INTEGRATING THE FAMILY INTO ADDICTION PREVENTION, INTERVENTION TREATMENT AND AFTERCARE: A GUIDE FOR FAMILIES AND ADDICTION PROFESSIONALS

Family is a common and familiar concept to almost everyone. A family is a natural social system, with properties of its own, one that has involved a set of rules, assigned roles, a power structure, has intricate overt and covert forms of communication, and has elaborated on negotiating and problem solving that allows various tasks to be performed effectively. Now when an individual in the family has an addiction everyone is affected by one family member's addiction. Addiction is a family disease. The family develops coping strategies to deal with the turmoil created by the addict's behavior. They may learn to withdraw in response to the addict's changing moods and erratic or volatile activity. The family learns to make excuses and even cover up for the addict. On one level they feel frustrated, defeated, lonely, responsible and even guilty. On another level, secrecy and avoidance reign. When the addicted individual gets treatment the family is so used to the struggle and purpose the family once had when the addicted individual was using, they unconsciously want to return to the way it was before the addicted individual got sober.

The family can be one of the most powerful tools to help people to change. So why isn’t the family accessed more by the drug and alcohol treatment professional. Also, why is it that some treatment programs see the family as a nuisance rather than as help? Other than the interventionist, the family therapist, and the treatment facilities, there is also very little help for the family. The interventionist (Johnson Model) typically only helps the family until they get into treatment. Typically, family therapists work with family issues and marital problems, but do not work on the family as a whole and how the addicted individual impacts the family. Treatment facilities typically only help the family while the addicted individual is in treatment. There is usually very little on-going help for the family recovery. The systemic model interventionists offer more help to the family by engaging the whole family into treatment. In this new model of intervention, the focus is on family and friends. This model has been developed and refined over the past 15 years by Interventionist Wayne Raiter. Systemic Family Intervention© involves a process of changing the maladaptive relationships that have inadvertently allowed, and sometimes even encouraged, the addicted individual to continue his/her behavior.

As the family develops new boundaries, the addicted person sees she/he must change as well. As part of the process, everyone involved learns about addiction. Because Systemic Family Intervention© involves the person's entire support system (family, friends, and sometimes co-workers) all the means through which the addict sustained his/her behavior are no longer in place. The addicted individual moves into a new environment that insists on change in him/her as well. With the addicted individual's entire support system involved, the means through which the individual previously sustained his/her behavior are no longer available. Everything changes, and the addict is pulled into the change process. This is a great approach, but it usually does not continue after treatment. The family is encouraged to go to family therapy and Al-anon. Many times family therapy and al-anon is not enough to sustain lasting change.

The best intervention approach that includes the family is The ARISE Intervention "Invitational Intervention" invites the addicted individual to participate in the intervention process. There are no secrets, surprises or ambush. Everyone involved is treated with dignity and respect. The ARISE model uses the addicted individual's support system to motive them into treatment. The ARISE model helps families, organizations and communities deal with issues such as: Addiction (substance abuse, alcohol, internet, sex, gambling), Mental Illness and treatment, Resistant Elders and long term care, and HIV/AIDS and Treatment. This model use Family Motivation To Change, utilizing the love, strength and wisdom of families, friends and co-workers to become a supportive ARISE intervention network. This network overcomes the denial, helplessness, blame and guilt and counters the isolation and reconnects families, engendering a sense of competence and renewing hope in their future. The ARISE model follows the addicted individual’s family through and up to six month after treatment. This model gives the family a good start at recovery.

With the Family Motivation To Change, in mind the family could use additional support as they move through the recovery process with the addicted individual. The family needs assistance just like the addicted individual has for example employ assistance programs or personal recovery assistance.

For more than 50 years there has been assistance for employees who have a drug or alcohol problem. This help comes in the form of employee assistance programs (EAPs) or employee assistance professionals, that can be attached to the company or not. These EAP’s help individuals with drug/alcohol and/or life issues that interfere with work.

Recently, in the last few years, there has been a focus on personal recovery assistants. Personal recovery assistants (PRAs) reinforce the foundation gained in a structured treatment environment. The PRA returns with the client to their natural environment (i.e. goes home with them and moves in for a designated period of time). The PRA mentors, guides, and supports the client as they navigate that precarious time, between leaving treatment and establishing a healthy routine as a recovering person. PRAs are also known as sober companions or sober coaches.

In the spirit of EAPs and PRAs the family could use a Family Recovery Assistance professional (FRP). A family recovery assistance professional helps the family to navigate through recovery for up to 12 months after the addicted individual enters treatment. It is known that in the process of recovery the addicted individual may relapse several times before he/she achieves abstinence. The FRP assists the family through the process and assists with interventions or a positive family interaction as needed. The FRP becomes like a family case manager, assisting in developing a family development plan, a Positive Family Interaction Agreement, and a Family Action Plan. ARISE Interventionists or Certified Family Recovery Assistance Professionals through Willingness To Change are best suited for working with the family through this 12-month process. The FRP helps coordinate the family’s treatment. This may mean acting as a liaison between the addicted individual’s treatment provider and the family’s therapist. The FRP also encourages the family to take care of their recovery by attending al-anon meetings and family counseling. The FRP meets regularly as set by the family. The family may meet in person, on the telephone, or electronically.

Another way, to increase the addicted individual’s chances of success in treatment would be to involve a Positive Family Interaction Agreement (PFIA). If there is a problem in treatment with the addicted individual (AI), there should be an agreement with the addicted individual on admission. This PFIA would state, if there is a problem in treatment (eg. AI wants to leave treatment or the AI breaks one of the facility rules), then the treatment staff will invite the names on the agreement to a Positive Family Interaction (PFI). Besides the family; friends, the employer, the mental health worker, the probation officer, the CPS worker, and etc. can be invited to the PFI, if they were listed in the PFIA. This meeting would also involve the AI and the AI’s primary counselor. This meeting would occur either in person or telephonically.
The purpose of the PFI is to resolve any issues or barriers to the AI’s treatment before the AI is exited from treatment, referred back to court, or the AI leaves without completing the program. A PFIA can be in place through a variety of modalities including detoxification, residential treatment, and out-patient treatment. With a PFIA in place, and using PFI, the AI has a much better chance of maximizing his/her treatment with this client-centered collaborative approach.


The FRP helps the family to create a Family Development Plan, which does exactly what its name suggests - outlines steps the family should take to work toward developing the family’s recovery. Just as the family had their expectations and roles before the addicted individual got help for his addiction. The Family Development Plan helps to develop their new roles and guidelines for the family now that it is in recovery.

A Family Development Plan:

1. Allows the family to identify specific problematic issues, as well as thoughts, feelings, and experiences with the issues.
2. Moves the family to identify a goal.
3. Helps the family decide how to deal with those problematic issues and reach their goal.

An example of a Family Development Plan:

1. Problem: We get very stressed because no one communicates in this family.
2. Goal: We want to be able to communicate better and reduce the stress within the family.
3. Plan: The whole family will meet every Wednesday night at 8pm for a family meeting. List of expected attendees: Dad, Mom, Aunt Ayesha, Billy, Joe, and Roberta.

As the family decides on the problems and issues they want to resolve with their Family Development Plan, the family can choose more than one. They don’t have to be as specific as the example. The family may have specific problems with concrete ways to work them out, or the family may have broader issues, such as fighting with a spouse or parent, that need to be tackled at varying angles.

Sometimes pinpointing the problems, as well as where the family is mentally and emotionally in life, can be difficult.

The Family Action Plan is a preset plan of action for the family to execute if the family is in turmoil. For example, if the addicted individual relapses, the family has a plan of action. The plan will consist of a pre-structure plan (warning signs) and crisis action planning (CAP). There are external events or circumstances that, if they happen, may cause a crisis within the family. These are normal reactions to events in the family’s life, but if they don't respond to them and deal with them in some way, they may actually cause the family to regress or to deteriorate. The family will write down those things that, if they happened, might cause an increase in problems within the family. Then make a list of warning signs the family has noticed happened prior. They may have triggered or increased problems within the past. Some of these warning signs are internal and may be unrelated to reactions to stressful situations.

In spite of the family’s best efforts, their problems may progress to the point where they are very uncomfortable, serious, and even dangerous, but they are still able to take some action and would involve the FRP and other professionals as needed. The names and contacts and under what conditions they would need to be called to assist will be laid out on this plan as well. This is a very important time. It is necessary to take immediate action to prevent a family crisis.

This is when the CAP comes into play. This is a detailed plan that gives a step-by-step process to the family in a time of crisis. This plan will help keep the family stabilized even when it seems like things are out of control. Develop this plan slowly. Include the following in your CAP:

· Problems or situations that are considered a crisis for the family.
· Who is involved and would want to take this action
· Treatment approaches, facilities, and professionals the family wants involved during and after the crisis.
· Actions that other family members can take that would be helpful
· Actions that should be avoided by the family
· What role the family wants the FRP to play in the crisis

Sometimes after all the best planning and assertive action, the family may find themselves in a family crisis. After any crisis, the family should get together with the FRP to debrief.

Another component the FRP will facilitate is regular meetings with the family with the psycho-educational component built in. The following topics with a worksheet will be covered during the psycho-educational meetings:

Addiction Facts
Family Alcoholism Quiz and UN Test
Understanding Family History
Signs and Symptoms of drug intoxication
Communication Skills
The Disease of Addiction
Defense Mechanisms
Family Roles & Characteristics
Family Systems
The Unhealthy Family System
Rate your family
The Healthy Family System
Challenges at Home
Enabling Behaviors
Changes
Characteristics of Co-Dependents
What Do I want for my Children?
Building Self-Esteem
Verbal Abuse

This is a comprehensive service created to supervise and support a continuing care plan. This extended service assists in identifying additional clinically appropriate recovery resources such as outpatient programs, physicians, and therapists in the families’ community. The service provides support for the families’ personal responsibility and accountability utilizing the skills acquired during the continued recovery process. Every family’s plan is based on family history, progress, and either an identified continuing care plan or the need to develop one.

The FRP’s concern is always the health and well-being of the family. The FRP must develop a strong cohesive bond with the family and keep moving the family forward in their recovery. The goal of the FRP is to provide professional oversight and support to the family as they transition through their recovery process. With such a comprehensive plan the family can restore their life and improve the quality of life for everyone in the family.

For more information on these practices and a free consultation please call the helpline at 1-877-644-5411 or www.willingnesstochange.org.


Biography of the Author:

Pete Nielsen is on the Board of California Association of Alcoholism and Drug Abuse Counselors (CAADAC) as Regional Director for Region 5 (Northern CA). He is also a Certified Clinical Supervisor. As well as being a Certified Alcohol and Drug Counselor-II, he is an Internationally Certified Alcohol and Drug Counselor. He has an extensive background in providing addiction interventions, treatment and working with the family. Mr. Nielsen is trained in the ARISE intervention model. He is currently working as a substance abuse professional in private practice providing interventions, recovery coaching, Department of Transportation drug and alcohol assessments, and counseling services. Contact Info: pnielsen@willingnesstochange.org or 530.409.7623.