By Dennis Miller, BHC Senior Writer

Addiction specialists have long recognized that alcohol and drug abuse are diseases of the family. But few treatment centers go so far as Caron Renaissance in Boca Raton, Florida does to actively involve families in treatment — up to and including admitting the entire family for a month. Their unique Family Restructuring Program provides patients and families with an intensive, live-in family treatment experience designed to help families address issues that may underlie a patient’s addictive behavior, repair the damage drug or alcohol abuse may have done and build a strong foundation for the patient’s long-term recovery.

The philosophy is not a new one for Caron, which has long been guided by the maxim, “The family is the patient.” At Caron Renaissance, however, that philosophy has been elevated to a level that may be unique in the treatment industry. “The whole idea behind it is that we’re trying to immerse the family in the treatment and clinical process so that we can engage them together in treatment, and begin to address the family system dynamics that are prevalent in any family system where there is addiction,” explains Mary Davis, BS, CMHP, a Family Counselor in the Caron Renaissance’s Family Services Department.

Of course, families are closely involved in treatment for all patients at Caron Renaissance, attending a three-day family workshop early in the patient’s stay and speaking to counselors at least twice a week throughout treatment. But when counselors detect that certain families could benefit from more intense therapy, they recommend the family check in to the facility for the Family Restructuring Program for a stay of anywhere from five days to a month. During this time, the entire family undergoes intense treatment alongside the primary patient in a safe, nurturing and professionally-guided environment.

“As they are here, they attend all the clinical sessions that the patient would normally attend,” explains Davis. “Some of the sessions they attend with the patient, and other sessions they may not attend with the patient. The idea is that they’re doing clinical work, both in the relationship with the patient and on themselves. So they’re taking a look at themselves: the family of origin that they came from and any family-of-origin themes that may be carried over into their current relationship with the primary patient. They’re looking at which dynamics are healthy, which ones are unhealthy, which ones support the recovery process and which ones don’t. And they’re working with the treatment team mostly in group therapy sessions trying to undo dynamics that are not helpful or supportive of recovery.”

While taking up to a month out of a busy family’s life in this day and age might seem like an imposition few families would be willing to accept, in fact, most do so willingly. “The resistance is not as great as you might think,” says Davis. “And I think there are a couple of reasons for that. One is because we try to help the family see their part in the relapse process from the get-go. Because we start that educational process at the front end, I think when we get to a point where we’re still not getting the results with the family we hoped to be seeing, the family recognizes that and they’re not as resistant as you might think. Most of them are pretty eager.

“And I think there are a lot of other reasons as well,” she continues. “We have a lot of patients here who have had a lot of multiple treatments. The families have been struggling from treatment to treatment. They’ve been carrying the burden of a lot of the consequences, whether it be legal involvements, family issues, financial problems, whatever. And sometimes they’re at a point where they’ve hit their bottom, and they’re ready to do anything because they want this to stop.”

“So they’re willing to try something new, and to try something that they haven’t been offered before. It’s a new concept, I think. I don’t know any other program that’s doing this. So I think a lot of them are receptive to it for that reason as well, because it does sound like something that makes patients think, ‘Hey, this makes sense. We haven’t done this before. Let’s do it. Let’s do whatever we can to try to end this journey from treatment center to treatment center.’”

For a complete overview of Caron Renaissance’s unique Family Restructuring Program, read our full interview with Mary Davis which follows. For more information, visit Caron Renaissance’s website at www.caronrenaissance.org.

BHC: Give us an overview of Caron Renaissance’s Family Restructuring Program and what makes it unique.

Mary Davis: This is a program that actually came to be a couple of years ago, and it is now a pretty regular clinical intervention that we’re using with a lot of families here. The whole idea behind it is that we’re trying to immerse the family in the treatment process and the clinical process so that we can engage them together in treatment, and begin to address the family system dynamics that are prevalent in any family system where there is addiction.

So, we bring the family down — usually it’s a spouse or parents or a parent, and sometimes siblings are involved as well — they come down and actually live in the residential setting with the patient. So they’re all under one roof. And this usually creates a situation where the real dynamics of the family system will then surface.

As they are here, they attend all the clinical sessions that the patient would normally attend. Some of the sessions they attend with the patient and other sessions they may not attend with the patient. The idea is that they’re doing clinical work both in the relationship with the patient and also on themselves. So they’re taking a look at themselves — the family of origin that they came from, and any family-of-origin themes that may be carried over into their current relationship with the primary patient. They’re looking at which dynamics are healthy, which ones are unhealthy, which ones support the recovery process, and which ones don’t. And working with the treatment team here in mostly group therapy sessions trying to undo dynamics that are not helpful or supportive of recovery.

The average length of stay per family is a week. We have some families that will stay for two weeks. That’s usually the ideal, if we can get the family member or members down here for two weeks. And we’ve actually had family members who have come in for a month and have participated and basically been in residential treatment with their patients for that period of time.

Let’s talk about the objectives. Usually what we see when we’re working with a patient, and what we have seen, is that most of our patients are not only dependent on their drugs of choice. Many of them are also dependent on the family systems. There’s an over-reliance usually on parental figures. And we want to break that dynamic. So, bringing them in here gives us that opportunity to actually see the over-reliance being played out, seeing that dynamic being played out right in front of us and being able to address it as it’s happening. Not only us as staff members, but the other patients as well are seeing it and addressing it with the family that’s here for the restructuring program. And that’s pretty powerful.

We’re also working on helping the patient begin a healthy separation and individuation process from their family as well. A lot of them are still very much attached to their family — as I said, over-reliant or dependent on their family in a very childlike way. They haven’t developed some of their own adult skills, so that kind of feeds that reliance. So as we’re helping the patient develop adult living skills, we’re also trying to help them go through that healthy separation and individuation process, and detach from the primary parental figures so that they can rely more upon themselves and be more interdependent versus dependent on family or others in their lives.

The family is the patient down here — that’s the way we view any family we begin working with. And we tell them this and introduce this concept right at the point of admission. Even before sometimes — as referral sources who know us are working with families and recommending Caron Renaissance, they’re often explaining that concept to them as well. But at the point of them talking with our admission staff, they’re learning our philosophy, of which the primary goal is to break any childlike, dependent patterns, and help the patient develop into an adult, sober, recovery position. And we’re trying to help the family see that this is not just about the primary patient who’s going to be coming in here. This is a family process. It’s something which we want the family to embrace. We want to involve the family as much as possible.

We contact the family twice a week. The primary therapist will talk with the family and the family counselor will talk with the family once a week as well. We bring them in here for a three-day intensive workshop. And then if we feel that some of the issues are greater than what can be accomplished through those ends, that’s when we usually recommend that they also come in for the family restructuring, so we can actually see them in action as a family and work on the issues that are surfacing that get in the way of recovery.

We try to get the family involved in self-help programs. We try to get the family, if needed, involved with their own therapy back home. Before they actually leave, our program will have recommendations laid out for them. We’ll try to already have a therapist lined up for them back home.

BHC: Do you find some families initially resistant to the idea of moving into the treatment center for a period of time and do you get some family members that say things like, “Hey, I don’t have a problem, it’s the primary patient who has the problem.”?

MD: Well, interestingly, the resistance is not as great as you might think. And I think there are a couple of reasons for that. One is because this concept is introduced — that is, the family is the patient, and we try to help the family see their part in the relapse process from the get-go. Because we start that educational process at the front end, I think when we get to a point where we’re still not getting the results with the family we hoped to be seeing, the family recognizes that as well, and they’re not as resistant as I think you might think.

At that point, they’re familiar that there is such a program. They’ve been talking to us twice a week already. They’ve been down here for our workshop program. They know where we stand, and they know what our concerns are for the family all along — we’re pretty upfront, pretty direct. So when we begin to introduce the idea — “Hey, I think you might really want to think about this and come down here for this program” — we’re not getting the kind of resistance that even I thought we might get from families. Most of them are pretty eager.

The other reason I think the family is not so resistant is that we’re trying to get the family system, including the patient, to break dependent patterns. And some of those dependency issues include the family being overly enmeshed and overly dependent sometimes on the patient. So when you approach the issue of, “Why don’t you come down here and live with your patient?”, there are some family members who are very eager to do that. Because in their mind, it’s going to bring them closer to the patient. And they’re struggling already being away from the patient, so they kind of jump on the opportunity to be down here with them.

And I think there are a lot of other reasons as well as to why the families aren’t that resistant. We have a lot of patients here who have had a lot of multiple treatments. The families have been struggling from treatment to treatment. They’ve been carrying the burden of a lot of the consequences, whether it be legal involvements, family issues, financial problems, whatever. And sometimes, they’re at a point where they’ve hit their bottom, and they’re ready to do anything because they want this to stop.

So they’re willing to try something new, and to try something that they haven’t been offered before. It’s a new concept, I think. I don’t know any other program that’s doing this. So I think a lot of them are receptive to it for that reason as well, because it does sound like something that makes patients think, “Hey, this makes sense. We haven’t done this before. Let’s do it. Let’s do whatever we can to try to end this journey from treatment center to treatment center.”

BHC: Is this primarily targeted to patients in a certain age range? That is to say, is it targeted at younger patients, or will it work equally as well for a mother figure in the family, or a father figure, or even an older patient?

MD: We’ve had various patients involved in the restructuring program. We’ve had middle-aged patients where a spouse has come in, and we’ve had our young adult population where usually one or both parents come in. So we’ve had a variety, and I think the impact is similar regardless of the age. I haven’t really seen any dramatic differences based on age. Our population here is 18 and over, so we’re working with an adult population and probably — I’m not sure if we really kept statistics on this — but probably the majority of folks we’re asking to come in for this might be the 18-to-35-year-old range. That’s been my personal experience, anyways, with the folks that I’ve worked with.

BHC: Describe a little bit for us the process of actually detecting some of the hidden damage that addiction does to the family system. You say the family comes in, and they’re living there, while you’re observing them constantly. Are you detecting these things through a process of therapeutic sessions, or is there also an element of just observing how the patients and families are interacting?

MD: The assessment process of what’s really going on in a family system, and where the ‘stuck points’ are or where is the dysfunction is, that begins at the front end, too. We have a packet of material that we send out to all the families when their family member comes in as a primary patient. And one of the items is a history, a psychosocial history, on themselves that we ask them to complete.

A lot of programs are familiar with psychosocial histories that they have the primary patient do or participate in. Well, we also have the family participate in one. So they’re going to give us information right from the beginning about their upbringing, their relationship with their parents and with their siblings. They’re going to be telling us from the get-go some of the experiences they’ve had that may have had an impact in their lives, such as whether they come from an alcoholic or addictive family system and so on.

So we’re gathering that kind of information from the beginning. Then, as we begin to work with the primary patient and we involve the family on a weekly basis, we’re getting to know them in terms of how they’re responding to the patient. So if we’re talking to them on a Tuesday of any week, and we’re telling them that the patient is missing group sessions or isn’t doing treatment work, we’re listening and hearing and watching how they’re responding to that, and that’s also how we pick up on how they cope.

There are family members that are going to respond by getting angry about that saying, “How? This is the third treatment I’ve put him through and he’s still doing this kind of thing! What do we need to do? Help us with this. We’ll do whatever you say to put a fire under this guy.” And then there are other families — if you want to take it to the other extreme, they may be very apathetic about it. They may kind of dismiss it like it isn’t any big deal. As long as he’s down there and he hasn’t left or he hasn’t used, that’s all they’re really looking for.

So we’re also making an assessment on how they cope with crisis and with the ability to hold the patient responsible and accountable. And we’re trying to work with families to get to a point where they can hold a patient responsible and accountable, and that’s a big problem for a lot of family members. It’s very difficult for parents, in particular, I think, in many situations to be able to put the responsibility on the patient — hold the patient accountable, give them a logical consequence for their behavior because they haven’t been doing this. The stakes have been getting greater. They’ve been becoming (the family member’s parents in particular) more and more terrified that their patient is going to die. So a lot of their responses become motivated by fear. They’re afraid, more or less, to rock the boat, because, “What if I do something and my patient goes out and uses and dies?” They’re going to feel guilty. They’re going to take it on.

So we’re trying to help them look at what’s motivating their responses. Is it shame? Is it fear? Is it guilt? We’re trying to help them look at other ways to try to resolve those underlying feelings themselves, and look at maybe where some of that comes from, because a lot of times it starts in their own upbringing, and some of the experiences they’ve already had. They may be reliving through their patient and are getting jammed up or stuck on responding appropriately, because they’re afraid there is just going to be a repetition of what they went through in their own families of origin.

BHC: How successful has the program been, and how do you define that success?

MD: We define sobriety very differently here, I think, than even some of the patients or families do before they get here. We don’t look at it as just abstinence. We want to see a patient meet sobriety by actually living as an adult, in recovery, living by sound principles and morals, and doing life day-to-day, maintaining responsibilities, and that sort of thing. That’s recovery; that’s sobriety.

So we, the clinical staff here, are looking at long-term consistency where somebody really can live life productively in line with love and morals and compassion and integrity and all that good stuff, and maintain a level of productivity without having to depend on others to get their needs met. And we’re also looking at families and doing a very similar thing where they’re holding their patient accountable to those expectations. So if you’ve got a family doing this consistently and you’ve got a patient doing this consistently, over time, then that’s success.

There are always going to be regressions, one way or another, and it doesn’t mean it’s going to result in a full-blown relapse but we anticipate that there will be regression. And we try to help the families prepare for that, to know what they’re going to do if there is a regression, so it doesn’t have to be full-blown relapse for the family or the patient.

As far as black-and-white numbers or statistics, I don’t know what we really have around that. It is a very difficult measure — any kind of measure, I think, when it comes to addiction, is difficult because you’re dealing with somebody’s word for it, and addicts, if they’re using, are not going to be the most credible source in giving the information.

So we also look at our alumni, both families and patients, and what’s going on with them. We try to maintain contact with our families and with our primary patients long-term. We have aftercare programs down here in Florida, as well as up the east coast, obviously, in Pennsylvania. And we really try to keep families and patients connected with us and we do have some kind of pulse as to how they’re doing and what’s going on long-term.

BHC: What kind of feedback do you get from the patients and their families about how this approach differs, how it’s superior and how it’s working better for them than others that they may have been to?

MD: I know the family restructuring program is unique. I haven’t heard of this program being offered at another treatment center. That’s not to say it’s not there — I just don’t know about one elsewhere. What I’m hearing from families is that this is different, this is unique, this is something that’s never been offered to them before.

What I’m hearing from families that go through this program is that it is very helpful to them, for a couple of reasons. One is their eyes are opened to behaviors, I think, in their patients that before, they couldn’t really see. And I think it’s because they’re working in a group therapy process, so they’re hearing it from other peers and other addicts, as well as seeing it with their own patient. And it’s almost a mirroring kind of effect when you’re in group therapy process. You’re the mirror for everyone else in that group and everyone else in that group is the mirror that you’re looking into. So they’re definitely opening their eyes to behaviors and concepts and insights that they didn’t have coming in.

And that is why we continue to maintain contact with them. We are monitoring on an informal basis. We’re monitoring whether they are integrating the insights that they got from here — whether they are trying to maintain some healthy detachment from their patient and whether they are trying to hold their patient accountable in life. And I would have to say from my experiences that it is working — family members are making the changes necessary to really hold their patient accountable.

BHC: What about cost, Mary? Is this something that adds to the cost of treatment? Is it something that insurance programs are likely to cover? And how do families deal with that? Is that a barrier?

MD: It hasn’t been. It is an addition to the cost of treatment. As far as insurance companies, we don’t deal directly with the insurance company so I’m not really certain. Family members can submit claims to their insurance companies for coverage. We don’t do that at this end. We will provide statements to the families to submit to their insurance companies, but I’m not really sure what’s being reimbursed. I’m assuming that it is for some folks, but this is an additional cost. They are living in our residence and they are attending full clinical sessions for the time that they’re here, so basically it’s a treatment cost. They’re paying for treatment for themselves and their family.

BHC: Where can behavioral health professionals get more information about Caron Renaissance’s Family Restructuring Program, or perhaps get in touch with you or others who can give them more information about it?

MD: All they need to do is contact us down here in Boca Raton, Florida. Probably the best place to start is just letting the receptionist know that they’re interested in more information. The number is 561-241-7977.

BHC: Do you have a website too?

MD: Yes. It’s www.caronrenaissance.org

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