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.

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.

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.