How to Support The Process of Change

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How to Support The Process of Change

Are you worried about a loved one’s use of substances? Do you see your partner’s health declining? Do you worry about some of the decisions your sister is making? Do you wish your teenage son would hang out with different kids? Do you think your girlfriend has one too many drinks, too often?

Maybe you have tried to talk to your loved one and feel hopeless because the conversation either goes nowhere or turns into a fight. As you try to find ways to help them change, one of the most important things you can do is to work on how you understand the problem. By understanding the foundations of behavior change and how behavioral choices are actually encouraged or discouraged, you can start to have an impact. You might even make some healthy changes in your own life!

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.

The following example is one many can relate to: 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! Even if you start having heart palpitations or you have to bleach your teeth, you might not want to stop, because you really enjoy the taste or you dread the headache you might get from stopping. Adding to all that, it might feel like you miss out on things you enjoy like sharing a morning coffee with your partner or coffee break with your colleagues. 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 reduces anxiety/stress and increasing social ease. Nicotine increases concentration and opiates decrease pain. These are all experiences that some people enjoy and may even feel they need because they don’t have any other way to have those experiences.

While it may be difficult, try 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 of a person’s choices 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.

About the Author:

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.