How to Help: A New Perspective

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How to Help: A New Perspective


If you are someone who loves someone misusing substances, it is likely that you want to help and want things to change. It’s also likely that you feel either incredibly overwhelmed or confused with where to start and what to do. Luckily there are lots of things you can do! And research has shown time and again that loved ones can have a powerfully positive impact on their loved one’s change process. We know however, from experience, that the most helpful thing to do first is to develop a new perspective on the issues confronting your loved one and your family.

Substance use is a highly stigmatized and misunderstood problem and the cultural narrative has been one of character/morality flaws, disease, pessimism about change, skepticism about medication options, constricted beliefs about what people need to do to get better (e.g., go to rehab, go to a meeting, “just say no!!!”) and a general disdain for people who lose control of themselves. The reality is that science has given us a much broader understanding of substance use problems, including who is at risk, how problems develop, what supports the change process, and what sustains change and engages motivation. By understanding these issues in a new light (one infused with the glow of science), you will become more flexible, effective and resilient as you try to help your loved one.

There are a few central new understandings we’d like you to walk away with as as they will help you use the evidence-based tools that are at your disposal. Here’s the story:

Behaviors Make Sense

First and foremost, all behaviors have a purpose. We (human animals) do things (perform actions) because we get something out of it (a sense of well-being, acceptance, praise, calmness, money, excitement, relief, etc). This “reinforcement” drives all behaviors, and determines whether we repeat them or lose interest in doing them, even behaviors that seem to be destructive, irrational, or “crazy”, like drug use. Understanding what each individual gets from their substance use (a behavior they are performing) is the key toward developing new helping strategies. By understanding what is reinforcing about their substance use (in other words what they get out of it) you can find other behaviors to reward or reinforce. You can also work towards finding new ways to help them get what they need (e.g. relief, reduced pain, pleasure) that are not destructive. This understanding can also be the beginning of empathy (instead of just anger or fear) about their use, and which will help you take the behavior less personally.

Ambivalence is Normal

All human beings engage in and then repeat behaviors that reward or reinforce us. If we do something that feels good in some way or reduces a negative experience in some way, we tend to do it again. When we need to move toward a new behavior that will eventually reinforce and motivate us (e.g., being healthy), it’s important to recognize that it might not feel good right off the bat. And the old behavior still does! The new gym workout makes me feel happy with myself, but the old chocolate ice cream still makes me happy as well. The outcome? Ambivalence! Which is wanting two conflicting things at the same time. Bottom line? Ambivalence is a normal part of change, no way around it. Most of us have both reasons to change and reasons not to change, or wanting to change and wanting things to stay the same. Knowing to expect ambivalence during change (a zigzag path of progress) can help you stay calmer, be more understanding, and stay constructive yourself, which is a huge advantage. Starting in a new direction, taking new action, often requires living with these contradictory voices. Importantly, you can learn ways to respond in interacting with someone who is ambivalent that can help strengthen the voice of change. Which leads us to…

Pay Attention to the Lights

How can we best communicate to help change? If we do things because we get reinforced for it, and it’s hard when starting new behaviors to not also keep going back to the old ones, we could use some support in keeping that straight. One of the things we humans are really good at is language. We’re pretty unique among creatures in communicating incredible amounts of complicated and not complicated information to each other through our words. And our words themselves, how we speak to each other, is one of our most powerful tools for reinforcement, both positive and negative. “That’s a beautiful thing you did”! … “What the hell were you thinking”? Language can lift us up and it can crush our spirits. It is also a major way we stay connected emotionally. So the understanding here? Communicating effectively and staying connected is a bottom line critical ingredient in helping loved ones during the process of change. We need communication to reinforce positive changes, to be clear about expectations, to “get on the same page”, to understand uniqueness and the other person’s story, and to help shift ambivalence.

A simple version of this? Slow down in your next couple conversations to listen and watch; see what is happening. Is the person hearing you? Paying attention or distracted? Open or closed? Following up or shutting it down? Understanding what you are seeing and hearing while connecting with a loved one (“conversational signals”) is vital to stopping and starting conversations and allowing them to be as constructive as possible. It’s easy to “run through red lights” and go off the road, so understanding how to avoid that and stay on course is critical. This helps this powerful tool of communication be used most effectively, and it takes time and effort to use this tool well.

One Size Does Not Fit All

And a lucky thing we have the nuances of language, because (back to #1) if we are trying to learn to reinforce new behaviors, it is really helpful to understand this: we are all different and unique. As individuals, as families, as people using substances, as people helping others. Likewise, there are many paths towards change and each child and family is different. Thus, what works for one family may not be the same for another family. Remember, we want to learn to reinforce things that matter to that unique person!…not things that are supposed to matter, or that matter to us and not them, or that matter to that family down the block! Families usually receive a lot of different advice and opinions from friends and professionals, often in the form of very black and white answers. These usually start with “you need to”, which can be a clue that they are not speaking to you, but to “families of addicts”. It helps to realize that there’s not only room for, but the need for different strategies and paths to change. Understanding the uniqueness of each person is also a fundamentally respectful and collaborative stance, for a parent, for a teacher, for a policeman, for anyone…and bottom line: seeing others this way increases their motivation to engage in change.

Practice, Practice, Practice

Foul shots and compassion. And to finish our story, when we are talking about learning new behaviors, and finding ones that are going to be reinforcing (you’ll know because they’ll want to repeat them!) for the person (“I like to get high but I also like working out now too…it helps my anxiety”), we have to understand that this is new learning, and it takes time and practice and compassion. You may think “she should be doing this anyway”, but the new behavior is going to take some time to develop, kick in and become solid. This is an important part of the blueprint for change: practicing, seeing what worked and what did not, and using that information to provide direction for the next step. This is true for both the person trying to change AND the people learning how to help them change! You are here learning something new right now! And…being willing to practice and being open to the messiness of learning something new DOES require compassion, again whether it’s for the person trying to change old negative habits or you, trying to learn how to help! New learning (like learning to shoot foul shots in basketball) needs 2 things: 1) repeated practice (and failure) and 2) nourishment (in the form of patience, encouragement and compassion for the process).

The Parenting North Star and Willingness

Moving Toward What You Value as a Parent/Partner/Friend. This storybook has a very important binding that holds it all together, which are your values as a person and your willingness to keep pursuing them. To help someone struggling with substance issues (or any behavioral issues for that matter), takes a lot of work, thought, compassion, patience, and emotional hardship. So we are suggesting 2 critical steps to work with and keep in mind: 1) Clarify what matters to you as a person. What kind of person do you want to be? Spend some time identifying your values and how to use them as a directional arrow, or north star, and 2) understand that to pursue these values will include being uncomfortable/in pain at times. To move in your valued direction takes “willingness”, an acceptance of this discomfort and a decision to walk forward anyway. Allowing yourself to be scared or mad, and at the same time open to learning new skills to engage with your loved one differently, is an example of willingness. The opposite of being “willing” would be the common reaction of trying to shut the whole process down with such behaviors as trying to force change – kick him out/send him away – or ignoring events entirely.

Your values can include any number of things: consistency, reliability, being loving, positive communication, keeping your loved one safe, connection, mutual respect etc. We are suggesting the importance of clarifying what tops this list for you and place it “north”, because it is easy to lose track of and not walk in this direction under stress, and substance use in your household is probably causing a lot of stress!. Then what happens? Everything BUT these values…yelling, erratic behavior (kick them out then turn around and bend the rules etc), disrespectful, angry communication, withdrawal etc. Clarifying the direction you want to head (even if you take off ramps at times) is critical AND uncomfortable..staying with what matters to you will mean NOT GETTING IT at times and living with that. It is painful, but allowing for that pain is the key to staying on track with what you care about. We call that “willingness”, and it takes practice, just like everything else new you are doing. So find that north star of values you want to look toward, knowing that it is a direction, not a goal and understand there will be turbulence (and joy!) in moving in that direction.

Summary of the “Story” Narrative

The summary of how to understand and help? We humans do things (and repeat those behaviors) because we get something out of doing them, whether they’re “bad for us” (substance abuse) or not. Changing behavior is most effectively done by adding in something new that is also rewarding, but this is challenging for most of us, AND the old behaviors and routes are still there “calling our name”, a natural pull. Providing support and encouragement for the new positive behaviors is REALLY helpful. Knowing how to TALK about these changes and their challenges (including the old behaviors which keep popping up) is a REALLY important way to help the person strengthen positive change. And in helping support someone attempting new behaviors, it goes a long way if you can see their unique challenges and needs, what matters to THEM, and try to support those in particular. Additionally, because new stuff is hard to do and we all suck when we start, change takes two more important steps: repeated practice and compassion, whether we are learning new behaviors to replace substance use, or we are learning how to help another person change. Last, the context of all this is usually pain; your loved one is struggling, you are scared/angry/fill in the blank, and things can get unmoored. So the first, middle and last part of the story is this: It also takes getting grounded in what matters to you as a person, clarifying and using your values as a “north star” to keep remembering where you are heading, and willingness to be uncomfortable and in pain at times to stay the course, and not just try to “make it all go away”.

About the Author:

Jeff Foote, PhD

Dr. Foote is a nationally recognized clinical research scientist who has received extensive federal grant funding for his work on motivational treatment approaches. Dr. Foote has worked in the addiction treatment field as a clinician and researcher since the late 1980′s, and has developed a unique motivational treatment approach that incorporates principles of group treatment as well as research-based principles of human behavior change. Previously, Dr. Foote was the Deputy Director of the Division of Alcohol Treatment and Research at Mt. Sinai Medical Center in NYC, as well as a Senior Research Associate at The National Center on Addiction and Substance Abuse at Columbia University (CASA) in NYC. Dr. Foote also served as Chief of the Smithers Addiction Treatment and Research Center as well as Director of Evaluation and Research between 1994 and 2001. Dr. Foote is a former team Psychologist for the New York Mets.