Addiction treatment programs and their clinicians must not miss opportunities to enhance their patients’ chances for success by engaging patients’ family members in an open and honest way, a three-person panel told attendees of a Dec. 10 Addiction Professional panel series event in Warwick, R.I.
But to do so, programs and counselors must overcome individual and institutional barriers ranging from subtle sabotage by family members to systems of care that don’t reimburse for recovery support services such as recovery coaching, panelists said.
“We do a lot of things that we subsidize out of the air. I don’t know how we do it sometimes,” said panelist Raymond V. Tamasi, president and CEO of the treatment organization Gosnold on Cape Cod.
Addiction Professional’s first panel series event featuring the topic “Family Dynamics in Addiction Treatment” brought together a panel with a broad reach in the addiction and mental health communities. Joining Tamasi were Fay Baker, director of project implementation and acute services at community behavioral health organization The Providence Center, and Bill Kelly, LMHC, LADC, clinical supervisor and consultant at Boston-based recovery home operator Hopewell Recovery Services.
Kelly opened his comments by stating that the treatment and recovery communities finally are beginning to put actions behind the long-stated rhetoric about addiction being a family disease. “Twenty years ago we wouldn’t be having a conference this morning on families and addiction,” he said.
Attendees received continuing education credit for the hourlong panel presentation; Addiction Professional’s panel series is sponsored nationally by Dominion Diagnostics. Additional sponsors for the Rhode Island event were Gosnold, Hopewell, and American Addiction Centers.
Parallels with the patient
The group stated that many of the same concepts that work in clinical care for the patient can and should be applied to family members. Baker and Kelly both referred to Stages of Change theory and stated that often the family’s readiness to change isn’t on a parallel track with the patient’s.
“Who in here likes change?” said Kelly. “Most people try to avoid change.” He said sabotage of a person’s recovery by family members is usually not done intentionally but can be extremely damaging. He referred to the “family dance” in which a patient will make changes through the treatment and aftercare processes but then returns to a family that is pulling in the opposite direction, especially when others in the family are active substance users.
Tamasi emphasized the importance of educating families in order to clarify lingering misconceptions and stigma about their loved one’s illness. But he added that the speed of the treatment system’s response remains critically important as well, as services must be available at the moment families overcome their ambivalence and pursue treatment for their loved one.
“I still don’t think we’ve established well-oiled access points for families to reach out for help,” said Tamasi.
Besides the challenges clinicians face in maximizing the presence of family supports in their patients’ lives, programs also must deal with institutional barriers that greatly restrict payment for family support services. Baker lamented that while some states have enacted billing codes for recovery coaching services, her home state of Rhode Island is not among them.
Kelly added that in order to serve patients and their families to the fullest extent, treatment and recovery programs need to expand their vision to include critical areas such as vocational services, even though these can be difficult to finance as well.
Tamasi said the strong federal confidentiality protections for substance use treatment information also pose a barrier, in that they often block families from receiving accurate information about their loved one’s status in treatment. He asked attendees to imagine how a family member would feel if, after making the difficult decision to help a loved one into treatment, he/she was told upon checking on the patient that the program couldn’t confirm or deny the patient’s presence at the facility.
“42 CFR Part 2 is really going to come into play if we’re going to think about really integrating with general medical care,” Tamasi said of the federal confidentiality statute.