Multiple Pathways – Part 2

We say “multiple pathways of recovery”… As if we have to “pick a program” and follow that pathway perfectly. 12-step, clinical support, favor all recovery, coaching, individual therapy, SMART recovery etc … pick one.

Pick one snd do it right. Subconsciously, that’s the message we receive.

Some people pick a path.

And that’s all there is to it. Now and forever. They are on the path. That’s fantastic. Wonderful.

However….

However, many of us pick multiple paths.

And many of us take a route that is not defined as a pathway or program.

The truth is most people figure out their own pathway over time.

With formal program or without formal program. The elements of recovery are many and they are not uniform.

Recovery Is Not Static

Recovery is not static. We adjust. We try different things. And we do it over and over throughout our recovery.

And when I say recovery.

I mean recovery from trauma, substance use, mental health struggles, emotional struggles etc…

The most important thing is … keep moving forward.

Obvious Things

I have been a therapist for 20 years. And several things are obvious.

1. There is no one way to get better.
2. There is only momentum.
3. Hopefully, forward momentum.

And if you are trying to better yourself. I celebrate you and admire you. Regardless of the pathway, program or “plan”.

People get really down on themselves for “slips” or mistakes or not following the plan perfectly.

As if the plan came down from God as the 11th commandment.

We All __________!

• We all struggle.
• We all slip up.
• In some way or in some form.
• We are all a work in progress.
• You will figure it out.
• Go easy on yourself

The post Go Easy on Yourself, But Do Something! appeared first on The Recovery Cartel.

Controversial and Unrealistic

Big Hairy Audacious Goals (BHAGs), are commonplace in the business world.

These are stretch goals, which may seem impossible, but nonetheless push organizations to the next level. People in the recovery movement shy away from BHAGs.

BHAGs are too controversial and very unrealistic.

Our Big Hairy Audacious Goals:

We believe that:

• every single person impacted by this health issue (substance use disorder),
• in every single place across America,
• should get help for substance use related issues every single time it’s needed.

Mythical labels like “he’s in denial”, “she’s an unwilling and non-compliant patient”, and “she needs to hit bottom” have no place in the debate surrounding the delivery of any healthcare service.

These labels serve as excuses to justify the systematic mistreatment of 90% of people with substance use disorders. And, by extension, the 150 million family members standing by in stunned disbelief.

It is the professional provider’s responsibility to figure out a way to connect to the disconnected and engage the disengaged.

Healthcare Disciplines

The person suffering from substance use disorder is, by definition, impaired by a brain disorder. They are acting irrationally, as you would expect someone with a brain disorder to act.

Therefore, we need to figure out a way to connect.

We need to borrow from other healthcare disciplines and utilize evidence-based community outreach protocols to engage or re-engage people in need.

Rather than wait for the person to “have enough pain” and come back for another round. Another round of the same process that “didn’t take” the previous time.

Assertive Community Engagement

FAVOR Greenville calls this “ASSERTIVE COMMUNITY ENGAGEMENT” and we are the world’s leader in the delivery of this person centered, participant first model.

How do we define recovery?

Simple, you are in recovery if you say you’re are in recovery. There is no application for membership. No right or wrong way to “do recovery”.

There is no superior recovery, equally, there is no preferred recovery. There is no “full recovery”, and most important there is no “do it this way or die” recovery. ,

Engaging Recovery Goals

Multiple pathways exist and we just want to see your life improve.

We want to see families restored and people come back to health.

We want to see people become productive and, n addition, live life to their fullest potential.

Our focus is on the upside of recovery rather than the downside of addiction.

Change Your World

We believe that if you sign on for this new lifestyle, the sky is the limit.

Life can be amazing. Uniquely amazing when you are no longer under the control of a substance.

I’m NOT saying life is easy in recovery. But it is amazing.

Recovery is NOT some life-long burden. It’s an opportunity to chase your dreams. To change your world and by extension change the WORLD.

3 Great Recovery Goals

1. DON’T quit.
2. DON’T write off recovery based on a bad experience or “failed” past attempts.
3. And finally, DON’T let anyone tell you what your destiny is….

Once again remember, no one owns recovery. No one gets to define the “right way”. There is no failure.

Get up… try again. Try a different way. Move forward.

The post Big Hairy Audacious Recovery Goals appeared first on The Recovery Cartel.

The Recovery Pathway

In the interest of clarifying my opinion on “most effective” treatment and/or recovery pathway or approach. (Not that anyone ask for my opinion)…

Note: THINK “approach” or “pathway” or modality. NOT particular provider.

There is no such thing as a superior pathway or treatment “modality”….

Trying to rank program effectiveness is like trying to make a list of the Cleveland Browns best seasons…I guess 1987 was better than the rest but they all still sucked.

It’s like ranking the world’s most compassionate 3rd world dictators. Or the best Boy Bands in music history…. it’s all relative. 💯💯💯

It’s an exercise in identifying less shitty; more so than identifying most effective.

Facts…as things currently stand:

• Any program/pathway is better than doing nothing at all (well…maybe not all of them). You will not be struck sober while hanging at the trap house. Do something.

• All programs systematically and pridefully ignore and reject 90% of people in need because those people “don’t want it”…. “won’t follow the program”….”haven’t hit bottom” etc…. there is nothing earth shattering about working only with the “willing” few….

• This is also the case for most Recovery “innovations” you see being promoted. Every “breakthrough app” or transformative “tele-coaching” program is founded on the assumption of a motivated and compliant patient. Even though motivated and compliant patients comprise less than 10% of the disorder. It’s not innovation. Innovation requires paradigm shifts and much more risk.

Nothing ever changes (in terms of improved outcomes) until time, money, energy and effort is brought to bear on solving the “unwillingness” problem.

No More Hitting Bottom

Breaking the old hit bottom paradigm will not be easy:

• Time- to develop and test engagement protocols and staffing issues. 
• Money- substantial money to start up, execute and scale engagement and retention programs. 
• Energy-bringing in non-treatment/and non-recovery problem solvers. New blood and new ideas. Turn away from traditional gatekeepers for ideas. Nothing non-traditional comes out of the traditional… logic. Use logic. 
• Effort-find people who will execute on this like a start up business. Incentivize the effort. This is an 80 hour a week problem. Obsession is required to turn this thing around.

Again I ask the question – Is Addiction a Healthcare Issue?

The post Is Addiction a Healthcare Issue? appeared first on The Recovery Cartel.

I Am NOT a LIAR, CHEATER, Or Thief.

I was born on July 25th 1968. It was not a voluntary process. No one ask me if I wanted to be here. Nonetheless, there I was!

Of course, I celebrate my life. This is not another nihilistic rant from a Nietzche wannabe struggling though a midlife crisis. Although, I could write that post as well. Been there…done that.

Today, I’m focused on the roots of my addiction.

I was born into a family that had been riddled with mutligenerational trauma. By no choice of my own.

For The Record

For the record, my bloodline also held dear…a Calvinistic work ethic beyond compare. Work… like your salvation depends upon it…literally. This kept us out of the house, distracted and independent.

That reality, along with a superhero mother, allowed us to rise above the terror of my father’s demons. It could have been much, much worse.

However, no one can deny, violence, emotional abuse, insecurity, divorce, and the ever-present cloud of substance use guaranteed that my childhood would include a few scars. Literally and figuratively.

In the 1970’s and 1980’s the general idea was “suck it up”. Today we know that post-traumatic stress and adverse childhood experiences can produce lifelong problems. Including substance use disorders and poor outcomes in terms of physical health.

My memories are encoded with feelings of fear and terror. They are still there. Especially at night. Laying in bed waiting for it to start up again. Worse, trying to predict if it was going to pop off again tonight. What’s his mood? What’s next? What did she say? What was that?

Loud sounds at night make me jump. I can sleep better if there is noise in the background. When I was a kid in Pennyslvania the furnace would drown out the battle.

So…I still need the furnace. Sometimes.

The Message Was Clear:
Addicts & Alcoholics Are Bad People

I took my first drink when I was 14. Older dudes around the neighborhood shared some nasty cheap beer. It wasn’t love at first sight.

But it did provide relief. From that fear, anxiety, and trauma.

As time went by, my substance misuse escalated. I will spare the details because you have heard 10,000 addiction stories. By the time I was 29 it had progressed to any and all opiate based narcotics.

Thank God I was able to stumble into recovery at age 31.

I did some things while actively using substances that I wasn’t proud of and not true to my own values.

I was not a good husband or a good father. However, its important to note. I was not a horrible husband or father.

I jumped into recovery meetings and counseling. Quite frankly I knew I was done with that old lifestyle. I didn’t think much about what “program” to follow. I just followed directions.

Interestingly, 19 years ago, the professional counseling and self-help support groups were nearly indiscernible. I fear this is still the case in most places around the country. Hard to tell the difference between your rehab and your home group. The message was identical. Some version of:

“You did this to yourself. Take responsibility. Do as you are told and don’t question anything…Also, you’re “puffed up” and have an ego problem. Get honest, you are a liar, cheater and thief”.

Looking back, I still have gratitude for the people who helped me. Especially the members of the self-help groups I attended. They gave their time. They were amazing. I have less gratitude for the counselors and “therapists” who shoved one size fits all thoughts down my throat. They were paid for that?

However, nineteen years of personal and professional recovery related experience have provided some perspective.

Treatment Programs & Recovery Support
Built On “Ego-Deflation”

It is widely accepted that ego-deflation is the core of the process for the more traditional recovery pathways. 

This link will take you to some resources on 12-step literature that clearly lays out the need for ego-deflation. This doesn’t mean all groups or all providers apply the principles in the same manner. Some are more confrontational than others. 

However, there is no question that the focus is on breaking you down to then build you up.

For the record, there is very little clinical theory or evidence that backs up a therapeutic approach focused on ego-deflation. 

Rational emotive behavior therapy and some isolated practitioners are among proponents. It seems that narcissistic personality disorder is the one area where ego-deflation has been supported.

The (flawed) assumption that most “alcoholics and addicts” are narcissists would explain the wide-spread acceptance of the ego deflation philosophy.

…the overwhelming majority of those with substance use disorder are not narcissists. It’s nearly 8 times more likely they DO NOT HAVE narcissism than they do. 85% of people with substance use ARE NOT narcissists.

Basic socialization theory (when in Rome do as the Romans) explains why people would go along with the process. Despite their better judgment.

When they said I was a liar, cheater, and a thief I did not push back. I wanted to be accepted. Furthermore, questioning these concepts is indicative of a person who is unwilling. No one wants to be “unwilling”. In treatment, unfortunately, questioning authority will be labeled as “resistance” and sanctions will be used to “get you back on track”.

The process starts to take on a punishing tone. Of course there are rewards at the end of the tunnel. If you follow directions you can expect a better life. I was no exception. Stopping the destructive behavior improved my life.

But I was not, and I am not, a narcissistic, self-centered sub-human. That is not the core of my issue. I do not need torn down to be built up. I need specific support to be lifted up. Fortunately, I got that support.

Trauma Not Narcissism

Dr. Gabor Mate cuts right to the chase. He flat out says all addiction is an attempt to escape trauma.

I’m not sure I would go that far. I think substance misuse is complex and varied. It’s an individual experience and the stages, forms and pathways are diverse. I don’t think we can say that all addiction is related to trauma.

We could say, I think, that the majority of those with substance use disorder have underlying trauma. I know I do.

Most people are more comfortable with the punishing model.

Phrases like “call them on their shit” and “non-compliant patient” are commonplace.

Sadly, many of our professional “helping” institutions embrace the narcissism/sociopath model over the trauma model.

“We readily feel for the suffering child, but cannot see the child in the adult who, his soul fragmented and isolated, hustles for survival a few blocks away from where we shop or work.” Gabor Mate-In the Realm of Hungry Ghosts

Narcissism is relatively rare in the general population. Lifetime prevalence rates of 7.7% for men and 4.4% for women. 

Among people dealing with substance use disorder severe (addiction, dependency etc…) the numbers are higher: 14.1% and 10.5% respectively.

Let’s be clear about something. Compared to the general population, it’s 2x more likely that someone with a substance use disorder also has narcissistic personality disorder.

However, the overwhelming majority of those with substance use disorder are not narcissists. It’s nearly 8 times more likely they DO NOT HAVE narcissism than they do. 85% of people with substance use ARE NOT narcissists.

Therefore, it is likely that the ego-deflating model is not optimal for nearly 85% of those with a substance use disorder.

There is a growing push toward more comprehensive approach to substance use disorder treatment. This includes trauma informed care, co-occurring disorder treatment and the mainstream acceptance of harm reduction psycho-therapy.

Progress is being made but there is a need for more aggressive scaling of these alternative models.

Positive Recovery…

In the meantime we need to emphasize alternative, professionally supported recovery pathways. Pathways that are strengths-based and emphasizes what is right with you rather than what is wrong with you.

Right now the choices are few. That’s just a fact of life. The stigma of addiction does not promote creativity. You keep your head down and your mouth shut. No one was going to invent anything in the era of anonymity.

In addition, decades of suppressed collective intellectual curiosity among those working in the field has contributed to a sort of industry wide atrophy. If you had a truly new idea you were laughed out of the room.

FAVOR Greenville & Youturn

I know. I was the guy talking about buprenorphine before it was cool to talk about buprenorphine.

Fifteen years ago I had to go underground to provide a place for people to get help. My life as a secret medication assisted treatment therapist.

At FAVOR Greenville, and Youturn we are committed to sending a positive strengths based message.

We have developed recovery coaching and educational modules based on positive psychology and motivational interviewing. We also open the doors wide to alternative recovery programs such as SMART recovery.

The challenge is scaling this philosophy. Right now these ideas are the exception.

They need to become the rule.

Also check out our Recovery Cartel blog… and videos.

This article was originally published on the Rich Jones Medium Page, please visit and share with your friends and colleagues. – https://medium.com/@richj_87305

The post The Case For Positive Recovery! appeared first on The Recovery Cartel.

AN ENVIABLY LIFE

By all conventional measures I lived a very successful, popular, well received, enviable life. All the while hopelessly and helplessly addicted to prescription opiates.

I really thought I had it all figured out.

I was never unemployed. Never was I homeless and I have always had my family.

It was, however, all on the brink of unraveling. But I didn’t fit the stereotype.

RECOVERY ON THE WAY UP

We don’t do anyone a favor when we focus only on the worst parts of the disease.

When we talk only about the “bottom”. I got recovery on the way up.

For me it was a process. Not at my bottom.C

But I was clueless as how to do life without a party or an escapee So I got help.

A FUNDAMENTALIST

I got support. I will be forever grateful for those guys.

Early on I became a real recovery fundamentalist. My group knew best.

It was “Our Way or the Highway”. I was 100% sure my view was right and I made sure to tell everyone.

There was only one way to do it. And that was “Our Way”.

CHANGED PERCEPTION

Then I woke up. I looked around.

My professional work was the first place I learned about the reality of recovery. Many pathways.

That became my experience. Many people were getting better in many different ways.

My “ONE WAY ONLY” worldview, well that just wasn’t true.

LESSONS

I did the same thing with politics. I picked my side.

Listening mostly to people who agreed with me. We told each other how right we were.

Our worldview was righteous. Then I woke up.

That too, was not true.

I did the same thing with my career. Get a graduate degree. Follow the cookie-cutter path.

Work your way to be a “Director”.

Be a good soldier and accept that things are not perfect. But we are helping people and there is nothing we can do about it, right?

The saying “it is what it is” became our mantra.

Do this work for someone else or some treatment center until you can retire. Fit into the corporate structure!

AGAIN NOT TRUE

I thought this was the only way to make a living in this field. Then I woke up. It wasn’t true.

Life is open for the taking. Why do it halfway?

My learned advice is to pave your own path and invent your own reality.

Leave a mark on the world and make sure people know you were here.

I didn’t change my life so that I could do normal shit.

ALL THE WAY IN!

When I made that decision to put the drugs down I also made a decision to go all the way.

No more escape.

No more numbness.

If I wanted to stay numb — I would have stayed high.

Be bold and take your recovery and life to the fullest!

That would be a real and true enviable life.

P.S EXTRA NOTE – In this blogs photo above is me and my son Issac when he was 4 years old and I was 12 years in recovery. That is when we pulled up all our roots. We took a 50% pay-cut and moved to Greenville SC for a job that really didn’t even exist. Thanks!

The post My Enviable Life – “It Wasn’t True”… appeared first on The Recovery Cartel.

Never Enough

For me and my hedonistic treadmill of a brain….Never enough goes beyond drugs.

Obsessive is my default setting.

Moderation in any area requires focus for me. I need to have my head in the game.

Recovery

Recovery from substance use disorder has made it possible to avoid total self destruction in these other areas.

However, I still need to be on top of things and open to support and ideas.

I need to seek out the right mentors.

What worked last month may need re-evaluated this month.

Change plans to change outcomes.

Plans & Outcomes

For example.

Work. It can consume me. Because it’s an escape and the achievement comes with a dopamine hit.

I’m very competent in this area of life so I will gravitate to work.

And if one hour of work is a dopamine hit, then another and another and another makes complete sense…..

90 hours later my kids can’t even recognize me.

Being Dad

Being a dad is tougher than work.

I never was taught anything about being a dad. My father was a maniac.

In my mind, I cant do anything well in the parenting area.

I perceive myself as incompetent. Plus it’s so freaking hard.

Therefore, I gravitate to what makes me feel better.

Hardwired

Human beings are hardwired to seek pleasure and avoid pain.

I will be a work in progress forever.

I can’t relate to being “set free”.

Quite frankly I do not trust people who play it off like the struggle is gone. I’m a work in progress.

The Spiritual Struggle

I just don’t believe those people who pretend to be so “spiritual” they don’t struggle.

Spiritual means embracing the struggle.

Suffering well when it’s bad and savoring the good days.

I will try to improve and master myself every single day. Until I die.

Magical Solution – Nope

Because there is no magical solution for me.

I think there are so many fake people out there. Bullshitters.

What you see is what you get with me.

I’m not the poster child for serenity

The post Parenting on the Hedonistic Treadmill appeared first on The Recovery Cartel.

Pleasure and Effort

Seems counter-intuitive.

Pleasure or “fun” is part of happiness. To be clear, it is not the main part of happiness and pleasure alone can not bring happiness.

But it is necessary. All work and no play can become a problem.

Hedonic vs Eudaimonic

What can you do for fun? Some people have a hedonic orientation. Pursuing fun and pleasure at all costs.

Especially at younger ages.

Others have a eudaimonic orientation. Focusing on achievement, goal attainment, and altruism.

Fun Changes Over Time

Most have a “mix” but “lean” one way or the other. This is not a static state and it can change over time.

What qualifies as “fun” also changes over time.

As you get older and social circles change your orientation toward “fun” may change.

As age related social norms change you will be drawn toward new activities.

Or, at the very least, you will be driven away from “old” activities. It’s just not cool 45 years old and hanging out at the night club.

The Pleasure Dilemma

The pleasure dilemma is more pronounced with people in recovery.

Obviously, the substance provided pleasure and, at least early on, some level of “fun”.

For me, it provided a ton of fun early on. It was always central to the experience.

Pursuing pleasure and fun is something you may need to work on in recovery. It may not come natural.

Remember, we do better when we live intentionally and plan our days.

Manage life or it will manage you.

Reward Deficiency Syndrome

Throw in the issue of reward deficiency syndrome (RDS) and finding ways to “enjoy yourself/have fun” can be quite frustrating.

RDS is somewhat controversial.

I believe it is a true phenomenon. However, like many other issues related to addiction, it is over emphasized.

It is likely NOT the case for many people with an substance use disorder.

Severity and individual factors must be taken into consideration. There is great variety among people with substance use disorders.

RDS-theory (Dr. Kenneth Blum). Born with low D2 (dopamine):

The Thrill Is Gone

Some people have fewer D2 receptors than the general population, up to 40% fewer in some brain areas like the nucleus accumbens.

These people are not as excited about reaching their goals.

Their whole “reward system” is relatively flat.

Life is not as much of a buzz for them as it is for most people.

The thrill is gone. In fact, maybe it was never there at all.

The wrong allele of the DRD2 gene, and fewer D2 receptors = RDS.

How are you going to get the thrills those around you seem to get?

Hyper-Excite, What?

Drugs, gambling, and other super-fun stuff might be the most effective way.

These “rewards” are hyper-exciting for most people.

For you, who are chronically under-excited, they might be the only way to feel really engaged with life.

Addiction, then, is just an unfortunate side-effect.

Reward deficiency leads you to seek out the biggest bang for your buck. Which makes sense, because everyone wants to feel the thrills and pleasures of life.

Crossing The Line!

Chronic substance use exacerbates and produces more severe RDS-like condition.

Even if the person “started” at a normal baseline they can advance to RDS via chronic substance use.

The theory proceeds as follows: as the person progresses with substance misuse (regardless of RDS or chronic exposure) they “cross the line” into a permanent neurobiological change. Where the altered system is “more sensitive”.

Re-Activation

The cascade can be “re-activated” very easily. “One is too many”. “Complete abstinence”.

“The first one…” Again, everyone is different and we don’t need to walk around in fear that RDS will somehow “take us out”.

Keep in mind: stress, trauma (chronic exposure) can influence D2 and RDS. Very complex.

Thrill seeking does not automatically equal RDS RDS can manifest itself in all kinds of addictions. Negative and positive.

Some people with a substance use disorder and/or in recovery have RDS but it is not universal.

Manage Dopamine

There are many reasons that substance use disorders develop. Complex and individualized.

There is no one explanation and there is no one solution. I believe I fall into the RDS category.

In recovery the brain will eventually return to pre-addiction baseline levels (in regards to dopamine). However, this pre-addiction baseline will still fall below normal range.

This makes the pleasure issue more challenging.

We need to manage our dopamine.

Distracting

There are ways to do that. More to come on how to manage this deficiency.

I’ve struggled with pleasure and fun and risk using work as a distraction from this reality.

I’ve just started a 60 day fix. My own invention.

I will let you know how it goes. – Thanks, Rich

The post PLEASURE REQUIRES EFFORT? appeared first on The Recovery Cartel.

WE

We believe that the solution lies within you.

We are not experts who are here to diagnosis and label you.

We don’t provide instructions and directions unless you specifically ask us for instructions and directions.

We believe in the power of the human spirit.

We believe this spirit can not be completely extinguished by addiction and our job is to meet you where you are and help you ignite your change process.

You can not “flunk out” of FAVOR Greenville. There is no right or wrong way to do recovery.

STRENGTH IN NUMBERS

We know that there is a wide variety of pathways and we know 46% of people figure it out in their own way.

At the same time, we believe in the power of one recovering person helping another. So we enthusiastically encourage you to come see us.

You may be able to do this on your own but it will probably be much easier with others.

IT’S JUST LOVE

To the family members: we know that substance use disorder impacts everyone.

We know that at least 60% of Americans are directly impacted (probably more).

We know that you have been told to “step back” and wait for “bottom”. We are here to tell you that, although detachment is necessary in some cases, you do not have to wait for bottom.

A PROCESS

There is no such thing as tough love.

It’s just love; or the appropriate expression of love.

We know that one family member has more impact than 8 professionals.

We want you to become experts so you can feel confident as you deal with a loved one’s substance use disorder… because there is no magic solution available.

Recovery is a process not an event.

The post We Just Want Your Life To Improve appeared first on The Recovery Cartel.

I am certain that there is no certainty surrounding substance use disorders and their “cause”.

Despite popular opinion and what you hear out there in Expertville.

We are relatively clueless. SUD falls in a category of medicine called “intuitive medicine”.

Versus treating appendicitis, which is an example of precision medicine. (See below; SUD would fall similar to depression, since society doesn’t actually think it’s a disease it’s not listed on this chart).

Like any other disorder, SUD will manifest itself in a wide variety of ways.

The level of complexity with co-occurring mental health and underlying factors of trauma/adverse childhood events is an example.

I also believe their are vast differences in the neurobiological component.

We are not all physiologically identical. All who “cross the line” may experience a fundamental change in the brain, however, how we get there varies greatly from person to person.

Furthermore, many haven’t “crossed the line” but misuse is killing them anyway. Let’s be clear. You do not have to be an “addict” in order to destroy yourself with substances.

Therefore, restoration to health will vary greatly from person to person. The destination and the path will vary.

In addition, what you need early in your recovery will differ from what is needed down the road.

Other issues are likely to take center stage as you progress in your recovery.

Be creative and open to other wellness alternatives. Avoid getting stuck.

However, if it’s not broke don’t fix it. If you are feeling good keep on the same path.

Simple logic…. #droppinknowledge2019.

The post Intuitive Medicine – What’s That? appeared first on The Recovery Cartel.

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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