A Compassionate Path to Healing for Families of Substance Users

Attempts by families to help adolescents or adults with problems of use, abuse, or dependence on psychoactive substances, aimed at control, do not work; in most cases, the patient will return to consumption.

A change of perspective is required towards the implementation of acceptance, validation, and training in skills such as conscious attention, which allows family members to understand that at first they act to calm themselves, and by doing so, they can provide more effective help, said the academic from the Faculty of Psychology (FP) of UNAM, Luis Ángel Pérez Romero.

When giving the conference "Psychological help to family members of users of mental health services: beyond the concept of 'codependency'," he said that those who use substances have at least two or three people around them, and thus, the number of people affected by this practice increases.

These are those close to them (mothers, fathers, uncles, children, friends), for whom there are not many empirically proven interventions,

The expert reiterated that patients who come to treatment do so because a family member takes them there in a large proportion; concern motivates those close to them to seek assistance, and those who come under pressure. But this causes them to abandon treatment shortly after, and later re-enter; this is repeated for several years.

There are those who have been in 20 rehabilitation “annexes” and the family begins to act with the purpose of changing the person, a situation that is known among self-help groups as codependency; that is, the incessant search for support for the other, which becomes hard for those who live or work with the person.

In psychology, explained Pérez Romero, two processes have been identified: change and acceptance. The first process focuses on stopping the person from consuming, recovering, and returning to how they were before, while the second focuses on family members accepting that the person will change when they have to.

According to the university student, scientific literature indicates that several treatments are aimed at making family members the agents of transformation for substance users. The FP has a program based on training in communication and problem-solving skills.

At the National Institute of Psychiatry, there is a coping program whose objective is for the family member to first examine their own coping style when dealing with the situation and solving their own problem; from there, they can encourage the patient to join a treatment, if he or she so desire.

Both approaches have evidence of their effectiveness; however, they are positions that maintain an incomplete vision of the challenge and lead to a limitation in the effectiveness of the results, said Pérez Romero.

Recently, psychology has integrated new theoretical and practical elements that could help intervene more effectively in the dynamics of people seeking help for their loved ones with mental health complications.

Among these new concepts are acceptance, validation, and training in skills such as conscious attention. The two perspectives come together: family members accept that users will have to change their pattern of psychoactive substance consumption when they are ready, and understand the internal implications for the family member, while also having an effective way to provide support during the user's process of becoming aware of the substance.

Many parents, children, friends, instead of acting based on what is happening, do so based on what they think, feel, remember, or want, and thus try to provide support; “they begin to act to alleviate their own pain.”

The implementation of this new perspective - which also has to do with contributions from recent years in psychology, such as mindfulness, and personal values ​​that have been shown to be powerful variables to achieve a change - allows them to understand that at first they act to calm down and by doing so they can provide more effective collaboration.

For a long time, treatments were focused on stopping consumption, but if one looks beyond this practice in life of the user, we can find reasons why they can be rehabilitated. In the context of substance use and other behavioral addictions, the first step is to focus on other aspects that motivate the patient, relevant to their life, and reach a goal of abstinence or moderation, said Luis Ángel Pérez.

You have to ask the what was important to them before consumption, to refer them to the significant areas of their existence. “You have to establish an agreement and work with a goal and, once you have made the commitment, find reasons that lead to modification in behavioral therapy. You have to find the reasons why it makes sense to do something other than consume substances.”

Codependency is ineffective; the family must be shown that direct attempts to help will not work, but that does not mean there is no way to provide assistance. It is also necessary to accept that there are attempts that do not have the desired effect, and to show a different route, concluded Pérez Romero.