Along with brain changes, the cycle of family dysfunctions that presents with addiction generationally repeats if patterns are not broken. Recognizing and identifying these patterns are needed for whole-person care.
Understanding the intergenerational transmission of substance use in terms of genetics, epigenetics, and behavior is often overlooked in treatment. Today, renewed interest in intergenerational transmission has emerged in the areas of substance use and trauma. In this context, intergenerational transmission refers to the complex interaction of environmental variables and family legacies.
My training as a family therapist included the study of intergenerational family treatments, which provide a way to think systemically over the generations. This field emphasizes the importance of family of origin and early life experiences to fully understand an individual, couple, or family system regardless of the presenting problem. Bowen’s Family Systems, Boszormenyi-Nagy’s Contextual Therapy, Framo’s Intergenerational Family Therapy, and Scharff and Scharff’s Object Relations Therapy are theoretical models used to explain the intergenerational transmission of behavior. As a result of this training, my client intake includes a three-generational genogram tracing the transmission of various problem behaviors through the generations.
Since substance use crosses generational lines,1 knowing the risks and protective factors informs effective treatment. Numerous factors impact intergenerational transmission. The following are a few of those factors that transmit along generational lines.
Genetics
Genetics influence the development of substance use disorders (SUDs). While heritability percentages for SUD vary, approximately 50% of the risk is considered genetically influenced.2 Genes contribute to vulnerability due to the way genetic mutations alter the structure and function of the brain.
To further investigate genetic contribution to SUD, genome-wide association studies (GWAS) have increased in recent years.3 These studies look for markers across the complete sets of DNA or genome associated with diseases. However, these studies have yet to produce a genetic prediction of SUDs due to the influence of environmental factors. Additionally, most of these studies are conducted primarily with European ancestry samples, which limits their predictive utility.
Another area of research interest is molecular genetic studies aiming to understand better molecular mechanisms and biological pathways underlying SUD. These advances hope to be used in the pharmacogenetics field to inform precision medicine interventions for SUD treatment. Currently, these studies have yielded limited success but may have future potential in substance use treatment.4
Epigenetics
Susceptibility to addiction is believed to have an underlying DNA epigenetic basis. Epigenetics is the study of how genes can be altered by external factors that turn them “on or off,” affecting how cells read genetic material. Certain factors, such as lifestyle/experience, cell type, development/aging, and sex, can trigger changes in gene expression and brain structures. More evidence supports these factors as highly associated with DNA modifications.5 Other factors, such as poverty, trauma, inadequate parenting, mental and physical health, and social systems, also play a role in addiction development.
Family Relationships, Attachment, Parenting, and Stress
Family relationships strongly influence a child’s development, perceptions, emotional regulation, and behavior. Children who grow up in families with a parent who uses substances are at higher risk for addiction due to genetic and environmental factors. For example, a child with a first-degree relative with addiction is four to eight times more likely to develop an addiction.6 Early exposure to addictive substances and shared family beliefs about substances help shape children toward addiction.
Attachment is impacted by parents who misuse substances. Healthy early attachment is marked by security and identity. Object relations theorists, such as London pediatrician, Donald Winnicott, posited that when the mother is alcohol dependent, for example, there is a failure of the maternal introject, which can lead to fulfilling the felt abandonment through substance use. In general, attachment-oriented research findings indicate insecure attachment can develop through substance use and lead to a host of negative behaviors, including self-medicating.7
A potential pathway to the intergenerational transmission of substance use and misuse is the parenting styles of individuals with substance use disorder. Positive interactions and engagement may diminish. Discipline skills and the monitoring of children can be problematic. When parents feel their discipline is slipping, they often resort to harsh punishment and coercive control8 and do not facilitate the child in learning inhibitory control. Additionally, substance misuse impairs executive functioning in the brain and creates problems with self-regulation and impulsivity in parents, disadvantaging them and their ability to teach regulation skills to their children. Deficits in inhibitory control are a potential pathway for intergenerational transmission and are known to be problematic for those with substance use.9
In families with addiction, stress is heightened. One response to that stress is to self-medicate with substances, a behavior repeatedly modeled and influenced by a lack of appropriate parental support.10 Moreover, living daily with someone who misuses substances is often unpredictable and can be accompanied by parental mood swings. Children may also be exposed to trauma and abuse in a stressed and unstable environment. Both are more prevalent in homes with substance misuse.11
Spiritually, intergenerational transmission is seen in patterns of behavior passed on through the generations due to original sin. Scripture tells us we have all sinned and fallen short of the glory of God (Romans 3:23). However, when those sin patterns are identified, we are not bound by them, given the work of the Holy Spirit who lives in us. In Christ, there is freedom. Chains are broken, and we are set free. No one is trapped in sin when repentance is sought. Galatians 3:13 affirms that Christ paid the price and covers all curses. Thus, spiritual help is needed to break intergenerational transmission.
In summary, intergenerational transmission of substance use should not be overlooked in assessing and treating clients. A systemic perspective is needed. Intergenerational transmission can be stopped by treating the body, mind, and spirit.
Linda Mintle, Ph.D., received her doctoral degree from Old Dominion University in Urban Health Services and Clinical Psychology. She has a master’s degree in Social Work and a Bachelor of Arts degree in Psychology and Communication, both from Western Michigan University. Linda is the author of 20 books; her latest, Living beyond Pain, co-authored with physician, Dr. James Kribs, brings hope to chronic pain sufferers.
Endnotes
1 Yap, M.B.H., Cheong, T.W.K., Zaravinos-Tsakos, F., Lubman, D.I., & Jorm, A.F. (2017). Modifiable parenting factors associated with adolescent alcohol misuse: A systematic review and meta-analysis of longitudinal studies. Addiction, 112(7):1142-1162. doi: 10.1111/add.13785. Epub 2017 Mar 20. PMID: 28178373.
2 Prom-Wormley, E.C., Ebejer, J., Dick, D.M., & Bowers, M.S. (2017). The genetic epidemiology of substance use disorder: A review. Drug and Alcohol Dependence, 180:241-259. doi: 10.1016/j.drugalcdep.2017.06.040. Epub 2017 Aug 1. PMID: 28938182; PMCID: PMC5911369.
3 Johnson, E.C., Chang, Y., & Agrawal, A. (2020). An update on the role of common genetic variation underlying substance use disorders. Current Genetic Medicine Reports, 8(2):35-46. doi: 10.1007/s40142-020-00184-w. Epub 2020 Mar 17. PMID: 33457110; PMCID: PMC7810203.
4 Patriquin, M.A., Bauer, I.E., Soares, J.C., Graham, D.P., & Nielsen, D.A. (2015). Addiction pharmacogenetics: A systematic review of the genetic variation of the dopaminergic system. Psychiatric Genetics, 25(5):181-93. doi: 10.1097/YPG.0000000000000095. PMID: 26146874; PMCID: PMC4549168.
5 Kaplan, G., Xu, H., Abreu, K., & Feng, J. (2022). DNA epigenetics in addiction susceptibility. Frontiers in Genetics, 13:806685. doi: 10.3389/fgene.2022.806685. PMID: 35145550; PMCID: PMC8821887.
6 McGue, M., Irons, D., & Iacono, W.G. (2014). The adolescent origins of substance use disorders: A behavioral genetic perspective. Nebraska Symposium on Motivation, 61:31-50. doi: 10.1007/978-1-4939-0653-6_3. PMID: 25306778; PMCID: PMC4659492.
7 Schindler, A. (2019). Attachment and substance use disorders-theoretical models, empirical evidence, and implications for treatment. Frontiers in Psychiatry, 10:727. doi: 10.3389/fpsyt.2019.00727. PMID: 31681039; PMCID: PMC6803532.
8 Fals-Stewart, W., Kelley, M.L., Fincham, F.D., Golden, J., & Logsdon, T. (2004). Emotional and behavioral problems of children living with drug-abusing fathers: Comparisons with children living with alcohol-abusing and non-substance-abusing fathers. Journal of Family Psychology, 18(2):319-30. doi: 10.1037/0893.
9 Pears, K., Capaldi, D.M., & Owen, L.D. (2007). Substance use risk across three generations: The roles of parent discipline practices and inhibitory control. Psychology of Addictive Behaviors, 21(3):373-86. doi: 10.1037/0893-164X.21.3.373. PMID: 17874888; PMCID: PMC1988842.
10 Lieberman, D.Z. (2000). Children of alcoholics: An update. Current Opinion in Pediatrics, 12(4):336-40. doi: 10.1097/00008480-200008000-00009. PMID: 10943813.
11 Harter, S.L., & Taylor, T.L. (2000). Parental alcoholism, child abuse, and adult adjustment. Journal of Substance Abuse Treatment, 11(1):31-44. doi: 10.1016/s0899-3289(99)00018-8. PMID: 10756512.