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Counselors must avoid crossing the line into controlling behavior
by William D. Anderson, Jr., LCSW, MSW
Over the last eight years, I have offered education, support and training to families struggling with addiction via the 1-Day Family Seminar at MARR, a drug and alcohol treatment center in Atlanta. In my presentation, family members are exposed to ways in which they enable, rescue and ultimately try to control their addicted loved ones. The more I delivered this lecture, however, the more I realized that counselors in the addiction field—myself included—often exhibit the very same behaviors they encourage families to stop, change or think about. Read more.
Keeping the spirit of volunteerism alive at MARR
There is an article on Facebook that has recently gone viral: 37 Things You’ll Regret When You’re Old by Mike Spohr. In the twentieth spot: ‘Not Volunteering Enough.’ Spohr writes that “nearing the end of one’s life without having helped to make the world a better place is a great source of sadness for many.” In fact, many people believe the best way to serve God is by serving others.
In the Beginning
Since its humble beginnings nearly 40 years ago, MARR has remained close to the core values on which the organization was founded. One of MARR’s six guiding principles, People Come First, promotes a healthy and strong recovery community from within, including clients, families, alumni, staff and volunteers. Every person plays an important role in bringing lasting recovery to drug- and alcohol-addicted individuals. It’s a team effort.
Volunteers Make a Difference
From the time MARR came into existence in 1975, to where it stands today, volunteers have always been a vital part of the program. “Early on, MARR recognized the benefit of having volunteers join our clients in group therapy,” says CEO Guerry Dyes. “It’s a way for community members to understand the disease of addiction and for clients to break out of isolation.” The Junior League of Atlanta (JLA), an organization of women committed to promoting volunteer work, helped launch the volunteer division of MARR’s treatment facility. These individuals devoted themselves to offering love, tolerance and acceptance to the clients of MARR. They helped bring chemically dependent men and women out of seclusion and into connection with others.
While MARR strives to stay ahead of the curve in the educational arena of addiction treatment, the organization also stays true to its traditions and the recovery methods that have been proven effective for many years. This not only includes the 12-Step Program, the importance of spirituality and the value of the therapeutic community, but also the volunteers who have been such an integral part of MARR since the beginning. “Our volunteers are more than just individuals who give their time to help those who are struggling with addiction,” says Dyes. “They have a true heart for people. They keep the spirit of MARR alive.”
If you would like more information about how to become a volunteer, as well as our next volunteer training, please visit our Volunteers at MARR page. We appreciate your willingness to serve our recovery community!
MARR’s Volunteer Program is made up of people who are both in recovery and others who are not. The purpose of having volunteers is to help create a loving environment in which clients feel safe and accepted as they reconnect and recover from addiction. MARR believes lending a hand to another human being—and expecting nothing in return—is the true meaning of joy.
By Jessica Schmoll, MS, LPC
Director, Women’s Recovery Center
When it comes to treating a chemically dependent woman, it is helpful to first consider creating a healthy, safe community in which she can explore a genuine sense of love and belonging, as well as practice new relationship and self-care skills. In order to create that space, she and her treatment family (staff and peers) are encouraged to embrace authenticity as a cornerstone on which to build.
Authenticity requires emotional honesty, vulnerability, perseverance, empathy and compassion toward self and others. It is no small feat. As the woman lets go of who she “should” be and allows herself to be seen for who she really is, she is more able to accept her strengths and imperfections, and practice boundary-setting by asking for what she needs—and has always deserved. No longer isolated and ashamed, she has a voice; she is known. Negative core beliefs can be explored and no longer dictate using behavior. She doesn’t regulate herself to meet outside expectations. She can be free.
Gender-specific and separate treatment allows addicted women to tell their stories, practice forgiveness for self and others, and honor their evolving faith without the distraction of trying to fit in by being someone they are not. Even when the therapeutic community is unsteady and in turmoil, community members can experience healthy conflict resolution rather than alienation and heartbreak. Using effective communication, the community model allows for women to hold each other up in gratitude and respect, and learn that they are strong enough to withstand the urge to use despite the stress of being in relationships that are complex and sometimes messy. They can resist falling back into old behaviors by acquiring a new sense of self that allows for life to be hard.
These are the skills that prepare women to integrate back into life post-treatment and carry on with relationships that will demand their energy and attention.
They say the journey of recovery is a “WE” program. At MARR’s Women’s Recovery Center, this philosophy is held to the highest standard. A “sisterhood” is created and nurtured, allowing the individual to flourish like never before.
The Big Book of Alcoholics Anonymous describes alcoholism as “cunning, baffling, powerful.” For nearly 40 years, MARR’s seasoned professionals and committed staff members have seen the insidiousness of addiction — cunning, baffling and powerful indeed. This devastating and often deadly disease rips families apart and ruins relationships.
But we have also bore witness to the hope that lies in recovery.
This September marks the 24th annual National Recovery Month — celebrating individuals in recovery; promoting the benefits of prevention, treatment and recovery for mental and substance use disorders; lauding the contributions of treatment and service providers; and sharing the message that recovery, in all its forms, is possible. So, what does the month of September mean to the dedicated staff at MARR?
National Recovery Month is a reminder of how far we have come in the field of addiction treatment. Today, the medical community recognizes addiction as a disease and not a moral flaw. Women, once haunted by the stigma of addiction, can now discover their voice and their freedom in gender-specific treatment. Many recovery centers encourage the addict and his or her loved ones to embrace a program of recovery because addiction impacts the entire family system. Individuals with co-occurring disorders are no longer turned away; instead, they receive specialized attention in a safe environment. And there is increased awareness and education about chemical dependency in communities than ever before. These are just a few of the many positive changes that have taken place over the last several decades.
Although we celebrate recovery 365 days a year, MARR joyfully commemorates National Recovery Month. This September — and every month thereafter — it is our mission to bring lasting recovery to alcohol- and drug-addicted individuals. The Big Book of AA may describe alcoholism as “cunning, baffling, powerful,” but it also gives hope to the struggling addict that “there is a solution!”
By Jessica Schmoll, MS, LPC
In 2013, as recent research continues to emerge and data are reviewed, the issues surrounding women and addiction are becoming progressively more understood and evermore concerning. The ramifications of the disease of addiction span beyond just a woman’s personal health and wellness; they impact families, communities, and society overall. While still very much a caregiver for family and friends, today’s woman may also be a student, a teacher, a doctor, or a lawmaker. She is everywhere, and the roles she plays impact many. As such, when the disease of addiction develops in a woman’s life, the attention and efforts of her community must engage to combat the catastrophic consequences that not only befall her, but them as well.
One must consider some of the reasons why women use drugs or alcohol initially. Socially and psychologically, the use and behaviors of addicted women often begin in response to internal questions that are relational in nature: “Will this help me feel less depressed? Anxious? Alone?” “Will this help me lose weight?” “Will this help me be more productive?” Using substances can even be a way to cope with unresolved trauma and subsequent difficulty achieving the much-desired intimacy on which women are wired to thrive. “Will this help me forget?”
It is also critical to contemplate the real physiological dangers women face in the addictive process that started as a way to self-medicate or belong. Biologically, women become intoxicated faster and get addicted sooner than men. Like their male counterparts, but at an accelerated pace, women face health challenges like heart damage and cirrhosis of the liver, compounded by an increase of occurrences of osteoporosis, brain atrophy, and pregnancy and infertility concerns (to name a few). As such, women are likely to be found requiring medical help years before their fellow male alcoholics and addicts.
Addiction is a biopsychosocial disease. To address it, one must remember that more than just the body requires treatment. In order to adequately acknowledge a partial interpersonal/relational cause, treatment must include a social intervention. In other words, to combat the lonely and shame-based nature of the disease, healthy relationships are critical in the healing process. Helping women learn to steer effectively through relationships with boundaries and self-care sets them up to leave behind the chaos and toxicity that occurs when substances serve as their companions, their lifeline.
Drug and alcohol addiction is a serious problem that can put a major strain on an addicted person’s relationships. If you are a friend or family member of an addict, your relationship with him or her has likely experienced its fair share of ups and downs. But here’s the good news: Once the addicted loved one seeks help for his or her addiction and gets on the road to recovery, there is hope for the relationship.
To maintain a healthy relationship with the recovering addict in your life, check out these helpful tips to ensure you’re reinforcing his or her recovery.
Show Support. When an addict is in recovery—especially early on—your ongoing support is essential to his or her success. Attend 12-Step family recovery meetings in your community (i.e. Al-Anon, Nar-Anon, CoDA, etc.); ask him or her how you can help; and just listen when needed. Let the recovering addict know you support him or her in this endeavor, physically, emotionally and mentally.
Maintain Boundaries. While it is important for you to show support to an addicted friend or family member who is in recovery, you must also maintain healthy boundaries if you want to your relationship with him or her to improve. Rule number 1: Your life should not revolve around the recovering addict. It is perfectly OK to be concerned about him or her, but always take time out for yourself. Otherwise resentment may build up.
Communicate. As with any relationship, communication is vital to enjoying a healthy relationship with an addicted loved one who is in recovery. While a life in recovery is the better way, it isn’t always easy. Sometimes an addict needs someone with whom they can talk openly and honestly. Be that person. (Of course, always encourage the individual to talk with his or her sponsor as well.)
Be Present. Emotional support is certainly a fundamental part of a healthy relationship, but physical support is just as important. Make the time to be available for the recovering addict in your life. Have a coffee date, go for a walk or enjoy some quiet reading time in the same room. Togetherness is what matters most. Your presence is another way to let your loved one know you care about his or her recovery.
A recovering addict has a greater chance at recovery when his or her relationships encourage recovery and not hinder it. Get involved in this new way of life, and you’ll reap the benefits of recovery, too. Be a part of the solution!
Author Jason Harter, CAC is an addiction counselor who strives to maintain relationships between affected family members. He enjoys blogging and is a contributing writer for bestaddictionscounselingdegrees.com.
A recovery program is essential for family members, too
Addiction leaves behind a path of destruction unlike any other disease. From legal issues, to health problems, to financial strain and beyond, chemical dependency tears relationships and lives apart. Fortunately, there is hope—addicts can become productive members of society and restore much of the damage caused by their addiction once they get on the road to recovery. The Twelve Steps of Alcoholics Anonymous (AA) have transformed lives and restored relationships. At MARR, we not only believe in the Twelve Steps—our addiction treatment program is built around them.
Oftentimes, an addict will enter into a program of recovery and begin to heal from his or her addiction, seemingly getting better and enjoying a new outlook on life. But what about the other person in the relationship? “When my husband first got sober, I was happy and scared at the same time. I mean, who was this ‘new’ man standing in my kitchen? Being around him just felt awkward,” says Melanie Sadler*. “He was getting healthy and I was left with resentment and pain from the past.”
Sadler is not alone. Although recovery for the addict is crucial if the relationship is to survive, it is not a one-way street. Both the addict and his or her significant other benefit from a program of recovery. MARR’s Family Recovery Center is committed to providing education, counseling and resources to those struggling with a loved one’s addiction. Through couples therapy, individual counseling and family support groups, we seek to introduce spouses and significant others to family recovery. Additionally, we encourage them to attend 12-Step meetings in their community (i.e. Al-Anon, Nar-Anon, Co-Dependents Anonymous, etc.).
When both individuals in a relationship practice the spiritual principles behind the Twelve Steps, they learn to speak the same language. They understand the tools of recovery, rely on their support network for guidance, implement healthy coping skills and focus on today. Resentments are addressed and freedom ensues. Instead of the process appearing one-sided, wherein only the addict gets better, both partners experience the joy that comes from a life in recovery.
“Once I began to embrace my own recovery through Al-Anon, the dark cloud that seemed to follow me everywhere started to fade,” Sadler says. “I found hope through the Twelve Steps and today, my husband and I have a healthy relationship. We got to know one another all over again, this time without drugs and alcohol.”
If you would like more information on MARR’s Family Recovery Center, call 678-805-5118.
*Name has been changed to protect individual’s identity
Every year, MARR conducts outcome research to determine the efficacy of our programs and examine the trends, in order to determine whether or not changes need to be implemented. The study allows us to demonstrate the value of our treatment facilities for funding purposes, as well as make accurate comparisons to national outcomes that help move the industry forward.
This year’s study draws 2012 calendar year information and data from the Admissions Department, Men’s Recovery Center (MRC), Women’s Recovery Center (WRC), TRADITIONS Recovery Center (TRC), Right Side Up Women and Children’s Program (RSU), and Family Recovery Center (FRC). Our studies continue to include more detailed information and analyses than previous years, and we are now able to make assessments over at least a five-year period. Because of the variety of information, we are able to examine MARR from a broader perspective and establish a foundation for future studies and program development.
As with every year, one of the issues with completing an outcome study is that it is appropriate and desirable to compare our outcomes against national outcomes. The best source for these types of outcomes is the SAMHSA Treatment Episode Data Sets (TEDS). While SAMHSA has updated its Discharge Study results, the most current data that SAMHSA has published regarding program discharges is from 2009. So, although the information has been updated, it still represents a three-year gap from our current data. Even though there is a 2011 study of treatment facilities, which includes some admissions data, it does not contain discharge information.
Because of this, the SAMHSA figures are only helpful for a general comparison with our data. In addition, there are no sufficient studies on a national or state level, particularly of programs that are similar to MARR and available for comparison. The best piece of information that we can glean from the SAMHSA study is that the national average for treatment completion for long-term residential treatment (90 days) remains consistent at 46%.
So, in order to examine our findings, we must compare the 2012 data against previous years of MARR outcome studies. Our hope is that by comparing and interpreting our results against the trends we have observed, we can utilize this study to develop programming to better suit our clients’ needs.
Comparison of Admissions and Discharges
Over the past few years, we have focused on the increased number of admissions of opioid addicts and how that affected our discharge rates. Last year there was a slight decline in the number of admissions of opioid addicts and a rise in the rates of admissions for alcoholics. This year the admissions for opioid addicts decreased for MRC, rose slightly for WRC, but increased sharply for TRC and RSU.
This change in the number of admissions for opioid-dependent persons directly impacted the number and types of discharges that we observed across our programs. In 2010, we saw an increase in the number of admissions for opioid addicts at MRC and, consequently, in 2010 and 2011, there was a decline in the completion rate. As the numbers of admissions for opioid addicts stabilized, or reduced for MRC, the completion rate is again increasing (from 68% in 2011 to 75% in 2012). Conversely, the number of opioid addicts admitted to TRC rose sharply in 2012 (from 24% in 2011 to 44% in 2012), and there was a corresponding drop in the completion rate (from 49% in 2011 to 37% in 2012). So, TRC is now experiencing what MRC experienced over the last two years.
Admissions for alcohol have remained consistent as the No. 1 drug of choice for MRC and WRC clients (and overall for MARR). This is consistent with national surveys for drug of choice of abuse and dependence. However, for TRC and RSU, alcohol is second and third respectively.
In 2012, MRC saw an increase in the completion rate, up to 75%. This increase reflects both professional and non-professional clients. Alcohol still remains the No. 1 drug of choice for clients, particularly among the professional population, while the number of clients admitted for opioid dependence decreased. The most interesting result, considering our experience over the past two years, was that there was a significant increase in successful completions of IRP by non-professional clients in 2012, particularly among the opioid-dependent clients. In 2011, only 50% of the opioid-dependent clients completed IRP, while 70% completed in 2012. The increase may be due to changes in treatment protocols that were implemented as a result of the increasing number of opioid-dependent clients and a better understanding of the effects of opioids on executive function. The changes made included giving clients more time to complete assignments such as First Step Inventory and Life Story, and extending their stay in Phase I as needed to ensure completion and stabilization before transitioning to Phase II. Training for counselors was also implemented to improve their understanding of the issues associated with opioid dependence. It is clear that these changes have made an impact on client outcomes.
The completion rate for WRC increased slightly in 2012 (45%) over 2011 (43%). (Note: the TEDS data for treatment completion for women from long-term residential treatment is 36%. So, even though WRC’s completion rate is below the overall national average, it is significantly above the national average for women.) Most significantly, the length of stay (LOS) for clients with non-standard discharges decreased dramatically for all non-standard discharge types, particularly the Medical/Psychiatric discharges. The lower LOS for this latter category indicates that the WRC clinicians are more proficient in working with the varying co-occurring disorders that may present themselves in women’s treatment, and they are able to more quickly provide the referrals needed for appropriate client care.
Last year’s outcome study focused on specific initiatives, increasing the LOS for Phase I of treatment and changing the program content and staff training to address the needs of women who enter treatment with a history of sexual abuse. (Clients who report a history of sexual abuse have a higher rate of non-completions than other clients.) The LOS has been increased for Phase I of treatment, and programming and training has been implemented to address the issues of women who have a history of sexual abuse. While these initiatives were implemented in 2012, we may not see any tangible results (increased completions) until we examine the outcomes for 2013.
TRC admitted clients from five new states in 2012 and had increased numbers from referral sources both previous and new. Among these admissions, TRC saw something that has never happened at MARR before: the number of clients admitted for opioid dependence (44%) was far beyond the number admitted for alcohol dependence (29%). While they also saw an increase in the numbers of amphetamine- and marijuana-dependent clients, second only to RSU, the opioid-dependent admissions made a stronger impact on the program. Even though there was the increase in admissions over 2011, the completion rate dropped dramatically (from 47% in 2011 to 37% in 2012). This decline in the completion rate is reminiscent of what happened at MRC when the rate of opioid-dependent clients first started to rise in 2009 with the resultant drop in completions in the following years. Another factor that contributes to the higher non-standard discharge rate is the fact that the average age of the clients admitted decreased. The average age of clients who completed the program was 31, while the average age of clients who relapsed was 26.
In 2012, RSU had 34 women who completed the program, which is an increase over 2011 (25). The Dekalb site had 21 completions, and the Fulton site had 13 completions. While RSU also continues to experience the same increases in the number of opioid addicts as the other programs (25% of admissions), they have not experienced the same increase in non-standard discharges due to the opioid-dependent clients relapsing. This may be due to the higher level of care (ASAM Level III.5) when the clients first come in and the longer LOS than the other MARR programs.
In 2012, as we have been observing since we began the FRC Outcome Study, clients whose family members attended the 3-Day Family Workshop completed treatment more often (73%) than those whose families did not attend (27%). This continues to reinforce our commitment to providing services for the families of our clients.
In an effort to track the recovery progress among family members throughout 2012, a follow-up questionnaire was sent to all family members who had submitted an initial family questionnaire when their loved one was admitted to MRC. The follow-up asked similar questions to the initial document, allowing us to examine changes in families’ attitudes toward the disease of addiction, their feelings about the problem of addiction within their families, and their utilization of both MARR and outside support resources.
FRC is now providing services to families in several different areas: The 3-Day Family Workshop (which had a total of 233 participants in 2012); the 1-Day Family Seminar for families in the community (which had 90 participants); the Helping Families Affected by Addiction CEU seminar for therapists (which had 20 participants); family support groups (which included 855 individuals attendees); individual sessions (there were 914 sessions conducted); and Beyond Boundaries, a new workshop that is designed to help individuals with significant symptoms of codependency.
If you would like more information on the 2013 Outcomes Study, please contact Clinical Director Jim Seckman at 678-805-5106.
Shifting the focus from the addict in your life to yourself
Addiction is an isolating disease, for both the addict and those who love him or her. The addicted individual becomes preoccupied with obtaining, storing, and hiding the supply of drugs and/or alcohol, so much so that relationships take a backseat. Similarly, family members detach from the outside world due to feelings of guilt, shame, fear, sadness, and disappointment. The destruction that addiction leaves behind is unlike any other illness.
Individuals who are in active addiction are unstable and unpredictable. They will lie, cheat, and steal in order to keep the disease alive. Oftentimes, family members live in a constant state of fear — the addict’s erratic behavior causes stress, anxiety, suspicion, paranoia, and doubt. As boundaries become distorted, the entire family system deteriorates. Family members may enable, rescue, or attempt to control the addict — with good intentions — but the relationship is all but destroyed.
If you have lost your identity because of a loved one’s addiction, it’s time to set healthy boundaries and begin enjoying life. Here are a few tips to help you get started.
Communication is everything in a relationship. Poor communication leads to frustration and resentment, while effective communication results in understanding and mutual respect. If you feel anxious, resentful, worn out, smothered, disregarded, disrespected, or hurt, it’s safe to assume that your boundaries have been violated. Below is a constructive technique for expressing your feelings to the addict in your life:
1) “When you [ actual behavior ], I feel [ emotion ] because _______________.”
2) “I prefer/want/need [ specific action ] because ______________________.”
3) “If you continue [ actual behavior ], I will [ specific action ].”
It’s important to note that once boundaries have been infringed upon, you must follow through with the appropriate consequences. Be patient — implementing effective communication techniques and setting healthy boundaries will not ensure overnight changes, but you will begin to experience improvements in your relationship with the addicted loved one over time. Most importantly, you will notice positive changes in yourself.