Families Matter/Family Matters, Family Drug Support Day 2020 Edition!

Families Matter/Family Matters Family Drug Support Day 2020 Edition!

Welcome to the February 2020 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout.

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“No one has ever hated themselves into being a better f***ing person.”

— Vinny Ferraro, Co-Founder of DharmaPunx

Tough love.  It isn’t a new phrase; it’s also one that we’ve discussed here before.  But it felt like it was time to return to this still too often-used phrase as we celebrate International Family Support Day on February 24th and honor those who have died – and those who have survived as well as those who struggle still – and brought us here.  And I hope you’ll bear with me if I repeat myself in this piece though I’m hoping to discuss some new points too since it’s been nearly two years since I wrote the original blog on tough love (that 2-part blog can be found here from Summer 2018).  Thanks in advance as always!

I recently came across the quote I used at the top of this blog.  And I fell in love with it!  After all, isn’t this the point?  I mean, we professionals have been saying that “tough love” is necessary because it’s necessary to hold people responsible for their actions, to make them a better – more mature – person.  In reality, first of all, tough love has nothing to do with love.  We can certainly say that sometimes loving someone is tough, or that we need to have alternatives or options (some call these “boundaries” which is OK though I’d argue that this word has been co-opted by us professionals, like “enabling”, and now is just another over-used phrase designed to shame people who use drugs or other less socially-acceptable behaviors) to have relationships with many of our loved ones, whether they’re using drugs or not.  That’s simply a way to have healthier relationships in general.  And there’s no absolute right or wrong here either which is tough.  Simple binaries are so much easier!  I also fully appreciate that saying to ourselves, “I need to have boundaries!” seems to be the right thing to do or say especially when we’re talking about people we love who have also left us feeling exhausted and worse when trying to find a way to have a relationship with them that doesn’t also kill us.  I’ll only say one more thing about why I find this concept of boundaries a mistake:  when I say “I need to have boundaries” I’m usually focusing on the negative, what I won’t do for you versus looking at options, or what I am willing to do (I’ll give some specific examples of how to provide options later in this piece).   I also need to say upfront that my suggestions may not be right for you and your family; only you can make that decision.  That doesn’t make my ideas right or wrong, just simply not a good fit for you.  That’s OK.  In fact, it’s good that you know what’s best for your situation – what’s doable – for your family. This leads us to what drug treatment (or any professional help) needs to be for individuals and the rest of their family members:  individualized.  And that means just that – no manuals designed to fit anyone; no experts on what works; no rights-or-wrongs for everyone.  Just deep listening to people to help them determine a what’s-best-for-them-right-now, one possible course of action.  And I do mean “one possible course” as we all also need to be flexible because the only constant in life is that all things change, right?[1]

When dealing with someone who is using drugs in a less than healthy way (yes there are healthy ways to use any drug), here are a few ideas we harm reduction professionals suggest to improve conversations with members of our families who use drugs in a less healthy, problematic way.

  1. Breathe!  I know this sounds silly but I’m not kidding.  When humans get stressed out, one of the first things that happens physiologically is that we start to do more shallow breathing. It’s part of our instinctive and protective stress response system (think, “there’s a Saber-toothed Tiger out there waiting to eat me!”).  But we can learn to override that instinctiveness by practicing some simple breathing techniques when things are going well or are calm (doesn’t help to practice when things are stressed if you haven’t already figured that out ).  Here’s a simple one that I try to teach all my clients:

Breathe in deeply through your nose, hold for a moment,

then exhale through your mouth.  Repeat this at least 5 times

and each time practice lowering your shoulders

and relaxing your facial muscles, arms, and legs.

Note: If you’re still stressed, try adding this:  rub your hands together briskly until they get warm (when our hands are warm it fools our body for a moment into thinking it’s more relaxed.  That’s why folks are more relaxed at the beach, for example, in the sunshine than in the cold and rain).  Then repeat the above again until you’ve relaxed.  Please remember we’re not going for complete relaxation as that wouldn’t honor the reason you’re stressed in the first place (maybe you really do need to be afraid even if it’s not of a tiger).  Rather, try to go for stress-less.

  1. Don’t freak out. When we discuss our loved ones using drugs – especially kids/young people – (and please remember I mean ALL drugs including alcohol and tobacco), we tend to lose it.  And that’s understandable because we’re scared for our loved ones.  Sometimes literally scared for their lives.  So, here’s another to look at their drug use.  First of all, it can be helpful to remind ourselves that most people, some 80-90%, “mature out” of using drugs problematically as other things in life become more important (such as a job, or other responsibilities of life). This typically happens by age 25-30 for most people.  Secondly, ask yourself, “Would I be this upset/scared/angry, etc if they were snowboarding, or hang gliding, or driving race cars?”  In other words, try putting their drug use into the same mental category as any number of other risky behaviors that society usually tolerates or even praises.  Got it?  Good!  Now I’m not suggesting that there’s absolutely nothing to worry about.  No one has a crystal ball to see the future so we’re all guessing on this one. I just want to be sure that our emotional state is in proportion to the actual risk of the behavior, not our belief around whether drugs are good or bad (they’re neither as they are inanimate things which aren’t capable of such thoughts), or that any drug use is a risk for addiction (it’s not).  Perhaps it would surprise you to know that in the midst of an opiate crisis in many parts of our country, more parents call drug/addiction help lines scared for their child’s use of cannabis than any other drug, even though it’s now legal in many states[2].  While I certainly appreciate the concern, I’m more concerned generally about young peoples’ use of alcohol than any other drug including opiates (though again this all depends on the individual and even the area/State they live in).  As of 2019, 88,000 people died from alcohol-related illnesses.  This makes alcohol misuse the 3rd leading cause of preventable death in the US.[3]  However, when it comes to adolescents, I realize that their deaths from alcohol and/or tobacco will likely come later in life so we tend to dismiss it (for now) and focus more heavily on opiate misuse (and with some good reasons of late).  However, binge drinking is common amongst youth – especially on college campuses – and may lead to not only alcohol poisoning (which can be fatal) but also to impaired thinking regarding driving safely, sexual encounters, suicide risk, and more.  It’s not that opiates aren’t a problem; we just need to not forget about alcohol’s misuse – and other drugs – when we discuss problematic opiate use.
  1. Talk first. So many people I work with come to me with all sorts of reasonable concerns about a loved one’s behavior.  When I ask, “And how has your loved one responded to your concerns?” all too often I hear, “Well I haven’t brought it up; I’m afraid they’ll get upset with me.” Many parents will even ask me questions about a session I had with their child even when the child is in the room with us all.  I’m not judging these parents at all.  I’m simply saying that instead of practicing tough love, where we need to “toughen up” is on ourselves, to be willing to have these difficult conversations with those we love.  And with groups like Family Drug Support, CRAFT, and SMART Recovery for Families, we have better ways to learn to communicate with each other and especially with loved ones whose behaviors are scaring the bejesus out of us.  To provide an example from my own life, I recently had occasion to have such a difficult conversation with my son Jesse and daughter-in-law Cristina.  Bless her for her willingness to be the facilitator as it’s always more challenging to do so with your own family!  We spent several hours all total (which I normally don’t suggest, BTW) and here’s a few ideas on how we did our “challenging conversation” (and please, this isn’t shared to compare or to suggest you should things this way but rather to simply demonstrate how ours went as an example.  And my points are on reflection too, not what we’d purposefully laid out first though I’ll certainly hope this deconstruction may be of help to others as well as ourselves for our next conversation):
  • Warm up: We’d already talked by phone and decided that we’d have a first conversation when I came to Los Angeles (LA).  But Jesse also asked that we do something relaxing and interesting to us all beforehand.  For us that was a trip to Pasadena to the Huntington Gardens[4].  Jesse and I had been there when we lived in LA when he was a teen but that was a long time ago.  As they’re preparing to landscape their (mostly) reno’d LA home, this was something that we could do together, in public, that had a secondary purpose (relaxation) and was in a neutral place.  So, I guess you could describe this as a “safer environment” to ‘warm up’ for the later conversation we’d agreed to have (I’m now thinking of this as similar to warming up one’s muscles prior to a challenging work out).
  • Ask for help. Second, we had someone outside the family of origin facilitating.  Again, I’m in debt to my daughter in law for her taking on this role.  While she’s certainly part of the family (and has been for 5 years now) and has been witness to some of the tensions between Jesse and I, she has not been around since the start of those tensions nor been a part of them.  This is also where professionals can be helpful as long as they don’t have an agenda beyond enabling your conversation in as safe an environment as possible.  We had discussed (and contacted) a couple of professionals to possibly help us with this conversation but found for our schedules, it just wasn’t feasible (we had to reschedule my visit 3 times as it was due to all our schedule changes and this was my own last opportunity to go down to LA for several months).
  • Be realistic. Realize that everything is not going to be fixed nor all discussion concluded after this talk.  We left the conversation acknowledging that more work needed to be done, with each of us having items to individually work on.  While we didn’t set a specific date to return to this (again, schedules!), we did say it would generally be within the next 6 months.  That was more realistic for us than setting an actual date right then.  Being realistic AND committing to getting back to the conversation is better than trying to force everyone into something.  We also all needed some time to decompress and think about the conversation we’d just had.  It was very emotional and a real challenge to have -and we did it anyway.  We are all capable of doing hard things, especially when we know we’re not alone and we’re loved by the people we’re talking to!

And what could we have done better? One place we will improve for next time is on limiting the time for the conversation.  I believe we went too long.  We were all exhausted afterwards, had difficulty listening deeply by the end, and were a little more apt to take things personally as a result. I usually advise families when having family conversations to limit it to no more than an hour at a time, and sometimes even shorter.  I also suggest limiting the topic to one or 2 at the most.  It’s better to discuss one thing well in 15 minutes than to try to fit everything in that you’ve been wanting to discuss (sometimes for years by this point) in an hour or more.  While the sentiment is appreciated, in reality it often becomes overwhelming to everyone.  And this feeling can be dangerous for those of us who use drugs problematically since if the conversations becomes too great of a stressor, we will be tempted to turn to drugs to alleviate some of those uncomfortable feelings.  Folks have even been known to overdose at times like this (this is also a usual occurrence in 12-Step fellowships after members do their “4th Step”[5] for instance.  More on that another time) due to using more than usual as their heart rate and breathing are increased along with other events.[6]

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4. The Bouquet of Options. In the book Motivational Interviewing[7], Drs. William Miller & Stephen Rollnick describe offering clients a “bouquet of options” regarding behavior change.  Think of this as a buffet not a prix fixe dinner.  So in families, the challenge is to come up with alternatives to tough love.  I love to say to clients, “OK so I know what you’re NOT willing to talk about/change, which leaves me curious about what you ARE willing to discuss/change at this point.”   It’s the same in families.  Maybe you can’t let your loved one live in your home anymore. I get it.  So what CAN you do?  The statement to your loved one might be something like this: “Your mother/father/whomever and I love you very much and we really want you to know that.  And we know that you’re doing the best you can right now & that you’re much more than a drug user!  We are going to need you to find another place to live right now because we’re just not OK with illegal drugs being in the house.  But, we’d be happy/delighted/willing to help you find somewhere else to live because we want you – all of us – to be as safe as possible.  Would that be helpful? Or perhaps there’s something else you can think of that would be helpful that we can discuss?” The idea is to state your love first (possibly including that you do see your loved one as more than their behavior, no matter what that behavior is), that you appreciate their use of drugs is complicated and with reason(s), and that some specific behavior is making you or others feel less safe and so can’t continue.  Then you offer an idea of what you ARE willing to do and suggest that you’re willing to negotiate other options as well.  This does NOT mean that you are obliged to do whatever they ask; your obligation is simply to listen.  And sometimes this approach doesn’t work.  However, in my experience, family members generally feel better with this approach both about how they interacted with their loved one and that they had more to offer them than simply to say “no” or threaten.  This approach also leaves the door open for everyone to bring new ideas back to the table.

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5. Love smarter. This is probably the biggest takeaway from all our conversations on Facebook and in general at FSDP and Family Drug Support[8].  I’ve often advised my training attendees and students to “work smarter not harder” (thank you to the cartoon character Uncle Scrooge McDuck, who was the first one I ever heard say this phrase).  And this will mean different things in different environments, absolutely.   For me, in part, it means speaking up about things that others do that hurt me or that I don’t like.   But it also means stopping for a moment to consider that, if they’re an adult, I don’t need to like everything my loved one decides to do, whether that’s drug use or not going to college.  So then the conversation with myself is “how do I love this person and show that AND disagree with some of their life choices?” Frankly, it’s easier to just cut people off.  Any alternative to tough love takes hard work, conversation, and may still turn out badly.  There simply are no guarantees in life (except death),

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

—Sir Patrick Steward as Capt. Jean-Luc Picard, Star Trek TNG

And so, on this International Family Support Day 2020, I hope you’re finding some options for you and your loved ones whatever behaviors/changes you all are trying to make!  And if I may, I’d like to remind us all that trying is doing – something.  It’s also in the trying that all long-term change begins so let’s all try more!  We’ll pick up more on that idea in the Spring Edition.  Cheers!

Dee-Dee

www.deedeestoutconsulting.com

All photos courtesy of unsplash.com

 

[1] Paraphrased from Heraclitus, Greek philosopher. https://plato.stanford.edu/entries/heraclitus/

[2] In part this is due to the false claim we as a country made many years ago that marijuana is a “gateway” drug.  This research was found to be flawed and we have since retracted this claim though many people are not aware of that. Here’s one source but there are many:  https://www.drugpolicy.org/sites/default/files/DebunkingGatewayMyth_NY_0.pdf

[3] Accessed 2.12.20:  https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

[4] https://www.huntington.org//

[5] Step Four in AA is “Made a searching and fearless moral inventory of ourselves.”  This is often followed immediately with Step Five, “Admitted to God, ourselves, and to another human being the exact nature of our wrongs.” Twelve Steps and Twelve Traditions (1987ed), AA World Services. NYC.

[6] “Drug, Set, Setting” (1986) by Dr. Norman Zinberg, MD discusses this concept and more.

[7] For more on this evidence-based conversational method, go to https://motivationalinterviewing.org/

[8] https://www.fds.org.au/about-us

Families Matter, Family Matters — Holiday Edition 2019

Welcome to the Holiday 2019 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.

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The Holidays.  The holidays are difficult to navigate even for the bravest and happiest of us.  People we may only see once or twice a year, foods we may eat rarely, and discussions that can be fraught with emotion are all on the list of possible “menu” items.  In my family, we toggled between two sets of grandparents (gratefully in the same small town) with a carefully navigated schedule crafted to not upset anyone, to be equitable with time spent at each locale, and to provide consistency for us youngsters.  Thanksgiving at one site one year, at the other the next.  Christmas Day with one set of grandparents, Christmas Eve with the other.  And New Year’s Eve was spent at various locations with the next morning mostly spent at either uncles’ as they or their wives were in charge of making the traditional New Year’s Day abelskivers as part of our collective Danish heritage.  Whew!  But it worked as I recall.  Of course, I also wasn’t the one schlepping kids and gifts and food back and forth all week!

This year my family (son, his girlfriend, and me) has decided to “postpone” Thanksgiving due to flight costs and frankly, all of us are pretty worn down from loads of travel for work – grateful and tired!  So, we’ll do something next month as all our schedules settle down for December. I’ve known some families who leave the States completely both for warmer climes and as an excuse to not engage in the mandatory family get-togethers which (for some) too often devolve into rambunctious excesses of alcohol, explosive conversations, and food they can no longer tolerate in their healthier lifestyles.  But what if you want/need/must attend some gatherings for the holidays?  Can we navigate these potential landmines better if we plan in advance?  Yes!  We can!  And so with that positive statement in mind, here’s some ideas for building a new Roadmap for a Happier Holiday.

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FSDP’s Top 5 Suggestions for Smoother Sailing during the Holidays

  1. Limit the alcohol served.  Now I’m not suggesting you can’t have any yummy holiday punches and outrageous cocktails, but I do suggest that everyone drink mindfully – even if that is to excess. Being smarter and safer with alcohol is just that:  smart and safer!  Have non-alcoholic beverages available for folks even if everyone is drinking alcohol.  One of the less good things about alcohol is the dehydration that occurs.  So having some fun sparkling waters can be an aid – and maybe reduce that morning headache a bit.  Plus there are so many incredible alternatives to alcoholic drinks today as more people are moderating their alcohol intake or not indulging at all:  seedlipdrinks.com, curiouselixirs.com, rockgrace.com and www.tostbeverages.com all have incredible non-alcoholic beverages that can look like the real deal.  Also, having a glass of something without alcohol between alcoholic drinks can be a smart move – and make the night (and your money) last longer.
  2. Have a breathalyzer at the door. Really!  Available at most drug stores and Amazon (ranging in price from $20-$130; check out this buying guide for more: https://bestreviews.com/best-breathalyzers), these home breathalyzers aren’t perfect but they’ll give the “blower” an idea of how intoxicated they might be (sometimes just seeing a number will convince Aunt/Uncle Pat to consider giving up their keys).  Partner this with a cheery holiday basket for the car keys of anyone who doesn’t plan to monitor their alcohol (or other drugs) use.  Put a colored tag on each with name, car type or license number, as well as cell numbers in case you need to move their car (street cleaning!) or so they can easily collect them the following day after taking a Lyft/Uber/cab/ride share home.
  3. Eat before you indulge. We know that food can absorb alcohol so be sure to eat some carbs and fat before you drink (yum:  avocado toast!!).  This can help you feel like you’re participating in the holidays while also drinking smart.  If you’re hosting this year, be sure to have some snacks available with your delicious cocktails!  You’ll appreciate folks eating a bit beforehand when they’re a bit less uninhibited at the dinner table!
  4. Watch the conversations. Instead of letting conversations just organically occur, what about trying another way to shape those potentially treacherous talks at the holidays?  Recently I bought a few “topic card sets” to use in trainings and with clients.  Here are a handful of examples from each and the companies they came from (though you can check Amazon for a ton of suggestions which you can then purchase wherever you like):

For provocative conversations:

(from Q&E Provocations for Applied Empathy by SubRosa at wearesubrosa.com)

What makes an experience meaningful?

Who has challenged you to be better than you once were?

What motivates you to progress?

 

For generally deeper conversations:

(from Big Talk at www.makebigtalk.com)

What is a new habit you want to form?

What are you thankful for this very moment?

What advice would you ask for from your greatest hero?

 

For more fun/funny conversations:

(from We! Connect Cards at www.weand.me)

What is a fun experience that you have recently had?

What are you passionate about right now?

What are people usually surprised to find out about you?

 

Or for more family of origin-oriented fare

(from TableTopics Family Gathering at www.tabletopics.com)

What’s the best story you heard about your grandparents/parents/aunt/uncle?

What do you remember about the homes your family has lived in?

What’s your favorite family story?

Or make up your own set of cards.  That way you can have even more confidence that your conversations will avoid any “hot topics” that you know of.  Or as folks come arrive, have a bunch of blank cards with colorful pens at a table and ask everyone to write a question or statement topic on a card. Put those in a festive box and pass it around at dinner or afterwards.  Go through the cards before you use them to hand select out any statements that you think might be too provocative or triggering.  Even some that I’ve listed here might be too much for some folks to answer.  Allow anyone to take a “new card” if they don’t like the one they drew, or they may ask for a new one to be drawn if one person is drawing – and don’t make them give a reason for passing on the chosen card.  You get the idea.

  1. Get naloxone! While Narcan can’t reverse all overdosing (such as methamphetamine or alcohol) many illicit drugs these days contain a bit or a lot of fentanyl or one of its analogues.  Therefore, even if the person you love says they’ve used meth or cocaine only, if wouldn’t hurt to give them Narcan™/naloxone if you notice the signs of overdose[1]. One of my fave new sayings is “Naloxone only enables breathing!”

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The holidays are not the time for heavy conversations in my opinion.  Those are best left either before or after such events, and with some practice and feedback from a professional, a friend, or anyone you trust to tell you the truth.  However, some conversations may need to happen before the holidays.  If you have a family member or friend who recently had treatment of some kind for a substance use disorder, I say be direct:  ask them what you can do to make the holidays more inviting and safer for them.  That doesn’t mean you’ll be able to do what’s asked, but that person will feel better just for you having asked!  All too often people simply assume what moderators/abstainers need and want to help support their recoveries.  People are different so individuals should be considered.

For the rest of the family, try not to walk on eggshells around your loved one who may still have a problem with alcohol or other drugs.  And you all may decide that the holidays just isn’t the right time to all get together.  It may be too “loaded” for everyone (pun intended).  If that’s the case, make a new tradition:  plan a separate small holiday just for a small group of supportive people.  For those in new recovery or who are struggling with drug use, being confronted with lots of people can be overwhelming and lead to more drug use for comfort.  Hopefully there will be other holidays that you all can have together down the road.

Happy Holidays Everyone, whatever you celebrate….and see you in 2020 with a new blog!!

-Dee-Dee Stout, MA

All photos courtesy of unsplash.com

[1] For a terrific article on opiate/opioid overdose, see https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/recognizing-opioid-overdose/

JOIN US for Beyond Binary: Rethinking Cannabis and Solutions to the Overdose Crisis!

⏰ Friends in the NYC area, SAVE THE DATE for Beyond Binary: Rethinking Cannabis and Solutions to the Overdose Crisis!

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Tue, November 26, 2019
1:30 PM – 4:00 PM EST

Brooklyn Law School
205 State Street
Brooklyn, NY 11201

Please JOIN US for a not-to-be-missed, illuminating and thought-provoking afternoon at Brooklyn Law School with Harry Nelson, the nation’s leading healthcare attorney and the author of “The United States of Opioids: A Prescription for Liberating a Nation in Pain”; award-winning neuroscience journalist and the author of “Unbroken Brain,” Maia Szalavitz; and harm reduction pioneer, Joseph Turner, the President/CEO and Co-Founder of Exponents!

Our featured experts will explore the interwoven topics of how approaches to the Overdose Crisis are informed by cannabis reform, and the ongoing evolution of policy. The event is FREE and SEATS ARE LIMITED. (Refreshments and snacks will be served!) Sign up now!

Repping the Family Voice at DPA’s Reform Conference!

What:  Repping the Family Voice at DPA’s Reform Conference!

When: November 6-9, 2019
Where: St. Louis, MO
http://www.reformconference.org/
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Why: Families for Sensible Drug Policy will be repping the family voice at Drug Policy Alliance’s Reform conference! Carol Katz Beyer and FSDP Secretary-Treasurer Rory Fleming will both be present to speak to harm reduction advocates across the nation and world about our innovative programs like Family Drug Support! We will also be attending to meet with other Open Society Foundations grantees for an upcoming push in New Jersey to replace tough love approaches with evidence-based public health endeavors and compassionate policies.

Rally to Demand Cuomo Apologize, Sign Lifesaving Bill!

What:  Rally to Demand Cuomo Apologize, Sign Lifesaving Bill!

When: Tuesday, 10/29 @ 11:30  
Where: Cuomo’s NYC Office- 633 3rd Ave (meet at Plaza across the street)
Trains: 4/5/6 to Grand Central   
Why:
Last Tuesday, the harm reduction community held a rally in response to Governor Cuomo’s stalling on signing this lifesaving legislation–the only overdose prevention bill for low-income NYers that passed last session, and with bipartisan support at that. In response to our rally, Cuomo’s Senior Advisor and spokesperson said, “I’ll put this administration’s record of fighting the opioid epidemic against anyone else’s. Spare me the rantings of the Advocacy Industrial Complex and whomever funds them.” 
 
Coalition partners, family members from across the state, and our member-leaders found these statements to be tone-deaf, spitting in the face of the grief and anger we unite around to end this crisis. In response to these statements from the Governor’s office and his continued inaction on signing the bill that would expand access to lifesaving treatment, we are all returning to his office to DEMAND AN APOLOGY THROUGH HIS SIGNATURE ON THE BILL
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Building Communities of Recovery, National Conference & Expo on Sunday, 9/22/19 at the Hilton Atlanta/Marietta, GA!

💊Join FSDP advisory board member, Harry Nelson – Attorney Author, The United States of Opioids and other featured guest luminaries for the Building Communities of Recovery, National Conference & Expo on Sunday, 9/22/19 at the Hilton Atlanta/Marietta, GA!

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Harry Nelson is a leading expert on America’s healthcare future and is frequently called on to make sense of the most complex aspects of our healthcare system, delivering valuable insights for healthcare providers, government, consumers, employers, and investors. He is the founder of Nelson Hardiman, the largest healthcare law firm in Los Angeles, and advises regulators on the most sensitive and challenging emerging health policy issues. He was one of the first lawyers in the country to develop a framework for compliance in cannabis, helping to shape California law and pushing for expanded clinical research on other plant-based controlled substances, and continues to play a leading role in the expansion of telehealth and machine learning in medicine. He has also played a key role in education and advocacy, including his leadership of the Behavioral Health Association of Providers. https://lnkd.in/eQksTMS

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Click here to REGISTER NOW! https://lnkd.in/eStaX5W

Stand With Safehouse!

Where? U.S. Courthouse, 601 Market Street
Philadelphia, PA 19106

When: NOON, Sept. 5, 2019

FSDP is making the family voice heard loud and clear in front of the U.S. Courthouse in Philadelphia! We are holding a mass gathering and protest on its steps, while the second hearing in U.S. v. Safehouse proceeded inside. The lawsuit could potentially make Overdose Prevention Sites legal, but the U.S. Department of Justice is fighting against proven harm reduction services that have saved lives in other countries.

Carol and FSDP Board Member Rory Fleming are speaking to the people gathered about why these sites are so crucial and why we need them immediately.

safehouse 2FSDP team at Safehouse Philly rally 2019

Fighting Stigma to End the Overdose Epidemic – A Harm Reduction Workshop

In preparation for International Overdose Awareness Day, join the Families for Sensible Drug Policy and the New Jersey Department of Health for an interactive Harm Reduction Workshop!

Date: Wednesday, August 21

Time: 9:00am-2:30pm

Location: War Memorial 1 Memorial Drive, Trenton, NJ

As NJ DOH explains that “Harm reduction is a life-saving, evidence-based public health tool for New Jersey communities.”

FSDP President Carol Katz Beyer will be in attendance and is honored to be representing the family voice at the event. She will join national experts and local leaders about how harm reduction can prevent overdose deaths, reduce drug-related stigma, decrease transmission of HIV and Hepatitis C, and promote the dignity and health of all people with substance use disorder.

REGISTRATION IS FULL. PLEASE EMAIL: HretEducation@njha.com to be added to the waitlist.

FSDP Representing the Family Voice Worldwide!

carol1Families for Sensible Drug Policy is humbled and proud to share the news of a special recognition and milestone! President and co-founder, Carol Katz Beyer is honored and privileged to have been selected to represent the family voice in the 2019 Global Commission on Drug Policy’s annual report!

(Left: Carol with Tony Trimingham, Founder of Family Drug Support in Australia)

Her testimony about losing two of her beloved sons to fatal overdoses was featured [along with only six other people from around the world] to spotlight the harms inflicted upon our families through prohibition and the War on Drugs.

carolThe scheduling of substances directly impacts families by criminalizing and stigmatizing our loved ones who use drugs, while heavily promoting and profiting off of other legal (but dangerous) drugs like alcohol.

The report was presented on June 26, 2019 in Vienna to coincide with the World Drug Report. The full report is now available for download to readers worldwide, and available in six different languages.

 

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Spring and the Cycles of Change!

Welcome to the Spring 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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I have been a Star Trek geek for as long as I can remember.  This infatuation even rubbed off on my son who designed the current World Tour stage for the multi-award- winning mega-band Muse to be shaped like a Klingon Bird of Prey[1].  I never quite understood my fascination with all things alien, watching the new Star Trek Discovery series week after week in tears.  Really??  Crying over a TV show, and a sci-fi show no less??    Well, after some 50 years of dedication and fanaticism, I think I figured it out:

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To borrow a phrase:  it’s the future, stupid.  The past is finished, complete, even if I do mine it reasonably often, still attempting to understand things as they unfolded oh so long ago. There is wisdom that has come from that exercise as well as some futility.  But it’s the future that really does it for me, makes me weak-in-the-knees excited & emotional all at once, like the old roller coaster The Big Dipper in Santa Cruz does every time I ride her.  And the relationships, the dedication, the incredible sacrifice and love emanating through every episode brings my heart into my throat with regularity.  That all makes me desire to keep going – which some days is a monumental feat I will admit briefly – as I see real possibility for us all, the Human Race.  And besides, if a Vulcan can ask for forgiveness (Sarek, in Part 1 of the second season’s finale) who am I to not give such a gift to myself and my families:  both the one of chance and the one of choice?  It appears this is the work of my future, the work of ‘Change to Come’.

And so we’re onto Change for this month’s blog.  And here’s where I’ll begin…

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Change is about leaving what we know behind, jumping into the abyss of the unknown just as a starship jumps into warp drive.  Never knowing what’s on the other side should be exhilarating for me (Remember? Rollercoaster lover?) and yet it’s always filled me with fear & uneasiness.  I’m still here though, alive – as are many others who shouldn’t be – and that’s all due to this thing called Change and those who have ridden this wave with us all.

“Most people never get a chance to learn what’s in their own hearts.  If we figure it out it’s often not what we expected, or even what we would have chosen for ourselves.” 

—Capt. Christopher Pike, 2019; Star Trek Discovery, episode 13

What’s in my heart?  I wondered when hearing this line of dialogue.  As so many others have too, I have studied several religions at various points in my life. My first exposure was as a child when I was baptized in the Congregational church of my maternal grandparents, and then as a grade school-age youngster in my family’s home (in Midland, MI) at the United Church of Christ (UCC) which they helped to build.  I am proud of the heritage of the UCC as a church of social justice and inclusivity.  Even at the height of my drug use, my minister refused my mother’s request that I not be allowed to attend nor teach at the church.  He believed in me and the idea that Change could only happen in a place of love & inclusion.  He also preached that God was not something outside of ourselves but rather inside of each and every living thing.  Finally, he told us that our church was about ‘accepting the unacceptable’ of society (that belief is partly what drew me early on to helping problem drug users ironically).  I also recall as a teen wishing to become Catholic as I saw many of my drug using friends able to attend confession each week which they believed absolved them of their “bad behavior” as well as allowed them to repeat it the following week.  To me, it simply appeared that Change for them was easy[2] – and I was jealous.

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In the pagan Wiccan traditions, every season brings Change of a new variety.  As we leave April and head into May, the Wiccan calendar moves to celebrate the festival of Beltane.  This date is also known more commonly as May Day.  It is a time for birth and renewal:  pastel colored eggs to signify fertility; a Maypole around which songs are sung while long ribbons twirl while celebrants dance around the phallic symbol of the pole, and rituals around fertility, crop blessings, and romance abound.  After a long hard Winter, Spring brought promise to our ancient people’s here; a promise from someone, somewhere, that they had not been abandoned nor forgotten.

I see Change as a promise to us too:  a promise that no matter what, nothing will ever remain the same; all will be well; don’t worry, be happy!  Within addiction, this is ultimately the challenge as there often seems little to be happy about when things turn bad.  When I was using drugs problematically, I see now that a good part of my reasoning was to keep things the same, status quo.  That provided me with ritual, some strange stability, and again ironically, a sense that I always knew what to expect.  As a person with a history of trauma, I yearned for something to keep me centered, something expected.  It’s also what kept me in violent/abusive relationships.  I recall saying out loud finally that I understood that “to know something – even something violent – was better than leaping into the unknown.”  Some people believe that those of us who remain in these violent relationships do so because they’re comfortable, that we become comfortable with the abuse.  I disagree. I say we become familiar with it and that’s the point:  it is better to stay with what we know v be so terrified that Change could be worse.  That’s how frightened we often are of Change.  IT is the enemy.  It is the same with addiction:  fear of Change can keep us from trying something new.

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And this leads me to the topic of families and the people they love who problematically use drugs.  We all resist change to some degree.  To some degree we would rather stay in the status quo, in the familiar, than take a risk into the unknown – “to go where no one has gone before” – or perhaps we’d simply prefer that someone else makes the Change and not us.  But this isn’t how Change works!

Recently a post from my dear friend and colleague Andrew Tatarsky[3] (Board member at FSDP) came through my Facebook feed, which Andy had reposted from a colleague apparently having a conversation with Dr. Gabor Mate, the renowned trauma & addiction expert and author.  Much like my beloved Star Trek it, too, has left me in tears each time I read it.  I hesitate to repost this dialogue here for fear of offending people reading this blog.  But I am going to take that chance and hope you will hear the hope and joy and see the “Way Out” – as our Brit neighbors wittily call an exit – as I unexpectedly did after reading it. Bring the hankies.  Here goes:

“We weren’t quite finished yet. I wanted to know about family members who are dealing with addiction. What can they do for a loved one who’s caught in the grips of active addiction? Because when people are that deep in addiction, they’ve lost themselves—they’re gone in a way. I know I was. I know there was nothing my family could have done no matter how much they wanted to.”

Gabor didn’t agree with me. “You don’t know that. What you do know is what they tried didn’t work, but you don’t know that there’s nothing they could have done. In one sense, you are 100 percent right: There’s nothing they can directly do to change your mind. There’s nothing they can directly do to change your mental status. There’s no way that they can talk to you, advise you, control you, beg you, accuse you. That does not mean there’s nothing they could have done. Imagine if your family had come and said, ‘Chris, here’s how it is. We recognize that your addiction is not your primary problem. Your primary problem is that you’re in a lot of pain. And that pain is not yours alone. That pain has been carried in our family for generations. And we’re as much a part of that pain as you are. You’re just the one who’s soothing it with that behavior. In fact, you’re the one whose behavior shows us how much pain there is in our family. Thank you for showing that to us. So we’re going to start working on you, because we realize that we’re as much a part of it as you are. We’re going to take on the task of healing ourselves. We invite you to be there if you feel like it. And if you’re not ready, sweetheart, then just do what you need to do right now.”

“Families also have to decide, can I have this person in my life, or can I not? If I want them in my life, there must be certain rules, like they can’t steal from me and so on, but if I can have them in my life, I must accept them exactly as they are, exactly where they’re at, and 100 percent accept that right now they’re using because they feel they need to. I’m not going to nag them, cajole them, advise them. I’m not going to say a thing that they didn’t ask me about. I’m just going to accept that this is who they are and I’m just going to love them. That’s a rational decision to make. It’s equally rational to say, ‘You know what? It’s too painful for me. I can’t handle it. I can’t stand to see you do this to yourself. It’s too stressful. I can’t be with that, so I’m sorry, I love you very much, but I can’t be with you.’ That’s legitimate, too.”

“What is completely nonsensical—and unfortunately the pitfall for most families—is to try to be in the addict’s life and try to change them all the time. That’s the one thing you cannot do. So either accept or lovingly distance yourself, but don’t try to stay in there with the intent of altering the other person. To the addict, that signals only one thing: ‘They don’t love me the way I am.’ That’s my advice to families. I do believe that addiction in a person can be a healthy wake-up call for them and for everyone in their lives.” — Dr. Gabor Maté, Dead Set On Living

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Change, especially when we look at addiction(s), sure isn’t linear; not even close.  In fact, even the theorists behind the Stages of Change[4] now use a spiral model[5] rather than their traditional wheel.  Me?  I’ve always seen Change more like a pinball machine, and I’m no wizard:  you know, one minute you’re over here, the next down there, and a moment later, ding, ding, ding!  It’s unknowable, it’s exciting, and it’s scary as hell.  That’s the Change I know…and I am finally just beginning to like Change rather than fear and respect it like an overbearing & abusive parent.  Bottom line:  it always happens whether I like it or not!

If I may, this seems like a good point to insert briefly the 7 Stages of Change[6] (SOC) as they apply to any Change you might want to make, and of course I will provide you with references for more on them if you wish (apologies to anyone in the know here.  Feel free to skip this next part):  precontemplation, contemplation, preparation or determination, action, maintenance, termination & relapse/recycle.  In a nutshell, here’s the definition and task of each stage (please keep in mind that these stages aren’t linear; remember – pinball!!)

Precontemplation:  When my behavior is in this stage it means I can’t see it as a problem so I’m unlikely to see a need for change (think the old idea of denial).  Perhaps my family, friends, or employer is seeing a problem in my behavior.  So here the main task is to increase my awareness of the need to change – to help me/someone recognize that the cons of not changing are greater than the pros of change.

Contemplation:  This is the stage of thinking (insert Rodin’s The Thinker).  I see my behavior as being a possible problem but I’m not ready to commit to making a change.  Ambivalence lives here.  Think of this stage as “well, maybe I should make this change but…”

Preparation or Determination:  When my behavior is in preparation, you’ll know because I’m planning out the needed resources, discussing how and maybe even why I want to make this change.  I might even begin to take baby steps toward my healthier self.

Action:  In action, I’ve moved forward and state my intentions to keep on that path toward healthier living.  Any positive change[7] is the key here.

Maintenance:  Since I plan to maintain my change in this stage, I will need to work on recognizing obstacles and other speed bumps to my continued Change path.

Termination:  For the researchers, this stage was noted by the problem behavior being eliminated for at least 6 months.  This stage is often left out of behavioral health programs (including rehabs) however as many don’t believe this stage is reachable.  I believe this concept deserves review, and that “termination” should be viewed personally and individually.  For myself, I do believe my former addictive behaviors with alcohol and other drugs is done, finis, over with, hasta la bye bye.  I have all sorts of other problem behaviors to continue to work on but not those.  Others will likely feel more comfortable with termination being left out of the Spiral of Change.

Recycle/Relapse:  The researchers decided that the term relapse wasn’t good enough as it isn’t accurate for most people making Change.  This is because to relapse means to go back to the beginning, in this case to precontemplation. And while some people will indeed return to precontemplation, most will instead recycle back into one of the other pre-action stages.

 

 

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Spring appears to have finally come to the Bay area.  While we are all grateful to not have to endure yet another year of horrendous drought, we are equally grateful to get a respite from the torrents of rain that have devastated communities throughout our Golden State recently.  Even as I write this, we are being warned of a touch more showers coming tomorrow, hopefully the last spurts for the wettest April I recall in my 40 years here.  Spring is a natural time to think of change:  flowers blossom; mice mate and dogs give birth; the seasons shift as our little Blue Marble of a planet tilts on its axis once again.  Like the seasons, Change is both predictable and unpredictable at the same time: the only thing we can be sure of is that nothing will remain the same and that Change happens, constantly and without permission.  I can accept that or not but like the moonrise, it will happen everyday in spite of my feelings about it.  So will my Change.  I will continue to change and grow because to do otherwise will be more painful. This I now know for sure.  So, I will make room for the Change in the same way as the philosophical cat Garfield says so brilliantly: “Everything I’ve ever let go of has claw marks all over it!”  No one said I have to Change gracefully.  And I will wait to cry one more time at Part 2 of the final episode of this Star Trek series season to begin my long winter of wait for the next season to begin.  And the next season, and the next Change, will come gratefully – both for my beloved Star Trek and for all of us, if we can just hang on to each other a bit longer.  Let the adventure continue…

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[1] The 2019 Simulation Theory World Tour (www.muse.mu).  The simulation hypothesis or simulation theory proposes that all of reality, including the Earth and the universe, is in fact an artificial simulation, most likely a computer simulation, leading to the 1990s-influenced stage and costume designs. (Wikipedia, accessed 4.14.19; 2019 personal communication with Muse Creative Designer Jesse Lee Stout).

[2] Please do not interpret my comments here as a negative stance on the Catholic church.  This is merely how I saw things as a teen, quite simplistically.

[3] Andrew Tatarsky, PhD is the author of “Harm Reduction Psychotherapy” (Guilford Press) and the founding Director of The Center for Optimal Living in NYC.  He can be reached at http://centerforoptimalliving.com/.

[4] The Transtheoretical Model (TTM) of Change was developed by the Drs. James Prochaska, Carlo DiClemente and John Norcross.  For more, please see their academic websites:  https://web.uri.edu/psychology/meet/james-prochaska/;   https://psychology.umbc.edu/people/corefaculty/diclemente/; https://www.scranton.edu/faculty/norcross/

[5] See “Changing for Good” by Prochaska, DiClemente & Norcross.

[6] There are a lot of good sources for SOC materials.  Here are a few standouts: https://www.lifehack.org/676832/stages-of-change-model; “Changeology” by John Norcross; “Changing for Good” by Prochaska, DiClemente & Norcross; “Changing to Thrive” by Drs. Prochaska.

[7] Thanks to my friend, the late Dan Bigg, founder of the Chicago Recovery Alliance (CRA) for this simple phrase. For more on CRA, go to https://anypositivechange.org/