Human beings are hard-wired to notice the dangers and threats in their environment. From an evolutionary perspective being anxious, worried, and “on your toes” were good qualities. However, in today’s world worry is a major and sometimes difficult challenge
Back in the day; worry would keep you alive in a dangerous world. If you were too relaxed you were going to get eaten or stepped on by a woolly mammoth.
We carry this same type of hypervigilance with us today.
The good news is, most of us are not in physical danger on most days. Instead, we tend to channel this energy and vigilance toward psychological threats and potential problems. Dealing with worry and anxiety is a challenge for all human beings.
It is certainly part of the recovery process.
Of course, this also applies to family members dealing with a loved one’s addiction.
A Major Challenge
Stating the obvious. Worry is a major challenge if you are dealing with your loved one and any healthcare issue. This is certainly the case with substance use disorders.
The chronic nature of these issues; The ups and downs; The seemingly outrageous, irrational and infuriating behaviors that accompany the disorder.
You have probably been told: “you need to focus on yourself” or “let go and let God” or “detach with love”. All of this is good advice. If only it were that simple.
If you are in recovery, from anything, managing worry is very important. Out of control worry and anxiety increases relapse risk and decreases quality of life. It’s a very important aspect of POSITIVE RECOVERY.
Perhaps some more information and practical suggestions will help you along the way:
What Are You Dealing With?
First, it is important to understand exactly what you are dealing with where worry and anxiety is concerned. You may have been told you have an anxiety disorder. You may have been told you are a chronic worrier.
For clarification purposes:
Worry: a state of anxiety and uncertainty over actual or potential problems. A chain of negative laden thoughts reviewing past issues or projecting future results.
Many times, worry takes on a problem solving element. An attempt to “figure it out”.
A couple of things right off the jump: The concept of “uncertainty over actual or potential problems” warrants further attention.
We must emphasize that where addiction and recovery are concerned, there are always real and actual problems to consider. YOU ARE NOT CRAZY FOR WORRYING ABOUT THE REAL PROBLEMS THAT EXIST IN YOUR LIFE. That is normal.
The issue gets more serious when you become consumed. When you worry about worry. When it debilitates and distracts you in a damaging manner.
Here is some practical advice and a couple of ideas to assist you in coping with worry and anxiety.
1) Try to stay in the present moment.
Worry involves an almost compulsive tendency to project future outcomes and/or ruminate on past issues.
Staying in the present moment is a SKILL that you can develop over time:
a) Daily practice to stay grounded include meditation, prayer, and mindfulness exercises. A couple other exercises include: turning off the music/radio as you drive to work; pay attention to your surroundings; many times we drive to work on automatic pilot.
b) In the moment exercises: When you find your mind wandering bring yourself back and place intentional focus on whatever activity is in front of you. Literally talk to yourself. In you mind walk yourself through the activity (“I am now calling the next customer”; “I am now grading these papers” etc…)
2) DO NOT try and suppress the worry by berating yourself.
DO NOT “worry about worry”. As we try and push down a thought or an emotion it tends to gain strength. Instead try to accept and observe the worry and “ride it out”. Remember, what you fight gets stronger. Accept the situation, observe the feelings and it will dissipate quicker than you may anticipate.
3) Try to focus on the positive things in your life.
Our brain picks up on the negative but we need to be intentional about noticing the positive.
Every day write down 3 good things that happened that day. Rather than a general gratitude list, “3 good things” should focus on very specific things that happened throughout the course of the day.
Write it down. Preferably at the end of the day; same time every day.
Try these things. Commit to 30 days of reprogramming yourself. See if it improves.
When dealing with our children’s addiction having the proper support is key.
We all want to put our best self forward. It is human nature. The sociologist Irvin Goffman referred to this as “impression management”.
We want to be viewed as competent and our children to be viewed as successful. Of course we want our marriages to be viewed as blissful as well as wanting our schools to be top notch and our community to be viewed as impeccable.
This has always been the case. Of course, Facebook has taken impression management to an entirely new level. We want the picture to look perfect, however, addiction makes the picture ugly. Unfortunately, these tendencies to hide the truth play right into the hands of addiction.
Denial exists on the individual level, the family level and the community level. Admitting that addiction has entered the scene is a very difficult thing to do. It comes with so much shame and embarrassment.
Keeping People from Getting Help
The stigma around addiction is alive and well and it keeps people from seeking help. It also contributes to the family tendency to unintentionally protect the addiction.
We don’t want others to know so we suffer in silence and we hope for the best. Many families won’t even talk to other family members for fear of being judged. We also know this can extend itself to our schools and other community institutions.
If we aren’t careful there will be a collective effort to minimize the seriousness of substance use disorders.
This is especially pronounced where parents are concerned.
What for Intrusive Thoughts
When you are dealing with a child who is struggling with addiction there will be a lot of fear based and anxiety. Intrusive thoughts can and will invade your consciousness.
Thoughts like:
What do we do now?
Is he going to make it out alive?
What if he winds up in jail?
Where do we send him for help?
Where did we go wrong?
How do we pay for this help?
Many uncomfortable “scenarios” will be played out in your mind.
You will spend an inordinate amount of time trying to figure out all the possible outcomes. This process is natural and hard to avoid. You will learn to manage the troublesome thoughts and ideas. Although, they do seem to come on they come naturally.
All of this contributes to a great deal of stress and can manifest itself in serious physical and mental health problems for parents.
But there are some UNNECESSARY thoughts that may pop up.
What Will They Think
This category will suck the life out of parents. These thoughts serve no purpose and will ultimately make the entire recovery process more difficult to manage.
We call this the “WHAT WILL “THEY” THINK CATEGORY.
You may ask. Who is this mysterious “they”?
“They” are all the people in your life that you believe will judge you and your kid harshly. Could be friends, could be family, could be acquaintances, could be co-workers, could be the preacher at church, could be anyone… anyone you are concerned may pass judgement.
Examples include:
What will grandma and grandpa think about this situation?
The preacher, what will think about my son?
What will my co-workers think about this issue?
What will the ladies my prayer group say about his behavior?
These are the thoughts that need to be crushed. Parents have enough on their plate.
We are Dealing with a Healthcare Issue
Adding the emotional turmoil of societal judgment will impede their ability to solve problems, think clearly and manage the very real stress associated with the situation.
Substance use disorders are a healthcare issue and should be treated as such.
If a person is drinking too much or using substances at a dangerous level it needs to be talked about and addressed. There is nothing to be ashamed of in seeking help. There is no downside to asking questions.
Developing a Strategy and Plan
Family members need an outlet to explore their concerns and individuals need ease of access to start the recovery process. We must create environments of open sharing and positivity.
We must make recovery a welcoming process. There needs to be an uplifting and empowering “vibe” around recovery.
Parents need to look for information and support and ultimately start to develop a plan for managing the issue:
Some simple and practical advice:
Inform and educate yourself on the subject of addiction and recovery.
Look for books and resources and look to experts but be careful because many people have declared themselves instant experts. Make sure they are people with experience in this area.
Reach out to other parents who have dealt with addiction. This makes a great resource.
Make a plan for your recovery and a plan for “your response” to the CURRENT STAGE of your loved one’s disease. Again, education is paramount.
Find a coach or supportive person to encourage and guide you as you make these plans.
Work the plan. Every time you get off track get right back on the plan.
Maintain Contact with your coach as your work the plan.
Encouragement and supportive advice is essential throughout.
The concept of “working on yourself” is difficult for families to grasp. In our Family Recovery Groups at FAVOR Greenville we spend a lot of time on this issue.
The impulse to control and fix is natural. It’s not pathological to want to rescue your child. It is biological hardwired into you as a mother.
You are compelled at an instinctual level to “save your child”. When people dismiss you out of hand and scoff at your desire to help they are being short-sighted and demonstrating a fundamental lack of understanding.
Kick the Bum Out
When people tell you to detach and “kick the bum out” they are being cruel and engaging in classic “do as I say not as I do” behavior.
These good people would not follow their own knee-jerk advice. If we were to reverse the roles.
Rescuing can, however, become counter-productive and enable the addicted individual to engage in ongoing self-destructive behaviors. In addition, you are going to personally self-destruct.
You can only handle so many sleepless nights and anxiety filled days.
The Worry Cycle
I know what it is like to find yourself in the worry cycle. That endless path of chasing scenario after scenario. All the “what ifs”. The negative impact of stress on physical health has been well documented.
Upwards of 70 serious health conditions are directly caused or exacerbated by chronic stress. The addiction will take you out as quick as it will take out your loved one.
Lastly, as you work on yourself you increase the likelihood of change in your loved one.
Family Systems Theory
The family is a system; changing one part of a system influences all other parts of the system.
Family systems theory holds that individual family members fall into predictable roles and serve particular functions within the larger family system.
In addition, the family system (indeed any system) exists to preserve itself.
Unless acted upon by a strong internal or external force the system will proceed down the path of collective destruction. Given this reality it is self-evident then that any individual part of that system could impact the system as a whole. Including the addicted individual.
Therefore, when in doubt.
Work on yourself!
It seems to me that all family recovery addresses three interrelated issues:
Anxiety, Worry, and Chronic Stress.
Therefore, why don’t you initiate a practice of focusing on actions. Focus on positive actions that reduce anxiety, worry and stress.
Helpful and Healthy Suggestions:
Become part of a group. We are social creatures. You don’t even need to enjoy the content of the group. Just being around people with similar struggles will prove uplifting.
The benefits of group are clear:
Universality – you realize you are not alone
Altruism – you get to help others
Imitative Behavior – you hear from others who have gone through the same thing and
Develop Coping Skills – more adaptive responses.
Instillation of Hope—Perhaps the most powerful factor
These are 3 FREE and easily accessible activities which have proven to reduce stress:
Go outside, take a walk
Listen to your favorite music
Smile and laugh
Do something fun for yourself that is solely meant to provide entertainment and fun and not work related.
Prayer and meditation. Regardless of your personal beliefs we know that prayer and meditation have positive impact on neurobiological pathways.
Find a confidant. One to one. Sometimes you can’t share at group level and having a one to one relationship can be invaluable. This could be a therapist, a sponsor, or a coach.
Eliminate toxic people from your life. You have no time for people who drag you down. Eliminate judgmental people.
And most important. –
RESIST THE TEMPTATION TO ISOLATE. ISOLATION CAUSES DEPRESSION.
It is isolation that is the main cause of depression, not serotonin,
Try a family recovery plan for 6 weeks and
I guarantee you will feel better.
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.
“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.
