Help for families of addicts | alcoholics – specifically – is the focus of the just released book, Beyond Addiction, How Science and Kindness Help People Change.

It is estimated over 100 million people are affected by a person’s substance abuse problem – 100 million! That is roughly one-third of the American population. And yet, a family member searching for help with what to do to help their loved stop drinking, cut down their prescription drug use or seek treatment, rarely encounters information targeted specifically to helping them – them – them first, not their loved one, first. And yet the impacts on the family members are significant and often pose one of the biggest stumbling blocks to a person with addiction or a substance abuse problem getting the help they need. And this is where Beyond Addiction, How Science and Kindness Help People Change breaks new ground. It is “A Guide for Families,” and it is my great pleasure to share this interview with two of its co-authors, Jeffrey Foote, Ph.D., and Nicole Kosanke, Ph.D. The third co-author of this book is Carrie Wilkens, Ph.D.

Thank you Jeff and Nicole for agreeing to this interview, and THANK YOU for writing such a powerful book to help families of addicts | alcoholics and substance abusers.

You describe your book as “A Guide for Families.” Can you explain why you are targeting families of addicts | alcoholics or substance abusers as your audience instead of the addict, alcoholic or substance user?

Honestly, because they are in such dire need! There are millions of family members out there who are worried about a loved one’s substance use, and they really want help and direction. The advice for families is almost exclusively focused on either confrontational intervention on the one hand or disengagement on the other. These two options are certainly appropriate for some extreme situations; however, what most people don’t know is that effective strategies exist in the middle-ground for family members to stay engaged with their loved one while affecting more of the change they want to see. Families intuitively feel that staying engaged is important – and research really supports that! Individual circumstances also matter a great deal (co-occurring disorders, matching treatment to individual needs and goals, type of substances, etc.) and sometimes the standard confront or withdraw feedback that families get from our culture really misses the mark with these important nuances.

In essence, families need more options. Substance abuse problems are estimated to negatively affect five people for every one person struggling – that’s over 100 million people! And actually, if more families were informed about helpful strategies to employ with positive reinforcement and communication, for instance, we might be able to curb some of these problems from spiraling out into the devastating tragedies they can become. We also created something called the Parents 20-Minute Guide to help parents in particular have these helpful strategies for engaging more effectively with their child, which is available for free if you print it out from our website.

Your book’s subtitle is, “How Science and Kindness Help People Change.” What do you mean by this?

Science and kindness are two words not commonly put together, but in fact science has a lot to say about the value and influence of kindness, especially when it comes to helping someone change.

We purposefully used the word “kindness” because when it comes to substance abuse, people typically think of confronting, educating, challenging, correcting… And it can be super hard to be kind when you are frightened, upset, confused and on your last nerve. But the book is full of information and skills that family members and friends can learn, practice, and use right away in their lives—both to help themselves and their loved one.

Our field of substance abuse treatment has not done a good job of disseminating new research into the actual practice of treatment. So we put the word “science” in the title because we want more people to understand what the research tells us about how to influence people – in actions, communication, in the advice given… There are principles and concrete strategies that science tells us really have an impact. For instance, motivation is increased when someone feels their perspective is understood and respected and if someone feels they have options for change that they are capable of… these are ideas that can be directly translated into how family members communicate with loved ones, which is the basis of the Community Reinforcement and Family Training approach (CRAFT) we talk about in Beyond Addiction. In every other health-related field, we expect (and demand) that our doctors know about and be able to provide the treatment with the most evidence of success. And yet family members who are concerned about a loved one’s substance use can easily go through the entire process, even researching themselves, without stumbling upon a practitioner who even knows about the existence of CRAFT, much less one that is able to provide it themselves. This is part of the conversation at large that we’d like to influence change in – letting family members in on the elements of relationships, interactions, and treatment that are shown to be effective for influencing change.

You talk about motivation as the reason people change. How would you help a family member find their own motivation to change their own behaviors, quality of life, in view of their unsuccessful efforts to get their loved one to stop using / drinking and/or seek help?

Actually, much of our book addresses the parallel needs of both the loved one and the person struggling with substances. What science tells us about motivation and how to encourage it (and likewise how it an be squashed) applies equally well to everyone, substance abuse problem or not. Giving people options, appealing to their own reasons and perspective, refraining from backing someone into a corner, providing nonjudgmental information, helping someone feel competent to make changes, and affirming the movements of change that do happen… these are all elements that research tells us help increase a person’s motivation. And those variables are just as helpful to know about when trying to help oneself. Family members who have been trying to help a struggling person for a long time often end up extending their boundaries too far, and learning to erect healthier limits can mean trying behaviors that are new and sometimes difficult. So we give a lot of attention in Beyond Addiction to the ways family members can set goals for themselves in a reasonable way so they can have some success to build on (and give themselves credit when they reach those goals!).

One thing that tends to be terribly difficult for family members is to really prioritize their own needs. Parents in particular ascribe to the deep belief and adage that they can only be as happy as their unhappiest child, so they feel their priority must be on the struggling child, and any semblance of self-care should be set aside until that child is better. This is an understandable stance as a parent, but of course a deeply problematic one. In Beyond Addiction we attend to this dilemma carefully, helping people recognize the value in self care: increasing resilience and strength makes one a better problem-solver, role model, helper, and better able to be alert to the vicissitudes of experience that may well be important to notice, like when something gets better (that might be recognized and supported) or when something gets worse (and more immediate danger might need attention). Sometimes the inherent value of one’s own needs does not ring loud enough in the face of a loved one’s suffering and danger. But unfortunately, substance abuse rarely requires only the skills of a sprinter – the mindset of a marathon runner is more helpful and relevant. This means that putting aside one’s own needs will make it more difficult to achieve the goal of surviving (much less thriving!) through the whole race.

What are the top three concepts family members of addicts | alcoholics or substance abusers needs to understand, first – the three concepts they’ve likely not known or understood thus far in their search for help for their loved one?

There are lots of things we talk about in Beyond Addiction that people intuitively know but have a hard time putting into practice, like the value of communicating in positive ways, setting limits and allowing negative consequences to occur directly to the loved one, practicing good self care, and reinforcing positive behavior when it happens. And those are things that require some diligence, practice, and patience, since emotions like frustration, anger, and fear often get in the way despite best intentions. But there are few things that people may really not understand…

One is that substance use is motivated behavior, not crazy behavior. It may seem insane from the family’s perspective, and be deeply maddening and frustrating, but usually from their perspective there is some logic to it (it makes them less depressed, more comfortable socially, decreases stress, etc.) and understanding “what’s in it for them” can be helpful in a whole variety of ways. It decreases the sense of distance created in a relationship when feeling a loved one is doing things completely illogical and crazy. It also helps because it identifies ways that they might be motivated for change – for instance, if other methods for achieving these aims were introduced. And it also opens the door for possible willingness for treatment – when the “reasons” for use are acknowledged, someone might feel attended to in a new way and willing to get therapy for that issue first. And once support is in place, there is greater possibility for change in the area of substance abuse as well.

Another thing people may not understand is that labels usually do more harm than good. Some people do find the label of “addict” or “alcoholic” useful for themselves as a self-identification. But most people find these labels to be obstacles to seeking and receiving support. If someone feels they have to sign on to a lifetime identity prior to receiving treatment, one can understand what an obstacle could be for someone (especially an ambivalent person). Studies consistently show that stigma and shame are impediments to seeking help. Labels also promulgate this idea that all “addicts” are the same, which is untrue – people differ on all sorts of levels that are quite important to recognize, both for the sake of helping them in a more individualized way, but also because people often do not feel recognized when being lumped into a one-size-fits-all category. And at It is estimated over 100 million people are affected by a person’s substance abuse problem – 100 million!  end of the day, the discussion about whether a loved one is an “alcoholic” is simply a waste of time. What matters much more than this label are the effects the substance use is having in a particular family and what will motivate change. In Beyond Addiction, we really encourage people to save their energy for the more constructive work of affecting their loved one’s motivation.

A third thing that people tend to misunderstand about a change process is that ambivalence is normal. If only change happened without second-thought, without hesitation, without backstep! But most processes of change occur with a fair amount of ambivalence and changing substance abuse is no exception. In fact, if ambivalence about change is denied or ignored, this can increase rather than decrease the potential of backsliding. It is incorrect to assume that someone must be willing to never use again in order to make healthy changes. Research tells us clearly that people can be helped long before they have that level of certainty. For many people change is a gradual process that includes different levels of mixed feelings along the way. Expecting otherwise just adds frustration to an already difficult process.

Aside from family members of addicts | alcoholics or substance abusers, who else would benefit from reading your book?

We would love to see more of a shift in the conversation at large with respect to substance abuse and substance abuse treatment. That means not only with consumers of treatment but in our culture overall, with medical and other helping professionals, and within our own field of substance abuse treatment providers. It wasn’t so long ago that knowledge about substance abuse was not even a requirement at a doctoral level of therapy training, for instance, and many mental health professionals know very little about substance abuse. The conversation about substance abuse needs to change to include more acceptance of different pathways to change, more compassion for family members and those struggling with substance abuse problems, and less rigidity that enforces stigma and shame for those in most need of empathy and encouragement. So we’d be happy if more health professionals overall read this book and were inspired to learn more about evidence-based treatments and ways to help their patients who may have only the beginnings of substance use issues, so our culture is more geared toward true prevention and decreasing barriers of stigma so access to help is expanded.

There are ideological debates within our culture and within the professional world of treatment as well that also get in the way of people getting help: factions of harm reduction versus abstinence-based treatment, medication assistance versus none, and using AA or not. These debates obscure the fact that individual differences actually matter a great deal. Medication will work for some people but not others, same with AA. If someone decides against medication or against AA, we need to stop blaming the consumer for this decision (“they’re not ready” or “they’re in denial”) and instead question the rigidity of the prescription. Offering options is a motivational mainstay, clearly backed by research showing that motivation is increased when people feel they are choosing among reasonable options.

You both, and your co-author, Carrie Wilkens, Ph.D., are clinicians affiliated with the Center for Motivation and Change (CMC). Can you briefly describe what CMC is about and why it is different than the public’s typical perception of addiction treatment and/or family support?

CMC offers treatment for substance abuse that is evidence-based and provided by doctoral-level clinicians in both individual and group therapy formats of varying levels of intensity based on client needs. We have two outpatient locations and a new inpatient setting located in the Berkshires. Historically it has been quite unusual to find this level of research-supported treatment being provided at all, but thankfully this is beginning to change. We utilize motivation interviewing, cognitive behavioral therapies (like relapse prevention, insomnia treatments, etc.), evidence-based treatments for trauma, and CRAFT. We make efforts to decrease barriers to accessing the support people need, such as individualizing treatment plans (some people prefer groups or individual therapy, etc.), we strongly encourage family participation which is a proven factor increasing the sustainability of changes with substance abuse, and as psychologists we are equipped to address a multitude of problems that are often either co-occurring with the substance problem and/or are uncovered once substance use abates. We also encourage 12-step attendance and participation for the interpersonal sober support, but we do not require that be part of the treatment plan. Our belief is that many people benefit from the 12-step approach and support, but many others do not, and having that as an option rather than a requirement is an important aspect of a motivational approach that increases access for more people to receive the help they need.

To learn more about the Center for Motivation and Change (CMC), please visit their website.