Diane and Jane are biological sisters who grew up in the same home. Diane is five years older than Jane. When Diane was 16, the sisters' father was prescribed opioids following surgery for a work-related injury. The sisters' mother worked the evening shift as a nurse and was often not home in the evenings. Diane observed her father's increased use of the pain medication and how it impacted him. A few times, she found he had fallen asleep with a cigarette still lit in his hand. She worked to keep Jane from seeing what she saw, and would often help her little sister with homework, make her dinner, and take her out of the house to the library or park. The father's substance use continued to escalate, and when in her senior year of high school, Diane found a used hypodermic needle wrapped up in paper towels in a trashcan when she was taking out the trash. She also observed that her father would rarely be awake when the sisters were home after school. Jane started asking questions about what was wrong with their father, but their mother would reassure the girls that their father was in a lot of physical pain, which made it difficult for him to do things he used to do easily. They began to notice their parents fighting more, and also that their mother had taken on longer and more shifts at the hospital. Diane applied to several top-tier universities and was accepted by an excellent school out of state. In spring of her senior year, she came home to find her father unconscious and not breathing. Diane was able to call 911 and her father was revived with Narcan. At that point she decided that she couldn't go away to college and risk something terrible happening while she is away. As a result, Diane is currently working full-time at the local mall and taking online classes so she can stay at home and continue trying to keep her father safe and her sister as protected as possible from the impact of her father's substance use.

1. In what ways has this father's opioid use disorder impacted the relationships in this family?

2.How might Diane's launching from the household alter these family dynamics? What risks and/or benefits might arise from her choosing to leave the family home?

3.If the father of this family decided to seek treatment, how do you anticipate these family relationships might change?