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Lapses and relapses are part of the change process for most (though not all) people attempting to make difficult life changes. They can be seen as sources of information rather than as failures to change; they point to where there’s more work to be done. The twelve-step practice of counting days and “going back to day one” after a slip is useful to some people, but others find it more helpful to learn from a slip and go forward. With a “relapse analysis,” as it is called, they build on the foundation they have made and value the work they have done so far. In all learning, there are mistakes and setbacks. These do not mean that what was learned is lost.
Treatment at CMC is evidence-based. We rely on treatment approaches that have been tested in controlled research studies over many years and found to be the most effective ways of working with substance use problems. In other words, we take our direction from science and do what works. CMC founders Dr. Jeffrey Foote and Dr. Carrie Wilkens have worked on federally funded research and have run some of the largest traditional programs in New York City. Through this combined experience they saw the need for evidence-based treatment, and the lack of places to get it. They opened CMC in 2003 to meet this need. Since then, the treatment field as a whole, along with healthcare policy and insurance requirements, has started to come around to evidence-based practices. CMC is committed to staying on the cutting edge.
The approaches we use are: a) motivational, to enable each client to figure out what changes are important to him or her personally, so that these changes can be sustained in the long run and b) cognitive-behavioral, to help each client identify real-world risks and stressors and target specific behavioral change, while developing a more fulfilling life. Our treatment is practical, problem focused, active, results oriented, and very supportive. We help clients monitor their progress by tracking their goals and readjusting their strategies and goals as needed. Treatment at CMC is non-shaming and promotes positive self-esteem, hope, and empowerment rather than the concept of a disease that will never go away—a potentially demoralizing idea that is not supported by the evidence.
In contrast to most addiction treatment, treatment at CMC is not based on a twelve-step philosophy. The twelve-step approach helps some people, but there is no evidence that it is the only way for people to make real and long-lasting changes. Other people find aspects of the twelve-step approach unhelpful, especially the imperatives to “surrender” and concede that “you are powerless,” to accept that “you have a disease for life,” or to call upon a “higher power.” At CMC we don’t tell people to get with “the program,” we help them design a program that will work for them.
Some of the clearest evidence we have concerning addictive behaviors is that people change in many, many different ways, along different paths, and that confining a person to only one option is most likely to block them from making positive change. Providing people with options for change lets them choose the changes they want and the way they want to make them, and to personally endorse the changes they make.
No problem. Based on your initial assessment, we’ll match you with one of our psychologists for individual sessions.
CMC has both individual and group therapy: some clients participate in both; some do one or the other. Again, this all depends on the issues that need to be addressed. Our treatment is problem-focused and very supportive.
In contrast to most addiction treatment providers, treatment at CMC is not based on a 12-step philosophy. The approaches we use are: a) cognitive-behavioral (a very practical real world approach that helps in identifying risks, stressors and areas that are in need of behavioral change, as well as actively working on developing a more sustaining life) and b) motivational (an approach that allows each client to truly figure out what changes are important to them personally, so that these changes can be sustained in the long run).
The United States treatment system (and public), unlike many other countries’, has traditionally held a black-and-white view of substance abuse as a “disease” for which abstinence is the only treatment. The data about how people really behave and change contradicts this view. For most people use falls somewhere on a continuum between unproblematic, problematic in varying ways and degrees, and destructive; and for most people change is gradual, a process of weighing the costs and benefits and then deciding to make change, usually incrementally until the problem behavior has changed enough. For some, this can result in successful moderation; for others, abstinence is required to eliminate the negative effects of their use. The bottom line? It’s different for different people.
Often by the time people seek professional help they are experiencing substantial problems. They may feel that abstinence is what they need, and that is how we focus their therapy. If, usually after a period of abstinence, someone wants to test the waters and see if controlled use is possible, he or she must take on this question in an honest and responsible manner: “Either I can use in a controlled way or I can’t, but fooling myself is no longer a useful option.” Clients collect data that we help them interpret, and they may conclude they are not reasonable candidates for moderation. Each client realizing this for him- or herself is a powerful predictor of positive outcome and sustainable change.
Our approach is based on respectful, non-shaming, non-judgmental ways of relating to clients. This has been shown repeatedly to result in clients being open and truthful about their struggles, as opposed to hiding them and “faking good.” In this setting, whatever their goals, we can openly explore and track with clients how well they are doing.
Positive support from a partner is one of the cornerstones of change, as many research studies have shown. When a partner is also using substances, it is most likely a serious threat to your changing. Clear, positive communication often goes a long way toward getting the support you need, or at least removing the negative influences of your partner. At CMC we teach communication skills for clients to articulate what they will need from their partner in trying to make changes for themselves.
No! In the traditional framing of relapse as failure, family and friends often live with a terrible sense of foreboding following any improvements on the part of their loved one, simultaneously counting the days and waiting for the other shoe to drop. This is no way to live.
According to the evidence, lapses and relapses are a natural part of getting better for most people. They are not failures to change but opportunities to learn. Ambivalence, too, is normal at any point in a process of change. Most people go through many stages of change—resistance, willingness, learning and progress, frustrations and setbacks, more resistance, more willingness, more learning and progress.
Understandably, ambivalence and setbacks may try your patience and equanimity. With new understanding, resilience, and skills to tolerate the downs with the ups, you won’t have to feel as though your life is on hold (or coming apart) until your loved one gets it perfectly. You’ll be in a better position to respond helpfully. Some responses are more helpful than others; in CRAFT you learn which is which.
It can be hard to feel hopeful when, despite your best intentions and major investments of time, money, and emotional elbow grease, change doesn’t seem to be “working.” We’re still optimistic. We know that you haven’t tried everything, though you may feel like you have. How do we know? At this point only a few treatment providers in North America share our approach for working with families and friends. There is progress in the field, but for now we can be pretty sure you’ll find something new in CRAFT.
Unlike traditional programs, CRAFT lets you take an active, collaborative role in positive change, encourages you to start as soon as you’re ready, and teaches you how. CRAFT shows you how to decrease your loved one’s defensiveness so that he or she is more receptive to help. CRAFT helps you rebuild your relationship whether or not your loved one chooses to enter treatment at the same time that it maximizes the chances that he or she will. CRAFT gives you tools to support your loved one during treatment and after, and CRAFT helps you take care of yourself. In clinical studies of CRAFT, 100% of participating family members felt better.
Group and individual sessions at CMC are supportive and constructive, not confrontational. There is strong evidence that challenging, aggressive confrontation is counter-productive to positive change. Our clients are challenged by the work of changing their lives. It’s not easy, but with the right support it can be empowering and deeply gratifying.
Stop yelling. In other words first, do no harm. It’s a deceptively simple instruction, for even when they understand why they should, family members say this is the hardest thing to change. It’s understandable that you feel like yelling, and your feelings matter. Your fear, anger, and sense of betrayal are important to expect, acknowledge, and act on as little as possible. It’s never helpful to yell. Confrontation leads to resistance. You may yell with the hope of discouraging some unwanted behavior, such as coming home late and intoxicated. Yelling, however, may undercut your loved one’s motivation, in this case motivation to come home sober, if to him or her it means, “this is what I come home to.” Yelling may also communicate that you don’t believe your loved one is capable of change. In one study, researchers discovered that a single act of confrontation by a therapist resulted in increased alcohol consumption by patients twelve months later.
Plus when you yell, you model yelling. That is, you effectively teach the other person to yell back. At CMC, according to the CRAFT model, we teach positive communication skills—how to say what you want to say in a way that’s most likely to be heard—as an effective alternative to yelling.
Also, be optimistic. That’s two things. But your attitude is critical, and forty years of research says you have good reason to be. People do change, especially when they and those they love think they can.
We invite you to put aside the question of whether someone is an “addict” or “alcoholic,” because it really doesn’t matter.
What matters is what matters to you and to them: What effect is the substance use having in their life and in yours? What will motivate your loved one to change? Real help is based on how well you know your loved one as an individual and the particular ways you matter to each other. Rather than reaching for a label, at CMC we recommend saving your energy for the more constructive work of problem solving. Our treatment for individuals starts with a thorough assessment of the particular psychological, social, and biological factors in each situation. We help families, for their part, understand the particulars of their situation in order to respond in the most effective ways.
Substance use and other compulsive behaviors do serve a function. It is critical to recognize this and develop alternatives that serve the same function. If drinking at the end of the day helps you relax and feel better about life, there are ways to get this same effect that don’t involve alcohol, including talking with a friend, listening to or playing music, having some quiet time alone, attending a support group, exercising, gardening, volunteering for a meaningful cause, walking the dog, doing a puzzle, spending time on a creative project—at least as many ways as there are people in the world! Stopping a behavior without finding something equally fulfilling to replace it is a sure route back to the old habit. “Just saying no” only goes so far; the real key is “just saying yes” to developing a new life that supports change.
Know that you can help, and you can take care of yourself in the process so that you begin to feel better—sleep more, cry less, get support, maintain your equanimity through the ups and downs—independent of the choices your loved one makes. Dealing with another’s substance problem is stressful, as you probably know all too well, and change usually takes time. To have a positive effect on your loved one you will need your resources; taking care of yourself keeps them from getting depleted.
Research has shown that you can help. The evidence is clear: involving family and friends in helping a loved one struggling with substances significantly increases the odds of improvement and helps maintain positive changes. Family influence is the most commonly cited reason for seeking treatment for substance use problems. In other words, you have an impact and you have leverage.
There is no magic bullet or single recipe for change, but CRAFT (Community Reinforcement and Family Training), the cognitive-behavioral approach based on twenty years of research that informs our work with families, will show you how to plan and implement helping strategies that are most likely to work for you and your loved one. CRAFT gives you tools to start making changes now. See our CRAFT services for more information.
We design treatment length and intensity (how often you come in) specifically for each person. After an initial, two-hour comprehensive evaluation, we decide together with you what makes the most sense as a treatment plan, including how frequently to come and how long it may take.
Some of our clients come once a week for individual sessions only; others come five days a week for group and individual treatment. Short-term options include evaluation only, or a brief two-week assessment and plan. A variety of factors indicate the type and intensity of treatment appropriate for each person: the severity of substance use and associated problems, sources of outside support, presence of other emotional and psychiatric issues, and the overall quality of your life and functioning.
Both cognitive-behavioral and motivational treatments are relatively short-term, typically lasting between two weeks and six months. (Motivational Interviewing, the approach behind our motivational work, takes only two sessions!) For all of our clients treatment is results oriented, that is, we use objective and individualized measures to continually assess whether the treatment plan is working.
Treatment length and intensity (how often you come in) is designed specifically for each person. After an initial comprehensive evaluation, we decide together what makes the most sense as a treatment plan, including how often to come and how long it may take.
Clients at CMC all have individualized treatment plans. Some come once a week for individual sessions only; others come five days a week for group and individual treatment. There are also short-term options that include evaluation only, or a brief 2 week assessment/treatment plan. The type and intensity of treatment is based upon a variety of factors including the severity of substance use and associated problems, sources of outside support, presence of other emotional/psychiatric issues, and the overall quality of your life and functioning.
The definition of a problem is different for each person. The most valuable indicator is to ask yourself: “Is my substance use causing problems in my life that I don’t find acceptable”?
Consider the ways your substance use affects your life. Some problems will be obvious (“my spouse is always upset with me”; “I had a car crash while drinking last year”) while others will be subtle (“I just don’t feel a hundred percent when I go to work in the morning”). Substance use can cause problems in different areas of your life—intimate and social relationships, work or school performance, physical health, and financial wellbeing. It can also decrease your ability to enjoy life.
Problems can occur with any amount of substance use; try to resist the urge to compare yourself to others as you think through your relationship with substances (“I don’t drink as much as my friend Jennifer”; “I’m not one of those people who misses work because of drinking”). If you can connect distress in any area of your life to your use, it’s reasonable to consider changing your relationships with substances. You may be surprised to discover the range of options available if you decide you could use some support.
Our cognitive-behavioral orientation points to the here and now: What variables in your day-to-day life impact your substance use? It is critical to also help clients understand their reactions to past problems or traumas in order to live more safely and productively in their current lives. But while many therapies spend a lot of time exploring past issues, cognitive-behavioral treatment is more active, helping clients put awareness of past issues in the service of changing current behaviors and problems.
Typically not at all, unless you are in need of our more intensive day program (IOP). Most clients attend in the evening or when their schedules allow during the day. In outpatient treatment you learn the necessary skills for positive change while living in your real life, with all its stressors. Learning to stay safe there, as well as build a healthy support system, is critical for long-term success.
Yes, part of helping people change is helping them want to change. Studies have shown that even when people say repeatedly that they don’t want to or simply can’t change, they do so all the time—even in the face of long odds. How? Because change becomes worth it to them. Weighing the pros and cons of changing or not, the balance shifts enough for them to say, “Enough! Let me try this another way.”
You can affect the balance. If you give people the right encouragement, stay connected to them, provide good options (not one ultimatum), and respect their right to be part of the solution, things get better. Change doesn’t always happen as quickly as we want and it can be messy, but it happens. With CRAFT, you’ll learn how to be a force in the direction of positive change.
There is no absolute readiness for change, and ambivalence is a natural part of the change process. While most substance programs won’t admit a person until he or she declares readiness to stop using forever, at CMC we know how to work with ambivalence, and when we work with families we teach them to do it too. So don’t wait for your loved one to “hit bottom”—it can be dangerous, and problems are more treatable the sooner they are caught. And don’t give up in the face of resistance from your loved one. Resistance is subject to influence like anything else.
In clinical studies, 70% of previously “in-denial” substance abusers whose family members did CRAFT engaged in treatment.
Absolutely. Approximately 80% of our clients have outside treatment providers with whom they continue to work as they participate in treatment at CMC. In fact, most people feel that by focusing on their compulsive behavior problems with us they are able to make significant progress with their outside therapist, as they work with new clarity and freedom on issues they had been avoiding with substances or other compulsive behaviors.
No. AA is a supportive, accessible self-help organization that has been instrumental in many people’s recovery. Over half of our clients actively participate in AA and other self-help groups in addition to the work they do at CMC. When appropriate, we encourage people to attend AA because it is an immediate and free source of support. We want people to engage in finding solutions to their problems. Whatever works!