Disorders in wealthy families: Cutting them off doesn`t work

While most treatment professionals acknowledge that addictive disorders don’t discriminate based on socioeconomic class, too few are able to negotiate the unique dynamics that arise in the context of ultra high net worth (UHNW) families. This unfortunate trend continues in spite of evidence indicating these families suffer from addictive and mental health disorders at astronomical rates. A recent study by Campden Wealth, one of the world’s most prestigious financial services companies, found that of the families it serves, 71% have an addictive or mental health disorder.

To combat the destruction that accompanies these afflictions, families must intervene in a way that is embraced by the person needing help. In this article, I will discuss how wealth can be used to motivate patients rather than push them deeper into the clutches of their disease. Through this approach, patients will enter treatment with the proper state of mind and motivation to maximize their long-term success after being discharged.

The problem

All UHNW families know there is no shortage of people outside their system eager to comply with their financially incentivized requests and well-intended directives. Within the family, however, a different story is frequently told. This is most pronounced when what is being addressed is an addictive disorder.

Think of the son who wrecks the family car in a drunken binge and, when the family insists he seek help, escalates his drinking. Or the daughter who becomes addicted to prescription pain medication after suffering a sports-related injury and, in response to the family’s interventions, falls into the deadly clutches of heroin she buys on the street.

Unsuccessful in their attempts to address the problem from within, UHNW families often seek the advice of outside treatment professionals who advise that they leverage financial resources and “cut off” the afflicted family member. While powerful and effective in the short run, such a strategy sabotages the patient’s long-term success and causes a destructive backlash.

To understand why this dynamic exists, we must look at the groundbreaking work of University of North Carolina Professor Alison Fragale. She found that to be effective, power must be asserted with status. Fragale defined power as “the extent to which an individual can control others’ outcomes by granting or withholding valued resources.”¹

According to Fragale, status is “the extent to which an individual is respected, admired and highly regarded.”¹ Power exerted without status will cause the person acted upon to respond in ways that punish the person asserting the power.

And money holds great power.² This is especially true among UHNW families, where gatekeepers such as parents and trustees have the discretion to grant or withhold other family members’ wealth. Regardless of how benevolent the arrangement was intended to be, this financial reality is a fertile ground for a host of negative reactions and unhealthy dynamics. At the top of the list are resentment of the gatekeeper’s power and fear on the part of beneficiaries that absent their wealth, they would be unable to survive in the world on their own.

When the dependent person has an addictive disorder, these dynamics become intensified. Therefore, any financial interventions intended to motivate a patient must be executed through the respect and regard of the human being that lies deep within the veneer of the patient’s symptomology. Such an approach will imbue the family member exerting the power with enough status to avoid a backlash and allow the patient to take ownership of his/her life.

But over the years, I’ve witnessed ill-advised UHNW families use the power inherent in their wealth to force a member afflicted with a substance abuse disorder into experiencing highly ineffective results. Instead of collaborating with the patient in ways that allow the person dignity in care, they shove their demands down his/her throat. When the patient vomits them out, they double down even more and in so doing, push the patient further away from the family and deeper into the clutches of the disease and the malignant relationships that support it.

Just over a year ago, I had the privilege of working with a UHNW family from the United Arab Emirates that utilized the services of a well-respected American interventionist, with emotionally damaging and financially wasteful results. (The identifying details of this case have been altered to protect the family's confidentiality.) The family approached me after paying a U.S. treatment center close to $200,000 to babysit their son for 75 days. While physically present in the program, the son refused to sign the proper releases, fell asleep in group, and failed to engage with his primary therapist. The patient, a 47-year-old whose $125 million dollar trust was ruled over by his 83-year-old father, suffered from an addiction to prescription opioid medications and was morbidly obese. He also happened to be a gay man whose “lifestyle” was disapproved of by his father and several other family members.

Over the last decade, the family had intervened on the patient on three different occasions by cutting off his funds and insisting he was a “sick man” who needed “curing.” The patient would comply with family members' requests to regain access to the funds, but soon after being out of treatment he would return to his destructive and disapproved ways. In the process, the family wasted precious emotional, relational and financial resources, calcified their differences and painted the son into a highly shaming corner. Furious over being robbed of his dignity and for being expected to act like an adult in the wake of being treated like an errant adolescent, the son acted out in hostile and self-destructing ways, constantly creating chaos.

The solution

In order to transcend the destructive relational pattern between the family and the son, I joined with the family in a way that enabled members to see the objective facts related to their dynamic and step back from its emotional reactivity. The goal was to give each family member the sense of being seen and heard as a human being rather than an object to be manipulated.

In more concrete terms, the father needed to stop being seen by the son as an ATM whose sole purpose in life was to fund his son's existence, while the son needed to stop being seen as an errant child whose existence tarnished the father's gild. Toward this end, I helped the father understand that his threats to cut off his son forced the son to act out in punitive, albeit self-destructive, ways. With the son, I worked to show him how the chaos and crisis he was constantly creating caused his father to deepen his beliefs that his son was fatally flawed.

I entered the system through the father, the person who held the most tangible power, and reduced the situation to language he could understand and in which he had a history of success. While the father lacked language to describe his emotions, he was incredibly adept at understanding the language of finance. Accordingly, we started with an accounting of the staggering amount of money he had spent effectively locking up his son in a legion of elite treatment centers around the globe. From a return-on-investment perspective, he was embarrassed to see that the money was not well spent, and in this awareness he became willing to consider modifications in how he viewed and treated his son.

Once I connected with the father, I began my work with the son to enable him to see that he would be well-served to begin acting like an adult and assuming responsibility for his behaviors. Fortunately, over the course of several lengthy meetings, both members of the family gained enough insight to relax, if ever so slightly, their entrenched patterns and agree to try something different.

The “different” the father agreed to try was to bring his son into the dialogue of his treatment as a responsible adult who was allowed a voice in his care. He also agreed to stop the ridiculous charade of “cutting off” a middle-aged son who had never worked a day in his life and was worth $125 million. The first attempt at different was easier than the second. This is because money and the way it flows through UHNW families is too often their primary vehicle of communication.

In this case, although he vehemently denied it, the father had manipulated the son’s finances to punish him for his lifestyle, justifying his actions based on the son's financial “irresponsibility” and “constant manipulation.” Several months into treatment, the father was able to see that he had never allowed the son any financial autonomy and was profoundly disappointed and angry that his son had taken a non-traditional path. The son in turn punished his father for this manipulation by escalating his non-acceptable behavior.

Fortunately, allowing each party to calibrate on a realm of status ameliorated this unhealthy pattern. While the father and son never will see eye to eye, they were able to articulate this truth and unite in it. They finally saw and felt the archetypal reality of the parent-child relationship: Disappointment exits, but love prevails.

It took nearly five months, but the son returned to treatment. The facility he chose was not one that his father would have, but it was one that gave the son the loudest voice in his treatment. The father also agreed to stop threatening the son with a financial cutoff, and we fashioned a financial plan for the son that allowed him to live a life cushioned by his wealth, but with plenty of room for aspiration.

The situation, while far from perfect, has vastly improved. The son just celebrated six months of continuous sobriety and has lost nearly 35 pounds. Instead of using his “allowance” to buy opioids and prostitutes, he’s allocating his capital to invest in a website for Palestinian women to photo document the trauma of their lives.

The father still struggles with his son’s choices and disapproves of the way the money is being spent, but he understands the consequences of his reactions. Most important, both family members understand the dynamics inherent in the different forms of power they possess, and before acting out they look within to imbue their actions with status.

Paul Hokemeyer, JD, PhD, is a family and addictions therapist who works as a clinician and patient advocate to elite individuals and families around the world. His research and experience is the subject of a book to be published by Hazelden Publishing in the summer of 2018. In addition to maintaining a private clinical and consulting practice, Dr. Hokemeyer is Senior Clinical Fellow at Caron Treatment Centers. He can be contacted at drpaulnyc@yahoo.com.

References

1. Fragale AR, Overbeck JR, Neale MA. Resources versus respect: Social judgments based on targets' power and status positions. J Exp Soc Psychol 2011;47:767-75.

2. Hokemeyer PL. Treating wealthy patients and their families: A guide for competent psychotherapeutic care. J Wealth Management 2012;15:9-11.