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The Family Factor

September 1, 2006
by James M. Pedersen
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A form of enabling in the addict's natural support system can advance genuine recovery

"I know about my son and his addiction better than he does,” a tearful mother in my office stated several years ago.

I remember the power of her statement. Although she was crying, the woman was calm and incredibly self-assured. As therapists are so fond of saying, “She had done the real work.” She sat before me, and the years of enabling now dissolved and distilled into her next simple, powerful statement:

“Maybe he's not responsible for his disease, but he is responsible for his recovery.”

“So how do we help him?” I asked.

“Actually, Jim,” she said matter-of-factly, “we can't. What we have to do is to find ways to help him help himself.”

This conversation took place some 20 years ago, and yet I somehow have never forgotten it. It helped me to begin a personal and professional process that I am still involved in—using the addict's family as a therapeutic tool for recovery.

This article is based on excerpts from my book The Family Factor. It is based on thousands of hours of interviews and hundreds of client cases. The book's goal is to present clinicians and families with practical, “how-to” ideas and activities that families can use in helping an addict help him/herself toward a genuine and sustained recovery.

Family's critical influence

The Family Factor is based upon the premise that of all the people involved with an addict, it is the natural support system that almost always constitutes the most decisive and powerful outside influence.

No one knows the addict and is invested in that person's success like the addict's family. Family members are the ones who have watched the disease's progression. They have enabled and have been “ripped off” countless times. They know the specific and unique components of the addict's relapse pattern and can predict, with uncanny certainty, what's going to happen next.

Historically, they are the ones who have provided money (what I refer to as the lifeblood of the addict), usually a whole lot of it. They don't just know the games—many times they have helped create them.

For the addict, almost without exception, the most necessary, influential, and dependent persons in their life are their family or “natural support system” (I use the two phrases interchangeably here). For right or wrong reasons, the addict always seems to gravitate back to the family. For the addict, the family often represents a primal source of comfort, blame, predictability, anger, resources, and insulation from an outside world that the addict simply cannot negotiate in any long-term sense.

We in the field talk a great deal about “enabling” in the family. But enabling should not be a dirty word, and doesn't need to be a dysfunctional process. Enabling is a high-energy expression of love for the addict. It takes two very distinct forms:

  • “Dystonic” enabling, or dysfunctional enabling that advances the addict's disease

  • “Syntonic” enabling, or functional enabling that advances the addict's recovery

Members of the natural support system typically arrive at the threshold of syntonic enabling only after they have passed though the dystonic phase and have given up in a healthy way. Borrowing from the 12 Steps, they have “come to realize they are powerless” and are ready to work with the therapist in treatment approaches based upon trust, realistic expectations, and natural consequences. This is the conceptual framework.

Potentially useful approaches

There are several practical approaches and activities therapists can add to their skill set in working with the addict's family.

The trust contract.

When in doubt, write it out! The centerpiece for real recovery with the family is the trust contract. It is conceived, written out, and signed by all parties involved. The trust contract involves rules (expectations), along with consequences for noncompliance. It is a living document that can be revised daily if necessary. It creates accountability and a concrete way to measure progress. It also greatly reduces the chance for misunderstanding and/or manipulation.

The kick-out.

This is sometimes politely referred to as “environmental manipulation.” It simply means the family demands that the addict leave their home. This major event should be used only under the following conditions:

  • It is the result of a major violation of the trust contract, such as using substances or stealing.

  • It is not done in an angry, impulsive fashion but rather in a matter-of-fact presentation.

  • It utilizes successive approximations. For example, the first kick-out may be for two to three days. The second may be for five days to a week, and the third may be for two weeks to a month. It is hoped that the family never has to go beyond the first two efforts, if the next condition is met.

  • The kick-out is utilized with the same intent as any therapeutic activity—namely, to facilitate a change in behavior. If the addict realizes that stealing $45 from Mom's purse will result in his expulsion from the home, and that experience is far worse for him than not having $45, he will (hopefully) reassess his behavior. I hedge here because any seasoned therapist knows there are so many variables in working with addicts (i.e., punishing the family for being kicked out, etc.). But this approach at least puts the addict in a position of real accountability and natural consequence for change.

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