What Are the REAL reasons for Addiction?

What Are the REAL reasons for Addiction?

by | Apr 18, 2024 | Family Addiction, Hope for Families TV

Whenever I tried to confront my mother about her behavior, she would always find a way to turn the tables and somehow blame me. Her ability to make me the bad guy never ceased to amaze me.

And I know I’m not alone in this. Here a few things I hear from family members:

 

  • “He would always blame us.”
  • “She made it quite clear that I am the bad person.”
  • “He’s angry at me for being angry he’s been drinking.”
  • “He makes me feel like everything I do is wrong.”
  • “Is it normal to feel like I’m the reason they drink?
  • “She’s blaming me for everything.”
  • “He says I’m being mean and selfish.”
  • “He’s found a narrative for making me the bad guy.”

I hear these kinds of things all the time from family members. In so many words, their loved one blames them. Short of that, their loved one abusing drugs or alcohol will constantly pick fights to keep their loved one’s from being able to focus on their substance use, set boundaries, or otherwise support their own well-being.

This is just one of the many ways in which a loved one’s substance abuse creates dysfunctional relationship dynamics in the family.

The bottom line is this, however: your loved one makes their own choices.

Your loved one makes their own choices.

But there’s this truth, too. No one chooses addiction. No one chooses addiction.

So who, or what is to blame for addiction? Well, there isn’t an easy answer, but there is a whole list of factors:

  1. The first is genetics. While we haven’t actually identified a gene specific to addiction, we do know that our different levels of sensitivity to stress is genetic and stress is a huge factor in addiction, as the substance use is usually some kind of coping response.
  2. This means that everything that causes stress is a factor. And one of the things that exacerbates any stress someone abusing substances experiences is the dysfunctional relationship dynamics that their own use generates and creates a vicious cycle.
  3. Next is insufficient support. So when you couple number 2 with the fact that our society has evolved in such a way that people’s support systems are at least 50% smaller than they were in the 1950s, and in some cases those support systems are non-existent, these things together constitute a huge driver of substance abuse problems and a huge driver of why and how they persist generation after generation.
  4. But that lack of sufficient support also extends to our health-care system. Health care in the US is very expensive. You have to have resources that many addicted people don’t have in order to be able to access it. And the challenge with substance use disorders is that every issue that our health care system has is magnified exponentially when it comes to treating substance use disorders, because addiction medicine and addiction treatment is very poorly regulated.

    On top of that there are huge systemic obstacles that make it prohibitive for anyone who wants to practice addiction medicine to actually do it. This even further limits access to qualified treatment professionals using evidence-based methods.

  5. Some of the blame can also go to our cultural attitudes about alcohol consumption. I mean, why does anyone have to explain why they don’t drink? No one asks anyone to explain why they don’t smoke. The pressure to consume alcohol is enormous. Such a huge portion of adult social activities revolve around alcohol. And you’re viewed as strange or a party pooper if you don’t drink. This creates a significant and totally unnecessary added burden to anyone trying to abstain.
  6. And then there’s the pharmaceutical industry that for so long pushed opioid-based pain medication insisting that it was not habit-forming when it most definitely was. And even when the pharmaceutical companies were sued for knowingly pushing this false narrative and these drugs, the award money has not gone to supporting addiction treatment in so many cases. Much of it has gone to law enforcement, despite the fact there is no evidence law enforcement has a positive impact on substance use.
  7. And speaking of law enforcement, this brings us to the War on Drugs. Criminalizing drug use and incarcerating people for possession has only exacerbated the problem.

    But even those areas of the US that have tried to decriminalize drug possession are considering rolling back those decisions as crime only increased – because – going back to reason number 3, our treatment is unregulated and cannot effectively address the problem.

    The places that have successfully decriminalized drugs were only successful because they took the money they saved and invested it in treatment programs and support programs for those recovering from substance abuse. But in the US at least, we do not have an addiction medicine or treatment system that could viably and effectively address the addiction crisis on a large scale. We should decriminalize drugs, but we need an effective addiction treatment system before we do.

Why is all of this relevant to you getting blamed for your loved one’s use?

Because it’s important to know that it’s not you, first of all.

And it’s important know the factors and identify where you want to try and push for change.

In my own work, I focus on helping families disengage from those dysfunctional relationship dynamics – one of which is your loved one trying to assign blame for their behavior to you. But I also help families use evidence-based methods to have a positive influence on their loved one’s use. This is something that the treatment system is way, way behind on.

Finally, we need families to be aware of these methods so they can both employ aspects of them themselves, and pressure the treatment industry to use them more widely. You can check out a brief overview of those methods in my previous Hope for Families TV episode.

And if you’re interested in learning more about those methods beyond my previous Hope for Families TV episode, you can check out online Workshop, The 5 Ways to Have a Positive Influence on a Loved One’s Drug or Alcohol Abuse. I’ll put a link in the show notes.

So, I’d love to hear from you: which of these things do you suspect is the biggest factor in your loved one’s drug or alcohol abuse? If you feel comfortable, share in the comments. I promise I’ll reply.

3 Evidence-Based Strategies Every Family Should Know

3 Evidence-Based Strategies Every Family Should Know

by | Apr 11, 2024 | Family Addiction, Hope for Families TV, Treatment

In my family growing up, shame-based confrontation was the name of the game. It’s no surprise that nothing ever really got resolved. Even those who tried to lovingly confront people about issues that were affecting them would end up in a vicious mud-slinging fight. Unfortunately, substance use issues, personality disorders, and other mental health problems go back generations in my family. So if there was a healthy model for conflict or difficult conversations, it was long gone in the past.

Having done my own healing – particularly from trauma – I know now how important emotional safety is to navigating these kinds of encounters. In my own family, no one could change or evolve because the emotional safety necessary to do so was never there. For my own healing, I had to create significant boundaries between myself and my family because there was no way I could create the emotional safety I needed to.

Having to do that is heartbreaking, and in my work, I support families with strategies for creating more emotional safety in their relationship with their loved one so they can have the kind of positive influence on their loved one that will support them in making positive changes.

So for this episode of Hope for Families TV, I’m going to talk about 3 of the most promising evidence-based treatment approaches to substance abuse. I want to highlight these three approaches precisely because they model tools that family members can also adopt to create the emotional safety needed to have a positive influence, and also because, sadly, these methods are not commonly used in actual treatment programs, and they need to be.

And I want to talk about these approaches because I can’t tell you how many times I’ve had families tell me how they got their loved one to go through treatment, and then they relapsed they day after they got out. Now there are multiple contributors to relapse, but I have no doubt that one of the reasons these methods have the evidence behind them that they do is because they build emotional safety.

Other things that make these approaches so powerful is that they’re both customizable, they address motivation to change using evidence-based practices, and – most importantly to my work, they outline methods family members can use to have a positive influence on their loved one’s drug or alcohol use.

So these three approaches are: Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management

And I’ll go through what each of these approaches are right now

So, Cognitive Behavioral Therapy – often referred to as CBT, operates on the premise that our thoughts, feelings, and behaviors are interconnected. It acknowledges that substance abuse is often a coping mechanism. By identifying and challenging negative thought patterns and beliefs associated with substance use, aka – the drivers of the use, individuals can develop healthier coping mechanisms and responses to triggers. CBT equips individuals with practical skills to manage cravings, deal with stressors, and prevent relapse so they gain greater control over their behaviors and consciously choose healthier responses to their triggers.

Motivational Interviewing is a collaborative, person-centered approach that explores an individual’s ambivalence towards change. It uses a utilizes strategic questioning and reflective listening techniques to elicit “change talk” – statements that reflect an individual’s desire, ability, reasons, and need for change. By amplifying and reinforcing change talk, therapists help individuals strengthen their intrinsic motivation and commitment to recovery. By fostering empathy, acceptance, and evoking intrinsic motivation, motivational interviewing empowers individuals to explore their values, goals, and reasons for change. Through reflective listening and guided questioning, motivational interviewing’s collaborative, non-confrontational approach helps individuals resolve their uncertainties and strengthen their commitment to recovery and positive change by fostering intrinsic motivation and respecting the person’s autonomy and individual agency.

And finally, Contingency Management leverages the principles of behavioral psychology to promote positive change through reinforcement-based strategies. It operates on the principles of positive reinforcement, offering tangible rewards or incentives to reinforce desired behaviors such as abstinence or participation in treatment. Contingency Management allows for customization and individualization of reward systems based on the unique needs, preferences and circumstances of each individual. By providing immediate and tangible rewards, CM helps individuals stay motivated and engaged in their recovery journey. Whether through vouchers, privileges, or other incentives, CM offers an effective way to encourage and sustain positive changes.

All three of these approaches are evidence-based approaches that have been proved effective in motivating people abusing substances to either fully abstain, moderate, or make changes that lessen the negative impacts of the use.

But they’re rarely used in actual treatment settings. People with substance abuse issues typically have to work with an individual therapist to access any of these therapies.

Why is is this?

Because the treatment industry is largely either completely unregulated or poorly regulated. Which means there is no medical board mandating the use of evidence based approaches like there is in other areas of medicine.

And given that these approaches are highly individualized and require more 1:1 contact with a trained therapist in these modalities – the very thing that makes them so much more effective – for profit, and even non-profit treatment centers, have neither the regulatory nor the financial incentive to implement them.

Most of them are continuing to use non-evidence-based programs dating back to at least 50 years. These programs are rarely individualized, despite what the treatment centers claim, and rely almost exclusively on group therapy and other group programming.

And I think it’s really important that families understand the evidence-based methods out there so they can better understand what they are and aren’t getting for their treatment dollars, and start both demanding more evidence-based options from treatment centers and better regulation and higher standards of care for the treatment industry.

So, I’d love to hear what your experience was of the treatment industry. Feel free to share your story in the comments. I promise I’ll respond.

Your Reality Matters: Overcoming Denial and Gaslighting

Your Reality Matters: Overcoming Denial and Gaslighting

by | Mar 7, 2024 | Family Addiction

Here’s one thing I know about what so often happens in families affected by a loved one’s drug or alcohol use. The denial and the gaslighting can get pretty intense. So intense that you seriously start questioning your reality.
And maintaining your sanity in the face of the denial and gaslighting really does require effective support, because if no one outside of your family circle is affirming that you’re not crazy, it is REALLY hard to not start thinking that you’re the one with the problem.
As as gen-x Swiftie, I can’t restrain myself. I just have to say, “you’re not the problem. It’s not you.”
But there are a number of reasons you should take your concerns with your loved one’s substance use seriously – like right now, in spite of the denial and gaslighting – and get the kind of Effective Support you need to be able to do that.

And a number of these reasons have to do with the fact that you have the ability to positively influence the problem, and many families are not aware of that.

You’re probably aware that we have a cultural narrative that is dominated by messages from 12-Step recovery saying you don’t have control. And you don’t, but what you don’t hear that cultural narrative acknowledging is that you DO have influence. You’re influencing your loved one no matter what you do.

So it’s important to understand how to influence your loved one’s in a positive direction, to learn what that actually looks like.

Because substance disorders occur on a spectrum. And the lower on the spectrum the substance use disorder is, the easier it’s going to be for you to have a positive influence.

So, don’t dismiss your concerns just because your loved one is denying them and gaslighting you. As the problem gets worse, you’re going to have to work even harder to have a positive influence on it.

But Effective Support is really important if you don’t want to get taken down by the denial and the gaslighting. Because without Effective Support, this kind of dynamic of denial and gaslighting can really push family members to start reacting in ways that become problematic. And then you do become part of the problem. Which only gives your loved one more ammunition to use to try and blame you.

If this is the dynamic in your family, there’s no judgement here – it’s damn near impossible not to get sucked into this kind of dynamic without Effective Support. And families don’t know what they don’t know.

So what might taking your concerns seriously in the face of denial and gaslighting look like?

Well, the number one suggestion I give to the families I work with is to actually drop the arguments about whether or not there is a problem. Unless you’re drug and alcohol counselor professionally trained in doing substance abuse assessments, the reality is, you’re not technically qualified to make that determination.

I don’t say that to suggest you’re wrong – I trust your own assessment. And often the problem is glaringly obvious. But I suggest dropping the argument because it’s not one you’re likely to win with your loved one. And it’s an approach they’re very unlikely to hear.

Rather, discuss how their drinking or drug use is negatively affecting you. Here, you have full authority. It’s your experience after all. Now, this doesn’t mean that your loved one won’t argue with you. They most certainly will. And they’ll try to gaslight you about your own experience. But they’re going to have a harder time getting under your skin here – especially if you have Effective Support – because you’re talking about your own reality here and not theirs. It’s going to be much easier to hold your ground from this place.

So, take your concerns seriously – today – because it’s much easier to have a positive influence on the concerns the sooner you start taking those concerns seriously. And focus on how the drinking or drug use is affecting you and the family.

And get the Effective Support you need to do that. That support can come from support groups, a therapist, or a knowledgeable and informed friend or faith community. I’ve got a list of potential support resources on my resources page.

And if you’re interested, I’ll be launching my own online support community in April. Make sure you’re on my email list so you can be the first to know when that drops.

My Love Hate Relationship with Gratitude – a.k.a. How Gratitude Used Right Helps Families Struggling with a Loved One’s Substance Abuse

My Love Hate Relationship with Gratitude – a.k.a. How Gratitude Used Right Helps Families Struggling with a Loved One’s Substance Abuse

by | Mar 1, 2024 | Family Addiction, Hope for Families TV

When it comes to family addiction, I’ve had a lot of awful experiences to work through. And oh my god, a shit ton of negative false beliefs about myself that I had to heal.

And for awhile, I tried turning to a lot of the mindset gurus that many of you may be familiar with. But it didn’t work. And for awhile, I thought the problem was me until I started both getting trauma therapy and also encountered the concept of toxic positivity.

 

What I didn’t understand at first is that a lot of the content I was encountering around mindset was actually toxic positivity. Brushing legitimate negative emotions – emotions that need to be processed – under the rug by “just thinking positive.”

You just gotta be positive and look on the bright side. You know, raise your vibration. That last one makes me want to hurl sometimes.

In too many of its manifestations, mindset work was just a toxic framework for sweeping legitimate difficult emotions – emotions that need to be processed in order to effectively move forward – under the rug.

I finally learned that you can’t BS your way to a positive mindset. Feelings have to be felt. Emotions have to be processed or we remain stuck.

And the concept of gratitude often gets conflated with this kind of toxic positivity. You know, just be grateful, look on the bright side, it could be so much worse.

And I know for a fact that for families struggling with a loved one’s substance abuse, this kind of gratitude is NOT helpful. It’s just not.

But that doesn’t mean there isn’t a use for gratitude. It just has to be an honest gratitude. So, I want to share a story about how this kind of gratitude was so powerful for me.

Over a decade ago, I was leaving a very toxic, emotionally and psychologically abusive marriage. And I was scared to death. My ex-husband had way, way more money than I did and he was using it to try and force me to accept his demands in the divorce. And I couldn’t afford to pay a lawyer for hours and hours of more work to try and fight it all.

I was just terrified that I either had to accept horrible terms or have all my money run dry trying to fight it. In many ways, the process of leaving was harder than staying.

I just had to trust that things would be much much better once that process was over – and they were!

But in the middle of that process, oh my freaking god, I was stressed. I super stressed in the marriage, too, but making a decision to leave was the most stressful of anything. I mean, please don’t get me started on why women don’t leave. My situation wasn’t anywhere near as scary as situations other women face and it was still pretty freaking scary.

That said, one of the things I did during that year that I was going through the divorce was make a gratitude journal. I just took a simple weekly planner, and every evening before I went to bed, I would fill in the space for that day with things to be grateful for.

Some days, there were these really amazing things that happened – in fact, a series of things that actually prevented my ex-husband from being able to force me to meet his unreasonable demands, without me having to spend thousands more in legal fees.

But most days I had to dig much, much deeper to find something to be grateful for. Most days I had to dig for some small thing that, had it not happened, I would have had an even more difficult day. I mean, many of my entries were things like I made a stoplight when I was running late. And some of them were in the middle.

But however impactful they were, I wrote them down.

But the difference here was that I was not pretending that things weren’t as bad as they were.

I wasn’t using gratitude as a yes, but…. I was using gratitude as a yes, and… Yes, my divorce was incredibly scary and stressful. AND there were all these little moments of respite that I probably wouldn’t have noticed if I hadn’t been making a point to remember and write down.

So, here’s what I know that practice of keeping a gratitude journal did for me. It kept my head from making the stress I was going through even bigger than it was. It was already big enough. And it just kept my head, in all its fear, from blocking out all those moments of respite, no matter how small. They were just as real.

So my gratitude journal practice just made sure that the fear didn’t overtake absolutely EVERYTHING in my life during that year. And that meant that I walked through that awful year in a more resourced state than I would have if I hadn’t been engaging in that gratitude journal practice.

And this is why I have this love hate relationship with gratitude. I often hesitate to suggest gratitude to the families I work with because I sure as hell don’t want to sound like I’m preaching some kind of toxic positivity BS.

But gratitude done right – and that is gratitude that isn’t being used to try and shove other legitimate feelings under the rug, but rather gratitude that is just to try and keep all the stress and fear from completely taking over everything – that kind of gratitude helped put me – and can help put you – in a more resourced state.

And frankly, that’s what ALL of my work with families struggling with a loved one’s substance abuse is designed to do. To put families in a more resourced state so they can respond to the problem more effectively.

So I feel like it would be remiss of me to not talk about how it can help – if used right.

Because here’s the thing: when I train families how to have a positive influence on their loved one’s substance use, one of the things I talk about is being proactive about managing your fear. Not that the fears aren’t legitimate – they are. We all know there are no guarantees.

But if you want to be able to have a positive influence on your loved one’s substance use, it’s essential not to let the fear take over everything. And establishing a gratitude practice is one way to do that.

The year of my divorce, there was even another benefit of that gratitude journal. My divorce was final the end of October of that year. So Thanksgiving – a day totally devoted to gratitude was coming right up. And one of the things I did after the divorce was final was review that gratitude journal. And I noticed all the people who repeatedly showed up in that gratitude journal with their kindnesses large and small.

On Thanksgiving, I sent each one of them a thank you message noting how frequently they showed up in that journal, the impact that had on such a stressful year, and how grateful I was for their presence in my life.

In other words, I shared that gratitude, which was just another really beautiful thing to be able to do and also something that helps keep our legitimate fears from taking over everything and puts us in a more resourced state.

So, some kind of gratitude practice might be something helpful for you to try. Not because it’s going to make your problems with your loved one’s substance abuse magically fade away. It’s not. But if you practice regularly, it can put you in a more resourced state.

And that’s the whole point of not letting the fear take over everything. Because being in a more resourced state will help you address your loved one’s substance abuse more effectively.

In fact, it’s never a bad idea to be in a more resourced state. Which is why I’m going to return to that gratitude journal practice.

And, as a final note, I’ll say that if a gratitude journal doesn’t resonate with you, you can always write little notes of gratitude and then collect them in a jar. You can review them at the end of a month, or even at the end of a year. And then reach back out to those that impacted you the most during that time and share the love.

So, I’d love to hear your thoughts about either establishing a gratitude practice, or a gratitude practice that you already use. I know we can all learn from each other, so feel free to share in the comments.

Are You Putting Your Life On Hold Waiting for Your Loved One to Recover?

Are You Putting Your Life On Hold Waiting for Your Loved One to Recover?

by | Feb 21, 2024 | Family Addiction, Hope for Families TV

So, I have a question for you? Do you feel like you’re putting your life on hold waiting for your loved one to resolve their substance abuse problem? I know I did this for years and years. If this sounds like you, too, I have a story for you.

So, about 20 years ago, when I was early in my recovery from family addiction journey, I reached out to my sponsor for support around some awful thing my mother had done. Side note – I know very well that 12 Step recovery is not for everyone, and I’m not trying to endorse it here. It just happens to be part of my own story, so I am sharing about it in that light.

At any rate, what I was calling my sponsor about was something my mother had done some version of a million times before. And I continued to just get totally rocked by it each time she did it again.

And my sponsor could see that, even though I’d been in this support program for awhile, I was still stuck essentially thinking my life was over unless my mother changed.

And she said something to me I’ll never forget. She said, “Madeleine, your mother has the right not to recover.”

And my first reaction to that was like, “Whachu talkin’ ’bout Willis?” And I know that reference is going to age me there, so if you didn’t get that, you’ll have to look the show Different Strokes. But suffice it to say I was absolutely in this totally flabbergasted place, like how could she make such a claim!

But just like a cancer patient has the right to refuse chemo, an addicted person also has the right to refuse treatment, for better or for worse.

And of course, they also have the right to the consequences of that decision.

Now, I know you might be confused to hear me say this because a big part of what I help families do is to learn how to have a positive influence on the substance use, because your loved one does not exist in a vacuum.

You are able to influence them. And doing that in a positive way does improve outcomes.

And I’m not here to go back on that in this video.

But part of having a positive influence on your loved one’s use is to live your own life, to the best of your ability whether they’re using or not. And feeling like you have to wait for them to recover before you can live your life doesn’t actually help anything. In fact it does the opposite.

And my sponsor’s “outrageous” claim is what drove that point home for me.

So let me explain how that works:

One of the things that drives continued substance abuse is shame. Shame may or may not have been part of what started the use, but it is definitely what drives continued use in spite of all the problems it causes.

Because, whether your loved one admits it or not, they are deeply ashamed of their use and of the things their use drives them to do. They are – I promise.

Now, it’s not helpful to act like their behavior is OK, but one of the ways you can help them with the shame is to live your life to the best of your ability. It not only helps you better weather this scary and chaotic journey, it also relieves your loved one of the the fear – and the shame – that they’re totally ruining your life.

So, what’s one very teeny-tiny way you can start to reclaim your life? Can you go back to your book club? Can you call a friend you haven’t talked to in a long, long time. Get you get back out on the golf course with friends? Even if you only did one little thing once a month, it would make a difference.

So what can you do? Let me know in the comments.

But before we wrap up this episode, I want to address one more thing that I’m sure you might be thinking. Maybe you’re feeling like living your life means that you don’t care what your loved one is struggling with, or that you don’t care what happens to them, or that you don’t that the severity of the problem that seriously.

Not at all. You can life your life and still care. You can live your life and still fully understand what’s at stake.

A loved one’s struggle with substances is a completely horrific journey to have to navigate. It’s full of grief and fear – and there’s no way around that, even if you do live your own life to the best of your ability.

And if your loved one doesn’t recover, or God forbid, loses their life to the substance, your heart is absolutely going to break. I’m not pretending it won’t.

But the only way to navigate this journey with your psyche relatively intact is to create a space for your own life, too.

It’s not easy, and I don’t claim to have done that perfectly myself. It was a very up and down journey for me. Every step of the way I’ve had to grieve for the mother I never had.

And my mother passed a little over a year ago, so then I had to grieve for the mother I never would.

But through my own recovery journey – which included living my life to the best of my ability – some days well, some days not so well, I discovered that, yes, my heart was broken over my mother. But there was so much more that my heart could hold.

A number of years ago when I was working at a family recovery program, I told the story of how my sponsor insisted upon me all those years agon that my mother had the right not to recover.

And after that session a mother came up to me and share that she’d been putting her life, and all the things she wanted to do, on hold for years waiting for her son to recover.

She didn’t realize that she had permission to live anyway.

You, too, have permission to live anyway. Not because you don’t care, but because you do. And just because we are experiencing this kind of really heavy problem that we didn’t choose, doesn’t mean that we can’t still choose moments of joy where we can.

Our lives, our psyches, our emotions, hold multitudes. And making whatever room we can for all of it will help both us and our loved ones.