Substance Abuse Treatment: It’s a Family Affair

Authors Apology:  My expertise on the Newsletter System we use is not the greatest, forgive me if you received multiple emails this cycle while I tried to get you the entire newsletter. 🙂

In this volume we are going to assume that you have done all the right things, the planets aligned and your family member has agreed to get help.  Reaching this point is not easy, and the battle from discovery of substance abuse to this point can be a long, protracted, and painful time.  But we will address this later on in the series.

There are a number of different ways to get help and types, and lengths, of treatment available.

IOP – Intensive Out Patient.  This is a daily trip to the facility providing the treatment, where the client will spend the day, or half day, depending on the assessment of the intake counsellor.  The program will consist of a variety of classes and information to help the client understand the chemistry of addiction, the social impacts, the family struggles and effects, the future implications of persistence, and other topics decided on by the treating facility.  Included will be family sessions that you simply must attend if you want to insure the greatest level of success.

Acute Detox.  This is a lock down environment designed to assist the acutely addicted person through the initial “come down” of cessation.  Symptoms vary with the substance being abused but your facility is well trained and can give you information you need to understand what will happen over the next few days.  Acute Detox can be the only residential portion of treatment or just the beginning of a residential program.  Medically assisted detox may include the use of drugs like Clonazepam, Ativan, Visteral, even Suboxone and Sebutex.  Most of these have addictive effects some of which are potentially worse than the drugs the client was using so be sure that they are only used very short term for the initial detox.

Residential Treatment.  This is typically a graduated privilege treatment methodology that can last anywhere from 28 days to 18 months.  The most common duration of stay is the shorter term 28 to 30 days.  Residential treatment includes all of the classes generally found in IOP, but also include the feature of environmental safety.  Removing the client from familiar ground to keep them from their drugs while they learn does provide an additional level of comfort that they will complete at least an initial time period of chemical cleansing.  Again, these programs will offer family sessions that you simply must attend if you want to insure the greatest level of success.

Of all of the above treatment types some may be faith based and some will be secular.  Some are physically rigorous and some are more laid back.  If you believe a faith based program is the best, I urge you to ask your family member first.  Remember, if your loved one has agreed to treatment, you need to keep them as open and willing as possible, and choosing for them when it may cause them to shut down is not a good idea.

12 Step Programs.  A large percentage of people in recovery today never went to rehab, but addicts who have gone to rehab should all end up in a 12 step program.  In other words it is possible to recover through one of the 12 step programs without the aid of a rehab, but the 12 step programs offer a path to change, a fellowship of others in recovery, and the best chance at sustained recovery.

Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Celebrate Recovery (CR), the latter of which is faith based, are the largest and most common of these.  Bear in mind that identification with others like ourselves (Addicts or Alcoholics) drives the success of these programs so commonly an addict should go to NA or CR, while an Alcoholic will probably find better success in AA.  For the family there is Alanon, and NarAnon, both of which provide help to families of those in recovery.  Again, it is vital these be attended as the information is transformative when applied in practice with your family.

These are some of the primary resources you need to begin to heal your broken family.  Let’s talk for a minute about not participating in the healing process.

If you believe that the problem all belongs to the person being treated for the substance abuse problem, you are almost guaranteeing yourself more misery.

“The progress an individual makes in treatment can be hindered or undermined or even reversed if family dynamics don’t change too. (David Scheff, Clean)”

Some of what is learned in the various family classes and Alanon/NarAnon is the behavioral changes we must make to be able support recovery.  Here are a just a couple of the common challenges we create if we don’t engage in treatment as family members which will impede treatment and recovery:

• Rescuing the child from anxious situations
• Under- or over-involvement in the treatment process
• Denial
• Difficulty setting limits
• Presence of parental substance use and mental disorders

Suveg et al. (2006)

These are indicative of Co-dependency and enabling behaviors.  This is where we take the risk discussed earlier in the series of “Loving them to Death” versus “Loving Them Enough to Make Tough Decisions”.

Studies have long since proven that the family dynamics that have contributed to, or been present during a period of substance abuse need to change in order to foster a sustained recovery for the addict.

• Family interventions can help modify the maladaptive family relationship patterns that can contribute to, or result from, a family members’ drug abuse
• Family members are key to helping with co-occurring disorders
• Family members are needed as change agents in the family members’ environment
• Family interventions can result in beneficial effects long after the “treatment” phase is over
• Family interventions can be used to bring a family member to treatment for the first time or can help to retain the family member in treatment

Santisteban, D.A. (2008)

This is a war and an important one.  Losing a battle is a painful possibility but you don’t have to put yourself in the position of being assured a loss.  Muster the whole family, arm yourselves to the teeth with the weapons of wisdom, and understanding.  Participate in every skirmish.

Co-occurring disorders, or dual diagnosis are terms you should be prepared to hear.  There is a large percentage of addicts that have mental health issues beyond addiction.  These disorders can sometimes be causative of the addiction or at least contributory.

Remember that “not feeling comfortable in our own skin” is one of the primary things you hear from addicts and these mental health issues can cause that feeling.  It is not uncommon that the addict started the substance abuse as “self-medicating” their discomfort.  It may be necessary for your family member to take some kind of medicine, at least temporarily, for this disorder.  I am not a physician or psychiatrist so I cannot tell what you should or should not do about psych meds only that you need to always be involved and vigilant.  If medicine is truly what they need then they should have it.

What the goal is with treatment is starting the addict down the path to a whole new life.  Old things have to go.  Old patterns, old playmates, playthings and playgrounds.  In other words, everything must change.

Life in recovery does not have to be boring which is what many addicts fear before they go to treatment.  What they don’t consider is that the millions of people that are in recovery today did not have lobotomies so they have no desire to have fun.  In fact, people in recovery are some of the most fun people on the planet.  Not only do they seek fun, but they have reason to enjoy more fully due to the gratitude they have for being clean.  After all, when you are doing fun things while you are under the influence you always have a cloud hanging over your head.  Guilt, shame, fear of arrest, and so on.  In recovery there is freedom.

You should have picked up in the language by now when I say “life in recovery”, that we are not talking about your loved one coming out of rehab cured.  If your loved one is an addict recovery should be become a way of life.  In fact, one of the things I have said in meetings over the years is that I do not live my life and add some recovery to it to keep me clean;  I live my recovery clean and build a life around it.  That is because relapse at any stage of recovery is possible, and this disease is progressive, which means that you won’t pick up where you left off, it will be as though you never stopped.

My Son, Joshua, stayed clean for a year and a half before he relapsed, and a one-time celebration because he got his son back from Child Protective Services lead to a 5 year run and ultimately his death.

Do not begrudge or resent your loved one spending time at meetings, be glad they have the time to spend there.

Next issue will pick up here as we talk about Life in Recovery.

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Resources:

Celebrate Recovery (CR) http://www.celebraterecovery.com
Narcotics Anonymous (NA) http://www.na.org
Alcoholics Anonymous (AA) http://www.aa.org