How do you keep family members supportive of treatment?

We see patients whose families are supportive initially, then they become vocal about leaving treatment feeling they should be ‘cured by now’. How can we help patients and families understand this is a chronic disease? I find many are still in denial about that aspect and have a hard time accepting it. Does family group therapy work for instances like this?

Regular User Asked on September 5, 2018 in Family Support Systems.
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In my experience, its harder than it sounds. Ideally, one would assume that the addict family member will be humble and welcoming for all counsel and treatment, while at the same time, the family in question is all loving, and caring unconditionally in all circumstances. The imbalances in these assumptions result into the tension you are asking about between the seemingly lack of patience among supporting family members and the addicted member. Quoting from an ncbi paper on Affected family members’ experience in such cases published on 2nd of June 2017;

  • Affected Family members frequently receive inadequate support to sustain them in their support-giving role. They regularly report they are not listened to and are excluded from key treatment decisions, by service providers. Their involvement with services is usually minimal, unplanned and unstructured, and constrained by confidentiality issues and service requirements. Affected Family members frequently find that supporting a member with problematic substance use has major detrimental effects on their own well-being and their coping resources are often exhausted, findings similar to those focusing on families of young people with first-episode psychosis  and older adults with mental health disorders. Indeed, England, Kennedy and Horton found that 32% of families report that anger, rage, aggression and violence by the person with problematic substance use causes them the most concern, but often they do not seek external help. Affected Family members  also feel isolated and receive little support from other family members. Families are frequently fractured because of the continuing damaging and destructive effects of the person’s problematic substance use-related behavior. Orford et al. propose a Stress-Strain-Coping-Support Model, to explain how Affected Family members respond to a member’s aggression and/or violence. Essentially, they use one or more of three broad approaches to cope with this behaviour: putting up (with the behaviour), withdrawing (from the person and the environment), and standing up (challenging the behaviour, seeking assistance from law enforcement and judicial agencies).

Orford and the team suggest three main approaches that explain how families end-up handling a family member with a substance abuse problem, but let’s face it, how a family decides to handle a person with a problematic substance use entirely depends on the willingness of the addictive person towards accepting help, their self control, the families quality of love and care (we can not assume that all families have equal love and care for each other, some families are really complicated).

For an ideal family, the rest of the family members require a high level of patience (knowing that impatience will only drive the addict member into a darker place), but also should not put up with voluntary violence, or irresponsibility.  Above all, working close with professional help matters most, and even in times when the family confronts the addict member, in those tense times, somehow it’s important to make sure the addict member knows deep down that they love and care for him/her. This love whether expressive or implicit will go a long way to guide the patient towards healing.

I hope this helps.

Regular User Answered on September 5, 2018.
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Hmm! Never thought of it. The patient is a victim but are times if their conduct is not checked, they tend to victimize the family too. Okay this changes my perspective on the matter. Thanks @Pauline for bringing this out. It explains a lot why the family in question can not alone handle their addict member no matter how much they care, professional support must be sought.

Regular User Answered on September 5, 2018.
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Thank you @Pauline and @OkidaCharles for your responses!

Regular User Answered on September 6, 2018.
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Hi,

I’m relatively new to addiction medicine and I don’t quite know what is common knowledge in the field. So this is sort of more a question  to you @TreatmentNC (and everyone else) than an answer. I’m curious as to how most friends and family participate in the rehabilitation process. What information do healthcare providers and people with experience provide them, and how do they usually respond?

I’ve recently started reading a book (Zoobiquity) which talks about similar diseases between animals and humans, and how their parallels might help humans understand how to treat the disease in humans. The author talks about why addiction is a common occurrence in both animals and humans: how whenever we complete a task that benefits survival – storing food (depositing $ into a bank), mating (scoring that one-night stand), or escaping danger (finding out that bump wasn’t cancer) – our brain releases a hit of “pleasure chemical (dopamine, oxytocin, etc,)” that rewards us. In the case of hard drugs or alcohol, we get that same chemical hit (just as a nuclear bomb verses what our brain usually provides us) without having to do any of the hard work. Before this, I used to think addiction was simply a genetic disease/mutation that caused some people to be more susceptible to certain chemicals. Honestly, I was also someone who once privately thought addiction could be “cured.” But this information means that our brains have been hardwired to seek out these chemicals since birth, right? So everything we work towards, even happiness, is coded by the release of these chemicals. Once someone gets attached to the shortcut to this euphoria, it’s kind of ludicrous to expect them to be “cured” of it. I’d imagine it’s like having confidential info on a company’s success, but refusing to buy its stocks, and having to constantly live with the reminder of potentially millions of dollars you’d earn from insider trading just out of reach.

She concluded the section by writing that perhaps knowing addiction is not just a malediction of humans, but a disease that has evolutionary roots that spans millennia and crosses species, might help patients and loved ones cope with their disease. Every organism is born an addict, to paraphrase. It did changed the way I’d viewed addiction. Just wondering if this sort of information is already commonly used to explain the disease to family members? Or if it’d make any difference to bring it up at all? I know it wouldn’t solve any of the problems that addiction might inflict on family members, but wondering if this could be useful in helping people understand that addiction is a Chronic disease that doesn’t just disappear.

Regular User Answered on September 8, 2018.
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Hello @Theobilden, thanks for sharing your study on addiction! @TreatmentNC and @Olivier, would you kindly look at this?  @Theobilden presents some facts here, but the fact still remains that I’ve seen many addiction patients fully recover! How do we explain their total recovery with the study presented in @Theobilden’s argument? Thanks all!

Regular User Answered on September 24, 2018.
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