What's a Family to do?

For a disease that strikes so many, addiction is still surprisingly misunderstood. Here are the things everyone should know.

Social worker Harry Swift arrived at Hazelden's burgeoning Center City campus in 1966 with an important if ambiguous assignment.

"I was to do something to help families," Swift recalls.

By the mid-1970s, that "something" took shape as the national model for helping families faced with addiction.

Recently retired from a half-century career in addiction counseling and administration, including six years as president of Hazelden in the late 1980s and early 1990s, Swift was the chief architect of Hazelden's preeminent Family Program. Marking its 40th anniversary this summer, the Family Program is a fixture of Hazelden's signature approach to addiction treatment and was the forebear of the organization's popular Parent Program and groundbreaking Sibling Program.

Help In Their Own Right

In his early days at Hazelden, it was customary for Swift to meet with family members of patients, usually the spouse.

"They were hurting and in pain. There was anger and deep disappointment and so much resentment that had built up over the years. And now their spouse was in a fancy treatment center being cared for while they were at home with all of the problems and bills to manage. They felt angry and frustrated from running up against the wall of addiction," explains Swift.

In meeting with family members, Swift's focus was on the patient's well-being.

"The thinking at the time was that we would be sending the patient back into a home environment that had previously caused him stress and anxiety. We met with the spouse to discuss what could be done to help the patient back at home. Today, we know that was a very primitive concept."

It didn't take long for Swift to realize that patient-focused counsel wasn't the kind of help families in distress needed.

"The program helps participants see how the anxiety of family members perpetuates the problem."

"We soon shifted our focus, recognizing that we can't 'repair' the family to make the patient well," he explains. "The patient has to take responsibility for his or her own recovery. Families needed help in their own right."

Taking its lead from Al-Anon, Hazelden's Family Program, originally called the Spouse Program, was established in 1972 as a three-day workshop on the Center City campus. Swift describes the earliest participants as anxious to get help but "fearful that they were to blame for the addiction."

That's why a first order of business in the program is to dispel family members of the notion that they cause, can control, or can cure their loved one's addiction. While these lessons are presented by Family Program counselors, they are best absorbed and understood by participants through the shared experience of others in the program.

This healing power of peer interaction was identified as central to the Family Program by Swift who, in 1972, recruited Hazelden alum and university-librarian- turned-addiction-counselor Terry Williams to lead the first Family Program groups.

Someone Who's Been There

"It was an experimental move at the time, but Harry thought I could help him with families as someone who'd been there," recounts Williams who led Hazelden's Family Program for 20 years. "I first arrived at Hazelden as a patient in 1970. I was the classic case of having hit rock bottom: Lost my university position, lost my family, the whole works," Williams shares.

Shortly after completing a nine-month program of treatment and extended care at Hazelden and resuming his career as a research librarian, Williams received Swift's recruitment call. Intrigued if not somewhat daunted at the prospect of developing a program for families, Williams returned to Hazelden for counselor training—and to help launch the new venture.

It Was a Bumpy Start

"The treatment staff had known me as a patient," explains Williams. "There were concerns about my qualifications — they weren't keen about the idea of having me work with families. And some counselors did not subscribe to Al-Anon's central tenet of 'detached concern.' They didn't think that wives taking a posture of detached concern was necessarily in the best interest of the patient."

Still, Swift and Williams knew that despairing families needed something hopeful and constructive.

Education and Mutual Support

"Harry envisioned a program for families that resembled Hazelden's treatment program for the alcoholic patient—a combination of education about addiction and self-help," recalls Williams. "Family therapy was revolutionary back then, and we didn't have a clear idea of what to do.

So we called in the wives of six patients for a three-day workshop. It was basically an introduction to Al-Anon principles. That was our start. It seemed to have effect. We began offering the program once a month, and eventually worked out a daily schedule of topics and exercises."

Williams received training in family systems theory at the Georgetown University Family Center under Murray Bowen, MD. Hazelden's Family Program grew and evolved over the years as a blend of family systems theory and Al Anon principles, always rooted in education and mutual support.

"The program helps participants see how the anxiety of family members perpetuates the problem," says Williams. "Having 'detached concern' is the idea of the family member calming down and starting to think through the situation rather than reacting emotionally. Anxiously trying to help—trying to 'cure' their loved one—is counterproductive."

The other key to the Family Program's effectiveness is the introduction of participants to others who share the same problem—a practice that's central to primary care addiction treatment.

"We used to say that the real help came along for Family Program participants after the staff went home," says Williams. "It is of tremendous comfort and relief to know someone else is experiencing the same thing. The shame is lifted. You realize you aren't alone."

Expanding the Reach

In 2007, under the leadership of John MacDougall who also serves as Hazelden's director of Spiritual Guidance, the Family Program in Center City was modified and expanded to reach more people. MacDougall's relationship with Hazelden began in 1987 when he sought out the Family Pro- gram to sort through the detritus of a child- hood scarred by alcohol-fueled abuse. Two years later, when his wife—who happened to co-pastor a Methodist church with him—decided to pursue a year-long program of theological studies, MacDougall returned to dual-enroll in Hazelden's clergy and counseling training programs. Although it was an intensive educational experience for MacDougall, one essential lesson remained elusive.

The truth about his addiction became inescapable when working with the men on Shoemaker Unit as a counselor trainee. MacDougall saw his life following the trajectory of their stories. He got sober in 1989. Five years later he returned to Hazelden as supervisor of Spiritual Care.

In 2007, MacDougall was asked to over-see and restructure the Family Program. The result: A four-day, nonresidential format—similar to the program offered at Hazelden in Springbrook, Oregon—and a 40 percent increase in enrollment. Today's program follows a standardized curriculum of lectures and guided small group discussions, with unstructured time for peer sharing.

Confront the Disease, Not the Person

One unchanging dimension of Hazelden's program through the years—and a key differentiator in the field—is its non-confrontational approach. Family members do not participate in programming with their loved one receiving treatment. Instead, family members hear from other patients going through treatment. And patients who participate in the Family Program do so apart from their actual families—gaining insight from other patients' spouses, parents, children, siblings.

"The resentments and baggage get moved to the side, and everyone sees things more clearly," says Swift, who engineered Hazelden's non-confrontational design at the start.

It's proved a providential call, says MacDougall.

"A great many programs use family members as battering rams to break down the patient's denial. That's so destructive," says MacDougall. "We ask family members to confront the disease by writing letters to patients about how they've been affected by addiction, but we do not put them in the same room to blow up at each other."

Another time-tested strength: The Family Program's duality of clinical expertise and mutual support—even though it's been a source of tension between some treatment clinicians and some AA adherents over the decades, notes Williams.

"I'm so proud of Hazelden for its long and difficult history of trying to bring the two camps into sync, the professional/ clinical and the self-help. The objective is one and the same: Helping people heal from addiction."

Article originally published in Summer 2012 VOLUME 17, ISSUE 1 of Hazelden Betty Ford Foundation publication, The Voice.

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