Family Case Management: Healing Families from Addiction

Family Case Management presentation

Articles:

• Resources for Friends and Family with an Addicted Loved One
• Support Groups for Families
• What Is Family Therapy?

Welcome to the Community Education series hosted by The Recovery Village and Advanced Recovery Systems.

Hey, everybody. This is Kevin Petersen, licensed marriage and family therapist, owner of Petersen Family Counseling and author of Chronic Hope: Parenting the Addicted Child. I have offices in Denver, Colorado, and Jacksonville Beach, Florida. Today, I am going to work with the Recovery Village and Advanced Recovery Systems and their Community Education Series. I am going to present to you “Family Case Management: Healing Families from Addiction.” Here we go.

Here’s a little bit about me — I was born and raised in Palo Alto, California. I graduated from Palo Alto High School in the fall of 1982. I attended the University of Southern California starting in 1982. I flunked out in 1988, and then I went and got sober and went back in 1991 and graduated in 1994. I also lived in South Spain; I was a tractor driver. I went back to school in 2008 and started my master’s in marriage and family therapy at Regis University in Denver, Colorado. I was part of the first class that graduated from their masters in marriage and family therapy. I worked for Arapahoe Douglas Mental Health in their child and family services and on their crisis response team, and I also worked in their psychiatric facility, called the Bridge House.

Let’s see, what other tidbits can I tell you about myself? I started my private practice in April of 2014 and ended up going full time in my private practice in August of 2014 and never looked back. I developed a two-day family intensive program called the Family Recovery Program and had that going in four different treatment centers in Denver. And that is kind of how I got my philosophy on how to work with families and how to work with families of addiction. I grew up in a house of addiction. My mother was a prescription drug addict, and we had to learn how to engage with that process.

I became an addict when I started using when I was 13 and 14. I got sober when I was 27. I went back to graduate school and became a mental health professional. So I always tell people I come from a house of addiction. I understand what it’s like to have a family member. I understand what it’s like to be an addict. I understand what it’s like to be sober, and I understand what it’s like to be a mental health professional that specializes in family systems and addiction and codependency. I think that’s enough about me — oh, I’m married. I have a lovely wife named Amy and we have two Boston terriers. Oh my gosh, here it says three. Otis passed away a couple of years ago. We have Bert, who’s four, and Blanch, who’s three and a half.

Alright, so let’s talk about family case management. What I always tell the families that I work with is when you feel like you’ve tried everything — and I mean everything — it’s time for family case management. What I mean by that is people don’t call me when they’re thinking that maybe there’s an issue and they might need a little help and they’re just gathering information. People call me when their house is on fire and they’re looking for immediate help and an immediate plan. So, what is family case management? Family case management is a step-by-step process to help families assess the impact of addiction on the family system and take 10 steps towards healing. I want to be critical — we’re not just talking about the addict or the alcoholic. We’re talking about the entire family and the entire system. We can definitely get the addict and the alcoholic to recovery and get them to where they need to be, but that’s only part of the equation.

I always break it up into three pieces. In the beginning, it’s before treatment. There’s before, during and after. Before treatment — that’s really what we’re doing, is going to triage what’s going on in the house right here, right now and see what’s happening and what you end up getting at. My average phone call starts like this: “Oh, my God. Oh, my God. You have to help us. We need to bring someone into your office right now.” And I always tell them, “No, no, that’s not what I do.” What I want to do is meet with all the relevant people in the family and talk about what’s going on and how it’s impacting the family and get a vision of where they are and what they’re willing to do and how far they’re willing to go. The second phase is during treatment. So let’s say we get someone into inpatient or outpatient treatment on some level — then we have to start talking about how we lead the family towards its own healing. So the addict, the alcoholic, is in treatment on some level and is getting help. That doesn’t solve the problem; it only solves a portion of the problem.

We have to make sure that the family is using that time effectively to take care of their own wounds, their own trauma and building up their own abilities to handle the situation. The third phase is after treatment, when it’s time to reunify the family system, and that’s what we’ve got to start talking about: What are the expectations of the person coming back from treatment? What are the expectations of the family system and the family members, and what’s that going to look like? Because the truth is, it has to change. We have to agree that the way things were or are, depending on who I’m talking to and when I’m talking to them, is not working. Therefore, we’ve got to start by fixing it and changing it and implementing change across the board.

Step one, before treatment — what I like to do is talk to folks and get them to understand that the previous actions had been ineffective. What I mean by that is they’re like, “Well, he or she is going to therapy, or they tried an IOP or, you know, they’ve been going to the gym. Or they’ve been going to church, or we’ve been having family meetings or I tried yelling and screaming and crying and pleading. We’ve gone to the rabbi, the minister. We’ve gone to the mom. We’ve gone to the school counselor. We’ve gone to our personal counselors. We’ve gone to a family counselor. We’ve gone to the psychiatrist. We’ve gone to our general practitioner. We’ve gone to a shaman. We’ve gone to fill-in-the-blank and it hasn’t worked.”

I want them to understand that they’ve played out all the cards and that there’s not a lurking notion that something else might work. Then, we’ve got to recognize that healing requires an integrated, holistic approach. What I mean by that is everybody has to participate — it’s not just the identified client. Too many times, the family sort of drops the ball and just expects the client to go to treatment or go to therapy and magically get better, and that solves the whole problem. It just doesn’t work that way. Then, the last part is we have to work together with the family and set very clear and specific goals. One of the things I always tell my families is that a house of addiction is like a business that’s going broke. As a consultant — and I see myself as a consultant — when you walk into a house of addiction or a family or a business that’s going broke, you don’t fire the receptionist and think the problem is solved. You have to go into the management team and recreate the way they work and recreate the entire culture of the company like we have to recreate the culture of the family.

Two things to remember: One, you are not responsible for your loved one’s addiction, but you are responsible for how you react to it. Too many times, the families I work with are like, “Oh my God, what did we do? Well, you know, how did we make this happen? This is my fault, etc.” The truth is, it’s not. You know, “addiction is addiction is addiction.” I always tell people addiction is like being pregnant. You’re either an addict and an alcoholic or you’re not — there’s no in-between. There’s no “kind of, sort of, maybe.” Let’s be clear: There’s no such thing as functional addiction or functional alcoholism. If you’re an alcoholic or an addict like I’m talking about, your life is being chipped away and you’re slowly losing. There’s no functional there. You may be going to work, but your life sucks. The second thing is recovery requires a continuum of care from detox to outpatient treatment to post-treatment support, and we’re going to get into that in just a second.

Step two — now, let’s say we’ve already established that the person needs help and the family has sat down and created some boundaries and figured out how to lay it down, and maybe had to do an intervention and deliver the person to treatment. Step two is, now that the person is in treatment, we have to start assessing and doing weekly meetings to discuss feelings and ask questions. I mean that with me as the case manager and with the client who’s in treatment. What’s going to happen is the family’s going to have questions: “I don’t understand. What is this? What are they talking about? I thought he just had, you know, some mental health issues. Why is everybody calling him an addict? I don’t understand.” What they need kind of is a guide — someone who has experience in this territory that can walk them through and answer all those questions.

The second thing the family needs to do is seek family support groups and resources, and that can be in any way. It can be the 12-step groups. They can be faith-based. There are therapeutic groups, and there is SMART recovery — there’s a ton of programs all over the country that are designed to help families that are engaged in this process. They’re critical because it allows the family to realize they’re not alone, number one. Number two, it gives them a resource; it gives them people to talk to and ask questions. And that’s, by the way, the exact same thing that the addict is going through.

Then, you want to be able to understand and assess the family dynamics. By that, I mean families tend to fall into roles. There’s the people that are the fixers. There are the people that are the fighters, the people that run away. There’s the people that sort of — we call it “fawning” or “flirting” — where when things get tense or uncomfortable, they get cute and funny and they think that’s going to solve the problem, and we want to start addressing everybody’s role in the system.

Most importantly, you cannot expect the addict to do something you’re not willing to do yourself. What do I mean by that? What I mean is, let’s say we have someone going to treatment or going to therapy or something to address their addiction. We can’t expect the addict to take care of their business if you’re not going to take care of yours. This is a team effort here; this is not a one-person effort — that’s critical. Therefore, it’s important to heal the family during treatment by using all those assorted resources. And like the little picture there says “You’re not alone and you matter.” And that is, I mean, one of the things. One of the big things I always say to the families that I work with is, “I want to let you know I’m not here to talk about the addict. I’m here to support you and help you. I’m here for your benefit. I’m here to help you get what you need and what you want.” Which is always a shift for them because, nine times out of ten, every professional they have come in contact with has been all about dealing with the addict and taking care of the addict. And frankly, a lot of these families are like, “I am so sick and tired of the addict getting all the attention and all the help. I need some help, too.” And that’s exactly what I’m here for.

Step three is called “after treatment.” In step three, we’re going to discuss a reintegration plan for all family members. The question now becomes, “What are the expectations? Does the addict need to do more treatment? Do they need to do sober living? Do they need to continue with IOP? Do they need to continue with psych and psychiatric services?” That all needs to be agreed upon ahead of time so, coming home, everything’s on the table — everything’s clear and concise. I’m a huge believer in the mantra: consistency, accountability and transparency. Consistency is — we do regular things regularly. We go to therapy regularly, we go to groups regularly, we meet regularly, we meditate regularly, we pray regularly. Whatever it is you need to do to keep your sanity, but you’ve got to do it consistently.

Accountability is — we let everybody know what’s going on. There’s no secrets, there’s no games. Cards are on the table. Same thing. While the accountability is also a function of getting outside help so that you’re talking to somebody about it, the transparency is the cards are on the table and everything’s above board. Outline your family members’ expectations. You know, “What are we going to do if they start using? What are we going to pay for? What aren’t we going to pay for?” Everything needs to be discussed and put on the table in this final phase when the reintegration is starting to be talked about. Seek a family therapist who specializes in codependency and addiction therapy. There’s a lot of folks in the industry and in the mental health industry that are wonderful, wonderful therapists, but they don’t know a lot about codependency and addiction. This tends to be a slightly baffling territory for them — and it’s critical that you find someone that does. I can help you with that; that’s not a problem. You know, I would definitely say read my book. There’s a lot of resources in there, and I’m always happy to point people in the right direction — anywhere in the country, no matter where you are.

Remember, addiction affects the family system, so the entire family must heal. Here’s the example I always like to use. You throw a rock in the middle of the pond and you know the old adage, right? You see the ripples go through the entire pond. So let’s say the addict’s the rock and you throw it in there, and bam — you just hit right in the middle. Splash. But that rock going into the water affects the entire pond; the entire ecosystem of the pond gets rippled from that. Same thing with the addict in the family; the entire family gets rippled from that. We all tend to make decisions based upon the addict that are maladaptive or, you know — we keep secrets, we cover stories, we lie, we do things that we really wouldn’t have normally done if that wasn’t what was going on.

So those are the things that gotta be addressed. There’s a lot of trauma that comes from being a family member of an addict. There’s a lot of shame that can come from that as well, and I’m willing to bet it’s probably generational. A lot of the families I work with will almost always say the same thing: “Oh, my God, we’ve never had any history whatsoever of addiction or mental health in our family other than this one person today.” And early in my career, I used to argue with them and fight with them and try to prove them wrong, and now I don’t. There’s no point to it. What I do now is stand back and say, “Oh, okay. That’s fascinating.” Then, over time, they start to acknowledge different family members with different issues and different things. That’s called being loyal to the tribe — it’s an unspoken gig within the structure of the family that “we’re not going to talk about that stuff.” And I’m gonna tell you, that started generationally — it’s not today.

Recovery is a journey. You want to use consistency, accountability and transparency for all the family members. If it’s good for the goose, it’s good for the gander. If we expect the addict to take their addiction seriously and their recovery seriously, we have to take that same thing. We have to take our recovery seriously as well. There’s nothing more impactful on a family system than the family getting into their recovery and raising the bar so that the addict actually has to meet it in order to be back engaged in the family system. The addict has to start taking care of their business as well, and it reinforces it and requires it and it’s wonderful. Continue with individual and family therapy — I think that’s critical for everybody. Twelve-step meetings and faith-based community support groups, if you so choose. If that’s where you’re at. There’s plenty of non-faith-based groups as well. Whatever works for you to make things better is what we’re looking for and trying to create.

Let’s talk again about consistency, accountability and transparency. Consistency — it creates its success through repetition. Consider when going to the gym; you know, if we go to the gym one time every three weeks, we’re probably not going to see a whole lot of results and we’re going to be struggling with it. But if we go regularly, we start by going three times a week and then we go four times a week or we go for regular walks or we go for regular bike rides or whatever it is. We create that level of consistency — we create success and it conquers the old way of life. You know, it’s the old “changing a habit.”

Accountability — it develops a sense of connection and community to help heal and help keep egos in check. One of the critical pieces of the 12-step community is sponsors and sponsees and your peers. The same thing with therapy goes the same way — when you have someone that you’re checking in with on a regular basis and communicating, “Here’s what’s going on, here’s what’s happening, here’s how I handled it. What do you think? Can you give me some feedback? Can we talk about it back and forth, back and forth, back and forth.” What we end up getting is an opportunity to be accountable and an opportunity to listen. What that also does — it creates that level of vulnerability with a sponsor or a mentor or a therapist or a minister or whatever it is, but it creates an opportunity to get that stuff down on the table and not keep the secret. One of the great adages in recovery is you’re only as sick as your secrets. So if we can get to a space where we’re putting our secrets on the table and not living that way, it makes a fundamental change.

Transparency — everything on the table and nothing is hidden in the closet that dispenses with shame. When we can put everything on the table and not walk around with these secrets that are sort of locked into our backpack, dragging us down. We start living in a world where we don’t feel like we’re defined by some giant negative image that we’ve created or society’s created and we feel like we have to keep a secret.

Resources — okay, so how do you get this done? Twelve-step meetings, there’s Codependents Anonymous, there’s Alanon on there, there’s Celebrate Recovery, there’s Adult Children of Alcoholics, there’s Nar-Anon — there’s all sorts and kinds. I’m a big believer in books, and one of the ones that are my favorites are Codependent No More written by Melody Beattie, which is right here. I think she does an amazing job. She was working at Hazelden in the ‘80s and was sort of one of the pioneers in understanding families and the family structure. Another one is called Unspoken Legacy by Claudia Black. Again, one of the pioneers in understanding family trauma, and that’s a great book. And then Facing Codependence by Pia Mellody, who was doing the same thing that Melody Beattie was doing, but she was doing it down at the Meadows, down inside Wickenburg, Arizona, in that territory. And of course, I think reading my book, Chronic Hope: Parenting the Addicted Child, is critical as well. Videos.

I’m a big fan of “Pleasure Unwoven.” It’s a documentary by Kevin McCauley, who’s a doctor, and he does a phenomenal job of explaining addiction and explaining the need for recovery, what recovery looks like, the biological side of addiction. I make all my families watch it, and I’ll always get the same thing. The families are like,”Oh, okay. Now I understand that he’s actually physically different than me, and then I get it.” And that really helps. Faith-based support groups can be a huge group asset as well. They don’t have to be faith-based; there are support groups all over the country that help families that are free or next to free, and I’m happy to help you find them.

Alright, that was a lot of fun. Again, Kevin Petersen, Master of Arts in Licensed Marriage and Family Therapy. Here’s my email address: [email protected]. My phone number — you’re welcome to call, text and give it away: (720) 541-6289. My email or my website there is petersenfamilycounseling.com if you’d like more information. By the way, in my book Chronic Hope, I actually detail more into how to use boundaries, accountability and structure with the families and to get to the point where you’d make a decision about whether or not you want to choose an intervention and go into treatment.

And I think I am done. It’s been a pleasure, and I’ve been really excited about this and I’m very grateful. Thank you so much. Feel free to call, text or email anytime about anything. I’m an open book. I love talking about this topic. It’s obviously a personal and a professional topic for me, and that’s all I have. Have a wonderful day.

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