Families Matter/Family Matters Family Drug Support Day 2020 Edition!
Welcome to the February 2020 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout.
“No one has ever hated themselves into being a better f***ing person.”
— Vinny Ferraro, Co-Founder of DharmaPunx
Tough love. It isn’t a new phrase; it’s also one that we’ve discussed here before. But it felt like it was time to return to this still too often-used phrase as we celebrate International Family Support Day on February 24th and honor those who have died – and those who have survived as well as those who struggle still – and brought us here. And I hope you’ll bear with me if I repeat myself in this piece though I’m hoping to discuss some new points too since it’s been nearly two years since I wrote the original blog on tough love (that 2-part blog can be found here from Summer 2018). Thanks in advance as always!
I recently came across the quote I used at the top of this blog. And I fell in love with it! After all, isn’t this the point? I mean, we professionals have been saying that “tough love” is necessary because it’s necessary to hold people responsible for their actions, to make them a better – more mature – person. In reality, first of all, tough love has nothing to do with love. We can certainly say that sometimes loving someone is tough, or that we need to have alternatives or options (some call these “boundaries” which is OK though I’d argue that this word has been co-opted by us professionals, like “enabling”, and now is just another over-used phrase designed to shame people who use drugs or other less socially-acceptable behaviors) to have relationships with many of our loved ones, whether they’re using drugs or not. That’s simply a way to have healthier relationships in general. And there’s no absolute right or wrong here either which is tough. Simple binaries are so much easier! I also fully appreciate that saying to ourselves, “I need to have boundaries!” seems to be the right thing to do or say especially when we’re talking about people we love who have also left us feeling exhausted and worse when trying to find a way to have a relationship with them that doesn’t also kill us. I’ll only say one more thing about why I find this concept of boundaries a mistake: when I say “I need to have boundaries” I’m usually focusing on the negative, what I won’t do for you versus looking at options, or what I am willing to do (I’ll give some specific examples of how to provide options later in this piece). I also need to say upfront that my suggestions may not be right for you and your family; only you can make that decision. That doesn’t make my ideas right or wrong, just simply not a good fit for you. That’s OK. In fact, it’s good that you know what’s best for your situation – what’s doable – for your family. This leads us to what drug treatment (or any professional help) needs to be for individuals and the rest of their family members: individualized. And that means just that – no manuals designed to fit anyone; no experts on what works; no rights-or-wrongs for everyone. Just deep listening to people to help them determine a what’s-best-for-them-right-now, one possible course of action. And I do mean “one possible course” as we all also need to be flexible because the only constant in life is that all things change, right?
When dealing with someone who is using drugs in a less than healthy way (yes there are healthy ways to use any drug), here are a few ideas we harm reduction professionals suggest to improve conversations with members of our families who use drugs in a less healthy, problematic way.
- Breathe! I know this sounds silly but I’m not kidding. When humans get stressed out, one of the first things that happens physiologically is that we start to do more shallow breathing. It’s part of our instinctive and protective stress response system (think, “there’s a Saber-toothed Tiger out there waiting to eat me!”). But we can learn to override that instinctiveness by practicing some simple breathing techniques when things are going well or are calm (doesn’t help to practice when things are stressed if you haven’t already figured that out ). Here’s a simple one that I try to teach all my clients:
Breathe in deeply through your nose, hold for a moment,
then exhale through your mouth. Repeat this at least 5 times
and each time practice lowering your shoulders
and relaxing your facial muscles, arms, and legs.
Note: If you’re still stressed, try adding this: rub your hands together briskly until they get warm (when our hands are warm it fools our body for a moment into thinking it’s more relaxed. That’s why folks are more relaxed at the beach, for example, in the sunshine than in the cold and rain). Then repeat the above again until you’ve relaxed. Please remember we’re not going for complete relaxation as that wouldn’t honor the reason you’re stressed in the first place (maybe you really do need to be afraid even if it’s not of a tiger). Rather, try to go for stress-less.
- Don’t freak out. When we discuss our loved ones using drugs – especially kids/young people – (and please remember I mean ALL drugs including alcohol and tobacco), we tend to lose it. And that’s understandable because we’re scared for our loved ones. Sometimes literally scared for their lives. So, here’s another to look at their drug use. First of all, it can be helpful to remind ourselves that most people, some 80-90%, “mature out” of using drugs problematically as other things in life become more important (such as a job, or other responsibilities of life). This typically happens by age 25-30 for most people. Secondly, ask yourself, “Would I be this upset/scared/angry, etc if they were snowboarding, or hang gliding, or driving race cars?” In other words, try putting their drug use into the same mental category as any number of other risky behaviors that society usually tolerates or even praises. Got it? Good! Now I’m not suggesting that there’s absolutely nothing to worry about. No one has a crystal ball to see the future so we’re all guessing on this one. I just want to be sure that our emotional state is in proportion to the actual risk of the behavior, not our belief around whether drugs are good or bad (they’re neither as they are inanimate things which aren’t capable of such thoughts), or that any drug use is a risk for addiction (it’s not). Perhaps it would surprise you to know that in the midst of an opiate crisis in many parts of our country, more parents call drug/addiction help lines scared for their child’s use of cannabis than any other drug, even though it’s now legal in many states. While I certainly appreciate the concern, I’m more concerned generally about young peoples’ use of alcohol than any other drug including opiates (though again this all depends on the individual and even the area/State they live in). As of 2019, 88,000 people died from alcohol-related illnesses. This makes alcohol misuse the 3rd leading cause of preventable death in the US. However, when it comes to adolescents, I realize that their deaths from alcohol and/or tobacco will likely come later in life so we tend to dismiss it (for now) and focus more heavily on opiate misuse (and with some good reasons of late). However, binge drinking is common amongst youth – especially on college campuses – and may lead to not only alcohol poisoning (which can be fatal) but also to impaired thinking regarding driving safely, sexual encounters, suicide risk, and more. It’s not that opiates aren’t a problem; we just need to not forget about alcohol’s misuse – and other drugs – when we discuss problematic opiate use.
- Talk first. So many people I work with come to me with all sorts of reasonable concerns about a loved one’s behavior. When I ask, “And how has your loved one responded to your concerns?” all too often I hear, “Well I haven’t brought it up; I’m afraid they’ll get upset with me.” Many parents will even ask me questions about a session I had with their child even when the child is in the room with us all. I’m not judging these parents at all. I’m simply saying that instead of practicing tough love, where we need to “toughen up” is on ourselves, to be willing to have these difficult conversations with those we love. And with groups like Family Drug Support, CRAFT, and SMART Recovery for Families, we have better ways to learn to communicate with each other and especially with loved ones whose behaviors are scaring the bejesus out of us. To provide an example from my own life, I recently had occasion to have such a difficult conversation with my son Jesse and daughter-in-law Cristina. Bless her for her willingness to be the facilitator as it’s always more challenging to do so with your own family! We spent several hours all total (which I normally don’t suggest, BTW) and here’s a few ideas on how we did our “challenging conversation” (and please, this isn’t shared to compare or to suggest you should things this way but rather to simply demonstrate how ours went as an example. And my points are on reflection too, not what we’d purposefully laid out first though I’ll certainly hope this deconstruction may be of help to others as well as ourselves for our next conversation):
- Warm up: We’d already talked by phone and decided that we’d have a first conversation when I came to Los Angeles (LA). But Jesse also asked that we do something relaxing and interesting to us all beforehand. For us that was a trip to Pasadena to the Huntington Gardens. Jesse and I had been there when we lived in LA when he was a teen but that was a long time ago. As they’re preparing to landscape their (mostly) reno’d LA home, this was something that we could do together, in public, that had a secondary purpose (relaxation) and was in a neutral place. So, I guess you could describe this as a “safer environment” to ‘warm up’ for the later conversation we’d agreed to have (I’m now thinking of this as similar to warming up one’s muscles prior to a challenging work out).
- Ask for help. Second, we had someone outside the family of origin facilitating. Again, I’m in debt to my daughter in law for her taking on this role. While she’s certainly part of the family (and has been for 5 years now) and has been witness to some of the tensions between Jesse and I, she has not been around since the start of those tensions nor been a part of them. This is also where professionals can be helpful as long as they don’t have an agenda beyond enabling your conversation in as safe an environment as possible. We had discussed (and contacted) a couple of professionals to possibly help us with this conversation but found for our schedules, it just wasn’t feasible (we had to reschedule my visit 3 times as it was due to all our schedule changes and this was my own last opportunity to go down to LA for several months).
- Be realistic. Realize that everything is not going to be fixed nor all discussion concluded after this talk. We left the conversation acknowledging that more work needed to be done, with each of us having items to individually work on. While we didn’t set a specific date to return to this (again, schedules!), we did say it would generally be within the next 6 months. That was more realistic for us than setting an actual date right then. Being realistic AND committing to getting back to the conversation is better than trying to force everyone into something. We also all needed some time to decompress and think about the conversation we’d just had. It was very emotional and a real challenge to have -and we did it anyway. We are all capable of doing hard things, especially when we know we’re not alone and we’re loved by the people we’re talking to!
And what could we have done better? One place we will improve for next time is on limiting the time for the conversation. I believe we went too long. We were all exhausted afterwards, had difficulty listening deeply by the end, and were a little more apt to take things personally as a result. I usually advise families when having family conversations to limit it to no more than an hour at a time, and sometimes even shorter. I also suggest limiting the topic to one or 2 at the most. It’s better to discuss one thing well in 15 minutes than to try to fit everything in that you’ve been wanting to discuss (sometimes for years by this point) in an hour or more. While the sentiment is appreciated, in reality it often becomes overwhelming to everyone. And this feeling can be dangerous for those of us who use drugs problematically since if the conversations becomes too great of a stressor, we will be tempted to turn to drugs to alleviate some of those uncomfortable feelings. Folks have even been known to overdose at times like this (this is also a usual occurrence in 12-Step fellowships after members do their “4th Step” for instance. More on that another time) due to using more than usual as their heart rate and breathing are increased along with other events.
4. The Bouquet of Options. In the book Motivational Interviewing, Drs. William Miller & Stephen Rollnick describe offering clients a “bouquet of options” regarding behavior change. Think of this as a buffet not a prix fixe dinner. So in families, the challenge is to come up with alternatives to tough love. I love to say to clients, “OK so I know what you’re NOT willing to talk about/change, which leaves me curious about what you ARE willing to discuss/change at this point.” It’s the same in families. Maybe you can’t let your loved one live in your home anymore. I get it. So what CAN you do? The statement to your loved one might be something like this: “Your mother/father/whomever and I love you very much and we really want you to know that. And we know that you’re doing the best you can right now & that you’re much more than a drug user! We are going to need you to find another place to live right now because we’re just not OK with illegal drugs being in the house. But, we’d be happy/delighted/willing to help you find somewhere else to live because we want you – all of us – to be as safe as possible. Would that be helpful? Or perhaps there’s something else you can think of that would be helpful that we can discuss?” The idea is to state your love first (possibly including that you do see your loved one as more than their behavior, no matter what that behavior is), that you appreciate their use of drugs is complicated and with reason(s), and that some specific behavior is making you or others feel less safe and so can’t continue. Then you offer an idea of what you ARE willing to do and suggest that you’re willing to negotiate other options as well. This does NOT mean that you are obliged to do whatever they ask; your obligation is simply to listen. And sometimes this approach doesn’t work. However, in my experience, family members generally feel better with this approach both about how they interacted with their loved one and that they had more to offer them than simply to say “no” or threaten. This approach also leaves the door open for everyone to bring new ideas back to the table.
5. Love smarter. This is probably the biggest takeaway from all our conversations on Facebook and in general at FSDP and Family Drug Support. I’ve often advised my training attendees and students to “work smarter not harder” (thank you to the cartoon character Uncle Scrooge McDuck, who was the first one I ever heard say this phrase). And this will mean different things in different environments, absolutely. For me, in part, it means speaking up about things that others do that hurt me or that I don’t like. But it also means stopping for a moment to consider that, if they’re an adult, I don’t need to like everything my loved one decides to do, whether that’s drug use or not going to college. So then the conversation with myself is “how do I love this person and show that AND disagree with some of their life choices?” Frankly, it’s easier to just cut people off. Any alternative to tough love takes hard work, conversation, and may still turn out badly. There simply are no guarantees in life (except death),
“It is possible to make no mistakes and still lose. That’s called life.”
—Sir Patrick Steward as Capt. Jean-Luc Picard, Star Trek TNG
And so, on this International Family Support Day 2020, I hope you’re finding some options for you and your loved ones whatever behaviors/changes you all are trying to make! And if I may, I’d like to remind us all that trying is doing – something. It’s also in the trying that all long-term change begins so let’s all try more! We’ll pick up more on that idea in the Spring Edition. Cheers!
All photos courtesy of unsplash.com
 In part this is due to the false claim we as a country made many years ago that marijuana is a “gateway” drug. This research was found to be flawed and we have since retracted this claim though many people are not aware of that. Here’s one source but there are many: https://www.drugpolicy.org/sites/default/files/DebunkingGatewayMyth_NY_0.pdf
 Step Four in AA is “Made a searching and fearless moral inventory of ourselves.” This is often followed immediately with Step Five, “Admitted to God, ourselves, and to another human being the exact nature of our wrongs.” Twelve Steps and Twelve Traditions (1987ed), AA World Services. NYC.
 “Drug, Set, Setting” (1986) by Dr. Norman Zinberg, MD discusses this concept and more. For more on this evidence-based conversational method, go to https://motivationalinterviewing.org/  https://www.fds.org.au/about-us