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November/December 2014 Issue

When Help Harms Rather Than Heals
By Leslie Adair, PhD, LP, LMFT
Social Work Today
Vol. 14 No. 6 P. 6

When a young person becomes addicted, it can be devastating. For some young people, drug use results in potentially life-threatening and life-altering consequences that negatively affect every area of their lives. Each situation, each loss, and each painful consequence builds up over time. Halting the damage becomes paramount and helping the young person establish a life of stable recovery is the goal. So, when young people enter treatment and begin the process of taking their lives back, they don't do this alone. Professionals, experts, and families enter into this process with them. While the focus in treatment is generally on the young person and the addiction, parents play a major role, though not always in ways that are helpful. Intervention that is meant to right the ship and get the family functioning well again sometimes harms rather than helps.

The Parental Journey
To tell the story of addiction through the eyes of a parent is to open up their most painful experiences and share them openly. Usually in the later stages of the journey, parents are numb and less concerned about holding these experiences close, but it didn't start out that way. In fact, for most parents, the thought that their child might become an addict was never even on the radar and partly explains why so many parents report feeling blindsided. No parent I have met had "addict" as a desired lifestyle for his or her child. They instead imagine their children growing up to be happy, well adjusted, contributing to society, and eventually sharing their lives with someone. They work hard to help make these dreams come true. They try to do all of the right things and work to provide their children with every opportunity they can. But things can go wrong, terribly wrong, and somewhere down the road they find themselves with one or more of their children in treatment for addiction.

As things begin to fall apart, parents' lives change in incremental, sometimes elusive ways that are hard to describe and harder still to understand. They experience a loss of trust in someone close to them and sometimes in themselves. They question their judgment about their son or daughter; they work to convince themselves there's no problem, that their child actually has it together. Without concrete evidence, parents are often left with self-doubt, confusion, and paralysis about what to do. They are hopeful that what their son or daughter is saying is true; parents want to believe it so badly they even act as though it is true. Then reality hits, and they can no longer hide behind the veil of denial.

Many parents have said that moment of truth, when they realize their child is an addict is like being punched in the stomach. Their hopes and dreams for their child are threatened, but their very identity as parents is also under siege. They become painfully aware of the social stigma associated with having a child with a drug or alcohol addiction. After all, parents admit later, they, too, had a tendency to judge those in the situations they now find themselves. Almost immediately they want to crawl into a hole and hide, to cover their head and stay down until the storm passes and they can hold their head high again, with their identity as a "good parent" intact. If that weren't bad enough, the shame that washes over them also begins to teach them how to keep secrets, how to pull away from others for fear of rejection. They come to know the pain of disconnection and isolation along with a profound feeling of loss. With fear and hurt and loss also comes anger toward the addict, the addiction, and sometimes even their spouse and others trying to help.

Other Underlying Issues
As parents travel this journey through addiction, the road is confusing and unclear. Alcohol or other drug abuse isn't necessarily the first thing that surfaces that can potentially alert parents that trouble is coming. Rather, their child begins to struggle meeting the demands of school or sports; relationships at home begin to deteriorate, as do other social obligations. Well-meaning professionals assess the situation to determine how best to help, and often they suggest mental health problems such as depression, anxiety, or ADHD as the cause. Eventually the addiction might be identified and off to treatment they go. But, when things don't change or they deteriorate more, many parents report that the unthinkable happens: the very professionals that are trying to help begin to blame the parents themselves.

When parents express concern and want information on what is happening and how their child is doing, they are sometimes told they are overinvolved. When they want to have a say in decisions, they are called controlling. When their child violates boundaries and is out of control, parents are often told it is their fault for not standing up to their child. When they let their fear, hurt, or frustration show, they are sometimes told they are reactive. These parents need something, but they aren't getting it. Instead the offered remedy is the suggestion to attend an Al-Anon meeting or go to family therapy to address their issues.

Challenges for Professionals
In defense of professionals working in the addiction field, we have our hands full. We have large caseloads of young people struggling with the concept of addiction as a life-long disease, when many of them can't conceive of what's happening beyond Friday night. We also know that manipulation, dishonesty, and perceptual distortion of reality are features of the disease, and it takes a lot of work to punch through these defenses. And, let's face it, most addiction professionals are undertrained in understanding and working in family systems. So when the family system starts demanding attention, we are poorly armed to manage this. But, it's easier than you think to begin to change the dynamics of treatment for these families, and I would argue that it would result in a better outcome.

Solutions for Helping Parents of Addicts
Recognize that in any given situation everyone involved wants something. The addict might want everyone to back off, so they can go back to using. The professional may want the addict or family to change in some meaningful way. Parents, too, want something and taking the time to find out what that is can be invaluable. Sometimes it will help you create a therapeutic alliance with the parents, which can be leveraged to produce change in the family system. Sometimes what they want can help you uncover the motivation behind the desire. When you know what that is, you may be able to help that parent find a better way of meeting that need. At other times, understanding the experience of parents and the fear, hurt, and helplessness they've experienced can guide you. If you validate these emotions for parents, it is amazing how workable they become.

There are really two things parents want and need above all as they navigate their new reality. One is that they need education. Their child has been gaining knowledge and help along the way, even if they try to push it away. Parents are often woefully ignorant of the disease and how it has affected every aspect of their family and their relationships with others. Secondly, they want connection with others again. They want connection with their child, their spouse, their other children, and their extended family, and they want connection back with the rest of the world that doesn't live in addiction. They want desperately to be heard and understood, but they are so ashamed that every contact with others feels vulnerable and painful. In order to help parents, we need to reframe the behavior we see and help them make those connections which usually starts with us. When parents are getting the validation, understanding, and support they need, they are better able to help their child and those helping their family accomplish the work they are doing.

— Leslie Adair, PhD, LP, LMFT, is director of Mental Health and Family Services at Hazelden Betty Ford Foundation in Plymouth, Minnesota.