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Disorders in wealthy families: Cutting them off doesn't work

August 22, 2017
by Paul Hokemeyer, JD, PhD
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While most treatment professionals acknowledge that addictive disorders don’t discriminate based on socioeconomic class, too few are able to negotiate the unique dynamics that arise in the context of ultra high net worth (UHNW) families. This unfortunate trend continues in spite of evidence indicating these families suffer from addictive and mental health disorders at astronomical rates. A recent study by Campden Wealth, one of the world’s most prestigious financial services companies, found that of the families it serves, 71% have an addictive or mental health disorder.

To combat the destruction that accompanies these afflictions, families must intervene in a way that is embraced by the person needing help. In this article, I will discuss how wealth can be used to motivate patients rather than push them deeper into the clutches of their disease. Through this approach, patients will enter treatment with the proper state of mind and motivation to maximize their long-term success after being discharged.

The problem

All UHNW families know there is no shortage of people outside their system eager to comply with their financially incentivized requests and well-intended directives. Within the family, however, a different story is frequently told. This is most pronounced when what is being addressed is an addictive disorder.

Think of the son who wrecks the family car in a drunken binge and, when the family insists he seek help, escalates his drinking. Or the daughter who becomes addicted to prescription pain medication after suffering a sports-related injury and, in response to the family’s interventions, falls into the deadly clutches of heroin she buys on the street.

Unsuccessful in their attempts to address the problem from within, UHNW families often seek the advice of outside treatment professionals who advise that they leverage financial resources and “cut off” the afflicted family member. While powerful and effective in the short run, such a strategy sabotages the patient’s long-term success and causes a destructive backlash.

To understand why this dynamic exists, we must look at the groundbreaking work of University of North Carolina Professor Alison Fragale. She found that to be effective, power must be asserted with status. Fragale defined power as “the extent to which an individual can control others’ outcomes by granting or withholding valued resources.”1

According to Fragale, status is “the extent to which an individual is respected, admired and highly regarded.”1 Power exerted without status will cause the person acted upon to respond in ways that punish the person asserting the power.

And money holds great power.2 This is especially true among UHNW families, where gatekeepers such as parents and trustees have the discretion to grant or withhold other family members’ wealth. Regardless of how benevolent the arrangement was intended to be, this financial reality is a fertile ground for a host of negative reactions and unhealthy dynamics. At the top of the list are resentment of the gatekeeper’s power and fear on the part of beneficiaries that absent their wealth, they would be unable to survive in the world on their own.

When the dependent person has an addictive disorder, these dynamics become intensified. Therefore, any financial interventions intended to motivate a patient must be executed through the respect and regard of the human being that lies deep within the veneer of the patient’s symptomology. Such an approach will imbue the family member exerting the power with enough status to avoid a backlash and allow the patient to take ownership of his/her life.

But over the years, I’ve witnessed ill-advised UHNW families use the power inherent in their wealth to force a member afflicted with a substance abuse disorder into experiencing highly ineffective results. Instead of collaborating with the patient in ways that allow the person dignity in care, they shove their demands down his/her throat. When the patient vomits them out, they double down even more and in so doing, push the patient further away from the family and deeper into the clutches of the disease and the malignant relationships that support it.

Just over a year ago, I had the privilege of working with a UHNW family from the United Arab Emirates that utilized the services of a well-respected American interventionist, with emotionally damaging and financially wasteful results. (The identifying details of this case have been altered to protect the family's confidentiality.) The family approached me after paying a U.S. treatment center close to $200,000 to babysit their son for 75 days. While physically present in the program, the son refused to sign the proper releases, fell asleep in group, and failed to engage with his primary therapist. The patient, a 47-year-old whose $125 million dollar trust was ruled over by his 83-year-old father, suffered from an addiction to prescription opioid medications and was morbidly obese. He also happened to be a gay man whose “lifestyle” was disapproved of by his father and several other family members.