Family-based interventions for chemical dependency and addiction

Chemical Dependency and the Family
Introduction
Any time there is a chemical dependency it affects more than just the user. That is because nearly everyone has a family—some network of kin or support who care about the purpose and are impacted by the grip that the substance has over the loved one’s life. Drug and alcohol abuse and chemical dependency are issues that families can both help and hinder, depending on how they approach the issue. This paper will describe interventions that can be of use for addictive families, barriers associated with educating families, ways to overcome those barriers, what specific family behaviors harm rather than help the addict, and what family members need to know to avoid negatively impacting treatment options.
Intervention Approaches for Addictive Families
Family-based interventions are among the best and most effective intervention approaches for addictive families (Copello, Copello, Velleman & Templeton, 2005). The reason these work so well is that they integrate the whole family into the intervention and treat the whole problem—which can oftentimes include family members and their issues relating to the addict’s behavior. As chemical dependency can wreak havoc on “a range of family systems and processes, including family rituals, roles within the family, family routines, communication structures and systems, family social life and family finances” (Copello et al., 2005, p. 370), it is important the family be supported when a member of the family is suffering from chemical dependency—and family-based interventions are one way to provide that support.
There are three main ways in which family-based interventions can be useful: first, in “working with family members to promote the entry and engagement of misusers into treatment;” second, in establishing “joint involvement of family members and misusing relatives in the treatment of the misuse;” and third in “responding to the needs of the family members in their own right” (Copello et al., 2005, p. 371). Family-based interventions can be used to put pressure on the addict, to bring the family together to cope with the fallout of addiction, and to provide comfort and support for those family members who suffer from seeing a loved one struggling with addiction. Family-based interventions can range from brief strategic family therapy to family behavior therapy (Austin, Macgowan & Wagner, 2005).
Group motivational therapy has always been shown to be an effective intervention approach because it highlights the need that addicts have for an intervention that is “autonomy supportive”—i.e., that gives that addict the sense of self-determination and empowerment (Foote et al., 1999, p. 181). It motivates the addict to focus on personal change within a group setting. In an environment such as this, the addict is both comforted and supported but also given the necessary intrinsic motivation to more effectively face the issue of addiction.
Barriers Associated with Educating Families
Some of the barriers associated with educating addictive families include a lack of familial support, a lack of family stability, and a lack of familial incentive. Communication is a key aspect of functioning families and has to be there in order for education to be possible (De Civita, Dobkin & Robertson, 2000). Families that suffer from various stressors, from financial stressors to structural stressors, also display many barriers to the reception of education about addiction, how to help those suffering from an addiction, and what not to do to exacerbate the situation (Cook, 2001). Stress is one of the worst component features in a family where addiction is a problem. Families that stress out members can cause breakdowns in communication and lead to the family support systems caving in. In order for the family to be open to receiving education, a stable dynamic has to be there to some degree.
Other barriers include a fear of treatment, privacy concerns, time conflict issues, and admission difficulty (Rapp et al., 2006). Fear of treatment is often a big barrier for families who are in need of education because they do not want to be labeled as a family suffering from addiction, or they do not know what sort of impact an intervention might have on the family dynamic. There is the tendency among this type of family to believe that the devil you know is better than the devil you don’t know—so they avoid getting educated on the matter. There is also the problem of believing that no one truly knows how to handle the matter so they are skeptical of any educational approaches. Privacy concerns are typically an issue as well: they want the matter to stay in the family and not be broadcast all over town. They do not feel that it should be anyone else’s business: they do not know how to communicate their own suffering and they feel that there is really nothing anyone can do anyone—a general hopelessness may pervade the family unit as a result. Time conflicts can also be a barrier as everyone in the family is frequently pressed for time just trying to make ends meet—whether it is with school or work or other family members who need attention. There is simply not always time available to commit to anything one way or the other. Then there is also the barrier of admission difficulty. Families who put up barriers to education can sometimes feel as though they cannot actually come out and admit there is a problem that needs to be addressed.
Overcoming the Barriers
Overcoming these barriers can be facilitated through the application of motivational interviewing, which “has shown value in helping clients manage the ambivalence that often surrounds substance use and the decisions to seek treatment” (Rapp et al., 2006, p. 234). Motivational interviewing helps because it provides families with the opportunity to negotiate their own conflicted feelings and experiences in order to choose to make a decision and seek education and possible treatment for their loved one. It is an intervention that gives the family a firm basis in clear, firm and deliberate choice-making via a sense of perceived empowerment through education. Motivational interviewing works through the question answer process that helps family members to eliminate doubts and identify paths to health that they otherwise might feel indifferent towards.
Treatment mentors are also another option, as they “help prospective clients deal with their fears about treatment and their reticence about revealing personal information to others” (Rapp et al., 2006, p. 234). In these cases, families just need a little guidance because of their hesitation to accept information, education, help and eventually treatment for the addict. The treatment mentor is there to act as a guide in the process of overcoming barriers and to provide families with the support and training needed in addressing the situation while there is still an opportunity to do so. The mentor does not take command but acts as a coach, helping families to identify opportunities and issues that they may be able to approach.
Strengths based case management is also an avenue to overcoming barriers and getting families to engage with the issue of addiction in spite of whatever reservations, fears, or time constraints they may have. Strengths-based case management focuses on getting families to identify the ways in which they can provide support and building on those strengths whatever they may be (Gardner et al., 2005). It focuses on looking at the positives in the family dynamic instead of the negatives and using these core strengths to construct a foundation that the family can use to address the issue of addiction in the family.
Family Behaviors that Harm Rather than Help the Addict
While families may be meaning well in their approaches to helping the addict, the steps they take are not always positive or supportive and can actually lead to more harm than good. Sometimes, for example, families can be too enabling of the addict by making it to easy for the addict to turn to the chemical dependency in trying times, by giving the individual too much independence, by not saying or doing anything that might make the person question him or herself, or by always praising the individual and telling that person how strong he or she is. Enabling is a harmful behavior that actually shields the addict from receiving the treatment that he or she needs (Rotunda & Doman, 2001). It prevents the person from seeking and obtaining the counseling, therapy or other types of interventions that can be used to actually address the addiction.
Financially supporting the addict can be a way of enabling because the addict is not forced to become self-sufficient and make choices about his or her life style. While not financially supporting an addict may seem like a hard step to take for a family member, the alternative is that they never actually make the decision to take responsibility and ownership of his or her life (Moore & Dietze, 2005). It often becomes a source of contention and conflict for other members of the family who disagree with the enabling. This leads to tension and in-fighting as non-addict members of the family struggle to reach a consensus on the best way of handling the situation. Communication breakdowns can occur with one member totally shutting out the others, which does not facilitate positive change.
Codependency is another way in which families can engage in harmful behavior. A codependent family member is one who believes that the only way to address the situation is to love the addict unconditionally and to support the addict in the way he or she wants to be supported. The codependent family member has a need to receive love or affection from the addict and perceives that by giving into the addict’s demands the addict will show that love. It is the opposite of adopting a tough love strategy, though that too can be problematic (Denning, 2010). The key to helping the family member suffering from addiction is to find the right balance between supportive affection and firm guidance.
How Family Members Can Negatively Impact Treatment Options
Family members can negatively impact treatment options by failing to provide the kind of familial support network that a struggling addict needs when thinking about treatment options. Families need to know how to interact with the addict in a way that is conducive to treatment. This of course can come by way of education and family therapy, but it is not always likely that families will receive the education they need in a timely manner. Social and emotional intelligence skills are important to possess in cases like this, but oftentimes families lack these skills.
Families need to provide social support in a manner that the addict finds genuinely helpful, otherwise the addict is likely to relapse and fall into old habits, begin associating with old friends in harmful environments that can lead once more to chemical abuse. Finding ways to give emotional and psychological support is essential in opening the door to treatment. Families should focus on being positive, stable, consistent, and oriented towards making progress (Gendel et al., 2012).
In other instances, families themselves can be the ones responsible for providing a poor environment for change. They may engage in lifestyle habits that lead the addict to greater use of chemicals, or they may be unable to provide the kind of stability required for an addict looking to make a change for the better. Families who are dismissive of treatment may make it harder for the chemical abuser to seek out treatment options. Families who are worried about having their lives looked into by doctors or counselors may warn the addict against seeking treatment because of insecurities the family members have.
There may also be an unclear sense of family roles. The roles that parents or siblings or children should play in a conventional setting disappear as they individuals struggle to cope with the addiction. They then fail to find ways to inhabit the roles required of them to assist with finding treatment. They neglect their duties both towards themselves and towards the addict and thus become unintentionally problematic and disruptive in their own approaches. It is important therefore for the family members to not succumb to hopelessness or despair and to take time for themselves that they might be able to function effectively and be ready for those trying and stressful times when their loved one is struggling.
Additionally, if the family is still supporting or enabling the addict or is refusing to engage in family counseling or family-based interventions, the family is placing restrictions on the addict’s actually ability to overcome his or her addiction. In some cases, the family will need to come together as an entire unit to help the addict uncover and address the underlying issues that have led to addiction in the first place. Other times they need to be there to offer their support so that the addict knows that a support network can be found in their family members—a place where they can go to vent, to rest, and to talk. Families who resist communication, however, become barriers to treatment themselves.
Conclusion
Families can be powerful resources for obtaining treatment for addicts—but they can also represent obstacles to treatment. Family-based interventions are effective ways of helping addictive families, but in order for them to be successful families have to be open to the idea of treatment, to the idea of going and opening themselves to uncomfortable thoughts and issues that need to be addressed. When families fear having their privacy intruded upon, or worry that they do not have enough time for the addict in the family, they become barriers to treatment. Barriers can be overcome through the use of treatment mentors, through education, and through motivational interviewing. However, families must be willing to stop engaging in enabling behaviors and must work to overcome any codependency they might have, as neither of these behaviors is truly conducive to an effective resolution of the problem of addiction. Families need to be stable and able to provide a support system for the addict—as that is the way towards a positive change for addictive families.
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