3 Evidence-Based Strategies Every Family Should Know

3 Evidence-Based Strategies Every Family Should Know

In my family growing up, shame-based confrontation was the name of the game. It’s no surprise that nothing ever really got resolved. Even those who tried to lovingly confront people about issues that were affecting them would end up in a vicious mud-slinging fight. Unfortunately, substance use issues, personality disorders, and other mental health problems go back generations in my family. So if there was a healthy model for conflict or difficult conversations, it was long gone in the past.

Having done my own healing – particularly from trauma – I know now how important emotional safety is to navigating these kinds of encounters. In my own family, no one could change or evolve because the emotional safety necessary to do so was never there. For my own healing, I had to create significant boundaries between myself and my family because there was no way I could create the emotional safety I needed to.

Having to do that is heartbreaking, and in my work, I support families with strategies for creating more emotional safety in their relationship with their loved one so they can have the kind of positive influence on their loved one that will support them in making positive changes.

So for this episode of Hope for Families TV, I’m going to talk about 3 of the most promising evidence-based treatment approaches to substance abuse. I want to highlight these three approaches precisely because they model tools that family members can also adopt to create the emotional safety needed to have a positive influence, and also because, sadly, these methods are not commonly used in actual treatment programs, and they need to be.

And I want to talk about these approaches because I can’t tell you how many times I’ve had families tell me how they got their loved one to go through treatment, and then they relapsed they day after they got out. Now there are multiple contributors to relapse, but I have no doubt that one of the reasons these methods have the evidence behind them that they do is because they build emotional safety.

Other things that make these approaches so powerful is that they’re both customizable, they address motivation to change using evidence-based practices, and – most importantly to my work, they outline methods family members can use to have a positive influence on their loved one’s drug or alcohol use.

So these three approaches are: Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management

And I’ll go through what each of these approaches are right now

So, Cognitive Behavioral Therapy – often referred to as CBT, operates on the premise that our thoughts, feelings, and behaviors are interconnected. It acknowledges that substance abuse is often a coping mechanism. By identifying and challenging negative thought patterns and beliefs associated with substance use, aka – the drivers of the use, individuals can develop healthier coping mechanisms and responses to triggers. CBT equips individuals with practical skills to manage cravings, deal with stressors, and prevent relapse so they gain greater control over their behaviors and consciously choose healthier responses to their triggers.

Motivational Interviewing is a collaborative, person-centered approach that explores an individual’s ambivalence towards change. It uses a utilizes strategic questioning and reflective listening techniques to elicit “change talk” – statements that reflect an individual’s desire, ability, reasons, and need for change. By amplifying and reinforcing change talk, therapists help individuals strengthen their intrinsic motivation and commitment to recovery. By fostering empathy, acceptance, and evoking intrinsic motivation, motivational interviewing empowers individuals to explore their values, goals, and reasons for change. Through reflective listening and guided questioning, motivational interviewing’s collaborative, non-confrontational approach helps individuals resolve their uncertainties and strengthen their commitment to recovery and positive change by fostering intrinsic motivation and respecting the person’s autonomy and individual agency.

And finally, Contingency Management leverages the principles of behavioral psychology to promote positive change through reinforcement-based strategies. It operates on the principles of positive reinforcement, offering tangible rewards or incentives to reinforce desired behaviors such as abstinence or participation in treatment. Contingency Management allows for customization and individualization of reward systems based on the unique needs, preferences and circumstances of each individual. By providing immediate and tangible rewards, CM helps individuals stay motivated and engaged in their recovery journey. Whether through vouchers, privileges, or other incentives, CM offers an effective way to encourage and sustain positive changes.

All three of these approaches are evidence-based approaches that have been proved effective in motivating people abusing substances to either fully abstain, moderate, or make changes that lessen the negative impacts of the use.

But they’re rarely used in actual treatment settings. People with substance abuse issues typically have to work with an individual therapist to access any of these therapies.

Why is is this?

Because the treatment industry is largely either completely unregulated or poorly regulated. Which means there is no medical board mandating the use of evidence based approaches like there is in other areas of medicine.

And given that these approaches are highly individualized and require more 1:1 contact with a trained therapist in these modalities – the very thing that makes them so much more effective – for profit, and even non-profit treatment centers, have neither the regulatory nor the financial incentive to implement them.

Most of them are continuing to use non-evidence-based programs dating back to at least 50 years. These programs are rarely individualized, despite what the treatment centers claim, and rely almost exclusively on group therapy and other group programming.

And I think it’s really important that families understand the evidence-based methods out there so they can better understand what they are and aren’t getting for their treatment dollars, and start both demanding more evidence-based options from treatment centers and better regulation and higher standards of care for the treatment industry.

So, I’d love to hear what your experience was of the treatment industry. Feel free to share your story in the comments. I promise I’ll respond.

What Are the REAL reasons for Addiction?

What Are the REAL reasons for Addiction?

Whenever I tried to confront my mother about her behavior, she would always find a way to turn the tables and somehow blame me. Her ability to make me the bad guy never ceased to amaze me.

And I know I’m not alone in this. Here a few things I hear from family members:


  • “He would always blame us.”
  • “She made it quite clear that I am the bad person.”
  • “He’s angry at me for being angry he’s been drinking.”
  • “He makes me feel like everything I do is wrong.”
  • “Is it normal to feel like I’m the reason they drink?
  • “She’s blaming me for everything.”
  • “He says I’m being mean and selfish.”
  • “He’s found a narrative for making me the bad guy.”

I hear these kinds of things all the time from family members. In so many words, their loved one blames them. Short of that, their loved one abusing drugs or alcohol will constantly pick fights to keep their loved one’s from being able to focus on their substance use, set boundaries, or otherwise support their own well-being.

This is just one of the many ways in which a loved one’s substance abuse creates dysfunctional relationship dynamics in the family.

The bottom line is this, however: your loved one makes their own choices.

Your loved one makes their own choices.

But there’s this truth, too. No one chooses addiction. No one chooses addiction.

So who, or what is to blame for addiction? Well, there isn’t an easy answer, but there is a whole list of factors:

  1. The first is genetics. While we haven’t actually identified a gene specific to addiction, we do know that our different levels of sensitivity to stress is genetic and stress is a huge factor in addiction, as the substance use is usually some kind of coping response.
  2. This means that everything that causes stress is a factor. And one of the things that exacerbates any stress someone abusing substances experiences is the dysfunctional relationship dynamics that their own use generates and creates a vicious cycle.
  3. Next is insufficient support. So when you couple number 2 with the fact that our society has evolved in such a way that people’s support systems are at least 50% smaller than they were in the 1950s, and in some cases those support systems are non-existent, these things together constitute a huge driver of substance abuse problems and a huge driver of why and how they persist generation after generation.
  4. But that lack of sufficient support also extends to our health-care system. Health care in the US is very expensive. You have to have resources that many addicted people don’t have in order to be able to access it. And the challenge with substance use disorders is that every issue that our health care system has is magnified exponentially when it comes to treating substance use disorders, because addiction medicine and addiction treatment is very poorly regulated.

    On top of that there are huge systemic obstacles that make it prohibitive for anyone who wants to practice addiction medicine to actually do it. This even further limits access to qualified treatment professionals using evidence-based methods.

  5. Some of the blame can also go to our cultural attitudes about alcohol consumption. I mean, why does anyone have to explain why they don’t drink? No one asks anyone to explain why they don’t smoke. The pressure to consume alcohol is enormous. Such a huge portion of adult social activities revolve around alcohol. And you’re viewed as strange or a party pooper if you don’t drink. This creates a significant and totally unnecessary added burden to anyone trying to abstain.
  6. And then there’s the pharmaceutical industry that for so long pushed opioid-based pain medication insisting that it was not habit-forming when it most definitely was. And even when the pharmaceutical companies were sued for knowingly pushing this false narrative and these drugs, the award money has not gone to supporting addiction treatment in so many cases. Much of it has gone to law enforcement, despite the fact there is no evidence law enforcement has a positive impact on substance use.
  7. And speaking of law enforcement, this brings us to the War on Drugs. Criminalizing drug use and incarcerating people for possession has only exacerbated the problem.

    But even those areas of the US that have tried to decriminalize drug possession are considering rolling back those decisions as crime only increased – because – going back to reason number 3, our treatment is unregulated and cannot effectively address the problem.

    The places that have successfully decriminalized drugs were only successful because they took the money they saved and invested it in treatment programs and support programs for those recovering from substance abuse. But in the US at least, we do not have an addiction medicine or treatment system that could viably and effectively address the addiction crisis on a large scale. We should decriminalize drugs, but we need an effective addiction treatment system before we do.

Why is all of this relevant to you getting blamed for your loved one’s use?

Because it’s important to know that it’s not you, first of all.

And it’s important know the factors and identify where you want to try and push for change.

In my own work, I focus on helping families disengage from those dysfunctional relationship dynamics – one of which is your loved one trying to assign blame for their behavior to you. But I also help families use evidence-based methods to have a positive influence on their loved one’s use. This is something that the treatment system is way, way behind on.

Finally, we need families to be aware of these methods so they can both employ aspects of them themselves, and pressure the treatment industry to use them more widely. You can check out a brief overview of those methods in my previous Hope for Families TV episode.

And if you’re interested in learning more about those methods beyond my previous Hope for Families TV episode, you can check out online Workshop, The 5 Ways to Have a Positive Influence on a Loved One’s Drug or Alcohol Abuse. I’ll put a link in the show notes.

So, I’d love to hear from you: which of these things do you suspect is the biggest factor in your loved one’s drug or alcohol abuse? If you feel comfortable, share in the comments. I promise I’ll reply.

Your Reality Matters: Overcoming Denial and Gaslighting

Your Reality Matters: Overcoming Denial and Gaslighting

Here’s one thing I know about what so often happens in families affected by a loved one’s drug or alcohol use. The denial and the gaslighting can get pretty intense. So intense that you seriously start questioning your reality.
And maintaining your sanity in the face of the denial and gaslighting really does require effective support, because if no one outside of your family circle is affirming that you’re not crazy, it is REALLY hard to not start thinking that you’re the one with the problem.
As as gen-x Swiftie, I can’t restrain myself. I just have to say, “you’re not the problem. It’s not you.”
But there are a number of reasons you should take your concerns with your loved one’s substance use seriously – like right now, in spite of the denial and gaslighting – and get the kind of Effective Support you need to be able to do that.

And a number of these reasons have to do with the fact that you have the ability to positively influence the problem, and many families are not aware of that.

You’re probably aware that we have a cultural narrative that is dominated by messages from 12-Step recovery saying you don’t have control. And you don’t, but what you don’t hear that cultural narrative acknowledging is that you DO have influence. You’re influencing your loved one no matter what you do.

So it’s important to understand how to influence your loved one’s in a positive direction, to learn what that actually looks like.

Because substance disorders occur on a spectrum. And the lower on the spectrum the substance use disorder is, the easier it’s going to be for you to have a positive influence.

So, don’t dismiss your concerns just because your loved one is denying them and gaslighting you. As the problem gets worse, you’re going to have to work even harder to have a positive influence on it.

But Effective Support is really important if you don’t want to get taken down by the denial and the gaslighting. Because without Effective Support, this kind of dynamic of denial and gaslighting can really push family members to start reacting in ways that become problematic. And then you do become part of the problem. Which only gives your loved one more ammunition to use to try and blame you.

If this is the dynamic in your family, there’s no judgement here – it’s damn near impossible not to get sucked into this kind of dynamic without Effective Support. And families don’t know what they don’t know.

So what might taking your concerns seriously in the face of denial and gaslighting look like?

Well, the number one suggestion I give to the families I work with is to actually drop the arguments about whether or not there is a problem. Unless you’re drug and alcohol counselor professionally trained in doing substance abuse assessments, the reality is, you’re not technically qualified to make that determination.

I don’t say that to suggest you’re wrong – I trust your own assessment. And often the problem is glaringly obvious. But I suggest dropping the argument because it’s not one you’re likely to win with your loved one. And it’s an approach they’re very unlikely to hear.

Rather, discuss how their drinking or drug use is negatively affecting you. Here, you have full authority. It’s your experience after all. Now, this doesn’t mean that your loved one won’t argue with you. They most certainly will. And they’ll try to gaslight you about your own experience. But they’re going to have a harder time getting under your skin here – especially if you have Effective Support – because you’re talking about your own reality here and not theirs. It’s going to be much easier to hold your ground from this place.

So, take your concerns seriously – today – because it’s much easier to have a positive influence on the concerns the sooner you start taking those concerns seriously. And focus on how the drinking or drug use is affecting you and the family.

And get the Effective Support you need to do that. That support can come from support groups, a therapist, or a knowledgeable and informed friend or faith community. I’ve got a list of potential support resources on my resources page.

And if you’re interested, I’ll be launching my own online support community in April. Make sure you’re on my email list so you can be the first to know when that drops.

My Love Hate Relationship with Gratitude – a.k.a. How Gratitude Used Right Helps Families Struggling with a Loved One’s Substance Abuse

My Love Hate Relationship with Gratitude – a.k.a. How Gratitude Used Right Helps Families Struggling with a Loved One’s Substance Abuse

When it comes to family addiction, I’ve had a lot of awful experiences to work through. And oh my god, a shit ton of negative false beliefs about myself that I had to heal.

And for awhile, I tried turning to a lot of the mindset gurus that many of you may be familiar with. But it didn’t work. And for awhile, I thought the problem was me until I started both getting trauma therapy and also encountered the concept of toxic positivity.


What I didn’t understand at first is that a lot of the content I was encountering around mindset was actually toxic positivity. Brushing legitimate negative emotions – emotions that need to be processed – under the rug by “just thinking positive.”

You just gotta be positive and look on the bright side. You know, raise your vibration. That last one makes me want to hurl sometimes.

In too many of its manifestations, mindset work was just a toxic framework for sweeping legitimate difficult emotions – emotions that need to be processed in order to effectively move forward – under the rug.

I finally learned that you can’t BS your way to a positive mindset. Feelings have to be felt. Emotions have to be processed or we remain stuck.

And the concept of gratitude often gets conflated with this kind of toxic positivity. You know, just be grateful, look on the bright side, it could be so much worse.

And I know for a fact that for families struggling with a loved one’s substance abuse, this kind of gratitude is NOT helpful. It’s just not.

But that doesn’t mean there isn’t a use for gratitude. It just has to be an honest gratitude. So, I want to share a story about how this kind of gratitude was so powerful for me.

Over a decade ago, I was leaving a very toxic, emotionally and psychologically abusive marriage. And I was scared to death. My ex-husband had way, way more money than I did and he was using it to try and force me to accept his demands in the divorce. And I couldn’t afford to pay a lawyer for hours and hours of more work to try and fight it all.

I was just terrified that I either had to accept horrible terms or have all my money run dry trying to fight it. In many ways, the process of leaving was harder than staying.

I just had to trust that things would be much much better once that process was over – and they were!

But in the middle of that process, oh my freaking god, I was stressed. I super stressed in the marriage, too, but making a decision to leave was the most stressful of anything. I mean, please don’t get me started on why women don’t leave. My situation wasn’t anywhere near as scary as situations other women face and it was still pretty freaking scary.

That said, one of the things I did during that year that I was going through the divorce was make a gratitude journal. I just took a simple weekly planner, and every evening before I went to bed, I would fill in the space for that day with things to be grateful for.

Some days, there were these really amazing things that happened – in fact, a series of things that actually prevented my ex-husband from being able to force me to meet his unreasonable demands, without me having to spend thousands more in legal fees.

But most days I had to dig much, much deeper to find something to be grateful for. Most days I had to dig for some small thing that, had it not happened, I would have had an even more difficult day. I mean, many of my entries were things like I made a stoplight when I was running late. And some of them were in the middle.

But however impactful they were, I wrote them down.

But the difference here was that I was not pretending that things weren’t as bad as they were.

I wasn’t using gratitude as a yes, but…. I was using gratitude as a yes, and… Yes, my divorce was incredibly scary and stressful. AND there were all these little moments of respite that I probably wouldn’t have noticed if I hadn’t been making a point to remember and write down.

So, here’s what I know that practice of keeping a gratitude journal did for me. It kept my head from making the stress I was going through even bigger than it was. It was already big enough. And it just kept my head, in all its fear, from blocking out all those moments of respite, no matter how small. They were just as real.

So my gratitude journal practice just made sure that the fear didn’t overtake absolutely EVERYTHING in my life during that year. And that meant that I walked through that awful year in a more resourced state than I would have if I hadn’t been engaging in that gratitude journal practice.

And this is why I have this love hate relationship with gratitude. I often hesitate to suggest gratitude to the families I work with because I sure as hell don’t want to sound like I’m preaching some kind of toxic positivity BS.

But gratitude done right – and that is gratitude that isn’t being used to try and shove other legitimate feelings under the rug, but rather gratitude that is just to try and keep all the stress and fear from completely taking over everything – that kind of gratitude helped put me – and can help put you – in a more resourced state.

And frankly, that’s what ALL of my work with families struggling with a loved one’s substance abuse is designed to do. To put families in a more resourced state so they can respond to the problem more effectively.

So I feel like it would be remiss of me to not talk about how it can help – if used right.

Because here’s the thing: when I train families how to have a positive influence on their loved one’s substance use, one of the things I talk about is being proactive about managing your fear. Not that the fears aren’t legitimate – they are. We all know there are no guarantees.

But if you want to be able to have a positive influence on your loved one’s substance use, it’s essential not to let the fear take over everything. And establishing a gratitude practice is one way to do that.

The year of my divorce, there was even another benefit of that gratitude journal. My divorce was final the end of October of that year. So Thanksgiving – a day totally devoted to gratitude was coming right up. And one of the things I did after the divorce was final was review that gratitude journal. And I noticed all the people who repeatedly showed up in that gratitude journal with their kindnesses large and small.

On Thanksgiving, I sent each one of them a thank you message noting how frequently they showed up in that journal, the impact that had on such a stressful year, and how grateful I was for their presence in my life.

In other words, I shared that gratitude, which was just another really beautiful thing to be able to do and also something that helps keep our legitimate fears from taking over everything and puts us in a more resourced state.

So, some kind of gratitude practice might be something helpful for you to try. Not because it’s going to make your problems with your loved one’s substance abuse magically fade away. It’s not. But if you practice regularly, it can put you in a more resourced state.

And that’s the whole point of not letting the fear take over everything. Because being in a more resourced state will help you address your loved one’s substance abuse more effectively.

In fact, it’s never a bad idea to be in a more resourced state. Which is why I’m going to return to that gratitude journal practice.

And, as a final note, I’ll say that if a gratitude journal doesn’t resonate with you, you can always write little notes of gratitude and then collect them in a jar. You can review them at the end of a month, or even at the end of a year. And then reach back out to those that impacted you the most during that time and share the love.

So, I’d love to hear your thoughts about either establishing a gratitude practice, or a gratitude practice that you already use. I know we can all learn from each other, so feel free to share in the comments.

Are You Putting Your Life On Hold Waiting for Your Loved One to Recover?

Are You Putting Your Life On Hold Waiting for Your Loved One to Recover?

So, I have a question for you? Do you feel like you’re putting your life on hold waiting for your loved one to resolve their substance abuse problem? I know I did this for years and years. If this sounds like you, too, I have a story for you.

So, about 20 years ago, when I was early in my recovery from family addiction journey, I reached out to my sponsor for support around some awful thing my mother had done. Side note – I know very well that 12 Step recovery is not for everyone, and I’m not trying to endorse it here. It just happens to be part of my own story, so I am sharing about it in that light.

At any rate, what I was calling my sponsor about was something my mother had done some version of a million times before. And I continued to just get totally rocked by it each time she did it again.

And my sponsor could see that, even though I’d been in this support program for awhile, I was still stuck essentially thinking my life was over unless my mother changed.

And she said something to me I’ll never forget. She said, “Madeleine, your mother has the right not to recover.”

And my first reaction to that was like, “Whachu talkin’ ’bout Willis?” And I know that reference is going to age me there, so if you didn’t get that, you’ll have to look the show Different Strokes. But suffice it to say I was absolutely in this totally flabbergasted place, like how could she make such a claim!

But just like a cancer patient has the right to refuse chemo, an addicted person also has the right to refuse treatment, for better or for worse.

And of course, they also have the right to the consequences of that decision.

Now, I know you might be confused to hear me say this because a big part of what I help families do is to learn how to have a positive influence on the substance use, because your loved one does not exist in a vacuum.

You are able to influence them. And doing that in a positive way does improve outcomes.

And I’m not here to go back on that in this video.

But part of having a positive influence on your loved one’s use is to live your own life, to the best of your ability whether they’re using or not. And feeling like you have to wait for them to recover before you can live your life doesn’t actually help anything. In fact it does the opposite.

And my sponsor’s “outrageous” claim is what drove that point home for me.

So let me explain how that works:

One of the things that drives continued substance abuse is shame. Shame may or may not have been part of what started the use, but it is definitely what drives continued use in spite of all the problems it causes.

Because, whether your loved one admits it or not, they are deeply ashamed of their use and of the things their use drives them to do. They are – I promise.

Now, it’s not helpful to act like their behavior is OK, but one of the ways you can help them with the shame is to live your life to the best of your ability. It not only helps you better weather this scary and chaotic journey, it also relieves your loved one of the the fear – and the shame – that they’re totally ruining your life.

So, what’s one very teeny-tiny way you can start to reclaim your life? Can you go back to your book club? Can you call a friend you haven’t talked to in a long, long time. Get you get back out on the golf course with friends? Even if you only did one little thing once a month, it would make a difference.

So what can you do? Let me know in the comments.

But before we wrap up this episode, I want to address one more thing that I’m sure you might be thinking. Maybe you’re feeling like living your life means that you don’t care what your loved one is struggling with, or that you don’t care what happens to them, or that you don’t that the severity of the problem that seriously.

Not at all. You can life your life and still care. You can live your life and still fully understand what’s at stake.

A loved one’s struggle with substances is a completely horrific journey to have to navigate. It’s full of grief and fear – and there’s no way around that, even if you do live your own life to the best of your ability.

And if your loved one doesn’t recover, or God forbid, loses their life to the substance, your heart is absolutely going to break. I’m not pretending it won’t.

But the only way to navigate this journey with your psyche relatively intact is to create a space for your own life, too.

It’s not easy, and I don’t claim to have done that perfectly myself. It was a very up and down journey for me. Every step of the way I’ve had to grieve for the mother I never had.

And my mother passed a little over a year ago, so then I had to grieve for the mother I never would.

But through my own recovery journey – which included living my life to the best of my ability – some days well, some days not so well, I discovered that, yes, my heart was broken over my mother. But there was so much more that my heart could hold.

A number of years ago when I was working at a family recovery program, I told the story of how my sponsor insisted upon me all those years agon that my mother had the right not to recover.

And after that session a mother came up to me and share that she’d been putting her life, and all the things she wanted to do, on hold for years waiting for her son to recover.

She didn’t realize that she had permission to live anyway.

You, too, have permission to live anyway. Not because you don’t care, but because you do. And just because we are experiencing this kind of really heavy problem that we didn’t choose, doesn’t mean that we can’t still choose moments of joy where we can.

Our lives, our psyches, our emotions, hold multitudes. And making whatever room we can for all of it will help both us and our loved ones.

12 Reasons Effective Support is Essential in Family Addiction

12 Reasons Effective Support is Essential in Family Addiction

I talk a lot about the fact that family members can have a positive influence on their loved one’s substance use. They don’t have control, but they do have influence. But there’s a catch:

Getting your own support is key to every single way a family member can have a positive influence on their loved one’s use. None of those other ways will work without it. Not to mention, effective support is absolutely essential for family members to heal.

The reality is you cannot possibly effectively support your loved one if you are not getting effective support yourself, because effective support is the key to your own healing.

There are a dozen reasons effective support is THE most important thing you need in order to heal yourself and improve your loved one’s chances of recovery. So I want to go through those one by one:

First, without effective support, family members develop unhealthy codependent coping mechanisms in an effort to cope with the fear and mitigate the pain of the situation. They are an understandable reaction to this situation, even though they are not productive.

The fear is understandable, and the pain is very real and may be overwhelming without some kind of support. The unproductive behaviors actually support family members in the face of the fear and the pain in the short term, but they don’t fix the heart of the problem.

If family members wish to address the heart of the problem, they need a kind of effective support that will both support them in the long term in the face of the fear and the pain, and help them address the heart of the problem.  

Second, the addicted person is not likely to respond lovingly to family members’ efforts to change. And because addiction can also easily divide other family members, it is quite possible that even other family members will not respond positively to your efforts to change the way you respond to your loved one’s use.

Sadly, other family members are not likely to provide the kind of support you need to change. You need another source of effective support if you’re going to be able to change in the face of this resistance.

Third, when family members stop covering up the problems their loved one’s substance use creates, unfortunately, they ultimately have to face the pain of those consequences: the embarrassment, the financial difficulties, the loss of jobs, the separations or even divorces, and tragically, sometimes even the death of their loved one.

In other words, they have to walk through the grief they may have been using their ineffective codependent coping mechanisms to avoid.

Effective support is essential for family members to have the courage to walk through these problems, to fully grieve, and remain emotionally and spiritually whole on the other side, even though the situation is heartbreaking.

Fourth, one of the things that is essential to healing from our own codependent coping behaviors is to feel our feelings and, again, ultimately grieve a loved one’s substance use and the problems it creates.

Family members need people who are safe to feel these feelings with. Family members need to learn to be vulnerable again. And effective support is essential to this process.  

An effective support person can also help family members identify feelings they struggle to name. This in turn helps family members better identify their needs and determine if boundaries need to be set and what those boundaries should look like. 

Fifth: Following number four, an effective support person can also help family members determine how and when to express their feelings with their loved one. They can help family members work through the feelings and then move beyond the pain so family members do not stay stuck in unproductive coping behaviors.. 

Sixth, effective support is even more necessary if there has been physical or sexual abuse from your loved one. It is not unheard of for the loved one or even other family members to find any possible exposure of that abuse so threatening that they turn the victim of that abuse into a scapegoat, denying or minimizing experiences, or placing the blame for the abuse on the victim. 

Seventh, change takes time. Recovery from substance abuse takes time. And family healing takes time. And you will never do all these things perfectly. Effective support is necessary to have the patience, compassion, realistic expectations, and continued energy to make the changes that will truly make a difference over the long term.

Eighth, just as addiction often comes with other co-occurring emotional disorders, it is not uncommon for both loved ones and family members to have their own emotional disorders beyond family addiction that impact the dynamic of addiction in the family.

Effective support is essential to addressing these other factors. These factors may also require a professional specific to the disorder. 

Ninth, living with addiction slowly undermines our ability to trust ourselves. We need support to rebuild this faculty. 

Tenth, fear and anger will take over and completely replace any love you might have felt if there is no effective support. Effective support will help you keep your heart and your humanity intact.

Eleventh, One way to have a positive influence is to allow your loved one to face reasonable and compassionate consequences for their use. But this is difficult to do and painful to watch them go through. You need effective support if you’re going to be able to do it anyway. 

And twelfth, accusations of others who don’t have a good understanding addiction, and who may be guided by the scores of cultural myths out there, can also unfairly make you feel guilty for your feelings and / or your decisions regarding the substance use. You need effective support in order to be able to stand your ground in the face of this. 

In sum, without effective support, the work of supporting your loved one in a way that actually improves their chances of recovery will be too difficult. Healing yourself while having the compassion that is so important to positively influencing your loved one is utterly impossible without it.

The shame and the isolation associated with addiction affect family members as profoundly as they affect the addicted person. And making changes that will improve your life and positively influence your loved one is not easy. Your chances of being able to do this in isolation are slim.

This is why you don’t need just any support – you need effective support. You will notice that I use the word  effective pretty much every time I mention support. Lots of people will think they’re genuinely offering support when what they’re actually doing is far from it. 

So we need to know exactly what effective support is. So here are four elements of effective support:

One: It comes from someone who does not judge, and who understands the immense challenges of a loved one’s substance use

Two: It comes from someone who understands your experience, either because they have their  
own experience with addiction, or because they have learned about addiction, or because they have professional training around the issue.

Someone who has no understanding can certainly offer compassion, and that can be helpful, but they probably cannot offer the kind of support that will assist you in effectively changing the way you respond to your loved one’s substance use. Compassion is somewhat helpful, but it will not get you where you need to go.

Three: It comes from someone who advocates for your own healing, not just your addicted loved one’s recovery.

Sadly, this is an area where a lot of family support services out there fall short. For example, many treatment programs do not offer any meaningful family recovery services, and of those that do, many of those programs focus solely on actions that support your loved one’s recovery, and ignore the family members’ need for healing themselves.

This means that family members cannot assume that, if their loved one seeks treatment, the treatment center will be an adequate source of support for them, too. Very few treatment centers provide any family support.

Four: When it comes to the challenging choices faced by family members, an effective support person does not tell you what to do. So for example, they won’t tell you to kick them out or to let them move in, to give or not to give them money, to pay or not pay for treatment, to stay in contact or sever contact.

They simply support you in arriving at the decision that feels the best for you and a decision that you most feel you can live with.

Now, there is one caveat to not telling family members what to do: an effective source of support will tell you that you need to take action to protect yourself if you are being subjected to violence.

As the source of support you have in front of you right now, I am going to tell you, if your loved one is using violence or the threat of violence to keep you from responding to or interfering with their addiction, you need to take every action possible to secure your safety.

Pay attention to the cues that they are about to become violent and back off if you see them. Stash money away, hide a set of car keys, find an alternate source of shelter with a family member, friend, or domestic abuse shelter so that you can leave if you need to. Have these things ready ahead of time so if the threat of violence arises, you are fully ready to take care of yourself. 

Nothing else I tell you here will have any effect if you are trapped in a violent situation. You must take action to ensure your safety first.

I hope you are not in that situation, but if you are, please take action right away.

OK, so the next question is, where can you find this kind of effective support? If you have friends and/or family members who meet these criteria, that is a beautiful thing.

Many family members don’t however. Even if you do, you might find a wider support network to be helpful.

So, in the next episode, I’m going to discuss several places you can find that kind of support and the pros and cons of each source of support.

But before I close out this episode, I invite you to share in the comments, to what extent are you finding effective support in the people you may have already turned to? In what ways are the sources of support you’ve turned not as effective as they could be?

Will it be difficult for you to turn elsewhere if you’re not finding the kind of support you truly need in family or friends? Just a note here: It’s perhaps best not to name names in the comments.

Taking Addiction Treatment Claims With a Grain of Salt

Taking Addiction Treatment Claims With a Grain of Salt

The average cost of 30-day residential addiction treatment in the United States is $42,500. Given that hefty cost, I think it’s essential that families know how to navigate the treatment industry.

So to that end, this week’s episode of Hope for Families TV is about treatment outcomes. And more specifically, how to critically examine claims about treatment outcomes.

So I’m going to go over Hazelden Betty Ford’s Patient Outcomes Study that came out in June of 2023 to show you how and why you need to examine these claims with a very critical eye.

So, Hazelden Betty Ford’s study was a two year study conducted using thousands of phone interviews with patients across residential treatment, virtual treatment, and intensive outpatient services.

They asked questions about abstinence, quality of life, and commitment to Twelve Step programming or similar peer support groups. And by the way, I’ve included a link to the study in the notes episode.

Of course, the most prominent aspect of the study is the abstinence rates, which makes sense, it’s the thing most people care about. So we’ll take a close look at those.

Hazelden organized the outcomes by the treatment setting, whether it was inpatient, or virtual intensive outpatient. They also break the stats down by complete abstinence from all drugs or alcohol, and then alcohol free and drug free.

They have good reason to break down these stats these ways. When it comes to treatment setting, Most people think 30-day residential treatment is the only way to treat substance use disorders or that it’s the best way to treat them.

But that’s actually not true. And if you look at Hazelden’s stats between residential and virtual outpatient, the outpatient stats are actually slightly better than the inpatient stats.

But what this study doesn’t do is attempt to explain why. There’s no analysis here at all. And this isn’t the only area where the report lacks critical details. But the analysis is actually pretty important.

The fact that the stats are better for outpatient treatment is why most insurance providers will not pay for 30-day residential treatment unless the person has already tried outpatient patient treatment and failed. Studies do show that both inpatient and outpatient treatment have similar success rates.

But having similar success rates doesn’t mean that one will work just as well as the other for everyone. And it would be helpful to understand the advantages and disadvantages of each. And providing some analysis of these stats could certainly help that.

So I’m going to hazard an educated guess here. One advantage of outpatient treatment could be that the person with the substance use disorder is going through recovery in the same context, in the same environment, in which they currently have to live. So they don’t have to navigate what can be a challenging and risky transition back to the real world after treatment. They’ve remained in it the whole time.

But that isn’t necessarily an advantage to everyone. Some people with substance use disorders need to drastically detach, and ultimately set significant boundaries around the people and places they were living in in order to recover. And residential treatment, and perhaps sober housing afterwards, can give them the space they need that will allow them to detach and set essential boundaries that will support their recovery moving forward.

Those are not the only possibilities by any means, but I throw those out there because it highlights the importance of having some analysis around these stats, and using that analysis to thoroughly assess people when they seek treatment for a substance use disorder.

But what Hazelden Betty Ford has shared doesn’t give families the information they would need to help them discern.

Furthermore, most treatment centers don’t even actually conduct a thorough assessment, even though a standard protocol for conducting such an assessment has existed for quite awhile now. Most addiction counselors simply assess potential patients by feel. And as you can guess, those “assessments” usually conclude that the person needs treatment.

And then there’s the reality that, if families are paying for treatment with insurance, as I previously mentioned, the insurance company may not approve inpatient treatment no matter what the assessment says.

Having some analysis about distinctions between the two treatment modalities could support families in contesting their insurance’s refusal to cover inpatient treatment if that’s what’s recommended (using the actual standard protocol for patient assessment, of course.)

Without this information, families are often at the whim of both the insurance provider and the treatment provider. And I firmly believe that this needs to change.

But the treatment modalities is not the only place that analysis is sorely lacking. When you look at the breakdown of the stats between full abstinence, abstinence from alcohol and abstinence from drugs, it would be really helpful to understand more about how and why those numbers break down the way they do.

It does make sense that the complete abstinence rates are the lowest. Many people will stop one drug but continue with or take up another. But what’s curious is that the abstinence rates for drugs are greater than they are for alcohol.

I’m not claiming that’s impossible, but given that the drugs we hear the most about are opioids, and that we are in the middle of a huge opioid crisis, and given how difficult it is to get off of opioids, it would be helpful to get more information about how they came by these numbers.

I don’t have all the answers to this, but one thing that is clear here is that Hazelden Betty Ford has clumped all drugs together into one stat. So they’ve put marijuana together with opioid. Two VERY different drugs with VASTLY different numbers of users, VERY different levels of toxicity, and VERY different recovery success rates. 

As someone committed to supporting and educating families struggling with a loved one’s substance use, this is where I start to get really pissed off with these stats. Because I consider conflating the stats for VASTLY different drugs absolute gross negligence. An utter betrayal and exploitation of family members trying to help their loved ones recover.

I know that’s a pretty harsh assessment, so let me just set a scene for you to show why this kind of conflation is so egregious:

So, imagine, after years of utter chaos, horrible problems created by the substance use, countless sleepless nights, absolute terror that your loved one might die, desperate pleading, and just being totally confounded by how your loved one could continue to use in the face of so many problems and so much insanity, your loved one finally admits they need help.

Here’s what’s important to realize about this situation:

  • You’re – understandably – absolutely desperate.
  • You’ve also been traumatized, perhaps for years.
  • You have a very small window in which to act – you’re loved one will want to walk back that admission almost as soon as they’ve made it. And you’re probably terrified that they will do just that.

None of these things are conducive to sound, reasoned, decision making about something that could likely cost around $42,500, especially in an industry that is so poorly regulated.

And Hazelden Betty Ford and every other treatment center out there knows this. And in this very limited publication of this study, Hazelden Betty Ford is absolutely capitalizing on it.

The majority of treatment centers do not want you thinking critically about treatment options or treatment outcomes. They just want you – or your insurance company – to write them a check. So they deliberately keep things vague.

Because without clarity and critical thinking, here’s what you’re likely to do: you go to Hazelden Betty Ford thinking what could be better? They’ve been doing this a long time. They’re well known. The best of the best, right? And Oh My God! Look at those success rates. Holy shit, 86% of people using drugs are still abstinent after a year? 91% from outpatient treatment are still abstinent after a year. That’s AMAZING!!!.


Your loved one is addicted to opioids, not marijuana.

And because Hazelden has not broken down the success rates, and because the desperate, terrified and traumatized state that you’re in has largely shut down your prefrontal cortex, and consequently your reasoning is significantly handicapped in this moment, you’re not likely to look at that stat critically.

And these stats absolutely need a critical eye. Because the success rates for opioid use disorder recovery are NOWHERE NEAR the stats Hazelden Betty Ford is displaying here. Not even remotely. But Hazelden Betty Ford doesn’t want you to know that.

And we’re not even done here. That is just one way that these stats have been thoroughly massaged in Hazelden Betty Ford’s favor.

So let’s continue our analysis.

In this report, Hazelden Betty Ford starts with stats for one month outcomes. And these stats aren’t labeled on the Web as coming from inpatient treatment, but they are on the PDF. I don’t if leaving off that heading on the web was deliberate or an error. But the absence of the heading on the Web does make it seem as if those stats are for everything.

Regardless, I have some questions for you here: when you send your loved one to treatment, are you looking for a single month of abstinence? Are you paying an average of $42,500 for a single month of abstinence? Is a single month even meaningful abstinence?

I’m pretty sure the answer to all of those questions is NO. So, why is Hazelden Betty Ford publishing stats for a single month of abstinence?

Because those stats are much better than they are for longer periods of abstinence. And those stats are the first thing you see. So those stats are your first impression. They leave you feeling that chances are really good for your loved one if you send them to Hazelden Betty Ford.

But the reality is, it takes the brain at least a year to heal from a substance use disorder. So really, the twelve-month stats are the only meaningful ones.

And when you look at the 12-Month stats, they are of course significantly lower. But even then, you might look at those one year stats and think, OK, this is what I’m paying an average of $42,500 for, an almost 60% chance that my loved one will be abstinent a year out. You know addiction recovery is hard, so maybe you feel like 60% is a pretty decent chance.

But you have to read in between the lines in this report. Because below those stats is a section titled “Receiving Treatment as Planned.”

In that paragraph, Hazelden outlines the relapse rates of those “discharged without staff approval” compared to those “discharged with staff approval.” And if you look back at those stats, you might realize that the stats shown in the those big bright obvious yellow tables only apply to those who were “discharged with staff approval.”

“Discharged with staff approval?” That’s a pretty obtuse way of saying that the stats only apply to the people who completed the treatment program.

So why wouldn’t Hazelden Betty Ford just be straightforward and clearly say that the stats are only for the people who completed the whole program? Why the opaque language?

Because you’d probably have additional questions that, once again, are not answered in this report.

Like, well, what percentage of people who enter treatment actually complete it? How is that broken down by the substance being used? What reasons do they cite for leaving treatment? What is Hazelden Betty Ford doing to address the most common reasons people leave?

Soooo many unanswered questions! Sooo much vagueness.

And if this is what Hazelden Betty Ford is doing, you can safely assume that this kind of vagueness, and this massaging the data to the treatment center’s benefit, is the standard, the norm, across almost the entire industry.

Again, none of the questions this report brings up are answered here. But YOU, the family member, should be asking them. Not only that, you should be demanding answers to these questions BEFORE you write that check. And that’s why I created this episode.

We Know Several Things That Support Addiction Recovery, and Yet Treatment Centers Rarely Do Them

We Know Several Things That Support Addiction Recovery, and Yet Treatment Centers Rarely Do Them

So what do you think you know about addiction recovery? And do you ever wonder why relapse rates are so high. Are you baffled by why we haven’t come up with better solutions to this problem? Or have you just resigned yourself to the idea that the addiction crisis just is what it is?

Whatever your answers to these questions, they all inform reason #10 of why I do what I do.

I do what I do because we have known several things that support addiction recovery for decades. Things like cognitive behavioral therapy and positive reinforcement, medically assisted treatment, harm reduction, and whole family support.

All of these things significantly improve outcomes, and yet very few treatment programs implement these evidence-based strategies.

And few people are aware of the senseless barriers that stand in the way of people struggling with a substance use disorder getting effective treatment

Quite the contrary. Many family members are under the impression that if their loved one goes to treatment, they will be getting some kind of standards-based treatment, especially given how expensive treatment is.

They assume that treatment centers must be regulated just like the rest of medicine is.

They assume their loved ones are being treated by people who are professionally trained according to some kind of regulatory standard.

They assume if their loved one relapses and returns to treatment, the treatment center will try a different approach.

And finally, many family members are under the impression that once their loved one spends 30 days in rehab, they’ll be fine.

But NONE of that is true.

In fact, we don’t have a health care system that even makes the full implementation of the elements that support addiction recovery possible. Without insurance or a just plain a lot of money, health care of any kind is difficult to access in the US.

But addiction care is also siloed from the rest of medicine and is either not regulated at all, or regulated by accrediting bodies who get paid by accrediting treatment programs, which is a clear conflict of interest.

People are rarely evaluated when entering treatment – despite the fact that clear and widely recognized addiction evaluation criteria exist. And Most treatment programs don’t have full-time doctors or therapists on staff. Most of the treatment in these programs is offered by people whose only qualification is that they have recovered from a substance use disorder themselves.

And very few treatment programs offer support for co-occurring mental disorders, which almost 50% of people with a substance use disorder have, and failure to also treat the co-occurring mental disorder almost invariably results in relapse.

On top of that, laws that came out of the war on drugs – laws that deny any one known to be abusing substances all kinds of things like housing, food benefits, and nursing care just to name a few – these laws confront medical workers with a catch 22. If they ask someone about potential substance use problems in the hopes of connecting them with care and treatment, and frankly just providing them much more holistic care, they also place that person at risk of losing many of the supports they need to live if that person answers yes.

Medical schools often don’t cover addiction medicine and fewer than 1 percent of people studying medicine go into addiction medicine.

Why? Because the funding they need to practice is not there like it is for other specialties, and many federal, state, and local laws make providing a full-range of addiction care services, including harm-reduction services like needle exchanges and safe consumption sites, impossible.

Furthermore, if you’ve watched my free video series, the Family Guide to the 5 Actions Required for Substance Abuse Recovery, if someone is even lucky enough to be able to access treatment, you know that the brain of an addicted person takes a year or more to fully heal. So 30 days of treatment is nowhere near sufficient.

And the after care plan that many clients completing treatment are provided is simply to go to 12 step meetings and get a sponsor, with no regard to whether or not 12 Step Recovery is the right kind of support for the person. And it very well may not be, particularly given the stance many in 12-Step recovery take against medically assisted treatment – treatment which the research unequivocally shows saves lives. 

Many people struggling with a substance use disorder end up incarcerated. But despite the fact that prisons and jails are legally required to provide medical care to inmates, almost none actually provide substance abuse treatment. Even though, the data from from the few that do show that providing addiction treatment improves outcomes and reduces recidivism.

Recovery is not easy and it takes time. The 5 Actions Required for Substance Abuse Recovery that I talk about in my free video series can’t be completed in 30 days. People recovering from a substance use disorder require ongoing support. Outside of 12 Step recovery groups – which as I’ve just explained are not the right fit for everyone – in today’s addiction care environment, they will struggle to get it.

For example, sober housing, which is one important form of continued support beyond treatment, is even less regulated than actual treatment centers. The numbers of sober housing providers that have essentially become cash cows profiting off of providing the housing, but almost no structure, boundaries, or recovery support, making more and more money as their residents relapse, return to treatment and then come back to sober housing, is beyond shocking.

And then finally, very few treatment programs offer any meaningful family support, even though whole family support has been shown to improve outcomes, and can stop generational cycles of addiction or other types of mental disorders and dysfunction. For families, too, their main option for effective support and their own healing is 12 Step family recovery.

If all of this sounds insane, it’s because it absolutely is.

And that is another reason why I do what I do. All of these failures also mean that culturally we are horribly misinformed. And with the advent of social platforms, this misinformation spreads very easily.

So I’m trying to spread more accurate information. And provide families with the education and effective support they need to address a loved one’s substance abuse, to positively influence the use as much as reasonably possible, and to do the work to heal from the trauma of their loved one’s use, and even generational cycles of addiction or other dysfunction.

6 Ways Family Members Mimic the Symptoms of a Substance Use Disorder

6 Ways Family Members Mimic the Symptoms of a Substance Use Disorder

Do you ever feel like your loved one’s substance use is making you crazy? Or do you react to the use in ways that don’t feel good to you or that you’re not proud of?

If you answered yes to any of those questions, then this episode is for you. This leads me to reason number 9 of why I do what I do.

I do what I do because addiction creates dysfunctional relationship dynamics in the whole family such that family members begin displaying similar symptoms as the substance user. In other words, in a way, families “get sick,” too.

And it’s so easy not to realize this because the behavior driven by addiction is far more obvious. But you may be surprised to learn that families actually display similar symptoms as addiction.

To demonstrate this, in this episode of Hope for Families TV, I’m going to present the 6 symptoms of a substance use disorder and show the ways in which family members often mimic them in unsuspecting ways. I think you will find this to be rather revealing.

So let’s get started:

Addiction Symptom Number One is Obsession: The addicted person is obsessed with the substance. If they’re not actively using or consuming it, they’re thinking about using or consuming it. This obsession goes hand in hand with the excruciating craving for the substance the person experiences.

So what does obsession look like in families?

With Obsession in Families: The family member becomes obsessed with the addicted person – experiences excruciating persistent thoughts and fears around the addicted family member and their behavior

Addiction Symptom Number Two is Increased Tolerance: The addicted person requires more and more of the substance over time to achieve the same effect, and after a while, they will never be able to achieve the initial experience they first had with the substance

So what does increased tolerance look like in families?

With Increased Tolerance in Families: The family member develops an increased tolerance for the addicted family member’s unacceptable and shocking behavior. They tolerate behavior from their loved one abusing substances that they would never even remotely tolerate from someone else.

Addiction Symptom Number Three is Loss of Control: The addicted person loses the ability to control their use of the substance. Once they start, they can’t stop

So what does loss of control look like in families?

With Loss of Control in Families: The family member loses the ability to maintain other important aspects of their lives– they too become increasingly isolated as other meaningful activities and relationships fall by the wayside and everything revolves around the addicted family member

Addiction Symptom Number Four is Persistence: The addicted person persists in use of the substance, despite negative consequences.

So what does persistence look like in families?

With Persistence in Families: The family members persist in their efforts to control or change the addicted family member’s use, despite overwhelming evidence that control doesn’t work, increasing despair.

If you’ve been following my work, you know that I talk about how families have influence. But they do not have outright control. Influence is a kind of soft power, but it’s not control, which is trying to force solutions.

Addiction Symptom Number Five is Loss of Pleasure in Normally Pleasurable Things: Because of the progressive reduction of dopamine receptors in the brain, the addicted person cannot find pleasure in normally pleasurable things. They become increasingly isolated, thus increasing their despair.

What does loss of pleasure look like in families?

With Loss of Pleasure in Normally Pleasurable Things in Families: you see that as the addicted family member becomes the central focus of their lives, family members lose the ability to enjoy life in both simple and grand ways.

And finally, Addiction Symptom Number Six is Avoiding Pain: The addicted person uses the substance to numb emotional pain and mitigate the stress the consequences of their use causes.

And what does avoiding pain look like in families?

With Avoiding Pain in Families: The family members use their efforts to fix, control and berate the addicted person for the destructive behavior in order to avoid their own pain, to avoid grieving the reality of their loved one’s disease, and to avoid coping with the fear of additional tragic consequences that could arise

With all of these symptoms that family members tend to mirror to a greater or lesser degree, family members do these things that mimic the symptoms of addiction in the desperate hope they will compel the addicted person to stop. And for good reason: addiction is deadly. We are all well aware that if our loved ones continue in their use, really, really, really bad things can happen.

The truth is, family members are faced with an enormous catch 22: the reality is, without effective support and pertinent information, our typical reactions to our loved one’s use often make it easier for the addicted family member to persist in their use. But responding differently can feel terrifying.

But families do need to respond differently if they wish to have a positive influence on the use.

And sadly, there are no guarantees – as family members, our only option is to do what we can to improve the chances and support our own healing. And all of this is another reason that effective support is so important for everyone.

More importantly, the fact that families end up mimicking the symptoms of addiction is one more reason why we will never resolve the addiction crisis unless and until we make whole family healing an essential part of the solution.

So, I’d love to know, do you see yourself at all in some of the ways family members mimic the symptoms of addiction?

I invite you to share in the comments below some of the ways you might be mimicking your loved one’s symptoms of addiction. Give examples if you feel comfortable doing so. And feel free to comment respectfully on what others have shared.

Holiday Boundaries: The Key to Surviving the Holidays with a Loved One Abusing Substances

Holiday Boundaries: The Key to Surviving the Holidays with a Loved One Abusing Substances

In this episode, I’m going to do a deeper dive into boundaries. I’ve said this before, but I’m going to repeat it here. Setting boundaries is both one of the most difficult things to do, and one of the most effective forms of communication when it comes to a loved one using substances.

In fact, boundaries may be the key to keeping your next holiday from turning into a shit show. What many people don’t realize is, however is that, if they’re set with compassion, and without shame, they are also one of the best ways to positively influence your loved one’s use.

So in this episode, I’m going to talk about what boundaries are, the importance of boundaries, how to communicate them with love, and why they are essential for both your loved one – whether they’re in recovery or not – and the well-being of the entire family.

So What Are Boundaries?

One of the most important things to understand about boundaries is that they are NOT about control and they are not about punishment. And that’s a good thing because trying to control another person often backfires. And you don’t have control anyway. But you do have influence. And boundaries, when they’re set right, are one of the most effective ways to positively influence your loved one’s use.

So if boundaries aren’t about control, then what are they about? Boundaries are actually about you. In dictionary terms, boundaries are the invisible lines that define the limits of acceptable behavior within a relationship. They are not barriers meant to isolate or punish, but rather safeguards that promote mutual respect and well-being in a relationship.

They respect another person’s autonomy – the fact that they’re free to behave as they choose. And they’re also free to face the consequences of that behavior.

But boundaries state that if a person engages in certain behaviors, then walls, to a greater or lesser degree depending on the behavior, will start to go up in the relationship. They are manners and degrees in which you will no longer connect with and/or support the person. What those walls look like can be highly variable. And some of that is dependent on the relationship. For example, Boundaries with children will sometimes look different than boundaries with adults.

So I want to give you some examples of what boundaries with your loved one using substances could look like.

Here are some examples of boundaries with adults:

  • I will not get in a car with you if you are drinking. Or even I will call the police if I know you are driving while intoxicated in order to protect everyone on the road. (If you use this last one, it will be important that you do it for the safety of all people on the road, not as a punishment. And I would state this clearly if you set this boundary.)
  • You will not be welcome, or you will be asked to leave family gatherings if you are under the influence of substances. Or I will leave an event or family gathering on my own if you are using substances.
  • I will not let you live here if you continue to use.
  • I will not wake you up so you can be somewhere you need to be or call into work for you if you are too hung over.
  • And the boundary family members sometimes need to set as a last resort, I will not continue a relationship with you if you continue to use.

While some of those boundaries I just mentioned can also be set with children, here are some others that can be used with children as well:

  • If you continue to use, you will no longer have access to the family car and we will not pay your insurance.
  • If you continue to use, we will no longer pay for your phone.
  • If you continue to use, we will block your access to the internet.
  • If you continue to use, we will limit other activities.

So those are some examples of what boundaries could look like.

But before you set any of these boundaries, it’s important to consider what you will use as acceptable evidence of use. Some families go as far as to require a drug or breathalyzer test. Others focus more on the unacceptable behavior that accompanies the use. If you’re focusing more on the unacceptable behavior that accompanies the use, then you will need to outline that behavior in the boundary.

In fact, you may want to outline a list of unacceptable behaviors that accompany the use as evidence.

So that’s what boundaries are, and some examples of boundaries you may choose to set with your loved one. Some of these, like your or your loved one’s participation at events, can be directly linked to the holidays. But all of them can be useful year-round.

Now, before I move on to the connection between boundaries and recovery, and how to communicate boundaries with compassion and empathy – which IS essential when you’re setting them, I want to talk about the partner to boundaries: and that’s rewards, or what many in the cognitive behavioral therapy field call positive reinforcement.

One of the things that so often happens in families affected by addiction and other dysfunction is that boundaries get weaponized and used as tools of coercion and shame. If that’s how boundaries are used, their chance of having a positive influence on the use is almost nil.

So if you really want to make the most of boundaries, it’s essential that you pair setting boundaries with rewards. The reward is not about something material, although it can be that too, but it’s mostly about support, appreciation and praise.

Setting boundaries without offering support and appreciation for positive behavior is frankly unfeeling, and depending on the extreme can even become abuse. At the very least, it renders the relationship very one-sided, all take and no give.

So even as you’re setting boundaries, it’s important to notice what your loved one does well, and offer support and praise for that. Additionally, if your loved one has other healthy interests that don’t involve substances, you can offer additional support for those interests as well.

And of course, you should offer to support, in whatever way you reasonably can, any efforts they make towards positive change.

When it comes to boundaries and rewards, basically, what you are saying is that, while I can’t be a doormat to your use, if you want help with the substance use, I’ll support you however I can. And I’ll support you and affirm you in any ways I can beyond that.

Unfortunately, even rewards can be hard to offer for family members. Because so often you’re angry. And rightly so. And that anger makes it difficult for family members to see what their loved one is doing right or doing well.

I’ve said a number of times before that setting boundaries is really hard – and it is – but families need support with rewards, too. In other words, they need a healthy place to vent their anger, and they need an outside perspective that will help them recognize ways they can reward, support, and praise their loved one.

OK, so we’ve talked about what boundaries are and what they could look like. Now let’s talk about the importance of boundaries.

The Connection Between Boundaries and Recovery

Boundaries and rewards positively influence your loved one’s use in two ways. The boundaries serve to make the use less attractive, and the rewards serve to make positive change more attractive.

But boundaries also serve at least two additional purposes. First and foremost, they provide a framework for a person in recovery to rebuild trust with their loved ones. And that’s one of the things recovering people most want to do in their relationships. But building trust takes time, and that can be challenging for a recovering person.

However, by clearly defining expectations and consequences, you basically offer them a roadmap for rebuilding that trust, because boundaries help create a stable and predictable environment, which is not only essential for building trust, it’s also essential for the recovery process.

Furthermore, boundaries protect both your loved one using substances and you the family from the potential negative consequences of substance abuse. They establish a line between supportive involvement and enabling behaviors on your part, helping you the family member avoid inadvertently contributing to the cycle of addiction.

But how you set those boundaries matters, and it’s important to communicate those boundaries with empathy, and without judgment. And you may need outside support to help you do this.

Effectively communicating boundaries requires a delicate balance of firmness – enough to show that you’re serious, and empathy for the fact that your loved one is struggling with a disease. It’s essential to express your concerns and expectations while maintaining a compassionate and non-judgmental tone.

So, Here are some tips for communicating boundaries with love:

Choose the Right Time and Place: To the best of your ability, find a calm and private setting for the conversation, and again, to the best of your ability, make sure your loved one is sober. The holiday season can be chaotic, so to the extent that you can, choose a moment when everyone is relatively relaxed, sober, and focused.

Use “I” Statements: I know this is not new, but you should frame your concerns in a way that emphasizes your feelings and your experiences. For example, say, “I feel worried when I see you drinking at family gatherings,” instead of making accusatory statements.

Express Empathy: Acknowledge the challenges your loved one is facing and express your support for their recovery journey or any kind of positive change. Let them know that the boundaries are meant to create a healthy and positive environment for everyone involved. It’s not just about them and their use.

Be Specific and Clear: It’s really important to clearly articulate the boundaries you’re setting because ambiguity can lead to misunderstandings and arguments about whether or not the boundary was actually violated. So be specific about the behaviors that are unacceptable and the consequences that may follow.

Listen Actively: This may be the hardest one, but it’s also important to encourage your loved one to share THEIR perspective and feelings. And then LISTEN. You don’t have to agree with everything your loved one says, but actively listening to what they say fosters a sense of mutual understanding and helps strengthen the lines of communication between you. And you may just learn something here that helps you have more compassion and better support your loved one in making positive change.

So those are 5 tips for communicating boundaries with love.

But establishing boundaries is just the first step; maintaining consistency in those boundaries is equally critical. Consistency provides stability and predictability, which are essential elements for both the individual in recovery and the family.

If boundaries aren’t consistently enforced, it can lead to confusion and erode the trust that the family is working to rebuild. In fact, one of the first rules of setting boundaries is to not make false threats. If you’re not prepared to uphold the boundary, it’s far better not to set it. Because setting a boundary you are not prepared to uphold actually erodes communication and trust. You will not be believed in the future if you do this and this will erode your loved one’s ability to trust you, just as their substance use erodes your ability to trust them.

You need to mean it when you set a boundary, and you need to enforce it consistently. And again, you will probably need additional support to do this. Because it’s HARD. It really is.

Consistency also reinforces the message that the boundaries are not arbitrary rules, but essential components of maintaining a supportive and healthy environment for the family. It demonstrates a commitment to the well-being of everyone involved and emphasizes the importance of personal responsibility in the recovery journey.

In fact, not enforcing boundaries consistently only contributes to the dysfunctional relationship dynamics in family addiction because rules and expectations change from one day to next.

And remember, while setting boundaries is a necessary part of supporting yourself, your family and your loved one, rewards, acknowledgement, encouragement and praise – in other words, positive reinforcement – are equally important.

Celebrate and acknowledge small victories in your loved one’s recovery journey. This positive reinforcement helps build self-esteem and reinforces the idea that adhering to boundaries leads to positive outcomes.

Boundaries around the holidays are important, but by also focusing on the positive aspects of progress, you can create a more uplifting and supportive atmosphere during the holidays.

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