The Family’s Role Before, During and After Drug Rehab
“You’re overreacting and blowing things out of proportion. Don’t worry, I may drink or use drugs sometimes, or more than you’d like, but it is nothing I can’t handle. I’m not an addict. If it makes you feel better, I’ll cut back, OK?”
This statement, or any number of variations, is the kind of response family members often hear when they ask a loved one who misuses alcohol or drugs to cut back or get help. If this sounds familiar, family therapy can be helpful, and there are also some things it is useful to know about addiction to help guide you in supporting your loved one before, during and after drug rehab.
What the Family Can Do Before Rehab
Understand that addiction is a disease. Cutting back on alcohol or drug use may seem like a simple solution, but because addiction is a chronic brain disease, it can be daunting, if not impossible, without professional help. An addicted person may deny there is a problem (unfortunately, that is typical addictive behavior), and family members may accept the denial (which is co-dependent or enabling behavior). Sometimes the only way to break the cycle is to get the loved one into addiction treatment.
Recognize that addiction impacts the entire family system. Addiction can run in families. It is estimated that 50% of all children in the U.S. younger than 18 (35.6 million children) live in a household where a parent or other adult uses tobacco, alcohol or illicit drugs. When a member of the household has an addiction, other roles in the family can change. A parent may become codependent or enabling. A child may assume a more parental role and take on adult responsibilities, while another may act out or become disruptive, and so on. These altered roles lead to family dysfunction that will need to be addressed to support recovery and help the loved one maintain sobriety.
Be aware that addiction also occurs in families with no history of the disease. Addiction can be driven by other factors such as school or work environments, peer pressure and co-occurring mental health disorders. Awareness of possible contributing factors helps family members be more vigilant in watching for signs of trouble so they can take steps to initiate treatment. Understanding the contributing factors of addiction also can help a family come to terms with their loved one’s disease and guide them with more love and compassion.
Consider the best approaches to treatment and recovery. Part of the difficulty of dealing with a loved one who has an addiction is figuring out how (and when) to help them without causing further problems. Many people don’t realize that addicts do not have to “hit bottom” before they can get better, so there is no need to wait for that to happen before you step in. Recovery can begin at any point, and the earlier treatment starts, the better. The most important thing is getting your loved one into rehab. Staging an intervention is often the way families choose to do this.
Stage an intervention. Prior to the intervention, research addiction treatment programs and select a facility. Develop a plan for managing your loved one’s personal affairs while they are in treatment. Complete all admissions paperwork with the treatment facility (get insurance details worked out and confirm that a bed is reserved). Once rehab arrangements are in order and the program start date is set, you can pack your loved one’s clothes and toiletries, and stage the intervention.
Don’t stage an intervention without a strategy. Be ready to provide clear, detailed information on the rehab program you have selected and make sure all players are on the same page regarding the plan and the presentation. None of the participants should have a personal agenda that could cause conflict. Avoid using the intervention to air grievances or get into emotional conversations about the past. The goal is to get your loved one into professional treatment — be compassionate, and don’t muddy the waters.
Don’t negotiate with the addicted person during the intervention. Remember, the intervention is a measure taken when other measures have failed, and it is intended to avert impending catastrophe by getting your loved one into professional treatment as soon as possible. If you negotiate or give in to the addict’s bargaining for more time or alternative measures, you risk enabling them and leaving them vulnerable. Stand firm, while making it clear that you are acting with loving concern.
Consider hiring a professional interventionist who can help ensure that the intervention goes smoothly. Interventionists are trained to handle conflicts, bringing the focus back to a supportive and positive effort to guide the loved one into accepting the help they need. Using a certified intervention counselor can give you and your family a better chance of getting your loved one into drug rehab.
Many interventions are derailed by sloppy plans and delays. Too long a time gap between the intervention and the first day of treatment can lead to a plan falling apart. To ensure this doesn’t happen, it is a good idea to coordinate the intervention for the same day treatment starts or the day/night before.
What the Family Can Do During Rehab
Participate in family therapy during addiction treatment. Studies show that whether an addict stays in treatment or not depends on their level of engagement in the drug rehab program, their motivation to change and the degree of support they receive from family and friends. Family participation in treatment improves an addicted person’s chances for success. Parents who complete treatment programs that include family-based therapies have a 65% reduction rate of substance use post-treatment. Young adults whose treatment includes family therapy that focuses on family function and relationships have a 50% reduction rate in destructive behaviors and substance use post-treatment.
Many rehab centers offer family programs or family therapy. Family programs may use a range of counseling approaches and therapies to address how family function and dynamics impact addiction. Counseling helps addicts and their loved ones heal and minimize addiction triggers within the family system.
What the Family Can Do After Rehab
Learn more about recovery and embrace the aftercare plan. It is a misconception that once someone has completed addiction treatment they are cured. Maintaining sobriety after rehab requires continued work, care and support. Successful recovery, as outlined in an aftercare plan that an individual receives when they transition out of rehab, involves good self-care, ongoing counseling, sober support meetings and avoidance of triggers to use. The family should commit to the aftercare plan to support their loved one’s recovery. Family members should also make efforts to take good care of themselves and learn more about recovery. This can include attending Al-Anon meetings and therapy to understand their role in their loved one’s addiction.
Maintain a healthy home and firm boundaries. Family members need to make sure they are not doing things that enable the addicted person to return to negative behaviors without consequences. They must follow their aftercare plan and actively commit to their recovery. This involves relearning how to be responsible and live with healthy boundaries. Family members can establish healthy boundaries by responding to inappropriate requests for money or help by suggesting practical solutions instead. It is OK to help the recovering addict figure out how to solve problems that present stumbling blocks to getting back on their feet, such as finding a job, organizing transportation or dealing with difficult relationships that result in ongoing conflict and instability. Offering problem-solving support strengthens family connections and encourages the addict to face and solve their problems one step at a time instead of avoiding them.
Provide opportunities for sober activities and social involvement. Even if family dynamics have been tense or painful, it is possible to work through those issues and learn to interact in positive ways. Reconnecting with family members in new ways after rehab through fun, sober activities can help the family heal while also supporting recovery. As long as everyone is careful to avoid the people, places and things that might trigger the addict to want to use, family members can introduce their loved one to new people, invite them to social activities like sporting events or church functions, join them at sober support meetings or get involved in volunteering together in the community. Isolation is not good for sobriety, so getting the recovering addict out of the house and interacting with others to practice the positive social skills and coping tools they learned during rehab is useful.
Life in recovery is all about maintaining a healthy lifestyle, developing positive behaviors and having regular contact with a supportive network of sober family members and friends, and the family has an important role to play in facilitating all of this.
The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia: casacolumbia.org and centeronaddiction.org)
Principles of Drug Addiction Treatment: A Research-based Guide. NIH, National Institute on Drug Abuse (NIDA), 2012. https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/podat_1.pdf
Substance Abuse Treatment and Family Therapy: A Treatment Improvement Protocol (TIP) 39. SAMHSA.
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