How to Help a Parent, Spouse, Child with a Substance Use issue

I just finished the book Beyond Addiction (Wilkens, Foote, Kosanke, Higgsa, 2014), a guidebook for families dealing with addiction. It summarizes new methods for helping people change that have been proven to be more effective than the more conventional “tough love” or “waiting for them to hit rock bottom” approaches that have been the go to in the past but failed to deliver lasting change. In it, the authors recommend a more effective method based on the CRAFT (Community Reinforcement & Family Training). It is encouraging to know that positive family relationships is one of the strongest protective factors against addiction. While we cannot make people change, loved ones have the power to effect positive change through their relationship and the way we interact with one another. I have highlighted some of the key points to consider when using behavioral strategies to encourage positive change.

Reinforcement is the driver for change, with positive reinforcement producing the longest lasting change in relationships. A reinforcer increases the likelihood of a behavior happening again (ex: your loved one comes home sober, you make them dinner and greet them in a good mood. The reinforcer is both delight and dinner). The reward should be proportionate with the behavior. For example, getting out of bed on time without you helping them – you may make them coffee. A week sober, maybe you go to a movie, etc.

Tips for choosing a reward: It should be something they like but that is also easy for you to provide and remove immediately. It’s best to communicate with your loved one ahead of time, for example “I will make you dinner if you are sober, if you are not, I will not be eating with you”. It also helps to reinforce and encourage any healthy non using behaviors such as attending to responsibilities, exercise, enhancing healthy friendships, etc.

the 2 most powerful approaches:

  • Use positive reinforcement to reward positive behavior when it occurs
  • Ignore or Withdraw the reward when the negative behavior occurs

4 main strategies for discouraging behavior you don’t want:

  • Hold back your reward (ex: making dinner if the person is using)
  • Allow natural consequences to occur (ex: do not wake them up if they are sleeping in and allow them to miss work)
  • Ignore the behavior you don’t want (if they are using around you, walk away, go into another room, go for a walk, etc)
  • Punish (this strategy is not recommended by the CRAFT approach as it is the least effective in soliciting lasting positive change. It can suppress but typically does not illuminate the behavior for any meaningful amount of time).

Lastly, 10 hopeful things to consider:

  • You can help. Family is one of the top reasons people refer for their motivation for entering treatment. Although it is an external motivator, it often leads to internal motivation for change
  • Helping yourself helps them. Practicing self care on a regular basis is the groundwork for both having a balanced life and for setting an example for others. To avoid burning out from our life stress, we must take time for ourselves.
  • Your loved one isn’t a bad person
  • The world isn’t black and white
  • Labels do more harm than good
  • Different people need different options and tailored treatment. Always present choice
  • Treatment isn’t the be all and end all. It aids the change process, but 25% stop their substance use without formal treatment
  • Ambivalence is normal (people can be motivated in both directions and torn about what to do)
  • People can be helped at any time
  • Life is a series of experiments. Notice what works and what doesn’t and adjust accordingly.

For additional free help, there is drugfree.org which offers parent coaching via phone support, and smartrecovery.org which offers both online meetings and weekly face to face meetings and families are welcome.