From 2005 to 2010, I lost everything to alcoholism: my family, my home, my practice, my health and my dignity. For three years as my addiction intensified, I bounced between homelessness, run-down recovery homes, hospitals and jails.
When people ask me today what was the worst part of my journey to wellness, I reply: loneliness. It wasn’t the insane-beyond-any-logic pull of cravings that had me attempt suicide. It was the knowledge that everyone I’d loved in my life, or who loved me, was gone.
The terror – the despair – that comes with that realization is staggering. That’s why, as a therapist, I’m encouraged by fresh thinking and new approaches that build upon what is absolutely essential for humans: the need for connection.
I know the lack of connection, made my condition much worse.
For decades, we’ve told families and loved ones of those battling substance use disorders, “They need tough love. They need to bottom out. Kick ‘em out.” For anyone who has ever loved an addicted child this advice goes against every natural instinct a parent has. A growing number reject it outright, because they intuitively know, it won’t make their child well.
British journalist Johann Hari tapped into that intuition in his hit Ted Talk. Everything You Think You Know About Addiction is Wrong resonated with over 5 million people to date. Hari explains that, in fact, it’s flawed attachment that has sent so many to substance use in the first place. He posits those battling substance use actually might need even more connection. I agree.
That’s why I’m now using Community Reinforcement and Family Training (CRAFT) with a large number of my clients and their families. Counter to the ALANON “Detach with Love” approach, CRAFT tells loved ones they can play a positive role and have a powerful influence in the user’s recovery. CRAFT teaches family members a set of skills that have been proven to be more effective than both ALANON and the standard Johnson Model Intervention at getting substance users to accept help. CRAFT also teaches stressed-out family members to look after their own needs too. The family is the client, not the substance user.
The Power of a Fresh Approach
I have to admit I was skeptical a bit about this approach. It’s common for loved ones to get frustrated and angry with the user. Families find themselves nagging, pleading, begging, threatening to get their loved one to stop using. They descend into a cycle of shaming and blaming the substance user. And for good reason. When we use, we are incredibly difficult. But the reality is, none of this works. We all just end up fighting more, and in my case, I drank in secret and lied about it.
It’s not that we intend to disappoint everyone. Neuroscience has shown that in those vulnerable to addiction, alcohol and drugs actually change how our brains work.-MIKE POND
It’s not that we intend to disappoint everyone. Neuroscience has shown that in those vulnerable to addiction, alcohol and drugs actually change how our brains work. Whether it’s learned behavior, hijacked brain reward circuitry, a medical disease, powerful genetic predisposition, a moral failing, or all of the above, in my mind, science is still in the process of discovery. Regardless of what caused the addiction, the outcome is the same. We become seriously ill and, like anyone else battling a life-threatening condition, we need the best evidence-based care to get well. Addiction costs Americans some 700 billion dollars annually (Canadians 70 billion estimated) and whatever we are doing right now isn’t working.
I experienced the power of CRAFT myself. When I relapsed February 2015, after five years of sobriety, my partner Maureen had just learned about CRAFT; she was researching it for a Canadian Broadcasting Corporation film on the best new evidence-based treatments for addiction. When I woke up from my night of drinking, to my astonishment, I received compassion, not judgment. We talked about alternatives to ensure my drinking didn’t once again spiral out of control. Our day didn’t descend into disappointment and recrimination. We focused on moving forward. Today, I credit this approach with helping me recover and probably saving our relationship.
CRAFT in Action
Families learn a whole new way of communicating with the substance user – a way that shifts the conversation from shaming and blaming to compassion and kindness.
This learning is scaffolded on the 7 Steps of Positive Communication as outlined below:
- Be Brief
- Be Positive
- Refer to Specific Behaviors
- Label your Feelings
- Offer an Understanding Statement
- Accept Partial Responsibility
- Offer to help
To illustrate these steps in action, I’m going to précis how my partner, Maureen, talked to me the morning after my relapse:
- Be Brief. This must be a difficult day for you.
- Be positive. Fortunately, we are in a different time and thanks to the research for our film, I know there are new treatments for alcohol use disorder and we can go and try them. I know we can lick this together.
- Refer to specific behaviors. You were very cold and distant last night, very unlike you.
- Label your Feelings. I was hurt because your warmth and humour disappeared.
- Offer an Understanding statement: I know the last thing you would ever want was to drink again. The motorcycle accident and ER visit really shook you up, I think.
- Accept partial responsibility: I know this is a chronic relapsing disorder, but I had become too smug about your recovery. That’s incredible pressure to put on you.
- Offer to help: I’ve found a doctor in Bellingham Washington who will administer Vivitrol. That’s the shot that keeps cravings at bay for 30 days. Would you like to talk to him? I’ll go there next Monday if you’d like.
This is not about coddling the user. CRAFT teaches how to positively reward the behaviour you seek and how to let natural consequences play out as the outcome of negative behaviour.
From my perspective as a clinician, the biggest challenge to this approach is getting the reluctant, burnt out family members to commit. They are exhausted by the mayhem substance use has caused in their family and often it’s simply survival, in their minds, to excise the addict.
The Beauty of CRAFT
The beauty of the CRAFT approach is that it teaches loved ones to look after themselves first. When they are healthier and less stressed, their sense of empathy returns. Then I say something like:
“Can you imagine walking through the world where no one has said a kind word to you in months, where every communication ends in shouting, anger, blame and disgust?” This is the world your son inhabits. The more we talk to him this way, the worse his problem becomes. It hasn’t worked to date. Are you open to trying something else?”
Most say yes. And then the transformation begins. It’s not easy, but the evidence confirms it works. If you’d like to see CRAFT in action, the Center for Motivation and Change in New York collaborated with us to build Addictionthextstep.com, which features the Addiction Crisis tool Kit. It’s funded by the Telus Fund for Health and Wellness.
On the site, you’ll find 20 scenarios most common to families. For instance, “My 17-year-old son is coming home drunk again. My husband wants to kick him out. What do we do?” Click on the scenario that most resembles your problem and begin a CRAFT journey of discovery. Dr. Jeffrey Foote and Dr. Carrie Wilkens deliver this transformative therapy for free.
A positive connection with a substance user is possible. It begins by changing your behaviours. Your loved one is worth the investment.