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Education of the Family

A critical role in successful treatment

Over the last several weeks, I have tried to provide several key ideas that are essential to integrate into any successful treatment program:

1. The first being that alcohol and drug addiction is a chronic brain disease – with all of the data supported by scientific studies. Since it is a chronic medical disease, you have to treat it as such in order to be able to manage it successfully over your lifetime.

2. The second idea - discussing the latest anti-addiction medications and their pivotal role within a comprehensive treatment program. Medications like:

a. Vivitrol for alcoholism or

b. Suboxone for heroin or prescription pain pill (narcotic)addiction

3. The third concept discussed ways to help spot signs of addiction in a family, friend or loved one and how to best access help for that person to get engaged in treatment.

4. Finally, I hope that you utilized the various treatment resources that I mentioned over the last several weeks, targeted specifically at patients and their families in order to help educate and support them through this process, with the two primary tools being my new book Healing the Addicted Brain ( ) and a patient-friendly website

Today, I would like to discuss how important it is for the family to become educated about all of these issues as well as many others, if the alcoholic/addict is to have a great chance of success. I will start out with a brief excerpt from my book:

“I am so tired of trying to handle the family responsibilities, the finances and everything else all by myself.”

“My kids hate their Dad for disappointing them so many times. Can you really blame them?”

“She’s not trying hard enough to stay away from her drug buddies.”

“If he really cared about us, he wouldn’t have blown all our savings… again!”

“If he shows his face here again, I will kick him out before he gets through the front door.”

“She doesn’t even remember slapping the kids around! How can she not remember?”

“I went to some stupid counseling session with him. The idiot shrink told me I was an enabler and insinuated that this disease had affected me as well.”

I’ve heard many comments like these from the families of my patients, and they illustrate a sad truth: addiction is never just one person’s problem—it devastates entire families. When your family member is in the throes of addiction, you can feel abandoned, anxious, fearful, angry, embarrassed, guilty, and a host of other emotions. The damage extends throughout the entire family as you struggle to cover up the problem, work around the addict, deal with your own negative emotions, and cope with the responsi­bilities the addict left untended and the roles that are unfulfilled. You, the family members, often become enablers unwittingly, helping the addict continue his or her damaging behavior and keeping the addiction in play. For all of these reasons, you need to be in recovery right along with the addict, although you may not realize that you need help.

The most important thing for you, the family member of an addict, to understand is that addiction is a disease, not a moral failing or inborn sin. That’s a good thing, because the disease of addiction is treatable and manageable with appropriate medical assistance, while sin is not. It may be difficult to arrive at this new understanding, and you may have trouble letting go of years of accumulated anger and resentment, but always re­member that your new understanding and skills will help your addicted loved one recover—and will help improve your life tremendously.” P185-186.

This excerpt summarizes a lot of the inaccurate information, strong emotionality and hopelessness that is present in most family members that are struggling to help save the life of the alcoholic/addict. If you think about it, the addiction spreads this “blanket of negativity and futility” across the entire family system. Then once the addiction becomes enough of a problem, if the family is lucky enough, the “patient” will go into a treatment program. As we all know, convincing the patient to go to treatment, as well as choosing the right program, can many times be a very long and arduous process. Once the “patient” is in the program, however, the entire family usually exhales a huge sigh of relief – the problem is solved, correct?, they actually get a break and can “rest-up” - and then hurriedly get back to their “regular” lives without the “stress” of their addicted loved one in their life for some period of time. In other words in most treatment programs, the patient is the one that gets all of the new information and teaching, while the rest of the family receives little to no intervention or information.

Fortunately, when the patient finishes treatment, many times they have achieved a higher level of understanding about their chronic brain illness and even may have learned some new “healthy” coping skills to more effectively deal with stress.

( Note: this does not always happen by the way, because if you remember from my previous blog entries, alcohol and drugs injure the brain and most of the time, this injury seriously impairs the patient’s ability to learn new ideas and remember new information – very important parts of their brains just go offline , in many cases for several months; unfortunately, these are the early months of sobriety, during which the addict/alcoholic is in the intensive treatment phase – precisely the time during which the addict/alcoholic has the worst chance of learning and retaining new tool sets and information. It really does not make a lot of sense does it? At least, until you start using some anti-addiction medications that can in partnership with the treatment program, accelerate the “rebooting of the brain” so that the learning and thinking systems can come back online much sooner)

However, unfortunately the family has usually not learned anything new, because no one told them that they needed to be using the time while the addict was in the active phase of treatment to learn all that they can about this life-threatening illness (either the treatment program did not involve them in order to convey this message or they were too tired/fed up to take the time to participate or both). Consequently, they are “stuck” in their old ways and dysfunctional habits- the ones that they have learned over the last 5-10 years of living with the growing addiction in their family member.

So what is wrong with this picture? What is the problem here?

Well, if the patient comes home with these new, “healthy” skills and yet he/she has not completely integrated them into their “habits” about how to approach life, and if the family is stuck using the old “unhealthy,” proaddiction communication patterns, then the momentum in the situation will be to pull the addict back into his/her own “old” ways (using denial, dishonesty, anger to deal with most situations) and thus seriously increase the chance of relapse. Well hopefully, it should be obvious that this is the WRONG scenario to occur after everyone has spent so much time, energy and money on the recent treatment program. Can you imagine this happening to a diabetic patient, where a patient goes into the hospital in a diabetic crisis and when he comes out, the family still has ice cream and other high sugar foods still all over the house? Does that make any sense at all?

Yet it does not have to be this way!! In fact, when you look at the last paragraph, it seems like a pretty “stupid” thing to do, doesn’t it? I mean this is really not rocket science. If someone is working hard to change the lifestyle because of any chronic medical illness ( ie diabetes, high blood pressure or alcoholism), they need as much support as they can from the different areas in their life to reinforce those changes. Therefore, in order to enhance a patient’s chances of remaining sober, the family needs to be educated just as aggressively as the patient about the issues surrounding this disease and how to effectively manage it in the future. If this occurs, and the patient participates in a comprehensive, science-based treatment program, then when the patient completes treatment and re-enters the family system, that system meets him at his “new level” ( or sometimes they are even at a higher educated level than the patient, because since they are not suffering from addiction-induced brain injury, they can learn and remember much more efficiently – they can retain more of the new skills in many cases). In this case, if the patient begins to drift back to old habits, then the family members can reinforce the healthy, pro-recovery skills and it should be much easier for the patient to stay sober.

Let me give you and example of these types of new skills. If you have read Healing the Addicted Brain or taken the elessons on the website, they you know that cravings are caused in many cases by malfunctioning circuits deep in the brain ( called the limbic system) which has been injured by the past alcohol/drug use. You will have also learned that cravings go away after 20 minutes or so on their own, if they do not lead to substance use. Additionally, you now know that the best way to get rid of a craving is to talk about it with someone else who is part of your sober support system (ie AA sponsor, family member etc.) When the patient learns these three very important pieces of information in treatment, they actually have some hope about being able to stay sober.

Now, to my point, if the family has not participated in treatment and not been educated about these three issues, and the husband (the patient) calls his wife at 3pm one afternoon and says, “Honey, I am having a very strong craving to drink, can you help me?” then this “news” to his wife in many cases will activate several “DEFCON level 5” emergency scenarios in her head and really scare her, thereby causing her to scream at her husband for failing treatment yet again and telling him that he has to go back into his treatment program for another month immediately, or she is taking her kids to her mothers and filing for divorce- and this time she really means it !!. However, in actuality, if the wife had learned that cravings are normal and the fastest and best way to make them go away is to talk to someone, then when she receives the phone call above, she actually praises her husband for reaching out and they have a pleasant talk for 5-10 min and build a plan together, thereby strengthening the marital bond that had been so hurt by the past addiction behaviors.

The latest scientific research studies have reinforced these principles of educating and involving the family, before, during and after the intensive phase of treatment, as a critical component of treatment success. Let me assure you, in the EnterHealth treatment program here in Dallas, we spend a GREAT deal of time trying to involve the family in treatment education and therapy during the entire course of treatment for a patient. We utilize the book and the website extensively to convey these life-saving concepts into the family’s understanding. However, there is a wealth of other educational resources out there to educate the family, for instance The Partnership for a Drug Free America( .) Just make sure that whatever resource you choose, that it discusses the concept of addiction as a chronic brain disease and uses the latest science-based concepts to treat it comprehensively. Most importantly, the family needs to work hard in treatment to have great success in living with a loved one who has alcohol or drug addiction.

Thanks for reading.

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