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

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/

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.

 

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

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

IMG_6574

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

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

Hello everyone and happy 2019!!

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

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

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

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

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

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

The objectives of IFDSD are to:

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

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

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

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

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

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

HandDonate

PLEASE SUPPORT OUR FAMILIES!

FSDP Brings Australia’s Family Drug Support Model to the United States

Our families have a vital role in the development and resolution of how substance use impacts their home—for far too long our families have not been afforded the opportunity to engage as active participants and problem-solvers.50556292_2514971128519511_2200632244790362112_o

Last weekend, January 11 to 13, 2019, presented an exciting opportunity for Families for Sensible Drug Policy and the Center for Optimal Living to embrace a new paradigm of support for families impacted by substance use when we welcomed the founder of Australia’s Family Drug Support Tony Trimingham, who led a sold-out weekend workshop training for attendees from across the US in the Family Drug Support model. Family Drug Support USA brings  innovative non-judgmental, peer-led support groups with solutions and strategies that encourage self-empowerment by recognizing each family as unique.

50767670_2514977328518891_849438153398812672_o

The workshop was in two parts: On Friday night was “Support The Family Improve The Outcome”, an introduction to the Family Drug Support model providing an in-depth overview including harm reduction tools and coping strategies.Saturday and Sunday was a two-day intensive training, which afforded participants an opportunity to work directly with Tony in an experiential workshop learning specific skills using harm reduction principles and the psychological approach of motivational interviewing to deliver support to those in need.
50463165_2514972238519400_1803922097232150528_o

This long awaited milestone for FSDP will provide our families with an opportunity to  access much needed community support and connection based on what families need, expect and experience. This model of support helps families better understand and strengthen the connection between ourselves and loved ones who use substances. The peer-led support groups present viable alternatives for families to explore potential solutions and coping strategies.

Our commitment to making the family voice heard will continue on February 24 as we bring communities together to commemorate International FamilyDrug Support Day,  a global event which aims to highlight the need for families impacted by substance use to not only be recognized and heard, but to be supported and encouraged to speak about their concerns and needs in drug policy.

50303827_2514978361852121_8070260557254492160_o

Holy Holidays, Batman!…Or Ten Ways to Get Through the Holidays

HandDonate

PLEASE SUPPORT OUR FAMILIES!

Welcome to our Holiday Special Blog, the December 2018 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout.

This month, Dee Dee, in her own inimitable style, shares some essential tips to navigate the holiday season in empowering ways…

To join our growing community of enlightened friends and advocates sign up here now.

Hello all! Here we are at the end of 2018 – and of my blogs for this year! Thank you all for your support and your readership! I have truly appreciated all the comments and shares over these past few months. And I’ve discovered just how much I love to do research on these topics!

In the past five months we’ve talked about the dangers and origins of Tough Love; recovering the word “recovery;” and Harm Reduction strategies for families. I know I promised 12 “Ways to Get Through the Holidays” but you know, I found myself doing only 10, perfect for counting on both hands! I hope you won’t be too disappointed. Most importantly, remember our 2018 take away for all families and their loved ones through this sometimes treacherous time:

It really is all about the love – and love is never tough!

love tree

So, who knows what the new year will bring. I know I’m eager to see 2019 and I haven’t felt that way in a long time. For the New Year, what ideas and suggestions do you have for new topics and conversations? Please write to me at deedeestoutconsulting@gmail.com and let me know. See you all next year!

Holy Holidays, Batman!

element5-digital-462736-unsplash

Xmas trees

Holidays. I love them and hate them.

And regardless of which camp you fall into – or perhaps you’re in the “in between” camp – the winter holidays can be a challenge to navigate, especially when there’s added drug use (yes, I mean that tasty eggnog or rum punch too) by many involved. As I sit here with all my research and ideas in front of me, it occurs to me that I can’t think of anything to add to an incredible list of “do’s and don’ts” already available all over the internet and social media.

But that said, perhaps it’s worth revisiting some ideas with a “reduction-of-harm-to-all” bent – and so here goes (OK to sing your fave holiday tune along to these 10 tips, too. Ho ho ho!).

1. Eat light

One of the best tips we can use is to save those heavy conversations for another time. Sure, there will be exceptions to this, but the holidays are already such a heavy meal in so many ways that experts suggest benching the Big Convos until after things have settled down, including our stomachs. So what’s one thing we can do to lighten the mood?

Perhaps we can simply focus on the positives this season and save the less positives for later. That’s a tip for all seasons according to CMC’s 20 Minute Guides for Parents & Partners. What do we mean by this? Think of finding positive things – called “reinforcers” – to say to your loved ones – family, friends, and those using drugs problematically. And here’s why: “The value in reinforcing positive behavior…is that it can start to compete with the reinforcing effects of drugs and alcohol. In essence, your [loved one] can learn to “feel good” in other ways rather than using drugs/alcohol.”[1]

John Gottman, the famous couples therapist, has stated that we need a “magic ratio” of 5 positive statements for every 1 that we make to someone. Dr. Gottman and his team successfully predicted divorce with 94% accuracy in 700 couples 10 years after scoring their negative-to-positive responses in one 15-minute conversation.[2] That’s pretty darned “magic” indeed. We see similar results in workplace conversations as well. So lighten up on the negatives and accentuate the positive statements this holiday season. You might see a greater gift than you ever expected

2. Hang out in the bathroom

This is something I suggest to those trying to reduce or eliminate their drug use as a place to be alone and use a quick meditation. (side note:  I realize that for some this can also be a triggering place for both families and their loved ones using drugs so like all good suggestions, please use your discretion as to whether any of these are right for you). But this is also a terrific exercise for anyone to use for a quick fix. This exercise is known as “The Ball and Triangle.”[3] I learned it from the developer, Terry Gorski, back in the 90’s. And it can be done anywhere, with your eyes open or closed. Here it is:

To start, take a deep breath in through your nose and out through your mouth, like a big sigh. Now imagine there’s an equal-sided triangle floating in space in front of you. In one corner of the triangle there’s a small ball, just sitting. On your next inhale, move the ball up the side of the triangle. On your exhale, allow the ball to fall back into its original place. Do this until you feel as relaxed as you desire.

There are many ways to get creative with this brief meditation too so feel free to experiment; make it your own.

3. Just like real estate: it’s all about location, location, location

One thing that I hear from families and their loved ones is that the location of the festivities is important. Some places encourage nostalgia though may also bring up tension. It may be helpful to discuss the location of events with the whole family. See how everyone feels. I have found with my own family that eating out at a local restaurant can be wonderful: a) everyone’s food intolerances can be honored; b) most folks will be on their best behavior when in public and finally c) no one has to do the dishes! Perhaps grandma’s or dad’s special chocolate pecan pie at Aunt Cristina’s house can be an alternative.

4. BYOB: Bring your own bottles

Even if you’re not the one with the drinking/other drug problem, it might be a good idea to limit your intake. The very best way to do this is to first, bring your own fave beverage. I’m a big fan of Pellegrino so typically carry a couple of bottles with me (I even bring a baggie of lime slices). That way I know what will be served. If you’re moderating your drinking especially, it’s really important not to get dehydrated which is easy to do in a heated room with booze. So experts suggest drinking water between alcoholic beverages. Again, an easy way to reduce your intake – and possible help stave off a nasty hangover too. Be sure to eat something as drinking on an empty stomach is never advised. Also food will help to absorb some of the alcohol which will keep your overall blood alcohol levels down. Finally since alcohol is known as a “social lubricant” for good reason, you might consider who you’d like to be in charge of your emotional state during this event (see # on Lizard Brain). But if you want to indulge more than usual, remember the previous tips and to call Lyft this holiday season. It’s so easy not to drive while intoxicated now – and expensive to get caught.

pup and mistletoe

5. Find support where you can

Hug your pet. See old friends. Go to a meeting at a support group, or a service at your local synagogue, church, temple, or mosque. Volunteer and make new friends. Lots of ways today to stay in touch with others even if only through social media. Visit someone in a nursing home or senior housing. Take a plate of cookies to a neighbor you’ve never met because you’re working all the time (no, they don’t have to be homemade).

6. Like a good photograph, mind your exposure.

If you’re spending time with those that irritate you, do so gently. It’s OK to limit the time you’re with those you love. This is your holiday, too.

7. Rest when you can

For many of us, the holidays are an expenditure of more energy. Sometimes more than we can muster! So resting and sleeping well are crucial to having the outcomes we want. You can think of rest as our body’s need to regenerate its resources to allow us to think before we eat, act, or wind up somewhere we didn’t want to go. I’ve learned that I can’t engage my mind when it’s running on empty, which leaves me with Lizard Brain[4] in control. Now I’m OK with old Lizard Brain having some fun once in a while but not all the time and especially not when I’m going to be in an emotionally challenging situation

8. Cravings aren’t just for drug users

Yes, you heard me right! I like to think of cravings as the body’s way to say “Holy crap, Batman, I need something – help!” The difference for families is that there aren’t any medications for your cravings (and yes I know there aren’t meds for all chemical cravings too but let’s ignore that for now). You may have physical or emotional cravings for all sorts of things from food to the latest mystery to taking a ski weekend in Banff. Whatever it is, it’s just possible that your body/mind is trying to tell you something. We want to learn from our emotions and not be afraid of them or ignore them. We all know the holidays are overfilled with stress so perhaps we can take a page from relapse prevention for drug users and learn to “urge surf”. Here’s how to do it[5]. And you can keep your eyes open or closed them as you find most comfortable:

First, think of something in your real life that’s challenging for you, something that actually triggers some strong emotions (be gentle with yourself here though. Nothing too tender please!). As you think about this challenging behavior or event, imagine that you’re NOT reacting in the moment with that usual strong emotion (you’ll be responding to the situation soon). As you’re thinking about this event, be mindful of where you’re sitting: how does it feel? Are you comfortable? Plant your feet gently and firmly on the floor if you’re sitting. Let your breath gently come in and out of your nose and notice the rising and falling of your chest/lungs. Now once again, think about the triggering circumstance. Really see yourself there at the moment and bring yourself right up to the moment that you’d typically lose your temper, or be overcome with sadness, or even use a drug/take a drink. Here we might think it’s a good idea to push away these strong emotions or swing the opposite way and give in to the emotion/behavior. Instead, I’m going to ask you to just be curious about this emotion and event without reaction. Ask yourself these questions: 1) what does the feeling really “feel” like? Where is it located in your body? 2) what about this situation/feeling feels intolerable? Can you stay with it and relax into it rather than get overwhelmed by the situation/feeling? 3) what is it you really need right now?

Finally, imagine that the feeling your experiencing is a wave on an ocean. You’re riding this wave like a surfer, using your breath as your surfboard. All you need to do right now is focus on your breath going in and out of your lungs and imagine that surfboard riding the waves like Bethany Hamilton! You’re able to keep your balance in spite of feeling a little frightened. Up and down, in and out, you’re riding your board; you’re not allowing the wave to push you off. This is “urge surfing”.

When you begin to feel relaxed and able to respond instead of reacting to a situation or feeling, you can let the board bring you home. Notice how you were able to ride the wave and not succumb to its power but rather allow it to be what it is: just a wave…and it will end. When you’re ready, come on back to the room while you let go of the triggering situation you were thinking of. Take a few deep cleansing breaths and know that you’ve got this! Bethany would be proud!free hugs

 

9. Ho, ho, ho!

I always encourage humor and lots of laughter during the winter holidays (actually I encourage it all the time!). Laugh till your face hurts. Be silly as often as possible. I read a piece recently on a family holding an “Ugly Christmas Sweater” contest with the winner getting a gift card to a favorite store. Wonderful idea! We humans are a pretty funny lot all in all and this is the perfect time of year to embrace that.

Movies are another great way to bring laughter into a room and there are some terrific old and newer holiday films that will make you pee your pants (in my family, it’s “A Christmas Story” hands down!).   Anything from “The Grinch” and “Charlie Brown Christmas” to “Bad Santa” and “Die Hard” are considered holiday fair game. Or perhaps you’re the sentimental type and look forward to watching your favorite heart-wrenching, tear-jerker each holiday. No problem! Those films are available as well (anyone for “It’s a Wonderful Life” or “White Christmas?”). Just be sure to temper those tears with some belly laughs

10 The holidays are a trip!

And they are literally for many of us! Traveling these days can be a trial-by-fire experience. Some quick tips: 1) Only use a carry-on bag 2) Bring something to read/watch/play and 3) slow down on imbibing early (planes really suck the moisture out of every part of us and alcohol makes it worse). For more excellent tips on everything “travel” this holiday season, check out Cheap Flights Survival Guide: www.cheapflights.com/news/holiday-season-travel-survival-guide

Bottom line for the season: Do your best, let go of the guilt/shame, and have as much fun as possible. That sounds like a pretty good recipe for 2019 to me, too. In fact, I think I’ve just found my 2019 New Year’s resolution. How about you?

chinese lanterns

[1] The Parent’s 20 Minute Guide by CMC: Center for Motivation & Change. (2016) Center for Motivation & Change. NY, NY. p93.

[2] https://www.ocde.us/PBIS/Documents/Articles/Positive+$!26+Negative+Ratio.pdf. Accessed 12.18.2018.

[3] https://terrygorski.com/2014/05/08/magic-triangle-relaxation-method/. Note: the Ball and Triangle exercise is now called the Magic Triangle Relaxation Method. Accessed 12.18.2018.

[4] The limbic system aka Lizard Brain is the seat of our emotions and the oldest known part of our brains.

[5] Bowen, S, Chawla, N. & Marlatt, G. (2011) Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician’s Guide. Guilford Press. NY, NY.

Introducing “FSDP Presents”: A Podcast Brought to You By Our New Partners at The Social Exchange!

HandDonate

PLEASE SUPPORT OUR FAMILIES!

FSPD is excited to announce our partnership with The Social Exchange, a brainchild of the brilliant Zach Rhoads and Aaron Ferguson.

26233524_10103289292747830_6908264666812993265_oThe Social Exchange interviews the world’s leading intellectuals about a variety of social topics: addiction, social science, philosophy, and many more.  Zach is a masterful interviewer and through their podcasts they offer listeners cutting-edge information about each topic.

What’s refreshing and unique is that there is no rule that the conversations are agreeable or comfortable. However, each conversation is guided by an honest, information-seeking style of dialectic. On The Social Exchange, ideas are challenged, people are respected.

As part of the partnership, FSDP will have the opportunity each month to select an FSDP community member to be interviewed on the podcast on a segment called” FSDP Presents”. We’re proud to have Glen Carner, Licensed Mental Health Counselor  from Hawaii as the inaugural podcast guest. Glen has a paradigm-shifting outpatient addiction counseling program, Family and Addiction Counseling LLC  that uses a collaborative harm reduction approach that coordinates care for his clients with relevant community supports whenever possible. As you’ll hear in the podcast, he blends his expertise with unbounding enthusiasm and a passion to work with individuals and families impacted by substance use.

You can hear the podcast here and learn more about Zach’s work with The Social Exchange on their Patreon page here.

NEXT UP ON “FSDP PRESENTS”: Kenneth Anderson, a pioneer of alcohol harm reduction and Founder of the HAMS Network: Harm Reduction, Abstinence, and Moderation Support.