Familes are often the primary support for people who have substance use and/or mental health problems. Families are likely to experience significant physical, emotional, social and spiritual stress. Although there are a growing number of interventions designed to help and support family members, many helpers “perceive this as secondary to the job of working with the person diagnosed with substance use and/or mental health problems”. Some helpers may lack training and tools that would allow them to feel confident and prepared to work with families, or may not be aware of the benefits of including everyone involved in the helping process;
Collaterals (family members) can be profoundly affected by having an ill family member, however quite often they also show a strong desire to understand addiction and mental health problems and have a high level of motivation to be part of the process of recovery. They quite often are an underutilized resource in addressing substance use problems.
To be successful, families need:
- the information about concurrent disorders
- skills to help them deal with the impact of concurrent disorders on their family life
- collaboration with treatment providers to find ways to manage the co-ocurring problems
- working towards increased well-being of the family
- acceptance and support
- empowerment them to be assertive about their needs.
Moreover, families need an opportunity to explore their attitudes, values and beliefs, and to feel like equal partners in the planning and delivery of treatment wherever possible. They need support and respect as well as information about a variety of evidence-based interventions including: professional and peer support and education about concurrent disorders, opportunities for family members to increase their feelings of personal mastery and ability to cope with the situation; dealing with grief and loss, discussing strengths and limitations, building resilience in the presence of emotional pain, conflicts, difficult emotions, extreme stress, emphasizing the importance of self-care; helping develop problem-solving skills; facilitating access to other services/professionals as needed
Many family members have trouble understanding why their relatives continue to use substances despite obvious negative consequences. It helps to assist family members think about how their relatives might see the benefits and costs of substance use; It helps to explore the consequences of use/gambling:
- lost jobs and income
- social rejection
- jail as a result of out-of-control behavior
- fear of loss (children, partner, family)
- increased fear of psychiatric episodes.
It also helps to begin to understand the benefits of using substances or engaging in other addictive behaviors, such as problem gambling. Examples include:
- excuses their behavior
- makes them feel good, at ease, relaxed
- balanced him
- makes them think they are important
- makes them sound more intelligent
- helps them to stay awake, keep thoughts going
- needed for social acceptance, to deal with peer pressure
- helps reduce anxiety
- escape—making troubles go away.
Family members often have a lot of information about mental health problems, particularly the health issues of the ill family member. However, this knowledge is often spotty and ill-formed. It is important to be able to understand the bigger picture; Family members are often preoccupied with “the diagnosis.” They want someone to tell them what is wrong and what needs to be done; however, quite often there are no simple answers or quick solutions, because the problems are just too complex.
Families need an opportunity to tell their stories. It can be more difficult to experience illness in someone you love than it is to have an illness yourself. Family members often need validation of how draining the experience of supporting someone with a mental health and substance use disorder can be. They also need people to understand how much they love their ill family member and want them to recover or go back to the way they once were. There are huge physical, emotional, financial and social effects of caring for someone with substance use and mental health problems, but there are also the positive and rewarding aspects of trying to help their loved one. Sometimes it is helpful to think about the positive aspects of the ill family members, like things we love about them or the strengths they have , as well as think about the most rewarding/positive part of the experience of caring for your ill family member.
Other things that families may find helpful are:
- Identifying any personal areas of concern over which they have some control
- Considering how they might learn to accept what they cannot change. Identifying areas over which one has little if any control and learning to accept these can be just as important as identifying areas of concern that are amenable to positive change.
- Exploring the benefits of taking care of oneself.
- Exploring self-care strategies in all areas: physical, emotional, social, spiritual, financial.
- Encouraging development of their own self-care plans.
- Short-term self-care strategies to help them break free from the anxiety, preoccupation and stress inherent in caring for a loved one.
- Validating the exhaustion and stress that families experience, so they can ease into the topic of self-care without feeling guilty about it.
Most family members experience a kind of journey of recovery that often parallels the ups and downs that their loved ones experience. But it is crucial they understand the importance of caring for the caregiver, as without their own physical, emotional, social and spiritual health, their attempts to help their ill family member would likely be ineffective. It is crucial to understand the idea of family resilience/ “hardiness” ability to “bounce back” after suffering extremely adverse consequences.
It may also be helpful to discuss motivation and stages of change as they relate to how ready and willing both the person with concurrent disorders and the family are to seek help. (The stages of change are: Pre-contemplation, Contemplation, Preparation, Action, and Maintenance.) Also, Relapse and relapse prevention need to be discussed as they can be an important, constructive part of the process of change and recovery. Relapse needs to be seen as something that can often be prevented or dealt with in a constructive manner. Often family members can see things shaping up and can help their relatives either avoid a relapse or to deal with it effectively. Families and the loved ones may find it helpful to discuss these openly and in a non-confrontational way: Had there been signs/events that indicated a relapse was coming? Does our loved one have a better sense of what was helpful in averting, or minimizing, a relapse ?
When the person with co-occurring mental health and substance use problems embarks on a process of recovery, family members also travel their own parallel journey. Also, it is important to keep in mind that a recovery means many different things to different people and does not necessarily mean a complete absence of all symptoms for the rest of a person’s life. Recovery can mean: gaining acceptance, beginning taking better care of oneself, learning to set limits and expectations with their ill loved one and developing a newfound sense of hope and serenity, coping better, or feeling less overwhelmed.
Families may feel a little better just by learning and using the inspirational recovery sayings (AA slogans) such as these:
- Pain is necessary, suffering is optional!
- A journey of 1,000 miles begins with the first step.
- Be part of the solution, not the problem.
- There are two days in every week over which we have no control—yesterday and tomorrow. Today is the only day we can change (OR: It is not the experience of today that drives people mad; it is the remorse of yesterday and the dread of what tomorrow may bring).
- If nothing changes, nothing changes (OR: If you do what you always did, you’ll get what you always got).
- Feelings aren’t facts!
- Let go or get dragged.
- Expectations are preconceived resentments.
- Serenity isn’t freedom from the storm; it is peace within the storm.
- Intolerance = Contempt, prior to investigation.
Ref: BC Addiction & MH