Families affected by mental health challenges and substance use disorders (SUDs) often develop distinct patterns of interaction, communication, and roles to adapt to ongoing stress and dysfunction. Understanding these family dynamics is essential for creating pathways to healing and recovery.

Family Roles in Dysfunctional Systems

When mental illness or addiction permeates a family system, members often unconsciously adopt survival roles to maintain balance and manage chaos.

Sharon Wegscheider-Cruse (1981) was among the first to clearly identify these roles, describing how they emerge to keep the system functioning despite dysfunction:

• The Hero: Often the oldest child, the Hero compensates for the family’s dysfunction by striving for perfection and achievement.
• The Scapegoat: This individual distracts from family problems by acting out, rebelling, or getting into trouble.
• The Lost Child: Quiet and withdrawn, the lost child copes by disappearing emotionally and physically.
• The Mascot: The mascot uses humor and playfulness to relieve family tension.
• The Caretaker (Enabler): Typically a spouse or parent, this role enables the dysfunction by covering for, rescuing, or otherwise mitigating consequences for the individual with mental health or SUD issues.

Claudia Black (1981) expanded upon Wegscheider-Cruse’s work by focusing on children growing up in alcoholic families and highlighting how these roles lead to predictable emotional outcomes such as fear of abandonment, shame, and difficulties with trust.

 Family Rules in Dysfunctional Families

Rules in these systems are often unspoken but rigid. Salvador Minuchin (1974), a pioneer of structural family therapy, emphasized that dysfunctional family rules create closed systems resistant to change.

Common dysfunctional rules include:

• Don’t Talk: Family members avoid discussing the addiction or mental health issues.
• Don’t Trust: Trust is undermined because promises are frequently broken.
• Don’t Feel: Expressing emotions is often discouraged to maintain a false appearance of normalcy.

Jay Haley (1976), an influential figure in strategic family therapy, noted that such rigid rules often mask deeper power struggles and inhibit effective problem-solving and adaptation.

Carl Whitaker (1989) brought a more experiential approach, suggesting that healing involves breaking through these rigid, dysfunctional rules with authentic emotional expression and shared experience.

Robert Subby’s Family Rules

Robert Subby, a leading figure in addiction and family systems, identified additional core “rules” commonly found in dysfunctional families. These were designed to maintain stability, but they perpetuate deeper dysfunction:

• Control: Family members attempt to control everything and everyone to manage chaos and prevent emotional pain.
• Perfection: High, unrealistic standards are maintained; mistakes are seen as catastrophic rather than opportunities for growth.
• Blame: Responsibility is avoided by shifting blame onto others, creating resentment and confusion.
• Denial: Serious problems, especially addiction and mental illness, are minimized, rationalized, or outright denied.
• Unreliability: Promises and commitments are frequently broken, leading to pervasive mistrust.

Subby emphasized that these rigid rules suppress authentic emotional expression, leading to emotional isolation, internalized shame, and intergenerational transmission of dysfunction (Subby, 1987).

Values Within Dysfunctional Families

The values within these families are often distorted adaptations to chronic dysfunction. Janet Woititz (1983) described the Adult Children of Alcoholics phenomenon, where childhood experiences with inconsistent caregivers lead to deeply ingrained maladaptive beliefs, such as:

• Over-responsibility and perfectionism
• Deep-seated fear of failure and abandonment
• Difficulty forming intimate, trusting relationships

John Bradshaw (1988) explored how dysfunctional families instill toxic shame — a pervasive sense of personal defectiveness — that becomes the foundation for identity.

Pia Mellody (1989), expanding on Subby’s and others’ work, highlighted how codependent values emerge in these systems. Values such as self-sufficiency at all costs, loyalty even when it is self-destructive, and achievement equals worth are often emphasized, while emotional authenticity and vulnerability are minimized or punished.

How These Dynamics Sustain Mental Health and SUD Issues

Structural family therapists, such as Salvador Minuchin, argue that these roles, rules, and values serve as homeostatic mechanisms, maintaining the family in a dysfunctional yet stable state. Thus:

• Efforts at individual recovery can destabilize the family, causing unconscious resistance.
• Relapse or sabotage may be embedded in systemic interaction patterns.
• Healing requires not just treating the individual but restructuring the family’s hierarchy and rules.

Jay Haley’s strategic family therapy emphasized interventions designed to disrupt problem-maintaining sequences and force the system to adopt healthier patterns.

Similarly, Carl Whitaker’s experiential approach emphasised that the seemingly crazy or symptomatic behaviors within the family are often the most honest reflections of unspoken pain — and that deep, transformational change requires playful confrontation, emotional authenticity, and shared vulnerability.

Healing: Deconstructing Old Patterns and Creating New Connections

Healing dysfunctional family systems involves consciously dismantling maladaptive roles, rules, and values and replacing them with healthier patterns. Key steps include:

1. Awareness: Identifying and naming the roles, rules, and values that have shaped behavior.
2. Emotional Honesty: Creating a safe environment for open expression of feelings, free from judgment or punishment.
3. Boundary Work: Establishing clear, flexible, and respectful boundaries to replace rigid, controlling, or chaotic relational patterns (Mellody, 1989).
4. System Reorganization: Restructuring family hierarchies to ensure that authority and responsibility are appropriately distributed (Minuchin, 1974).
5. Accountability: Replacing cycles of blame and denial with personal responsibility, empathy, and forgiveness.
6. Building Trust: Repairing broken trust through consistent, reliable behavior over time.
7. Integrating New Values: Shifting from control, perfectionism, and secrecy to values rooted in authenticity, compassion, resilience, and mutual support.
8. Professional Support: Engaging in family therapy, individual therapy, support groups (e.g., Al-Anon, ACA), and psychoeducation to support and sustain relational healing.

True recovery is relational. Healing is not simply the removal of symptoms—it is the creation of a new family culture grounded in emotional connection, healthy autonomy, mutual support, and enduring trust.

Sources:

Woititz, J. G. (1983). Adult Children of Alcoholics. Health Communications, Inc.

Black, C. (1981). It Will Never Happen to Me: Growing Up with Addiction as Youngsters, Adolescents, and Adults. Ballantine Books.

Bradshaw, J. (1988). Healing the Shame That Binds You. Health Communications, Inc.

Haley, J. (1976). Problem-Solving Therapy. Jossey-Bass.

Mellody, P., Miller, A. W., & Miller, J. K. (1989). Facing Codependence: What It Is, Where It Comes from, How It Sabotages Our Lives. HarperOne.

Minuchin, S. (1974). Families and Family Therapy. Harvard University Press.

Subby, R. (1987). Lost in the Shuffle: The Co-Dependent Reality. Health Communications, Inc.

Wegscheider-Cruse, S. (1981). Another Chance: Hope and Health for the Alcoholic Family. Science and Behavior Books.

Whitaker, C. A. (1989). Midnight Musings of a Family Therapist. Norton.