With the best of intentions, families can fall into unhealthy roles when attempting to cope with a loved one's alcohol or drug addiction. Enabling, denying, blaming and preoccupation are common coping behaviors. Listen in as host William C. Moyers talks with therapists Sarah Schwalbach and Julia Edelman about how addiction affects the family system, what it means to "detach with love" and why helping a loved one who has addiction starts with getting help for yourself.
0:00:13 William Moyers
Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on substance use issues. Issues that matter to us, and issues that matter to you. Including prevention, research, addiction, treatment and recovery from substance use disorders. I'm your host, William Moyers and today I'm joined by two colleagues: Julia Edelman and Sarah Schwalbach. Welcome.
0:00:40 Sarah Schwalbach
Thank you. Thank you for having us.
0:00:41 William Moyers
Well tell me a little bit about how it is that you all work in this field at our facility for youth in suburban Minneapolis.
0:00:49 Sarah Schwalbach
Sure. So I got started in the Plymouth Family Program as a Practicum student when I was finishing up my Master's Degree in Marriage and Family Therapy here in the Twin Cities area. And I did my Practicum the last—about nine months of my studies at the Family Program basically wouldn't leave when I was done so they gave me a job. Which is really nice of them because I love the Family Program. So that's how I—thank you—that's how I ended up here.
0:01:15 William Moyers
Welcome, Sarah. And Julia.
0:01:19 Julia Edelman
Similar, I started as an intern in the Family Program. I like to think I came to the program honestly because I am in recovery myself, coming on 27 years on April Fool's Day. I decided—decided I had to stop fooling myself and—and so I really wanted to give back to the community and get involved in a professional manner as well. So I—I've been there ever since. That was about six years ago.
0:01:47 William Moyers
Thank you. I can't think of two better experts to talk about our topic for today which is Family Roles When Addiction Takes Hold. Julia, tell us about the impact that addiction has in families not just in the individual with the illness.
0:02:01 Julia Edelman
Addiction is truly a family disease. There's no stone left unturned. Each family member is impacted. Sometimes we look at a—a mobile that you might hang over a baby's crib, right? And you could put weights on one—one component of that mobile. And that's what addiction does. The addict goes down, the mom goes down, the siblings go down, the whole family system becomes weighed down. Until recovery begins. So, the impact shows up in many different ways depending on the family makeup.
0:02:39 William Moyers
Sarah, does addiction affect the family equally or does it affect different members differently?
0:02:44 Sarah Schwalbach
I'd say it affects different members differently. What we've noticed though over time is that the family—that addiction affects the family and the addict or alcoholic in many more similar ways than different ways. But yeah, within the family system everybody's going to be impacted a little bit differently.
0:03:04 William Moyers
And the term that we often hear when it—talk about addiction in families is the term co-dependence. What does that mean, exactly?
0:03:12 Julia Edelman
I think co-dependence the best way that I like to describe it: it's where—where we don't know where one person leaves off and another person begins. It's almost like looking at a blurry photograph, right, and two bodies almost become merged. So, they're—they're fused and what we do, the work that we do in the Family Program is allow each family member to see how they need to take care of themselves first and foremost. And allow the addict to pick up the—the barbells, to do their own heavy lifting and their own work. So, we really try to help family members differentiate the roles in the families.
0:03:56 Sarah Schwalbach
Yeah, another term that often comes up when we're talking about co-dependency is enmeshment. Right?
0:04:01 William Moyers
0:04:03 Sarah Schwalbach
Enmeshment, yeah, relationships that are enmeshed. Meaning people have a difficult time really functioning on their own or without that other relationship or person.
0:04:14 William Moyers
But parents love their children, right? And they want only what's best for their children. What's wrong with getting involved in your child's struggles if they struggle with substance use disorder? I mean they—we often hear the term detachment or to detach with love. What does detach with love mean? How do you do that?
0:04:34 Sarah Schwalbach
So detaching with love, and Julia can chime in too—detaching with love to—the way I understand it and talk with families about it means beginning to separate the person from the disease or the actions or the behaviors, the choices that they're making. So, you can still love your son, daughter, brother, sister, spouse, without agreeing with the choices that they're making or their behaviors, yeah.
0:05:06 Julia Edelman
Yeah and it is particularly hard for parents—we are hard-wired to help our kids. We pick them up and put bandages on things when they're, you know, knee-high to a bullfrog, right? And we're helping them and nurturing them and at some point that helping them becomes actually hindering them. When there's active addiction going on. So we need to understand that, educate ourselves and then learn how to take a step back.
0:05:34 William Moyers
So co-dependence is an unhealthy dynamic, right?
0:05:38 Julia Edelman
0:05:39 William Moyers
And how does that unhealthiness manifest itself in the family members? So, for example, if you have a young man or a young woman in our facility, our youth facility in Plymouth, how does that co-dependency manifest itself in the parent?
0:05:54 Sarah Schwalbach
Yeah. Kinda goes back to what I mentioned before about how family members are often impacted by the addiction in many more similar ways than different ways as the addict or alcoholic. So, family members are—are impacted on a physical level, on an emotional level, on a cognitive level. In their relationships, in their spiritual life, in their environments. Kind of functionally work, school. So in lots of different ways or facets or areas of their life.
0:06:26 Julia Edelman
And sometimes we see it play out I can show you or give you some examples might be 'If you go to treatment, we'll give you a car.' Right? Or, maybe an example without using addiction might be 'I'm gonna write that college essay for you.' Right? So that's how—that's a way that many people can relate to. With addiction, it might be bribing, uh, cajoling, denying.
0:06:57 Sarah Schwalbach
It can also look like, you know, my—my son or daughter is out until all hours of the night I don't know where they are and that mirroring of that behavior—I'm up until all hours of the night, tracking their phone or—or listening for them to come home or waiting for the phone to ring. And so those parallel processes of—that we experience.
0:07:21 William Moyers
What about parents who say that they know that they have to wait until their loved one hits bottom before they get them help? What is your response to that?
0:07:31 Julia Edelman
I believe we all have very different bottoms. And a bottom for one family may be a DUI, it may be a legal charge, it might be breaking and entering. I actually ask parents to look at the—the hard fact that the Big B, the ultimate bottom, if we keep enabling, if we keep jumping in, and if we're not taking care of our side of the street, the big bottom is what?
0:07:59 William Moyers and Sarah Schwalbach
0:07:59 Julia Edelman
0:08:01 Sarah Schwalbach
0:08:01 Julia Edelman
So we don't wanna get there. So we don't have to get there. And most people don't get there. But we have to—we can't go in and cushion the little bottoms for them.
0:08:09 Sarah Schwalbach
Right. That's what we talk about with enabling or—or avoiding getting into enabling behaviors. Not cushioning those little bottoms along the way. So that the full impact of the natural consequences that are gonna come about are able to be felt by their loved one.
0:08:29 William Moyers
That's so hard as a parent. And I—I know you all are both counselors or therapists working in the Family Program at our youth facility. And that program is three or four days, right? I mean how do you reach or how do you teach parents in that really short period of time? I mean that's not the end of their experience, that's the beginning, right?
0:08:51 Sarah Schwalbach
0:08:52 Julia Edelman
Right. Exactly. It's the most beautiful process. We start out with, actually much like an AA or NA circle, we start out in a circle with introductions of the family members. And we have youth, we have siblings ages 12 on up that are also allowed to come in.
0:09:08 William Moyers
Brothers and sisters can come?
0:09:09 Julia Edelman
Brothers and sisters of the clients that are in treatment. And so we start out just getting to know each other, you know, looking across the circle and seeing, oh that person looks pretty normal, you know? We're not all alone.
0:09:24 William Moyers and Sarah Schwalbach
0:09:24 Julia Edelman
And then we layer on top of that education, what is addiction and we—we look at the disease model of addiction, and then we layer on top of that the next day looking at family roles, and we layer on top of that looking at enabling and—
0:09:39 Sarah Schwalbach
Those parallel processes. How everyone has been impacted by the addiction. Clients and those struggling with the addiction and the family members.
0:09:42 Julia Edelman
Yes. Yeah. Co-occurring disorders and then we get into having each family member look at what they can do. Now that they understand that they have their own recovery to work on. So let's write down some hard and fast things. What can you do, what's one step you can take toward health. And maybe it's going to Al-Anon.
0:10:08 William Moyers
And yet you don't expect anybody to leave there having mastered anything that you've talked to them about, right? 'Cause as we know recovery is a lifelong experience.
0:10:15 Julia Edelman
0:10:16 William Moyers
Not just for the addict or the alcoholic in your life but your own life is about a process of discovery, a process of healing, and that doesn't happen in a set timeframe, right?
0:10:27 Sarah Schwalbach
No, we hope it's a catalyst. You know? It's a beginning. [nods] It's the beginning of a family recovery process for them.
0:10:35 William Moyers
Is it a different approach though? I mean parents are always we're—I mean, I'm a parent and I'm used to attending to my children's needs even when they grow up, right? I don't consider myself to be co-dependent but they might disagree with me, they might think I'm totally co-dependent and I'm working on that.
[Sarah Schwalbach and Julia Edelman chuckle]
0:10:55 William Moyers
But how—how does the dynamic work when, well how do you set boundaries as a parent when you've got a—a child who is in that recovery process?
0:11:05 Sarah Schwalbach
You begin to look at what are you responsible for, what am I responsible for? When I'm setting boundaries, what's my motivation or my intention behind that boundary? Am I coming from a place of fear, trying to control the—the situation or the outcome? Or am I coming from a place of I'm controlling what I can control including my resources, my time, my energy, and—and setting boundaries from—from that place. It's also—it comes back to values, too. We talk a lot about the values that a family member has.
0:11:38 Julia Edelman
0:11:41 Sarah Schwalbach
And getting back in touch with—with your values as—as a mom, or dad or sibling—
0:11:47 William Moyers
0:11:48 Sarah Schwalbach
And then setting boundaries rooted in those values.
0:11:52 William Moyers
Because addiction wrecks boundaries, right? And addiction wrecks values, family values.
[Sarah Schwalbach and Julia Edelman both nod]
0:11:58 Sarah Schwalbach
It can. It can. It adds chaos into the system.
0:12:01 William Moyers
0:12:01 Julia Edelman
Total mayhem, chaos. And so we wanna re-establish a hierarchy in the family. Often that means asking parents to look at themselves as the CEOs of their home. Reclaim that status because usually it's been lost in this process. And then as Sarah was saying, set clear, concise, rules and boundaries, and expectations and the big one where we often as parents often fall—fall down, right, is being able to follow-through.
0:12:32 Sarah Schwalbach
0:12:33 Julia Edelman
So we set the—the boundary, we set a consequence if the boundary isn't maintained, and then to follow through is the—really, really critical piece.
0:12:43 Sarah Schwalbach
And if you're not ready to follow through, you're probably not ready to have it be your boundary.
0:12:47 Julia Edelman
0:12:48 William Moyers
Oh, that's interesting. How do you encourage parents or siblings who—how do you encourage them to take care of themselves? What—what should they be doing even if their loved one is gonna continue to use?
0:13:02 Sarah Schwalbach
It comes back to that oxygen mask analogy or image. You know you get on an airplane and—and they're going through the safety instructions and what is the—the attendant at the front tell you to do in—in the state of an emergency? Well, there will be an oxygen mask that falls from the ceiling and you put it on yourself before assisting others, right? So with family members, it really does—it can feel like the most counterintuitive thing to do in—in when you're in the midst of it, but it's the most helpful thing to do to put on your own oxygen mask. Help yourself first. Because if you're deprived of oxygen you're not gonna be any help to your loved one who's struggling with addiction when they need you. [nodding]
0:13:46 Julia Edelman
Yeah and I would add to that, too, setting a positive in that way, right—you're setting a positive example. Getting help for yourself. Really taking a—a thorough inventory of your own self and your own shortcomings. And maybe getting involved in individual or family therapy definitely finding a support community. Whether it's Al-Anon or Nar-Anon or Families Anonymous. But finding that community so you're not feeling so isolated and all alone. Can be really, really critical.
0:14:21 William Moyers
And in the short time we have left just a couple of minutes we've talked a lot about the family dynamic as it relates to the other family members but what about your counsel, your support for the addict or the alcoholic in that recovery process? What is your counsel to them or that—your advice? Because they're still in that family, but they're having to do things differently.
0:14:39 Julia Edelman
Yeah. So I—we're all—we use a lot of metaphors in our family program. So here's mine.
[Sarah Schwalbach laughs]
0:14:45 William Moyers
Well it makes sense.
0:14:45 Julia Edelman
We're in the middle of—of winter here—and a polar vortex. So, I look at it like ice fishing, right? So you're out there ice fishing, there's a big hole in the ice. If somebody—if my family member falls in that hole, heaven forbid, right, what happens if I jump in after them? What happens to me? I don't wanna do that, right? But what I can do is throw them a line. Throw them a rope. Throw them a lifeline. And trust that they will grab onto that.
0:15:16 Sarah Schwalbach
Yeah. And the—the addict, alcoholic, will—they'll have their own recovery, to be working. While the family is working on theirs. And sometimes they may you know be walking parallel with each other, other times the addict or alcoholic may be a little bit ahead of the family in terms of their recovery and the family needs to catch up. Or vice versa. But everybody's on their own path.
0:15:41 Julia Edelman
Yeah. And in Hazelden people are getting—the clients are getting the tools they need to live a life of recovery. And we offer that for family members as well. And we really encourage the family members to allow their sons and their daughters to pick up those tools and not do it for them. It's kind of like if you have a manager at work and they give you a task to do, a job to do, you don't want that person micromanaging you, right? Act as if they can do it. Give them that—that choice. To choose. To pick up the tools. Choose recovery.
0:16:20 William Moyers
So at the end of the day then what both of you do is to instill in people that sense of hope.
0:16:25 Julia Edelman
Yeah. Yeah. [nodding]
0:16:26 William Moyers
So that when family roles, when addiction takes hold, we know the terrible toll that addiction takes. But the great rewards of hope that comes through that process is possible.
0:16:36 Sarah Schwalbach
0:16:36 Julia Edelman
0:16:37 William Moyers
Thank you very much to both of you, Julia and Sarah, for joining us today and for sharing your experience with our viewers and our listeners who I know will be grab—holding onto every word that they've heard from you today as they navigate their own journeys. Through the addictive process in their own families. Thank you for joining us today—
0:16:55 Julia Edelman
Thanks so much.
0:16:56 William Moyers
And thanks to all of our viewers and our listeners for joining us for another edition of the Let's Talk Podcasts. I'm your host William Moyers and please be sure to join us for another conversation on the issues that matter to us and of course matter to you, too.