The Dilemma for Families Affected by Addiction

Martin was a 22-year-old son who lived with his parents. They loved him, but were equally frustrated with him. Martin would borrow the family car to “run out briefly” for cigarettes. However, he would end up on a cocaine binge with the car for three days inconveniencing and worrying his family. To add insult to injury, he would sneak back in the house and sell the family silverware to buy drugs. Finally, so fed up, they set a limit: if it happened again, they would change the door locks, and he would not be able to live at home any longer.

Martin was “good” for a month, and the parents were hopeful. Then it happened…again. True to their limit, they changed the locks while he was away. Two days later, Martin banged on the door and wanted to get in. His parents were firm and would not open the door. But then they slipped him under the door, the keys to the family yacht to sleep at the boat marina. All their good intentions to set a limit melted in the midst of parental concern for his safety. It is not easy for families to find the balance between making or breaking addiction denial.

A Different View of Denial and Resistance

Rather than thinking of people as being resistant or in denial, it is more productive to remember that resistance is an interactional process. It is best seen as an opportunity to understand a person’s stage of readiness to change and to respond accordingly. Helping families understand stages of change provides them the structure to actually live the Serenity Prayer more effectively — to be able to know what they can change and control; and what they cannot change and should let go of.

Understanding Stages of Change in Families

The identified client and the family are usually at different stages of change. The parents are ready for their son to be more responsible and in recovery. The drugging as he still has a roof over his head, food in his belly, and money in his pocket — compliments of his parents’ hard work. So to ensure a common language on stages of change, here is a brief review of a one model of stages of change, the Transtheoretical Model of Change (Prochaska, Norcross, and DiClemente, 1992, 1994).

Pre-contemplation is not yet considering the possibility of change although others are aware of a problem; could benefit from non-threatening information to raise awareness of a possible “problem” and possibilities for change.

Contemlation is ambivalent, undecided, vacillating between whether he/she really has a “problem” or needs to change; motivational strategies are useful, but aggressive or premature confrontation provokes strong resistance and defensive behaviors.

Preparation takes the person from decisions made in the contemplation stage to the specific steps necessary to solve the problem in the action stage; certain tasks make up the first steps towards action; planning to take action within the very next month. Action to bring about specific change; overt modification of behavior and surroundings; support and encouragement are very important to prevent drop out and regression in readiness to change.

Maintenance sustains the changes accomplished and prevents relapse; not a static stage and lasts as little as six months or up to a lifetime; replace problem behaviors with new, healthy life-style.

Relapse and Recycling are expected, but not inevitable setbacks; learn from relapse; comprehensive, multidimensional assessment to explore all reasons for relapse.

Termination stage is the ultimate goal when a person exits the cycle of change, without fear of relapse.

Applying Stages of Change to Families

To outside observers, it seems obvious that Martin should see what he is doing to his family. How could he not know that his behavior is totally irresponsible and that he needs to accept his addiction and embrace recovery? But Martin is at a pre-contemplation stage or at best in the contemplation stage. While his parents continue to fund, feed and support him, he genuinely does not experience any problems with his drug use.

Similarly, it seems obvious that the parents should see how they send mixed messages to Martin. They ban him from returning home, yet give in and let him stay on the family boat. How could they not know that they are enabling and that their inconsistent limit-setting increases his denial? This is where understanding stages of change can help to compassionately join both parents and Martin. It is not that they are resistant or in denial. It is just that they are ambivalent about how to set a limit but risk losing the love and safety of their son.

Helping people change involves a process that honors the stage of change in the client/family. Starting there, the counselor’s task is different for each stage of change. The guide below points the way to focus the work (Miller and Rollnick, 2002). Families in Recovery

When families see a loved one driving, as it were, towards the cliff, it is hard not to jump in and rescue him or her. It is even harder to healthily detach and let the natural consequences of one’s actions happen — whether that is to spend the night in jail; or get kicked off the football team because of poor grades. Helping families know when and how to intervene; what limits to set and what behaviors to tolerate or not can go a long way towards helping families to recover. Even if the identified client is not ready to embrace recovery, the rest of the family can begin to have a life of their own. When counselors help families embrace recovery for themselves, the change in the family dynamics just might bring recovery to the identified client. Working with families to understand the difference between making and breaking denial is the difference between attracting families into recovery; or dooming them to continued rescuing and frustration.

References

Miller, W. R. and Rollnick, S. (2002). Motivational Interviewing — Preparing People for Change. (Second ed.) New York, NY: Guilford Press.
Prochaska, J.O., Norcross, J.C., and DiClemente, C.C. (1994). Changing For Good. New York, NY: Avon Books.
Prochaska, J.O., Norcross, J.C. and DiClemente, C.C. (1992). “In Search of How People Change: Applications to Addictive Behaviors.” American Psychologist, 47, 1102-1114.