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

relapse recovery word cloud

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

“Expectations are resentments under construction.” -Anne Lamott

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

mobile Denise Carbonell flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cheers!

Dee-Dee Stout

deedeestoutconsulting@gmail.com
www.deedeestoutconsulting.com

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

Photo credit: Denise Carbonell, Flickr, Creative Commons license

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

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

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

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

— Vinny Ferraro, Co-Founder of DharmaPunx

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

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

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

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

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

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

and each time practice lowering your shoulders

and relaxing your facial muscles, arms, and legs.

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

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

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

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

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

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

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

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

Dee-Dee

www.deedeestoutconsulting.com

All photos courtesy of unsplash.com

 

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

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

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

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

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

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

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

[8] https://www.fds.org.au/about-us

Families Matter/Family Matters 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.

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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

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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).

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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.”)

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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.

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

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

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

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

For provocative conversations:

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

What makes an experience meaningful?

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

What motivates you to progress?

 

For generally deeper conversations:

(from Big Talk at www.makebigtalk.com)

What is a new habit you want to form?

What are you thankful for this very moment?

What advice would you ask for from your greatest hero?

 

For more fun/funny conversations:

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

What is a fun experience that you have recently had?

What are you passionate about right now?

What are people usually surprised to find out about you?

 

Or for more family of origin-oriented fare

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

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

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

What’s your favorite family story?

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

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

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

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

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

-Dee-Dee Stout, MA

All photos courtesy of unsplash.com

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

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

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

beyondbinary

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

Brooklyn Law School
205 State Street
Brooklyn, NY 11201

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

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

Repping the Family Voice at DPA’s Reform Conference!

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

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

Rally to Demand Cuomo Apologize, Sign Lifesaving Bill!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

All photos courtesy of unsplash.com

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

 

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…