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.

Was Your Thanksgiving an Alcohol or Drug-Filled Sh*t Show? How to Shift Your Experience of the Remaining Holidays

Was Your Thanksgiving an Alcohol or Drug-Filled Sh*t Show? How to Shift Your Experience of the Remaining Holidays

So, if you celebrate Thanksgiving, how was it? I ask because Growing up, and even when going home for the holidays as an adult, I never knew how the holiday would go. It was always a crap shoot.

To be honest, at times, it could be a ton of fun and full of laughter. I think that’s what kept me continuing to go back when I could as an adult – hoping that this one would be one of the good ones.

But then there were the ones that weren’t good. And when they weren’t good, they were really, really bad. They were seriously a total sh*t show. A night mare of drinking, arguing, insults, threats of violence. And someone was always the scapegoat or the black sheep for that year. And then, of course the gossip around everything that was wrong with that person would continue well after the holidays were over.

And those horrible holidays happened frequently enough that they clearly weren’t just flukes.

And it wasn’t until I had started recovering from family addiction that I realized that there WERE alternatives to this drug, alcohol, and mental illness-fueled sh*t show. But one of the first steps to that healing was recognizing all the ways the dysfunctional family dynamics kept me sucked into it.

Call this a list of what kept me doing the same thing over and over again during the holidays and expecting a different result:

  • Believing family myths. My family has this myth going that they’re all creative geniuses and that the mental health and substance issues go hand-in-hand with that creative genius. And to be fair, many people in my family are genuinely highly creative. But they would narcissistically argue that the creativity somehow justified the damage of the substance use and other abusive behaviors driven by mental illness or personality disorders.So step one was to stop believing the myths that propped up the family dysfunction. They may be creative people, but they’re mentally and emotionally sick and need mental health and substance use support.
  • Sacrificing safety and well-being for convenience or cost savings. This is really about the things that kept me from being able to leave the gathering when things started heading south. Things like agreeing to stay with family members who are “only trying to help me out” financially, when in reality, that offer came with added expectations of putting up with the chaos. Or driving down with other family members which left me without an easy means of leaving and potentially jeopardizing my ride back if I didn’t scratch the chaos and dysfunction up to “par for the course.
  • Leaving myself with no other options. Part of this goes part and parcel with numbers one and two, but there are other emotional and psychological ways I was left with no other options. There was another part of the family mythology that had me believing that I was nothing without my family, and so the thought of not being part of these significant family gatherings left me feeling like a total loser, small and alone. Like I was totally unworthy of love when in fact the total opposite was true.Unpacking this required me to get Effective Support and to stop isolating myself in the face of the family addiction. I still had to grieve the love that was not currently available to me in my family, but effective support allowed me to create family of my own choosing.This gave me viable options during the holidays, not just people who were willing to take in a “stray” or “holiday orphan” during the holidays, but again, that chosen family that truly wanted my company during the holidays.

So that was how I started to change my experience of the holidays. So I would love to know about you:

If you’re in the U.S., was your Thanksgiving also a shit show? And is a part of you dreading the remaining holidays? Thanksgiving is already under our belts. And so I invite you – if you feel comfortable – to consider how you could support yourself in doing something differently around the holidays.

If my experience above resonated with you, you might consider doing some reflection or journaling on the following three questions:

    • What family myths keep you sucked into the family dysfunction, and thus keep you doing the same thing and hoping for something different? What keeps you believing them?
    • Are you sacrificing you safety and well-being for convenience or cost savings? If so, how? Can you brainstorm other options?
  • Have you created your own mythology around you self-worth or my worthiness that is somehow tied to tolerating the chaos in the family? This can become its own perverted form of FOMO in my experience.

Before you answer these questions, I highly recommend you have a trusted, supportive, and non-judgmental person – who is NOT a family member – with whom you can share what comes up when you answer these questions. Not that you have to share any of it, but I say this because what comes up might feel really heavy, and you may need someone to help you process. This can be a friend, a clergy person, a support group or a therapist. But I don’t recommend sharing what comes up with family members unless you are absolutely sure that what you share won’t be used against you.

So that’s a start. But there are a few other things you can do as well.

    • Acknowledge your feelings. If your holiday was indeed a sh*t show, then it will be important to acknowledge whatever feelings you feel about that, whether that’s anger, disappointment, sadness, frustration or something else. For better or worse, all healing is on the other side of feeling feelings. Which sucks, I know.

      But there’s the catch here. There may actually be a step that you need to take before this one, if your family is anything like mine. And that is to believe that you actually have a right to these feelings. As in, they’re valid and there’s nothing wrong with you for having them.

      I didn’t have a right to my feelings growing up, and when I got upset or objected to anything I was told I was too sensitive and I just needed to get over it. It was no big deal, and I was now creating problems for making a big deal of it. And if I didn’t get over it, I was told I just needed to leave that in the past.Coming to believe you have a right to these feelings requires effective support. And if that’s the case for you, I’ll put a link in the blog to an IG reel I have on what constitutes effective support. And there are links on my resources page to where you might find it.

      But if you feel like you don’t have a right to these feelings, that could be one of the things that keeps you brushing them under the rug year after year, and, like I did for so long, continuing to do the same thing over and over every time the holidays came around and hoping for a different result.

      And you know, the holidays would go “relatively” well just often enough to keep me hoping. But it never, ever, stuck.

    • There’s another thing you can do, but before I mention that, I think a little context would be helpful.

      So, I often do a little ChatGPT work before I write blog posts. It’s a great tool for identifying what the dominant narrative is on the interwebs about any given issue. And when it comes to addiction and family addiction, what comes up often makes me want to hurl.

      To be fair, the previous point did come up, but what ChatGPT had to say about acknowledging your feelings was completely devoid of how difficult that can be and what actually gets in the way it for families. And the next point was to initiate honest and open communication. Theoretically, a good idea.

      In practice, it’s much more complicated.
      In fact, I’m quite confident that you’ve already tried to communicate your concerns, but they have not been heard. And sure, there may be ways in which it would be helpful to shift your approach, but if what you say is not backed up with boundaries, the communication often gets you nowhere, and your words can end up twisted, taken out of context, and then used against you.

      So before we talk about communication, I think it’s important to talk about boundaries. Because when most of the literature talks about communication, they are focusing on communicating your concerns. With words. Depending on the severity of the substance use or other dysfunction in your family, words about your concerns often get nowhere.

      When it comes to unacceptable behavior driven by substance use or other dysfunction, boundaries are actually the most effective source of communication there is. But they’re incredibly difficult to set and even harder to stick to. Because you pretty much have to count on backlash.

      This is why I’m developing an entire workshop on setting boundaries with a loved one’s substance use. It is one of the best forms of communication out there when it comes to family addiction, but it’s damn near impossible to do if you don’t have effective support. 

  • Speaking of boundaries, one of THE most important boundaries to set around the holidays is to Have a Plan B.

    When you leave yourself with no other options, you end up stuck on the ride with the family dysfunction. And for years, I had left myself with no other options, both psychologically with my thinking about being nothing without my family, and also materially with the choices I made during the holidays that left me with no readily available option for stepping away from the chaos.

    I personally had to approach this in a couple of ways. When it came to changing my thinking, I needed Effective Support in order to do that. In my case, I found that both through support groups and professional therapy.

    Once they family mythology no longer had such a tight grip on me, then I was able to make different choices about if and under what conditions I could participate in family holidays. I would only participate if I had my own transportation and a place to stay that was not with a family member. Sometimes that was a hotel, other times I stayed with friends.

    When I could, I would also connect with understanding friends – usually other members of my support group – and ask if they could be my backup holiday gathering in case I had to leave my own family gathering.

    And when it comes to the holidays, the boundaries for me were the conditions under which I was willing to participate, and the Plan B. And when it comes to the Plan B, it’s important to be very clear with yourself about what type of behavior or situation is going to trigger the Plan B.

    I suggest also making a commitment to an understanding friend that you will trigger the plan B if those conditions are met. If you’re at all like me and are conflict averse, it’s easy to say things aren’t that bad when in fact they are. But the Plan B is how you say that the behavior is unacceptable.

    And when you have a Plan B in place, you don’t even need to get angry because you know you’re not trapped. This allows your communication to be far more compassionate. Because it allows people to be who they are while still taking care of yourself. Then healthier communication can happen after the drama of the holidays has subsided.

  • But, the thing is, all of this requires support. If you’re looking at the myths that keep you stuck, you’re going to feel some things. And it’s a lot easier to allow yourself to feel those things if you’ve got a reasonably healthy support system outside of the family.

    If you’ve never before set a boundary, if you’ve never created a Plan B for the holidays, if you’ve never deliberately planned for an easy exit around holiday gatherings, the first time you do that can feel really, really scary. And the reality that all if this is even necessary will also bring up grief. Which again brings you back to feeling your feelings. Again, knowing there are people who have your back will make it much easier to walk through that fear.

    Finally, as with everything around family addiction. Everything I’ve suggested here is easier said than done. And that’s the thing that makes me crazy with a lot of the advice out there to families. They make it sound like it’s so simple. The concepts are simple, but the practice of them is anything but.

    I know very well that I’m suggesting things that can be really scary to execute in practice. So I want to close this post by saying, if you’re not ready to execute on all of this, that’s OK. Maybe you just reflect on how you get wrapped up in some kind of family mythology. Or maybe you just take your own car, even though you have no intention of leaving, no matter what happens. Maybe you just start to feel feelings that you’ve never been allowed to feel.

    Start with what you can and just keep it in the back of your head that in the future you can take it a little farther.

    Family addiction and dysfunction is like a huge cruise ship or a semi. Neither can turn around on a dime. It takes time and often some back and forth.

    But if your Thanksgiving was a sh*t show and you’re even considering what you could do differently, that’s beautiful first step.

One Important Reason Why Treatment So Often Fails

One Important Reason Why Treatment So Often Fails

Welcome to episode #8 in my “Why I do what I do” series!

Have you ever wondered why treatment outcomes are so poor? One of the biggest reasons for such poor treatment outcomes informs reason #8 of why I do what I do.

I do what I do because upwards of 50% of people with substance use problems also have another co-occurring mental disorder, whether that be depression, bipolar disorder, ADHD or some other mental disorder.

While the presence of a co-occurring mental disorder, or what is sometimes referred to as dual diagnosis, presents unique challenges, if both the mental disorder and the substance abuse are not addressed together, the chances of recovery reduce drastically.

And, the chance of the addiction becoming fatal increases significantly as well.

But often treatment programs fail to adequately account for this reality.

Very few treatment providers are equipped to provide the kind of integrated, holistic care that would allow them effectively treat people with co-occurring disorders. Therapists will often turn people away, saying they can’t treat, say the depression, or the bipolar disorder, until the person gets sober.

And yet, the person needs treatment for those things if they are going to have a reasonable chance of getting sober as they are often subconsciously using the the substance treat the mental disorder.

One of the reasons so few treatment programs effectively address the existence of co-occurring mental disorders is that the treatment protocol at many treatment providers is still largely informed by the Minnesota Model, one of the earliest treatment models that have been developed.

The Minnesota Model heavily integrates the principles of 12-Step recovery, and focuses primarily on group therapy, with some limited individual counseling.

The Minnesota Model also relies heavily on staff members who are in recovery themselves. But because substance abuse treatment is not broadly regulated across the United States, these staff members may or may no be professionally trained and credentialed in drug and alcohol counseling. Their only qualification may be that they have recovered from a substance use disorder themselves. They are not likely to have any mental health credentials.

While some people do have success undergoing treatment using the Minnesota Model, addiction treatment is not one-size-fits-all. Different people will require different approaches. And more evidence-based treatment approaches, such as cognitive behavioral therapy, have been developed since the advent of the Minnesota Model.

More importantly, there are underlying factors that contribute to substance use disorders that the Minnesota Model is just not designed to address. Factors like high levels of chronic stress, a history of dysfunctional family relationship dynamics, and trauma, all increase a person’s vulnerability to both substance use disorders and mental health disorders.

But the majority of 12-Step programs, on which the Minnesota model is based, begin the premise that the reasons for the substance use are unimportant. And that just isn’t true in many cases.

And while the 12-Step process can offer tremendous value, it does not work with the majority of mental health issues, especially trauma. These are things you can’t just work steps 1, 2, and 3 on, or turn over to your Higher Power, or do a 4th step on. These things require professionally trained mental health intervention. And this is what many treatment centers don’t provide enough of.

I’ll interject a little bit of my own experience here as a family member who has been working multiple 12-Step programs – which I still have a tremendous amount of respect for – in trying to heal my own experience family addiction.

For much of my time in 12-Step recovery, I was in complete denial about the amount of trauma I had been subjected to because of the amount of addiction and mental health disorders among members of my family. I had pretty much internalized my family’s unwritten rules that anything that happened was in the past and you just needed to get over it. And I couldn’t figure out why other people in my 12-Step recovery groups were experiencing so much more recovery than I was, despite the fact that I was earnestly working the 12 Steps too.

This isn’t to say I didn’t experience any recovery. I absolutely did. But I couldn’t seem to get to where other people were getting, no matter how hard I tried.

Once I realized I did need help addressing the trauma I had experienced, I found a trauma therapist who also happened to be in a 12-Step fellowship. And one of the things that I said to her in our first session was “Do you know how many fourth steps I’ve done?” (The fourth step, by the way, is to make a searching and fearless moral inventory of yourself.) And when I said this to her, she simply said, “Fourth steps don’t heal trauma.” And they don’t. Professional trauma therapy heals trauma.

The 12-Step process can be tremendously valuable in creating structure and providing emotional support for your personal and spiritual growth. They are a beautiful tool for recognizing what you can and cannot control in your life and for taking responsibility for what you can control. And they are an incredibly helpful, and one of the most effective tools I’ve seen, when it comes to healing relationships, which, if you’ve seen my free video series The Family Guide to the 5 Actions Required for Substance Abuse Recovery, you know is an essential part of healing from a substance use disorder.

12-Step programs also provide a shit ton of hope and inspiration for anyone suffering from a substance use disorder or struggling with someone who is. And all of this, of course, supports mental health. But they are not a remedy for genuine mental health disorders.

That absolutely proved to be true in my case. Once I had a fair bit of trauma therapy under my belt, I started experiencing the kind of recovery that I was seeing other people get out of the 12-Step process.

Our entire treatment industry needs to provide much more holistic and personalized treatment options if we are ever going to resolve the addiction crisis. More people die because the treatment industry is failing to consistently solve for the presence of co-occurring mental disorders. Treatment options that can address substance use with co-occurring disorders are unbelievably lacking in this country. Which is insane given that so many people, up to 50% of people with a substance use disorder, suffer from a co-occurring mental disorder, and the substance use is often an attempt to medicate the other mental disorder.

It’s unconscionable that we are letting this reality slide. I do what I do because we need broader awareness of that problem, and we need people, especially families, but really everyone, advocating to change that.

There Are Many Addiction Myths. But Even the Antidotes Sometimes Get It Wrong

There Are Many Addiction Myths. But Even the Antidotes Sometimes Get It Wrong

Welcome to episode #7 in my “Why I do what I do” series!

Have you ever watched the TED talk by Johann Hari called “Everything we think we know about addiction is wrong”? If you haven’t, I highly recommend it.

The fact that so much of what we think we know about addiction is wrong informs reason #7 why I do what I do.

I do what I do because our culture is so steeped in myths about addiction that often tragically misguide families. Families need to be equipped with accurate knowledge and tools to better be able to navigate their loved one’s use.

One of the reasons many of these myths persist, despite the fact that the medical community has demonstrated that they’re false, is because one of the hallmarks of substance abuse is harmful and hurtful behavior. And that creates a dilemma that doesn’t have an easy answer.

Yes, addiction is a disease. But that doesn’t make the behavior OK. This is, in fact, a brief summary of the two competing realities of addiction, what I call addiction’s double bind. Addiction is a disease, but people active in addiction hurt people, and they hurt them badly.

And while there is no one right way to navigate these two realities, if we’re going to successfully address the addiction crisis and generational cycles of addiction and other dysfunction, we HAVE to occupy that middle ground. That messy, uncomfortable, middle ground.

Many of the myths surrounding addiction, and even codependency, are borne from a refusal to acknowledge this messy middle. I do what I do because I don’t believe we will ever be able to effectively resolve the addiction crisis if we don’t work to address both these realities.

So the work I do supports families in finding the right approach for them in that messy middle.

But what does occupying that messy middle look like? Well, in preparation for creating this video blog, I asked ChatGPT to write a blog post for families on myths around addiction. And the output was interesting. It did come up with 7 legitimate myths about addiction, but with one exception, each explanation of the particular myth failed to acknowledge both realities about addiction.

Take the myth that addiction is a moral failing. Here’s ChatGPT scraped from the web on this myth:

“It’s time to dispel the damaging belief that addiction is a result of moral weakness. Addiction is a medical condition, not a character flaw. When we label it as such, we stigmatize our loved ones, making their recovery journey even more challenging.

Instead, let’s focus on providing love, understanding, and encouragement. By supporting your loved one, you can help break down the stigma surrounding addiction and create an environment where healing can take place.” 

And that is all true. Absolutely. But why do people think addiction is a moral failing in the first place?

They think it’s a moral failing because of the damaging behavior. That stuff is real. The damage is real. And the damage is not at all effaced by the fact that addiction is a disease.

Addiction is not a moral failing, but the behavior driven by addiction does have significant moral implications that cannot be ignored. Moral implications that affect the family members more than anyone else in most cases.

If we’re going to effectively address the problem, we have to occupy a the messy middle. So what can that look like in this case?

Here again, we’ll see people say you have to set boundaries. And they’re right. Yes, you do. But if you set those boundaries from a place of judgment and shaming of the behavior – as if it’s a moral failing, you’re exacerbating the disease and further stigmatizing your loved one.

You have to set what I call “Compassionate Boundaries.”

What are Compassionate Boundaries?

Compassionate boundaries are boundaries motivated by self-care, motivated by your need to take care of yourself around the behavior, rather than as any kind of punishment for or judgment of the behavior.

We do our best to acknowledge the fact that the behavior is driven by the disease so we don’t stigmatize our loved one, while also taking care of ourselves around the behavior, because the behavior is not acceptable, no matter what’s driving it.

I do what I do, not only because there are so many myths about addiction and codependency going around that misguide families, but because even the antidotes to those myths can also be misguided.

I do what I do because there just aren’t any simple solutions. And I don’t believe we’ll ever resolve the addiction crisis until we acknowledge how truly complex the problem really is. Until we acknowledge what I call addiction’s double bind – the fact that addiction is a disease, but also that people active in addiction hurt people, and they hurt them badly.

I don’t believe we’ll ever resolve the addiction crisis unless we can find a way to occupy the messy middle between these two realities. And the work I do supports families in figuring out what that messy middle looks like for their particular situation.

So, I’d love to hear from you. What are your thoughts? Drop a comment below or email me at questions@madeleinecraig.com.

The Treatment Industry Largely Ignores Families

The Treatment Industry Largely Ignores Families

Welcome to episode #5 in my “Why I do what I do” series!

So, I’m wondering, how much do you know about the treatment industry. If you’re like most families that I’ve worked with, you probably know little, if anything.

That leads me to reason #5 why I do what I do.

I do what I do because I get contacted by treatment providers all the time requesting that I link to something on their site.

I don’t provide backlinks to treatment programs because I’m not able to vet them adequately and I don’t want to look like I’m endorsing any of them. That said, when I get a request like that, I always check out the treatment center’s website. And the thing I look for on every site some kind of meaningful programming that supports the whole family. Like, ideally, they would have some sort of family programming, too.

But out of the scores of requests I get for a backlink on my site, only one of the treatment centers actually had legitimate family programming. With a couple of exceptions, the rest of them had absolutely nothing, not even info on their website, to support families. The two exceptions simply had a very superficial article on enabling. And like I said, I’ve been contacted by scores of treatment centers.

And that begs the question, if they don’t do anything to support families why are they reaching out to me?

I can tell you why. They are reaching out to me because they are looking for two things:
One is fairly innocuous: They want backlinks to their sites to improve SEO rankings.

The other is a little cringey: They want to make families aware of the existence of their facility, because outside of insurance, by and large it’s families who pay the treatment bills.

But treatment facilities are rarely transparent about what they do and their success rates. In fact, I’ll be doing a post, probably in November on a report that Hazelden Betty Ford published in June about their success rates. That report is very opaque – you really have to read between the lines and look at what they’re not saying – and this is from Hazelden Betty Ford. And the figures displayed in that report are curious at best.

Furthermore, when families get to the point where their loved one is truly willing to accept treatment, the situation is soooooo precarious. And it’s precarious for a number of reasons.
When someone with a substance abuse problem admits they have a problem and they want help, families have a VERY SMALL WINDOW in which to act, before their loved starts walking back that admission that there’s a problem and retreats back into denial. So family members need to take action fast. That’s going to happen the minute the admission leaves their mouth.

It’s often a serious crisis that compels someone abusing substances to admit they need help. And this crisis is likely traumatizing family members just as much as it is the loved one abusing substances. The more stress a person is under, the more the amygdala – the fear center in the brain whose sole job it is to keep us safe – the more amygdala is going to shut down the prefrontal cortex. This is the area of the brain we use for logic, reasoning, and making decisions.

But consider this: the average cost of 30-day residential treatment in the United States is over $42,000.

This means that family members end up in a situation where they’re making an extremely high-stakes decision in a situation in which they have very little time in which to act, they don’t have all the information they need or even know what questions to ask, and their brain isn’t fully online.

I do what I do because I want to help family members prepare themselves ahead of time, so they are prepared, they have all the information they need and they know what questions to ask.

And this is so important, because as cringey as the relationship between treatment centers and families can be, these treatment centers have to operate within a really flawed and deficient health care that is by and large driven by market forces.

Given that family members are one of the primary for treatment centers, I believe if the treatment system is going to change, it’s going to be because family members demand it. I do what I do because I want to empower families to make those changes.

So, I’d love to hear from you. What are your thoughts? Drop a comment below or email me at questions@madeleinecraig.com.

We Know So Much More About Addiction & Family Addiction, But Myths Still Abound

We Know So Much More About Addiction & Family Addiction, But Myths Still Abound

Have you ever been told that your loved one just need to hit bottom before they’ll ever change?

Well, that is categorically untrue and is in fact a dangerous myth that still circulates in society.

So many of the cultural myths about addiction and family addiction (often referred to as codependency, although codependency occurs in many contexts), are hindering our ability to effectively address the addiction epidemic and its effects on families.

The myth I mentioned above is a case in point. But this myth is only one of many. Frankly, I’ve got a list of at least 30.

To learn more, watch the episode below. It’s the third episode in a series I’m doing called “Why I do what I do.”

So, I’d love to hear from you. What are your thoughts? Drop a comment below or email me at questions@madeleinecraig.com.

“You Can’t Control It” Is Only a Partial Truth

“You Can’t Control It” Is Only a Partial Truth

Have you ever had someone tell you that you can’t control your loved one use’s and that you just need to let go and detach and thought there has got to be something that I can do address this problem?

If you answered yes, I’m really glad you’re here, because this episode of Hope for Families TV is for you!

I talk a lot about cultural myths that circulate about addiction and family addiction. While the slogan “You can’t control it” is not a myth, it’s also not a complete truth. Families do have influence on the problem. They’re influencing the problem no matter what they do.

To learn more, watch the episode below. It’s the second episode in a series I’m doing called “Why I do what I do.”

So, I’d love to hear from you. What are your thoughts? Drop a comment below or email me at questions@madeleinecraig.com.

We Will Never Resolve the Addiction Crisis Without Supporting Families

We Will Never Resolve the Addiction Crisis Without Supporting Families

Have you ever wondered why we have not been able to resolve the addiction crisis? And why the problem just seems to keep getting worse?

If you answered yes to this question, this episode of Hope for Families TV is for you!

There are of course, several reason why we haven’t made more progress in addressing the problem. One of them, however, has to do with the lack of adequate support for you the family member.

To learn more, watch the episode below. It’s the first episode in a series I’m doing called “Why I do what I do.”

So, I’d love to hear from you. What are your thoughts? Drop a comment below or email me at questions@madeleinecraig.com.

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