Engagement Specialists, Family Play Critical Roles in Recovery

When it comes to conversations around the best treatment options for substance use disorders (SUD), professionals spend a lot of time debating between medication-assisted treatment and abstinence-based approaches, among others. While both of those—and several others—are highly effective, there are more significant issues that society needs to address first.

One is the number of overdoses reported during last year’s COVID-19 pandemic. Up almost 30% from 2019, 2020 saw a staggering 93,000 overdose deaths in the United States. One of the big myths of SUD and recovery is that person with SUD must “hit rock bottom.” Why? You wouldn’t expect a person with diabetes to go into a diabetic coma before dealing with their health issue.

Again, what’s important is staying alive, and we know that the rock-bottom theory contributes to increased deaths, especially in this age of fentanyl and carfentanyl. The truth is there are as many paths to recovery as individuals struggling with SUD. What’s most important is recognizing there is an issue and developing a plan to address the issue. 

A Non-Traditional Approach to Recovery

As healthcare professionals, we know 90% of individuals who struggle with SUD don’t seek recovery for 3 general reasons: fear, stigma and not wanting to admit they have a disorder. When someone struggling with SUD hears the word “recovery,” they automatically assume that means they need to go to rehab, but that’s not necessarily true. An astounding 46% of people reported that they were able to reach SUD remission on their own. Even though that’s a promising number, keep in mind that the more severe the substance use disorder, the more likely the individual will need professional support.

Instead of focusing only on the traditional approach for recovery, it’s essential to outline what a non-traditional approach looks like. One such online program, Heritage CARES, has taken an approach to recovery that has already demonstrated sustainable results. This virtual program has three modules: trained, engaged recovery coaches; an online, on-demand video resource library; and a managed care assessment portal.

The model was involved in a 2020 study conducted by Clemson University, Prisma Health, University of South Carolina School of Medicine and FAVOR-Greenville. The study found that “SUD is a chronic, relapse-prone disease, and the most critical factor for predicting improvement at 5 years post-discharge is ongoing engagement (Weisner et al., 2003).” Over a 6-month post-discharge period, 84% of the participants stayed on track with a recovery coach vs. 34% of the participants who received a traditional standard of care without a coach.

Research has shown that if people engage in treatment AND recovery, they will get better. Staying engaged with a recovery plan is crucial, though. According to the Journal of Drug and Alcohol Dependence, for example, abstinence-based opioid use disorder programs see a whopping 85% dropout rate.

It’s worth clarifying that SUD isn’t simply a “bad habit” or “bad behavior.” It truly is a neurological condition that won’t just go away on its own. Over time, it becomes uncontrollable and irrational, something the individual becomes dependent on. SUD affects nearly half of all Americans, either directly or indirectly. In fact, 46% of Americans either struggle themselves or have a close friend or family member that struggles with SUD (SAMHSA). And 18% of workers also go home to addiction every single day (Gallup).

How the Family Fits Into Recovery

Another critical topic to address is how a person’s family fits into their recovery journey. Because SUD directly and profoundly impacts a person’s family, loved ones should be involved in the recovery process from the beginning. The only reason to exclude them is if it would prove detrimental or dangerous for the person needing recovery or any family member.

Many times, an individual’s recovery starts with a family member. Having worked in behavioral health and SUD recovery for 20 years, I’ve seen many family members begging for help and options at my practice. SUD profoundly impacts families. The work is hard on both sides. What does that look like?

• Recovery programs need to include family care as a component of SUD recovery and affordable – if a program you’re looking at only deals with family recovery during a two-day weekend, keep looking. There are many issues family members deal with, and sweeping those emotions under the rug is a mistake that will also affect the individual struggling with the SUD. Instead, family members should create their own plan and work it right alongside their loved one.
• Family recovery is a unique process that should be guided by “family systems theory.” It is a primary intervention, not an add-on or afterthought, and it’s not limited to traditional avenues of “detach with love” and “tough love.” Professional family recovery will individualize services and interventions to the family instead of a mirror or approximation of Al-Anon family group meetings.
• Programs should not be dependent on the addicted loved one’s recovery status. They should universally offer family recovery programming. The addicted individual’s recovery status may influence the specific support provided. However, families should have access to professional family recovery support even if the addicted individual is disengaged.

The family has tremendous power that can be harnessed and focused in a way that increases the likelihood their loved one will seek recovery. Frequently, when family members start to change, the person with a substance use disorder will begin to change. Family systems theory tells us that if you move one part of the family, you move the entire family. Like a mobile above a baby’s crib, moving one part without impacting the whole is impossible.

Rich Jones, MA, MBA, LCAS, SAP, is executive vice president and executive director of Heritage CARES.