***[The Road to Recovery (2008)]{.underline}***

**Recovery and the Family: Extending Treatment to Everyone**

*[Shoot Date]{.underline}: February 20, 2008 [Air Date]{.underline}:
June 4, 2008*

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**Abstract**: Nearly 24 percent of children (or 17 million) live in a
household where a parent or other adult is a binge or heavy drinker, and
approximately 13 percent of children (or 9.2 million) live in one where
a parent or other adult uses illicit drugs^1^. Because the negative
effects of addiction aren't limited to the individual who is abusing
drugs and alcohol, recovery must extend to the entire family. Aside from
the many options available to persons in need of treatment, supports
also exist for children, spouses, and others affected by a family
member's addiction. This program will present the many avenues toward
effective treatment, emphasize the importance of getting an addicted
loved one into treatment, and celebrate the benefits enjoyed by the
family in recovery. 

Source: ^1^The National Center on Addiction and Substance Abuse at
Columbia University, New York, NY. March 2005. *Family
Matters: Substance Abuse and the American Family,* p. ii.

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**[Panel #1: Substance Abuse in the Family]{.underline}**

**[Key Questions]{.underline}:**

1.  **How prevalent is substance abuse in the family?**

2.  **How does one's substance abuse have an effect on family members?**

3.  **What can family members do to assist a loved one suffering from a
    substance use disorder?**

    **Substance Use in the Family *(Source: 2007 NSDUH)***

-   In 2006, among persons aged 12 or older, an estimated 22.6 million
    (9.2 percent) were classified with substance dependence or abuse in
    the past year.

-   Based on combined 2005 and 2006 data among pregnant women aged 15 to
    44:

    -   4.0 percent reported using illicit drugs in the past month.

    -   11.8 percent reported current alcohol use.

    -   2.9 percent reported binge drinking.

    -   0.7 percent reported heavy drinking.

        **Psychotherapeutics, i.e., "Prescription Drug Abuse" *(Source:
        2007 NSDUH)***

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-   Psychotherapeutics includes the nonmedical use of any
    prescription-type pain relievers, tranquilizers, stimulants, or
    sedatives.

-   Among persons aged 12 or older who used pain relievers nonmedically
    in the past 12 months, 55.7 percent reported that they got the pain
    relievers they most recently used from a friend or relative for
    free.

-   An estimated 5.2 million persons were current nonmedical users of
    prescription pain relievers in 2006, which is more than the
    estimated 4.7 million in 2005.

-   The number of persons aged 12 or older who used psychotherapeutics
    nonmedically for the first time within the past year rose from
    647,000 in 2005 to 2.6 million in 2006.

    **Parents with Substance Abuse Disorders**

-   8.3 million children in the United States, approximately 11 percent,
    live with at least one parent who is in need of treatment for
    alcohol or drug dependence. \[*CSAT*\]

-   More than half of the children in foster care have parents with
    drug- or alcohol-related problems. \[*Child Welfare*\]

-   Substance use disorders in families with dependent children cost
    society more than an estimated \$250 million per day due to \[*Child
    Welfare*\]:

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-   Medical problems

-   Emotional problems

-   Long-term consequences of potential or actual abuse and neglect

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-   The children of drug abusers are a high-risk group and treatment for
    the parent becomes prevention for the child.

-   Children from these families are also more likely to have problems
    with delinquency, school performance, and emotional development,
    such as aggressive behavior and hyperactivity.

    **Prevalence of Substance Abuse Among Youths *(Source: 2007
    NSDUH)***

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-   22.2 percent of 18- to 20-year-olds, and 16 percent of 16- or
    17-year-olds, reported past month illicit drug use in 2006.

-   In 2006, about 10.8 million persons aged 12 to 20 (28.3 percent of
    this age group) reported drinking alcohol in the past month.
    Approximately 7.2 million (19.0 percent) were binge drinkers, and
    2.4 million (6.2 percent) were heavy drinkers.

-   An estimated 7.9 percent of 16- or 17-year-olds and 19.7 percent of
    18- to 20-year- olds reported driving under the influence of alcohol
    in the past year.

    **Parental Involvement *(Source: 2007 NSDUH)***

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-   Youths aged 12 to 17 who believed their parents would strongly
    disapprove of their using a particular substance were less likely to
    use that substance than were youths who believed their parents would
    somewhat disapprove or neither approve nor disapprove.

-   The following examples of parental involvement were cited in the
    2007 NSDUH as having an effect on reducing substance abuse by
    youths:

    -   checking on whether or not youths had completed their homework

    -   providing help with their homework

    -   limiting the amount of time that youths spend out with friends
        on school nights

    -   making youths always or sometimes do chores around the house

    -   limiting the amount of time that youths watch television

    -   letting youths know that they did a good job and that the
        parents were proud of something they did

-   The rate of past month use of any illicit drug was 8.1 percent for
    youths whose parents always or sometimes helped with homework
    compared with 16.9 percent among youths who indicated that their
    parents seldom or never helped.

    **Role of Parents and Families in Youth Treatment and Recovery**

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-   Families play an important role in the recovery of substance-abusing
    youths but this influence can be either positive or negative.
    \[*TASC*\]

-   The effective treatment of youth substance abusers often requires a
    family-based treatment model that targets family functioning and the
    increased involvement of family members. \[*TASC*\]

    **[Panel #2: Making Treatment Effective and More Easily
    Available]{.underline}**

    **[Key Questions]{.underline}:**

1.  **Why is treatment for one important for the entire family?**

2.  **What does it mean to "personalize" treatment, and why is it
    imperative that treatment be tailored to the individual?**

3.  **How does stigma prevent people from getting into treatment, and
    what can be done to overcome stigma?**

    **Addiction's Impact on the Family**

-   In a 2004 survey, 63 percent of Americans said that addiction to
    alcohol or drugs has had some impact on them at some point in their
    lives. Of those affected by addiction:

    -   24 percent were affected by a parent's addiction

    -   11 percent by their children's addiction

    -   29 percent by a close friend's addiction *(Faces & Voices of
        Recovery)*

        **Prevalence of Treatment**

-   In 2006, of the estimated 22.6 million Americans aged 12 or older
    who were classified with substance dependence or abuse in the past
    year, only 4.0 million received some kind of treatment for a problem
    related to the use of alcohol or illicit drugs.

    **The Effectiveness of Treatment**

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-   Standard treatments have been shown to produce significant
    reductions in drug use and in drug-related problems of crime, family
    violence, unemployment, and welfare dependence. *(NIDA*)

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-   Treatments for drug use disorders are just as effective as
    treatments for other chronic conditions such as high blood pressure,
    asthma, and diabetes.[^1]

-   Following treatment, alcohol- and drug-related medical visits
    decline 53 percent.

-   Treatment is a path of recovery that can involve many interventions
    and attempts at abstinence. Just like any chronic disease, there are
    varying levels of success when it comes to treatment. *(NIAAA*)

    **Retention in Treatment**

-   In 2004, only 40 percent of people discharged from treatment
    programs actually completed treatment.[^2]

-   Remaining in treatment for an adequate period of time is critical
    for treatment effectiveness.

    **Personalizing Treatment**

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-   No single treatment is appropriate for all individuals. Types of
    treatment greatly depend on the substances misused, impact on other
    aspects of a person's social and occupational life, the environment
    in which the person lives, psychological well-being, financial and
    legal problems, as well as a person\'s individual needs and
    characteristics. *(SAMHSA, adapted by Dr. Hoffman)*

-   Effective treatment attends to multiple needs of the individual, not
    just his or her drug addiction.

-   An individual's treatment and services plan must be assessed often
    and modified to meet the person's changing needs.

    **Drug Courts**

-   There are more than 1,600 planned or existing drug courts in the
    United States that provide job/skill training, family and group
    counseling, and other resources that help individuals and their
    families cope \[with substance use-related offenses and
    issues\].[^3]^,^ [^4]

-   Juvenile drug courts are intensive treatment programs established
    within and supervised by juvenile courts to provide specialized
    services for eligible drug-involved youths and their families.

    **Family Courts**

-   Cases assigned to family court include \[*NC Court*\]:

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-   Juvenile delinquency charges

-   Domestic violence, neglect, and abuse charges

-   Child custody and visitation rights, and involuntary commitments and
    guardianships

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-   Within the court, families can access social services, dispute
    resolution assistance, and receive counseling.

    **The Benefits of Investing in Treatment**

-   A 2006 study by *Health Services Research* in California has shown
    that treatment in general has a benefit-to-cost ratio of 7:1, with
    substance use disorder treatment costing \$1,583 per person on
    average, yielding a monetary benefit to society of nearly \$11,487
    for each person treated.[^5]

-   Another study conducted in Washington State clinics discovered as
    much as a \$23 return for every dollar spent on treatment.[^6]

-   On a societal level, for every \$1 invested in opioid treatment, \$4
    is recovered in social costs. *(NCCHC)*

    **Barriers to Treatment *(Source: 2007 NSDUH)***

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-   21.1 million persons (8.6 percent of the population aged 12 or
    older) needed treatment for an illicit drug or alcohol use problem
    but did not receive treatment at a specialty substance abuse
    facility in the past year.

-   The five most often reported reasons for not receiving illicit drug
    or alcohol use treatment among persons who needed but did not
    receive treatment at a specialty facility and perceived a need for
    treatment included:

    1.  Not ready to stop using (37.2 percent).

    2.  No health coverage and could not afford cost (30.9 percent).

    3.  Possible negative effect on job (13.3 percent).

    4.  Not knowing where to go for treatment (12.6 percent).

    5.  Concern that might cause neighbors/community to have negative
        opinion (11.0 percent).

        **Stigma--- in general**

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-   In 2001, 19 percent of people in recovery surveyed by Faces and
    Voices of Recovery were afraid of being fired or discriminated
    against if they entered treatment.

-   An estimated 22 to 23 percent of the U.S. population experiences a
    mental disorder in any given year, but almost half of these
    individuals do not seek treatment. *(U.S. Department of Health and
    Human Services \[HHS\])*

-   Embarrassment and shame often are listed as the second most common
    barriers to recovery.[^7]

-   Stigma is a barrier. Fear of stigma, and the resulting
    discrimination, discourages individuals and their families from
    getting the help they need.

    **Stigma--- in the family\***

-   Stigma can keep family members from disclosing a relative's
    substance use disorder, which is counterproductive when they are
    trying to encourage a person to seek treatment.

-   Results from a recent study suggest that families of people with a
    drug use disorder are viewed by society in the most stigmatizing
    manner, when compared to families of people with mental illness or
    emphysema.

-   Society views them as more responsible for onset of the disorder,
    and they may feel more ashamed of their family member.

\* [Source]{.underline}: "Blame, Shame, and Contamination: The Impact of
Mental Illness and Substance Abuse Stigma on Family Members," *American
Journal of Public Health*)

**[Panel #3: Family-Oriented Treatment Options]{.underline}**

**[Key Questions]{.underline}:**

1.  **How does treatment for one benefit the entire family?**

2.  **What support systems are available for family members of addicted
    individuals?**

3.  **What are some programs that take a family-based approach to
    treatment?**

    **The Benefits of Treatment on the Individual and Family**

-   Treatment allows individuals to improve relationships with family,
    peers, and coworkers.

-   In addition to reducing alcohol and/or drug use, treatment can:

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-   Improve mental and physical health

-   Reduce personal health costs

-   Increase productivity in the workplace

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-   People with untreated substance use disorders have a greater risk of
    suffering from additional diseases, which increases health-related
    costs, and have a greater chance of death. *(CDC)*

    **The Benefits of Treatment on Society as a Whole**

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-   Research suggests that treatment can:

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-   Reduce criminal activity up to 80 percent

-   Reduce arrests up to 64 percent *(NIDA)*

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-   Effective treatment reduces harm, such as in physical/sexual
    assaults and motor vehicle crashes, to the general public by the
    behavior of those who are dependent on alcohol and/or drugs.

-   Treatment is associated with a 19 percent increase in employment and
    an 11 percent decrease in the number of clients who receive
    welfare.[^8]

-   CSAT's Discretionary Services Program reported the following, from
    intake to 6 months past intake *(CSAT)*:

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-   Abstinence from substance abuse increased 63.3 percent

-   Employment and school attendance increased 33.5 percent

-   Those reporting having stable housing increased 20 percent

    **Counseling and Outpatient Therapy**

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-   Counseling and other behavioral therapies are critical components of
    virtually all effective treatments for addiction. \[*NIDA*\]

-   This type of program does not require individuals to take time off
    from work, leave their families, or enter a hospital as an
    inpatient. *(Illinois Institute for Addiction Recovery \[IIAR\])*

-   Counseling and therapy help people to:

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-   Address issues of motivation and improve problem-solving abilities

-   Build skills to resist substance use

-   Replace substance-using activities with constructive behavior

-   Develop interpersonal relationships and the ability to function in
    the family and community

-   Work through mental health and co-occurring issues

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-   Motivational counseling is an intensive process that enlists
    patients in their own recovery by avoiding labels, avoiding
    confrontation (which usually results in greater defensiveness),
    accepting ambivalence about the need to change as normal, inviting
    clients to consider alternative ways of solving problems, and
    placing the responsibility for change on the client. (TIP 26:
    Substance Abuse Among Older Adults)

    **Support Groups and Aftercare**

-   In 2006, more than half of the 2.5 million persons aged 12 or older
    who received specialty substance use treatment in the past year also
    received treatment at a self-help group (1.5 million persons).

-   Encouraging people in recovery to seek out aftercare following their
    initial treatment will help them sustain their path of recovery.[^9]

-   Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) and other
    12-step-like programs are self-supporting entities that are not
    allied with any sect, denomination, politics, organization, or
    institution. \[*AA and NA, adapted by Dr. Hoffman*\]

-   Al-Anon holds regular meetings for spouses and other significant
    adults in an alcoholic's life, while Alateen is geared to children
    of alcoholics. \[*NIAAA*\]

    **Family Therapy**

-   In contemporary family therapy, each member of the family is capable
    of being assessed and can act as a unit of intervention, for
    example, by changing his interactional patterns.

-   Contemporary family approaches also target extended systems, most
    notably an adolescent\'s peers, school, and neighborhood, which are
    believed to contribute to dysfunctional interactions in families.
    (TIP 32: Treatment of Adolescents with Substance Use Disorders)

    **EAPs (for employed individuals and their family members)**

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-   An employee assistance program (EAP) can help people find a
    treatment program and provide confidential problem identification,
    short-term counseling, and follow-up services to help resolve the
    problem.[^10]

-   Aside from providing noticeable health improvements among employees
    and their families, EAPs are financially practical. In 1996, the
    average total cost of an EAP was \$45.50 per employee.[^11]

-   The benefits of EAPS include:

    -   Less absenteeism and fewer accidents

    -   Decreased use of medical and insurance benefits

    -   Savings in workers' compensation claims

    -   Fewer grievances and arbitrations.[^12]

        **Drug Education for Students and Families**

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-   D.A.R.E. is a police officer-led series of classroom lessons that
    teaches children from kindergarten through 12th grade how to resist
    peer pressure and live productive drug- and violence-free lives. It
    is now being implemented in 75 percent of our nation\'s school
    districts and in more than 43 countries around the world.
    *(D.A.R.E.)*

-   [www.theantidrug.com](http://www.theantidrug.com/) contains
    information for parents on specific drugs, warning signs of drug
    use, as well as advice on how to prevent children from using drugs.

    **Interventions**

-   In an intervention, several significant people in a
    substance-abusing patient\'s life confront the patient with their
    first-hand experiences of his or her drinking or drug use. The
    formalized intervention process includes a progressive interaction
    by the counselor with the family or friends for at least two days
    before meeting with the patient. (TIP 26: Substance Abuse Among
    Older Adults)

    **[Panel #4: Other Family-Related Addiction Issues]{.underline}**

    **[Key Questions]{.underline}:**

1.  **How can family members assist a loved one currently in or needing
    treatment?**

2.  **What kinds of opportunities does Recovery Month present for the
    family to come together in the face of addiction?**

3.  **How can one's co-occurring illness affect family members?**

    **Enabling**

-   Enabling is defined as any behavior or action, either intentional or
    unintentional, that assists the alcohol- or drug-dependent person in
    the continuation of his or her addiction.

-   Though usually done out of love and misguided concern, enabling
    allows the addict to continue the destructive behavior.

-   Examples of enabling behavior include: making excuses for the
    addict/alcoholic, paying his or her bills, bailing the person out of
    jail, and making rationalizations for the irresponsible behaviors.

    **Extended Family Members**

-   Extended family members may experience feelings of abandonment,
    anxiety, fear, anger, concern, embarrassment, or guilt; they may
    wish to ignore or cut ties with the person abusing substances. Some
    family members even may feel the need for legal protection from the
    person abusing substances.

    **Intergenerational Effects of Addiction**

-   The effects on families may continue for generations.
    Intergenerational effects of substance abuse can have a negative
    impact on role modeling, trust, and concepts of normative behavior,
    which can damage the relationships between generations.

-   For example, a child with a parent who abuses substances may grow up
    to be an overprotective and controlling parent who does not allow
    his or her children sufficient autonomy. (TIP 39: Substance Abuse
    Treatment and Family Therapy)

    **National Association for Children of Alcoholics (NACoA)**

-   NACoA advocates for all children and families affected by alcoholism
    and other drug dependencies. They help children who have been hurt
    by parental alcohol and drug use by raising public awareness of the
    issue, providing leadership in public policy, advocating for
    appropriate, effective, and accessible education and prevention
    services, and facilitating and advancing professional knowledge and
    understanding.

    **Adult Children of Alcoholics World Service Organization (ACA
    WCO)**

-   Adult Children of Alcoholics is a recovery program for adults whose
    lives were affected as a result of being raised in an alcoholic or
    dysfunctional family. It is based on the success of Alcoholics
    Anonymous and employs its version of the Twelve Steps and Twelve
    Traditions. Members meet with each other in a mutually respectful,
    safe environment and acknowledge their common experiences.

    **Recovery Month**

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-   The *Recovery Month* effort aims to promote the societal benefits of
    alcohol and drug use disorder treatment, laud the contributions of
    treatment providers and promote the message that recovery from
    alcohol and drug use disorders in all its forms is possible.

    **Child Welfare Programs**

-   Problems with alcohol and drug abuse are estimated to exist in up to
    80 percent of the families known to the child welfare system. In
    most cases, the parents' substance abuse is a long-standing problem
    of at least five years. \[*RM 2003*\]

-   Some States are pairing clients with individuals in recovery who
    serve as mentors or recovery coaches; these individuals provide
    encouragement, arrange child care and transportation, and hold
    clients accountable for compliance with treatment plans. \[*NCSL*\]

    **Serious Psychological Distress, or "SPD," and Substance Abuse
    *(Source: 2007 NSDUH)***

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-   Among the 5.6 million adults aged 18 or older with both SPD and a
    substance use disorder in 2006, 50.8 percent received some sort of
    treatment:

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-   39.6 percent received treatment only for mental health problems

-   2.8 percent received specialty treatment only for substance use

-   8.4 percent received simultaneous treatment for mental health
    problems and specialty substance use

    **Major Depressive Episode, or "MDE," and Substance Abuse *(Source:
    2007 NSDUH)***

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-   In 2006, 15.8 million adults (7.2 percent of persons aged 18 or
    older) had at least one MDE in the past year.

-   Among adults aged 18 or older who had MDE in 2006, 24.3 percent were
    dependent on or abused alcohol or illicit drugs, while among adults
    without MDE only 8.1 percent were dependent on or abused alcohol or
    illicit drugs.

    **Importance of Treating Co-Occurring Disorders Simultaneously**

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-   The treatment of both mental health and substance use disorders can
    help prevent the exacerbation of other health problems, including
    cardiac and pulmonary diseases.[^13]

-   Ensuring that treatment is available and accessible for both
    disorders is essential to providing a successful path of recovery.
    *(TASC)*

-   Although not readily available, specialized therapeutic community
    MICA ("mentally ill chemical abuse") programs are promising for
    patients with co-occurring mental and addictive problems. *(TASC)*

    **[Additional Resources]{.underline}**

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-   **The U.S. Department of Health and Human Services (HHS)**

[www.hhs.gov](http://www.hhs.gov/)

-   **The Substance Abuse and Mental Health Services Administration
    (SAMHSA)**

[www.samhsa.gov](http://www.samhsa.gov/)

-   **The Center for Substance Abuse Treatment (CSAT)**

[csat.samhsa.gov](http://www.csat.samhsa.gov/)

-   **National Institute on Alcohol Abuse and Alcoholism (NIAAA)**

[www.niaaa.nih.gov](http://www.niaaa.nih.gov/)

-   **National Association for Children of Alcoholics (NACoA)**

[www.nacoa.org](http://www.nacoa.org/)

-   **Alcoholics Anonymous (AA)**

[www.alcoholics-anonymous.org](http://www.alcoholics-anonymous.org/)

-   **Narcotics Anonymous (NA)**

[www.na.org](http://www.na.org/)

-   **Al-anon/Alateen**

[www.al-anon.alateen.org](http://www.al-anon.alateen.org/)

-   **Faces and Voices of Recovery**

[www.facesandvoicesofrecovery.org](http://www.facesandvoicesofrecovery.org/)

**[Sources Cited]{.underline}**

[^1]: Kleber, H.D., O\'Brien, C.P., Lewis, D.C., McLellan, A.T. October
    4, 2000. "Drug dependence, a chronic medical illness: Implications
    for treatment, insurance, and outcomes evaluation." *Journal of the
    American Medical Association* 284 (13), p. 1689.

[^2]: *Treatment Episode Data Set (TEDS):  Discharges from Substance
    Abuse Treatment Services.* DHHS Publication No. (SMA) 06-4207, DASIS
    Series S-35. Rockville, MD:  U.S. Department of Health and Human
    Services, Substance Abuse and Mental Health Services Administration,
    2006, p. 2.

[^3]: "Facts on Drug Courts." National Association of Drug Court
    Professionals Web site: *www.nadcp.org/whatis/facts.html*. Accessed
    August 27, 2006.

[^4]: Rempel, M., Fox-Kralstein, D. Cissner, A., Cohen R., Labriola, M.,
    Farole, D., Bader, A., and Magnani, M. *The New York State Adult
    Drug Court Evaluation: Policies, Participants and Impacts*. New
    York: Center for Court Innovation, 2003, p. 25.

[^5]: Ettner, S., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi,
    M., Hser, Y. January 2006. "Benefit-cost in the California treatment
    outcome project: Does substance abuse treatment pay for itself?"
    *Health Services Research* 41(1), p. 192--213.

[^6]: French, M. T., Salome, H. J., Krupski, A., McKay, J. R., Donovan,
    D. M., McLellan, A. T., Durrell, J. 2000. "Benefit-cost analysis of
    residential and outpatient addiction treatment in the State of
    Washington." *Evaluation Review* 24(6), p. 609--634.

[^7]: Peter D. Hart Research Associates, Inc., October 2001. *The Face
    of Recovery.* Washington, DC: Peter D. Hart Research Associates,
    Inc., p. 10.

[^8]: Center for Substance Abuse Treatment. 2004. *National Treatment
    Improvement Evaluation Study (NTIES), 1992--1997.* \[Computer file\]
    Rockville, MD: U.S. Department of Health and Human Services,
    Substance Abuse and Mental Health Services Administration.

[^9]: Lash, S.J., Blosser., S.L. "Increasing adherence to substance
    abuse aftercare group therapy." *Journal of Substance Abuse
    Treatment*, 16(1), January 1999, pp. 55-60.

[^10]: U.S. Department of Labor Web site:
    *www.dol.gov/asp/programs/drugs/workingpartners/dfworkplace/ea.asp*,
    section entitled "Employee Assistance." summary of p. 1. Accessed
    October 31, 2006.

[^11]: Bray, J.W., French, M.T., Bowland, B.J., Dunlap, L.J. "The Cost
    of Employee Assistance Programs (EAPs): Findings from Seven Case
    Studies." *Employee Assistance Quarterly,* 11(4), 1996, p. 1.

[^12]: *What Works: Workplaces Without Alcohol and Other Drugs*. U.S.
    Government Printing Office 282-148/54629. Washington, DC: U.S.
    Department of Labor, October 1991 (reprinted 1994), p. 11.

[^13]: *Report to Congress on the Prevention and Treatment of
    Co-occurring Substance Abuse Disorders and Mental Health Disorders.*
    Rockville, MD:  U.S. Department of Health and Human Services,
    Substance Abuse and Mental Health Services Administration, 2002, p.
    ix.