“With a map, directions, and the family in the driver's seat, Get Your Loved One Sober is an important book for any family affected by alcohol abuse.”
—Claudia Black, Ph.D., author of
It Will Never Happen to Me
“For decades it was believed that there was nothing one could do to help substance-abusing loved ones until they hit bottom or that heavy-handed confrontational tactics were necessary. Bob Meyers has developed a remarkably effective and gentle method for working through family members and concerned significant others to help their ‘unmotivated’ loved ones get into treatment. It is no longer necessary to feel helpless and hopeless. This book offers clear and practical advice based on solid scientific research.”
—William R. Miller, Ph.D., distinguished
professor of psychology and psychiatry
and author of Motivational Interviewing
“Get Your Loved One Sober is an outstanding resource for persons dealing with loved ones who refuse to get help for their substance abuse problem. Years of research show that the approach described in this book works. I highly recommend it.”
—Timothy O'Farrell, Ph.D., chief of the
Families and Addiction Program, Harvard
Medical School, Department of Psychiatry
“If you feel like your life is out of control because of someone else's substance abuse, this book will put you in the driver's seat with research-based strategies that can make life infinitely better—for you and your loved one. Get Your Loved One Sober fills a void for everyday people as well as professionals who feel helpless and hopeless concerning substance abusers in their lives. Clearly written and engaging, this book can move you from feeling like a passive victim to becoming an empowered, active player in helping a loved one overcome a drinking problem.”
—Anne M. Fletcher, M.S., R.D., L.D.,
author of Sober for Good: New Solutions
for Drinking Problems—Advice from
Those Who Have Succeeded and
recipient of the Research Society on
Alcoholism Journalism Award
“Lucid and clear, this book will help those who love an addicted person find the practical steps they need to take to facilitate change. I recommend it highly.”
—Thomas Bien, Ph.D.,
coauthor of Mindful Recovery
and Finding the Center Within
Get Your Loved One Sober
Alternatives to Nagging, Pleading, and Threatening
Robert J. Meyers, Ph.D.
Brenda L. Wolfe, Ph.D.
HAZELDEN®
Hazelden
Center City, Minnesota 55012-0176
1-800-328-0094
1-651-213-4590 (Fax)
www.hazelden.org
©2004 by Robert J. Meyers and Brenda L. Wolfe
All rights reserved. Published 2004
Printed in the United States of America
No portion of this publication may be reproduced in any manner without the written permission of the publisher
Library of Congress Cataloging-in-Publication Data
Meyers, Robert J.
Get your loved one sober : alternatives to nagging, pleading, and threatening, / Robert J. Meyers, Brenda L. Wolfe.
p. cm.
“The program described in this book is based on the Community Reinforcement and Family Training (CRAFT) therapeutic model”—P. .
Includes bibliographical references and index.
ISBN 1-59285-081-2 (paperback)
Ebook ISBN: 978-1-59285-775-3
1. Alcoholics—Rehabilitation. 2. Alcoholics—Family relationships. 3. Codependency. 4. Change (Psychology) 5. Self-control. 6. Narcotic addicts—Rehabilitation. 7. Narcotic addicts—Family relationships.
I. Wolfe, Brenda L. II. Title.
HV5278.M28 2004
362.292'3—dc22
2003057149
08 07 06 05 04 6 5 4 3 2 1
Editor's note
The stories in this book are composites of actual situations. Any resemblance to specific persons, living or dead, or specific events is entirely coincidental.
Cover design by Theresa Gedig
Interior design by Rachel Holscher
Typesetting by Stanton Publication Services, Inc.
Authors' Note
The program described in this book is based on the Community Reinforcement and Family Training (CRAFT) therapeutic model, which has been evaluated in multiple clinical trials (see references) and found to be an effective intervention for the concerned family and friends of substance abusers. Nonetheless, no guarantees, explicit or implied, are given that the reader will experience outcomes similar to those seen in clinical work. This book is not a substitute for therapy.
To those people who have taught me and continue to teach me about the meaning of life: my mother, Evelyn Fritzsche Meyers, my sons, Nicholas Andrew Meyers and Oliver Joseph Meyers, and most of all, my wife and partner, Jane Ellen Smith.
—Bob Meyers, Ph.D.
As always, my work is dedicated to the many teachers who have both instructed me and molded my thinking over the years, and to my family who is my true source of strength.
—Brenda L. Wolfe, Ph.D.
Contents
Acknowledgments
Can This Book Help You?
A Note from Bob Meyers
Chapter 1: The Program
Chapter 2: The Road Map
Chapter 3: Play It Safe
Chapter 4: Pick a Destination
Chapter 5: The Driver's Seat
Chapter 6: Let the Good Times Roll
Chapter 7: Disable the Enabling
Chapter 8: Problem Solving
Chapter 9: Communication
Chapter 10: Behavior Basics
Chapter 11: Treatment
Chapter 12: Relapse Prevention
References
About the Authors
Acknowledgments
I would like to acknowledge the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) for their support and encouragement on all the CRAFT research projects. I would also like to thank all the knowledgeable and hard working staff at the Center on Alcoholism, Substance Abuse, and Addictions (CASAA), especially Matt O'Nuska, Roberta Chavez, and Erica Miller. I especially would like to thank my colleague and friend Bill Miller without whom the CRAFT research would have not been possible.
—Bob Meyers, Ph.D.
First and foremost, I wish to acknowledge all the patients who have honored me by allowing me to enter their lives and learn from their experiences. After book learning is done and exams are passed, it is ultimately the patient who creates the clinician. I wish also to acknowledge my coauthor, Robert J. Meyers, for his passion and commitment to this project. If ever there was a soul behind a program, Bob Meyers is the soul of CRAFT. Working with him to offer this effective program to the public is a joyful way to give back to the patient community that has given so generously to me.
—Brenda L. Wolfe, Ph.D.
Can This Book Help You?
If you live with or love someone who drinks or drugs too much, this book can help you. This book offers you a program that has been proven to help people whose lives are affected by a problem drinker, a drug user, or someone who does both. If you feel stuck in a hopeless, substance-ruled life, this book can help you. If you have ever called, or wanted to call, a crisis line, clinic, or hospital and said, “Help, my husband is drinking himself to death” or “Help, my kid stays out all night getting high, and I'm scared to death,” this book can help. You will also find help here if alcohol or drugs are destroying your marriage or scaring your children. Whether
you are the wife, husband, lover, parent, son, daughter, or friend of an alcoholic or drug user, this book offers you the tools both to help you help your loved one find the path to sobriety and to improve your own life.
Throughout the book you will notice that we primarily illustrate our points with alcohol abusers. The program, however, has been proven to be effective with loved ones who abuse a wide variety of substances ranging from alcohol and marijuana to heroin and crack. Thus, you can effectively apply the program to your loved one regardless of the substance of abuse.
If you have “tried everything” and nothing has worked, but you are not ready to give up, then you are in the right place. The scientifically validated program on which this book is based has been designed specifically for people who feel they have “tried it all.” They have scolded, nagged, begged, bribed, detached, and tried a few tricks not fit to print. Just like you, they love their drinkers enough to keep trying and trying. What they have not done (and what we will teach you to do) is use that love to change the way they and their drinkers interact so that they spend less time feeling miserable and their loved ones discover the pleasure in being sober. From where we sit, that's an awfully good deal. We are confident that you will also find it to be so.
Of course, we cannot guarantee that every single problem will be solved. What we can promise is that we will teach you skills to regain control of your life and to offer your drinker the best help available. In some cases, applying these skills does not result in complete abstinence and happily-ever-after—but in most cases, it does result in a better life for you and in sobriety for your drinker. The happily-ever-after is up to you and your loved one to create.
To keep their discussion uncluttered, the authors primarily refer to drinkers for the rest of the book, rather than to drinkers and drug users. The material is equally applicable to both groups, although extra caution should be taken in cases where the user's lifestyle is centered around violence and criminal activity.
A Note from Bob Meyers
For the past twenty-seven years I have devoted my professional life to the study and treatment of substance abuse. As you might suspect, my interest in this area comes from personal experience. I grew up in a household that was dominated by alcohol abuse. In my home, it was my father who drank. As far back as I can remember, our family life revolved around his drunks and my mother's efforts to get him sober. As you can imagine, life was no picnic. I watched my mother suffer; she yelled, nagged, pleaded, and threatened—all to no avail. My dad continued to drink, and I escaped by joining the navy at seventeen. Sadly, when my mother died at the young age of forty-five, my dad was still drinking. She never realized her dream of a “normal” life with him. I have always felt that his drinking somehow contributed to her early death. My goal as a scientist and clinician is to help other families avoid the pain that mine has suffered.
Although my mother was blessed by the support and comfort she found in Al-Anon meetings,* she was never able to achieve her most cherished goals of getting my father into treatment and getting him to stay sober. It is to her, and the millions of other families that are tortured by substance abuse, that my work and this book are dedicated.
Most substance abuse treatment programs are designed for the individual who is ready to give up his or her substance use. That is, most programs operate on the assumption that the individual has already decided that clean and sober are more attractive than getting high and is now entering treatment to find out how to achieve that goal. If this were true, which it is not, the success rates of these programs would be much more impressive than they are. As it stands, most users refuse to enter treatment and of those who do, most drop out after just a few sessions. Part of the reason for this is that many of the people who enter treatment are there through coercion (court-ordered or threatened with divorce or abandonment, for example) and not because they see a personal benefit to participation. They make the appropriate noises but remain in denial about how their drinking or drug use is preventing them from enjoying a more satisfying life. Thus, they quickly drop out and return to their treatment-resistant stance. What has been missing from the treatment field are programs to teach those of us who love drinkers and drug-abusers to help them see the benefits of treatment, to help them be ready for and open to change.
Historically there have been few options for those individuals seeking help for treatment-resistant loved ones suffering from substance abuse. Most treatment options either focus exclusively on helping the concerned family member take care of him- or herself or helping him or her talk the user into treatment. In fact, there have been very few programs designed to teach family and friends (we call them Concerned Significant Others, or CSOs) how to encourage their substance abusers to enter treatment. Moreover, until now, there have been no programs that help the CSO take care of him- or herself and teach him or her how to get the drinker into treatment.
The past ten years of my career have focused on developing a treatment program that both helps CSOs improve the quality of their lives and teaches them how to make treatment an attractive option for their substance abusers. Working with other dedicated scientists and clinicians, we have developed a multifaceted program that uses supportive, nonconfrontational methods to engage substance abusers in treatment.
Called Community Reinforcement and Family Training (CRAFT), the program we developed uses scientifically validated behavioral principles to reduce the loved one's substance use and to encourage him or her to seek treatment. Equally important, it assists the CSO in reducing stress and introducing meaningful new sources of satisfaction into his or her own life. The results we have had with CRAFT have been extremely rewarding. Most clients (CSOs) find new joy in their lives from the changes they make for themselves, as well as from the satisfaction of seeing their loved ones begin the journey to healing.
Let me briefly describe some of the research that has supported CRAFT as a successful model of engaging substance users in treatment. In one recent trial funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 130 frustrated family members were randomly assigned to one of three treatment groups (Miller, Meyers, and Tonigan 1999). One treatment group was structured to simulate the type of support and guidance CSOs would traditionally receive from attending Al-Anon meetings. Specifically, it encouraged involvement in the Twelve Step program with the focus on getting the resistant drinkers to enter formal treatment, along with teaching CSOs about denial, detachment with love, and codependency issues (Nowinski 1998). The second treatment group was the Johnson Institute Intervention (Johnson 1986), which prepared the CSO for a confrontational family meeting with the drinker that hopefully would lead him or her to enter a formal treatment program. The third treatment group was CRAFT, which taught the CSOs new strategies for guiding the substance user into treatment at the same time it guided them in attending to their own needs. All three treatments were delivered one-on-one and included up to twelve hours of therapy. The outcomes we were interested in were twofold. Obviously, we wanted to see which approach resulted in the greatest number of loved ones agreeing to enter treatment for their substance abuse. The other outcome of interest was what impact the treatments had on the CSOs' quality of life.
The graph in figure 1 shows the impact of the three treatment approaches on the number of drinkers, initially in denial, who entered treatment. As you can clearly see, CRAFT resulted in approximately two to six times the number of loved ones willingly engaging in an alcohol treatment program. Compared to a 64 percent success rate for CRAFT, the Johnson Institute approach only resulted in three out of ten drinkers in that group engaging, and the Al-Anon approach engaged barely more than one out of ten drinkers.
The impact of the three approaches on the CSOs themselves is equally interesting. In this study we measured depression, anger, family cohesion, family conflict, and relationship happiness. In all cases, we found that at three and six months after treatment, CSOs reported they were much happier, less depress
ed, less angry, and had more family cohesion and less family conflict than prior to treatment (Miller, Meyers, and Tonigan 1999).
Since things worked out so well with the alcohol dependent population, our next step was to evaluate the program with drug abusers (Meyers et al. 1999). The National Institute on Drug Abuse (NIDA) funded a study to determine whether CRAFT would show promise with this population. Everyone who volunteered for the study received CRAFT treatment.
Over the twenty-four months of the study, CSOs whose loved ones were drug-addicted and in denial worked through the CRAFT program. The results were even better than expected. Of the sixty-two CSOs who participated, 74 percent succeeded in engaging their loved ones in treatment. In addition, all CSOs reported significant reductions in anger, anxiety, depression, and negative physical symptoms. Regardless of whether their loved ones entered treatment, the CSOs themselves felt better. As I think back to the pain I watched my mother endure all those years (not to mention my own distress), I cannot help but wish she had had this kind of help. Even if she had not succeeded in dissolving my father's denial, how wonderful if she could at least have learned to take care of her own needs (in spite of him) well enough to enjoy life.
In another study that looked at treatment-resistant drug abusers (Meyers et al. 2002), we randomly assigned family members to one of two types of treatment, each of which were offered in the same clinic and provided twelve individualized treatment hours. One of the treatments was based on Nar-Anon and Al-Anon and emphasized getting the substance abuser into treatment. The second group received CRAFT therapy. Again, there were positive changes in CSO psychosocial functioning. CSOs who learned the CRAFT approach were able to engage their loved ones into treatment at more than double the rate of the comparison approach. In this case, the CRAFT-trained CSOs happily saw 67 percent of their substance abusers enter treatment while the Nar-Anon/Al-Anon group engaged only 29 percent of their loved ones. Our conclusion, based on the research I have described as well as other studies conducted over the past years, is that CRAFT truly represents a new, effective means of helping people just like you improve the quality of their lives—by developing meaningful self-care and seeing their loved ones get the help they need to live more fully.
Get Your Loved One Sober Page 1