FSDP Blog

“Love Has No Labels: The Rise and (hopeful) Fall of Tough Love in America?” — Part 2

Welcome to the August 2018 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. To learn more about how your family can join our growing community of enlightened friends and advocates sign up here now.tyler-nix-525388-unsplash

Last month we started our discussion of “tough love” and its origins. This month we’ll continue this look at this well-known and used concept to see if it really works and is the most effective strategy for families who love someone who misuses drugs.

We’ve discussed Synanon and its use of harsh confrontation and “tough love” in treating drug use problems. We’ve looked at Al-Anon and its concept of “letting go with love” and seen that what that often looks like is anything but love – though setting limits is important, too. Also, we’ve discussed how this concept of “tough love” isn’t just bad for helping drug users make changes but also bad for loving family members. We also talked about the difference between gaining or giving approval versus love. Finally, we looked at what more pain does for drug users: encourages them to use more, not less. So, let’s pick up the conversation here, starting with more on harsh confrontation.

You may have questions by now and I’m going to try to guess what some of them are and provide answers here. 1) Is tough love the same as harsh confrontation? The answer is yes! 2) I thought treatment is supposed to break through the denial of a person addicted to substances? The answer is no, that’s actually more likely to harm clients especially those with other underlying mental illnesses including trauma. 3) Don’t people who use drugs problematically need to be shown what a mess their lives are and how they’ve hurt others, such as their families? Again, the answer is no, they’re fully aware already and are usually extremely ashamed of their lives and behaviors even though families may not see this.

By the way, these are all reasonable questions to ask. Let me suggest, as many experts in the field do, that we look at how we treat other chronic medical conditions. Let’s take diabetes for example: when one has diabetes and is reliant on medication, do we complain that they are “addicted” to insulin? Of course not. We’re happy that there is a medication that can help them live a more full and healthy life. But with medication-assisted treatments (MAT) we hear negative comments (Narcotics Anonymous (NA) has made their views clear in their official pamphlet on MAT) such as how folks are just trading one drug for another; that they aren’t really “clean”. Here in California, our Department of Health Care Services has informed treatment providers that they expect us not to ask clients to engage in activities that we wouldn’t ask of those with other chronic health conditions such as diabetes. So, for instance, would we ask someone with diabetes to list their character defects that may have led to their illness? Of course not. Would we ask them to hold hands in prayer around a circle? No again (while any individual may find this helpful, we wouldn’t consider this professional treatment). We certainly wouldn’t put a toilet seat around their necks and tell loved ones to throw them out of the house for eating less healthy foods! But these are all deemed reasonable treatment approaches to addiction to many in our profession even today. (This calls for a lengthier discussion on addiction that I’ll do in another installment)

As I often do, I got out the dictionary to view some definitions of these 2 words as I prepared to write. Using the online version of Merriam-Webster’s (M-W) dictionary, I found “tough” means durable, strong, resilient, sturdy, rugged, solid, stout (I couldn’t resist!), long-lasting, heavy-duty, industrial-strength, well built, made to last. And what of love? “Love” is defined by M-W as “unselfish, loyal and benevolent; concern for the good of another.” Love is further defined as “an assurance of affection.” An assurance of affection. Wow. In my experience with “tough love”, there was absolutely none of that. In fact, withholding affection/love is at the crux of “tough love.”

So if these 2 words are polar opposites, how did they come to occupy the same space in our heads and in our common lexicon? As stated previously,    the phrase “tough love” was originally used by therapeutic community programs such as the former Walden House in San Francisco and DayTop Village and Phoenix House in NYC and continues to be used frequently today (just Google it to see for yourself). Using this concept of tough love, parents were encouraged to check their troubled teens into wilderness camps and behavior modification programs to deal with their kids increasingly frustrating and sometimes dangerous behaviors. And parents absolutely mean/t well; they were at a loss as to how to control their “out of control” teens. Plus they were listening to the so-called experts tell them, “you have to stop coddling your kids; you need to get tough with them – show them who’s boss.”

My own parents tried to do this with me when I was 15 or 16 (It backfired. I filed for legal emancipation and won. However, my relationship with my parents and siblings was forever damaged, as was I). It would seem that the concept of tough love is really about control. And when did control become synonymous with loving?

“Tough love” is also often associated with criminal activity or with children. In other words, if you’re a person who uses drugs problematically – or a criminal or a child – our society says using tough love is acceptable. The thinking is that in any of these three instances the person you’re using “tough love” with is incapable of learning any other way; their behavior must be controlled for their own good. In fact, the definition according to an old book we used to use in addiction treatment and studies called “Addictionary” (by Judy and Jan Wilson, 1992; Hazelden) “tough love is a phrase that describes behavior to stop enabling addiction. When you refuse to cover up for an addict, to rescue them, or to prevent them from experiencing consequences of their addiction, that is tough love. It is loving of the person but tough on the disease.” But is this true? And is this the most effective treatment modality? Perhaps the best question is who does the concept of tough love harm? I’d argue that tough love harms everyone involved – and that often once used, it damages relationships beyond repair.

But it works sometimes, right? I guess that depends on your definition of “works.” Can you get your loved one to behave or not behave in a way that’s acceptable to you? Probably, with enough threatening and coercion. But again, that’s not love. And it usually isn’t helpful for those of us diagnosed with a mental illness or substance use disorder (or chronic pain condition). In fact, Johann Hari, in his book “Lost Connections” argues that disconnecting from loved ones (as parents and partners are often told to do) who are “misbehaving” is typically the worst thing a parent or partner can do; losing connections to love – friendships, enjoyable activities such as sports, pets, and more — is often the exact scenario that is ripe for addictive behavior and other mental illnesses to thrive in, to fill the void left by the withholding of love and affectional bonds. I know I can definitely relate to this.

Now let’s be clear here: I’m not saying that limit setting is unnecessary. Of course, it’s necessary. Limit setting is part of being a responsible parent and, sometimes, a loving partner. But the most important piece is that when you set limits with someone, you do so with unconditional love and appreciation for the other person.

You listen to their ideas, negotiate, and you have this conversation–this is crucial–when you’re not emotional. Once again, the time for limit setting is BEFORE the undesired behavior occurs, not afterwards (when limit setting is done after the behavior occurs, it’s called ‘punishment’). There are exceptions, which again each family must work out for themselves (this is the work of family or couples treatment/therapy). Bottom line, when dealing with the problematic drug-use of a loved one, yelling, screaming, throwing out their alcohol or other drugs, etc, isn’t helpful to anyone.   And it certainly isn’t loving behavior.

Now let’s be clear here: I’m not saying that limit setting is unnecessary. Of course, it’s necessary. Limit setting is part of being a responsible parent and, sometimes, a loving partner. But the most important piece is that when you set limits with someone, you do so with unconditional love and appreciation for the other person.

OK so what about the idea that “addicts” must be shown what a mess their lives are and take responsibility? Well, I can tell you that I was aware every moment that my life was a mess when I had a substance use disorder as we now term the condition. There was no need to show me how bad things were. In fact, whenever I got a glimpse of the mess that was my life, I wound up using more to cover the pain and the shame. This is a typical response we see in many problem drug users. Lastly, let’s look at how tough love confronts personal responsibility. The tough love that my family of origin gave me did two things: 1) made me more ashamed and reluctant to try to change (if it’s my fault and I’m such a fuck up, why bother trying to change?); and 2) ruined any chance of a healthy family system because my family couldn’t look at what they may have contributed to my life of addiction (no I don’t blame them). Most of the “mess” or “unmanageability” as 12-Step would describe it, are problem behaviors of illicit drug users due to the illegality of most drugs of misuse. When drugs are illegal, drug users must go to places to get drugs where they are likely to be put in danger, risking rape and other physical harms, as well as jeopardizing their freedom by being caught by police with the results often being arrest/jail/prison, especially if you happen to be black or brown. Plus, drug users tend to use more in these circumstances than they would in safer locations, and they overdose more often. More on this in future segments.

So here we are at the end of this discussion on “tough love”. And I hope I’ve shown that tough love doesn’t look much like love at all. Instead the concept appears to be all “tough” with “control” at its core. Think of it this way: with positive reinforcement (think B.F. Skinner and others), I reward you for positive behavior (coming home on time) by giving you something you want (perhaps an extended curfew on one night) and set limits regarding less positive behaviors (think staying out after curfew) but I do this BEFORE you are late. And I do this when I’m not emotionally raw. If I wait and give you “consequences” for your undesired behavior, then I’ve punished you. That does not lead to positive behavior change. It leads to controlling with fear. Also, too often we fail to couple “consequences” with any kind of reward for the positive behavior. And when that consequence is withholding love and affection, well, can you see where this could lead to increased drug use? Not what anyone wants. But now we’re “woke” and can see while it isn’t what I wanted, it is expected. This denial of love and affection leads more people to have a (another?) traumatic experience and we know trauma and addiction – and other mental illnesses – tend to feed off each other. I am sure that this is not the outcome that any parent – or partner or loved one – wants for their child/partner/loved one.

So what have I learned – and what do I hope I’ve shared with you all here on this topic of “tough love?” Here are my Top Four “Take Aways” from this discussion:

1) Perhaps the most important take away is this: I hope I’ve made the case that we as a culture need to stop treating the concept of “tough love” as something positive and healthy. I’m optimistic that I’ve shown how inaccurate and horribly damaging to individuals and families tough love actually is, too;

2) That the concept of tough love really means that this concept is tough on all of us: drug users and loved ones/families alike. Like my own unrepaired family of origin, I have seen so many that will never recover from this so called “treatment intervention/sign of love.” Nothing could be further from the truth;

3) That what we really need instead is a concept let’s call “love AND limits,” meaning there is no limit on our love – ever – and (not “but”) we human beings have limits, too: on our time, our resources, our finances, and more. That’s called life and should always be negotiable and honest.

4) We can no longer afford to use a tired, inaccurate, corrosive concept such as “tough love” to (hang in here with me ok?) “excuse” us from the task having difficult conversations about hard topics with people that we love, what I’m calling “Compassionate Conversations.” What do I mean by this? I mean we must begin the work of having conversations that are about deep, profound, empathetic listening to one another, conversations that seek to really understand.

Today it seems that the conversations we typically have with loved ones – especially with drug users – are ones with agendas to get them to stop using. So, what’s the worst that could happen if we could truly let go of our old agendas and just listened? And just for the record, I’m not suggesting that we should agree with how our loved ones view something or how they behave right now, but rather I’m suggesting that our conversational goals change from getting-them-to-do-something-I/we-want to one of astonishing appreciation: of their views, their perspectives, their reasons for using/behaving in less than healthy ways. Let us decide that gaining compassion will be our attending agendas in these conversations.

Our world today is filled with rhetoric (with few real conversations) that is siloed and dishonest, cut off from reality, and full of prejudgments and predetermined agendas. Sadly, when we act from these values, we do so from fear–fear of losing power, fear of not being accepted, fear of losing our place in the world, fear of losing our loved ones to drug use and more. But when we push forward incorporating these fears rather than fighting them and force ourselves to see what is and become “woke” as the modern vernacular states, we have opportunities galore to change our relationships to ourselves, to our loved ones, and to the world. We learn how to say things like, “I love you more than anything AND I’m uncomfortable/unhappy/it’s difficult being around you when you’re loaded/high/under the influence. But when you’ve come down/sobered up/are able to moderate, let’s have lunch/dinner/go to that movie we’ve talked about.” Or how about, “I really love spending time with you when you’re emotionally available to me/us/the family/yourself.” I realize these “compassionate conversations” aren’t dramatic so they won’t make for good “reality” television, however they do make for good, healthy, strong relationships in real life. Plus research shows us these types of conversations are also more likely to help encourage positive changes toward healthier behaviors for everyone.

So, let’s tip “tough love” into the collective trashcan and from our collective vocabulary. Instead let’s work towards an agenda/belief of “love and limits” through “compassionate conversations.” Frankly, after all the pain caused to us all from using “tough love”, just how much harder can this new way of being really be?

#stopthestigma #recoverywithoutabstinence

In honor of September being Recovery Month, don’t miss next month’s edition: Reinventing Recovery

 

“Love Has No Labels: The Rise and (hopeful) Fall of Tough Love in America?” — Part 1

 

Welcome to the second installment 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. To learn more about how your family can join our growing community of enlightened friends and advocates sign up here now

tyler-nix-525388-unsplash
(photo by Tyler Nix @unsplash)

Hello again!

Before we get into the meat of this topic, I need to say a couple of things: First, I apologize for not finding a way to present this in my usual more light-hearted way. This just seemed too serious of a topic for that. I just finished reading Maia Szalavitz’ 2006 book Help at Any Cost which deeply disturbed me. Although I was certainly aware in a general way about a lot of the material about teen “treatment” programs, I was both obsessive to finish the book (reading until 2AM) and distressed that these programs are still around. Here in the Bay Area, our local newspaper, The San Francisco Chronicle just did an expose on teen “leadership” schools. As a result of the excellent journalistic work, many supporters and contributors to these programs have now removed their support, both financial and verbal. But there are some who insist these programs are meaningful.

This is also true in Ms. Szalavitz’ book. I’ve seen this in my classrooms over the years of teaching folks to become certified alcohol and other drug counselors. Many of my former students came from Synanon-influenced programs (often ones they attended as clients and then became workers, which I did, too) such as the former Walden House and Delancey Street (which is the only true therapeutic community (TC) left as they do not employ any professionals, the definition of a TC) and some have insisted that they were helped by such “tough love.”

I had the opportunity to ask the world-renowned researcher, Emeritus Professor William R. Miller (author/developer of Motivational Interviewing (MI) about this once. “is it possible that these folks were actually helped by these abusive tactics?” He responded, “I believe that these are people that are so motivated to make a change in their lives that you could have put them anywhere and they would’ve found a way to get better. So, their lives improved not because of the treatment they received but in spite of it.” That response has stuck in my mind and did so while writing this blog installment.

Finally, I was allowed to view the new film Fix My Kid, a documentary on the organization Straight, Inc, a popular behavior modification program for teens from the 1970’s (it was closed in the 1990’s but really just redesigned and opened under new names).  I can’t begin to tell you how upset I became watching this.  Some of this is certainly due to my own experiences with “tough love” but as a human being, I don’t see how anyone could view this without teetering between anger, outrage, and incredible sadness.  I highly recommend a viewing when it becomes available – but be prepared.

And two more blog housekeeping things:  1) As this topic is both so important and large, I’m doing two installments this time.  Today we present Part 1, covering some of the basics of “tough love” and approximately one month later you can expect to see Part 2, which will go into more detail especially as to how the culture came to embrace this concept.  Please let me know at info@fsdp.org what you think about this two-part format.  2) Since September is National Recovery Month, I’ll be doing an installment on the word “recovery” then which I promise will not be your typical take on the word!

And so…here we go again!

“Love means never having to say you’re sorry.” If you remember that phrase, you were around in 1970 when the film, Love Story, came out (starring Ali MacGraw and Ryan O’Neal) and this phrase about love was the tagline in the studio’s advertising that, using today’s language, went viral. Even then I wasn’t very fond of the phrase. To me, love was quite the opposite: it meant I could make mistakes and saying you’re sorry was part of the healing process – and love would always still be there; it was a given; it had no limits – even if I do. We’ll return to setting limits later.

I’ve been reading a lot of things about love/tough love/etc, preparing for this blog. In a piece from the HuffPost from 2012, writer Sheryl Paul states that if there are conditions on love, then it’s not love but approval – either trying to get it or give it. I hadn’t thought of it in quite that way but she’s absolutely right. And love is NOT the same as approval. In fact, the challenge of love is to love. Full stop. Anything else is based on approval and doesn’t feel like love to the person on the receiving end – because it’s not. Real love isn’t conditional.

A popular phrase in 12-Step/AlaAnon is “you have to let them hit bottom.” We are told as family members that this is “letting go with love.”  However, what if “their bottom” is death? Or jail/prison? Or something else traumatic? How is letting someone “hit their bottom” showing love and not simply trying to control or give approval for “doing the right thing” and not “enabling”? And what evidence do we really have that hitting bottom works? None, save some individual stories of such (side note: I just googled the phrase “hitting bottom” and found a disturbing number of articles and treatment centers advocating this approach). Back to Dr. William Miller: MI has shown us, as has CRAFT (Community Reinforcement Approach and Family Training; developed by Dr. Robert Meyers), that standing by and letting a problem drug user get to the absolute worst place they can does little to actually help them seek treatment/change. In fact, it typically makes things worse (the late Dr. G. Alan Marlatt showed this in several studies and discusses this in his seminal books, Harm Reduction and Relapse Prevention).

Anecdotally, when I was in more pain (of all kinds) and things got even worse, that made drug use even more attractive, no matter the negative consequences. And this is typical. This doesn’t mean family shouldn’t allow for some natural consequences. What those are and how one decides when enough is enough must be decided by each individual family and needs to be discussed with the problem drug user beforehand so there are no surprises

So, where did we get this idea of “tough love” especially if it’s harmful? And why is it still such a popular approach? Although tough love is a concept used on adults as well as teens, according to Szalavitz’ book, Help at Any Cost, the phrase “tough love” was first coined by Bill Milliken in his book of the same name in 1968 that discussed parenting approaches. There is also another book of nearly the same name, ToughLove by Phyllis and David York from 1985. Either way, the phrase started out as a term for parents to describe interventions to be used as their teenagers began to act out – perhaps using/misusing alcohol and other drugs – and engage in other less-healthy/desirable behaviors. Unfortunately, typical adolescent separation/developmental behaviors became pathologized (still often are….more on that perhaps at another time). Before the phrase “tough love” caught on in parenting circles, the concept was used here in California by a group long gone but whose long reach can still be felt in drug treatment facilities here and across the country: Synanon.

Synanon was a California institution. It was founded in 1958 in the then sleepy beach town of Santa Monica, by Charles (Chuck) Dederich. According to journalist Matt Novack, Synanon “was one of most dangerous and violent cults America had ever seen…” I have seen the outcomes of Synanon up close and personal through my work in treatment facilities, many founded by former Synanon members. Several ideas of these persuasive and talented people were sensible. Sadly, though I believe all meant well, many of their ideas were still too infused with the highly confrontational concepts of Synanon. Having worked and been trained in some of these treatment centers, I am saddened to know that while I helped many people in the dozen or so years I worked in this confrontational style, I am aware that I harmed many others. But Synanon was more than highly confrontational. It was far worse and caused far greater harm.

Synanon was the developer of something they called “The Game.”

“They played the “game” in which anyone was allowed to say anything, true or not, to someone to cause an effect. Only the threat of violence was prohibited. It was a game because one being gamed could turn the game on another.

Addicts’ behaviors and past lives were attacked viciously in games, members were told their lives depended on staying, contacts with family were prohibited, and a system of rewards and punishments was applied. Publicly one was berated ({given a] “haircut”) for misdeeds…Dederich and Yablonsky acknowledged that the system was brainwashing…”

And brainwashing was what Synanon leaders believed drug users needed. According to Paul Morantz (an attorney Dederich attempted to murder for suing Synanon) is credited with coining the phrase “Today is the First Day of the Rest of Your Life.” He also “preached “Act as If” which meant do not try to reason as to what Synanon asks they do; as thinking got them there, just trust what they were told and act as if it is right.” Alcoholic Anonymous (AA) uses similar slogans today. In fact, Dederich was a longtime AA member and popular speaker before his transformation to cult leader (Dederich later became mentally unraveled, extremely paranoid, and preached of a new religion he called Synanon III.

Synanon was heralded as a drug addict-saving program and even had the blessings of Governor Edmund “Pat” Brown, who exempted them from health licensing laws. They also started seeing monetary gains as Hollywood superstars such as Robert Wagner, Leonard Nimoy, and Ben Gazzara came to play “the game.” Life magazine did a 14 page in-depth article in which they quoted a Congressman calling Synanon the “Miracle on the Beach.” Columbia Pictures even made a film on it. By the mid-1960’s, Synanon was known as a alternative community which attracted its members through a focus on living a “self-examined life” using “the Game” to uncover hidden truths in group sessions. Even non-drug using professionals were invited to join as long as they “gifted” their assets. Like other cults, Synanon worked by controlling its members. In Synanon the main source of control was by use of “the ‘Synanon Game.’ The “Game” could be considered a therapeutic tool, likened to group therapy; or a social control, in which members humiliated one another and encouraged the exposure of one’s innermost weaknesses, or both.” This was truly tough love at its “finest.”

Today we may not see toilet seats around clients’ necks (I heard reputable reports that this was done in some drug treatment facilities up to the late 1990’s, to demonstrate that a client had behaved like a ‘piece of shit’) but we certainly continue to have the ethos of stigma, shaming, and harsh confrontation we inherited from Synanon. The threads of Synanon are woven throughout drug treatment programs everywhere in the US (and further in a few cases) today.

PART 2 “Love Has No Labels: The Rise and (hopeful) Fall of Tough Love in America?” coming August 2018

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IMG_6574Dee-Dee has worked in the addictions/mental health worlds for more than 30 years and continues to maintain a busy clinical practice where she works with a variety of clients whose behavioral goals include abstinence, moderation, and “anything they want and in any way they want” to achieve their goals. Her book, Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World is widely available and has received positive reviews.

 

 

“Family Matters – Families Matter”: FSDP’s New Blog by Dee-Dee Stout

IMG_6574FSDP is excited to introduce the premiere of Families Matter – Family Matters, our new blog authored and curated by FSDP’s Guest Bloggerpioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout. We are indeed privileged to have Dee-Dee on Team FSDP, sharing her wisdom, charm and storytelling ability with us….

To learn more about how your family can join our growing community of enlightened friends and advocates sign up here now

Treat people as if they are who they can be and you help them become who they’re capable of being —- Goethe

Hello! And welcome to the premiere of FSDP’s blog Families Matter – Family Matters!

I will be talking with you about everything and anything having to do with alcohol and other drug use: family concerns including treatment, policy, advocacy, and whatever else you all might want to know/talk more about. I hope you will send me questions, topic ideas, comments, thoughts and more anytime. Please send your requests to info@fsdp.org

And now to the blog….

It was suggested that I might use this premier “episode” to talk more about who I am in relation to addictions/mental health, harm reduction, and advocacy. For this episode I decided to focus on “advocacy”: what it is and how I got started. (I’ll save how I’ve changed as a result of learning to be a better advocate for later – especially regarding how I now work with folks including families).

So, as the line goes: “Fasten your seat belts; it’s going to be a bumpy night!”download

Worms. Yes, those creepy crawly things some of you might use to improve the soil in your gardens or perhaps on a fish hook. Worms were my first lesson in advocacy and it come from my wonderfully crazy father. What do worms have to do with advocacy, you ask? Well, let me start at the beginning…

When I was about 3, I decided for some reason that I hated worms. I don’t mean kinda- didn’t-like-them, or say “eeuuwww – worms!” whenever I would see them. I mean all-out-I’m-declaring-a-war-on-them HATE. I would go around our neighborhood squishing them all spring whenever I saw one – and that was pretty often in the Midwest in springtime. At this point, my folks and I were living in Ann Arbor, Michigan, where my folks were in school at the University of Michigan and my dad was studying science. He saw me stepping on worms one day and didn’t think that was a ‘positive behavior’ (he knew worms were helpful). So, he got the brilliant idea that if he taught me about how special worms were – their scientific value if you will – I wouldn’t want to kill them anymore. Sounds logical, right?

So, he set up all kinds of fascinating scientific experiments on worms: he put them in darkness to show me how they didn’t need light to move around well; he put vinegar on them and watched them recoil from that ingredient; he cut them in half to show how they could still survive. Finally, he tried putting salt on them which they didn’t seem to like. These experiments went on for a week! At the end of the week, I distinctly remember my father asking me, “so Adelia, don’t you feel bad for killing these wonderful creatures now?” To which I naturally replied, as any 3-year-old would, “well I still don’t like them but I guess I won’t kill them anymore.” Vindication was his – and I had learned my first lesson in advocacy – or how to stand up for a being without a voice!

Now if you knew my dad you’d know that this lesson in “advocacy/knowledge is important” idea isn’t at all strange for him. For instance, my dad always had binoculars, a copy of Peterson’s Guide to Birds, and trash bags in the car. These items were as important and as ubiquitous as the gum he always kept in the ashtrays. Whenever we were driving with him, we would practice “spotting” birds, stopping to view them through those binoculars to then find their photo in the Peterson’s guide. We would also stop periodically to pick up trash: not ours as we had a small trashcan in the car, but just litter: on the side of the road, caught in trees, at roadside picnic areas – everywhere (side note: at 81 he’s still picking up trash now in downtown Chicago!).

Now you might be asking, what in the world do these stories have to do with advocacy? Well, I believe they’re all connected if we look at the origin of the word. According to dictionary.com, advocacy stems from the Latin “advocare” which means “to add a voice.” Another site, vocabulary.com states the origin is the word “advocatus” which means “one called to aid another.” So, advocacy of the Earth, of our planet’s creatures – great and small – and our responsibility as stewards of them – such as keeping their home free of trash – is advocacy: we are giving voice to and aiding those who need us to do so.

I don’t think I ever realized just how long I’ve been an advocate of one sort or another until recently. And that the early lessons I got especially from my dad has led me down this path of demanding we hear the voices of those that struggle to speak – and just how these experiences have shaped my life, especially now.

My most powerful and personal lesson of advocacy – namely championing a cause – came when a bit later, when I was about 8 or 9 years old. I have always had an extremely close and empathetic bond with animals of all kinds: for one, they don’t judge and they love us unconditionally. As a kid, I grew up with cats (two Siamese, to be exact) though later I added a dog or 2 to the mix that always included a couple of cats at least. But I also felt a closeness to all animals and enjoyed studying about them. After my folks graduated University, my dad took a job as a traveling salesman for a hospital and clinic supply company (he would remain there for 25 years and not leave until after my mother died). His territory was the entire state of Michigan which included both the Upper (or the “UP”) and Lower Peninsulas. Sometimes I had the opportunity to travel with him which I loved.

On one of these trips, I became aware of something called “roadside zoos” which most gas stations seemed to have then. These so-called “zoos” were actually cages (usually quite small) holding all sorts of animals indigenous to Michigan: bears, beavers, otters, raccoons, and more. Often the gas station would have a large stuffed black bear out front signaling that they had one of these “roadside zoos.” The animals locked in these cages paced a lot – when they could move – and always seemed sad and scared. I cried every single time I saw one of these zoos. On one of these trips, I became so upset that I couldn’t be consoled. My dad told me I should write to my Congressmen and other politicians to complain about these zoos and inform them of the conditions these animals were in (my first lesson in Civics!) and so I did. I wrote to our State Senators, the Governor, and even the President of the United States. And I received letters back (one was even handwritten!). I was very impressed!

Later that year, the State’s Congressional body moved to outlaw these “roadside zoos” and of course my dad said my letters must have had an influence on this decision. I’m not so sure about that but it sure pleased me as a youngster to think it might have, and caused me to pass along this Civics lesson to my own son and others. It also added to my lessons in the importance of standing behind something you believe in: advocacy.

The final piece of my younger “lessons in advocacy” came from being raised in a rather unique church: The United Church of Christ in Midland, MI. The UCC as it’s known, is a church of social justice. We were taught by our beloved minister, Reverend Glenn Baumann, that God lives within each of us and that the only sin was alienating oneself from god (and therefore from others including oneself). We were taught to recycle early on (Michigan was the first state in the US to implement recycling. Anyone remember the Seinfeld episode on such?) as part of caring for the land and resources that were loaned to us while we lived here. This concept of caring included animals. It also included other animals, people, especially those who were marginalized such as drug users, including me.

In 1973, a psychologist by the name of Dr. Don Crowder moved to Midland and advocated for opening an overdose clinic. Of course, Midland’s City Council said we had no drug problem in our city (Midland, MI was then, and is today, the international home of the Dow Chemical Company: you know, Ziploc bags, Saran Wrap and Napalm bomb manufacturers). Dr. Crowder went ahead and opened his clinic which was also staffed by another young psychologist in practice with him – and the two of them trained many of us drug users to help those overdosing, generally in the form of “bad trips” from psychedelics in those days. As I left Midland in 1975, I’m not aware of what happened to the clinic. But again, it fit into my idea of civic duty, church life, and generally caring for others who needed us to go to bat for them, to “sustain the weight of” their burdens – in other words, to be advocates.

I don’t know what led any of you to advocate for sensible drug policies and drug users in general but I hope to hear some of your stories, now that you’ve heard mine. I am a firm believer in the power of stories (hence my book is full of them!) to shape and to influence culture – and of course people. And I see the beauty, as you all do, in what FSDP co-founders Barry Lessin and Carol Katz Beyer have created here at FSDP: loving those that may be (just now) unlovable, and moving away from the one-size-fits-all of treatment for problematic drug users and their families/communities.

It is these stories – sprinkled with science and humor – that I’ll be bringing to you all over the coming months. Thanks for hanging in with me for this premier episode!

Next month: Why “tough love” isn’t love at all but certainly TOUGH – and how we can do better to change this horrible yet ubiquitous phrase. Peace.

FSDP Testifies at the New York State Assembly Committee on Alcoholism And Drug Abuse

Thanks to our friends at VOCAL-NYFSDP was honored to be asked by New York State Assemblyperson Linda B. Rosenthal’s office to submit testimony to the NY State Assembly Standing Committee On Alcoholism And Drug Abuse on the adequacy of funding for prevention, treatment, and recovery services in New York State.
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Carol Katz Beyer and I had an opportunity to represent the voice of the family to share the family perspective acknowledging that on how to use funds to better ensure that life-saving harm reduction strategies and tools will get into the hands of families before problems develop and therefore be able to prevent many overdoses:

 

“The staggering number of people who are relapsing and dying is unacceptable despite having proven strategies to reduce mortality and improve care.  New York State has made it a priority to emphasize the need to address substance use disorder as a public health issue but we now must take the next steps to shift funding streams to enable universal access to proven life-saving public health tools such as medication-assisted treatment, naloxone, and harm reduction services.”

The full testimony can be found here.

Reflections on Stigma’s Insidiousness in the Addiction Treatment Community

A therapist colleague of mine who doesn’t work within a harm reduction framework has a nephew who is struggling with problematic substance use and she shared with me last week that she finds herself being more sympathetic to her clients than her nephew about their drug use.

fsdp-our-missionI had the same reaction as her when I was involved as a family member in my own family’s therapy experience when my nephew was working on his substance misuse issues. It was before I was a harm reduction therapist and my incongruent reaction to this opened my eyes to my own perceptions of my substance using clients and I realized just how pervasive the judgments about people using substances are in our culture.

fsdp-donateThe judgments were so ingrained for me, it took me several years to shed these stereotypes, but as family members we don’t have the luxury of time and such an opportunity for this awareness. These judgments are damaging to individuals and families in treatment–damage that makes healing that much more difficult. It reinforces, and sometimes adds to, the trauma that many people enter treatment wanting to address.I’ll be exploring the effects of stigma on our families in future posts and would love to include your reactions on how it has affected you and your relationhip with your loved one, and what have you done, or do, to adjust…

I’m curious about people’s reactions to this from the perspective of a family member, a person using substances, or a treatment provider?

Any suggestions for reducing the treatment-inducing stigma that can can be such a barrier to good care? Email me at barry@fsdp.org with your experiences and I’ll share them in future blog posts.

An FSDP Advocate Planting Seeds of Harm Reduction in the South

FSDP is proud of our team of advocates and we’re pleased to share the latest blog post from our  Community Outreach Advocate Janet Goree and how she is planting seeds of harm reduction in the Georgia state corrections system…

As Community Outreach Advocate for Families for Sensible Drug Policy,  I take every opportunity to embrace and share our mission of empowering families to increase access to effective substance use disorder treatment and reduce the harmful consequences of oppressive drug policies.

After my youngest child was sentenced to a very long prison sentence I looked for a support and advocacy group where I could make a difference, an organization that was doing work that I could believe in. I found FSDP and knew I was home, especially because of the focus on families.

One of my regular outreach activities is visiting the Mitchell County Correctional Institute, a medium/minimum security facility housing 135 state inmates as well as 24 county offenders. The facility sits just on the outskirts of the tiny town of Camilla Georgia where I live.  Every other month I arrive at the facility on a Friday morning to speak to a roomful of inmates whose release dates are in sight.

The facility is run by Warden Bill Terry and is an exception in Georgia because of the commitment of the warden and his programs manager Kim Hatcher. They want to make sure the men leaving their facility have as many tools possible to make sure they never return.

My background is in child abuse prevention, which I became involved in after the shaking death of my granddaughter Kimberlin. I became involved in prison reform after my son Bobby was sentenced to thirty years in prison for robbing a drugstore.

Janet G blogI have just started to introduce harm reduction into the presentation. The first part of my presentation to the inmates is about the stressors they will be facing when they get out and some ways they can cope with them. I do an exercise with them called ” match the crime to the time”. The two crimes are 1) shaking a six week old child causing her death, and 2) robbing a drugstore while being improperly withdrawn from methadone at the hands of a professional. No one was physically injured.

The two sentences are 1) five years probation and 2) thirty years mandatory minimum. While most on the outside not involved with theJanet G blog1he work we do would guess that the murder of the child would certainly be the more severe sentence, the guys on the inside all get it. You see there is no money in locking up murderers but hundreds of millions of dollars have been made behind the war on drugs. Both of these crimes and sentences have impacted my family as my son Bobby is the one serving thirty years.

Just before I leave I tell them about FSDP and assure them that there are people out working very hard to change things, people that care about them. I look each and every one of them in the eye and wish them luck. Then I quietly say a little prayer as I walk out the doors they are locked behind.

FSDP and Our Global Partners Bring a New Paradigm of Family Drug Support to the United States

Our heartfelt presence at The International Harm Reduction Conference #HR17 in May 2017 was a springboard for a dynamic and thought provoking weekend: A celebration of family empowerment that filled attendees with enthusiasm and hope, while offering enlightened strategies, tools, and opportunities for advocacy.

Day 1: Workshop on Peer-Led Family Support Model18664623_1720713967945235_3219150813966158127_n

The two-part weekend that followed was an expansion of our global partnership including Liz Evans and Mark Townsend (not pictured) of New York Harm Reduction Educators (NYHRE) and Washington Heights Corner Project which featured a workshop introducing Tony Trimingham’s Family Drug Support (FDS) model (in center at right with Barry Lessin and me) and an international panel discussing the life-saving value of Supervised Injecting Facilities (SIFs).

Our families have a vital role in the development and resolution of how substance use impacts their home—for far too long our families have not been afforded the opportunity to engage as active participants and problem-solvers. The weekend offered a new paradigm of support for families impacted by substance use.

18581706_10102491791666402_8890817018380267324_n-3The weekend events, highly lauded by a passionate gathering of family members and clinicians, were a milestone for FSDP, allowing us to offer our vision of tangible support for families, based on what families need, expect and experience. This model of support helps families better understand and strengthen the connection between ourselves and loved ones who use substances. The peer-led support groups present viable alternatives for families to explore potential solutions and coping strategies.

Day 2: International Panel about a Public Health Response Proven to Save Lives: Supervised Injection Sites (SIFs)

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We were delighted to have CNN political commentator Symone Sanders (at right, between Liz and Tony) emcee the gathering at the Malcom X and Dr. Betty Shabazz Memorial and Education Center in Harlem. It was a moving interactive presentation before a diverse and engaged audience. The featured presentations were delivered by harm reduction pioneers Tony and Liz, who poignantly shared their own personal stories reflecting the inspiration that led them to do their groundbreaking work that included establishing successful SIFS in Sydney and Vancouver, respectively.

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Evidence from years of research is conclusive that SIFs reduce HIV and hepatitis transmission risks, prevent overdose deaths, reduce public injections, reduce discarded syringes, and increase the number of people who enter drug treatment. Across the globe, there have been no reported fatalities from an overdose in an SIF.

Personal Relevance

My own personal journey as a parent and healthcare advocate was inspired by the compelling and relatable perspectives shared during the presentations, as I too am a mother who is devastated by the recent loss of my precious son and student of the world, Bryan.

Bryan’s life parallels many young lives who, despite a loving relationship with a beautiful new wife, a supportive family in his corner and an amazing circle of friends who believed that laughter was the best medicine, his valiant attempts with sustainable periods of time in and around “recovery” were ultimately circumvented by much of what does not work about a ‘one size fits all’ model. Far too many young lives are tragically being lost to an accidental and fatal overdose that is preventable!  

My own perspectives and belief system came full circle from the early days when our families were first indoctrinated to the mantra of the addiction professionals champing for ‘hitting bottom’ and ‘detaching with love’ as the remedy. Despite a decade-plus of extensive and ongoing attempts by my own family to embrace the recommendations of the traditional treatment industry, our personal situation continued to implode on a downward spiral of pricey interventions, therapeutic wilderness programs, and exorbitant rehabs that over promised and under delivered.

Myths like encouraging us to use the criminal justice system, or advising us that advocating for our child’s well-being essentially reduces us to ‘enablers’ and ‘codependents’, only exacerbated the family issues and compromised health rather than supported it. If only we had the opportunity to turn our focus to empowerment and safeguard our loved ones with viable medical models during those times that they were in active addiction. Many people with problematic substance use have little or no access to evidenced-based care, or simply were not ready or able to embrace a path that was limited to abstinence-based recovery.

Our families deserve person-centered screenings and alternative solutions that meet them where they are with the goal of optimal health and wellness based on individual needs and unique circumstance.

Stay tuned to learn about more of our upcoming events as our momentum moves forward towards the Fall, where we will be representing the voice of the family at the 2017 Drug Policy Alliance Reform Conference.

 

Representing the Voice of the Family at the 2017 International Harm Reduction Conference #HR17

C_DNaZxXgAAUhpMRepresenting our family voices in the global harm reduction community, FSDP Co-Founder Barry Lessin and I enthusiastically attended the 2017 International Harm Reduction Conference #HR17 in Montreal, Canada, May 14-17, 2017.

The theme of this year’s conference was ‘At the Heart of the Response’ and addressed “innovative harm reduction services, new or groundbreaking research, effective or successful advocacy campaigns and key policy discussions or debates. With delegates from more than 70 countries the programme not only reflects the truly global nature of our movement but also addresses key international issues”

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We had the opportunity to meet with our global partners Australian Family Drug Support (FDS) powerhouse Tony Trimingham (right) and Shaun Shelly (below) to identify the issues that are unique to families and bringing the family voice into our home communities. The inspirational and motivational moments were continued with a dynamic and thought provoking celebration of family empowerment that culminated in New York City May 20-21, 2017 with an extraordinary weekend filled with enlightenment and hope. Barry and I are energized and privileged to bring the FDS model of family support to our cherished friends here in the United States. We remain humbled and honored to serve our growing network of families who are asking for non judgmental alternatives to support optimal health and well being for their loved ones impacted by substance use while managing their own needs and self care in the process.

FSDP AC_9Zk_UUwAAB1qWdvisory Board member Shaun Shelly (whom we got to meet in person for the first time!) explaining the challenges and successes in his groundbreaking work in harm reduction service delivery to his native South Africa.

One of the highlights of #HR17 for many of the attendees was the dynamic presentation given by Andrew Tatarsky (right) on “The Scientific Revolution of Addiction Treatment”, exploring how his model os Integrative Harm Reduction Psychotherapy 18558570_1716762775007021_2210259828598535816_o(IHRP) can enhance harm reduction services and make addiction/substance misuse treatment relevant to the majority of problematic drug users who have been turned off or hurt by traditional abstinence-only treatment.

18527769_1714581398558492_4107739766811187219_nPausing to honor the dedication and commitment of our global partners, appreciating the connection and spirit of compassion shared among cherished friends like Zeeshan Ayyaz Shani, who sadly could not attend because of visa related obstacles. Paying tribute to his courageous advocacy and extraordinary efforts on behalf of drug users in Pakistan through his exemplary work with Middle East and North Africa Harm Reduction Association (MENAHRA).

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Barry and Tony discussed the new collaboration of Tony’s Family Drug Support model of family support and FDSP’s commitment to bring strategies and solutions into the homes of our families!. Below, Tony joins me, Deborah Peterson Small, who spoke at a morning plenary on the global priorities of drug policy, and Ernie Drucker, valued mentor to FSDP and author of “A Plague of Prisons”. 
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Stay tuned for more about FSDP’s next steps in our collaboration with Tony’s Family Drug Support to empower families, restore health and save lives…

FSDP to Address Aspiring Medical Professionals in Philadelphia, PA

14731154_10154153120499195_2687285408442853763_n - Version 2Families for Sensible Drug Policy (FSDP) Co-Founder Barry Lessin and FSDP members Brooke Feldman and Kenneth Anderson will be on a panel to discuss “The Culture and Misperceptions of Addiction” with medical students at the Philadelphia College of Osteopathic Medicine on Thursday, January 5, 2017, 5:30 to 7:30pm this Thursday.   This is an amazing opportunity to reach healthcare providers at the beginning of their careers with a message about harm reduction and compassionate, evidence-based care for substance use problems.  

Said Barry, “I spent most of my career as an abstinence-only, one-size-fits-all psychologist until I became aware of the War on Drugs five years ago and began viewing drug use and people who use them through a human rights and public health lens. I realize now that using this model was doing more harm than good by reinforcing stigma and shame by blaming my clients for the lack of success in treatment. I now embrace a harm reduction, client-centric approach and feel it’s important to share my harm reduction knowledge and experience with people who will have an important impact in providing care.”

Brooke Feldman, an outspoken recovery advocate and Huffington Post columnist [link], as well as FSDP member, said, “It is imperative that all medical professionals understand substance use and its related impact on whole health and wellness.  Only through truly understanding the delicate interplay between mental and physical health, including alcohol and other drug use, medical professionals can be best positioned to practice the holistic, integrated care that is the future of quality healthcare in this country.”

Kenneth Anderson, Executive Director and Founder of Harm Reduction, Abstinence and Moderation Support (HAMS) and long time FSDP member, broke down the myths and facts he plans to address at the session:

Myths and facts about substance use disorders

Myth: Everyone with an addiction dies from it unless they get addiction treatment.

Fact: 90% of people with alcohol dependence recover whether they get treatment or not. For drug dependence the rates are even higher; 98-99%.

Myth: Lifetime abstinence from all mood altering substances except caffeine and nicotine is necessary for recovery from addiction. 

Fact: Half of all people with alcohol dependence recover via controlled drinking. Marijuana is frequently an exit drug from more harmful substances.

Myth: Addiction treatment is effective.

Fact: Most treatment centers do not use evidence based treatment even if they claim to do so for the sake of collecting insurance payments. The odds of dying of heroin overdose after graduating from a 28 day inpatient program are 3,000% higher than if one continues to use heroin with no treatment.

Myth: Patients must be confronted and forced against their will into AA because they are in denial and only the 12 step program is effective.

Fact: The more people are confronted the more they will drink. Actually listening to what the client wants is the most effective approach here as it is everywhere else. Although some people benefit from the AA fellowship, others, including myself, are greatly harmed by it. I nearly drank myself to death before I left AA.

FSDP continues to be the voice of families affected by the cruel and ineffective drug war, everywhere from the meetings where policy is made to the institutions where new healthcare professionals are trained.  Stay tuned for an update after the event!  

 

FSDP at the Southern Opioid Epidemic Symposium

FSDP’s Co-Founders Barry Lessin and Carol Katz Beyer, and our Harm Reduction Coordinator Jeremy Galloway represented us at the Southern Opioid Epidemic Symposium held at Emory University’s Rollins School of Public Health this past week.

The symposium convened academic, medical, research, policy, and government stakeholders to identify and develop strategies to advance a comprehensive response to the opioid epidemic in the South and beyond.

Barry Lessin was invited to speak, and here’s the text of of his talk “The Significance of the Family in Developing Harm Reduction Strategies and Practices in the Southeast and Beyond:

15541250_1393299694023257_4760824146094682188_n“I’m an aging hippie from the VietNam war protest days when I came of age, during the drugs, sex, and rock and roll era and as a result developed an ingrained distrust of the federal government.

When FSDP was invited to join the Southern Collaborative on Opioid Harm Reduction , my initial thought was ‘Oh my God, I’m going to meet with the government to talk about drug use. I hope they don’t ask me too many questions about my past’. My worry and disbelief quickly dissolved when we got to the meeting and saw how serious the government is about attacking the opioid problem with comprehensive harm reduction …

We’re again a very divided nation, even more so in some ways, but I have optimism because of our ability to convene forums like this to tap into the brilliant minds gathered here to identify life-saving solutions to this public health epidemic.

So being here is an exciting and encouraging moment for myself, co-founder Carol Beyer, Jeremy Galloway and the 1000s of families and diverse stakeholders we represent because it’s an opportunity to be a part of process of an ongoing collaboration with this esteemed community to address the needs of the millions of families who have suffered the direct consequences and collateral damage of substance use and the existing harmful drug policies.

FSDP is a global coalition of families, professionals, organizations and drug policy reform advocates who view substance use through a human rights and public health lens. Viewed this way, Harm reduction interventions, are a natural fit for managing substance use, but have rarely found their way into family settings.

We have listened to our families, parents and users alike, sharing their lived experiences of being harmed by a broken treatment system that uses ineffective, often unregulated treatment methods, that treat people more like commodities to fill beds than patients being provided effective care.

When people relapse with other complex problems similar to addiction that require lifestyle changes like cancer, heart disease, and diabetes, we don’t blame the person for treatment failures, we don’t tell them they’re in denial, or they ‘need to ready’ or they must ‘hit bottom, we don’t throw them in jail, or kick them out of schools.

With other conditions, we respond with scientific, commonsense, and compassionate approaches and we look at the treatment methods that are failing them and do more research to provide better treatments.

Families are in a unique position to directly influence the development or resolution of substance use problems because substance use doesn’t take place in a vacuum but in the normal context of family life and relationships as well as the wider culture that the family resides in.

We know that problematic substance use is a complex interaction of psychological, biological and socio-cultural variables. Prohibition-based drug policies directly contribute to a cultural narrative that views the substance as the primary problem, ignoring the uniqueness of each family, the culture it exists in, as well as the family’s strengths and resources.

We don’t have to reinvent the wheel–harm reduction approaches are already in place for other conditions. We can use this knowledge to extend these benefits to implement family-friendly strategies and practices in combatting the opioid problem.

FSDP bring diverse communities together to embrace enlightened drug policies—empowering families, restoring health, saving lives. We are dedicated to identify a vision and approach that will provide solutions and pathways forward…

Our meeting here offers us an opportunity for us to engage with the communities brought together here who share the public health lens of substance use, to be catalysts for change by tapping into your knowledge as scientists, educators, and healthcare providers to eventually develop the necessary strategies and practices and the hands-on tools to offer our families to restore our health to the level we deserve.”