Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening is based on a model that research has proven to be effective. The generic description of the program you have been working through is cognitive-behavioral therapy or skills-training therapy. At our clinic, the program is called Community Reinforcement and Family Training (CRAFT) and grew out of an earlier program called Community Reinforcement Approach (CRA), which directly treats the drinker. CRA continues to be the treatment of choice in our clinic and has helped a great number of problem drinkers replace alcohol with a positive lifestyle.*
You can find programs similar to CRA and complementary to what you have been doing here by looking for treatments that include phrases in their descriptions such as “social skills training,” “behavioral marital therapy,” “cognitive-behavioral treatment,” “rational-emotive therapy,” “motivational treatment,” or “solution-focused therapy.” It is important to keep in mind that different treatment centers and providers will have their own “spin,” so to speak, on the treatment models. That is, they will offer programs of different lengths, different delivery formats (individual, family, group), and likely use slightly different language to describe what may well amount to the same treatments. As you investigate the various options in your community, remember that you are looking for treatment to help your loved one figure out the triggers and reinforcers of her unhealthy behaviors, teach her how to change the triggers and reinforcers that can be changed, and teach her how to change her responses to those that cannot.
There are hundreds of treatment programs from which to choose, and it is beyond the scope of this book to even begin to describe each and every one. Suffice it to say, however, that the program you select should minimally address the three skills just listed and also be a comfortable place for you and your loved one. Do not be shy to call around, ask questions, interview providers, and ask about ancillary services the program may offer. You are the “customer” and have the right to make sure that you are selecting the best “product” for you and your loved one. Use the phone directory and look up alcohol and drug rehabilitation or mental health centers. Also check with the local state alcohol and drug agency.
Over the years there has been much debate about whether inpatient or outpatient treatment works best. From a cost-effectiveness standpoint, however, it does not look as though inpatient therapy (which is considerably more expensive than outpatient) adds much to success rates (Miller and Hester 1986). Nonetheless, you should explore all options, as there is no single best way, and what works or does not work for your neighbor may or may not work for you. Before you set your heart on any one facility, however, check with your health insurance to see whether it is covered.
There is a fair degree of variability in outpatient programs. In addition to the different approaches they may take, you also have choices about the structure. They might offer once a week sessions for individuals, group therapy, or evening sessions to accommodate work schedules. Many programs also provide day treatment programs that require attendance from morning to mid- to late-afternoon each day. Many outpatient programs require patients to attend self-help groups such as Alcoholics Anonymous (AA) in addition to therapy, and some outpatient groups use a Twelve Step format as their treatment. The bottom line on all treatments is that they cannot work if the drinker does not attend and participate long enough to let them work.
In addition to an active treatment program, many people find it helpful to make use of a good support group such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) for your loved one, and Al-Anon and Nar-Anon for you. In fact, the social support and help with structuring time that formerly was spent drinking or drugging is tremendously helpful to many people.
Interview Treatment Providers
Once you decide on the best approach for you and your drinker, take the time to interview a few different treatment providers who fit your ideal model. Different therapists using the same approach will work differently with different clients. Let the therapists you want to interview know what you are doing. Most will be willing to meet with you (often without charge) to discuss their approach. At minimum, the provider should be willing to spend a few minutes with you on the telephone answering your questions about his approach.
When you interview treatment providers, ask any questions that come to mind, and voice your concerns. (In fact, prepare a list of questions ahead of time so that you don't overlook anything.) A good facility (or therapist) will not only welcome your questions but will help you think of questions if you are unsure about what to ask. It is in the facility's best interest to ensure that all clients understand what it has to offer and how the program works.
The more obvious questions to ask include the following:
How much does the program cost?
Does my insurance cover it?
How long is each session?
How frequently will my loved one attend sessions?
You will also want to know whether treatment is given in groups only or whether there are options for individual, couple, and family therapy.
If your loved one has been a heavy drinker for a long time and shows signs of physical dependence, she might need to be admitted to a hospital or detoxification unit before treatment can begin. You should find out if the treatment facility has access to this type of medical support. If not, ask how you could arrange for it in addition to psychotherapy.
Drinking often masks other problems such as depression or anxiety disorders, and when an individual stops drinking, these problems become evident. Thus, it is important to ensure that the program has the appropriate personnel to deal with mental health issues. In some cases, the individual will require medications to help him through the difficult withdrawal and readjustment period.
Ask the therapist to describe her philosophy and give you a detailed description about the treatment itself. Our recommendation, based on scientific research, is that you seek treatments that fall into the categories of behavioral therapy or cognitive-behavioral therapy, either for the individual or couple or family. If you are considering another approach, or someone is trying to talk you into one, ask this person to give you a list of the published outcome research supporting the treatment. Find out as much as you can before deciding.
You will also want to know what the therapist's qualifications are. Is the therapist a certified alcohol counselor or a licensed psychotherapist? If not, we would recommend looking elsewhere. You should also find out how long the individual has been working with problem drinkers. There is no perfect amount of experience to look for, but unwillingness to give you this information is a flag to look elsewhere. There are pros and cons to more- and less-experienced therapists. More experience can translate into greater effectiveness, but newly graduated therapists tend to be more up-to-date in the field. It all comes down to finding someone you are comfortable with and feel confident in.
Finally, ask how the therapist plans to involve you in the program. If she seems surprised at the question, this is not the therapist for you. You need someone who will work with both of you (and other family members as needed) to change not only the drinker but also the drinker's environment. Changing one without the other is not a recipe for success.
Windows of Opportunity
With treatment ready for when your loved one indicates readiness, you can begin to start looking for those windows of opportunity. That's right. You do not rush home to inform your drinker that you have found a fabulous treatment plan. If you have ever tried this before, you know what the response is likely to be.
The best way to avoid rejection and increase the likelihood your drinker will be open to the idea of treatment is to watch for those moments when his motivation peaks. Those might be times your loved one is particularly disgusted with himself or when the two of you are getting along particularly well and your drinker wants to please you. You know your drinker best so be alert for receptive moments.
Just as you carefully
plan and practice the changes you make to improve the way you relate to your drinker, finding the windows of opportunity to suggest treatment also requires careful thought. As we said, you know your drinker best, so we cannot tell you what to look for. However, we can guide your thinking with the questions in Activity 22. Linda was pleasantly surprised to realize that there were actually a number of conditions under which she thought Ron would be receptive to the idea of therapy. Read her answers in the example and then write down your answers in your notebook.
Activity 22. Open That Window
When would your drinker be most likely to try something new in the way of treatment? Probably toward the end of one of our late-night relaxed chats.
Is there a particular time of day he/she is most relaxed? Late night.
Would your loved one be most open to discussing the possibility of treatment when the two of you are alone or with others? If with others, with whom? Alone.
Would your drinker be most open to treatment after a few days of sobriety or while suffering the aftermath of a major drunk? I think when he's got a hangover.
Is your drinker most open to your suggestions when the two of you have not fought for a few days or when making up from a fight? When we've not fought for a few days.
Would your loved one be willing to enter treatment if it were for your relationship? (This would be what we call a “backdoor” approach—doing it to improve the relationship and coincidentally also improving the drinker's health and behavior.) Don't think this is relevant.
Review past attempts to get your loved one into treatment. What worked? What did not? Tried plenty of times to talk him into it, argued, yelled, belittled. Nothing worked.
Once you identify a few situations (or moods) that you think would be conducive to suggesting treatment, play various scenarios through your mind. Try to anticipate with as much detail as possible what the setting will be, what you will say, and how your drinker might respond. Be sure to think it through. What will you say if she responds positively, and what will you say if she responds negatively? In other words, plan, plan, plan!
For example, you may have noticed that your drinker feels really guilty after being ugly toward you, and you think this would be a good time to suggest treatment. The conversation might go something like this.
Drinker: I didn't know what I was doing. I'm so sorry. How can I make it up to you?
You: Actually, there is something you can do. I know you didn't mean to hurt me, but you did. I have a therapist who can help us stop doing this. I really want us to go together. Would you be willing to give it a try?
Drinker: Yeah, I guess so.
You: Thank you so much. I'll call right now for an appointment.
If the drinker hesitates, a good response would be the following:
You: Let's go just once or twice to see if it helps. If you really don't like it, we can stop.
Drinker: Okay, but I'm not promising anything.
You: That's okay. I just really appreciate your willingness to consider it. That makes me feel good.
The fact is that the drinker will stop treatment anyhow if he dislikes it, so there is no point in insisting. Your loved one has control over where and when he does what—so acknowledge that control. Demanding that someone does something typically results in his wanting to do just the opposite. In our experience, we have found that once the drinker gets into treatment and the therapist eases his fears, the person accepts help. It is getting him in the door the first time that is hard.
It is best not to ask if your loved one wants to go for help. Make the statement matter-of-fact—but do so in a nurturing, responsibility-sharing way rather than a dictatorial one. Offer treatment as something that will make your life together better rather than as something that will fix your loved one's “defect.” Here is another example.
It is Saturday morning and you are home with your loved one. Although she drank last night, she isn't hungover and is in a good mood. You offer to fix her favorite breakfast and keep the mood upbeat as you talk about common interests. If your loved one's good mood continues and you feel the time is right, you may have this conversation:
You: It sure is peaceful around here this morning. I enjoy the quiet.
Drinker: Yes, it is peaceful this morning.
You: I have been doing some thinking lately. I feel that things have been going better between us, but I would like them to get even better. I really love you.
Drinker: I love you too.
You: I have been going to a therapist to help me sort things out. I think it's helping.
Drinker: I didn't know you were going to a therapist. What's going on?
You: Well, I love you so much I want to do everything I can to make our life happier. Wouldn't you like to make our life together happier?
Drinker: I hope this isn't going where I think it's going. Things are going fine this morning. Can't you just leave things alone?
You: I just want things to be as good as they can be. Would you be willing to come with me just once to meet my therapist? Do it for us.
Drinker: Is this some sort of marriage counseling? We don't need that crap; we're doing fine.
You: We are doing fine, but we can do better. Going with me once isn't going to hurt you.
Drinker: I'll think about it. Can we change the subject now?
You: Sure. We can talk about it later.
In this example we model how to keep the interaction positive and avoid confrontation. Remember, go with the flow. Don't force the issue if your loved one resists. Once the ice is broken, it will be easier to raise the subject the next time a window of opportunity opens. It may take several tries until your loved one accepts help, but if you avoid fighting over the subject, you can continue to raise the issue until your loved one agrees.
You can even continue to up the ante according to your sense of the situation. You can become more forceful (not confrontational) as you sense his resistance weakening, or you can increase the promised rewards. You can also decrease what you are asking of your drinker by moving from “come to therapy with me” to “come for one session” or simply “talk to my therapist on the telephone and find out what she has to offer.” Some drinkers are also enticed to meet the therapist by being told that the therapist has heard so much about them, the therapist just wants to meet them. There is no limit on how creative you can become to prop that window of opportunity open and entice your drinker to step through.
In working with clients over the years, we have found a few strategies that work well with most people. As always, though, evaluate each one for how appropriate it is to your situation. Only the first two suggestions apply to everyone.
Safety first. No matter how carefully you plan your treatment suggestions, abandon your plans in a flash if your drinker shows signs of turning violent. Drop the subject, soothe him, and save your breath for next time. There will be a next time and the goal is for you to be able to take advantage of it.
Make sure the therapist and program you have selected will feel comfortable to your drinker. That is, don't arrange an evangelical therapist for an atheist drinker or group sessions for someone who suffers social anxiety. Try to find a comfortable match between the therapy/therapist and your loved one. On the other hand, be prepared and prepare your drinker for a tough process. Change, as you know, is tough. However, keep in mind that the objective here is happiness, and most things worth having do have a cost.
If you are in therapy, it sometimes helps to let your drinker know and invite her to join you. Remember, though, to use a PIUS communication and make it a positive invitation. You might say something like, “I've been in therapy because I'm having a hard time, and it would be great if you could come too to help me…. My therapist would love to meet you.”
Another option if you are in therapy is to have your therapist call your loved one with an invitation to attend a session. Again, the invitation should be positive in that the therapist's objective is to meet an import
ant person in your life to better understand your relationship. Furthermore, ask your therapist to simply invite your drinker to one session. If the session goes smoothly and your drinker seems comfortable, then he would be asked to return for a second session.
If you are not in therapy, you can introduce the topic by asking your drinker if she would be willing to talk to a therapist with you. Instead of laying everything on the drinker's shoulders (“You need treatment because you are a drunk”), emphasize your commitment to the relationship and to doing what it takes to live happily together (“I really want to be a better partner in this marriage, and it would help me if you came to talk to a therapist with me.”) Once your loved one has agreed to work on improving your life together, addressing alcohol will become a natural part of that process.
If the drinker has refused to come to treatment but knows you are involved in a program, you may give him a card with a scheduled appointment for him. This sometimes carries more weight than a verbal invitation. If your loved one misses the appointment, you can always discuss it later and possibly make another.
You may mention that you heard about a new/effective/interesting program and invite your loved one to try it with you—no strings attached.
If your loved one has been sick, you can say you are concerned about her health and would she at least seek help for the physical problems.
Appeal to your loved one's loves. Ask him to get help for job security, the children, your marriage, your sex life, his health, and so on. Often, the most powerful incentive for change is fear of losing one's greatest loves.
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