When someone is addicted to alcohol or drugs, the immediate and systemic negative effects are not just felt by the substance user. Addiction inevitably affects those closest to the substance user and can be equally devastating to the family members and their quality of life. Families, often in uncharted territory, begin the coping process with maladaptive thoughts and strategies. The addicted loved one seeks to manipulate and mold the family into a counterproductive mechanism that provides comfort to the substance user while sowing confusion, anger, and uncertainty within the family.
The process of intervention seeks to help families understand why they have waited as long as they have before trying something different. Substance users are almost never able to manage their addiction on their own. The addiction lives and breathes thanks to enabling, codependency, and comfort. These three conditions are often present, provided (to the surprise of many) by the substance user’s immediate family. Over time, the family relies on these strategies to cope with the situation, and the substance user expects this way of living to continue and feels a sense of entitlement. In due course, the family becomes needed and dependent on helping the substance user, giving the loved one needed comfort at the expense of their own. It is at this point when families become afraid to do anything. They find reasons to do nothing in order to protect themselves from any uncomfortable change. Families formulate more reasons for not attempting an intervention than the substance user will for not entering a treatment program. In the end, it is less difficult to help a substance user accept treatment than it is for a family to let us in and offer it.
Is Addiction a Mental Illness or a Disease?
This question is asked frequently in regards to alcoholism and substance abuse. The American Medical Association and the American Society of Addiction Medicine believe that addiction is a disease. The American Psychiatric Association classifies it in the DSM (Diagnostic Statistical Manual) as a substance use disorder. We do know that while substance abuse can be chronic and progressive, it can also be treated. We also know that when someone is diagnosed with a substance use disorder classified as severe, it does not appear that willpower alone can stop the abuse. The key is to never start, but how does one do that or what do you do if substance abuse is already occurring? In our experience, the most effective methods used are those that involve addressing one’s traumatic thoughts or experiences and then changing behaviors that have led to compulsion and destructive habits, both physical and emotional.
A “Dual Diagnosis” refers to a condition where an individual has been identified as having a substance use disorder, coupled with one or more mental health disorders. The substance use disorder is classified as mild, moderate, or severe based on certain criteria. In cases of a dual diagnosis, the mental health disorder could have been present before the substance abuse or caused by the use of drugs and alcohol. Regardless of whether the substances are the direct cause of the mental health issues, when someone is addicted to alcohol or drugs, he or she is not behaving in a normal mental state. Therefore, it is always important to take into account an addict’s mental health in the treatment and recovery process. A drug and alcohol assessment is often completed with the family of a substance user prior to a drug and alcohol intervention. This allows the family and the interventionist to consider the mental health needs of the substance user and to assist in preparing an addiction recovery plan that addresses those needs.
Effective Treatment and Therapy Plans
When a pattern of alcohol use or drug abuse is recognized in a family member, it should be the impetus to consider a professional intervention for addiction and follow-up treatment. The sooner the problem is addressed, the greater the opportunity for a successful outcome. Here are some options that have been successful in the treatment of addiction for both substance users and families.
Interventions and therapy are just as much for the family as they are for the substance user. Behavioral Couples Therapy (BCT), similar to family therapy, suggests that when the spouse of a substance user is involved in the treatment plan, positive results are achieved more often than when there is no involvement. When families are involved in the recovery process and undertake their own family therapy program, they too can help themselves and their loved one’s treatment team. The healthier a family becomes, the greater the ability to set boundaries and hold the substance user accountable for behavior and actions. Family therapy and involvement can also allow the family to provide more accurate information to the substance user’s treatment team. The substance user will almost always see the situation differently from the family. It is also not uncommon for the substance user to omit information and not be completely forthright with what has happened back home. Treatment and discharge plans often exclude the family’s considerations. Families not in therapy may be unable to provide healthy insights, or they may provide information based on unhealthy, codependent, and/or enabling behaviors. Conversely, families engaged in therapy are far more likely to improve the outcome for the substance user while families not engaged in family therapy are far more likely to hinder it.
Families can ask themselves this question at any time: Is what we are doing making it more or less difficult for our loved one to seek or stay in treatment? Families can also ask: Is what we’re doing benefiting him or her or is it benefiting us? When a family is not engaged in therapy, it is not uncommon to see unhealthy behaviors continue that may compromise the substance user’s ability to get better. We encourage families to be open to family therapy before, during, and after the substance user’s rehabilitation program. The healthier the family and home environment, the greater the opportunity for positive growth and change.
Alcoholics Anonymous (AA):
Alcoholics Anonymous is considered an effective, evidence-based treatment and is often recommended as part of an overall treatment plan. As one of the most famous institutions and methodologies for treating alcohol use disorder, AA guides people through the 12-step program to encourage self-awareness of unhealthy behaviors and to engage in behavioral modification. When integrated with cognitive behavioral therapy, family therapy, alcohol abuse intervention, and a strong support system, it can be very effective. Regardless of the substance of choice, AA has produced many successful outcomes. When family therapy and support are added, the likelihood of a successful positive outcome for both the family and substance user is increased.
Although not the same, imagine that Al-Anon is to families of alcoholics what Alcoholics Anonymous is to an alcoholic. Al-Anon suggests a method of detachment and holds that family members are unable to cure or control the alcoholic and are not the cause of the alcoholism. What families do have control over is themselves. Families are free to either take care of themselves and learn how to cope effectively with an alcoholic loved one or to continue enabling the alcoholic’s destructive behavior with maladaptive coping strategies.
As part of our Family Recovery Coaching at Family First Intervention, families are encouraged to explore and engage in Al-Anon as well as seek an Al-Anon sponsor. We have found that families who go to Al-Anon and work the 12 steps with a sponsor do much better than families who do not.
Families are unable to be both objective professionals and family members simultaneously. The chaos and drama of the addiction and its effect on the family system make it impossible for the family to formulate effective strategies in their emotionally-flooded state. A family approaching their loved one without a professional is akin to your loved undertaking self-treatment. Intervention specialists are able to help families and substance users on their respective paths to recovery.
A big difference exists between a Professional Interventionist and a passionate person in recovery providing paid 12-step services. Intervention Specialists are trained and have certifications, carry professional liability insurance, and maintain an office and support staff. Intervention Specialists should also have a team of people to help with all aspects of the intervention process, including family guidance. A treatment center offering free services over the phone, however, or sending an admissions person to your home for free or at minimal cost does not constitute the role of a professional intervention specialist. An Intervention is not about the speech given to substance users in an attempt to get them into treatment. It is a strategic process that involves many moving parts, including consultation, effective and possibly ineffective family member involvement, determining the level of care, family education, transportation, ongoing family recovery coaching, and being available to the family when problems arise throughout the substance user’s treatment journey.
Many therapies and interventions are effective, especially when a professional facilitates the strategies. Intervention Specialists who involve the family and help them understand the need for change rather than merely telling the family to stop enabling can significantly increase the likelihood of a successful outcome.
Whether or not a substance user enters into a treatment program after the intervention, it is strongly encouraged that the family starts its own recovery efforts. All family members who are affected, such as parents, children, siblings, grandparents, extended family, and partners, can benefit from family support through all the stages of the substance user’s recovery. From a clinical perspective, the stages of change can be affected by the family, and they play a significant role in whether the substance user agrees to seek help and then continues receiving it. The intervention process helps families and substance users move through the stages of change. These stages are:
- Pre-contemplation: In this stage, there is no overt intent to change damaging behaviors on the part of the substance user as he or she does not see or believe there is a problem to address. Although it is rare to see a substance user in this stage, a family’s denial of a problem or inaction on its part could keep the substance user from seeing either the need for change or the presence of a problem.
- Contemplation: The substance user is aware there is a problem, is looking at the situation, and is considering change. The consideration to do something different comes from the loved one weighing the pros and cons of substance use versus entering treatment. During this stage, the substance user is strongly influenced by the family’s codependency and enabling—or lack thereof. Families may not be able to force substance users to see the benefits of recovery, but they can help them see the devastation caused by the addiction by setting boundaries and holding them accountable for their actions. Interventions are strongly influential in this stage of change.
- Preparation: The substance user has made an assessment that doing something different is a better option, and preparations for treatment begin. This is where we lose most families. The substance user starts the negotiations in the preparation phase and fills families with hope that is often nothing more than promises in exchange for the family doing something the loved one wants. For a family to help the substance user move into the action phase, boundaries need to be maintained. Substance users aren’t in treatment until they are in treatment. And how many times have you heard the “would’ve, could’ve, should’ves” from them? Stop watching their lips, and start watching their feet. The time has come to take action, which is the next phase.
- Action: The substance user has started to make behavioral modifications and puts the treatment plan into action. Where families fail at this stage is believing the nightmare is over because the substance user appears to be on track. The early recovery is no time to let down one’s guard. In our experience, this is the time when substance users can be the most manipulative. They are abstinent, they look better, speak well, but they are still not where they need to be. We encourage families to expect at least 2 years of sustained sobriety and behavior modification. Even then, family members should not let their guard down but rather remain vigilant in their own recovery. Knowing behavioral relapse warning signs for the substance user is an important factor at this stage as well as the maintenance/growth stage.
- Maintenance/Growth: During this stage, the substance user is doing well and the family is feeling a sense of normalcy. While we never want a family to live in fear, to be pessimistic, or to wait for the other shoe to drop, relapse can happen. The most effective course of action is for the family to continue on in its own recovery and let the substance user live his or her life. Should the substance user start to display behavioral shifts back to old ways, the family is allowed to say something before the behavioral relapse reverts back to substance use.
Each of these stages has unique difficulties as well as moments of significant growth. The more family members engage in their own recovery, the greater the chance of success for both the family and the substance user.
At Family First Intervention, we believe that recovery is a lifelong process. It requires the support of friends, family members, and professionals. We implement rehabilitation and intervention plans that are unique to each person we treat, and we’re proud to have helped countless families and substance users turn their lives around. It is often stated that the substance user has to want help or hit bottom in order for things to improve. Could the same also apply to the family? The question is: Within this environment, what is the family doing or not doing that may be preventing either of these things from happening?
If you would like to learn more about our intervention process and pursue a change for you and your family, please contact one of our intervention specialists today – we’re here to help.