Spiritual River Podcast E02 – Jeff Foote and the CRAFT Approach

Spiritual River Podcast E02 – Jeff Foote and the CRAFT Approach

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Patrick: So, the guest today is Jeff Foote. Thanks for doing this interview. Iím excited to learn about your work and the CRAFT approach. Jeff is the PHD research scientist. Heís been working on the addiction field for several decades. Heís the clinical director at the Center for Motvation and Change and glad to have him here so we can learn more about your work. Jeff, can you tell us a bit about your new book and the CRAFT approach?

Jeffrey: Sure. So we just came out with a new book two weeks ago so itís been a little hectic. Itís called Beyond Addiction: How Science and Kindness Help People Change and itís a guide for families. Thatís something how we spent the last three years working on and writing, and as I said, it just out two weeks ago on Amazon or wherever you want to get it. Actually, we have our own site for it which is http://beyondaddictionbook.com/ and you can get it there too.

Patrick: Thatís great.

Jeffrey: Iím a clinical psychologist and Iíve been doing addiction treatment for about 25 years now, back here in the northeast, in New York City. Now, actually just, also, two weeks ago, Iím not sure how these things happened together, but if I had to do it all over again, I maybe wouldnít do it this way but we also just opened up an inpatient residential program up in the Western Massachusetts in the Berkshires. And itís a 13-bed private facility and itís a Ė

- Approved Treatment Center -

about-treatment

Patrick: Oh, wow.

Jeffrey: Boy, itís beautiful. Itís sitting in it right now. Itís two feet of snow, and some days I think thatís beautiful and some days I canít get to work in time but mostly itís a good thing. But itís beautiful, and itís beautiful up here so itís a kind of a spiritual area, actually. The Berkshires are kind of known for culture, and spirituality, and transformation, and people come here to Berkshires for that, in all sorts of venues. Thereís lots of music, lots of dance, lots of yoga. Thereís a very strong recovering community up here and itís just a wonderful place. So, anyway, we just opened this inpatient rehab up here two weeks ago as well. And I thought the fun thing to talk about today might be the CRAFT approach. So thatís really the heart of the book that weíve written. It really is for families. Families are Ė the numbers in the United States in terms of substance use are pretty staggering. Something north of 20 million people are defined as having some sort of abusive dependence diagnosis. You got to work pretty hard to get that diagnosis. Thatís not easy to get.

Patrick: Right.

Jeffrey: You got to earn it. But if you think about that number, and think 20-25 million folks specifically struggling, the numbers around that are something like, for every drug and alcohol abusing person you have something like five people who are specifically close to them suffering the consequences of that. So now youíre talking about a 100 million people in the United States. There are different rates in different countries but speaking about those here, thatís a lot of people and thatís a lot of impact. And itís kind of one of those things that everybody says and everybody knows somebody whoís had some sort of problem, kind of thing.

Patrick: Sure, sure.

Jeffrey: And thatís true. The issue from our perspective has been what do you do to help families? Thereís been some traditional approaches in the 12-step community, Al-anon, and Nor-anon, and so forth, and Al-Ateen, and so forth, have been really useful resources for people. One of the main things being the community, had being the support, have being the permission to take care of yourself, which in any family system is one of the things that starts to really sort of go to pieces is peopleís ability to take care of themselves, in which theyíre so worried, and theyíre so angry, and theyíre frustrated, and theyíre guilty that somehow theyíve let this happen or they could have prevented it. Probably the worst one in my experience is the shame people feel. My son is struggling with heroin addiction and I feel horribly ashamed as his mom, and I donít want to talk to anybody and dump the big secret.

Patrick: Ah.

Jeffrey: And thatís just a crusher for families, those kinds of emotions. Itís an interesting thing when you think about it in the culture really here and the culture in the United States and I have to say itís actually quite different in different cultures but in this culture thereís kind of two approaches that have been offered to people. One is the, what Iíve just said, the more tossed up oriented self-care, but the part of that method though also is detached, so that detached with love message. Itís been more associative of the Anon programs.

Patrick: Right, right.

Jeffrey: And then, the other side, which is sort of like the flip side, opposite in some sense, but not, if you think about it, which is the more intervention oriented confrontational approach. And thatís the one thatís all over the culture in terms of reality TV shows and all that kind of drama. Lots of crying, lots of screaming, lots of door slamming, lots of miraculous recoveries. And unfortunately, what we know, where I come from, itís not just what looks good but itís when the rubber meets the road, what actually works. Thatís what evidence-based treatment means. Thatís what we do. Thatís what we talk about in the book Beyond Addiction, evidence-based treatment means when you actually level the playing field and compare apples to apples instead of apples to oranges, and apples to bananas, and apples to anything else. We actually do a number of studies Ė at this point, thereíve been studies on for 30-40 years around these various issues related to addiction.

Patrick: Right.

Jeffrey: When you do that, what you find out is things like interventions are actually miserably unsuccessful. And what I mean by that is that the numbers sort of donít lie. You talking really in-controlled studies, where you had people who were doing interventions who were blue blood interventionists. And thatís what they did and you compare that to people who were doing CRAFT as an approach, and you compared that to people who are being referred to an Al-Anon type approach. What you find is that the success rate for engaging that loved-one into treatment for interventions is around from anywhere to zero into 30 percent. And with Al-Anon youíre talking about 10 to 15 percent. And with CRAFT, which is the approach I can talk about, youíre talking about 65 to 75 percent, which is just unbelievable.

Patrick: Now let me clarify real quick. You said traditional interventions, you said 30 percent. Does that mean 30 percent, well, intervene and the person will get sober and stay sober or just 30 percent go and actually do the intervention, or 30 percent that the person will respond and go to rehab, or, what does that mean, the 30 percent?

Jeffrey: Thatís an awesome question. Thatís the scientist question. You want to know actually what the actual numbers mean. What weíre talking about in those studies is a couple of things. One is, and itís been probably eight or ten of these studies now, which is a fair amount. The numbers that theyíre looking at there are the number of people who actually enter treatment. So that was the goal. There are several goals in this. They wanted to measure the mental health, changes in the family, whether they got better or they got worse in terms of like, depression, anger, anxiety in the family, not just the person with the substance problem. The other mean outcome variable was, did the person enter any sort of treatment at all. And that would not had been done except for, Iíll tell you a little bit in a second, what has not been done very much is, after the person enters treatment, how does that go? Whatís the outcome for them?

Patrick: Right, right.

Jeffrey: But if youíre just looking at, oh my God, my husband, this is a call I would get regularly, right? My husbandís drinking. He wonít stop and he tells me he doesnít have a problem. What am I supposed to do? Iím about to leave, Iím about to kick him out. So what do you say to that person? Thatís a very typical situation. My kid keeps coming home totally stoned and now heís stealing stuff from the house, what shall we do? And when you take that group of people, and this has now being done across different types of substances, different socio-economic statuses, different relationships, like parents with kids, spouses, grown children intervening, or dealing with their parents who are having substances problems. Across all these different populations and across different types of substances, what you find is that if your outcome is, how many of those folks do we actually get to walk into any kind of treatment. Youíre talking about 30 percent with interventions.

Patrick: Okay.

Jeffrey: Now when you break that down, what you find is that a lot of that is people saying, when theyíre signed to that treatment condition, in a study, theyíre like, thereís no freaking way Iím doing that. Iím not going to go ahead and do an intervention because that sounds insane to me.

Patrick: Right.

Jeffrey: But this is the way you have to — in my opinion as a researcher, this is what you actually have to think about, these things, which is this is the real world, like if you said to someone, how about trying this and theyíre saying no. Well, thatís an outcome.

Patrick: Yeah.

Jeffrey: If itís totally unacceptable, if I said you have cancer and hereís the conditions, I can give you chemotherapy and it will make you kind of sick or I can cut your head off.

Patrick: Right.

Jeffrey: And they say, you know what, Iím not doing the second one, Iím sorry. Well, thatís an outcome — and it would cure you, ok.

Patrick: Right, yup.

Jeffrey: Thatís an outcome because youíre getting people saying, thereís no way Iím doing that. So, in the real world, which is really to me, what matters the most, in the real world with real people, what are they going to do? And you get a huge turndown rate when you say I want to do an intervention. I will say, by the way, thereís another kind of intervention approach called ARISE, and for the life of me, I can never remember what the acronym stands for but itís a whole different way of working and it actually resembles CRAFT much more and itís got a, in a very few studies that has been done on it, itís got a much higher success rate.

Patrick: Ah.

Jeffrey: And the reason is because what ARISE does is work collaboratively with the person whoís struggling. So the first step of an ARISE intervention is not meeting secretly without telling the person. Thatís not the first step. The first step is inviting the person to a meeting, together, a family meeting, to say, hey look, we all have a lot of concerns, weíre going to meet next Tuesday, we would love to meet with you because everybodyís really worried so we would just like to hash stuff together and see if we could come up with some ideas that makes sense. That approach makes so much more sense to families than saying weíre going to meet secretly. Weíre not going to tell your husband about it then weíre going to invite him to his brother-in-lawís house and tell him itís his birthday party and then tell him he has to go to rehab when he gets there.

Patrick: Right, the ambush.

Jeffrey: Right, my point is not that an intervention is never necessary because, absolutely, sometimes, it is. When things are really desperate, itís absolutely the thing you would want to do. The problem is, itís often the thing thatís done even if you didnít need to do it. And the real problem of that in the long run is that what we do know from a couple of studies is that people who are intervened with do worse afterwards. They have a higher relapse rate, theyíre madder, their relationships are more fractured, basically, because they didnít like that. So we just turn back to CRAFT then, which is the other category, and the other condition often then is referring to Al-Anon. And the reason the success rate of getting your loved-one into treatment by going to Al-Anon is so low because thatís not what itís for. Thatís not what Al-Anon is designed for. Itís designed to help the family. And help them get some self-care, help them understand whatís going on, lower their distress and anxiety and anger levels and start to find their footing again in their own life. And thatís a lovely thing. And itís a key to that. What did you say?

Patrick: Itís just self-care and detachment, thatís basically Al-Anon. And I wanted to interject that when you were saying that, I think I should have been a research scientist, I was studying AA to see a kind of a flip side from the alcoholicís perspective that AA World Services did a census study that spans like 40 years of data and I think itís called a recidivism rate maybe, the rate of which people relapse —

Jeffrey: People relapse and go back.

Patrick: — and they actually leave AA. And it says that something Ė I was going to say it was Ė an insanely high number. I think it was 87 percent of people who go to their first meeting will have left AA within a year and never come back to it, and Iím looking at this data and Iím saying, what you said, thatís an outcome.

Jeffrey: Yup, right.

Patrick: These people are saying no to the solution and yet so much of the industry just keeps saying, hey, this is the solution. If you would just give AA a chance it will work in your life and Iím kind of saying, hey, in the real world, 87 percent, over the long term, are basically saying no to your solution. Itís kind of a random approach so I guess I definitely see where youíre coming from when you say, when people say, no to something, thatís an outcome.

Jeffrey: Right. And thatís such a powerful thing youíre saying. Thatís such an incredibly important way to frame all this because it doesnít have to be about AA or anything. Itís exactly what you just said. If youíre saying hereís the solution and 87 percent are saying no, not me, well then, maybe thatís not the solution. Well, maybe itís the solution for 13 percent, or maybe itís the solution for 30 percent, and we just have to figure out a way to help them enter that system better, and itís still not a solution for 70 percent. We donítí really know. But what we do know is what you just said. Most people are coming back, right? If in my world, which is sort of a professional treatment world, the shame of all that is that for years what we have done is to say thatís their problem. Theyíre not ready.

Patrick: Yup

Jeffrey: I consider it my job to help people get ready. Not to say, well, youíre not ready so come back when youíre ready. If you come back when youíre ready, you donít need me anymore.

Patrick: Right. Exactly.

Jeffrey: Youíre changing now. Once youíre ready, to hell with a psychologist, you donít need to speak with me. You may need a couple of pointers here and now I can give you some tips about strategies and stuff like that but youíre doing it and thatís great. My job as mental health person, which is different than my job as a sponsor or my job as a physician or any of those things, is to help with motivation. Itís to help people so it clear up the path in front of them so they feel like theyíre able to walk forward.

Patrick: Youíre doing the hard work. Itís so much easier once theyíre ready to say, oh, I sponsor people in AA and once theyíre ready, they come to me and I help them. Well, thatís the easy part. Youíre actually doing the hard work.

Jeffrey: Well, I think itís all hard, to tell you the truth because the other fundamental truth about change, and this doesnít have to be about changing addiction issues, itís true about changing anything, is that ambivalence is a huge part of it. People come and go in their motivation. Itís about changing things. I really got to get back to that gym and start exercising. Well, thatís how I feel today and by tonight, when Iím supposed to go to the gym, you know what, Iím thinking, itís busy tonight, I had a long day, probably tomorrow I can get on that.

Patrick: Right.

Jeffrey: So thatís ambivalence, right? I want one thing and I also want another thing, which is I want to relax and rest. And in the morning I wanted to exercise and feel better about myself physically. Same is absolutely true for substance use. You know, I really got to cut down on my drinking. Good God, I hate the way I feel in the morning and my wife is really not happy with me. By 7 oí clock tonight, you know what, itís kind of a bummer waking up that way but it would be really fun tonight to go out and have a couple of drinks with the guys Iím working. Thatís ambivalence, right? People come and go. Again, I think one of the tasks in CRAFT, and in motivational interviewing, which is a whole another approach, are really how do you engage people, how do you stay engaged. And just to talk about CRAFT for a minute, and again thatís the core part of this Beyond Addiction book, is the CRAFT strategies. Iíll just say the book sort of gives an overview of addiction and sort of modern thinking about addiction and what motivation is and how you help people change and exactly what you and I are talking about right now and how to take care of yourself. But then once you get into the core of the book, itís really about CRAFT, which is this community reinforcement and family training approach. Thatís a terrible name but itís a whole series of behavioral approaches that were developed by a psychologist named Bob Meyers. Heís out in a university in New Mexico and heís been there for 25 years or so. And heís been doing the research studies and then a bunch of other people on the country has started their research studies on this also. Actually thereís a HBO, that HBO Special Addiction came out about 6, 7 years ago. Lovely. Really well done. And there was a one of the little sidebars for like 20 minutes. They had one on families, on CRAFT. And they interviewed Bob, and they interviewed some people who were doing it, and so forth. Itís a really lovely segment so I direct people to that also.

Patrick: Okay.

Jeffrey: But his dad was a pretty bad alcoholic. And he described that as kind of one of a big stimulus for him to think about these issues in a different way than someone else might. The basic point being, how do you help a family who, really, you donít go to school for this stuff. You donít go to school for what to do when your husband is an alcoholic. What would you know how to do that at all, right?

Patrick: Right.

Jeffrey:† And there you are and things are going to hell in a hand basket and so I said before, the emotions that are piling up are bad. The guilt and the anger and the shame and all that. And what CRAFT says is, you donít need to bang him over the head and you donít need to detach. Those two strategies are not so successful. And what you can do is take care of yourself, like Al-Anon would say, and stay connected. So you donít actually have to detach. Those are not Ė you donít have to detach to take care of yourself. And thatís one of the central concepts and findings in CRAFT. You can take care of yourself and you can stay connected and help. Itís a very powerful idea and it actually works. And people have been told over and over again, if you stay connected, youíre an enabler. If you stay connected, youíre co-dependent. And all these kind of words and concepts that, in my experience have become sort of like curse words for people. Theyíre all sort of like, diagnoses for them. Well, I must, because my husband drink, I must be X,Y, and Z. I must be an enabler, I must be co-dependent. Well, you know what, youíre probably somebody who loves your husband and who would do just about anything to help him and help your family, and that makes sense. So, of course, youíre doing anything you can. Lots of these things are probably helpful. Some of them probably arenít helpful. Some of them probably would be called enabling and a lot of them would just be called loving your husband and try to help him get better. And itís such a powerful force, I mean, when you step back and think about like, who would have the most impact on someone using substances? People who love them. People in their family. It doesnít mean they know how to do it necessarily but they sure have a lot of impact to that process, right?

Patrick: Yup.

Jeffrey: So youíre really harnessing a huge engine there like, theyíre going to come talk to me. As a psychologist, what am I going to do? Iím going to talk to them a couple of times a week for an hour each time and then the other 150 hours, theyíre doing whatever theyíre doing. But the wife, or their kid, or their parents is around all the time.

Patrick: Right.

Jeffrey: So if that person can learn some effective strategies, theyíre a hugely powerful influence. And what we find in all these CRAFT studies, over and over again, is when you take this approach, you get these very high engagement rates of getting your loved-one into treatment, as I said, sort of close to 70 percent, which is just a ridiculously high number in the research world. You get improved mental health in the family and, this is kind of an interesting one, even if the person never enters treatment, their substance use gets dramatically reduced.

Patrick: Ah.

Jeffrey: So, if you take it away from the whole idea of the only goal is to get them into treatment, which kind of the idea of an intervention. Just get them into treatment. Get them on that plane to rehab. In my world, who cares? Thatís not the end goal.

Patrick: Right.

Jeffrey: That guy goes to rehab? The really important, and I say this to people for years, sending them off to rehab, I said, this is the easy part. The hard part is coming back to your life and making a goal of it in a way thatís actually going to work differently. So if we can work with families to help them change the whole way that the family operates, youíve really established an entirely different system, whether that person goes off to treatment or doesnít. And I can talk, I can just sort of walk through the fundamental principles of CRAFT if youíd like. That would be helpful.

Patrick: Yeah, maybe you can touch on some of the specific strategies that families might use around a struggling alcoholic or addict and how that works with CRAFT.

Jeffrey: Sure. I mean, thereís kind of four or five basic areas that really have a big impact. And one of the main things that kind of underpins this kind of an approach, and any kind of behavioral approach, is the idea of reinforcement. So thatís the technical term. One thing we tell families is, your husband, your loved-one is not using substances because heís crazy. And heís not using them because he wants to hurt you. Heís using them because he gets something out of them. If having a drink or tan was like putting your hand on a hot stove, he wouldnít be doing it anymore.

Patrick: Right.

Jeffrey: Ever. He would never, ever do it again. But clearly, thatís not what itís like. Clearly, thereís any number of reasons that this is happening. Thatís the fundamental understanding which is, people get something out of everything they do, otherwise they stop doing it. So that includes substances. And if you step back and think about it, well, my son started smoking a bunch of pot, well, why is that? Probably because his peer group is doing it, because heís a pretty anxious kid and he suddenly feels like he fits in, because heís got ADD and heís really bored in school because he canít sit still and this helps him feel much more comfortable by going to school because heís not bored every second. Alright, those are three reasons, those are three different reasons. You could find three or ten or twenty different reasons for the kid sitting next to him as to why heís smoking pot. You could find twenty different reasons why the 35-year old computer engineer guy sitting next you on the bench is drinking too much, right, which is his wife passed away last year and heís got two kids and heís completely overwhelmed and filled with grief every second and when he drinks at home at night, it helps him feel better. It helps him go to sleep. And now itís gotten out of hand, right? The other guy next to him started drinking when he was 14. His dad is an alcoholic. Heís got it in his genes and he canít drink without drinking, way over drinking, every time he drinks and he has a blackout every time he drinks. Thatís a different scenario.

Patrick: Sure.

Jeffrey: So that guy biologically has a different response to alcohol than the guy whose wife just died. And the guy sitting next to him had a really bad broken leg as a ski instructor three years ago and he was in horrible pain and he had four operations on his leg and heís on pain medications for six month and he started abusing it. So all these people are addicts and alcoholics. I mean, those arenít even terms I use anymore, I had to tell you, because, to me, those are all people coming from different places and we have problems on substances. And we need to understand them. We need to understand where youíre coming from, Joe, where youíre coming from, Bill. Yeah there may be some overlap, but I got here a different way than you got here in terms of this substance problem. So for families to start to understand that thereís a reason, or many reasons, that this is happening is a really fundamental issue because one: it helps them not take it personally, or less personally, which is a real problem, right? If my husband keeps drinking and then weíre not having sex anymore and he doesnít come home on time so I got, Iím taking that personally, right?

Patrick: Right.

Jeffrey: But if I can start to understand that there are other things about it than its effect on me, it doesnít mean I like it but it means that at least I can understand that there is something going on with him, right? The second part why the idea of reinforcement is so important is then, and this is a really important part of CRAFT, then we can start to move things around in a way where we can reinforce different, more positive behaviors. So when he comes home after having had too many drinks, Iím not going to get into it. Iím not going to fight with him. Iím not going to have a screaming match. Iím going to leave him alone. The next morning, Iím going to try to figure out ways that Ė Iím going to start to think through ways that we can reinforce positive behaviors. So Iím going to take him up from work on Thursdays and weíre going to go to a movie, which is something he loves to do. No big deal, itís just us planning something thatís going to compete with the substance use and thatís positive and thatís pleasurable. So when he says, if one of the fundamental reasons that heís drinking after work is he hates his boss and he hates his job and heís totally wound up everytime he leaves there at 5 oí clock. So two night a week, we make a dinner date at 5:30 at a place he likes to go have dinner and then we go to a movie. Because that actually turns out to be relaxing. Or I start going to an exercise class with him on Wednesday nights. And I talk him into doing Zoomba, which he thought is the stupidest thing he ever heard and turns out he really likes. And you start to put those kind of things in place, which are reinforcing positive behaviors. And itís really profound. Itís doing — itís competition. If you come home and youíre not drinking, letís watch our favorite show together. Letís watch CSI on whatever night itís on because we used to really like to watch that together. And now youíre usually sleeping because youíre drinking.

Patrick: It almost sounds like a bit of Ė and Iíve explored Ė in writing on Spiritual River, itís the idea of a replacement strategy. It said you just canít take away the Ė you just canít take away the drugs and the alcohol and expect things to work out or return to normal. You have to replace it with something. And Iíve explored this idea. Sounds like CRAFT or something or similar to that.

Jeffrey: Precisely. Exactly the same concept. Yup, and youíre calling it Ė youíre using a different word and itís the exact same idea. Thatís right. Thatís awesome. Because itís saying, letís make sure Ė itís like, itís the reason itís a kind of a just say no strategy ultimately made no sense. I appreciate the idea but itís a bad deal. Whoís going to do that? Just say no? And then what? Then Iím going to be the anxious guy I used to be and I donít actually feel comfortable going out for work-related functions and thatís a dead end.† Thatís not going to be sustainable. And thatís what weíre talking about is how do we make these changes sustainable. So if as a family member I can start to work on ways that we can shift around what we do and what we support then we actually can introduce positively reinforcing activities over time. Then thatís in competition. So thatís the whole idea of reinforcement. Itís really very powerful. The second thing thatís really focused on a lot in CRAFT is communication and communication strategies. And again thereís a lot of focus on positivity and by that we donít mean some sort of like, just be happy or pollyanna kind of thing at all. What we mean is, literally, how do you make things shift around and focus more on positive aspects of whatís going on because thatís what helps people change. And that has been found over and over again in across types of problems, not just about substance issues. The positive reinforcement really helps so in my communication strategies, I need to learn, and this part of what CRAFT teaches people, literally, specific communication strategies of how to have interactions that are more likely to work, less likely to make the person defensive, and are going to let them hear me more easily, which what matters. Because again, once you start down to spiral, communication is often the first thing to go. Weíre just yelling or weíre shut down in silence. Neither of those are going to get us out of this hole. But if I can learn how to actually interact in a way that doesnít feel demeaning, it doesnít feel shaming, isnít me just biting my tongue every second, but with me being able to actually support stuff and notice things that are positive and work collaboratively, it has a huge impact on my loved-one whoís struggling. And that whole aspect of collaboration is just a big part of this. Now it doesnít mean they just get to do whatever they want to so the other parts here which are very important are self-care. Sort of the airplane analogy, if you start to lose oxygen put on your oxygen mask first. They say that because youíre not going to help anybody if you donít put on your oxygen mask first. Youíre going to pass out.

Patrick: Right.

Jeffrey: And thatís really critical. You have to work on that part of which people really do ignore in a crisis because youíre going to run out of gas. And then youíre going to be stranded in the middle of a highway and youíre not going to be able to help anybody. And these situations are not like, one week weíre having a problem, the next week itís all fine so I just need to sprint through this. Weíre talking about years. These things just donít turn around. You have to find ways to take care of yourself. Literally, on a behavioral level like, I need to talk to a couple of my friends who I havenít talked to in a while. I need to start getting my hair done once a week because I really enjoy doing that. I need to start taking walks again in the morning because that makes me Ė allows me to brief, clear my head and get myself set for the day. Those are things that really help. And the other part, and thatís the part that would overlap with Al-Anon also. And then the last part of CRAFT Ė so we have understanding reinforcement and being able to reinforce positive actions, which includes the phrase Bob Meyers likes to use, ďcatch and being good,Ē which is a really hard thing once youíre in the middle of that kind of maelstrom. But good things do happen. He did come home one time, sometimes. Your kid did clean up their room one day this week and often we miss that because weíre so mad and resentful. Itís like, well, he shouldíve cleaned up his room because, of course, I’ve told him a hundred times. Okay, thatís fine, but he did so give him some props. Recognition, acknowledgement of the things that are happening starts to again change the atmosphere and starts to make it seem the other person like, well maybe it is worth changing. Maybe I can get something from doing this. Maybe something positive can happen in my family.

Patrick: Yup.

Jeffrey: Because theyíre also feeling that, right? Everythingís going down the drain and itís my fault and Iím mad about that and ashamed of myself for causing all these family problems and all I get is grief all the time so nothing can really change. Yet suddenly my wife is actually making me dinners when Iím home and sober. I start to feel like, well, maybe things could change.

Patrick: Yup. Sure, sure.

Jeffrey: And there is another part that which we call allowing natural consequences, which is closer to the enabling idea, which is if something bad is happening to my husband because of his substance use, I need to let those things happen because in that sense, the world is actually a very helpful teacher. If he woke up too late to come to our sonís soccer game on Saturday morning, I need to let that happen. I need to let him feel bad about that because thatís really on him. And not to get into a fight with him about it because then heíll just Ė then it will become about what a jerk his wife is for bugging him about it all those time. But let him sit with the fact that his 10-year old feels disappointed that he wasnít in his game and thereís nothing else to say about it, really. You drank too much, you missed the game, and thatís what happened. Those kind of consequences can really help the person change too because it takes it out of the fight realm and use it, sort of just puts it back on their lap and says, okay, thatís you and you can deal with it. You can change it if you want. So that combination of letting the natural consequences occur and really acknowledging, rewarding, reinforcing the positive things they are doing has a big impact. And thatís kind of what CRAFT is about in a nutshell, is being able to work in those positive ways, really working to understand how to do that, changing your communication patterns, taking care of yourself, allowing the natural consequences to occur when they do. And itís remarkably effective. The other nice thing, I think, for families is that itís a very affirming positive approach. Itís not based on I have to let go and itís breaking my heart and I just need to leave him alone and he needs to hit bottom and all that stuff which, we have found out, is, in fact, is not so true even. It certainly doesnít feel right.

Patrick: So at least itís giving the family something positive for them to focus on. Theyíre trying to reinforce the positive stuff so it gives them an active role thatís actually positive —

Jeffrey: Thatís right. Exactly. Gives them an active role and itís really effective active role. We actually have, I was going to say, I keep saying this thing about this book Beyond Addiction, and thatís why we called it, the subtitle is: ďhow science and kindness help people changeĒ because itís not. Itís just a bunch of research studies saying this is what works. The kindness part of this really matters. Working in a kind, collaborative, respectful way with people who are struggling, it matters. We donít treat people with cancer shamefully and badly and make them feel like theyíve done something terrible. Thatís not helpful. Theyíre in a struggle, they need support, they need kindness. I was going to say a couple of things, we have a website which is motivationandchange.com and Iím just saying it because we have on that, thereís some resources for families like, thereís a couple of workbook resources on there called the 20-minute guide. One is for spouses and one is for parents who have kids, like adolescents.

Patrick: Okay.

Jeffrey: You donít have to read the whole book if you donít want to. You should, itís great, but the 20-minute guides are also nice resources, just kind of like practical resources with about 15 different sections. Theyíre 60-70 pages long, theyíre short. And theyíre just practical tools for families in how to communicate differently, how to take care of yourself, how to set limits, how to allow for natural consequences, how to do problem solving. And the 20-minute guides, I think, could be really helpful and that in a very practical Ė what am I supposed to do today, kind of a way. And thatís all about CRAFT also.

Patrick: Okay, great. Well, youíve covered such Ė youíve covered everything basically. I had all these questions lined up and we didnít even need them because youíve covered it so thoroughly, but let me ask you one. What do you think is next for you? You got your book there and youíre trying to spread this message and get this approach to become more mainstream which I think is terrific. I kind of reviewed it, I didnít realize how useful it was in comparison to the sort of the old method of Al-Anon and the old confrontational approach so it was really exciting for me. So what do you thinkís next for you?

Jeffrey: Well, right now, Iím trying to get this rehab up and off the ground and weíve been up for two weeks and we do a lot of CRAFT here for families of the clients who are here also. Weíre doing a huge project with the partnershipatdrugfree.org, which people probably remember as that group who put out that, this is your brain on eggs, or whatever that was your eggs. That whole thing about your brain and fried eggs. But the main thing that weíre doing with them is actually an incredibly exciting project which is, weíre developing a Ė we just did a whole training last summer, weíre going to do another one in June with them, for training parents to be coaches for other parents using CRAFT.

Patrick: Oh, wow.

Jeffrey: And weíre hoping to develop a Ė basically a national self-help network where parents can call other parents who have been trained in CRAFT related ideas and hear more about that than hear about the other kind of stuff they might hear, because, again, parents are another group who are just like, lost at sea when these things start to happen. And they get a lot of bad advice, really, frankly. So weíre trying to develop a whole national network. Right now, people can call the patnershipatdrugfree.org and thereís a parent support network. Thereís like a call-in line in there, itís parent support network, and they can talk to a counselor but, ultimately, whatís going to happen and what weíve started now is that they can call Ė they can get referred over to another parent whoís been through it all. Half the parents weíve been training have lost kids to substance use. The other half their kids are still alive but theyíve had terrible struggles. So theyíve been there and they know it and now they have some other tools, which are CRAFT related and motivationally related to help other parents. So thatís an incredibly moving and wonderful experience, actually, is to develop that whole training protocol for those coaches and hopefully weíll just keep training coaches over this year, next year, and just keep moving forward with that as a whole self-help network for parents, which Iím really excited about.

Patrick: Yeah, that sounds amazing, very interesting. Okay.

Jeffrey: Yeah.

Patrick: Alright, well, thank you again, Jeff. This has been incredibly helpful. Spiritual River audience, Iím sure is going to get a lot out of this and theyíre going to follow up, hopefully, and check out your book which is Beyond Addiction and they can also find you on the web at — what was it?

Jeffrey: www.motivationandchange.com.

Patrick: Okay, great.

Jeffrey: And there you can find the books also there too, and the 20-minute guide.

Patrick: Okay. Well, thank you again. Thank you so much for coming on today. Itís been really helpful.

Jeffrey: Thank you, it was really fun to talk with you so I really appreciate the time.

Patrick: Okay, great. Thanks.

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