Family therapy for addiction: An interview with Denver addiction counselor Cynthia McKay04/03/2023 2023-04-07 20:33
Family therapy for addiction: An interview with Denver addiction counselor Cynthia McKay
Family therapy for addiction: An interview with Denver addiction counselor Cynthia McKay
Addiction is a complex issue that affects not only the individual struggling with substance abuse but also their family members.
We sat down with our lead therapist — Cynthia McKay, JD, MA, LAC, MFT — to discuss the role of family in the recovery process, in particular providing therapy to the family as a group.
We also covered some of the innovative addiction treatment methods available here at the center, such as detoxing from alcohol and opioid cravings with an outpatient IV therapy program.
tl;dr: Although family dynamics can be a main factor in causing addiction, family can ultimately be one of the best support systems to help patients maintain sobriety and avoid relapse.
Ballen Medical & Wellness: Welcome, Cynthia! So, tell us about the role of family in addiction. Why is it important to treat the family as well as the addict?
Cynthia: There’s several main types of addiction, and family dysfunction can be a huge factor in most of them. Family dysfunction creates all kinds of negative patterns and habits in childhood, and we often carry these into adulthood where they can culminate into addiction as a form of self-medication. So just imagine if we don’t treat these patterns and dynamics. They can be very damaging to someone in recovery, and continue to drive the need to self-medicate.
And that’s where family therapy comes in…
Cynthia: Exactly. So with family therapy, we can go beyond just treating the patient and really help get everybody in the family on the same page. Because once someone goes through detox and gets sober, it’s really a lifetime journey of maintaining sobriety. And the more community and support they have, the better the aftercare, this greatly increases the odds of avoiding relapse.
All of this doesn’t just benefit the person recovering from addiction though. As we eliminate old habits and move into new good habits, the entire family can really progress to a better place as a unit but also individually.
Cynthia: Yes, that is so true [laughs]. And the family doesn’t want to hear that, but again, the addiction was most likely a product of the dysfunction before it started, you know, creating more dysfunction itself.
That said, we really want to move into the future. We remember the past of course, but we don’t want to focus on it. Instead we want to focus on where we want to go as a family unit. How can we support all of ourselves? Not just the addict, but everybody involved. And that includes extended family as well, so that you can actually sit down and have a reasonable holiday dinner together without all the problems you’ve had in the past. It’s more achievable than you might think.
I’m sure a lot of families without addiction would love to achieve that as well. How does all this work logistically by the way? Are the addict and the family being seen together by you in the same therapy session?
Cynthia: Both. We would have an initial session with the patient so we can start working on their addiction and put a plan together to help them detox from whatever substance they’re on, whether it’s alcohol, methamphetamines, prescription drugs… And then we would start to bring the family in as well.
What we’re really trying to avoid is someone going through the withdrawal process, being in this vulnerable state, and then having family members pounce on them with old habits. That doesn’t benefit anyone. So we want to get everybody together after the patient has gained some ground and is a little more stable.
Obviously some families can have very intense dynamics and be combative. How do you handle that in a session?
Cynthia: It’s very important to handle that. There should be no animosity or antagonism in the counseling sessions. And these are counseling sessions. This shouldn’t be confused with an intervention or something like that.
I have a tendency to have people communicate with fair fighting rules, and my first rule is no fighting. We want to make sure that everyone is communicating well, and in a supportive manner to everyone else.
That said, we don’t want to minimize things either. The person with substance abuse has caused a lot of damage to their loved ones. Now we don’t want to focus on that and say “You should feel guilty.” We want to recognize this damage as a byproduct of the addiction and heal from there.
Listen, when you’re addicted, your mid-brain which is usually concerned with survival is thinking about getting a drink or a drug as much as every 15-18 seconds. So the family needs to understand the origins of the problem, and that the addict isn’t some hopelessly maladjusted person — they just had an addiction problem that caused them to be a bad actor. They want to become a better person, and we’re all here to help with that.
Cynthia: It varies by patient and by family of course, but we can start making positive improvements very quickly if the family and the patient are committed. And generally people are committed if they’re here at the center.
The timeline for the patient recovering from addiction is a little less individualized, so let me speak to that a bit. After the initial evaluation, we decide the best way to treat this person. If there’s alcoholism involved, we might want to get them on prescription medication like Naltrexone or Vivitrol for example. Then we go through all of the psychotherapy that’s involved to figure out why they became addicted in the first place. And that could mean starting at any particular interval in their lives to see, you know, where the problems began.
The first evaluation is about 75 minutes, and sessions thereafter are 50 minutes. It goes as far as we need it to go, and there may be some treatment in conjunction with the psychotherapy to help reduce the cravings and bring back more mental clarity and energy. At our center we might recommend ketamine or NAD for instance. These are IV therapy treatments, and we have a full IV room with really experienced medical staff to make sure these things are done very safely. Remember, withdrawal can be very dangerous if it’s not done medically.
Now, in terms of timeline, we can get the cravings reduced pretty substantially in a lot less time than you might think. We have an outpatient IOP program that does this in 10 days using IV therapy, but you’ll feel less cravings in just 2-3 days.
And then, in general, it’s usually about 28 to 30 days when the body starts responding to having the toxins go away. We also encourage a little bit of outdoor activity or any kind of activity that’s physical, and staying hydrated with lots of water. Endorphins from exercising can also really help the patient feel better. And then I’d say it’s about 90 days when the brain really starts functioning better, though that also depends on the severity of the addiction and how long it’s been going on for.
And then, after about 120 days in conjunction with all the treatment, we really see how different people are. All of a sudden they’re able to remember things, they’re able to communicate better, they remember the past that they weren’t able to reach in their minds before because of all the mental clutter up there and the toxins.
It’s really amazing. If someone is committed to this, to getting better with us, we can literally help them have a new lifestyle with a whole new way of interacting with people and a whole new way of thinking. And that to me is just the ultimate reward for being a therapist. It’s just worth everything to see that change in people.
Now, you mentioned IV therapy and touched a bit on what is really kind of a neural restoration or brain reset. I believe the neurotransmitters that cause the cravings are actually reset as well. Could you tell us a little more on that, about how the IV therapy can aid in the addiction recovery process as well as the cognitive restoration?
Cynthia: Absolutely. Under the supervision of our medical team, we help patients create a comfortable and safe withdrawal program. The supervision is really critical, as something like alcohol withdrawal can be life-threatening if it’s not managed medically.
The program itself may include NAD infusion therapy or other medications to help reduce cravings and restore those neurotransmitters you mentioned. It’s not a one size fits all though. It’s very important to have the program tailored to that person so that they can have a very comfortable withdrawal, a safe withdrawal, which is, you know, really the main thing we want to achieve at first before going deeper into understanding sobriety and what it will take to maintain it.
There’s also a mental health component in a lot of cases. Many patients aren’t just struggling with addiction but with depression, anxiety, and other issues related to substance abuse. In these cases, treatments like ketamine therapy may be beneficial. Our goal is really to provide a tailored, comprehensive treatment plan for each individual, so it’s different in every case.
Now there may be the occasional relapse, so it’s important to realize that, but that’s what psychotherapy’s for. We teach a number of skills such as dialectical behavioral therapy, cognitive behavioral therapy, and mindfulness. And in conjunction with the medication and the IVs… it’s just amazing how you can emerge from this as an entirely new person. Of course it depends on each individual and what they need, but we’ve saved marriages, we’ve put relationships back together with children and parents… And it all feeds each other. The healthier the addict is, the healthier the family dynamics are, or the dynamics with partners… it all reinforces each other and creates the aftercare and the support that’s needed to bridge the gap from the physical withdrawal to the more psychological process of staying sober.
A lot of people wait for something really eventful to happen before getting help for their addiction, like losing a job or a relationship, or worse sadly. Do you have any advice for what signs people should look for in themselves or their loved ones before things get that dire?
Cynthia: Yes, well, the biggest thing with substance abusers is they often don’t realize just how bad it is and how it’s affected their life, their job, their family, their health in general. Because if your habit is to go home after work and have a few drinks, and that turns into a lot of drinks on a regular basis, or you’re binging on the weekends, you’re just affecting every single organ in the body and it really takes years off your life.
But everyone has a threshold. If you start missing work, if you’re drinking or using substances alone, if you’re starting to drop off from your social circle or pursuing people just to drink with or find drugs with, if you’re losing interest in activities, like spending less time with your family… Maybe they’re going on a hike, and you’d usually go, but you just can’t find the joy in it anymore. You’re probably suffering from anhedonia in that case, where you’re really finding the joy in anything anymore and instead you’re contemplating where your next drink or drug is coming from.
Another sign to look for are little physical pains. A lot of people don’t realize how quickly a medical problem can surface from a substance addiction and cause them to be hospitalized. I’ve seen people binge drink and end up with a cardiac arrhythmia, like atrial fibrillation, and in a matter of minutes it can cause a stroke. And we’re not talking about elderly people. So there are a lot of different things that drinking and drugs can do.
And it’s important to stress that there’s not necessarily a lot of clear warning before a complication from addiction can become literally deadly. We just don’t know how to predict something catastrophic like that so it’s better to get help sooner rather than later.
Okay, so we covered family, we covered some of our approach to treatment, we covered some of the signs to look for… Just one last question for you. What’s the first step for someone who thinks they might need help? Is it calling to schedule an appointment?
Cynthia: Well, the first thing is that you have to actually want help. If you’re just here because your mom or your spouse said something like “Well, I made an appointment for you, you need to go in and get help,” that just doesn’t really work. I’ve been an addiction therapist for a very long time as well as a psychotherapist, crisis interventionist, all these things. But I will tell you, if the patient doesn’t want help, I can’t do a whole lot for them.
So if you see your life deteriorating, whether it’s in your relationship, your work, at home, whatever the case may be, you probably have a lot more to lose and we want to prevent that. So once you come to that idea that you need help, then that’s when I really want to see you and I’m going to meet you there and be in it a hundred percent with you to help you through it. You’re not going to be alone.
And you know what? There’s no more stigma with this. People get addicted by prescription drugs, by social drinking, by anything. So there’s no stigma, and getting treatment at our center is a hundred percent confidential. You’re completely covered by HIPAA, and nobody’s going to talk about your situation. You could even run into your neighbor here and they wouldn’t know whether you’re getting IV therapy for hydration and sports or something more serious.
But the main thing is to realize this can be treated, and you can do it, and you can stay alive by making the right choice and saying, “Hey, I think I do need help.” There really is no reason not to get help, and a million reasons to get it.
Well thank you, Cynthia. We really loved talking with you as always. And for anyone thinking about coming in, please know that Cynthia has both in-person and remote hours. And if you’re not ready for that first session and just have a few questions, Cynthia or someone else at the center will be happy to get them answered for you.