Family Involvement in SUD Treatment: More than Just Al-Anon
To date, many treatments that focus on substance abuse, addictions, and other behavioral problems center around the “user” themselves.
Treatment providers have tried to engage and involve family systems in the substance abuse counseling process. But, major deficits remain. In fact, many treatment facilities advertise their programs as having a strong, family clinical component. Yet, they often disappoint. I wonder how many of the 14,000+ specialized drug treatment facilities in the US actually focus on targeting and supporting the family in an effective way.
Why Involve the Family in Substance Abuse Counseling?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), treatment outcomes improve when the focus of substance use disorders (SUD) treatment broadens from an individual to a family perspective. With a condition that often has life and death implications, it is very important that this occurs. This article will describe some of the specific reasons to get the family involved in their own substance abuse counseling as soon as possible.
Compassion for Families who are Negatively Impacted
Substance use disorders and other addictions all have tremendous impacts. These can be felt not only by the users themselves but by everyone in the immediate vicinity. Oftentimes, this means the family. An individual who engages in self-destructive behavior puts themselves at physical, emotional, and legal risk. But, there is also a great risk of psychological harm to those around them. Anyone who has had a family member struggle with an addiction can tell you how stressful and taxing the process can be!
Examples of daily experiences that family members have to endure include:
- Constant worry
- Witnessing horrible events
- Lies and betrayal
- Finding a loved one overdosed
- Being subjected to hostility and instability
Families have often gone through the wringer. But, they deserve to have their own care and support.
Organizations such as Nar-Anon, Al-Anon, and Families Anonymous (FA) are examples of mutual support programs for people whose lives are affected by someone else’s drinking or substance abuse. Other programs like Adult Children of Alcoholics & Dysfunctional Families (ACA) provide support to those who grew up in addicted households. Family members often benefit from supporting each other through these programs. These programs offer excellent support for family members in need. But, there is often much more work that needs to occur (hence the title of this article).
To Limit Perpetuating Factors (“Enabling”)
Family members are often motivated with the best of intentions. But, they may engage in behaviors that “enable” or perpetuate a person’s substance use disorder or addiction. For example, consider a parent who is fearful of some harm befalling their adult child who abuses substances. They always rescue them from crises of their own making. This, in turn, prevents the user from experiencing natural consequences and discomfort. These are essential for anyone’s growth and learning process.
Consider another parent who offers financial support to their unemployed adult child who is actively using drugs.
The parent fears that without this support, their child will be homeless and hungry. Or will resort to illicit ways of earning money on their own. This parental support is often provided in hopes of being a temporary leg up. But, in actuality, this can prevent the child from learning crucial lessons in personal responsibility. And, the building of self-esteem. In short, the family member is being held hostage by their own fears of what their loved one will do if support is withdrawn.
Yet, it is often this very support that perpetuates the problem. Involving the family in substance abuse counseling can provide a crucial chance to educate them on the behaviors that actually enable the substance use disorder. This allows for a chance to teach non-enabling ways of providing support. This ensures the unhelpful cycle gets interrupted.
To Address Underlying Issues (from a Trauma-Informed Perspective)
The last section spoke about the need to interrupt processes that, despite coming from a loving and caring place, actually perpetuate the problem. Unfortunately, it often takes more than education and insight into what to do or not to do. “Just stop rescuing… just stop giving your child money. Stop bailing your husband out of jail. Don’t pick up the phone when your child quits rehab…” These are things that are often easier said than done. Especially when these experiences generate very strong emotions. Often, more-comprehensive, trauma-informed family work is needed. This work helps to provide the supportive, non-enabling environment that their loved one needs to thrive.
Consider the Following Situation
A father has a hard time setting limits and saying no to their child. As a result, they grow up with a strong sense of entitlement, poor respect for boundaries, and thus a lack of natural consequences and accountability. This child grows up feeling genuine, intense frustration and distress when encountering life’s challenges. As a result, they resort to drugs or other maladaptive behaviors to cope. Educating this father on the need to provide more direct limits and accountability may be insufficient. Especially when in the middle of a crisis.
You see, at the core of this father’s struggle is a history of vicious abuse and neglect during their own childhood growing up. This leads to overcompensation in the permissive and enabling way they currently parent. This father will need to address and resolve their own traumatic past. By resolving past trauma, they can be the strong and accountable parents they need to be.
Consider This Other Example
A mother feels traumatized by the overdose of her adult son who survives and is back to using. This mother experiences classic post-traumatic stress symptoms related to the near-death of her baby boy. Her hypervigilance and very-heightened sensitivity to this topic, primed by her experience, causes her to hover, worry, and be in “rescue mode” for her child. As a result, she is unable to follow through with healthy boundaries. She may often need to address her own traumatic experience related to the son’s overdose to think in an objective way. By doing so, she can better understand how to act and not react, and be the calm presence her child needs in recovery. Most important, doing her own work in addressing these issues will provide well-deserved relief from her terror and distress as well.
Often, having a family member or loved one with a SUD, psychological or behavioral issue, activates underlying vulnerabilities and core wounds within themselves.
Feelings of helplessness when dealing with an addicted child can be magnified. These can be especially overwhelming if this same sense of helplessness was a theme growing up in their own childhood experiences. Negative beliefs of worthlessness or being “not good enough” that originate in childhood can easily become activated and triggered. An example could be raising a child who now struggles with substances and is incapable of living an effective life. For these reasons, family members must often do their own work to address issues that stem from a long time ago.
Nothing Happens in a Vacuum
The substance user must, at the end of the day, take personal responsibility for managing their own mental and emotional state. But, family members can often create unnecessary tension and stressors for the recovering individual in direct and indirect ways. People in the user’s system can be a source of interpersonal conflict. Or, become trigger points in an already emotionally vulnerable situation.
For example, a substance user feels hurt and upset by her mother’s constant invalidation. As a result, drugs become a maladaptive coping mechanism for managing those uncomfortable emotions. Yet, this mother could have a very positive impact on the recovery process. But, only if she does her own work to be a more effective communicator.
In another example, a teen resorts to substance use to cope with emotional distress. They experience excessive anger and chaos in the home.
Therapy and progress for the teen become very limited when they must return to and live in the same, unhealthy system. If this family were to address their own issues and create more stability and calm in the home, success is more likely.
In yet another example, a substance abuser gets frustrated with their partner’s preoccupation with work and emotional unavailability. This leads to the use of substances to cope with their feelings of loneliness and detachment. Much work with the user, in this case, is needed in finding healthier coping skills, practicing effective communication, etc. But, an amazing opportunity exists for their partner to address and resolve their own struggles with intimacy and attachment. The family members in the preceding examples are not the ones abusing substances. But, it is still their responsibility to do their own therapeutic work in this regard.
Family involvement in substance abuse counseling, addiction, and mental health treatment is critical for success. All families are different. There are many variables related to culture, demographics, and personal historical factors. As such, an individualized approach is always necessary. Education, attendance at support groups (such as Al-Anon, Nar-Anon, and Families Anonymous), and a trauma-informed therapeutic approach are all important components of the family process. They lead to increased chances of success for recovery. We recommend finding an experienced addiction therapist who can help you achieve recovery in the entire family system.
At Mangrove Therapy Group we believe in treating substance use disorders (SUDs), addictions, and other behavioral problems from a systems perspective. Contact us to schedule an appointment with one of our skilled addiction therapists. We have experience in guiding families who are struggling with a loved one’s addiction. To start your therapy journey, please follow these simple steps: