Dr. Ken Carpenter, our Director of Training and one of the inventors of the ITC, recently appeared on Be Present: The Diane Ray Show, a podcast on mental, physical, and spiritual wellness.
Those of you who have taken trainings with Ken are familiar with his special blend of scientific insight and down-to-earth wisdom, and you’ll find plenty of that in this conversation on stigma, different perspectives on substance use, and involving family and friends in healing and behavior change. You can also listen to the conversation on Spotify or Apple Music.
Diane: Welcome everybody. Thank you so much for joining the show today, I really appreciate you listening. I’ve got an amazing conversation for you today, so definitely stick around.
Drug abuse, use, and addiction is a huge problem in this country, and chances are addiction has touched your life in one way or another. Being in the radio business for all the years that I have, working at rock stations and whatnot—if you know anything about my background, you know that I did run with a crowd of hard partiers—I saw addiction take down some really talented people, and a lot of times, I was even in the position of covering for people, you know, when they were drunk or high. Or driving people around when they couldn’t drive.
There was even an incident where we had to call 911 because someone passed out in the studio and had to be taken out on a stretcher. You know, that’s a whole other story. But needless to say, it’s touched me personally in a lot of ways, and also with close friends going into rehab or needing to go into rehab, and I’ve often felt helpless in dealing with these people and seeing their pain.
And it’s heartbreaking, and it’s a huge problem. Addiction has touched so many lives. For a long time it’s been AA: Alcoholics Anonymous or Narcotics Anonymous was the gold standard of treatment, and the 12 steps were the way to go. And that was it. And a lot of people have been helped by these programs, but a lot of people have also fallen through the cracks.
And there’s new research out now and new approaches to dealing with this problem, and we’re gonna talk about that today. The Invitation to Change Approach is something new, and it’s offering evidence-based skills to help lo help your loved ones make positive change.
So my guest today to talk about this is Dr. Ken Carpenter. He is the Director of Training for the Center for Motivation and Change’s Foundation for Change, and he’s a licensed clinical psychologist and research scientist, and his team has put together an amazing book and program called The Beyond Addiction Workbook for Family and Friends. And this helps people address substance abuse as well as other compulsive behaviors in a really productive way.
And I’ve been spending some time reading over this information and I’m really interested to talk to you. So thank you, Ken, for sitting through my rambling intro. And welcome. Thanks to the podcast today.
Ken: Oh, thanks for having me, Diane. I appreciate the time, space, and the support, so thank you.
Diane: This is something that’s so needed. I mean, if anybody looks at the stats on how drug abuse and addiction is affecting our lives—everyone’s heard about the opioid and the fentanyl crisis that’s tearing apart cities, families, all across the country. 275 million people abuse drugs world wide. Last year, one in four families in the US were impacted by substance abuse. So I think everybody is impacted, right? In one way or another, by some degree of separation or another.
Tell me a little bit about how your approach is addressing this differently than, like I had mentioned, the AA or NA approaches that were just the standard for so many years.
Ken: As you note, the numbers are staggering, and certainly, you don’t have to go far to know someone who’s struggling with these issues, or loved ones who are trying to help someone who’s struggling with it. So it’s really pervasive in a lot of ways and impacts so many lives.
And it’s interesting, as you’re saying—I came from the treatment world and, you know, I started running into these numbers, like that only two out of 10 people who are in the throes of a substance use disorder actually reach out for help, that are actually gonna knock on my door as a professional. And it just started to paint the picture of the number of people that are out there trying to make these changes not in the context of a professional relationship, but in the context of their work colleagues, their families, their spouses, their loved ones.
So it kind of raises the question: well, what’s being offered for all these people that are on the front line, who see their loved ones struggling and want to be of help? And I think that historically, loved ones and families have been viewed differently when it comes to substance use problems, and I think in a broad way, have just been sidelined—told, “you’re not part of this. If you try to be part of this, if you try to be helpful, you are actually making it worse.”
And for some situations perhaps that’s helpful advice, you know, to give space. But for a lot of other families, they’re like, “Yeah, we love this person, they’re struggling. This relationship is important. We’re just looking for a compass for how to go about this, because there’s not many compasses out there that are useful.” So that kind of stemmed where a lot of this work came from, and I have to be honest, my profession hasn’t done a great job taking things off the bookshelf and bringing it out into the world.
So there are strategies and ideas that get housed up in professional treatment books, but don’t make it into the hands of families. So we’re teaching things that were first tested back in the nineties, but it’s still brand new to families. And we are thinking about how we can hand this over to the families and the loved ones and the spouses—and that led to all this work.
Diane: I wanna get into that, because I’m really interested in what I’ve seen over the past few years—there’s been an embrace of looking at different ways to tackle this problem. Like, I get things showing up in my feed like, “Join the Sober Sisters Club, step down in moderation.” I think there’s a little more openness to approaching this in a different way.
And what do you think of some of these new programs? Because I know there’s some controversy, where there’s a lot of pushback from the old guard of “Look, this is the way it works, the 12 steps work. Why mess with that.” But don’t you think it’s a positive thing that there’s starting to be different options for people?
Ken: Well, I’m a big believer that one size does not fit all—we are all unique. There are many roads into using substances and many roads out of it.
When you look at how people go about changing, people change in all kinds of ways. They find different roads. So I think for some people, their lives were saved by going to AA. They found a community, or they found someone who was really supportive to them, or they got a set of lenses to view their journey that was helpful to them.
And it’s the power of relationships, often, that are there. So as long as we can expand that, I think you’re right—there are other invitations out there for people to try on their own way of change. Why close doors when people are entertaining the idea of trying to make change? Let’s help them find their road that’s gonna be the most impactful.
Diane: And change and transition is so hard for so many people. We’d prefer the devil we know, right, instead of looking elsewhere. So I like that your book and your approach really addresses that. And one of the things I thought was interesting in my reading was that you encourage us to understand why the person is doing what they’re doing.
Ken: I think it’s probably one of the hardest things, particularly when you’re sitting with someone who’s struggling, and you’re anxious and concerned—the challenge is bringing a curiosity to what you’re seeing, even when what you’re seeing can be scary or upsetting. And I think that’s such an important point that sometimes is lost, that first step. And in the book we talk about that, that behaviors make sense if we bring a curiosity to what it is about the behavior that’s been useful for a person.
If I can have those conversations as a starting point, I’ll get to understand you in a different way that could help me become a better helper, and get a better understanding of what this change process would entail.
We call it the “righting reflex.” If we don’t bring that curiosity, it’s easy to just listen to our mind, and say, “Here’s the problem, this is how you fix it.” But that takes out the curiosity to really try to understand the uniqueness about the situation for that person.
Diane: Right. And it’s not as simple as, “Oh, so and so’s drinking too much.” It’s, “What is the real issue? What’s underneath that? What are they pouring the alcohol and drugs over, to cover or to cope or to deal with it?”
And isn’t it trying to understand and get to that real issue? What the real problem is?
Ken: Spot on. I mean, to your point, two people could be drinking at the same table, the same amount of drink, the same exact drink, yet one person says, “This helps me become a little bit more talkative, so I feel more social.” But the other person might say, “Now when I go home at night, I’ll be able to sleep, and those nightmares that I have will stay quiet for a while.” So it’s the same behavior, but what’s behind it is totally different. It’s serving a different purpose. And both people would probably require a different path in making change, and there would be different asks of them to engage in that change process.
Diane: There was an interesting sentence in the book I wanted to ask you about. You’re talking about cognitive-behavioral and motivational approaches, which treat substance abuse like any other human behavior. Well, that’s interesting. You wrote, “functional approaches aimed to challenge a person’s ‘denial’ about his ‘disease,’” using quotes, and that kind of flies in the face of people that are really adamant that addiction is a disease.
I just wanted to ask you about that. Do you feel that it’s a, quote, “disease,” or that these problems are based on these other things that you’re looking at, in the cognitive behavioral approach?
Ken: Yeah, there is so much war around that term “disease,” and it really can be quite a spirited conversation depending on the circumstances.
I approach the word with caution. I have a background in behavioral science. I would never say that we are not biological beings—anything we do affects our biology, and substances affect our biology. So to that extent, someone who’s very much involved in substance use is altering brain chemistry in a way that’s going to impact their behavior and change and motivation at times.
Yet, that’s not the only place where we have to stay, to understand the change process. So, when speaking with an individual and trying to understand, I’m not talking to the dopamine receptors per se, but to a whole human being with a history and subjective experiences. So, to come back to your question, is it a disease?
I think it’s a multifaceted experience, and there are different ways to understand it that can all be helpful. So you’ll notice I’m kind of sidestepping the word on that, because I think people use that word differently. I always want to understand—well, when you say disease, what does that mean to you? How are you using it? I tend to say that it’s both a behavioral and biological challenge, and life is biological and behavioral.
Diane: Thanks for answering that, because there’s the camp that says, “People who say it’s a disease, they’re just playing the victim, and saying that they’re not in control.” And I think people are able to control it, right? Given the right help and support.
Ken: There’s decision making throughout the whole process, and I think you hit the nail on the head—given the right circumstances. That’s what dictates the kinds of decisions that come more readily to us.
So, say that me and you were sitting out in the desert, and we gave up drinking water. If we were out there for about 12 hours in the blazing hot sun, our mind and our experiences are gonna make us feel differently about that cup of water in front of us than if we were sitting up north in 35 degree temperatures.
It’s the same water. But, to your point, the motivation and the impact of our decisions can vary based on circumstance and situation. So there is that element of decision-making, as well as awareness of what impacts decision-making. So that, I think, is the hopeful part, which is that I can start to understand what the challenges are and when I’m more likely to think one way over another. And that awareness helps me make different decisions.
Diane: And bringing the family and friends in, and making them a part of it. Before, you had mentioned the tough love situation—you know, you’re supposed to turn your back. And also from the perspective of the person struggling, they’re supposed to cut everybody out of their life. The idea is that it contributed to their drinking or using. So there’s a lot of turning your back, right? Cutting people out and that kind of thing.
And I’m gonna throw my own personal experience in here since I have you here, I can ask you this—I have a long time friend that I love like a sister, who’s abused alcohol since we were in high school to varying degrees.
She functions and has a job and everything else, but she isolates herself. Inevitably, I’ll get those phone calls. She’s on the East Coast in my home state of Florida, I’m here in California, so I know at a certain time not to answer the phone because I’ll get this drunk phone call.
And I don’t want her to feel alone, or that I’m avoiding her, but I can’t always sit through these hour-long rambling phone calls. I know she’s in pain, and when you talk about varying degrees—like, this is someone that functions, but I think there’s this veil, this dullness over her life, that’s caused by her alcohol abuse. I don’t think she’s really living, and I want to try to help her.
I wanted to send her books and things like that. And I try not to be judgmental, but I know inevitably—you know, there’s been a few DUIs – sooner or later something’s going to happen. So in my approach with her—without trying to be judgmental and accusatory and things like that, because that hasn’t worked over the years—how do you talk to people like that?
Ken: Well, to your point, if judgment and force and other more directive approaches yielded the positive outcomes we want, I would be here talking to you about how to be forceful and judging and all that, saying, “hey, this is what works.” But to your earlier point about motivation, we know what can invite people to think about making change, versus the kinds of interactions that actually tend to make people defend their behavior more. So the motivational interaction point is right: as we try to sidestep the judgment and forcefulness, how can we approach these interactions?
And to the things that you just highlighted—as a helper, you can respond with intention. So one first thing to ask is, “What am I comfortable supporting here? What are the kinds of behaviors I’d like to strengthen, and help that person nourish? And what are some of the behaviors that I’m not willing to go along with, and how do I want to respond to them if I do see them?”
So, to your point, maybe the long phone calls where the person’s intoxicated haven’t been helpful in the past. As a helper, you have your right to say: “I love talking with you, I want to hear what you have to say, but I’m gonna step out of this conversation now. It seems like you’re not fully present, or it seems like right now you’re under the influence—but can we schedule tomorrow? Would that be a better time?”
So you might step out of that conversation that night, and the next morning you could give a text or a ring: “I’d love to catch up from where we started last night. When would you be free?” Then, we’re still keeping the connection there, and that’s not turning your back. Instead, I can be intentional about when we have our talks and when I’ll be present for you, and I’ll let you know that, so that you have a compass on how you can find me and talk. So that’s one idea.
And effective listening—that’s the other thing. When you’re checking in with the person, you can say, “What’s going on, what are your thoughts?” Or, “Last night seemed really tough, what was going on for you?” and giving people space to talk. And we can try to keep our “righting reflex” on the backburner, and try to see where the person is at, which can also be a way of changing the tone of interactions a little bit.
Diane: I’ve tried that a couple of times. I’m gonna take your advice. But it was interesting in this recent situation, where my good friend was hammered, and she was telling me this big, long, drawn-out problem. I did say, “Well, let’s talk another time, let me call you tomorrow.”
But when I called her the next day knowing she’d be sober, I said, “So, do you wanna talk about this problem?” She just goes, “What problem? Everything’s fine.” I’m like, “Not really. I heard last night it wasn’t really fine. So what was really happening?” And it was like pulling teeth, trying to get the real issue out—but then she finally confessed a little bit.
It’s just been going on for so many years, and maybe I am enabling in some degree—I’m sure I am in some way. I just know that if I could help her to realize that she could change, she could go from black and white to technicolor. You know, her life could be so much better than it is right now.
Ken: You see a life for her. You see a part of the way she can be in the world that maybe she doesn’t see or have access to in this moment.
If it’s okay to repurpose the enabling word, if you bear with me on that, because I think there’s some utility in it—the way I would kind of frame that is, “I am an enabler in so many different ways, and I want to enable her to be able to connect with a meaningful life.” And there’s nothing bad in that purpose of my aspirations for you, the way I would like to support you. I want to help you, and “enable” you to step in that direction. Maybe there are things I need to think about to not inadvertently help you step in a direction I don’t wanna support, but it’s a nuanced word.
You have a particular direction you wanna help her see. And a first step is to ask, “How can I use my relationship to help that process happen, even when it’s not linear, and there’s all these ups and downs and back and forth?” Sometimes change is very nonlinear, and there’s a lot of stops and starts, and it can take a long time for people.
When you make invitations that are consistent with your values, sometimes it can seem like really small drops in the bucket—but they plant seeds. And that’s sometimes the way we think about it: you’re building a context that can start to shift the possibility for change.
Diane: Well, that makes me feel better, because I wanna still have compassion. And you write in the book that compassion is something that is missing from some other approaches, and something that we really need to take a look at is to have compassion. And even in people that aren’t close family members, like I try to have compassion. I mean, here in Southern California there’s open drug use, like you see it in my neighborhood, you know, homelessness issues, and I think drug use is a huge part of that. But we should have more compassion, shouldn’t we, in our dealing with this issue?
Ken: Yeah, we should. And as you highlight—man, part of the tough lifting of being human is always being able to connect with that. Because, you know, life is challenging, relationships are challenging. The challenge is: “How do I find a compassionate stance here, both for myself as a helper, and also in the context of my relationship with this person?”
And that’s something we talk about a lot, particularly when it comes to families (or any caring relationship), where sometimes the narrative in addiction spaces is that “you have to do X, Y, and Z,” but to the person hearing that advice, “X, Y, and Z” are actually the very things that pull them furthest away from the kind of person they want to be in their relationship with the person struggling.
So instead, we say that there’s room for being able to connect. How do you want that person to see you in these really difficult times? How do you want to step into the moment? What resonates with you as a helper, to help you be here in the way you want to be here? Let’s help define that.
Sometimes we’ll work with family members, and we say, “You’ve tried the yelling, you’ve tried the tough love. You’ve cut the person off. You’ve stayed up many, many nights with your eyes open, feeling guilty about the way you’re responding. But you have a choice. In your heart of hearts, how do you want to be seen in these moments? What ways of responding would be consistent with that version of you, so you can be present the way you want to be?”
And sometimes that’s left out of the narrative. Sometimes people feel like they have to be not themselves in order to be helpful.
Diane: Right, I like that explanation. And I’m just curious—I mean, I can tell you’re very compassionate and that you really care about this work, and I know a lot of people that do come into this line of work have had addiction problems or experiences in the past. Was that the case with you, or were you just interested in helping?
Ken: I came into psychology just wanting to understand what it’s like to be human. Just from journeying in life, you’re like, “Wow, this can be really hard sometimes. My mind isn’t being my ally here. Why am I feeling this way?” And I was just like, that’s such a big thing of being alive—how do you even begin to try to understand your experiences? So that’s what piqued my interest in psychology, and in substance use and various things.
Substance use has touched my family, it’s touched my circle of friends. And I don’t want this to sound wrong, but I had a sense of always wanting to work with underdogs. And when I was learning, I wound up working in substance use treatment clinics, and getting to know the people that were coming there for help and getting to know them differently from the way they’ve been known, and it brought to light some of the challenges of just being human in so many common ways. So that’s where I’ve been, and now also working with families.
Because starting in the treatment end, you work with people struggling, but the whole family often was left on the sidelines. But families want to be helpful, and families make a difference. Relationships make a difference. And yet, so much of the old narrative was: “the thing you have to get rid of is get rid of your relationships.” And it seemed like odd advice—as humans, we are relational beings.
No one would say with cancer: “Don’t talk to people that are supportive to you. Cut off talking to your loved one.” Yet when it came to substance use and some of the struggles there, that was the advice. And it was just very interesting. I always was like, why? And does the evidence support that? And that kind of led to the work we’ve been doing with families.
Diane: That’s interesting, because I guess people assume that someone in that field would come directly out of having a personal experience with addiction—like that you were an addict yourself.
Ken: Right. No, I wouldn’t say I ever was. Have I been abstinent my whole life? No, certainly not. You know, you experience what both the upsides and downsides are of substance use, and how it can be useful in certain ways and where it can jam you up in certain ways. So in those domains, there’s experiences to pull on, yet I want to be careful because I know that the person I’m sitting across from and listening is—their experience could be totally, totally unique to them.
Diane: Right, everybody’s had a different experience or a different point of view. And when I look back on my own life experience where there’s so many different directions that I could have gone in myself, and then something stopped me from falling over the precipice—you know, totally going headlong into addiction. And I’ve wondered why I’ve been able to not go down those paths, when other people that I worked with – really talented, wonderful people, and good friends that I’m still friends with—were not able to do that.
Ken: Yeah, a really interesting question, and I think it gets at the heart of these individual differences, which, you know, every person carries their history book, their biology, their learning history in ways that coalesce and influence that particular journey. And to your point, you know, two people can experiment with the same thing, and yet for one person, it could be a totally different outcome than the other. I think that’s an important part of it, to see the uniqueness of each individual.
Diane: Right—that’s why I like this approach so much, and what I’ve read of the Invitation to Change Approach, and what you’re doing with the book and the Beyond Addiction Workbook.
And I wanted to just wrap up with getting your advice on, you know, one thing you could tell people that are listening. There’s probably a good chance that they have someone in their life that’s struggling with addiction in some degree. What would you say? Even if it’s something long term, and years and years have gone by, it’s possible to change, isn’t it?
Ken: Yeah, I think that you’ve raised that issue of hope, and I know this journey can just feel so dark and lonely and hopeless at times. And often it’s that isolating effect that families and loved ones can feel when we don’t think we’re being as effective as we’d like to be, or what we’re trying is not working.
So a kind of multi-pronged message for families is that there is hope, people do change—and the timelines can be so different. But change is more likely to happen in the context of supportive relationships.
And that doesn’t mean you have to mortgage off your values. You do get a choice about stepping into a helping relationship that resonates with the way you want to be present for this, and you can get support to help you think about the best ways to do that—ways to nourish yourself as a helper, as a human being. You can learn a set of communication and behavioral and self-care strategies that can make this journey more helpful both to you and your loved one, as they consider their struggles and what direction they’re going to go in.
And I like that message of hopefulness, and stepping towards help. I do wanna put that out there, because there’s probably a lot of people that may be doing this all by themselves, for many, many years, and haven’t told a soul about what the burden has been like.
Diane: I’m so glad you’re out in the world doing this—because life is hard, and we need people like you. And we need this help and this message, and especially at this time.
So how can people find and get the book, get the workbook, get some help—what’s the best place I could send them to to get in touch with you?
Ken: Well, the best umbrella is our not for profit, the Center for Motivation and Change’s Foundation for Change, at cmcffc.org. There’s tons of resources there and ways of guiding.
The Beyond Addiction Workbook for Family and Friends is kind of a do-it-at-home way—helping you get a compass of, “How can I journey through this? What would be some ideas that I can think about that might change the way I’m interacting with my loved one?”
No one’s born an expert in any of this. And I always tell people, as a psychologist: with all the schooling I went through, no amount of education has educated me out of the human condition. So it’s about learning, about thinking about ideas, finding what resonates with your value system and practicing it. And, often, sitting with yourself as compassionately as you would with someone else who is struggling, because sometimes we have a hard time sitting with ourselves in the same supportive way. And that takes practice as well.
Diane: Well, I will have the links in the podcast notes for the book and how to get in touch with you. And also if you like the podcast and the conversation, please like, follow, subscribe, and listen wherever you get your podcasts. I really appreciate it, and thank you so much for joining me today. Ken, you’re doing important work.
Ken: Diane, thank you so much for giving us the platform and helping us get our voice out there, and for all that you do. Thank you.