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Partners fare better if health services follow legislation

Researcher surprised to find how little it takes to improve the quality of life for people living with substance abusers.

Photo of doctor Bente Birkeland
Bente Birkeland recently defended her doctoral thesis ‘Life situation when your partner has substance use problems: Quality of life and everyday experiences’.

“Several of the people I interviewed had never talked to anyone about their problems living with a substance abusing partner. But in that case, Norwegian health services have failed. If healthcare professionals had complied with the unique legislation we have in Norway, more people would be able to improve their quality of life”, Bente Birkeland says.

She refers to the law stating that health services have an obligation to include the next of kin, also children, when a substance abuser is in treatment.

“Addiction treatment is part of the specialist health services in Norway, which means that the treatment is on the same level as psychiatry and that healthcare professionals should include and involve partner or family members”, Birkeland says.

Bente Birkeland recently defended her doctoral thesis on how the children and the sober partner deal with a partner who has an addiction problem.

She has extensive experience as a therapist and teaching instructor at ARA, the Department for Addiction Treatment in Kristiansand, and has researched the various sides of addiction for several years. She is a social worker and holds a master’s degree in psychosocial work. And now, she is also doctor of health sciences at the University of Agder (UiA), Department for Psychosocial Health.

Services for substance abuse – not mental health care

Her thesis shows that many of the people living with substance abusing partners are under massive pressure and do not receive necessary help. One problem is that many doctors refer the addict’s partner to mental health care, but that may be the wrong solution according to the researcher.

“We have to inform the partner on where to find help. Many are referred to psychiatry, but when the problem is a substance abusing partner, mental health care may not be the right fit. They should be referred to addiction treatment services instead, where they have knowledge about addiction problems and its effect on family members”, Birkeland says.

She also points out that health and social services should include the partner more often when  individuals are in treatment and follow-up.

“When a substance abuser is referred to the specialist health services for substance abuse and is diagnosed with substance addiction, the problem has already been there for a long time. The sober partner and the children have in other words been living in a stressful environment where the substance abuser has dominated the life circumstances of the whole family”, Birkeland says.

Quality of life with relation to addiction

The goal of the doctoral thesis has been to find out what the quality of life and everyday experiences are like for someone who has a partner with substance abuse problems.

“Previous research has focused on psychological perspectives on identity and dysfunctional families. My study focuses on the partner of substance abusers, particularly partners who have children and share parental responsibilities with the addict”, the researcher says.

“The people I have interviewed in my study are not necessarily sick; they are partners of substance abusers. I have examined their life quality using general indicators like physical conditions, psychological situation, social relations, friends, relationship dynamics, having kids with an addict and the perceived quality of life”, Birkeland says.

Every aspect of life affected by the addict

The freshly made doctor used various research methods while working on her thesis, among them surveys and in-depth interviews.

The survey responses mostly matched those of the general population. The researcher thinks this may have been because the partners responded to the survey while their partner was in treatment and the situation was stable.

In the more comprehensive interviews Birkeland conducted, everyday life was described as near-daily conflict with the substance abuser.

“In the conversation with each individual, it emerged that the whole life situation of the sober partner was affected by the addict, also the children were strongly affected by the addiction”, Birkeland says.

She conducted in-depth interviews with ten partners of addicts, six women and four men. It became clear that every aspect of family life was affected by the ups and downs of the addict.

It is especially hard to share parental responsibilities with an addict. It can take a tremendous toll on a sober partner to be in a constant loyalty conflict between the children, substance abuser, school, employer and others.

Loyalty, obligation and dilemma

The sober partner is constantly grappling with questions such as: What do I tell the kids, should the kids spend time with the addict when I am not sure the person is using, should I be present while they are using, should I give pills to the addict for the sake of peace, or should I not?

“The parental role becomes complicated, and people who live with an addict rarely have other adults they can talk to. Families where substance abuse occurs often have to cope with guilt and shame and fear of being considered inferior”, Birkeland says.

Distancing

The best solution for improved quality of life for the sober partner and the children seems to be to distance themselves from the person who is actively using.

“Those who manage to distance themselves from the addict get an easier, more manageable life, either because the person is in treatment, or because the addict and the partner live apart. This is consistent with previous research”, Birkeland says.

She stresses that even after making a final break with the addict, the partners still feel vulnerable for a long time after.

“When they have children together, the unease and the vulnerability will always remain “, Birkeland says.