How to Become a “Reinforcer”

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How to Become a “Reinforcer”

reinforce_lgIf you are a partner, friend, spouse, parent, sibling, grandparent or any other person who is worried about a loved one’s use of substances, it is highly likely that you want to help them change. It may be that you have been reading or searching the internet about what you can do. Maybe you have considered an intervention. Maybe you have been trying to talk to your loved one and feel despairing because the conversation always seems to fall into a big fight that goes no where constructive. Maybe you have talked to a friend or even a treatment provider looking for suggestions.

In your search for ways to help, we can unfortunately make a safe bet that you have not come across many discussions about the power of positive reinforcement. In fact, it is almost guaranteed that you have come across mountains of suggestions that are the exact opposite, like confrontation, distancing, disengaging, doling out consequences, etc. Our society has taken to using all of these strategies again and again – whether we’re talking about the decision to use drugs or alcohol or eat healthy or get out of bed to get to school on time – without ever stepping back to think about the foundations of behavior change and how behavioral choices are actually encouraged or discouraged.

People repeat actions that are either rewarding or reinforcing. In other words, people do things that are worth it to them somehow. And as you might expect, behavioral change is much easier to start and maintain when it feels worth it! For all of us, the reasons to change a behavior have to feel weightier than what you’re getting out of the current behavior.

To use a more minor issue as an example, if coffee tastes good to you and helps you have energy in the morning (you get something out of it, there are benefits to using it), you’re unlikely to change the habit of drinking it every day, unless you have a pretty compelling reason! Like if you start having heart palpitations or your dentist tells you your teeth stains require ongoing bleaching which leave your teeth feeling sensitive. But even then, you might not want to stop or might really struggle in stopping, because you really enjoy the taste or you dread the headache you might get from stopping. Adding to all that, it might feel awkward or lonely to not drink coffee in the morning with your spouse or your colleagues who are all drinking coffee each morning together. These downsides of change can start to add up and may eclipse your view of the reasons in favor of changing.

Now imagine the potential benefits of other drugs of abuse like alcohol, nicotine, and opiates which are quite powerful in their ability to make people feel things that are reinforcing. Alcohol for example has benefits such as reducing anxiety/stress and increasing social ease. While it may be difficult, we encourage you to sit down and write out all the benefits your loved one might associate with their substance use. What do they get out of it? What do they like about it? Doing this exercise will help you understand with a good deal more empathy why your loved one is doing what he/she is doing, even when it hurts or frightens you. When your husband’s alcohol use is threatening his health and you can only see it as “totally crazy,” that can be really hard to take. When you see that his alcohol use (the same behavior that is still threatening his health) is also the only moment in his life that he feels calm and able to unwind from the stress of his day or connect with his friends, maybe you will still worry about his health but have more empathy for his actions. When you understand the reinforcers involved for him, you can talk through and find other solutions for the problem.

Not only are there benefits to your loved one’s use, but there are downsides to changing. For example, if your husband gives up drinking he might feel more anxious and find himself not being able to fall asleep. Maybe he will have to distance himself from some of his friends, and while you don’t like them, maybe they have been a presence in his life for a long time and will feel like a big loss. In order to change, the benefits have to be addressed AND the downsides of changing have to either be pretty small to begin with or be shrunk down. That process of shrinking the downsides of change — or alternatively, increasing the salient reasons to change — is something the people around the substance user can actively participate in!! You can help make change feel really worth it and you can help mitigate some of the downsides of changing.

Start by brainstorming about the different upsides and downsides of change that are within your control to influence. Are there ways you can reinforce or reward non-using behavior? Many family members treat their loved one the same way whether they are using or not (“I’m mad at you when you’re drinking, but still mad at you when you’re sober because I’m thinking about when you were drinking!”). Instead, it can be helpful to reward and reinforce times when they are abstinent or trying not to use. Noticing them (“I appreciated that you came home last night on time”), complimenting (“I really think you are doing a good job trying to resist using with your friends, I know it’s hard”) and cooking a nice meal to share if they are sober can all reward their efforts to reduce their use. It can also be helpful to think through ways you can support non-using behavior. In particular, it can be very helpful to think of activities that might compete with substance use (e.g., at the same time or filling a similar function as the substances) and work to bring them into your loved one’s day-to-day life.

Many family members hear about positive reinforcement and worry that being nice, using any rewards, or reinforcing through kindness and attention will make them weak or a sucker. The reality is that reinforcing positive change just requires more strategic and thoughtful planning about when to be reinforcing. And being kind and creative about suggesting non-substance using activities and joining in with these activities does nothing but support positive, healthy behaviors that are alternatives to substance use. The bottom line is that you can have your limits and boundaries in important ways AND have a really positive influence with kindness. The two things do not have to cancel each other out. What Does cancel things out in terms of putting a damper on a change-supportive environment, is hostility, yelling, and coercion. Setting healthy limits and boundaries in a kind way can be much more effective.

Nicole Kosanke, PhD

Nicole Kosanke, PhD, is director of family services at CMC, where she specializes in working with family members of people abusing substances and in the assessment process for families and individuals with substance abuse issues. Dr Kosanke has been working in the research and clinical practice of substance abuse treatment for many years. She has most recently co-authored a book called Beyond Addiction (Scribner, February 18th) that is a compassionate and science-based family guide for navigating the addiction treatment world, understanding motivation, and training in the use of CRAFT skills. These practical skills include self-care, positive reinforcement, positive communication, and staying connected in a constructive, positive way to help your loved one. In 2007 Dr. Kosanke was featured in an O, The Oprah Magazine article about her client’s experience in treatment at CMC, which was later published in O’s Big Book of Happiness: The Best of O.

Carrie Wilkens, PhD

Carrie Wilkens, PhD, is the Co-Founder and Clinical Director of the Center for Motivation and Change in NYC and in the Berkshires. She co-authored an award-winning book, Beyond Addiction: How Science and Kindness Help People Change with Drs. Foote and Kosanke. Together they also contributed to a user-friendly workbook for parents: The 20 Minute Guide: A Guide for Parents about How to Help their Child Change their Substance Use. In collaboration with the Partnership for Drug-Free Kids, Dr. Wilkens and the CMC team is developing a national parent training program (the Parent Support Network) to provide parent coaches to families in need of support through a free hotline. Prior to these ventures, Dr. Wilkens was the Project Director on a large federally-funded Substance Abuse and Mental Health Services Administration (SAMHSA) grant examining the effectiveness of motivational interventions in addressing the problems associated with binge drinking among college students. She is regularly sought out by the media to discuss issues related to substance use disorders and has been on the CBS Morning Show, Katie Couric Show, and Fox News as well as a variety of radio shows including frequent NPR segments such as the People’s Pharmacy and The Diane Rehm Show.