Families Matter/Family Matters November 2020 Dee-Dee Stout, MA

Dr.: We all had to stop pretending we were fine [first].
Capt.: We are not, are we?
Dr.: How could we be? But we’ll get there.
—from Star Trek Discovery (11/2020)

Grief.  Sigh.  Sometimes I think the only things that have connected us in the past four years – but especially this year – have been anger and grief.  Anger at the opioid poisoning deaths of especially young people; anger at the fires raging due in part to climate change and also due to human policies; anger at police; anger at immigrants; anger at the “Other Party” and so on.  And grief at the incredible fear and divisiveness that most of us here in the US just aren’t used to, frankly.  It’s been a real challenge to navigate these “Waters from Hell” for many of us, especially those of us who are deeply sensitive to such strong emotions eliciting behavior(s) that scares us.  However, have the experiences of this year (and perhaps more) pushed us closer too?  Possibly.  Many of us have found new ways of connecting to each other (hello FaceTime and Zoom!) which has been crucial in our personal grief processes and allowed us to begin to heal in some slow small ways.  That healing will not be pretty, but it will be.

“Without the valleys, there can be no mountains.”
— Uncle Pete c. 1990

Evergreen forest, mountains, sky with clouds

Sigmund Freud first talked about grief as “mourning [that] comes to a decisive end when the subject severs its emotional attachment to the lost one and reinvests the free libido in a new object.”1 However, after the loss of his beloved daughter, Sophie, to the Spanish Flu, he changed his views which can be heard in this excerpt from a letter to Ludwig Binswanger, one of her best friends and colleagues:

“We know that the acute pain we feel after a loss will continue; it will also remain inconsolable and we will never find a replacement. No matter what happens, no matter what we do, the pain is always there. And that’s the way it should be. It’s the only way to perpetuate a love we don’t want to give up.2 (emphasis mine)

I admit that I never thought of prolonged grief in quite that way. Well, not until recently. I have a client who went through the breakup of an important relationship in his life and has been struggling with his pain. One of the things we recently discussed was this idea that to NOT be grieving – strongly, painfully – would have to mean the relationship wasn’t particularly important. And that was certainly not the case for him. Which led our conversation to ask a couple of existential-type questions: “What life can come from death? What good can come from the painful?” I think we’re collectively – as well as individually – forced to consider these questions now.

So what is grief and are there really five stages to getting though it? First of all, grief comes in different forms and in different ways for each person. The celebrated psychiatrist, Dr. Elisabeth Kubler-Ross, whose work with terminally ill patients led her to conceive her now-famous five stages of grief (denial, anger, bargaining, depression, and acceptance)3 never meant for these stages to be boxes and certainly not for all people – or even any single person. Her point was that most of us go through some process (the five stages) that may include all of these stages or only one. Bottom line: grief is a process. Borrowing from an article by David B. Feldman, PhD, in Psychology Today,4 I would agree with his suggestion that three general principles hold true about grief. And we can see these in our sometimes inconsolable sadness from the loss of an election to the loss of a job/career to the death of a family member, and more: 1) denial is natural; 2) faith can be lost or shaken; 3) acceptance usually comes – though perhaps more slowly than we’d like or expected. Ironically the loss of an addiction can also bring on grief as it is typically an important relationship in the life of a problematic drug user even if also destructive. Acknowledging both the grief and the meaning of the relationship can be hard for the drug user, as well as other family/friends, to admit.

Another side of grief can be positive, even encouraging. Grief can inspire us to make positive changes in our lives. It can also instill faith, some hope of the promise of change on the horizon. We must believe that things will get better ultimately or there’s little reason to try to change. And therein lies the rub, to misquote Shakespeare!New York Times newspaper with Joseph Biden on the cover

So where are we today, November 9, 2020? We have awoken to a new President/Vice President-elect (most agree on this but not all). Things may change quite a bit come January 20, 2021 – or not. We’ll have to wait and see. That’s the hard part with change: the waiting. An old friend of my son’s (and me) is a popular actor (Jesse and I met her when they were both young teens in Hollywood). She posted something yesterday on social media about how pleased she was to be able to share with her young daughters that a woman was just elected to one of the highest offices in our country; that they too could become Vice President – or President – or anything else they want to be just for seeing Senator Kamala Harris be part of this new administration. People screamed at our friend; called her names; swore at Senator Harris and called her all kinds of names; unfriended this actor – all for simply posting that she was happy to share this positive and empowering moment with her daughters. This is what grief looks like. It’s not pretty but it’s real. And we need to deal with it.

I worry that the millions of us who voted to keep the current administration in government will be dismissed, called names, pushed aside. I have heard many derogatory names applied to these “others” and while I admit that I too have made some rude remarks, I actually want to be sure that most of these voices are heard and honored. Their pain and grief is real and they need help to heal. This has reminded me of what it feels like to be the “bad kid” who uses drugs – or the “bad parent” whose kid uses drugs. These black and white views aren’t useful and they’re not accurate. We humans are far more complex than that. Just as we as a nation need to begin to heal, we can’t even begin until we acknowledge that we’re grieving. One cannot happen before the other. And the same holds for families and other loved ones when it comes to how you see your loved one who also happens to use drugs for a variety of reasons: you must admit your grief and sadness before you can begin that long trek of healing. Neither will be easy; both are absolutely necessary to our survival as individuals and as families.

“Pain is inevitable. Suffering is optional.”5 Black man covering his face with his hands

One of the main reasons I love harm reduction practices is because in harm reduction we not only acknowledge the relationship we drug users have with substances (and other behaviors) but we get to the heart of them in our work. We don’t shy away from looking directly at the root of these behaviors: the good, the bad, the ugly. Our friends and families must also take a hard look at their relationship to less healthy behaviors they’ve developed as coping mechanisms gone awry. After all, it takes a village to raise us – including our less healthy behaviors!

Grief is also something we don’t discuss or honor well in our greater American culture. Traditional bereavement leave is three days. Three days! My mother died nearly 40 years ago, and I still grieve the loss of her. Mostly I grieve the loss of what could’ve been, the life we might have had together; her growing up with Jesse and watching his spectacular life unfold. Seeing me make huge changes in my life and then helping others as she always insisted was the right thing to do. These thoughts and dreams still make me incredibly sad. They should. As Freud discovered, if they aren’t still painful, even after nearly four decades, then perhaps the relationship just wasn’t that important. I won’t accept that, so I maintain my grief, though the pain of it has lessened over the years as it usually does. So how can we be expected to grieve the loss of a behavior that had great meaning to us in just a few weeks or even months? And what if we’re not allowed to grieve because we are told we and our families/friends can only view our drug use/behavior as negative? And what if we never find an antidote to that pain?

We’re all grieving something right now: economic loss; election results; racial and sexual injustices; stigma and shame; family/friends’ death from COVID, drug use, or something else. It’s something we can either turn away from and deny (the first stage of grief) or we can be brave and turn into the uncomfortableness of it all. I vote for turning in: let’s feel every ounce of grief and sadness, let’s mourn our losses, and continue to work to experience our feelings fully; let’s honor all these relationships with people and places and things that we’ve had, or wished to have. Let’s use this collective grief, whatever the cause, as the connection between us. I believe if we can do the latter, our individual friends and family members – as well as our collective American family – may just be able to begin the incredible journey that will be the start of our grief and healing. We don’t need to do this alone; we are all connected, whether we like it or not. And like the Captain said, “We will be alright.” If we try.

Everything will be alright #4

NOTE: Exciting News! Look for my Families Matter/Family Matters FSDP Fundraiser e-Book – coming soon – on our brand new website! Carol, Mary Kay, and the whole Team FSDP and I wish you a happy and healthy holiday season. Thank you for your support this giving season and always! See you back here in the New Year! 2021, here we come!!!

Cheers!
DD
deedeestoutconsulting@gmail.com
www.deedeestoutconsulting.com

1“Mourning beyond melancholia: Freud’s psychoanalysis of loss,” Clewell, T. (2004) J Am Psychoanal Assoc. Winter 2004;52(1):43-67. doi: 10.1177/00030651040520010601.
2https://exploringyourmind.com/when-sigmund-freud-lost-his-daughter-sophie/. July 8, 2020.
3Kubler-Ross, E. “On Death and Dying.” (1969)
4“Why the Five Stages of Grief Are Wrong.” Feldman, D. July 7, 2017. Psychology Today. Accessed on 11.9.2020. https://www.psychologytoday.com/us/blog/supersurvivors/201707/why-the-five-stages-grief-are-wrong
5This quote has been attributed to the Dalai Lama, Haruki Murakami, and M. Kathleen Casey.

FSDP Families Matter l Family Matters Relapse Trilogy: August 2020 Dee-Dee Stout, MA

relapse recovery word cloud

Relapse/Relapse Prevention: Part 3 of 3
Change

“It is possible to make no mistakes and still lose. That’s called life.”

-Patrick Stewart as Capt. Jean-Luc Picard, Star Trek: The Next Generation

Change. Relapse.  Much has been written about these phenomena and we certainly understand these processes better than we ever have.  However, as much as we know, one thing keeps me up at night – both regarding my own desired changes and those of my clients – and that’s this phrase: “We don’t budget enough for change.”  This was the first thing Dr. Alan Marlatt – researcher, psychologist, and mentor to many of us professionals in harm reduction and relapse prevention – taught me about relapse prevention and change.  So what did he mean by this?  He meant that we humans don’t expect change to be so darned difficult, so elusive; we expect change to be an event not a process and so we don’t plan on the spending the resources it will take to be successful in making a change, or to maintain that change.  And it’s this thinking that gets us into A LOT of trouble.

A related phrase from Dr. Marlatt is “Seemingly Irrelevant Decisions,” or SIDs.  Here’s an example of this concept:

“I decided to change my eating habits to see if I could improve the inflammation I’m having from areas of severe arthritis.  I found a good nutritionist that I connected well with and we began our journey by looking at my current eating habits.  One of the suggestions she made is that I reduce or eliminate added sugar in my diet and to help with this goal, she suggested I eliminate sugary products from the house to help me avoid temptation.  Makes sense, I think, so I easily agree to do this.  While at the store later that day, I spy a new gluten-free dessert (gluten-free is another part of my new eating plan).  I say to myself, “Oh this could be really good and after all, it’s gluten-free.  I really deserve something after all the changes I’m making.  I’m sure this will be fine!”  And I buy it, ignoring the sugar content and instead focus on the gluten-free aspect.”

See the SID? “It’ll be OK…I really deserve this…after all it’s gluten free.”  Now I don’t want to suggest having a bit of sugar on occasion is wrong or bad.  That’s up to me to decide, and a bit of sugar is actually OK for me to have (though it might not be for some).  However, since I’m just beginning this new plan, it might be a good idea to stick as closely to my plan as possible until I get my “sea legs” under me, until this new way of eating becomes more of a regular habit.

Pastry on a fancy plate
photo credit unsplash.com/@kai

This incident reminds me of the challenge with abstinence or any “perfect change”  If I say that I’m never going to eat sugar again then I’m more likely to have a harder time challenging my “one time won’t hurt” statement in a couple of ways.  If I were to change that perspective just a bit and instead start out by saying, “I’m going to cut down on sugar and eat it for special occasions only,” then I have more flexibility.  I could then say I’m going to try this new dessert, but save it for a special occasion.  Or I could eat part of that sugary thing, and stop myself by saying, “Oh jeez, I really didn’t want to do that.  I can put it away and save it for another time like I said I would.  I’ll just stop right now.  No problem.”  What does this accomplish?  For one, I’m not catastrophizing that I ate some of the dessert.  After all, It’s not like a little bit of sugar is absolutely going to lead to my eating a ton of sugar later.  I know I can restart my less/sugar-free plan immediately.  Also, I don’t feel like I’ve broken my vow of abstinence, something Dr. Marlatt called the Abstinence Violation Effect, or AVE.  But if I don’t commit to abstinence, doesn’t that mean I’m allowing or choosing to make room for relapse?  That’s what we’ve been taught, definitely.  Let’s keep going and see.

The AVE concept is crucial to understanding relapse, something I’ve come to call the “fuckits”.  You know, when you’re on a diet and someone offers you your favorite chocolate, so you eat a piece or two and then say, “F**k it. I already blew my diet so I might as well just keep going.”  Dr. Marlatt liked to say, “Instead of continuing your drinking or other behavior, how about simply recommitting to your goal and stopping the behavior right there?”  I remember thinking, “Really?  What a concept!  You can always begin again?”  Well perhaps not if you’ve been taught that “once you have a drink or other drug, your addiction – that sleeping tiger – is awakened, and all hell will follow.” This is the problem with that sleeping tiger/disease model of addiction when it comes to relapse.

cherub statue facepalm
flickr.com/photos/londonmatt/37246007506/

Ironically, those who believe in the disease concept of addiction are at higher risk of giving in to the “fuckits”.  Dr. William Miller, co-author/developer of Motivational Interviewing, discusses this in an article titled, “What predicts relapse? Prospective testing of antecedent models”. In this study, Dr. Miller found two things were most predictive of relapse: 1) not having the ability to cope (i.e. lack of coping skills which I think makes sense) and 2) one’s belief in the disease model. Wow. That’s right:  one’s belief in the disease model of addiction makes one more susceptible to relapse. Now I want to be clear here:  just because many, like Drs. Marlatt and Miller and numerous others, don’t believe addiction is a disease (or at least it’s not for everyone) that doesn’t mean for a moment they don’t see addiction as a serious medical condition.  We can also all agree that drug use changes one’s brain chemistry.  I mean, that’s the point:  I drank and used a ton of drugs for 20 years (from 12 to 31 years old) because for most of those years, drugs worked to positively change my brain chemistry!  And this leads to the challenge for many folks with the argument against a disease concept of addiction:  when they hear us say we don’t believe addiction is a disease, they hear that we must therefore believe it isn’t a medical problem or that drugs don’t change our brains.  Nothing is further from the truth.

We simply mean that addiction is not a disease, not a medical condition only.  But it’s definitely a chronic illness – and one that needs to viewed holistically (we’ll return to the concepts of ‘disease v. learning states or other possibilities’ and what good rehab should provide in a future blog as there’s much to say here.  What’s important for this blog is that thinking of addiction as a lifelong, never-ending, permanent diseased brain state predicts relapse). At this point, I’d like to add a disease to our discussion that is purely medical:  COVID-19 or the novel coronavirus.  This is an important part of our conversation on relapse since we’ve seen a spike in overdoses and drug use in general, especially alcohol.  And even if you’re not drinking or using other drugs during this time of sheltering, financial crisis, and protests/renewed awareness around racial inequalities, you’re being affected by our collective drug use and distress.  I know I am.

I’ve been having a rough time recently with feeling incompetent as an addiction/health counselor, a bit burned out, just like I think we all are in some way these days.  When this happens (which it does occasionally even when there isn’t COVID-19 etc. to concern me) I usually reach out to friends and/or colleagues to talk about what I’m feeling.  So that’s what I did:  I called a friend earlier today who’s a therapist as well as a longtime friend and we wound up talking about the concept of ‘”deprivation” or giving something up, like alcohol or other drugs.  We discussed how humans don’t respond well to “deprivation” like we’re currently going through – and being worried we will be even more deprived soon is making this time even more stressful.  What we respond better to is a “warm turkey” approach to change in our lives.  Another way of looking at this is we respond better to adding something to our lives rather than looking at what we’re giving up.  That’s why harm reduction strategies can be so helpful in so many different areas of our lives.  Instead of “giving up,” one thing harm reduction suggests is that we NOT look at what we have to give up.  Instead we suggest that folks change perspective and use strategies that help see change as something we’re moving towards (such as our values or goals in life) rather than what we’re walking away from (drug use, etc.)  This is generally a more helpful point of view.

 

This leads to another set of important questions to ask yourself when you or a loved one goes to make a change in life that may also help you avoid a return to that behavior: “How do you typically make changes successfully in your life?”  Looking at our successes helps build motivation to try again as well as giving us a possible starting point for a new change.  One of my favorite sayings is this: “Success breeds success and failure breeds failure.”  That means that we need to focus more on when someone does not use a drug, eat less nutritious food, does exercise, whatever.  We should be asking, “What/how did you manage to do that?”

Clients are always shocked when I ask them that.  And they usually struggle to answer by the way by saying, “I don’t know” or “Why?”  It seems that this is due to our culture’s preoccupation on highlighting when things go wrong, when we make less healthy decisions, “tough self-love,” if you will.  I’m not suggesting we should never look at these issues, but I am saying that if what we’re trying to do is help motivate someone we love including ourselves, we need to first look at successes. So, what can we friends/other family members/concerned others trying to help do?  “Catch” our loved ones doing well.

This concept is straight from Solution Focused Brief Therapy (SFBT). Having been trained in SFBT in the early 2000’s really helped me change my focus with clients who had recently “relapsed.”  Prior to this time, I was taught to focus on the negative actions and particularly on the “problem” thought processes that led to a client returning to the old behavior.¹  Again, while there’s a time for reviewing when things started to go wrong, doing this before someone is emotional stable is typically retraumatizing and distressing – and too often leads to more drug use (or other behaviors) and not less.

Community Reinforcement Approach and Family Training (CRAFT), in which I was trained in the late 2000’s by its developer Dr. Robert Meyers, also uses this idea of our focus being “catch your loved one doing what you want them to do” instead of the old, less positive behavior.  Here’s an example:

Back to my example of changing my eating habits.  So, my family is trying to support me in these changes that I’m struggling with.  Which seems more supportive & motivating?  1) my son saying, “Mom what are you eating?  Don’t you remember how sick that makes you feel?  Does the doctor say it’s OK to eat that?” or 2) my son saying, “You know mom it’s so great that you’re making these changes and I know it’s hard.  I’d love to cook a meal for you that includes things you’ve seen are better for you to eat.  What could I make for you that’s healthy for you?” or even 3) my son says, “Mom, I’ve noticed how much more fun it is to be around you since you started eating on this new food plan!  You seem in less pain and you have more energy to do things.”  Hear the difference?  Or how about my son saying, “You look like you’re not feeling well tonight Mom.  We could just watch a movie here instead of trying to go out this time if you prefer.”

Let me give you an example regarding drug use:

Your daughter has been using opiates for a while and you’re really scared that she’s developed an unhealthy attachment to them.  You’re also frustrated that too often when you see her lately, she appears ‘out of it’ and unable to participate in whatever plans you all have made.  Instead of confronting her when she’s under the influence, CRAFT suggests you wait until she’s less or not intoxicated to have a reasonable conversation with her (no drama please!)  If that’s not possible, then saying something like, “You know sweetheart we all love it when you’re able to play cards with us on Friday nights.  And we all agreed that when we play cards, we’d all be abstinent.  I can see that tonight you’ve not been able to abstain and I understand.  We’re sorry that you’re not able to play tonight, but let’s try another night over the weekend, OK?”  You’ve confronted the behavior you don’t want and highlighted the behavior you do want. Another possible response would be to say, “I see you’ve been using today and you’re not feeling like yourself/well.  What if we just watch a movie together tonight and save cards for another time when we can all abstain?  Would you like to spend some time with us, or is that too much right now?”  Can you see yourself saying something like this to your loved one using drugs problematically, rather than suggesting you can’t be around them when they’re under the influence?  Is it possible?

“Do. Or do not. There is no try.”
-Yoda, Star Wars: The Empire Strikes Back

Bottom line: change is hard.  And boy, is that an understatement!  We are seeing that played out everywhere in our world right now.  And there are no short cuts, no “express elevator” to change.  Only hard work and baby steps of the “two forward, three back, four forward, one back” kind for most of us.  And that’s OK.  As long as we stay on the spirally road of change we have the possibility of something actually changing.  I can absolutely guarantee that no change will happen if you quit trying.  In other words, Yoda was wrong!  Trying is what we MUST do, constantly, no matter what.  The average times someone tries to quit smoking – called the most addictive substance in the world by some – is 30!!! Can you imagine after the 25th round of drug rehab someone says, “It’s OK, it takes what it takes.  Just keep trying!” Ha.

Sadly, our culture implies that we should only need one, perhaps two, treatment episodes to be abstinent, the only “allowed” goal of nearly all our drug treatment in the US.  And yet, we also say “this is a chronic relapsing disease”.  Well, guess what?  You can’t have it both ways.  So what’ll it be?

Of course, this also implies that we need affordable as well as effective drug treatment.  But perhaps what we need even more is an early form of help, a way to support people making changes that they want to make, in a way that makes sense to them, and that might even feel positive.  Dr. Marlatt also used to say that (paraphrasing here) “We need to make recovery as enticing and helpful as drug use – and if we can’t, we need to admit that.  At least be honest.” I wonder what would’ve been different for so many of the thousands of folks I’ve worked with over the years if we simply managed to do that and stop pretending that drugs are all bad.  After all, if they’re that bad, why did I (or anyone else) continue to use them for two decades?  We’re not stupid, and I wasn’t physically dependent on them for many years so it can’t be just that.  We must look at change and especially addiction and change much differently – and we CERTAINLY have to look at drugs differently.

Well, that’s it for me for now.  I’ll be with you again sometime in September for Recovery Month to discuss more about the words recovery, relapse, and others.  In fact, I’ll be giving you a list of words to be wary of when you hear them coming out of the mouths of professionals, especially rehabs.  For now, let me leave you with this: what if we decided the word recovery meant simply change, and not abstinence (such as my own phrase, Harm Reduction Recovery™)?  What might drug treatment look like if we did just that?

In the meantime, please join us Friday, August 14, 2020 at 5pm EDT for Responding to an Opioid Overdose at Home as part of our preparations for National Overdose Awareness Day, August 31, 2020.

And get ready for the publication of our online eBook coming in September in honor of Recovery Month!  This eBook is a collection of my blogs for FSDP over the past two years as well as some added musings from a few Friends of FSDP we know you’ll enjoy.  All proceeds will go to FSDP to continue their support of sensible drug policies and related efforts.  Thanks in advance!  See you in September!!

Be well, be safe, and be kind.

Cheers!

DD
Author, Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World
To contact me, go to www.deedeestoutconsulting.com

¹Terence Gorksi’s method of relapse prevention is highly based in CBT.  His method/curriculum is also the primary theory used in traditional rehab.  I studied with Mr. Gorski in the mid-90’s but it was Dr. Alan Marlatt that ultimately helped me shift my work and thinking in this area along with Chicago’s Dr. Scott D. Miller who had studied with the developers of SFBT.

²For more specific information, here’s one reliable source with criticisms: https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html

International Overdose Awareness Day 2020 event – Responding to an Opiod Overdose at Home training

NJ Harm Reduction Aug 2020 IMG_1342

Responding to an opioid overdose at home: administering naloxone, non-coercive aftercare, and radical love

Friday, August 14 at 5:00pm Eastern, Families for Sensible Drug Policy is privileged to join New Jersey Harm Reduction Coalition (NJHRC) co-directors Jenna Mellor and Caitlin O’Neil for an online overdose reversal training for families, followed by a discussion on harm reduction approaches to a caring for a loved one who uses drugs.

The event coincides with International Overdose Awareness Day, a global day of solidarity with friends around the world to spotlight a dialogue in love and remembrance, informed by harm reduction and human rights.

We will discuss non-coercive aftercare, advocating for your loved one’s right to health & dignity, and engaging in radical love. Participants can contact NJHRC after the training to request a naloxone kit and fentanyl test strip kit to be mailed to them via the NJHRC request line 1-877-4NARCAN.

To tune in at 5:00pm Eastern on Friday, August 14 to follow NJHRC on Facebook at facebook.com/njharmreduction, or message us for the link!

FSDP Families Matter l Family Matters Relapse Trilogy: May 2020 Dee-Dee Stout, MA

relapse recovery word cloud

Relapse/Relapse Prevention: Part 2 of 3
For the (Rest of the) Family

“Expectations are resentments under construction.” -Anne Lamott

Relapse and families. Google this combination and you’ll get some 42 million hits. 42 million!! But I could find only one reference to an actual Family Plan for THEIR relapses/lapses into old behaviors and sadly it’s a list that in my opinion is too long and too loaded with traditional thinking (we’ll look at it in a bit). I don’t even like the language I’m using here: “relapse” meaning someone has used a drug again? Or perhaps something else? (we don’t speak of “relapse” in cancer or diabetes care, do we?) And I realized recently that when I use the term “family” I’m too often meaning ‘the folks that don’t have a drug problem’. But isn’t the “addict” part of the family? And more important, isn’t our usual language leaving them out of the family literally – the sense of connectedness, a being unit, that they likely already don’t feel a part of? Or is that the point? Sigh. But we’ll focus on language another time. Here I want to ask us to see relapse/lapsing in a bigger context: that family members who don’t have drug problems can fall back into their old behavior patterns too and therefore “relapse” or “lapse”. And it’s this that I want to focus on in Part 2 of our blog on Relapse Prevention: if the system I live in/am part of doesn’t change, how can I or anyone change within that system? And if we all don’t begin to understand why someone is using drugs, how would our loved ones with a drug problem begin to make changes? The short answer, I’d argue, is they can’t.

mobile Denise Carbonell flickr

In the 1980’s, the late John Bradshaw was the darling of PBS with his specials, one titled “On The Family” . I took one of his courses when he came to the Bay Area in the early 90’s and one thing I remember (and still use) is this: the family system is like a mobile – touch one part of it and everything shifts. The other main take away for me is how he said the word disease, which Bradshaw would pronounce dis-EASE. As we’ve all learned more about trauma and traumatic events, this pronunciation has come back to me. As I write this series on relapse prevention and change, I find it a timely reminder as well. I used drugs for more than two decades not ONLY because of my dis-EASE but often because of it.

I recall the Family Program that we had at the hospital-based treatment facility I entered and, later, at which I worked. Every Thursday evening for a year, the former patient (me!) could return for a Continuing Care Group (not called “aftercare” on purpose as we believed that the treatment stay was just the beginning of treatment not the end of it), family and other significant others could attend the Family Meeting, and kids (under 12, I believe, and for an extra fee) could attend Kids Connection. So, every Thursday evening for a year, my ex and I and my son Jesse attended their respective support group meeting and afterwards, we went for dinner. It was incredibly helpful for all of us as it made clear that the whole family is involved in treatment (or needs to be); the patient wasn’t the only one needing to make change. All of this was included in the cost of my treatment stay. Additionally, significant others could attend our annual Family Intensive (for an added fee). This was a week-long program to focus on healthy communication, how to care for yourself, how to support your loved one in crisis/relapse, bringing sex back into your relationship, and much more. The program was designed and run by one of my longtime sponsors and mentors, Dr. Mickey Apter-Marsh (Mickey had a PhD in Human Sexuality as well as having trained as a therapist). She also liked to say she had a “black belt in Al-Anon.” In those days, we spoke of co-dependency and enabling – words I find lacking in nuance today – but nevertheless, these were ground-breaking concepts in the late 1980’s-early 1990’s. While I would change some of the specifics in a program in 2020, we (and most inpatient treatment providers) had an incredible and mostly free support program for family members. We recognized most patients would be returning home after treatment, to the same place that they problematically used alcohol and other drugs, and those other family members would need support to make their own changes too if treatment was to be successful.  What happened?

Earlier I mentioned the one entry I found on Google on this topic. It’s from Debra Jay It Takes a Family: A Cooperative Approach to Lasting Sobriety (2014).  Ms. Jay uses Terry Gorski’s “Relapse Warning Signs” and developed what she calls “Family Relapse Warning Signs.” Here are a couple of entries from her 34-item list:

  • I allow my daily activities to interrupt my recovery schedule including my Al-Anon meeting, daily reading, time with my sponsor, service work, or working the Twelve Steps.
  • Temporary issues, such as an illness, keep me away from recovery activities, but I do not return once I am well or otherwise unburdened.
  • I’m not eating enough or too much.

First of all, if Al-Anon and other 12-Step support helps you, who am I to disagree? I would suggest the first entry could be read another way which concerns me: “Nothing is more important than my recovery – defined as abstinence –- and my life activities are unrelated to it.” I’m sorry but to me that just doesn’t make sense. Also, if this is an approach to ‘sobriety’ as Ms. Jay states, that would be only for the family member problematically using drugs, right? Or is she referring to ‘sobriety’ as something different than abstinence? Some do make that argument, which I’m not going to address here, but Ms. Jay doesn’t explain her terminology (please note: I have not read her book though). Finally, the way the title of this piece is worded to me also sounds like the family is doing these things ONLY to help the “addict” stay sober. We’ve talked before about recovery being more than abstinence; in fact, our government believes that to be true as well as is suggested in SAMHSA’s definition. My definition of recovery? Simply this: mindfulness+connectedness+inner growth™.

I decided to see if FSDP member and my old friend, Dr. Stanton Peele, JD, PhD, had some thoughts on this topic.  Stanton shared with me some of what he and collaborator Zach Rhodes discuss with their clients participating with their online treatment for problem drug use, The Life Process Program:

We wouldn’t suggest divorcing someone if they’re still smoking even if you’re quitting but you may need to have some reasonable limits around each other’s behavior. Bottom line: your whole intimate group/family is going to have to change — like reciprocity marital counseling.  The main topic of conversation becomes ‘how can we go forward without setting one another off?’

Family relapse prevention is something we don’t often discuss in this culture when talking about addiction. However, in Australia, Family Drug Support, (FDS), has been talking about family system change for many years. Let’s return to our mobile for a moment. I think we can all agree being in a relationship with someone(s) who are engaged in less healthy or potentially problematic behaviors affects us all – and maybe it affects us regardless of whether its problematic or not (that’s also another convo!). Anyway, it’s going to be necessary for us all to look at how we need to think about and adjust our own actions and words to support change in The Family System, regardless of whether our loved one problematically involved in some less than healthy behavior – the “addict” or “identified patient” to use the common term – makes a change or not. Tony Trimingham, CEO of FDS, (and someone with his own personal story of inconceivable change after his son died from a drug-related event) discusses several concepts involved in Family Relapse Planning in his helpful booklet, “A Guide to Coping: Support for Families Faces with Problematic Drug Use.” Here are a couple of suggestions from this booklet:

  • Look at the outcome or goal you’re expecting from treatment. Are you defining “success” as your loved one being drug free for a year? Five years? 6 months? What if they cut down or change to a less harmful drug? What if they leave formal treatment but maintain the change they’ve made? Unfortunately, our expectations (and this applies to all family members) usually have a way of setting us up for disappointment. So, let go of those expectations (easier said than done)!
  • Have access to support for yourselves. Groups (all kinds), professionals, education, books, and more can all be helpful. Just skip the TV and Dr. Phil or Dr. Drew please.
  • Accept the reality of the situation. Acceptance doesn’t mean agreement! However, it does mean that we must learn to separate our feelings of hurt, disappointment, and fear from the fact that people we love – even those who use drugs problematically – are entitled to determine their own lives and decisions about it. And who knows? Maybe those decisions will include getting some help? (It did for me)
  • Support isn’t rescuing. “Parental and family support have been shown to be one of the strongest factors in “successful” treatment” of alcohol and other drug problems. One of the main things I work on with families is helping them determine how they can support their loved one in a way(s) that works for everyone. That means, like good negotiating, no one is going to be completely happy with the results. There’s always a way to give support.
  • No one knows what’s best for your family except your family. And by “family” I mean including the person problematically using drugs. With limited exceptions, if you can continue communicating with your loved one including family conversations about their drug use, your efforts will pay off greatly. This may not be easy, but it can be one of the most important things you do. Please remember, no professional – including me – can tell you what’s best for your family. A good professional is there to help you have these critical, complicated conversations and help you sort what each member of the family desires, needs, expects, is willing to do, etc. But we do NOT have your answers; we can only help you uncover yours.
  • Make a plan. Here in California, we encourage all residents to have an earthquake or other disaster plan. I’ve been calling relapse prevention plans “earthquake plans” for years as I see them in the same sphere: we hope we won’t have an earthquake but let’s be prepared for it, as best we can. For families, I want you to know what your “bottom lines” are; what you’d like to see your loved one do if they return to using a drug problematically; what your loved one wants to happen if there’s a lapse; how you’ll show your loved one that you need to make changes too. I’d also like you all to know how each of you – including the one problematically using drugs – can say something to you about your own lapse. In my family, we used a code word. We all agreed that when someone said the code word (say, “penguin”), it meant we stopped the conversation, agreed to return to the conversation later, and let it go for then.

Having a relapse prevention plan for families and other concerned loved ones also says to our loved one problematically using drugs that we understand this is a system, a family, and we’re in it together; we’re willing to do our own work to help make some positive changes in our family while they make their own, or not. Dr. Gabor Mate has a story about this that always brings me to tears, which he related to Chris Grasso in his book Dead Set on Living: Making the Difficult but Beautiful Journey from F#*king Up to Waking Up. Here’s an excerpt:

…you’re the one whose behavior shows us how much pain there is in our family. Thank you for showing that to us…because we realize that’s we’re as much a part of it as you are. We’re going to take on the task of healing ourselves…

In the work I do with families, one consistency is that there is no consistency. As Mickey’s husband, Dr. Earle Marsh, MD*, used to say to me often, “Baby, life’s a crap shoot. You just do your best and let it roll! ” Each family I work with has their own ideas as to what’s important to them, what their own values and goals are. Those are the ingredients that I need to gently guide them towards what’s best for them. I may certainly, with their permission, suggest they view or consider something in a slightly or radically different way but ultimately, they are the arbiters of their own family actions.

So, are there some things in general that families or other loved ones of someone with a behavior problem can do for themselves? Yes. In fact, the very first one is to see that you need to make changes too, regardless of whether your loved one (with the problematic behavior) ever changes. This doesn’t mean to leave your loved one behind. Instead of focusing on what you’re NOT willing to do, I suggest families focus on what they CAN do for their loved ones using drugs problematically. We want to reward the behavior we’d like to see more of instead of punishing the behavior we want to see less of. This lets our loved ones know that we’re not closing the door on them and (no “buts!”) we have limits regarding some behaviors.

A relapse prevention plan should be a helpful road map for everyone on this journey we typically call “recovery”. After all we’re all affected by each other’s behavior, so we all need to make our own road map. A good relapse prevention plan should also allow for spontaneity in life and not be written as if it’s a legal contract but rather as a general guide to where we all want to be. It should be fluid and flexible, responsive to new events and circumstances. We take more time to talk about the colors we put on our walls than we do on what we want to happen when life throws us a curve ball. So, by yourselves or with professional assistance, be sure to write your own relapse plan – or wellness plan – now so you know where you’re headed. And whatever you do, don’t leave home without yours!

Cheers!

Dee-Dee Stout

deedeestoutconsulting@gmail.com
www.deedeestoutconsulting.com

*Dr. Marsh was the Ob/Gyn deptartment chair at UCSF for many years. He taught the first course on addiction for medical students there as well. Doc Earle, as he was known, was also a longtime active member of Bay Area 12-Step, whose first sponsor was the co-founder of AA, Bill Wilson. Doc and Mickey were my lifelong friends, co-sponsors, and even part of my Master’s committee. You can read Earle’s story in the AA Big Book (Physician Heal Thyself: 35 Years of Adventures in Sobriety by an Aa ‘Old Timer’).  They are both gone now and long ago broke their own anonymity.

Photo credit: Denise Carbonell, Flickr, Creative Commons license

From Conflict to Conversation

Welcome to the Fall 2019 Back To School edition of Family Matters – Families Matter, authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout.

Close up of red autumn leavesFall. Thoughts of crisp autumn nights and drinking apple cider come up for me, of my youth spent in the Midwest. It also reminds me of “back-to-school” time which can cause some concern for many parents, as well as their new students heading off to University. I’ve been working with a couple of sets of parents with college-aged kids who are all nervous that these young folks aren’t prepared for the new challenges, new people, and new temptations both healthy and less so. Perhaps there’s been problematic drug use or some other challenging behavior/mental health concern which is also interfering with their child’s ability to prepare better for these new experiences. So, what’s a family to do? While we might not be able to prepare our kids for every new experience, we can definitely work on listening better to what they say they need/want – and what they don’t want/need from us – which I think is at the core of improving all family relationships. Plus, these same communication skills will be used for the rest of all our lives: with our family members, friends, colleagues, everyone. And yet, these are skills that are rarely taught, which leaves us to learn them through trial and error or with the help of books, coaches, counselors, podcasts, and more. So, how can we learn to listen more and talk less, no matter what’s getting in the way?

While there is no magic answer to doing this, it really is the simple answer to better communication. And boy, it’s really easier said than done! With my own fractured family, I see just how hard this is to do. But there are ways we can get better. Here are a couple of ways to improve conversations within families and begin to get a bit better at “listening more and talking less,” especially with our adult kids using drugs problematically. The first, from the Australian online group Family Drug Support (FDS), founded by Tony Trimingham, (look for FSDP’s launch of our own FDS USA soon!) are these basic ideas: 1) Choose your moment – e.g. not when someone is under the influence of drink/drugs. This first step to better conversations is also discussed in many other books and trainings on Family Coaching including Robert Meyers’ Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening and The Parent’s 20 Minute Guide1.

Another strategy I have adopted from The Parent’s 20 Minute Guide is to think of conversations as if there are traffic lights in a thought bubble above the other person(s) head. For example, a green light means someone is engaged and listening (though perhaps not about the subject you’d like to discuss!); a yellow/caution light means we may be headed into dangerous territory (think “danger, danger Will Robinson”, to borrow a phrase): actions such as voices starting to be raised or someone changing subjects defensively; and a red light means the conversation has gone off into unwanted topics, leaving our loved one and/or us threatening, screaming, swearing, or falling silent and retreating. Not a lot of listening going on when we see these behaviors so experts suggest we stop trying to have a conversation then and simply step away. Remember, these “lights” refer to all family members not just the person(s) using drugs problematically. That’s really important. In fact, one of the parents I work with calls these “caution” signs “relapse warning signs for the whole family.” Here’s an example of how a conversation might look using all the lights:

Beginning statement from you: “I’m really concerned about your grades this semester.”
Your child: “OK I know I’ve slipped a bit but can we discuss this later please?”
Your response: “OK I understand this isn’t a good time. When can we talk about this please?” (green)
Your child: “Stop interfering in my life! I’m an adult now and you can’t tell me what to do!!”
Your response: “You’re right you are an adult. We’re just concerned and want to help if we can.” (red)
Your child (voice raising): “I know, I know! But I’ve had a lot of hard classes and it’s been a lot more work than I thought! Can’t you just get off my back?”
Your response: “You sound pretty stressed out right now. Let’s talk about this over the weekend when we’re both calmer.” (yellow/caution)

Another strategy toward better listening – or what clients sometimes call “not taking the bait” in conversations – comes from Motivational Interviewing or MI. In MI, there’s a strategy we teach called “key questions” which I think are brilliant. These are statements I make when it either feels like I’m wanting to take charge of a situation or it seems that someone expects me to have answers for them. These are a way to respond that shows my interest in the conversation while not taking the bait of thinking I need to come up with answers/take charge. Here’s an example:

You: “I’m really concerned about your grades this semester.”
Your child: “Well what am I supposed to do? It’s really stressful…and these classes are much harder than in high school!”
Your response: “Things are definitely harder than you expected (this is called a reflection). What do you think would be helpful to make things easier right now (key question)?”

See how this parent has let go and not taken the bait? Instead of saying something like, “well you know what you need to do is…” and trying to solve this problem for them – in MI we call this “the expert trap,” which means we’re assuming we HAVE the right answers for someone else, like we’re experts in other people’s lives which of course we’re not – this parent gives the solution back to their child. This also helps the child learn to figure out what’s best for them and not to rely on us parents. By the way, this doesn’t mean we can’t ever offer advice or have an idea. But again, borrowing from MI, when we do so, the third tip for better conversations is to ask for permission before offering any ideas. Yes, you heard me: ASK FOR PERMISSION. It’s simple thing to do and it shows respect to the other person.2

Along these same lines, something I learned to use with my now adult son while he was in college was to ask at the beginning of a call, “do you want me to listen with the goal of giving advice or with the goal of just listening?” That simple phrase helped me a lot. It was important for me to set that goal up front and it also seemed to help my son communicate to me more fully and honestly. Of course, the REAL trick is to keep quiet when you hear things that make you want to scream, “NOOOO!!!” But I learned that my son – like most of our kids – was pretty darned good at making generally healthy decisions for himself – and the couple of times that he wanted advice, he was able to ask for that since I’d respected his desire and not given unwanted advice the other times he called. Come to think of it, he might’ve even called home a bit more than he would have.

The more we understand that much (most?) of someone’s drug use is a direct result of medicating trauma, anxiety, depression and more, the more we also see that improving conversations with our loved ones is crucial to keeping our families listening and attached rather than talking at each other and detached. And that’s always the goal, huh?

Navigating conversations in families is always challenging let alone when someone is using drugs problematically! I get it. And I can definitely say that this way of deeply listening to each other takes work, commitment, and practice. And a willingness to make a lot of mistakes. To help reduce mistakes, one of the parents I work with likes to make “flashcards” of bytes of responses they could make when their adult child begins to unravel or becomes demanding (and old pattern of push/pull that they’ve all become expert on). I am immensely impressed with these families and their collective loved ones for their efforts to change these imbedded patterns!

Being a part of a family takes real effort, like all relationships, with more listening than talking at the core. Dr. William Miller, who co-wrote the book Motivational Interviewing, has a new book out called Listening Well: The Art of Empathetic Understanding that I often use with families if they’re interested. It’s an easy read, less than 100 pages, with exercises at the end of most chapters (some of which are three pages long) that can be done in session with a professional as well as at home for practice. In it, Dr. Miller discusses the idea that one of the main ingredients to “listening well” is to have compassion and empathy toward one another: this means all family members, drug users and non-drug users alike. To me this concept is also at the core of an idea that I first learned from an early mentor of mine, Jane Peller, LCSW, co-author of Recreating Brief Therapy and retired professor of Social Work, Northeastern University: think of this as “Appreciation.” Jane taught me that if I were to be successful with a client, I needed to find something to appreciate in each of them – and if I can’t then I need to refer them on to someone else who might be able to help. Well, I say if we’re going to be successful in conversation with someone using substances, we need to appreciate what those substances are doing for that loved one that nothing else seems to help. I also need to find something in my loved one to appreciate about them as they are today, not as I remember them or wish they were (again this applies to all members of the family). I even go so far as to explain to everyone I work with that someone’s drug use (or other problematic behaviors) makes perfect sense if we understand that drug use is a symptom of something and not a pathology. After all, all behaviors provide us with some reward – or we’d stop engaging in them (even if the reward is negative by the way).

This is where listening deeply comes into play. We need to be able to hear – and possibly without words – the reasons that our loved ones are using drugs or are engaged in other less healthy behaviors. To those using drugs problematically I will often say that they too need to find a way to appreciate the drugs they’ve been using (I realize that may sound strange but hang with me). Why? Because it’s likely that those drugs kept them alive to get to this place – of considering change. And then I typically follow up that remark with, “And isn’t it interesting that the very behavior that helped you cope/stay alive is now killing you/putting the things and people you love at risk?” Finally, I’ll ask something like this (here comes the key question): “So, what do you think you’d like to do now?” This is what I like to call an INVITATION to make a change – or to think about making a change or consider what would need to happen to be ready to consider a change, or anything that speaks to talking about any positive change.

Late afternoon sun shining on water through trees“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.” F. Scott Fitzgerald

Please don’t hear that I’m suggesting for one minute that you must agree with or like your loved one’s drug use or any other behaviors (nor do they need to like yours). Not at all. In fact, that’s the “trick”: “How do I appreciate/try to understand this thing you’re doing/using that may be helpful & deadly to you and that I really hate because it may kill you?” Well, I’d argue that this is our job as family, as loved ones, and definitely as parents: we recognize that your behavior shows just how much pain our family and our beloved family member is in.3

Gabor Mate and others in the trauma world have spoken about the rates of trauma in folks with problematic drug use/other coping behaviors; for women, it’s up to 99% of those seeking treatment for substances (Najavits, 2002)! Trauma is a main factor in drug use because of the fact that so many drugs work well to alleviate the anxiety, fear, and uncomfortable, overwhelming feelings that often arise with trauma (as someone with a diagnosis of non-combat PTSD, I can attest to how well various illicit and licit drugs can work – and how they can become problematic without treatment to address the trauma): “Up to 59% of young people with PTSD subsequently develop substance abuse problems. This seems to be an especially strong relationship in girls,” according to recent information from our National Institute of Health or NIH. But let me be clear here: not all trauma rises to the level of PTSD. Nor does all problematic drug use stem from trauma. However, the rates of trauma symptoms are increasing along with the rates of anxiety in teens of today causing some to see anxiety and trauma as the next health crisis in the making.

At the end of the day, only you and your family can decide what’s important to you all, what values you hold as a family, and how you’re going to respond to a loved one’s substance use, problematic or otherwise. Whatever you decide, I invite you to consider that as your child moves into adulthood and leaves home, it may be time to reevaluate your relationship with them and make a goal to HAVE a longlasting relationship with your child no matter what they do/decisions they make. To lose your family support is about the most damaging thing we know of when looking at any number of health-related problems. We also know that family support is a major reason for successful treatment for substance use disorders, and that being connected is the best way to support mental illness as well.4

While we may not be pleased with all the decisions our children make – nor they of all of ours – perhaps we could all do a bit better to act with compassion, empathy, and most of all, with unconditional LOVE toward each other. I know that I would never have made the Herculean effort to change my own drug-related behaviors/improved my mental health if it weren’t for the love of my son and my former husband. I certainly had no self-compassion and therefore no reason to stop – and my family of origin had mostly written me off. It’s been a lot of hard work – the same hard work I am honored to witness in the families and individuals I work with today. And while drugs hold little interest for me anymore, it doesn’t mean I have a life of ease or that my relationship with my adult son perfect. But I don’t look for perfection anymore – not in me and never in my clients. After all we’re human and therefore we will screw up. Doing better is good enough for me now. I hope it can be for you, too.

Dee-Dee Stout, MA
Author, Coming to Harm Reduction Kicking and Screaming
www.deedeestoutconsulting.com

All photos courtesy of unsplash.com

1By the Center for Motivation and Change, 2nd edition (2016).
2These are all conversational suggestions. There are a LOT of ways to have better conversations and plenty of materials out there to help us. I have listed only a few here. -D.S.
3Paraphrased from Gabor Mate’s conversation with the author Chris Grosso in Dead Set on Living (2018), Gallery Books.
4Hari (2018)

 

June 8th forum on marijuana regulation in Peekskill, NY

Our amazing panel from Saturday June 8th forum on marijuana regulation in Peekskill. Many thanks to Peekskill City Councilmember Vanessa Agudelo and Peekskill NAACP for organizing it, and my co-panelists attorney Saad Siddiqui, parent Lisa Tane, Black Westchester publisher Damon K. Jones and Nelson Guerrero of Cannabis Cultural Association. A very friendly and receptive audience, one more example of changing the narrative.

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Livestream of the event is available at http://bit.ly/2wJDHoW.

Backstories

Welcome to the Summer 2019 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.
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Backstories.  To me, it’s what makes us humans interesting and individual – and what I love the most about my jobs:  hearing people’s backstories.  It’s also the most important piece of information on which we base our opinions of others. As it’s been nearly a year since FSDP asked me to write a blog for them, I thought perhaps I would share a bit of my backstory with you all.  And since I’m unlikely to meet many of you (unfortunately) I can be brutally honest.   Learning more about people is also a big part of my job as a coach, counselor, and educator as it helps show their motivations for change and for not making changes.  First let’s define what a backstory is exactly.

According to dictionary.com[1], a backstory is “a history or background, especially one created for a fictional character in a motion picture or television program.”  That’s how I first became familiar with the word (while my son studied acting years ago).  It came up again when studying Motivational Interviewing (MI)[2] with Dr. William Miller and his colleagues at University of New Mexico Albuquerque in 2000.  This occurred during a conversation on the Spirit of MI which then was defined as “collaboration, evocation, and supporting autonomy.”  One of the biggest discussions both in and out of the classroom was on this idea.  One of the ideas we discussed was how knowing more about a person’s motivation for their actions helps us understand them better.  And that understanding is crucial to my work (and I’d argue to us all) in order to be accurately empathetic[3] and compassionate which are both necessary qualities in order to be helpful to others.

I attended a conference this week in San Francisco that was put on by the Drug Policy Alliance (DPA).  FSDP was one of the co-sponsors so it made sense that I would go as our local representative. I had no warning internally of how this conference would affect me, both personally and professionally but it has.  The conference was on “Coerced Treatment:  For Your Own Good” and was co-sponsored by some terrific organizations from around the country (more on that later).  There were several panels with amazing discussions on various kinds of coercion:  addiction treatment, mental health treatment, suicide prevention, and more. Panelists included experts in harm reduction, policy, and especially many with lived experience.   In fact, one of the biggest take-aways from this conference for me is the importance for those of us with lived experiences to share our stories to help make policy more effective and less harmful, to increase empathy and compassion by knowing a bit more of our backstories, and to be brave enough to speak your truth especially when so many are talking against your idea(s).  So, with that in mind and with the upcoming anniversary of these blogs, here goes a bit of my backstory.  First, in no particular order, let me name a few of the labels I’ve worn (all of which have been placed on me by others):

Genius, Schizophrenic-nymphomaniac, Incorrigible, Hopeless, Drug Addict, Alcoholic, Bad mother, Slut, Bitch, Favorite teacher, Lesbian, Insubordinate, Passionate, Mother-killer, Spoiled, Teacher’s pet, Smart ass, Talented, “Smarted person I’ve ever worked with who does some of the dumbest things” (a former boss’ assessment). Funny.
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When I was about 9 or 10, I made a decision to have friends at any cost.  I was tired of being the “smart one” without many friends.  This happened to be about the same time my siblings were born.  At 12, I discovered marijuana and alcohol (well I knew something about alcohol before then as members of my extended family drank but I had not tried it myself yet).  It was also around this time that my first sexual assault occurred (it wouldn’t be my last).  I don’t recall how it was that I started to see psychiatrists, but it was also around this time.  There was a psychologist I saw, Dr. Don Crowder.[4] After meeting with me for some months, he informed my family that I was acting like a pretty normal teenager (it was the early 70’s) and suggested we do some family therapy.  I recall my never seeing him again after that conversation with him (he remains the one professional I trusted for many many years afterwards).

After seeing a succession of other mental health professionals, I was taken down to Detroit to see a psychiatrist with Children’s Hospital, a Dr. Fishoff.  It was here, after one meeting, that I was given the label of schizophrenic-nymphomaniac.  My family was told that I was hopeless and should be committed to an institutional school for the mentally ill.  I discovered all this by complete accident, stumbling on a file with my name on it in my father’s file cabinet (it was also where the phonebook downstairs was kept plus I often helped my dad by doing some filing for him so the cabinet wasn’t locked or hidden).  Imagine my surprise when I discovered this file.  After reading it alone in my room, I was baffled at first and then terrified to read the letter from Dr. Fishoff. Also in the file was information on a residential school for the mentally ill in Ohio which my parents had decided I was to be sent.   I recall calling my boyfriend at the time, pretty freaked out, and then I have no further recollection until I was in court, suing my parents for legal emancipation.  I won.  I can’t tell you even how I knew about such a legal “divorce” nor who represented me.  I recall being given a legal document which I needed to show that I was now responsible for myself and essentially an adult.  I do remember finding an apartment to rent and having to show the document to the landlord to prove that I could enter into a contract.  I also recall being told I was now an adult “with all the responsibilities and none of the privileges” such as voting!

What I do remember all too well are my feelings of rejection, betrayal, hurt and disappointment.  I recall feeling that I couldn’t trust anyone except my friends and certainly not any of my family members.  I also remember being in so much pain that I would curl up into a fetal position, my legs pulled as close to my body as possible.  I wanted to become as small as I could so I could disappear.  My favorite fairy tale became “The Little Mermaid” as it was both Danish (my maternal grandfather’s parents emigrated from Denmark) and she dissolved into seafoam at the end.  That’s what I wanted too.  Seafoam sounded so elegant and gorgeous – and peaceful.  And so to get there, and to help with the endless pain I was in, I began to use more and more drugs.  I needed to be loved, held closer not pushed further away.  I wanted to shout “Can’t you see how much pain I’m in?”  and “Why am I not enough for you to love me?”

This is the event that has most shaped my life – for better or worse – and it appears to be the reason my family has never healed.  It’s only been spoken of once that I recall, too.  My folks (technically my dad and step mother.  My birth mother had died of pancreatic and other cancers in 1984 at the age of 44 when I was 28.  My dad remarried to a woman who was an executive VP with Dow Chemical which is why they were in SF at this time) came to stay with my ex-husband and our family as they had to leave the Fairmont Hotel in San Francisco where they were staying for business reasons due to the 1989 Loma Prieta earthquake[5].  While they were there, I asked my dad why, if I had schizophrenia, treatment with medication was never tried.  Since I had been studying psychology, I became aware that even in the 1970’s, medication was a pretty typical course of treatment – certainly before institutionalization.  I recall his saying that that time period was a particularly traumatic time for him and so he didn’t remember much so he couldn’t answer the question and didn’t want to talk more about it.  I remember thinking to myself at the time that, while I certainly understood it was traumatic, why didn’t he seem to think it was ALSO traumatic on me?  And that was it.  Case closed.  My drug use apparently was all anyone needed to explain why I was vilified and abandoned.  My mother told me often during those years that she wished I had never been born, that I’d ruined her life, and that she hated me for it.  We never got a real chance to speak again before she died though she did come to see my son and I in California on her way to Australia.  It was the first time she acknowledged my toddler son and spent time with us[6].  I’m grateful to that time.

After leaving Michigan for good at 17, I took the scenic route to CA.  A job in radio brought me from AZ to CA and out of a marriage to an abusive man (who only seemed to do so when he drank too much so I thought the abuse was my fault for many many years. Plus my father had been physically abuse at times when I was a teen so I was accustomed to it and the concept of all bad things being my fault).  After numerous sexual assaults in college (including an affair with my married psychology professor) and discovering cocaine (yes!!!), I was ready to head to CA:  even my medical specialist encouraged me to move to CA and get pregnant to solve gynecological problems I had suffered since about age 9 (the trauma I had endured at the hands of male MDs over the years is also another story).  Long story short, after 20 years of multiple drug use/misuse/addiction, I agreed to enter residential treatment at a local hospital and have been drug-free since.  My life is far from perfect and being drug-free doesn’t mean everything else is hunky-dory.  It’s merely one way to measure my success in one area of my life – abstinence.  I now think that it’s also the easiest, least accurate way to measure recovery, too.

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“Why do we use the worst-case scenarios as the basis for policy?”

This question was raised in one of the workshops.  It slapped me in the face hard when I realized the reality of those words.  We seem to ask for laws/edicts/regulations etc, mainly after worst-case scenarios occur as if they are the sign posts we needed to make big changes.  While this can be understandable, it can also lead to unintentional harm to others (the severe changes to how we now prescribe opiates for chronic pain patients is a good example of harmful policies implemented after thousands of deaths but not due to mainly prescription opiate use but rather due to tainted street opiates).   So what the heck do we do?  How do we make better policies and advocate for more sensible changes?

FSDP wants to influence policymakers to make better policies – after all, it’s in our name!  And we want our policy makers to use sensible, harm reduction strategies to shape those policies (think Portugal). Although this is a staggering task, we appear to be making some headway.  Included in the policies we’d like to see changed are things like offering numerous options for treatment and recovery for those using drugs problematically and their families; including family support as part of every treatment option; having all education/prevention/treatment be honest conversations about drug use – the good, the bad, the ugly – while demanding that scare tactics NEVER be used again…ever!  Another big portion of this conference, and of the work of FSDP, includes stopping our national & ever-increasing use of incarceration as a means to “treat” drug problems.  In many urban areas, jails are the largest providers of treatment to those with addictions and mental illness[7].  Drug and mental health courts may not be much better, depending on their concepts of both drug use/drug users and of the mentally ill, treatment, and especially medications for addiction treatment. Treatment facilities must have better oversight by the State/County/City and Federal governments.  And all providers of that often high-cost treatment services must be held to the same high standards that we now demand of hospitals and clinics treating other medical conditions[8].  We must demand that our policies be based in more than just “evidence-based treatments” and question the proof that agencies are properly using these methods as they often claim.  We must demand the use of objective outcome measures such as Scott Miller’s FIT and Barry Duncan’s PCOMS/Better Outcomes Now[9], both of which are based on measuring the client’s views of their lives and not the clinician’s view which is typical.  And we must demand that family members of problem drug users and drug users themselves be involved in policy setting at every level.  One new motto of this concept was said often at the conference: “If you don’t have a seat at the table, you’re probably on the menu.” Yes!

At FSDP, we don’t claim to have all the answers because no one does.  In fact, I often advise people I speak to about treatment for mental illness and/or addiction that if a professional ever claims to have “the answer”, run!  While it feels good to talk about a single answer, we must remain both optimistic and realistic – meaning we know that there really isn’t any single answer to cancer, or tooth decay, or anything.  What we desperately need is to change the conversation to change the outcomes in treatment in our country.  And while we acknowledge that this means there must be a (small) place for coerced treatments, we want this option to be thoughtfully considered, on a case-by-case basis, and only used after every other option has been exhausted.  So what works?  It depends on the individual!  But one basic ingredient is needed for treatment to have any chance:  love and appreciation.  Jane Peller, a former mentor of mine, used to say, “You must find something to appreciate in every client you work with if you’re going to be successful working with them.”  And love?  When I asked my son why he didn’t become a ‘drug addict’ as genetically and environmentally the odds were stacked against him, he said, “because I always knew I was loved mom.”  That response still brings tears to my eyes (and to Stanton Peele to whom I shared this with years ago).

Too often here in the US (and other places too) we jump to fixing problems using these worst-case scenarios as dramatic examples (see how HORRIBLE things are EVERYWHERE because of ….insert single item) because it feels good and looks like we’re doing something (anything!) to solve some very serious problems.  However, we must resist that urge to implement more Band-Aid fixes.  Instead, we need leaders who are willing to be uncomfortable with not knowing the answers to all problems, leaders who are willing to admit there are no easy answers to be found, and leaders who are willing to try bold strategies such as the harm reduction concepts we advocate at FSDP along with our many incredible partners.  While love isn’t all we need to solve addictions, love is absolutely at the core of what we need.  As the developer of MI has said (when describing what MI is), “[MI is] love with a goal.  Love isn’t all MI is but without it, you’re not using MI!” And without love at its core, treatment can’t work either.  I believe this awareness is the first step (pun intended) forward to address our collective addiction issues in this country – which are many – and that means really seeing people just as they are, not as we’d like them to be; understanding & listening to the backstories of our loved ones and their families to see WHY we are a nation of problem drug users – and being willing to look right into the eyes of the wounded (that’s both the folks using drugs problematically & their families) about what they all need from US to make meaningful and desired changes.    And then?  We need to just listen, intently, and with love.

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Dee-Dee Stout, MA

*All photos courtesy of unsplash.com

You can learn more about Dee-Dee at www.deedeestoutconsulting.com & reach her for comments or questions at deedeestoutconsulting@gmail.com.

[1] Accessed 5.18.19.

[2] According to the website, www.motivationalinterviewing.org, Motivational Interviewing (MI) is defined as “a collaborative conversation style for strengthening a person’s own motivation and commitment for change.”

[3] https://positivepsychologyprogram.com/empathy/

[4] I was living in Midland, MI at the time.  Dr.  Don Crowder was a young psychologist who also attended our church with his family.  Now retired, I found him recently through LinkedIn (I’ve searched from time to time over the years) and was able to thank him for his kindnesses all those years ago.  He was lovely and responded to my note though I doubt he remembered me.

[5] The 6.9 Loma Prieta earthquake shook us for about 12 seconds, hitting the Bay Area at approximately 5pm on 10/17/1989, causing the collapse of part of the Bay Bridge, most of the Marina District, and even a section of the double-decker style Nimitz freeway in Oakland.  The quake occurred during the World Series which was being played in Candlestick Park and televised.  63 people are known to have been killed, thousands were injured, and it resulted in $5.6-6 billion dollars in property damage (equivalent to about $11.3-12.1 billion dollars today).

[6] My mother’s literal last words were to my son.  I’ve always seen her herculean effort to sit up and speak 2 words as her apology and acknowledgement of her love for him and for me.

[7] “In a recent television documentary, the Los Angeles County jail was identified as the largest provider of mental health care in the United States.” http://shq.lasdnews.net/pages/PageDetail.aspx?id=508. Accessed 5/28/19.

[8] While written in 2016, this article is one of many that discuss the problems caused by the lack of oversight in rehabs around the country: https://www.thedailybeast.com/why-drug-rehab-is-outdated-expensive-and-deadly

[9] More on these measurements can be found at www.scottdmiller.com & https://betteroutcomesnow.com respectively.

 

Let’s Honor International Family Drug Support Day on February 24!

Welcome to the February 2019 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.

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This month, Dee Dee, with her exuberance and energy, explains why International Family Drug Support Day means so much to so many of us… 

Join us in honoring International Family Support Day on February 24, 2019!! Please follow us on Facebook and check out our website at fsdp.org for more information.

Hello everyone and happy 2019!!

I’ve had a remarkably busy start to the New Year as perhaps some of you have as well, meaning there was no blog for January.  My apologies!  As the Lunar/Chinese New Year just passed, it seems a good time to discuss the new partnership between FSDP and Family Drug Support Australia.  Having attended the engaging and insightful training in NYC with Tony Trimingham (www.fds.org.au) at Dr. Andrew Tatarsky’s Center for Optimal Living site, I want to speak about the work of both these organizations as we prepare to commemorate International Family Drug Support Day (2/24).  This date is important to Tony personally as this is the date his own son, Damien, died of a drug-related overdose in 1997 (see https://vimeo.com/249347700 for more from Tony).  Each year Tony and his team have chosen a topic on which to focus.  This year it’s #SUPPORTTHEFAMILYIMPROVETHE OUTCOME.

31 years ago when I began my journey into traditional recovery, there was family support built into the rehab I entered.  There was even a program for my young son, Jesse, though that program was an additional fee.  But the Family Program, which met every Saturday during my treatment stay, was vibrant!  In those days, the family was too often seen as part of the problem however (think “enabler” and “codependent”, labels I would never use today though many professionals still do).  Today we know that family[1] support is crucial to long-lasting change to happen for those with problem alcohol and other drug use.

Families have lacked support in their struggles and in daily living with those they love with problems using drugs (including alcohol).  International Family Support Day is one way to highlight the need for families like outs at FSDP to not only be recognized and heard but also supported and encourage to speak out regarding their concerns and their needs, including the needs of their loved ones with problematic drug use.  One saying that I love is this: “If my family member had died of cancer or heart disease or a car accident, neighbors would be bringing me a casserole.  Not so with addiction.”  We at FSDP say we want to see casseroles!

One of the biggest and fastest growing areas of family work in addictions is the notion that abstinence doesn’t have to be the final goal.  In my world, I call this Harm Reduction Recovery™ (HRR).  Recovery without abstinence is entirely possible but it does require thinking out of the norm!  HRR can be a goal to itself or perhaps it’s a stepping stone on one’s path to abstinence – or something in between.  Families see that the most important first goal is keeping their loved one(s) alive.  That means for many families, requiring that they throw their loved one out when they exhibit the very symptoms we want them to seek treatment for is no longer an option.  As my aunt (who’s taught me a ton about families, addiction, and harm reduction) said, “He’s my child.  I’m not going to be able to sleep at night worried that he’s not only using drugs but now he’s alone on the streets.  I don’t need more to worry about; I need less.”  More and more families are speaking out against easy “solutions” like exiting their loved ones.  They’ve come to the realization that my aunt did:  throwing your loved one out may not be the best solution.  In fact it may increase your own stress and add more trauma to all involved which doesn’t lead to a reduction of drug use.  In fact, it often leads to an increase.  We have learned that the opposite of recovery isn’t harm reduction but rather zero tolerance (and tough love).  And we will NOT enable these concepts to rule us anymore.

Speaking of tough love, refusing to participate in this concept is another area of growth in family addictions work.  We’ve learned through research that many problem drug users are using alcohol and other drugs to soothe trauma(s) they have experienced in life.  Addiction is definitely enabled by, if not always directly caused by, trauma(s).  We also know that having a trauma history can be a barrier to seeking help (lack of trust; fear of others’ judgments; lack of confidence; distrust of healthcare professionals, and more).  Therefore again, if we want our loved ones to seek help, we must be willing to reduce/do away with as many barriers as possible.  Demanding abstinence can be a huge barrier; insisting that problem drug users “hit bottom” is a re-traumatization which also increases barriers.  Families are converging and demanding better for their dollars from rehab providers and other professionals.  We at FSDP are behind them all the way!

Families for Sensible Drug Policy (or FSDP) was founded by Barry Lessin, a therapist working in the addictions field, and Carol Katz Beyer, a mom who lost 2 of her 3 young adult sons to drug-related overdoses.  She knows a thing or two about what it’s like to change your approach to drug treatment/rehab and drug users!  As we head into International Family Drug Support Day (IFDSD), here are a few things Carol and the gang at FSDP want you to know about this special day:

The objectives of IFDSD are to:

  • Reduce stigma and discrimination for families and drug users (bring on the casseroles!)
  • Promote family drug support services for families and friends (all treatment needs to include all players)
  • Promote harm reduction strategies for families and friends (no more tough love or zero tolerance)

In addition, the following issues will be highlighted around the world by all participating in this event:

  • Establishing the important role of FDS and FSDP volunteers in providing family support in the US, Australia, and the world
  • Reducing fatal and non­fatal overdoses from drugs including pharmaceuticals
  • Promoting the widespread availability of naloxone
  • Promoting greater inclusion of family members in the decision-making process for families experiencing problematic drug use
  • Promoting greater support and resources for treatment services for those who want it and need it – and appropriate alternatives for those not yet ready

For more on what you can do in your area – or if you have an idea of your own – please contact Carol Katz Beyer at carol@fsdp.org.

The take-away:  please join us this year on February 24 to honor International Family Drug  Support Day in any way that feels right to you.  I’ll be lighting my candle that night for all those using drugs problematically and their families of chance and/or choice, as well as those lost to this complicated condition we call “addiction”.  I’ll also be saying a “thank you” to my son, Jesse Lee, my late former husband (Bob) and my late in-laws (Rhett & Faren) for their constant, unconditional love and support while I developed a path to recover me.  I’m also lighting my candle for my friends who were with me in the beginning and those who are with me now and those who will be with me in the future.  Without them all, I would not be here and for that, I will always be grateful and will continue to work for the voice of all in addiction to be heard and honored. Support the Family, Change the Outcome.  It’s a recovery revolution and the time is now.

[1] Let me define “family” here:  One type is the family you’re born into which I call your “family of chance.”  The other is the one you create which I call your “family of choice.”  Sometimes they are the same of course.  The important point is that you need not have a “family of chance” present, but you must have a family of choice then.  All humans need community in some form as we are social beings.  How much and what kind is up to the individual.

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PLEASE SUPPORT OUR FAMILIES!

September is Recovery Month: Reinventing Recovery

 

Welcome to the September 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.

In the first of a series of our Fall 2018 blogs, since September is Recovery Month for SAMHSA, this seemed the perfect time to write about the word, or concept of, “recovery” specifically as it’s typically applied in substance use disorder (or “addiction”) treatment.

September is also the traditional “back to school” month and many of us have kids who are returning to school or perhaps young adults transitioning to college. This is a good time to to review constructive ways to talk to our kids about alcohol and other drugs, and also to take a new look at treatment, drug policy, binge drinking. and how to negotiate the holidays  Therefore, for the remainder of 2018, our blogs will take a look at those topics and more. See you next month! #recoverywithoutabstinence #stopthestigma #familiesmatter

And now our 2018 “Recovery Month” edition:

Reinventing Recovery

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Photo by Toa Heftiba from unsplash.com

Usually when we hear (or often use) the term “recovery”, it has a very specific meaning: nearly always 12-Step oriented, abstinence-only based, and says to us this is a disease you’ll have forever. I want to definitively make the case for a new kind of recovery in the world of addiction(s): an “inclusive v exclusive” recovery that does not require the elements we’re used to – including abstinence – but whose definition can certainly contain it …and so much more. 

Recovery. It’s a truly loaded word (pun intended). Let’s go on a bit of a journey to see how and from where our concept(s) of recovery stems as it’s a word that comes with a lot of baggage, both positive and less than positive.

According to etymonline.com, the origin/first use of the word “recovery” comes in the mid-14th century and meant “return to health.” “Recovery” originates from the Anglo-French word “recoverie” meaning “remedy or cure.” The additional meaning of an “act of righting oneself after a blunder, mishap, etc.” is from the 1520’s. Could this also be at the root of the word having such moral implications?

In his July 2014 article for Psychology Today, well-known addiction expert, author and former Harvard Medical School professor, psychiatrist Dr. Lance Dodes discusses some of the problems we have with the word “recovery.”[1] In part, he sees the word as acceptable in the context of “recovering from a medical illness”, meaning that 1) relapse/lapse is normal, and that 2) one is headed toward a cure or an ending of the condition/illness. Quoting from the article, Dr. Dodes says, “In most of life, ‘being in recovery’ means a person is making progress even though s/he isn’t ‘cured.’” This is far different than how we too often hear the word used in addiction treatment circles or our greater culture. In both places, “recovery” typically means that one is abstinent and attending a 12-Step group – “working the program” to use the language of AA for example. This is meant to establish an “us vs. them” quality: you’re either attending meetings, working the Steps, and have a sponsor so you’re “in recovery” or you’re not and therefore you’re not in recovery. Black or white; right or wrong. Plus, the implication is that anything short of a 12-Step traditional recovery means you’re not doing recovery “right.” A lot of people – including many professionals – believe this is what the word means and ONLY what it means. I, too, believed this for a long time.

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photo by Danielle MacInnes for unsplash.com

I went to residential treatment here in Oakland, CA, in the late 1980’s. These were the “salad days” for residential treatment, coming on the heels of First Lady Betty Ford openly discussing her addiction to alcohol and pain medications.[2] No one of her stature had ever talked about their alcohol and other drug problems in the US and her “coming out” can’t be understated; it was also a huge step in reducing the stigma/shame for others to seek help for their substance misuse/problems. Finally, this event was also partly responsible for opening the doors of treatment to become the Big Business it is today (more on that in another piece).

In treatment, we were taught that addiction is a 3-fold disease: bio-psycho-social (some also added “spiritual”). It was like a, sleeping tiger, always waiting to pounce on you unless you were constantly vigilant in your recovery (meaning abstinence, attending meetings regularly, and “working a good program.”). We were taught phrases such as, “Your mind is like a dangerous neighborhood: don’t go in it alone” and “Avoid old people, places and things to stay sober.” In other words, 1) don’t trust your own thinking because you’re an addict/alcoholic and “your best thinking got you here”, 2) you’re never fully recovered, and 3) you must cut off all your old friends as they were only using friends and therefore not interested in your well-being; your relationships were only based on drug use. I remember someone saying that everything I had done up to the point of my entering treatment/recovery didn’t count – but now my life could really begin: “Today is the first day of the rest of your life”[3] was up on a wall somewhere. Scary stuff. And I was scared straight.

In what’s known in 12-Step circles as the Big Book (Alcoholics Anonymous 3rd edition), there are several references to the word “recovery” and “recovering” (somewhere around 15) but also references (about 10) to the word “recovered” which is akin to blasphemy today in most 12-Step circles.[4] This is another point of contention for many of us. Can we ever say we’re “recovered” or even “cured?” I say, “yes we can,” to borrow a phrase. And that we should. Why? Because to those outside of traditional treatment/recovery, I hear folks constantly say, “Apparently treatment doesn’t work because you people are never recovered!” I had never thought of the phrase “recovering” as potentially responsible for this perception. I personally say that after over 30 years of continuous abstinence, I am completely comfortable declaring that I’m “recovered;” the problems I have today have nothing to do with illicit drug and/or alcohol use (sometimes that would be simpler, frankly). The first paragraph in Chapter 2 of the 3rd edition of the Big Book titled, “There is a Solution,” also appears to see an end state to addiction. It states: “We, of Alcoholics Anonymous, (italics theirs) know thousands of men and women who were once just as hopeless as Bill. Nearly all have recovered (emphasis mine). They have solved the drink problem.”[5] This passage certainly seems to imply that one can indeed recover. But then what exactly does it mean to recover? And how do we achieve this state of being?

Mindfulness + Connectedness + Inner Growth

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Photo by Austin Chan for unsplash.com

 

A Phrase is Born. While working for the large American HMO Kaiser in the 1990’s, I was charged with developing and leading a relapse prevention track for patients in our Chemical Dependency Recovery Program (CDRP). These were folks for whom the course of treatment we offered (intensive outpatient program or IOP) didn’t work – or, as we phrased things back then, patients who didn’t try hard enough, were in denial of their “disease,” or simply relapsed back into drug/alcohol use due to inattention to “people, place, and things.” During one of our evening groups we were working on a definition for “recovery” and decided to see what we could come up ourselves. After all, we surmised, how can one relapse if you don’t have a clear idea of recovery?

Mindfulness, connectedness, and inner growth was the phrase we all agreed described the basic ingredients for recovery. It wasn’t until later that someone noticed we neglected to include anything about abstinence/sobriety, 12-Step attendance, or the other usual things we associate(d) with recovery. I remember that night well because a gigantic light bulb didn’t just light up, it blew up in my head! This was the moment I began to wrap my head around the idea that perhaps alcohol and other drug use itself – and abstinence specifically – really had nothing to do with one’s healing or recovery; recovery wasn’t in fact begun with stopping drug use first (which is what we always told folks). What was at the core of the concept of true recovery of one’s life we decided were these 3 elements defined here – which may or may not include an end to one’s drug use:

Mindfulness: paying attention – to what you’re doing, who you’re with, what you’re putting in your mouth/arm/throat/etc., really everything that’s happening as well as you humanly can, plain and simple.

Connectedness: this means getting reacquainted with yourself, a vertical connection, we called it – your body, your mind, your spirit – and fully trusting them. This also spoke to the idea that your mind is connected to your body (yes, no matter what Descartes[6] said, they’re attached; it’s called a neck!). This vertical connection could also be to a higher power or great spirit of some kind. Connectedness includes a horizontal connection, too, or connection with others.[7]

Inner growth: this was a bit more difficult to flesh out at the time but we settled on it meaning whatever an individual does that leads to their seeking out new information and new ideas, being a part of the world at large. This could be going to school, walking in the park, dating, making new friends, a yoga practice, meditation, attending synagogue/mosque/church/temple/circle, or even reading. Or anything else that “feeds” a human’s curiosity and need for knowledge.

And that was it. Drug use, abstinence, continued using or something in between, wasn’t mentioned. Why? Because we realized that in any other bio-psycho-social illness (which nearly all are), one did not have to recover perfectly. In fact, in my definition humans cannot do this – at least not all the time. And we realized that it wasn’t the alcohol or other drugs that were at the core of the problems we had: they were but a symptom. [8]

Therefore, one could indeed be in recovery and use drugs. Not problematically because then you’re not connected or mindful or growing. But we agreed (again to our collective surprise) that yes, one could be using alcohol or other drugs – having a healthy relationship with them – and be mindful, connected, and growing internally: in recovery. And we also agreed that for some folks, to have these 3 elements in their lives could require abstinence: total, partial, forever or for a while, we made no comment on those notions. That would remain up to the individual (which also fits within AA/12-Step guidelines of no one being able to tell another that they are an “alcoholic or addict.”). In fact, we realized that having healthy relationships of all kinds could be achieved through these three elements. What a jolt to the brain this was to us all!

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Photo by Ron Smith for unsplash.com

YOU GOTTA GIVE THEM HOPE”, Harvey Milk[9]

These days, I have come to realize that it appears these elements or ingredients of recovery also build on one another: for example, you first need to improve or have some mindfulness about what you’re doing before you can truly connect with others and yourself, and that action can lead to growing internally. And again, we made the argument then which I’ll repeat here, drugs and drug use (including alcohol of course) don’t necessarily impede one’s ability to recover or regain health from having problems with them – or being “addicted.” The problem is in one’s relationship with substances or behaviors that have become problematic or compulsive, and that we continue to engage in despite negative consequences – what we call “addiction.” So here’s the Big Question: what if we as a collective culture decided to work on these 3 ingredients and the issues that get in one’s way of achieving them? What if we decided to help those in need to uncover why they – or collectively, why so many of us in the wealthiest nation in the galaxy – need to use substances in order to cope? Hmmm…

It’s time to reinvent the word recovery to mean this: “I have recovered my life and my health. with or without abstinence. I am mindful, connected, and growing.” Now that’s real recovery!

One of the ways to address these issues of the lack of mindfulness, connectedness, and inner growth is with what the Canadian author, physician, and addiction expert Dr. Gabor Mate calls “compassionate inquiry.”[10] Dr. Mate makes the case for needing people in our lives who can/will listen deeply, compassionately to those of us involved in using substances/behaviors that are causing pain in our lives. Another advocate of doing things differently in treatment is Stanton Peele, PhD, JD. In his newest book on addiction, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The Perfect Program,[11] Dr. Peele discusses these issues at length, as he has for over 50 years. As an early adopter of harm reduction principles, he has tried to get us all – but especially we Americans – to see that the way we have come to view addiction is all wrong: 1) it’s not a disease, 2) most people quit on their own (so how can it be a disease), and 3) not all people are susceptible to becoming addicted. In fact, by viewing addiction as a disease, our society has actually increased the possibility of relapse[12]. It reminds me a bit of Charlton Heston’s famous line at the end of the film, The Planet of the Apes, when he realizes where he really is – back on Earth: “You finally really did it. You maniacs! …God damn you. God damn you all!” In looking for the reasons for addiction, we have to consider that perhaps, unintentionally, we have done much of the damage ourselves with our racist policies, unscientific treatments/interventions, and blaming of the people who use drugs (and often their families as well). It sure is easier to blame a drug(s). It’s much harder to look within, compassionately and deeply, for the reasons so many of us are in pain (of all kinds) and need relief to cope with living.

I see September’s Recovery Month as a great time to take a look at what we’ve done with addiction treatment and recovery. And to take a hard look in the Mirror of Truth about our society and its complicity in addiction(s). It’s time to stop the unscientifically-tested treatment of this “medical-and-more” complicated condition. It’s time to demand professionals who are highly trained and compassionate – always. It’s time to radically change how we view people with substance problems – and their loved ones – regardless of whether you believe this is a condition of their making or not.

It’s time to reinvent the word recovery to mean this: “I have recovered my life and my health. with or without abstinence. I am mindful, connected, and growing.” Now that’s real recovery!

DON’T MISS NEXT MONTH’s EDITION: 

COMMUNICATING WITH LOVE ABOUT DRUGS WITH SOMEONE YOU LOVE. 

[1] https://www.psychologytoday.com/us/blog/the-heart-addiction/201407/what-does-it-mean-be-in-recovery

[2] A Johnson Institute-style intervention was held in 1978 for Mrs. Ford leading her to seek treatment for her substance use. In 1982, she founded The Betty Ford Center which is now part of the Hazelden family of programs.

[3] As discussed in our last piece on “tough love,” the originator of this phrase is the founder of Synanon, Chuck Dederich.

[4] “A Reference Guide to the Big Book of Alcoholics Anonymous” by Stewart C.; (1986). Recovery Press, Seattle, WA.

[5] p17. Note: The “Bill” that is referenced here refers to the co-founder of AA, Bill Wilson.

[6] Rene Descartes was a 16th c. French philosophermathematician, and scientist; dubbed the father of modern Western philosophy who famously argued that the human body and mind were separate. Wikipedia.com

[7] Remember that church I mentioned in my first blog, the United Church of Christ or UCC? There we were taught that God was within each person and living thing on Earth and that we were all connected. Very Deepak Chopra. Hmmm…

[8] Interestingly enough, a similar idea can be found in AA’s Big Book on p85, in this line: “What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” And I was taught that “spiritual” merely meant connected.

[9] Quote from slain San Francisco Supervisor Harvey Milk, one of the country’s first openly gay politicians. This is from a tape recording (1977-11-18) to be played in the event of his assassination, quoted in Randy Shilts book, The Mayor of Castro Street: The Life and Times of Harvey Milk. (1982), p. 277. Wikipedia.com; personal communications.

[10] From Dr. Mate’s website, drgabormate.com: “Through Compassionate Inquiry, the client can recognize the unconscious dynamics that run their lives and how to liberate themselves from them.”

[11] For more information, view the results of the NESARC study and more, discussed in Dr. Peele’s book, p36-42. (2014), Da Capo Press.

[12] Miller et al; “What predicts relapse? Prospective testing of antecedent models.” https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.91.12s1.7.x

“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