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Parenting​ ​through​ the behavioral ​health apocalypse!

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The Behavioral ​Health Apocalypse!

Before I get to my article on the current state of behavioral health, I would like to make it clear what I intend to do with The Recovery Cartel blog. There are several very important objectives.

1.) I write so that my head does not explode. I have continuous and ever-present thoughts surrounding addiction, mental health, sociology, societal problems etc… And I have very serious observations and opinions regarding society’s response to these issues. If I don’t write about and/or talk about it my head is likely to explode. I don’t want that to happen.

2.) I write for a targeted audience. Specifically, an audience that wants to take a deeper dive into an issue. If you want clichés and the standard company line, I’m not the guy for you. If you want to go deep on the macro-issues and explore causes and conditions then this is the place for you.

3.) I want to explore NEW solutions and try and shatter the existing paradigm. I think we are fighting a battle against substance use disorders and mental health issues using antiquated and illogical techniques.

4.) I intend to write really long posts. Read the whole thing. If that resonates please sign up for my blog posts.

Today I would like to explore parenting through our current behavioral health apocalypse…

Mental health rates among youth and young adults at a record high. Overdose is number one killer of people under the age of 50. The social media explosion and the smartphone era is leading to an entire generation of overwhelmed and disconnected people. In the meantime, substances are evolving.

It seems like more and more powerful drugs are being pushed into the market. The DEA is under the control of big pharma and the prescription opioids are going to keep coming. It’s the perfect storm for this overdose epidemic. We also need to acknowledge the record setting suicide rate and our ineffective systemic response in this area as well. We are a country in the middle of a behavioral health crisis.

It is especially difficult for parents dealing with a child’s behavioral health crisis. Despite more need than ever, there is little specialization in this area. Family based responses are the exception not the norm and parents are cycled through traditional framework which was never intended to address parent to child relationships.

3​ ​problems​ ​to​ ​ponder​ ​as​ ​you​ ​parent​ ​through​ ​this​ ​perfect​ ​storm?

Problem:​ ​Psychological​ ​Beat​ ​Down​ ​Associated​ ​With​ ​Raising​ ​Kids​: It used to be that a parent’s job was to “raise” your kids. Get them to age 18. Maybe early 20’s if they went to college. Get them through the experience relatively well adjusted. Get them through relatively healthy. Prepare them for the future but not prepare their future.

Then Dr. Spock came along and told parents to become friends with their children. Then parents started to live vicariously through their kids. Parents became obsessed with their children’s achievements. Get them on this team and in this activity. Buy them this car and these clothes. Must get them into Harvard. Must see them achieve.

Parents always encouraged their children. Parents even demanded hard work from their kids. But parents in the past did not tie their own self-esteem and self-image to the success of their kids. That all has changed.
Imagine how much more complex and problematic this reality is made by substance use disorders. How the stigma feeds into the already existing sense of failure and inadequacy that many parents feel.

Here’s a common scenario:

When you meet someone at the grocery store:
The first thing they do is tell you about their kid.

Super Parent: “Joe just finished first in competitive pogo-stick jumping and he’s ranked second at
Stanford School of business. How is your kid doing”?

Imperfect Realistic Parent: “Well… he was named president of his unit at rehab… we are hoping he
does 90 meetings in 90 days when he comes home because they told us this is his after-care”

Not​ ​a​ ​very​ ​pleasant​ ​experience…and​ ​in​ ​most​ ​cases​ ​the​ ​imperfect​ ​parent​ ​takes​ ​evasive​ ​action​ ​and avoids​ ​the​ ​question.​ ​ ​Redirect​ ​the​ ​conversation​ ​to​ ​the​ ​broccoli​ ​sale​ ​in​ ​aisle​ ​13… ​ ​and​ ​then​ ​leave​ ​the store​ ​feeling​ ​terrible​ ​about​ ​yourself​ ​and​ ​the​ ​situation.

Solution:

● Work on conscious contact with the facts of life for EVERYONE on this planet. No family is perfect. The “hallmark movie” family is a myth. The perfect Sunday School family is a myth.
Everyone is dealing with some type of struggle. For some it is a mental health or a substance use issue. For others it is a medical condition. For others it is infidelity or divorce. Just look at the rich famous members of the celebrity class. Good God they are completely miserable.

● Bonus advice: Accept yourself and accept the fact you are going to avoid the conversation.
Avoid people who want to vicariously live through their children. Go for it. Its self-preservation.

Problem:​ ​Bubble​ ​Wrap​ ​Generation​ ​And​ ​Addiction​: Participation trophies. Self-esteem training classes.
Medals for everyone. If everyone gets a trophy then no one feels left out. But, if everyone’s a winner then no one is a winner. We created this. My generation. Me as a parent. I feed into this bullshit. I don’t want my kids feeling less than. It’s our fault. It’s not just the millennials. It’s the pre-millennials (I just made that up).

The term helicopter parent is born out of this dynamic.

When addiction, mental health, or emotional issues enter the picture for the bubble wrap generation the helicopter parenting instincts will kick into high gear. Remember, the helicopter parenting dynamic goes way beyond addiction. Helicopter parenting is the norm today. Parents spend all day driving their kids around. As stated above. Getting them involved in swim class, gymnastics, soccer, Chinese checkers tournaments, gluten free baking courses etc… Parents spend all night doing their kids science project with them. Checking the elementary school website for the latest assignments. Planning the bake sale to raise money for the field trip to view manatees for science class. PARENTS ARE CONDITIONED TO BE HELICOPTERS.

THEN ADDICTION AND MENTAL HEALTH ISSUES SHOW UP AND ALL THE PROFESSIONAL GENIUSES IMMEDIATELY TELL THEM TO DETACH. Then mom and dad have trouble detaching and they beat themselves up for not utilizing “tough love” effectively:

“I’m the worst enabler in the world”!

“I know I have made this worse…look at me I’m the poster child for enabling”….

And all this anxiety and emotional energy is wasted on this useless “detachment” battle.

Keep in mind the therapists who are telling you to “detach” are rushing home to make sure that little Suzy gets to her weekly “future astronauts of America club” on time because God knows this will surely get her into Harvard.

100%​ ​Ridiculousness!

Solution:​ This advice is for the “helpers” not just the parents. This is not 1955. Too many times the “advice” given to parents come out of the Al-anon tradition. When Al-Anon was founded the group was not addressing parents of 18 year-old heroin addicts. They were addressing wives of 50 year-old alcoholics. Detach with love was invented for spouses not for parents.

You may get to a point where you can detach but you need to be easy on yourself while on the journey. Have an understanding of the truth around parenting through behavioral health issues. Attend support groups and get educated. Try to avoid groups that make you feel worse about yourself. Definitely avoid therapists who make you feel worse about yourself.

Try and keep perspective. You will eventually be able to set the appropriate boundaries…but is likely to be a process of starts and stops.

Problem:​ ​Today’s​ ​PILL​ ​CULTURE​ ​And​ ​The​ ​7​ ​Minute​ ​Psychiatric​ ​Appointment​: When did the pill culture take over America? According to the Center for Disease Control (CDC) 48.9% of Americans report being on at least 1 prescription drug in the past month; 23.1% report being on 3 or more prescriptions in the past month; and 11.9% report being on 5 or more prescription drugs in the past month. Obviously, these medications are warranted in many cases.

Seventy five percent of doctor visits result in a prescription being issued. We certainly have developed the mentality that a pill is the preferred solution for what ails you in terms of physical health. Is this the same for behavioral health issues? It seems to be the case. Some interesting points to consider from Medco and their America’s State of Mind Report): Click here to read the report

● Overall, the number of Americans on medications used to treat psychological and behavioral disorders has substantially increased since 2001; more than one-in-five adults was on at least one of these medications in 2010, up 22 percent from ten years earlier.

● The most notable increase in the use of these medications (anxiety medications) was seen in children ages 10-19; utilization increased among this age group by almost 50 percent. While younger people showed marked increases, older people showed declines.

● In the United States, an estimated 5.4 million children ages 4 to 17 have been diagnosed with ADHD and the percentage of children with a parent-reported ADHD diagnosis increased by 22 percent between 2003 and 2007 according to the Centers for Disease Control (CDC).

● While​ ​it​ ​is​ ​well​ ​known​ ​that​ ​ADHD​ ​is​ ​prevalent​ ​among​ ​children,​ ​diagnosis​ ​and​ ​treatment​ ​of ADHD​ ​has​ ​in​ ​fact​ ​grown​ ​at​ ​a​ ​much​ ​faster​ ​rate​ ​among​ ​adults.​ ​Additionally,​ ​a​ ​gender​ ​shift​ ​occurs in​ ​adulthood​ ​when​ ​slightly​ ​more​ ​women​ ​are​ ​shown​ ​to​ ​be​ ​using​ ​ADHD​ ​drug​ ​treatments​ ​than men. ​ ​Among​ ​adults,​ ​women​ ​ages​ ​20-44​ ​showed​ ​the​ ​highest​ ​prevalence​ ​in​ ​use​ ​of​ ​ADHD​ ​drugs in​ ​2010​ ​(nearly​ ​2.0​ ​percent)​ ​and​ ​saw​ ​the​ ​greatest​ ​spike​ ​in​ ​their​ ​numbers,​ ​rising​ ​264​ ​percent from​ ​2001-​ ​2010.

We could go on all day exploring these trends. The bottom line is. Pills have become part of everyday culture in America. A pill is the solution for everything from sexual dysfunction to sleep problems to inability to get your work done.

And wonder why Johnny would go to a party and “take a dangerous” drug for recreational purposes. We have told Johnny pills are your friend since he was 3 years old.

We also know that psychiatric services are focused on medication adjustments and not talking through issues. This is just the reality of the situation. In order to make the business model work psychiatrists must see more and more patients.

This lack of attention was chronicled in a New York Times article and has become the generally accepted norm. Here is a link to the New York Times Article: Click here

Parents will naturally be drawn to leaning on expert support. But what do we do when the expert doesn’t have time for us? What do we do when medication becomes the go to option for nearly all issues? What do we do when this is happening in the day and age of Xanax abuse?

Solution:​ ​ ​Parents​ ​must​ ​become​ ​educated​ ​and​ ​system​ ​savvy.​ ​ ​The days of blindly “trusting” the professionals are behind us. This is probably true of all of healthcare. It is definitely true where behavioral healthcare is concerned.

We all need to become our own advocate. If a provider is offended you ask questions or want more information start looking for a second opinion. Unfortunately, psychiatric services can be hard to find. Therefore, sometimes you must stick out with a sub-par provider. Never discontinue medication without doctor advice. But look around at other options.

Become educated about solutions that lay beyond the 7 minute psychiatric appointment. Solutions that lay beyond medication. Talk therapy, alternative therapy, mutual aid groups, life coaching, exercise, nutrition are all things that can contribute to emotional health. Your service provider may not suggest options. Unfortunately, people tend to stick to their favorite treatment modality.

Try to find someone who can serve as a case-manager or a coach regarding system navigation. Practical advice and feedback is invaluable. It can be especially beneficial to find someone who has “been there done that”.

If you are able to develop a plan of attack for these three problem areas you will be ahead of the game. This is a most difficult period of time to raise kids.

We all need support and useful information. I hope you sign up for ongoing Recovery Cartel posts.

I will be going after this issue in depth in future posts as well….

Family Recovery - Richard Jones

21st Century Family Recovery

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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.

Recovery Cartel Blog

Top 2 Questions from Family Recovery Group

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Family Recovery Group:

FAVOR Greenville conducts 4 family groups per week with at least 140 people in attendance in any given week. We have served over 6,000 family members the past 4 years. With that in mind we will explore some of the more common themes that arise from the group discussion.
An instructional manual for family members based on the most common Family Recovery Group questions. Two questions per day:

1) What the hell is wrong with my loved one? Substance use disorders occur on a continuum. One of the most challenging issues is getting someone to realize they “have a problem”. There is no x-ray or blood test that will definitively reveal the presence of “addiction”. The closest thing we have to a definitive diagnosis comes via the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We also know that not everyone who “parties hard” is addicted.

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We also know that addiction is more than bad behavior. There is a fundamental “brain change” that occurs when addiction enters the picture.

This has been hotly debated and many people challenge this assumption.

There are some who believe addiction is a moral choice, there are some who believe it is a problem of connection, others who believe it is a learning disorder, and some who believe that it is a spiritual problem.

There are also people who believe addiction is a combination of all of the above.

There is probably much we do NOT know about addiction. We essentially stopped learning in the 1970’s when the Minnesota Model took over treatment. However, I think it is important for people to realize that the brain is impacted. Regardless of how you semantically describe the process; something changes in the brain. This contributes to compulsive use and obsessive thinking about the substance and use despite consequences:

recovery science

This image displays the depressed dopamine levels that occur with chronic substance misuse. I’m not a neurologist but I would prefer the brain on the right over the brain on the left. The absence of dopamine prohibits the experience of pleasure resulting in the addictive behaviors described above.

Dr. Kevin McCauley in “Pleasure Unwoven” uses the example of a diabetes Type 2 to illustrate the disease of addiction.

Diabetes Type 2 is a chronic, lifestyle disease you “give to yourself” based on choices you make regarding substances you put in your body.

Addiction is a disease you “give to yourself” based on choices you make regarding substances you put in your body.

family recovery

What can I do about this?

The best way to answer this question is to describe the treatment and recovery process. However, I would like to take a moment and discuss crisis response. It is likely that you have experienced potentially life-threatening situations and dangerous behaviors when dealing with a loved one’s addiction. If this is the case you need to take action to ensure everyone’s safety.

In most areas, this means contacting 911 and/or emergency services.

If a person is out of control and a danger to themselves or another person you have no choice but to make this call. Believe it or not, sometimes legal involvement can be a blessing in disguise.

There are multiple options and ways to attack this issue. Most people have heard about “rehab” and many equate this to recovery. Rehab does not equal recovery. There are different levels of care associated with the treatment process and a thorough clinical assessment can help determine the recommended level of care.

The single most difficult part of the process is getting your loved one to recognize the problem and follow through on the services. Interventions can help with this. Family recovery groups can help you as you work through this issue. However, interventions require serious commitment on the part of the family.

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If you are not able to put together an intervention team you may be able to solicit some support outside the family. Perhaps someone else can talk to your loved on? Sometimes we listen to others while we ignore those close to us. Developing a recovery message is also an important part of the process.

A recovery message comes from a place of love rather than confrontation. It is important to communicate that you are concerned with your loved one’s health and this is not meant to be punishment.

Putting together the team can be a difficult process. It’s important that everyone be on the same page. All significant people in the person’s life need to be in agreement. Sometimes you can accept “lower level” of care if it means everyone can come together.

For example, you may agree that the person will start at an outpatient level of care rather than an inpatient rehab level of care. Quite frankly, if you are able to get the person to a clinical assessment you have made some good in-roads. It’s not all about rehab. Please understand many people recovery without rehab.

Special Note: there is no such thing as “tough love”. You may need to work on the appropriate expression of love. But you do NOT need to be tough. Love involves setting boundaries. You DO NOT have to be mean in order to make your loved one get help.

It is important to get good support and advice when working through these things. I have heard people give families the most outrageous advice. Things like: “Kick the bum out”; “Don’t even give him a baloney sandwich”; “Don’t talk to them at all”; “Cut all ties”. This may be appropriate in extreme cases but it should not be applied across the board. Everyone’s situation is different. Every case is individualized. Please select your support system carefully. It can get real ugly out there.

Special Note Number 2: Beware the treatment center predators. If you call a 1-800 phone number they may try and bully you into getting your loved one into treatment “today or they will die”. Try to find a therapist or a person with some independent training to help you decide what to do. The rehab “pimps” are everywhere.

Remember, recovery is a process so taking care of yourself along the way is extremely important. It is okay to focus on getting your loved one help. It is unrealistic to think you will “walk away” from them and “detach” completely. We would encourage you to explore all options, including family intervention/coaching support. However, it is important that you try and take care of yourself along the way.

We will continue this series and talk about other common questions including options for self-care.

Stay tuned….

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Mean What You Say, Say What You Mean

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Boundaries

Boundaries is a word that gets bantered about all over the place in the recovery world. Actually it gets thrown around in all aspects of life. People devote extensive time to working on boundaries and setting limits within relationships. It is most certainly one of the key aspects of leading a healthy life. Without boundaries you can lose yourself and, in extreme cases, become involved in abusive relationships.

How do you “do” boundaries? What are the skills and guidelines for setting boundaries? Many times, a circular conversation ensues around setting boundaries:

Family member (FM): I don’t know what to do my kid just keeps smoking pot in his room and I have told him to stop.

Very Helpful Person (VHP): Well just set a boundary about smoking pot.

FM: How do I do that?

VHP: Just tell him. Stop smoking pot or there will be consequences.

FM: I tried that. He is still smoking.

VHP: That’s cause you didn’t set the boundary.

FM: What boundary?

VHP: The one about smoking pot.

FM: How do I do that?

VHP: Just tell him. If he doesn’t quit smoking pot there will be consequences.

FM: What kind of consequences?

VHP: Take his phone.

FM: I tried that. He just flipped out until I gave it back.

VHP: That’s cause you need to set boundaries about how he talks to you.

FM: What do you mean?

VHP: Tell him he can’t talk to you like that.

FM: He knows that. He does it anyway.

VHP: Well you need to get better boundaries…  I heard they are having a sale at Walmart. Two for one. Let’s go.

Maybe I’m exaggerating just a bit. I am the king of hyperbole. However, the process of setting boundaries is much more involved than a simple declaration of intent. There are entire books dedicated to the concept. Maybe we can keep it simple by focusing on a variation of the classic saying: Say what you mean!  Mean what you say! But don’t say it mean!  How does this apply to addiction and family recovery.

Say what you mean!

“Saying what you mean” is about consistency between one’s thoughts and words. It is a plea to be honest, to truthfully represent one’s understanding, state or intent when describing it verbally (Runion).  This is difficult for everyone. It gets especially challenging when addiction enters the picture.

Consistency between one’s thoughts and words presupposes that one has awareness of one’s thoughts.  It has been said that the average human being has at least 77,000 thoughts per day and the overwhelming majority operate below conscious recognition. Under the best of circumstances we have difficulty staying in the present moment. Our behaviors and words are influenced by past experiences and future considerations. It is hard to have consistency when you aren’t even sure what you are thinking. It is as if life “just happens”.

Now add in addiction and all the chaos, drama, and fear associated with that reality. I would argue that a family member living through a loved one’s addiction experiences post traumatic stress disorder. Traumatic experiences are encoded and frozen in the information processing system of the brain making thought recognition even more difficult. At any given time family members will be triggered and re-experience previous events and situations.

How can you say what you mean when you aren’t even sure what you mean?

Therefore it is important to gain an understanding of “what you mean”.  What is it that you want to see happen? What is the specific problem that you need to address? One of the ways helpers inadvertently confuse the family even further is by telling them “you need to work on yourself”. This muddies the water because many times the family actually wants to “help” their loved one. I’m hear to tell you. That is perfectly understandable.

After you work through “what can I do” family members will frequently come to the conclusion that they must change some of their behaviors. This is where the boundaries talk comes in. Some recommendations:

Identify “target” outcome-How do you want to be treated?

Remember the target outcome is about you not about the other person. Ask yourself: What do I need to be different in order for my life to improve? Try to avoid focusing on the behavior of the other person excepts as it relates to you. A quick example:

Johnny returns from rehab and is living at home with you. He’s 22 and not sure about going back to school or going to work. Johnny tends to go out late with his friends. He is 22…the night starts for him at 10 pm. You are 50. The night ends for you at 10 pm. Johnny tends to come in at 1 am. You are frequently up all night waiting for him to come home. Even though you aren’t sure he is using your anxiety and worry gets the best of you. The lack of sleep is starting to impact your life. You realize you can’t go to sleep until Johnny is “in for the night”.

At first glance the issue seems to be Johnny not coming in at a reasonable time. Your impulse may be to break off a speech about a curfew and coming in at reasonable hour. However, for a 22 year old 1 am is reasonable.

The real problem is your lack of sleep.  So the target is: “I would like to get enough sleep” NOT a random curfew for Johnny.

This changes everything. Say what you mean in this case is translated as “I NEED TO GET A DECENT NIGHT SLEEP or you won’t be able to continue to live here. Something has to change about how late you stay out”.  The details of this can actually be worked out with Johnny. Maybe this means he agrees to come in at midnight. Or maybe it means he agrees to spend the night with a positive friend rather than come home late.

Mean what you say!

“Meaning what you say” is usually about consistency between one’s words and subsequent related behavior or actions.  This is where the rubber meets the road. Meaning what you say implies that you can carry through with what ever limit you set forth when you “say what you mean”.

The most important part of this process is thinking it through before you set the boundary and discuss the limitations and associated consequences. If you make statements that you cannot carry through on your authority is significantly undermined. It is better to say nothing at all than to make an empty threat.  Of course, this is easier said than done. You need to develop ways of “pausing” before speaking on these subjects.

You also need to develop a team of people who can support in processing situations and exploring options. Parents for example, need to support one another in the decision making process. If there is disagreement around boundaries this will become a glaring problem when the boundaries are enforced. Sometimes a trusted coach or sponsor can help your family discuss these tough issues. Sometimes a therapist or counselor will be necessary. In some cases the parents will need to address deeper issues. The graphic below is meant to describe the importance of having crucial conversations regarding these underlying issues. Sometimes the “rules” and techniques (boundaries) need to wait until the foundation is shored up. For example, its hard to make sure everyone is on the same page regarding boundaries if mom thinks dad is “just not a good parent” and “does not want the best for the kid”. This will require clinical support to work through these complex issues.

In addition to parents, it is sometimes necessary to bring extended family into the discussion. Grandparents for example are intimately involved in many kid’s lives. Extended family members and friend have influence. They need to be on the same page with many of the boundaries that are set in these situations.

Furthermore, parents and extended family should discuss ways to give each other respite and support. Recovery is a process not an event. A marathon not a sprint.

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Once the boundaries are agreed upon it is important to stay involved with your support system so that you can carry through over the long term.

Even more importantly, it is important to communicate these expectations clearly to your loved one. This is where the final part of the formula comes in.

But don’t say it mean!

Addiction is a beast. It can bring out the worst in all of us. The addicted individual will engage in outrageous self destructive behaviors. Stealing, lying and manipulating may become common place. If you aren’t careful your loved one will have you believing that 2 + 2= 8.

In turn this can bring out frustration in the family. Family members can lash out in anger and say things in aggressive ways. Impulsive statements about “throwing you out” become commonplace. Clear communication is going to take an effort. There is no easy way to maintain your cool in the face of an addition related crisis. However, here are some general guidelines:

VERY IMPORTANT: KNOW YOUR TRIGGER AREAS. ASK FOR HELP WITH YOUR BLIND SPOT.

Perhaps most importantly is recognition of your “hot buttons”. If you are going into a potentially conflict laden situation gaining awareness of what gets you fired up is very important. You may need to ask for feedback from you spouse or other family members in order to identify this. Many times these issues fall into our “blind pane”. However, identifying these potential trigger areas is vital to successful communication of the boundaries.

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  • Don’t confront the person when they are under the influence. Wait until the next morning. Unless it is immediate crisis and person is danger to self or others in which case enact emergency services.
  • Rehearse the conversation.
  • Bring bullet points or a script. The addicted individual will try and get you off track and will bring up things unrelated to boundaries. Stay out of the weeds.
  • If the boundary involves outside forces (ie…the person needs to be evicted, the person needs commitment, etc…) make sure you have all the extraneous details worked out. Paperwork, phone calls to rehab, list of shelters.  Bring this to the meeting. Again, having a family coach or a group to support you in this preparation can be helpful.
  • Have the conversation when you have energy and you are not already emotionally depleted.

I want to go on the record. This is all easier said than done and none of it is an exact science. Please become involved in local support groups and seek out professional assistance as you prepare for these conversations. Managing boundaries is hard enough. Addiction makes is downright overwhelming.

Family Recovery

Family Recovery – Beyond Co-Dependency

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4 Key Principles of Family Recovery

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.  I can still hear myself saying it: “Addiction is the individual’s problem and not a family systems issue”.   Of course, I held tight to the company line of providing 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.

The truth is the majority of us in the drug and alcohol treatment field were taught that the individual was primary and family secondary.  I would argue that it remains that way to this day.  Some 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.  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 are even less likely to see the integration of family therapy.  The majority of family support takes the shape of referrals to Al-Anon 12-step groups.  If other family recovery self-help groups are available, they may be a referral source as well.  True family systems interventions remain rare and sporadic.

Remember, the industry’s perspective on the family came primarily through Al-Anon.  These groups 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 clinical services.  The latter demands a comprehensive family therapy 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”. (page 1)        

As time has passed I have placed even greater emphasis on the value of “Family Recovery”.  This has culminated in a distinct set of protocols. We have developed a process of engaging and supporting the family that has proven exceedingly useful over the past 7 years.  We have applied this Family Recovery approach 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.

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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.

Finally, 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 30 people.

 

Family Recovery

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 127 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 year in our work with families?

  • 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 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.

“A mother’s love for her child is like nothing else in the world.” 

“It knows no law, no pity, it dares all things and crushes down remorselessly all that stand in its path”

Agatha Christie

  • 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.
  • 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.
  • 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.  We will talk more about that in the future.