RHIZOME CONNECTIONS
Comprehensive Mental Health & Addictions Services
CENTER FOR DIVORCE TRANSITION
Dean C. Wolf, LCSW-C
Licensed Clinical Social Worker
(410) 876-3030
202 E. Main Street 20 Pleasant Ridge Dr., Suite H 304 York Street
Westminster, Md. 21157 Owings Mills, Md. 21117 Gettysburg, Pa. 17325
Family Centered Recovery Monograph
Narrative
Drug and alcohol addiction has long been considered a “family disease” impacting in
devastating ways on individuals, families and significant others who become entrapped
by the addictive process. The insidious process of addiction has significant emotional
and physical consequences and inflicts untold suffering for millions who succumb to the
effects of what many consider an epidemic in the United States. It has been estimated
there are approximately 30 million people addicted to alcohol and drugs in our country
however, it is likely the statistic is grossly underestimated, especially if you take into
account culturally co-existing addictions to tobacco, gambling, sugar and food, sex and
pornography and others. Further, the statistics regarding addiction do not reflect the
extent to which families and their natural extensions such as parents, grandparents,
siblings, uncles, aunts, cousins, friends, neighbors, employers and the community at large
are adversely affected and impacted upon. In that regard those who become connected to
the “addictive process” themselves become sufferers and jailed by the effects of this most
complex and challenging problem.
The process of addiction is one in which family members and significant others often
become entrapped by the repetitive patterns of destructive substance misusing and
attendant problematic behaviors by their loved ones. Family members and significant
others become inducted into patterns of “enabling” and “co-dependent” behaviors
themselves as they struggle to find ways to address and challenge the destructive path of
their loved one. Inadvertently these behaviors serve to maintain the problem as family
members and significant others in their often heroic efforts to support their loved one
become increasingly connected to the addictive process through rescuing, overprotection
and capitulating to irresponsible behaviors. In other circumstances there are in many
families “co-addicts” who themselves are caught in an addictive process and
unfortunately inhibit change in their loved one by supplying and engaging in substance
misuse with them. In this context and amidst their frustration, disappointment, feeling of
impotence and lack of authority to escape from the addictive process families seek help
for their loved ones from inpatient residential rehabilitation programs, hospital programs,
community based outpatient treatment centers, addiction medicine specialists and the
like.
Okomentoval(a): [PN1]: Do you know the work of Karl
Tomm from Calgary? I found especially his “interactional
patterns” framework very inspirational. It is very relational
way of understanding what is happening in the family
interactions and at the same time, it inherently says that the
substance use cannot be considered an individual problem...
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The dominant practice for the treatment of substance misuse and addiction in diverse
treatment settings in the United States is to focus on the individual as the unit of service
and intervention. Primarily individuals referred for treatment in residential rehabilitation
programs and community based outpatient programs are placed in group therapy,
encouraged or mandated to attend self- help meetings (Alcoholics Anonymous/ Narcotics
Anonymous) regularly, placed in education programs regarding the dangers and
consequences of substance misuse and when appropriate prescribed drugs to cut down on
the desire or craving of the drug of choice. Families may be involved in various ways in
the treatment process including providing “family education” that may include signs and
symptoms of addictive behavior, treatment options and avoidance of enabling behavior.
However, it is very rare in this country to find inpatient and community based treatment
centers that have primary family treatment components or who significantly integrate
family therapy in their continuum of service. Families are advised their substance
misusing loved one is unlikely to change unless they are “motivated” or “ready to
change” and “there is nothing family members can do until their loved one hits “rock
bottom.” I have worked in the mental health and addictions fields for over forty years
and have spoken with and treated thousands of individuals and families impacted upon by
the addictive process. Family members shared with me over these many years with few
exceptions they were told by helpers there was nothing they could do to influence the
course of addictive behavior in their loved ones except to stop engaging in enabling
behavior. Families report the advice they most often receive is to either cut all ties with
their substance misusing love one or throw out of their home. Further, with the same few
exceptions families uniformly report no effort was made by treatment professionals to
assess their suffering and to offer family therapy as part of the overall treatment plan or
approach. The perception and experience of families seeking help for their loved ones is
their voices were not heard and they felt “left out” of the treatment process
Description of Family Centered Recovery
Family Centered Recovery was developed over many years and integrates research
evidence, practice experience and the common sense notion that involving families and
natural support systems in a significant and central way whenever possible in the
treatment process is likely to yield better outcomes. There are many advantages to
assigning families major roles and responsibilities in assisting their loved ones along the
path of recovery. I will describe this in the following section of this description. The
theme of family centered recovery is to enlist family members and their natural supports
and social networks as “change agents.” In general the family is empowered by enlisting
their participation and support in every aspect of the treatment process including
assessment, intervention, treatment, planning and management. The family and its social
network is activated to identify patterns of substance misuse and actively plan and
intervene, support and challenge patterns of addictive behavior and to attend the suffering
of all family members and significant others impacted by the addictive process. For
example, in many families drug screens are taken by a family member as an
empowerment tool for accountability and enhancement of responsible behavior in their
substance misusing love one.
Okomentoval(a): [PN2]: In Czechia, I would say, it is “the
only practice”:-) I am in correspondence with a couple where
the guy is a recovering opiates user and they moved from
Brno to London recently. He had a relapse there and entered a
Drug and addiction program. His wife was shocked when the
person from the program called her the next day, whether she
is OK, whether she needs something, she offered her some
services and groups too.. She said: “this could never happen
in Czechia”.
Okomentoval(a): [PN3]: Yes, exactly this is the point. The
relationships should be in the center of the service....
Okomentoval(a): [PN4]: Again, I believe Karl Tomm´s
notion of IP´s might be useful here. I have experience that
people understand this theory quite well and they can start
identifying pathologising interactional patterns themselves
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The family and social network may be charged with the responsibility of developing
rules, guidelines and expectations for their loved one and his/her behavior and to promote
pro-social and functional behavior. Families at the center of this recovery process learn
to assume functional roles with their loved one and to separate themselves from the
addictive process while remaining connected to their loved one in more productive ways.
If their loved one is hesitant, resistant or not ready to change the family and its social
network can be engaged even without the participation of the loved one. Families learn
how to precipitate crisis if necessary and by challenging addictive behavior in new ways.
The power of the clan or tribe if you will is catalyzed to support and challenge their loved
one so as to promote and sense of hope and optimism that change is possible after what is
often been years of individual and family suffering.
Family Centered Recovery is a consumer driven practice where families are
considered experts on their own realities and pathways for change are self-determined.
This practice does not supplant but is an alternative to the dominant practice in our
country where professionals are central to the process of assessment, intervention,
treatment and planning. Families have an abundance of expertise and through collective
efforts are likely capable when empowered properly to exert influences on the addictive
process of their loved one in ways not ordinarily considered by treatment programs that
have an individual treatment outlook. Further, family members and social networks are
likely to be involved with their loved ones over the life span and if empowered properly
provide a naturally sustainable support system for recovery over time.
Family Centered Recovery is certainly not a cure for addiction and may be considered
as part of a continuum of services or a freestanding modality and can easily be integrated
into other variations of treatment. The approach may not be preferred or appropriate in
every situation. In a field that clearly states that addiction is a “family disease” it would
seem sensible to turn our attention and resources to an epidemic problem that impacts so
significantly on families, natural supports and our communities. Family Centered
Recovery embraces the idea that suffering brought on by the addictive process is
connected not only to individuals but to families, natural supports, social networks and
communities and therefore is a collective/communal problem that is best turned around
through collectively constructed solutions.
Advantages & Benefits of Family Centered Recovery
• Research and practice experience clearly indicate that high levels of family
involvement in treatment and intervention of substance misuse yield better
outcomes in recovery processes
• Family expertise and involvement enhances and widens possibilities for
assessment, intervention and treatment planning
• Family involvement provides a context for relapse recognition, prevention
and management
• Families, natural supports and social networks provide a more sustainable
structure for long term recovery in that they will often stay connected to their
loved one over a lifetime long after treatment professionals terminate their
involvement
Okomentoval(a): [PN5]: This makes sense to me since I
have the experience that talking about rules and guidelines
can bring immediate relief even in very complex situations
Okomentoval(a): [PN6]: Very encouraging! Have you
tried to involve another recovering addict in the family
meeting? Just an idea how to support the hope and
optimism...
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• Families that are empowered properly can move from a position of enabling
and co-dependence to that of “change agent” in supporting and challenging
patterns of substance misusing behavior
• Family Centered treatment recognizes, attends and intervenes in the suffering
of all family members and significant others affected by the addictive
process
• In situations where loved ones are hesitant, resistant or not ready to change
families and their social networks can be instrumental in challenging the
addictive process of their loved one and inspiring them to accept change.
• Loved ones who have hurt and offended family members by substance
misusing behavior have a direct opportunity to make amends and re-build
bridges with their families and significant others, an essential element for
healing in the process of recovery
• Family Centered Recovery has an inherent prevention component in that
working with families allows for early recognition/intervention on behalf of
other family members who may be vulnerable to the addictive process
• Family members identified as co-addicts and substance misusers who tacitly
support and reinforce substance misusing behavior in their loved ones have
been shown in research and practice to be willing to modify or work toward
abstinence when called upon as a sacrifice to help a loved one get clean.
• Organizing and assembling family members, natural supports and social
networks such as parents, grandparents, uncles, aunts, cousins, siblings,
spouses, children, friends, neighbors and significant others provides a
powerful context for supporting, challenging and intervening in the addictive
process (See description of Family Network Therapy)
• Family members uniformly and frequently report that their central
involvement in the process as outlined engenders hope, optimism and
renewed energy for change in that they become contributors and an integral
part of turning around substance misusing behavior in their loved ones
Description of Family Network Therapy
Family Network Therapy was founded and developed in the 1960’s by Ross Speck,
M.D., a psychoanalyst and family therapist and Carolyn Attneave, Ph.D., a Native
American Indian Clinical Psychologist. Originally Speck and Attneave conducted
“family networks” with individuals who had been labeled as “schizophrenics” and their
families. The family network practice has been revived and adapted to working with
substance misusers and their families as well as complex crisis situations and cooccurring
problems (mental health/substance misuse/addiction) and has become an
integral component of Family Centered Recovery.
In Family Network Therapy an assemblage of family members and their social
network is convened for the explicit purpose of addressing issues related to the complex
web of problems associated with the addictive process of a loved family member or
significant other. Family Network assemblage may include but is not limited to the
substance misusing loved one, parents, siblings, spouses, birth children, significant others
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such as boyfriends/girlfriends, uncles, aunts, cousins, friend, neighbors, pastors/minister
and members of faith communities/churches, employers, co-workers. Generally speaking
networks usually vary in size ranging from about 12 to 40 or more participants and are
most frequently conducted in a home setting.
A central feature of Family Network Therapy is to identify and activate family
members and their social network and to enlist them as “treatment or change agents” in
influencing the course of the addictive process and its deleterious effects on all family
and network members. The substance abusing family members is invited to the network
meeting but it is not necessary he/she attend in order for the network to do its work. In a
network meeting the family and social network with or without the participation of their
loved one identify problem areas and begin to construct pathways for change that
addresses concerns and suffering associated with the addictive process the family has
been immersed in often for many years. The activation of this process is called the
“network effect” in which there are predictable stages the network members move
through in order to make the necessary breakthroughs in changing addictive behavior
processes. The network may develop rules, guidelines and expectations for behavior of
their loved one, set boundaries on their substance misuse behavior, develop and
implement accountability measures that enhance responsibility, address job and financial
issues, develop measures to monitor substance misuse and to promote pro-social and
functional behavior. Family members may be challenged regarding enabling, codependent
behavior and supportive suggestions made to resist the pulls of the addictive
process. If other family members are themselves going through an addictive process the
network often grapples with how this may impact on their loved one and take steps to
challenge the co-addict to make significant changes in his/her substance misusing
behavior. In these social networks it is usual for many family and their natural supports
to be experiencing considerable suffering having been exposed for many years to an
addictive process and the attendant stress, anxiety and depression that so often
accompanies their journey. Family Networks in identifying these dynamics take steps to
help ameliorate the suffering of network members, including children and assist them in
escaping from the negative influences of the addictive process.
Family Network Therapy is a facilitated process conducted by a qualified professional
that may require the participation of more than one facilitator especially in very large
network groupings. I have personally conducted hundreds of such meetings over the last
several decades. The task of the facilitator is to guide the network through a series of
stages that ultimately help family members and significant others as well as the substance
misusing family member to reduce harm and suffering attendant to being connected to
the addictive process. Family Network Therapy meetings may be scheduled weekly,
monthly, on a one time basis or at any agreeable interval as desired by the network.
Family Network Therapy may be a stand-alone intervention or part of a continuum of
services that may include individual and group therapy, family therapy, participation in
self-help meetings, medically assisted therapy and substance abuse education.
Family Network Therapy may be distinguished from what is traditionally called an
“intervention” where family members, usually no more than a handful meet with their
substance abusing loved one to influence him/her to accept treatment usually in an
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inpatient rehabilitation setting. In Family Network Therapy the family and social
network assumes the position of “treatment agent” with the goal of supporting and
maintaining their family member in the home and community. Relying on family
expertise, empowerment and placing responsibility and trust in families and their social
networks to influence the course of the addictive process is a departure from traditional
pathways for change in our culture where professional expertise dominates practice in the
treatment of addictive processes.
Family Centered Recovery was developed to address what appears to be a major gap in
the service continuum in the field of addictions treatment and intervention, in particular
involving, empowering and entrusting families to be an integral part of assessment,
intervention, planning, decision making and treatment in working with addictive
processes in their substance misusing loved ones. Further the development of Family
Network Therapy enhances those possibilities for changing patterns of addictive behavior
by enlisting and unleashing the powerful forces of connection and relationship to address
the suffering of all family members and significant others who are impacted by the
addictive process. I welcome your thoughts, feedback and wisdom from families and the
professional community as to how this methodology may be beneficial and helpful in
addressing and combating this most complex and challenging epidemic problem we are
facing in our communities.
Dean C. Wolf, LCSW-C
Founder/Director, Rhizome Connections
Licensed Clinical Social Worker
States of Maryland & Pennsylvania
Board Approved Clinical Supervisor (Maryland)
For further questions or inquires please contact Dean Wolf
Office phone: (410) 876-3030
E-mail: baurwof@qis.net
Okomentoval(a): [PN7]: this is important to distinguish