Spring and the Cycles of Change!

Welcome to the Spring 2019 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout.
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I have been a Star Trek geek for as long as I can remember.  This infatuation even rubbed off on my son who designed the current World Tour stage for the multi-award- winning mega-band Muse to be shaped like a Klingon Bird of Prey[1].  I never quite understood my fascination with all things alien, watching the new Star Trek Discovery series week after week in tears.  Really??  Crying over a TV show, and a sci-fi show no less??    Well, after some 50 years of dedication and fanaticism, I think I figured it out:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

 

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!

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

HandDonate

PLEASE SUPPORT OUR FAMILIES!

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

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

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

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

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

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

love tree

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

Holy Holidays, Batman!

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Xmas trees

Holidays. I love them and hate them.

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

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

1. Eat light

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

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

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

2. Hang out in the bathroom

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

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

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

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

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

4. BYOB: Bring your own bottles

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

pup and mistletoe

5. Find support where you can

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

6. Like a good photograph, mind your exposure.

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

7. Rest when you can

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

8. Cravings aren’t just for drug users

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

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

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

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

 

9. Ho, ho, ho!

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

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

10 The holidays are a trip!

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

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

chinese lanterns

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

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

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

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

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

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.

 

“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

 

“Love Has No Labels: The Rise and (hopeful) Fall of Tough Love in America?” — Part 1

 

Welcome to the second installment 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

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(photo by Tyler Nix @unsplash)

Hello again!

Before we get into the meat of this topic, I need to say a couple of things: First, I apologize for not finding a way to present this in my usual more light-hearted way. This just seemed too serious of a topic for that. I just finished reading Maia Szalavitz’ 2006 book Help at Any Cost which deeply disturbed me. Although I was certainly aware in a general way about a lot of the material about teen “treatment” programs, I was both obsessive to finish the book (reading until 2AM) and distressed that these programs are still around. Here in the Bay Area, our local newspaper, The San Francisco Chronicle just did an expose on teen “leadership” schools. As a result of the excellent journalistic work, many supporters and contributors to these programs have now removed their support, both financial and verbal. But there are some who insist these programs are meaningful.

This is also true in Ms. Szalavitz’ book. I’ve seen this in my classrooms over the years of teaching folks to become certified alcohol and other drug counselors. Many of my former students came from Synanon-influenced programs (often ones they attended as clients and then became workers, which I did, too) such as the former Walden House and Delancey Street (which is the only true therapeutic community (TC) left as they do not employ any professionals, the definition of a TC) and some have insisted that they were helped by such “tough love.”

I had the opportunity to ask the world-renowned researcher, Emeritus Professor William R. Miller (author/developer of Motivational Interviewing (MI) about this once. “is it possible that these folks were actually helped by these abusive tactics?” He responded, “I believe that these are people that are so motivated to make a change in their lives that you could have put them anywhere and they would’ve found a way to get better. So, their lives improved not because of the treatment they received but in spite of it.” That response has stuck in my mind and did so while writing this blog installment.

Finally, I was allowed to view the new film Fix My Kid, a documentary on the organization Straight, Inc, a popular behavior modification program for teens from the 1970’s (it was closed in the 1990’s but really just redesigned and opened under new names).  I can’t begin to tell you how upset I became watching this.  Some of this is certainly due to my own experiences with “tough love” but as a human being, I don’t see how anyone could view this without teetering between anger, outrage, and incredible sadness.  I highly recommend a viewing when it becomes available – but be prepared.

And two more blog housekeeping things:  1) As this topic is both so important and large, I’m doing two installments this time.  Today we present Part 1, covering some of the basics of “tough love” and approximately one month later you can expect to see Part 2, which will go into more detail especially as to how the culture came to embrace this concept.  Please let me know at info@fsdp.org what you think about this two-part format.  2) Since September is National Recovery Month, I’ll be doing an installment on the word “recovery” then which I promise will not be your typical take on the word!

And so…here we go again!

“Love means never having to say you’re sorry.” If you remember that phrase, you were around in 1970 when the film, Love Story, came out (starring Ali MacGraw and Ryan O’Neal) and this phrase about love was the tagline in the studio’s advertising that, using today’s language, went viral. Even then I wasn’t very fond of the phrase. To me, love was quite the opposite: it meant I could make mistakes and saying you’re sorry was part of the healing process – and love would always still be there; it was a given; it had no limits – even if I do. We’ll return to setting limits later.

I’ve been reading a lot of things about love/tough love/etc, preparing for this blog. In a piece from the HuffPost from 2012, writer Sheryl Paul states that if there are conditions on love, then it’s not love but approval – either trying to get it or give it. I hadn’t thought of it in quite that way but she’s absolutely right. And love is NOT the same as approval. In fact, the challenge of love is to love. Full stop. Anything else is based on approval and doesn’t feel like love to the person on the receiving end – because it’s not. Real love isn’t conditional.

A popular phrase in 12-Step/AlaAnon is “you have to let them hit bottom.” We are told as family members that this is “letting go with love.”  However, what if “their bottom” is death? Or jail/prison? Or something else traumatic? How is letting someone “hit their bottom” showing love and not simply trying to control or give approval for “doing the right thing” and not “enabling”? And what evidence do we really have that hitting bottom works? None, save some individual stories of such (side note: I just googled the phrase “hitting bottom” and found a disturbing number of articles and treatment centers advocating this approach). Back to Dr. William Miller: MI has shown us, as has CRAFT (Community Reinforcement Approach and Family Training; developed by Dr. Robert Meyers), that standing by and letting a problem drug user get to the absolute worst place they can does little to actually help them seek treatment/change. In fact, it typically makes things worse (the late Dr. G. Alan Marlatt showed this in several studies and discusses this in his seminal books, Harm Reduction and Relapse Prevention).

Anecdotally, when I was in more pain (of all kinds) and things got even worse, that made drug use even more attractive, no matter the negative consequences. And this is typical. This doesn’t mean family shouldn’t allow for some natural consequences. What those are and how one decides when enough is enough must be decided by each individual family and needs to be discussed with the problem drug user beforehand so there are no surprises

So, where did we get this idea of “tough love” especially if it’s harmful? And why is it still such a popular approach? Although tough love is a concept used on adults as well as teens, according to Szalavitz’ book, Help at Any Cost, the phrase “tough love” was first coined by Bill Milliken in his book of the same name in 1968 that discussed parenting approaches. There is also another book of nearly the same name, ToughLove by Phyllis and David York from 1985. Either way, the phrase started out as a term for parents to describe interventions to be used as their teenagers began to act out – perhaps using/misusing alcohol and other drugs – and engage in other less-healthy/desirable behaviors. Unfortunately, typical adolescent separation/developmental behaviors became pathologized (still often are….more on that perhaps at another time). Before the phrase “tough love” caught on in parenting circles, the concept was used here in California by a group long gone but whose long reach can still be felt in drug treatment facilities here and across the country: Synanon.

Synanon was a California institution. It was founded in 1958 in the then sleepy beach town of Santa Monica, by Charles (Chuck) Dederich. According to journalist Matt Novack, Synanon “was one of most dangerous and violent cults America had ever seen…” I have seen the outcomes of Synanon up close and personal through my work in treatment facilities, many founded by former Synanon members. Several ideas of these persuasive and talented people were sensible. Sadly, though I believe all meant well, many of their ideas were still too infused with the highly confrontational concepts of Synanon. Having worked and been trained in some of these treatment centers, I am saddened to know that while I helped many people in the dozen or so years I worked in this confrontational style, I am aware that I harmed many others. But Synanon was more than highly confrontational. It was far worse and caused far greater harm.

Synanon was the developer of something they called “The Game.”

“They played the “game” in which anyone was allowed to say anything, true or not, to someone to cause an effect. Only the threat of violence was prohibited. It was a game because one being gamed could turn the game on another.

Addicts’ behaviors and past lives were attacked viciously in games, members were told their lives depended on staying, contacts with family were prohibited, and a system of rewards and punishments was applied. Publicly one was berated ({given a] “haircut”) for misdeeds…Dederich and Yablonsky acknowledged that the system was brainwashing…”

And brainwashing was what Synanon leaders believed drug users needed. According to Paul Morantz (an attorney Dederich attempted to murder for suing Synanon) is credited with coining the phrase “Today is the First Day of the Rest of Your Life.” He also “preached “Act as If” which meant do not try to reason as to what Synanon asks they do; as thinking got them there, just trust what they were told and act as if it is right.” Alcoholic Anonymous (AA) uses similar slogans today. In fact, Dederich was a longtime AA member and popular speaker before his transformation to cult leader (Dederich later became mentally unraveled, extremely paranoid, and preached of a new religion he called Synanon III.

Synanon was heralded as a drug addict-saving program and even had the blessings of Governor Edmund “Pat” Brown, who exempted them from health licensing laws. They also started seeing monetary gains as Hollywood superstars such as Robert Wagner, Leonard Nimoy, and Ben Gazzara came to play “the game.” Life magazine did a 14 page in-depth article in which they quoted a Congressman calling Synanon the “Miracle on the Beach.” Columbia Pictures even made a film on it. By the mid-1960’s, Synanon was known as a alternative community which attracted its members through a focus on living a “self-examined life” using “the Game” to uncover hidden truths in group sessions. Even non-drug using professionals were invited to join as long as they “gifted” their assets. Like other cults, Synanon worked by controlling its members. In Synanon the main source of control was by use of “the ‘Synanon Game.’ The “Game” could be considered a therapeutic tool, likened to group therapy; or a social control, in which members humiliated one another and encouraged the exposure of one’s innermost weaknesses, or both.” This was truly tough love at its “finest.”

Today we may not see toilet seats around clients’ necks (I heard reputable reports that this was done in some drug treatment facilities up to the late 1990’s, to demonstrate that a client had behaved like a ‘piece of shit’) but we certainly continue to have the ethos of stigma, shaming, and harsh confrontation we inherited from Synanon. The threads of Synanon are woven throughout drug treatment programs everywhere in the US (and further in a few cases) today.

PART 2 “Love Has No Labels: The Rise and (hopeful) Fall of Tough Love in America?” coming August 2018

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IMG_6574Dee-Dee has worked in the addictions/mental health worlds for more than 30 years and continues to maintain a busy clinical practice where she works with a variety of clients whose behavioral goals include abstinence, moderation, and “anything they want and in any way they want” to achieve their goals. Her book, Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World is widely available and has received positive reviews.

 

 

FSDP Celebrating Life: A Town Hall with New Solutions for the Opioid Crisis

Please join FSDP co-founders Carol Katz Beyer and Barry Lessin, Team FSDP and our partners–The Center for Optimal Living, Harm Reduction Coalition, The New School, International Network of People Who Use Drugs (INPUD), New York City Department of Health and Mental Hygiene, New York State Psychological Association’s Division on Addictions, and VOCAL-NY—who are representing our families to demand solutions based on a new paradigm of healthcare that provides a comprehensive continuum of care with multi-tiered strategies that empower families with reality-based solutions.

celebratelife_townhall (FINAL)We are privileged to be represented on the panel of representatives from the fields of public health, psychotherapy, community engagement, public policy, and The New School’s Student Health Services who will present their perspectives on the impact of opioid use, the opioid crisis, and how to reduce the number of overdoses.

We will also be training attendees in overdose prevention strategies and naloxone kits will be provided to those who wish to receive them.

Following an overview of the current opioid use patterns and overdose rates in New York, we’ll discuss the programmatic work that is being done to address the multiple challenges associated with this issue. We’ll hear from people who work with active drug users as well as current and former people using drugs contributing to the panel discussion. In addition, treatment professionals will describe an integrative harm reduction approach to working with people using drugs.

Overdose deaths are preventable and we shouldn’t be punished for making progress in our in our path to optimal health and well-being! Lives will be saved when we shift our thinking about treatment to complement and support public health overdose prevention strategies. A harm reduction-informed continuum of care linking harm reduction strategies to the full array of effective substance use disorder treatments needs to be integrated with overdose prevention efforts.

Families impacted by substance use deserve the best care available. Every other medical condition is guided by best practices and we expect nothing less. We are in the best position to help our loved ones and we demand the information and services required to give us the best chance for successful outcomes.

This event is open to the public and is free of charge.

Special Evening for Families with Dr. Robert Meyers, Developer of CRAFT

FSDP’s latest collaboration with Dr. Bob Meyers, the developer of Community Reinforcement and Family Training (CRAFT), and Andrew Tatarsky and his Center for Optimal Living will give attendees a unique opportunity to meet Drs. Meyers and Tatarsky, hear an overview of the CRAFT treatment model and be part of a Q & A to follow.

FAMILY CRAFT

This special evening will be hosted by FSDP Cofounders Carol Katz Beyer and Barry Lessin.

WHEN AND WHERE:

Friday March 10, 2017, 6:30- 8pm.

The Center for Optimal Living, 370 Lexington Ave, Suite 500, NYC 10017

Tickets are still available but space is LIMITED, so SIGN-UP NOW!

For additional information, please email barry@fsdp.org.

CRAFT fosters a different journey toward treatment and recovery for families. It is love-based and empowers families to stay TOGETHER rather than “detaching” or using harsh, punishing methods with loved ones.

Supported by 20 years of peer-reviewed research, CRAFT is a comprehensive behavioral program that teaches families to optimize their impact while avoiding confrontation or detachment. Most programs developed to promote or encourage positive lifestyle changes are not always built upon the level of long-term research and analysis that supports CRAFT as a successful model for engaging substance users toward treatment.

CRAFT methods are evidence-based and provide families with a hopeful, positive, and more effective alternative to addressing substance problems than other intervention programs. CRAFT works to change the loved one’s environment to make a non-substance using lifestyle more rewarding than one focused on using alcohol or other drugs. In the CRAFT model, concerned significant others (CSOs) are the focus of the therapy instead of the substance abuser. Randomized clinical trials have shown CRAFT 3 to 5 time better at engaging resistant substance users than Alanon or the Johnson Institute style.

For more information on CRAFT, click HERE:

WE LOOK FORWARD TO SEEING YOU THERE!