The Economic Consequences of Opioid Addiction in America

Devon reported, however, that the most important part of family counseling was an
exercise called the knee-to-knee exercise. This is a structured communication exercise
that focuses on expression of emotion and “listening to understand” as opposed to
“listening to respond.” Family members complete a written exercise that prompts them
to express their feelings regarding a wide variety of their loved one’s behaviors. The
family members sit in chairs “knee to knee” and then share their feelings while the other
family member listens. Family members are not allowed to respond to what they hear.
Removing one’s ability to respond increases the likelihood for genuine listening. Devon
was able to truly hear, for the first time, how his actions had truly impacted his family.
Devon shared that he had no idea that his drug and alcohol use had caused so much
pain and fear in his family.
As family therapy concluded, each family member left with a much clearer
understanding of the process of recovery, both in their individual lives and the life of
Devon.
Meet Robert
Robert is also a young man in his early 20s who was admitted into treatment with a
primary diagnosis of severe alcohol use disorder and severe cocaine use disorder.
Robert shared that he drank his first beer when he was 6 and began to use marijuana,
cocaine and alcohol by 12.
Robert is an only child from a well-educated, middle-class family. His father is an
attorney and his mother is a successful businesswoman. Robert’s parents are very
goal-driven and he frequently had a difficult time living up to their standards of
perfection. This caused Robert to feel a great deal of shame. Robert grew up not being
able to identify his emotions. Expressions of feelings, other than anger and sometimes
sadness, were not allowed within his family (an unspoken rule) and so Robert learned to
suppress his feelings.
Robert also shared that it was easy to manipulate his mother with respect to his drug
use. Robert’s mother would always take his side, mistakes were never his fault, and he
rarely, if ever, suffered consequences for the choices he made. This is an example of
co-signing unhealthy behavior and it a hallmark of addictive relationships. It is the
normalizing or minimizing of unhealthy behaviors and the removal of responsibility for
those behaviors. This prevents the person with the disease of addiction from learning
from his or her unhealthy choices.
Robert also had deep-seated resentments toward his father. Robert’s father would often
be at a favorite bar instead of attending Robert’s hockey games and Robert could never
get the validation that he so desperately craved from his father. This emotional
distancing between father and son also reinforced his mother’s unhealthy closeness
and the sense that he could “do no wrong” in his her eyes.
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