family is a homeostatic system that has a structure, stability, consensus, and continuity, all of which operate to accomplish socialisation and social control of members. Family is the crucible within which individuals learn to adopt or resist problem behaviours. A common theme is the extent to which substance abuse hinders or interferes with and changes functioning, especially spousal and inter-generational roles and responsibilities, and diverts socialisation to undesired ends (Ablon, 1976; Holmila, 1988; Yamaguchi & Kandel, 1985). For example, wives may compensate for the lack of involvement by alcoholic husbands by performing father-designated tasks themselves. In single parent families, decreased role functioning by an adult substance abuser may lead to additional tasks falling on the shoulders of elder children or female offspring (e.g., Joe & ChesneyLind, 1995). The development and success of family therapy
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for substance use derives directly from this ‘systems’ perspective combined with various psychologically-based therapeutic approaches (Waldron & Slesnick, 1998). Very broadly speaking, three aspects of family derived directly from a structural-functional perspective have been found to predict problem outcomes or to create youth “at risk” for adopting substance use. These are: (a) family structure—size of household, number of biological parents present (Flewelling & Bauman, 1990; Laub & Sampson, 1988; Tienda & Angel, 1982; Wells & Rankin, 1991). (b) family sentiment—degree of warmth, affection or hostility in the attachment between youth and parents, degree of involvement of parents in child’s life (Empey, 1982; Hirschi, 1969; Kandel & Andrews, 1987; Needle, Su, Doherty, Lavee, & Brown, 1988; Newcomb, 1994; Nye, 1958, 1979; Strasburg, 1978). (c) family activity—parental drug consumption; favorable parental attitudes and normative standards towards substance use (Brook, Gordon, Whiteman, & Cohen, 1986; Johnson, Hoffmann, & Gerstein, 1996; McDermott, 1984; Peterson, Hawkins, Abbott, & Catalano, 1995). Consistently over the past several decades, many rigorously designed and well executed studies undertaken have pointed to these three aspects as the keys to understanding family and substance use (Boyd, 1999; Denton & Kampfe, 1994; Foxcroft, Ireland, Lister-Sharp, Lowe, & Breen, 2004). While such findings about these static, easily measured attributes of family are very robust and have allowed important advances in knowledge, they do not address adequately what we believe to be equally important aspects, especially for designing and implementing preventive, educational or ameliorative interventions or policy—namely, the complex interactive, social and emotional nexus that comprises family life. We need to know what goes on in one-parent families that allows some youth to avoid substance misuse, and in two-parent families that leads some youth to adopt substance use. Darling and Cumsille (2003) point to the literature’s insistent spotlight on predicting adolescent drug use [smoking] from stable characteristics, such as family structure, as a possible reason why understanding is limited about the developmental processes involved in youth initiation to substance [cigarette] use. We agree. Inter-relationships among family structure, sentiment and activity collectively constitute the crucible within which family members are socialized to become proper citizens of the nation-state.
Problems with the present view of family So, we argue, the ethos, logic and practices of family life, and the ways in which macro-social processes impinge upon these, should become a major target for the study of family and substance use. Why has this not been the case to date?
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Commonsense knowledges A major reason is that theorising about the family is generally based on everyday, taken-for-granted notions of what constitutes family, a tendency long noted by theorists in family studies itself. “[T]he researcher in the field faces a set of linguistic and intellectual problems by virtue of being simultaneously a member of society, enmeshed in its values and ideology and also attempting to be a dispassionate analyst” (Bernardes, 1985a: 200; Bernardes, 1985b; Morgan, 1975; Rapoport, Fogarty, & Rapoport, 1982; Skolnick & Skolnick, 1974). These commentators acknowledge that researchers are in a difficult position—that of attempting to construct a theoretical model of family and its workings while simultaneously trying to divorce themselves of their common sense knowledge and experience of family and its accompanying ideology. While researchers in the field of social and family sciences have confronted this dilemma directly, investigators in the alcohol and drug field have failed to be conscious of it, ignored it, or opted to stick with a rather mechanistic and ossified conceptual and theoretical toolkit. The predominance of positivist epistemology, research design and methodological approaches, including random controlled trials and evidencebased approaches (Foxcroft et al., 2004; Thomas, Baker, & Lorenzetti, 2004), are means to achieving such a divorce. But at a cost—that of failing to understand the multiple, emotionally nuanced, historically situated social interactions and practices that comprise a family constellation, its domestic experiences, and outcomes therefrom. An injurious consequence of the epistemological and theoretical dominance of an unexamined structural-functionalism is that family is treated essentially as a “black box” that is left “unpacked.” This leads to the creation and imposition of social services and public policies aimed at alleviating or eradicating (problem) substance use, without offering even the possibility of any theoretical or research insight into power relations within families or, as importantly, into the coercive or oppressive potential of the state and its administrative apparatus (Bourgois, Lettiere, & Quesada, 1997; Knowles, 1996; Zaretsky, 1976). Moreover, it results in several far-reaching, critical mismatches throughout the substance use literature. These serious disjunctures comprise: (i) a lack of correspondence between the theoretical bedrock and the aspects of family that are the primary targets for investigation; (ii) a misalignment between espoused topics of interest and the modes of inquiry employed to investigate them; (iii) the imposition of normative assumptions leading to the identification of special “at risk” groups then subject to surveillance and intervention by state agencies. Reduction of conceptual complexity While the family is claimed to comprise a social group, with a structure and internal dynamics, the attributes of family
that are actually investigated and measured are primarily psychological not social. Inherently complex factors identified as predicting substance use (e.g., family size) are quickly reduced to simpler, often dichotomous, foci. Thus, step-parent or single-parent families come to be ranged against families with two biological parents—“broken homes” versus “intact homes” (Boyd, 1999; Denton & Kampfe, 1994; Foxcroft et al., 2004). How does this structural characteristic resonate with sentiment or activity? Absence of a parent (usually a father) is rarely investigated further, with reasons for and duration of absence as well as the emotional quality of previous relationships often being unexamined. The concept of “at risk” youth, too, is poorly explicated beyond this label. A clear impression lurks that vulnerable youths are male, frozen in age somewhere in the mid-teenage years, and lack influential siblings, peers, or extended family connections. Social science has successfully unpacked and problematized many structural and interactive attributes of family in ways that raise important questions about the meaning and utility of findings throughout the substance use literature. For example, when alcohol and drug researchers talk about ‘family’ do they mean family as kinship system—if so, on what basis are kin and non-kin to be defined as biology rarely suffices (Gubrium & Holstein, 1990; Peletz, 1995; Stack, 1974; Stack & Burton, 1998)? Do substance researchers mean family as household—if so, who resides within a household? Are individual household members both kin and non-kin (Anderson & Allen, 1984; Rapp, 1999)? Do investigators mean family as domestic unit? If so, how are domestic activities recognised and apportioned between members, how many separate domestic units exist in a household, how many residential units comprise a household (Sharman, 1991)? Do researchers include non-kin who are part of support networks and who may become classified as ‘fictive family’—by the researchers at least. To others in the family these are not members with a fictional or even notional presence (Litwak, 1960; Sussman, 1965)? In other words, notions of kinship, biology, residence, household, domesticity and the meanings associated with being a family member, do not correspond exactly or easily with the idea of family as represented in the predominantly psychologically-oriented substance literature. Nor are these more complex notions easily measured, whether by extant or newly developed instruments. Little wonder then that researchers in the substance field have largely overlooked these social concepts when investigating family structure, let alone family sentiment or activity. In so doing, however, they have impoverished the field. Limited methods Even when researchers espouse interest in family sentiment or activity, that is, in the interactive and emotional qualities of relationship within families, the factors typically investigated have been psychological rather than social or interactive—“degree of attachment between youth and parents”, “warmth of relationship”, or “favourable parental atti-
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tudes and normative standards towards [alcohol or drug] use,” for example. But what is the content of the sentiments expressed? When? How? By whom, towards whom, and about what? How do sentiments change? Where is family history or remembrances taken in to account? How does such discourse fit with the belief system or power structure of the family or permit the negotiation of meanings? It is surprising just how infrequently symbolic interactionist or any theory of social dynamics is used to understand the construction and mobilisation of family practices with respect to substance use. Yet these theories have been widely used to good effect in other areas of investigation of family life, such as the management and resolution of marital conflict (Boss, Doherty, LaRossa, Schumm, & Steinmetz, 1993; Farrington & Chertok, 1993; Gubrium & Holstein, 1993; Klein & White, 1999; Sprey, 1969), and in other areas of substance use research, for example, in MacAndrew and Edgerton’s (1969) work on ‘drunken comportment.’ The changing nature of family relationships has been noted by Gubrium and Holstein (1990), among others, who argue that family status and activity is continually subject to new evidence and reinterpretation. Because, however, researchers in the alcohol and drug field view family largely as static, when change is considered, it is presented as dysfunctional, as a breakdown in the family that can create favorable conditions for deviant behavior (Hoffmann & Johnson, 1998). The notion of family as static, however, does not “take us far towards understanding social actors or the myriad contexts in which they organize themselves, relate to one another, acquire and use resources, or create order and meaning in their lives” (Peletz, 1995: 351). Normative assumptions Because family is a “cornerstone of our [researchers’ and subjects’] mutual sense of reality” (Bernardes, 1985a, p. 209), perceptions of both others and ourselves are constructed in terms of typical or normative family roles and idealized relations with which we are accustomed. The acceptable family structure for properly socialising children becomes that easily conjured up by an image of what is or should be ‘normal’—that is, a ‘nuclear’ family composed of two parents and their biological offspring residing without others present in a single household, usually seen in policy discussions as a household headed by a male breadwinner. The normal family is imagined to be a haven operating as a retreat, as a regenerator for its members, as a bulwark against intrusion by outside forces, including government. As such, it ministers to the psychological needs of family members (or at least the adult men within it), preparing well-adjusted children and proper citizens, and soothing the tensions of those operating in the world outside the family (Collier, Rosaldo, & Yanagisako, 1982; Lasch, 1977). This “normal” well-functioning, nuclear family easily becomes pitted against “deviant” or supposedly dysfunctional, alternate family forms, viewed as pathological and unwork-
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able, sources of social problems and troublesome behaviors (Skolnick & Skolnick, 1974). For the last 30 years, however, especially within sociology, researchers have studied a broad diversity of family forms. They have identified as inappropriate any prescriptive, homogenous or normative notion of “the family” (Coontz, 1992; Coontz, Parson, & Raley, 1999; Skolnick, 1991). Apparently unaware of this body of work, discussions about family in the substance abuse field are still usually prescriptive, based on assumptions about normativity and deviance. Particular families or population groups are regularly carved out and identified as being ‘at risk.’ Nonnuclear family structures are prime examples of allegedly “at risk” families—that is, alternate forms composed of blended families with step-parents and half-siblings, single-parent families, female-headed families, extended families containing grandparents or cousins, or chosen families of adoptive parents or gay/lesbian parents. Within many of these distinct and alternate family forms, socialisation of children can and does occur in a manner considered developmentally entirely appropriate and consistent with that in nuclear families. Different structures do not automatically lead to detrimental family sentiments or activities. It is no accident that alternate family forms predominate among migrant, ethnic minority, lower socio-economic or inner-city populations (Wagner, 1997), where the exigencies of daily life dictate large, extended households in order to survive (Stack, 1974). Nor is it an accident that these populations are alleged to have particular issues or problems with alcohol or drug use. Also singled out as being ‘at risk’ for substance abuse are other non-normative or supposedly deviant groups, such as people with Dual Diagnoses (i.e., mental disorders as well as substance use), the Elderly, the Poor, and the Homeless (Orford & Harwin, 1982; Roman, 1988). Designating any family as being “at risk” because they have an alternate structure, seriously under-appreciates the strengths and resilience of a wide range of contemporary family constellations (Coontz et al., 1999; Skolnick, 1991). There seems to be little doubt in the minds of many substance use researchers that the family exists. That family is a structured societal institution, with normative, measurable, stable attributes, such as size, membership, biological connections, and well-defined interactive roles and behaviors. Gubrium and colleagues (Gubrium & Holstein, 1990; Gubrium & Lynott, 1985), however, offer a post-modern challenge to the very idea of the family, asking instead “what is family?” They argue that investigation of a structural unit known as family is not useful because it does not exist as such. Rather, family is a rhetoric and ideology that ascribes particular practices, sentiments, memories and logic to a socially-defined, constantly changing interactive domain called “family.” Hence, family is best investigated not through its presumed inherent, static or structural properties but more obliquely. They argue family is best understood through discourse on the idea of family, by knowing how it is talked about, by noting how, where, when and why family is invoked and by whom, what is said about it and how it is expected to
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operate—for example, who gets incorporated as a member and when, under what circumstances, or when “family” is supposed to provide care for ailing affiliates or to discipline errant members. Topical sparseness The relative paucity of modes of inquiry employed about family and substance use is matched by the sparse, albeit important, topical foci that have repeatedly engaged researchers, such as youth initiation to and family predictors of use, intervention programs and treatment efforts. While the influence of peers or the media (such as film or TV) is often noted as salient especially in initiating substance use by youth, the importance of siblings, grandparents and other family members receives relatively little mention. Likewise, the role of family in historical in acceptability of and response to substance use (e.g., Temperance movements [Courtwright, 2001; Wagner, 1997] or the development of various therapeutic approaches, such as self-help groups like Alcoholics Anonymous [Tonigan, Ashcroft, & Miller, 1995; Wilcox, 1998]), has not been a sustained topic of research. Among many relevant topics that would benefit from more sustained study are: family beliefs about, practices around and socialisation of children to conventional use – and to unorthodox use or abuse – of legal substances, medications or dietary supplements; connections between legal and illegal drug use; family and alcohol and drugs in leisure pursuits such as sports, dancing, and music events; connections between recreational and occupational substance use. Study is also needed of substance use across the individual life course and family developmental cycle, by age, gender, ethnicity, education, sexual orientation, disability status, as well as occupation, religion and regional location, whether urban, suburban or rural. Macro-social contexts (e.g., various religions) that encourage children and families to engage in or to resist consumption of certain substances also need to be examined in much more detail.
New horizons The study of family in the alcohol and drug field has not yet expanded to include contemporary social theory nor has it wrested itself far from classic structural-functional formulations. This tardiness to shift basic epistemological or theoretical approaches to understanding family has contributed significantly to conceptual stagnation with respect to family in the substance use field. Epistemological and theoretical exploration In contrast to the torpid image of the family so present in alcohol and drug studies, theorists in family studies have recently produced a diversity of vibrant, dynamic depictions
of family enabling old and new topics to be tackled in a much broader range of ways, for example, marital conflict, intergenerational relations, gender expectations and performance, patterns of emotional support and assistance. To achieve this, family scientists have incorporated a wide range of theoretical perspectives from other mainstream disciplines, drawing on psycho-sociological and anthropological works offering an abundance of new ideas and modes of investigation, as well as innovative possibilities for policy and intervention (Boss et al., 1993; Cheal, 1991, 2002; Farrington & Chertok, 1993; Klein & White, 1996; Osmond & Thorne, 1993; Sussman, Steinmetz, & Peterson, 1999). Various styles of qualitative research now complement an expanded quantitative repertoire (Gilgun, Daly, & Handel, 1992). Modernist, positivist, empirical approaches now nestle next to a variety of epistemological and theoretical approaches, some but not all of which are post-positivist in perspective—for example, social interactionism, conflict theory, Marxist and non-Marxist political economic perspectives, feminist theory and, more recently, practice theory and Foucauldian approaches towards understanding power relations between family and the state (Boss et al., 1993; Cheal, 1991, 2002; Doherty, 1999; Sussman et al., 1999). Knowles (1996), for example, taking a Foucauldian perspective on the “invention of normality and dangerousness,” argues that particular families (in this instance, abusive) come into existence only when the power differential between state and family is manifest through the administrative attention given these families by various regulatory bodies and their official rules. Abusive families are created when the discourse promulgated by the state meets contestation and resistance by parents who behave in ways at odds with the normative notions of proper childcare. Thus, notions of flexibility, instability, plurality, discourse and power are now penetrating the family research arena to good effect (Hansen & Garey, 1998). They are beginning to make an appearance in the domain of substance use also: for example, Bourgois’s work (2000, 2003) using Foucauldian notions of biopower in order to understand drug policy development and deployment. All of which makes the continued search for stable or static characteristics of family, such as structure, far less relevant than understanding the complex, shifting, nuanced assemblage of beliefs, structure, function and emotion that comprise family and social life. Contemporary theoretical perspectives provoke interesting new questions about family and substance use, afford new insights, and are able to account better for the effects of policy on people’s lives. Post-modern perspectives are based on a view of socio-cultural environments in which rapid transformations occur via globalisation, information transfer/communication and commodification, such that relationships, whether personal, familial or social, are constantly being formed, re-formed, melded or discarded, frequently with unpredictable, dynamic outcomes (Cheal, 2002; Herzfeld, 2001). Children are viewed as especially vulnerable to the accelerated proliferation of new opportunities, new personal
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choices, new forms of pleasure, new forms of social control (Cheal, 2002). Consider, for example, the world of club drugs and youth, which highlights well how different are the experiences of contemporary youth and their parents (many of whom used alcohol and probably marijuana but few other illegal substances). It demonstrates the challenges posed to public health, law enforcement, policy and researchers when confronted by rapidly changing, globally distributed phenomena. A plethora of drugs, including ‘designer drugs,’ is consumed by contemporary youth closely linked with the current popularity and notoriety of music-dance events at clubs, parties, and especially raves (Jenkins, 1999; Ward & Fitch, 1998: 109). “Raving,” described as “the largest, most dynamic, and longest lasting youth subculture or counterculture of the postwar era” (Martin, 1999: 77) and its associated “drug culture” is becoming normative. The general ethos, esoteric lore and social mores of different types of dance-music events are increasingly familiar to youth participants, some of whom are as young as 12 or 13 years of age, while essentially remaining unfathomable foreign territory to their bewildered parents and rapidly shifting targets for state agents charged with surveillance and control (Adlaf & Smart, 1997; Griffin, 1993; Parker, Aldridge, & Measham, 1998; South, 1999).
Conclusion This paper has several purposes. First, to identify major themes within research on alcohol and drug issues in the family. Second, to question the adequacy of underlying assumptions and theoretical constructions of how family is presently conceptualized in the alcohol and drug literature. And, last, to encourage substance researchers to embrace contemporary conceptualisations and theories of family. We aim not to denigrate past efforts but to urge exploration of new ideas and ways to expand and enhance present theoretical and methodological practices, to achieve greater representation of family in all its diversity. While many such advances have been hotly debated theoretically, politically, and empirically, there is no doubt that these newer modes of inquiry have revitalized family studies, giving it new relevance, producing new insights. Similar incorporation of newer ideas would boost the substance arena’s investigation of family out of its current theoretical doldrums and enliven, enrich and enhance its relevance, especially with respect to policy. Researchers should view the pluralistic, flexible, contingent, contradictory, partial and fluid depictions of family not as failings but as representations of the wonderful, complex, messy, fluid, fuzzy, ambiguous aspects of family life as they occur in the world. We encourage conceptual expansion in studying family and substance use because “A discipline that is engaged in constantly reshaping its foundations, as well as its theoretical structures, is capable of more flexible responses to changing conditions than a discipline whose only choices are between
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the contradictory poles of fixed divisions” (Cheal, 1991, p. 158).
Acknowledgments Support for the preparation of this paper was provided in part by the National Institute of Drug Abuse, grant #R01 DA 14317 (Geoffrey Hunt, Ph.D., Principal Investigator) and the National Institute on Alcohol Abuse and Alcoholism, grant #R01 AA 11971 (Geoffrey Hunt, Ph.D., Principal Investigator). We also gratefully thank colleagues Dwight Heath, Robin Room, Leah Rutherford and the anonymous reviewers for providing useful suggestions and thoughtful comments on earlier versions of this paper. Of course, they are not responsible for any view that we express.
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Representations of family: a review of the alcohol and drug literature Judith C. Barkera,∗ , Geoffrey Huntb,1 a
Department of Anthropology, History and Social Medicine, University of California, 3333 California Street, Suite 485, San Francisco, CA 94143-0850, USA b Institute for Scientific Analysis, 1150 Ballena Blvd, Suite 211, Alameda, CA 94501, USA Received 2 February 2004; received in revised form 27 June 2004; accepted 1 July 2004
Abstract Family has a central role in youth socialisation, including substance use. Family is both the genesis of alcohol problems (through parental consumption or supportive attitude) and a solution, via family therapy. In contrast, family is not the primary unit of direct socialisation to drug use. Rather, attributes of family (such as structure, sentiment, and activity) lead to youth delinquency, which results in drug use. These representations of family are based on taken-for-granted notions supporting a Parsonian-style structural-functionalism, highly influenced by Freudian psychoanalytic ideas. This theory of family, permeating and uniting otherwise separate literatures on alcohol and drugs, reduces complex concepts to simple, easily measured static attributes rather than developmental or social processes; uses a limited repertoire of predominantly quantitative methods; imposes unwarranted normative assumptions; and has investigated a truncated selection of topics. A call is made for expansion of the epistemological, theoretical and methodological bases, to include contemporary social theory, such as post-modern, practice theory or Foucauldian ideas, and a range of qualitative approaches when studying family and substance use. Pluralistic, flexible, contingent, contradictory, partial and fluid depictions better represent family life in a context of rapid societal transformations, often with unpredictable outcomes, occurring via globalization, information transfer/communication and commodification. © 2004 Elsevier B.V. All rights reserved. Keywords: Family; Alcohol; Drugs; Social theory; Epistemology; Methods; Deviance; Structural-functionalism
Politicians, policy analysts, the media, researchers, health practitioners, social service providers, educators and the general public share two views about family: that it is a crucially important societal foundation, and that it has a central role as an institution of primary socialisation. They also share a perception that dysfunctional families create social ills that can and must be addressed, substance use or abuse being one such undesirable outcome (Boyd, 1999; Skolnick, 1979; Waldron & Slesnick, 1998). Within the vast empirical literature on family and substance use, few studies exist on how precisely the family has been theorized. Consequently in this paper, we review, ∗
Corresponding author. Tel.: +1 415 476 7241; fax: +1 415 476 6715. E-mail addresses: [email protected] (J.C. Barker), [email protected] (G. Hunt). 1 Tel.: +1 510 865 6225; fax: +1 510 865 2467. 0955-3959/$ – see front matter © 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2004.07.002
evaluate and comment on the concepts, theories and assumptions about family which regularly appear in the alcohol and drug arenas. We critique the single, stolid vision of family that dominates and permeates that literature, and argue that a broader range of epistemological stances and social theories, more appropriately tailored to the exigencies of contemporary family life would enhance understanding, as well as education, prevention and intervention efforts. Most of the literature on which we draw is written in English and derived from studies based in the United States (US) which dominates the amount of funding provided for substance research (Hunt & Barker, 2001; Klingemann & Hunt, 1998). With notable exceptions (e.g., Bourgois, 1996b; Ulin, 1996), this literature has focused firmly on consumption of psycho-active substances while being largely inattentive to family in the production or distribution of alcohol or drugs. Our comments reflect this focus on consumption.
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Family in alcohol and drug studies: divergent yet . . . At first glance, work on family in the alcohol and drug arenas is more different than similar. Not only is the literature on alcohol more extensive than for drugs, but it also had quite distinct disciplinary starting points and underpinning premises, with vastly different impacts on subsequent conceptualisations, intellectual outcomes, and investigations of the genesis and management of social problems (see also Barker & Hunt, forthcoming). Alcohol The study of alcohol and family aimed at understanding alcoholism, came out of medicine and diverse psycho-social approaches to studying family life. A largely unexplored under pinning is that controlled alcohol use is normative and pleasurable (Heath, 1981, 1985, 2000; Hunt & Barker, 2001; Peele & Grant, 1999; Room, 1984). Most alcohol consumers are neither dependent nor likely to become so. Consequently, abstinence is not the only way to prevent the development of alcohol-related problems. Alcoholism is either (a) a disease manifest by particular, susceptible individuals, whence, bio-medical science exploration of genetics, especially gene–environment interaction (Anthenelli & Schuckit, 1997; McGue, 1994; Troost & Filsinger, 1993); or (b) a result of socialization – or its failure – within the family. Thus, a major focus is the ways family shapes alcohol-related behaviour, including, for example, what and how one drinks appropriate to gender, age, ethnicity, socio-economic class, occupation, or regional setting (Jacob & Leonard, 1994; Orford & Harwin, 1982; Peele & Grant, 1999). Family is viewed as both the genesis/locus of alcohol problems as well as a source of solutions (Doherty, Boss, LaRossa, Schumm, & Steinmetz, 1993; Waldron & Slesnick, 1998). Abuse of alcohol hinders proper functioning by severely disrupting family rituals and cohesiveness (Bennett, 1987; Bennett & McAvity, 1985; Bennett, Wolin, & Noonan, 1977; Wolin, Bennett, Noonan, & Teitelbaum, 1980). Alcohol-related behaviors can become “central organising principles” (Steinglass, 1999; Steinglass, Bennett, Wolin, & Reiss, 1987: 47), with wives deemed co-dependent enabling their alcoholic husband’s problem consumption (Schaef, 1991; compare with Fillmore, 1984). Therapy involving the whole family can become necessary (Waldron & Slesnick, 1998). While alcoholism resulted in non-normative, different, undesired or disvalued outcomes, it was not classed as criminally deviant behaviour, and a family member’s errant behaviour was often remarkably well tolerated. Drugs The literature on family and drugs is not a simple parallel to that on alcohol. Investigation of drug use derived primarily from criminology and its concept of deviancy, and aimed at explaining criminal drug behavior. Virtually absent, until
very recently, is any idea that the use of illicit drugs, ‘soft’ or ‘hard’, could be controlled or normative (Klingemann et al., 2001 on natural recovery; Pearson, 2001). So, only total abstinence from use is acceptable. Family is not conceived to be the primary unit of direct socialisation to drug use. Characteristics and activities within the family are said to lead first to delinquency, consistent with a criminological definition of deviancy and its intense attention to youth deemed vulnerable. Delinquency results in drug use (along with other socially undesirable attitudes and behaviors). In other words, drug use is an indirect or secondary effect of family socialisation. Moreover, family is presented as unable or unwilling to tolerate members who continue to use drugs or whose dependence becomes disruptive. Offending members are expelled. Rarely, however, is there actual discussion of family life, even though many substance users maintain ties to parents, siblings, and offspring. A fledgling discourse is arising, however, about drug-using women and parenting (Banwell, 2003; Murphy & Rosenbaum, 1999; Rosenbaum, 1981). Generally, though, the drug user is presented as a passive, isolated individual, lacking in agency and essentially leading a solitary life. Other divergences These differences also create a fracture between alcohol and drug research, a split that has deleterious intellectual consequences for understanding ingested substances in general in both family and social life (Hunt & Barker, 2001). The creation of two largely distinct literatures is bolstered by the socio-political organisation of the investigative, regulatory enterprises (Bourgois, 2000; Courtwright, 2001; Hunt & Barker, 2001). For example, researchers classify themselves as either alcohol or drug investigators, with allegiances to distinct disciplinary training, professional associations and conferences, and publish in different journals. Distinct funding streams exist (the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse being separate institutes of the U.S. National Institutes of Health). Diverse governmental agencies are charged with preventing, monitoring and controlling access to various substances, and of related divergent policies regarding the policing, legalization, taxation, and commercial exploitation of specific products. Moreover, alcohol and drug researchers tend to employ different research methods, with ethnographic investigation of the ‘lived experience’ of consumers being more prevalent in drug than alcohol studies. This has a curious though unintended effect—of being a form of ‘Othering,’ of exoticizing drug users compared to alcohol consumers, an alienation subtly fostered by the image of drug users as passive, apathetic, asocial individuals, ostracised by family and society. Discussion of “shooting galleries”, drugs-forsex, poverty, persistent homelessness, ravaging diseases, and other vulgarities presented as an inherent part of a “drug lifestyle” (Bourgois, 1996a, 1996b, 1998; Singer, 2000) are not matched in the alcohol literature. Even the literature on
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alcohol-inflamed domestic violence seems subdued in relation to many ethnographic depictions of the deprivations and horrors of life for (injection) drug users. Without any scholarly attention being paid to normal drug use, however, it is impossible to situate these accounts properly, to know if they represent the extremes of a continuum or are indeed inevitable and typical of a lifestyle resulting from use of certain drugs. . . . A basically similar view Despite these differences in the fundamental assumptions of the alcohol and drug arenas, a remarkable and intransigent uniting feature is the extent to which the basic conceptualisation and theoretical depiction of ‘family’ is identical, invisible, and ignored. An entrenched perception that current conceptualisation of the family is non-problematic, not in need of further theoretical development or exploration. Classic structural-functional theory In general, both the older and more contemporary literature on family and substance use is mired in classic or modernist theory, essentially unchanged since its development (Doherty, 1999). The alcohol and drug field is bogged down in a social-psychological theory of family developed in the 1930s to 1950s and unchanged since then. A notion of family derived from Parsonian-style structuralfunctionalism, highly influenced by Freudian psychoanalytic ideas (Cheal, 1991; Gubrium & Holstein, 1990; Parsons & Bales, 1955), which “emphasised the importance of harmony of goals and functions between families and societies” (Doherty et al., 1993: 10). As such, families are conceptualised as ahistorical, bounded, functioning small groups or social systems, with interdependent, self-regulating parts, a set of well-defined roles, based on gender, age, and social position, and a commonly accepted set of behavioural norms and values widely shared throughout a homogeneous population. Within this framework, family is a homeostatic system that has a structure, stability, consensus, and continuity, all of which operate to accomplish socialisation and social control of members. Family is the crucible within which individuals learn to adopt or resist problem behaviours. A common theme is the extent to which substance abuse hinders or interferes with and changes functioning, especially spousal and inter-generational roles and responsibilities, and diverts socialisation to undesired ends (Ablon, 1976; Holmila, 1988; Yamaguchi & Kandel, 1985). For example, wives may compensate for the lack of involvement by alcoholic husbands by performing father-designated tasks themselves. In single parent families, decreased role functioning by an adult substance abuser may lead to additional tasks falling on the shoulders of elder children or female offspring (e.g., Joe & ChesneyLind, 1995). The development and success of family therapy
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for substance use derives directly from this ‘systems’ perspective combined with various psychologically-based therapeutic approaches (Waldron & Slesnick, 1998). Very broadly speaking, three aspects of family derived directly from a structural-functional perspective have been found to predict problem outcomes or to create youth “at risk” for adopting substance use. These are: (a) family structure—size of household, number of biological parents present (Flewelling & Bauman, 1990; Laub & Sampson, 1988; Tienda & Angel, 1982; Wells & Rankin, 1991). (b) family sentiment—degree of warmth, affection or hostility in the attachment between youth and parents, degree of involvement of parents in child’s life (Empey, 1982; Hirschi, 1969; Kandel & Andrews, 1987; Needle, Su, Doherty, Lavee, & Brown, 1988; Newcomb, 1994; Nye, 1958, 1979; Strasburg, 1978). (c) family activity—parental drug consumption; favorable parental attitudes and normative standards towards substance use (Brook, Gordon, Whiteman, & Cohen, 1986; Johnson, Hoffmann, & Gerstein, 1996; McDermott, 1984; Peterson, Hawkins, Abbott, & Catalano, 1995). Consistently over the past several decades, many rigorously designed and well executed studies undertaken have pointed to these three aspects as the keys to understanding family and substance use (Boyd, 1999; Denton & Kampfe, 1994; Foxcroft, Ireland, Lister-Sharp, Lowe, & Breen, 2004). While such findings about these static, easily measured attributes of family are very robust and have allowed important advances in knowledge, they do not address adequately what we believe to be equally important aspects, especially for designing and implementing preventive, educational or ameliorative interventions or policy—namely, the complex interactive, social and emotional nexus that comprises family life. We need to know what goes on in one-parent families that allows some youth to avoid substance misuse, and in two-parent families that leads some youth to adopt substance use. Darling and Cumsille (2003) point to the literature’s insistent spotlight on predicting adolescent drug use [smoking] from stable characteristics, such as family structure, as a possible reason why understanding is limited about the developmental processes involved in youth initiation to substance [cigarette] use. We agree. Inter-relationships among family structure, sentiment and activity collectively constitute the crucible within which family members are socialized to become proper citizens of the nation-state.
Problems with the present view of family So, we argue, the ethos, logic and practices of family life, and the ways in which macro-social processes impinge upon these, should become a major target for the study of family and substance use. Why has this not been the case to date?
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Commonsense knowledges A major reason is that theorising about the family is generally based on everyday, taken-for-granted notions of what constitutes family, a tendency long noted by theorists in family studies itself. “[T]he researcher in the field faces a set of linguistic and intellectual problems by virtue of being simultaneously a member of society, enmeshed in its values and ideology and also attempting to be a dispassionate analyst” (Bernardes, 1985a: 200; Bernardes, 1985b; Morgan, 1975; Rapoport, Fogarty, & Rapoport, 1982; Skolnick & Skolnick, 1974). These commentators acknowledge that researchers are in a difficult position—that of attempting to construct a theoretical model of family and its workings while simultaneously trying to divorce themselves of their common sense knowledge and experience of family and its accompanying ideology. While researchers in the field of social and family sciences have confronted this dilemma directly, investigators in the alcohol and drug field have failed to be conscious of it, ignored it, or opted to stick with a rather mechanistic and ossified conceptual and theoretical toolkit. The predominance of positivist epistemology, research design and methodological approaches, including random controlled trials and evidencebased approaches (Foxcroft et al., 2004; Thomas, Baker, & Lorenzetti, 2004), are means to achieving such a divorce. But at a cost—that of failing to understand the multiple, emotionally nuanced, historically situated social interactions and practices that comprise a family constellation, its domestic experiences, and outcomes therefrom. An injurious consequence of the epistemological and theoretical dominance of an unexamined structural-functionalism is that family is treated essentially as a “black box” that is left “unpacked.” This leads to the creation and imposition of social services and public policies aimed at alleviating or eradicating (problem) substance use, without offering even the possibility of any theoretical or research insight into power relations within families or, as importantly, into the coercive or oppressive potential of the state and its administrative apparatus (Bourgois, Lettiere, & Quesada, 1997; Knowles, 1996; Zaretsky, 1976). Moreover, it results in several far-reaching, critical mismatches throughout the substance use literature. These serious disjunctures comprise: (i) a lack of correspondence between the theoretical bedrock and the aspects of family that are the primary targets for investigation; (ii) a misalignment between espoused topics of interest and the modes of inquiry employed to investigate them; (iii) the imposition of normative assumptions leading to the identification of special “at risk” groups then subject to surveillance and intervention by state agencies. Reduction of conceptual complexity While the family is claimed to comprise a social group, with a structure and internal dynamics, the attributes of family
that are actually investigated and measured are primarily psychological not social. Inherently complex factors identified as predicting substance use (e.g., family size) are quickly reduced to simpler, often dichotomous, foci. Thus, step-parent or single-parent families come to be ranged against families with two biological parents—“broken homes” versus “intact homes” (Boyd, 1999; Denton & Kampfe, 1994; Foxcroft et al., 2004). How does this structural characteristic resonate with sentiment or activity? Absence of a parent (usually a father) is rarely investigated further, with reasons for and duration of absence as well as the emotional quality of previous relationships often being unexamined. The concept of “at risk” youth, too, is poorly explicated beyond this label. A clear impression lurks that vulnerable youths are male, frozen in age somewhere in the mid-teenage years, and lack influential siblings, peers, or extended family connections. Social science has successfully unpacked and problematized many structural and interactive attributes of family in ways that raise important questions about the meaning and utility of findings throughout the substance use literature. For example, when alcohol and drug researchers talk about ‘family’ do they mean family as kinship system—if so, on what basis are kin and non-kin to be defined as biology rarely suffices (Gubrium & Holstein, 1990; Peletz, 1995; Stack, 1974; Stack & Burton, 1998)? Do substance researchers mean family as household—if so, who resides within a household? Are individual household members both kin and non-kin (Anderson & Allen, 1984; Rapp, 1999)? Do investigators mean family as domestic unit? If so, how are domestic activities recognised and apportioned between members, how many separate domestic units exist in a household, how many residential units comprise a household (Sharman, 1991)? Do researchers include non-kin who are part of support networks and who may become classified as ‘fictive family’—by the researchers at least. To others in the family these are not members with a fictional or even notional presence (Litwak, 1960; Sussman, 1965)? In other words, notions of kinship, biology, residence, household, domesticity and the meanings associated with being a family member, do not correspond exactly or easily with the idea of family as represented in the predominantly psychologically-oriented substance literature. Nor are these more complex notions easily measured, whether by extant or newly developed instruments. Little wonder then that researchers in the substance field have largely overlooked these social concepts when investigating family structure, let alone family sentiment or activity. In so doing, however, they have impoverished the field. Limited methods Even when researchers espouse interest in family sentiment or activity, that is, in the interactive and emotional qualities of relationship within families, the factors typically investigated have been psychological rather than social or interactive—“degree of attachment between youth and parents”, “warmth of relationship”, or “favourable parental atti-
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tudes and normative standards towards [alcohol or drug] use,” for example. But what is the content of the sentiments expressed? When? How? By whom, towards whom, and about what? How do sentiments change? Where is family history or remembrances taken in to account? How does such discourse fit with the belief system or power structure of the family or permit the negotiation of meanings? It is surprising just how infrequently symbolic interactionist or any theory of social dynamics is used to understand the construction and mobilisation of family practices with respect to substance use. Yet these theories have been widely used to good effect in other areas of investigation of family life, such as the management and resolution of marital conflict (Boss, Doherty, LaRossa, Schumm, & Steinmetz, 1993; Farrington & Chertok, 1993; Gubrium & Holstein, 1993; Klein & White, 1999; Sprey, 1969), and in other areas of substance use research, for example, in MacAndrew and Edgerton’s (1969) work on ‘drunken comportment.’ The changing nature of family relationships has been noted by Gubrium and Holstein (1990), among others, who argue that family status and activity is continually subject to new evidence and reinterpretation. Because, however, researchers in the alcohol and drug field view family largely as static, when change is considered, it is presented as dysfunctional, as a breakdown in the family that can create favorable conditions for deviant behavior (Hoffmann & Johnson, 1998). The notion of family as static, however, does not “take us far towards understanding social actors or the myriad contexts in which they organize themselves, relate to one another, acquire and use resources, or create order and meaning in their lives” (Peletz, 1995: 351). Normative assumptions Because family is a “cornerstone of our [researchers’ and subjects’] mutual sense of reality” (Bernardes, 1985a, p. 209), perceptions of both others and ourselves are constructed in terms of typical or normative family roles and idealized relations with which we are accustomed. The acceptable family structure for properly socialising children becomes that easily conjured up by an image of what is or should be ‘normal’—that is, a ‘nuclear’ family composed of two parents and their biological offspring residing without others present in a single household, usually seen in policy discussions as a household headed by a male breadwinner. The normal family is imagined to be a haven operating as a retreat, as a regenerator for its members, as a bulwark against intrusion by outside forces, including government. As such, it ministers to the psychological needs of family members (or at least the adult men within it), preparing well-adjusted children and proper citizens, and soothing the tensions of those operating in the world outside the family (Collier, Rosaldo, & Yanagisako, 1982; Lasch, 1977). This “normal” well-functioning, nuclear family easily becomes pitted against “deviant” or supposedly dysfunctional, alternate family forms, viewed as pathological and unwork-
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able, sources of social problems and troublesome behaviors (Skolnick & Skolnick, 1974). For the last 30 years, however, especially within sociology, researchers have studied a broad diversity of family forms. They have identified as inappropriate any prescriptive, homogenous or normative notion of “the family” (Coontz, 1992; Coontz, Parson, & Raley, 1999; Skolnick, 1991). Apparently unaware of this body of work, discussions about family in the substance abuse field are still usually prescriptive, based on assumptions about normativity and deviance. Particular families or population groups are regularly carved out and identified as being ‘at risk.’ Nonnuclear family structures are prime examples of allegedly “at risk” families—that is, alternate forms composed of blended families with step-parents and half-siblings, single-parent families, female-headed families, extended families containing grandparents or cousins, or chosen families of adoptive parents or gay/lesbian parents. Within many of these distinct and alternate family forms, socialisation of children can and does occur in a manner considered developmentally entirely appropriate and consistent with that in nuclear families. Different structures do not automatically lead to detrimental family sentiments or activities. It is no accident that alternate family forms predominate among migrant, ethnic minority, lower socio-economic or inner-city populations (Wagner, 1997), where the exigencies of daily life dictate large, extended households in order to survive (Stack, 1974). Nor is it an accident that these populations are alleged to have particular issues or problems with alcohol or drug use. Also singled out as being ‘at risk’ for substance abuse are other non-normative or supposedly deviant groups, such as people with Dual Diagnoses (i.e., mental disorders as well as substance use), the Elderly, the Poor, and the Homeless (Orford & Harwin, 1982; Roman, 1988). Designating any family as being “at risk” because they have an alternate structure, seriously under-appreciates the strengths and resilience of a wide range of contemporary family constellations (Coontz et al., 1999; Skolnick, 1991). There seems to be little doubt in the minds of many substance use researchers that the family exists. That family is a structured societal institution, with normative, measurable, stable attributes, such as size, membership, biological connections, and well-defined interactive roles and behaviors. Gubrium and colleagues (Gubrium & Holstein, 1990; Gubrium & Lynott, 1985), however, offer a post-modern challenge to the very idea of the family, asking instead “what is family?” They argue that investigation of a structural unit known as family is not useful because it does not exist as such. Rather, family is a rhetoric and ideology that ascribes particular practices, sentiments, memories and logic to a socially-defined, constantly changing interactive domain called “family.” Hence, family is best investigated not through its presumed inherent, static or structural properties but more obliquely. They argue family is best understood through discourse on the idea of family, by knowing how it is talked about, by noting how, where, when and why family is invoked and by whom, what is said about it and how it is expected to
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operate—for example, who gets incorporated as a member and when, under what circumstances, or when “family” is supposed to provide care for ailing affiliates or to discipline errant members. Topical sparseness The relative paucity of modes of inquiry employed about family and substance use is matched by the sparse, albeit important, topical foci that have repeatedly engaged researchers, such as youth initiation to and family predictors of use, intervention programs and treatment efforts. While the influence of peers or the media (such as film or TV) is often noted as salient especially in initiating substance use by youth, the importance of siblings, grandparents and other family members receives relatively little mention. Likewise, the role of family in historical in acceptability of and response to substance use (e.g., Temperance movements [Courtwright, 2001; Wagner, 1997] or the development of various therapeutic approaches, such as self-help groups like Alcoholics Anonymous [Tonigan, Ashcroft, & Miller, 1995; Wilcox, 1998]), has not been a sustained topic of research. Among many relevant topics that would benefit from more sustained study are: family beliefs about, practices around and socialisation of children to conventional use – and to unorthodox use or abuse – of legal substances, medications or dietary supplements; connections between legal and illegal drug use; family and alcohol and drugs in leisure pursuits such as sports, dancing, and music events; connections between recreational and occupational substance use. Study is also needed of substance use across the individual life course and family developmental cycle, by age, gender, ethnicity, education, sexual orientation, disability status, as well as occupation, religion and regional location, whether urban, suburban or rural. Macro-social contexts (e.g., various religions) that encourage children and families to engage in or to resist consumption of certain substances also need to be examined in much more detail.
New horizons The study of family in the alcohol and drug field has not yet expanded to include contemporary social theory nor has it wrested itself far from classic structural-functional formulations. This tardiness to shift basic epistemological or theoretical approaches to understanding family has contributed significantly to conceptual stagnation with respect to family in the substance use field. Epistemological and theoretical exploration In contrast to the torpid image of the family so present in alcohol and drug studies, theorists in family studies have recently produced a diversity of vibrant, dynamic depictions
of family enabling old and new topics to be tackled in a much broader range of ways, for example, marital conflict, intergenerational relations, gender expectations and performance, patterns of emotional support and assistance. To achieve this, family scientists have incorporated a wide range of theoretical perspectives from other mainstream disciplines, drawing on psycho-sociological and anthropological works offering an abundance of new ideas and modes of investigation, as well as innovative possibilities for policy and intervention (Boss et al., 1993; Cheal, 1991, 2002; Farrington & Chertok, 1993; Klein & White, 1996; Osmond & Thorne, 1993; Sussman, Steinmetz, & Peterson, 1999). Various styles of qualitative research now complement an expanded quantitative repertoire (Gilgun, Daly, & Handel, 1992). Modernist, positivist, empirical approaches now nestle next to a variety of epistemological and theoretical approaches, some but not all of which are post-positivist in perspective—for example, social interactionism, conflict theory, Marxist and non-Marxist political economic perspectives, feminist theory and, more recently, practice theory and Foucauldian approaches towards understanding power relations between family and the state (Boss et al., 1993; Cheal, 1991, 2002; Doherty, 1999; Sussman et al., 1999). Knowles (1996), for example, taking a Foucauldian perspective on the “invention of normality and dangerousness,” argues that particular families (in this instance, abusive) come into existence only when the power differential between state and family is manifest through the administrative attention given these families by various regulatory bodies and their official rules. Abusive families are created when the discourse promulgated by the state meets contestation and resistance by parents who behave in ways at odds with the normative notions of proper childcare. Thus, notions of flexibility, instability, plurality, discourse and power are now penetrating the family research arena to good effect (Hansen & Garey, 1998). They are beginning to make an appearance in the domain of substance use also: for example, Bourgois’s work (2000, 2003) using Foucauldian notions of biopower in order to understand drug policy development and deployment. All of which makes the continued search for stable or static characteristics of family, such as structure, far less relevant than understanding the complex, shifting, nuanced assemblage of beliefs, structure, function and emotion that comprise family and social life. Contemporary theoretical perspectives provoke interesting new questions about family and substance use, afford new insights, and are able to account better for the effects of policy on people’s lives. Post-modern perspectives are based on a view of socio-cultural environments in which rapid transformations occur via globalisation, information transfer/communication and commodification, such that relationships, whether personal, familial or social, are constantly being formed, re-formed, melded or discarded, frequently with unpredictable, dynamic outcomes (Cheal, 2002; Herzfeld, 2001). Children are viewed as especially vulnerable to the accelerated proliferation of new opportunities, new personal
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choices, new forms of pleasure, new forms of social control (Cheal, 2002). Consider, for example, the world of club drugs and youth, which highlights well how different are the experiences of contemporary youth and their parents (many of whom used alcohol and probably marijuana but few other illegal substances). It demonstrates the challenges posed to public health, law enforcement, policy and researchers when confronted by rapidly changing, globally distributed phenomena. A plethora of drugs, including ‘designer drugs,’ is consumed by contemporary youth closely linked with the current popularity and notoriety of music-dance events at clubs, parties, and especially raves (Jenkins, 1999; Ward & Fitch, 1998: 109). “Raving,” described as “the largest, most dynamic, and longest lasting youth subculture or counterculture of the postwar era” (Martin, 1999: 77) and its associated “drug culture” is becoming normative. The general ethos, esoteric lore and social mores of different types of dance-music events are increasingly familiar to youth participants, some of whom are as young as 12 or 13 years of age, while essentially remaining unfathomable foreign territory to their bewildered parents and rapidly shifting targets for state agents charged with surveillance and control (Adlaf & Smart, 1997; Griffin, 1993; Parker, Aldridge, & Measham, 1998; South, 1999).
Conclusion This paper has several purposes. First, to identify major themes within research on alcohol and drug issues in the family. Second, to question the adequacy of underlying assumptions and theoretical constructions of how family is presently conceptualized in the alcohol and drug literature. And, last, to encourage substance researchers to embrace contemporary conceptualisations and theories of family. We aim not to denigrate past efforts but to urge exploration of new ideas and ways to expand and enhance present theoretical and methodological practices, to achieve greater representation of family in all its diversity. While many such advances have been hotly debated theoretically, politically, and empirically, there is no doubt that these newer modes of inquiry have revitalized family studies, giving it new relevance, producing new insights. Similar incorporation of newer ideas would boost the substance arena’s investigation of family out of its current theoretical doldrums and enliven, enrich and enhance its relevance, especially with respect to policy. Researchers should view the pluralistic, flexible, contingent, contradictory, partial and fluid depictions of family not as failings but as representations of the wonderful, complex, messy, fluid, fuzzy, ambiguous aspects of family life as they occur in the world. We encourage conceptual expansion in studying family and substance use because “A discipline that is engaged in constantly reshaping its foundations, as well as its theoretical structures, is capable of more flexible responses to changing conditions than a discipline whose only choices are between
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the contradictory poles of fixed divisions” (Cheal, 1991, p. 158).
Acknowledgments Support for the preparation of this paper was provided in part by the National Institute of Drug Abuse, grant #R01 DA 14317 (Geoffrey Hunt, Ph.D., Principal Investigator) and the National Institute on Alcohol Abuse and Alcoholism, grant #R01 AA 11971 (Geoffrey Hunt, Ph.D., Principal Investigator). We also gratefully thank colleagues Dwight Heath, Robin Room, Leah Rutherford and the anonymous reviewers for providing useful suggestions and thoughtful comments on earlier versions of this paper. Of course, they are not responsible for any view that we express.
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