It is widely accepted in the addiction treatment community that the ravages of addiction affect those close to the using person in a myriad of ways. The pain, embarrassment, degradation and sense of loss experienced by families and significant others are overwhelming while the addict is actively using drugs.
This mindset does not change when the addict receives treatment. After treatment there are a different set of variables that families experience and must attempt to overcome--such as what they expect when an addict returns home and what they should expect, and how they respond to perceived inconsistencies in addict behaviors.
Unlike a newly recovering addict, the family has limited knowledge and understanding about the recovery process--an awareness that is necessary to assist it as it does battle with the demons in this new arena. Very few treatment programs adequately prepare families with more than cursory drug education and recovery expectations related to their loved ones. The importance of families needing to take care of self is not addressed in treatment or included in the discharge planning process. Consequently, the family's understanding of the need for a support network is compromised by its intentions to be a good support system for the recovering person.
When an addict completes treatment, there are usually promises and good intentions to stop using and to lead a productive life. Often noticeable positive changes can be readily identified. Then the subtle return to old ways begins. For many, the changes last only a few hours, for some a few days, and for some a few months. Very few realize the recovery attitude for years. For families, this new reality becomes overwhelming when their best efforts to encourage and support the recovering person are inadequate. The addict does not respond and behave in ways that reflect being in recovery. Or, in other words, the addict is just not doing what he or she is supposed to.
So what happens when good intentions are not enough? Families get misused and abused and become enablers rather than helpers. Does this sound anything like what your families encounter as they try to demonstrate support and concern for their loved ones? Have your best efforts to assist them in understanding the recovery process proved to be less than satisfactory, leaving you at your wit's end?
Are the families feeling responsible for not doing enough or not being there for the recovering person while they struggle with learning a new way of being? Have your families tried support groups and networking and found it unfulfilling? Maybe they just don't know what to look for when things appear to change for the worse. If you can relate to any of these situations, consider affording your families a different experience.
Coaching model
After my article on coaching recovery was published in this magazine (see January 2004 issue), I received an overwhelming response from persons wanting to know more about what the coaching process entailed. To my surprise, more than two-thirds of the inquiries were from parents and significant others of newly recovering addicts. Their questions and concerns prompted research that formulated a coaching format specific to working with the families and significant others of recovering persons.
Unfortunately, very little evidence-based research and best-practice results for coaching families of addicts was identified. However, the paradigm of coaching readily supports the utilization of interventions readily available in the counseling realm. The stages of change model developed by DiClemente and Prochaska has proven fruitful and is easily modified to enable family movement. Areas of concentration are family-focused and not addict-centered. This allows input from all persons who are going to be actively involved with assisting the newly recovering addict.
During the contemplation stage, the families must determine what they are willing to do and who will do what. The outline should be very simple, but its content is crucial to the family transition from enabler to supporter. For instance, who is responsible for getting the addict to a support group meeting if he or she doesn't have transportation or money? If the family accepts that task, for how long should it do it? Should it ensure that the addict stays at the meeting and finds a sponsor? These are a few of the many questions that need to be answered in determining role responsibility.
Coupled with role responsibility is boundary setting as the addict prepares to enter the action stage. This relates to what is acceptable behavior for the addict and the family. Consideration must be given to expectations that support recovery and realistic consequences. It might be considered something like the line that's drawn in the sand. Helping families to define in behavioral terms what they are willing to tolerate is crucial to coaching them through the early stages of the recovery process.
Last, but certainly no less important, is the creation of a support network. The most readily identified are Al-Anon, Nar-Anon and Alateen, but many churches and other organizations have outreach support programs also. Some are more behaviorally focused than spiritually centered. The important thing is to find one that works.
Reaching out to these organizations is done for the sanity and well-being of the family. Regardless of the recovering person's success or lack thereof, families must know and understand that they neither created the addiction nor have responsibility for the addict. Having persons who can empathize with feelings of inadequacy and experiences of helplessness is a powerful tool and a viable support mechanism. While participating in this type of forum can be uncomfortable in the beginning, the eventual benefits realized will far outweigh the initial discomfort.
Skilled clinicians and coaches are welcomed to utilize this intervention to facilitate and enhance the meaningful dialogue necessary for movement through the change stages. I also encourage ongoing dialogue among us to enhance the services each of us provides.
By C.E. English-El, MA, LPC, NCAC II, CCS
C.E. English-El is a consultant in private practice in the Washington , D.C.
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