Guide for Families

Part II: Treatment and Recovery

Researching Your Treatment Options

At times of emotional conflict, it might seem that the family is just a set of isolated individuals who happen to live under the same roof, but this is far from true. The family is a deeply interconnected system in which each member’s actions can either undermine or support the others. Getting help for an addicted family member can be difficult, especially if other members of the household feel angry or ashamed, or if they are in denial about the problem.

It is very common for people to feel alone when they discover that their parent, child, or partner is struggling with addiction. In fact, addiction affects families from all economic, racial, and ethnic groups. According to the Treatment Episode Data Set (TEDS) report of 2002-2012, 60 percent of individuals admitted to treatment programs for substance abuse in 2012 were white, while 20 percent were black and 13 percent were Hispanic.

admissions and race

Levels of Substance Abuse Treatment

There are many different levels of substance abuse treatment, from outpatient centers to inpatient hospital programs to long-term residential treatment facilities. During the course of recovery, a client may enter at a more intensive, closely supervised form of care before graduating to a level of treatment that allows more autonomy and independence. This process will vary according to a client’s needs; however, the levels of care generally include the following:

Levels of Care

Medical detox: For most individuals affected by substance abuse, treatment begins with a period of detoxification, or “detox,” in which the person is medically stabilized while intoxicating substances are cleared from the body. Detox services are offered in a variety of settings, including hospitals, inpatient treatment centers, outpatient programs, clinics, and more.

Inpatient rehabilitation: This level of rehabilitation, or “rehab,” often follows a period of intensive detox and involves 24-hour medical supervision at a hospital or other treatment facility. In the rehab phase, the emphasis shifts from chemical detoxification to therapeutic treatment for the psychological and emotional causes of addiction, through services such as group therapy, individual talk therapy, family counseling, and recreational therapy.
Residential treatment: Clients who can benefit from the stability and security of 24-hour monitoring are good candidates for residential treatment. Residential treatment facilities offer therapies in an attractive setting with comfortable, homelike surroundings and a supportive atmosphere. Residential treatment may last for many months, depending on a client’s needs.
Partial hospitalization: Partial hospitalization services combine the structure and supervision of an inpatient program with a higher degree of independence. Clients who have demonstrated a high degree of motivation to recover, and who have advanced through more intensive levels of treatment, are good candidates for partial hospitalization programs, which offer recovery services on an outpatient basis in a hospital or inpatient treatment facility.
Intensive outpatient programs: Outpatient treatment, in which the client participates in recovery activities during the day while returning to a private home or transitional housing program at night, is appropriate for individuals who no longer need 24-hour supervision and who are fairly advanced in their recovery process.
Transitional living/sober housing programs: After rehab, clients may feel more secure in their sobriety if they can live in an atmosphere that supports abstinence from drugs or alcohol. Transitional living homes provide these advantages while giving the client the opportunity to reintegrate into the community. These sober houses are usually located in a conventional neighborhood, giving clients access to community resources, medical services, and job opportunities while allowing them to return to a setting that feels safe and supportive at night.

Outpatient programs, also known as ambulatory services, are among the most common choices for individuals with a shorter history of substance abuse, a high level of motivation to participate in recovery activities, and work or family obligations that prevent them from committing to inpatient rehab. Inpatient programs are often recommended for individuals who have a severe history of substance abuse, who need close monitoring during the detox and rehab process, or who have multiple addictive disorders or co-occurring medical conditions.

outpatient treatment

The TEDS report of 2002-2012, which tracks patterns in substance abuse treatment in the US, notes that outpatient recovery is the most popular approach to treatment in the country, with 61 percent of Americans admitted for treatment in 2012 receiving ambulatory services. By comparison, 17 percent of admissions were for residential rehab, and 22 percent were for detox services only. However, it’s important to remember that the choice of a treatment center is a highly personalized decision, based on various factors, such as:

  • The client’s medical history and physical condition
  • Severity of substance abuse
  • Multiple substance addictions
  • Co-occurring psychological conditions
  • Family responsibilities
  • Occupational or social obligations

The choice of a treatment facility should be made in partnership with a therapist, physician, or other health professional, along with the family. As you research the treatment options available to you, the following checklist can help you and your loved ones determine your needs and priorities. Rate the following factors on a scale of 1 to 10, with 1 being the least important attribute or quality, and 10 being the most important:

choosing rehab factors

Factors to Consider When Choosing a Rehab Program

Is the facility accredited by national organizations? Programs that have been accredited by organizations like the Commission on Accreditation of Rehabilitation Facilities (CARF) must meet the highest standards of competency and performance.

What recovery services are offered? Look for a facility that offers a variety of interdisciplinary recovery activities, including core services like individual therapy, group therapy, and 12-Step programs, as well as family counseling, experiential therapy, grief and trauma therapies, and recreation therapy.

What kind of support is available for families? Because family participation is so crucial to recovery, the program should offer extensive support for parents, children, or spouses, including counseling, group therapy, educational programs, and family activities.

How long does treatment last? The length of treatment is usually determined by substance abuse treatment professionals who have analyzed the client’s needs; however, clients and their families have a voice in determining whether a long-term or short-term program is more appropriate for their needs.

Is the facility local or out of state? Choosing a facility that’s close to home can help to maintain family relationships during treatment; on the other hand, some clients find that they can focus more effectively on recovery in an out-of-state location.

What kind of services are provided after rehab? Completing a rehab program can mark the beginning of a new start in life, but most clients continue to need support from professionals and peers after they leave treatment. Aftercare services may include sober living centers, alumni weekends, family support groups, educational workshops, and other activities that focus on maintaining abstinence.

What amenities are available? Amenities like fitness rooms, landscaped grounds, housekeeping services, and organic meals can make rehab more comfortable and enhance the recovery experience.

How much does treatment cost? When it comes to seeking treatment for a condition as serious as addiction, the cost of treatment should not be your first priority. However, the cost of treatment and the availability of medical insurance or financial assistance to help cover expenses are very real considerations for most families.

Covering the Costs of Treatment

treatment costs When it comes to selecting a treatment program that can address the impact of addiction on a family, there are many elements that should take priority over the cost of treatment. However, the reality is that the cost of treatment and the client’s financial resources are deciding factors in many clients’ choice of a treatment program. The availability of personal savings, health insurance coverage, or government-funded programs can also affect a family’s decision about where to seek treatment.

Long-term residential rehab, which can last for months, is generally more expensive than partial hospitalization or outpatient treatment because of the cost of 24-hour staffing, housing, meals, recovery activities, amenities, and other expenses. Partial hospitalization programs and outpatient treatment are less costly, and programs are usually shorter, lasting from 4-6 weeks, on average. In addition, outpatient care may be easier to fund through health insurance plans.

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When Someone You Love Is in Treatment

If you understand what a loved one is going through in treatment, it can be easier to provide the emotional support they need at this time. In detox and rehab, clients confront not only the physical demands of getting clean and sober, but also the mental challenges of facing and overcoming their addiction.

A typical day in a residential rehab center might include activities like the following:

early morning meditation

Early morning meditation

individual counseling

Individual counseling

group therapy

Group therapy

family counseling

Family or marriage counseling

exercise

Exercise or recreational therapy

meal time

Meal time

flexibile time

Flexible time

Although it’s important to be aware of a loved one’s schedule in rehab, a list of activities doesn’t reveal the whole story of what clients experience in recovery. A comprehensive rehab program gives clients the means to make profound changes in their lives, restoring health to the body and mind. Yet the process of making those changes can be challenging. In sobriety, people often experience emotions that they have suppressed with drugs or alcohol, and emotions like the following can leave a loved one feeling exhausted or confused:

  • Fear of the future
  • Anger at partners or relatives
  • Guilt over past actions
  • Ambivalence about getting sober
  • Grief over personal losses
Family members should not expect recovery to happen quickly; it can take months, or more likely years, for suppressed emotions and grudges to be resolved. A recovery program should provide the tools that clients need to begin working through these feelings, such as in-depth work with a therapist, support from peers who are also in recovery, and an opportunity to explore spirituality as a means of growth. Access to therapeutic groups, educational courses, and 12-Step programs will also increase self-awareness and help clients handle potentially painful feelings.

Recovery can be a sensitive time for the parents, children, and partners of clients in rehab, as well as for the clients themselves.

Individuals who are experiencing withdrawal from intoxicants, or who are working to rebuild their lives in the aftermath of addiction, can experience depression, anxiety, mood swings, or sudden outbursts of anger. For the loved ones of people in recovery, the guidance of an experienced family therapist or marriage counselor can be invaluable. In order to have a lasting effect on the health of a family, therapy must address the dysfunctional coping patterns, flawed communication styles, and boundary issues that may have contributed to an atmosphere of addiction, notes the Substance Abuse and Mental Health Services Administration (SAMHSA).

How Does Family Therapy Work?

The emotional and psychological work of rehab is not limited to the individual with the substance abuse problem.

If the family is to grow stronger, and the home is to become stable enough to sustain sobriety, substance abuse must be addressed as a family issue. Family therapy sessions are conducted as part of a comprehensive rehabilitation program, and they may be held on a one-to-one basis or with all family members present. In addition, the loved ones of rehab clients have the opportunity to participate in support groups with other individuals whose relatives are in treatment. Peer support programs like Al-Anon and Alateen are also available as a source of strength and hope for individuals whose loved ones are in rehab.

Family therapy sessions are led by professionals who have specialized training in substance abuse treatment, such as a graduate degree in counseling, social work, or psychology. These therapists should be licensed or certified in their field, and they should have additional credentials in the area of addiction treatment.

Examples of professionals who may conduct therapy sessions include:

  • Licensed family therapists
  • Marriage counselors
  • Social workers
  • Psychologists
  • Psychiatrists
  • Members of the clergy

The idea of attending therapy sessions is intimidating to a lot of people. Family counselors often hear objections to therapy from the parents, adult children, or spouses of individuals suffering from substance abuse. Statements like, “I’m not the one with the problem,” or “None of this is my fault,” are quite common in therapy sessions. But individual and group therapy sessions have actually led many individuals to examine the behaviors and thought patterns that contribute to substance abuse in the home, ultimately creating a more stable, supportive environment.

According to SAMHSA, the benefits of family therapy can include:

  • Healing emotional wounds caused by the disease of addiction
  • Restoring trust between the family and the individual in recovery
  • Reconciling family members who have become separated or estranged
  • Promoting forgiveness among family members who have been harmed
  • Helping everyone in the family understand the nature of substance abuse
  • Creating positive change in all members of the household, not just in the family member in rehab
  • Establishing a more balanced, healthy lifestyle in homes that have been damaged by substance abuse

Although the primary focus of therapy is typically on the individual who is going through rehab, therapeutic strategies are designed to support every member of the family, so the unit as a whole emerges stronger and long-term sobriety can be sustained.

The Family’s Role in Recovery

family therapy In spite of the coping strategies, social services, and resources that rehab provides, the family is still one of the greatest sources of support for a person going through recovery. According to the Journal of Psychoactive Drugs, family involvement in the recovery process has consistently proven to be one of the most significant factors predicting long-term abstinence after rehab. Listed below are some of the actions family members can take to maximize the benefits of rehab and promote long-term abstinence from drugs and alcohol:

  • Attend family and/or marriage counseling sessions as recommended by the client’s treatment team.
  • Encourage the loved one in rehab by maintaining a positive attitude about recovery.
  • Seek out opportunities for education about substance misuse, addiction, and recovery.
  • Be willing to address any conflicts, emotional barriers, or resentments that might interfere with a sober environment at home.
  • Be prepared to create an atmosphere that’s conducive to long-term sobriety by removing addictive substances from the home and making other changes recommended by the client’s rehab program.
  • Take part in alumni activities, workshops, and family weekends after the client completes the rehab program.

Family members must be aware of the possibility that they may resent their loved one for bringing painful issues to the surface. However, these uncomfortable feelings can be resolved if the family is willing to participate wholeheartedly in the therapeutic process. Throughout the recovery journey, family members should remember that the discomfort or pain that arise in therapy can ultimately lead to stronger, healthier, more trusting relationships.

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Drawing the Line between Supporting and Enabling

For most of us, the impulse to help someone we love — whether it’s a blood relative, a close friend, or an intimate partner — comes naturally. But when it comes to addiction, that impulse to provide help and support can become distorted into a form of dysfunctional behavior called “enabling.” According to Psychology Today, family members must learn to draw the line between empowering a loved one who’s suffering from addiction and enabling the destructive behavior to continue.

Consistently making it possible for a loved one to abuse drugs or alcohol can result in codependency, a state in which the individual comes to rely on the loved one’s addiction for a sense of control, power, or security. While the codependent person may not abuse alcohol or drugs, they can become dependent on the loved one’s addiction for a sense of self-esteem or a feeling of emotional stability.

Codependent behaviors to watch for include:

  • Making excuses to cover up a loved one’s addictive behaviors (“He can’t come to work, he’s sick,” or “I’m just paying her bills so she won’t have to steal to support herself.”)
  • Putting the loved one’s needs before your own or before the needs of other family members
  • Continuing to help a loved one, even when they refuse assistance or become abusive
  • Feeling that your sense of self-worth relies on your loved one’s reactions or opinions
  • Feeling a sense of resentment against your loved one, even though you’ve insisted on helping them
codependent behaviors

One of the most important aspects of the recovery process — not just for the individual suffering from addiction, but for everyone in the home — is to learn the difference between empowering and enabling. Here are a few differences to keep in mind when you’re faced with a choice about how to help someone in recovery:

Enabling Is . . .

  • Making excuses for a loved one’s mistakes
  • Letting a loved one abuse you or someone else
  • Neglecting your own needs to help someone else
  • Allowing a loved one to skip out on therapy or recovery activities

Empowering Is . . .

  • Holding that person accountable for their choices and behavior
  • Refusing to accept anything but respectful treatment
  • Letting your loved one take care of their own needs
  • Attending therapy sessions or support groups with your loved one

Life after Rehab

What can a family expect when a relative or partner comes back from rehab? Although the recovery process may begin with treatment, it continues for months or years after rehab ends. The National Institute on Drug Abuse reminds us that while the symptoms of substance abuse can be treated and managed, addiction is a chronic brain disease that cannot be permanently “cured.” Like other chronic conditions, including heart disease, diabetes, or arthritis, addiction requires a significant change in lifestyle in order to prevent a recurrence of symptoms. Consistent application of the coping strategies learned in rehab, combined with the encouragement and compassion of a strong support system, is necessary to prevent relapse.

Rehab and Behavior

Partners, parents, and children may expect their loved one to be a new person after rehab, without the unpredictable moods or dysfunctional behaviors that they displayed before treatment. While a person in recovery may be more stable and have more coping tools at their disposal, it’s unrealistic to expect perfect behavior at all times. People in recovery may still display the following behaviors after rehab:

  • Mood swings
  • Emotional manipulation of family members
  • Depression
  • Cravings for drugs or alcohol
  • Anxiety
  • Difficulty coping with stress

Family members should be aware of the possibility that their loved one may be dealing with difficult emotions that were suppressed by drugs or alcohol. They may still experience the urge to drink or use drugs, or have trouble handling stressful situations. Patience and compassion are necessary to cope with these behaviors when they occur. At the same time, it should be clear to the individual in recovery that abusive behavior, manipulation, lying, and substance abuse will not be tolerated. Some therapists recommend that the individual in recovery sign a contract with the family to clarify boundaries and expectations once the individual is living at home again.

What to Expect from a Rehab Program

therapy Family members should never feel that they are all alone after rehab ends. To promote long-term abstinence and provide ongoing support, comprehensive recovery programs include a phase called “aftercare.” In aftercare, clients who have completed the initial stages of rehab can continue to participate in recovery activities and obtain support from their treatment team, even while they are staying in private residences or sober living homes. Families can participate in the aftercare process by continuing to attend therapy sessions, alumni weekends, or workshops with the person who has completed rehab.

Families should expect that a rehab program will provide referrals to resources in the community that can support the recovery process, such as 12-Step groups, spiritual centers, therapists, social workers, or healthcare providers who specialize in substance abuse treatment. These resources should be available not only for the person who has finished rehab but also for everyone in the household who needs and wants support.

Although there’s no known cure for the disease of addiction, there are services and resources available to manage this condition and provide sources of strength and healing. The list of resources below can help families who are seeking information or support when faced with the challenges of substance abuse.

General Resources for Families

Al-Anon Family Groups: Based on the 12-Step philosophy of recovery that originated with Alcoholics Anonymous, Al-Anon is a support program for the family members, partners, and concerned loved ones who have been affected by alcohol addiction. Their website offers lists of meetings, access to Al-Anon literature, and support services for newcomers as well as current members.
Family Systems Therapy: This is a comprehensive guide to the philosophy and concepts behind Family Systems Therapy, an approach that treats every member of the household as an essential part of the recovery process.

Family Therapy Can Help: For People in Recovery from Mental Illness or Addiction: Published by the Substance Abuse and Mental Health Services Administration, this guide for laypeople explains the goals and strategies of family therapy clearly and concisely.

National Council on Alcoholism and Drug Dependence (NCADD): NCADD has served as a public resource on substance abuse for over 70 years. The organization’s website provides educational materials, information, and access to support services for individuals and their loved ones.

National Institute on Alcohol Abuse and Alcoholism (NIAAA): A branch of the National Institutes for Health, this government agency conducts research and provides information about the effects of alcohol on human health, as well as resources for support and treatment for alcohol addiction.

Partnership for Drug-Free Kids: Support, guidance, and information about drug addiction are available through this organization, which has been advocating for families and teens affected by substance abuse for over 30 years.

Principles of Drug Addiction Treatment: A Research-Based Guide from the National Institute on Drug Abuse (NIDA): This online publication from the US government’s primary agency on substance abuse offers a wide range of resources and support services for individuals suffering from alcoholism or drug addiction.

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