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

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

“Expectations are resentments under construction.” -Anne Lamott

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

mobile Denise Carbonell flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cheers!

Dee-Dee Stout

deedeestoutconsulting@gmail.com
www.deedeestoutconsulting.com

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

Photo credit: Denise Carbonell, Flickr, Creative Commons license

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

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

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

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

— Vinny Ferraro, Co-Founder of DharmaPunx

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

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

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

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

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

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

and each time practice lowering your shoulders

and relaxing your facial muscles, arms, and legs.

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

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

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

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

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

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

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

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

Dee-Dee

www.deedeestoutconsulting.com

All photos courtesy of unsplash.com

 

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

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

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

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

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

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

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

[8] https://www.fds.org.au/about-us

Repping the Family Voice at DPA’s Reform Conference!

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

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

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

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

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

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

Hello everyone and happy 2019!!

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

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

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

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

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

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

The objectives of IFDSD are to:

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

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

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

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

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

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

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PLEASE SUPPORT OUR FAMILIES!

A Milestone for FSDP: Family Drug Support USA, a Step Forward for Families Impacted by Substance Use.

E9EBF66E-DF9E-4FAE-A784-24EFD7AB8B2AA long-awaited milestone for Families for Sensible Drug Policy of bringing a new paradigm of support for families impacted by substance use occurred last month when Tony Trimingham, founder of Australia’s Family Drug Support, came to the United States and trained our first group of family members and professionals from across the United States at a sold-out workshop in Family Drug Support USA.

Family Drug Support USA, co-hosted by our friends at the Center for Optimal Living in New York City, is a program of innovative non-judgmental, peer-led support groups with solutions and strategies that encourage self-empowerment by recognizing each family as unique. It 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.

We were humbled by the interest of the attendees in learning the model and impressed with their passion and brilliance in their shared experiences. Family members and advocates from diverse communities attended the training to bring the groups home, planting seeds of harm reduction and hope.  It was a remarkable weekend, tangible evidence of our mission to bring communities together to embrace enlightened drug policy–empowering families, restoring health and saving lives.

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.

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.

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Our commitment to making the family voice heard will continue on February 24 as we bring communities together to commemorate International Family Drug Support Day, (IFDSD) 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.

To learn more about what you can do for IFDSD, please…

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.

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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.
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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.

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

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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.

Harm Reduction for Families: Communicating With Love

Adding to our Fall series, welcome to the November 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 shares her unique perspectives on harm reduction’s influence on family communication

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

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Communication.

This is a huge topic which I can only hope to touch on here. But I hope that I can offer some suggestions, look for some possible answers from you all (families) and see what we know in science now.

For more than fifty years, we professionals have made (still make??) terrible mistakes in our advice about communicating with loved ones who use drugs: DON’T BOTHER! We said things like, “All addicts are liars” and “They must hit bottom” and “You need to use tough love with addicts”. We called you all names: codependent, enabler, co-addict/alcoholic. Now don’t misread me here: we’re discussing a family which is a system.

To use the favored metaphor from famed American educator and author, John Bradshaw[1], “families are like mobiles: touch one side of a mobile and the entire piece shifts.” This means all family members must participate in changing in order for change(s) to actually happen. Bradshaw, [2] (who also coined the terms “dysfunctional family” and “inner child”, and some believe ushered in the self-help movement of the 1980’s) used to call the problem a “dis-EASE” with the world. I think that is still one of the best definitions of addiction we have. And it speaks to the trauma that all too often accompanies addiction/drug use. More on that in the future.

So, what does communication in a harm reduction world look like? Here’s an example from Patt Denning and Jeannie Little’s book, Over the Influence[3]:

“You can love your child and kick her out of the house. You can kick her out of the house and pay her rent somewhere else. In these ways you can continue to love and support her and limit the damage she can do to your marriage, your house, and your other kids. In other words, you can make changes in your relationship with your loved one way before you are completely worn out. In fact you should.”

A second example is from the Center for Motivation and Change’s (CMC) booklet, “The Parent’s 20 Minute Guide”[4] (they use the term “parent” to mean any caregiver). In the section titled “Helping with Understanding”, CMC makes the point that the behaviors your child is engaged in (i.e., using drugs) make sense and we parents need to appreciate that relationship that our loved ones have with substances even as we struggle to understand it. Wow, huh? This can be a tough request but here’s why it’s crucial to Communicating with Love:

“Feeling relaxed, exhilarated, less anxious, braver, funnier, and part of the group, are all potential benefits of using substances. If there were no benefits, there would be no use.” (emphasis mine)

This is enormously important for families to understand. Without this acknowledgement, little communication with love can happen. We need to remember that our loved ones’ actions have more to do with their personal reasons for using (the reinforcers) than us. This knowledge can help us to not take our loved ones’ actions so personally and to start to see the reasons for the substance use: loneliness, boredom, social/fitting in, anxiety, trauma, and more. The CMC 20 Minute Guide goes on to say,

“Understanding what your child gets from using can also lower your fear and anxiety, as it makes the behavior less random and more predictable. If he uses to fit in with other kids, then you know he’s more at risk when he’s out socializing than home with the family.”[5]

With this information in hand, strategies can be launched with your loved one and everyone can be invited to brainstorm options when your loved one is faced with potentially triggering social situations.

The Guide also has worksheets, such as the one titled, “Behaviors Make Sense”[6] which is designed for the parents to complete based on their understanding of their loved ones’ reasons for using drugs. I would suggest that these worksheets might be even more effective if completed with your loved one. That way you’re not left guessing about the relationship your loved one has with substances. It also allows for further exploratory conversations to better understand your loved ones substance use (it’s also possible that your loved one isn’t sure of all the reasons they use drugs; this openness to conversation could allow them time to consider why they use a substance(s)).

Denning and Little also provide some excellent guiding concepts for families to use, calling them “Harm Reduction Principles for Family and Friends:”[7]

  1. Promises only cause problems
  2. There are no rules except the ones you make
  3. You cannot enable drug use (unless you are supplying them)
  4. Base your actions on your values
  5. Base your actions on what you can manage
  6. You have triggers too
  7. Any limits you set are about you

I would add a couple of others:

8) Everyone’s doing the best they can so be kind/gentle with yourselves – and with your loved one (it may seem like your loved one cares more for drugs than for you right now but I doubt that’s really true)

9) You probably can’t solve this problem, but you can make it better or worse

10) For change to be successful for your loved one, you must also change

So perhaps now you’re thinking, “OK Dee-Dee, this is all great but is there some research to tell us how to communicate with love?” Yes there is!

CRAFT. Community Reinforcement Approach and Family Training[8], developed by Robert Meyers, PhD (Research Associate Professor Emeritus in Psychology at the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addiction) is an answer. Bob Meyers (full disclosure: I have been trained by Dr. Meyers in CRAFT) came to the field of addiction through his own family’s problems with substance use. He became convinced that there could be a better way to interact with loved ones using substances and focused his research on finding some answers to this lifelong idea. Taking Dr. Nathan Azrin’s Community Reinforcement Approach (CRA) and combining it with his own brand of Family Training, Dr. Meyers developed CRAFT, now an evidence-based therapy.

CRAFT is unique in addiction counseling in many ways. One of the most important, in my opinion, is its focus on “catching people who use drugs doing something ‘right’”. In other words, instead of the main focus being on punishment for misbehavior, CRAFT encourages us to focus on the times when your loved one isn’t engaging in the ‘misbehavior.’ It also supports the idea that drug use (especially problem drug use) doesn’t happen in a vacuum: it happens within a system and all parts of the system must change.

Too often the drug user is seen as the Identified Patient (or Problem aka the IP) and taken off to treatment to make changes which we’re often led to believe will solve all the family problems. However, if the system she is in doesn’t also make changes, how do we expect her changes to be maintained? This is what’s called “magical thinking” (which has sadly been perpetuated too often in my profession); it’s also a set up for failure. All too often treatment does fail[9] too regardless of how much she wants to make a change(s).

Down under, Tony Trimingham, founder of Family Drug Support (FDS Australia), shares some similar ideas in his “Letter to Family and Friends.”:

“When we expect immediate changes and refuse to be with the person during the process we undermine the very goal we seek to accomplish.” [10]

I want to stop here for a moment to reflect on things that I’m suggesting families can do differently – I want to emphasize that I am NOT pointing these things out in order to lay blame. Never. Are there things we could’ve/should’ve done differently as families with loved ones who love drugs? Absolutely. Does that mean we are to blame/responsible for the drug use? Not likely. But we are part of the overall system – and therefore we must be willing to look at our part in the creation of that system of dis-ease we are all in squarely in the face.

After all, isn’t that what we ask people who use drugs to do in treatment? What I’m saying is that when there’s a complicated, possibly chronic condition in the family, it affects everyone, therefore, the solution(s) has to involve everyone. Gratefully we now have more options & suggestions for families than the old “let them hit bottom” and “stop enabling/being codependent.” We can now say, “don’t stop loving your family member!” and “when our loved ones are ill we need to hold them closer.” Learning how and when to “hold them closer” so change can be possible is the challenge. One way of helping us may be to learn more about change in general. How does it happen? How can we help or hinder change? Is it ever successful?image004

We’ve learned a great deal about how people make change(s) in their lives. The researchers James Prochaska, Carlo DiClemente, and John Norcross discovered how change happens back in the late 1970’s which they called the Transtheoretical Model (TTM) or Stages of Change for short.[11] We’ve learned that instead of looking at abstinence as the best or only way to recover or change, incremental positive change may be the best route: “Any positive change” is the slogan the late harm reductionist, Chicago Recovery Alliance founder Dan Bigg[12] who has used this slogan to describe how to view the small steps typically needed to move toward change.

Harm reduction for families at its core is about providing support to help families make decisions that fit their individuality: their values, their needs, their loved ones. It’s about helping families to see that abstinence is one possible outcome but doesn’t need to be the only one – nor is it always the best option for everyone.

For many people, the best way to make change is to go mindfully and slowly, small step by small step, moving closer and closer – with some setbacks – toward the big change you plan to make. Think of how many people quit smoking (side note: The Stages of Change were discovered when the developers/researchers looked at some 1500 smokers). Usually smokers quit on their own, either with or without the help of aids as nicotine replacement (Nicorette gum, inhalers, lozenges; anti-craving medications). Others just stop, cold turkey. But most professionals now will suggest – for those not wanting that “cold turkey” method – a “warm turkey”[13] approach is a good option especially for those who have a difficult achieving their goals with “cold turkey” methods.

The same can be true for abstinence or moderation goals in drug/alcohol use. Families can now Google terms such as “harm reduction for families” and find options that may be more in line with their values/goals and those of our loved ones using drugs. With cannabis legal in more and more states every day, many of us have found that we are looking to this substance to prove helpful in treating addictions (we already know about its usefulness – alone or in conjunction with cannabidiol CBD[14] – in treating anxiety, pain, depression and more for many people). Most families I work with now are more than delighted to have their former problematic drug-using loved one find relief and assistance in some form of cannabis.

Harm reduction for families at its core is about providing support to help families make decisions that fit their individuality: their values, their needs, their loved ones. It’s about helping families to see that abstinence is one possible outcome but doesn’t need to be the only one – nor is it always the best option for everyone. And by the way, one can definitely not be abstinent (defined as not taking any medication/drug) and still be “in recovery.[15]” More and more families are coming to see harm reduction as a better fit for them than the old “hit bottom/throw them out” model as they see the harm that is caused to them and their loved ones by such traditional, zero tolerance policies.

Families have also had enough of the old ways of thinking from my profession – the misinformation/scare tactics, the lack of nuance in treating them and their loved ones who use drugs, the one-size-fits-all approach – even the beloved American disease model of addiction has been challenged by many of the families I see![16] Family work in addictions is at a crossroads: in my opinion, it is the outcry from families that will be the reason new harm reduction policies will be adopted. It is your voices that are the loudest, strongest, and which will be best received since frankly, families are seen as victims of addiction unlike “addicts” (I’m not suggesting this view is accurate or not, simply that it is a reality in our culture). Bottom line: once again it’s about LOVE. LOVE which is the center of positive and healthy communication – and something we can all improve on demonstrating within our families this minute.

So grab one of these books – or perhaps you know of another one that fits your needs best – and start reading and practicing. It’s time for our Family Recovery movement. We must demand better, more from the professionals and other healthcare practitioners. And we must learn to improve our own communication with love.[17]image008

(Note: all photos are from unsplash.com)

Don’t miss next month’s edition:  “Holy Holidays, Batman!!  12 Tips for Enjoying the Holidays in Spite of Everything.”  

 

REFERENCES

[1] www.johnbradshaw.com.

[2] Ibid. Accessed on 9.26.18.

[3] Denning, P & Little, J. (2017). Over the Influence, 2nd Edition. Guilford Press. NY:NY. p221.

[4]https://the20minuteguide.com/. Accessed on 9.26.18. p11-12.

[5] Ibid

[6] Ibid. p13-14.

[7] Denning, P & Little, J. (2017). Over the Influence, 2nd Edition. Guilford Press. NY:NY. p221.

[8] www.robertjmeyersphd.com. Accessed on 9.26.18.

[9] Statistics for success re: professional treatment is difficult. 30% is the highest publicized rate yet this number generally reflects only those who completed treatment, not who improved longterm. AA’s rates are about 5%.

[10] https://www.fds.org.au/newsletters/letter-to-family-and-friends (accessed 10.22.2018)

[11] https://en.wikipedia.org/wiki/Transtheoretical_model (accessed 10.22.2018)

[12] Chicago Recovery Alliance (CRA): www.anypositivechange.org

[13] https://www.ncbi.nlm.nih.gov/pubmed/1787547

[14] https://www.projectcbd.org/about/what-cbd. Accessed on 10.25.2018.

[15] https://www.aa.org/assets/en_US/p-11_aamembersMedDrug.pdf

[16] See works by Marc Lewis, Maia Szalavitz, Stanton Peele, Jeff Foote, Denning & Little, Andrew Tatarsky, to name a few professionals in the field who do not ascribe to the traditional disease concept of addiction. Dr. Marc Lewis is a neuroscientist, researcher and former drug addict who has authored several books on this subject: http://www.memoirsofanaddictedbrain.com/authors-bio/

[17] Another book I suggest & use with families: William Miller’s (Motivational Interviewing) 2018 book titled, “Listening Well: The Art of Empathic Understanding.” It’s available at Amazon and beyond.

 

Welcome Family Drug Support USA This Giving Tuesday!


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GivingTuesday is a global day of giving fueled by the power of social media and collaboration.

Celebrated on the Tuesday following Thanksgiving, (November 27 in the U.S.) and the widely recognized shopping events Black Friday and Cyber Monday,

FSDP is excited to announce that starting at 5am PST on November 27, Facebook and PayPal will contribute a total of $7M to partner with our stakeholders and match any donation to your designated nonprofit of choice! Giving Tuesday is a not to be missed opportunity to help us support more families by bringing Family Drug Support USA to communities across the nation. Our Facebook friends can also have their gifts matched by using the fundraising for nonprofits option on Facebook for which includes birthday fundraisers and the donate button feature

As a mother, Carol Katz Beyer, who has been personally impacted by the devastating loss of her two children Bryan and Alex, was inspired to co-found Families for Sensible Drug Policy with Barry Lessin to regain control of our families’ health by collaborating with our stakeholders to implement a new paradigm of care and support based on compassion, science, public health and human rights.

Please read this heartfelt message from Tony Trimingham to learn more about Family Drug Support:


“When someone dies as a result of illicit drugs, it is estimated that on average they lose 35 years of their lives (compared to 5 years for nicotine and 15 years for alcohol). Not only does this rob the person of a chunk of their life, it has a massive impact on their family. When my 23-year-old son died from a heroin overdose, not only did I experience profound grief and shock, there was excruciating pain and a massive impact on me, and all my family. If I could get to sleep (which was rare) I would dream of him being alive, then I would wake up to the nightmare. I found myself breaking down on an almost daily basis, and simple everyday tasks became difficult.

 My wife and friends who were suffering their own grief had to cope with my not coping. I would hear his voice in public places and thought I saw him walking along the street. For the first 6 years after he died this level of pain continued and it took a long time before I was able to smile again and enjoy the normal things in life. It is now 21 years and while the pain has subsided and is not as acute, there isn’t a day go by where I don’t feel sad, and miss my son. I have missed out on conversation with him, possible grandchildren, and seeing him progress through life. I have had similar conversation and reflections with hundreds of other families who have lost people, and suffer the same anguish. For this reason, Family Drug Support believes that keeping people alive and safe is the first priority when it comes to dealing with problematic drug use.

In my work with Family Drug Support, I have spoken to more bereaved families in the last six months than I have in the last six years. This is because of the increase in the use of legal opiates, and also because street heroin is back on the radar. The truly sad fact is that these deaths, along with those at music festivals from taking pills, are completely preventable.”

Family Drug Support Training is an opportunity to work directly with Tony Trimingham 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. People that successfully complete the training will be able to bring this peer to peer support to their communities.

Please click here for more information about Family Drug Support USA

Meet Tony Trimingham in this video describing the workshop.

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Our families desperately need your help and we urge you to join us as part of a long term solution that will keep our loved ones safe, connected and plugged in to the services that will keep them alive. A watershed moment reflecting our nation’s most significant public health disaster, requires that we as a nation embrace a multi-tiered and realistic approach towards prevention, education and access to healthcare services.

Your donation no matter how big or small helps save lives by forwarding our mission to deliver the message of harm reduction to communities around the world. Please help us reduce overdoses and empower families by educating and advocating for progressive solutions for family support based on science, compassion, public health and human rights.HandDonate

Donate Now!

Sign up HERE to receive our newsletter stay informed on the latest news and events.

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

Welcome to the August 2018 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout. To learn more about how your family can join our growing community of enlightened friends and advocates sign up here now.tyler-nix-525388-unsplash

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#stopthestigma #recoverywithoutabstinence

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