“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.

 

 

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!

FSDP at the Southern Opioid Epidemic Symposium

FSDP’s Co-Founders Barry Lessin and Carol Katz Beyer, and our Harm Reduction Coordinator Jeremy Galloway represented us at the Southern Opioid Epidemic Symposium held at Emory University’s Rollins School of Public Health this past week.

The symposium convened academic, medical, research, policy, and government stakeholders to identify and develop strategies to advance a comprehensive response to the opioid epidemic in the South and beyond.

Barry Lessin was invited to speak, and here’s the text of of his talk “The Significance of the Family in Developing Harm Reduction Strategies and Practices in the Southeast and Beyond:

15541250_1393299694023257_4760824146094682188_n“I’m an aging hippie from the VietNam war protest days when I came of age, during the drugs, sex, and rock and roll era and as a result developed an ingrained distrust of the federal government.

When FSDP was invited to join the Southern Collaborative on Opioid Harm Reduction , my initial thought was ‘Oh my God, I’m going to meet with the government to talk about drug use. I hope they don’t ask me too many questions about my past’. My worry and disbelief quickly dissolved when we got to the meeting and saw how serious the government is about attacking the opioid problem with comprehensive harm reduction …

We’re again a very divided nation, even more so in some ways, but I have optimism because of our ability to convene forums like this to tap into the brilliant minds gathered here to identify life-saving solutions to this public health epidemic.

So being here is an exciting and encouraging moment for myself, co-founder Carol Beyer, Jeremy Galloway and the 1000s of families and diverse stakeholders we represent because it’s an opportunity to be a part of process of an ongoing collaboration with this esteemed community to address the needs of the millions of families who have suffered the direct consequences and collateral damage of substance use and the existing harmful drug policies.

FSDP is a global coalition of families, professionals, organizations and drug policy reform advocates who view substance use through a human rights and public health lens. Viewed this way, Harm reduction interventions, are a natural fit for managing substance use, but have rarely found their way into family settings.

We have listened to our families, parents and users alike, sharing their lived experiences of being harmed by a broken treatment system that uses ineffective, often unregulated treatment methods, that treat people more like commodities to fill beds than patients being provided effective care.

When people relapse with other complex problems similar to addiction that require lifestyle changes like cancer, heart disease, and diabetes, we don’t blame the person for treatment failures, we don’t tell them they’re in denial, or they ‘need to ready’ or they must ‘hit bottom, we don’t throw them in jail, or kick them out of schools.

With other conditions, we respond with scientific, commonsense, and compassionate approaches and we look at the treatment methods that are failing them and do more research to provide better treatments.

Families are in a unique position to directly influence the development or resolution of substance use problems because substance use doesn’t take place in a vacuum but in the normal context of family life and relationships as well as the wider culture that the family resides in.

We know that problematic substance use is a complex interaction of psychological, biological and socio-cultural variables. Prohibition-based drug policies directly contribute to a cultural narrative that views the substance as the primary problem, ignoring the uniqueness of each family, the culture it exists in, as well as the family’s strengths and resources.

We don’t have to reinvent the wheel–harm reduction approaches are already in place for other conditions. We can use this knowledge to extend these benefits to implement family-friendly strategies and practices in combatting the opioid problem.

FSDP bring diverse communities together to embrace enlightened drug policies—empowering families, restoring health, saving lives. We are dedicated to identify a vision and approach that will provide solutions and pathways forward…

Our meeting here offers us an opportunity for us to engage with the communities brought together here who share the public health lens of substance use, to be catalysts for change by tapping into your knowledge as scientists, educators, and healthcare providers to eventually develop the necessary strategies and practices and the hands-on tools to offer our families to restore our health to the level we deserve.”

A Treatment and Support Guide for the Rest of Us

Good Treatment is Hard to Find

I spent a decade using heroin and about nine years trying to stop. It’s not that I didn’t want to quit–I didn’t know where to turn. In my Internet research and through word-of-mouth, I either came up empty or ran into a lot of myths and misinformation. Stigma created an additional barrier to me getting the help I wanted.

In recent years we’ve learned much more about addiction and effective treatments, but significant barriers remain. While the county I live in has one of the highest overdose rates in the state, there are no opioid treatment providers. This is a common problem in rural, and even some urban and suburban, areas.

With that in mind, here’s a comprehensive (though not overwhelming) list of treatment and support options which are either evidence-based or use evidence-based tools, followed by links to harm reduction resources. Harm reduction organizations provide education, treatment referrals, naloxone overdose rescue kits, syringe exchange programs, access to contraception, HIV and hepatitis C testing, and other vital services which might otherwise remain unmet.

Everyone is different and there are many pathways to recovery. Guides like this will grant broader access to recovery resources for people who want to stop harmful substance use, without having to navigate through a series of ads and promotional materials, and provide access to life-saving tools for active substance users and people with mental health disorders.

Jeremy G


Find Treatment:

Self Empowering Addiction Treatment Association Provider Directory
SAMHSA Methadone Treatment Locator
SAMHSA Buprenorphine (Suboxone) Physician Locator
SAMHSA Comprehensive Treatment Locator
Comprehensive Directory of Methadone Treatment Providers (US & Canada)
Moderation Management for Alcohol

Support Groups:

Self-Management and Recovery Training: SMART Recovery, offers structured in-person and 24×7 online meetings)
LifeRing Secular Recovery
SOS Sobriety (Secular Sobriety)
Women for Sobriety
Harm Reduction for Alcohol (HAMS) Support Group
Mental Health Peer-Support Resources
National Alliance on Mental Illness (NAMI) Support Directory

Resources for Parents:

Drug Policy Alliance’s Safety First Program
Community Reinforcement Approach and Family Training: CRAFT (for Parents and Families)
SMART for Family and Friends Online Resources
Families for Sensible Drug Policy: FSDP

Harm Reduction Resources:

What is Harm Reduction? from Harm Reduction International and Drug Policy Alliance
Harm Reduction Publications from Harm Reduction Coalition
Connect Locally to Harm Reduction Organizations in Your Area
International Network for People Who Use Drugs: INPUD

Originally posted at: Making Noise in the South


Useful Videos:

Stanton Peele: What is Harm Reduction

Tom Horvath, founder of Practical Recovery and SMART Recovery, on Self Empowering Addiction Treatment

“Everything You Think You Know About Addiction is Wrong” from Kurzgesagt (based on the work of Johann Hari)

Intro to CRAFT (Community Reinforcement Approach and Family Training): CRAFT vs Alternatives

We’re Bringing Dr. Robert Meyer’s CRAFT Workshop to Philadelphia

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We are excited to be partnering with the Parents Translational Research Center at the Treatment Research Institute in Philadelphia, PA to bring Dr. Robert Meyers highly acclaimed Community Reinforcement and Family Training (CRAFT) workshop to Philadelphia, PA from March 28, 2016 — March 30, 2016.

Supported by 20 years of peer-reviewed research, Community Reinforcement and Family Training (CRAFT) is a comprehensive behavioral program that teaches families to optimize their impact on substance using loved ones while avoiding confrontation or detachment. CRAFT methods are evidence-based and provide families with a hopeful, positive, and more effective alternative to addressing substance problems than other intervention programs.

For complete information about the workshop click here: CRAFT PHILADELPHIA Brochure. Space is limited, so sign up today. Completion of this training is the first step toward becoming a certified CRAFT therapist. Continuing Education credits will be awarded upon satisfactory completion. For those of you who aren’t aware of CRAFT or if you want more information about the CRAFT approach, please check out this link.

Below is a testimonial by Dr. William R. Miller about Bob Meyers and the CRAFT trainings:

‘Bob Meyers has made exemplary contributions to knowledge about the treatment of substance abuse and dependence, overseeing two decades of programmatic research to develop, refine, adapt, test and disseminate CRAFT. Bob is an exceptional human being and colleague. He is a superb clinical teacher who garners top marks from audiences ranging from counselors in recovery to doctoral-level health professionals. Dr. Meyers brings extraordinary energy, compassion, depth and humanity to his research, treatment and training’. 

William R. Miller, Ph.D. Emeritus Distinguished Professor of Psychology and Psychiatry. 

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We look forward to seeing all interested mental health professionals there!