Substance Use And Family Systems

Approaching The Work Together

Healing as a family unit in the wilderness setting is my foremost goal as a practitioner. Working primarily with students who have had substance issues of varying degrees, I have been able to work with the student who may have recently tried pot to those with unmanageable opiate use, and everything in-between. Although my role is to serve as the primary therapist for the student, the family system is often the first major focal point of my clinical explorations. Intergenerational concerns such as traumas, misattunement, and substance issues with other immediate family members are the leading therapeutic discussion points I have encountered. A relational approach is an important standard and transparency serves as the formidable combatant to the insidious nature of addiction. Having the focus solely fall on a student in the desert can distract from underlying familial challenges in the home. Knowing how chaotic and frustrating life before wilderness therapy, informs my approach and perspectives allowing me to establish an emotionally and logistically safe space with the student and their parents/guardians. In addition, allowing space for all to grieve the loss of what the family’s “previous life” may have been and all it encompassed is a pertinent step to moving forward as a collective–as a family.

Understanding The Relationship

Deconstructing “substance use” and the relationship to the Family System starts with the diagnostic name itself. Once known as “drug addiction”, the severity and harshness of those two words incited a shameful backlash that resulted in the term “substance abuse” to take hold. This term evolved into what is now referred to as “substance use” or substance use disorder (SUD). My approach when working with a student who has had issues with substances is focusing on the relationship they have with substances themselves. Straying far away from demonizing substances, the process of analyzing the relationship can help activate the grief process. It is also inherently connected to the relationship the student has with themselves. Initially, shame, social awareness, and level of personal functioning can serve as major contributors to the use of substances. A teenager’s susceptibility to developing problematic substance use is high due to the stage of brain maturation during adolescence being in a malleable state. It can be an intense combination of, “I have no fear!” mixed with, “more rewards now!” This can be a risky combination. The wonderful opportunity the desert provides is through the time and engagements that serve as catalysts to creating new neural networks within their brain.

Overall sense of self can be low when we first meet a student who is beginning their journey in wilderness. For some students, this can be a result of a negative self perception that is mired in shame and regret for their previous behavior and/or decisions. For others, a level of disconnect and denial presents itself in belief such as their actions were being “blown out of proportion” or that they can “easily change or stop if they wanted and they are fully aware of, and in control of, what they were doing”.  Developing self-efficacy through wilderness hard skills, mixed with new resources for emotionally connecting and expressing one’s feelings fit nicely into the “substance use toolkit”. This toolkit can be utilized as we uncover and understand the direct correlation that exists between the relationship they have with and within their family dynamic. Knowing that an individual’s substance use, or “overuse”, is directly linked to their place and relationship in the family makes the issue of substance use one that the whole family must get behind and participate in.

It’s A Family Affair

Current trends in the world of addiction have been riddled with stigmas and the majority of current treatment models veer far away from dusty old copies of AA’s Big Book, or the concept of rigid abstinence in general. Things such as “scare tactics” or other punitive measures have been replaced with harm reduction methodology, or more mindfulness-based therapies. Having been indoctrinated in the recently controversial, disease model of addiction, I still find validity in aspects of it that ring true. Are some humans more prone to cultivating a debilitating substance issue? Absolutely. If another family member was an alcoholic, is there a likelihood you could be labeled with this moniker as well? When I hear that sentiment, curiosity of what pain, trauma, or mental health concern a person may have had and how it may have gone unnoticed, unresolved, or plainly, avoided comes to mind. Increasing access to, and efficacy of substance use treatments, while removing moral stigmas, may be the best combinations of both worlds.

Out of all my approaches, one remains steadfast–the quest to live in the present moment. The freedom encased in this concept serves as a fundamental starting point when working with substance use and families as one. Our departure from the present moment can be the cause of unnecessary fears, anxiety, and sorrows one may hold to be true. Realistically, in a family dynamic, balance of time must be established and setting the present moment as the goal is an imperative starting point. My relationship with substances has evolved over the past 20 years, and despite their lack of physical presence and involvement in my life, I spend my life diving into understanding both the positive outcomes as a result to use as well as the negative consequences and harm. Ultimately, however, it is the process of gaining a deeper analysis of the relationship students have to substance use, the relationship with family, and how best to work within the family system that provides a steady framework from which I approach my role as a primary therapist. The “work” can be very hard and yet it is through this collective work of family focused interventions that can provide one of the greatest pathways to support recovery for the whole family.