End-of-Life Care and Addiction: A Family Systems Approach

296 Pages·2009·1.47 MB·English

by  Dr. Suzanne Bushfield

End-of-Life Care
and Addiction
A Family Systems
Approach
Suzanne Young Bushfield, PhD, MSW, is a Licensed Clinical Social Worker who
has worked with families for over 25 years in the fields of end-of-life care,
healthcare,andmentalhealth.Sheisasocialworkeducatorandresearcher,and
worksasanAccreditationSpecialistfortheCouncilonSocialWorkEducation.
Suzanne has served on the faculties of the University of North Dakota, Lewis
Clark State College in Idaho, Arizona State University, and New Mexico State
University,andhasparticipatedintheCSWE–Gero-EdCenterinitiativesfunded
by the John A. Hartford Foundation.
Brad DeFord, PhD, M Div, writes about aging, addiction, spiritual development,
andend-of-lifecare.Throughhisprivatepractice,Thresholds,heisacertified
transitionsconsultantandlifecoach.HeisalsocertifiedasaLevelOneHospice
Manager through The National Hospice and Palliative Care Organization
(NHPCO). Brad has been a church pastor, a hospice chaplain, and the leader
anddeveloperofabereavementprogram.For6yearsheservedastheLeaderof
theSpiritualCaregiverSectionoftheNationalCouncilofHospiceandPalliative
Professionals (NCHPP). Brad holds advanced degrees from Union Theological
Seminary in New York and the Divinity School of the University of Chicago.
End-of-Life Care and
Addiction
A Family Systems Approach
SUZANNE YOUNG BUSHFIELD, PhD, MSW
BRAD DeFORD, PhD, M Div
New York
Copyright2010SpringerPublishingCompany,LLC
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ThroughoutthisvolumevariousexcerptsappearfromOpeningOurHearts,Transforming
Our Losses, copyright 2007, by Al-Anon Family Group Headquarters, Inc. Reprinted
bypermissionofAl-AnonFamilyGroupHeadquarters,Inc.Permissiontoreprintthese
excerpts doesnot mean thatAl-Anon Family GroupHeadquarters, Inc.has reviewed
orapprovedthecontentsofthispublication,orthatAl-AnonFamilyGroupHeadquar-
ters,Inc.necessarilyagreeswiththeviewsexpressedherein.Al-Anonisaprogramof
recovery for families and friends of alcoholics—use of these excerpts in any non Al-
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LibraryofCongressCataloging-in-PublicationData
Bushfield,Suzanne.
End-of-life care and addiction : a family systems approach / Suzanne Bushfield,
BradDeFord.
p.cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-8261-2141-7(alk.paper)
1.Substanceabuse—Socialaspects.2.Addiction—Socialaspects.3.Terminalcare.
4.Families.I.DeFord,Brad.II.Title.
HV4998.B872010
362.17’5—dc22
2009036398
PrintedintheUnitedStatesofAmericabyHamiltonPrinting
I would like to dedicate this book to my own family, whose emotional
process has made me who I am today.
—B. D.
Iwouldliketodedicatethisbooktomyhusband,Bob;andmyfamilywho
havealwaysencouraged andsupportedme,andfromwhom Ifirstlearned
what it means to be part of a family system.
—S. Y. B.
We also dedicate this book to those who work with families facing end-
of-life and addiction.
—B. D. & S. Y. B.
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Contents
Preface ix
Acknowledgments xiii
1 Death and Addiction: A Family Affair 1
2 Addiction Treatment: What Every End-of-Life 19
Care Professional Should Know
3 The Physiological, Psychological, and Spiritual Effects 39
of Addiction
4 A Systems Approach to Dying: What Every Hospice Team 65
Needs to Know About Family Systems Theory
5 Applying Family Systems to the End-of-Life Care of Addicts 93
and Their Families
6 The Challenges of Caring for the Dying: The Teamwork of 119
Families and Hospice
7 ApplyingFamilySystemstotheBereavementCareofFamilies 147
With Addiction Emotional Process
8 The Hospice Team as a Family System: Systems Aspects to 173
End-of-Life Care
9 Hospice Teams and Addiction Emotional Process 197
10 The Spiritual Care of Addiction and Dying 223
Afterword: When the Hospice Journey Meets the Road to Recovery:
Taking 12 Steps Toward the End of Life 251
Index 267
vii
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Preface
This book began with a simple observation we repeatedly encountered
in our work with hospice teams: Providing care to patients and their
families was different somehow when those patients and/or families
hadhistoriesofaddiction.Wenoticedthatcertaindiscernablepatterns
were repeated, to the extent that when a family entered hospice care,
someone on the team thought the new family was similar to another
family we had served not long before. “This Jones family? They are an
awfullotliketheSmiths,”wouldcharacterizethetypicalcasepresenta-
tion. And we would worry that we were not treating each family as its
own discrete entity—but sure enough, soon the Joneses would indeed
begin looking to us very much like the Smiths.
In our effort to understand what we were experiencing, certain
discoveries emerged. For one thing, the medical model, common in
hospice care, did not help us discover the uniqueness of each family.
In part this is because the medical model is reductive: It only told us
who the patient was according to the conclusions of his or her disease
process. The medical model led us to have certain expectations of the
persons who came onto our hospice services—mostly that they would
die in a way appropriate to the course of the disease taking their life.
There was, we supposed, a comfort in this—not for the person or the
family, but for us, the members of the hospice team. Somehow being
among so much death and dying was made more comfortable if, in
some way, the processes we witnessed were predictable.
Unfortunately,thatpredictabilityledtodisinterest.Theendofsome
people’slivesbecame“hohum”forusbecauseoftheroutine.However,
whenadiseasetookanunexpectedturn,suddenlythereweremoments
of interest again. We were interested because the way that particular
person was dying was “different,” and that difference caught our
attention.
ix