An Invitation To Change With Carrie Wilkens, PhD

6 Mar , 2023 podcasts

 

Addiction recovery can be a daunting task, but remember that substance use disorder is a treatable condition. There is always hope for living a drug-free life again. But current methods of addressing substance abuse do not encourage seeking treatment. Carrie Wilkens, PhD, Co-founder of the Center for Motivation and Change, wants to change that conversation. In this episode, Carrie shares her “Invitation to Change” approach to help people experiencing substance use disorders more effectively. Tune in to find out how best to encourage your loved ones who have this problem to seek professional treatment.

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Listen to the podcast here

 

An Invitation To Change With Carrie Wilkens, PhD

A Compassionate Path To Healing

Addiction recovery can be a daunting task, but remember that substance use disorder is a treatable condition. There is always hope for living a drug-free life again. But current methods of addressing substance abuse do not encourage seeking treatment. Carrie Wilkens, PhD, Co-founder of the Center for Motivation and Change, wants to change that conversation. In this episode, Carrie shares her “Invitation to Change” approach to help people experiencing substance use disorders more effectively. Tune in to find out how best to encourage your loved ones who have this problem to seek professional treatment.

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On the show, I am speaking with Carrie Wilkens, PhD. Carrie is the Cofounder and Clinical Director of the Center for Motivation and Change. She’s also the Cofounder and President of the CMC Foundation for Change, a nonprofit organization with the mission of improving the dissemination of evidence-based ideas and strategies to professionals and loved ones of people struggling with substance abuse.

Carrie co-authored the award-winning book, Beyond Addiction, which provides a roadmap to recovery that blends science and kindness with clinical knowledge. The Invitation to Change approach that you’ll hear Carrie talk about is a compassionate way to seek to understand the struggles of addiction and offer behavioral models to create meaningful change.

Why are we talking about this in the Compassion Lab? You don’t have to be struggling with addiction to understand how this model can offer a bridge to new ways of connection and healing all difficult situations. It’s a rare person who hasn’t been touched by this topic. Learning how to change our approach, our understanding, and our behavior is how we find better lives, whether it’s helping someone we love or seeking change within ourselves. Let’s get onto the conversation with the very passionate Carrie Wilkens.

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Carrie, thank you so much for taking the time. I appreciate your time invested with me.

I’m happy to be here. I’m happy to be talking about all this stuff.

It’s an important conversation that we need to be having, and we talked a little bit before about the state of mind. I was looking at a mental health report earlier because we put together some mindfulness programming for the company. It’s very interesting to see the stats and what’s happening with people. We are resilient creatures, but there’s a lot that we can do to help us along this journey that we call life. We’re going to talk about that for sure.

Origin Story Of Carrie Wilkens

Before we get into that, let’s talk a little bit about you, because it’s important to share with our readers a little bit about your origin story. How did you get into this work? Could you ground everyone? I have shared your bio in advance before we start talking so people reading will know that much about you, but there’s way more than that. Can you share a little bit about your origin story with everyone?

I’m a psychologist and part of why I’m on the show is because we had a new workbook come out that is for family members in terms of how you help a loved one make significant, hopefully, healthy life changes when it comes to dealing with the substance use problem. I’m twenty-plus years into this career, and the field has changed a lot, thankfully. Part of why I got into the field in the first place was that years ago when I was being trained as a psychologist, people didn’t talk about addiction much, and interestingly, I was trained and wasn’t trained to ask specific questions if it came up, we were told to recommend those clients to an addiction program.

The belief and a lot of psychotherapy circles were that people with addiction problems could, shouldn’t, and couldn’t be in therapy. They needed to be in addiction programs and when they were ready for therapy, they could come back and do therapy, or we were trained to do therapy without specific skills on how to deal with the behavioral issues. You always have a training client, and clients that you’re working with and you’re getting a lot of supervision and your supervisor’s talking about what you’re doing and what’s happening with the client. You’re learning a lot and it’s shocking to me that that ever works.

In my last session with her, she’d had been having a hard time coming to the session and she was traumatized. She was in a pretty traumatic environment. It made sense and we were talking about all the different ways that trauma was getting in the way of her being able to come to the session and do different things in her life.

She told me she was drinking two bottles of wine a day. I had never been trying to ask about it. I had never been trained to be curious about it, and it explained everything. I said to myself at that moment in time, “That is never going to happen to me again.” I sought specific training in my internship in a postdoc with substance use in particular.

I grew up in the middle of Western Kansas. It’s in the middle of nowhere. I have family members who struggled with substance use issues. There were no resources. Nobody knew how to talk about it. In high school, we were all binge drinking. I could have killed myself 1 million times out in Western Kansas, driving intoxicated, and it wasn’t talked about and wasn’t dealt with.

I had friends who had very serious car accidents and bad things that happened as a result of substance use through my whole life, and constantly questioned, “Why can’t we talk about this? Why are there no effective options for people? Why are people labeled addicts and alcoholics or expected to grow out of it?”

There have got to be other ways that we can address these issues. I’ve spent my whole career trying to figure those things out and try to get the word out that’s all possible. We can positively influence each other. There’s a range of treatment options available to people. You can be helped at any stage. There’s a real belief that you can only help somebody with a substance use issue when they’re ready or when they’ve bottomed out. This could not be farther from the truth. I’m glad to be talking to you so that we can dispel some of those myths and talk about how change can happen.

There's a real belief that you can only help somebody with a substance use issue when they're ready or when they've bottomed out. This could not be further from the truth. Share on X

I admire the work that you do, Carrie. Isn’t it such a fascinating question that you ask about the decoupling years ago of addiction, work, and therapy? It’s funny, I’m fascinated always by how we find our way into what we do and the experiences that we have, that I think about my high school, and my college experience, it was all normalized. In all the parties, there’s drinking.

The Normalized Culture Of Substance Abuse

Growing up, coming of age, you’re going to drink and you’re going to do all these risky behaviors, but why have we done that? Why have we normalized it? I don’t have the stats. You’re probably closer to this than I am to the prevalence of addiction issues in the country and probably globally because of this normalized culture of substance abuse.

That’s interestingly starting to change. One of the outcomes of the pandemic is shows like this and people finding all ways to communicate with each other. I’ve been blown away by the number of shows that are out there with people talking about their change in relationship with alcohol in particular. Many of them are talking about like the impact of the alcohol industry. It’s an enormous industry and generates a lot of revenue.

There are a lot of financial reasons why alcohol use is promoted in a variety of different settings. We saw how much the cigarette industry had to change. Once people became aware, “This is bad for us.” It was a hard shift because it made a lot of money. There are a lot of financial reasons why this is as you said normalized.

The counter to that is addiction problems for a whole host of historical reasons. We get to spend an episode talking about the history of addiction and the stigma associated with that. Addiction and behavioral problems are stigmatized. You’re a weak person, you’re a bad person, you’re a person full of character defects, and your family must have something wrong with them.

There are all the ways that we think about people with addiction problems in particular that make people not want to have that problem. You’ve got this, it’s normalized, it’s fun, it’s all good, everything’s great, and then you have this. If you have a problem with it, something’s wrong with you. We make it so that we cannot talk about it. There are all these people that are struggling and worried about themselves, or worried about a family member.

They can see things not going so well, but they’re like, “I hope that problem goes away. I hope that’s not what it is because I don’t want to be an alcoholic. I don’t want to be an addict and I don’t want addiction in my family. We’re going to try to push that away.” It’s a very powerful impulse and the biggest thing that prevents people from seeking treatment is the stigma and shame associated with having the problem in the first place.

Carrie, there’s a stigma even with therapy. There’s this place of, “I don’t want to admit that there’s something wrong.” As we try to evolve as a society and a culture, we’re trying to get to a place that says, “We are all trying to do this thing called life. We’ve all got our challenges. We all are working through it.” It’s okay if there are areas in which you need help, but I do agree with you. A lot of times people, don’t want to reveal that they don’t want to ask for help.

Causes And Different Levels Of Addiction

There are levels of addiction and we’re talking about substance abuse. For most of us, we can look at our lives and see places where there’s an addiction present, whether it’s to our phones, shopping, or eating. Are the fundamental causal factors of those different levels of addiction different as you get into substance abuse versus these other things.

I’ll probably say about five times during this episode, “That topic could be a whole other episode.”

We’ll do part five sessions.

There’s the neuroscience behind why we do things when something becomes a compulsion, a habit, or an addiction down the road. There are a lot of complicated neuropsychiatric issues at play there. One of the simplest ways to talk about it is our dopamine and the reward centers of our brain get activated by certain things and different substances activate different parts of the brain, so saying “Dopamine is a complete oversimplification of the whole thing.”

For most readers, it’s fine to know, a sunset, a piece of cake, a glass of wine, a cigarette, or phones. I was laughing with my husband. I’m trying not to be on my phone after 10:00 at night. I turned on Instagram, and there was a silly little goat video with the music and the goats were bouncing. I got so backed up. I was like instantly awake, and it was like a shot of dopamine to my brain.

This is the exact opposite of what I needed. I never had to distract myself and I ended up getting completely overstimulated before I’m going to bed. Those reward pathways get hit in a variety of different ways like caffeine and sugar. Depending on your biology and life experiences, your need for that little extra dopamine hit, or the ways that you start to habituate to that dopamine hit.

It’s different for every single person. We’re after the reward part of it. It feels good in some way. We humans tend to repeat things that work in some way. One of the ways that we talk to family members and with our clients in general, is behaviors make sense. If you step back and think, how does this behavior make sense?

There may be a whole host of problems associated with it. It makes sense in some way. If you can understand how it makes sense, then you can go about trying to figure out alternatives. If I’m having a couple of glasses of wine at the end of the day to wind down from a stressful day, that’s a helpful thing. It feels good. It works quickly. I know how it’s going to work every single time. If I don’t want to have those two glasses of wine, I can’t take those out and expect to feel awesome, I’m going to miss it. I need to figure out a way to replace it with something else.

That period of replacement where I’m learning something else that’s going to replace this thing that works well for me, that’s where people get uncomfortable. That’s where the work has to happen. That’s where practice takes place, and we don’t have a lot of patience for that space. That’s getting worse with our phones and our devices. We want things to happen quick. I hit on Amazon. I want that box the next day.

That idea of I can change how I feel quickly is taking hold and I’m worried about young adults in particular because they’re influenced by their phones and all the social media that we’re not learning how to manage our feelings and bodies in the way that our bodies are evolved to be, which takes some time and practice. We have to process things and slow down, which again is the exact opposite of what’s happening around us and that’s a real problem.

 

I’m very worried about it. I see it with my teenagers and their friends, between gaming and phones, and it’s very natural. It’s a cultural norm for them whether it’s before bed. It’s what you said about being able to be. There’s an endless distraction. If you’re sitting in a doctor’s, you can be on your phone. I do think the neurochemistry that is dangerous. It’s probably changing the brain in some ways and on how that they’re interacting. Is that true? Is there science about how it’s changing the brain or no?

That research is being done and there’s research out about attention. We’re having shorter attention spans. People are saying, “I can’t read a book now. I can’t read a long news article. I can only take sound bites or I flip to the next thing.” All of this goes back to the substance part of this and why people get caught up in substances.

Substances do a whole host of things for people. They can change our moods and how our bodies feel. They can change how we interact with other people. They can change how we feel when we’re alone. Substance and all the other things you named like gambling, gaming, and all these things can disrupt things that we might be struggling with if we didn’t have that to go to.

Again, people get into this stuff because it works in some way. The problem is they start to have consequences because our brains can’t handle it, and we build up a tolerance. You’ve got the habit of, “I’m having a drink every single time I’m stressed.” I don’t have any other skills to deal with that, so then I start to drink after a fight with my loved one. I then start to drink on a weekend when I have a lot to do. Every single time I feel stressed, my brain says, “A drink’s going to help.”

This thing started our managing one thing starts to build into other areas, and I’ve lost the ability to manage my stress in any other way. I’m going to that drink. It turns out alcohol does have a host of consequences that come with it, and most people over time will build up a tolerance and two drinks are not going to work.

Maybe you’re going to have that 3rd glass of wine, and then the 4th, and then the 5th, and then you’re not feeling because your tolerance is going up. You’re needing more. You’re having the physiological effect of more alcohol use. You’re probably having all the emotional stuff around your life because you’re drinking more. People are starting to get more upset. You’re losing control a little bit more and all that stuff that comes along with overusing substances.

Again, you ask that person to give that up. They’re going to have all those feelings and all that stuff that they’ve been managing with alcohol. They’re not going to know what to do with all this other stuff. You’ve got to be able to give them space and time to learn, “I’m not going to drink. How do I manage my stress? I’m not going to drink every single time I get in a fight with my partner. How do I have that fight differently way? How do I take care of myself after that? I’m juggling fifteen things on a weekend that stresses me out. How do I deal with that without alcohol?” There’s a lot of learning in that.

Why There Is Resistance To Change

It takes a lot of effort and energy and this horrible snowball effect that you’re talking about. It gets worse and more progressive until your body and your relationships break down. What is it about humans? We are so resistant to change. One day, we’re in a pattern, we’re in a groove, and it could be a very destructive groove or it could be not that of a desert, but we’re just that. Here’s our habit. There are a lot of books about habit, but in your experience, Carrie, why are we so resistant to change? I’m sure many of your clients have been like, “Tomorrow I’m going to start,” and it’s starting. What is that resistance all about?

The reality is it’s going to be different for every single person. You line up 100 people and you say, “What’s hard about change for you?” Every single one of that people is going to have a different reason why. It’s why it’s hard. There’s something about behavior change and addiction in particular that makes people want to talk about it in this very black-and-white. “Give me the answer to this thing,” and I’m constantly telling people, “One size does not fit all.”

There is no one-size-fits-all when it comes to behavior change, particularly for addiction. Share on X

Keep remembering that because your change process is going to be completely different from the person next to you. You might be able to learn tips and tricks and things, but there’s going to be something different about your environment, your physiology, and you’re learning history. Part of what we’re constantly trying to do is trying to help people slow down and examine their own lives, their strengths, their challenges, the environment around them, and the people around them so that you can be able to start to say, “What do I need?”

If I’m going to make this change, what do I need? That’s a big difference from how addiction treatment used to be. Addiction treatment used to be, you go to rehab, you go to AA meetings, and you read the big book. This is how you get sober. It was very black and white in terms of how you had to change. There’s very little evidence that’s going to work for most people.

It works profoundly well for some people. When you know, for people who find that path and that’s where they end up. It’s an amazing fix for many things in their lives and gives them a community that’s incredibly helpful to them. It doesn’t work for most people. We’ve got to figure out ways to help all those other people and their families find ways to make changes. Different communities have different beliefs about substances and what they need to get better.

Some people are never going to seek treatment. I’m somebody who is constantly saying to most people, “There are interesting studies on what they call natural recovery, which are people who met the criteria for an addiction problem, a substance use problem.” If they sat across from their doctor who would say, “You have an alcohol use disorder, and it’s severe,” those people get better without ever seeking treatment.

They decide to change on their own, but part of what happens is we haven’t created space for those people to talk about their process. There’s a shame about having the problem in the first place, so they change. They’re not going to tell you that they ever had a problem in the first place. It was too shameful to have the problem. We don’t talk about it. People in twelve-step recovery and people who have been through treatment and feel proud of that talk about it. They want to share it, and they want other people to do it.

That’s great, but there are all these other ways that people change that we don’t hear about. It happens all the time. Maybe they started going to their synagogue or to church. Maybe they picked up a yoga practice. Maybe they got into couple’s therapy and their relationship got better. There are so many ways that substance use can suddenly not be as important. We don’t hear about it so much, and I wish people would talk about it more openly.

The “Invitation To Change” Approach

Let’s talk about it more because one of the reasons that you and I got connected is that this is a show about compassion and a lot of the approach that you take and your colleagues take is very compassionate. Everyone’s had a different experience with this conversation. Sometimes you hear tough love, “I’m not going to be an enabler,” and other times, you have high levels of engagement. Can you share a bit more about your approach and what you’ve learned from a different way of tackling the problem?

There has been also a lot of research in the last several years about the impact of the words we use when we talk about this problem. A lot of the words easily roll off your tongue because it rolls off of everybody’s tongue. It’s how our culture talks about substance use or tough love. Addicts are all the same. You got to let them bottom out.

You got to attach with love. You got to use tough love. All over these things that people say to each other and we talk about, they’ve done studies with medical professionals. When medical professionals treat people with substance use issues in a hospital setting if in their chart and their notes that they refer to them as addicts, they had a whole host of ways that they thought about that client that was very different than when they called that person a person who uses substances. It’s as simple as that.

It’s a little shift in how medical professionals approached the person with a problem. We have a video that you can see on our website that goes and shows all the traditional words of addiction. If you sit and listen, feel how those words make you feel. You end up feeling pretty pessimistic. If your mind is full of this idea of, “People with substance use problems cannot change until they bought them out. They can’t change until they’re ready to change,” you are going to approach that problem pretty pessimistically.

You’re going to be like, “There’s nothing much I can do. They’re selfish.” There are all these ways that we push them away because it’s frightening. It can be frightening and maddening to have somebody in your life abusing substances. There are also some reasons why that happens too. The reality is that we can approach that problem with understanding and curiosity and be able to step back. Going back to that idea of, “Behaviors make sense,” if we can be like, “That behavior is scary, harmful, troubling potentially, and makes sense to the person doing it. How can I understand that?”

When I approach that person with that understanding and some curiosity about them, that conversation is going to be very different than if I approach them and say, “You’re an addict and you need to go to treatment. You’re an alcoholic and you need to stop drinking.” You see how that makes you feel.

If I tell you that, your impulse says, “No, I’m not.” I might be worried about my drinking problem, but if you come at me like that, I’m going to be, “No, I’m not.” If we can help family members learn other strategies for approaching those conversations where they approach the conversation. They’re very specific communication strategies that we learn as therapists. That’s part of why I can sit with somebody and have them not feel defensive. I was trained to do that.

Part of what we’re doing is helping family members learn those skills so that you can talk to your teenager, your partner, or your employee like, “I see something because I’m concerned about it.” It’s trickier in an employment setting, but with family members being able to create an environment where the person wants to feel safe enough and wants to talk with you, that can change the whole dynamic and give you a lot more information that you can then work with.

If family members create an environment where a loved one with a substance use problem feels safe enough and wants to talk, it changes the whole dynamic. Share on X

The approach that we have developed is called The Invitation to Change approach, which is just even the title. It’s an invitation. It’s not a demand, which has a completely different impact on somebody. Some people will be reading this and they’ll be like, “You’re asking me to be nice.” They’re spending all of our money or they’re not taking care of their responsibilities. It’s not about not being angry at the problem. Your feelings are probably justified.

It is to be able to use the strategies and The Invitation to Change approach to approach that problem strategically and effectively. What we want to help people do is learn strategies that help them be effective in their goal, which is to help their loved ones doing something destructive and consider the change.

What else is coming up for me as you’re speaking is how this applies not only to the conversation of addiction but how we relate to each other. Often, there’s the power of our belief systems. When we believe something, it can communicate not just in our words, but even in our energy. You could tell when you approach someone and you automatically know they’re in a certain space. Not to go way into the quantum world but I know the observer effect and how we can affect a situation based on what we’re bringing into it, our belief system, and what we expect to happen.

We’ve all been on the receiving end of a conversation, maybe not about substance abuse, but where we know someone is in a certain state of mind and you feel, “There’s nothing I’m going to be able to say to break through this so I’m going to disengage.” How do we break through? I have to imagine probably everyone who’s reading has someone in their life, if not directly in their family but someone they know, a friend, or someone at work that has this challenge. How would you guide them in starting? I know there are a ton of resources that people can follow up with from your book and your workbook that you’ve shared. Where’s a baby step? Where can they begin?

I’m going to give you a little background of where The Invitation to Change approach came from because it’s important to know that we’re just not nice people coming up with this nice strategy. A large part of Invitation to Change is something called CRAFT, which is Community Reinforcement And Family Training. This was a treatment protocol for family members who had somebody in their life that they were concerned about, who was resistant to treatment. It was designed for a parent or a partner whose child or spouse had a serious problem and didn’t want treatment. It was designed to help them motivate that person into treatment.

The studies are now several years old across different severities of substance use and with different populations including homeless youth and tough situations. They put family members in three conditions. They put them in Al-Anon to do an intervention or to learn CRAFT because Al-Anon and interventions are what most people say you need to do if you’re a loved one. Those are the things that you get. They put them head-to-head and had people do that, and then see if they got their love going into treatment.

The averages were for Al-Anon is this. About 13%-10%-13% of those people got their loved one into treatment. That’s a pretty low number. Al-Anon isn’t designed to get your loved one into treatment. Al-Anon is a lovely self-help group that is incredibly helpful to a lot of people, but it’s about taking care of yourself. Most family members want their loved one in treatment. They something to happen to their loved ones.

Referring somebody to Al-Anon can be a great thing but the odds of that getting their loved one into treatment are low. Interventions, interestingly, which is completely contrary to what is on every interventionist website or the TV show Intervention was about 30% of people got into treatment. Also, a pretty low number, and the problem with that is a significant number of the people that were in that part of the trial dropped out of it.

That’s what I was going to say. I bet they’re being forced and they’re not choosing that help. I would think it would not stick.

I’m talking about the family members. The family members were put in that were being trained in intervention and they said, “I don’t want to do this.”

They stopped.

What you brought up is also problematic. You’re going to have readers who are like, “I was saved by Intervention, or the only reason why I ended up in treatment changed my life was an intervention. My kid could have died without intervention.” I’m sure they’re those stories. I occasionally refer people to interventions because the situation is so dire. I’m like, “Your loved one is going to die. You have to do this.”

I’m not a never-do-an-intervention person, but to have that be the first place you go or even the 7th, 8th, 9th, and 10th place you go is usually too soon. What you see is people may go to treatment but they’re pissed, they’re mad, they’re not ready, they don’t want to be there, and they’re mad at their family and their friends for doing that. They then get out of treatment and there’s all this, “I don’t trust you guys.” That could be your biggest support system. There are problems associated with interventions.

The people who did the CRAFT, who learned this set of strategies got their family members into the treatment 63%, 64%, and 65% of the time. That’s a big number. What they also found was that the substance use of the person who had the problem was down before they got to treatment. The mental health, the anxiety, the depression, and all the things that the family members experienced were less. The family members felt better, people sought treatment, and their substance use went down even before they got treatment.

 

CRAFT is a set of strategies that help people understand reinforcement to be able to reinforce positive behavior change. A whole part of it is understanding natural consequences, like letting natural consequences play a role. A big portion of it is communication strategies, like being able to shift your communication strategies. The fourth element is self-care. We were trained in CRAFT and have been doing CRAFT for decades now. We’ve been training family members to share these strategies with other family members.

One of the things that we realized was that we were trying to train people and they were steeped in the traditional notions of addiction. When you’re talking about positive reinforcement and engaging with somebody with a substance use issue in a positive way, they were having this, “That goes against what I’ve been told. I’m supposed to detach. I’m supposed to use tough love.”

You had to retrain. There was a whole phase of reorientation to this different way of being.

That’s why we developed the Invitation to Change approach which includes a CRAFT. This goes back to your original question, “What are the baby steps?” The part that we added is something that we call helping with understand, which is shifting your perspective and how you understand this problem and behavior change.

Again, if you go into it with this very specific mindset, you’re going to approach that problem in a particular way, but if you’re going into it with, “How I understand how my loved one’s behavior makes sense. I’m going to step back and try to understand this, I’m going to recognize that one size doesn’t fit all.”

I’m not going to be like, “This is the only way you can do it. If you’re not in treatment, then I’m going to cut you off.” There could be ten different things that might help your loved one, and we’re going to explore all of those. Driving home, the point of the ambivalence is normal. Going back to what you asked me earlier, “Why is behavior changed hard?” it’s because we don’t sit with ambivalence.

Ambivalence is uncomfortable and usually, when you’re in the process of making a behavior change, there’s part of you that wants to change, there’s part of you that’s stuck in that habit, and there’s part of you that, particularly with substance use, the physiological effect of it may be powerful for your body. To give it up, you might feel withdrawal and that’s uncomfortable. I might want to change, but I don’t know how to deal with my withdrawal symptoms, so I keep going back. That doesn’t mean I don’t want to change. That means I don’t know how to deal with my withdrawal symptoms. I may want to change.

We see people not change and we get mad at them, and we assume that they don’t want this. We don’t want it, and we give up instead of creating this environment where we can be open and curious about, “What’s the struggle here? What do we need? What do we need to alter in your environment? What skills do you need to learn? What do you need to practice? Are there medications that you need to explore because your cravings are so uncomfortable and you can’t manage them? Is that something you need to do for a little while?”

Shifting with how you understand the problem gives you more space to work and many other things to consider. That’s step one, shifting how you understand and approach the problem. The second part is something that we call helping with self-awareness, which is what you were saying earlier also. It’s that awareness of, “How am I feeling? How am I doing?” If I try to, I can use all the communication skills in the book and be good at it, but if I go into it with no sleep the night before and after having a fight, that conversation’s not going to go well.

Helping with understanding involves shifting your perspective, how you understand the problem of substance abuse, and how you understand behavior change. Share on X

It’s being able to know yourself so that you can time these conversations when they’re going to go well for you. Maybe you do need to distance yourself for a little while so that you can orient yourself, take care of yourself, and get your feet back on the ground. Maybe you need to enlist help, but you’ve got to be able to reflect on yourself.

Self-care is part of the CRAFT. What we added was self-compassion because a large part of behavior changes that idea of, “I’m going to practice. I’ve got to try new things,” family members have to do that too. If I’m going to change my relationship with you, I’m going to have to try to do new things as well.

I’m not going to be good at it either. I’m going to screw up. I’m going to not know how to approach a thing. If I got a big harsh internal critic in my head saying, “I’m a bad mom or terrible at this,” or whatever that chatter is, I’m going to give up more quickly than if I have a more compassionate response of, “That didn’t go so well. I need to go back and think about how I want to do it again differently. I got to have some compassion for myself because this is hard. I’m scared. I’m upset and I’m having a hard time.”

It’s being able to compassionately know you’re having a hard time. Can you take care of that like you would take care of a friend who was having a hard time instead of pushing yourself to your wit’s end, where you’re doing everything in a completely burned-out state? There’s a lot of work that we’re trying to do with a family member so that they can be a better helper to their loved ones and to themselves.

The last part is helping with action and helping behaviors, which is more about how you let those natural consequences play a role and reinforce the behaviors that you want to see. There are a lot of how you support healthy behaviors. When your loved one comes home sober or has a conversation with you that is open.

You might not like what you have heard, but if you got them talking and they shared information with you, you want to reinforce that. You want to sprinkle water on that so that can happen again. It’s trying to help people understand those reinforcement strategies. People want to start there. They want to go, “Tell me what to do.” We’re like, “You got to understand the problem and take care of yourself first so you can use those skills effectively.” Again, it’s different for different people, but there’s a lot in there that can help.

For your question of, “Where do I start?” every person’s going to start in a different place. Some people may be self-aware and they’ve done that work, so they can go right into the communication part. Some people need to spend a lot of time in the understanding section and shift how they understand this problem and you may toggle and move.

We designed it as a wheel because you’re going to have setbacks and you got to go to a different place. In the center of the wheel is the idea of practice where no matter where you are and no matter what you do, you’re going to have to do it multiple times and have that compassion where you keep at it, keep trying, and you’ll get better. That’s how your loved one’s going to change and that’s how you’re going to change. Let’s have some compassion for that.

Everything you’re saying, Carrie, is like a life practice. In every process, whether it’s a grieving process or a growth process, you take some steps forward, you might fall back, or you go back in. You maybe have a map on how to tackle this. We talk about self-care on this show and in the lab at Coke about how we show up as self-care because it’s certainly not going to help your loved one if that inner critic is saying, “I’m such a bad mom because that’s being projected out. They’re taking that on,” and all of a sudden, “I’m causing all these problems. It’s like a death spiral from there of negativity.

Navigating Self-Care

I’m amazed at how often the self-care conversation is difficult for people. There is this, “It’s not about me. It’s about them.” No, it’s a dance between my psyche, your psyche, what’s happening in this situation, and as we go back to the labels of an addict, how I show up for you. Am I grounded? Am I calm? Am I able to perceive and receive in different ways or am I showing up as a complete hot mess? There’s such a different outcome for those two states.

Every person’s different and every family’s different. I do think partly because we see it all the time where a family wants their loved going to be in treatment and they want treatment to fix their loved one. They don’t want to be a part of the process, and their loved one doesn’t want to have them be part of the process. That can be a tricky thing to help people realize. Historically, what has been said is, “This is a family disease.” Again, that makes a lot of people say, “I don’t want that disease. That’s not me, so I’m not going to participate. You tell me I have a disease. I am not in this conversation anymore.”

Part of what we’re trying to do is help people go back to this idea that we all have stuff. We all struggle with something. If you can bring your humanness to this and the idea of, “I can be curious. I want to help my loved one value.” The other thing that we spend a lot of time with people is going back to your values. What kind of person do you want to be in every moment? We all do stuff that is not aligned with our values and especially when we lose our tempers, we do say things that’s not who we want to be.

 

My loved one has scared me, taken advantage of me, or abused me. I got to distance myself from that loved one because I’ve been hurt so bad. That’s a completely understandable impulse. You may need to do that in certain situations. You also have people who are like, “I love them and I want to be connected to them. I don’t want to cut my kid off.”

I did an interview with a parent about this whole tough love. You got to let them hit rock bottom. This mom had a 25-year-old daughter and she was told repeatedly, “She’s not going to change. You have to let her hit rock bottom.” She was like, “Every time somebody said that to me, it was like ripping my heart out.”

That is not a message any mother can tolerate. It’s not a message that most parents can tolerate. That’s not what we want to happen to our loved ones. With the fentanyl and the opioid crisis, that has equal death for far too many people. If we can obliterate that phrase, I would like to participate in doing that.

People get in that space because it’s hard and frightening. Part of what we’re trying to do with our foundation is to build community and support so that family members can speak with other family members. That’s the other thing. There’s never going to be enough treatment providers around to deal with the level of the problem.

People don’t often want to talk to treatment providers. They want to talk to somebody else who’s been through it. To talk to another parent who has been through hell and back with their kid, stuck with it, used and practice strategies, and now has a connection with their kid, that’s incredibly compelling. That’s what a parent wants to hear about.

What we’re trying to do is help family members learn these strategies and we’re starting an Invitation to Change support groups that you can hear from other parents or other family members who use these strategies and help their family members and themselves. One of the things that’s lovely is people will say how much they changed in the process.

You’re connected to the whole process. How do you not change?

For the communication strategies, in particular, a number of times, people have said, “I started learning these strategies to help my kid. I use them in the grocery store checkout line. My whole experience goes better.” You realize how you talk to people and what you bring to every interaction matters. To turn all that awareness on for people, it’s a process. When you’re in crisis, that’s a hard thing to consider. You want to be out of the crisis.

What you bring to every interaction matters. Share on X

That’s the other thing. When you hear people say, “It’s not me. It’s them,” it’s because they’ve been in crisis. The problem is significant, hard, and scary. They want to be done with it. They don’t want to slow down and think about themselves and how they’re participating or not participating. I have compassion for that.

There are some hard truths. No one wants to look at, “What’s been my role? How could I have contributed to this?” Even if you didn’t contribute at all, no one likes to feel out of control. You see your loved one and you can’t make it better by sheer will. It’s a very scary feeling to have that level of out of control.

As I hear you sharing the process of CRAFT, every part of my body and soul says, “That makes sense. You’re surrounding the person with support. You have a process and practice to move forward.” I’m surprised that it’s a revelation in some ways compared to the way things have been because we can all put ourselves in the shoes of the one with the addiction problem or whatever challenge we’ve had in our lives.

Using Invitation To Change In Addiction Recovery

As you said a minute ago, we all have them. To have people surround us with, “We’re here to hold your hand, walk you through this process, and give you tools, strategies, and support,” that’s a better road than, “I’m going to drop you off, shut the door, and hopefully, you’ll be turned around in 30 days.” It’s amazing. Do you see the spreading through the addiction circles or is it still more of an unusual way? What do you see as a professional in this?

Thankfully, it’s catch-and-hold, which is good. It’s the way you described it. We’re a community. We want to bring you in. We want to hold your hand. We want to get you through this process. We’ve been there. That embrace that you’re describing is what the twelve-step community does well. They’re masters at it. They do it incredibly well and save thousands of lives.

It’s doing exactly that thing, but what we haven’t done so well is what do we do about everybody else, who that approach does not work for, or they’re not going to do that. We’ve left them in the dark and we’ve left those families in the dark. That’s what these other strategies are because CRAFT isn’t for everybody. Al-Anon may be how you get better, but we’re trying to expand this idea of, “If that doesn’t work for you, there is this whole host of things that you can do instead.”

We’ve got lots of people who do both, and it’s not this or that. Different things work for people at different times. What you need at the beginning stage of your process is going to be very different from then later, and you have to stay flexible and constantly be assessing that. As we said earlier, there’s a lot of money in that the alcohol and cigarette industry that keeps this all going.

That’s true for the addiction treatment industry. There was a lot in that industry. It’s a complicated industry and it has not served its clientele well. I say that as part of a person in the industry. We’ve been trying to change it. Treatment programs were very one size fits all for a very long time and they’ve had to change because the science is there. They can’t avoid science.

Consumers are becoming more educated, thankfully. Consumers are starting to say, “That doesn’t work. People are dying.” The opioid crisis has activated mothers and parents, and they’re the biggest advocates of, “This cannot stand. We can’t continue doing this. It’s not working. My child is dead because of this approach. Let’s open it up.”

That activism is starting to change things. I’m super grateful to every single parent out there who’s doing that work. Things are changing and more states are starting to mandate that CRAFT be part of what the treatment programs that are state-funded are starting to do. There’s more and hopefully, the tides will continue to change.

The behavioral principles are the same. CRAFT was developed for substance use, but if your loved one’s struggling with eating issues or gambling or they work in a lot of different ways, you might have to fine-tune it, given the behavior that you’re hoping to address. I think of parents. We wrote, Beyond Addiction: How Science and Kindness Help People Change.

That book is about CRAFT, how to use it, and how to understand the treatment length. Nobody knew about it. When we wrote that book, it had been well researched. Robert Meyers who developed it got so much research and he was out banging that drum for a decade before we wrote that book. We would give lectures and I would say, “Who knows about CRAFT?” It would be like crickets.

That’s amazing.

Now when I give lectures and I say, “Who knows about CRAFT?” the whole room will raise their hand. People are learning about it, which is awesome.

That is amazing.

The one thing I wanted to go back to before we’re wrapping up is the reality of substance use when it is in the severe spectrum of things. There’s almost always something else along with it that the person is struggling with which, as you said before, when people are swallowing that bitter pill of, “Maybe I contributed to this or I have a part in some of it.”

That is true. There are a lot of people whose loved ones are struggling with substances who had no idea about and they’d have no understanding of it because it happened the number of times where your child was sexually abused by a neighbor or was sexually assaulted in college, or something happened to your loved one along the way that gave them PTSD. They have trauma and they started using substances to manage their trauma.

You have this family where you’re like, “Things are good here and suddenly, you’re behaving in this way that makes no sense and we don’t understand it.” There’s OCD. Different mental health issues behind the substance use. When you’re trying to help families also figure out how that behavior makes sense and be super aware, it may be another pretty serious issue that the person then also has to figure out.

They’re figuring out their substance issue, but then they’ve got to figure out, “How do I deal with this grief? I’ve had unresolved grief.” That’s a whole learning process. “How do I deal with trauma?” All that comes along with that. That is this idea of compassion. I’ve never met somebody with a serious substance use problem who felt good about it.

They’re in agony. They’re struggling. They want things to be different. They don’t know how to do it, which is what’s so painful about it. They don’t like when people say those black-and-white things of, “All addicts are the same. They’re not serious. They’re in denial.” That’s the other thing. They’re suffering and struggling. They don’t know how to change. It’s easier to say, “I don’t have a problem,” than to acknowledge, “I don’t know how to do this any differently.”

There’s so much to be said for us to get to a place where we can own our full selves, the part that we all have our superpowers and we all have our areas in our lives that don’t work well for us. For some people, those areas that don’t work well are annoying, and for others, they’re highly destructive. As we’ve said several times in this conversation, “No one gets out of this whole journey without having struggle and having a challenge.” It’s a shared experience. The whole story of compassion is to understand that everyone is fighting that battle and we need to show up for each other.

You also talked about the layers of trauma that can be feeding into that. It goes back to where we began the conversation of this whole decoupling of addiction versus therapy. This is a journey of the whole self. When we had our initial conversation, there was much about this process and the work you do. I want to acknowledge you, by the way, for the amazing things that you’re doing in the world. It applies to the journey of life. It’s how we communicate in families. It’s how we build bridges with each other when we can’t seem to connect.

We’re all learning how to do that again after all the challenges of the last several years on how to reconnect, and how to reorient ourselves in the world. I feel like the work you’ve done, whether or not you have someone in addiction or anyone that you want to improve communication with, there’s value in checking out the book and the process and seeing what you can learn from it. At least that’s how it resonates with me.

Thank you for that. We love doing this work because people get better and you get to work with these incredible, compelling, and interesting people and their families. I get rewarded for my work every day. It’s stressful at times for sure. You incur a lot of loss when you work with this population, but the number of people who changed for the better so far outweighs that. There’s lots of gas in my tank, which comes from working with people. You’re right. That’s part of what we put in The Invitation to Change. I mentioned the first book, but the second book is The Beyond Addiction Workbook, which is about the Invitation to Change model, which we’ve talked about.

Those parts of increasing your self-awareness and being able to reflect on, “Am I being the person I want to be? What is stressing me out? How do I take care of myself so I can show up as the best version of myself? How do I understand whatever problem I face from a non-stigmatizing way?” Many people struggle with weight. That’s another incredibly stigmatized problem. We have horrible things that we think when we see somebody who might be struggling with their weight. It’s shocking how awful that is. Being aware, being able to notice that within yourself, and check yourself.

It’s being able to understand, “What is the function of my judgment? Why am I feeling the need to judge this other person? What purpose is that serving me? Why am I needing to distance myself when the odds are this is just another human who’s struggling with something that I can’t possibly understand? My judgment is not serving them and it’s not serving me. It’s not making me a better person to judge somebody. It’s not how it works.”

Isn’t this the nature of compassion for us to seek to understand that everyone is on their journey, having their experience of life, and we need to keep our side of the street clean and do our work and be supportive of those traveling the road alongside us? I do have one closing question, but before I ask it, we’ve mentioned the books, but if people want to find you as far as the website or is there a certain place other than Beyond Addiction and the books that I will include that people can get more information about you and your colleagues?

The foundation is CMCFFC.org. That’s a nonprofit that is designed to try to get this Invitation to Change approach out further in the world. For people who don’t have access and resources, it’s all low fee, free. We’re trying to get it out in the world. Over 2024, part of our fundraising efforts is to beef that side up with free videos you can share with people and the free online groups that you can join so that you can talk to other family members who’ve used this approach.

That’s all getting expanded over the course of 2024, hopefully. For the two treatment programs, you can find us at MotivationAndChange.com, and all of our books and everything are on all the websites. We fill the websites with other resources, so you can learn about them. I live in Alabama. What should I look for a treatment provider if I’m in Alabama and I don’t have access? We try to be as helpful to people as we can. There’s a reading list and all things that we try to offer.

Those are amazing resources. I have one last question before I let you go. This one is not about the process. This is a pan-out question for Carrie. In your life journey, I always like to ask my guests some of the best wisdom. If you were to leave our readers with some wisdom that you gained, either from your experience or maybe a mentor, what would you share in regard to closing comments on that?

It’s everything that we’ve been talking about around compassion. Try to find self-compassion and develop that as a practice because it changes everything. Every hard thing that we face, every hard thing that we’re trying to do, every new thing that we’re trying to learn, and every old thing that we’re trying to heal from shifts if we’ve got compassion.

 

It makes you wonder, “Where along the way we get so hard on ourselves about what we need to know and do?” I was at a conference and George Mumford, the amazing mindfulness teacher who had worked with pro sports, was talking about being at a basketball game and one of the players missing a free throw. He said, “There’s no sense of that player saying, ‘I’ve let the team down. I can’t believe that. I’ve blown the game. I’m such a terrible teammate.'”

It’s the voice. He goes, “Rather than that, say, ‘What was it about my technique? Let me look at that. What could I just modify for the next time?’ without the voice of judgment.” As we leave this conversation here, compassion for others, compassion for ourselves, that we’re all making the journey, doing the very best that we can. I must say again, “You are doing more than your very best. You are giving so much of yourself in service to others to heal and restore.” Thanks, again, Carrie. I appreciate all that you do.

Thank you. Thanks for having me.

 

Important Links

• Center for Motivation and Change
• CMC Foundation for Change
• The Invitation to Change
• Beyond Addiction: How Science and Kindness Help People Change
• The Beyond Addiction Workbook
• George Mumford

 

About Carrie Wilkens

Carrie Wilkens, PHD, is cofounder and clinical director of the CMC in New York City, NY; Long Island, NY; and Washington, DC. She is cofounder of CMC: Berkshires, a private inpatient/ residential program employing the same treatment approaches in Western Massachusetts.

She is also cofounder and president of the CMC: Foundation for Change, a nonprofit organization with the mission of improving the dissemination of evidence-based ideas and strategies to professionals and loved ones of persons struggling with substance use through the Invitation to Change approach. Wilkens coauthored the award-winning book, Beyond Addiction with Jeff Foote, and coauthored a user-friendly workbook for parents, The Parent’s 20 Minute Guide.

 

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Addiction recovery, behavior change, drug addiction, drug rehab, substance abuse, substance use disorder

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