This post was originally published on December 25, 2015.
When it comes to dealing with a person who has a serious drug or drinking problem, there is a fine line between compassion and delusion. I think most families start with the former and evolve into the latter. Both can potentially evolve into complete resentment. I, like the majority of people with somewhat extensive knowledge of addiction, believe the addicts themselves need to decide and want to get help. No one can make this decision for them or will the desire to change for another person, no matter how much love has been shared between them. But there is a small school of thought, recently highlighted through a story in the Boston Globe, that poses the theory that it is possible to instigate a changed mind for an addict who hasn’t hit the proverbial rock bottom yet. Or maybe even one who already has, multiple times.
So Few Admissions
The prevailing wisdom is that addicts and alcoholics have to want to get treatment. But per the 2013 National Survey on Drug Use and Health referenced in the Globe story, there are 20 million people in our country with substance abuse disorder. Nineteen million of those claim they do not need help. The ones in denial are costing us with drug, alcohol and tobacco related issues—according to a 2009 Columbia University study, a whopping $468 billion a year. The idea that addicts themselves need to admit and choose to get help, affects laws, too. According to the Globe article, “At least 13 states won’t provide welfare to those who test positive for drugs.” I’m sorry to sound soulless, but that kind of makes sense to me.
Letting Go of Letting Go
The Globe piece centers on a mother and daughter, the daughter has been to a total of seven rehabs and two halfway houses, kicked out of all but one. The mother, Susan Knade, as been an Alanon member for years but still can’t grasp the concept of “detaching with love.” In other words, when her daughter, Caroline, calls her crying in the middle of the night, scared, alone and experiencing heroin withdrawals, she can’t bring herself to hang up and simply hope she’s doing the right thing. This is where the not so common approach comes in—it’s called CRAFT, Community Reinforcement and Family Training. Developed by Dr. Jane Ellen Smith and Dr. Robert J. Meyers, PhD, the CRAFT method is a different spin on what most people consider an intervention. The method seems to be motivational rather than confrontational, and does not support the 12-step ideas of “letting go and letting God” and “not standing in the way of miracles.” While Alanon encourages family members to completely step away, CRAFT believes their support can be crucial to someone’s decision to try to quit and seek treatment.
There was a book published about this method in 2014, Beyond Addiction: How Science and Kindness Help People Change but it’s based on studies of 130 families published in 1999 and 2002, which seems like a rather long gap and makes me wonder if this concept didn’t go mainstream for a reason. Still, apparently two thirds of the families experienced positive results from using the CRAFT method.
The woman in the story, Susan, references the book and how she decided to take the CRAFT approach with her daughter despite years of Alanon training that would suggest she quit enabling and not bail her daughter out anymore. Rather than scolding her, shaming her or taking the role of “I’m right and you’re wrong,” the CRAFT ideology is about using positive language, getting them to open up, avoiding yes or no questions, agreeing with whatever concern the person suffering expresses and generally making them feel safe. CRAFT implements the belief that addicts will be more willing to admit and acknowledge their problem if their thoughts around their behavior are reinforced positively rather than punished.
More Preventative Than Effective
This process seems promising but way more so for younger people (especially those still under their parents’ roofs), and only if they aren’t too far down the road of multiple relapses and years of destruction. The daughter in the story, Caroline, ends up relapsing despite her mother’s new approach but based on what’s revealed about her history, that isn’t very surprising. Had her family known about CRAFT when her issues first started surfacing (she was free basing Percocet in her bedroom with a boyfriend as a teenager), maybe things would be different?
It’s hard to believe that something like this could be effective for full-grown adults who developed a severe drug or alcohol dependence. As the article points out, it’s easy to see why family members or loved ones would want to take anything that could remotely resemble responsibility for keeping a distrustful addicted person sober. I think adults on both sides of the spectrum—addicts and the non-addicts in their wake—have a harder time changing thought patterns and behaviors the older they get. The support of one’s family is certainly helpful, but it might not be the sole determining factor for someone truly in the depths of their powerlessness.