Interventions Offer Support for Loved Ones of Individuals With Addiction, Mental Health Conditions

Mental health and/or substance use disorders often have devastating effects not only on the individual, but on their loved ones as well. Although concerned significant others (CSOs) can be severely impacted, few therapeutic models are designed to help the loved ones of individuals in treatment.

At the Cape Cod Symposium on Addictive Disorders on Thursday, Jack Perkins, DMin, LADC, CSAC, CCLC, founder of Psuche Education, Counseling & Life Coaching Services, Fort Gibson, Oklahoma, delivered a presentation on the impact of mental health and addictive disorders on families. Ahead of his session at the Symposium, Perkins spoke with Addiction Professional by email to discuss how addiction and mental health conditions affect family members, therapy models and interventions to help families cope, and issues that providers should be mindful of when incorporating CSOs into an individual’s treatment plan.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: How does the addiction or mental health condition of a loved one impact family members? What signs or symptoms in family members should have caregivers on the lookout?

Jack Perkins: A starting place is to put the problem into perspective. Over 53 million people over the age of 12 have used illegal drugs or misused prescription medicine within the past year. Approximately 26% of the population—1 in 4 adults—struggle with serious mental health disorders. With reported cases, it can be assumed that approximately 65 million families and concerned significant others (CSOs) are directly impacted by these disorders. They too often result in devastating consequences on CSOs.

Concerned significant others face a plethora of issues, many that their loved one isn’t aware of or is not processing. Many CSOs struggle with anxiety and depression. They often begin to experience issues like family conflict, social withdrawal, financial difficulty, guilt, and shame—often blaming themselves, anger, physical health issues, and so forth. One man with a son struggling with schizophrenia and addiction told me he and his wife were having marital problems and he was filing for bankruptcy. He was in counseling for a major depressive disorder. An overwhelming sense of helplessness and hopelessness is experienced by many CSOs.

Grief is one of the major issues CSOs face, broader in scope than just experiencing a death. As I present and talk to CSOs, a common theme I hear is the impact of loved ones taking their lives by suicide or by overdose. The National Alliance on Mental Illness (NAMI) reported that 90% of those who end their life by suicide may have experienced symptoms of mental health disorders. Additional types of grief are anticipatory grief, complicated grief, cumulative grief, masked grief, and grieving what could have been and/or anticipated but will not be realized. I believe any time CSOs see major changes in relationships, sleep patterns, anxiety and/or depression, and suicidal ideation, they should seek professional help.

AP: Can you identify and briefly describe different therapy/coaching models that help families cope? How do you determine which model is appropriate for each family?

JP: In a sense, there are 2 corollary tracks that require attention for CSOs to take. First, they must decide how to encourage their loved one to seek treatment. If the safety of the family is threatened, they will need professional interventions designed to encourage the family member to get help. There are 3 basic intervention models:

• The Johnson Model confronts the individual.
• The Systemic Intervention Model focuses on repairing the family system.
• The Systemic Process of Accountability, Repair, Education, and Direction is a cognitive behavioral model with the goal of long-term recovery.

Second, CSOs need to accept that their needs are real, and they need help. While there are a variety of models for helping families, more work needs to be done to help CSOs know about available services. CSO should be referred to healthcare providers for an assessment to determine treatment options. There are 3 basic models for helping CSOs:

• Community support groups;
• Counseling and psychotherapy groups; and
• Healthcare providers providing psychoeducation and support groups in communities.

NAMI is a great resource for CSOs; it is a support network that has a professional foundation. This is highly recommended, even when CSOs seek professional counseling. The Journey of Hope Family Education Course is a peer-led, manualized intervention that focuses CSOs’ attention to mental health causes, treatment models, recognition of relapse, medication, and so forth.

AP: What are some of the biggest potential issues to be cognizant of when incorporating families into an individual’s treatment plan?

JP: Traditionally, providers have focused on the person with a mental health disorder and/or an addictive disorder. Too often, when a provider has a family session, it becomes about the client, and CSOs leave feeling they are the problem or have not been able to get the help they need. I recall only a few healthcare providers referred CSOs to get an assessment and seek counseling.

Confidentiality and dual relationships are issues to which providers must remain sensitive. Providers need to develop a model that is emphatic and sees the primary client and CSOs as having equal status. They will need to exercise great care to avoid splitting issues, coming across as taking sides, and other issues that hurt the therapeutic relationship(s). The Community Reinforcement & Family Training (CRAFT) is a great resource for healthcare providers when working with families. It is utilized in a variety of settings, including outpatient addiction clinics, mental health centers, recovery communities, harm reduction centers, psychiatric settings, schools, and private practice. This is a well-done model that I recommend.

AP: Is there anything else that you would like to add that we have not yet covered?

JP: Most of my observations have focused on families with loved ones with mental health and addictive disorders; however, these issues impact our wider communities in astronomical ways. Healthcare providers need to partner with other agencies (e.g., legal entities, departments of human services, and other social agencies, churches) to address some of the underlying issues that perpetuate these disorders. This is where a lot of time, energy, and resources need to be applied. Systemic change requires agencies to work collaboratively.

Reference

Perkins J. Impact of mental health and addictive disorders on families and communities. Presented at Cape Cod Symposium on Addictive Disorders; September 7-10, 2023; Hyannis, Massachusetts.