HOWARD SAMUELS, PSY.D., entered his first treatment program at age 19. It took him more than a decade to turn his life around. He founded and runs THE HILLS TREATMENT CENTER so that everyone can benefit from what he learned the hard way. HARA ESTROFF MARANO talks with him about the elements of treatment that matter most for lasting change.

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HARA: What role do families play in addiction?

HOWARD: I have 27 years sober now and I've dedicated my life to helping others, but I wouldn't be here if my family hadn't saved my life. They didn't give up; they intervened and intervened until I went into treatment.

Do families tend to give up when they have an addict member?

Many people are ignorant about what is happening within their family. When it hits them that one of them is an addict or alcoholic, they have no clue how to solve the problem. Yet the family is crucial to recovery because it has the most power to save a loved one--the emotional connection and the ability to set boundaries in a loving way, although it takes time.

Do families give it the time needed?

Families get very frustrated, which is why they need as much help as the addict/alcoholic. The family also needs to change and learn not to enable or shame the addict/ alcoholic.

What exactly is "enabling"?

Enabling comes in many forms, such as giving addicts whatever they want. This deprives them of learning how to build self-esteem, which you build by doing esteemable acts--going to work every day, going to school, being productive, and building a life and healthy relationships. Another example of enabling is setting boundaries but failing to uphold them when the time comes. An addict/alcoholic must understand the consequences of his or her actions or will most likely continue with the same behavior; this responsibility lies with the family.

What do you do?

Families need education about drugs and alcohol and help with healthy parenting. Often, by the time a child--or adult--comes in for treatment, the whole family is dysfunctional. Some people didn't even realize a loved one was on drugs. They don't keep the connection with those close to them on a daily basis, so they can't gauge what is right or what is wrong. We help families to reevaluate what they're doing and to be humble enough to change. Drug addiction/alcoholism provides an opportunity to help families change for the better.

Do families fear they'll be blamed?

Yes. There are two extremes. One is the family that is so angry that they don't want to be a part of treatment. They simply avoid; it's not their problem. It's the wife's problem or the kid's problem or the husband's problem. The other is the family that is afraid of being blamed--because in reality they already have been blamed. Addicts and alcoholics are always pointing their finger at the people closest to them. They're victims; everyone else has caused their problems.

Are there surprises with families?

You don't know what issues will crop up. An alcoholic woman in my program was doing great when her husband began sabotaging her. He left wine out, wouldn't get rid of the alcohol. Now that the wife is healthier and reclaiming her role as mother, the husband is losing the control he had. The "normies" feel they're saving the family. They like the power and control; they don't want to look at what is dysfunctional about themselves.

That has to be addressed?

Absolutely. The important thing is to educate the family as to what is really going on. Their issues have never been looked at because everything was hiding behind the alcoholism. If I help only the alcoholic/addict and send him/her back to a dysfunctional family, he/she will be drinking within months.

Why?

Everyone falls back into the old pattern. That is why you can't just change the addict/alcoholic; you have to change the family system. It's about the family as a whole.

Do some families resist participating?

Each case is individual, but in the past we've recommended that the addict/alcoholic distance him- or herself from the family unit for their own well-being. I suggest that all young adults become more independent. They hate the dependency, but they're too scared of being on their own. Once sober, they can enter our sober-living homes; we help them get jobs or go back to school. We help them stand on their own two feet and build self-esteem. With married couples, if the "normie" is highly dysfunctional and/or unwilling to give positive support, we'll recommend that the spouse move out. Many families are set in their ways. Through treatment, we hope the family is open to change, just as the addict/alcoholic must be.

What do families most misunderstand about the role of the family?

They're too controlling. There's no intimacy in control. We help the family let go a little and develop a little trust. They have to allow the addict to grow and build self-esteem on their own or to fall on their face and hit a bottom--and learn from their mistake.

Is there something about the role of the family that addicts misunderstand?

They're very self-centered. Most addicts mistakenly think that everything is all about them. They feel like victims to the world and take no responsibility for how their behavior has hurt so many people. Their "beast" inside has removed all sensitivity to anybody else. Real recovery is achieved through service, helping your fellow man.

What else do you emphasize?

Humility and being your authentic self as well as being of service to your family, to your community. Even if you don't have a family, you have a family within the community of recovery. The point is to develop an intimate connection with another human being, to be your authentic self, and to have the humility and strength to abandon arrogance and grandiosity; those qualities are part of the disease of addiction/alcoholism and are built on fear.

EVERYONE plays a part

When helping becomes enabling:

* Helping includes doing things that will positively benefit another.

* Enabling allows the addict to continue destructive behavior, often by supplying money, shelter, legal, or any other form of help.

* Enabling is done with good intentions but is not truly healthy.

* Enabling prevents addicts from experiencing the consequences of their actions; it may keep them from seeing they have a problem.

Codependency and marriage:

* Codependency occurs when one partner puts the needs of the addict spouse before higher own.

* It fosters the tendency to behave in overly passive and caretaking ways that harm the relationship.

* When a codependent partner has had enough, it can nudge the addict toward change.