Beyond Addiction: How Science and Kindness Help People Change: CRAFT for Families
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Hi all. I have just finished reading Ch 2 of Beyond Addiction. I'm finding the book interesting, with some helpful ideas. It is such a pleasure to read something that is so counter to the "tough love" approach we often hear. However, so far it seems a bit simplistic. What has been said about motivation, the importance of being understood, etc., is fairly intuitive, but not always practical when dealing with someone in active addiction. The book seems to presume rationality on the part of the addict.
I think the helpfulness of the suggestions so far depends on each unique situation - the age and maturity level of the addict, the progression of the disease, the DOC, the relative positions of the people involved (i.e., parent-child, husband-wife, etc.). I'm hoping that future chapters will offer suggestions and approaches that are more practical in the context of the often chaotic craziness of life with a person in active addiction.
My personal experience was with two young men, at two different times, one 17-19 years old, the other 20-21, and the DOC was heroin. Each lived with me for a period of time, and I was essentially in the parental role. Some disaster struck almost daily, neither was able or willing to be functional, they never had money or could support themselves. They would not contribute to the household, and I was left to decide if I would provide them with minimal support at no cost to them (housing, food) or not. My refusal to help them more that this - even when communicated in the most measured, respectful way - was seen as a hostile act by them, and they reacted accordingly. The youngest stole from me. My efforts at understanding, nonjudgmental, helpful communication often resulted in one of two outcomes - listening to drug-fueled impractical fantasies and irrational perceptions of persecution, or efforts on their part to manipulate me. I am not saying that the book will not be helpful, and I anticipate that the above realities that I know are experienced by so many people living with addicts (especially parents with addicted children) will be addressed more realistically in future chapters.
In Ch 2, there is some inconsistent discussion of the impact of ultimatums on the addict. Whether or not ultimatums are the ideal approach to stimulate change, they are often necessary for the health of the person living with an addict. I am at the point where I know I cannot have a person in active addiction living in my home - period. After the emotional pain I experienced with the first young man, my psyche just can't handle it. If the person living with me is not making serious efforts at recovery, he has to go. Is that an ultimatum? Maybe, but it is what is required for me.
In regard to ultimatums, the authors first discuss the difference between internal and external motivation, stating that while external motivation cannot by itself support sustained change (internal motivation is required for that), it can nevertheless provide the basis to initiate change. The author notes that such external motivators that can tip the balance in favor of change and lead the addict to seek treatment include things like - "it is either the drug or our marriage." This sounds like an ultimatum to me, and the author is saying that this is an example of an external motivator that can begin the positive process of change (p. 134). Later in the same chapter, however, the author suggests that ultimatums are never ideal and, in fact, can be counterproductive (p. 163).
I think the helpfulness of the suggestions so far depends on each unique situation - the age and maturity level of the addict, the progression of the disease, the DOC, the relative positions of the people involved (i.e., parent-child, husband-wife, etc.). I'm hoping that future chapters will offer suggestions and approaches that are more practical in the context of the often chaotic craziness of life with a person in active addiction.
My personal experience was with two young men, at two different times, one 17-19 years old, the other 20-21, and the DOC was heroin. Each lived with me for a period of time, and I was essentially in the parental role. Some disaster struck almost daily, neither was able or willing to be functional, they never had money or could support themselves. They would not contribute to the household, and I was left to decide if I would provide them with minimal support at no cost to them (housing, food) or not. My refusal to help them more that this - even when communicated in the most measured, respectful way - was seen as a hostile act by them, and they reacted accordingly. The youngest stole from me. My efforts at understanding, nonjudgmental, helpful communication often resulted in one of two outcomes - listening to drug-fueled impractical fantasies and irrational perceptions of persecution, or efforts on their part to manipulate me. I am not saying that the book will not be helpful, and I anticipate that the above realities that I know are experienced by so many people living with addicts (especially parents with addicted children) will be addressed more realistically in future chapters.
In Ch 2, there is some inconsistent discussion of the impact of ultimatums on the addict. Whether or not ultimatums are the ideal approach to stimulate change, they are often necessary for the health of the person living with an addict. I am at the point where I know I cannot have a person in active addiction living in my home - period. After the emotional pain I experienced with the first young man, my psyche just can't handle it. If the person living with me is not making serious efforts at recovery, he has to go. Is that an ultimatum? Maybe, but it is what is required for me.
In regard to ultimatums, the authors first discuss the difference between internal and external motivation, stating that while external motivation cannot by itself support sustained change (internal motivation is required for that), it can nevertheless provide the basis to initiate change. The author notes that such external motivators that can tip the balance in favor of change and lead the addict to seek treatment include things like - "it is either the drug or our marriage." This sounds like an ultimatum to me, and the author is saying that this is an example of an external motivator that can begin the positive process of change (p. 134). Later in the same chapter, however, the author suggests that ultimatums are never ideal and, in fact, can be counterproductive (p. 163).
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comments on Beyond Addiction
Thank you for your thoughtful response to the book, SeekingGrowth. I'm in about the same place in "Beyond Addiction" as you are, and having similar reactions.
One issue I have is that the authors seem to presume that the non-user will be able to maintain calm and rational responses even in the face of the craziness of the person with whom we are involved. I would imagine that at least in your case you were older than the young men you were trying to help, so you had (and have) the wisdom of maturity. I'm more like the woman described as "Kim" on page 20, who is coping with her husband's "distressing behaviors." It's one thing to know that those behaviors are in part due to the impact of alcohol (or abstinence) on the person's brain; it's quite another not to react or care when the person is acting like an (excuse the English but I can't think of a synonym) a--hole. I, too, am hopeful that future chapters will explain more clearly how one goes about doing that.
I totally agree with you about the authors' inconsistency when it comes to ultimatums, too. Also, from personal experience, it was only when I told my husband to move out (he said no), and then I said okay, our children and I are leaving, that he decided he had to change.
My other beef about the book: I wish the authors gave specifics about the "science" to which they refer. They tell us that even the case-studies are composites, rather than real people. I would be more persuaded by their research and insights if they were more forthcoming about the studies upon which these conclusions are based. I see that some of the studies are included in the "Notes" at the end of the book; I would prefer they be integrated into the narrative as well.
One issue I have is that the authors seem to presume that the non-user will be able to maintain calm and rational responses even in the face of the craziness of the person with whom we are involved. I would imagine that at least in your case you were older than the young men you were trying to help, so you had (and have) the wisdom of maturity. I'm more like the woman described as "Kim" on page 20, who is coping with her husband's "distressing behaviors." It's one thing to know that those behaviors are in part due to the impact of alcohol (or abstinence) on the person's brain; it's quite another not to react or care when the person is acting like an (excuse the English but I can't think of a synonym) a--hole. I, too, am hopeful that future chapters will explain more clearly how one goes about doing that.
I totally agree with you about the authors' inconsistency when it comes to ultimatums, too. Also, from personal experience, it was only when I told my husband to move out (he said no), and then I said okay, our children and I are leaving, that he decided he had to change.
My other beef about the book: I wish the authors gave specifics about the "science" to which they refer. They tell us that even the case-studies are composites, rather than real people. I would be more persuaded by their research and insights if they were more forthcoming about the studies upon which these conclusions are based. I see that some of the studies are included in the "Notes" at the end of the book; I would prefer they be integrated into the narrative as well.
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I just wanted to stop by and welcome Sauerkraut to the forum.. I just noticed this is your first post... the more points of view the better. Thank you for joining us.
I am re-reading the book.. it was last spring when I first went through it... I basically remember the chapter as a general overview on motivation.. how people use for different reasons.. their use is motivated by something particular to them...and moving along the path of change each person will require different motivation. But Im going to jump back into this chapter, its interesting also to read it a second time because Im catching things I didn't the first run through.
with my husband when he was actively using, we did separate early on.. I kept telling him if he wanted to live that way then go ahead on his own until he was ready to quit. And he did that... the negative consequence backfired IMO because at that time he felt my complaining about his using and being unhappy was his only problem. He had a good job, money, and could go off on his own and he actually just got more involved in using, deeper with the friends from his office, etc. So for me.. and many stories I read I feel negative consequences backfire... or they become an external factor pressuring someone to change.. but I think one of the ideas of the book is that people have to find the real internal motivation.. for my husband in the end what brought on his recovery was my pushing him into treatment (external), but what has sustained his recovery is the internal motivation of pursuing his own hopes and dreams.. having a loving family, being a good husband, being a good father and active in his sons life, his career goals, and even mini goals he sets in life... taking vacations, being involved in sports.. all the things that make him happy and bring personal satisfaction.
I am re-reading the book.. it was last spring when I first went through it... I basically remember the chapter as a general overview on motivation.. how people use for different reasons.. their use is motivated by something particular to them...and moving along the path of change each person will require different motivation. But Im going to jump back into this chapter, its interesting also to read it a second time because Im catching things I didn't the first run through.
with my husband when he was actively using, we did separate early on.. I kept telling him if he wanted to live that way then go ahead on his own until he was ready to quit. And he did that... the negative consequence backfired IMO because at that time he felt my complaining about his using and being unhappy was his only problem. He had a good job, money, and could go off on his own and he actually just got more involved in using, deeper with the friends from his office, etc. So for me.. and many stories I read I feel negative consequences backfire... or they become an external factor pressuring someone to change.. but I think one of the ideas of the book is that people have to find the real internal motivation.. for my husband in the end what brought on his recovery was my pushing him into treatment (external), but what has sustained his recovery is the internal motivation of pursuing his own hopes and dreams.. having a loving family, being a good husband, being a good father and active in his sons life, his career goals, and even mini goals he sets in life... taking vacations, being involved in sports.. all the things that make him happy and bring personal satisfaction.
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Hi - this is my first post here also, but I have been active in other forums. I'm reading BA now, and getting a lot of help from it. The approach to communication has really helped with getting my daughter to open up, and get help. It's a long road.
I think it's important to set boundaries - everyone needs to figure out what theirs are. When I first realized that my daughter had a serious drug problem, I thought there were 3 choices, kick her out, force her to go to rehab, or nothing. I discovered that there was another option, that looks to the outside world like nothing, but involves providing emotional support without enabling. It was difficult, but she was actually helped by this to choose to stop and become sober. I became better at not throwing fuel on the fire when things got tense. Unfortunately, she has relapsed, but understanding that relapse is so common, it is part of the process of learning how to handle the problem and to recover, helps me to stay calm and keep trying to figure out what I can do to help and assist.
I think it's important to set boundaries - everyone needs to figure out what theirs are. When I first realized that my daughter had a serious drug problem, I thought there were 3 choices, kick her out, force her to go to rehab, or nothing. I discovered that there was another option, that looks to the outside world like nothing, but involves providing emotional support without enabling. It was difficult, but she was actually helped by this to choose to stop and become sober. I became better at not throwing fuel on the fire when things got tense. Unfortunately, she has relapsed, but understanding that relapse is so common, it is part of the process of learning how to handle the problem and to recover, helps me to stay calm and keep trying to figure out what I can do to help and assist.
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Originally Posted by Jogna 
Hi - this is my first post here also, but I have been active in other forums. I'm reading BA now, and getting a lot of help from it. The approach to communication has really helped with getting my daughter to open up, and get help. It's a long road.
I think it's important to set boundaries - everyone needs to figure out what theirs are. When I first realized that my daughter had a serious drug problem, I thought there were 3 choices, kick her out, force her to go to rehab, or nothing. I discovered that there was another option, that looks to the outside world like nothing, but involves providing emotional support without enabling. It was difficult, but she was actually helped by this to choose to stop and become sober. I became better at not throwing fuel on the fire when things got tense. Unfortunately, she has relapsed, but understanding that relapse is so common, it is part of the process of learning how to handle the problem and to recover, helps me to stay calm and keep trying to figure out what I can do to help and assist.
I think it's important to set boundaries - everyone needs to figure out what theirs are. When I first realized that my daughter had a serious drug problem, I thought there were 3 choices, kick her out, force her to go to rehab, or nothing. I discovered that there was another option, that looks to the outside world like nothing, but involves providing emotional support without enabling. It was difficult, but she was actually helped by this to choose to stop and become sober. I became better at not throwing fuel on the fire when things got tense. Unfortunately, she has relapsed, but understanding that relapse is so common, it is part of the process of learning how to handle the problem and to recover, helps me to stay calm and keep trying to figure out what I can do to help and assist.
I knew u looked familiar, thx for coming by and sharing with us!
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Ch. 2: Motivation – Why Do People Change?
I think this chapter is meant to be a fairly high level explanation of motivation.. how it works for all of us…and then getting into slightly more detail on how motivation is influenced by substance abuse.
Motivation occurs in the brain and the book explains it as being a link between our emotions and our actions. It also goes on to explain how motivation is also impacted by dopamine. I found it interesting to think about the 0-60 rule… the quicker a substance or activity affects the brain, the more powerfully the brain is motivated to use that substance… the book gives examples of other things that might generally make a person happy or feel good.. but these things will release much less dopamine because of the imbalance created by the artificial stimulus… this accounts for the lack of motivation to pursue other alternatives…
This is interesting because I have often heard people say that if a person is so highly motivated to use substances, and have proven themselves so resourceful… then the simple black /white comparison comes about... IF they were willing to put that much effort into obtaining a drug, then they are also able to exert the same effort in changing their life. I feel often family get frustrated because they don’t see these ambitious attempts… or become frustrated when a person tries to make a change initially but its short lived.
For me, greater understanding allows me to take things less personally, and also have more compassion for what a person is going through especially in initial stages of making a change; detoxing, incorporating positives into their life… therapy for example will help a person develop new coping strategies, but it doesn’t provide instant dopamine release… the link between emotion (knowing therapy will help in the long run) and the actual action (of attending on a regular schedule and doing the exercises that go along with it)….
So it leaves me thinking what else affects motivation…
Our interactions with our loved ones have impact on their motivations…
we can influence our loved ones choices, by helping them make the connection between positive experiences, and positive actions.
And this does not take special effort on our part necessarily but I think it often takes a change in our way of thinking, managing our emotions -and this in turn allows us to react in healthier, more productive ways for ourselves and for our loved one.
The book goes into a discussion of SDT – Self Determination Theory – evidence supported work by Edward Deci and Richard Ryan; both psychologists at the University of Rochester… their work explains the impact of the interpersonal, social environment on human motivation and behavior.
From this comes the concept of external and internal motivation.
Internal motivation is based on our own reasons for making a choice or performing an action.. its what we want for our own personal reasons and may include our own values, goals in life, or just our way of thinking.
External motivations comes from reasons outside of us… these can be company policy, rules of the school we attend, rules set by parents, demands by a spouse, or to avoid having a license revoked, or ending up in jail, etc.
The book shares the concept of self-determination extends to all kinds of relationships… parent/teacher, employer/employee, parent/child, husband/wife, doctor/patient, coach/athlete… etc…
The author goes on to state on often in their practice they see people who come in for treatment based on external factors.. often this is what gets people in the door. It is what also got my husband into the door of rehab….
This is also consistent with what I have read from the National Institute of Drug Abuse.. a large portion of people seek treatment due to encouragement from family, friends initially… and NIDA actually encourages family not to stand back and avoid taking action to encourage treatment because addiction is like most other illness.. early diagnosis and treatment work best.. waiting for a person to find their own internal motivation (hitting a rock bottom on their own) is not necessary, and not even wise… people die from delayed treatment… Ok sorry I digress.. but I hate it when people die…
The book goes on to discuss what must happen to sustain change.. and that is an internal shift of motivation…. External forces initiated the change.. but it will take internal motivation by the individual to sustain it. The book goes on to explain how important it is for each of us to find our own reasons for doing things… totally agree with this..
The book also goes on to say… In the book they feel that most people are best motivated by a combination of external and internal motivations… in the book they reference an example of recovery by physicians.. and I have also seen studies related to that of airline pilots… both groups have extremely high rates of recovery.. I think for airline pilots it was in the 90% range.. external motivations include what is required by their profession.. drug testing, counseling, meeting with a rep on a regular basis, risk of losing their career if they fail.. but also the interanal motivation is also high because most of these people want to be doctors, airline pilots and live that life that those professions bring…. This life and all it holds is their internal motivation.
Ok, movie time for me. My husband is motivating me to stop now
The first, critical step in helping people change is to understand the motivation for their behavior in the first place ….what in the here and now makes sense about their behavior, to them….using substances or engaging in other compulsive behavior is goal oriented behavior, not crazy, or stupid, or immoral…..Understanding the reasons behind a person’s behavior, however, contains the seeds of a solution to the problem.
Motivation occurs in the brain and the book explains it as being a link between our emotions and our actions. It also goes on to explain how motivation is also impacted by dopamine. I found it interesting to think about the 0-60 rule… the quicker a substance or activity affects the brain, the more powerfully the brain is motivated to use that substance… the book gives examples of other things that might generally make a person happy or feel good.. but these things will release much less dopamine because of the imbalance created by the artificial stimulus… this accounts for the lack of motivation to pursue other alternatives…
This is interesting because I have often heard people say that if a person is so highly motivated to use substances, and have proven themselves so resourceful… then the simple black /white comparison comes about... IF they were willing to put that much effort into obtaining a drug, then they are also able to exert the same effort in changing their life. I feel often family get frustrated because they don’t see these ambitious attempts… or become frustrated when a person tries to make a change initially but its short lived.
For me, greater understanding allows me to take things less personally, and also have more compassion for what a person is going through especially in initial stages of making a change; detoxing, incorporating positives into their life… therapy for example will help a person develop new coping strategies, but it doesn’t provide instant dopamine release… the link between emotion (knowing therapy will help in the long run) and the actual action (of attending on a regular schedule and doing the exercises that go along with it)….
So it leaves me thinking what else affects motivation…
The brain and the world in which it operates are inextricably intertwined; we literally take in substances, people, and other stimuli, and they affect the very structure and functioning of our brains; our brain in turn affect our behavior toward substances, other people and other stimuli in the world. Understanding the interactive nature of motivation, you can see the value in staying engaged
we can influence our loved ones choices, by helping them make the connection between positive experiences, and positive actions.
And this does not take special effort on our part necessarily but I think it often takes a change in our way of thinking, managing our emotions -and this in turn allows us to react in healthier, more productive ways for ourselves and for our loved one.
The book goes into a discussion of SDT – Self Determination Theory – evidence supported work by Edward Deci and Richard Ryan; both psychologists at the University of Rochester… their work explains the impact of the interpersonal, social environment on human motivation and behavior.
From this comes the concept of external and internal motivation.
Internal motivation is based on our own reasons for making a choice or performing an action.. its what we want for our own personal reasons and may include our own values, goals in life, or just our way of thinking.
External motivations comes from reasons outside of us… these can be company policy, rules of the school we attend, rules set by parents, demands by a spouse, or to avoid having a license revoked, or ending up in jail, etc.
while their influence and power tend to fade over time, external forces are often the reasons we do things in the first place.
Within these relationships, the way one person interacts has proved to affect the type of motivation the other person experiences. In other words, your behavior toward your loved one can help foster her internal motivation
This is also consistent with what I have read from the National Institute of Drug Abuse.. a large portion of people seek treatment due to encouragement from family, friends initially… and NIDA actually encourages family not to stand back and avoid taking action to encourage treatment because addiction is like most other illness.. early diagnosis and treatment work best.. waiting for a person to find their own internal motivation (hitting a rock bottom on their own) is not necessary, and not even wise… people die from delayed treatment… Ok sorry I digress.. but I hate it when people die…
The book goes on to discuss what must happen to sustain change.. and that is an internal shift of motivation…. External forces initiated the change.. but it will take internal motivation by the individual to sustain it. The book goes on to explain how important it is for each of us to find our own reasons for doing things… totally agree with this..
The book also goes on to say…
the traditional treatment mandate “come back when your ready” partly got it right. Maintaining change usually requires that people develop their own reasons for wanting that change. What this mandate, did not get, however, is that a person’s internal motivation is directly influenced by external factors, including treatment providers. Our mandate has become: How do we help you shift your motivation
Ok, movie time for me. My husband is motivating me to stop now
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Allfor thank you for explaining how external and internal motivation works. This is exactly what got me into recovery and remain in recovery. I saw this play out with other clients in the programs I attended. Most entered the IOP kicking and screaming so to speak. They were there because they were forced to be there. Whether it was a government agency like ACS/CPS or the judicial system / traffic bureau or employer or a family member. Then later on while in the program the internal motivations took root. So it is very true that what gets a person into treatment is often very different from what keeps them in recovery.
I think another very important point to make is that just because a person relapses doesn't mean it's a failure and that person is doomed to a life of active addiction. I read this a lot where family will say they sent their loved one to rehab and the moment they got out they used again. They assume their money spent at that rehab was wasted. That is not the case. Their loved one learned the skills to stay clean...they just need to prefect those skills. Just for purposes of simplifying this concept I will compare recovery to a gymnast who is training for the Olympics. That person spends hours upon hours of training. Same as a person who has been in rehab. It takes time, effort and sometimes failure to learn this new skill. A gymnast might fall or mess-up a move. A person in recovery might relapse. These failures help to prefect that new skill that's being learned. So I think it's important for family to understand that relapses can occur and those do not necessarily mean failure to long term recovery. I think if family understand this then they will be much more patient and not fear relapses so much. Recovery is a process....a journey. Again it takes time, hard-work and sometimes failure to build a solid recovery. :-)
I think another very important point to make is that just because a person relapses doesn't mean it's a failure and that person is doomed to a life of active addiction. I read this a lot where family will say they sent their loved one to rehab and the moment they got out they used again. They assume their money spent at that rehab was wasted. That is not the case. Their loved one learned the skills to stay clean...they just need to prefect those skills. Just for purposes of simplifying this concept I will compare recovery to a gymnast who is training for the Olympics. That person spends hours upon hours of training. Same as a person who has been in rehab. It takes time, effort and sometimes failure to learn this new skill. A gymnast might fall or mess-up a move. A person in recovery might relapse. These failures help to prefect that new skill that's being learned. So I think it's important for family to understand that relapses can occur and those do not necessarily mean failure to long term recovery. I think if family understand this then they will be much more patient and not fear relapses so much. Recovery is a process....a journey. Again it takes time, hard-work and sometimes failure to build a solid recovery. :-)
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I am going to get the book...
One thing I have noticed , is that there are a lot of people trying to persuade me on what to do with my mate. I have had people inside AND outside the program with opinions about how I should relate, or shouldn't to him. Those individuals are all living lives, in some respects, that I wouldn't want to live.
AlAnon is a helpful program for me, and is working for me. However, the changes in me have not been motivating change in my mate.
One thing I feel VERY good about, is that I have been consistently kind to my mate and told him I love him, even during our separation. He has been nasty, distant, and told me he has "no love for me." He treats our dogs a lot better than he treats me. I "detached" enough to get off the booze myself and begin healing, but I have not towed the party line some folks would like me to: abandonment and divorce .
I decided to love him, in whatever way possible, in spite of how he treats me.
One thing I have noticed , is that there are a lot of people trying to persuade me on what to do with my mate. I have had people inside AND outside the program with opinions about how I should relate, or shouldn't to him. Those individuals are all living lives, in some respects, that I wouldn't want to live.
AlAnon is a helpful program for me, and is working for me. However, the changes in me have not been motivating change in my mate.
One thing I feel VERY good about, is that I have been consistently kind to my mate and told him I love him, even during our separation. He has been nasty, distant, and told me he has "no love for me." He treats our dogs a lot better than he treats me. I "detached" enough to get off the booze myself and begin healing, but I have not towed the party line some folks would like me to: abandonment and divorce .
I decided to love him, in whatever way possible, in spite of how he treats me.
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Originally Posted by Eauchiche
I am going to get the book...
One thing I have noticed , is that there are a lot of people trying to persuade me on what to do with my mate. I have had people inside AND outside the program with opinions about how I should relate, or shouldn't to him. Those individuals are all living lives, in some respects, that I wouldn't want to live.
AlAnon is a helpful program for me, and is working for me. However, the changes in me have not been motivating change in my mate.
One thing I feel VERY good about, is that I have been consistently kind to my mate and told him I love him, even during our separation. He has been nasty, distant, and told me he has "no love for me." He treats our dogs a lot better than he treats me. I "detached" enough to get off the booze myself and begin healing, but I have not towed the party line some folks would like me to: abandonment and divorce .
I decided to love him, in whatever way possible, in spite of how he treats me.
One thing I have noticed , is that there are a lot of people trying to persuade me on what to do with my mate. I have had people inside AND outside the program with opinions about how I should relate, or shouldn't to him. Those individuals are all living lives, in some respects, that I wouldn't want to live.
AlAnon is a helpful program for me, and is working for me. However, the changes in me have not been motivating change in my mate.
One thing I feel VERY good about, is that I have been consistently kind to my mate and told him I love him, even during our separation. He has been nasty, distant, and told me he has "no love for me." He treats our dogs a lot better than he treats me. I "detached" enough to get off the booze myself and begin healing, but I have not towed the party line some folks would like me to: abandonment and divorce .
I decided to love him, in whatever way possible, in spite of how he treats me.
Loving them doesn't mean you're letting them walk on you, it simply means, you care about them and want the best for them. That's healthy.
I have a BIL, in particular, who is very vocal about what I should do about my H. I am not prepared to do what he wants, and he can be vocal about it since he doesn't have to live it. It's hard to follow what YOU feel right, not what others tell you should feel right. Ultimately, you live your life, and they don't. Do what YOU feel is right.
And glad you are getting the book
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Originally Posted by allforcnm
Ch. 2: Motivation – Why Do People Change?
I think this chapter is meant to be a fairly high level explanation of motivation.. how it works for all of us…and then getting into slightly more detail on how motivation is influenced by substance abuse.
Motivation occurs in the brain and the book explains it as being a link between our emotions and our actions. It also goes on to explain how motivation is also impacted by dopamine. I found it interesting to think about the 0-60 rule… the quicker a substance or activity affects the brain, the more powerfully the brain is motivated to use that substance… the book gives examples of other things that might generally make a person happy or feel good.. but these things will release much less dopamine because of the imbalance created by the artificial stimulus… this accounts for the lack of motivation to pursue other alternatives…
This is interesting because I have often heard people say that if a person is so highly motivated to use substances, and have proven themselves so resourceful… then the simple black /white comparison comes about... IF they were willing to put that much effort into obtaining a drug, then they are also able to exert the same effort in changing their life. I feel often family get frustrated because they don’t see these ambitious attempts… or become frustrated when a person tries to make a change initially but its short lived.
For me, greater understanding allows me to take things less personally, and also have more compassion for what a person is going through especially in initial stages of making a change; detoxing, incorporating positives into their life… therapy for example will help a person develop new coping strategies, but it doesn’t provide instant dopamine release… the link between emotion (knowing therapy will help in the long run) and the actual action (of attending on a regular schedule and doing the exercises that go along with it)….
So it leaves me thinking what else affects motivation…
Our interactions with our loved ones have impact on their motivations…
we can influence our loved ones choices, by helping them make the connection between positive experiences, and positive actions.
And this does not take special effort on our part necessarily but I think it often takes a change in our way of thinking, managing our emotions -and this in turn allows us to react in healthier, more productive ways for ourselves and for our loved one.
The book goes into a discussion of SDT – Self Determination Theory – evidence supported work by Edward Deci and Richard Ryan; both psychologists at the University of Rochester… their work explains the impact of the interpersonal, social environment on human motivation and behavior.
From this comes the concept of external and internal motivation.
Internal motivation is based on our own reasons for making a choice or performing an action.. its what we want for our own personal reasons and may include our own values, goals in life, or just our way of thinking.
External motivations comes from reasons outside of us… these can be company policy, rules of the school we attend, rules set by parents, demands by a spouse, or to avoid having a license revoked, or ending up in jail, etc.
The book shares the concept of self-determination extends to all kinds of relationships… parent/teacher, employer/employee, parent/child, husband/wife, doctor/patient, coach/athlete… etc…
The author goes on to state on often in their practice they see people who come in for treatment based on external factors.. often this is what gets people in the door. It is what also got my husband into the door of rehab….
This is also consistent with what I have read from the National Institute of Drug Abuse.. a large portion of people seek treatment due to encouragement from family, friends initially… and NIDA actually encourages family not to stand back and avoid taking action to encourage treatment because addiction is like most other illness.. early diagnosis and treatment work best.. waiting for a person to find their own internal motivation (hitting a rock bottom on their own) is not necessary, and not even wise… people die from delayed treatment… Ok sorry I digress.. but I hate it when people die…
The book goes on to discuss what must happen to sustain change.. and that is an internal shift of motivation…. External forces initiated the change.. but it will take internal motivation by the individual to sustain it. The book goes on to explain how important it is for each of us to find our own reasons for doing things… totally agree with this..
The book also goes on to say…
In the book they feel that most people are best motivated by a combination of external and internal motivations… in the book they reference an example of recovery by physicians.. and I have also seen studies related to that of airline pilots… both groups have extremely high rates of recovery.. I think for airline pilots it was in the 90% range.. external motivations include what is required by their profession.. drug testing, counseling, meeting with a rep on a regular basis, risk of losing their career if they fail.. but also the interanal motivation is also high because most of these people want to be doctors, airline pilots and live that life that those professions bring…. This life and all it holds is their internal motivation.
Ok, movie time for me. My husband is motivating me to stop now
I think this chapter is meant to be a fairly high level explanation of motivation.. how it works for all of us…and then getting into slightly more detail on how motivation is influenced by substance abuse.
Motivation occurs in the brain and the book explains it as being a link between our emotions and our actions. It also goes on to explain how motivation is also impacted by dopamine. I found it interesting to think about the 0-60 rule… the quicker a substance or activity affects the brain, the more powerfully the brain is motivated to use that substance… the book gives examples of other things that might generally make a person happy or feel good.. but these things will release much less dopamine because of the imbalance created by the artificial stimulus… this accounts for the lack of motivation to pursue other alternatives…
This is interesting because I have often heard people say that if a person is so highly motivated to use substances, and have proven themselves so resourceful… then the simple black /white comparison comes about... IF they were willing to put that much effort into obtaining a drug, then they are also able to exert the same effort in changing their life. I feel often family get frustrated because they don’t see these ambitious attempts… or become frustrated when a person tries to make a change initially but its short lived.
For me, greater understanding allows me to take things less personally, and also have more compassion for what a person is going through especially in initial stages of making a change; detoxing, incorporating positives into their life… therapy for example will help a person develop new coping strategies, but it doesn’t provide instant dopamine release… the link between emotion (knowing therapy will help in the long run) and the actual action (of attending on a regular schedule and doing the exercises that go along with it)….
So it leaves me thinking what else affects motivation…
Our interactions with our loved ones have impact on their motivations…
we can influence our loved ones choices, by helping them make the connection between positive experiences, and positive actions.
And this does not take special effort on our part necessarily but I think it often takes a change in our way of thinking, managing our emotions -and this in turn allows us to react in healthier, more productive ways for ourselves and for our loved one.
The book goes into a discussion of SDT – Self Determination Theory – evidence supported work by Edward Deci and Richard Ryan; both psychologists at the University of Rochester… their work explains the impact of the interpersonal, social environment on human motivation and behavior.
From this comes the concept of external and internal motivation.
Internal motivation is based on our own reasons for making a choice or performing an action.. its what we want for our own personal reasons and may include our own values, goals in life, or just our way of thinking.
External motivations comes from reasons outside of us… these can be company policy, rules of the school we attend, rules set by parents, demands by a spouse, or to avoid having a license revoked, or ending up in jail, etc.
The book shares the concept of self-determination extends to all kinds of relationships… parent/teacher, employer/employee, parent/child, husband/wife, doctor/patient, coach/athlete… etc…
The author goes on to state on often in their practice they see people who come in for treatment based on external factors.. often this is what gets people in the door. It is what also got my husband into the door of rehab….
This is also consistent with what I have read from the National Institute of Drug Abuse.. a large portion of people seek treatment due to encouragement from family, friends initially… and NIDA actually encourages family not to stand back and avoid taking action to encourage treatment because addiction is like most other illness.. early diagnosis and treatment work best.. waiting for a person to find their own internal motivation (hitting a rock bottom on their own) is not necessary, and not even wise… people die from delayed treatment… Ok sorry I digress.. but I hate it when people die…
The book goes on to discuss what must happen to sustain change.. and that is an internal shift of motivation…. External forces initiated the change.. but it will take internal motivation by the individual to sustain it. The book goes on to explain how important it is for each of us to find our own reasons for doing things… totally agree with this..
The book also goes on to say…
In the book they feel that most people are best motivated by a combination of external and internal motivations… in the book they reference an example of recovery by physicians.. and I have also seen studies related to that of airline pilots… both groups have extremely high rates of recovery.. I think for airline pilots it was in the 90% range.. external motivations include what is required by their profession.. drug testing, counseling, meeting with a rep on a regular basis, risk of losing their career if they fail.. but also the interanal motivation is also high because most of these people want to be doctors, airline pilots and live that life that those professions bring…. This life and all it holds is their internal motivation.
Ok, movie time for me. My husband is motivating me to stop now
One thing I wonder about, I recently read an article about how alcohol damages the white matter tracts in the frontal lobes of the brain, which are the integration center for the other parts of the brain. These parts are important for self-regulation and impulse control, and the more they drink, the more the damage. Basically, the part of the brain they damage is the part that would help them to stop.
Booze damages part of the brain that deals with self-control | Daily Mail Online
That said, I wonder how sound of mind an addict is? Do we need to really "up" the motivation for them to understand, since that part is damaged? If so, how do we do that?
BTW, I hate it when people die too.
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Im feeling guilty because i havent been reading or posting. Today I downloaded the audio version and I think now I can listen on my drive to work. I was reading the book in the summer but it was when my husband was away for a week with work. Why am I afraid to share this book is what I cant figure out? Theres nothing bad in the book to upset him, so its my own feelings putting up the wall but I cant pinpoint it? 
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Cleanin.. that's a really good comparison .. a gymnast... I often feel like people have a totally different set of standards for someone dealing with an addiction then they do for themselves.. and everyone else... A person recovering from an addiction is almost supposed to be a superhuman... have unwavering motivation, be able to cope with anything that comes their way, never get down on themselves or life, be in a state of gratitude non stop.... lol.. I think its incredibly unrealistic for family to take on these ideas...and often as you said 30 days in rehab was supposed to fix all of it.. and possibly in a rehab that's not even providing adequate treatment.... but still its supposed to give all the skills and all the tools ever needed... its just unrealistic...
Very much like a gymnast.. you have to first master the basics, then start expanding and learning all your unique moves.. sometimes you fall, or just do it wrong.. but its a learning process.
The next part of the book.. which I don't have time to get into tonight..is about how motivation itself changes, shifts... a lot of it I think is easy to relate to even if you think about motivation in terms of trying to maintain a diet.... who hasn't had a problem with that at some point in their life?
SVL: Good questions about do we need to "up" motivation. It would seem like it would be based on the stage of addiction. It would be interesting to ask a therapist (evidence based) how they motivate based on stages of addiction..
Blue: Don't feel guilty...read (or listen) when you can.. it shouldn't be a chore, keep it as something positive.
Very much like a gymnast.. you have to first master the basics, then start expanding and learning all your unique moves.. sometimes you fall, or just do it wrong.. but its a learning process.
The next part of the book.. which I don't have time to get into tonight..is about how motivation itself changes, shifts... a lot of it I think is easy to relate to even if you think about motivation in terms of trying to maintain a diet.... who hasn't had a problem with that at some point in their life?
SVL: Good questions about do we need to "up" motivation. It would seem like it would be based on the stage of addiction. It would be interesting to ask a therapist (evidence based) how they motivate based on stages of addiction..
Blue: Don't feel guilty...read (or listen) when you can.. it shouldn't be a chore, keep it as something positive.
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Chapter 2 ....continued
What We Know About Motivation
Ex: Loser, bum, addict
Why are people motivated to use a substance? Its based on the outcome of how that choice feels to the person.
The book believes if we ( as family members ) understand the different motivations behind the choices our loved one makes to use a particular substance, going so far as to say.. at a particular time... we will be able to more clearly look at the problem "without judging, writing off, or hating the person for it".
In general what I think the book is explaining that each person... all of us, not just substance abusers... are motivated to do things.. or not do things... based on how the outcome feels to us.. We use our own reasoning to determining the pros and cons of a choice, what the Cost/ Benefit is & are motivated based on what the expected outcomes are.
With substance abuse, we may not agree with our loved ones reasoning behind their choice to partake... but to understand a person is using their own form of reasoning, their own cost/benefit analysis is an important concept.... and it helps in our goal of bringing about change.
I think its also important to remember at this point the other basics we have learned, how the brain is affected when a person is using.. we know dopamine, the frontal lobe, and the limbic system are all functioning in compromised ways... these factors are also involved in the reasoning process,the cost/benefit process & therefore they also affect a persons motivation, and influence the ultimate choice that is made... Choice is complex and this is often not disclosed to family members...
This is why I personally find it distasteful to hear people tell an upset family member "he is choosing drugs over you". Sounds simple and very personal... when the truth is its not either.
Motivations Matter and are subject to Influence... this is one of the key points I see
Motivations Change Over Time ... another key point
The book suggests when examining motivations to look at every reason one has for making a change.. but then realize motivation often changes as circumstances change, time passes, etc.
Short term reasons for making a change can be much different than what will ultimately motivate someone in the long run. ( i.e ...external motivations can start a change, but internal motivations are needed to sustain change) Understanding that motivation is not fixed is important because having this awareness can actually help us, and I think it also free's us in a way.
Just a note... I think of this in terms of a family member setting a "boundary" also... Ive often heard in negative tone " you didnt stick to your boundary" but unless a person is periodically reviewing why that boundary is put in place... it may be that the original motivation for having that boundary is no longer an issues.. maybe we are stronger emotionally now, or our loved ones behavior has changed over time....I think we can do harm to ourselves if we dont allow ourselves flexibility, and acknowledge our motivations, our reasoning also changes, and this is normal.
Reactive Motivations is also talked about in the book, and I think this is very relate-able for family members.
For anyone who read the first CRAFT book.... Get your Loved one Sober Alternatives to nagging, pleading, and threatening.. I think the title says a lot... these things dont work... we guilt, shame, evoke anger in our loved one, they in turn make a reactionary promise to stop using .. reactionary motivation.. but its superficial and not well thought out by the person. However often family members take this to heart... and when the motivation flames out.. we become upset and angry. He lied ! Of course this often triggers more negative reactions on our part.
The book says "Motivation to change can occur whenever the costs of a behavior outweigh the benefits" .... in terms of our loved ones perspective.. not ours.
This is about allowing the natural negative consequences of specific behaviors to affect our loved ones... the example is a common one... if your husband is drunk the night before, allow him to be responsible for getting up, and getting to work on time. If he oversleeps dont wake him up, let him see this as a cost of his drinking.. let him face the consequence of an angry boss, fear of trouble at work... and as a bonus most likely it will reduce our stress, our frustration of being the one to force him up, worrying he will be late, possibly starting an argument.. This is a simple example.. but one Ive seen used to explain "enabling" quite often. As I recall all of this is discussed more in later chapters... also discussed is helping our loved one associate positive feelings for positive behaviors...
Self Image is also discussed as part of Motivation...
This one I believe was a motivating factor for my husband... when we became parents.. he has often talked about one of his motivations was to be a good father to our son & to be present in his life... he had am image in his mind based on his childhood and experiences... This helped him realize he couldnt be that person and continue on with substances. I dont think it was the only motivation, but it was one of many.
I like the example of the mother and words from her child... then how she was able to confide to her husband about the self inspection she did because of the little ones comment... He provided a sounding board, and offered her support to change her situation...she was using pills on a regular basis.. The example may sound simplistic.. but I actually think many people recognize substance abuse issues early on, before things spiral so far out of control. As the book states.. change can happen at any time... whenever the cost /benefit analysis tips towards motivating change...
Ambivalence is a Normal part of motivation and the change process
Substance abuse has an upside to our loved ones... in the cost/benefit analysis, it has both a cost and a benefit... they use for a reason that make sense to them... this is where the ambivalence comes from. I.E. I have more energy, I can stay up late and study, I have more friends, I will get sick if I stop, Im not as depressed, My anxiety is better... etc... The book says of course there's a counterargument to each one of these, but this is what generates the ambivalence.. one foot in, one foot out in terms of motivation to change.
Ideas about ambivalence affect both the substance user and family... the book states that we both need to accept ambivalence as part of the process of change. What I take from the book is that in a therapeutic setting, doctors want a patient to discuss their pro /con, cost / benefit and share their ambivalence... Ideally it should also be the same at home with a spouse in a relationship that is strong on communication.
The book also states:
This relates very much to comments I often hear: he just didnt want it bad enough, didnt try hard enough, he failed. In turn we, the family member should be angry, disappointed, and stop giving him chances...
Note: Im not suggesting individual family members dont have their breaking points.. but I think this concept lends more to what family is "told" they should think and feel.. which in turn influences our ideas, reasoning, decision making... he will never change, he is just an addict doing what addicts do... very common things I personally hear all the time... but they are very one dimensional phrases IMO.
Motivation is Interactive, affected by environment, and YOU are the environment
Going back to the SDT - Self Determination Theory.. we learned " our interpersonal environment has a huge impact of how much we feel like starting, end up sticking wiht, and enjoy a particular action along the way. In parenting, teaching, managing employees, and many other arenas, what we do ( and dont do) deeply affects other peoples motivation to act or change."
The book makes a point of sharing the following:
Its not our job, or our fault
We cant make people change
What we can do is learn to provide an environment that lets them be less reactive to what we're doing (yelling, judging) and more concerned with their own behavior and consequences.
The things that can Change Motivation
What enhances people's motivation to do something, and keep doing it, according to the evidence:
Feeling acknowledged, understood, accepted as you are ( not contingent on doing something, or not doing something).
Getting Information without pressure
Having Options
Having reasons that make sense for a particular choice
Having a sense of competence about how to change / what steps to take
Getting positive feedback for positive change
What tends to crush our motivation to do something:
Feeling misunderstood or judged
Other people pushing you to do it
Having only one option
Not having reasons for change that make sense to you (the person doing it)
Not believing you can do it
Getting yelled at
The book gives some very good examples of how our behaviors, the ways we communicate with our loved one.. can either motivate or crush motivation..
and also looking at these examples I think its easy to see why relationships deteriorate, and why both people end up angry, frustrated, and unhappy... and just to add from my own experience... to someone using substances these type of conflicts generally require a fall back to coping skills.. and often for a substance user this means they will "use" to cope with the stress induced.. which in some cases would make our relationships toxic.
Confrontation - The biggest motivation killer
The Craft approach, presented by the book is considered a non-confrontational approach to helping our loved ones. The way I have come to understand the approach is that we are able to help our loved one by impacting their motivation, their own desire to change... we cant make them change.. but we do have influence based on the power of our relationship.
The book goes through a series of behavioral analysis with exercises... similar exercises are also in the Get Your loved one sober book ..Im not sure if these contain more? But that ends chapter 2. If anyone worked the exercises and wants to share, that would be interesting.
What We Know About Motivation
motivation is a state specific to a given behavior, not a general trait inherent in a person
When it comes ot substance problems, however its easy to lose objective distance and let the problem taint our view of the whole person. The more unacceptable, frightening, or disturbing a person's behavior seems to us, the more it pulls us to make judgements about the whole person
Why are people motivated to use a substance? Its based on the outcome of how that choice feels to the person.
The book believes if we ( as family members ) understand the different motivations behind the choices our loved one makes to use a particular substance, going so far as to say.. at a particular time... we will be able to more clearly look at the problem "without judging, writing off, or hating the person for it".
In general what I think the book is explaining that each person... all of us, not just substance abusers... are motivated to do things.. or not do things... based on how the outcome feels to us.. We use our own reasoning to determining the pros and cons of a choice, what the Cost/ Benefit is & are motivated based on what the expected outcomes are.
With substance abuse, we may not agree with our loved ones reasoning behind their choice to partake... but to understand a person is using their own form of reasoning, their own cost/benefit analysis is an important concept.... and it helps in our goal of bringing about change.
I think its also important to remember at this point the other basics we have learned, how the brain is affected when a person is using.. we know dopamine, the frontal lobe, and the limbic system are all functioning in compromised ways... these factors are also involved in the reasoning process,the cost/benefit process & therefore they also affect a persons motivation, and influence the ultimate choice that is made... Choice is complex and this is often not disclosed to family members...
This is why I personally find it distasteful to hear people tell an upset family member "he is choosing drugs over you". Sounds simple and very personal... when the truth is its not either.
Motivations Matter and are subject to Influence... this is one of the key points I see
Motivations Change Over Time ... another key point
.... Motivation is not fixed in place by one decision. Motivation is not a threshold that one crosses over into "being motivated" . Its a shifting balance over time with many contributing factors. It can fade, it can gather strength, it can make a lot of sense in the morning and a lot less by the evening; its a moving target.
Short term reasons for making a change can be much different than what will ultimately motivate someone in the long run. ( i.e ...external motivations can start a change, but internal motivations are needed to sustain change) Understanding that motivation is not fixed is important because having this awareness can actually help us, and I think it also free's us in a way.
Just a note... I think of this in terms of a family member setting a "boundary" also... Ive often heard in negative tone " you didnt stick to your boundary" but unless a person is periodically reviewing why that boundary is put in place... it may be that the original motivation for having that boundary is no longer an issues.. maybe we are stronger emotionally now, or our loved ones behavior has changed over time....I think we can do harm to ourselves if we dont allow ourselves flexibility, and acknowledge our motivations, our reasoning also changes, and this is normal.
Reactive Motivations is also talked about in the book, and I think this is very relate-able for family members.
Reactive Motivations tend to be emotion based (guilt, shame, anger), superficial and not clearly thought through. As a result, they dont hold after those reasons change or those emotions subside.
The book says "Motivation to change can occur whenever the costs of a behavior outweigh the benefits" .... in terms of our loved ones perspective.. not ours.
If, however, you can understand how your loved one has constructed his ledger - the-cost-benefit balance inherent in his behavior - it can help you understand your potential to influence his costs, benefits, and perceptions, which in turn will affect his motivation for change. Specifically you can change your behavior in a way that shifts the costs of your loved one's behavior back to him so you arent carrying the burden on your shoulders
Self Image is also discussed as part of Motivation...
when people see their behavior as inconsistent with their self-image or goals, their motivation to change can increase. We can find potential energy for change in any gap between how we see ourselves now and who we want to be, we may look at our current state of affairs and this "This is not who I am" and the balance can shift for making a change.
I like the example of the mother and words from her child... then how she was able to confide to her husband about the self inspection she did because of the little ones comment... He provided a sounding board, and offered her support to change her situation...she was using pills on a regular basis.. The example may sound simplistic.. but I actually think many people recognize substance abuse issues early on, before things spiral so far out of control. As the book states.. change can happen at any time... whenever the cost /benefit analysis tips towards motivating change...
Ambivalence is a Normal part of motivation and the change process
Motivation waxes and wanes. We need not panic in the face of ambivalence when we know that fluctuating is just what motivation does; it's in it's nature, and we can work with it.
One of the great insights of the motivational therapies developed for substance abuse problems has been just this: that ambivalence is integral to change, not an unfortunate feeling to be squashed or avoided, or a failure to "get with the program"
Ideas about ambivalence affect both the substance user and family... the book states that we both need to accept ambivalence as part of the process of change. What I take from the book is that in a therapeutic setting, doctors want a patient to discuss their pro /con, cost / benefit and share their ambivalence... Ideally it should also be the same at home with a spouse in a relationship that is strong on communication.
Similarly if you cant tolerate ambivalence in the change process, your loved one will sense this and probably tell you only what he knows you want to hear, if he tells you anything at all. If he knows you wont go berserk, on the other hand, he'll be more likely to tell you when he's wavering. When you know about it, ambivalence is a huge opportunity for you to help
...holding to a black-and-white notion of unwavering commitment to change is often a setup for excessive disappointments and destroyed confidence about lapsing. Many people (and their loved ones) believe that if a person returns to old behavior patterns he must not really want to change, or even worse, is just an "addict" who cant change. A lapse is in fact much more productively understood as the benefits of using outweighing the costs at that time. By understanding the benefits we can help find the competing beneficial behaviors, or ways to reduce the benefit's pull
Note: Im not suggesting individual family members dont have their breaking points.. but I think this concept lends more to what family is "told" they should think and feel.. which in turn influences our ideas, reasoning, decision making... he will never change, he is just an addict doing what addicts do... very common things I personally hear all the time... but they are very one dimensional phrases IMO.
Motivation is Interactive, affected by environment, and YOU are the environment
Motivation is malleable. Interactions with other people affect our motivations
The book makes a point of sharing the following:
Its not our job, or our fault
We cant make people change
What we can do is learn to provide an environment that lets them be less reactive to what we're doing (yelling, judging) and more concerned with their own behavior and consequences.
You cant make someone want to change, but you CAN help him realize that he wants to change, and help reduce his need to defend his current behavior which can get him stuck there. You'll be in a position to do this IF your stay connected. You wont if you detach.
The things that can Change Motivation
What enhances people's motivation to do something, and keep doing it, according to the evidence:
Feeling acknowledged, understood, accepted as you are ( not contingent on doing something, or not doing something).
Getting Information without pressure
Having Options
Having reasons that make sense for a particular choice
Having a sense of competence about how to change / what steps to take
Getting positive feedback for positive change
What tends to crush our motivation to do something:
Feeling misunderstood or judged
Other people pushing you to do it
Having only one option
Not having reasons for change that make sense to you (the person doing it)
Not believing you can do it
Getting yelled at
The book gives some very good examples of how our behaviors, the ways we communicate with our loved one.. can either motivate or crush motivation..
and also looking at these examples I think its easy to see why relationships deteriorate, and why both people end up angry, frustrated, and unhappy... and just to add from my own experience... to someone using substances these type of conflicts generally require a fall back to coping skills.. and often for a substance user this means they will "use" to cope with the stress induced.. which in some cases would make our relationships toxic.
Confrontation - The biggest motivation killer
the evidence gathered in almost every study of therapeutic techniques is that resistance to change increases with confrontation. Confrontation undermines motivation
Staying involved has the power to help your loved one change course. Remember what the evidence says: your skillful involvement has a positive impact on your loved ones motivation and is usually more influential than any other factor. At the same time, specific, temporary, strategic detachment when your loved one is intoxicated or hung over is something you can do to influence your loved ones motivation... Remember there is a sweet spot of engagement that keeps us connected but at the same time gives the other person room to consider information, make decisions, and learn from mistakes, as opposed to use being on his back all the time nagging. Ultimately, we can help people change, though we cant do it for them.
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Originally Posted by allforcnm
This is why I personally find it distasteful to hear people tell an upset family member "he is choosing drugs over you". Sounds simple and very personal... when the truth is its not either.
.
Great summaries, Allfor. You do a wonderful job in zoning in to what is important in each chapter!
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Jumping ahead for a moment ... reading the beginning of chapter 4 and this: "It is countercultural to treat your loved one with kindness and empathy when popular opinion dictates hostile confrontation or detachment"
This, this, this! This is why I am reading the book. This is what H has said to me every time I have detached, as I only know how to detach fully. My counselor at the time taught me that detaching fully was the only way to go - even when he wasn't drinking, if I gave him any sympathy, support, engagement, I would only be encouraging him. Instead, it told him I didn't care about him anymore.
What I am wanting is a way for BOTH of us to get past this with our dignity and respect intact. So far, everything I have read from this book is teaching me this is possible.
This, this, this! This is why I am reading the book. This is what H has said to me every time I have detached, as I only know how to detach fully. My counselor at the time taught me that detaching fully was the only way to go - even when he wasn't drinking, if I gave him any sympathy, support, engagement, I would only be encouraging him. Instead, it told him I didn't care about him anymore.
What I am wanting is a way for BOTH of us to get past this with our dignity and respect intact. So far, everything I have read from this book is teaching me this is possible.
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Thank you for sharing SVL.. that is what I wanted when I started on this journey too. Healing for all of us. When I started out there were many unknowns, but little by little the fog began to clear. With the help of therapy, using the communication techniques in CRAFT, and also remembering to take care of myself - I found my way through. Even if things had worked out differently with my husband.. And at times it felt like there were giant mountains to be climb in order to make that happen... I know I still would have been ok, and I would have had peace in my heart.
Please feel free to keep sharing from any part of the book... Ive been going chapter by chapter... but no one else has to..
Please feel free to keep sharing from any part of the book... Ive been going chapter by chapter... but no one else has to..
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Chapter 3
Change: How Do People Change?
“Changing the way you think about change can make you a more effective collaborator”
I find this part of the book actually very enlightening, because if I go back and think about earlier parts of the book where it talks about how we know statistically many people stop abusing substances in a variety of ways.. no formal treatment, or formal program are required… ambivalence is a normal part of change, change is a process… it only is then logical as a family member we should have thinking to match. We cant have the exact answer as to know where our loved on will find the motivation.. we know having choices helps; being forced down one path is shown to lower motivation… in the book it talks about small things that can signify change such as our loved one beginning an exercise program, talking to the pastor at church.
In the book it asks us to think about a time in our own life when he had to implement a change... do we recall our motivations? Did they fluctuate, did we need to learn new skills? Did we slip and fall, revert back to old behavior, was it a straight line or a crooked path? Another good question I ask myself… Did I have help along the way? Including the support of family and friends.. for me fortunately, the answer would be yes when I think about any major challenges Ive faced.
Stages of Change
James Prochaska and Carol DiClemente; both psychologist… who created the Stages of Change model approximately 30 years ago… it talks about the stages of change people go through, and also what would be most helpful to people in each stage to “facilitate further change”
1. Precontemplation
No intent to change. The problem hasn’t been defined, and there may only be minimal awareness there are negative consequences to a behavior.
What helps? – nagging, arguing, trying to persuade someone to change at this time will only promote defensiveness. But what we can do is validate any perceptions our loved ones show where there might be a hint of realization there are downsides to a behavior, helping him to reflect on situations, and if he is happy the way things are going in general.
2. Contemplation
A person recognized negative impact due to a behavior, but also feels ambivalence about taking action, or overwhelmed by the prospect of change. I think this is where a person begins to construct the metal ledger of pro / con, positive/ negative….
What helps? Allowing the person to talk openly about their feelings of ambivalence, showing support towards examination of behaviors, but in a way that keeps defenses down, avoids arguments.
3. Preparation / Readiness
A person is getting ready to make a change, but may not know how to accomplish this and is considering a plan of action. A person might try a therapist, or check out a support group.. they are seeking information and checking out options.
Again I think this points to range of options as a benefit.. the person feels in control and is empowered to find what works on an individual basis..
What helps? Encouragement, discussing options, helping identify possibilities, and yes according to the book, its ok for family to do research, or mention things you think they might be interested in.. be it a meditation class, or local treatment centers, etc.. And I think the idea is this is done in free will, without pressure… allowing the person space and freedom to look at alternatives. But in general we would try to show optimism they will find something that works for them.
4. Action
A person is ready to take action. The book notes its important the person feels they are on a path of their choosing, that they can feel good about, optimistic about….
Have to agree with this, I know in my husbands rehab, they often said a person should feel excited about recovery options, its not punishment. While recovery takes time and effort, there is no reason it cant be a positive experience.
What helps? Acknowledging & supporting their efforts.. helping out where we can to make it easier, or just plain possibly for them to pursue their action plan.
5. Maintenance
A person works to prevent a return to old behaviors and continues progress.
What helps? Collaboration- being someone our loved one can turn to when they want to discuss their ledger, cost/benefit of making this change… remember for long term change, benefits must outweigh the costs… Later in the book we will learn more about how positive reinforcement system will help encourage and support our loved one..
This is an article that was posted on partnership Drug Free last year, and it also breaks down the stages of change, and I think shows how as a family member or friend.. we can meet each person where they are at in the stage of change and learn to effectively support change through our responses and interactions…
http://www.soberrecovery.com/forums/...ervention.html
Per the book:
Very much agree with this. In my journey these last couple years I have had so many people offer comparisons, but because I view all people as unique individuals with unique needs, and who will ultimately find their own unique solutions… comparing doesn’t hold a lot of value for me personally.
Change: How Do People Change?
“Changing the way you think about change can make you a more effective collaborator”
When you impose preconceived notions of what change should look like and how it’s supposed to go, it is a setup for unnecessary stress. Rigid expectations tend to backfire, making others more reluctant to change, while you wind up more anxious and dissatisfied if change doesn’t happen the way you think it should.
In this chapter, we explain “reinforcement” – that is, the variables that influence a person to choose a particular action as well as how the world around her supports or discourages that choice.
Stages of Change
James Prochaska and Carol DiClemente; both psychologist… who created the Stages of Change model approximately 30 years ago… it talks about the stages of change people go through, and also what would be most helpful to people in each stage to “facilitate further change”
1. Precontemplation
No intent to change. The problem hasn’t been defined, and there may only be minimal awareness there are negative consequences to a behavior.
What helps? – nagging, arguing, trying to persuade someone to change at this time will only promote defensiveness. But what we can do is validate any perceptions our loved ones show where there might be a hint of realization there are downsides to a behavior, helping him to reflect on situations, and if he is happy the way things are going in general.
2. Contemplation
A person recognized negative impact due to a behavior, but also feels ambivalence about taking action, or overwhelmed by the prospect of change. I think this is where a person begins to construct the metal ledger of pro / con, positive/ negative….
What helps? Allowing the person to talk openly about their feelings of ambivalence, showing support towards examination of behaviors, but in a way that keeps defenses down, avoids arguments.
3. Preparation / Readiness
A person is getting ready to make a change, but may not know how to accomplish this and is considering a plan of action. A person might try a therapist, or check out a support group.. they are seeking information and checking out options.
Again I think this points to range of options as a benefit.. the person feels in control and is empowered to find what works on an individual basis..
What helps? Encouragement, discussing options, helping identify possibilities, and yes according to the book, its ok for family to do research, or mention things you think they might be interested in.. be it a meditation class, or local treatment centers, etc.. And I think the idea is this is done in free will, without pressure… allowing the person space and freedom to look at alternatives. But in general we would try to show optimism they will find something that works for them.
4. Action
A person is ready to take action. The book notes its important the person feels they are on a path of their choosing, that they can feel good about, optimistic about….
Have to agree with this, I know in my husbands rehab, they often said a person should feel excited about recovery options, its not punishment. While recovery takes time and effort, there is no reason it cant be a positive experience.
What helps? Acknowledging & supporting their efforts.. helping out where we can to make it easier, or just plain possibly for them to pursue their action plan.
5. Maintenance
A person works to prevent a return to old behaviors and continues progress.
What helps? Collaboration- being someone our loved one can turn to when they want to discuss their ledger, cost/benefit of making this change… remember for long term change, benefits must outweigh the costs… Later in the book we will learn more about how positive reinforcement system will help encourage and support our loved one..
Change is a process rather than an event
This is an article that was posted on partnership Drug Free last year, and it also breaks down the stages of change, and I think shows how as a family member or friend.. we can meet each person where they are at in the stage of change and learn to effectively support change through our responses and interactions…
http://www.soberrecovery.com/forums/...ervention.html
Per the book:
It is important to try to resist comparing your loved one’s, or your own pace and style of changing with others’. Preconceived notions of how the change process should go will only set you up for disappointment, as change seldom follows a predictable path.
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Join Date: May 2012
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Chapter 3 ... continued
Behavioral Principles of Change
For me what I take away is: addiction is driven by reward mechanisms; the brain responds to positive reinforcements (the feelings and satisfaction) it receives in expectation of using, and during use… they key is: behavior is goal directed and motivated… not irrational. Although compromised parts of the brain may be challenging rational thought, and sometimes winning the battle of choice at times.
The book states, when researchers rank evidence based treatments for substance problems, in order of effectiveness, behavioral approaches consistently come out on top…
Habits are learned behavior
A lot of our individual personalities come from learned behaviors
A lot of what goes on in relationships is learned behavior; we learn how to relate to one another, how to react and respond, the emotional reactions, verbal responses, communication patterns, give and take…
The book defines two scenarios one as dance partners, and the other as two people boxing… Interesting example…. In the latter example I picture jab, defend, run to the other side of the ring to avoid fighting, stay detached.. but there lacks a partnership or cohesion….
We are all constantly learning
Remember, earlier in the book… it stated we as family and friends; are part of the environment for our loved ones. If we stay engaged with our loved one, then our place in their life has more significance, and we have more influence and opportunities to provide positive motivation.
The book states, in order to change we don’t unlearn behaviors; we have to learn alternatives.
Any attempt to do something new is a risk… I see this for a person trying to stop a substance, or as a family/friend trying to learn a new technique like CRAFT. There is risk… we might not be able to do it, it might not work for us, we may make mistakes along the way.
With our loved ones, we should be able to relate to how difficult it is to make a change.. to give up one way, and attempt to learn a new way… we should be accepting there is risk.. and understand change is a process. The book gives varying examples.. but in most cases, people are using substances to fill void in their life. Anxiety, anger management, depression, fear, etc… To remove the substance leaves a hole… The holes need to be filled with alternatives.. the gaps with competing positive behaviors.
The book puts a lot of emphasis on learning… it asks us to think about what it took for us to learn things in our own life… playing a musical instrument, following our educational pursuits… it’s a learning curve.. a process. For the most part, we were kind to ourselves, we didn’t expect perfection, and we realized making mistakes, and even failing at certain junctures were just part of the process. One bad test score didn’t mean we had failed the class… one bad basketball game didn’t mean the team was a loser, or that they didn’t try hard enough.
The book also puts a lot of emphasis on the dangers of expecting our loved ones to be perfect at change…
The book quotes Alan Marlatt, PhD, who called this the “abstinence violation effect” (AVE) and described this process as one of black and white thinking where a misstep results in the persons thinking that everything is now out of their control. This way of processing the event is associated with greater likelihood of relapse. He says it is most helpful (and protective) to understand change as an incremental, stepwise process that requires practice and patience.
I also like this quoute:
This comment is something I can relate to, because I often feel in society there is an impression.. perhaps it’s a rock bottom concept.. a person gets hit in the head with an apple and change should happen right NOW. And if it doesn’t well there is hopelessness, he will never change…
With my own husband, when I look back now and having many discussion with him, we can see where he was in the stages of change at given times before he even entered rehab. He did for example stop one drug he had been abusing, but didn’t have luck with other prescription pills. But looking back, there was change at work…. Just on example.
Behavioral Principles of Change
For me what I take away is: addiction is driven by reward mechanisms; the brain responds to positive reinforcements (the feelings and satisfaction) it receives in expectation of using, and during use… they key is: behavior is goal directed and motivated… not irrational. Although compromised parts of the brain may be challenging rational thought, and sometimes winning the battle of choice at times.
If we understand people’s choices in this way, and understand that reinforcement coming from other behaviors, through other channels, can promote an alternate choice, then we have a lot to work with.
Habits are learned behavior
A lot of our individual personalities come from learned behaviors
A lot of what goes on in relationships is learned behavior; we learn how to relate to one another, how to react and respond, the emotional reactions, verbal responses, communication patterns, give and take…
The book defines two scenarios one as dance partners, and the other as two people boxing… Interesting example…. In the latter example I picture jab, defend, run to the other side of the ring to avoid fighting, stay detached.. but there lacks a partnership or cohesion….
We are all constantly learning
Through our every interaction with the world we learn: how to do things, that we can do things, and how we feel about things… thoughts and feelings – including motivation are “covert” behaviors.. These covert behaviors directly influence our “overt” behaviors, the ones observable to the outside world. Our thoughts, feelings, and overt behaviors are influenced by the environment… they are or are not reinforced – that is, supported or discouraged --by the environment
The book states, in order to change we don’t unlearn behaviors; we have to learn alternatives.
Any attempt to do something new is a risk… I see this for a person trying to stop a substance, or as a family/friend trying to learn a new technique like CRAFT. There is risk… we might not be able to do it, it might not work for us, we may make mistakes along the way.
With our loved ones, we should be able to relate to how difficult it is to make a change.. to give up one way, and attempt to learn a new way… we should be accepting there is risk.. and understand change is a process. The book gives varying examples.. but in most cases, people are using substances to fill void in their life. Anxiety, anger management, depression, fear, etc… To remove the substance leaves a hole… The holes need to be filled with alternatives.. the gaps with competing positive behaviors.
The book puts a lot of emphasis on learning… it asks us to think about what it took for us to learn things in our own life… playing a musical instrument, following our educational pursuits… it’s a learning curve.. a process. For the most part, we were kind to ourselves, we didn’t expect perfection, and we realized making mistakes, and even failing at certain junctures were just part of the process. One bad test score didn’t mean we had failed the class… one bad basketball game didn’t mean the team was a loser, or that they didn’t try hard enough.
The book also puts a lot of emphasis on the dangers of expecting our loved ones to be perfect at change…
many people have the expectation themselves, or of others, that one bad day, decision, or incident puts them back at square one. This way of thinking is particularly strong in dealing with substance problems, where some people believe that one episode of old behavior (a slip, or lapse) resets the clock to day one. People need to be more forgiving when it comes to other areas of learning…. When we understand change – including change in substance abuse – as a learning process, an incremental approach makes sense.
I also like this quoute:
Recognizing that for most people change is more like learning to read than getting hit on he head with an apple, you’ll be less likely to blame a loved one for being “bad at it” in the beginning, or despair when he has bad days later on.
With my own husband, when I look back now and having many discussion with him, we can see where he was in the stages of change at given times before he even entered rehab. He did for example stop one drug he had been abusing, but didn’t have luck with other prescription pills. But looking back, there was change at work…. Just on example.
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Chapter 3... continued...
Insight Isnt Enough
This point I think is also important for family and friends to understand. Because it goes to our loved one saying one thing, but doing another… I book gives an example of cigarettes, and I also think about it even in terms of food. Perhaps I know I need to lose weight and eat better, but I decide to do it once I eat this pack of donuts. Doing one thing, but saying another… The book says the limbic system or primitive brain is in charge, motivating us to keep on doing what we were.. in substances with such a much more dramatic impact.. it can feel like a crisis to keep using.. emergency…
The book says what helps is reinforcing the rational parts of the brain that truly do want to change… something we can assist with using positive reinforcement strategies.
This takes practice in the real world… in addition to lets say a therapists office…
From the book I take away, We can be an important part in this process of practice… How we look at the situation when our loved one stumbles … is it a learning experience, or do we view it as a catastrophe, decide they just don’t want it bad enough, or they aren’t serious enough? Decide to get tough in hopes the person will respond to our negativity? We are part of their environment.. how we respond plays a part in their motivation. Positive reinforcement increases motivation … to try again, look for what works for them as individuals and practice more..
The book also says, it’s the same for us in learning new ways to interact with our loved one.. to practice collaboration, positive communication, and healthy ways to support… . it takes practice on our part. The book gives an example of a client who was once constantly arguing with her husband who admitted to being angry all the time… but she was able to change her behaviors, use the communication tools (to follow in the book) and began to feel better herself.. she didn’t have to detach to remove her anger, she had to learn a new way to relate and communicate to her husband. This change in her also had an impact on him; his defensiveness for example.. and in turn communication began to improve.
With anyone making a change:
Its ok for change to feel uncomfortable.
Its ok for change to take time.
With substance abuse, healing of the brain takes time. The book lends more towards compassion and using knowledge of how the brain heals; to help us cope with the stages of change… especially the action phase.
The Joy Effect….
The book says willpower gets a lot of play in popular culture when it come to change, but joy takes people much, much further.
Change needs to have its own pleasures.
Research shows the importance of building a happy life as critical to reducing substance abuse
Change is not a miracle
Change takes thought, planning, work, and reasons to do something different
The book offers exercises for us to do on the stages of change… making a decision to try a behavioral approach like Craft also fits in with where we are at in the stages of change in our own life…
The Next Chapter is entitled How to Cope, its starts Part II of the book, and is directed at family and friends… the book so far has IMO has led us briefly through what addiction is, how it impacts our loved ones in a physiological way, shows lightly why behavioral approaches, motivational approaches work if applied correctly by family members who learn an approach like Community Reinforcement and Family Training .. CRAFT.
The book to me again has led us through many of the facts about addiction from an evidence based perspective.. see NIDA is my suggestion as they also work to break many of the myths surrounding addiction that are out there such as rock bottom.. not a good idea. They validate the fact many people recover on their own, they verify recovery rates are close to other chronic illness like diabetes, or hypertension…they debunk ideas family cant help …. as you will see NIDA clearly states family can be an important factor in recovery… .. family is not codependent for wanting to help their loved one if its done in a healthy way, and we can learn healthy ways while staying engaged with our loved one if we so choose. And now before the book begins to show us how to help using CRAFT.. it has us shift focus on ourselves .. to make sure we have our own oxygen mask out and are caring for our own needs before going any further.
Insight Isnt Enough
Substances are rewarding to brains at a fairly primitive level; they effect parts of the brain involed in deep emotions. Because these brain structures – collectively called the limbic system or “primitive” or “lizard” brain – are nonverbal and nonintellectual, people can appreciate intellectually how problematic their substance use or behavior is, but still have little or no ability to change
The book says what helps is reinforcing the rational parts of the brain that truly do want to change… something we can assist with using positive reinforcement strategies.
People need to experience change to know that it can be done, to get some feedback about what happens when its done, to feel differently after doing it. Through this process we learn we can do something differently…
From the book I take away, We can be an important part in this process of practice… How we look at the situation when our loved one stumbles … is it a learning experience, or do we view it as a catastrophe, decide they just don’t want it bad enough, or they aren’t serious enough? Decide to get tough in hopes the person will respond to our negativity? We are part of their environment.. how we respond plays a part in their motivation. Positive reinforcement increases motivation … to try again, look for what works for them as individuals and practice more..
The book also says, it’s the same for us in learning new ways to interact with our loved one.. to practice collaboration, positive communication, and healthy ways to support… . it takes practice on our part. The book gives an example of a client who was once constantly arguing with her husband who admitted to being angry all the time… but she was able to change her behaviors, use the communication tools (to follow in the book) and began to feel better herself.. she didn’t have to detach to remove her anger, she had to learn a new way to relate and communicate to her husband. This change in her also had an impact on him; his defensiveness for example.. and in turn communication began to improve.
With anyone making a change:
Its ok for change to feel uncomfortable.
Its ok for change to take time.
With substance abuse, healing of the brain takes time. The book lends more towards compassion and using knowledge of how the brain heals; to help us cope with the stages of change… especially the action phase.
In our experience, however, some understanding of the physiological impact of substances helps our clients have compassion for poor, battered brains recovering from substance abuse, and for the people who have to live with these brains until they feel better
The book says willpower gets a lot of play in popular culture when it come to change, but joy takes people much, much further.
Change needs to have its own pleasures.
Research shows the importance of building a happy life as critical to reducing substance abuse
Change is not a miracle
Change takes thought, planning, work, and reasons to do something different
You can help make it worth it for your loved one, by helping to create an environment in which positive behavior is rewarded by your affection, presence, collaboration, and other forms of reinforcement, while negative behavior is shut out in the cold….
The Next Chapter is entitled How to Cope, its starts Part II of the book, and is directed at family and friends… the book so far has IMO has led us briefly through what addiction is, how it impacts our loved ones in a physiological way, shows lightly why behavioral approaches, motivational approaches work if applied correctly by family members who learn an approach like Community Reinforcement and Family Training .. CRAFT.
The book to me again has led us through many of the facts about addiction from an evidence based perspective.. see NIDA is my suggestion as they also work to break many of the myths surrounding addiction that are out there such as rock bottom.. not a good idea. They validate the fact many people recover on their own, they verify recovery rates are close to other chronic illness like diabetes, or hypertension…they debunk ideas family cant help …. as you will see NIDA clearly states family can be an important factor in recovery… .. family is not codependent for wanting to help their loved one if its done in a healthy way, and we can learn healthy ways while staying engaged with our loved one if we so choose. And now before the book begins to show us how to help using CRAFT.. it has us shift focus on ourselves .. to make sure we have our own oxygen mask out and are caring for our own needs before going any further.
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