3 Evidence-Based Strategies Every Family Should Know

3 Evidence-Based Strategies Every Family Should Know

by | Apr 11, 2024 | Family Addiction, Hope for Families TV, Treatment

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.

Taking Addiction Treatment Claims With a Grain of Salt

Taking Addiction Treatment Claims With a Grain of Salt

by | Jan 18, 2024 | Hope for Families TV, Treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Except…

Your loved one is addicted to opioids, not marijuana.

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

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

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

So let’s continue our analysis.

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

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

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

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

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

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

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

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

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

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

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

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

Soooo many unanswered questions! Sooo much vagueness.

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

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

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

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

by | Jan 11, 2024 | Family Addiction, Hope for Families TV, Treatment, Why I Do What I Do

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.

One Important Reason Why Treatment So Often Fails

One Important Reason Why Treatment So Often Fails

by | Nov 23, 2023 | 12 Steps, Family Addiction, Hope for Families TV, Treatment, Why I Do What I Do

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.

The Treatment Industry Largely Ignores Families

The Treatment Industry Largely Ignores Families

by | Nov 2, 2023 | Hope for Families TV, Treatment, Why I Do What I Do

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.