Family recovery therapy is the next step in the evolution of addiction treatment. One of the basic principles of family recovery therapy is that a single clinician, a licensed mental health professional trained in family recovery therapy and educated in addiction treatment, functions as the treatment team leader. This clinician coordinates, case manages, and provides in-person treatment for the individuals in the addictive/codependent family system on a weekly basis throughout the first year of continuous sobriety.
This approach contrasts with what is called the rehab, or colloquially, the “spin dry” model, where the addict is sent away to a treatment facility for 30 or 60 days – an approach that is costly, has changed little in over 90 years, and fails half the addicts who go this route. This rehab model has basically remained unchanged since the 1940s, when AA established residential centres to help badly impaired drunks.
The conventional treatment approach
Addiction treatment in the past, and as it is generally still practiced today, is fragmented, leaving the addict and the family confused about what steps to take.
In an all-too-common scenario in the rehab-centered treatment model, an interventionist, working with the family, sends the frightened, confused, sick, and mentally ill addict away to a residential rehab, a business that, in a cookie-cutter process, does its best to detox, stabilise, and educate this addict. They then refer the recovering individual to ongoing treatment options back home.
When an addict goes through residential rehab treatment, upon discharge they are likely given a list of follow-up resources, outpatient programmes, and local support groups. But how does an addict, barely detoxed and not yet solidly on their feet, know how to discern which path might benefit them? After years, perhaps decades, of addictive behaviour, the recovering addict needs much more support than a short stay at a rehab facility can provide. Fifty percent of those who leave a rehab centre will relapse before the year is out.
And what about the family members? They might have learned about the existence of social support groups for families while attending a family weekend at the rehab centre. But how do they learn how pivotal their role is in their loved one’s recovery? How do they learn how to best support themselves and their loved ones once the addict returns home?
Family members who, perhaps actively or unconsciously, have enabled their loved one’s addiction and who may be mired in codependency also need support. They will need long-term, possibly lifelong, care. At the rehab centre, they may have received an hour with a family counsellor and certainly not more than a day of education and support. Upon the addict’s return, family members unconsciously pull for family dynamics to return to the previous status quo, a situation that not only sets the stage for the addict’s relapse but also ensures the family’s continued dysfunction.
A new treatment paradigm
In the family recovery therapy model, a state-licensed, addiction-trained mental health psychotherapist treats the addict and those who have enabled the addiction starting from day one and throughout the critical first year of continuous sobriety. This mental health professional is also trained to refer and coordinate treatment with the resources that can address the myriad psychological, medical, vocational, or legal issues that can come up during that first year. A 30-day rehab may not even begin to touch on deep psychological issues, entrenched marital problems, chronic unemployment history, and more, all of which can be addressed by the FRT therapist over the course of a year-long treatment process.
In the FRT model, treatment starts today, with the first phone call. After the family is on board, the addict is invited in. Once the addict grasps that their problem is out in the open and that their family will no longer enable them, the addict virtually always agrees to keep coming in for sessions with their family and to continue talking about their problem. Once this happens, and it may take many weeks to get to this point, a comprehensive course of family system treatment can commence.
What about the addict or the codependent who refuses to attend? This has happened only a few times in my 25 years of practice. In those situations, I’ve worked with the other family members who are ready to recover from this systemic disorder.
The true nature of addiction
It is critical to understand that addiction is defined as a medical disease.
Addiction is a chronic, relapsing, but treatable brain disease. An addict, on their own, is unable to stop their addiction. Almost always, they need to have an experience of “hitting bottom” – a time when they realise they absolutely cannot continue living the way they have and they must do something different. By utilising the FRT model, the addict is likely to hit bottom much sooner; when the family recovery therapist, working with the enablers, stops their active enabling, it raises the addict’s bottom. With the FRT’s help, the addict will come to accept the problem they have been denying and follow the suggestions for recovery.
Larry Fritzlan is a licensed marriage and family therapist, a certified addiction therapist, and a board-certified intervention professional. His new book is Addiction Therapy and Treatment: A Systems Approach