WCSAD | Family Involvement in Recovery Can Help Young Adults With SUD

Family involvement is a critical element to success in the recovery process for young adults suffering from addiction and substance use, Trish Caldwell, MFT, LPC, CAADC, CCDP-D, CCTP, Vice President, Family Services for Recovery Centers of America, King of Prussia, Pennsylvania, shared in a West Coast Symposium on Addictive Disorders virtual presentation Thursday.

There has been a 30% increase in substance use-related deaths since 2019, with over 93,000 lives lost in the past year, shared Dr Caldwell.

“We are seeing an increased rate of overdoses that is leading to the traumatic experiences of families, and the urgency in the behaviors associated with them,” Dr Caldwell said. “That becomes a key factor to our understanding of why and how is the family engaging in the recovery process.”

Young adults ages 18 to 25 are the highest risk of misusing substances, with the catalyst among this age group being prescription drugs. The highest rates of marijuana misuse are seen among ages 12 to 17. Dr Caldwell cited recent research suggesting that increased use of marijuana prior to the brain’s full development can lead to additional substance misuse down the line.

When it comes to being involved in the addiction recovery process for young adults, it is important for treatment teams and families to remember that the patient did not have the opportunity for their brain to fully develop, and the parent never had the opportunity to finish raising the child.

“If you have a young adult who has been using substances probably since they were an adolescent, which is very common…then at that age, whatever coping skills their brain was supposed to be developing, it didn't,” Dr Caldwell said.

The amygdala, the driving and impulsive part of the brain, and the prefrontal cortex are deeply affected by substance use during development.

Dr Caldwell emphasized an importance in treating young adults suffering from addiction differently than adults. Young adults who began misusing substances at an early age might have to learn organizational skills, how to moderate impulsivity, and how to delay gratification, among other basic coping mechanisms.

“Their brain hasn't developed enough to be able to do this on their own, they need the scaffolding that we, as providers and family members, need to be able to engage in,” Dr Caldwell shared.

‘Invisible Loyalty’

In Dr Caldwell’s experience, multigenerational trauma and multigenerational substance use correlates with an increase in loyalty caused by shared experiences. In these situations, Dr Caldwell suggests discussing treatment plans in recovery houses and other treatment options outside of the home with the families. She emphasized the importance of never asking a young adult to choose between their recovery and their family.

“Invisible loyalty holds much greater weight, and so if you put yourself in a position where the young adult has to choose between their family and their recovery, they will always choose their family,” she said.

Family members often learn behaviors intended to encourage recovery, which actually protect the addiction. This can be known as toxic stress.

Dr Caldwell discussed the limbic system, the part of the brain which aids behavioral and emotional responses, and how both family members and young adults suffering from addiction get stuck in habits by engaging this.

“They think the fact that their child is alive is because they were controlling them, is because they were yelling at them, is because they were doing everything for them,” Dr Caldwell said.

It is the professional’s job to validate these family members’ thoughts, but also teach them how the brain operates, and that the more the patient gets stuck in this limbic system, the harder it will be to recover.

The cortex, the part of the brain that thinks through things, is what needs the most engagement to recover.

“If you are dictating to them what they need to do to stay sober…you are telling them everything to do, that part of the brain is not getting stronger,” she said.

Traumatic events for family members that contribute to this cycle can include witnessing an overdose, domestic violence, behaviors associated with substance use seeking, police in the home, thoughts of daily life, and death threats.

“In your attempt to keep somebody that you love alive, your brain circuitry started to circulate around engaging in behaviors that your brain has learned work. Treatment is helping you to recognize that that's not what's working,” she said.

Engaging Families in the Treatment Process

Dr Caldwell shared the following tips for engaging families in the treatment of loved ones:

• Don’t be the “bill collector.” Reach out to families with updates often.
• Create a strong therapeutic alliance with the family to validate their struggles and create a mutual conversation that overall will help both the family and the patient recover.
• Assist the family in healing by providing education and family sessions.
• Help them develop a family recovery plan.

“It is a particularly important for families and loved ones to provide constant support and encouragement,” Dr Caldwell said. “I want them to believe in the possibility of hope, I want them to believe in the possibility of recovery, but I need for families to begin their own recovery process.”

Dr Caldwell also emphasized helping families understand that it is acceptable and important to make their loved one accept the consequences of their behaviors by creating boundaries and sticking to them.

The guiding tool she said families should use during the recovery journey is asking themselves: “Is the behavior I’m about to engage in going to support recovery, or is it going to protect the disease of addiction?”

Clinical Relationship

Dr Caldwell closed the presentation with suggestions for maintaining trust in the clinical relationship, including practicing full transparency with the patient, helping the patient understand the clinician’s role, following clinical integrity, honesty, not colluding with the patient, and helping the patient set boundaries.  

“Our job is not to protect our patients from their life, our job is to help them learn how to manage themselves inside it,” Dr Caldwell concluded.

Reference

Caldwell T. Best behavioral practices in substance use disorder treatment. Presented at: West Coast Symposium on Addictive Disorders; September 29-October 3, 2021; Virtual.