Families and substance users spend countless hours sifting through treatment center websites trying to determine what they have to offer. Many centers claim to have the best drug addiction treatment methods and programs, and the best success rates. We’re here to let you in on a little secret; they are all doing the same thing. Sure, some of them have nicer amenities, better food, and myriad activities. At their core, in order to receive funding from their financial providers, they have to offer evidence-based care if they want to be reimbursed. If there is not a code for the treatment being provided that is recognized by the insurance carrier or funding source, then they aren’t doing it. And for those centers that offer effective treatment but aren’t classified as evidence-based, the patient may be responsible financially if the treatment has not been proven as an effective method in the eyes of the insurance company or funding source.
One of the primary reasons for this is the disease model of addiction. The model, developed by Dr. E.M. Jellinek in 1960, set forth a classification of people said to have a disease. Called the Gamma group in this classification, they are said to experience a loss of control which is what is believed to separate this class of individuals from others in the study. In his research, Jellinek used only Caucasian males and excluded women, other races, and differences in cultural beliefs. Somehow, this model and theory are still employed today in treatment, and the model is the only one recognized by the American Medical Association (AMA). This is why so many treatment centers use similar programming. Like the Jellinek approach, these treatment centers follow a one size fits all treatment. The insurance companies and funding sources of state-run facilities recognize this as a viable model and therefore only reimburse those who accept and adhere to the theory. So, remember this when you or a loved one is in treatment: the professionals are not dictating your care. Dr. Jellinek’s theory and the insurance companies are.
With all that being said, treatment can be extremely effective for the masses. Utilizing modern-day, evidence-based treatment applications such as Cognitive Behavioral Therapy, Behavioral Couples Counseling, and 12-step facilitation has produced many success stories. Of the evidence-based treatment, Behavioral Couples Therapy is very similar to an effective intervention strategy. Any time a significant other or the family is involved and helps the substance user enter treatment, it increases the likelihood the substance user will stay in treatment and excel.
All the data confirms that nothing produces better and more effective results than the counselor/client relationship. Regardless of the treatment center and regardless of the application, if the substance user does not connect with the treatment team, the ability to improve is greatly reduced. Studies show that a counselor who is respected can get farther with a client using the wrong treatment than a counselor who is not respected but is using the appropriate treatment. This is not something an admissions person at a treatment center will admit. This frank assessment can only come from people who get to know the substance user and the treatment centers and their personnel. Such knowledge and insight may not always get it right, but it is certainly better than picking a random center based on things that are less relevant.
Families considering doing interventions should trust the professionals in their assessments when determining the level of care and treatment application. We have found that families, with misplaced emotions, family history, anger, fear, guilt, shame, codependency, and biases, subconsciously look for treatment plans with themselves in mind rather than the substance user. There remains, at times, an overwhelming desire to protect the feelings of the substance user, even this far into the process. We ask that families surrender to unbiased professional guidance just as the loved one is expected to do at the intervention and subsequently at the treatment center.
Environment is one of the surest predictors of outcome in addiction treatment. When we think of the environment in addiction treatment, we think of the comfort level and the ability of the substance user to see the need to address a problem. A family that provides an environment that lacks accountability and boundaries disables the substance user from seeing the need for change. Whether the environment is made more comfortable for the substance user directly or not, there is always something a family can do differently to encourage and start the process of change for the loved one.
Working with professionals who can view the problem from a fresh perspective that is not emotionally biased can be extremely helpful. Regardless of the substance user’s decision to change or not, a family can benefit from entering their own recovery by way of intervention, family therapy, and support groups.
Different forms of therapy involve the family, and some work far better than others. Here are options that are effective and several that are less so:
Interventions are initiated by families with a goal of making healthy changes that positively impact the substance user. Interventions are effective strategies that help family members understand addiction and their role in the family dynamic; this has a significant impact on whether the substance user considers seeking help. Interventions help substance users move from the contemplation stage of change into the preparation, action, and maintenance stages of change. By altering the environment that prevents change, families allow the substance user to see the impact of the addiction on themselves and those around them.
Contingency Management Therapy (CMT)
This is a type of behavioral therapy that utilizes positive reinforcement or rewards for certain types of positive behaviors and actions. It has been used to treat disorders, including alcohol use, cocaine use, and opiate use. The rewards consist of vouchers, monetary rewards, or whatever system that family members and the therapist prescribe to the loved one. Many families have tried this on their own, and in our experience, they achieve about the same results as when done in a clinical setting.
The problem with CMT, a classical conditioning theory, is that it pairs desired behavior with a reward, often something of value that can be converted to cash. We all know about Pavlov’s conditioning theory where a dog learns that when the bell rings, it’s mealtime, and the dog starts to salivate. But what happens if the bell rings but there’s no food? What happens if the reward system ends? CMT may be good in practice but only if the reward system continues indefinitely. In our experience, this system fails utterly as a treatment for addiction. Most of the time, when substance or alcohol users are provided external stimuli, they proceed to build their addiction recovery around external stimuli and external validation. Contingent Management Theory is insufficient in that it does not fix the internal problems; it only puts a band-aid on the overall problem. CMT provides a reward system that does not address and change destructive behaviors and the reasons for them. Recovery, in our experience, is an inside job.
The following anecdote makes the point best of all. A class was being held on the West Side of Chicago regarding HIV and the use of needles. Clients were given a monetary reward for each day they attended as well as a separate reward for attending all the classes. While on break, every one of the participants admitted to spending the earned reward money to purchase heroin down the street after class. The program was viewed as a success because people learned about the proper use of needles and the risk of HIV. Was it a success that they purchased heroin after class with the reward money? Did they continue to practice proper needle use protocol to avoid HIV as a result of the class? Or did they just come for the reward? One thing is certain; they did not change their behavior in regards to drug use, and they still used needles.
Group Family Therapy
Group family therapy helps families address internal conflict. Most conflicts are rooted in the roles each family member adopts trying to balance out the family system all the while coping with the turmoil caused by the substance use. Counseling that utilizes cognitive behavioral therapy, peer support groups, or multisystemic therapy can be helpful in bringing families back together. Addiction is not a victimless crime, and it affects the family as much, if not more, than the substance user.
Substance Abuse Treatment
In addition to the family therapy components of recovery, individual therapies for an addict or an alcoholic are part of the treatment plan. “Substance Abuse Treatment” can be used as the umbrella term to describe different therapies and treatments that aid in the recovery from substance abuse. The typical levels of treatment for a substance user are detoxification, residential (RTC), partial hospitalization (PHP), intensive outpatient (IOP), and outpatient (OP). Once discharged from treatment, options such as sober living, self-help groups, and individual counseling are encouraged. Many substance users will remain in some form of substance abuse treatment for the remainder of their lives. The substance abuse treatment is as important as the family therapy which seeks to address the underlying environment and relationships that could prevent effective substance abuse treatment.
Each method of substance abuse treatment can utilize a variety of tenets, modalities, therapies, or processes which can also carry over to other phases of treatment. These include but are not limited to:
- Cognitive-Behavioral Coping Skills Therapy: focuses on changing one’s thinking on problems such as poor self-esteem or image issues. The aim is to correct repetitive destructive behaviors.
- Motivational Enhancement Therapy: helps clients become aware of personal strengths and ways to utilize them in order to facilitate their pathway to recovery.
- Twelve-Step Facilitation Therapy: embodies the tenets of AA and NA and is applied to help patients create structure, have sponsorship, live amongst a supportive community, and achieve long-term goals with the understanding that recovery is a lifelong journey.
While the person in recovery can choose which therapy or therapies they most prefer, the addiction treatment specialists have a duty to introduce the addict or the alcoholic to the full menu of available therapies and help them understand how they can assist the recovery. At the same time, the interventionist, addiction specialists, and clinical specialists can assist with suggestions and provide input on the available curriculum of therapies that may be most beneficial for the substance user’s family.
Although the person in recovery and the family are able to voice what they would like to do, we have found that in early recovery, both substance users and family members may not be in the best position to know what is best for them. Substance users often make decisions based on shortcut thinking to avoid discomfort, and families often make decisions to protect the substance user’s feelings. Substance users are often not yet in a place of healthy thinking, and many families are still cycling through heightened emotions. Surrendering to professionals in the early stages of addiction has been shown to be a helpful course of action.
After rehabilitation, a person with a substance or alcohol use disorder will benefit greatly from a relapse prevention plan that addresses overcoming urges, triggers, and new challenges in recovery, especially those that seem to appear without warning. A relapse prevention plan is not a simple do-and-don’t index card. The most effective relapse prevention plans focus on behavioral change, asking for help from others, and developing a different perspective.
Relapse Prevention and the teaching of relapse prevention techniques should be a part of every phase of treatment for drug addiction and alcoholism. During detox, an individual is educated on what detox is, what is happening and why, as well as what to expect from the next phases of treatment. Even at this point when the substance user isn’t feeling good and probably is not interested in much more than getting through the detox, the seeds of continued sobriety and relapse prevention have already been planted.
One of the chief concerns of families of recovering drug addicts and alcoholics is whether or not the treatment will work. It is a helpful reminder to families that addiction is not overcome simply because they have detoxed or completed a treatment program. Continuing sobriety is far easier in than outside of treatment. Families and substance users who work closely with interventionists and addiction specialists can put together long-term plans for addiction recovery that include relapse prevention and lifelong sobriety. These should be standard goals of every facet of the drug addiction treatment process. Treatment is really an effort to create long-term stabilization and is where the substance user starts to build a long-term plan. To say the treatment center didn’t work— period— may not be accurate. There are many moving parts during treatment and far more moving parts to consider after treatment.
Family boundaries and family recovery have a significant impact on relapse prevention and follow through. Almost every family that says the treatment did not work failed to work on themselves. The recurring theme we hear is: the loved one left treatment and returned home, often with family assistance. In other words, he or she returned to the same environment. A family holding their loved one accountable and notifying his or her treatment team of the family’s boundaries is crucial to strengthening relapse prevention efforts. The substance user instinctively would like to revert to the way things were. A family has a lot of power in determining whether that is going to happen.
At Family First Intervention, we understand that substance abuse doesn’t affect just the individual with an addiction. We also understand the power and influence a family has; they just need to be shown how to utilize it effectively. Family members are put through turmoil, and they are an equally important part of the overall family system affected by the substance user. Families who address the effects of substance abuse on themselves and change as a result significantly increase the opportunities for the substance user to improve as well.
We have been providing intervention services since 2005 and constantly work to improve our strategies and curriculum. Our goal is to bring the most effective drug addiction treatment methods to families and to provide closure to every family, knowing they did everything they could to help the substance user and themselves.