Warming up the family to change

Now that we’ve covered all the roles in the addicted family system over multiple blogs (see below for links), let’s talk about how we take a family that is in the throes of addiction, and warm them up to change. 

Families affected by addiction are locked into patterns, behaviors and belief systems, and the best way to change the system is for everyone in the system to participate in the change.

My preferred way to do that is based on the Systemic, Invitational Model of intervention that was created by Ed Speare and Wayne Raiter. This model is a huge departure from the “surprise party” kind of intervention you’ll see on TV, where the family gathers in secret, writes letters to the addict in advance, and then surprises them en masse, to convince the addict why they should go to treatment. 

In a systemic intervention – or what my colleagues and I prefer to call a family workshop – everyone in the family who is available and willing to participate is invited to come from the very start. No secrets.

There are no meetings done without everyone else in the system knowing about them, and everyone in the family – including the person suffering from substance abuse (or any other addiction) – can choose to attend or not. Everyone has choice.

The one caveat to that is that I don’t typically include children under the age of 16 because if they’re younger than that, they often don’t have the capacity to focus for a multi-day workshop. In addition, depending upon the content discussed, children shouldn’t be exposed to certain information. Addiction can lead people to make poor choices like infidelity, or breaking the law, and so it’s vital that we protect children from hearing that information.

Multi-Day Family Workshop

It’s called a family workshop, for two reasons: 

1. The term intervention has such a negative connotation, and people are afraid of it

2. The family and I work together for multiple days to help them understand that the everyone is suffering from the addiction, and the entire family is in need of change, not just the one who is abusing substances 

From the start of our work together, it’s made very clear that the goal is not to get one person into rehab; it’s to help everyone understand how the disease has progressed in this family – because of substance use andenabling/codependency.

Through education and action exercises, like sculptures, or sociometry exercises where family members are asking to identify their feeling or belief about certain things, they can be helped to understand how addiction has affected them, and how they have accommodated the addict – in an effort to protect or care for them. They also learn how that attempt at healing actually hurts, and had led to more pain and damage for everyone.

They learn that the whole family has contributed to the progression of the illness:

• The addict who is using and/or drinking – they can’t stop, even if they want to – and they live with deep shame at the havoc they are creating within the family
  https://theactioninstitute.com/if-i-could-stop-i-would/
  
• The chief enabler enables – making excuses for the addict that allow them to keep using/drinking
  https://theactioninstitute.com/im-just-trying-to-help/
  
• The hero child steps in to take care of everybody, because the enabler is pre-occupied with the addict
  https://theactioninstitute.com/ill-take-care-of-it/ 
  
• The scapegoat child gets into trouble to deflect from what’s going on with the parents, in an effort to protect them from scrutiny
  https://theactioninstitute.com/screw-you-all/
  
• The mascot child acts as a diplomat, or uses comic relief to distract everybody from what’s really going on
  https://theactioninstitute.com/i-havent-got-time-for-the-pain/
  
• The lost child being lost and hiding in their room helps the family by not being a problem 
  https://theactioninstitute.com/ill-be-in-my-room/

If none of these roles is familiar to you, and you want to know more, I’ve linked each of them to prior blog posts I’ve written about each role

Action Interventions

Using sociometry, I get people up out of their seats, moving around the room in a way that they can vote with their feet and make choices, based on where they’re standing in the room, and who they might be choosing based on a certain question.

An example of that would be a spectrogram, which is just a continuum laid out on the floor, that I often use when I start with families. One exercise I typically use is to have one end of the continuum represent, “I know everything there is to know about addiction,” and the other end represents, “I know nothing about addiction.” Family members are then invited to go stand on the spot on the continuum that represents their response. Family members often have ideas about addiction, but it’s only backed by their personal experience, and not by science.

They don’t know that addiction is a brain disorder, and that it takes concerted, long term effort to heal from. They often don’t know that no one is ever cured of it, but rather, they can experience a daily reprieve through recovery. They also frequently don’t know that the longer someone stays engaged in addiction recovery services, like rehab, an intensive outpatient program, therapy, etc, the greater the person’s chance of sustained recovery. 

I also often use locograms – meaning locations – where I might put out different feelings on the floor (I’ve printed and laminated these words): anger, sadness, joy, fear, shame, loneliness, numbness, other, and ask them to go stand on the spot that represents how they’re feeling that day. 

We always include an other in locograms because there’s no conceivable way that I can come up with every response people might be feeling. But if they stand on that spot, they have to be able to name what other means to them. It’s not a “whatever” spot. 

Everyone gets to stand in the place that’s right for them, regardless of which exercise we’re doing, and no one gets to tell anyone else where they think they should be standing. One of the adult children might stand on anger and share, “I’m pissed that I have to be here for this.” The chief enabler might go stand on the other spot and share, “I’m standing here because I’m hopeful that we might be able to get better together.” 

Because they’ve all been so busy trying to cope living in this chaotic environment, in many cases, this is the first time family members have ever gotten honest with themselves about how they’re feeling. And in many – if not most – family workshops, the first time they’ve slowed down enough to get underneath the dysregulation they’ve been feeling, to access things like fear and sadness. 

Genogram

Another important exercise that we do is called a genogram, which is basically a graphic diagram of the family tree, going back generations, looking at who in the family has had addiction of any kind. Drugs, alcohol, work, food, sex, hoarding amongst aunts or uncles, cousins, grandparents, or even great-grandparents, if people know their lineage.

We also include challenging or traumatic experiences like miscarriages, or placing a child for adoption, or a child dying, divorce, infidelity, poverty, mental illnesses, like depression, or bipolar disorder, or schizophrenia, or even suicide or homicide. 

Maybe somebody in the family has been incarcerated. Maybe ancestors emigrated, and the family was split up for a period of time while one person traveled to the new country they were going to be living in, to earn money and establish residency so that they could eventually raise enough money to send for the rest of the family. That split in the family system is traumatic, even though it might be for good reasons. 

I’ve done many genograms with families over the years, and because keeping secrets is so common, there is often information that emerges that multiple members of a family don’t know about. Someone might say, “I didn’t Aunt Sally died by suicide.” Or, “I didn’t know Mom had a stillborn child before I was born.”

Generational Trauma

The key to reducing shame – which is a huge driving factor in addiction – is to help all of the family members understand that addiction, enabling, and trauma didn’t start with this generation. 

We know that addiction is passed down through our genes, and through research, we now know that trauma is too. According to the online medical source Medline, epigenetics is the study of changes in gene expression that occur without altering the DNA sequence. So, in other words, it’s a natural change in the expression of our genes that wasn’t manipulated through science.

One of the earliest studies in epigenetics was conducted by Dr. Rachel Yehuda at New York University, who along with her colleagues focused on how trauma experienced by parents led to epigenetic changes in their children, which affected their mental health and stress responses. Yehuda’s research was done on children and grandchildren of Holocaust survivors.

A genogram provides us evidence that this is not the first time that this family has been dealing with addiction, mental illness and/or trauma, but now that the family learns the effects of those, they have an opportunity to change it the trajectory of the system so that this disease does not have to spill over into the next generation.

One of the ways that I often frame that with families, particularly if the person who’s suffering from substance abuse has children and/or grandchildren, is to ask them this. “Do you want to be sitting in a family workshop in a room like this 20 years from now, because your child or your grandchild is suffering from the same disease that you are? If you don’t, then here’s your opportunity.” 

It’s everyone in this family’s opportunity to help change the trajectory of this family – and legacy of generations to come. 

The really good news about epigenetics that I always share with families is that once people start to get healthier, that healing passes through the genes as well. Dr. Yehuda talks about this at length in a wonderful interview on the podcast On Being. 

Everyone Gets a Treatment Plan

At the end of that multi-day family workshop, we come together to develop a plan for everyone to determine what they’re going to do to contribute to this family getting better. Ideally, the person who is suffering from addiction will go to treatment, and I’m happy to make recommendations for places that might be appropriate.

Other family members may need to be assessed for addictive behaviors, too, or be evaluated for mental health issues like depression or anxiety, or for neurodivergence. Family members will typically be referred to therapists in their own area, and I might recommend that they go to a retreat center that specializes in trauma or co-dependency to do an intensive workshop. I also strongly suggest that family members attend Al-Anon, Nar-Anon or CODA meetings or Adult Children of Alcoholics and Dysfunctional Families meetings. 

Now, sometimes the addict balks at the recommendations, so we might have to explore their choice in action, with everyone in the family weighing in. My colleague Dr. Jim Tracy, who has done extensive work with families over the years, does a great exercise with them when this happens.

So say for example, I’ve recommended that the addict – let’s call him Tim – go to detox and then rehab. But Tim has his own plan. 

So I’ll set up a spectrogram and ask them all to place themselves on the continuum based on this criterion”

I think Tim’s plan will work and he’ll be able to stay sober, I’ll stand towards this end of the continuum (as I gesture in one direction), or if I don’t think Tim’s plan is going to work at all, (as I gesture in the other direction). I then ask the family members to go stand on the spot that would correspond to their answer, and share from where they’re standing about why they put themselves where they did.

Most likely, the family members will be standing on the end of the spectrum that they don’t think the plan will work, especially if Tim has a history of relapse. When someone like Tim sees his family standing on the opposite end of the spectrum from him, and hears from multiple people about how he’s tried it his own way in the past, and relapsed, that can often be what helps Tim accept that treatment is the better option. 

After we complete this multi-day family workshop, everyone steps into their treatment plan recommendations and then will meet again periodically to track their progress. I may meet with the family while Tim is in rehab, if he’s been willing to go. If he’s not willing to go, then I may need to meet with the family again pretty quickly – within another week or so – to help the family members set some clear boundaries about what they’re willing to accept from Tim, and what they’re not. 

For example, if he refuses the treatment recommendation and continues to do drugs or drink, the family might need to set a boundary – or a series of boundaries – that they won’t give him any more money, or won’t let him stay at their homes, or they won’t make excuses for him anymore to bosses or friends or other family members. 

The thing about this type of boundary is that everyone has to be on the same page, because if most family members stop enabling and one person continues to do so, then the disease will continue to progress. And that family member who is willing to give in to Tim and take care of him, and enable him, will struggle more and more as a result of the addiction. 

The truth is that a lot of family members struggle to uphold boundaries, which is why they need support from professionals and programs like Al-Anon and Nar-Anon and CODA, where they can learn to keep the focus on themselves and allow the person in active addiction the dignity of their own process – even if that process means they’re struggling.

It’s a Choice, Not an Ultimatum

Time and time again, I have seen that when the family sets and keeps boundaries, eventually the addict runs out of options and agrees to get help. When they struggle with the boundaries, because of they fear or guilt, they will often say to me, “I can’t kick him to the curb!” 

I have to remind them that there are no ultimatums given, only choices. For example, they might have a boundary that if Tim can stay clean and sober, he can live in their house. However, if Tim can’t stay sober, then he can’t live there. That gives Tim the choice. They are not kicking him to the curb: they are offering Tim a choice. 

It’s all about choice – for everyone in the system. 

My hope is that they all choose health, and that’s what I’m there to support. I expect that people will slide back into old behaviors – out of fear or guilt – and my job is to help them get back on track, and keep moving forward towards greater happiness and health. 

Having grown up in an addicted family system, I’m living proof that if healing is done one day at a time, long term recovery – in all ways – is possible. 

An Invitation

My invitation for this blog is to think about the epigenetic inheritance that you have received, connected to a family history of addiction, pain or trauma, and what you can do to shift that in a positive way for the generations to come.

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About Jean:

Jean Campbell, LCSW, SEP, TTP, TEP has been bringing together groups of people to heal for over 31 years. She blends her extensive experience in psychodrama, sociometry, group psychotherapy, somatic healing and trauma resolution to offer training for helping professionals, personalized intensives, clinical consultation, and leadership workshops. You can find her at theactioninstitute.com, on Instagram at @actioninstitute, and on Facebook at @actioninstituteofcalifornia.