(Hint: Evidence-Based Practices and Family Systems Focus)
As a member of a multigenerational business family, I am all too familiar with the disproportionately high rates of behavioral health disorders in the privileged classes. I have watched relatives cycle through multiple alcohol and drug treatment programs with little lasting benefit. Early on, it became clear to me that much of adolescent and young adult treatment was ineffective at best and, far too often, destructive — damaging family relationships and, in some cases, exposing children to emotionally or psychologically abusive environments.
My response was not to disengage, but to build something different: high-quality counseling and advisory services for families and their children who had already endured failed treatments, unproven models, and advice that was not only misguided, but at times lethal. As some readers may know, I learned about the 92% success rate for pilots from the Hazelden Bulletin in 1998 and began applying their behavioral support model (HIMS Program) in my work with families.
I also began connecting with others in the field fed up with the poor outcomes, including parents with children lost to overdoses taking action to change the system. One, Pam Lanhart, started Thrive Family Recovery Resources, and her words go straight to the heart of so many families:
It was the Fall of 2016 when the seed was planted for an organization in MN that would provide more than just “support groups” to families impacted by addiction. When my son was young and using, I needed education, I needed tools, I needed skills-based actionable solutions and I needed to be around people that inspired the hope of recovery. But nothing like that existed.
So, with the help of mentors and a lot of encouragement from people in the recovery eco-system, we took a leap of faith and started Thrive. …today we (help) families find resources, learn how to reduce harm in their family, learn how to meet their loved one where they are at with dignity and unconditional positive regard, and learn the tools and skills that they needed in order to change the way they interacted with their loved ones. (https://www.thrivefrr.org/)
Thank you, Pam, for your courage to take on the system that so vigorously opposes your approach.
What stood out was this: alcohol and drug addiction is the only area of medicine where one group — doctors and pilots — routinely receives a fundamentally different, more rigorous, and more successful standard of care than the general population. At the time, the question was simple:
Why does this work so well, and why isn’t it being offered to others — especially families in crisis?
Twenty-five years later, here we are.
Rather than re-litigate tragedies that continue to unfold — including highly publicized cases like the Reiner family, which exposed once again how vulnerable families can be misled by a broken adolescent treatment system — I want to outline seven key differences between the prevailing approach and what seems to lead to improved outcomes. After each, I include a question families should ask prospective helpers and service providers. I do this because families are often making life-altering decisions under extreme duress — overwhelmed by fear, anger, grief, and exhaustion — while their children face ever-increasing access to drugs and alcohol at younger ages than ever before.
1. A Proven Behavioral Model
Our approach is grounded in the same highly successful programs used for doctors and pilots — programs with verifiable outcomes, not promises. These professionals are routinely drug tested for five years as a condition of returning to work to ensure public safety. Independent medical boards and airlines employ trained case managers to oversee recovery, require written recovery contracts, and mandate clear relapse protocols. Regular, reliable drug and alcohol testing is non-negotiable.
Question: What is your behavioral approach, and how do you measure success?
2. Family Is Central — Not Peripheral
Family involvement is not optional; it is essential. The adolescent or young adult is often a symptom of deeper family dysfunction rather than the sole cause of distress. This means everyone participates in the evaluation process — including testing — and everyone engages in therapy. It also requires families to listen differently. High-net-worth families are accustomed to being told what to do by experts. That dynamic does not serve recovery, particularly when the most common outcome of failed treatment over the long term is death.
Question: What role does the family play in the recovery process?
3. Evidence-Based Practices Matter
“Evidence-based” is not academic jargon; it is a phrase born of parents burying their children after following the traditional 28-day inpatient → AA/Al-Anon → relapse cycle. Families who survived that grief began asking for proof — not anecdotes — that treatment actually works. This led them to Medication-Assisted Treatment and other approaches backed by research. The doctor/pilot model is one such example. Others can be found through Harvard’s Recovery Research Institute, including the uncomfortable truth that buprenorphine is the only proven effective treatment for opioid use disorder.
Question: Which evidence-based practices do you follow — and where is the data?
4. Be Outcome-Oriented
Recovery is not theoretical; it is practical. Every individual and every family system is different — particularly in affluent environments where isolation, pressure, and access intersect. For adolescents, progress often involves trial and error. Their voices matter. Listening to their concerns about not using, about treatment experiences, and about fear of change is not optional — it is required under ASAM standards.
Question: How will your approach help me — and help my family heal?
5. Use Clinical Standards for Assessment and Placement
Sound treatment begins with proper assessment. ASAM criteria and the APA’s Diagnostic and Statistical Manual of Mental Disorders provide clinically grounded frameworks for understanding illness progression and treatment options. This includes examining parenting styles, family culture, and early trauma. Unfortunately, many high-net-worth families are deeply familiar with the damage caused by emotional absence and unaddressed childhood stressors — realities that are often minimized or hidden.
Question: What standards guide your assessment, placement, and treatment decisions?
6. Demand Safe and Respectful Treatment Environments
Children from affluent families are uniquely vulnerable in many treatment settings. The wealthy and well-known remain one of the last socially acceptable targets for ridicule, and their children often enter inpatient or therapeutic communities at real risk of bullying, shaming, or exploitation — by peers and staff. No one takes the emotional risks required for change when they feel unsafe. This is one reason we often prioritize intensive outpatient models within supportive, respectful environments.
Question: How do you address anti-wealth bias among staff and patients?
(If the answer is “there isn’t any,” find someplace else.)
7. Work Only with Properly Credentialed Professionals
Addiction remains the only field of medicine that routinely pretends it is not an illness. Instead, it is framed as a moral failing or a “personal problem” your neighbor can fix. Medical boards solved this years ago. Professionals with advanced degrees and rigorous training are far less likely to abuse the therapeutic relationship. Too many in this industry operate with hidden “dual relationships” — money, reflected fame, power, or sex. Families must vet carefully before allowing outsiders into their system.
Question: Who have you worked with, and who will vouch for you?
In Summary
Look for an individualized, family-oriented, professionally guided approach grounded in clinical assessment and evidence-based practices. The goal is not to escalate crisis, but to stabilize it — to quiet fear rather than inflame it.
How did I learn all of this? By trying to save family members. Through fear, frustration, exhaustion. Through watching friend’s siblings endure a dozen failed treatments. Through seeing trust funds keep roofs overhead while lives unraveled. I became a licensed alcohol and drug counselor and interned inside treatment centers to understand — firsthand — how affluent families and their children are viewed. My life’s work became improving treatment outcomes for high-net-worth families, particularly late adolescents and young adults.
Many families eventually realize that “28 days” is a business model, not a solution. That realization usually comes after years of failed treatment and staggering financial and emotional loss. The first task then is to undo the damage. (On a personal note: yes, family members have been lost to “tough love.” Fire anyone who recommends it. It is not evidence-based.)
At the first sign of trouble, turn to family counseling — including assessment for learning differences and ADD. Do not isolate your child as the problem. Medicating without addressing the family system merely postpones what will worsen over time. Addiction progresses. The snowball grows.
Finally, understand that there is an ongoing war within the recovery community: the entrenched abstinence-only model versus reforms driven by evidence. Buprenorphine is the clearest example — widely used internationally for decades, yet still denied to many in the U.S. Adolescent treatment remains particularly broken, often reflecting parental avoidance rather than meaningful engagement.
Pam and I are members of the Governor’s Council on Addiction, where our colleagues bring in so many stories of hardship and losses. We are privileged to be so trusted.
It is winter for many families — cold, relentless, and frightening. We walk with them toward spring.