The Brain Story Certification: Module 16
Module 16: Addiction Treatment, Part A – FamilyBased Approaches
Excerpt from “Family Systems in Addiction Treatment”
Claudia Black, PhD
The Meadows Treatment Center
- Addiction also belongs to the family system, and not just the individual
- When we focus only on the individual with an addiction, without focusing on the family, we fail to target breaking the cycle of addiction.
- Medicating depression found in family members of an individual living with an active addiction does not do much to address the underlying issues.
- What are the family systems in each partner’s family of origin? This is relevant to explore the adverse childhood experiences that have occurred and reoccured throughout the family’s history.
- The family history is our training ground – what are the family of origin issues? What are the learned behaviours and internalized thoughts/feelings/beliefs?
- Consider the neurobiology throughout the generations.
- Many discussions focus on healthy parenting practices (think of Maslow’s hierarchy of needs + supportive parenting). What is often not discussed is the significance of healthy rituals. We need to examine what rituals are healthy – as they promote resiliency.
Excerpt from “Making the Case for Family Recovery in Addiction Treatment”
Ariella Goodwine Fisher, MFT
The Addictions Institute
- The addicted family is one in which the central organizing factor for the family is the addiction. It controls the family’s core beliefs, development, and behaviour.
- An addicted family system – the rules/roles/rituals/etc. all serve to protect the addiction within the family. It can include substance and process addictions.
- How the addiction becomes protected
- Parents become afraid to maintain rules – fear that these rules will be broken and then the reality of the issues that emerge will be faced. Parents internalize more and more, worrying and fearing the child spin out of control. There is a lack of boundaries.
- Parents cease socializing with parents of similarly aged children – feelings of shame.
- Parents increase marriage conflict – arguing about the addicted child.
- Beliefs around experimentation in teen years
- “They turned out fine” argument
- Hyperfocus on or neglect of other children in the home.
- How spouses sacrifice self:
- Creating a narrative that explains away the addiction (a justification or explanation)
- Spouse develops their own pathologies (emotional – such as anxiety – or alternative addictive behaviours) rather than confronting the reality of the addiction.
- Increased isolation
- Training others in the family to accommodate the addictive behaviours – walking on eggshells. Often carried out by the “non-offending” parent.
Excerpt from “Family Systems in Addiction Treatment”
Claudia Black, PhD
The Meadows Treatment Center
- Emotional abandonment
- Hiding a part of who you are to be acceptable or protect the self
- When we have to:
- Hide mistakes/vulnerabilities
- Your feelings
- Your needs
- Your accomplishments/success
- We often do to others what was done to us in childhood.
- Help people learn to honour and embrace themselves today. We can emotionally abandon ourselves through the learned behaviours.
- The inability to tolerate feelings without the need to medicate is a risk for addiction.
- When we cannot live up to the expectations of other’s unrealistic expectations.
- When someone is disappointed with you and attack your whole being/worth/value vs what you did or did not do.
- When others expect you to be an extension of themselves – fulfilling their dreams
- When others are unwilling to take responsibility for their feelings, thoughts, behaviours and expect you to take responsibility for them.
- Parent esteem solely derived through the child’s behaviour or accomplishments.
Excerpt from “Family Systems in Addiction Treatment”
Claudia Black, PhD
The Meadows Treatment Center
- Trauma repetition:
- Self-destructive behaviours that take place repeatedly and are rooted in something that took place in childhood that started with trauma
- Reliving a “story” from the past. It can be that people do not understand the stages of addiction – not seeing the addiction for what it is. Often goes with low self-esteem.
- Engagement in repeated abusive relationships
- Repetition of painful experiences – including specific behaviours, scenes, persons, and feelings.
- What are the common belief systems between members of the family?
Excerpt from “Making the Case for Family Recovery in Addiction Treatment”
Ariella Goodwine Fisher, MFT
The Addictions Institute
- What stops when the substance user ends their addiction,
- Abstinence is an event, recovery is a process. Abstinence is not recovery.
- Recovery is a developmental process, not a singular event and not a prescribed outcome. The changes needed for recovery take a long time and reworking of the family system. Meaning-making of the recovery takes longer to develop than the period provided through abstinence.
- Recovery does not have a predetermined or end goal that the client must achieve.
- The interaction creates constant and chronic tension in the family – the tension between members becomes the focus on individuals and families as a whole. Family roles break apart the enmeshment to become individuals for their own healthy development. The emerging anxiety is the treatment of a dysfunctional family system so that a new family system can emerge.
- Outside resources are valuable sources of help (such as 12-step programs and other community organizations). Reaching outside of the family system is essential.
- Beyond being willing to accept help outside of the family, there is a need for the family to recognize that they have lost control and that the status quo is no longer working. Increases willingness to accept help outside of the system.
- They strive for balance in the family is essential! Change disrupts balance even if it is unhealthy. It is also not uncommon for family members to revert to old ways to maintain the status quo. The system tries to sustain itself. We give space to the client while they navigate the holes within the dysfunctional family system so that they can transform the system.
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. Facing Addiction in
America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS,
November 2016. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf
- Evidence-based approaches include:
- Family Behaviour therapy (FBT)
- Multi-Systemic Therapy (MST)
- Multi-Dimensional Family Therapy (MDFT)
- Brief Strategic Family Therapy (BSFT)
- Functional Family Therapy (FFT)
- Behavioural Couples Therapy (BCT) includes a sobriety contract, communication skills