The Family's Role In Treatment Success

Despite the family’s constant fear of relapse, they actually invite it by either grossly enabling her or creating their own relapse triggers that make her want to use.

The unfortunate truth about addiction treatment with teens and young adults is that ineffective family support plays a huge role in poor outcomes. This is not to say that parents intentionally set out to sabotage their child's treatment. It's been my experience that most would do whatever it takes to help their child overcome an addiction problem. The problem is helping them know exactly what it is they should do!

The following is an excerpt from my book, Rehab Works! A Parent's Guide To Drug Treatment. In the chapter titled "Treatment Success." two case studies are examined that shed light on the influence parents can have with regard to treatment success. The first case provides an example of an all-too-familiar scenario in which parents fail to utilize the treatment process effectively, which ultimately compromises the client's chances for treatment success. This is then contrasted with an example that illustrates what parents can do to increase the chances for treatment success—even when it doesn't look like treatment is "working."

From "Rehab Works! A Parent's Guide To Treatment Success"

In example A, Heather’s parents disregarded several things they should have learned in their family education sessions. They failed to put structure in place that would minimize exposure to triggers, which allowed Joanie to engage in lots of slippery behavior. More important, they failed to ensure successful completion of the continuum of care by taking her out of intensive treatment and placing her in outpatient therapy before she was ready for this lower level of care. Withdrawal from IOP at that point drastically reduced any chance of accomplishing what the parents thought they wanted when they first signed Heather in for treatment at the residential facility.

From a Stages of Change perspective, Heather never made satisfactory progress with regard to contemplation and preparation. She doesn’t believe she has a problem, nor does she understand or respect the need to minimize triggers in her life. Disregarding this critical fact and moving her forward in the continuum of care would be an example of skipping stages, which leads to a shaky foundation for recovery. However, Heather’s parents have taken themselves out of the game and will more than likely remain oblivious to this fact. If lucky, the new therapist will identify the fact that Heather needs more than what he or she can offer and recommend they remain in IOP until she is successfully discharged.

Unfortunately, not all private practice therapists specialize in treating substance use disorder—much less adolescent substance use disorder—and this could be overlooked. With addiction clients, individual therapy at this point would be more appropriate for addressing co-occurring issues as an adjunct to treatment or for ongoing support once the client has completed treatment and has reached the maintenance stage. I said it before, and I’ll say it again: Addiction clients need addiction treatment. There is a big difference between outpatient therapy and intensive treatment.

For Heather and her family, nothing has really changed. The family is still revolving around the addict, as everyone’s attention is focused on “Heather’s recovery” rather than including themselves as part of the recovery effort. From a family systems perspective, the young person who develops a drug problem tends to become the “identified problem.” And one of the tough lessons parents must learn is that this negative focus frequently becomes an unhealthy pattern that allows the dysfunctional dynamics of the family system to continue:

1. It fosters a self-fulfilling prophecy for the addict.

2. It allows the family to avoid addressing other unhealthy dynamics within the family system.

When parents fail to recognize the need for the entire system to change, it becomes a case of returning the tree to poison soil. Heather is still identified as “the problem,” and trust me—she feels it. With the laser beams focused on her, there is a persistent unease within the family system: “What’s she going to do next?” 

Despite the family’s constant fear of relapse, they actually invite it by either grossly enabling her or creating their own relapse triggers that make her want to use. Take for example her parents’ avoidance of addressing their own issues. Dad appears to have anger issues and his default position borders on being abusively critical of Heather. Despite his claim of being supportive of her recovery, he practically invites her failure by constantly assuming it’s going to happen. Mom recognizes that the situation with Dad is not healthy, but her own fear of rocking the boat prevents her from taking any action to address these dynamics in a healthy way. She ends up feeling stuck between Heather and her father, and the whole scene makes Heather bitter and resentful because on some level she knows exactly what’s going on—and she knows it’s not right. Like an anchor around the addict’s neck, unhealthy family dynamics become stressors that inevitably foster further negative attitudes and behaviors, which in turn reinforce the addict’s role as the “problem.” She eventually messes up, the family says, “See, I told you so,” and they put her back in rehab. She fulfills her role as “the problem,” and the dysfunctional family system carries on, status quo. If parents don’t take responsibility for their part in working to restore the family system to a healthy balance, the client’s treatment progress will be hindered. Here is where we begin to identify the fine line between healthy support and obsessive enmeshment or shaming detachment. This goes to the heart of understanding what codependency is all about and underscores the importance of parents grasping the concept of family recovery. 

The parents in example B, on the other hand, provide a good example of using the tools gained through the treatment process. First of all, don’t underestimate the significance of the fact that they simply attended everything. It’s easy for parents, particularly when they get to the IOP phase, to come up with excuses to skip a therapy session here, a multi- family group there. Yet it could be said that virtually every interaction the family has with the treatment program leads to progress in some form or fashion. Likewise, a missed activity is a missed opportunity. You never know when something might occur that will positively impact your child’s treatment. Consider just a small sample of the endless possibilities you create by simply showing up:

• A therapeutic breakthrough in an intense family session
• A helpful conversation with another parent during a break
• An informative lecture that gives you new perspective on a particular topic
• A casual interaction with your counselor that changes your whole attitude about treatment 

While these refer to random incidents that can occur at any given time during the treatment process, the cumulative effect of consistent and enthusiastic participation over time is great. Developing effective relationships with staff, bonding with other parents and beginning to experience the fellowship and support that is part of recovery, absorbing the vast amount of education involved with chemical dependency treatment—these are some of the intangible elements associated with a positive treatment experience, and they are all within the parents’ control. Supporting a successful treatment episode for a child requires a substantial time commitment from the parents—however inconvenient it may be—and it begins by simply attending all activities and following directions. Jason’s parents were at every session and got started in Al-Anon right away, soaking up everything they could possibly learn. As Jason’s behaviors continued to be dictated by his addiction, their efforts paid off by allowing them to respond in a healthy manner:

1. They did not allow themselves to be controlled by his behavior.

2. They did not enable him.

I feel much better about this scenario than one in which parents fail to recognize their part in providing effective support and inevitably sabotage the client’s treatment. Jason may not be sober now, but just because things go south following an initial treatment episode, treatment is far from over. The more the parents continue to demonstrate their own recovery, the more the impact of treatment remains front and center. This includes maintaining boundaries that do not enable continued addictive behavior—even if this goes on for years in what feels like a stalemate with an addict who does not want to change. In the big picture, Jason’s parents are in a much better position of helping him succeed as his story continues to play out. 

Rehab Works! A Parent's Guide To Drug Treatment is available on Amazon.

The Rehab Works! Family Recovery Program is now available as an online course for treatment facilities to offer parents of teen and young adult treatment clients. Please message Jim Savage for more information, or visit www.rehabworks.net for more information.