The document summarizes Rachel Russell's presentation on the Freedom Institute's relational paradigm approach to addiction treatment and family programming. Some key points: - Freedom Institute takes a systemic/relational approach, integrating family into individual treatment. Family therapists conduct joint assessments and family sessions. - Traditional treatment views the addicted individual as the problem and the family as either enabling or toxic. Freedom Institute's approach restores the "we" and expands competence across the family system. - Family programming includes family therapy, parent/partner groups, and multi-family groups. The goal is to normalize addiction's impact, make room for multiple perspectives without blame, and help families reconnect. - Treatment aims to redefine

1. Families and Substance
Use Disorder
A Relational Paradigm in Addiction Treatment
Rachel Russell, M.A., Chief Clinical Officer, Freedom Institute
Presented to: ICAAD London
May 2018

2. Agenda
1. Introduction & Context
2. Overview of Programming
3. Approaches to Family Work
4. Relational/Systemic Thinking
5. Case Example
6. Results
7. Q & A

3. Freedom Institute
● 40+ years in New York City
● Not-for-profit, independently run
● Educated, outwardly successful clientele
● Clinical Team all have advanced degrees
● Variety of theoretical approaches

4. Freedom Institute
Treatment Offerings
specific to Substance Use
Disorder
Intensive
Outpatient
Program
Abstinence
DBT modality
Minimum 8 weeks
Random drug
testing
10 hours/week
Sober Support
Group
Ambivalence
Motivational
Interviewing
10-week
commitment
Recovery Groups
Early Recovery (< 3
mos.)
Advanced Recovery
(3 mos. to 1 yr.)
Extended Recovery
(> 1 yr.)
Psychodrama
DBT Groups

5. Freedom Institute
Other Offerings
Care Coordination
Interventions
Assessments
Treatment Planning
Referrals
Family Services
Family Therapy
Couples’ Therapy
Parent Group
Significant Other
Group
Multi-Family
Groups
Hallways
School-Based
Prevention
Social-Emotional
Wellness
Prevention of
Substance Use &
Other High-Risk
Behaviors

7. Family Programs in
Traditional SUD Treatment
Not even considered
“Toxic”
“Must let go”
Individual
Treatment
Family
Treatment
Individual
Treatmen
t
Family
Treatmen
t
Education focus
“Codependent”
Individual has to be “ready”

8. Spectrum of Family Responses
Ignore
Deny
Focus
Obsess

9. Family Programming
at Freedom Institute
Individual
Treatment
Family
Treatment

10. Architects of Freedom
Institute’s Family
Programming
Ackerman Institute
▪ Since 1950’s
▪ Nathan Ackerman
▪ Relational/systemic model
▪ Elements from Bowen,
Minuchin, Milan, Satir, etc.
▪ 3+ years of post-grad
training

11. Family Integration
into Treatment
▪ Family Therapists distinct from Individual Therapists
▫ Entire family usually included
▪ Joint Assessments
▫ Young Adults required
▪ Family Session in IOP Package
▪ Multi-Family Group

12. Family Work throughout
the Treatment Process
Assessment
Initial
Treatment
(first 2-3 mos.)
Ongoing
Treatment
(until 1 year)

13. Mid-Afternoon Slump
Prevention
Questions or
comments so
far?

14. Systemic/Relational
Approach
Restore the “We”
Expand Competence

15. A?
24 1922
Opiates
Smith Family

16. Traditional view of an
addict within a family

17. A
A? A
?
A
Orphan
Depression
Sober
Suicide O.D.

18. Common Scenarios
“Fix my [child]”
“Over-anxious” mother
Distant/”nonchalant” father
Rageful parent
Resentful siblings
“Perfect” siblings
Substance abusing parent
Parent with undiagnosed mental health issues
Adoption
Divorced parents, with animosity

19. Relational Techniques
● Be transparent
● Collaborate, recognize family expertise
● Go up a generation
● Reframe/track/externalize problem
● Examine beliefs and themes
● Ask circular questions
● Move the locus of the problem
● Track other dynamics besides the presenting problem
● Normalize and depathologize
● Both/And...

20. Family Work throughout
the Treatment Process
Assessment
Initial
Treatment
(first 2-3 mos.)
Ongoing
Treatment
(until 1 year)

21. THANKS!
Any questions?
You can find me at @username &
user@mail.medhjdjs
● Observe family dynamics
● Get multiple perspectives on the presenting issue
● Begin psychoeducation about substance use disorder
● Create space for family members to be open about their concerns
● Get information on family history of addiction, mental health issues, trauma, etc.
● Get information about family strengths and resources
Assessment

22. THANKS!
Any questions?
You can find me at @username &
user@mail.medhjdjs
● Balance individual treatment and concerns of family with redefining problem
more systemically
● Negotiate practical matters, such as how information will be shared (slip/relapse,
attendance, pre-lapse behavior, etc.)
● Expand family resources (internal and external)
● Primary client is the family as a whole
Initial Treatment

23. THANKS!
Any questions?
You can find me at @username &
user@mail.medhjdjs
● Identify ways family gets stuck focusing on ‘addict’
● Expand the conversation
● Make room for multiple perspectives
● Revisit problem definition so that blame is neither on the addict nor on family
members -- move the locus of the problem
● Look at family boundaries
● Help the family find ways to connect even in times of stress
● Identify and help reclaim parts of family relationships that have gone missing
because worry (or substance abuse) has gotten in the way
Ongoing Treatment

24. Multi-Family
Group

25. MFG Format
01 Goals for the
Day
02 Introductions
03
Psycho-
Education:
Common
Situations
04
Group within
a Group

26. GOALS
▪ Normalize how substance abuse
impacts families
▪ Highlight importance of
connecting as a family
▪ Begin to make room for
multiple perspectives without
blame or conflict
▪ Begin to reclaim parts of family
relationships that have gone
missing because of
worry/substance abuse

27. INTROS
▪ Who is in your family, including
anyone not here today
▪ What drug(s) brought you here
▪ What is one of your family’s
strengths?

28. PSYCH-ED
▪ Substance abuse hijacks the
family
▪ Investigator/detective, scrutiny
▪ Blame, history of blame
▪ Avoidance, fear of triggering
▪ Mixed messages about
connection vs detachment
▪ Lack of acknowledgment
▪ Other family problems get
ignored
▪ Family no longer has fun
together

29. GROUP
WITHIN A
GROUP
What do you feel your family
members don’t see or understand
about you because substance abuse
has gotten in the way? This could be
related to the substance abuse or
just about you as a person.

30. Multi-Family Group
Group within a Group:
▪ In what ways do you struggle with wanting or not wanting
family support?
▪ In what ways do you struggle with whether or not to step in?

31. EVERYTHING IS
PERFECT UNTIL
IT’S NOT.
~Howard Bragman