Family members develop coping strategies to deal with the turmoil created by the addict's behavior. They might learn to withdraw in response to the addict's changing moods and erratic activity. The family learns to make excuses and even to cover up for the addict. On one level family members feel frustrated, defeated, lonely, responsible and even guilty. On another level, secrecy and avoidance reign. When the addicted individual gets treatment, the family is so used to the struggle and purpose it had when the family member was using that it unconsciously wants to return to the way it was before the individual got sober.

The family can be one of the most powerful tools to help people to change. So why isn't the family accessed more by the drug and alcohol treatment professional, or at least accessed more effectively? Why is it that some treatment programs see the family as more of a nuisance than help? The interventionist (Johnson Model) typically helps the family only until they get into treatment. Family therapists typically work with family issues and marital problems, but do not work on the family as a whole and how the addicted individual affects the family unit. Treatment facilities typically help the family only while the addicted individual is in treatment. There is usually very little ongoing help toward achieving family recovery.

Newer intervention approaches

The systemic model interventionists offer more help to the family by engaging the whole family into treatment. In this newer model of intervention, developed and refined over the past 15 years by interventionist Wayne Raiter, the focus is on family and friends. Systemic Family Intervention© involves a process of changing the maladaptive relationships that have inadvertently allowed, and sometimes even encouraged, the addicted individual to continue his/her behavior.

As the family develops new boundaries, the addicted person sees the need to change as well. As part of the process, everyone involved learns about addiction. Because Systemic Family Intervention involves the person's entire support system (family, friends and sometimes co-workers), all the means through which the addict sustained his/her behavior are no longer in place. The addicted individual moves into a new environment that insists on change in him/her as well. With the addicted individual's entire support system involved, the means through which the individual previously sustained his/her behavior are no longer available. The addict is pulled into the change process.

This is a great approach, but it usually does not continue after treatment. The family is encouraged to go to family therapy and Al-anon, but many times these do not achieve enough to sustain lasting change.

The best intervention approach that includes the family is The ARISE Intervention (A Relational Intervention Sequence for Engagement). “Invitational Intervention” invites the addicted individual to participate in the intervention process. There are no secrets, surprises or ambush. Everyone involved is treated with dignity and respect. The ARISE model uses the addicted individual's support system to motivate the individual into treatment. The ARISE model helps families, organizations and communities deal with issues such as a variety of addictions; mental illness and treatment; resistant elders and long-term care; and HIV/AIDS and treatment.

This model uses Family Motivation to Change, utilizing the love, strength and wisdom of families, friends and co-workers to become a supportive ARISE intervention network. This network overcomes the denial, helplessness, blame and guilt and it counters isolation and reconnects families, engendering a sense of competence and renewing hope in their future. The ARISE model follows the addicted individual's family through treatment and up to six months after treatment. This model gives the family a good start at recovery.

Additional family assistance

With the Family Motivation to Change in mind, the family could use additional support as it moves through the recovery process with the addicted individual. The family needs assistance that would resemble help often available to the addicted individual through employee assistance programs (EAPs).

For more than 50 years there has been EAP support for employees who have a drug or alcohol problem; more recently, there also has been a focus on personal recovery assistants (PRAs) who reinforce the foundation gained in a structured treatment environment. The PRA returns with the client to his/her natural environment, moving into the home for a designated period and mentoring the client as he/she navigates that precarious time between leaving treatment and establishing a healthy routine as a recovering person. PRAs also are known as sober companions or sober coaches.

In the spirit of EAPs and PRAs the family could use a family recovery assistance professional (FRAP). This person would help the family to navigate through recovery for up to 12 months after the addicted individual enters treatment. It is known that in the process of recovery the addicted individual might relapse several times before achieving abstinence. The FRAP would assist the family through the process and would help with interventions or a positive family interaction as needed.

The FRAP, which is mainly a theoretical construct in the field at this time (I have used the techniques in my own practice), would become like a family case manager, assisting in developing a family development plan, a positive interaction agreement, and a family action plan. The FRAP might act as a liaison between the addicted individual's treatment provider and the family's therapist. The FRAP also would encourage the family to take care of its recovery by attending Al-anon meetings and family counseling. The FRAP might meet with the family in person, on the telephone or electronically. Services could be charged on a flat rate or hourly.

The FRAP would help the family create a family development plan, outlining steps the family should take to work toward furthering the family's recovery. Just as the family had its expectations and roles before the addicted individual got help, the family development plan would help develop new roles and guidelines for the family now that it is in recovery.

A family development plan allows the family to identify specific problematic issues, as well as thoughts, feelings and experiences with the issues. An example of an identified problem might be, “We get very stressed because no one communicates in this family.” It then moves the family to identify a goal. In the same example, the goal might be, “We want to be able to communicate better and reduce the stress within the family.” Finally, it helps the family decide how to deal with those problematic issues and reach its goal. In this example, this might involve the entire family meeting every Wednesday night at 8 p.m., with the expected attendees formally listed.

As family members decide on the problems and issues they want to resolve with their family development plan, the family can choose more than one. The problems don't have to be as specific as those cited in the example. The family might have specific problems with concrete ways to work them out, or the family might have broader issues, such as fighting with a spouse or parent, that need to be tackled from various angles.

Sometimes pinpointing the problems, as well as where the family is mentally and emotionally in life, can be difficult. In these cases, a “family action plan” is a preset plan of action to execute if the family is in turmoil. For example, if the addicted individual relapses, the family has a plan of action. The plan will consist of a pre-structure plan (warning signs) and crisis action planning (CAP).

There are external events or circumstances that, if they happen, might cause a family crisis. These are normal reactions to events in the family's life, but if family members don't deal with them in some way, they might actually cause the family to regress or deteriorate. The family will write down those things that, if they happened, might cause an increase in problems within the family, and also make a list of warning signs that the family has noticed in the past.

In spite of the family's best efforts, its problems might progress to the point where they are serious and even dangerous, but it is still able to take some action and would involve the FRAP and other professionals as needed. The names and contacts and under what conditions they would need to be called to assist will be laid out in this plan as well. This is a very important time. It is necessary to take immediate action to prevent a family crisis.

This is when CAP comes into play. This is a detailed plan that gives a step-by-step process to the family in a time of crisis. This plan will help keep the family stabilized even when it seems like things are out of control. The plan should be developed carefully and should include the following:

• Problems or situations that are considered a crisis for the family;

• Who is involved and would want to take this action;

• Treatment approaches, facilities and professionals that the family wants involved during and after the crisis;

• Actions that other family members can take that would be helpful;

• Actions that should be avoided by the family; and

• What role the family wants the FRAP to play in the crisis.

After any crisis, the family should get together with the FRAP to debrief.

Another feature the FRAP will facilitate is regular meetings with the family, with the psychoeducational component built in. Among the topics that with a worksheet can be covered during the psychoeducational meetings are addiction facts, a family alcoholism quiz, signs of intoxication, communication skills, defense mechanisms, family roles and characteristics, rating the family, enabling behaviors, characteristics of codependents, and building self-esteem.

This is a comprehensive service created to supervise and support a continuing care plan. This extended service assists in identifying additional clinically appropriate recovery resources such as outpatient programs, physicians and therapists in the family's community. The service provides support for the family's personal responsibility and accountability using the skills acquired during the continued recovery process. Every family's plan is based on family history, progress, and either an identified continuing care plan or the need to develop one.

The FRAP's concern is always the family's health and well-being. The FRAP must develop a strong bond with the family and keep moving the family forward in its recovery. The FRAP's goal is to provide professional oversight and support to the family as it transitions through its recovery process. With such a comprehensive plan the family can restore its life and improve the quality of life for all of its members.