Letter To Friends and Family: Embracing a Harm Reduction Approach

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LETTER TO FRIENDS AND FAMILY:

Someone you care about is drinking or using drugs. You can see many ways he or she is creating problems in his/her life and creating harm in yours. Whether your partner, child, sibling or friend, you have stood by them in support as they have tried or refused treatment.

You may have left them, kicked him/her out or considered it; begged, pleaded, bargained, been tough, or soft. You are advocating for them because you love this person, fear for them, feel responsible for their well being or all of the above- yet you feel frustrated, defeated and confused about what to do next. You may be experiencing profound helplessness and have feelings of sadness, anger and isolation. Today’s optimisms induced by a new promise of never again is replaced by tomorrows disappointment when promises are broken. You end up with questions about loyalty, love, support and limits. How much help is too much? How many times do you cover up or overlook broken promises? How many times do you unbolt the door to let them have a shower or a sleep or feed? Should you give up hope of them changing, preferring family peace to fighting for change through chaos? Experts may have told you that you need to stop enabling, to start practicing tough love. You hope they’ll recognize how they are hurting themselves and others who care about them. The truth is that there are stages of change that are different for every family and staying connected helps individuals explore solutions that may be helpful for them.

Denial and hitting rock bottom

You may have learned that addiction is a disease and that only total abstinence with the support of the twelve steps is the treatment. You’ve come to believe that they must want to continue using or else all the trouble they’ve had would have convinced them to give up their substances. Their denial is so thick that only hitting rock bottom will motivate them to get sober. You’ve been told to stop bailing them out, cleaning up their mess, let them face consequences. Eventually they will hit rock bottom and sobriety will be possible and only with sobriety will come a life. Having believed this you urge them into treatment. However in spite of the acceptance and popularity of abstinence based treatment your family member has not got better. Despite the advice to abandon them you’ve loved them since they were born and the prospect of their death is too hard to contemplate.

Understanding how people change

So you’ve had it with promises and disappointments, exhausted by the fear and the suffering the substance abuse has brought, ashamed of their behavior, feel terrible for those they’ve hurt. You’ve heard of being patient, coping and passive in the face of all this. You’re tempted to take the advice, quit or get out. The problem is though, TOUGH LOVE DOESN’T WORK. It’s also awful for everyone to put into practice. It is totally unrealistic to expect people to change complicated behaviors on the basis of an ultimatum. Any approach that limits you to an all or nothing choice ignores the reality of HOW PEOPLE CHANGE. People change in incremental steps, practicing new behaviors and new ways of coping with life and feelings over time. The crucial ingredients to making lasting changes are understanding and support. When we expect immediate changes and refuse to be with the person during the process we undermine the very goal we seek to accomplish.

Separating a person from their behavior

Understanding, however, does not mean that you do not set limits. You set limits with two-year-olds and you set limits with adults. The limits you are setting are on behaviors. Children need limits that protect them from traffic, fire, poison etc. Adults need different limits, e.g. you can’t yell at me, I can’t let you take all our money for drugs. It is more usual to separate a person from his or her behavior. Spending all our money on drugs and alcohol doesn’t mean we are stupid we may be just overcome by need. Behaviors can be changed. Aspects of our personality can change. First of all we must have a basic sense of being valued to make it worthwhile to take care of ourselves. When we have children we give them unconditional love.

As they grow, the older they get, the less we can expect unconditional love to exist between parent and child. Relationships become equal partnerships in which we have to earn love and respect even from our parents. This is normal and healthy. Once we grow up the only place we can get unconditional love or more accurately unconditional positive regard is from a skilled therapist. You are not your child’s, partner’s or friend’s therapist. You don’t have to provide unconditional love to an adult no matter how much they may need it.

Harm reduction approach

The harm reduction approach suggests that you undertake the same kind of balanced evaluation of different options for taking care of yourself that we have encouraged our drug-using loved one to undertake. Weigh the pros, cons and consequences of actions so that whatever actions you take reflect the complexity

of the relationship with your loved one using drugs and the rest of the family. Just as the drug user needs to respect the complexity of his or her relationship with drugs before making decisions that will actually work and that can be maintained, you need to respect the complexity of your relationship with the drug using loved one. Harm reduction does not mean you have to end a relationship to improve it. Nor is abstinence the basis for an improved life. Nor does a drug user have to hit rock bottom to change. Incremental changes in drug using behavior along with incremental improvements in emotional coping skills are realistic and achievable goals. Abstinence may come at some point but for most people with substance misuse problems it is almost never a first step. For families it means a new way of thinking about the issue.

A new way of thinking

We know that this new perspective is a lot to swallow. It goes against everything you’ve learned about what addiction is and how it should be treated. How can someone who is still drinking or using the very drugs that make everything worse get better? We’re asking you to develop an entirely new set of ideas about this person you love and his or her relationship with drugs and alcohol. Your ability to be helpful to this person, and take care of yourself, will be enhanced by a change of perspective.

Adapted by Tony Trimingham, Founder, Family Drug Support http://www.fds.org.au/, and Barry Lessin and Carol Katz Beyer, Co-founders, Families for Sensible Drug Policy (FSDP) http://fsdp.org/ from:

‘Over the Influence’ by Patt Denning, Jeannie Little and Adina Glickman: Guilford Press.

 

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