Addiction Treatment: Mending the Patient and Family

You’ve heard the cliché. There is no “I” in team. There’s also no “I” in treatment or recovery.

When it comes to treatment for substance abuse and addiction, a team effort is vital, especially when the team includes the patient, clinical experts and the patient’s family, according to John Eustace, M.D., medical director of the Addiction Treatment & Recovery Center at South Miami Hospital.

“Very few people come to addiction treatment on their own,” Dr. Eustace says.  “Sometimes the family is the patient.”

At times, the family can be a major factor in substance abuse problems, especially in a home disrupted by physical abuse, addiction or distribution of drugs and alcohol. A chaotic family atmosphere should be addressed in therapy for the sake of the patient’s long-term recovery, Dr. Eustace says.

On the other extreme, even within the walls of a healthy family home, an individual may experiment with drugs and alcohol and become addicted for a variety of reasons, including genetic, biological or emotional factors. In that scenario, the family might struggle with anger, shame, guilt and confusion. Failure to address and resolve those issues can have a negative impact on the patient’s recovery efforts, Dr. Eustace says.

“The untreated family can place the patient at risk for a relapse,” he says.

For example, a patient’s late return from a therapy session could trigger past memories of the patient’s disappearance for drug or alcohol binges. “Old ghosts” of past feelings may prompt family members to greet the patient with distrustful “where were you” messages, which lead to toxic disbelief in the recovery process.

“Old messages can derail recovery,” Dr. Eustace says. “Without processing and deleting old messages, the patient and family are at risk even after treatment.”

How does a family become involved in therapy?

“First of all,” Dr. Eustace says, “It’s voluntary. The family can never be forced to come in.”  A variety of emotions — emotional fatigue, distrust and fear —can make family members reluctant to participate in the recovery process.

“We do everything we can to create a nurturing environment,” Dr. Eustace says, adding that family members need to be reassured about the privacy of the process and the value of their participation.

Sometimes, the family reaches out for professional help on behalf of a sibling, spouse, child or parent who is battling addiction, but resisting treatment.

What is family therapy?

There are several components of family therapy, including:

  • Individual assessment: Family members participate in one-on-one sessions with a counselor. This step — without assigning blame or guilt — is important for collecting a family history and determining if there have been other cases of addictive disorders in the immediate or extended family. 
  • Education: Family sessions provide information and discussion about the biological and genetic roots of addiction, with evidenced-based research about the impact of chemicals on the brain, judgment and personality. “We offer explanations, not excuses,” Dr. Eustace says. “The family becomes more supportive if they know some of the factors that lead to addiction.”

What about the concept of enabling?

There are two kinds of enabling.  In the negative sense of the word, a family can enable addiction by providing money (for food, gas or other needs) that the patient uses to buy drugs and alcohol.

“We do review enabling behaviors that may contribute to the progression of the illness,” Dr. Eustace says.

But a different kind of enabling, in the form of intervention, can be a positive force for treatment and recovery.

Intervention — the process in which the family encourages the substance abuser to undergo professional help and treatment — is best delivered with high doses of love and support, but without shaming, punishing or alienating the patient, Dr. Eustace says.

It’s the Love First intervention technique that follows the medical model used to help cancer patients who refuse medical treatment. The goal is to establish a compassionate dialogue advocating treatment. Dr Eustace coaches families to deliver this script to enable a patient to seek help:

“We love you. We’ll help you get to treatment. We’ll support you in treatment, but we can’t support this lifestyle of abuse anymore.”


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