Boundary-Setting Framework

Understanding Leverage

Leverage is anything the client depends on that the family controls. When a loved one calls and says "They won't go to treatment," your first question should be:

"If they're not willing, we can talk through either a professional intervention or setting boundaries that force change. You actually have more leverage than you realize. Let me ask you: where does your loved one live? Who pays for it? Do they have a car? A phone? Are they on your insurance? Do you give them money?"

The Seven Leverage Points

1. Housing

Who owns or rents the home? Whose name is on the lease? If the family controls housing, they can require treatment as a condition of staying.

2. Phone

Who pays the phone bill? If it's the family, they can disconnect service until the client enters treatment.

3. Car / Transportation

Who owns the car? Who pays insurance? Who makes payments? If the family controls this, they can remove access.

4. Money / Financial Support

Do they ask for money regularly? Does the family pay for food, bills, or other expenses? Stop all financial support.

5. Healthcare / Insurance

Are they on the family's insurance plan? Can they be removed or threatened with removal?

6. Access to Children / Family

Can the family control visitation? This is particularly powerful for parents who are using.

7. Meals / Food

Do they come home to eat? Does the family provide groceries? Stop feeding the addiction by withholding support.

The Key Question

After identifying leverage points, ask the most important question:

"How willing are you to set boundaries?"

If they're not willing, they can't create change. And you need to tell them that directly.

The Boundary-Setting Process

Step 1: Assess Current Leverage

Ask specific questions to map out what the family controls:

"Let me ask you some questions:

- Where does your loved one live? Who pays for it?
- Do they have a car? Who pays insurance/payments?
- Do they have a phone? Who pays?
- Do they work? Do you help financially in other ways?
- Are they on your insurance? Can you remove them?
- Do you give them money? When do you do this?"

Step 2: Be Direct About What It Takes

"Based on what you've told me, you have leverage. But it only works if you're willing to use it. And that means being willing to potentially make things harder for them in the short term so they get better in the long term. Are you willing to do that?"

(If no): "I respect that. But understand — without boundaries, change probably won't happen. You can't force someone to get sober. You can only stop enabling the addiction. When you're ready for that conversation, call me back."

(If yes): "Good. Here's what that looks like."

Step 3: Set Specific Boundaries

"Here's what we need to do:

1. You stop giving them money.
2. You stop paying their phone bill (if applicable).
3. You stop paying for their housing (if applicable).
4. You tell them: 'I love you. I can't watch you destroy yourself. You can get clean at Tulip Hill Healthcare, or you can figure out life on your own. But I won't support the addiction anymore.'

Then you follow through. If they call asking for money, you say no. If they show up at your door, you say no. If they guilt you, you say no.

Will you do this?"

Step 4: Create the Treatment Path

"Once you set boundaries, they often decide treatment is easier than homelessness, hunger, or losing their phone. When they're ready, here's what we do: You tell them, 'I've found a place. You go, or you're on your own.' And then you call me. We'll get them assessed and admitted the same day if possible."

Step 5: Support for the Family

"Here's the thing about boundaries: You're going to feel guilty. You're going to want to cave. So you need support too. We have family programs, and we also recommend Al-Anon or similar for you. Taking care of yourself while your loved one gets help is crucial. You can't pour from an empty cup."

Real Example from Calls

Family Member: "She won't go. She thinks she's fine. I can't force her."

Closer: "You're right, you can't force her. But you can stop enabling her. Let me ask: Who pays for her phone?"

Family Member: "I do."

Closer: "Okay. Where does she live?"

Family Member: "With me. It's my house."

Closer: "Does she have a car?"

Family Member: "She uses mine when she needs it."

Closer: "So you're paying for her phone, providing her housing, and giving her access to a car. She's not going to treatment because she doesn't have to. Everything is being provided. Here's what needs to happen: You tell her she has two choices — go to Tulip Hill Healthcare, or find somewhere else to live. No more phone. No more car. No more financial support. Are you willing to do that?"

Common Resistance from Families

"But I can't kick them out — they'll be homeless!"

"I understand that fear. But here's the reality: they're not going to be homeless. They're going to choose treatment. And if they don't — if they truly choose homelessness over getting help — then you've learned something important: your support was enabling them, not helping them. Most people, when faced with real consequences, choose treatment. But they won't choose it while you're making the addiction comfortable."

"What if they overdose or hurt themselves?"

"That's a real fear. But let me ask you this: is what you're doing now preventing that? Because from what you've told me, they're still using. The risk of overdose exists right now, under your roof, with your support. Setting boundaries doesn't create new risk — it forces them to confront the existing risk and make a choice. You can't protect them from themselves forever. But you can give them a clear path to help."

"They'll just go live with their using friends"

"Maybe. But those friends won't support them forever either. And when that falls apart, they'll remember that you offered a better option: treatment. The boundary isn't about controlling where they go. It's about making it clear that you won't support the addiction anymore. What they do with that information is up to them."

What NOT to Do

Don't let them negotiate: "Just one more month" becomes one more year
Don't cave when they guilt you: "You don't love me" is manipulation
Don't make empty threats: If you say no phone, mean it
Don't give money "just this once": Once always becomes again
Don't enable while claiming boundaries: Half-measures don't work

The Tie-Down Close

After explaining the boundary-setting framework:

"So you have leverage. You know what needs to happen. The question is: are you ready to do it? Because if you are, I can help you. But if you're not, we're just spinning our wheels. What do you want to do?"

This forces the family to commit or admit they're not ready. Either way, you've clarified the path forward.

When Boundaries Work

Boundaries are most effective when:

The family controls significant resources (housing, money, phone)
The client isn't deeply entrenched in a using network
The family is unified (not undermined by one enabling member)
The family follows through consistently

When done right, most clients choose treatment within 3-7 days of boundaries being set. They test the boundaries first (calling, showing up, guilting) but when they realize the family is serious, they capitulate.

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