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

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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.

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

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PLEASE SUPPORT OUR FAMILIES!

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

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

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

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

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

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

Harm Reduction for Families: Communicating With Love

Adding to our Fall series, welcome to the November 2018 edition of Family Matters – Families Matter, our new blog authored and curated by FSDP’s Guest Blogger–pioneering harm reduction therapist, educator, advocate and author Dee-Dee Stout.

This month, Dee Dee shares her unique perspectives on harm reduction’s influence on family communication

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

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Communication.

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

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

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

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

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

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

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

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

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

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

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

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

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

I would add a couple of others:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(Note: all photos are from unsplash.com)

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

 

REFERENCES

[1] www.johnbradshaw.com.

[2] Ibid. Accessed on 9.26.18.

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

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

[5] Ibid

[6] Ibid. p13-14.

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

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

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

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

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

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

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

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

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

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

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

 

September is Recovery Month: Reinventing Recovery

 

Welcome to the September 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.

In the first of a series of our Fall 2018 blogs, since September is Recovery Month for SAMHSA, this seemed the perfect time to write about the word, or concept of, “recovery” specifically as it’s typically applied in substance use disorder (or “addiction”) treatment.

September is also the traditional “back to school” month and many of us have kids who are returning to school or perhaps young adults transitioning to college. This is a good time to to review constructive ways to talk to our kids about alcohol and other drugs, and also to take a new look at treatment, drug policy, binge drinking. and how to negotiate the holidays  Therefore, for the remainder of 2018, our blogs will take a look at those topics and more. See you next month! #recoverywithoutabstinence #stopthestigma #familiesmatter

And now our 2018 “Recovery Month” edition:

Reinventing Recovery

DD 2 cups
Photo by Toa Heftiba from unsplash.com

Usually when we hear (or often use) the term “recovery”, it has a very specific meaning: nearly always 12-Step oriented, abstinence-only based, and says to us this is a disease you’ll have forever. I want to definitively make the case for a new kind of recovery in the world of addiction(s): an “inclusive v exclusive” recovery that does not require the elements we’re used to – including abstinence – but whose definition can certainly contain it …and so much more. 

Recovery. It’s a truly loaded word (pun intended). Let’s go on a bit of a journey to see how and from where our concept(s) of recovery stems as it’s a word that comes with a lot of baggage, both positive and less than positive.

According to etymonline.com, the origin/first use of the word “recovery” comes in the mid-14th century and meant “return to health.” “Recovery” originates from the Anglo-French word “recoverie” meaning “remedy or cure.” The additional meaning of an “act of righting oneself after a blunder, mishap, etc.” is from the 1520’s. Could this also be at the root of the word having such moral implications?

In his July 2014 article for Psychology Today, well-known addiction expert, author and former Harvard Medical School professor, psychiatrist Dr. Lance Dodes discusses some of the problems we have with the word “recovery.”[1] In part, he sees the word as acceptable in the context of “recovering from a medical illness”, meaning that 1) relapse/lapse is normal, and that 2) one is headed toward a cure or an ending of the condition/illness. Quoting from the article, Dr. Dodes says, “In most of life, ‘being in recovery’ means a person is making progress even though s/he isn’t ‘cured.’” This is far different than how we too often hear the word used in addiction treatment circles or our greater culture. In both places, “recovery” typically means that one is abstinent and attending a 12-Step group – “working the program” to use the language of AA for example. This is meant to establish an “us vs. them” quality: you’re either attending meetings, working the Steps, and have a sponsor so you’re “in recovery” or you’re not and therefore you’re not in recovery. Black or white; right or wrong. Plus, the implication is that anything short of a 12-Step traditional recovery means you’re not doing recovery “right.” A lot of people – including many professionals – believe this is what the word means and ONLY what it means. I, too, believed this for a long time.

DD begin cup
photo by Danielle MacInnes for unsplash.com

I went to residential treatment here in Oakland, CA, in the late 1980’s. These were the “salad days” for residential treatment, coming on the heels of First Lady Betty Ford openly discussing her addiction to alcohol and pain medications.[2] No one of her stature had ever talked about their alcohol and other drug problems in the US and her “coming out” can’t be understated; it was also a huge step in reducing the stigma/shame for others to seek help for their substance misuse/problems. Finally, this event was also partly responsible for opening the doors of treatment to become the Big Business it is today (more on that in another piece).

In treatment, we were taught that addiction is a 3-fold disease: bio-psycho-social (some also added “spiritual”). It was like a, sleeping tiger, always waiting to pounce on you unless you were constantly vigilant in your recovery (meaning abstinence, attending meetings regularly, and “working a good program.”). We were taught phrases such as, “Your mind is like a dangerous neighborhood: don’t go in it alone” and “Avoid old people, places and things to stay sober.” In other words, 1) don’t trust your own thinking because you’re an addict/alcoholic and “your best thinking got you here”, 2) you’re never fully recovered, and 3) you must cut off all your old friends as they were only using friends and therefore not interested in your well-being; your relationships were only based on drug use. I remember someone saying that everything I had done up to the point of my entering treatment/recovery didn’t count – but now my life could really begin: “Today is the first day of the rest of your life”[3] was up on a wall somewhere. Scary stuff. And I was scared straight.

In what’s known in 12-Step circles as the Big Book (Alcoholics Anonymous 3rd edition), there are several references to the word “recovery” and “recovering” (somewhere around 15) but also references (about 10) to the word “recovered” which is akin to blasphemy today in most 12-Step circles.[4] This is another point of contention for many of us. Can we ever say we’re “recovered” or even “cured?” I say, “yes we can,” to borrow a phrase. And that we should. Why? Because to those outside of traditional treatment/recovery, I hear folks constantly say, “Apparently treatment doesn’t work because you people are never recovered!” I had never thought of the phrase “recovering” as potentially responsible for this perception. I personally say that after over 30 years of continuous abstinence, I am completely comfortable declaring that I’m “recovered;” the problems I have today have nothing to do with illicit drug and/or alcohol use (sometimes that would be simpler, frankly). The first paragraph in Chapter 2 of the 3rd edition of the Big Book titled, “There is a Solution,” also appears to see an end state to addiction. It states: “We, of Alcoholics Anonymous, (italics theirs) know thousands of men and women who were once just as hopeless as Bill. Nearly all have recovered (emphasis mine). They have solved the drink problem.”[5] This passage certainly seems to imply that one can indeed recover. But then what exactly does it mean to recover? And how do we achieve this state of being?

Mindfulness + Connectedness + Inner Growth

image copy 2
Photo by Austin Chan for unsplash.com

 

A Phrase is Born. While working for the large American HMO Kaiser in the 1990’s, I was charged with developing and leading a relapse prevention track for patients in our Chemical Dependency Recovery Program (CDRP). These were folks for whom the course of treatment we offered (intensive outpatient program or IOP) didn’t work – or, as we phrased things back then, patients who didn’t try hard enough, were in denial of their “disease,” or simply relapsed back into drug/alcohol use due to inattention to “people, place, and things.” During one of our evening groups we were working on a definition for “recovery” and decided to see what we could come up ourselves. After all, we surmised, how can one relapse if you don’t have a clear idea of recovery?

Mindfulness, connectedness, and inner growth was the phrase we all agreed described the basic ingredients for recovery. It wasn’t until later that someone noticed we neglected to include anything about abstinence/sobriety, 12-Step attendance, or the other usual things we associate(d) with recovery. I remember that night well because a gigantic light bulb didn’t just light up, it blew up in my head! This was the moment I began to wrap my head around the idea that perhaps alcohol and other drug use itself – and abstinence specifically – really had nothing to do with one’s healing or recovery; recovery wasn’t in fact begun with stopping drug use first (which is what we always told folks). What was at the core of the concept of true recovery of one’s life we decided were these 3 elements defined here – which may or may not include an end to one’s drug use:

Mindfulness: paying attention – to what you’re doing, who you’re with, what you’re putting in your mouth/arm/throat/etc., really everything that’s happening as well as you humanly can, plain and simple.

Connectedness: this means getting reacquainted with yourself, a vertical connection, we called it – your body, your mind, your spirit – and fully trusting them. This also spoke to the idea that your mind is connected to your body (yes, no matter what Descartes[6] said, they’re attached; it’s called a neck!). This vertical connection could also be to a higher power or great spirit of some kind. Connectedness includes a horizontal connection, too, or connection with others.[7]

Inner growth: this was a bit more difficult to flesh out at the time but we settled on it meaning whatever an individual does that leads to their seeking out new information and new ideas, being a part of the world at large. This could be going to school, walking in the park, dating, making new friends, a yoga practice, meditation, attending synagogue/mosque/church/temple/circle, or even reading. Or anything else that “feeds” a human’s curiosity and need for knowledge.

And that was it. Drug use, abstinence, continued using or something in between, wasn’t mentioned. Why? Because we realized that in any other bio-psycho-social illness (which nearly all are), one did not have to recover perfectly. In fact, in my definition humans cannot do this – at least not all the time. And we realized that it wasn’t the alcohol or other drugs that were at the core of the problems we had: they were but a symptom. [8]

Therefore, one could indeed be in recovery and use drugs. Not problematically because then you’re not connected or mindful or growing. But we agreed (again to our collective surprise) that yes, one could be using alcohol or other drugs – having a healthy relationship with them – and be mindful, connected, and growing internally: in recovery. And we also agreed that for some folks, to have these 3 elements in their lives could require abstinence: total, partial, forever or for a while, we made no comment on those notions. That would remain up to the individual (which also fits within AA/12-Step guidelines of no one being able to tell another that they are an “alcoholic or addict.”). In fact, we realized that having healthy relationships of all kinds could be achieved through these three elements. What a jolt to the brain this was to us all!

image copy 3
Photo by Ron Smith for unsplash.com

YOU GOTTA GIVE THEM HOPE”, Harvey Milk[9]

These days, I have come to realize that it appears these elements or ingredients of recovery also build on one another: for example, you first need to improve or have some mindfulness about what you’re doing before you can truly connect with others and yourself, and that action can lead to growing internally. And again, we made the argument then which I’ll repeat here, drugs and drug use (including alcohol of course) don’t necessarily impede one’s ability to recover or regain health from having problems with them – or being “addicted.” The problem is in one’s relationship with substances or behaviors that have become problematic or compulsive, and that we continue to engage in despite negative consequences – what we call “addiction.” So here’s the Big Question: what if we as a collective culture decided to work on these 3 ingredients and the issues that get in one’s way of achieving them? What if we decided to help those in need to uncover why they – or collectively, why so many of us in the wealthiest nation in the galaxy – need to use substances in order to cope? Hmmm…

It’s time to reinvent the word recovery to mean this: “I have recovered my life and my health. with or without abstinence. I am mindful, connected, and growing.” Now that’s real recovery!

One of the ways to address these issues of the lack of mindfulness, connectedness, and inner growth is with what the Canadian author, physician, and addiction expert Dr. Gabor Mate calls “compassionate inquiry.”[10] Dr. Mate makes the case for needing people in our lives who can/will listen deeply, compassionately to those of us involved in using substances/behaviors that are causing pain in our lives. Another advocate of doing things differently in treatment is Stanton Peele, PhD, JD. In his newest book on addiction, Recover! Stop Thinking Like an Addict and Reclaim Your Life with The Perfect Program,[11] Dr. Peele discusses these issues at length, as he has for over 50 years. As an early adopter of harm reduction principles, he has tried to get us all – but especially we Americans – to see that the way we have come to view addiction is all wrong: 1) it’s not a disease, 2) most people quit on their own (so how can it be a disease), and 3) not all people are susceptible to becoming addicted. In fact, by viewing addiction as a disease, our society has actually increased the possibility of relapse[12]. It reminds me a bit of Charlton Heston’s famous line at the end of the film, The Planet of the Apes, when he realizes where he really is – back on Earth: “You finally really did it. You maniacs! …God damn you. God damn you all!” In looking for the reasons for addiction, we have to consider that perhaps, unintentionally, we have done much of the damage ourselves with our racist policies, unscientific treatments/interventions, and blaming of the people who use drugs (and often their families as well). It sure is easier to blame a drug(s). It’s much harder to look within, compassionately and deeply, for the reasons so many of us are in pain (of all kinds) and need relief to cope with living.

I see September’s Recovery Month as a great time to take a look at what we’ve done with addiction treatment and recovery. And to take a hard look in the Mirror of Truth about our society and its complicity in addiction(s). It’s time to stop the unscientifically-tested treatment of this “medical-and-more” complicated condition. It’s time to demand professionals who are highly trained and compassionate – always. It’s time to radically change how we view people with substance problems – and their loved ones – regardless of whether you believe this is a condition of their making or not.

It’s time to reinvent the word recovery to mean this: “I have recovered my life and my health. with or without abstinence. I am mindful, connected, and growing.” Now that’s real recovery!

DON’T MISS NEXT MONTH’s EDITION: 

COMMUNICATING WITH LOVE ABOUT DRUGS WITH SOMEONE YOU LOVE. 

[1] https://www.psychologytoday.com/us/blog/the-heart-addiction/201407/what-does-it-mean-be-in-recovery

[2] A Johnson Institute-style intervention was held in 1978 for Mrs. Ford leading her to seek treatment for her substance use. In 1982, she founded The Betty Ford Center which is now part of the Hazelden family of programs.

[3] As discussed in our last piece on “tough love,” the originator of this phrase is the founder of Synanon, Chuck Dederich.

[4] “A Reference Guide to the Big Book of Alcoholics Anonymous” by Stewart C.; (1986). Recovery Press, Seattle, WA.

[5] p17. Note: The “Bill” that is referenced here refers to the co-founder of AA, Bill Wilson.

[6] Rene Descartes was a 16th c. French philosophermathematician, and scientist; dubbed the father of modern Western philosophy who famously argued that the human body and mind were separate. Wikipedia.com

[7] Remember that church I mentioned in my first blog, the United Church of Christ or UCC? There we were taught that God was within each person and living thing on Earth and that we were all connected. Very Deepak Chopra. Hmmm…

[8] Interestingly enough, a similar idea can be found in AA’s Big Book on p85, in this line: “What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” And I was taught that “spiritual” merely meant connected.

[9] Quote from slain San Francisco Supervisor Harvey Milk, one of the country’s first openly gay politicians. This is from a tape recording (1977-11-18) to be played in the event of his assassination, quoted in Randy Shilts book, The Mayor of Castro Street: The Life and Times of Harvey Milk. (1982), p. 277. Wikipedia.com; personal communications.

[10] From Dr. Mate’s website, drgabormate.com: “Through Compassionate Inquiry, the client can recognize the unconscious dynamics that run their lives and how to liberate themselves from them.”

[11] For more information, view the results of the NESARC study and more, discussed in Dr. Peele’s book, p36-42. (2014), Da Capo Press.

[12] Miller et al; “What predicts relapse? Prospective testing of antecedent models.” https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1360-0443.91.12s1.7.x