VIII

I Love an Addict, How Can I Help Myself?

You could say this chapter is about the Eighth Toxic Compulsion—codependency, otherwise known as being “stuck,” because the family system you grew up in is altered and dramatically affected by the addictive behaviors of one of its members. If you don’t address this collective corrosion, you may not be able to use the self-care tools in this book very effectively or stay in recovery very long.

It was the cofounder of Alcoholics Anonymous, Bill Wilson, who said: “If you sober up a horse thief, you’ve got a sober horse thief.” By the same token, even if you clean up a person with a dependency for any of these toxic compulsions, there is probably a codependent somebody in that person’s life who is still stuck in a system of behaviors that can undermine recovery.

This subject is the overlooked holy grail of recovery. It is the issue that needs to be fundamentally addressed, not only by the people who are affected by somebody’s addiction disease, but also by the addicts themselves. Even when you take the alcohol and drugs and other compulsions out of their life and out of the family structure, their system is still broken, still corroded by years of neglect. The relational toxicity is like a virus of attitudes and perceptions, affecting how you see the world, how you relate to life.

People come to me all the time and they say, “My daughter has a problem,” or “My son has a problem,” or “My wife has a problem.” And I reply, “Okay, you want to know what to do? You’re not going to like it.” And they go, “Oh, really?” They are sort of surprised. I tell them, “You go take care of yourself.” And usually they react with, “No, you don’t get it. My son (or daughter or other loved one) has the problem, not me.” They simply don’t want to see how they are a part of the problem.

In AA’s big book on alcoholism there is the statement “The root cause of our alcoholism is our defective relations with others.” That statement applies to all of the toxic compulsions discussed in this book, not just alcoholism. We ruin our relationships, and that makes us so uncomfortable we further engage in the toxic compulsions to distract ourselves. This is at the core of how enabling behaviors evolve.

Most enablers believe they’re doing something for somebody who is in trouble and they wrap it up in this idea that “My kid is drowning and I’m going to save them.” What kind of monster wouldn’t try to save their loved one, right? The problem is they need to realize their family dynamic is probably at the center of why the loved one is drowning in a compulsion. Yes, there is a genetic component, and yes, there is a childhood trauma component, but everything is exacerbated by a toxic family dynamic. If that is unaddressed, it creates an enabling highway, and the enabler has as much invested in that highway as the person suffering with the active addiction.

Both of my parents had a problem with alcohol. My mother was a powerful and amazing woman in so many ways. Yet her life was a mess not just because of her circumstances, which included two brothers who were assassinated and a divorce. I don’t diminish the importance of her circumstances. But her alcoholism never allowed her to process these experiences, and to deal with and move on from it. She was stuck, and we children had to stand by and watch this person we loved in unbelievable pain act it out in all sorts of ways. We were powerless to do anything about it. There was nothing I could do that would help her, and that affected me for the rest of my life.

If somebody is engaged in their addiction and they’re not dying, and I mean like literally dying on a floor somewhere, the family and loved ones need to establish firm boundaries. There was a time when I was dying on a floor and I couldn’t get up. I had pleurisy and pneumonia. I was on the methadone maintenance program. I was shooting cocaine every day, and I was in law school. I was on the floor of my apartment and I couldn’t get up. All I could do was dial my mother. I didn’t want to dial 911 because I was afraid it might get the media involved. So I called my mother, the last person I wanted to call. She came over and I remember her stepping over my body to get to the phone. I’m crying because I literally can’t get up off the floor. My mother called somebody and an ambulance took me to a New York hospital. They saved me and convinced me to go to rehab, and my only question was, “Can I get methadone in rehab?”

At that point, somebody had to save me. Otherwise, I would have died. If my mother had said, “No, you’re a drug addict. I’m not coming over there,” I might have died. So you first of all have to address the urgent life-and-death stuff. Once that was done, she should have said to me, “Look, these are your options. You go to treatment. If you don’t go to treatment, lose my number. There’s no money, there’s no nothing. I will support you in your recovery for a period of time. Then you’re on your own. I really mean it.” And if she had done that, my drug addiction probably would have ended that day.

But my mother wasn’t healthy enough to do it. All of the stuff she did and who she was—giving up her life for her kids, the family she came from, her disappointments in life, her need to feel like the mother of the year—all made her an enabler. It was all about her. She loved me and cared about me and wanted me to be healthy, but it was really all about her.

So I say to people in a relationship with an addict, go take care of yourself and you will change everything. Most people don’t get it, or won’t do it. They don’t understand the connection. I am hoping this section of the book will help to make those interconnections much clearer and give urgency to the need to break free of them.

You have to focus on yourself. You must take care of yourself. When you do that, everything changes in the family system, because a sick system cannot tolerate somebody who is healthy. Either you leave the system, or the system changes. Many people think that seems too drastic. They don’t grasp how they are the product of a system that’s brilliant at obscuring reality. They don’t see how the attitude of family and friends that says, “Okay, let’s just get him clean and sober and we’re done,” is the real problem.

I am here to tell you there is no immediate gratification in this process. The process is difficult, painful, and it takes courage. The best you can hope for is that you’ll stop your enabling. But I can also reassure you that there is freedom at the end of this road no matter who you are, whether you’re the toxic compulsion person or the victim of a toxic compulsion person. There is freedom awaiting you, in the way you live your life. That will be the best narcotic you’ve ever had.

Recovery isn’t about just putting down the substances or stopping the compulsion processes. It’s about changing the core of who we are, and that’s a process that could last a lifetime and probably will.

So be gentle with yourself. But be as honest as you can be. Understand this as a process and your vision will change over time. It will change if you have commitment. Once you see more clearly, you simply can’t do it anymore. The clarity will absolutely obliterate your need to engage in these toxic enabling behaviors.

How Stuck Are You?

Are you an enabler? Are you unknowingly helping to perpetuate someone’s compulsion problem? If you’re not sure, here is a simple litmus test devised by treatment experts Dr. Morteza Kahleghi and Dr. Karen Khaleghi in their book The Anatomy of Addiction (2011, Palgrave Macmillan): “Empowering someone is doing something for someone, or helping him to do something that he does not have the capacity to do himself; enabling is doing something for someone that she can do, or very well ought to be doing, for herself.”

If you’re unsure whether you’re contributing to someone’s self-destructive behaviors, ask yourself the following series of questions:

Do I make excuses, to myself and others, for the person’s bad behaviors and judgment? This might include minimizing the person’s compulsion control problem, calling it a “passing phase”; or it might be contacting a teacher or a boss with excuses for the person when he or she fails to show up on time.

Do I remain silent in order to avoid confrontations and arguments? This can be due to a fear of losing the person’s love, or a fear of being subjected to verbal abuse or physical reactions when you voice an opinion.

Do I take on responsibilities that should rightfully be the other person’s? This might include paying an adult child’s bills or keeping their personal affairs in order when they are fully capable of doing so on their own.

Another Way to Know If You’re “Stuck”

Miles Adcox, CEO of Onsite Workshops (www.onsiteworkshops.com), uses a 10-point evaluation of “stuckness.” His definition was developed in 1989 by 22 treatment experts: Codependency is a pattern of painful dependency on compulsive behaviors and on approval from others in an attempt to find safety, self-worth, and identity.

Answer the following 10 questions as honestly as you can:

• Do you feel responsible for other people’s thoughts, actions, feelings, and well being?
• Is it easier for you to feel and express anger toward injustices done to others than about injustices done to you?
• Do you feel best and most comfortable when you are giving to others?
• Do you feel insecure and guilty when someone gives to you?
• Do you feel compelled to help other people resolve their problems? Is that something you live for?
• Do you lose interest in your own life when you are involved with someone?
• Are you often unable to stop talking, thinking, or feeling about someone else?
• Do you stay in relationships that don’t work and tolerate abuse to keep people loving you?
• Do you leave bad relationships only to form new ones that turn out just as bad?
• Do you feel empty, bored, or worthless if you don’t have someone in your life to take care of, or if you have no problems to solve or crisis to deal with?

The more yes answers you gave to these questions, the deeper into a codependency “stuck” pattern you probably find yourself.

What Family Treatment Experts Advise

In their book Unchain Your Brain: 10 Steps to Breaking the Addictions That Steal Your Life (2010, MindWorks Press), Dr. Daniel G. Amen and Dr. David E. Smith described the importance of treating addiction as a family affair and an opportunity to create a brain-healthy family. People who simply drop their child or relative off at a treatment facility and say, “Fix this person,” usually are afraid someone will point out their role in contributing to the problem or that they have the problem themselves.

“To heal one person, the whole family must be healed,” the two doctors wrote. “Family members have to examine their own behaviors to determine how they might be contributing to the problem and be willing to change their ways. They need to get involved in the addicted person’s treatment and recovery by attending family day events at treatment centers, participating in family therapy or couples therapy, and accompanying them to support groups.”

Some other perspectives follow below.

Families hold a life preserver

From Prof. Howard Shaffer, associate professor of psychology, Harvard Medical School, and director, Division on Addictions, the Cambridge Health Alliance: Families of people with addiction need to do the same kind of assessment that an addict does. They really have to look at their biological, psychological, and social activities to see whether they’ve contributed to this addiction unknowingly or knowingly, and whether they have to make changes in order to help their loved ones out of the situation they’re in. Even if they find a genetic predisposition from generations past, but no addiction for several generations, it’s easy to blame the other person and say, “Hey, they’ve got the same problem.” The family needs to educate itself about the nature of addiction. They need to learn how to minimize relapse opportunities for their loved one. Because if they love this person, they should view themselves as holding a life preserver for somebody who’s fallen overboard. They can throw the life preserver in good conscience, but they’ve got to hold on to the other end.

Are families harder to treat than addicts?

From Miles Adcox, CEO of Onsite Workshops in Tennessee, devoted to therapeutic trauma and compulsivity programs: When you get underneath the codependence, you get a lot of the same compulsive behaviors and a lot of the same symptoms that come from the compulsivity. So you’re looking at three categories of symptoms that we see in a lot of codependences: delusion (meaning denial), emotional suppression, and compulsive behaviors. What you see on both sides is chronic low self-worth and relationship problems. Untreated codependency can cause medical problems, and anxiety and stress can get to a point where you can be damaged physically as well. You hear a lot of times from addiction professionals that the family is harder to talk to than the patient. They say, “I’m more frustrated with the family than with the patient.” And the reason they say that is because a high percentage of professionals in substance abuse counseling and treatment are recovering addicts and alcoholics themselves. They’ve done their work to get sober, so there’s a level of comfort for them to sit in front of another addict early on in recovery. But a large majority of families have not done their stage-two work. They haven’t done their codependency relationship work. So when the family member has the same level of resistance that is seen in the addict, there’s a real discomfort … and we don’t know what to do with them.

What we’ve found is that almost everybody with addiction has some level of trauma. And in codependency we found the same thing. So you could say that all self-defeating, self-destructive, persistent, resistant-to-change behavior is rooted in trauma—trauma that was most likely born out of a family system. I actually see this a little stronger in the process addictions, such as gambling. It manifests itself a little differently because it wears a different mask. In chemical dependency or alcohol, enabling is real clear. It’s because you’ve got one person who’s doing this behavior. And it could kill him at any time. And yet you’ve got another person who comes in and enables that to continue happening. So most people from afar can sit back and look at that and say, “Okay, that’s codependency and that’s addiction; that’s really clear.” I challenge people in our field to have the same level of empathy for the family as they do for the addict, because nobody is really waving the codependency flag or talking about it in treatment much anymore.

Use your leverage to get an addict’s attention

From Dr. Drew Pinsky, addiction medicine specialist and clinical professor of psychiatry, University of Southern California School of Medicine: The one thing I tell family members is to use whatever leverage you have. Remember, it’s not about you, it’s about them. So you have to come from a loving place, but you can come from a very firm place, too. Use law enforcement, use money, use anything you can to get their attention. You may not get their attention until they’re sitting in the jail, homeless, and you’re saying, “I’m sorry, I’m not going to bail you out.” That gets their attention.

You must confront someone with firm caring

From Dr. Herbert Kleber, director of the Division on Substance Abuse at the Columbia University College of Physicians and Surgeons and former deputy director for demand reduction in the White House Office of National Drug Control Policy: When you have someone, either a family member or a friend, who has problems with alcohol or other drugs and you want to help them, nagging them is not going to help. You have to somehow show them that you not only care, but that you’re not going to continue to put up with their behavior. So if the two of you go out together and he insists on wanting to drive home and you let him drive, you’re not doing a favor for your friend, let alone for yourself. So you want to be supportive, but you don’t want to jeopardize your safety or, in a sense, enable that individual by acting as if what he’s doing is perfectly fine. You have to carefully confront the individual in a way that comes across as loving, that says you care, but also can’t always be covering up or apologizing, doing all those things that mean “enable.”

You must learn to “own” the process

From Sid Goodman, director, Caron Renaissance treatment facility, Florida: Families do not cause nor can they hope to cure addiction in their loved ones. Neither can treatment staff. The family contribution to later addictive disease is the failure to allow their children to complete necessary developmental tasks. But, both staff and families can play vital roles in the recovery process. A recognition that the work must be done by the addict is, in fact, crucial to understanding addiction as a biopsychosocial disease. It may take a village to nurture that process, but there is no alternative to the patient working through these defensive structures and owning the process.

You must work the steps with your partner

From Dr. Patrick Carnes, psychologist, author, and former clinical director of sexual disorders services, The Meadows, Arizona: In Recovering Couples Anonymous (RCA), they call it the three-legged stool: my recovery, your recovery, our recovery. In family therapy, to treat somebody individually about something that is a couples or family problem often makes things worse. They get sent off separately to Al-Anon, AA, SA, S-Anon, JA, or J-Anon, and they go to their separate meetings and tell their stories. But it’s a sympathetic audience. She’s in her group and the women are saying, “You don’t have to let him walk all over you.” And he’s in his group and they say, “You’ve got system boundaries with her.” So they come home and it’s like the shootout at the O.K. Corral. The 12 Steps are master works of neuroscience, but you have to do it together with your partner. In RCA, the honesty goes up and, with it, the health of the relationship, because you’ve got other couples watching. Couples speak to you differently about both sides of the story. So if you’re in recovery and are a couple, you’ve got to realize that you do a dance together and you’ve got to learn how to use the 12 Steps together as a couple.

Codependency in Asia is about shame

From Billy Pick, regional advisor, Office of HIV/AIDS, Bureau for Global Health, United States Agency for International Development: In Asia the cultures are based on family. They don’t view addiction as a disease over there. It’s viewed as a kind of moral failing. It’s not only seen as a moral failing by you, but it’s a moral failing by your entire family. So codependency in Asia is astronomical, particularly concerning the youth, because parents don’t want neighbors to know their kid has a problem. That would embarrass the entire family. It’s a shame-based culture, and everything is about outward appearances. The first family counseling I ever saw in China was a bunch of guys sitting there with their heads down and a mother yelling at them about how embarrassed the family was and how much shame they had brought on the family. They don’t understand the concept of codependence yet. They would say that’s how families are supposed to behave.

Say you care, and there are consequences

From Pamela Hyde, administrator, Substance Abuse and Mental Health Services Administration (SAMHSA): Sometimes people wonder, “What can I do? I see my friend who’s clearly doing what she shouldn’t and how can I deal with that?” It’s everything from expressing concern, being open to discussion, trying to not preach, but trying to raise concerns, trying to ask questions about whether or not that person thinks about that as a problem or not; maybe providing information that sometimes adults are drinking at levels they don’t realize are problematic. And just letting people know that there’s a concern. I think one of the biggest issues is people understanding that somebody else cares about them, and offering to say, “What you’re doing is problematic for yourself and for your family and friends.” To change their life, some people just need family or friends to say they care, and that if the behavior continues there will be consequences.

Letting a group of people love you

From Dr. Jeffrey D. Roth, addiction psychiatrist, author, editor of Journal of Groups in Addiction Recovery, and medical director, Working Sobriety Chicago: “How can I get him to stop?” What I say to that person is, “Who wants to help right now?” If the person says, “I want to help get my husband to stop drinking,” I’ll say, “If you want your husband to stop drinking, you may need to lead the way into recovery. Are you willing to do that?” If the person says, “I’ll do anything that it takes.” I’ll say, “Really?” And they’ll say, “Yes.” And I’ll say, “Are you willing to go to a meeting?” And they’ll say, “You want me to go into an AA meeting?” And I’ll say, “No, unless you have a problem with drinking, in which case, yes, you can go to an AA meeting. But since you’re concerned about your husband’s drinking, have you ever heard of Al-Anon?” Some have, some haven’t. Some of them have various different excuses why they don’t want to go to Al-Anon: “Oh, I hate those meetings,” or, “I went to one five years ago and all that happened was I listened to everybody else’s problems and I felt worse than I felt before.” I’ll say, “Oh, isn’t that interesting? You went to the Al-Anon meeting to try and help everybody else, just like you’re trying to help your husband, and it didn’t work. Well, congratulations. I guess maybe you learned something at that meeting.”

“Would you be willing to go to an Al-Anon meeting and consider the possibility that instead of giving all those people help, that you instead take their help?” And the person will say, “Those people were messed up. They could never be of any help to me.” And my next response is, “Well I tell you what, how about we do a diagnostic test. This is not going to be therapeutic. You’re not going to enjoy this. It’s not going to make you feel any better. I’d like to simply do it as a diagnostic test because even if you’re not interested in going to Al-Anon, you’re saying you’re interested in coming to group psychotherapy with me.” And my experience is that if you’re allergic to any support from any group, in Al-Anon you’re probably going to be allergic to the support that you’re going to get there.

Let’s find out what the allergy is now before you come into a group. There’s no point coming into group and then leaving right away and thinking you’ve had enough failures in your life. You think you’re a failure because your husband hasn’t stopped drinking. So go to the Al-Anon meeting, sit there, and don’t even give them your real name. Don’t introduce yourself. After you attend the meeting, I’d like you to make a list of 10 reasons why it was the worst experience in your whole life. Bring it back to me and let’s talk about it, because whatever it is you didn’t like about the Al-Anon meeting, you’re going to find you don’t like about what I do. Because even though the structure is very different, it’s a group of people. And my speculation is you may need to get used to people loving you in order to take in some love from your husband. What do you have to lose?

Children sense when something is wrong

From Jerry Moe, vice president and national director, Children’s Programs for the Betty Ford Center and advisory board member of the National Association for Children of Alcoholics: A woman who was in treatment here at the center had kids who were seven, eight, and nine. I must have met with her four or five times, trying to convince her to let the kids come to the children’s program, because what so often happens in treatment is people who go into treatment for their own addiction often grew up in a family where there is addiction. That’s generational; it gets passed down. Well, finally she said, “Okay, here is the deal. My kids can come to the children’s program provided that”—and she took out a piece of paper. She had, like, six conditions I had to follow: I couldn’t talk about this, couldn’t do this, you can’t mention this. And you know what? I looked at her and said, “Absolutely.” And so the kids came into the program.

And what’s really different about what we do is that we work with boys and girls for 25 hours over four days. You really begin to see what’s going on in their lives. So 45 minutes into the program that day we take a break. We show the kids where the restrooms are, and I’m waiting outside for the seven-year-old boy to come out. He comes out and we’re walking back to the group room and he grabs my sleeve and tugs it really hard. He points for me to bend down because he wants to whisper and he says, “Do you want to know a secret?” And I say, “Only if you want to tell me.” And he says, “I know where my mom keeps her needles.” He went on to tell me her story. I think often we adults don’t want to admit that kids know what’s going on. Kids know that something is wrong, but nobody really explains it to them, and so many kids say, “It must be me. Maybe I’m doing something wrong.” I would say that happens 70 percent of the time. Part of the conspiracy of silence is children are left confused. If kids aren’t given an explanation that sounds truthful and that’s age-appropriate, they’ll make up a story for it all to make sense. So we have to find language to help kids understand what’s going on with their parents because addiction is a family disease. It takes everybody hostage.

An effective treatment approach for Hispanic families

From Dr. Jose Szapocznik, professor and chair, University of Miami Miller School of Medicine, Department of Epidemiology and Public Health: We have found in Hispanic families that the members are strongly engaged with each other. Sometimes the passion is negative, but even negative passion is a connection. So that is something we work with very effectively. We developed a treatment approach in which we address the kinds of conflicts that go on in these families when the kids are engaging in drug use and other delinquent behaviors. It’s a rebelliousness and rejection of parental authority that brings a lot of kids into treatment.

In family sessions, something as simple as saying to a mother or father, “You feel very, very strongly about your child. You must care about your child an awful a lot. You want your child to succeed. You really love Johnny and you are frustrated, but you really love Johnny and want the best for him.” Parents very quickly say yes. And at that point, we might turn to the child and say, “Did you know that your parent is concerned for you, that your parent wants the best for you, that your parent loves you?” Typically, the child will say, “No, I didn’t know.” And so we transform an interactional pattern from, let’s say a father or mother was fighting with the kid and the kid was withdrawing, to an interactional pattern where they can talk about any concerns that the parent has for this child. What are the expectations, the emotions, the ambitions; what are the parent’s wishes? And we move from there to Johnny—“What is it that you want, and does your father know what you want?” And then you start to have a conversation at a very different level where they’re talking more adult to adult, and where that angry, negative effect really calms down. Family approaches to treatment are really the most effective. And it’s much easier for somebody from the outside to do an intervention because the parent is caught up in their own emotions as a family member. The parent must learn to say, “I support you, but not your illness.”

Sometimes confrontation is necessary if there is some urgency, if the child is endangering his life. But confrontation is a very inefficient intervention because you get a lot of resistance. Instead of just saying that it’s a family issue, you say, “Mom, I can see how worried and how painful this is to you and how sad you are.” And all of a sudden you are beginning to identify that there is more than one patient in the family. We can spread the patient input to all family members in a way that they feel they have something to gain without ever having to confront their feelings that this isn’t their issue. If you begin to change the environment of the kid, the family and social environment, even if it’s just the way they interact with each other, the kid becomes a different person. And often the kid will outgrow the drug use.

Families save the addict to save themselves

From Debra Jay, interventionist, lecturer, and coauthor with her husband, Jeff Jay, of Love First: A Family’s Guide to Intervention (2008, Hazelden): We know when we do interventions we’re looking at late-stage alcoholics. The family isn’t seeing there’s a problem, or they’re dismissing it as something else, like he’s immature, or he’s under a lot of stress—all the typical excuses a family makes for the disease.

The onset of the disease does not correspond with the onset of symptoms. As an example, with diabetes, by the time you have symptoms, you’ve had the disease for a long time. That happens with addiction as well. Once addiction takes hold, it’s not easy to just have a conversation with an alcoholic or an addict and get them to change their behavior.

There are so many myths in our field. The first one, which I think is the most pervasive, the most damaging, I call the “action stopping” myth. It says you can’t help an alcoholic until he wants help. So that’s it for families: Step back and let the addiction run through your family like a freight train. There’s nothing you can do. And we hear that all the time. We hear it from doctors; we hear it from people in AA. It just stops people from thinking about it. Well, it’s a completely different story when you say, “If you can’t help an alcoholic until he wants help, what will get him to want help?” You see, now I’m thinking differently. Now that opens up the door to possibility. Now I can start looking for solutions and answers.

And then there is the myth about “hitting bottom.” And this is really important in terms of families, because when a family is told that you have to let your alcoholic hit bottom, what nobody tells the family is, “Guess what, you’re going along for the ride.” If we say the alcoholic is going to have to hit bottom, even the smallest child is going to have to hit bottom along with them. And that’s just not acceptable. The solution for the alcoholic can’t be the undoing of the family. We presume in saying that the alcoholic has hit bottom that they go running off to AA or to a treatment center. But the reality is they’re proficient at collecting enablers, and alcoholics can bounce along the bottom for a long time and get people to clean up the mess, get people to save them from themselves, save them from their addiction.

This is a family disease, but we do not treat it that way. The way things have been set up, even with AA, is that when a person gets out of treatment, we tell family members their recovery is sort of none your business, so don’t ask them what they’re doing, don’t ask them about their meetings, don’t ask them if they have a sponsor. They don’t want you staring over their shoulder. And this is the same person who has wreaked havoc on this family forever. When you talk about enabling, we’ve always focused on the family as if they’re madly trying to save the alcoholic. The truth of the matter is they’re trying to save themselves. They have to save the alcoholic to save themselves. And what do you say to a mother with three small children who is depending on that alcoholic to bring the money home to pay the mortgage? Just let him go? No! You can’t tell her that because she’s going to be on the street with three small children. Keep him employed and keep him functioning, because I’m saving myself, I’m saving the family.

Put yourself into a nonshaming environment

From Ann Smith, executive director, Breakthrough at Caron, and a recognized pioneer in helping adults to shift destructive life patterns to improve their relationships: I don’t call it codependency anymore. Instead of codependent, I use the word “stuck.” So the therapy we do is about getting unstuck. Codependency was a partial explanation. It’s really all about attachment. We all have attachment needs. When they’re not met, we feel sick. But we are not sick. When your abandonment needs are not met, you are not sick, you are hurting. But there are all these shaming labels of “look how sick we are.” I don’t look at good people as sick. With positive psychology, we don’t attribute blame and shame to people who are doing the best they can do given the circumstances they were in. But we do give them full responsibility for changing it.

Here is our basic premise: All of us are born expecting we will have all of our needs met by one or more people who are designated as ours. And we expect that as our emotional needs are met, the wiring in our brains will be positively affected by that experience, and we are hardwired to attach to that person in those years between birth and years three and five. We’re not taking in information. We are processing experience. So in those experiences, if that attachment, that connection, that love connection, is interrupted or is really inconsistent, then we as individuals have to start working harder at figuring out how we’re going to attach to them, since they’re not coming to us. And so we start to adapt, and we figure out ways to do that.

Everybody who comes here to Caron comes with an attachment problem. Every human being begins with that same need for connection. In a lot of people, it is disrupted in some way. If it’s disrupted really early, you’re going to have major problems. If it’s disrupted early but not in a major way, you’re going to limp a little. If you’re in a really crazy family but the attachment is secure, you’re going to be fine. It doesn’t mean you’re going to be fine biologically speaking. You could have depression, anxiety, all kinds of things you could have inherited. But you’re not going to have the kind of attachment injury that we’re talking about. I don’t care if they’re an addict or whatever they are, it’s the same. And their issues are around relationships. So an addict before they became an addict had all these issues, after they got sober they still have all these. It’s not really about addiction. An addiction is just a young adult’s way or a teenager’s way of pushing that pain away for a period of time.

So when we get people in here who are in recovery, especially the ones who are not sober for very long, they still describe themselves as an addict. And they attribute every single thing that’s wrong with them to addiction. And honestly, it’s got nothing to do with it. Their addiction was a period of time where they found that drugs or alcohol or whatever process was helpful in managing those emotions—until it backfired.

Family provides an environment for recovery

From Dr. Jon Morgenstern, vice president and director of Health and Treatment Research and Analysis at Columbia University’s National Center on Addiction and Substance Abuse: Families have to keep in mind that 80 percent of interventions fail. And then what happens after your intervention fails? What is the next step? You can’t lock people up. That’s what people want to do. But you have to get the person with a problem in a position where they have to do something that’s not entirely coerced. Interventions often must wait until the person has become highly motivated for treatment. I’m a very big believer in the effect of environment as a powerful factor in recovery. The family can provide the context of environment.

What does a successful family intervention look like?

From Paul J. Gallant, founder of Gallant & Associates and a board-registered interventionist: The most important part is telling people that their loved one does not have to hit bottom. So raising the bottom is the challenge. I tell folks if one person in the family system has had enough, then intervention is possible. That is the key piece. The second most important part is understanding that this is a family-system problem, and when we approach a family, everyone needs to take action to get into recovery. A lot of families only want to point the finger, saying, “Just fix them.”

A lot of times I get a call from a sibling or a father or mother and we begin to address the denial that exists in the family. A good intervention means that people have had enough and are willing to set boundaries and limits. It’s really good when there is leverage. If the guy’s father has had enough of his son’s cocaine use and the son works in the family business, for instance, there is leverage. Another example would be a pilot who might lose his license unless he gets sober.

I did an intervention once with seven family members. The mom was the subject of this intervention. We had her parents present, along with the husband and children. What helped make it effective is that we had seven different viewpoints of this woman’s problem with alcohol. Each person wrote a love letter that followed a format. Each told the mom three things: They expressed how they love her; they shared some memories and some of her qualities; and they told her their concerns and gave behavioral examples of how her alcoholism had affected them.

Some family members talked about Christmas dinner, or an afternoon out on a boat. They had specific times and incidents when her alcoholism had caused them shame or embarrassment. All participants at the preintervention meeting had in hand a completed intervention letter. We met that evening and talked about what an intervention is and is not. It’s not family therapy. It’s not about her bad marriage. We got everybody more comfortable with the process and what would happen the following morning. We talked about the disease of alcoholism and recovery, the family role, and the treatment center.

We met at 7 a.m. and showed up at the mom’s home. She was in the kitchen, and I introduced myself. This is the surprise model of intervention, and 85 percent of the time we get our person into treatment the morning of the intervention. She listened to the seven letters being read, and I asked her if she was willing to accept the help that her family offered. She was tearful and said yes, so we took her straight to the treatment center. We got the husband into Al-Anon and got him a counselor; we got the kids into Al-Anon; and every single person in that room except one accepted the help. We helped the mom get sober, but she would return to this home and that’s why it’s always important for the family to get help, too. The word “intervention” means a change in course, and that’s what these families need.

Can family or friends intervene on their own?

From Bill Teuteberg, professional interventionist, Minneapolis, Minnesota: It’s not always necessary for family and friends to have an interventionist involved. But it depends on the dynamics of the family. It should be possible for a family to intervene with itself, but it needs to be a care confrontation rather than an intervention. Family or friends need to say, “We love you, but we can’t continue to support you in killing yourself. We’ve made arrangements to help you, and to find help for ourselves.” Leverage and consequences are necessary for this to work. Often that involves money. It never happens without the use of leverage and consequences being spelled out. Maybe 25 percent of these types of interventions succeed. The person might walk out of the family system or friendships for a month or so, but they come back if the family system holds itself together and people keep their commitment to boundaries.

I get 300 phone calls a year about interventions, and no two are alike. Before someone calls me, usually the intervention process has already started, but in a haphazard way. Someone may have expressed their concerns to the person with the problem, but maybe that conversation didn’t go well. At least 50 percent of the time, in my experience, the rest of the family is sicker than the person they’re pointing the finger at. So you double your chances of success in an intervention if you have a professional interventionist involved, because that person can establish who in the family has agendas other than just getting their family member into treatment. If the intervention is set up correctly, it’s usually successful.

Recommended Family Self-Help Groups

Here are two particularly effective and ethical groups that can provide support for family members trying to heal the damage caused by an addict in the family:

Recovering Couples Anonymous is a world service organization (existing in eight countries) that describes its mission this way: “Ours is a fellowship of recovering couples. We are committed to restoring healthy communication and caring and, as we do this, we find greater joy and intimacy. Many of us participate in other 12-Step fellowships. We share our experience, strength, and hope with each other that we may solve our common problems and help other recovering couples restore their relationships. The only requirement for RCA membership is a desire to remain in a committed relationship.” (www.recovering-couples.org)

Al-Anon Family Groups were established for family and friends of problem drinkers. Alateen is a branch of the program designed for teenagers. The group’s Web site hosts a list of questions to ask yourself to help determine whether it’s a program that would be helpful to you or someone you care about. The group describes its function this way: “In Al-Anon, members do not give direction or advice to other members. Instead, they share their personal experiences and stories and invite other members to ‘take what they like and leave the rest’—that is, to determine for themselves what lesson they could apply to their own lives.” (www.al-anon.alateen.org)