Spiritual River Podcast E02 – Jeff Foote and the CRAFT Approach

Patrick
  • By Patrick

    Patrick: So, the guest today is Jeff Foote. Thanks for doing this interview. I’m excited to learn about your work and the CRAFT approach. Jeff is the PHD research scientist. He’s been working on the addiction field for several decades. He’s 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 it’s been a little hectic. It’s called Beyond Addiction: How Science and Kindness Help People Change and it’s a guide for families. That’s 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: That’s great.

    Jeffrey: I’m a clinical psychologist and I’ve 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, I’m not sure how these things happened together, but if I had to do it all over again, I maybe wouldn’t do it this way but we also just opened up an inpatient residential program up in the Western Massachusetts in the Berkshires. And it’s a 13-bed private facility and it’s a –

    Patrick: Oh, wow.

    Jeffrey: Boy, it’s beautiful. It’s sitting in it right now. It’s two feet of snow, and some days I think that’s beautiful and some days I can’t get to work in time but mostly it’s a good thing. But it’s beautiful, and it’s beautiful up here so it’s 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. There’s lots of music, lots of dance, lots of yoga. There’s a very strong recovering community up here and it’s 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 that’s really the heart of the book that we’ve written. It really is for families. Families are – 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. That’s 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 you’re talking about a 100 million people in the United States. There are different rates in different countries but speaking about those here, that’s a lot of people and that’s a lot of impact. And it’s kind of one of those things that everybody says and everybody knows somebody who’s had some sort of problem, kind of thing.

    Patrick: Sure, sure.

    Jeffrey: And that’s true. The issue from our perspective has been what do you do to help families? There’s 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 people’s ability to take care of themselves, in which they’re so worried, and they’re so angry, and they’re frustrated, and they’re guilty that somehow they’ve 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 don’t want to talk to anybody and dump the big secret.

    Patrick: Ah.

    Jeffrey: And that’s just a crusher for families, those kinds of emotions. It’s 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 it’s actually quite different in different cultures but in this culture there’s kind of two approaches that have been offered to people. One is the, what I’ve 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. It’s 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 that’s the one that’s 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, it’s not just what looks good but it’s when the rubber meets the road, what actually works. That’s what evidence-based treatment means. That’s what we do. That’s 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 – at this point, there’ve 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 don’t lie. You talking really in-controlled studies, where you had people who were doing interventions who were blue blood interventionists. And that’s 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 you’re talking about 10 to 15 percent. And with CRAFT, which is the approach I can talk about, you’re 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: That’s an awesome question. That’s the scientist question. You want to know actually what the actual numbers mean. What we’re talking about in those studies is a couple of things. One is, and it’s been probably eight or ten of these studies now, which is a fair amount. The numbers that they’re 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, I’ll 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? What’s the outcome for them?

    Patrick: Right, right.

    Jeffrey: But if you’re just looking at, oh my God, my husband, this is a call I would get regularly, right? My husband’s drinking. He won’t stop and he tells me he doesn’t have a problem. What am I supposed to do? I’m about to leave, I’m about to kick him out. So what do you say to that person? That’s a very typical situation. My kid keeps coming home totally stoned and now he’s 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. You’re 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 they’re signed to that treatment condition, in a study, they’re like, there’s no freaking way I’m doing that. I’m 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 they’re saying no. Well, that’s an outcome.

    Patrick: Yeah.

    Jeffrey: If it’s totally unacceptable, if I said you have cancer and here’s 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, I’m not doing the second one, I’m sorry. Well, that’s an outcome — and it would cure you, ok.

    Patrick: Right, yup.

    Jeffrey: That’s an outcome because you’re getting people saying, there’s no way I’m 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, there’s another kind of intervention approach called ARISE, and for the life of me, I can never remember what the acronym stands for but it’s a whole different way of working and it actually resembles CRAFT much more and it’s got a, in a very few studies that has been done on it, it’s got a much higher success rate.

    Patrick: Ah.

    Jeffrey: And the reason is because what ARISE does is work collaboratively with the person who’s struggling. So the first step of an ARISE intervention is not meeting secretly without telling the person. That’s 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, we’re going to meet next Tuesday, we would love to meet with you because everybody’s 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 we’re going to meet secretly. We’re not going to tell your husband about it then we’re going to invite him to his brother-in-law’s house and tell him it’s 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, it’s absolutely the thing you would want to do. The problem is, it’s often the thing that’s done even if you didn’t 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, they’re madder, their relationships are more fractured, basically, because they didn’t 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 that’s not what it’s for. That’s not what Al-Anon is designed for. It’s designed to help the family. And help them get some self-care, help them understand what’s going on, lower their distress and anxiety and anger levels and start to find their footing again in their own life. And that’s a lovely thing. And it’s a key to that. What did you say?

    Patrick: It’s just self-care and detachment, that’s 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 alcoholic’s perspective that AA World Services did a census study that spans like 40 years of data and I think it’s 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 – I was going to say it was – 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 I’m looking at this data and I’m saying, what you said, that’s 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 I’m kind of saying, hey, in the real world, 87 percent, over the long term, are basically saying no to your solution. It’s kind of a random approach so I guess I definitely see where you’re coming from when you say, when people say, no to something, that’s an outcome.

    Jeffrey: Right. And that’s such a powerful thing you’re saying. That’s such an incredibly important way to frame all this because it doesn’t have to be about AA or anything. It’s exactly what you just said. If you’re saying here’s the solution and 87 percent are saying no, not me, well then, maybe that’s not the solution. Well, maybe it’s the solution for 13 percent, or maybe it’s the solution for 30 percent, and we just have to figure out a way to help them enter that system better, and it’s still not a solution for 70 percent. We don’t’ 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 that’s their problem. They’re not ready.

    Patrick: Yup

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

    Patrick: Right. Exactly.

    Jeffrey: You’re changing now. Once you’re ready, to hell with a psychologist, you don’t 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 you’re doing it and that’s 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. It’s to help people so it clear up the path in front of them so they feel like they’re able to walk forward.

    Patrick: You’re doing the hard work. It’s so much easier once they’re ready to say, oh, I sponsor people in AA and once they’re ready, they come to me and I help them. Well, that’s the easy part. You’re actually doing the hard work.

    Jeffrey: Well, I think it’s all hard, to tell you the truth because the other fundamental truth about change, and this doesn’t have to be about changing addiction issues, it’s true about changing anything, is that ambivalence is a huge part of it. People come and go in their motivation. It’s about changing things. I really got to get back to that gym and start exercising. Well, that’s how I feel today and by tonight, when I’m supposed to go to the gym, you know what, I’m thinking, it’s busy tonight, I had a long day, probably tomorrow I can get on that.

    Patrick: Right.

    Jeffrey: So that’s 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 o’ clock tonight, you know what, it’s 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 I’m working. That’s 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 that’s the core part of this Beyond Addiction book, is the CRAFT strategies. I’ll 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, it’s really about CRAFT, which is this community reinforcement and family training approach. That’s a terrible name but it’s a whole series of behavioral approaches that were developed by a psychologist named Bob Meyers. He’s out in a university in New Mexico and he’s been there for 25 years or so. And he’s been doing the research studies and then a bunch of other people on the country has started their research studies on this also. Actually there’s 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. It’s 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 don’t go to school for this stuff. You don’t 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 don’t need to bang him over the head and you don’t 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 don’t actually have to detach. Those are not – you don’t have to detach to take care of yourself. And that’s one of the central concepts and findings in CRAFT. You can take care of yourself and you can stay connected and help. It’s a very powerful idea and it actually works. And people have been told over and over again, if you stay connected, you’re an enabler. If you stay connected, you’re co-dependent. And all these kind of words and concepts that, in my experience have become sort of like curse words for people. They’re 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, you’re 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, you’re doing anything you can. Lots of these things are probably helpful. Some of them probably aren’t 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 it’s 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 doesn’t mean they know how to do it necessarily but they sure have a lot of impact to that process, right?

    Patrick: Yup.

    Jeffrey: So you’re really harnessing a huge engine there like, they’re going to come talk to me. As a psychologist, what am I going to do? I’m going to talk to them a couple of times a week for an hour each time and then the other 150 hours, they’re doing whatever they’re 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, they’re 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? That’s 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 that’s actually going to work differently. So if we can work with families to help them change the whole way that the family operates, you’ve really established an entirely different system, whether that person goes off to treatment or doesn’t. And I can talk, I can just sort of walk through the fundamental principles of CRAFT if you’d 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, there’s 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 that’s the technical term. One thing we tell families is, your husband, your loved-one is not using substances because he’s crazy. And he’s not using them because he wants to hurt you. He’s 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 wouldn’t be doing it anymore.

    Patrick: Right.

    Jeffrey: Ever. He would never, ever do it again. But clearly, that’s not what it’s like. Clearly, there’s any number of reasons that this is happening. That’s 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 he’s a pretty anxious kid and he suddenly feels like he fits in, because he’s got ADD and he’s really bored in school because he can’t sit still and this helps him feel much more comfortable by going to school because he’s 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 he’s 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 he’s got two kids and he’s 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 it’s gotten out of hand, right? The other guy next to him started drinking when he was 14. His dad is an alcoholic. He’s got it in his genes and he can’t drink without drinking, way over drinking, every time he drinks and he has a blackout every time he drinks. That’s 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 he’s on pain medications for six month and he started abusing it. So all these people are addicts and alcoholics. I mean, those aren’t 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 you’re coming from, Joe, where you’re 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 there’s 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 we’re not having sex anymore and he doesn’t come home on time so I got, I’m 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 doesn’t 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, I’m not going to get into it. I’m not going to fight with him. I’m not going to have a screaming match. I’m going to leave him alone. The next morning, I’m going to try to figure out ways that – I’m going to start to think through ways that we can reinforce positive behaviors. So I’m going to take him up from work on Thursdays and we’re going to go to a movie, which is something he loves to do. No big deal, it’s just us planning something that’s going to compete with the substance use and that’s positive and that’s pleasurable. So when he says, if one of the fundamental reasons that he’s drinking after work is he hates his boss and he hates his job and he’s totally wound up everytime he leaves there at 5 o’ 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 it’s really profound. It’s doing — it’s competition. If you come home and you’re not drinking, let’s watch our favorite show together. Let’s watch CSI on whatever night it’s on because we used to really like to watch that together. And now you’re usually sleeping because you’re drinking.

    Patrick: It almost sounds like a bit of – and I’ve explored – in writing on Spiritual River, it’s the idea of a replacement strategy. It said you just can’t take away the – you just can’t 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 I’ve explored this idea. Sounds like CRAFT or something or similar to that.

    Jeffrey: Precisely. Exactly the same concept. Yup, and you’re calling it – you’re using a different word and it’s the exact same idea. That’s right. That’s awesome. Because it’s saying, let’s make sure – it’s like, it’s the reason it’s a kind of a just say no strategy ultimately made no sense. I appreciate the idea but it’s a bad deal. Who’s going to do that? Just say no? And then what? Then I’m going to be the anxious guy I used to be and I don’t actually feel comfortable going out for work-related functions and that’s a dead end.  That’s not going to be sustainable. And that’s what we’re 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 that’s in competition. So that’s the whole idea of reinforcement. It’s really very powerful. The second thing that’s really focused on a lot in CRAFT is communication and communication strategies. And again there’s a lot of focus on positivity and by that we don’t 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 what’s going on because that’s 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. We’re just yelling or we’re 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 doesn’t feel demeaning, it doesn’t feel shaming, isn’t 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 who’s struggling. And that whole aspect of collaboration is just a big part of this. Now it doesn’t 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 you’re not going to help anybody if you don’t put on your oxygen mask first. You’re going to pass out.

    Patrick: Right.

    Jeffrey: And that’s really critical. You have to work on that part of which people really do ignore in a crisis because you’re going to run out of gas. And then you’re going to be stranded in the middle of a highway and you’re not going to be able to help anybody. And these situations are not like, one week we’re having a problem, the next week it’s all fine so I just need to sprint through this. We’re talking about years. These things just don’t 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 haven’t 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 – 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 that’s the part that would overlap with Al-Anon also. And then the last part of CRAFT – so we have understanding reinforcement and being able to reinforce positive actions, which includes the phrase Bob Meyers likes to use, “catch and being good,” which is a really hard thing once you’re 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 we’re so mad and resentful. It’s like, well, he should’ve cleaned up his room because, of course, I’ve told him a hundred times. Okay, that’s 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 they’re also feeling that, right? Everything’s going down the drain and it’s my fault and I’m 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 I’m 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 son’s soccer game on Saturday morning, I need to let that happen. I need to let him feel bad about that because that’s really on him. And not to get into a fight with him about it because then he’ll just – 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 wasn’t in his game and there’s nothing else to say about it, really. You drank too much, you missed the game, and that’s 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, that’s 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 that’s 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 it’s remarkably effective. The other nice thing, I think, for families is that it’s a very affirming positive approach. It’s not based on I have to let go and it’s 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 doesn’t feel right.

    Patrick: So at least it’s giving the family something positive for them to focus on. They’re trying to reinforce the positive stuff so it gives them an active role that’s actually positive –

    Jeffrey: That’s right. Exactly. Gives them an active role and it’s really effective active role. We actually have, I was going to say, I keep saying this thing about this book Beyond Addiction, and that’s why we called it, the subtitle is: “how science and kindness help people change” because it’s not. It’s 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 don’t treat people with cancer shamefully and badly and make them feel like they’ve done something terrible. That’s not helpful. They’re 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 I’m just saying it because we have on that, there’s some resources for families like, there’s 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 don’t have to read the whole book if you don’t want to. You should, it’s great, but the 20-minute guides are also nice resources, just kind of like practical resources with about 15 different sections. They’re 60-70 pages long, they’re short. And they’re 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 – what am I supposed to do today, kind of a way. And that’s all about CRAFT also.

    Patrick: Okay, great. Well, you’ve covered such – you’ve covered everything basically. I had all these questions lined up and we didn’t even need them because you’ve covered it so thoroughly, but let me ask you one. What do you think is next for you? You got your book there and you’re trying to spread this message and get this approach to become more mainstream which I think is terrific. I kind of reviewed it, I didn’t 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 think’s next for you?

    Jeffrey: Well, right now, I’m trying to get this rehab up and off the ground and we’ve been up for two weeks and we do a lot of CRAFT here for families of the clients who are here also. We’re 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 we’re doing with them is actually an incredibly exciting project which is, we’re developing a – we just did a whole training last summer, we’re 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 we’re hoping to develop a – 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 we’re trying to develop a whole national network. Right now, people can call the patnershipatdrugfree.org and there’s a parent support network. There’s like a call-in line in there, it’s parent support network, and they can talk to a counselor but, ultimately, what’s going to happen and what we’ve started now is that they can call – they can get referred over to another parent who’s been through it all. Half the parents we’ve been training have lost kids to substance use. The other half their kids are still alive but they’ve had terrible struggles. So they’ve 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 that’s an incredibly moving and wonderful experience, actually, is to develop that whole training protocol for those coaches and hopefully we’ll 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 I’m 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, I’m sure is going to get a lot out of this and they’re 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. It’s 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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