I want to speak directly to you as someone who may be walking alongside a loved one who is struggling with substance use. In a recent podcast conversation, I interviewed therapist Karen Perlmutter, who specializes in substance abuse and mental illness and has over a decade of experience working with families. Our discussion focused on her evidence-based curriculum designed specifically for families, available through her practice, Collaborative Counseling LLC. Karen’s work exists because she has seen how much pain families carry and how often they are left out of the treatment process, and she is committed to making sure you do not have to navigate this alone.
Karen shared how, early in her career, she focused almost entirely on the person with the addiction and realized later that she had a major blind spot: she was not fully seeing the mountain that families are climbing at the very same time. She uses “the mountain” as a central metaphor in her work. Addiction sits at the top, and on one side is the person who is using substances, struggling in their own way. On the other side is the family, scrambling to reach them, often exhausted, scared, and confused. Karen’s curriculum is about building a bridge between those two sides, helping families deeply understand what their loved one is facing while also honoring the very real and valid struggles families experience themselves.
In our conversation, Karen described what she calls a “desperation for restoration.” Families remember their loved one at their best and are desperate to get that version of them back. Out of that desperation, many of us try to fix, rescue, control, and manage every aspect of our loved one’s life. These efforts are loving and understandable, but as Karen points out, they often backfire or become counterproductive. In her course, she walks families through practical, step-by-step ways to move out of crisis-driven reactions and into more effective, compassionate responses that actually support change rather than unintentionally fueling the cycle.
Karen also talked about shame as one of the heaviest burdens families carry. You might find yourself asking where you went wrong, what you could have done differently, or why this is happening in your family. Karen emphasizes that addiction is a complex disease with biological, psychological, social, and spiritual components. It is rarely, if ever, about one person’s failure or one family’s flaw. She shared the story of a father who came to see that he was responsible for only a small piece of his child’s struggle, and how that realization allowed him to move out of paralyzing guilt and into a place where he could actually be helpful. Her curriculum is designed to help families untangle blame, understand the true complexity of addiction, and find support from other families so they no longer feel isolated or uniquely defective.
One of the most frightening issues Karen and I discussed is suicidal language. Many families hear statements like “I can’t do this anymore” or “Maybe it would be better if I weren’t here” and are thrown into terror. Karen explains that this kind of language can sometimes express overwhelming feelings, sometimes be used in a manipulative way, and sometimes signal real, imminent danger. In her course, she teaches a concept she calls “language precision” to help families listen more carefully to what is being communicated, respond thoughtfully rather than reactively, and know when and how to seek professional help. Her goal is for families to take all suicidal language seriously, but not to be held hostage by it.
Another core element of Karen’s approach is helping families set value-based boundaries. Many of us set boundaries in the heat of the moment: “If you ever do this again, you are out,” or “I’m done helping you forever.” These kinds of boundaries come from real pain, but they are often unsustainable and confusing for everyone. Karen instead encourages families to identify their core values, such as safety, honesty, respect, and kindness, and to create boundaries that flow from those values. That can translate into limits around money, substances in the home, behavior in shared spaces, or how communication is handled. When boundaries are rooted in values rather than raw emotion, they tend to be more consistent, clearer, and more likely to be upheld.
We also talked about the pressure families feel around “self-care.” Karen acknowledges that when you are in constant crisis, being told to take a bubble bath or relax can feel dismissive or impossible. In her experience, families first need help stabilizing the immediate chaos—understanding what is happening, putting some initial boundaries in place, and getting educated about the illness. Only after that groundwork is laid does self-care begin to feel possible. Throughout her course, she weaves in realistic, practical forms of self-care and emphasizes the importance of connecting with other families and supportive professionals. Karen is clear that families deserve support and that their well-being matters, not only for their own sake but because a more grounded, supported parent, partner, or sibling can show up more effectively for a loved one.
All of these insights are built into the family course Karen you can find at collaborativecounseling.podia.com. It is a structured, evidence-based guide for families navigating addiction, covering understanding the disease, using the mountain metaphor, working through shame and comparison, responding to suicidal language, setting value-based boundaries, and slowly reclaiming your own life and health in the process. The course is designed so you can move at your own pace, revisit key concepts, and use it as a shared framework for conversations within your family.
