1. Reconstructing Family Dynamics in Addiction Treatment
Presented by: Samuel Bierman and Cheryl caplan-zalis

2. The Importance of Family Involvement In Treatment
Unresolved family of origin issues and multi-generational themes often play a central role in the relapse process
Family beliefs of addiction and recovery are often distorted and education about the process can be life saving
The addictive process will overwhelm the healthiest of families and create co-dependency, maladaptive behaviors, and put the whole family system at risk.
Families normal position is to protect, defend, rescue their loved ones, which is counterintuitive in the recovery process.
The identified patient has a much greater chance at long term recovery if the whole family is in recovery.

3. What does family treatment look like across the country
No Family Involvement In Treatment
Family Education Programs
Comprehensive Family Involvement Programs
Unfortunately, an estimated less than 30% of treatment center’s have any family involvement in treatment or family programs.
Belief that the recovery process is solely the responsibility of the patient.
Sometimes due to low reimbursement for family work
Belief that getting the family involved is too difficult (HIPAA) or too much work for staff
Traditionally, weekend family education programs with the goal of educating families on the disease of addiction
Little to no process or actual family work with the patient
Majority of education programs are conducted by part time staff with little knowledge of the family system
Minimal family involvement besides the education program
Involve the family throughout the entire treatment stay and continuum
Educate, re-direct, inform, process, reconstruct the family system for the best desired outcomes
Family support groups, family process groups, alumni family buddies, family recovery process
Reconstructing family dynamics and roles from a dependent position to interdependent position

4. Examples of Best Practices of Treating Family Systems
Treatment centers that engage the family before the treatment process begins and works with the family throughout the entire stay
Separating the recovery process from the identified patient and the family members. Family members need to be on their own recovery process
Residential Family Restructuring (Caron Renaissance) – Actually inviting the family into treatment to witness family dynamics and reconstruct in real time
The family is the patient, and the patient is the family.
Family follow up after treatment episode ends

5. How Do We Reconstruct Family Dynamics?
Recovery for families often means going against one’s own instincts in order to allow the patient to experience the natural consequences of their own behavior
Boundary setting (financial support, emotional support)
Challenging dependent and enabling behavior and roles
Educating families that they did not cause addiction, but their actions and behaviors can create barriers to recovery
Re-defining roles in the family system, communication styles, boundaries.
Identifying strengths and competencies of families in order to help them confront the issues that serve as obstacles to the recovery process

6. Boundaries – Setting Boundaries means that I will respect and protect myself from inappropriate behavior
Guidelines
Definition of Boundaries
Format of Boundaries
The purpose of setting a boundary is to take care of yourself
Set limits that you are willing to follow through with
Do not set boundaries to manipulate
Lot of family members are fearful to set boundaries due to fear of abandonment. This is why the support of clinicians and the program is vital!
Something that sets a border or a limit
Sets a physical, emotional, intellectual, or spiritual space
Boundaries can be spoken/unspoken
Boundaries are a way to protect ourselves
Be specific
Be reasonable
Enforce them
Make them natural/logical

7. Vital Boundaries for Families
I will not allow you to physically or verbally abuse me or the family
I will not knowingly believe or support lies
I will not allow active addiction, addictive behaviors in my home
I will not rescue you from the consequences of your addiction or addictive behaviors
I will not finance your addiction or addictive behaviors
If you want to act crazy, that’s your business. You cannot do it in front of me. You must leave or I will walk away.
You can ruin your fun, your day, or your life – that is your business. I will not allow you to ruin my fun, my day, or my life

8. Enabling Vs. Empowering
Enabling – Doing for others what they CAN do for themselves
Empowering – Encouraging and guiding others so they have the power over their own decisions
Fix Problems
Protect from consequences
Carry and take on their feelings
Control the situation
Rescue
Don’t Listen
Doing it for them
Dependence
Caretaker
Showing empathy
Listening without reacting
Encourage
Share
Confront
Guiding
Support
Caregiver

9. What is the cause of families being over enmeshed and dependent in todays world?
Pain tolerance of our youth
NO MORE SKINNED KNEES
Failure to Launch
Average age children leave the home
Pressure’s to succeed and “keeping up with the Jones’s”
Instant gratification in the information and social media age
Depletion of tolerance and patience in waiting for results

10. What should the results look like?
The patient repeatedly experiences firm boundaries set by family, friends, peers, and the treatment team. The dissolution of rescue fantasies take form.
The family begins to experience their own strengths and weaknesses rather than those of their love one. The family becomes oriented to their own family system and internal regulators. This is painful, but anxiety reducing and sobering.
The family is now able to build a stable and functional self identity within the family system; which enhances feelings of positive regard, self worth, and genuine acceptance over the recovery process.
The entire family system is able to lift each other up, on their own recovery process and support each other throughout life without sacrificing each other’s sanity.

11. Question and Answers
Open Forum discussion