Families not only need to be involved in the treatment planning for a loved one with a substance use and co-occurring mental health disorder, but they need to be seen as the primary unit of healing, neuropsychiatrist Judith Landau, MD, told a National Conference on Addiction Disorders (NCAD) audience on Friday.
“The more the family does, the better the results,” Landau said as she described the process characterizing the trademarked ARISE model of intervention. “It's almost that we have to work ourselves out of a job.”
Much of Landau's morning plenary presentation at the Baltimore conference focused on achieving stronger collaboration with families and shattering myths about family connection and involvement. Counteracting the often-held belief that individuals with addictions inevitably become disconnected from their families, Landau pointed to two studies showing that daily phone contact with parents occurred nearly two-thirds of the time among young people with heroin addiction and less than 10 percent of the time in a comparable non-addict population.
Therefore, treatment programs must capitalize on this connection and also “draw on the family's inherent resilience, rather than labeling behavior and communication patterns as dysfunctional,” Landau said.
She pointed out that the actions that providers often label as reflecting family dysfunction are generally initiated to protect the family from harm, and that these patterns will change once these issues are resolved (such as through family-focused treatment).
Providers have to work collaboratively with their colleagues, so that patients don't simply receive the service based on the door through which they entered treatment, and they must invite families to be part of the collaborative team, Landau said.
“We've learned a lot since the days of 'parentectomy,'” she said, referring to an historic tendency to eliminate families from the treatment equation rather than seeing them as equally deserving of care.
Focus on young people
In discussing the dual phenomena of a rising suicide rate among young people ages 10 to 24 and increases in drug overdose deaths, Landau pointed out that the field needs to pay closer attention to cultural changes that have defined a new life stage between adolescence and adulthood. She also took issue with a term often applied to struggling members of this age group.
“I don't see it as a failure to launch,” Landau said. “I see it as our failure to adapt to the cultural shift” that manifested in a newly defined decade of the life cycle.