Book Review: It Takes a Family

I just finished Debra Jay’s new book, It Takes a Family: A Cooperative Approach to Lasting Sobriety and wanted to share a few thoughts with you.

Bill White was one of the first people I heard challenge our failure to distinguish between treatment and recovery. Jay picks up this theme and details the limitations of treatment–that treatment is good at stabilization, but in most cases it’s not designed to provide long term recovery support and monitoring. Where White’s focus is challenging treatment providers to develop systems and services to provide long term recovery monitoring and support, Jay’s focus is on giving families and addicts the information and tools to develop their own systems of long-term recovery monitoring and support.

Jay identifies Physician Health Programs as the gold standard for addiction treatment and outlines eight elements that they share:

1. Positive rewards and negative consequences
2. Frequent random drug testing
3. 12 step involvement and an abstinence expectation
4. Viable role models and recovery mentors
5. Modified lifestyles
6. Active and sustained monitoring
7. Active management of relapse
8. Continuing care approach

She proceeds with chapters on addiction as a disease, why our emphasis on motivation is misplaced, an inventory of the behaviors associated with successful recovery (suggesting that relapse is not random), a new look at enabling and the toll that addiction takes on families–adults and children.

All of these chapters are extremely well done and concise, however, two chapters stand out to me.

The chapter on the disease model takes some very complex information and conveys it in a manner that is very clear and concise. Rather than just describing neurological mechanisms, Jay describes addiction as it is experienced by the addict and those who love them. It’s not frothy emotional appeal, but it’s description is emotional and experiential as well as intellectual.

The chapter on enabling is unlike anything I have ever read on the topic. It is nonjudgmental and conveys and unparalleled level of empathy for the addict and the family. It explores the chronic stress associated with living with addiction and the impulse to protect not just the addict, but also the family–detaching and letting the addict hit bottom often means that the family hits bottom with the addict. In the absence of a viable alternative, fear of losing the family rules decision-making. That alternative is Structured Family Recovery. Structured Family Recovery provides a path to enabling recovery.

The second half of the book is a step-by-step guide to implementing Structured Family Recovery.

So, what is Structured Family Recovery? It’s a way for families and addicts to try to construct their own version of the same gold standard that addicted physicians get. It’s a commitment from the family for each family member to develop a recovery plan of their own and attend a weekly family meeting (via conference call) in which all family members are accountable to each other. The focus is not of the addict, rather it is on the family as a whole. Jay provides several checklists for families and 52 weeks of outlines for the family meetings. There is a lot about the model that excites Jay, but one of the most interesting is the family’s new-found empathy for the addict. When the family member is accountable for working a recovery program of their own they develop greater empathy, understanding and respect for how difficult this is for the addict.

The first chapter of this section continues the refreshing and startling level of insight and empathy for all parties, with sections about how to talk to your addict and how the addict can talk with their family. These sections sensitively and impressively speak to the nuanced, conflicted and powerful feelings and thoughts experienced by everyone–the addict’s ache to get the spotlight off themselves and family member’s fear, anger, hope and relief.

Professionals who view Physician Health Programs as the gold standard have been searching for ways to emulate elements of the model for all of our clients in a voluntary and sustainable manner. Jay has done an enormous service to addicts, families and the field in offering a potentially free approach for achieving this goal. This will be invaluable for clinicians who are looking for ways to extend support and monitoring. More importantly, this book empowers families and addicts to do it themselves.

Debra Jay and her husband (Jeff) are renowned and respected interventionists who serve a lot of high-powered families and individuals. However, the thing I respect and admire most about them is their generosity in sharing their knowledge, experience and tool kits with the rest of us. Love First gave us step-by-step instructions for interventions and helped families decide if they could do it on their own. It Takes a Family continues their open source tradition by giving families Jay’s entire model and helps them decide whether they are capable of doing it on their own.

For less that $11 (relatively) intact families who are committed to working together to support recovery and heal their family now have a detailed road map written in a confident and reassuring voice that makes the reader feel like Debra is right next to you and understands exactly what you’re going through.