Whether Bold by the Front Door or Reticent at the Back, It is Just as Warm by the Fire
This wisdom of my grandfather has served me well through the years. In counseling, it is often the quiet, sometimes gentle, but nonetheless persistent pursuit of facts that can guide someone in counseling to insight. The funny thing about insight is that once gleaned, change soon follows. 

Sandra Anice Barns wrote, It is so hard when I have to, and so easy when I want to. I have come to look at this line as speaking to what individual dealing with addiction or compulsive behaviors often realize when realizing that the hassle of change is less than that of continuing. 

Change is many things, but first, it is an "inside job." People do not change other people, but they can influence others to change themselves. I have found that humor, metaphor, and allegory are all pretty good means by which to invite people to step back, look at themselves and their behaviors from a new perspective and answer a simple question: Is what I get by following this path worth what it costs me to continue taking it?

When the answer is yes, the journey continues along its present trajectory. If, however, the answer is no--or, and this is the precursor of change, I am ambivalent and therefore unsure--I contemplate change. When this contemplation is internal, when the tipping point in my cost-benefit analysis of my behavior is reached, I do not so much decide to change because something or someone external to me "made me," but because, as Barnes suggests, I move from feeling I have to change to deciding I want to change.

I have found many stories, cartoons films, music and other examples from the popular culture that have served to be useful in my efforts to invite individuals to evaluate the facts in their lives from a different perspective. Last week I found another and wish to share it here.

I found this video clip - see http://bit.ly/dT6d8g - humorous. It was sent as a link in one of the ubiquitous emails I receive from friends and acquaintances who share "stuff from the web," the purpose of which is to prompt a smile. Although I smiled when I watched, the potential the video held to stimulate a serious conversation about drinking to excess, particularly in a collegiate population, struck me.

If you have a moment--the video is only 3-min long--watch it and enjoy. If you have a thought regarding the video in general or, more specifically, if use in stimulating serious discussion with a group regarding prompting change, I will look forward to your comments here...or you can write directly to chapman.phd@gmail.com

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Dr. Robert

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Educating Family and Close Friends of Individuals with 
Substance Use Disorders: 
Blooming Where You are Planted

Generally, those who provide counseling services related to substance use disorders (SUD) do so when working with the person who uses. Another all too often overlooked but nonetheless important individual affected by SUD is the family member or close friend of the user. Finding psychoeducational materials designed to assist these individuals in understanding both the disorder and the way it affects the loved one is essentially to seek the Holy Grail of addictions literature. As with substance users involved in treatment, it is important for practitioners to meet the “individual” where he or she is on the continuum of readiness to pursue change. Frequently family and friends of substance users are at a very early stage of changing their behavior, what practitioners sometimes refer to as a pre-contemplative stage of readiness—I do not need to change, the user must make the change—or a contemplative stage—I can see how making some personal changes may help, but I am not ready to do so—at best. As such, I proffer several resources and suggestions for your consideration.

First, it might be helpful for the family member(s) or friend(s) to read some firsthand accounts of addiction and recovery. By reading first-person accounts of what it is like to be addicted, what is involved in the addicted person’s life that results in a movement towards change, and what life after change is like, family and friend glean an “insider’s perspective” on addiction. This can be quite helpful in letting go of the all too often tendency to think that all the user needs to do is “just stop”—for a humorous look at how effective this expectation is, watch this brief YouTube clip - http://www.youtube.com/watch?v=T1g3ENYxg9k

 Here is a link to some of the stories in the Big Book of AA that presents the stories of recovery from some of the early members of Alcoholics Anonymous. Granted, the drug used by the authors of these stories is alcohol, but the stories tend to give an accurate picture of the compulsion and obsession associated with addiction and, as the result, set the stage for viewing addiction as a bona fide health care problem and not a question of willpower - http://www.aa.org/bigbookonline/en_personalstoriesii.cfm

Next, it is useful to revisit the issue of “willpower” and consider it as more than an issue of perseverance or determination. According to the moral model of addiction, either “drugs are perceived as being bad and therefore so are those who use them,” this is often referred to as the “dry moral model,” or, drugs “may or may not be bad” depending on the drug (heroin/meth = bad; caffeine/alcohol = good), and strong (willed) people can use them without problems...the “wet moral model”…implying that those who experience problems are “weak willed” individuals.

An earlier essay I posted on this blog -  http://robertchapman.blogspot.com/2010/08/understanding-willpower-urban-myth-or.html may be interesting to review. Likewise, there is a collection of essays on my web page (http://www.robertchapman.net click on the essays link in the menu) that may be useful as well...be sure to check out the “counselor’s holiday message” posts. Again, you will need to scan these in order to discern which may be apropos to your interest in this topic.

Next, the film, “Rain in My Heart” may be useful. This is a documentary on alcoholism, but it allows the viewer to see the “down and dirty” reality of alcoholism/addiction and how it is not a question of will, but rather a medical disorder if not an illness or “disease.” The documentary lacks the “canned” or “preachy” feel of many professionally produced videos on addiction. It is available on YouTube in 10 installments of about 8 – 9 min each. The URL for the first being http://www.youtube.com/watch?v=NP0InrPZpjg with the next installment usually listed on the right side of each subsequent screen.

Related to this is another two-part YouTube video entitled, “The Man on the Back.” This you will need to screen carefully as it may not be useful, either in its focus or the fact that it is in Icelandic with English subtitles, but trust me that the subtitle do NOT detract from the power of this video. It has nothing “overtly” to do with addiction, but is a powerful piece on co-dependency and enabling, useful as a metaphor for addiction...the “hiker” in the film being the individual “with” an addiction and the man on the back the personification of the addiction itself. This is a bit of a reach for a lay person to get, however, without having a trained/experienced addiction professional or perhaps recovering person to “set the stage” before watching the video and then processing it at the end. The entire video, both parts, is 20 minutes, so it is brief. The URL for the first installment is: http://www.youtube.com/watch?v=T0m9iu6O3dg with the second linked from the menu on the right side of the page.

The challenge when trying to reach someone who: (1) believes he or she already knows ‘what’s what’ as regards addiction and (2) is so angry, hurt, and/or scared that hearing about let alone investing time and effort to read material that will “educate” about addiction is perceived as “fruitless” at best and a complete waste of time at worst. For this reason I suspect that “at this stage” it might be more productive to help the individual to understand addiction on an emotional level rather than try to engage him or her in a more cerebral or “intellectual” investigation of the disorder. Remember…this individual has been frustrated if not deeply wounded by the loved one’s behavior as dictated by his or her addiction.

Do not expect those who have been personally and profoundly affected by the SUD of another to accept any of these suggestions or “psychoeducational” interventions willingly or with thanks. As a matter of fact, initial overtures of help are frequently met with resentment. If, however, the information is proffered, with an emphasis on “I care” rather than “you need to know,” it is not uncommon that the individual will consider the material if not return in order to seek your counsel and support.
Dr. Robert

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