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More than token support

May 1, 2009
by Pete Nielsen, ICADC, CADC II
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Families affected by addiction need formalized and ongoing assistance

Pete nielsen, icadc, cadc ii

Pete Nielsen, ICADC, CADC II

Family is a common concept to nearly everyone. A family is a natural social system with properties of its own-one that involves a set of rules, assigned roles, a power structure, intricate overt and covert forms of communication, and negotiation and problem-solving techniques allowing various tasks to be performed effectively. When an individual in the family has an addiction, everyone in the family is affected.

Family members develop coping strategies to deal with the turmoil created by the addict's behavior. They might learn to withdraw in response to the addict's changing moods and erratic activity. The family learns to make excuses and even to cover up for the addict. On one level family members feel frustrated, defeated, lonely, responsible and even guilty. On another level, secrecy and avoidance reign. When the addicted individual gets treatment, the family is so used to the struggle and purpose it had when the family member was using that it unconsciously wants to return to the way it was before the individual got sober.

The family can be one of the most powerful tools to help people to change. So why isn't the family accessed more by the drug and alcohol treatment professional, or at least accessed more effectively? Why is it that some treatment programs see the family as more of a nuisance than help? The interventionist (Johnson Model) typically helps the family only until they get into treatment. Family therapists typically work with family issues and marital problems, but do not work on the family as a whole and how the addicted individual affects the family unit. Treatment facilities typically help the family only while the addicted individual is in treatment. There is usually very little ongoing help toward achieving family recovery.

Newer intervention approaches

The systemic model interventionists offer more help to the family by engaging the whole family into treatment. In this newer model of intervention, developed and refined over the past 15 years by interventionist Wayne Raiter, the focus is on family and friends. Systemic Family Intervention© involves a process of changing the maladaptive relationships that have inadvertently allowed, and sometimes even encouraged, the addicted individual to continue his/her behavior.

As the family develops new boundaries, the addicted person sees the need to change as well. As part of the process, everyone involved learns about addiction. Because Systemic Family Intervention involves the person's entire support system (family, friends and sometimes co-workers), all the means through which the addict sustained his/her behavior are no longer in place. The addicted individual moves into a new environment that insists on change in him/her as well. With the addicted individual's entire support system involved, the means through which the individual previously sustained his/her behavior are no longer available. The addict is pulled into the change process.

This is a great approach, but it usually does not continue after treatment. The family is encouraged to go to family therapy and Al-anon, but many times these do not achieve enough to sustain lasting change.

The best intervention approach that includes the family is The ARISE Intervention (A Relational Intervention Sequence for Engagement). “Invitational Intervention” invites the addicted individual to participate in the intervention process. There are no secrets, surprises or ambush. Everyone involved is treated with dignity and respect. The ARISE model uses the addicted individual's support system to motivate the individual into treatment. The ARISE model helps families, organizations and communities deal with issues such as a variety of addictions; mental illness and treatment; resistant elders and long-term care; and HIV/AIDS and treatment.

This model uses Family Motivation to Change, utilizing the love, strength and wisdom of families, friends and co-workers to become a supportive ARISE intervention network. This network overcomes the denial, helplessness, blame and guilt and it counters isolation and reconnects families, engendering a sense of competence and renewing hope in their future. The ARISE model follows the addicted individual's family through treatment and up to six months after treatment. This model gives the family a good start at recovery.

Additional family assistance

With the Family Motivation to Change in mind, the family could use additional support as it moves through the recovery process with the addicted individual. The family needs assistance that would resemble help often available to the addicted individual through employee assistance programs (EAPs).

For more than 50 years there has been EAP support for employees who have a drug or alcohol problem; more recently, there also has been a focus on personal recovery assistants (PRAs) who reinforce the foundation gained in a structured treatment environment. The PRA returns with the client to his/her natural environment, moving into the home for a designated period and mentoring the client as he/she navigates that precarious time between leaving treatment and establishing a healthy routine as a recovering person. PRAs also are known as sober companions or sober coaches.