If you have any connection to the recovery community you most likely have heard the adage: “addiction is a family disease”. This idea is the rationale behind treatment centers having Family Programs for the loved ones of an addict/alcoholic in treatment. There are many wonderful treatment centers offering family programs, staffed by talented counselors, to coincide with their loved one’s treatment program. Unfortunately, most family programs are limited to a “family day” (once weekly for an hour or two, occasionally offered a couple days in total), rarely -if ever- with ongoing professional family therapy. Given this lack of emphasis, recommended continuing care from a family program is the singular advice: "go to Al-anon". This is inadequate. Which is not to say that 12-Step programs for family members and loved ones do not play a crucial role in coping with the addiction/alcoholism in their family life. Al-anon and Al-ateen, similar to Alcoholics Anonymous and Narcotics Anonymous, continue to be the foundation of countless people’s recovery from drugs and alcohol. Yet, I implore you to challenge old ways of thinking.
If we actually believe addiction is a family disease (and most addiction experts emphatically agree that it is), the question arises: are family members receiving enough clinical support? Now, let’s contrast the ongoing care generally recommended to patients discharged from an inpatient treatment program. A continuing care recommendation for the recovering addict/ alcoholic often has an outpatient treatment component where they might participate in Day Treatment (an outpatient treatment program, typically meeting 6-7 hours per day (during business hours), 4-5 times weekly for about one month). Followed by Intensive Outpatient Treatment (“IOP” often meeting 2-3 hours per day, 3-4 times weekly for a couple months or more). Additionally, the outpatient recommendation can include a move to a sober house, recovery case management, ongoing work with a mental health professional, and most often active engagement in a 12-Step program. In the context of time investment, it really does equate to a full time job for some and a part-time job for the rest. Totaling some form of treatment for an average of six months, with decreasing levels of care and time investment, has arguably become the minimum continuing care recommendation with those struggling with severe substance use disorders. Let me be clear about the recommended investment that addiction professionals and treatment centers usually suggest to the recovering addict/alcoholic: it is a good thing. A very good thing. It is saving lives. My concern is the lack of referrals and resources provided to family members following their loved one’s treatment program. There are, of course, exceptions where addiction professionals are coordinating services for family members in need of support with mental health professionals experienced with family therapy. Al-anon, while infinitely important to those who engage it, is not treatment or therapy. I would be curious to see a research study tracking the percentage of people attending a family program at a treatment center, subsequently going on to participate in a 12-Step Program (such as Al-anon), for more than one meeting. While only anecdotal, I would argue it being far less than the actual need.
One possible response to the shockingly under-served population is the obvious: connect family members, in need of support, with family therapists.
I clearly cannot be the first person submitting this notion. The fact that coordinating resources for families is not a standard part of best practice policies within the addiction treatment field is quite perplexing. I am open to any coherent explanation as to why families are routinely not connected with experienced therapists in family therapy, as well as being provided with other necessary resources.
Having asked many professionals in the field, I have yet to find one. When addiction is in the household, often many other issues are close at hand including depression, anxiety, legal issues, poor boundaries, unhealthy communication, abuse, trauma, and grief. Antiquated arguments such as “family members need to work their own recovery programs separately” or “the addict/alcoholic needs to establish his/her own recovery before they can focus on their relationships” only serve to contradict the original assertion that addiction is a family disease. The systemic nature of relationships and family dynamics dictates that something so transformative as recovery does not, and cannot, exist in a vacuum. Change is hard. Healthy change is stressful and puts strain on relationships.
Having clear and healthy boundaries between family members’ recovery programs is definitely a positive thing, but we should not lose sight of how addiction has a ripple effect of discord permeating all intimate relationships.
Family therapy can help support and facilitate navigation on the often arduous path of recovery. Generally speaking I commend and support the ever evolving and improving field of addiction treatment. But would be remiss without encouraging an expanded vision of adequately supporting family members still suffering in the wake from addiction. Accountability, structure, and support are needed by all.