The Family Role in Supporting Your Child
The family role in supporting a child with co-occurring disorders is critical. This includes everything from recognizing that there is a problem, to motivating a child to get help, to navigating the treatment system to find the best fit for your child and helping him or her sustain gains in recovery. It can be a significant emotional, time and financial commitment, but research shows that family involvement improves outcomes. Families can also help ensure diagnosis is accurate.
In addition to the mechanics of getting treatment and providing information to the treatment team, you can also help in other ways:
Encourage Treatment Participation
Encourage your child to keep appointments and participate in all aspects of his or her treatment plan. This may include individual, group and family therapy, medications and job and life skill-building. If a case manager is working with your child, stay on the same page and provide input on progress made, as well as setbacks. Keeping a calendar of appointments and ensuring transportation is available if needed may be necessary.
Some parents use positive reinforcement to improve chances that their child will stick with a treatment plan. Hearing that their parent is proud of them or receiving a letter from home while in residential treatment to keep them motivated can be very meaningful to young people. As a parent you can also offer incentives for participating in treatment, as mentioned previously in Section Ten.
Provide Emotional Support and Encouragement
Often adolescents and young adults so desperately want to be “normal.” They don’t want to have to deal with treatment. They don’t want to take any medication. They are hyper-aware of stigma and may minimize one or both disorders as a result. Listening to concerns and being empathetic can go a long way toward helping them stay the course, in addition to simply letting your child know that you care.
Some adolescents and young adults have been to multiple treatment programs and may feel demoralized or that “nothing works.” You too may feel hopeless if your child needs treatment yet again. It can help both of you to reflect on any aspect of previous treatment that was useful (such as learning about his mental health challenges, finding a therapist that she liked, feeling better for even a short period of time, learning a new coping skill, meeting someone in treatment that he could relate to, etc.). It helps if you think about every treatment episode as an opportunity to build upon what was already learned.
Participate in Family Education
Many programs offer what is referred to as a psychoeducational group for families. These groups are provided so that families can learn more about mental health symptoms, signs of substance use, treatment options, medications and relapse warning signs. It’s also a place where families can process what has happened since the last session and get advice as to how to respond more effectively if warranted.
A family weekend or four-day educational program is often offered in residential treatment settings. There are also designated times for visits and, in some cases, time off campus.
Attend Individual and Family Counseling
Participate in individual counseling and family counseling if offered, both with and without your child. These sessions can help you address concerns, improve family interactions and problem solve with the support of a counselor in a safe environment. Skilled therapists can help you and your loved ones learn how to relate to each other and respond effectively to build a stronger family.
Assist With Medication Management
In addition to providing input to doctors when prescribing medications to your child, you may need to fill prescriptions and give your child the medication, depending on his or her age. It can help to keep a notebook of the name of the medicine, the prescribed dosage, and what you notice with respect to side effects and symptom reduction. If multiple medications are needed, it can help to get a weekly pillbox from the pharmacy to organize pills rather than counting them out each day.
It isn’t uncommon for young people to be dissatisfied with their medications at first. This may mean that the medication they are taking has side effects they don’t like. It can also mean that the substances they were using did a better job of addressing their anxiety, boredom or other reasons for use. In either case, it can be helpful to discuss this with the treatment team to make adjustments if necessary. Often visits with psychiatrists are very brief — sometimes just 15 minutes — so being prepared to discuss how the medication is working is critical and can make the most of the session.
Alcohol and other drugs can worsen mental health symptoms and interact negatively with medications. Keep all substances out of your home, including household products that can be used as a substitute for alcohol (like hand sanitizers or vanilla extract), as well as products that can be sniffed or huffed (like keyboard dust cleaners). If you do keep alcohol or marijuana in the home for your personal use, keep it secured along with any medications that can be misused.
Help Establish Structure and Meaning
Co-occurring disorders can disrupt your child’s sense of purpose, throwing daily structure into a tailspin as substance use and mental health problems dominate your child’s life. Getting back to meaningful activities is one of the cornerstones of recovery and can help motivate your child to manage their mental health and provide reasons to stay sober. Asking about and encouraging involvement in school, work, volunteer activities, hobbies, sports and other interesting activities is important.
Hopefully, the treatment team will guide you and your child in creating a purposeful, structured day, but if not, try to put a plan together with your child. A weekly planner can be helpful in terms of establishing a schedule for when to wake up, do chores, attend school or work, participate in recreational activities, attend counseling, etc. This is not to suggest that every minute of every day must be scripted, but it can help to set expectations and to identify gaps in your child’s schedule that can be filled with meaningful activities.
Promote Healthy Social Supports
Support groups can be a great way for your child to meet other people who understand what he or she is going through. Groups are also a potential source of resources and referrals, along with social supports for engaging in activities that promote well-being. Encourage attendance at meetings for substance use such as 12-step (e.g., AA or NA) and SMART Recovery. You can search for mental health peer support groups at association websites (e.g. Anxiety and Depression Association of America (ADAA), Depression and Bipolar Support Alliance (DBSA) or National Eating Disorder Association (NEDA). Dual Recovery Anonymous is a 12-step meeting specifically for people with co-occurring disorders. Many of these organizations have meetings that can be attended online or in person and have other useful content on their websites.
Your child may welcome your participation at a meeting or prefer to go alone or with a friend. Take your child’s lead on this issue, especially if he or she would prefer to attend without you being there. Your child may welcome the opportunity to share with the other members but be reluctant to say anything in front of you. Also, every meeting is different so if your child doesn’t care for one, encourage trying a different one.
One note of caution: Some participants at 12-step meetings believe that medications are a crutch and unnecessary for “true recovery.” This is not the official position of these organizations, with the exception of Narcotics Anonymous. NA has taken a position stating that anyone on medication-assisted treatment (MAT) for opioid use disorder is not abstinent. Despite overwhelming evidence that MAT can save lives, some NA meetings will limit the participation of anyone on MAT. If your child is on MAT, he or she may be better served by a different support group.
You can also help adolescents and young adults find and engage in sober recreational activities. Aside from support groups, recovery centers host outings (such as flag football, 5K runs, coffee houses, movies, game night, cooking classes, picnics, etc.) that may be of interest to your child. Many kids think they will never have fun again if they aren’t using substances, so helping them learn to how to do this is an important part of recovery.
Join Family Support Groups
Support groups for families geared toward a loved one’s substance use include Al-Anon, Nar-Anon, Families Anonymous and SMART Recovery for Friends and Family. In addition, most of the mental health associations mentioned earlier provide supports to families as well. AA and Al-Anon as well as NA and Nar-Anon often host meetings at the same time and location. If the opportunity presents itself, it’s nice to attend and compare notes afterwards over a cup of coffee or ice cream.
Foster Coping Skills
Help your child learn to address stress in a healthy way by developing coping skills. Stressors can be major, such as an unexpected loss, moving, attending a new school or starting a new job, or they can be minor, such as everyday annoyances or worries. Coping skills can help your child deal with these issues and with mental health symptoms related to depression, anxiety, sleep problems and hallucinations, as well as cravings to use substances.
Help your child process stressful experiences by being there as a sounding board to listen. It can help to ask questions like “What do you think you should do under the circumstances?” or “How do you think you want to handle this situation?” rather than jumping in with answers. While it may be tempting to solve problems for your child, it can undermine self-esteem and confidence. Reminding your child of coping strategies for managing stress can also be helpful, like taking deep breaths or learning to meditate. Your child’s treatment team should be able to provide advice about how to support your child in developing healthy coping skills.
Engage in Self-Care
Helping someone with co-occurring disorders is like being in a marathon than a sprint, so self-care is critical. Remember that if you fall apart, you won’t be able to help your child. Coping with your own stress without using substances, eating nutritious meals, exercising, taking medications as prescribed, getting regular sleep, attending support group meetings, etc., can help you feel better while modeling a healthy lifestyle for your child. Engaging in mindfulness practices (like yoga, breathing exercises, meditation, Tai Chi, or guided visualizations) can also be useful and can be done with your child or as a family.
Know the Signs of Relapse
It isn’t unusual for relapses to happen, despite quality treatment and your child and family’s best efforts. Knowing your child’s “vital signs” for both mental health and substance use disorders is important to head off a relapse as well as to address one should it occur.
The symptoms of relapse are often different for mental health and substance use, so it may take some careful thought to identify what to look for. The treatment team and your child can be helpful in figuring out what the early warning signs are and what to do if you spot them. Having a relapse prevention plan in place can help shorten its duration, getting your child back on track to well-being.
Hope that things can be better is a powerful motivator that can strengthen a person’s desire and determination to attend to their health and well-being. You and other family members can play a critical role in helping your son or daughter feel hopeful, recognize that change is possible and that he or she can lead a wonderful, fulfilling life.