• Awakening the Family - building a recovery team

Awakening the Family

Becoming a Recovery Team for the Beloved Addict

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Family is primordial. It defines us. It is who we belong to and who belongs to us. It’s for each of us to decide who we call family. We are born into families, marry into them, or choose them from the people we love best. We come into this world with a deep need for knowing there are people who will always show up for us when we need them, stick with us through thick and thin, and love us at our best or worse.

Addiction changes that. It trespasses into families, multiplying itself into our lives, slowly changing the very foundation of family life, while blindfolding us to the ways it is eroding what we hold most dear. Addiction isn’t about one person; it is a disease that infiltrates entire collections of people who we know as our family.

Debra Jay

Debra Jay, author of “It Takes a Family,” (2nd ed., Hazelden)

Addiction steadily incubates darker emotions in a family, dimming the inner light until it’s difficult to remember feelings of laughter, having good fun together, being relaxed in one another’s company, or trusting. Dark emotions advance slowly over time, eventually leaving little room for joy, delight, geniality, or hope for the future. Emotions elicited by addiction settle deep into the “little brain” within our brains–the amygdala–which plays a crucial role in our emotional responses and the storage of emotional memories and events, all the while directing decisions we make in the name of defending our survival. When fear or anger begin to rule, relationships are progressively damaged. We are no longer who we once were, not by choice, but by the workings of our brains when encountering a growing addiction within the family.

The amygdala, operating in our unconscious mind, knows there is trouble long before the prefrontal cortex (thinking brain) wakes up to the fact that addiction is ruling the family system. As a result, family members commonly develop behavioral patterns designed to protect themselves from a loved one’s addiction without consciously identifying addiction as the primary problem. This happens because the action of the amygdala, as a key component of our survival instinct, bypasses the slow moving, thinking brain. We call this denial. But the word denial carries with it the connotation of deliberate choice, which leads to family blame.

Addiction professionals and other well meaning people explain to families, again and again, how to properly “see” what is happening to their beloved addict and themselves, with the assumption that educating them will lead to the right behaviors and desired outcomes. When this doesn’t work, the common refrain is, “Families are sicker than the alcoholic!” But the awakening of the family rarely happens with such insufficient efforts. We must do something with the capacity to cool down the amygdala and the family system. Awakening often begins with very practical actions that lead to spiritual solutions.

A Hebrew word, Yasha, often translated as “salvation,” has a literal meaning of “bringing into a spacious place.” When we are brought into a spacious place, we are saved from the confines of our enemy. Addiction is a constrictor. It makes our inner and outer worlds smaller. It isolates us. We don’t talk, we don’t trust. Unspoken rules are dictated by the disease, and family members hunker down in silos of survival. Brains cells begin to disfigure and retreat inward from toxic stress (Gould, Elizabeth). Children’s rapidly developing brains are changed–the very architecture of these young brains is weakened (“Center on the Developing Child,” Harvard University). While Yasha is about breaking down barriers, making room for new ideas, opening us up to receiving help from others, the question that hasn’t been adequately answered is: How do we effectively move families bound by addiction into this spacious place? After all, they, much like their addicted loved ones, are prone to resisting help. They expect the solutions to come from changes within the addicted person, not from themselves.

But first we need to ask the question before the question. Why, when families are faced with the addiction of a loved one, do they resist taking the steps prescribed for saving themselves and most probably their alcoholic or addict?

There is more than one explanation, but the dominating reason is the long-accepted language of inaction being spread from person to person and prescribed by professionals and believed even by many recovering addicts and dominating the messaging of popular media. This language of inaction blocks family awakening. It tells families why they can’t do anything and stops them from exploring possibilities. It results in a kind of self-confinement that results from families believing they not only can’t do anything, but they shouldn’t even try.

Of course, this doesn’t mean families do nothing. Since the language of inaction blocks them from seeking out truly effective solutions, family members instead come up with kitchen table solutions that they apply crisis to crisis. Families are constantly putting out fires. Desperately attempting to survive in the moment, they are madly scratching out little bits of safety. But for all their efforts, the big picture reveals an alcoholic getting sicker and a family increasingly damaged.

So what are the messages of the language of inaction? There are many, but it’s the trifecta of the most damaging, action-stopping myths that do the most harm.

The first myth is: You can’t help an alcoholic (addict) until he wants help. This is the most unchallenged myth and the one most responsible for allowing addiction to progress unchecked. Instead, we need to ask: If you can’t help an alcoholic (addict) until he wants help, what will get him to want help? By changing the language, we change how we think about and approach the problem.

The second myth is: Treatment won’t work if she doesn’t want it. Success isn’t determined by how an alcoholic or addict feels when admitted into treatment or what motivates her to accept treatment, but what happens once she is in treatment. Instead we need to ask: Before we get her into treatment, how do we determine which program will provide the right level of support for her needs?

The third myth is: You just have to let the alcoholic (addict) hit bottom. The myth of hitting bottom tells us we must do nothing other than let the pain of negative consequences accumulate in an alcoholic or addict’s life, until pain forces them into treatment. This is a dangerous prescription for the addicted person, since some bottoms come with no bounce: loss of family, loss of health, damaged brains, prison, and death, to name a few. Other bottoms play out over years, eroding the potential our beloved addict once had, and virtually all bottoms are harmful to those closest to the alcoholic. When a family is given “hitting bottom” advice, the warning they rarely receive is that your family is going to hit bottom with the alcoholic, even your smallest children. The destruction and suffering of the family is an unacceptable consequence of a loved one’s addiction. Instead we need to ask: How can we raise the bottom to today?

It’s easy to see how we can transform these myths from action-stopping language to the language of possibility. In doing so, we give back hope, open doors to what is feasible, and offer families a sense of purpose. But this change of language and resulting feelings of hope is just a starting point and, in a practical sense, the place where we, as a society, most often abandon families. We offer woefully insufficient guidance. Treatment services are often beyond a family’s financial capacity. Families search, but cannot find a reliable helping hand as they navigate this long road toward recovery. To make matters worse, there are legions of untrustworthy providers populating the Internet.

Is it any wonder that relapse rates are high and families, disheartened, throw up their hands as if to say, “We’re done!” Addiction professionals, possibly trying to explain away the failure to improve recovery success rates, talk about addiction as a chronic, relapsing brain disease. Many go so far as to say, “Relapse is part of recovery!” It’s a language we don’t use when talking about cancer or heart disease or diabetes. It’s also a language that creates a negative social norm for addicts and their families–relapse is normal, relapse is inevitable, you are going to relapse. But is it truly a relapsing brain disease? Or is it a chronic disease requiring more support than is provided and, thus, people relapse? When we look at the success rates of impaired licensed professionals, such as physicians, who participate in five-year support programs designed for achieving lasting sobriety, we can confidently say it’s more likely a lack of support that is to blame than an inevitably relapsing brain.

Robert L. DuPont, M.D., et al., studied 904 addicted physicians in 16 different states, all participating in five-year support programs (post-treatment) called Physician Health Programs (Setting the Standard for Recovery: Physician Health Programs, 2009). Participating doctors were addicted to alcohol (50%), opioids (35%), other drugs (15%), alcohol and other drugs (31%), and 17% had legal troubles related to their addiction. Following these doctors for over five years, the researchers found that, during this time period, 78% had zero relapses, 15% had one relapse, and only 7% had more than one relapse. The research team concluded that the key is the length of time doctors received support for their recovery, providing even those who relapse a high probability of succeeding. Compare that to the general population, where it is estimated that 70% of addicts who receive treatment relapse in the first year.

Some might think that doctors have a higher success rate precisely because they are doctors. There is nothing that indicates that the profession contributes to success. Rather, doctors typically arrive to treatment sicker because they have complex enabling systems that unwittingly keep them from accessing help earlier, and, once in treatment, they are more difficult to treat than most other patients. It is precisely because they don’t recover easily from their addiction that they are required to participate in multi-year support programs if they hope to continue practicing medicine.

It’s not just physicians. Impaired attorneys in similar programs do exceedingly well. For example, the Judges and Lawyers Assistance Program of Louisiana regularly achieves even lower rates of relapse than the Physician Health Programs in DuPont’s study. With approximately 120 attorneys currently under monitoring in Louisiana, 95% have had zero relapse over a four-year span (Stockwell, Joseph).
This evidence granted by a challenging patient population who is highly successful at staying sober through participation in multi-year support programs, give us good reason to change the language we use to describe addiction. After all, these doctors and lawyers show us that relapse is not inevitable. Therefore, rather than calling it a relapsing brain disease, it is far more accurate to describe relapse as a symptom of insufficient support when treating this chronic disease of body, mind and spirit. If families understood that relapse wasn’t inevitable, that there are things we can achieve by working together, and that creating lasting sobriety is
very doable, most families would volunteer to be part of the solution. But first they need to know how.

As astonishing as it may seem, considering the severity of the addiction crisis in the United States and the amount of money it costs our country annually (approximately $520 billion), our population at large, including most professionals, is broadly ignorant of how family can transform into a working recovery team, even though these teams, properly structured, create a high probability of success for motivating a loved one to accept treatment, complete treatment, and commit to a recovery program designed for long-term sobriety.

The family has historically been left out of the recovery equation by treatment professionals. This happens largely because insurance doesn’t reimburse for most family programming, and because treatment teams don’t really know how to design programs that engage families in a way that leads to a long-term cooperative family approach to recovery. A treatment team’s specialty, after all, is in treating the addicted person and only for a specified period of time. Once treatment is completed and the patient is discharged to begin a life in recovery, the treatment team no longer plays a role. This is when a family recovery team becomes most crucial.

As a result of leaving families on the sidelines, they are left trying to solve this insidious and perplexing problem while using the wrong language. Most of the necessary words and concepts don’t even exist for them. How do families awaken when they lack the required knowledge base? Consequently, they aren’t prepared to take part in a recovery dialogue. As the father of an addict said: “Fides ex auditu–faith cometh by hearing.” Families excluded from recovery dialogue regularly lose faith, no longer believing anything can change.

The lack of a shared recovery language creates a barrier between addict and family. This happens in two important ways. First, when families aren’t provided a language that can effectively communicate with addicts, families instead rely on a reactive language (anger, blame, fear) that further alienates addict and family. Second, when families lack the language of recovery required for working together as a recovery team, they face a low probability of replicating the success rates found among impaired doctors and lawyers.

What we need, to paraphrase Pope Francis, is a “field hospital” that unlocks the power of family, providing them with a way to save their suffering alcoholic or addict and, ultimately, themselves. We need a field hospital accessible to all who seek it. It is a field hospital that meets people on ground zero, in their homes, their churches, their communities. It is a field hospital that never costs anybody anything. It is a field hospital that keeps growing and evolving with the needs of its users. It is a field hospital that is always available at everyone’s finger tips. It is a field hospital that can be shared from person to person. It is field hospital that never existed before, simply because no one imagined it. But, today, it is a field hospital imagined and launched. It is a field hospital called Get Help Give Help.

Get Help Give Help uses technology to answer the addiction crisis by sharing sophisticated and nuanced, action-based information from person to person, family to family, community to community, bringing about an ecumenical shift in how we think and act when faced with someone’s addiction. Addiction needs to be addressed in its earlier stages, not its latest.

Get Help Give Help is divided into two goals. The first goal (Get Help) is to guide families out of the problem and into the solution. Get Help offers families a compendium of action-based knowledge. Get Help is a place for learning the language of recovery. Get Help information is available on 5-minute audio snap trainings, each offering one nugget of action-based knowledge making learning simple and efficient.

Get Help teaches families how to design a spiritual negotiation that is highly successful at moving their loved ones out of active addiction and into recovery, because all other steps for helping follow this one. Get Help then answers the many questions families encounter as they move forward through a loved one’s treatment and recovery experience, such as how to find the right treatment for a loved one, how to find low cost or no cost treatment, how to avoid con artists when searching for treatment, how to talk to a loved one’s counselor in treatment, how to talk to your loved one in treatment, what to do if your loved one wants to quit treatment early. It answers questions about what your loved one’s schedule in treatment should include and why, what is an aftercare plan and what kinds of recommendations should a family expect, how does a family prepare for a loved one returning home, and what does it mean when we talk about recovery, and what are the elements required for working a solid recovery program? We answer questions about what creates lasting change and what doesn’t. We discuss ways families and friends can build a positive social norm for recovery, which makes relapse much less likely. And the list goes on.

The second goal (Give Help) transforms each of us into an arrow on the road map. We simply point others to Get Help Give Help, the place where families get detailed direction at no cost. Give Help is exceedingly easy. Anyone can do it. Give Help places no demands on time or busy schedules. Give Help is something we can always have with us–we simply use our smartphone or tablet or computer. With technology, we share Get Help Give Help in a snap. For those who are low tech, we share by downloading and printing a small piece of paper with the Get Help Give Help web address, tucking it into a wallet or purse, and handing it to anyone who is struggling with a friend or relative’s addiction. Learning how to Give Help takes just a couple minutes, transforming us all into someone who can change a family’s future by simply pointing them in the right direction. The website has short how-to videos on how to Give Help: GetHelpGiveHelp.info.

Once a family accesses Get Help Give Help, the first thing they do is share the information with other family members and begin building their family recovery team. Families working as teams achieve the highest success. An addicted person can easily circumvent the concerns of an individual family member, but a group of people who are trained and knowledgeable, and know how to take the right action, makes it highly unlikely that addiction will win. When a family builds a knowledgable, action-based recovery team, it’s the most loving thing they can do for their addicted family member or friend. The very act of building a team, coming together empowered by knowledge, learning a shared language of recovery, and taking appropriate action, produces an awakening in an entire family. They see what they could not see before, they do what they could not do before.

Get Help Give Help also guides families and close friends on what it takes to work together as a family recovery team. This isn’t a hit or miss approach. It requires structure. Get Help Give Help introduces families to an approach called Structured Family Recovery® (SFR), which creates a system that supports long-term sobriety, much like programs for impaired doctors and lawyers. SFR begins with families working as teams supporting a loved one’s sobriety, but ends up transforming families in ways they never expected.

We can best take a look at Structured Family Recovery through the experience of a real life family. This family team consists of the recovering addict, his parents, two uncles, and a friend who is also in recovery. The family began SFR almost three years ago, never imagining that they would continue to faithfully meet every week during all this time. It is deeply understood among these family team members that, with SFR, they have collectively created something to be cherished, something they don’t want to lose.

One of the uncles, who is a psychiatrist by profession, wrote the following narrative about his experience when asked to participate on an SFR team with his own family. The family, living in three different states, holds SFR meetings weekly by conference call. The uncle’s narrative reveals how a family is awakened when they come together with structure, learn a shared language of recovery, and work together toward a common goal. Here are the uncles thoughts:

“SFR can help bring something to life in a family.

“When a loved one asked me to support his ongoing recovery work by joining a weekly call, I was surprised to learn those calls would be guided by a program that directly involved the family. Structured Family Recovery understood the healing potential of the family and the challenge of awakening that potential. This recognition is too rare. A thoughtful design that steps up to the challenge–as is found with SFR– is rarer still, and patients, families, and providers are the worse for it.

“Families are like gravity and everyone feels the pull as they navigate their lives, but it’s hard to keep this in mind, particularly when providing any kind of health care. As a psychiatrist, I know that on a good day the practitioner might rise to number seven on the list of influences affecting someone’s health. Families are at the top of that list and always in the room, in some form, regardless of the physical or mental health condition being treated. It took four years as a rural family doc, followed by a psychiatry fellowship focused on family therapy, for me to get some sense of how to work in that room.

“It took much longer to realize the healing potential of the family in the room, whether the family was intact or not, alive or dead, present or separated by continents and cultures. At the very least, a person’s family was the original context within which everything else was experienced, so it informed all my work. Otherwise, therapy with individuals, couples, families, and groups, medication recommendations, inpatient treatment, teaching and supervision: all of it would have felt like addressing the third violinist, without ever hearing the whole orchestra.

“A vital healing source is aroused by any specific knowledge of that context, and it becomes a living presence in the room whenever the family is actually there, physically or in spirit. This is the bedrock of SFR. It has helped us evoke that presence and has guided us in keeping it as alive and real as possible from week to week. This healing presence is as alive as if it were another body joining us. It is alive in the space we nurture with our time and our attitude during our calls, and that presence stays with us through the rest of the week.

“Our collective awareness of this vitality is implicit in the question we have asked ourselves at different times: “Do we keep going?” An “I” statement beneath our query could be this: “I’m afraid something essential will die off if we stop.” Most likely, that fear was a prime driver in the beginning, but SFR has introduced us to the healing presence that now gathers our commitment, and we still want to see where we can go with it. We have transformed fear into trust along the way, and we now trust each other in ways that would have been hard to imagine at the beginning. That trust will help us see when it’s time to move on from our weekly calls and support us in our decision.”

I had never met this family before I received their phone call. The family reached out to me because I was the founder of Structured Family Recovery. They wanted me to experience one of their SFR meetings. Of course, I agreed. By the conclusion of the SFR meeting I attended, with all communication over a conference call, I felt I’d known each member of this team for a very long time. I felt part of this family. When the uncle writes about a living presence in their SFR meetings “as alive as if it were another body,” I can testify to feeling that presence. It was a spiritual force so strong, it pulled me into this team. I felt intimacy, belonging, warmth, and recognition. I knew these people. Not from past experiences but from a place in my soul.

The spiritual awakening of this family was all encompassing. It didn’t emanate from any one individual, but was its own life-force shining through the work of the many. As a father from a different family explained: “Working together as an SFR team brought us to a post-resurrection vocabulary. The language is peace and forgiveness.”

This article originally appeared in
Human Development Magazine.

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