MDFT is an outpatient treatment approach for teens, involving the whole family in counseling sessions. The practice has emerged during the last two decades and is the focus of federal research toward reducing teen drug abuse. One distinguishing factor of MDFT is acknowledging that teen drug abuse is influenced by several factors – friends, homelife, and community – and thus a multi-dimensional approach is needed to resolve the problem.

Another element that makes MDFT unique is that it is organized into phases, based upon knowledge of what is considered normal adolescent cognitive and emotional development. Providers do not progress to the next phase until the current phase has been successful, and should have knowledge of teen development.

Three distinct stages of MDFT are recognized: the first stage, or building a foundation; the second stage, called Work the Themes; and a third stage, called Seal the Changes and Exit. In addition to the stages of MDFT, five types of interventions can occur during treatment. These are one-on-one interactions with the teen, interventions with only the parents, or activities that modify the ways the teen and the parents interact. Sessions can involve additional members of the family, or work with the school or community-based entities that influence the teens’ drug behaviors.

Treatments can occur at home, at school or other community places. Themes may include helping parents deal with feelings of being powerless to provide influence to their teen, and ways to address conflict successfully.

During sessions where the teen works with the therapist without the family, themes like how to make decisions and talk about feelings are the focus. Ways to solve problems and reduce stress are also addressed, as are plans for acquitting career skills or training. Simultaneously, the parents learn about parenting styles that may be more effective at discouraging drug abuse – such as the difference between exerting guidance instead of just control.

A San Francisco-based study worked with 95 teens involved with drugs to explore the success rate of MDFT alongside therapy involving several families at once, and therapy involving several teens in a group setting. The teens’ drug use habits were assessed at the beginning of treatment and one year after, including their success at school and the way the family functioned. Teens and their families who took part in MDFT showed more improvements in behavior and school/family success than teens in the other treatment programs – and these positive changes continued beyond the treatment duration.

While a variety of approaches may be utilized to counteract teen drug abuse, the Center for Treatment Research on Adolescent Drug Abuse describes MDFT as successful because it pinpoints the highest risk factors connected with teen drug abuse. The treatment simultaneously improves the systems and processes that can generate successful teen development, both independently and within the family unit.
 

How Parental Alcoholism Impacts Children

Research shows that children of alcoholics are at greater risk for a range of problems: physical illness, emotional disturbances, behavioral problems, lower educational performance, and a susceptibility to develop alcoholism or other addictions later in life.

Genetics and Family Behavior

There is strong, scientific evidence that alcoholism runs in families. Children of alcoholics are at more risk of developing problems with alcohol and other drugs than children of non-alcoholic parents. In fact, many scientific studies, including twin studies of children of alcoholics, show that children of alcoholics (COAs) are four times as likely to become alcoholics themselves as children whose parents are not alcoholics. Thus, genetic factors play a major role in the development of alcoholism. But it isn’t an automatic sentence. Research also shows that more than half of children of alcoholics do not become alcoholics.

Not only is there a heritable basis for alcoholism running in families, but the children of alcoholics form their beliefs about drinking from perception of their parents’ drinking patterns – how much they drink and how often. It is no surprise, then, that COAs often emulate this drinking pattern when they begin to experiment with alcohol themselves.

Children first learn about alcohol by watching their parent drink. When drinking to excess becomes an everyday phenomenon, children perceive this is the norm. They begin to formulate their expectations about alcohol at a very early age. In other words, they see what alcohol does to their drinking parent or parents. They cannot, however, escape the influence, since it is all around them. This can be very damaging to children, especially younger children and adolescents.

Factors that Make Parental Alcoholism Worse for Children

According to research from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (http://pubs.niaaa.nih.gov/publications/FamilyHistory/famhist.htm), a person’s risk increases if he or she comes from a family where:

• Both parents abuse alcohol and other drugs
• An alcoholic parent is depressed or has other psychological problems
• Parents’ alcohol abuse is severe
• Family conflicts lead to aggression and violence

Co-Dependency

Family members – children and spouses – of an alcoholic frequently become co-dependent. That is, they are addicted to another person’s alcoholic behavior.

Sometimes, the alcoholic (parent or spouse) will discontinue drinking for a short period of time. This leads the COAs and spouse into a falls sense of security. They believe that everything’s okay, the problem is solved. It isn’t.

Children of alcoholics often feel responsible for the problems of the alcoholic, believing, wrongly, that they somehow created the problem. They internalize these feelings, ultimately suffering tremendous guilt, shame, and sense of helplessness and hopelessness. They may try to hide the evidence of their parent’s alcoholism, or make excuses to others for parental absence at functions, lie to friends, school, employer or others about the parent.

They may either serve the alcoholic parent drinks or try to get rid of the stash of alcohol. Both are attempts to stave off the problems that may ensue from an alcoholic parent getting out of control, erupting into violence – or to just keep the family together.

This is co-dependency. The co-dependent children and spouse of an alcoholic soon forget about their own needs and desires. They’re too busy looking out for or covering up the problems of the alcoholic family member. They may attempt to cure or control the drinker – to no avail.

COAs learn how to tiptoe around their alcoholic parent. Fearing reprisals, they try hard to please the parent in a never-ending and fruitless attempt to get the parent to stop drinking. By denying the problem exists (parental alcoholism), the COAs and spouses enable the alcoholic to continue his or her drinking and not face up to the troubles such drinking causes.

Drinking During Pregnancy

Studies have shown that the rate of drinking during pregnancy seems to be increasing – despite the known dangers to the fetus from such exposure to the effects of alcohol. Even moderate alcohol consumption during pregnancy affects the developing fetus. The mother who drinks may not be an alcoholic, but her fetus cannot escape the effects of the alcohol.

Approximately 6 percent of women who drink during pregnancy bear children who have Fetal Alcohol Syndrome (FAS). For those siblings born to a mother who drinks subsequent to the birth of an FAS infant, there is an almost 70 percent chance that those offspring will also have FAS.

The more severe the mother’s drinking during pregnancy, the more severe the FAS in the child. According to Drinking and Your Pregnancy, from the NIAAA (http://pubs.niaaa.nih.gov/publications/DrinkingPregnancy_HTML/pregnancy.htm), FAS children tend to:

• Weigh less and be smaller at birth than non-FAS infants
• Have problems eating and sleeping
• Have problems seeing and hearing
• Have trouble following directions and learning how to do simple things
• Have trouble paying attention and learning in school
• Need special teachers and schools
• Have trouble getting along with others and difficulty controlling their behavior
• Need medical care all their lives

Severe FAS children may exhibit facial deformities, mental retardation, slow growth, and persistent behavioral difficulties. Secondary effects of FAS among adolescents and adults include mental health problems, school disruptions (getting suspended or expelled from school or dropping out), getting in trouble with the law, having problems securing or maintaining employment, and dependent living as an adult.

Crime and Violence

Incest and battering are common in alcoholic families. An estimated 30 percent of father-daughter incest cases and 75 percent of domestic violence cases involve a family member who is an alcoholic. COAs are more likely to become targets of family abuse and/or to witness family violence at the hands of an alcoholic parent.

What often happens is that the victims of such violence and abuse shoulder the blame for what has happened to them. They often turn to alcohol themselves as a way out of the pain of guilt, shame and helplessness they feel. Their childhood has been ripped from them, and they are robbed of normal childhood experiences. How can this not negatively impact COAs?

How it all plays out has a lot to do with whether or not they receive treatment while they are still children. COAs, if not treated when they are young, will carry their problems with them into later life.

Alcoholism is a key factor in 68 percent of manslaughters, 62 percent of assaults, 54 percent of murders and attempted murders, 48 percent of robberies, and 44 percent of burglaries.

Young and Adolescent COAs

Living with alcoholic parents is particularly devastating on young children. Youngsters often show symptoms of depression and anxiety such as being afraid to go to school, bed-wetting, having nightmares, crying, and not having friends.

When they’re a little older, adolescent COAs may stay in their rooms for extended periods of time, become secretive, and have difficulty relating to other children or say that they have no one to talk to. Teen COAs may begin to show depressive symptoms such as perfectionism, hoarding, isolation, and becoming extremely self-conscious. Some teen COAs may start to develop phobias.

Inpatient admission rates for COAs are triple that of other children. Inpatient admission rates for COAs with mental disorders are almost double that of other children. Studies show that total healthcare costs for COAs is 32 percent greater than for children from non-alcoholic families.

Other problems that COAs experience:

• Lower cognitive and verbal skills – Tests of COAs show a lowered cognitive ability and poor verbal skills. They may find their ability to express themselves is impaired, which can, in turn, affect school performance, peer relationships, the ability to develop and sustain intimate relationships, and hinder their performance at job interviews. This does not imply that COAs lack intellectual ability – just that their ability to express themselves suffers.

• Difficulties in school – COAs are more likely to be truant, to drop out of school, repeat grades, or be referred to the school counselor or psychologist. This may not be due to intellectual ability, but may be more because of performance-related anxiety, difficulty bonding with teachers and peers, fear of failure, or other reasons yet to be determined. More research is needed in this area. What is known is that COAs often feel they will be a failure – even if they do well in school. Raised in an environment lacking stimulation, and with alcoholic parents, who may themselves have poor cognitive or verbal skills, affects COAs in measurable and predictable ways. For example, pre-school COAs exhibit poorer reasoning and language skills than non-COA children. Poorer quality of stimulation at home predicts poorer performance among COAs versus non-COAs. Later on, COAs have difficulty with abstract concepts, and may require specific instructions and concrete explanations.

Adult COAs

When they mature, adult COAs often fail to relate their problems to their growing up with alcoholic parents. Many adult COAs have problems with aggression, depression, and impulsive behavior.

Studies show adult COAs often abuse psychoactive substances, in addition to or independent of alcohol. They’re also likely to have difficulty establishing healthy relationships with others. They have problems with intimacy. Since they don’t trust others, they fear if they try showing love to another, they will be hurt just as their alcoholic parent hurt them as a child.

COAs frequently fail at being parents, having poor role models to emulate. Career decisions are often poorly made. Nearly all adult COAs have a negative self-image and describe feeling worthless and a failure. Almost one-third of any sample of alcoholics has at least one parent who is an alcoholic. Children of alcoholics are also more likely to marry into families with alcoholism than children of non-alcoholics.

How to Help Young COAs

Adults – other than the alcoholic parent – can help young COAs by efforts to:

• Help the children develop autonomy and independence
• Develop a close bond with a care-giver
• Successfully cope with potentially hazardous or devastating emotional experiences
• Develop coping strategies for day-to-day living
• Engage in acts to help others
• Develop strong social skills and social orientation
• Perceive their experiences constructively – even if those experiences have caused them pain or suffering – so that they can gain positive attention from other people early in their lives

There is hope for COAs in families with parental alcoholism, if:

• Family rituals and traditions (such as holidays, vacations, or mealtimes) are maintained and highly valued
• The alcoholic parent is confronted with his or her problem
• There are consistent and significant others in the life of the child or children
• There is moderate to high religious observance

If these conditions exist, the COAs may be protected from many of the consequences of parental alcoholism.

Advice for Children of Alcoholics

Just because the parents drink to excess doesn’t mean the children of alcoholics need to grow up to become abusers of alcohol and drugs themselves. It only means the risk is greater. But there are things that COAs can do to minimize the risk.

• Avoid underage drinking – Research shows that the earlier a child begins to drink, the more likely they are to become an alcoholic or to abuse other substances as an adult. Drinking that starts before the age of 14 puts children at higher risk of becoming alcoholics – both due to genetics and environmental factors. And, underage drinking is also illegal.

• Talk to a health professional – Children whose parents drink to excess should seek help from a health professional. This can start at school by talking with a school counselor or nurse, the family doctor, or member of the clergy. These people can recommend groups or organizations to help children avoid problems with alcohol. Adult COAs who have already begun to drink can use the assistance of a health professional to assess their drinking patterns and determine if they need to cut back and, if so, get help on how to do so.

• Adult COAs should drink moderately, if at all – Guidelines from the U.S. Department of Health and Human Services and the U.S. Department of Agriculture suggest that moderate drinking for an adult should be no more than 2 drinks per day for men and 1 drink per day for women. This is true whether or not the parents were alcoholics. Naturally, there are some people who should not drink at all. These include pregnant women, alcoholics in recovery, people who take certain medications or have certain medical conditions, and people who plan to drive or engage in activities requiring attention or skill. Adult COAs, if they plan on drinking moderately, should pay careful attention to alcohol consumption. It may be harder for them to moderate their drinking, and they can easily pass from a casual drinker to a heavy drinker or even a hard-core alcoholic. As drinking increases, so does the risk of alcohol-related social problems such as violence and trauma, and drinking and driving, and medical problems associated with alcohol, including liver disease, brain damage, and cancer.

Alateen, Al-Anon and Alcoholics Anonymous

Children of alcoholics can get help by attending meetings of an organization known as Alateen, which, along with Al-Anon for the spouses and other affected family members of alcoholics, is affiliated with Alcoholics Anonymous (the organization for persons dependent upon or addicted to alcohol and other substances). The fact is that children and spouses of an alcoholic require treatment just as much as the alcoholic. Alateen and Al-Anon are the two most successful organizations for helping children and spouses of alcoholics. They are based on the 12-step A.A. principles. Their goal is to help family members understand that they are not responsible for the alcohol dependency of another family member. Their own recovery does not depend on the alcoholic getting better.

A school counselor, nurse, or nurse practitioner can give support and information to COAs on how to find Alateen meetings.

Fork in the Road

In the end, children of alcoholics have a rough road to travel. On the one hand, they may have a solid support system independent of the family and avail themselves of help to overcome the myriad problems of family alcoholism. On the other, they may lack either the will or the necessary ongoing support to lift themselves out of the misery of their childhood environment and parental alcoholism.

Caring adults and friends can help by encouraging COAs to seek professional counseling or to attend Al-Anon or Alateen (or Alcoholics Anonymous, if the COAs have become dependent on alcohol themselves). While the damage that’s already done may be substantial, there is always hope. But COAs, just as alcoholics, can’t do it on their own. The baggage that goes along with alcoholism in the family is just too great a burden for an individual to overcome without constant encouragement and support.

COAs each come to a fork in the road, albeit at different times and for different reasons. At some point, each child of an alcoholic has the opportunity to make an important decision: Repeat the pattern of parental alcoholism or fight to be free.

While the diagnosis of a personality disorder is usually reserved for individuals in late adolescence and adulthood, early family experiences are often addressed in treatment in order to correct current dysfunctional behavior, distorted thinking and perception and distressful emotion caused by these disorders. Treatment is considered to be a long-term endeavor.

To illustrate the nature of personality disorders, their characteristics and their pervasive dysfunction in relationships, the Antisocial Personality Disorder is used here as an example. This disorder is one in which there is a pattern of disregard for and violation of the rights of others. Some of the diagnostic criteria for Antisocial Personality Disorder are:

• failure to conform to social norms

• unlawful behavior

• deceitfulness, lying, use of aliases or conning others

• impulsivity– acting without consideration of consequences

• aggression

• disregard for safety of self and others

• failure to honor one’s responsibilities and obligations

• lack of remorse

These criteria clearly describe dysfunctional ways of behaving in relationship to others. To further illustrate how relationship issues are related to personality disorders, there is strong evidence that individuals who have had erratic, abusive or neglectful parents are vulnerable to developing this disorder. Also, the treatment for individuals with this disorder (and other personality disorders) attempts to correct one’s relationship to others. For example, treatment of Antisocial Personality Disorder often seeks to repair some of the missing moral development of early life such as the experience of having empathy for others.

Antisocial Personality Disorder is just one example of personality diagnoses that address the dysfunctional styles of behaving and coping within relationship to others. Other personality disorders are listed here along with a brief description of relationship problems found in each:

• Borderline Personality Disorder– relationships are governed by fear of abandonment by others

• Histrionic Personality Disorder– there is an intense need for the attention of others and relationships are thought to be more intimate than they really are

• Narcissistic Personality Disorder– there is a belief that one is more special and more entitled than others

• Avoidant Personality Disorder—there is avoidance of interpersonal contact and fear of being disliked

• Dependent Personality Disorder– there is an excessive reliance upon others

• Obsessive-Compulsive Personality Disorder– there is rigidity that interferes with relationships

• Paranoid Personality Disorder—there is a belief that others cannot be trusted

• Schizoid Personality Disorder– there is no enjoyment or desire for close relationships

• Schizotypal Personality Disorder– there is acute discomfort in relationships and an inability to maintain them

All of these personality disorders describe distorted interpersonal boundaries and a distortion in the ability to be appropriately intimate with others. Relationships in families of substance use and addiction can display many of the characteristics of all of these personality disorders and are traditionally thought of as causing intimacy problems for individuals who grow up in these sorts of families. In particular, codependent traits and behaviors have become identified as especially prominent in such families and while codependency is not identified as a formal diagnosis of personality, it does speak of specific dysfunctional personality characteristics, behavior and coping that are enduring and patterned as are those in personality disorders.

Codependency became an issue of concern in substance treatment long before the term was coined. An earlier concept, co-alcoholism, embodied the many traits, characteristics, behaviors and dynamics of codependency, but was used specifically to describe relationships involving alcohol. Co-alcoholics were considered to be family members of alcoholics — primarily spouses — who were impacted by the alcoholism of their loved one in dysfunctional ways. Co-alcoholic and enabler were used interchangeably to describe a person who took on the responsibilities of the alcoholic and made amends and/or accommodations for the alcoholic’s behavior. Denial of the alcoholism was seen as a core characteristic of co-alcoholics and enablers. The behavior of co-alcoholics was also seen as contributing to the progression of the disease of alcoholism.

Treatment of alcoholism grew to include family members in hopes of intervening in co-alcoholic behavior and thus improving the chances of alcoholics maintaining recovery. Addressing family system dynamics was considered to be essential in the recovery efforts of substance dependent individuals and continue to be today. In the 1980s, the adult child and codependency self-help movements– particularly among 12 Step groups– further defined and popularized these concepts.

There is a significant body of literature about relationships and family dynamics that involve substance use. Some early authors who have addressed these issues are:

• Melody Beattie, Codependent No More and Beyond Codependency

• Claudia Black, It Will Never Happen to Me and It’s Never Too Late to Have a Happy Childhood

• John Bradshaw, Healing the Shame That Binds You; Homecoming: Reclaiming and Championing Your Inner Child; Family Secrets: the Path to Self-Acceptance and Reunion

• Pia Melody, Facing Codependence; Breaking Free and Facing Love Addiction

Such literature has helped define in depth the difficulties and dynamics of codependency as well as the process of recovering from such relationship dysfunction. Further, such works have identified codependency as usually beginning in childhood in one’s family of origin and to be characterized by behavior in relationships as well as by certain types of thoughts, feelings and perceptions of one’s self in relationship to others. Some of the hallmarks of codependency are:

• Behavior of codependency

o attempts to control others

o attempts to please others

o assuming responsibility for others

Such behaviors are common in relationships of addiction and are classic examples of the behavior seen in the family members of addicts and alcoholics. These behaviors are typically used to lessen the impact of the loved one’s addiction.

• Emotions of codependency

o anxiety

o depression

o sadness

o numbness

o anger

o self-loathing

o guilt

o shame

The emotions of codependence are direct results of living with another’s addiction and attempting to solve the problems surrounding the addiction as well attempting to solve the problems of the addict.

• Beliefs of codependency

o self-worth depends upon a relationship

o good feelings depend upon others’ approval

o self-esteem depends upon solving others’ problems

o well-being depends upon the status of the relationship

Such beliefs underlie the behaviors and feelings of codependency. Another person is the focus and good feelings about the self are derived solely from the relationship. Co-dependency is based upon an inherent “no-win” situation because codependents involve themselves with dysfunctional people who “need” “to be fixed”.

There are several ways that codependency can be manifested within relationships. Some of these are:

• clinging

• panicking

• becoming submissive

These characteristics are typically caused by anxiety and fear of loss and abandonment. These are individuals that we typically call “people pleasers” who seek approval and act from a motivation to be liked. The threat of losing their relationship causes these types of codependents to lose themselves as they seek to understand and demonstrate what the other person wants. Their chief motivation is to avoid abandonment.

Other codependents are more concerned with a fear of losing control. This is manifested in relationships by:

• being demanding

• being manipulative

• using emotional blackmail

• creating turmoil, chaos and drama

Still other codependents live their lives through others by:

• making personal sacrifices

• being focused on the well-being of another while disregarding one’s own well-being

• being focused on the goals of another while dismissing one’s own

• being focused on the thoughts and feelings of another while dismissing one’s

Codependents display a variety of behaviors that can, at various times, include a unique mix of the many types listed here. The common theme is, however, a focus upon accommodating and maintaining a relationship with someone who is impaired. Traditionally, codependency has been in relationship to an individual with a substance disorder, however, these characteristics can be found in relationship to people with other dysfunction such as mental illness and criminal behavior. Typically, codependents have learned these behaviors as children and continue them throughout adulthood to some degree in all their relationships. For this reason, codependents, like individuals who have personality disorders, display fixed patterns of coping and interaction within relationships. Along with their behaviors there are also fixed beliefs about self, others and the world that create poor coping and distress in daily life.

Self-help groups such as Codependents Anonymous use the 12 Steps of Alcoholics Anonymous to address codependency and recovery. The first step of Codependents Anonymous is the only step of the 12 which differs from the original 12 Steps used in Alcoholics Anonymous. The first step of Alcoholics Anonymous says:

We admitted we were powerless over alcohol and that our lives had become unmanageable.

In contrast, the first step of Codependence Anonymous states:

We admitted we were powerless over others and that our lives had become unmanageable.

Codependents Anonymous suggests several points to consider when determining if one has codependency. Among these are:

• patterns of denial that cause difficulty in identifying feelings

• patterns of low self-esteem that cause difficulty in making decisions, getting one’s needs met and perceiving oneself as lovable or worthwhile

• patterns of compliance that honor others’ opinions, feelings, desires and wishes, while dismissing one’s own

• patterns of control in which one behaves to be needed, approved of, care for others and control others

As in the diagnoses of personality disorders, these patterns of codependency are considered to be chronic and fixed patterns of behavior and coping. Recovery implies the need to change behavior and coping strategies in relationships. Codependents Anonymous offers a definition of codependency recovery in its preamble stating:

Co-Dependents Anonymous is a fellowship of men and women whose common purpose is to develop healthy relationships…share with each other in a journey of self-discovery — learning to love the self.

Recovery pursuits for the codependent involve becoming aware of one’s own feelings, values and beliefs; improving interpersonal boundaries in which one’s own needs and wishes are honored; tolerating true intimacy; developing assertiveness and improving self-care. Self-help groups are valuable recovery resources for codependency and many find that psychotherapy and counseling are as well. Often therapy will address current issues, along with problems from earlier stages of life such as those in one’s family of origin where codependent beliefs and behaviors were learned. In many ways, treatment for codependency is similar to treatment for formal personality disorders in which dysfunctional beliefs and perceptions must be replaced with more appropriate ones.

Active participation in a substance treatment program can also be a time of increased danger for victims of addicted partners who become more volatile when sober. When a batterer leaves substance treatment prematurely the risk of domestic violence can be significantly increased and more dangerous. Addicted batterers who have not completed treatment are unstable due to withdrawal symptoms. They are more sensitive to stress and more likely to act out.

Some partners of addicted batterers find themselves in a no-win situation when the batterer stays in treatment. Since programs encourage family participation, the risk of “upsetting” the batterer in therapy perpetuates the domestic violence cycle. Batterers blame their victims for the violence and victims often assume responsibility for it. Domestic violence is not treated in couple’s therapy for this reason. Another reason domestic violence is not treated in couple’s therapy is that the therapy sessions themselves become justifications for later episodes of battering. For example, some programs encourage partners to openly discuss the negative impact of substance use and to confront inappropriate behavior and denial. Such “appropriate” participation in the family portion of substance treatment programs can endanger the physical safety of the addicted batterer’s partner.

Families of domestic violence should fully inform the staff of substance treatment programs about their history of violence since substance treatment and early return to family life can be times of high and serious risk. Families should also ask treatment programs to individualize services in order to honor safety needs. While substance recovery is a primary need, it is dangerous to defer safety issues since risks can significantly increase in early treatment and early abstinence. Partners should also pursue domestic violence services while the addicted batterer is in treatment and newly sober to create a plan for safety in managing substance treatment or for exiting the relationship.

Intensive Family Recovery Programs

If at all possible, enroll in an intensive family recovery program well before the addict completes treatment and returns home. This will give family members adequate time to process the information and do what’s necessary to make the household ready for the recovering addict. Intensive family recovery programs are available in different blocks, everything from week-end seminars to 10-day residential programs. The best treatment centers offer comprehensive family therapy programs while your loved one is in treatment. If you live locally, they may also offer ongoing family support groups.

Why attend an intensive family recovery program? Simply put, attendees are free of the distractions of the outside world, of schedules and work and pastimes. They are able to devote the time necessary to learn about addiction and how they can help the returning addict by changing some of their own unhealthy behaviors.

What Happens in Family Recovery

During family recovery programs, which are intended exclusively for family, friends and close partners of an addict, attendees receive counseling, undergo education, learn new skills and form lasting relationships in a safe and supportive environment.

While style and philosophy vary from one family recovery program to another, here are some key elements:

• One-on-one and group counseling – Counseling sessions are held with family members on a one-on-one basis as well as group counseling.

• Learning about co-dependency – In essence, co-dependency is a set of unhealthy behaviors that anyone involved with an addict can have. While they are not themselves addicts, other family members nevertheless may have developed a set of coping behaviors that, in effect, enable the addict to continue using. A key element of family recovery involves understanding what these co-dependent behaviors are and learning how to substitute healthy behaviors for them.

• Understanding addiction – Someone who is not addicted often has a tough time understanding what causes addiction in another. They may feel it is a character defect, or something that a person should be able to snap out of. They may display anger, shame, disgust or pity toward the addict – none of which are helpful. In fact, without treatment, family members can actually contribute to the recovering addict’s relapse shortly upon return home. Learning about addiction is a critical part of the family recovery program and one which is best accomplished in a structured treatment program.

• Recognizing unhealthy habits and building healthy ones – It’s hard, sometimes, for people to see that the things they’ve been doing and saying are counter-productive to engage in around a recovering addict. In family recovery programs, attendees learn, through interaction with professional counselors, how to identify unhealthy habits and build new ones. These negative behaviors, which so damage recovering addicts, are replaced with healthy ones that are both nourishing and supportive of the family member in recovery. Part of this is learning about triggers, the situations that cause an addict to relapse. Some triggers are caused by unhealthy behaviors that family members need to change.

• Building an ongoing support network – Parents, siblings, spouses or significant others and close friends need others they can turn to in moments of uncertainty or crisis. Just because they receive family treatment doesn’t mean that is the end of the road when it comes to help. Not only do attendees learn a great deal in the family recovery program, they also meet others in the same situation. A big advantage of intensive programs, especially, is the opportunity to interact with these individuals in a safe and supportive environment, and to fashion relationships – even friendships – with them that can sustain them over the long term.

• Peer interaction activities – Many family recovery programs include barbecues or picnics or other group activities designed to allow for interaction and sharing of experiences with others who have a recovering addict in the family. During periods of relaxation, attendees have the opportunity to realize the common bond they share with other members of the group.

• Introduction to 12-step meetings – Either as part of the intensive or family recovery program, attendees are introduced at least to the concept of the 12-step support group meetings designed for co-dependents and/or family and friends of recovering addicts. Such groups include:

o Al-Anon/Alateen (For child, parent, spouse or friend who has been affected by someone else’s drinking) – 1-888-4AL-ANON

o Co-Anon (Cocaine addicts’ family groups) – 1-800-898-9985

o Co-Dependents Anonymous (CODA) – 1-323-969-4995

o Co-Dependents of Sex Addicts (COSA) – 1-763-537-6904

o Gam-Anon (For those involved with compulsive gamblers) – 1-818-377-5144 (L.A. Hotline), 1-718-352-1671

o Nar-Anon (For relatives and friends who are concerned about the addiction of another) – 1-310-547-5800 (Southern California), 1-800-477-6291

o S-Anon (for those who have been affected by someone else’s sexual behavior) – 1-818-973-2235 (L.A.), 1-800-210-8141

o Adult Children of Alcoholics (ACA) – 1-310-534-1815

What to Do After Family Recovery

Following completion of family recovery, make it a practice to do as many of the following as possible:

• Attend 12-step meetings. – Attend as many 12-step meetings as you can each week. Go with an open heart and open mind, and be ready to follow the newcomer suggestions – when you are comfortable doing so. These include getting a sponsor or mentor, reading available literature, and seeking your own spiritual counseling according to your preferences.

• Apply 12-Step principles. – Apply the principles of the 12 steps in the organization you have joined (12-step meetings for friends/family members of addicts). Recognize that the only person you can change is yourself – and that is a significant accomplishment, especially when learning how to be supportive of the recovering friend/family member who is an addict.

• Recognize your own role. – Think about your own role in the relationship with the recovering addict. See how your reactions can be modified to better foster healthier behaviors on your part.

• No enabling. – Resolve never to enable the addict to use – no matter what pleas, exhortations or threats you may hear. Understand that the addict in recovery may be tempted to relapse – and your refusal to enable such behavior may make a profound difference. Regardless, you cannot help the recovering addict by giving into his or her pain. They must experience the pain themselves and work through it in recovery, using the techniques and strategies learned during treatment.

• Ensure a clean home. – This recommendation is one that every family should go through prior to the recovering addict’s return home. But it is also one that should be an ongoing practice. This isn’t to say that you’re snooping, but you do need to ensure that there’s nothing in the house that facilitates using or compromises the recovering addict’s resolve to remain sober. No drugs or alcohol, no paraphernalia, etc.

• The importance of sharing. – Share experiences and talk about problems you encounter with others during 12-step meetings. Through such interactions, you may find the comfort, support and helpful advice that may steer you through tough times. It always helps to have an understanding ear from someone who knows what you’re going through – since they’ve been there themselves.

• Set aside time for reflection and meditation each day. – Every member of the recovering addict’s family and close friends should pay attention to their own personal development (spiritual as well as physical and emotional), reduction of stress, practice of health behaviors and discipline to do what’s necessary. Read from a book of meditation, do yoga, deep breathing, visualization, and admiring nature – do whatever gets you outside yourself and into a reflective mode. At day’s end, give thanks for the blessings you have received during the day and ask for any help you need in dealing with a situation involving your relationship with the recovering addict. These actions will help you enhance your own recovery.

• Keep an active social life. – Being in recovery as a family member means that you need contact with the outside world. Everything cannot be solely about the relationship with the addict. You need to go out and enjoy friendships, attend social and recreational events, laugh and have fun. This will improve your overall mental outlook, refresh and rejuvenate you – benefiting everyone in the family.

• Offer encouragement. – Encourage the recovering addict to continue attending 12-step meetings and be supportive of his or her efforts to heal. Do not be jealous of the time they need to spend doing these things, as it will work against the recovery process.

• Time is required. – Recognize that the recovering addict needs time to fully embrace sobriety from whichever addiction he or she has. Even if there are small – or major – setbacks, be ready with encouragement and support for the recovering addict to get back on the road to recovery.

• Give yourself kudos. – It’s hard work being in family recovery. You’ve put in a lot of time and hard work. Take a moment to acknowledge your own efforts in the recovery process. This time of self-recognition is important so that you don’t find yourself feeling underappreciated or self-sacrificing. Remind yourself that you are doing this out of love.

• Practice changing negatives to positives. – You can’t stop negative thoughts from popping into your mind, especially in reaction to something upsetting such as a behavior or comment by the recovering addict. What you can do, and what you should practice, is changing those negative thoughts into something more positive. For example, if you feel that things aren’t changing fast enough with respect to the recovering addict’s being able to function according to how you think he or she should, change that thought to one that acknowledges that recovery takes time and that you will give it the time it needs. Of course, you can’t always immediately figure out how to see the positive in a negative. That’s okay, too. Give yourself some leeway here. Just try to keep the negatives out of your verbalized comments or your body language. If you don’t feel comfortable saying something, leave the room until you can speak in a more positive tone. Remember that it’s difficult for you to change the way you view things at times. Give it time and keep practicing.

• Take care of yourself. – You need to pay attention to your own physical health and well-being before you can attend to that of others, including the recovering addict. Take care of any outstanding health issues you may have, get regular physical examinations, rest, and relax so that you are in the best physical and mental health you can be. By taking care of yourself, you will be in a better position and frame of mind to offer encouragement and support to the family member or close friend who’s in recovery.

Family Therapy Benefits Everyone

In the final analysis, family therapy benefits everyone concerned. You want the best for the recovering addict and one way to facilitate that is to be as prepared as you can once he or she returns home and is reunited with the family. You should be prepared to take the time to go into family therapy so that you have the skills and the knowledge to know what to do and how to handle situations as they arise. You can’t presume to know how to do this yourself. That’s the purpose of family therapy.

Give yourself, your recovering loved one, and the rest of the family the most hopeful scenario by going into family therapy. Of all the things that you can do for your loved one, this is perhaps the most important after being fully supportive of his or her recovery.