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Traditionally, the family component of addiction treatment centres around concepts of “co-dependence” and “boundaries” with a heavy emphasis on teaching family members to identify and avoid “enabling” behaviours. The underlying premise is that one person in the family has a problem, and that problem is causing problems for everyone else. Families are usually treated separately from the person with the substance use disorder, and it is not uncommon to hear “the family shouldn’t be involved” or “the client isn’t ready to deal with family work.” This presentation will o er an alternative framework that: contextualises addiction as a problem that a ects the family as a whole, challenges blame, cultivates collective problem-solving and emphasizes a relational paradigm. Such an approach o ers an opportunity for families to be involved in recovery at any stage of individual treatment, and builds on family strengths to support individual (and family) recovery in a unique way.

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  1. 1. Families and Substance Use Disorder A Relational Paradigm in Addiction Treatment Rachel Russell, M.A., Chief Clinical Officer, Freedom Institute Presented to: ICAAD London May 2018
  2. 2. Agenda 1. Introduction & Context 2. Overview of Programming 3. Approaches to Family Work 4. Relational/Systemic Thinking 5. Case Example 6. Results 7. Q & A
  3. 3. Freedom Institute ● 40+ years in New York City ● Not-for-profit, independently run ● Educated, outwardly successful clientele ● Clinical Team all have advanced degrees ● Variety of theoretical approaches
  4. 4. Freedom Institute Treatment Offerings specific to Substance Use Disorder Intensive Outpatient Program Abstinence DBT modality Minimum 8 weeks Random drug testing 10 hours/week Sober Support Group Ambivalence Motivational Interviewing 10-week commitment Recovery Groups Early Recovery (< 3 mos.) Advanced Recovery (3 mos. to 1 yr.) Extended Recovery (> 1 yr.) Psychodrama DBT Groups
  5. 5. Freedom Institute Other Offerings Care Coordination Interventions Assessments Treatment Planning Referrals Family Services Family Therapy Couples’ Therapy Parent Group Significant Other Group Multi-Family Groups Hallways School-Based Prevention Social-Emotional Wellness Prevention of Substance Use & Other High-Risk Behaviors
  6. 6. Family Programs in Traditional SUD Treatment Not even considered “Toxic” “Must let go” Individual Treatment Family Treatment Individual Treatmen t Family Treatmen t Education focus “Codependent” Individual has to be “ready”
  7. 7. Spectrum of Family Responses Ignore Deny Focus Obsess
  8. 8. Family Programming at Freedom Institute Individual Treatment Family Treatment
  9. 9. Architects of Freedom Institute’s Family Programming Ackerman Institute ▪ Since 1950’s ▪ Nathan Ackerman ▪ Relational/systemic model ▪ Elements from Bowen, Minuchin, Milan, Satir, etc. ▪ 3+ years of post-grad training
  10. 10. Family Integration into Treatment ▪ Family Therapists distinct from Individual Therapists ▫ Entire family usually included ▪ Joint Assessments ▫ Young Adults required ▪ Family Session in IOP Package ▪ Multi-Family Group
  11. 11. Family Work throughout the Treatment Process Assessment Initial Treatment (first 2-3 mos.) Ongoing Treatment (until 1 year)
  12. 12. Mid-Afternoon Slump Prevention Questions or comments so far?
  13. 13. Systemic/Relational Approach Restore the “We” Expand Competence
  14. 14. A? 24 1922 Opiates Smith Family
  15. 15. Traditional view of an addict within a family
  16. 16. A A? A ? A Orphan Depression Sober Suicide O.D.
  17. 17. Common Scenarios “Fix my [child]” “Over-anxious” mother Distant/”nonchalant” father Rageful parent Resentful siblings “Perfect” siblings Substance abusing parent Parent with undiagnosed mental health issues Adoption Divorced parents, with animosity
  18. 18. Relational Techniques ● Be transparent ● Collaborate, recognize family expertise ● Go up a generation ● Reframe/track/externalize problem ● Examine beliefs and themes ● Ask circular questions ● Move the locus of the problem ● Track other dynamics besides the presenting problem ● Normalize and depathologize ● Both/And...
  19. 19. Family Work throughout the Treatment Process Assessment Initial Treatment (first 2-3 mos.) Ongoing Treatment (until 1 year)
  20. 20. THANKS! Any questions? You can find me at @username & user@mail.medhjdjs ● Observe family dynamics ● Get multiple perspectives on the presenting issue ● Begin psychoeducation about substance use disorder ● Create space for family members to be open about their concerns ● Get information on family history of addiction, mental health issues, trauma, etc. ● Get information about family strengths and resources Assessment
  21. 21. THANKS! Any questions? You can find me at @username & user@mail.medhjdjs ● Balance individual treatment and concerns of family with redefining problem more systemically ● Negotiate practical matters, such as how information will be shared (slip/relapse, attendance, pre-lapse behavior, etc.) ● Expand family resources (internal and external) ● Primary client is the family as a whole Initial Treatment
  22. 22. THANKS! Any questions? You can find me at @username & user@mail.medhjdjs ● Identify ways family gets stuck focusing on ‘addict’ ● Expand the conversation ● Make room for multiple perspectives ● Revisit problem definition so that blame is neither on the addict nor on family members -- move the locus of the problem ● Look at family boundaries ● Help the family find ways to connect even in times of stress ● Identify and help reclaim parts of family relationships that have gone missing because worry (or substance abuse) has gotten in the way Ongoing Treatment
  23. 23. Multi-Family Group
  24. 24. MFG Format 01 Goals for the Day 02 Introductions 03 Psycho- Education: Common Situations 04 Group within a Group
  25. 25. GOALS ▪ Normalize how substance abuse impacts families ▪ Highlight importance of connecting as a family ▪ Begin to make room for multiple perspectives without blame or conflict ▪ Begin to reclaim parts of family relationships that have gone missing because of worry/substance abuse
  26. 26. INTROS ▪ Who is in your family, including anyone not here today ▪ What drug(s) brought you here ▪ What is one of your family’s strengths?
  27. 27. PSYCH-ED ▪ Substance abuse hijacks the family ▪ Investigator/detective, scrutiny ▪ Blame, history of blame ▪ Avoidance, fear of triggering ▪ Mixed messages about connection vs detachment ▪ Lack of acknowledgment ▪ Other family problems get ignored ▪ Family no longer has fun together
  28. 28. GROUP WITHIN A GROUP What do you feel your family members don’t see or understand about you because substance abuse has gotten in the way? This could be related to the substance abuse or just about you as a person.
  29. 29. Multi-Family Group Group within a Group: ▪ In what ways do you struggle with wanting or not wanting family support? ▪ In what ways do you struggle with whether or not to step in?