Understanding the Impact of Stigma

✌️Understanding the impact of stigma in the mental health and substance use disorder world(s).

I posted something the other day. It said “I had a panic attack today etc…”

After I made this post, I had these moments where I thought to myself:

“My goodness Rich … why would you post that ..”.
“What are people gonna think”?
“You’re supposed to be a leader”…
“You’re supposed to have your shit together”..

I was able to recognize these thoughts. And handle it.

Mental Health Struggles

But if that’s what I’m thinking as a provider, an advocate, a person in recovery and a professional in the field…. imagine what people in “regular” professions without the awareness and education think…

I learn about this stuff constantly. And I know that mental health struggles are the rule, not the exception. Yet I still get up in my head.

Maybe it’s just me. And the rest of you have it in check… but I think the stigma around these issue is so strong.

Unconsciously impacting us. Scripts of inferiority running through our minds.

The Same Secrets

The solution, the way I see it, is not a well orchestrated public relations campaign on mental health awareness and/or substance use disorders.

That certainly helps. But the solution is… We all talk about it!!!

It becomes commonplace and routine topic. As they say…

The big secret is. We all have the same secrets.

The post The Impact of Stigma appeared first on The Recovery Cartel.

Hard Working & Solid

There are many good people working hard to provide solid mental health and substance use therapy and coaching.

There are tried and true therapeutic interventions.

The “self-care” list is pretty consistent, containing the standard stress management tips and mental health hygiene recommendations.

For example, this is list on the CDC website:

Ways to cope with stress:

• Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
• Take care of your body. Take deep breaths, stretch, or meditate
• Try to eat healthy, well-balanced meals.
• Exercise regularly, get plenty of sleep.
• Avoid alcohol and drugs.
• Make time to unwind. Try to do some other activities you enjoy.
• Connect with others. Talk with people you trust about your concerns and how you are feeling”.

You can check it out yourself, but every list is basically some form of that CDC list.

Check out Psychology Today. Virtually identical.

No one can argue with those recommendations. However, I vow to work hard to discuss things that are different than that basic list.

I will not say the same thing that all the other providers/experts say.

I will add something different. Or at least I will try to add something different.

Tonight’s Recommendation:

1. Create a Firewall

Create a firewall between work and “home time”. Today I spent 13 hours with zoom meetings packed one after the other, conference calls, FaceTime news interview.

With only small slivers of time in between the calls/zoom meetings.

And then all the sudden BOOM !

The day is over. And I’m home.

2. Ritual & Routine

I recommend you create some type of ritual and routine that marks the end of work and the beginning of home time.

Analogous to someone coming home from manual labor.

Your hands are dirty, your clothes are dirty. You wash your hands, you change your clothes for obvious reasons.

However, this also serves as a transition from work to home.

3. Consistently

Figure out some type of routine that fits your individual circumstances.

Change clothes. Take some time alone. Communicate the plan to your family.

Maybe you go for a run.

Maybe you sit down and journal.

The important thing is to follow this routine consistently.

Otherwise, it won’t be a routine.

The post Rich Jones Recommendations appeared first on The Recovery Cartel.

Tragic Optimism

Reality can sometimes be extremely uncomfortable. For example, I have witnessed institutional and community denial and mismanagement of Substance Use Disorders for decades.

Resulting horrific outcomes. Yet change is aggressively resisted.

People are pretty good at putting a positive spin on a pretty shitty situation.

When you take a more realistic stance you are a trouble-maker. A pessimist. A buzz-kill.

Victor Frankl talked about “tragic optimism”.

Not the pie in the sky “everything is going to be okay” optimism.

Rather, reality based assessment of the situation followed by an operating system that says:

• Yes, things CAN get better and we CAN get through this.
• It is possible.
• There is hope.
• But it’s going to take monumental effort.
• And it’s going to require some really difficult decisions and crucial conversations.

Social psychology tells us these situations progress along a pretty predictable timeline.

A Sentinel Event occurs (911, 2008 financial crisis, COVID19, OR a more localized tragedy/event).

Sentinel Event

Things UNFOLD:

1) Initially, people are stunned and in shock.

2) People may even be energized by the adrenaline rush associated with such a dramatic and threatening situation.

3) Some people may even be excited. Everything is closed. Like a “snow day” from school. That is naive and it wears off quick. People say things like “time to catch up on some reading and complete some projects around the house…” I do not understand such thinking. I can not accept that position. However, it is relatively common.

Fear & Anxiety

4) In terms of work and the economy, the fear and anxiety may set in quickly. Depends on your circumstances. If you have a family you probably start spinning up pretty quick. The uncertainty is hard to reconcile. You are worried. At the same time, some people will be apathetic and indifferent until they are forced to take notice.

5) People double down on their “preferred interpretation” of the situation AND begin to vigorously defend said interpretation. In this particular case of COVID-19 it goes like this

• If you hate Trump. This is more of a reason to hate Trump.
• You need to make sure you take every conversation about the virus and turn it into an indictment of Trump.
• If you love Trump then you want to make sure you repeatedly state “things are not that bad. We should not even have this lock-down. More people die from the flu” etc…

6) In the meantime, some people know that they do not know. Some prefer to not make statements without a relatively high level of confidence in the accuracy and truth of the position. In this case, there are limited sources of objective information. There are preferred sources. Remove the middleman as much as possible.

7) As time goes by the tensions and concerns mentioned above will become more pronounced.

Calm Waters

An intervention or external circumstance can sometimes calm the waters.

8) In this case, the stimulus will help calm these waters. The stimulus, especially support for small business and support to bridge payroll and unemployment insurance. That will help ease the pain.

9) The recovery community will experience a similar progression of emotions and reactions. Online meetings will continue but enthusiasm is likely to wane. Again, the early “adrenaline rush” will be replaced by the mundane day to day reality of “cyber life”.

10) There will be ongoing decision points. On an individual level, a family level and an organizational level. There will be roller coaster of emotions. There will be difficult decisions along the way.

11) On an individual level, a family level, a community level, an organizational level, a business level and a societal level. We will need to make some bold move and there will be some unpopular decisions made.

We Will Get Through This

There is no question, we will get through this.

But if you think its going to be easy you need to think again.

Time to focus. Time to get to work. Keep moving forward and keep pushing.

Do all you can with all you have to help keep your tragic optimism in control. And…

Some Hints

1) Take time in the morning to calm your mind. Don’t jump on your phone right away to check the headlines. All bad.
2) Go outside for a walk.
3) Listen to music. Late 80’s / early 90’s east coast rap. Or whatever you are into.
4) Laugh: YouTube videos of cute kittens and shit like that.
5) Start a journal. Get your thoughts out of your head.
6) PHYSICALLY take care of yourself. I’ve stopped eating Zingers….
7) If so inclined, pray… Pray.

That’s all for today. Love each other, Rich Jones | Recovery Cartel

The post Tragic Optimism & COVID-19 appeared first on The Recovery Cartel.

Cultural Crisis…Seismic Societal Shift

It’s generally accepted that deaths of despair (suicide, overdose) and related issues are the result of a fundamental cultural crisis. Or perhaps the more optimistic view; that it’s a societal shift or transition. Not a crisis.

Either way, we know that everything is changing and many of the traditional institutions of society are proving inadequate.

This includes healthcare and certainly behavioral healthcare (counseling, therapy, treatment, mental health, substance use disorder).

The “institutions of behavioral health” are not immune to this upheaval.

Therapy & Coaching

In the future the fundamentals of therapy and coaching will be redefined.

The therapeutic hour will be delivered/distributed via “touches” that are shorter in duration and higher in frequency.

87% of people prefer asynchronous communication (text primarily) over face to face and/or phone.

Gen Z (born after 1996) will most certainly prefer this approach.

Actually, everyone will prefer this approach.

The Nature of Things

This new model will become the primary approach leading to the dismantling of traditional office based mental health and SUD services.

This new approach will be shown to be exponentially more effective than traditional office based/inpatient services.

This will be the beginning of massive shifts in the helping professions that will arise alongside the inevitable societal shifts on the horizon.

We know this to be the case as it is the nature of things.

It’s the cycle. It’s inevitable. The time is near.

A brave new world awaits.

I hope we don’t lose an entire generation in the meantime.

The post A Brave New World Awaits Us appeared first on The Recovery Cartel.

JUST SAY NO, Again by Richard Jones

Understanding the process of human behavior change is a difficult thing for most of us.  We are conditioned by cultural messages of “pull yourself up by your bootstraps” and “ just do it ”.

Our heroes are often people who overcame great odds through sheer will and determination.  Motivational speakers rip us a new one and tell us to get up earlier and never give in.  Self-help gurus tell us that self-talk and surrounding ourselves with the just the “right people” will make the change stick.

They tell us to bring our game to a new level.  Of course, there is some truth to all these things.

However, in reality behavior change is a complex process that varies from person to person. It is especially ironic that behavior change is so misunderstood by the general public; given the fact psychologists know quite a bit about human behavior change.

Neurobiology of Addiction

The issue of behavior change is even more pronounced where addiction is concerned; given the neurobiology and brain change associated with this issue.

Addiction adds fuel to the existing ambivalence around changing substance use behavior.  The individual is impaired and just “not thinking straight” and this makes the change even more difficult.

With the best of intentions we will confront people in addiction and offer advice.  We demand they change and push remedies and solutions. We do this because we want to help.  It is very natural and it is know as “the righting reflex”.

However, in the overwhelming majority of cases our efforts to influence change produce the exact opposite of the stated intent.

Instead of driving the person toward recovery, these efforts drive the person deeper into the behavior.

When you argue with someone about the seriousness of their substance misuse issue they argue back.

As they argue back and debate their position it reinforces the “rightness” of their position.  The more we say something out loud the more we believe it.

Understanding the Righting Reflex

In terms of behavior change the righting reflex is the “common human tendency to try and make things right”.

You are out with your girlfriend and she is talking about her toxic relationship with her mother.  She is going on and on about “every phone call turning bad”.  You can tell she is upset.

You care for your girlfriend.  So you offer some unsolicited (obvious) advice:  “Why don’t you just hang up on her the next time she starts in on you”.

Your girlfriend instantly looks at you like you are a monster from the Texas Chainsaw Massacre series.

She tells you “I can NOT BELIEVE HOW INSENSITIVE YOU ARE”….and then she immediately rushes home and calls her mom to report your behavior, pounds a carton of ice-cream, and spends the night bashing you.  Her mother joins in for good measure.  It turns into a memorable night.

Although the above situation may be humorous, the scenario with addiction is dead serious.

Addiction is a Brain Disease

Remember addiction is a brain disease that makes processing, analyzing, and integrating information very difficult.  We are predisposed to defend our addiction and justify our actions and are primed for an argument.

We will debate you to death if it means we can hang onto our substance use.  When someone approaches us with instructions, unsolicited advice, or confrontational statements we will enter into fight or flight and it is unlikely we assimilate anything that is said.

 Note: This does not mean you ignore bad behavior. This means you convey your boundaries and plan your intervention in a strategic way. You avoid the arguments and stick to your expectations and the associated bottom lines.  Mean what you say, say what you mean, but don’t say it mean. 

Theory of Change:

People change for a wide variety of factors. Many times, I would argue most times, these factors are not the obvious factors.

For example, we say to ourselves “you would think Rich would quit drinking given the fact he is going to lose his job”.  What we don’t know is the value Rich places on his job and the impact this may have on him.

Unfortunately, the same could be said for the threat of lost marriages or losing custody of children.  Even the threat of jail leaves many un-phased.

However, I believe in the human spirit. I believe all people, no matter how low they have been using, have desires and values they hold dear.

They may not be able to access this easily as it is buried under layers of guilt, remorse, shame, and learned helplessness.  But it is there.  The good is there and their personal values are there.

Change will arise when the tension between your stated values and your current behaviors becomes unbearable.

If I value my family or believe my family is important and I become aware that using is detrimental to my family and I continue to use; the internal tension can provoke change.

IF I AM ABLE TO GET IN TOUCH WITH THAT TENSION.

Use to Avoid the Tension and Pain

Many times, we will run from that tension and use to avoid the tension or numb the emotional pain.

This is where interventions, support groups and professional support can help the person access his or her true nature. The internal tension between stated values and behavioral reality is called COGNITIVE DISSONANCE.

We will also “argue with ourselves” regarding these beliefs or values and the supporting information.  Also, we can talk ourselves out of the dissonance.  We can question our own reality.

This is very pronounced where addiction is concerned.

We believe that the essence of coaching and counseling is facilitating a trusting relationship with the person in need.

If we have a relationship we can process events, explore behaviors, and highlight the existing tensions.

If I break out into a speech along the lines of “change or die” I am highly unlikely to ever see the person again.  He or she will isolate and continue to talk themselves out of the need for change.

We believe it is much better outcome to keep a connection.

We also believe that the process of change is accelerated in the context of a therapeutic relationship.

Obviously, it is difficult for family members or friends to provide that therapeutic relationship. Finding competent supports for the individual in need is essential to the process.

However, family members and friends can develop a realistic view of what works in behavior change. This awareness may save you a bunch of time, energy and emotion.  Be strategic about supporting behavior change.

Deliver Boundaries and Information

Deliver Boundaries and Information In a Matter of Fact/Calm Manner. Perhaps the best thing family members can do is to provide clear and consistent information and boundaries around the substance use.  Try to deliver the information and expectations in a rational non-emotional way.

There are generally accepted “stages of change”.  Many times, we will act as if the person is in “preparation” or “action” when they are actually in pre-contemplation or contemplation.  If we move faster than the person in need we will sabotage the process.

None of this is easy and everyone makes mistakes.  It’s an emotionally laden experience and many times we will not think before we speak.  Just remember your main goal is to move the process along.

Sometimes this requires a calm approach when you feel compelled toward a more confrontation process.

Come see us soon at FAVOR Greenville family groups or check out my live stream…

The post JUST SAY NO TO JUST SAY NO… appeared first on The Recovery Cartel.

Understanding behavior change

Understanding the process of human behavior change is a difficult thing for most of us. We are conditioned by cultural messages of “pull yourself up by your boot straps” and “just do it”.

Our heroes are often people who overcame great odds through shear will and determination.  Motivational speakers rip us a new one and tell us to get up earlier and never give in.  Self-help gurus tell us that self-talk and surrounding ourselves with the “right people” will make the change stick.

They tell us to bring our game to a new level.  Of course, there is some truth to all these things.  However, in reality, it is a complex process that varies from person to person. It is especially ironic that behavior change is so misunderstood given the fact we know and understand quite a bit about human behavioral change.

The issue of behavior change is even more pronounced given the neuro-biology of addiction. Addiction adds fuel to the existing ambivalence around changing substance use behavior.  The individual is impaired or, “not thinking straight” and this makes the change even more difficult.

With the best of intentions we will confront people in addiction and offer advice.  We demand they change.  We push remedies and solutions. We do this because we want to help.  It is very natural and it is known as the righting reflex.  However, in the overwhelming majority of cases our efforts to influence change produce the exact opposite of the stated intent.

Instead of driving the person toward recovery, these efforts drive the person deeper into the behavior.  When you argue with someone about the seriousness of their substance misuse issue they argue back.  As they argue back and debate their position it reinforces the “rightness” of their position.  The more we say something out loud the more we believe it.

 UNDERSTANDING THE RIGHTING REFLEX:    

In terms of behavior change the righting reflex is the “common human tendency to try and make things right”.  You are out with your girlfriend and she is talking about her toxic relationship with her mother.  She is going on and on about “every phone call turning bad”.

You can tell she is upset. You care for your girlfriend.  So you offer some unsolicited (obvious) advice:

“Why don’t you just hang up on her the next time she starts in on you”.

Your girlfriend instantly looks at you like you are a monster from the Texas Chainsaw Massacre series.

She tells you “I can NOT BELIEVE HOW INSENSITIVE YOU ARE”

….and then she immediately rushes home and calls her mom to report your behavior, pounds a carton of ice-cream, and spends the night bashing you with her mother joining in along the way.

Although the above situation may be humorous, the scenario with addiction is dead serious.

Remember addiction is a brain disease that makes processing, analyzing, and integrating information even more difficult.  We are pre-disposed to defend our addiction and justify our actions.  We are primed for an argument.

We will debate you to death if it means we can hang onto our substance use.  When someone approaches us with instructions, unsolicited advice, or confrontational statements we will enter into fight or flight and it is unlikely we assimilate anything that is said.

 Note: This does not mean you ignore bad behavior. This means you convey your boundaries and plan your intervention in a strategic way. You avoid the arguments and stick to your expectations and the associated bottom lines. 

Mean what you say, say what you mean, 

but don’t say it mean. 

Theory of Change: People change for a wide variety of factors. Many times, I would argue most times, these factors are not the obvious factors.  For example, we say to ourselves “you would think Rich would quit drinking given the fact he is going to lose his job”.

What we don’t know is the value Rich places on his job and the impact this may have on him.  Unfortunately, the same could be said for the threat of lost marriages or losing custody of children.  Even the threat of jail leaves many unphased.

However, I believe in the human spirit.  I believe all people, no matter how low they have gone, have desires and values they hold dear.  They may not be able to access this easily as it is buried under layers of guilt, remorse, shame, and learned helplessness.  But it is there.

The good is there and their personal values are there.  Change will arise when the tension between your stated values and your current behaviors becomes unbearable.

If I value my family or believe my family is important and I become aware that using is detrimental to my family and I continue to use; the internal tension can provoke change.  IF I AM ABLE TO GET IN TOUCH WITH THAT TENSION.

Many times, we will run from that tension and use to avoid the tension or numb the emotional pain.  This is where interventions, support groups and professional support can help the person access his or her true nature.

The internal tension between stated values and behavioral reality is known as COGNITIVE DISSONANCE.

We will also “argue with ourselves” regarding these beliefs or values and the supporting information.  We can talk ourselves out of the dissonance.  We can question our own reality.  This is very pronounced where addiction is concerned.

We believe that the essence of coaching and counseling is facilitating a trusting relationship with the person in need.  If we have a relationship we can process events, explore behaviors, and highlight the existing tensions.

If I break out into a speech along the lines of “change or die” I am highly unlikely to ever see the person again.  He or she will isolate and continue to talk themselves out of the need for change.  We believe it is much better outcome to keep a connection.  We also believe that the process of change is accelerated in the context of a therapeutic relationship.

Obviously, it is difficult for family members or friends to provide that therapeutic relationship. Finding competent supports for the individual in need is essential to the process.  However, family members and friends can develop a realistic view of what works in behavior change. This awareness may save you a bunch of time, energy and emotion.  Be strategic about supporting behavior change.

Deliver Boundaries and Information In a Matter of Fact/Calm Manner:  Perhaps the best thing family members can do is to provide clear and consistent information and boundaries around the substance use.  Try to deliver the information and expectations in a rational non-emotional way.

There are generally accepted “stages of change”.  Many times, we will act as if the person is in “preparation” or “action” when they are actually in pre-contemplation or contemplation.  If we move faster than the person in need we will sabotage the process.

None of this is easy and everyone makes mistakes.  It’s an emotionally laden experience and many times we will not think before we speak.  Just remember your main goal is to move the process along.  Sometimes this requires a calm approach when you feel compelled toward a more confrontation process.

Come see us soon at FAVOR Greenville family groups or check out my live stream…

The post Behavior Change -Truth and Understanding… appeared first on The Recovery Cartel.

As many of you know I am drawn to alternative approaches to counseling and drug and alcohol rehabilitation. A very popular approach for “young people” is wilderness therapy. I believe the expansion of this modality could benefit many people; regardless of their age.

I am recycling a research paper from grad school in effort to stimulate some reflection on the utility of “wilderness therapy”. This paper will focus on wilderness and adventure based experiential therapy.

On the surface this appears to be a very broad topic area.  There are many descriptions and definitions of this type of experience.  Russell (2001) uses challenge courses, adventure based therapy, wilderness experience programs, and wilderness therapy as examples of a process where activity and experience are utilized to affect positive change in individuals.

One could broaden this even further and include wilderness base camping under this umbrella.  It is necessary to acknowledge all these titles in order to provide a comprehensive exposition.  At the same time, it seems appropriate to narrow my focus on a unifying description or name of the approach I will be exploring.

To this end I will utilize “adventure therapy” (Berman & Davis-Berman, 2001) as the base that guides this exploration.  I will seek to establish a clear definition of adventure therapy.

It is important that this delineation takes into consideration “the considerable debate” (Itin, 2001) that exists related to adventure therapy.  This requires an examination of the historical foundations of wilderness programming so that a framework for the debate can be established.  I will include an investigation into the qualities of staff and programs which employ adventure therapy as a means of more fully illuminating adventure therapy.

An important aspect of this essay includes a thorough review of the theoretical underpinnings of adventure therapy.  In addition, I will explore counseling theories and approaches which are applicable to adventure therapy.  Finally, I will use this forum as an opportunity to explore my reactions and position where adventure therapy is concerned.  I intend to propose a framework appropriate to adventure therapy that did not appear in the literature (stages of change theory).

“The use of adventure experiences as a programming tool formally began in the 1940s” (Priest & Gass, 2005).  Furthermore, the importance of experience in the arena of learning and human growth can be traced to the philosophy of Plato and Aristotle who championed experience as the answer to the question, “How can we best learn or teach?” (Kraft & Sakoss, 1985).

Therefore, we can see that the concept of experience, mentoring and on the job learning has existed within human culture for centuries.  However, experiential programming as it is known today finds its roots in the 1930’s and 1940’s with the development and promotion of the “Hahnian approach” which ultimately resulted in the establishment of Outward Bound.

Kurt Hahn became interested in the “social diseases or declines that he believed were causing individuals within society to lose certain positive attributes” (Nicholas, 2008).  Nicholas (2008) enumerates these societal ills along the following lines: a decline in physical fitness due to modern methods of transportation, a decline in initiative or enterprise due to a social tendency towards being a spectator rather than a participator, a decline in the individual’s memory and imagination because of confusion and restlessness in modern life, a decline in skills and care because traditions of craftsmanship had diminished, a decline in self-discipline from an over-reliance on ubiquitous stimulants and tranquilizers, and a decline in human compassion because of the hurried lifestyle inherent to a modern lifestyle.

In response to this Hahn began Outward Bound as a program for youth, many of whom were destined for the armed services (Priest & Gass, 2005).  Hahn and his colleagues designed physically and mentally challenging courses that encouraged the youth involved to push themselves and work together toward identified goals.

Original Outward Bound courses included orienteering, search and rescue training, athletics, small-boat sailing, ocean and mountain expeditions, obstacle-course training and service to the local communities (Miner as cited in Priest & Gass, 2005).

Today’s Outward Bound programming has become even more varied and includes “long wilderness courses, urban education programs, short intense challenge training’s, or even custom courses designed to the needs of the client” (Nicholas, 2008).

Outward Bound does not equal adventure therapy, however, it has been widely accepted as the foundation of the movement that has lead to adventure therapy’s growth.  In addition, much of the philosophical foundation of Outward Bound can be generalized to adventure therapy and wilderness experience programs.

It is clear that Hahn felt that the in the moment experience associated with challenging outdoor activities could provide a way to overcome many of the ills of society.  Although he did not articulate this in a systematic clinical manner it is evident that his position is very similar to the foundations which exist today regarding the experiential framework of adventure therapy.

Over time Outward Bound expanded and other outdoor based programs took root.  These programs included the National Outdoor Leadership School (NOLS) established in 1965, Project Adventure established in 1971, and the Wilderness Education Association established in 1977 (Nicholas, 2008).

Nicholas (2008) reports that there were over 190 adventure based programs in the United States by the mid nineteen seventies.  These programs were established to provide various services including “therapy, recreation, and education” (Attariran as cited in Nicholas, 2008).  Despite the diversity of the mission there remained the underlying principle of outdoor, experiential based interventions as a means of initiating positive change.

Another noteworthy development in the wilderness programming realm was the development and formalization of wilderness base camping as a means of helping at risk youth.  Again, the challenge and intensity of the experience is the focal point of the process.  However, wilderness base camping involves the added dimension of daily residential life in a wilderness setting.

This provides incredible opportunity for activity intensive experiences, ranging from construction of living facilities to recreational activities and educational responsibilities.  This is accomplished through an intimate and intense group process: “The heart of wilderness camping is the structure of small groups process in the out-of-doors” (WRTCA).

Wilderness base camping provides a ready example of the processes deemed helpful in the area of outdoor programming.  In addition to the here and now experience, examples of these benefits include increase in self-worth, improved problem-solving, improved social judgment and interpersonal skills, and increased assertiveness and leadership skills which can be generalized to resisting negative peer influences.

Although wilderness experience programs cannot be distilled merely to Outward Bound and Wilderness Base Camping models alone, these paradigms provide a useful framework for understanding wilderness experience programs in general.

As previously mentioned, the experience is a fundamental and essential aspect of all wilderness experience programs.  It seems appropriate to discuss this aspect of the process in more depth.  The concept of experience is not unique to wilderness programming.

Many therapeutic and educational approaches promote the power of the experience.  In the case of education this is seen as a pragmatic and productive manner of working with students.  The idea of experiential education can be traced back to John Dewey who proposed that “subject matter should not be learned in isolation and that education should begin with student experience and should be contextual” (Breunig as cited in Nicholas, 2008).

Related to clinical underpinnings one need look no further than Fritz Perls and gestalt therapy to see the centrality of the experience in the therapeutic process.  Wagner-Moore (2004) describes the “processes underlying gestalt” as the “experience/contact cycle”.  The gestalt therapist provides a setting where the client is challenged to confront “unfinished business” with the intent of creating a here and now experience that is then processed by the therapist (Wagner-Moore, 2004).

The result is increased awareness and insight.  What is important for the gestalt therapist is processing what is happening right now rather than discussing what may have happened in the past.  This is very similar to the goal of the adventure therapist.  Different techniques (ie…physically and emotionally challenging outdoor programming) are utilized to create “client disequilibrium” (Fletcher & Hinkle, 2002).

This disequilibrium can be thought of as “a state of dissonance (which) is crucial for client change” (Fletcher & Hinkle, 2002).  A common term associated with this eventuality is “taking a client out of his or her comfort zone” (Fletcher & Hinkle, 2002).  Many times this situation provides an opportunity for the adventure therapist to use the here and now experience to encourage increased awareness, insight and possible change.

In addition to gestalt theory there are other clinical applications that should be discussed related to adventure therapy.  On its most basic level adventure therapy involves both individual and group sessions.  Individual sessions involved one-to-one interaction centering on the task at hand and the associated issues.  The adventure therapist needs to be able to develop trust to facilitate a productive therapeutic relationship much the way a traditional therapist does.

However, it should be noted that there are unique aspects associated with the therapeutic relationship.  For example, the amount of time and intensity of experience challenges the traditional view of professional boundaries (Fletcher & Hinkle, 2002).  “The primary individual counseling theories are cognitive, rational emotive, and reality” (Fletcher & Hinkle, 2002).

Fletcher and Hinkle (2002) explore the details of these theories as they play out in adventure therapy: cognitive theory use the adventure experience to highlight cognitive processes and the resultant feelings and behaviors which manifest themselves through interactions and self-talk; rational emotive theory takes center stage related to apparent danger associated with the experiential activity which can be used to challenge the client regarding existing perceptions of real versus perceived risk; reality therapy capitalizes on the natural and logical consequences which are ever-present in the adventure based activity.

At is core, however, adventure therapy relies on the experience in itself as the catalyst to raise awareness and insight and influence change. In most cases the modality of service delivery is group sessions.  The group is central to the experience.

The adventure therapist usually leads a group through the expedition or trek and typical group issues are magnified through the out-door setting.  Groups typically progress through clear stages which have been identified in a variety of ways.

One of the most useful has been developed by Tuckman and Jensen in 1977 (Priest & Gass, 2005).  Tuckman and Jansen used the following to describe group development:  forming is characterized by the discomforts, concerns, feelings, and doubts group members experience in a new group.

This is the initial stage of group formation; storming follows and occurs when members begin to question the group process and authority of the group.  There is growing comfort but overall the group remains unstable and potentially volatile; norming involves the establishment of appropriate and necessary standards for the group.

There is a greater sense of order and the members are generally comfortable with each other; performing arises when the group is focused on the task at hand.  Members concentrate on mutual support and the group is becoming very productive; adjourning involves closure and the end of the group.

Adjourning is also a period where the group can become restless as they struggle with appropriately closing relationships (Priest & Gass, 2005).  The experiential group provides extensive content and process opportunities for the effective facilitator.

At the same time the challenge inherent in the expeditionary aspect of adventure therapy requires a facilitator who can address and utilize the inevitable crisis states that may arise.  “Catching members in the act breaks the cycle of behavior, thoughts, and feelings by increasing awareness.  Awareness is the necessary precursor to change.  Awareness and insight are the goals attributed to group counseling experiences” (Corey as cited in Hill, 2007).

The wilderness experience and the associated stress and challenges provides innumerate situations that allow important issues to be highlighted: (1) here is what your behavior is, (2) here is how your behavior makes others feel, (3) here is how your behavior influences others’ perceptions of you, and (4) are you satisfied with the world you have created (Corey as cited in Hill, 2007).

The therapeutic factors that have been identified with group counseling include universality, altruism, group cohesiveness, and interpersonal and vicarious learning (Yalom, 1985).  It is clear how these elements can be translated to adventure therapy.

For example, during a trek everyone is equally involved in the expedition.  All share the same goal and responsibilities.  Everyone is truly in the experience together; it equals the playing field.  Another example, this one related to altruism, concerns the multitude of opportunities to assist other members.  One member may offer to share his or her water or assist in carrying a pack up a steep incline.

An effective adventure therapist will highlight all these occurrences as they arise.  Family counseling models have also been applied to adventure therapy (Fletcher & Hinkle, 2002).  Structural (Minuchin, 1974), strategic (Haley, 1987; Madenes, 1978), and systemic (Bowen, 1978) all have aspects that can be integrated into adventure therapy.

Structural theory drives assessment and restructuring the group’s transactional patterns, systems perspectives recognize that the individual’s actions influences the larger group or system, and strategic theory informs the use of intentional and planned activities to address presenting issues and concerns in the group process (Fletcher & Hinkle, 2002).

In addition to the clinical foundation an effective adventure therapist must have hard or “technical” skills (Priest & Gass, 2005).  This refers to the ability to manage the group in the wilderness and ensure the safety of all involved.  Priest and Gass (2005) conceptualize these technical skills on the generic and meta-skill level and clarify that the hard skills must be distilled down to the details related to each specific adventure activity.

For example, issues of risk management that apply to all adventure activities include weather interpretation, first aid, trip planning, physical fitness and mental awareness (Priest & Gass, 2005).   An adventure therapist must also have good leadership, problem-solving, decision making, ethical behavior, effective communication skills and experience based judgment (Priest & Gass, 2005).

These attributes apply across all the various experiential activities.  Examples of skills that apply to specific experiences include understanding and negotiating river crossings during back-packing outings, understanding movement techniques, chimneying, and counterforce belaying in top-rope climbing, and knowing snow climbing techniques for mountaineering (Priest & Gass, 2005).

What then constitutes a comprehensive and efficacious definition of adventure therapy?  This is a difficult question to answer as so much falls under the purview of adventure therapy.   The most effective manner of defining adventure involves a three level exploration.

On one level I will evaluate adventure therapy in comparison to other “wilderness experience programs” (Russell, 2001).  Secondly, I will explore adventure therapy as it relates to identified clients, approaches utilized, and intended outcomes (Itin, 2001).  Finally, I will address the characteristics of therapists and programs and associated issues such as degree held, certification and accreditation as a means of further differentiating adventure therapy from other outdoor experiences (Priest & Gass, 2005).

Adventure therapy can be understood when taken in context with other wilderness  experience programs (WEPs). These WEPs range from Outward Bound experiences to boot camps (Russell, 2001) and provide an opportunity to examine the differences across clearly defined domains.  Among these domains, Russell (2001) includes key components and wilderness dependency.  “Key components” refers to the elements that are required for a program to be considered adventure therapy.

“Wilderness dependency” is related to where the intervention must be delivered (Russell, 2001).  In the end there is a level of subjectivity associated with establishing a definition of adventure therapy.  At a certain point one must choose between the different positions in each domain.

Adventure therapy differs from other WEPs in many ways.  Key components of adventure therapy include the use of planned expeditions with the intention of challenging small groups as they move from place to place in a self-sufficient manner.  Examples of expeditions include back-packing, canoeing, rock climbing and caving (Crisp as cited in Russell, 2001).

Adventure therapy utilizes clinical assessment in the process of selecting candidates for involvement, treatment planning is part of the programming, and the provision of group facilitation is conducted by qualified professionals (Davis-Berman & Berman as cited in Russell, 2001).  Russell (2001) also cites the following unique aspects of adventure therapy.

Adventure therapy programs are licensed when appropriate and possible and the program is supervised by licensed practitioners.  The clients have contact with licensed therapists in group and/or individual sessions.  The adventure therapy program has staff which specialize in clinical areas (for example substance abuse counselors) and staff which are trained in managing the specific population they serve.  It is not necessary that all staff are trained and certified clinically but the program must be managed by such staff.  The appropriate degree and certification depends on the clientele being served.

The adventure therapy profession has not defined specific degrees required for service delivery.  The existing requirements for credentialing in the behavioral fields should be generalized to adventure therapy.  For example, if the adventure therapist is working with substance abuse clients in the state of Pennsylvania he or she should hold a degree and certification consistent with the regulations of the Pennsylvania Department of Health Bureau of Drug and Alcohol Program Licensure staffing requirements.

Wilderness dependency is an interesting question.  For purposes of my definition adventure therapy must take place in the outdoors.  The naturally occurring events involved with being in the wilderness provide the bedrock of adventure therapy.  Clientele appropriate for involvement in adventure therapy vary widely.

The most common group targeted for adventure therapy is “at risk youth” or adolescents with emotional and behavioral problems.  However, the Association for Experiential Education (1998) in the publication Exploring the Boundaries of Adventure Therapy: International Perspectives provides a more comprehensive account of clientele appropriate for involvement in adventure therapy.  These include “offenders and sexual perpetrators, mental health concerns, and families” (Association for Experiential Education, 1998).

Substance abusing clients and victims of abuse, trauma and disease have also been identified as appropriate for adventure therapy (Fletcher & Hinkle, 2002).

It is easy to see that defining adventure therapy is a difficult task.  However, I will boil it down to the following elements.  Adventure therapy must include a clinical component, at the very least at the level of supervision, preferably at the level of direct practitioner.

Adventure therapy must operate within an articulated framework and the experiences must intentionally target a desired goal and change.  This necessitates assessment and treatment planning.  Adventure therapy is appropriate for a variety of clients whom would typically be served in traditional settings.

Staff facilitating the experience should meet staffing requirements consistent with the realm in which the program operates.  Finding qualified adventure therapists is a challenge.  The ideal candidate has the education, training, and qualifications to provide clinical services and wilderness experience that ensures the safety of all involved.  This is an uncommon combination.  It represents an ideal and programs should work toward this ideal.

Choosing adventure therapy as a topic for my paper was not a difficult decision.  Due to my professional experiences I have come to embrace adventure therapy.

I am the director of an inpatient drug and alcohol rehabilitation center for court ordered youth.  I am responsible for the on campus delivery of services.  However, these clients also participate in expeditions while they are in the program.

This element of the program is supervised by another director who has a background as an adventure therapist.  He meets all of the expectations described above and is very accomplished in the area of adventure therapy.  My involvement in the process includes selection of candidates for the expeditions, clinical supervision of the wilderness addiction counselors, establishment and review of goals pre-trip, and review of progress/concerns post-trip.

I have participated in tripping (expeditions) on a very limited scale.  However, I am very supportive of the experiential part of the program.  I have seen the positive results of adventure therapy in many clients.  Examining the topic of adventure therapy in more detail has only reinforced my position.  Along with course content, writing this paper has opened my eyes to aspects of adventure therapy that I was unaware of.

For example, an understanding of the theoretical orientations and foundations of adventure therapy has been very helpful.  At best the uninformed believe that adventure activities are positive and beneficial to those involved; at worst they equate it with boot camps and view adventure therapy as a punitive way of dealing with problematic youth.  Rarely is adventure therapy viewed as a true clinical intervention.

Having the ability to cite the ways in which well established therapeutic theory applies to adventure therapy helps in clarifying these claims.  As I dug into the existing research and literature the same counseling theories came to the surface; cognitive approaches, behavioral/reinforcement, rational emotive, reality therapy, family systems, and gestalt theory.

These theories are widely accepted in the therapeutic world and bring legitimacy to the practice of adventure therapy.  Researching this topic provides me with the basics for articulating the clinical benefits of adventure therapy.

At this point I would like to discuss a theoretical orientation that did not appear in the literature.  However, it provides a structure that seems to fit well with adventure therapy.  Stages of change theory (SOC), as developed by Prochaska and DiClemente appeared in prominence in the early 1980’s (Connors, Donovan, DiClemente, 2004).

Although the details of SOC are beyond the scope of this paper I will describe the fundamentals.  SOC holds that, when it comes to changing a problem behavior, people go through identifiable stages.  Furthermore, there are interventions and approaches that are more or less appropriate dependent of the assessed stage of change.

By maximize the use of appropriate interventions the clinician can help move a person through these stages toward a lasting behavior change.  Connors, Donovan, and DiClemente (2005) identify these stages as pre-contemplation, contemplation, preparation, action and maintenance.  Within each of these stages there are change processes that are either behavioral in nature, experiential in nature, or contain both behavioral and experiential elements.  This is where the application of SOC is most appropriate.

Behavioral processes involve things that a client can do to develop and support change.  For example, a client can attend 12-step meetings to support long term recovery and this falls under the behavioral process of “helping relationships” (Connors et al., 2005).  Experiential processes describe events or experiences that precipitate and promote the change.  For example, a client may receive feedback from peers during a group that forces him to take a honest look at his past behavior leading to a revelation that increases desire to change.  This experience falls under the experiential process of “self re-evaluation” (Connors et al., 2005).

The behavioral processes are as follows (Prochaska as cited in Connors, et al, 2005): stimulus control, helping relationships, counter conditioning, reinforcement management, and self liberation.  Adventure therapy could be viewed through this lens.  For example, for a chemically dependent client participation in the activity or expedition could access the behavioral process of counter conditioning as the client experiences a substitute activity that does not involve the use of substances.

Reinforcement management is applicable when rewards are accented to support positive efforts toward change and these types of opportunities arise daily during expeditions.  Experiential processes are even more prevalent.  These include (Prochaska as cited in Connors et al, 2005) consciousness raising, dramatic relief, environmental re-evaluation, social liberation, and self re-evaluation.

During a typical trekking experience the client will be stressed and challenged.  The resultant state of “disequilibrium” (Fletcher & Hinkle, 2002) promotes dramatic relief which is defined as reacting emotionally and having a cathartic experience.  The intimacy of the group provides ample opportunities for social liberation which occurs when the client realizes that society may support a change in his or her behavior because the group supports the change.  One could take each individual processes of change describe by Prochaska (as cited in Connors et al, 2005) and make a case that highlights it applicability to adventure therapy.

On a personal note, I will be participating in my initial trek June 10, 2009 thru June 17, 2009.

This will be a float trip in the back country of Canada.  We will put in at Lake Ogaseanane and make our way to into the interior of the nature reserve.  The location is in western Quebec near Kippawa.

I am staying out for a week only and it is likely that the group will remain longer.  I am, after all, a beginner.

I am doing this with very seasoned staff and I am looking forwarding to gaining a greater appreciation for the intensity and dynamics of an expedition.  I have come to believe that it is necessary to have a certain hands on understanding of the process if I am to effectively evaluate who may be appropriate for trip.  This is a direct result of this course and researching this paper.

Although I will be unable to be a true adventure therapist, my hard skills are very poor, I can take advantage of opportunities to increase my knowledge base.  For me developing the technical skills is much more intimidating than developing and implementing the soft skills.  I have limited exposure to the technical aspects of being in the outdoors.

It is evident that picking an area of interest and comfort is appropriate for developing technical skills.  For example, I feel that I could make progress as it relates to back-packing.  I am in decent physical condition and it seems that the technical skills associated with hiking are less complex than the skills necessary for other disciplines such as top roping or mountaineering.  I am in no way interested in learning the skills necessary for caving.  That is left for braver individuals.  I am, however, certainly interested in expanding my abilities in the area of adventure therapy and my work place provides built in opportunities to go out and play.

References

Alvarez, A., Stauffer, G. (2001). Musings on adventure therapy. The Journal of Experiential Education, 24, 85-91.

Berman, D., Davis-Berman, J. (2001). Critical and emerging issues for therapeutic adventure. The Journal of Experiential Education, 24, 68-70.

Burg, J. (2001). Emerging issues in therapeutic adventure with families. The Journal of Experiential Education, 24, 118-122.

Connors, G., Donovan, D., DiClemente, C. (2004). Substance Abuse Treatment and the Stages of Change: Selecting and Planning Interventions. New York: Guilford Press.

Fletcher, T.B., Hinkle, J.S. (2002). Adventure based counseling: An innovation in counseling. Journal of Counseling and Development, 80, 277-285.

Hill, N. (2007). Wilderness therapy as a treatment modality for at-risk youth: A primer for mental health counselors. Journal of Mental Health Counseling, 29, 338-349.

Itin, C. (1998). Exploring the boundaries of adventure therapy, International perspectives: Proceedings of the 1^st international adventure therapy conference: Perth, Australia. Boulder, Colorado: Association for Experiential Education.

Kraft, R., Sakofs, M. (date unknown). The Theory of Experiential Education, 2^nd Edition. Boulder, Colorado: Association for Experiential Education.

Nicholas, S. (2008). Outdoor adventure education. Research Starters Education.  Great Neck Publishing.

Priest, S., Gass, M. (2005). Effective Leadership in Adventure Programming, 2^nd Edition. New Hampshire: Human Kinetics.

Russel, K. (2001). What is wilderness therapy?. The Journal of Experiential Education, 24, 70-79.

 Wagner-Moore, L. (2004). Gestalt therapy: Past, present, theory and research. Psychotherapy: Theory, Research, Practice, Training, 41, 180-189.

Wilderness Road Therapeutic Camping Association: The Wilderness Camping Program Description. Retrieved 6/4/09 from http://www.therapeuticcamping.org/WRTCA-program.html.

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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.

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.

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.

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