allforcnm

Beyond Addiction: How Science and Kindness Help People Change - A Guide for Families
by Jeffrey Foote PhD, Nicole Kosanke PhD, Carrie Wilkins PhD

~Book Discussion~

I read this book when it was first released earlier this year. It’s a wonderful adaptation of the first book I read on CRAFT – Get Your Loved one Sober, Alternatives to Nagging, Pleading, and Threatening.. by Robert J Meyers.. I really enjoyed Beyond Addiction, and found it to match up with what I was taught through my own therapist. CRAFT is the approach I began using while my husband was in rehab, and I found it to be a very positive experience for me, and I also feel it helped unite our family during this challenging time.

Im going to share a few of the factual parts of the book shared in the Introduction.. Help Beyond Hell...some of it is just the basis for the CRAFT program, and how it came about through research on behavior approaches for addiction treatment.

One of the most important concepts of CRAFT is that Family Can Help their Loved One…. AND… We are capable of taking care of ourselves... AND... We are able to live happy and healthy lives … at the same time….


Interesting fact:

It wasn’t until the 1970’s that the National Institute of Alcohol Abuse and Alcoholism… & National Institute of Drug Abuse were formed.. Up until this point, addiction had been excluded from scientific study .. it was kept separate from other medical conditions because it was originally thought to be a moral or spiritual issue. Once these organizations came about… government funding began channeling money into research.. And now some 40 years later we have evidence to support why people become addicted, what works best at treating addiction & the behaviors associated with addiction. We also have evidence that supports and affirms…Family plays an important role in the recovery process.

Myths like the concept of Rock Bottom are being shown as dangerous concepts.. Because like every other illness, early diagnosis, and treatment work best… not waiting until the problem becomes critical and then hoping help will come before its too late.

The treatment system is starting to change… thankfully

Evidence shows there are as many ways to treat addiction, as there are people who have an addiction. Many people recover on their own without treatment because people have self righting systems...evidence also shows certain types of treatment work best..

“Cognitive - behavioral, and motivational approaches that treat substance abuse like any other behavioral problem, are significantly more effective than confrontational approaches aimed to challenge a person’s denial about their disease”

Substance abuse issues are complex. The whole person needs to be treated; including any underlying issues: depression, anxiety, ADD, bipolar, etc. Psychiatric care should often be included in the treatment plan, simply working on the addiction isn’t enough if other conditions exist.

Science has explained the role of addiction in the brain, and helped create medications to aid in treatment of addiction and underlying issues.. these are valuable and appropriate tools for many individuals.

So much of this is important to families IMO because in the past family has been told there is nothing they can do to help their loved ones… addiction hasn’t been treated like other medical conditions.. so family was supposed to behave and respond in a different manner… step back and don’t get involved….even though there was nothing to substantiate this concept.


Interesting Fact:

CRAFT – Community Reinforcement and Family Training is an evidence based, clinically proven approach to helping family members of substance abusers.

CRAFT stemmed from research started in the 1970’s when the Community Reinforcement Approach (CRA) was developed; at this time evidence began to show “Family Involvement was a crucial factor in successful change” …CRA is considered the most effective behavioral therapy approach used today when treating substance abusers. The CRAFT program created by Robert J Meyers (one of the original CRA researchers) extended this approach to family members and created a program just for us.


Evidence based facts about CRAFT:

Two Thirds of the people who were using substances; initially resistant to treatment, agreed to go to treatment after CRAFT techniques were employed. (~ 5 sessions)

The majority of participating spouses, parents reported being happier, less depressed, less angry. They reported more family cohesion and less family conflict regardless if the substance abuser engaged in treatment.


…all I have time for tonight…

PinkCloudsCharley

I picked this book up last night from the library and just started reading it over lunch today. I am on page 7 of the intro, Hope in Hell, and I can tell this is going to be an amazing book. Can't wait to get more into it!!

This book is going to be filled with OMG moments for me. Already I have slowed down my reading pace (I usually read very fast) and point 1 (under "What can I do right now?") has me hooked. It says, terms like "tough love, enabling, codependency and detach with love" confuse us and leave us feeling guilty and blamed. One man wondered about making waffles for his daughter because she still smoked pot.

Yes, yes, yes! This is me! I feel confused and guilty. I worry that I enable simply by smiling at him in the morning after he has had a drinking binge. I am so excited about this book!

BlueChair

Thank you for getting the book discussion started Allfor !

Ive been trying to figure out how to summarize the whole chapter at once, but duh I dont have to do it that way do I? I can break it down in bite size pieces.

I create my OWN stress !!

Soverylost: I told you there are so many good parts and points I want to highlight all of it. Even the short letter written to our spouses at the end of the introduction is awesome.

PinkCloudsCharley

I have never done a book review online before, is there a certain format? Or do we just chime in with our thoughts, observations and what we find helpful?

I was especially moved by the Words of Encouragement at the end of the intro:

You can help
Helping yourself helps
Your loved one isn't crazy
The world isn't black and white
Labels do more harm than good
Different people need different options
Treatment isn't the be-all and end-all
Ambivalence is normal
People can be helped at any time
Life is a series of experiments

Things you can change:
How comfortable you are right now
How optimistic you are in general
What behaviours you encourage
How much you argue
How often you smile
How much you sleep
How strong you feel
Your habitual reactions
Your tone of voice
What you pay attention to
Your point of view
The atmosphere in your home
How isolated you feel
How you deal with stress
How much you worry
Your heart rate
How you spend money
How you express concern
What substances you use
How you help
How you get help
What kind of help you get
The first thing you do when you wake up in the morning
Whether anything good happens today
How much you enjoy life.

I can already see how much this book is going to help me.

BlueChair

I think these were good points:

The toxic combination of fear, anger, worry do a lot of damage to us emotionally and physically. I liked this quote " it wears on your heart both figuratively and physiologically. You may have got to the point where the only way you show love toward this person is by worrying"

When my husband started acting distant to me, it was because he was using but I didnt know it at the time. I could sense something was wrong, thought it was stress but I sensed a change at that point things were already shifting out of balance and while he was pulling away and being distant I was thinking more about him and worrying what is wrong. It only got worse when I realized he was actually shooting up drugs, and then when he was very sick. Worry was the #1 feeling I had when I thought about him.

Ive come to realize in the midst of the crisis I was in this was ok, it was the normal behavioral response, any caring person would feel this way.

But you cant allow worry to remain up there at the top of the relationship list or it undermines everything you have together. I started working on this when he was in rehab, because I realized my reactions are something I have control over.

It goes to the list of things I have control over too:

How comfortable I am right now
How optimistic I am
Viewing life as a system of experiments
My habitual reactions
What I pay attention to
Not allowing myself to see things only in black/white because its too simplistic
How I express my concerns
How I show my love (this isnt on the book list, but its on mine)

BlueChair

This concept I LOVE:

CRAFT treats the problems families face as a deficit of skills rather than as a disease of codependency. These SKILLS can be learned.

Oh Yeah !!

allforcnm

Answering the question WHY CRAFT WORKS:

This is also an important statement to understanding CRAFT in my opinion.. Commonly family and friends are told there is no connection between their relationships and their partners substance abuse.. this concept supports the idea family cant help, because family has no impact… again, supports the fact there is nothing family can do but detach and wait for the person to hit their rock bottom..

However I think many people understand instinctively relationships do have power, what’s lost is how to harness that power and have a positive impact on our loved one.

** I like this point too Blue. I never felt comfortable with the label of codependency, it just never fit me, or my situation **

The other concept that makes CRAFT work I think is the idea of CHANGE. Realizing “just stopping” substance abuse isn’t really a sustainable goal.. the question then turns to “what promotes staying stopped”.

As family and friends… we are asked to look at WHY our loved ones use.. our loved one specifically.. because all people are different … drug use affects the reward centers of the brain and fills a need. So what is the reward they give themselves by using? And how can we use the knowledge we have of our loved ones to help promote other alternatives that fill that same need.

allforcnm

The book answers the question .... Can I help if he doesn’t want to change…

Yes. With a motivational approach such as CRAFT (and CRA which is implemented by therapist working directly with substance abusers) part of helping people change is helping them want to change.. We use our skills to help influence, but our loved one comes to the conclusion they want to change on their own…

As Family members we CAN stay connected to our loved ones… we don’t have to detach. We can provide encouragement, options (not ultimatums). We can respect our loved ones right to be part of the solution, and we can maintain our own balance by taking care of ourselves and setting proper limits.

People make changes when the balance shifts.. when the benefit of stopping a behavior outweighs the benefit of continuing the behavior. This can happen at any time.. the sooner the better… The concept of a low and dark rock bottom where losses have stacked up, never has to happen… Many people in recovery… use the phrase “rock bottom” just to explain the point in their own mind … when the scales tipped for them…

Through CRAFT we learn: How we communicate with our loved one has a huge impact on:

Our loved ones attitude toward change, their willingness to take responsibility for self, the atmosphere in our home, and how we feel.


Learning about the stages of change is critical for family:

Learning about substance abuse, and about the stages of change… we learn lapses and relapses can be part of change and we don’t have to make them into a crisis… they are not necessarily failure but only a natural part of the process of change. Change encompasses a lot: resistance, ambivalence, willingness, learning, progress, setbacks, then more resistance, willingness, learning and progress.

How we respond to this cycle of change is critical to our own well being, and our ability to provide support to out loved ones. Through CRAFT we learn skills based on a new understanding of change, we learn resilience, and how to manage the ups and downs of the change cycle in order to keep our stability.

Things we will learn that help:

Seeing our loved ones point of view
Knowing our full range of options
How change works
How to treat our loved one with kindness and respect
How to problem solve
How to have patience
How to navigate the treatment options
How to support an aftercare plan
How to explain even if you don’t love his behaviors, you still love him
How to get out of the way in order to allow our loved one to face the natural consequences
How to take care of ourselves… because this helps them too..

allforcnm

10 Evidence based reasons to have Hope:

1. You can help

– research shows involving family and friends increases the odds of improvement and helps maintain change. The opposite has been said too often:. “to help, is not to help” “tough love” “enabling” “detach with love” “codependency” No wonder family is left feeling confused, feeling guilty and blamed.. all this falls back on the rock bottom concept which has been found through evidence to be a dangerous concept.. Addiction needs early diagnosis and treatment like all other medical conditions…


2. Helping Yourself Helps

-You don’t have to choose between your own self-preservation and his. Your emotional resilience, physical health, social supports, and perspective on change can contribute to his.

.. like on an airplane, put your oxygen mask on first before helping others…


3. Your loved one isn’t crazy

- and they are not “bad” either… people use because they get something out of it. Different reasons for different people ranging from being able to perform at work, or in the bedroom, feeling comfortable in social situations, to ease depression, or maybe because they find the lifestyle fun. Even though we may not understand, there is a logic in their mind.. and their perspective matters.. If we can understand then we have a better chance of helping our loved one.. we don’t have to condone their behavior in order to understand it.

Evidence shows most substance abusers stop on their own… Most people are capable of rational decisions even when using substances…

The book states, evidence shows the more you criticize someone, the more defensive a person becomes….and this is often mistaken for denial… The book offers strategies that promote respect and optimism that are proven to lower defenses and get you both working on the same side against the problem.


4. The world isn’t Black and White

This one is key I think.. I love the analogy used here too.. And this is wonderful and I find true from my experience:

quote] The truth is that people are more likely to make big changes and continue with these changes if they are given time and help to choose among reasonable alternatives [/quote]


5. Labels do more harm than good

The book shares a fact Ive heard from places like National Institute of Drug Abuse, and that’s many people don’t seek help for fear of stigma. The labeling that comes with addiction.. who wants to accept a label of addict or alcoholic? I agree with the book.. Black and White thinking leads to labels, and separates people… “addicts” and the rest of us… More than 20 million people who suffer with substance abuse are thrown all together, and said to be exactly the same… To me its truly laughable, but its also very sad… people die because of stigma. The book suggest putting aside the concept of a label, and just look at how substance abuse is affecting your life and that of your loved one.


6. Different People Need Different Options

-- The books talks about all the various options.. inpatient, outpatient, group therapy, individual therapy, varying program designs and lengths of time, medications, treatment for coexisting disorders, cognitive behavioral therapy, sober companions, self help support groups, involvement in church, beginning exercise programs… finding what works for each individual, and keeping an open mind that people need different treatment options.

I agree on further comments saying the point is not to get people into just any treatment, but to work with them and find treatment that will work best for them, and actually motivate them to change.

7. Treatment isn’t the End All Be All

With CRAFT you can make positive changes in your life regardless if your loved one enters treatment. Evidence shows using CRAFT results in better communication and relationship satisfaction, increased happiness on the part of the family member, reduced use of substances even if the loved one doesn’t enter treatment. CRAFT asks us to think about what we need to do in order to build a better life. This includes what will increase our personal satisfaction: reaching out to family and friends, seeking help for depression or anxiety, beginning an exercise program, participation in church, kinder self talk, meditation… and the same applies to our loved ones.. what changes can they make to improve their lives…


8. Ambivalence is Normal

This is something I that is rarely discussed IMO.. again going back to black and white thinking… people are said to be ready for change or they are not… they have hit rock bottom or they havent..

But in fact ambivalence is part of the process of change… and scientific evidence shows people can be helped even if they are in a state of ambivalence.

*I find this is how I typically make changes also, so it makes sense to understand this in terms of our loved ones. Why would they be different? I think it speaks in part to our reactions, our expectations, and the error of often holding our loved ones to a different standard than we might apply to ourselves.


9. People can be helped at any time

In this point the book talks again about motivation and change… how people change when the benefits outweigh the costs.. and this shift can occur at any time. The skills we learn through CRAFT can help us relate to our loved ones in ways that reduce confrontation, and reduce defensiveness. The book points out what often looks like denial, or an unwillingness to change is often a form of defensiveness. Through the various CRAFT techniques we learn to recognize, reward, encourage positive change while allowing natural consequences of substance abuse to reach our loved one.


10. Life is a series of Experiments

Adopt an open ended questioning, experimental approach to life. Observe, try, notice what works and what doesn’t… be proactive instead of reactive… Be yourself but be as willing to change as you want your loved one to be. Try not to take things personally because behavior is the issue here, not character. Behavior can change… observe situations and how you affect those situations..
Remember: Change is a process

PinkCloudsCharley

the term codependency has always made me feel uneasy. When you are in a non-addict relationship, it's called being kind and caring. When one is an addict, suddenly you are "enabling" and "codependent". I stopped doing laundry for H, one of the jobs I have actually always enjoyed doing, because I thought I was being codependent. What did he think? That I didn't love him anymore, that I was abandoning him. why was it ok when he wasn't drinking (or drinking too much) and suddenly not ok now? If it messed with his mind, it was messing with mine more! things that were loving and caring before were enabling now.

BlueChair

Good question !!

Ive spent a lot of time thinking about this one too, because the ideas of enabling and codependency extend beyond active addiction so right now I should still be worried about these things supposedly. Ive heard this idea about dont do anything for my husband that he can do for himself, or ideas like he needs to be self sufficient and Ive been babying him and taking on his responsibilities making myself codependent, or his addiction or his lack of recovery is allowing him to be a slacker and Im tolerating it.

Problem is my husband already is, and always has been self sufficient. He can do his own laundry, just like I can take out the garbage (ok this is questionable since the one day I accidentally drove to work with a stinky bag of garbage in my trunk because I forgot to put it in the bin) HOWEVER I guess the point is within a marriage there is a balance of shared responsibility and we divide it up however seems fair between us.

These things become issues all the time in marriage, just because one person will feel like their doing more.

I guess with addiction issues, the question I would ask is "has the balance of shared responsibility shifted in your home? " Is he doing his share, or has the burden unfairly fallen on you because of his drinking?

Then, what I think is if we don't acknowledge this and present it as damage being done to the relationship or the family then we are in a way hiding a consequence of his addiction. His behaviors might be causing us to become resentful, or feel undervalued or under-appreciated. If we hide this fact then I think we are enabling.

I think it lends more to a communication issue first, and then I guess it could come down to your own needs of self care. Certain things you have to do for you and the kids, but your not supermom. The only things you can logically let go of to reduce your load are things he is capable of doing for himself like his own laundry. This then is supposed to represent a consequence to him.

When I think of enabling I try thinking about the natural consequences, its not me trying to insert punishments, or withdraw my love. It has to represent the true state of being.

The counselor I had explained it better to me, but this is the way I think of it.

I would love to hear thoughts?

PinkCloudsCharley

That's interesting, Blue.

My H is very self-sufficient too. And when he is actively drinking, he becomes even more self-sufficient. Almost functions like his own island, if that makes any sense. So the idea that I am enabling is confusing to me. I don't cover for him at work, I don't clean up his bottles (or the place where he drinks, never have. that's *his* mess) I don't explain away his behaviour others, I simply don't talk about it at all.

However, the responsibility does shift in our home. And I guess if I "enable", it is in that sense. He becomes self-sufficient, and looks after only himself. Child-raising, for example, falls more on my shoulders. And I don't want to address it with him because there is fallout.

I believe in natural consequences and try to allow them to happen as much as possible. I have always tried to do that with my kids, and I try to allow it to happen to H *as much as it is possible*. If he is in a dangerous situation, and the natural consequence is something very drastic or life-changing, I will step in and not allow it to happen. Case in point, I will not allow him to drive when he drinks. I know that some people believe you should not stand in their way, but not only does that threaten his livelihood (as he spends a lot of time on the road) it threatens his life and the lives of people around him. I think that is negligent on my part, to allow that to happen.

I like the idea of not using it as a punishment or withdrawing your love. Very important, and one I struggle with. I've gotten to the point where when I am upset at H, I'm not sure if I even love him anymore. It's crazy, not true at all, but I am in such a state of chaos, hurt and confusion that my emotions shut down. I need to learn to control that. The part that I just read about dopamine, the brain, and cravings told me he is reacting because of a loss of chemicals in his bloodstream. His body is crying out and he is struggling. Hard to remember when he is raging and upset, but it will make it easier for me to stay out of his way and let him try to manage his body.

And I get frustrated because our communication levels are so poor at this point, that he will not tell me anything. I understand how I have contributed to that. no one wants to be nagged, badgered, yelled at, "detached" from ... and I have done those and more. Not excusing his behaviour at all. However mine has been less than exemplary.

Love how you took the garbage to work lol! Totally something I would do ...

KariSue

Oh gosh, I just got the book today at the library. I LOVED that part too! I sooo agree with that. I am only on page 10 so far but I can tell it will speak to me. It feels right.

I also picked up another book that was by it on the shelf. "7 Tools to BEAT addiction" by Stanton Peele. It looks good too.

Kari

KariSue

Thanks allforcnm! Because of your post I picked up the book at the library today.

Kari

KariSue

I agree. But on the other hand, I stopped doing my family's laundry when my 3 kids could reach the washer knobs. Lol! (Sorry couldn't resist)

Seriously though, I decided that anything I would normally do for for my other 2 I would do for AS. Anything I wouldn't do, I don't now do for him either.

Kari

PinkCloudsCharley

I don't do DD's laundry anymore either. She's a teenager, she can do it on her own LOL! And it's about time she learned!

BlueChair

I think we have a responsibility in situations where great harm is likely too, at least for myself I would feel negligent if I didnt do what I could.

I think your situation is different than mine. You've probably already addressed the issue with him. Like he knows he's not participating as much with care of you youngest as he should, and its because of his moods and drinking.

With me, when my husband was using during most of the time it was hidden and I felt something was off, not right, strange, he was more distant from me. But I didnt speak out on my feelings and I allowed myself to write it off as being related to his stress at work. What I feel now is that even if no drugs were involved, I made a mistake in not validating my own feelings, I should have opened it up to him and at least put the questions out there.

I dont know if its truly enabling, maybe its only a regret? Nothing I did really enabled him to use drugs because I wasnt contributing to his ability to use in any way. The only thing possible would have been my silence and failure to discuss my feelings with him.

But then I dont know where it would have went?

HAHA whats sad about the garbage is, even after I smelled the stink I couldnt figure out where it was coming from ! The next day I had to ask one of my friends at work, did I by any chance stink yesterday? I was afraid the odors had clung to me. She said no, but I still have my doubts !

BlueChair

I hope you join us Kari !!!



I havent read any of Stanton Peele yet, but his books are recommended at Smart I think, and they released a free podcast of an interview they did with him in October.

I will try to link it here:

SMART Recovery® Special Event Podcasts : WEBINAR: Questioning Dr. Stanton Peele -- with Dr. Tom Horvath

allforcnm

Thank you for sharing that Kari.. I hope you like the book and find helpful ideas for yourself and family.... please share with us as you read

allforcnm

I wanted to share something with you from the CRAFT 20 minute guide....

What is “Enabling”?

It’s important to understand this often misused word. It means softening or removing the negative consequences of another person’s negative behavior, which in effect encourages the continuation of that behavior. If you rush to get your partner out of bed for his brunch plans with friends, even though he stayed out too late the night before, he never has to face his upset friends. He never has to link his behavioral choice (staying out too late) with the natural consequence (upset friends). He only has to face your upset and stress, which are likely very common and easily tuned out.

The confusion? Many people think enabling means doing anything nice for a loved one who is abusing substances. If, in your anger and disappointment at certain negative behaviors (using drugs, coming home late), you withdraw all your positive attention (even when he is sober and trying to engage in a nice conversation), you create a negative environment that is not good for anyone, you or your partner.

Making a difference requires understanding the difference:

Promote positive behaviors with positive outcomes.
Allow negative behaviors to have negative outcomes.

~~

I highlighted the portion about creating a negative environment because it sounds like this is what you experienced when you stopped doing his laundry.. and maybe that's small.. but perhaps it could be considered withdrawing of positive attention.. stopping an activity that was viewed as "nice".. and instead incrementing a punishment ?

Im attaching the link to this page and it has a small video about this topic from one of the authors of this book.

Natural Consequences: Allowing Them To Happen - The 20 Minute Guide


One of the ideas I found interesting is that the importance of allowing negative consequences is to allow our loved one to start an internal conversation in their own mind... what they are missing, or why this happened...

Just tossing this out.. but in regards to your husband not participating as much in child-raising... A natural consequence for him might be his realization that he is missing moments in these precious years of childhood... isn't that one of the worst things he could experience? My guess is on some level he does realize this.... and its happening without you even confronting him. But maybe think about that dynamic, and if he's ever acknowledged it.

~ This idea may also be something different because I think we are all familiar with the ideas that float about saying an addict doesn't care, an addict doesn't feel, and addict isn't capable of love... But Craft believes a person with a substance abuse issue is still capable of all these emotions... the problem often begins when they try to cope with the emotions. ~