Transcript Family Focused Intervention and Treatment James M. Tracy, DDS, CADCII, BRI II Rancho Mirage, CA 92270

Family Focused Intervention
and Treatment
James M. Tracy, DDS, CADCII, BRI II
Rancho Mirage, CA 92270
Change Theory and Intervention
• Intervention is a process not an event
• The change process applies to the entire
family not just the substance abuser
• The family is usually more difficult to
achieve long lasting change than the addict
Apply to families what has been
proven to work in PHP’s
• Individualized treatment followed by long-term
case management has been proven to improve
outcomes
• I incorporate most elements commonly found in
PHP’s monitoring agreement
• I provided a long-term family focused case
management and monitoring service
• Long term accountability for the families
combined with long term monitoring for the
recovering family member
Teaching Points
• We now understand that we can improve outcomes
by extending the duration of treatment – 90 days or
more
• Extended treatment combined with long-term
monitoring can dramatically improve outcomes
• When family member’s focus on their own
recovery:
– Outcomes improve – Stephanie Brown research
– More patients complete treatment
• One family week during treatment is rarely enough
– Educational oriented programs often do not result in
family beginning their own recovery process
• Treating The Family is more difficult
Family Interventions
• Some families require interventions at
different times in the recovery process
– Some need more than one intervention
• To begin the recovery process
• During treatment
• Immediately post treatment when families
return to the old family dynamics
3 Main Models of Family Intervention
• Confrontational Intervention Model- What many
interventionist do but call it a Johnson Model,
but is actually the anti-Johnson Model
• Johnson Model – Most common, uses
carefrontation, surprise model with focus on the
IP
• Arise Model – Invitational Model with focus on IP
• Systemic Family Intervention – Invitational
Model with focus on the family
Alcoholic Family System
Dis-Ease
Systemic Family Intervention
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Invitational
Motivational
Family Focused
Respectful
Honest and non-deceptive
Process oriented not an event
Highly effective
Systemic Family Intervention
Overview
• Everyone hears the same information
together – becomes easier to come to a
common goal
• Each person processes how they have been
affected by the problem
• With entire support system involved,
addictive behavior is difficult to sustain.
• Support system becomes aware of the
effect of enabling behavior.
• Each member commits to change.
What is the goal of family
intervention?
• To recognize the effects of addiction on the
family
• To recognize and change old patterns of
behavior
• IP is invited to join family in the process of
change
• Focus is on family health, regardless if the IP
goes to treatment – It takes a sophisticated
cast of enablers for addictive disease to
continue
Systemic Family Intervention
Today
• The invitation process is an important part of
the Intervention process
• We are having at least 90% of the IP’s
attending the intervention workshop
• The workshop goes much the same
regardless of the IP attending or not
attending the workshop
Utilize Experiential / Sculpting and
Psychodrama Techniques
• The most effective treatment approach for families
• Most families struggle with traditional talk therapy
• “We are going to be doing a lot of stand up therapy
instead of sit down therapy”
• “When I hear something, I forget”
• “When I see something, I remember”
• “When I do something, I understand”
- Chinese Proverb
• “Show me your family”
• Experiential approaches seem to break through and
effectively address each member’s issues
Principles Involved in
Effective Invitational Interventions
• Invitational Models – Prior Notification
– Stages of Grief
– Motivational Interviewing
– Stages of Change
• Developing Elements of a therapeutic relationship
– Empathy
– Genuineness
– Unconditional positive regard
• Framing – frame requests in terms of what the
person has to gain by agreeing with your
suggestions
Why is prior notification so important?
• Allows the IP to cycle through the early stages of
grief and stages of change.
– Move from denial and anger to bargaining by
the time of intervention
– Usually will move from pre-contemplator (no
problem) to contemplator (ambivalence)
Risk of the surprise model
We want to avoid this guy
Massive malignant denial
Anger + fear = RAGE
Families Perception
Pre-Intervention & Pre-Contact
The family is connected with pain, anger, and
frustration. There is also isolation and loss
Focus is on the Addict/Alcoholic
The family is saying
“I’ve tried everything”
“We have to wait until he/she hits bottom”
“It’s not the chemicals, it’s……..”
“This family is all screwed up. I want out”
1st contact
• The catalyst understands the problem is chemical
and contacts the interventionist who explains the
systemic process.
– The catalyst contacts the potential team and arranges for
an assessment, either conference call or in person
– Entire methodology is explained: assessment, team
selection, coaching for invitation and what to expect
during the workshop
• Explain and re-explain process vs event
• Offers HOPE
Families Perception
1st Contact with Interventionist
• What the family members are saying:
– “How can this model get him/her into treatment”
– “I’m relieved we don’t have to sneak around”
– “You don’t know who your dealing with, he has never
listened to anyone but himself”
– “If I tell him he’ll run, he’ll freak out!”
– “Is it really that bad?”
– “We can’t wait, it needs to happen NOW!”
– Are focused on the knock down drag out event
Assessment
• The process is explained in detail with key
people, including the Invitation process and
coaching, the 2 day workshop and aftercare.
• Questions and concerns are addressed
• A commitment is made, including date set, and
deposit is received
• Participants are given instructions, asked not to
drink or use during the process and to attend alanon or AA/NA meetings
• Everyone is given a intervention workbook to
give an accurate history
Families Perception
Assessment
• “It’s not our problem, I don’t think I’ve been
affected”
• “I think he is drinking because he is depressed”
• What do we do when they refuse to attend?
• He’ll never agree to come
• “What’s your record; what guarantees are there
that this will work?”
Invitation Process
• Invitation plan is started at the assessment
• Decide who will call or meet with the IP first. (usually
the chief enabler)
• Continually reinforce not to be attached to his/her
initial reaction.
• A lot of coaching during this process, extremely time
consuming
• Can be extremely unpredictable and volatile
• Usually calms down as workshop nears
Beginning the
Invitation process
creates stress within
the Alcoholic family
System
Breaking the
NO TALK rule
Families at beginning of Invitation
• Terrified to talk to the IP about the problem
• Have never talked about how they have been
affected or even how they feel
• Believe that if he IP’s initial reaction is not favorable
that the intervention can not work
• Takes about 20 hrs of coaching
Family Perception after 1st contact
• “He told me the only problem he has is my
bitching at him”
• “We need to cancel the intervention, he said
he won’t come”
• “He will meet with you and I, but no one else”
• “My sister told me I blew the whole thing, she
always criticizes anything I do”
• “I’m a wreck, I don’t think I can do it!”
• “I thought you were going to call him”
Families Perception
Day one, The Disease
• Family members are feeling hope and trust in the
process - “This wasn’t as bad as I was expecting”
• The family is saying
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“I never realized all this; it makes total sense”
“I now realize how I’ve been affected
“Why didn’t the doctor say anything?”
The IP is saying “yeh, I can see myself in what you
discussed”
– “I can’t go to treatment, if I leave we’ll go broke”
Families Perception Day 2
Enabling and Codependency
• The family is clear on new boundaries and their own
commitments for treatment
• IP is invited to join the family in the process
• The family says
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“This is the best we’ve ever communicated”
“You predicted everything”
“The bad stuff that I was afraid of never happened”
“I realize that I also have a problem”
“What if I don’t have the time for family week”
Families: The Missing Link
You Don’t have to Drink to
Suffer from Alcoholism
 Entire family system is affected
 Measured by behavior
 Multi-generational legacy
 Compulsive behaviors
The Pink Cloud
• Families feel relief while the alcoholic or addict
is in treatment
– “It’s the first time I’ve been able to sleep in
years.”
– “I’m working my program and everything is
wonderful”
• High relapse rate when the addict/alcoholic
returns home
– It is common for family members to revert back to
old behavior
– Old alcoholic family dynamics re-emerge
– This can be the all too common result regardless of
the duration of treatment
Alcoholic Family
System
Vacuum
Trauma of Early Recovery
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Addicted Family System must collapse.
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Myth - Most expect the problem to be ‘fixed’
when the patient returns home – regardless of
what they say
•
Many families do not survive the disruption and
turmoil caused by abstinence.
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Early recovery can be very difficult for children
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At times the addict cannot return home or they
will not remain sober
Many families cannot survive the
trauma of early recovery
How Can Families Survive?
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Imperative families utilize outside supports to
weather early recovery.
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Outside support networks (12-step programs,
treatment centers, and therapists) provide a
“holding environment” for all family members.
Network becomes a cushion and substitute for
the Dysfunctional Family System.
• Research recommends additional treatment and
unlimited continuing care. (Stephanie Brown)
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Family Twelve Step Programs
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Naronon, AlAnon, CODA, Families Anonymous
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How can you expect your loved to do something
you are not willing to do?
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I.P. and family experience resistance to change.
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Regular meeting attendance, get a sponsor, and
use them!
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Your loved one learned a new language of
recovery while in treatment, will you be able to
communicate with them?
Where we are today
• We’ve known for some time that we need to
improve the family’s treatment experience
• We haven’t had many answers, except to
ignore the problem
• We believe that treatment centers as well as
interventionist are beginning to develop more
effective family treatment, aftercare, family
case management and monitoring
Couple’s therapy in early recovery
• We recommend therapy for most couples after
treatment
• Should be more educational type therapy to help
couples understand that it will take time to
develop a new recovering family system
• Help couples balance the responsibility of
maintaining recovery and incorporate healthy
parenting – i.e., better parenting skills
• Assist them in seeing early recovery is difficult
and that what they are experiencing is normal
– They are right where they are supposed to be
Developing healthy relationship
dynamics in early recovery can be
difficult
Current recommendations during a
Systemic Family Intervention
• For the addict
– Multidisciplinary Assessment if indicated
– Treatment – most commonly at least 90 days
– Urine monitoring and case management for 2 years
• For the family
– 6 month (Minimum) to 2 years family case management
– 3 workshop type treatment experiences with in the first 6 months
• Family week at treatment center
• Codependency or Family of Origin Workshop (As individuals)
• Some type of family Intensive – post treatment
– Individual Therapy
– Couples Counseling – Ideally following a Couples intensive
• For Everyone
– Family Intensive
– Family Reintegration Workshop – Commonly at the end of Residential
Treatment
Treatment options for Families
• Onsite – Retreat Setting
– Living Centered Program (LCP) – Experiential based family of origin
treatment and codependency
– Coupleship Program
– Family Intensives
– Family Reintegration Program
• Caron – Codependency treatment week
• The Bridge – 14 to 30 day codependency residential treatment
• Meadows – Survivors Weeks
– Offers survivors level I & level II
• Pinegrove is also offering a number of Family Intensive
Programs
Intensive Workshops
• Individual therapy can be slow and difficult early on
• Traditional couple’s therapy can be HELL early on – educational
therapy can be useful
– Couples are usually able to benefit from more intense therapy after
completing an intensive workshop
• Workshops can be the equivalent to a year of therapy
– All end in resolution, hope, recommendations and treatment plans for
future
– Always recommend to return home to therapist
– Referring therapists report that therapy is more productive after
Onsite
• Experiential therapy proven to more effective
Case Management
• Research recommends additional treatment
and unlimited continuing care. (Stephanie
Brown)
• 90 days of Family Case Management-Life
Coaching is included as part of my intervention
service
• Recommend 6 months to 2 years of Family
Case Management
• Recommend multiple treatment experiences
in the first 6 months of family recovery
Onsite Family Re-Integration
Workshops
• Intensive 4 ½ day family experiential workshop
designed to:
– Improve family dynamic
– Plan for a healthier system
• Ideal for treatment centers as an additional family
week to:
• Develop healthy limits and boundaries to reduce enabling
• Challenge myth that the patient is ‘fixed’ after treatment and
everything will be wonderful
• Create a longer range treatment plan which can enhance success
• Too frequently, families are doing well while their
loved one is in treatment and seem to forget
everything when they rejoin after treatment
– Are shocked that everything isn’t wonderful
Individual Family Reintegration
Workshop
Designed to help weather the trauma and stresses
of early recovery – may be in crisis following
treatment or at the end of treatment
An intensive 3-4 day workshop to improve family
dynamic’s; help develop their plan for successful
reintegration of a new, healthier system.
Develop a treatment plan for the entire family
which could result in more extended treatment.
Define what healthy support is and how it can be
achieved.
Individually tailored for each family to address
specific familial issues, including the establishment
of healthy communication, limits and boundaries.
Aftercare and Case Management
• At the end of the initial 3 month agreement families have
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Attended Living Centered Program at Onsite or it’s equivalent
Family week at the treatment center
Family Reintegration Workshop at the end of treatment
Engaged in Therapy
Engaged in 12 step program for family, Al-Anon, Naranon, Coda
etc
• Recommend Case Management for the family for at least 1 year
• Recommend Urine monitoring and case management for the
patient
– As well as a monitoring program designed to be similar to health
professionals
Urine Testing and Monitoring
• Random urine testing
– Only 9 % of patients completing treatment have
urine testing post treatment
– Recent studies support random urine testing
dramatically improves outcome’s, Dupont et al.
• Doctors and Pilots have a approx. 90% success at
the end of 5 years if the following has happened
– Adequate treatment
– Long term monitoring and case management
Family Recovery
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