Family Recovery in the 21st Century
Early in my career I was a staunch supporter of the primacy of individual recovery. Influenced by my own recovery experience I was certain the family had little to do with recovery success. If someone slipped up or relapsed or otherwise “failed” in their recovery effort it was simply due to a lack of willingness. The family system held no sway. Family recovery was an issue best left to others.
I can still hear myself saying it:
“Addiction is the individual’s problem and not a family systems issue”.
Of course, as a professional I held tight to the company line and provided the family education on addiction and I would support referrals to Al-Anon support groups. However, I firmly believed that the individual was responsible for his or her recovery and the family was essentially an after-thought.
The family could support from a distance, learn how to be less “co-dependent”, reduce enabling behaviors, start “taking care of themselves”, and otherwise stay out of the way.
Fortunately, I had professional supervision and experiences which directly challenged this view. I found myself in the role of clinical director of drug and alcohol services working primarily with adolescents with substance use disorders. We developed a true adolescent specialty program and the integration of family therapy was integral to our success. In addition, we received intense consultation and supervision by a licensed martial and family therapist. This process fundamentally changed me. For the better.
It is going to require an intentional and intensive focus on family engagement to change the culture around the family recovery experience. Some inpatient rehab programs hire a family specialist to run a “family program”.
Usually, a weekend experience for family members while their loved one is in rehab. Perhaps some phone calls with a loved one occur while the person is in rehab. However, when you evaluate the entirety of the “rehab experience”, I would guess the “family component” comprises at best 20% of the focus. With occasional exceptions, family work is an adjunct to the rehab stay and never really given its due.
On the outpatient level, we may see more integration of family therapy but the majority of family support comes thru attendance to Al-Anon family groups.
If other family recovery self-help groups are available, they may be a referral source as well. These groups are helpful, however, they were developed to support wives of recovering alcoholics. Specifically, wives of white middle class men.
The terminology and the advice that sprang out of this process, detach with love for example, may have worked well for these early groups. However, things have become much more complex. Furthermore, there should be a clear distinction between 12 step self-help groups and professional services. The latter demands a comprehensive family orientation. The former does not.
Duncan Stanton and Thomas Todd describe this phenomenon in the following manner in their book The Family Therapy of Drug Abuse and Addiction:
“these (treatment) modalities met with varying degrees of success…However, nearly all of them address addiction as primary problem in the individual, that is, one that is located either in the “body” or in the “personality”. Little attention has been given to the interpersonal process, except as it applies to peer group, or as it is dealt with in certain family oriented self-help groups such as Al-Anon or Families Anonymous”.(pg. 1)
As time has passed I have placed greater and greater emphasis on the value of “Family Recovery“. This has culminated in a distinct set of protocols and a process we have used over the past 7 years in various settings. We have swung the doors of our programs wide open to families regardless of the recovery status of their loved ones.
We operate with a few basic principles that have guided our family programming from the very beginning.
1) We believe that there is merit in family recovery in and of itself.
Family members experience profound health concerns when substance use disorders are present. These include chronic stress, physical problems, sleep difficulties, depression and anxiety. Even if the person suffering with a substance use disorder never makes a change the family deserves special focus and support to deal with these issues.
2) The family has tremendous power that can be harnessed and focused in a way that increases the likelihood their loved one will seek recovery.
Frequently, when family members start to change the person with a substance use disorder will start to change. Family systems theory tells us that if you move one part of the family you move the entire family. Like a mobile above a baby’s crib it is impossible to move one part without impacting the whole.
3) Family members are frequently the first point of contact in the process of recovery initiation.
Family members constitute a more willing customer base. They will call for information and options well before their loved one darkens the doors of our center. They are open to feedback and, in many cases, begging for information and options. Therefore, FAVOR Greenville sees the family as a ready-made channel for engagement of those in need.
4) Family recovery coaching is a unique discipline and the shared experience of families in recovery can be capitalized on in a manner consistent with basic peer support services.
With these principles in mind, my most recent endeavor (FAVOR Greenville) started family programs in 2013 with a simple open “Family Recovery Group”. The group was modeled on basic group facilitation processes of universality, mutual support and mutual respect. Our initial group attendance was 12 people.
We held these groups every Monday night at 6:30pm. The group exploded in attendance based nearly entirely on word of mouth. In 2016 this group averages 54 people per week with a high this past month of 103 people in attendance. The group has become more didactic and educational in nature. However, we start each group with questions from the week and we make sure the topic of education/discussion is generated by the group. There are usually 10 to 15 new people at group and an equal number of “veterans” who have been in attendance since the group started.
Over time an interesting phenomenon arose. The group was intended for any and all family members. Spouses, children, siblings and parents together in one group. However, the group quickly morphed to 90% parents.
In response to this we developed our second family recovery group.
Every Thursday night at 6:30pm we hold our S.O.S. (Significant Other Support) group. This group focuses on spouses or adult children. This group has a different tone than the parent group because the dynamics are different spouse to spouse versus parent to child. This group has operated for 2 years and average attendance is 20 people.
We have just added an off-site Family Recovery Group in our neighboring town of Spartanburg SC. Many people from Spartanburg had been making the trip to Greenville. However, it became clear that the community needed a satellite group. We launched this group in 2016 by forming a partnership with a local church. We rent the space and facilitate essentially the same group. Average attendance at that group has been 20 people.
Furthermore, we are scheduled to start a Family Recovery Program in nearby Laurens County in September 2017 in partnership with the Laurens County Hospital Foundation.
We also have a children’s program for children of parents in recovery and/or children of parents struggling with active substance use disorder. This is a curriculum based program and we run it periodically based on community response/need. We have had 103 children complete this program. Along those same lines we have added two teen recovery groups serving teens in any stage of the process from prevention to recovery. We have had 207 teens attend our groups.
Another distinct area of family recovery support at FAVOR Greenville is our family recovery coaching.
These are parent to parent; spouse to spouse; family to family coaching relationships put in place to supplement the various groups provided at FAVOR Greenville. We actively recruited family members who had been “working a recovery program” and developed a specific curriculum to supplement our regular coach academy.
These family members completed a specialized training academy to become FAVOR Family Recovery Coaches. To date we have trained 53 family coaches and currently have 29 active Family Recovery Coaches who volunteer on average 5 hours per week to coach and support other families.
We have been over-joyed with the Family Recovery Coaching programming. We have provided over 8,000 hours of family recovery coaching since initiating the program. The family coaches are incredibly enthusiastic and grateful and this is reflected in the way they engage our families in need. This has been magical to watch.
Overall, it is important to note, 48% of the service hours delivered at FAVOR Greenville are delivered to family members in need.
The distinct difference with our program is the following: Family recovery is not an add- on or adjunct to service; family recovery is front and center and a cornerstone of the center. We have found that family members want to be included in the process and they make great volunteers and supporters.
FAVOR Greenville will continue to place formal emphasis on family recovery and we believe our program will expand in the area of family recovery as we move forward in our mission.
What have we learned over the years in our work with families?
1). Parental experience in dealing with addiction is 100% different than spousal experience.
This cannot be over-stated. It is important for family programs to provide specialized services and information for parents. We must maintain an awareness of the influence that Al-Anon has on traditional family work. Al-Anon sprung up as a support group for spouses of those in Alcoholics Anonymous and many of those principles do not translate smoothly to parents.
It is a completely different experience for parents as they struggle with setting boundaries and reducing enabling behaviors. It is not a simple set of instructions and the conversation must be delivered in a way that is acceptable to the parent. For example, do not tell a parent “you are sick and just need to take care of yourself”. The result of such a statement will be complete disengagement. This is a reality that must be acknowledged and accounted for. We must become more individualized and engaging in our work with families.
2).Families can become skilled in responding to addiction.
It is possible to teach family members basic skills that can be useful in responding to their loved one’s addiction. We can help them develop basic recovery messaging. We can help them be strategic about when and how to bring up crucial conversations. It is even possible to teach basic motivational interviewing principles and skills.
Families love information and they are empowered when they feel more competent. I am not saying that a family member can serve as a loved one’s counselor. However, he or she may be able to provide really helpful and tangible support. The idea of complete detachment and “staying out of it” is looking less and less appropriate the more I work with families. It has been said that 1 family member wields the power of 8 professionals. Let’s teach families ways to capitalize on that power.
3). Professional Peer Family coaching is a real discipline.
We have been training family coaches for 3 years now and there is nothing more powerful than a family to family supportive relationship. The practical shared experience and the exceptionally strong sense of empathy is beyond comparison. It is one of the most therapeutic supports available for family members in need. We need more family coaches and we need to honor family recovery professionals.
4). In that same vein, professional family coaching and family mentor-ship is a key part of the recovery continuum.
The workforce that fills this role can be drawn from family members who have their own experience, friends who walked the path with an addicted individual, and allies of recovery to include therapists, counselors, tech staff, and others; as long as this group is able to display sufficient empathy toward the unique struggles of the family. We believe it is possible to develop trained and credentialed specialists
Despite this progress we know that we have not even scratched the surface of what can be done with families. The reality is family members have to be front and center in this fight against addiction. It is not sufficient to merely state “addiction is a family disease”.
We have to do programming that reflects a belief in addiction as a family disease. Furthermore, like many things in addiction treatment field our fundamental assumptions around family recovery need to be re-evaluated. Terms like co-dependency, enabling and detachment all require a second look. This seems self-evident given the manner in which they came to guide family services and the changing face of addiction since that time.