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(p. 97) Treatment and Recovery for the Family 

(p. 97) Treatment and Recovery for the Family
Chapter:
(p. 97) Treatment and Recovery for the Family
Author(s):

Dennis C. Daley

, and Antoine Douaihy

DOI:
10.1093/med-psych/9780190926632.003.0011
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date: 20 January 2021

Treatment for the Family

As you know from previous chapters, SUDs have many negative effects on families, so treatment provides a way to deal with these effects. Treatment professionals can help you and your family influence your loved one with the SUD to get help. These professionals can assist you and others to cope with the problems created by the SUD, which can result in improved mood, feeling more in control of your life, and being less focused on your family member with the SUD.

Treatment can also introduce you to recovery and mutual support programs like Al-Anon or Nar-Anon. These programs provide support that continues after treatment is finished, helping you continue to grow and change.

Residential Family Treatment Programs

Some residential and hospital-based programs for people with addiction offer residential programs for their family members. These programs last for several days to a week or more and involve participation in lectures, discussions, therapy sessions, and mutual support meetings. While you (p. 98) may attend treatment activities with your family member who has the SUD, you may also attend some activities without him.

Some centers provide a family program regardless of whether or not your affected family member is in treatment. Such programs focus on helping you understand your own issues and gain a greater sense of control over your life.

If your family member is in a rehab program, ask her about family services that are provided. If she gives you the runaround, call the treatment program directly, express your concerns, and inquire about services for families.

Family Education and Support Programs

Residential and hospital-based inpatient programs usually offer these options during weekends or evenings. These are less intense than programs where families stay onsite but can be very educational and supportive.

Outpatient Counseling

Programs, clinics, and private counselors may offer individual, group, or family counseling. Counseling focuses on your concerns for yourself, for your loved one with the SUD, and for other family members, including any children. Many studies show that adolescents and adults improve when they participate in family therapy. This doesn’t mean that other treatments can’t help, but family therapy may enhance the outcomes of treatment. These therapies can have an impact on stopping or reducing substance use and helping individuals with am SUD and their spouses to become more stable in their relationships, and children often benefit when parents improve.

You can still benefit from help even if your family member with an SUD refuses to attend sessions with you or to get help for the SUD. Remember to take care of yourself.

(p. 99) Assistance Getting Your Loved One into Treatment

An intervention can be used to encourage a family member with an SUD to get treatment, even if she doesn’t want help. Some programs and private counselors or recovery coaches offer this service. There are several different approaches to these interventions, most of which show good rates of treatment entry for the person with the SUD. (These programs include Community Reinforcement and Family Training [CRAFT], A Relational Intervention Sequence for Engagement [ARISE], brief strategic family therapy, multisystemic family therapy, and behavioral couples therapy.) Family members often feel or function better when an intervention is attempted even if their relative struggling with an SUD refuses to get help.

Recovery of the Family

A system refers to a combination of parts that work together to form the whole. A family is a complex system with many parts, each of which affects the others. For example, when one family member is sick with a medical, psychiatric, or substance problem, other members of the family are affected. They may feel upset, worried, angry, or responsible. Or they may try to pick up the slack and take over the sick member’s responsibilities.

The different parts of a family system are:

  • roles assumed by the individual family members

  • rules or guidelines governing behavior (usually unspoken and unwritten)

  • family relationships and patterns of interacting within the family (e.g., spouse to spouse, spouse to child, child to child)

  • relationships with extended family members (e.g., grandparents, aunts, uncles)

  • communication patterns

  • family rituals

(p. 100) For the overall family, recovery involves changing how the family functions. It not only has to adjust to the sobriety of the recovering member (if this person is in recovery) but also has to make changes to function more effectively as a unit.

Areas the family may need to address include accepting the SUD, stopping behaviors that reinforce substance use, improving communication, shifting family roles, reestablishing boundaries between generations, and building family togetherness. In some families, problems such as violence or abuse must be addressed. Professional treatment may be needed to address these issues and make changes in how the family functions. The change process can continue after treatment in mutual support programs.

Not all families are alike in what need to change. What a family addresses depends on (1) the impact that SUDs has had on the system and (2) what the family wants to change. Some families resist systemic change and think of recovery as relating only to the person with the SUD. This is a natural reaction to SUDs but one that must be challenged. Otherwise, the family may remain focused on the person with addiction and not change how it operates.

In some cases a family member may be in recovery but other members are not interested or not available. Obviously, the entire family system cannot work together to change if some family members have no interest or investment in recovery or are unavailable. In the rest of this chapter, different areas of family recovery are discussed. For family members, recovery involves (1) learning information, (2) overcoming the emotional distress caused by a close relationship with a relative with an SUD, and (3) making personal changes.

What Can Families Do?

There are a number of effective strategies that you can follow to help rebuild your family from the negative effects of SUDs. These include:

  • Accept the substance problem.

  • Don’t cover up the problem.

  • (p. 101) Improve family communication.

  • Reestablish effective family roles.

  • Promote family togetherness.

  • Stop abuse or violence.

  • Seek professional help.

Accept the Substance Problem

The starting point for change in the family system is to acknowledge that an SUD exists and that the family is affected. If family members deny or minimize the SUD or its effects on the family system, changes are not likely to occur. Acceptance requires honesty and a willingness to face the truth about the SUD. The family can discuss the SUD and the details of its impact on the family unit and individual members.

Don’t Cover Up the Problem

Don’t make excuses for your relative with the SUD, don’t shield him from the negative consequences of his substance use, and don’t passively accept it and do nothing about it. These behaviors may be motivated by good intentions as the family does what it thinks is best. However, the outcome is the member with the SUD is less likely to do something about the problem if there are no consequences.

The member may have to face the consequences of substance use. For example:

Jerome’s cocaine addiction got so bad that he lost his business, his truck, his equipment, and every cent he had. To support his addiction, he started to write bad checks and stole blank checks from his father that he forged and cashed. He wrote thousands of dollars’ worth of bad checks. At first, Jerome did a lot of lying and wheeling and dealing to cover his tracks, but things eventually caught up with him. He was arrested and put in jail. Despite Jerome’s long history of addiction and (p. 102) prior criminal record, his parents were going to post bond so he could get out of jail. However, they changed their minds.

Had they posted bail for their son, the message Jerome may have gotten might have been, “Don’t worry about getting in trouble. Mom and dad will bail you out.” Plus, he may have continued to use cocaine since he would have been shielded from negative consequences (going to prison for crimes committed to buy drugs). Interestingly, after being in prison for about a year, Jerome got active in NA. When he left prison, he attended a treatment program and has been drug free for over 10 years.

We believe people with addiction are often put in prison when they could benefit instead from treatment, but the reality is that many people with SUDs will spend time in jails or prisons.

An open discussion among family members can help identify examples of family behaviors that are not helpful in the long run. If you yourself behaved in this way, don’t judge yourself harshly: You did what you thought was needed at the time to help your family member with addiction.

Improve Family Communication Skills

Family members can share reactions and feelings to each other’s behaviors as they relate to the SUD; depending on the family, the member with the SUD can be present during these discussions or not. This sharing should be done without hostility or contempt. The family member who receives the feedback should not be defensive. If, for example, a mother constantly shields her husband from the negative consequences of his drinking, their children can talk about how this affects them and how they feel about it. The mother should listen to her children’s feelings and concerns. If a daughter with an SUD gets most of the time and attention from her parents, the other children in the family should share their reactions and feelings about this.

(p. 103) Open communication can bring the family closer together. It helps members understand each other and establishes the norm that attention should be directed toward all family members. Although it is helpful for the family to openly discuss these issues, by no means should the communication always revolve around the SUD and associated problems. Communication should focus on other experiences, interests, opinions, and ideas of family members. Families should talk about positive experiences and events. They can share accomplishments and the good things they observe or experience themselves. Giving compliments is a helpful strategy to make family members feel good about one another.

Reestablish Effective Family Roles

SUDs cause roles in the family to shift. Family members may take on the responsibilities or roles of the person with the addiction. A child, for example, may end up in a surrogate parent role in which he takes care of brothers and sisters. A child or teen may fall into the trap of becoming a confidant to the parent who does not have an addiction, listening to problems and offering advice and comfort. A parent may assume the roles of both mother and father because the spouse is impaired by the SUD.

Roles that have been assumed by family members may need to change for the family to move toward health. The recovering member may need to reintegrate into the family and assume roles that were avoided or taken over by other members during the active addiction. For example:

When Lonnie got sober, he assumed the roles of responsible husband to his wife and father to his two daughters. He did his share of disciplining and teaching the children rather than letting this fall on his wife’s shoulders as had been the case. Lonnie’s wife, Rhonda, had to shift her role as chief caregiver and stop trying to function as both mother and father. Their oldest daughter, Laurel, had to shift her role as mom’s “best buddy” in which she listened to her mother’s complaints about her father’s drinking. (p. 104)

Lonnie was able to resume his appropriate roles with little difficulty. However, Rhonda had trouble letting go of her need to control the family. She got jealous of Lonnie and felt threatened by the fact that the children began talking to him about their problems. Initially, she felt angry and unappreciated. Fortunately, Rhonda worked through these issues in treatment, and the family is doing well now with members assuming appropriate roles. Boundaries between parents and the children are now maintained, whereas during Lonnie’s active drinking, they had been blurred.

Promote Family Togetherness

One of the benefits of recovery is that the family becomes closer and more cohesive. Family togetherness develops when members communicate openly with each other and share what is going on in their lives. Sharing activities and experiences and attending mutual support programs promotes togetherness.

Developing family routines and rituals also builds family togetherness. Many events, such as birthdays, graduations, and holidays, are ruined by alcohol and drug use. Recovery gives the family an opportunity to reestablish rituals or develop new ones, and enjoy special occasions together.

Stop Abuse or Violence

Emotional, sexual, and physical abuse can be caused or worsened by an SUD. The family should not tolerate any abuse or violence. The effects of exposure to violence on children can be deep and long lasting whether the child is the recipient of violence or an observer. For example, 19-year-old Santiago stated that seeing his mother and sister hurt by his father during drunken rages was more emotionally disturbing to him than the punishments he personally endured when hit by his father.

(p. 105) Similarly, the effects of sexual abuse on children are harmful and can cause emotional damage for a long time. Children need to feel safe in their homes. Abuse has to stop so the child can heal.

Spouses sometimes suffer physical and emotional abuse as well. As a result, they may live in fear and feel victimized by their circumstances. They may feel trapped and not have the psychological or financial resources to stand on their own.

If violence was or is an issue for your family, there should be a plan to follow should abuse or violence occur again. Violence should not be tolerated. When children are in the home, they need to be protected by adults from violence.

Seek Professional Help

Professional help may be needed for the family unit to resolve problems and make changes. This is especially true in cases involving abuse or violence. Any questions or concerns you have can be discussed with a counselor or family therapist. The advice of friends or sponsors in Al-Anon, Nar-Anon, and other support groups can be sought as well.

In the next chapter, recovery of the individual family member is discussed. This will help you focus more on yourself and less on your loved one with an SUD.