Parents of adult children with drug addiction dealing with shame and courtesy stigma

Abstract

The study aims to provide insight into the lives of parents to adult children with drug addiction. We focus on how the parents’ social life and interactions were affected by feelings of guilt and shame, and how they dealt with the stigma that often accompanies drug addiction. 32 semi-structured interviews were conducted with parents (age 46–70) of adult children (age 18–47) with drug addiction in Sweden. Three themes emerged (1) Experiences of guilt, shame, and courtesy stigma, (2) Impact on social life and relationships and, (3) Strategies to reduce guilt and shame. Guilt, shame, and courtesy stigma complicated and restricted the parents’ social interactions. Many parents applied a selective openness, carried experiences of alienation and in some cases isolated themselves. At the same time, several parents described that they were open about their child’s addiction in certain contexts. For some parents, this meant a relief from guilt and shame and an opportunity for increased social interaction. Both informal and professional support for family members of individuals with drug addiction is vital to reduce experiences of guilt, shame, and courtesy stigma.

Keywords:

• Alienation
• courtesy stigma
• drug addiction
• parents
• selective openness
• shame

Introduction

Drug addiction leads to consequences not only for the individual but also for those closest to them. Family members of a person with drug addiction often experience negative consequences on family relationships, social life, and mental health (Orford et al., 2010; Richert et al., 2018). The effects on the immediate family can be understood through the concept of family burden. Objective family burden includes the time and energy that the relative spends on health and care efforts and subjective family burden the emotional stress that the family members' situation entails. Family members describe feelings of being confined to the home, being isolated from others, and being responsible for the well-being of the person with drug addiction. These emotional stressors are often expressed in worry, anxiety, shame, and guilt (Sales, 2003; Schene, 1990). A heavy family burden usually affects many aspects of family members life, including social relations, health, working life and economy (Richert et al., 2018).

A child's drug addiction is often seen in relation to upbringing and family conditions (Smith & Estefan, 2014), this can lead to the parents being questioned and blamed by people around them. The stigma that comes with a drug addiction thus affects not only the individual but also their parents (Corrigan et al., 2006; Jackson et al., 2007; McCann & Lubman, 2018). Corrigan et al. (2006) concludes that family members of individuals with a mental health illness or a drug addiction often experienced prejudice and discrimination on the basis that they could be associated with someone marked by a stigma, something Goffman (1963) has defined as courtesy stigma. Courtesy stigma implies that the carrier tries to conceal their associations which are perceived as stigmatizing due to the fear of being discredited, this can impact the persons social life and interactions (Goffman, 1963). Courtesy stigma in combination with parents’ often heavy family burden (Sales, 2003; Schene, 1990) can lead to mental illness (Orford et al., 2010; Richert et al., 2018; Smith & Estefan, 2014), and in some cases even suicidal thoughts (Butler & Bauld, 2005).

Furthermore, research highlights risk factors within the family as important explanations for drug addiction (Dube et al., 2003), these explanations can contribute to a blame culture and consolidation of stigmatizing attitudes (Barker & Hunt, 2004; Devaney, 2017; Jackson et al., 2007; Smith & Estefan, 2014). It becomes a double burden when parents often bear the blame for their children's situation alongside the responsibility to help them recover (Corrigan et al., 2006; Devaney, 2017; Jackson, 2018; Orford et al., 2010). The responsibility of parents for their children's drug addiction is maintained through both societal expectations of caregivers and general beliefs about what it means to be a ‘good’ parent, as the child’s future is often seen as determined by the parents’ parenting ability (Höjer, 2012; Lind et al., 2016). The view that children develop problems as a result of parental shortcomings is often reflected in parents' tendency to blame themselves for their children's problems and situation (Hlungwani et al., 2020; Mafa & Makhubele, 2019; Mathibela & Skhosana, 2021), something that can be seen as a form of self-stigma. Self-stigma is an internalized form of stigma that involves the parent accepting the prejudices of the environment, and often precedes and transcends the public stigma (Corrigan et al., 2006; Lloyd, 2013). The result of this is often a diminished self-esteem and lower quality of life (Corrigan et al., 2015).

Previous studies provide a unanimous picture that parents of children with drug addiction carry feelings of shame and guilt (Butler & Bauld, 2005; McCann & Lubman 2018; Richert et al., 2018; Usher et al., 2007). Many parents choose to keep the child's problems within the family as they are concerned about how others would perceive and react to them (Barnard, 2005; Choate, 2015; Jackson, 2018; Usher et al., 2007), these concerns result in many parents isolating themselves from relatives and friends (Groenewald & Bhana, 2016; Mafa & Makhubele, 2019, 2020; McDonagh et al., 2019). Scheff (1990, 2000, 2003) can help us understand the parents’ withdrawal as he argues that one important motive behind human behavior and actions is the wish to avoid shame. As shame arises in the interaction with others, there is an effort to avoid interaction that can give rise to the feeling—withdrawal can thus be seen as a natural part of the shame reaction. The withdrawal and concealment can lead to a cementation of shame; however, stigma research has also shown that disclosure can reduce shame (Burns, 2021; Corrigan et al., 2015).

McCann and Lubman (2018) highlight how parents of adult children with drug addiction experienced a lack of knowledge and empathy as well as accusing attitudes within their social networks. They were criticized for being too harsh toward their children or accused of setting too few boundaries and thus enabling and reinforcing their children’s problems (Orford et al., 2013), which is in line with the idea of ​​co-dependence (Nordgren et al., 2020). Many parents also testify to being badly treated by professionals when they seek support for themselves or their children (Choate, 2011; Jackson & Mannix, 2003; McCann & Lubman 2018; Richert et al., 2021). The reactions of those around them can lead to the strengthening of the parents' self-blame and self-stigma (Hlungwani et al., 2020; Mafa & Makhubele, 2019; Mathibela & Skhosana, 2021).

The child's unpredictable behavior and often risky lifestyle is another reason why the parents' social interactions decrease. Daily routines, activities and vacations outside the home can be canceled for fear of what might happen if the parents are not available to their child (Orford et al., 2010). Ara Francis', (2012) concept of family trouble sheds light on these sometimes drastic changes in the parents’ life. The family constitutes a unique unit from which everyday life and decisions are made; family members social interaction, identity markers and roles are thus influenced by the relationships within the family. Francis (2012) identified four dimensions of family trouble within her study of parents whose children had various forms of problems, including drug addiction (1) ‘The disruption of routine’, as the child developed a problem, the parents' daily routines and the expected social order were overthrown by them being forced to spend more time on parenting. (2) ‘The disruption of role performances and salient identities’, family trouble could be compared to a domino-like effect as it threatened the identities and self-experiences of the parent. (3) ‘The disruption of relationships’, lack of time, and the experience of courtesy stigma led to social isolation. (4) ‘Inner turmoil’, the intended life the parents had envisioned for themselves and for their child was disrupted which led to a sense of sorrow and otherness.

As shown above, research highlights how parents of children with drug addiction often carry feelings of guilt and shame and that family burden, family trouble, courtesy stigma, and self-stigma can be seen as closely interlinked concepts that can be useful for understanding the parents' experiences. There are relatively few qualitative studies that have examined in depth how guilt and shame affect parents' daily lives and social interactions and measures taken by the parents to reduce these feelings. In this study we focus on how the parents themselves describe their situation and how their lives have changed in relation to the child’s drug addiction. An important goal of the study is to contribute to an in-depth understanding of the stigmatization process many parents of children with drug addiction go through in relation to their informal networks. The overall purpose of the study is to investigate how parents’ feelings of guilt and shame affect their social life and interactions, and how they deal with the courtesy stigma that often comes with having a child with drug addiction. A better understanding of how parents deal with stigma and feelings of shame, and in which situations and encounters these feelings increase and decrease, can be of great help to both professional and non-professional helpers who meet this group.

Methods

The study is based on 32 semi-structured interviews with parents of adult children with drug addiction, conducted in 2016. We used a qualitative approach, viewing interviews as interpersonal interactions where narrative data is produced (Charmaz, 2014; Holstein & Gubrium, 2016). The interview guide was based on seven overarching themes, (a) background information about the parent and the child, (b) the child’s drug addiction and life situation, (c) their explanations for the child’s drug addiction, (d) experiences of threats and violence, (e) perceived consequences for the parent, (f) coping strategies, (g) experiences of help-seeking. The analysis for the current study is mainly based on themes e, f and g. The interviewer sought flexibility, allowing the parent’s responses to lead the interview in different directions. In this way, we got insight into what the parents considered most important and relevant to speak about, which is in line with intensive interviewing (Charmaz, 2014).

Fifteen of the interviews were conducted face-to-face (lasting an average of 87 minutes) and 17 were conducted by telephone (lasting an average of 95 minutes). The interviews were recorded and then transcribed verbatim. We did not notice any differences in data quality between face-to-face and telephone interviews, something previous research comparing different interview methods also show (Sturges & Hanrahan, 2004).

Sampling and Participants

We recruited interviewees for the study through a combination of convenience sampling and purposeful sampling (Morse, 2007). Based on accessibility, we contacted the Parents’ Association against Drugs (Föräldraföreningen mot narkotika, FMN), the largest Swedish organization for family members of persons with drug addiction. FMN is a non-profit organization which provides free advice and support to help families of individuals with drug addiction. Information about the project was disseminated via FMN’s platforms and contact network. A large part of the recruitment of parents took place through this convenience sampling. To achieve a more heterogeneous group of parents, we later used purposeful sampling in the research process. As we experienced that fathers and parents who were not involved in support groups were more difficult to recruit, we focused on these groups during this part of the research process. In our attempt to reach these groups of parents, interviewees were also recruited via the research project’s website, Facebook groups dedicated to drug problems and various treatment activities that included cooperation with family members. As a result of our recruitment fifteen of the interviewed parents were or had been active members of FMN. Three had been involved in other organizations for family members and 14 had not been members of any such organization. However, all interviewees were recruited based on their ability to speak as experts (Morse, 2007) in the field of being the parent of an adult child with drug addiction.

Of the 32 parents, 24 were mothers and eight were fathers. Other studies targeting relatives of people with drug problems have also experienced difficulties in recruiting male family members (Jackson et al., 2007; Orford et al., 2010; Usher et al., 2007). The parents were between 46 and 70 years old. The sample consists of participants from both southern, central and northern Sweden and from urban and rural areas, although a majority of the parents lived in larger cities. Most had completed upper secondary school (28) and had extensive work experience (26); everyone had a stable housing situation. Two of the parents (one woman, one man) stated that they themselves had previously had drug problems, while seven of the mothers stated that the child's father had experienced alcohol problems and one mother reported that the father had used cannabis in a problematic way. The majority of the mothers interviewed were single (14 out of 24) while the majority (six out of eight) of the fathers were in an ongoing relationship with the child's biological mother.

The adult children of the interviewees were between 18 and 47 years old. According to the parents, the children had used drugs between five and twenty years; all had used cannabis and the majority had used several other drugs, including heroin or amphetamines. Twenty of the children were using drug at the time of the interview, eight had been drug-free for a year or more, and three had died because of their drug addiction.

The project on which this article is based was approved by the Regional Ethics Review Board in Lund (application number: 2015/215; 2015/806). To ensure the participants’ confidentiality, they have been given pseudonyms and we have replaced names and places that could lead to the interviewees being identified by others. The two researchers who conducted the interviews both have extensive experience of social work with people in crises or difficult life situations. This meant a readiness to comfort interviewees during the interview and to offer subsequent support for those who so wished.

Analysis

When coding and analyzing the transcribed interviews, we employed key techniques and approaches used in grounded theory (Bryant & Charmaz, 2007; Charmaz, 2014). Grounded theory has an inductive approach, where data forms the basis for generating theory. Although our goal was not to generate new theories, our analysis is in line with grounded theory, namely to stay close to the material and focus on the actions and processes described by the parents, both in individual interviews and in the material in general (Charmaz, 2014).

As the material was extensive (678 transcribed pages), we initially conducted an open coding of the interview transcripts, to make the material more manageable. During this coding, we noticed that the parents' stories were permeated by feelings of shame and guilt over their children's situation. The analysis therefore came to focus on stories about the parents' feelings of shame and guilt and experience of courtesy stigma; this became a central code. Following the open- and central coding procedure a more focused coding was conducted, and direct quotes were coded line-by-line. At this stage, overarching analytical themes emerged based on what the parents emphasized in their narratives (Charmaz, 2014). Interview citations that were representative of the material in general and that provided a clear illustration of the analytical themes were selected and included in the final text. In translating these quotations, special attention has been paid to preserving the content and meaning of the interview subjects’ colloquial use of language.

Results

The results provide insight into how parents of adult children with drug addiction themselves describe their situation, how their lives have changed due to the child's drug addiction, and how they with time have coped in response to these changes. Three main themes and related sub-themes could be distinguished in the material, (1) Experience of guilt, shame, and courtesy stigma; (2) Impact on social life and relationships; (3) Strategies to reduce guilt and shame.

Experience of guilt, shame, and courtesy stigma

As parents of children with drug addiction, they became potential targets for judgment and blame. However, it was not only by their social networks that their ability as parents was being questioned; this was also something that the parents themselves did to a large extent. Against this background, the theme has been divided into two common sub-themes; (1) self-blame and (2) to face negative attitudes.

Self-blame: ‘I felt that I had failed’

Many parents asked themselves the questions ‘why’ and ‘what have I done wrong?’ They talked about a constant self-blame and there was a retrospective reflection on their children's upbringing and their own parenting.

The following quote is representative for many of the parents' feelings and thoughts about their potential role in the child's drug addiction:

I felt that I had failed. I started to blame myself and began to wonder what I had done wrong and what I could have done differently and what I should have done. (Matilda).

The parents gave different explanations for the children's drug addiction. Common to most parents, however, was that they also sought explanations linked to their parenting, even in cases where they themselves felt that the children had had a good and safe childhood.

Yes, we have, we have thought about it a lot, and we also say that to others, but we cannot understand what we did wrong. We believe we have been very kind parents to them, and they have been given what they needed and…/Yes./We have never been, we have never beaten our children ever. Nothing like that at all./No, no./And we do not have any alcohol or drug problems. (Johan).

Although many parents saw themselves as loving and caring, they embraced the general picture of drug addiction as a result of ‘failed’ parenting. However, Johan, emphasized that they were good parents and that the children grew up under favorable conditions, something that can be seen as a way to reduce feelings of guilt and shame and as a way to protect themselves from condemnation from others. It seems important for many parents to show that they had given their children ‘what they needed’, that they did not beat their children, that they did not have drug problems themselves, and that they had an education and good finances. Sometimes, they also brought up the children's siblings who had not developed similar problems. This could be interpreted as a wish to provide a counterpoint to the stereotypical image of ‘problematic families’ that is often presented as a risk factor for children to develop drug addiction, an image that the parents may expect others to have of them.

To face negative attitudes: ‘Throw him out’

Drug addiction is a societal problem that is associated with negative attitudes. It is criminalized and often associated with violence and other crime. The parents experienced that people around them did not understand the situation they were in. Some gave unwelcome advice while others tended to blame them as parents and hold them responsible for the situation their child was in.

Malin felt that drug addiction is more associated with guilt and stigma compared to other problems or diseases:

I think it’s easier to have a child who is mentally handicapped or mentally ill than a drug addict.

Why?

Because many people have a view of drug problems as something self-inflicted, that it is something you can prevent and if you do not seek help, you do not want to stop, and all this. In addition, you are a criminal when you do drugs. You are a criminal just because you have it in your body, you do not have to steal or commit other crimes; it is enough to have drugs in your body. (Malin).

The parents' experiences imply a general view of drug problems as self-inflicted and that it leads to criminal behavior, which increased the rejection of those around them.

Janet, as many of the parents, lost some of her social contacts, and she felt she had to defend her actions when she felt questioned as a parent.

I opted out a lot from my own life. I also abandoned many friends. I did./Well./It's a decision I made. I felt that I didn’t have the energy to defend why I did certain things anymore./…/They couldn’t understand why I did certain things, and they just told me to throw him out, or that you've done enough. So, then I thought that they did not have to stay in my life/…/I can do better without such unwanted advice. (Janet).

Many parents felt they had to defend themselves against the negative attitudes of people in their surroundings who had implied that they had made mistakes and that they as parents were somehow to blame for their children's situation. The parents were often expected or encouraged to ‘put their foot down’, ‘throw out the child’ and ‘close the door’ in order for the child to accept the consequences of their drug use. This shows that the parents were not only blamed in relation to the fact that their child had developed a drug problem, but that they were also seen as responsible for the child's continued drug use, and for their child’s recovery. As could be seen in Janet’s story, this could affect the parents' experiences of guilt and shame and in the long run also their social life and relationships.

Impact on social life and relationships

The parents’ experiences of guilt, shame, and courtesy stigma both in relation to their self-blame and the negative attitudes of those around them led to their relationship with their social networks being affected to a great extent. Many parents expressed an uncertainty about what others thought and felt about them as parents, and a fear of how they would be treated if they were to reveal their children’s problems. This theme is divided into three sub-themes which have been identified in the parents’ stories: (1) selective openness, (2) alienation and (3) social isolation.

Selective openness: ‘You cannot talk about this with just anyone’

When the parents chose to open up to people, it was primarily well-chosen friends and family. Bridget put it this way: ‘You cannot talk about this with just anyone’. Johan said something similar: ‘It doesn't feel like something everyone should know.’ This selective openness was one way the parents' dealt with negative attitudes of others and avoided the risk of further stigma and shame. They only opened up to those closest to them and avoided certain social situations for fear of being asked questions they did not want to answer or of being singled out as a ‘failed’ parent.

Jenny was one of the parents who carefully chose to whom she opened up to, which led her to avoid everyday encounters with other parents in her community.

Did no one know?

No, just our family and my closest friends. But those in the village, I tried to hide it from them, because I was ashamed.

It was a small town?

Yes, a small village and that's where all my children have gone to school. I felt a huge shame, that I was a failure as a parent and… so I totally tried to hide it. But then again maybe the whole village knew about it somehow. I did not dare to meet his old classmates' parents, who might ask, ‘well what is Noah doing?’ and just stand there and… And the other children [her children] were also doing sports, but I could not go to their training because I would also meet other parents there. So, it ended up with my husband having to go to all the training sessions. (Jenny).

Jenny wanted to avoid situations where she might have to talk about her son's drug addiction, and therefore changed her daily routines. Many parents, like Jenny, made active choices in avoiding social situations where they might receive questions about the family or may feel compelled to talk about their children's problems. The parents’ selective openness meant that they many times also had to conceal what they were going through. The concealment and not being comfortable to talk about the situation often led to the feeling of being alone in dealing with the child’s condition and was also something that inhibited many parents in different social contexts.

Alienation: ‘There they are laughing while my son is dying’

Some parents described what can be labeled alienation. In many ways their lives changed, and their social interactions suddenly seemed strange, uncomfortable, and accompanied with emotional distress. In the same way that parents felt that people around them did not understand them, as has been demonstrated in previous themes, this theme addresses the alienation the parents often felt in relation to others, especially other parents. Erika was one of the parents who described this feeling of alienation. She expressed what can be interpreted as a distance to the life and relationships she had had before her son developed a drug addiction.

Has it affected your social life?

Yes, it has because you do not even have the energy to laugh with those people you used to know./No./. You don’t even laugh, and I did not understand…there they are laughing while my son is dying. (Erika).

Matilda was another parent who expressed a sense of alienation in relation to her friends. She found it too difficult to listen to their stories about their children's successes, a reminder of what life could have been like for her and her daughter:

I had such a hard time listening to my friends talk about their daughters as, they have taken driving licenses, they have done so, they have moved together with a boyfriend and life went well, while mine crashed, my daughter’s life crashed (starts crying). (Matilda)

Mehdi talked about how his energy for socializing ran out and that he had a hard time listening to other parents’ experiences:

I could get so annoyed with mothers who talked about such banal things, where I could feel, ‘what the hell, be happy that you have a daughter who lives at home and takes care of herself and has lots of like’… I could even get annoyed at such things, and I was… I could not bear to talk to people anymore, I could not cope, I was so tired of myself that I could not bear to talk to people, I could not bear being social in the same way. (Mehdi).

This sub-theme addresses how some of the parents experienced a feeling of being different and an outsider. Instead of an experience of recognition in everyday worries, there was a feeling of being different from those they met. It was painful to hear other parents talk about their children's success, a contrast to their own situation. It became a reminder of how life could have been, something similar to a sense of loss, grief or inner turmoil. It also became difficult to answer ‘common’ questions such as ‘What is your daughter doing now?’, ‘Should your son move home again, why?’. The intended life the parents had envisioned for themselves was disrupted as their adult children did not live the independent life that the parents had expected. The feeling of alienation, again, often led them to withdraw from social contexts.

Social Isolation: ‘It has become very lonely’

Many parents said that it became difficult to maintain social relationships. The time and effort it took for the parents to deal with their children's situation was energy-consuming and often led the parents to sacrifice their social lives. Another aspect was the parents' negative experiences in the meeting with others, something that led them to become even more selective in their social contacts.

Malin told us how her social relationships had diminished and how she became ‘more or less isolated’ herself.

How has having a child with drug problems affected your life situation?

It has become very lonely. My circle of friends has diminished. There were long periods when I more or less isolated myself. I just worked and did not socialize with people. Much because I did not know how to deal with people's attitudes toward drugs. (Malin).

Malin simply did not know how to handle encounters with other people due to the uncertainty of what they thought about drug problems, this led her to avoid social interaction. People's supposedly negative attitudes meant that her social network of contacts diminished and that she eventually felt lonely. Many other parents told similar stories, they withdrew as a result of protecting themselves from curious questions from neighbors, colleges and acquaintances, questions they simply did not have the strength to answer. This strategy of protection from unpredictable reactions can be seen as a red thread throughout this main theme.

Mehdi experienced guilt and shame in relation to his child's addiction, but it was not only this that affected his social life, his social contacts also gradually withdrew.

It sounds like his situation takes up a lot of energy and thoughts. Is this a reason for this isolation you speak about, that you do not have the strength and time?

Yes, it is a combination of having guilt and shame and being distant from people around me. From the beginning when you ended up with these problems, those around you showed a certain understanding and empathy and so on, but when this drags on you notice that friends and acquaintances and even family one by one fall away and want less and less contact with you. Then you also intuitively feel that…/Yes./Finally you will stand there alone. (Mehdi).

Many parents chose to isolate themselves from social contexts because they bore shame and guilt over their children’s problems but also because of the fear of being questioned by others. In some cases, the parents, like Mehdi, felt that their social networks distanced themselves, and that they therefore felt alone in the situation.

Strategies to reduce guilt and shame

The parents had a long experience (five to twenty years) of being a parent to a child with drug addiction which gave us an indication of how their relation to feelings of guilt and shame had come to change over time. The parents dealt with their guilt, shame, and social relationships in different ways. However, there was a common pattern—many parents, after initially choosing to handle the situation on their own, began to feel a need to confide themselves to someone or to seek support. Just as shame could be a strong motive behind the parents' withdrawal, this main theme shows that the longing for understanding, and belonging could be just as strong. The wish to connect to people made the parents eventually overcome the fear of being exposed or judged and therefore decided to disclose their situation, even if they often carefully chose when and where to do so. This was evident in the sub-themes: (1) the importance of disclosure, and (2) becoming part of a new community.

The importance of disclosure: ‘The more you hide it, the more shameful it becomes’

Several parents spoke about the importance of being open and talking to others about the problems, even though they saw this as frightening and challenging. Talking about the problem could lead to several positive changes. They experienced it as ‘damn liberating’ not having to conceal the problem, and to ‘getting rid of this hypocrisy’. Several parents also described how openness reduced shame, provided an opportunity for help and support and reduced isolation or loneliness.

Eda described how she after a long period of concealing the problem, she chose to open up since she felt alone and in need of help.

Yes, it's difficult, it’s so individual. But I think that if you have the strength and ability, you should try to be open about it. Because the more you hide it, the more shameful it becomes. Just like with mental illness. And then you should try to seek help for your own sake and maybe meet others in a similar situation, so that you do not feel so alone. But then of course it can be hard to be open about it. (Eda).

As the section on selective openness showed, it can be hard to decide to whom to disclose and in what context. In several of the parents’ stories, it became clear that it was important to get support from people in one's central network. However, many parents found it difficult for people who did not live with the problem daily or did not have experiences of being a relative to a person with drug addiction to fully understand them.

April said the following:

My closest friends around here and also friends elsewhere have given me a lot of support and help, I really think so. However, I feel that since they have not experienced these problems themselves it is hard for them to really understand what I want to say, but I feel that I have had support and help. Really. I also feel that from siblings and so on. But they have not really understood either, they have just thought 'yes, but throw him out' or yes 'but he must get into treatment'. They have not really understood what it means, and that it is not that easy. (April).

When she was advised by people close to her to ‘throw out’ her son, she felt that they did not understand and the advice was not helpful. She differentiated between those who had the same experiences as her and those who had not, those who could show sympathy for her situation and those who really understood. Several parents talked about how ‘nice’ it was to talk to people who had similar experiences and how this often facilitated their interaction and reduced their guilt as a parent to a child with problems.

To become part of a new community: ‘There you realized that you were not alone’

As a way of dealing with others' judgmental attitudes, some parents turned to social contexts where they could meet others with similar experiences. This often led to a feeling of being understood, a sense of community and of not being alone in their situation. These contexts could also be interpreted as a safe space where they could be honest in a way they did not feel they could be otherwise.

Many parents turned to the Parents’ Association against Drugs (FMN), the association that organizes the most parents of children with drug addiction in Sweden. Others turned to family groups online, such as Naranon or open Narcotic Anonymous (NA) meetings. The common denominator was that these were associations where they could meet people with their own experiences of drug problems.

Jenny turned to FMN and expressed how the meeting with other parents in a similar situation helped her ‘a lot’ especially in relation to the shame she felt. She also said that she later became involved in helping other parents, something that gave her a sense of belonging and purpose in life.

In this respect, FMN has helped me a lot, just this to meet others. What was nice about FMN was that I could go there and open up to them that this had happened. And everyone there understood what I was feeling here [puts her hand on her heart]. But my friends did not understand what I felt here, so then you had to try to describe it, but it is not possible. It is not possible to understand if you have not experienced it./…/It became a community there and you could say things like ‘now he has done this and this, which is criminal’ but I could still talk about it even if I did not call the police, such things. And this has given me the motivation to try to help others who are in the same situation. (Jenny).

Many parents, like Jenny, expressed the importance of sharing similar experiences; something that led to openness and understanding. Robert talked about how much things changed after he and the child’s mother contacted FMN.

Then you are ashamed, my God, it is shame and guilt, 'what have we done wrong?'. We have blamed ourselves a hell of a lot. Especially before we contacted FMN. There was a lot of shame and guilt. We would hardly go out/…/When we came to FMN, we joined a self-help group. There you saw that you were not alone./…/So, we are not alone in this. Then you listened to others and told your story and they understood exactly what it was like. You get such an understanding of each other. (Robert).

For Robert and the child’s mother, the new community connected to FMN was a turning point and the shame and guilt he felt before subsided along with their experience of no longer being alone.

This sub-theme shows the importance of a sense of belonging and a safe place where you do not feel judged. It also points to another dimension that some parents talked about, being able to help others. For some, FMN or other associations became a new social arena that replaced the social life they had lost.

Communities or associations are often based on a common view or approach to a phenomenon. FMN has traditionally held a view that parents must set strict boundaries, not becoming ‘enablers’ by reducing consequences of the child's addiction. Some local associations have given advice to ‘close the door’ when the child is using drugs, partly as a way to protect themselves as a parent, partly as a way to let the child take the consequences of their drug use. Some parents found this advice difficult to accept and believed that it was directly unhelpful (compare Nordgren et al., 2020). Bridget, who had been in contact with FMN on one occasion, described it as ‘terrible’. She did not think their solution was one she could accept: ‘That they said, 'close the door'. I could not take it then. That was their solution’.

Evy expressed something similar:

Well, I have been active within FMN and think that they have done very good things and so on. But this thing about closing the door, I actually do not believe in. I'm pretty sure Conrad [her son] would have been dead if we had followed that advice. (Evy).

Thus, not everyone who turned to FMN for support had positive experiences, especially when it came to unwelcome advice on how to act toward your child. Some of the parents who expressed dissatisfaction with their dealings with FMN believed that they knew their child best, and they were convinced that FMN's advice would not have been helpful. For these parents, it had been more difficult to find a community where they felt they could be completely honest and accepted. Some, however, said that they turned to other associations online or that they themselves found a friend with similar experiences.

Discussion

The results show how the parents’ feelings of guilt and shame and their experiences as carriers of courtesy stigma complicated and restricted their social interactions. This can be understood against the background of drug addiction as strongly stigmatized, associated with crime, desperation and unpredictability—something that can increase the rejection of drug users and people associated with them (Lloyd, 2013). Parents can in this context be seen as a particularly vulnerable group as there is a well-established idea that the child's development is dependent on the parents' choices and actions, something that is referred to as parental determinism (Lind et al., 2016). Parents of children with drug addiction can therefore become potential targets for judgment and guilt-blaming. Often, the parents experienced being met with negative attitudes or unwanted advice. However, it was not only people in their social surroundings that tended to question the parents' abilities; this was also what the parents themselves did to a large extent as they initially saw the child’s problems as a result of their own shortcomings as parents. They seemed to carry a self-stigma as they internalized the prejudices and guilt-blaming by people in their surroundings (Corrigan et al., 2006; Lloyd, 2013).

The parents were emotionally negatively affected as a direct result of their courtesy stigma. Many parents expressed insecurity about what others thought and felt about them, and a fear of how they would be treated. They acted according to a general feeling of being questioned and of being wrong, they felt ashamed. According to Scheff (1990, 2000, 2003), shame is a central human feeling, which in many cases overrides other emotions and stands in direct relation to social bonds between people. In this context, shame can be interpreted as a significant factor in the parents' behavior and in their social interactions and can thus be seen to maintain and cement the parents' vulnerability.

Most parents were selectively open (McCann & Lubman, 2018); only a few people that they were especially close to gained insight into their child's drug addiction. Some parents preferred, at least initially, to handle the situation on their own. This was because they felt they could not handle other people's negative attitudes, but also because they wanted to avoid the feelings of rejection and shame that could arise in the interaction. Some previous relationships were lost, and the parents' social networks diminished, something Francis (2012) describes as disruption of relationships. Some parents also described how they avoided social contexts as they did not want to be exposed. The parents therefore created a distance in relation to others, something that in many ways dictated their lives—everyday life was adjusted in line with their avoidance of contact with people who did not share their courtesy stigma (Goffman, 1963). The parents' social bonds weakened, and shame made relationships with others unpleasant (Scheff, 2000). This in turn led them to avoid things that they would otherwise do, many parents experienced what Francis (2012) would call a disruption of routines. The parents’ disruption of relationships and routines can also be related to their experience of family burden (Sales, 2003; Schene, 1990). The emotional stressors described above—worry, shame, and social isolation—are all indications of subjective family burden and courtesy stigma can be seen to increase this burden. The objective burden was also very much present, as they spent more time and attention to their child’s situation and needs they tended to have less energy to maintain daily routines and social relationships.

The parents' lives had been largely overturned as a result of their children's drug addiction. Their expectations of how their now adult children would stand on their own two feet had been shattered. It became clear how the parental role was extended through the constantly acute situation that the adult child was in. The parents went through a particular disruptive experience and their roles and self-images previously taken for granted were being questioned, they experienced a disruption of role performances and salient identities (Francis, 2012). The parents' expectations of what a relationship between an adult child and parent would look like were not met. This led to a feeling of difference, an alienation, something that can be interpreted as an inner turmoil (Francis, 2012) but also as a reaction to their courtesy stigma identities. This reaction resulted in a feeling of exclusion, of being separated from their social networks. Meeting parents, who did not share similar experiences, reminded them of how life and the parent-child relationship could have developed differently; a reminder that was associated with grief, which is a feeling many parents of children with drug addiction can recognize in themselves (Oreo & Ozgul, 2007). The concept of family trouble highlights the dominolike effect that the child’s drug addiction has had on many of the parents' lives. As the parents' expectations were overthrown it greatly affected their feelings and actions and consequently several aspects of the parents' social life.

Many parents felt blamed and misunderstood but some parents expressed the importance of daring to talk about the problem, which could lead to several benefits. According to a study on self-stigma in people with mental illness, the disclosure of their stigma identity could lead to prejudices and negative attitudes having a less negative impact on their well-being (Corrigan et al., 2015). To open up about the child’s drug addiction could also amount to a reduction of stigma-related stress and anxiety because less energy was spent on trying to conceal the problem or worrying about being exposed.

However, the process of disclosure is not easy, and parents weigh their need to confide their worries to someone in relation to the risk of being blamed as responsible for their child's situation. This can be seen as a calculus of disclosure, where a careful evaluation of the risks and benefits of disclosing a stigma identity is being made (Black & Miles, 2002). Courtesy stigma can be seen as a manifestation of this uncertainty in the parents' interaction with their surroundings. Their experience of courtesy stigma along with a wish of being understood and connected to people often led the parents to seek out contexts where they could meet people with similar experiences. They talked about how they had been understood in the meeting with parents in a similar situation, and how, the shame often alleviated. By socializing with parents with similar experiences they avoid the anxiety of being exposed (Goffman, 1963) and their social bonds being threatened (Scheff, 1990, 2000, 2003). Relatives' associations can thus be a good context for many parents but with that said, some associations have a clear ideological orientation or principles that are followed, and this may result in some people feeling judged and not welcome, which a significant number of the interviewed parents had experienced.

That the parents turned to people with similar experiences can be seen as a result of their calculation of disclosure. Selective openness and negative attitudes are constantly parameters in this calculation: for whom, in what way and when to tell are questions that clearly appear in the parents' stories. The difficulties of disclosure can be seen not only in relation to the parents' informal network but also in relation to the authorities as they also experience misunderstanding and stigma in the meeting with professional helpers (Richert et al., 2021). Relatives' help-seeking can extend over years as it is a process that usually takes time (McDonagh et al., 2019). That is, the parents’ experiences can be seen through different stages: the uncertainty about the nature of the problem (Liahaugen Flensburg et al., 2022), self-blame, coping alone (McDonagh et al., 2019), ambivalence and resistance about help-seeking, seeking help within the informal social network and finally seeking professional support in coping with their child’s situation (Richert et al., 2021). This prolonged and gradual process of help-seeking was also evident among the parents in our study.

The results shed light on how the disclosure and stigmatization processes are intertwined and change over time. Parents who initially felt shame and guilt over their child’s situation distanced themselves from people in their original informal network. This distance was a result of not feeling understood, with the consequence of becoming alienated. With time this isolation and the need for support and someone to talk to led to them to become more open about their situation. Whether or not being open meant sharing their story with old friends, or reaching out to new ones in support groups, being open led to a sense of relief and a reduction of stigma.

Implications

The result points to the importance of contexts where relatives of individuals with drug addiction can meet people with similar experiences along with the need for increased professional support. Since guilt and shame, in combination with family burden, prevent family members from seeking help for themselves, it is important that professionals who meet people with drug addiction actively explore their relatives' possible need for support and, when possible, include them in the treatment process. Detection and support for parents, in early stages of their children’s drug addiction, could prevent a negative cycle of guilt, shame and isolation, thus reducing many years of suffering. There are today several evidence-based methods for supporting family members of people with drug addiction, these should be used to a greater extent within both social services and health care. These support measures must be based on an inclusive and empathetic approach with the aim of reducing experiences of guilt and shame (Richert et al., 2021).

Acknowledgement

The research project on which this article is based was designed and carried out by Björn Johnson, Bengt Svensson and Torkel Richert. Interviews with the parents were conducted by Svensson and Richert. We are very grateful to the parents who kindly shared their experiences with us.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The research project was funded by Forte, the Swedish Research Council for Health, Working Life and Welfare.