10 Reasons We Are Hopeful
Excerpts from Beyond Addiction: How Science and Kindness Help People Change. Written by Drs. Foote, Wilkens, and Kosanke with Stephanie Higgs.
We can’t underline enough times that you can help.
The research evidence is clear: involving family and friends in helping a loved one struggling with substances significantly increases the odds of improvement and helps maintain positive changes. Family influence is the most commonly cited reason for seeking treatment for substance use problems. In other words, you have an impact and you have leverage.
The opposite has been said too often, that the best way to “help” is not to help. You have probably run into confusing terms like “tough love,” “enabling,” “codependency,” and “detach with love.” They’re everywhere, so it’s no wonder so many people are confused—maybe even feeling guilty and blamed.
Our clients who have read books on codependency worry about doing anything nice for their loved ones for fear that it might be “enabling” their behavior. One client asked if it was okay to make waffles for his daughter on Sunday morning. He knew she still smoked pot sometimes, and he was scared of inadvertently encouraging this by being nice. We will teach you how to take care of your loved one without condoning or supporting the behavior you don’t want.
Conversely, when frustrations and disappointments mount, you may, understandably, want to get “tough”—yell or turn your back. But when you yell at your loved one to stop drinking, are you straightening them out, or giving them more reason to drink? When you don’t yell at your loved one to stop drinking, are you sending the message that it’s not important to you?
These are all good questions. Our answers may surprise you. We’ll show you how to extricate yourself from negative patterns, not by “detaching” but by encouraging positive, non-using behaviors instead. To avoid confusion and promote the spirit of positive change, we recommend that you forget the words “tough love, “enabling,” and “codependency” and begin to question these popular terms and slogans. Just because they’re catchy doesn’t mean they’re true.
You will learn when to use which strategy, for example when you feel calm enough to try a new communication strategy, or when you’re too angry to talk without fighting and it would be more effective to turn off your phone and watch a movie, or when you’re so worried you’d better do our “Is This an Emergency?” checklist and decide whether to call 911. You will learn to maximize your helping potential.
It’s not either/or. You don’t have to choose between your self-preservation and his. The evidence is clear about this too. You might feel distant, you might feel like you hardly know him anymore, but you and your loved one are on parallel paths. When you help yourself, you help your loved one.
Your emotional resilience, physical health, social supports, and perspective on change can contribute to his. First, you will be setting an example. Second, you need internal resources to do what is most helpful for your loved one.
As you learn new skills you’ll notice that what we will ask of you will be similar to what you will ask of your loved one. We want you to feel better about you and learn how to take care of you. We want you to feel hopeful about your life and remember how to have fun. We want you to notice what’s not working for you, try something different, and practice, practice, practice.
To paraphrase the classic airplane safety announcement: you both need oxygen; we want you to put on your oxygen mask first.
Or bad. From your perspective your loved one’s behavior may seem to lie somewhere on a spectrum between ill-advised and demonic. From their perspective it makes a certain kind of sense—and their perspective matters. People don’t use substances because they’re crazy. People don’t use substances because they’re bad people. People use substances because they get something they like out of it.
Maybe it makes socializing easier, or makes business doable, or makes sex possible, or makes depression go away. Maybe it’s fun (one of the hardest reasons to accept when the downside is so apparent to you). It’s different for different people. Of course there are serious downsides to the way your loved one used substances, and the suggestion that you try to understand her point of view may seem galling to you. But understanding—not condoning—why people do what they do gives us a much better chance of helping.
It may seem like a leap, but most people, including people with substance problems, are capable of making rational decisions. Large epidemiologic studies have found repeatedly that most people stop abusing substances on their own, without formal treatment or intervention. If you believe however that a person is incapable of honesty, reasoning, and constructive collaboration with you, there will be no chance of engaging on these terms. And probably they will live down to your expectations. Research has shown that the more you criticize someone, presumably (and understandably) in the hopes of “getting through” to them, the more defensive they’ll become—what’s often taken for “denial.” This book offers strategies based on respect and optimism that are proven to lower defenses and get you on the same side working together against the problem.
You may feel you have lost touch completely with your loved one’s good qualities. That’s a sad place to be, but understandable. One of our hopes is to help you find the good in him again.
Traditional notions of addiction give you two, and only two, options. People are said to be addicts or not. Addicts are said to be ready to change or not. They’re either recovering or they’re in denial, “with the program” or not. (In the black-and-white view there’s only one program.) Treatment is rehab or nothing. Success or failure. Healthy or sick. “Clean” or dirty. Abstinent or relapsing. And for friends and family: “intervening” or “enabling.” The good news? It’s not true!
The truth is, problems with substances vary; and individual differences matter. Some people with substance problems find it helpful to identify as “addicts.” But the truth is, “addict” is not a psychiatric diagnosis and “because they’re addicts” is not really an explanation; it’s just circular logic. The current scientific evidence supports an explanatory model involving psychological, biological, and social factors. And while you might fantasize about an ejector seat that can jettison your loved one straight to rehab and he will come back cured, that’s black and white thinking, too. The truth is that people are more likely to make big changes and continue with those changes if they are given time and help to choose among reasonable alternatives.
Black-and-white thinking is not just a philosophical problem; it’s a barrier to change. Studies have shown repeatedly that one of the major impediments to seeking help for substance problems is stigma. Many people don’t seek help because they expect to be offered only one way to get it, by accepting a label of alcoholic or addict.
Black and white thinking naturally leads to labeling, including an us-and-them mentality that divides people into “addicts” and “the rest of us.” In fact, by branding more than twenty million Americans with a single label and treating them according to that label, the treatment community has given people the wrong idea, that everyone struggling with these problems is basically the same.
Having heard all the prevailing opinion, you may not be sure whether your loved one is an addict. Or you may be sure, and you’re wasting a lot of energy trying to argue them into agreeing with you. We invite you to put aside the question of whether someone is an “addict” or “alcoholic.”
Because it simply doesn’t matter.
What matters is what matters to you and to them: What effect is the substance use having in their life and in yours? What will motivate your loved one to change? More often, true help is based on how well you know your loved one as an individual and the particular ways you matter to each other. Rather than reaching for a label, save your energy for the more constructive work of problem solving.
Inpatient, outpatient. Group therapy, individual therapy. Outpatient once a week, twice a week, every day. Anti-craving medications, medications for symptoms of withdrawal. Treatment for co-occurring disorders like depression or attention deficit. Extended care facilities. Sober companions. Self-help support groups. Cognitive-behavioral therapy. “90 in 90.” Talking with a rabbi or priest. Starting to exercise. To say that there are many options for treatment and therapeutic activities is an understatement! Some are not as widely available as others; some approaches are better supported by evidence than others.
The most important things to bear in mind are (1) no single size fits all and (2) having a choice among treatment plans and plans for change in general predicts positive outcomes. On these points the evidence is crystal clear. Giving people options helps them feel less trapped and more invested in the resulting plan.
Backing people into a corner and telling them what they should do—the “rehab or else” thinking of traditional interventions—might get them into rehab. But rehab might not be the best option for them, and coercion may kill their motivation to even participate while in rehab, as well as undermine their motivation to continue making changes once they leave rehab. (If there is a moment of truth in rehab, it’s not when people enter, it’s when they leave.) Then again it might not get them into rehab at all and only succeed in freaking them out.
There’s been over half a century of high-confrontation addiction treatment in this country aimed at “breaking through” an addict’s supposed “denial” or resistance to treatment. Some of us in the field now have recognized—and studies have proven—that this kind of confrontation increases resistance.
Evidence-based treatments give you the option—many options, in fact—to opt out of the awful, self-fulfilling prophecy of confrontation and resistance. The point is not to force your loved one into just any treatment. It’s more helpful to find the best kinds of treatment for your loved one’s particular problems, and engage his or her motivation to be part of the plan.
You can make significant changes in your life, including your relationship, whether or not your loved one enters treatment. You might have been relieved to learn there’s a good chance that your loved one may even get better without treatment. Again: one study found that 24% of people diagnosed with alcohol use disorders (abuse and/or dependence) recovered on their own within a year.
The clinically proven CRAFT approach for family and friends that informs much of a section of our model (called Helping with Understanding) results in better communication and relationship satisfaction, increased happiness on the part of the family member or friend, and reduced substance use even when the loved one doesn’t enter treatment. In other words, you can be a positive influence and your loved one can get better, all without ever crossing the threshold of a treatment center or self-help group.
If your loved one does enter treatment, or is already in treatment, we will help you support that process during and after. We recommend that you think less about getting your loved one to admit to an addiction and go to treatment and think more about what it takes to build a better life. For you that could be reaching out to friends, treatment for depression, more exercise, kinder self-talk, starting a morning meditation routine, revisiting an old hobby. For your loved one it could be talking to her pastor, talking to her mom, starting a new exercise routine, revisiting an old hobby, being more honest with you. People get better, in a variety of ways, so many ways we don’t know them all. Our clients surprise us and your loved one may surprise you.
We’re not saying this will be easy or that there is one thing that will make all the difference—though sometimes it does. We’re saying that building a better life in ways that matter to people individually is how people sustain ongoing, long-term change.
Many people who could benefit from help do not seek treatment because they expect to be labeled or given absolute mandates about what they should or should not do in order to be successful. As a result, many people avoid seeking treatment until their problems are more severe. In traditional treatment programs, the ambivalence that is normal in every change process is silenced or punished. Not uncommonly, the very people who need treatment most get kicked out of treatment when they lapse. Why? Because, until recently much of the treatment world operated under the assumption that people aren’t ready for help until they are willing to consider never using again. Ambivalence was taken as a sign that people were not ready.
Thankfully, according to empirical evidence, people can be helped long before that kind of acceptance takes place, if it does at all. The data about how people really behave and change contradicts the view that a commitment to absolute, lifelong abstinence is the only legitimate option. One major clinical study found that believing lifelong abstinence to be a requirement of change predicted higher rates of relapse. For most people use falls somewhere along a continuum of unproblematic, problematic in varying ways and degrees, and destructive. For many people change is gradual, a process of weighing the costs and benefits and experimenting to find out what works. Change often happens incrementally, rarely in a straight line, and continues until the problem has improved to the satisfaction of the one making changes.
At the time they enter treatment, many people need to abstain from using a substance to eliminate the negative effects and establish a steady path. As providers, we support their efforts and teach them the skills to be successful. The evidence suggests, however, that for others moderation is a reasonable and viable goal. Moderation can be a terrifying concept for families and friends when they’ve witnessed someone repeatedly lose control; but it has been demonstrated in research and in everyday life to work for some people. Perhaps more important is the revelation that more people may find their way to abstinence when given a choice. Many of our clients start with moderation as their goal and wind up with abstinence based on their own conclusions. It’s not uncommon for people to come to treatment saying they do not think they want to stop altogether. We see them go through a process of discovery: they consider what it is they want to do, and how to do it, learning to trust themselves as they weigh benefits and costs and make positive choices that make sense to them. They realize for themselves what works, knowing the advice they are getting from us is geared toward helping them, not forcing or condemning them. They feel respected and in turn gain self-respect. They see for themselves when moderation does not work (“I actually couldn’t stop drinking after two glasses”) and they modify their plan based on real-world experience and feedback, until they decide they don’t want to drink anymore. It’s stunning. “I never thought I would want to stop drinking altogether,” they say. More often than not, if we had told them in the beginning, “You must stop drinking,” they would never have gotten there.
People using substances are no exception. There is no absolute readiness for change, and ambivalence is a natural part of the change process. A good therapist knows how to work with ambivalence, and you can learn too. So don’t wait for your loved one to “hit bottom”—it can be dangerous, and problems are more treatable the sooner they are caught. And don’t lose hope in the face of resistance from your loved one. Resistance is subject to influence like anything else.
Motivation for change can occur whenever the costs of a behavior perceptibly outweigh the benefits. Sometimes external factors influence motivation. For example, as public awareness of the health costs of smoking cigarettes increased, many people quit.
Other times internal factors move a person to change. For example, when a person who used to drag herself into a job she hated gets a new job that she likes very much, she starts to consider whether the mild hangover she has every morning from drinking three glasses of wine every night interferes too much with her work. Instead of rolling her hangovers into her overall resentment of her job, she perceives them to get in the way of her enjoyment!
We can’t stress this enough: what looks like unwillingness to change is often a defensive reaction. People with substance problems respond to kindness and respectful treatment with significantly less resistance (as do the rest of us)!
The positive communication skills you’ll learn will help lower defenses. You can learn strategies for increasing the costs and decreasing the benefits of your loved one’s substance use. You can learn how to recognize, reward, co-create, and support turns for the better. You will begin to allow the natural, negative consequences of your loved one’s use to weigh in (on them, not you!).
Try thinking like a scientist. This doesn’t mean having all the answers or being overly analytical; it means adopting an open-ended questioning, experimental approach to life. Observe, try, notice what works and what doesn’t, and adjust your strategies accordingly. Be proactive instead of reactive. As difficult as it is when your buttons have been pushed and you’re impatient for change, try to stay calm. Be Copernicus, open-minded enough to recognize something as counter intuitive as the earth revolving around the sun. Be Gandhi, observing people to understand them, acting according to your reason as well as your heart. Be yourself, but be as willing to change as you want your loved one to be. And try not to take things personally; behavior is the issue here, not character. Behavior can change. Try to temper your emotions enough to observe how things are going and how you affect them, not because your feelings aren’t valid, but because there is plenty of evidence that a calm, clear-eyed approach gets better results. Easier said than done, yes, but the tools are available to help you do it.
In short, you can hope for change, and you can do something about it. Not all at once, because change takes time, and effort, and practice. It is more of a process than an end result. This is actually good news, because it means change starts here and now; it is not something that happens later.
Certainly you can hope for specific, measurable changes, all along the spectrum from “little”—a full night’s sleep, a week without a fight, a dinner party where he didn’t get drunk—to “big”—six months without using a substance or a decision to enter treatment.
A hope—and challenge—is to encourage you to take off your black-and-white glasses and try to see the many shades of your situation. We encourage you to step back and think through what might be effective (a kind word), not just what would feel good (a loud shout). We encourage you to care for yourself as much as you care for your loved one. We encourage you to listen: to your loved one, because what he or she thinks, feels, and wants matters and needs to be understood; and to yourself, because the same holds true for you.
We know these encouragements are hard to take in at times, and that the simpler world of ultimatums beckons. It takes courage to be encouraged. We encourage you to copy a pocket-sized version of our ten principles below (or whichever of them are most helpful to you) and carry them around, stick them to your bathroom mirror, and generally let them lead you toward a more loving, trusting, working, and satisfying relationship with the person you’re worried about.
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-end-all.
Abstinence isn’t the be-all-end-all either.
People can be helped at any time.
Life is a series of experiments.
Now we come full circle: we’re optimistic because the evidence supports many ways to help, and we’re optimistic because there’s plenty of evidence that optimism helps. People don’t try what they don’t think they can do. We hope to with you what you can do.
Share why you are optimistic
At CMC:Foundation for Change, we believe that people can change and that things can get better. We have seen it happen. As part of our mission to spread hope, we invite you to see why others feel optimistic or to share your own reasons for having hope in the face of this struggle.
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