Families are taking a growing role in the recovery of people in treatment for substance addictions, and a leading researcher said Thursday that recovery strategies are just as important for the family as a whole as for the addict.
Dr. Robert Ackerman talked about the impact of opioid addiction on families Thursday at an annual workshop on the Indiana University of Pennsylvania campus. The session was part of the weeklong Mid-Atlantic Addiction Research and Training Institute summer conference, an organization that Ackerman established during his 28 years as a professor of sociology at IUP.
Challenges to recovery from drug addition have grown in recent decades because of a growing acceptance of narcotics use, fostering an atmosphere of denial because the drugs are legal and prescribed, he said.
“The American Medical Association in the late 1980s and ’90s added a fifth vital sign that needs to be assessed in patients — pain,” Ackerman said. “Is you patient in pain? And what they are telling physicians is do not allow your patients to remain in pain. You need to address the pain.”
That’s a fundamental part of the growth in the trend toward addiction, as more pharmaceutical companies developed more opiate-based drugs and as pain management clinics began to emerge.
And Ackerman said AMA research published in 1980, showing a 1 percent rate of addiction among painkiller patients, helped pave the way to the spiraling growth.
“All of a sudden now what we’re trying to do is crack down, on the source and the supply,” he said. “The other thing is the futility. The futility right now is incredible throughout the country. We don’t have a national sense of just how dangerous this is, and we don’t have a national response. The governors of 23 states have declared a state of emergency in their states.
“The other thing is that disproportionately, families to a great extent might be led to believe that if this is medical, it’s going to be a medical solution. That’s not what the solution is going to be.”
As Ackerman see it, prevention is the key.
“Until we start to seriously think about some of the solutions, if there is such a thing, without prevention, this problem is going to continue to rise.”
Compounding the problem of addiction to legal pain pills, Ackerman said, is the growing addiction to heroin.
“They switched to an illegal substance. It’s cheaper. They’re running out of places to get prescriptions,” Ackerman said.
The national opiate problem exploded in southern Ohio, parts of West Virginia, parts of Kentucky and western Pennsylvania, Ackerman told his audience.
“I don’t know what the outcome of this opiate crisis is going to be,” Ackerman said. “I think we’re going to see more and more people involved in combating this. Pennsylvania has developed what are called “centers of excellence” and 50 have been funded throughout the state, to try to help with the problem,” Ackerman said. “We’re seeing some innovation, but I’m not sure how it is going to turn out.”
Along with devastating lives of addicts and their families, the opioid crisis has stressed the resources dedicated to solving it.
“I’ll tell you where the stress is really happening — hospital emergency rooms, because of all the opiate overdoses,” Ackerman said. Data from the Centers for Disease Control and Prevention ranks Pennsylvania at No. 14 in the nation in the increase of overdose deaths from 2014 to 2015.
“It’s putting a lot of strain on the alcohol and drug programs we do have, and let’s be honest about it — I don’t know of a drug and alcohol program that hasn’t had budget cuts.”
A growing trend in counseling is to lay out the science of the problem, Ackerman said.
“The use of neuroscience is something that, since the turn of this century — that is being able to understand more of just how addiction affects the brain and how people are wired.
“And the other thing that has been there is mindfulness. Mindfulness is an approach that’s used not just in the substance abuse field but in dealing with many other things, such as people who deal with chronic pain,” Ackerman said.
“One of the changes that has been difficult in the addiction field is the reduction in inpatient services. Twenty years ago, most treatment for substance abuse had a person go live in the treatment facility for a 28-day residential program. But what has happened over the years, because of managed care, there’s a reduction in the residential programs. They are still there, but you’re not getting 28 days of treatment automatically. And this led to development of intensive outpatient treatment … three or four nights a week, you come for four hours, go to work, do what you do, then come in for intense outpatient work.”
Coupled with growth in addiction and recovery programs, Ackerman said, is the realization that non-addicted family members need as much care, in part to stop the spread of addiction from generation to generation.
“We don’t hear much about family programs raising this particular issue,” Ackerman said.
Residential and outpatient addiction programs have put together family programs that are run on weekends, especially at inpatient treatment centers.
Organizers need to recognize and answer family members’ concerns about investing their time in time-intensive counseling programs, Ackerman said.
“If you want family members involved, you better ask some basic fundamental questions. ‘What’s in it for me?’” Ackerman said. “If this isn’t addressed, I don’t care how good you are, if you can’t establish a motivation for them being there … if you want them to learn about addiction and want them to help support sobriety and wellness, you have to answer, ‘What’s in it for me?’ Because it is still all about them.”
Family members need to be taught to set goals for themselves, and to define what they want for their loved one. They need to understand how their behavior and role as a “family manager” affects their addicted relatives, Ackerman said.
Relatives need to understand the disease of addiction, learn skills for living with addiction, learn how to discourage excessive alcohol or drug use, and understand how to communicate with an abuser in a positive manner.Family counseling sessions should help addicted people and their relatives to lay out long-term plans and goals for recovery. Families also should learn that the recovery techniques don’t work the same way for everyone, Ackerman said. Some may take longer than others to respond, some will respond in different ways, and not all will reach the same level of recovery — a factor called recovery lag.
In some programs, Ackerman said, participants complete their goals and plans on paper, then anonymously share them among other families in the counseling sessions and critique them.
The role of forgiveness has been debated in addiction recovery programs, Ackerman said.
“People aren’t sure what to do with it,” Ackerman said. “For the longest time … it has been viewed predominantly as belonging to the realm of religion. Can forgiveness belong in the therapeutic process?
“There are theories, and one is in restorative therapy … and I think that that’s where it belongs as well. However, the whole issue is this. I don’t know of anything that is more personal than forgiveness. It is really human.”
Forgiveness is a multi-step process that evolves in different stages of treatment, Ackerman said.
“The last level is ‘true forgiveness,’ that occurs when you as a victim and the person who has hurt you … have totally worked it out between the two of you, and now your relationship grows in a positive sense,” he said.
“People ask me, ‘do you think I should forgive?’ It’s not my place to answer that. You have to decide how that helps you to get where you want to go.
“Forgiving is one thing. Getting ready to forgive is another.”
Ackerman was a member of the IUP faculty from 1982 to 2010, and now teaches at the University of South Carolina. He was the founding director of MARTI at IUP and is a cofounder of the National Association for Children of Alcoholics (nacoa.org). Ackerman has written a dozen books, talked about addiction on national television broadcasts, served on boards of national organizations, and is internationally known for his work with families and children.