Family Dynamics and the Treatment of Co-Occurring Disorders

The family is our integral unit of resilience and survival in times of stress and the core stabilizer of our communities. Disruption of families by trauma and stress precipitates significant problems such as addiction, post-traumatic stress disorder (PTSD), and other serious physical and mental illnesses. Connectedness and attachment to family and culture of origin correlate with reduced risk-taking behaviors and violence. Facilitating family, cultural, and community ties can, therefore, be protective against the effects of trauma.

Family dynamics and research studies illustrate the effectiveness of including family members and professionals for effective collaboration for the prevention, treatment, and aftercare of co-occurring disorders. Working with family motivation to help loved ones and themselves attain healthy lifestyles must be the cornerstone of an effective, collaborative continuum of care.

In a recent webinar for Harmony Foundation, ARISE Network founder and president Judith Landau, MD, DPM, LMFT, CFLE, CIP, CAI, CRS and ARISE senior trainer, supervisor, and interventionist Michelle Holcomb, PhD, LPC–S, CAI discussed the role of the family as key members of the collaborative team to address co-occurring mental health issues. 

Dr. Holcomb started with some food for thought. She asked webinar participants to consider

  • How does a person’s experience interacting with their community/environment impact their overall well-being?
  • What if these interactions are traumatic?
  • How does an individual’s genetic make-up directly impact their overall well-being?
  • How does a family impact the well-being of an individual struggling with a mental health and substance use disorder?

Dr Landau then explained that our society faces “growing regional and global concerns from opioid epidemics and the COVID-19 pandemic to the re-emergence of intolerance, human trafficking, global climate change, terrorism, and random acts of violence.” 

People are especially vulnerable during times of change. “On average, traumatic events result in a 30 percent increase of stress-related issues such as PTSD, cardiac arrhythmias, or pulmonary disease; attachment disorder, depression, and suicide; as well as onset or relapse of substance use disorder, behavioral compulsions, or other mental health issues,” Landau said. “The stress families feel with transitions can manifest in physical symptoms. We each have a distinctive stress response. Over 90 percent of visits to primary care are somatic stress.”

Traumatic events have an impact not only on individual people but also on their families. An individual healing journey is influenced by family ties. Dr. Landau explained how:

  • Families are a valuable resource and source of support for the management of illness
  • Families provide a more accurate picture of the individual’s symptoms, compliance, etc., than the individual alone
  • Families are the primary source of many health-related beliefs and behaviors
  • If the family is not included in the collaborative team, they become a liability rather than a resource

In the second part of the webinar, Landau and Holcomb talked about co-occurring disorders (also known as dual diagnosis), which consist of two or more of the following:

  • Substance use disorder
  • Behavioral compulsion
  • Physical illness
  • Mental illness

For treatment to be effective, it must address a patient’s conditions concurrently, not consecutively. Co-occurring disorders are so prevalent that “dual diagnosis is an expectation, not the exception,” explained Dr. Holcomb.

Co-occurring disorders require multidisciplinary collaboration, but that is often not available. “Specialization has resulted in fragmentation of treatment,” Holcomb said. “Often, the focus is on isolated body parts rather than the whole individual. People are seen as individuals in isolation, rather than as members of a unique social, environmental, and cultural context, but concurrently, advancements in Western understanding have resulted in more holistic approaches to healing and wellness.”

A typical example of that fragmentation is obesity, where many experts treat aspects of the condition without collaborating. The nutritionist treats dietary habits, the fitness coach addresses exercise habits, the endocrinologist may explore the underlying endocrine disorder, etc. in competing and typically non-collaborative services.

A patient might find short-term weight-loss success through an intensive exercise program, weight-loss medication, surgery, or dietary changes but, as with any complex, chronic, relapsing disease or addiction, rarely are those short-term successes sustained,” Dr. Landau explained. “Without addressing the emotional, psycho-social triggers of any complex, chronic, or relapsing disease, acute flare-ups can be expected repeatedly and frequently. Conversely, without addressing the medical issues, acute flare-ups and relapse are also inevitable.”

Collaborative care improves outcomes significantly. A treatment study revealed that “60 percent of patients receiving integrated care achieved substance abuse remission but only 20 percent of those receiving separate addiction and mental health treatment,” Landau told the webinar audience.

Families need collaborative care, too. “If there is an intergenerational history of substance misuse and mental illness, the family is likely to have developed dysfunctional patterns. Hyper-vigilance and fear of social stigma may delay their seeking treatment,” Holcomb said. “To meet these treatment challenges, we need to provide continuing care rather than episodic treatment. We need interdisciplinary collaboration to handle the complexity of the multiple challenges, and we need adequate training in collaboration and involvement of colleagues from other disciplines to arrive at an accurate diagnosis.”

Landau and Holcomb presented their definition of effective, multidisciplinary collaboration:

  • The coordinated efforts of conventional, complementary, and alternative practitioners working with the individual and the family.
  • The goal is long-term biopsychosocial, cultural, and spiritual health.
  • The basis is trusting the individual and family’s intrinsic capacity for healing.
  • The goal can be realized when all are connected with resources that enable them to access their inherent resilience, strength, and competence.

“The most significant predictor of treatment success is the provision of an empathic, hopeful, continuous treatment relationship in which integrated treatment and care coordination are provided over time,” they emphasized.

Families need to be integrated into the collaborative approach because they are “a valuable resource and source of support for the management of any illness, and families provide a more accurate picture of the individual’s symptoms and compliance than the individual alone. Without involving families in healing, we lose our most important resource.” 

In conclusion, Dr. Landau briefly introduced Transitional Family Therapy (TFT), an evidence-based therapy that helps access and facilitate family and community links to build a matrix of healing in families and communities by enhancing relational resilience.

Key actions of TFT are

  • Empower family, community, and natural support system
  • Reinforce connection to family and culture-of-origin
  • Focus on individual, family, and community healing and recovery versus pathology
  • Resolve unresolved grief and trauma
  • Moblize and reconnect the extended natural support system

Harmony Foundation has long utilized a holistic approach to healing addiction and co-occurring conditions such as trauma, depression, and anxiety. All staff at Harmony have been trained in trauma-informed care. Realizing that addiction is a biopsychosocial and spiritual disease, Harmony’s treatment program promotes physical, emotional, and spiritual healing, empowering patients to embark upon a lifelong recovery journey.

If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (970) 432-8075 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.