Family Matters – Families Matter

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

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

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

relapse recovery word cloud

Relapse/Relapse Prevention: Part 1 of 3
For the Problematic Drug User

Relapse. It’s THE most scary word in addiction treatment, one that we all get nauseous when we hear it, because we all worry about the return of problematic drug use (recurrences/relapse) especially during times of stress for our loved ones with a history of substance use disorders[1]. And right now, we’re in the most stressful time we’ve ever seen. The other word we talk about a lot now when discussing problem drug use and recovery is “connectedness.[2]”  We know it’s one of (if not THE) most important ingredients to successful recovery of any kind and mental wellness for humans. So how the heck do we “connect” and otherwise avoid “relapse” during the worse pandemic our modern world has seen?  And “herein lies the rub,” as Shakespeare (sort of) famously said!

First off, let’s start with a definition of “relapse”.  Many professionals have suggested that we stop using this word as it’s pretty meaningless and very confusing but let’s look at what it typically means. Relapse has been used as a term within addiction treatment for a long time.  Ironically, for a country who claims to see addiction as a disease, we don’t discuss “relapse” in any other medical care:  we usually use the term “recurrence.”  Think diabetes care or cancer, two conditions that are often used for comparison for the disease model of addiction.  We don’t say someone relapsed in/on cancer or diabetes, right?  We might say the condition has reappeared, or there’s a recurrence of the condition or symptoms.  So how did this word get used for this other “disease?”  That’s actually up for some debate as it doesn’t appear to have been first used by the medical community which was originally thought.  Rather, it seems to have come

[1] https://www.drugabuse.gov/about-nida/noras-blog/2020/03/covid-19-potential-implications-individuals-substance-use-disorders

[2] There are many sources for this but here’s one terrific one re: well being in general:  http://ccare.stanford.edu/uncategorized/connectedness-health-the-science-of-social-connection-infographic/

from the moral community during the Temperance Movement.  My background is in Relapse Prevention.  I studied with Terence Gorski[1] and ran many groups on this topic (for Kaiser as well as other hospitals and treatment providers) over the years and my private practice was first called “Relapse Prevention Systems”.  In the mid-1990’s, I even did my Master’s project on Relapse Prevention which is how I became acquainted with the foremost authority on relapse prevention and the author of the first book on the subject, Relapse Prevention[2], the late Dr. G. Alan Marlatt.  Another famous American researcher on addictions, Dr. William Miller (developer and co-author of Motivational Interviewing[3]) also spent a great deal of his career looking at this phenomena[4].  What these men found is truly fascinating and likely shocking to some.  Two predictors appear to highly influence whether a client returns to old behaviors:

  • A lack of coping skills
  • A belief in the disease concept of alcoholism (emphasis mine)  

Wow.  Surprised by that last one?  Many of us were – and still are frankly (and I’ll write more on relapse prevention in research specifically another time).  Now today we might add “a lack of connectedness” as one of those coping skills a client (that includes all family members remember) might be lacking.  Professionally, we’ve done a pretty good job of helping clients to learn coping skills.  Every rehab or treatment agency I know of has some group or class in coping skills training. But perhaps we’re missing something here.  During a private conversation I had years ago with Dr. Marlatt, we discussed what might still be missing in relapse prevention as people in treatment typically have at least one recurrence of their old habit/behavior in their long-term recovery/change if not more.  He said he believed it was likely this (paraphrasing due to my memory of the exact quote): “We’ve done a great job of teaching coping skills to folks.  What we haven’t done such a great job of is helping folks learn how to pick up those skills when they need them.”  In fact, at the time I recall we hypothesized that Motivational Interviewing might be a helpful bridge to this skill of picking up one’s coping skills v picking up the drug!

How about the physical side of relapse? Let’s look at cravings for drugs for a moment.  In some ways, you can think of cravings for drugs as a symptom of distress and certainly of withdrawal from drugs (I’ll assume we can all relate to the feelings of sudden distress especially right now).  Gorski calls these symptoms “Post-Acute Withdrawal Syndrome”[5] or PAWS.  I came to recognize this “constellation of symptoms,” as we call any group of symptoms, as basic symptoms of nearly all generalized distress/anxiety symptoms – and even as symptoms of trauma*:

  • inability to think clearly
  • memory problems
  • emotional overreactions or numbness
  • sleep disturbances
  • physical coordination problems
  • stress sensitivity

This makes sense since you could certainly think of detoxifying from any drug as a state of distress, and not just of the body but also of the mind and one’s world (bio-psycho-social).  Hmm…

*To the other family members:  you too have PAWS!  We’ll talk more about your symptoms and recurring behaviors/habits as well as what you can do to ‘HHALLT’[6] your own less healthy behaviors and turn your reactions into responses.

So much of recovering one’s life – or building a new one – is about new behaviors, which is definitely where a lot of the distress comes from.  The conversations we hear in our heads often goes like this:  Can I make these changes?  Will I ever have a life I can be proud of?  Will I find work again? Will people find me boring/will I be bored?  What will people think of me if they discover I’m a former drug addict (whatever term you’d like to use here)? Who will I be without drugs like alcohol?  How will I ever have fun again? I remember saying all these things and more many, many times.

social distance queue at drugstore

Right now we’re practicing social distancing which is completely necessary to protect us all.  And at some point we’ll be back to our more usual social events though perhaps we’ll never be quite so nonchalant about things such as hugging strangers and even shaking hands will folks without quickly handwashing or using sanitizer.  The world is likely to be different from here on which means the world for those of us recovering from problematic drug use is going to be too.

How exactly will this affect those of us in recovery?  That remains to be seen.  I had a brief call with a young client today who’s currently in rehab.  He complained that they can’t attend 12 Step meetings right now which is what he knows he needs to stay away from using drugs:  not necessarily the Steps but definitely being connected to others.  And he’s not even a little bit interested in using video platforms.  So, what will folks like him do?  Hopefully not get a good case of the “fuckits” (we’ll discuss this more later in the series).  Gratefully many of us in the professional world have been providing telephonic sessions or using video platforms to provide services and many of our clients are comfortable with the technology.  But it is a change for many on ‘both sides of the couch’.  I’ve found more clients willing to use these platforms at least for now.  But for those professionals and our clients who can’t see a steady diet of using technology instead of live meetings of all kinds, we need to stay at home, go out only to get groceries or necessary products, and vow to make this as short and safe a “sheltering” as possible.

And if you, like my client, are already in treatment or a family member is, you all may be the lucky ones right now:  there’s no cooking/food concerns; no wondering where you’ll  sleep; no need to work right now; and you have people around you to connect with at any time.  For others who are wondering how to keep their behavior change changed?  We’re just going to have to adjust for now.  For some folks that may mean not trying to stop or reduce their drug use right now.  In those cases, I would suggest using “best practices” for whatever drug (including alcohol of course) you may be using (some online resources can be found in this footnote[7]).  There’s a lot of information to be found online and many of us professionals are offering free brief support services to provide a bit of information or listen/talk as needed to support someone in need.  Some other ways to chill the distress?  How about learning or practicing more regular meditation (which has been found to be beneficial with just 15 minutes of daily practice!)[8]?  Or how about taking a free course online?  Try Coursera, The Great Courses Plus, or Open Culture for free University courses online. Or an exercise class?  My daughter-in-law did an online dance class in LA recently and said several thousand people were online!!  AA has always offered telephonic support (I did the overnight shift for several years once a month) and all support groups now have something available online (see the footnotes for some information to get you started). And finally, nutritional health is extremely important right now! (here’s a link to a recent study on nutrition and anxiety to get you started[9]) And think of it this way?  In an online class of any kind, you can be anyone you want and never have to say a word!  There are benefits to being online – real anonymity!

daisies reaching up to sun

Finally, if you can, reach out to others.  There are still some ways to do this safely for many of us and helping others helps us feel connected and improves self-esteem[10].  So if you’re healthy and able, consider working or volunteering to pick up meals or groceries for folks (check with your local food banks, shelters, Uber/Lyft, and more). Most of us can still go outside and walk which I’m encouraging all my clients who are able to do so.  Walking around the block may not be quite as interesting as being at the seashore, or in the mountain trails or deserts but maybe you’ll find a new appreciation for your ‘hood:  smell the flowers (yes, Spring has come in spite of COVID19), wave at neighbors (keep that 6’ distance of course) and check out your local businesses to support in some way, both now and later.  Beauty is truly everywhere if we look for it.

staying safe

So, stay safe and sane during this time and find novel ways to connect.  Stay informed though take breaks from whatever news you watch/listen/read.  Find an old friend to say hello to – or make some new ones online.  Or just binge your favorite shows!  My family and I are going to have a meal together this week via FaceTime:  we’re going to cook in our separate kitchens and then sit down together to chat about what’s happening in our lives that isn’t virus connected.  We’ve even considered picking a topic to help us stay on track of something interesting or fun and not just complaining!  Whatever you do, do it with a splash of humor and lightness. We CAN do hard things and – this too will pass.

Cheers!

Dee-Dee

Reach me at deedeestoutconsulting@gmail.com or www.deedeestoutconsulting.com

Stay tuned for Part 2:  Relapse & Other Family Members & Part 3: Ch-Ch-Ch-Ch-Changes, coming soon!!

[1] https://www.cenaps.com/

[2] Relapse Prevention, Second Edition: Maintenance Strategies in the Treatment of Addictive Behaviors 2nd Edition.  Marlatt, GA & Donovan, DM. (2007).  The Guilford Press.

[3] Motivational Interviewing, Third Edition: Helping People Change (2013).  Miller & Rollnick.  The Guilford Press.

[4]This is just one link to an article on RP by Dr. Miller. https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1360-0443.91.12s1.6.x

[5] https://www.facebook.com/GorskiRecovery/posts/post-acute-withdrawal-syndrome-what-you-need-to-knowby-terence-t-gorskipost-acut/202822603165503/

[6] Borrowing from a 1980’s addiction treatment mnemonic, HALT, one of my RP groups & I lengthened HALT into HHALLT:  Pay attention to these intense feelings: Hunger, Hurt, Anger, Loneliness, Lust, or being too Tired.

[7] These are just a few FREE online services: https://hams.cc/support/ support for abstinence, moderation, drugs including alcohol; https://erowid.org/ for info on psychedelics; www.moderation.org ; https://www.smartrecovery.org/; http://aa-intergroup.org/; https://anypositivechange.org/resources/ for resources on safer drug use. Also for anxiety/depression, check out my former TA/colleague Jeremy Prillwitz’ group at therapy@leoralerba.com .

[8] Here’s 2 studies but there are others:  https://www.psypost.org/2019/06/study-15-minutes-of-meditation-associated-with-similar-effects-as-a-day-of-vacation-53798; https://www.psypost.org/2020/03/daily-meditation-decreases-anxiety-and-improves-cognitive-functioning-in-new-meditators-after-8-weeks-56198

[9] https://www.psypost.org/2015/01/diet-nutrition-essential-mental-health-31312

[10] Here’s one resource for this information but there are many:  https://umatter.princeton.edu/respect/tools/self-esteem

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.

cactus

“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]

flower2

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.

donald

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 February 2020 Blog Dee-Dee Stout, MA

Families Matter/Family Matters February 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.

Capture

Good enough.  I don’t know about all of you, but I stopped making New Year’s resolutions years ago.  For me at least, they seemed just another way that I was saying to myself, “you’re not good enough”.  And of course, we know how poor the outcomes are for those resolutions: according to one survey, only 8% of us follow through and successfully complete out resolutions[1]. Ouch!  However, this doesn’t mean I don’t have goals, or as I’m calling them now “a direction I’m headed right now.”  Yes, it’s more cumbersome but it lands better on me.  So what direction am I headed in 2020?  The Land of Good Enough.  And I’m not talking only in actions but mostly about getting OK with being “good enough” in all areas of my life.  This may not sound very challenging but it sure is to me – and apparently also to several others with whom I’ve mentioned this topic.  And why is that?  Well, that’s part of what we’re going to explore in this New Decade’s Family Matters/Families Matter blog.

2020 is perched on a precipice of many important as well as disastrous moments in our lives:  climate crises (now occurring horribly in Australia as I write this); elections including the Presidential this fall; racial & faith killings; further drug use crises & legalizations of (more) psychedelics; the coronavirus outbreak, and more.  So how does this concept of “good enough” help us through these and other challenges?  Let’s find out together.

I can’t recall when or where I first heard the phrase “good enough” but I’m pretty certain it was in something I was reading related to parenting.  The general idea was that we are all unable to be perfect parents so perhaps embracing the concept of simply being “good enough” would be a positive move.  Think of this as “harm reduction parenting”! Somehow, the author seemed to be saying, we need to let go of the need to be perfect parents as this is utterly unattainable anyhow.  So what if we looked at that in relation to other areas of or lives too?  Perhaps it’s due to my age now but I’m exhausted from trying to please everyone else:  parents, children, students, even clients sometimes.  And I don’t mean to suggest that embracing “good enough” means I am giving up on gaining new skills or learning.  Not at all.  To me, accepting I am “good enough” is the only way to make change.  It was the brilliant psychotherapist and theorist Carl Rogers who said, “The curious paradox is that when I accept myself just as I am, then I can change.[2]

This is true of us in recovery especially.  If I can only see what needs to change, I will get overwhelmed at the huge task in front of me.  That will likely lead me to feel more stressed out which will likely lead me to increase my use of those old habits/behaviors that are causing me & others pain.  It’s a vicious cycle.  Where I think we get terribly confused is in the word “acceptance”.  We seem to think that if we accept where we or someone else is, it means I agree with the behavior, that somehow I’m saying, “sure keep on doing what you’re doing; it’s ok with me!”  Nothing could be further from the truth.  The truth is we humans aren’t terribly adept at holding two competing ideas at the same time, what some consider to be the definition of “critical thinking.”

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

heart

I’m working with a family right now (the parents and the son) who’s oldest son has struggled with chaotic drug use for some time.  After hundreds of thousands of dollars spent, numerous types of treatment (some truly terrible, they now understand) and countless hours with me, things seemed to be in a pretty good place.  Then the bottom fell out:  he overdosed.  Thanks to Narcan, he is alive. Things went well again for a brief period and then again, his drug use got out of control.

In another family, the son did well this semester only to suddenly drop out this semester.  The had tried a new therapy and was really hopeful even after more trials of medications than either of us can count in the past 5 years.  But now, with yet another “failed” attempt, his depression has returned.

These are familiar stories to most of the families I work with and hear from, but also from their loved ones chaotically using substances.  It’s tempting to get angry and frustrated, or to even want to quit trying (me too as I’m also human!).  But what we really all need to focus more deeply on in scenarios such as these is that we’re all doing the best we can in some pretty awful circumstances.  And we definitely need to have more compassion for each other, along with some ‘radical acceptance’ of the reality of all our unique circumstances.

“Believing that something is wrong with us is a deep and tenacious suffering,” according to the book jacket of Tara Brach’s remarkable book, “Radical Acceptance.”  She goes on to discuss the trap of our habits that often occurs, calling it “the trance of unworthiness.” I love that idea:  I’m in a trance and that’s why I’m having such a hard time making a change!  And after all, if I’m not worthy of change, why should I bother?  I know that’s how I felt during my 2 decades of troubled drug use.  And I had lots of people around me in their own trance unable to see me as anything but a damn drug addict.   It wasn’t until I had people who deeply believed in me and my ability to make change – and managed to get my own tiny amount of acceptance of where I was – that I was able to begin to recover from a lifetime of pain.  It wasn’t quick nor without pain but I wasn’t alone and I had purpose in my life again.  So how do we start this practice of self-acceptance?  There are several ways of course and I encourage you to seek one or more that feels good to you.  One that I’ve just become aware of and use myself as well as with clients is something fairly new called “Mindful Self-Compassion.[3]

“Mindful Self-Compassion” is a way to “[learn] to embrace yourself and your imperfections [and] gives you the resilience needed to thrive.”[4]  Why do so many of us have such a difficult time loving ourselves?  I suspect much of this comes from our false belief that loving oneself means thinking we’re perfect or better than others.  Or perhaps it comes from the seemingly nearly universal idea that if we’re loving ourselves, we’re self-centered or selfish.  Nothing could be further from the truth!  Self-compassion, according to Neff & Germer, has none of these traits.  And in fact, they argue that if we can’t learn to love ourselves compassionately, we also can’t do so for others.  It’s also just good for us: “Individuals who are more self-compassionate tend to have greater happiness, life satisfaction, and motivation, better relationships and physical health, and less anxiety and depression.  They also have the resilience needed to cope with stressful life events such as divorce, health crises, academic failure, even combat trauma.”[5]  We don’t have the research yet but I’d say it’s safe to assume that cultivating mindful self-compassion would also lead to better parenting and possibly even reduce the need for medicating ourselves so much (for me the term “medication” includes prescription drugs as well as illegal substances used problematically).

breathe

So how does this translate in relationships to others?  Neff & Germer believe that there are “2 types of relational pain:  connection, when…people we love are suffering, and disconnection, when we experience loss of rejection and feel hurt, angry or alone.”[6]  They believe that we are each responsible in part for each other’s emotional states, which they call “emotional contagion.”  This of course flies right in the face of those of us taught that we are ONLY responsible for our own emotions and NEVER for others (they are responsible for their own feelings).  Perhaps we got that one wrong?  In the meantime, let me share with you my favorite brief meditation that I’ve used for more than 20 years.  It is in the lovingkindness tradition so fits with our discussion of Mindful Self-Compassion and can be used as way to take a “Self-Compassion Break”[7] the next time you find yourself upset with someone, including yourself:

With your eyes open or closed, in any position you are in though sitting is generally thought best (but I use this walking & even while driving).  Repeat the phrase below 3 times and between those repetitions, breathe deeply in through your nose (holding briefly) and exhale through your mouth.

[8]May I be filled with lovingkindness

May I be well

May I be peaceful and at ease

May I be happy*

(*A suggested substitution here if you find “happy” to be too uncomfortable or challenging right now, use the word “kind to myself.”)

lovewhoyouare

Now I’m not going to suggest that these ideas of radical acceptance and mindful self-compassion are easy for most of us to attain.  I’m constantly practicing these concepts.  But I do best when I’m able to accept where I am and appreciate that I’m doing the best I can right now:  sometimes that’s great and other times, I struggle frankly.  What I’ve learned in my 6-decades plus of life is that I’m not alone and if I keep actively working on these notions of mindfulness and self-acceptance/compassion, I am able to feel like I really am “good enough” some days.  And that’s definitely a positive change.  That also seems like a “good enough” place to begin for this New Decade.  Join me.

 

Happy 2020!

DD

deedeestoutconsutling@gmail.com

www.deedeestoutconsulting.com

 

 

All images courtesy of unsplash.com

[1] https://finance.yahoo.com/news/many-people-actually-stick-resolutions-214812821.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAIQ_LjZjZKDh5IS6cLk99vcJy7ccHqZ-nekHQEYlSjWWoodJzCrPYCVy7agi8zV5u3IVgQg5iPY6qFzA1hSTjukhnAktz9jeKj0oyFWxWJfYMsEuBzoxmTPGK-BcMOcyR-AkIAEtkDnCed8TB99shKGMRrvI94ZXibZZpXhG20n8.  Accessed 1.23.2020.

[2] From “Radical Acceptance” by Tara Brach. Bantam Dell, 2003. P24.

[3] “The Mindful Self-Compassion Workbook”.  Kristin Neff, PhD & Christopher Germer, PhD.  The Guilford Press, NY.  2018.

[4] Ibid. p1.

[5] Ibid.

[6] Ibid. p130.

[7] Ibid. p34.

[8] From “A Path with Heart” by Jack Kornfield. Bantam Books, 1993. Jack Kornfield is the co-founder of Spirit Rock in Marin County, CA. www.spiritrock.org.

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.

Screen Shot 2019-11-25 at 1.04.14 PM

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.

Screen Shot 2019-11-25 at 1.04.25 PM

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!”

Screen Shot 2019-11-25 at 1.04.39 PM

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/

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)

 

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.
IMG_6574

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.
Screen Shot 2019-05-30 at 3.42.42 PM

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.

Screen Shot 2019-05-30 at 3.45.59 PM

“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.

Screen Shot 2019-05-30 at 3.48.21 PM

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.

 

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.
IMG_6574

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:

startrek

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…

change

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.

flowers

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.

peter

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

desert

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.

 

 

change

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…

adventure

[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/