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Rebuilding Trust in Early Recovery

This article originally appeared on ProTalk: a rehabs.com community

It’s a conversation that happens a hundred times a day around the world, in the homes of newly sober families. “You just need to trust me,” the newly sober person tells their distrusting family member.  “How can I trust you when you have lied to me before?” the family answers, weary of more disappointment. “I haven’t had a drink in a month! I am going to counseling every week. What more do I need to do to show you that I’m serious?” the sober person replies.

This is one of the widest chasms that exist between the recovering person and their family. The person in recovery looks at the effort they are making every day, maybe ever hour and sometimes every minute, to stay sober. Many times each day those well-used pathways light up in their brain and call out for a chemical fix, and just as many times the recovering person has to answer “No, I am not going to use today.” The recovering person might be avoiding their drinking buddies, passing on invites to party with friends, spending their free time in meetings or therapy, fully experiencing the sadness or anxiety or thoughts of old traumas that the drinking and drugs were helping them to avoid. Recovery is hard work. The recovering person rightly wants recognition for the effort that is being made today.

The family feels skeptical. Maybe the genuine goals of the addicted person sound too much like broken promises of the past. With only a few weeks of this new sobriety under their husband’s or daughter’s belt, it feels too early to trust the change. Sure, its nice to know they are aren’t using right now, but will it last? The family walks around holding their breath, waiting for the “other shoe to drop.” Its going to take a long time to ease the suspicion and cynicism that was hard-earned over the last few years.

Neither party is wrong. The recovering person is working hard and likely their efforts are sincere. The family, on the other hand, has been traumatized by living in fear and frustration for so long. They are rightfully cautious in their hopefulness about these new changes.

Trust is hard to build and easy to break. It takes time to rebuild the trust that addiction has dismantled. The recovering person can take solace in the knowledge that their behavior will speak for itself. Each day of recovery is one more brick in the foundation of a new reliability that the family will come to trust and believe in. Each day sober is speaks louder than a thousand promises.

The family can rest assured that feeling cautiously hopeful is a healthy response to something new that we are not sure is reliable yet. Like freshly formed ice, we want to know its strength before we skate out towards the middle. Trust does not materialize overnight and nor should it. But don’t let your cautiousness blind you to the successes and efforts of your loved one. Congratulate them on sobriety milestones. Applaud their recovery efforts. Share your pride in their accomplishments. Listen to their hopes for the future. Ask them what you can do to support their recovery. Be sure that over time your hypervigilance and anger is diminishing. If it’s not, seek out individual counseling support for yourself or family counseling for your relationship.

In the “Big Book” of Alcoholics Anonymous, author Bill W described of the turmoil that addiction causes in the lives of loved ones. “The Alcoholic is like a tornado roaring his way through the lives of others,” he wrote, “Hearts are broken. Sweet relationships are dead. Affections have been uprooted.” Freshly sober and feeling like simply not drinking should be enough to mend broken hearts, “He is like the farmer who came up out of his cyclone cellar to find his home ruined. To his wife, he remarked, ‘Don’t see anything the matter here, Ma. Ain’t it grand the wind stopped blowin’?”  So, yes, it is a relief to all that the wind has stopped blowing, but it will take time and effort to put the farm back in order.

Myths about teens and substance use

Busting the worst myths about teens and substance use

Raising healthy youth who launch enthusiastically into adult life with few scratches and bumps is hard work. Parenting a teen is full of awkward moments, self-doubt, hilarity, sweet memories and plenty of chewed finger nails. One of the big worries of parents trying to escape adolescence unscathed is the potential of drug and alcohol use interfering with their child’s successful launch from the nest. Avoid some common parenting pitfalls by debunking these widespread myths.

Myth #1: “Making something taboo only makes it more attractive to teens.”

The Myth of the Taboo says that if you make something off-limits to teens, they are more likely to do it. Adopt a laissez-faire attitude about something, like marijuana use for example, and you remove the allure.

It may be hard to believe when your kids constantly texting with their friends and rolling their eyes every time you talk to them, but parents are the biggest influence on their child’s decisions about substance use. In surveys, teenagers name their parents as their primary influence on decisions about whether or not to drink alcohol. Setting clear family rules about drug and alcohol use is an effective prevention strategy.

Consider the results from the bi-annual survey of Washington State youth:

  • When teens believe their parents think it’s wrong for them to use marijuana they are 5 times less likely to be current marijuana smokers by 10th
  • When they believe that their community thinks it’s wrong for teens to use marijuana, they use marijuana at half the rate of their peers who think the community thinks it’s alright.
  • When family rules about drugs and alcohol are clear, 10th graders are less likely to be current marijuana smokers (15% versus 35%), less likely to be current alcohol drinkers (18% versus 44%), and less likely to binge drink (11% versus 31%).

It’s not only what parents think about marijuana use that matters. The more teens think marijuana use is a bad idea, the fewer teens use marijuana: only 6% of 10th graders who think smoking marijuana is very wrong have tried it at least once as compared to 51% of 10th graders who think its possibly not wrong.

https://www.askhys.net/

It is not the taboo nature of underage drinking and marijuana use that makes teens more likely to use. The polar opposite is true. When parents clearly communicate their strong disapproval of underage substance use, their children are likely to avoid or abstain from alcohol and marijuana use.

Myth #2: “All teens smoke pot”

Marijuana sure is popular. In fact, it is the primary drug of abuse for adolescents admitted to inpatient rehab. It is more popular among teenagers than cigarettes. It is quickly becoming legal in one form or another around the country.

With marijuana as popular as it is, it may be difficult for you to believe that three-quarters of high school students did not smoke any marijuana this month. Only half of high school students have even tried marijuana. Heavy marijuana use is even more rare. Less than 1 out of 10 high school students smoked at least 10 times this month.

If you have a teenager at home, talk to them about the real numbers. Let them know that even though it may seem like everyone at their school is getting high, most of their peers are making the decision not to smoke pot or drink alcohol. Tell them that you hope that they will do the same.

Myth #3: “My child is safer drinking at home with their friends than out who-knows-where.”

It is called “social hosting” and it’s a dangerous myth about safer underage drinking. Different from the practice of serving small amounts of alcohol to your own children during family dinners or holidays, social hosting refers to parents hosting underage drinking parties for their kids. Social hosting includes parents supplying alcohol, or simply allowing underage alcohol use, at gatherings of their child’s friends. Twenty-eight states have laws prohibiting social hosting and many municipalities have established their own regulations. For example, the upscale city of Mercer Island, Washington, fines parents $250 for hosting underage alcohol-related gatherings on their property, even if they were unaware that the party was taking place.

Check the law in your state:

http://socialhost.drugfree.org/

http://alcoholpolicy.niaaa.nih.gov/prohibitions_against_hosting_underage_drinking_parties.html

I have heard the thinking behind this practice from well-meaning parents. The logic is that all kids are going to drink alcohol at some point anyway. It follows that if they are bound to drink alcohol with or without their parent’s permission, at least the parent knows where their child is, knows their child’s friends, can monitor for safety, and can eliminate drunk driving or legal trouble. Unfortunately for those who mean well, the research tells us how ineffective this strategy really is.

The research on social hosting is clear. In a 2014 review published in the Journal of Studies on Alcohol and Drugs, there was a clear consensus across three studies, including over 10,000 participants, that social hosting increased alcohol-related harm to minors. “Social hosting is never a good idea,” say the review’s authors, “Parents might believe that they are keeping their children and their children’s friends safe by allowing them to drink in their home. This is not the case. Adolescents who attend parties where parents supply alcohol are at increased risk for heavy episodic drinking [binge drinking], alcohol-related problems and drinking and driving.” So much for keeping them safe.

The truth about teens and substance use

Although it’s not abnormal for teenagers to experiment with alcohol and marijuana, most high school kids are not using regularly and even fewer will go on to develop problematic heavy use or addiction. Expressing your disapproval of underage alcohol and marijuana use and setting clear rules against it reduces use. Delaying the age at which they first experiment with substance use and reducing the amount they use will help protect them from developing future addictions. Stay involved in your teen’s life because you are the biggest influence on your child’s decisions about their use. Exercise your influence.

How CRAFT works

The family in this article represents a composite of many typical clients and does not contain any identifying information about past or current families with whom I have worked. 

When Jen and Aaron came to see me they were nearing the end of their rope. Their 19 year old daughter had barely completed her first year of college. In the last few months things had deteriorated. She was living at home, sleeping odd hours, unemployed and not attending classes. Her parents were pretty sure that drug use was the cause of the downturn in her behavior but she denied it.

Things at home were tense. They felt that they were doing all they could to get her back on track – out of the house and back in college. Jen found herself constantly nagging and lately doing quite a bit of yelling too. Aaron’s frustration was leading him to adopt a cold shoulder towards his daughter. What could he say that would make any difference anyway? They had tried ultimatums but somehow it just felt easier to let matters drop than figure out how to enforce their rules. How many times had they threatened to kick her out of the house if she was using? Yet, here she was, living at home clearly getting high.

For decades the leading advice for the family members of addicted people has been a mashup of Al-anon’s focus on self-care, co-dependency literature about detachment, and the ultimatums of interventions and tough love.

Jen and Aaron had heard this kind of advice from countless well-meaning people. “Just kick her out,” friends and extended family would say. “You have to detach from her and let her hit bottom.” Yet they couldn’t bring themselves to do something that felt so harsh and dangerous. Jen sought support from Al-anon and appreciated the community of understanding people but couldn’t grasp the idea of “letting go” of her daughter when she so clearly needed help.

What most people don’t know is that there is an alternative approach for families who want to help an addicted loved one and themselves. I first learned about Community Reinforcement and Family Training (CRAFT) when I was facilitating a support group for parents of adolescents with drug and alcohol problems. The positive, relationship-based approach felt intuitive to me. Using CRAFT, I watched family members establish new boundaries and ways of communicating that allowed them to improve their home environment and family relationships without abandoning the person with the addiction. CRAFT helps families answer the primary question they ask me when they first walk into my office, “How do I stay in relationship with this person I love without losing my sanity or enabling their addiction?”

Over a period of months, Jen and Aaron came regularly to my office to learn how to talk to their daughter again, using positive communication to empathize with her as well discuss the drug use openly. They gained insight into the ways that they were facilitating the drug use and stopped giving her rides to meet up with using friends, allowing valuables to disappear from the home without consequence, or giving her cash when they knew that she was buying drugs. They learned to watch for something positive and were always ready to encourage a healthy behavior like looking for work, agreeing to see a doctor, or staying in for the evening. They re-engaged her with the family, with the clear expectation that plans would be cancelled if she showed up intoxicated. They examined their own well-being and prioritized their own self-care. They researched treatment options and found ways to invite her to consider getting help that called on her motivations rather than her parent’s fears.

Jen and Aaron were surprised to find how much influence they appeared to still have with their daughter. They didn’t have control over her or her addiction, but they found all the ways that they could influence change in their home and in their relationship with their daughter. They had replaced nagging and yelling with clear communication. They found that they were confident about their boundaries and more able to say “No” when there were feeling manipulated. They were done enabling but still ready to help. Something was shifting.

Soon the day came when their daughter said that she was willing to try treatment. Jen and Aaron were ready. They knew that helping their daughter get into treatment was a healthy way to be involved in her recovery efforts. They already had a treatment agency in mind and had checked their insurance benefits. She had her intake appointment a couple of days later.

Loving, involved family members are a protective factor for people who have substance use problems. CRAFT values the role of the concerned family and respects their input. A review of the evidence on CRAFT shows that, “studies have consistently demonstrated that CRAFT is 2 to ­3 times more successful at engaging treatment resistant individuals in substance abuse treatment than the traditional Al­-Anon model and the Johnson Intervention. More specifically, studies show that CRAFT successfully engaged approximately two-thirds of the treatment ­refusing individuals into treatment,” regardless of type of substance use, ethnicity of the family, or types of relationship, including spouses, siblings, or parent–child.

One of the most satisfying parts of using CRAFT to help families is the efficiency with which it initiates change. The research shows that generally, “substance users engaged in treatment after only 4 to ­6 sessions [with the concerned family member]. Irrespective of whether the substance user engaged in treatment, the [family member] reported a sizeable reduction in their own physical symptoms, depression, anger and anxiety.”

When Denise Mariano’s son was in the height of his addiction to heroin at 19 years old, she was fighting insurance companies and trying to make sense of the maze of rehabs to find treatment for him. “People told me that I was the biggest part of the problem. They told me to use tough love with my son. They told me don’t let him back home, if he calls, don’t help him: only they can help themselves and they must hit their bottom.”

Denise is one of 55 volunteer peer parent coaches through the Parent Support Network, a free program of the Partnership for Drug-Free Kids. Each of the volunteers have been trained in CRAFT to coach other parents through their concerns about their children’s substance use problems.

“In my heart, letting go and giving up hope on my son was not an option,” says Denise. “Such options would never be acceptable if our son was suffering from another medical disease.  We chose to not give up hope, to set healthy boundaries and continue to stay engaged.”

Today, Denise’s son is in recovery and Denise volunteers a few hours a week providing CRAFT oriented coaching to other parents through the Parent Support Network. “CRAFT has allowed me to support that journey rather than control it,” says Denise.

 

CRAFT resources for family members:

“Get Your Loved One Sober: Alternatives to Nagging, Pleading and Threatening”

The CRAFT primer written by CRAFT researcher Dr. Robert J Meyers, Get Your Loved One Sober is easy to read and provides concrete advice to the family members of people in addiction.

 

“Beyond Addiction: How Science and Kindness Help People Change”

A much welcomed second book using CRAFT methods for caring family members wanting to lead positive change in their family and help a loved one find recovery from addiction. Written by the psychology team at the Center for Motivation and Change in New York.

 

CRAFT support groups and certified therapists

https://www.robertjmeyersphd.com/download/CertifiedTherapists.pdf

CRAFT certified therapists are not easy to come by but you can find a listing online on Dr. Meyer’s website. Therapists wanting to become trained can also find upcoming workshops on the site.

 

SMART Recovery Friends and Family

http://www.smartrecovery.org/resources/Family&FriendsBrochure.pdf

SMART Recovery offers in-person and online meetings using Cognitive-Behavioral Therapy to help people change their substance use and find recovery. SMART Recovery Friends and Family has online and in-person support groups for the loved ones of addicted people and uses CRAFT principles.

 

Parent Support Network phone coaches

http://www.drugfree.org/community/parent-support-network/

Parent Support Network volunteer coaches uses CRAFT trained peers to provide support over the phone to parents struggling with their child’s substance use problems.