When Older Adult Substance Abuse Affects Others: What Helps and What Doesn’t?

Jan Ligon, PhD, LCSW
Georgia State University

The abuse of alcohol and other drugs in the older adult population, which includes the aging “baby boomers,” is escalating. It is anticipated that the need for treatment will grow to 4.4 million older adults by 2020 (Dowling, Weiss, & Condon, 2008). The treatment admissions rate for adults over 50 doubled from 1992 to 2008, while the percentage of females admitted to treatment has increased from 18% to 25% during this period (SAMHSA, 2010). When compared to previous reports, older adults seeking treatment are less likely to be married or employed (SAMHSA, 2010).

The relationship between substance abuse and the aging process is not well understood and the literature regarding effective treatment interventions is limited (Cummings, Bride, & Rawlins-Shaw, 2006). Even less is known about how substance abuse affects other people. This Endpage focuses on evidence based models that address “concerned significant others” or CSOs (Meyers, Roozen, & Smith, 2011). CSOs are the other people in the person’s life who are impacted by having a person with a substance abuse problem in the family. CSOs include spouses, partners, parents, grandparents, children, siblings, and others. The number of CSOs far exceeds the number of substance abusers. However, there is scant mention in the existing literature of this population and even less about what can help. This very large group of people has been referred to as the ‘silent majority’ in the addiction prevention, treatment, and recovery literature (Ligon, 2005).

While all of the intervention resources target the people who have a substance abuse problem (ONDCP, 2011), Gruber and Taylor (2006) note four compelling reasons for taking a family perspective on substance abuse: “(1) It occurs in families, (2) It harms families, (3) families both participate in and can perpetuate active addiction, and (4) families are a potential treatment and recovery resource” (p. 3). How to engage and connect with families affected by older adult substance abuse can be challenging and is likely to require some rethinking about the notion of “helping” this population.

In the past, families of substance abusers have been viewed as being codependent people, who are a part of a family disease, where each family member assumes defined roles. A manual published by the Center for Substance Abuse Treatment (2004) on helping families includes a section about codependency, but then goes on to note that scientific inquiry into the usefulness of the label is largely nonexistent. Concerning the use of family role labels, such as mascot and enabler, Vernig (2011) determined that there are more problems associated with the use of these labels than clinical benefit. There is also strong disagreement about the use of a ‘family disease’ view in working with those affected by substance abuse. Simply stated, families do not believe the term to be true (ADAW, 2006).

With growing concerns about the lack of usefulness for these traditional views, there has been an encouraging shift in approaches with CSOs in both the U.S. and the U.K. One example, Community Reinforcement Approach and Family Therapy (CRAFT), is an evidence-based model that uses strategies and goals to support desired changes (Meyers, Roozen, & Smith, 2011). Developed in the U.K., the 5 Step Method (Copello et al., 2010) views CSOs as simply everyday people who are coping with difficult circumstances in their families. The authors are careful to avoid a family disease view or to blame family members for having responsibility for their loved ones addiction.

Two additional approaches, although not evidence-based, would fall under the category of ‘promising’ in the Curtis (1996) research hierarchy. Six Skills for Families Affected by Substance Abuse (Ligon, 2004) is a tool for use in learning skills related to clarification of roles and boundaries, limit setting, and goal development. Denning (2010) applies a harm reduction approach with CSOs, in order to facilitate changes in incremental steps, through understanding, and by providing support for each CSO individually.

Finally, Al-Anon, a derivative of the AA 12-Step model, provides support through selfhelp groups that are widely available in many communities. While these groups may be helpful to some, others will be challenged by the program’s approach, which conveys to families that they are powerless over their loved ones addiction and to avoid efforts to change the addicted family members. To the contrary, CSOs are not powerless and can play a significant role in encouraging their addicted family member to enter treatment (Harris, 2010; Roozen, de Waart, & van der Kroft).

Having an older adult with a substance abuse problem in the family can be very difficult and challenging to CSOs. Families are likely to experience feelings of anger, fear, frustration, and embarrassment (Denning, 2010), while others may justify the problem as simply a part of the aging process (Briggs et al, 2011).

Although it is very apparent that more research is needed and that the level of services and funding to help CSOs is woefully inadequate, there is much that can be done now, based on what we do know. First, providers of services can consider changing their approach with families and avoid the use of simplistic terms that simply do not capture the complexity of the problem. Indeed, it is likely that our approach to CSOs matters more than the content of any particular intervention or model. Second, we can infuse content on CSOs in articles, books, websites, and other outlets so that we are able to reach more CSOs in our communities. Finally, we can avoid the trap of applying existing family models that we know and find familiar, including those that label and pathologize families. These approaches should be replaced with others that are evidence based, while we continue to build our knowledge of how we can more effectively help the many people who live in families where they are affected by an older adult who has a substance abuse problem.

Author Information:

Jan Ligon, PhD, LCSW is an Associate Professor of Social Work at Georgia State University, Atlanta, GA, USA. E-Mail: jligon@gsu.edu


  • Alcoholism and Drug Abuse Weekly (ADAW, 2006). Public opinion poll shows deep-seated conflict about addiction as a disease, Volume 13 (33), August 21, 2006
  • Briggs, W.P., Magnus, V.A., Lassiter, P., Patterson, A., & Smith, L. (2011). Substance use, misuse, and abuse among older adults: Implications for clinical mental health counselors. Journal of Mental Health Counseling, 33(2), 112–127.
  • Center for Substance Abuse Treatment (2004). Substance abuse treatment and family therapy. Rockville, Maryland, Substance Abuse and Mental Health Services Administration.
  • Copello, A., Templeton, L, Orford, J., & Vellman. (2010) The 5-step method: Principles and practice. Drugs: education, prevention, and policy, 17, 86-99.
  • Cummings, S. Bride, B., and Rawlins-Shaw, A. (2006). Alcohol abuse treatment for older adults: A review of recent empirical research. Journal of Evidence-Based Social Work, 3, 79-99.
  • Curtis, G. C. (1996). The scientific evaluation of new claims. Research on Social Work Practice, 6(1), 117-121.
  • Denning, P. (2010). Harm reduction therapy with families and friends of people with drug problems. Journal of Clinical Psychology in Session, 64(2), 164-174.
  • Dowling S., Weiss, R. B., & Condon, T. P. (2008). Drugs of abuse and the aging brain. Neuropsychopharmacology, 33, 209–218
  • Gruber, K.J., & Taylor, M. F. (2006). A family perspective for substance abuse: Implications from the literature. Journal of Social Work Practice in the Addictions, 6 (1/2), 1-29.
  • Harris, P. (2010). The concerned other: How to change problematic drug and alcohol users through their family members. Lyme Regis, UK: Russell.
  • Ligon, J. (2004). Six “Ss” for families affected by substance abuse: Family skills for survival and change. Journal of Family Psychotherapy (15), 95-99.
  • Ligon, J. (2005). Families and significant others: the silent majority in addiction treatment and recovery. NAADAC News, National Association for Addiction Professionals, 15 (4).
  • Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The Community reinforcement approach: An update of the evidence. Alcohol Research & Health, 33(4), 380-388.
  • Office of National Drug Control Policy (ONDCP, 2011). National drug control budget, FY 2012. Retrieved from: http://www.whitehouse.gov/sites/default/files/ondcp/policy-andresearch/ fy12highlight_exec_sum.pdf
  • Roozen, H. G. de Waart, R., & Petra van der Kroft, P (2010). Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction, 105, 1729–1738
  • SAMHSA: Substance Abuse and Mental Health Services Administration (2010). Office of Applied Studies. . The TEDS report: Sociodemographic characteristics of substance abuse treatment admissions aged 50 or older: 1992 to 2008. Rockville, MD. Retrieved from: http://www.oas.samhsa.gov/2k10/240/240OlderAdm2k10Web.pdf
  • Vernig, P. K. (2011.). Family roles in homes with alcohol-dependent pare

This is an Author's Original Manuscript of an article whose final and definitive form, the Version of Record, has been published in the Journal of Social Work Practice in the Addictions, 13 (223- 226), 2013) ©Taylor & Francis, available online at: www.tandfonline.com, DOI 10.1080/1533256X.2013.784686.

AFINet Member Login

Latest News and Research

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
Prev Next

Technical problems with membership applications

We have just discovered that the AFINet Membership application form has not been working for the l... Read more

Addiction and the Family International Network (AFINet) Webinar Series

AFINet is a free-to-join Network, providing a platform which: brings together researchers, poli... Read more

Notice of Annual General Meeting (AGM)

Notice of Annual General Meeting (AGM)  Preceded by a Webinar about Family Members Affecte... Read more

The 5-Step Method via Zoom

Family Drug Support in New Zealand are using the 5-Step Method remotely, holding videoconferencing... Read more

Medications for Opioid Use Disorder report added to website

A new report (“Medications for Opioid Use Disorder”) has been put onto the website under Country Rep... Read more

Contributions required for the next AFINet newsletter

The next AFINet Newsletter is due to come out at the end of June, and there is a call to all members... Read more

AFINet Newsletter December 2019 (issue 10) published

Welcome to the 10th issue of the AFINet newsletter! As you may recall, we have adjusted the format o... Read more

AFINet-related scientific papers added to website

AFINet Trustee Richard Velleman has added a list of AFINet-related scientific papers published from ... Read more

First AFINet International Conference at The Discovery Museum, in Newcastle, UK, November 2018

    Conference Programme and Pack   AFINET CONFERENCE PROGRAMME   AFINET ABSTRACTS   A... Read more

AFINet member Urvita Bhatia presents Poster and gives Twitter interview

AFINet member Urvita Bhatia presents Poster and gives Twitter interview at the Wellcome Trust / Depa... Read more

AFINet members publish a systematic review of “Psychosocial interventions for addiction-affected families in Low and Middle Income Countries

AFINet members Anil Rane, Urvita Bhatia, Jim Orford, Richard Velleman and Abhijit Nadkarni recently ... Read more

5-Step Method training in New Zealand

Matua Raki (the national addiction workforce development centre in New Zealand) has been working clo... Read more

5-Step Method training in Australia

As part of the ‘Checkmate’ programme (reported elsewhere in this newsletter) , Gill and Richard Vell... Read more

Article supporting our 5 Step intervention in DNN Magazine

Great to see an article in support of our 5-Step intervention for family members in the Feb '17 issu... Read more

Training near London in the 5-Step Method is announced

Save the Date!  On 1st & 2nd November 2016, Richard and Gill Velleman will be running a 2-day tr... Read more

What I’ve been reading this month (July 2016), from Jim Orford

I have just read two articles which come from countries which, as far as I know, have not produced ... Read more

Further findings from the UK bereavement through substance use study published

Another paper from this recently completed 3 year study in the UK, which focuses on a subset of in... Read more

Core findings paper from UK bereavement through substance use study published

A paper outlining the main findings from a recently completed UK study in to bereavement through... Read more

AFINet 1st AGM, Birmingham, UK on Wednesday July 15th 2015

AFINet 1st AGM Birmingham Wednesday July 15th 2015 Winterbourne Gardens, Edgbaston Park Road, B... Read more

Final event of a major 3 year study in to 'bereavement through substance use'

In June 2015 AFINet members, Lorna Templeton and Richard Velleman, attended the final event of a m... Read more

5-Step Method training in Hong Kong & new book with contributions from AFINet members published

Following the delivery by Richard Velleman and Gracemary Leung of a 2-day 5-Step Method training i... Read more

The Parenting Support and Drug Use Study:

The following papers may be of interest to AFINet members. They report findings from a two year lo... Read more

Family members affected by a relative's substance misuse looking for social support: Who are they?

Brazilian AFINet colleagues, Helen Sakiyama et al. have had a paper describing their research in Sao... Read more

Iran’s first research about family members affected by addiction

Iran’s first research about family members affected by addiction has been published! In fact we thin... Read more

Conflict and dilemma in experiences of adult family members caring for a problem-drinking parent.

“How do I tell my children about what my mum's like?” Conflict and dilemma in experiences of adult... Read more

Involving family members in drug treatment: A pilot study of a social network intervention for heroin users in opiate substitution treatment

This multi-site randomised controlled trial aims to test the feasibility of implementing and evalua... Read more

Testing the short questionnaire for family members affected by addiction: help required

The short questionnaire for family members (affected by addiction) – the SQFM(AA) – is starting to ... Read more

First AFINet Newsletter published

This is the first AFINet Newsletter so a big welcome to all AFINet members and to others of you wh... Read more

Results from the first English Family Drug and Alcohol Court (FDAC)

A team at the Centre for Child and Youth Research at Brunel University, London, led by Professor Jud... Read more

A recent article raises interesting questions for AFINet about cultural differences

Although this interesting qualitative study by Maria Fotopoulou, of the School of Social and Politic... Read more

Is a child, harmed by the mother’s drinking during pregnancy, entitled to compensation

Is a child, harmed by the mother’s drinking during pregnancy, entitled to compensation, and what are... Read more

Bereavement through substance misuse

The first phase of this UK 3 year study (funded by the Economic and Social Research Council) has bee... Read more

Supporting young people affected by parental alcohol misuse in Northern Ireland

A major 4 year project is underway in Northern Ireland. Building on previous work (further informati... Read more

2-day Workshop on The 5-Step Method: Supporting Family Members of People with Drug, Alcohol and Gambling Problems

Richard Velleman, a founder AFINet member, is travelling to Hong Kong in April to co-run (with Grace... Read more

When Older Adult Substance Abuse Affects Others: What Helps and What Doesn’t?

Jan Ligon, PhD, LCSW Georgia State University The abuse of alcohol and other drugs in the older adu... Read more

Addiction in context: The influence of families and wider social networks, theory and practice

During November 2013 Alex Copello was invited to give one of the keynote addresses at the Australa... Read more

The Forgotten Carers: Support for adult family members affected by a relative’s drug problems reports

This work builds on the first phase of UK Drug Policy Commission (UKDPC) family research, with a... Read more

Jim Orford speaks about gambling and family members at the Third International Multidisciplinary Symposium

Jim Orford recently made two presentations about gambling and family members at the Third Internat... Read more

Alcohol Focus Scotland | Unrecognised and under-reported

"1 in 3 people report having heavy drinkers in their lives" and "1 in 2 people report being harmed... Read more

Steps to Cope

Two projects have been completed in Northern Ireland with our AFINet partners to develop and evaluat... Read more


If you would like to receive the AFINet newsletter, please complete the required information below:

Technical problems with membership applications

We have just discovered that the AFINet Membership application form has not been working for the last 6 months, due to a technical error. While it has been fixed now, all applications since May have been lost (we had assumed that the lack of applications was due to Covid!).

We are very sorry for this. If you have applied for membership and have not received a response, we would kindly ask you to re-complete and re-submit the form (to be found here: www.afinetwork.info/members/apply-for-membership). If you know of any colleagues or friends who have tried to join AFINet over this period, it would be very helpful if you could forward this information to them, and encourage them to re-apply.

The AFINet Trustees