The family dimension – why family treatment yields better outcomes for addicts

Today, I’d like to talk a little about our new Family Programme, which we rolled out some three months ago – not only to an extremely positive and grateful response from participants, but more significantly for us, immediate progress in family dynamics between the family and client.

After extensive research into the models currently being used by the few other treatment providers who offer this service, we found that most were offered as a charged option and run on a parallel dimension – where families received a few hours of coaching separate from the client. So we decided to create our own programme that literally integrates the family into their loved one’s treatment because families need to understand that addiction is a family illness.

This ‘illness’ is clinically known as Codependency and is a set of dysfunctional behaviours and distorted beliefs adopted by family members in order to survive in a family that is undergoing severe prolonged stress. In the case of addiction, the family members unconsciously take on roles to help them deal with the addict/addiction in an unhealthy way. The ‘caretaker’ role actually supports or enables the progression of the addiction, while the addictive behaviour overtime causes the caretaker and other family member’s symptoms to worsen as well. Either way, the cycle must be broken for the family system to be supportive of a lasting recovery.

If the family is not treated right alongside the client, the client’s chances of long-term recovery, once he leaves us, will be slimmer because we have been able to treat only one part of the family not the whole unit – and there is now much clinical evidence to support this approach, be it from the NCBI, or the overarching conclusion of the Journal of Marital and Family Therapy, Family Therapy for Drug Abuse: Review and Updates 2003–2010, which states “that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.

So we have made our family programme available to the families and loved ones of all our clients in primary treatment by offering it for free as an incentive to attend. The programme is a three day course run during the last week of every month that quickly draws the family into a therapeutic process that is deep, rich, challenging and emotional.

The families get to be a part of their loved ones’ community over the three days – eating together, attending the same yoga and meditation classes, etc; while the clinical team takes  a multi-pronged treatment approach.

The first day is dedicated to psychoeducation. We start with a very thorough but easy-to-grasp, interactive presentation on the modern definition of addiction as defined by ASAM – that it is in fact a neurological disorder. It is needed to dispel the belief that addiction is a moral issue, and that one cannot control it and that it is nobody’s fault.  As most of the time the family have a belief that it is somehow their fault and this provokes the unhealthy family behaviours and codependent relationships.

This is followed by another presentation on how addiction affects the family – and how unknowingly the family’s behaviours and emotions have been supporting and promoting the illness. Families generally do not like hearing this as they have been working very hard to rescue the addict.

We then employ a group therapy strategy to help to break these unhealthy behaviours and beliefs.  We hold one process group session a day, facilitated by two counsellors, for all the participating families. The benefits are multiple – it gives them a space to talk about their feelings and experiences in a non-judgmental environment for the first time. It allows them to identify with other families going through the same situation as well as draw on each other’s experiences. But even more beneficial, is when one of the participant’s behaviours or actions are challenged by another participant or facilitator – it becomes a lesson for all.

The second and third day also feature workshops to illustrate some of the concepts the families have learned from a 360° angle.  We usually have clients whose families are present, come in and do a presentation to the group that demonstrates how he/she is dealing with the same problem but from an addict’s perspective. (For example, for the concept of enabling, the client drew a mind map of their newly learnt awareness of a ‘tool’ they had been using to manipulate their family to feed their addiction).

The third day, we dedicate to outcomes and kick starting the process of change from an unhealthy family system into a healthy one. The family first meets in private with their loved one’s counsellor, then their loved one is called in to the following session. Here, with the professional help of their counsellor the family is guided in setting new boundaries with the addict. The meeting is usually a highly emotional one where both sides get to say things that they normally would have been too scared to express.

Our family programme is to principally help families derive a new strategy as well as a long term plan for supporting the addict after their 28 or 60 days of treatment – and this can only happen if the family has a correct and proper understanding of the disease. As for the various dysfunctional roles and patterns that the other family members have succumbed to that could have life-long negative impacts on those individuals, we urge them to seek therapy going forward.

For the monthly schedule of our family programme please click here.

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