If you skipped the section on self-care, please make sure to circle back and read it. Self-care will give you the strength and resilience required to cope with a loved one’s addiction and put you in the best position to provide support.
Generally, one of the first casualties of active addiction is relationship with family. Al-Anon Family Groups teach family members the 3 C’s: you didn’t cause it, you can’t control it and you can’t cure it.
However, families are not powerless. Family members can control how they interact with their loved one and this can have a positive impact on their loved one and will affect how family members feel about themselves.
If someone outside the family is harming a family member, the family will get angry and try to protect their loved one. With SUD, the loved one is harming himself or herself. It is easy to understand how family members may become angry, distraught and upset with their loved one. Anger is a secondary emotion, often arising out of fear or frustration. These feelings are natural but not helpful. What is helpful is to keep in mind, in all interactions with your loved one, that he or she is ill.
The principles set out in this section on Family Support are a combination of Community Reinforcement and Family Training (CRAFT) and motivational interviewing. These principles are discussed in much greater detail in Beyond Addiction: How Science and Kindness Help People Change which is an excellent resource for families struggling with addiction.
The 20 Minute Guide, one for Parents and one for Partners, can be purchased or accessed online for free. It explains these principles and provides tools to practice. Free videos are also available through Addiction. The Next Step.
“Good News: Things get better with CRAFT. Families feel better, substance use often decreases, and people with substance problems usually enter treatment when a family member uses CRAFT.”
— Beyond Addiction
- Educate Yourself
- Empathy and Compassion
- Positive Reinforcement
- Natural Consequences instead of Punishment
- Motivating Change
Knowledge is power; knowledge about drugs, addiction, treatment and stigma. Knowledge about these topics will give you hope for recovery.
If you learn about drugs, you will know that if your loved one is addicted to marijuana you at least do not have to worry about overdose. If your loved one is addicted to opioids, you will know that you can save your loved one’s life by getting a naloxone kit and learning how to use it. You will know that stopping benzodiazepines or alcohol cold turkey can kill your loved one.
If you learn about addiction and the reasons people use drugs, you will learn that persons in active addiction do not use to get high, but to feel normal and numb their pain or to not experience their feelings. Once they are addicted, they use drugs to ward off the pain of withdrawal. This will allow you to have empathy, which will help you maintain a connection which, in turn, will help your loved one move towards recovery. And you will know that most persons with substance use disorder recover; some even recover on their own.
You will also learn that there are many roads to recovery and your loved one will have to figure out which path is best for him. Learning what works can be a lengthy process and some relapses along the way can be expected. Relapse is not a sign that treatment failed. Recovery is a learning curve and your loved one is learning.
If you learn about treatments, you will know which treatments are effective and be able to advocate for your loved one to ensure effective treatment will be provided. This will increase the chance of long term recovery and reduce the chance of relapse. For example, detox may not be advisable for people addicted to opioids. It may be preferable for them to go on medication assisted treatment (MAT) with a sufficiently long taper, which has been shown to significantly decrease mortality rates.
Finally, if enough of us learn about stigma and education others about stigma, we can change how society views SUD. This will eliminate the discrimination facing persons with SUD and their families and ensure publicly-funded, timely, compassionate, evidence-based treatment for all.
Empathy and Compassion
If you often feel angry at your loved one who is struggling with addiction, it could be a sign that you need to adjust the limits or boundaries that you have put in place. Proper boundaries help to keep you safe from abusive or other behavior which can make you resentful and feeling like a victim. With proper boundaries in place, and a good understanding of addiction, it will be easier to maintain empathy and compassion for your loved one. Remembering that your loved one is ill facilitates positive communication and reinforcement, which will improve connection and motivation to change.
Good communication is a cornerstone of good relationships. Good communication involves active listening. This basic guide is a good refresher on better communication skills for everyone at all times. It becomes particularly important when relationships become strained as they do when a loved one is in active addiction.
Often persons in active addiction can feel hopeless, depressed, and have a poor self-image. This is where families can make things better or worse. You can support them by making sure that your words do not confirm their negative feelings. Keeping your communications positive will not only help your loved one but it will help you too. Everyone at times says things that they regret later. Keeping things positive will help you avoid subsequent feelings of regret. Positive communication sends the message that you are both on the same team fighting the addiction instead of in opposite ends of the ring fighting each other.
At times this may be difficult to do because your loved one’s communications with you may be negative or offensive but there are only two alternatives in this situation. Sink down to that level of negativity or rise above it.
Some points to keep in mind and practice:
- Don’t engage when your loved one is high, drunk, hungry, tired or in a hurry;
- Tone and volume (how you say something) can be more important than what you say (aim for an empathetic tone and don’t yell);
- Be brief (avoid lectures and nagging and stay on point);
- Use “I” statements instead of “you” statements which can lead to defensive responses. For example, it is easier to hear “I worry when you I don’t know where you are” than “you are inconsiderate because you never let me know where you are”.
- Listen carefully, repeat back to make sure you understand your loved one’s position, and validate their viewpoint. Validation does not mean you agree with them; it means they have been heard and you understand where they are coming from. They will feel good that they have been heard and you will be better able to empathize if you know where they are coming from.
- If you have a request or concern you need to express, consider sandwiching it between two positive statements.
- Be a good role model; no one is perfect – admit when your behaviour or communications have been harmful and apologize.
Positive reinforcement means catching someone doing something good and acknowledging their efforts or successes. This will help your loved one feel good about himself and less hopeless about his situation.
This is easier to do at the beginning of SUD because it will be easier to find actions to praise than when someone is in a severe addiction.
Even the tiniest of positive behaviors is worth acknowledging, but the acknowledgement must be genuine. The positive reinforcement should be in proportion to the positive behavior. It could be as simple as expressing gratitude that your loved one came home for dinner, or came home on time, or smiled at you. Rewarding your loved one’s positive behavior can take the form of a smile, a soft touch or a kind word. Many tiny celebrations of the good can add up, just like many small criticisms can become overwhelming.
Families cannot encourage their loved ones to change through positive reinforcement if the families are out of the picture. If you have made the decision, for your own health and sanity and that of other family members, that you cannot live with your loved one, this does not mean that they have to be out of your life. When you no longer have daily contact, it can be much easier to make targeted attempts at connection. Again, you can set your own limits, for example, that you would like to get together but only if your loved one is sober at the time. It is important to try to maintain contact. It can be as simple as meeting every so often for a meal, keeping the conversation light, and providing positive reinforcement for the fact that you are eating together.
“Reinforcing constructive, non-substance-related behaviors is the core strategy of CRAFT. You can choose to respond to your loved one’s positive, non-using behaviors in a way that will increase the likelihood of these behaviors reoccurring. At the same time, you can choose how to respond to his negative behaviors, including but not limited to substance use, in a way that reinforces it or not.
The two most powerful things you can do to help promote change are:
- Reward your loved one for positive behavior.
- Ignore or withdraw a reward for negative behavior.”
— Beyond Addiction
Natural Consequences instead of Punishment
Not rewarding bad behavior is equally as important as rewarding good behavior. This is generally what people mean when they talk about not “enabling” the addiction. People learn by suffering the consequences of their actions. It is better for you and your loved one if you are not exhausted from trying to minimize the consequences of his or her addiction. Natural consequences are what happen when you don’t intervene. They can be small (being late for school or work) or big (failing at school, losing a job, losing custody of a child or becoming ill). Natural consequences provide motivation for change.
It is easy to explain the concept of natural consequences. Applying the principle in any particular set of circumstances can be extremely difficult, particularly when there is an issue of safety. If you are living with your loved one it may feel like every day is a test because there are often issues of safety. In these circumstances you have to decide if you can live with the natural consequences that your loved one may suffer. No one will be able to make these decisions for you. However, this is a topic that is very common in support groups and knowing that you are not alone and hearing what others have done in similar situations can help you make decisions in your best interest and the best interest of your loved one.
Natural consequences are not the same thing as punishments. Punishments are when you intervene to provide a negative consequence, for example, taking away someone’s cell phone. The problem with punishment is that it takes the focus off the natural consequences of problematic substance use and puts the focus on you. Your loved one can come to see you as the problem, rather than their substance use. Instead of the two of you being on the same team against addiction, you are in opposite ends of the ring against each other. This destroys the connection with your loved one that you are trying to build or maintain. Punishments can increase harm if your loved one also struggles with ADHD.
“If you are a parent of a teen or young adult with ADHD and substance problems, you have an extra reason to find alternatives to punishment. The only positive value of any punishment is that it can be anticipated and therefore avoided by behaving well. People who are particularly impulsive or struggle with ADHD symptoms are not good at anticipating the future and seldom think through consequences before they experience them. As a result, for these people, punishment as the only consequence can lead to a profound sense of learned helplessness, defeat, and generally feeling bad about themselves.”
— Beyond Addiction
In order to help motivate your loved one to change, you must first understand why he or she uses substances in the first place. There are all kinds of reasons to try a substance but continued problematic use usually means the substance is being used as a coping mechanism to deal with physical and/or emotional pain like anxiety and depression. Having empathy for your loved one will help motivate you to stay connected and change their environment to support long term recovery. You can affect your loved one’s motivation to change.
People are motivated to change their substance use when they perceive that the costs of using the substance outweigh the benefits. As addiction progresses and becomes more severe, the costs generally increase and the benefits decrease. Increased tolerance to the drugs means that eventually people are using to avoid the pain of withdrawal (i.e. feel normal), rather than to get high. In other words, over time people’s motivation to change will increase. People struggling with addiction are suffering. They may want to change but feel like they are hopeless or just can’t do it.
You can support your loved one by staying positive. Let them know you think they can do it and that you will be there to support their efforts. Provide positive feedback whenever possible. Remind them that every step in the right direction is progress. In early recovery there can be a complete loss of enjoyment until the brain adjusts to the absence of drugs. This lack of enjoyment is temporary. In recovery the brain heals over time.
Changing any behavior is difficult. It is a learning process that takes time. There will be setbacks. If your loved one relapses, don’t panic. Relapse is part of long term recovery. It will be stressful, but your loved one is learning. He is building a new life and a new way of being.
Confrontation adversely affects motivation. It is best to work with your loved one and support his motivation to change than to try to force it upon him. In any event, under current laws in Canada it is extremely difficult to force anyone in to treatment, even our youth.