Written by David Partington.
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It must be fourteen years ago that I learned a vital lesson about helping addicts. I had been walking along a road trying to persuade M to return to Yeldall Manor, the drug rehabilitation centre where he had been for the last few months. I didn't plead with him to return, but it must have sounded that way. He still kept on walking towards London, and I had to return to the Manor to cope with my anger and frustration about the waste of my time and everyone else's time - and, somewhere in it all, my concern about M and whether he was going to be OK.
The lesson I learned then is simply summed up by Dick Schaeffer in Choices and Consequences: ’You sat on the burner, baby; now you sit on the blisters!’ What this means is that every addict has the capacity to accept responsibility for themselves. If you got the ‘blisters’ by being foolish enough to do something you knew was going to cause you pain, you need to accept responsibility for that, learn from your mistake, and build for the future.
That's what this section is all about: creating a family environment or framework in which the addict or alcoholic can learn to face reality and accept responsibility for their own actions. The beauty of it is that it's when they begin to learn to accept responsibility for themselves that they begin to make the biggest strides into freedom.
Speaking the truth in love
The addict has often created a fantasy life around themselves. The alternative is to accept their life for what it really is - unfair, unloving, unattractive, boring. It's for this reason that we need to create a home and family environment in which truth and reality prevail. If we don't, we will continue to reinforce the wrong attitudes in the addict’s life and circumstances. It means speaking the truth in love - but not from an attitude of judgment and bitterness, and that's never easy. Speaking the truth in love threatens not only them, but our own security. But it’s essential if real change is going to take place.
Some time ago now I began visiting a particular friend, an ex-resident of Yeldall Manor, to seek to help him get back on track after slipping into reusing. I was some weeks into giving that help when I realised he wasn't ready to change. He hadn't made the choice to take responsibility for making changes in relation to his wife, his home and his work - changes which would be uncomfortable, but which were essential for everyone concerned. I had to say to him, with difficulty, ‘I hear you saying you want things to be different, but what are you prepared to be and do which is different?’ We agreed that it would be better to continue the counselling at a later date, whilst being friends in the meantime.
As I'm writing this, that friend is making dramatic strides, not only in terms of choosing the discomfort of stopping the drugs he was using, but in making those other vital decisions which are making a major, positive difference for his wife, his home and his work situation. But he had to choose.
Agreeing on ‘bite sized chunks’.
At Yeldall Manor we've learned over the years to help residents do things in ‘bite sized chunks’. For instance, we don't expect a heroin addict to give up smoking immediately they come in. Realism demands that we look at the facts - they are giving up a drug which has dominated their lives for years. Once they are through the physical and psychological addiction to heroin, we can help them face up to the issue of giving up tobacco. (This doesn't mean we allow the addict to do what they want with impunity; concern for non-smokers in the house, as well as fire hazards, require us to expect that anyone needing to smoke does it outside!) So don't push too hard for change. Try not to get involved in discussing life-changing developments which are too big too soon. They may well see that changing their job, flat and even their partner is the answer; but your job is to communicate reality. The next appropriate step may simply be for them to get an alarm clock to help get them up in the morning; to get to work punctually time so that their boss doesn't keep giving them a hard time. Instead of changing their accommodation, it may be that they need to clean it up or spend time decorating it. In order to begin to put relationships with their partner right, maybe what they need to do is simply to say sorry!
Allowing them to hit rock bottom.
Every instinct within us understandably wants to protect those we love from discomfort or suffering or pain. But, if you want to see the family member who is addicted find real freedom, then you're going to have to get used to gritting your teeth so they hit rock bottom much quicker. The fact of life is that, until they come to the place where they themselves realize the desperation of their circumstances, they will continue to deny reality and refuse to acknowledge how bad the situation is. And little will change!
It is never easy to refuse a lift to the station to a resident who wants to leave Yeldall Manor. But it's part of our rules. The reason is simple: the mile walk to the bus stop has been enough to help residents accept the fact that they prefer to face reality in the security of our programme rather than in the harsh world outside. Facing reality is not a quick fix, it's often a long painful road. But it's a road that leads to freedom not continued addiction.
Breaking your own old habits
It will take some time for you to break your habits when it comes to helping someone face their responsibilities. But it's worth doing. Only when you sit back and let them come face to face with reality will they begin to choose to really change; when you:
· Leave them to clear up their own vomit.
· Let them wash their own soiled clothes.
· Let them phone the boss or school and tell them why they can't come in.
· Choose to allow them to take responsibility for their lies.
· Leave them to pay their own fines and deal with their own debts.
· Tell them that they must tell the children why they can't keep a promise.
If they won't accept responsibility?
If they won't clean up their own vomit, what do you do? The answer depends a great deal on who is affected by their refusal to accept responsibility for themselves, and by their failure to respect others.
If it’s only you, and you can live with the mess, then leave it and give them time to face reality. If there are other members of the family around, then you have responsibilities to them too, and a different response may be appropriate:
· If the vomit is in a shared bedroom, then the other person may need to move out.
· If they won't provide money for housekeeping, then it may be appropriate for them to buy and cook their own food.
· If they won't pay their fines or debts, and other people’s security is threatened (e.g. if your joint bank account is frozen), then it may be necessary to open a completely separate bank account, and even seek legal advice to protect others involved.
When it comes to facing reality, another vital issue is this: If the addict in the family can get away with things, what message are you sending to other members of the family, especially your children?
Helping them face their responsibilities may not only demand some radical steps but actually working out a written contract between yourself and the addict. This is used in many rehabilitation settings like Yeldall Manor, and is even being used in school and legal situations to help young people in the early stages of drug and alcohol abuse.
The vitally important issue about a contract is that it is not imposed but is an agreement between two parties - you and the person with the drug or alcohol problem. And, it is written down, and has a set period in which to operate.
The major reason for a contract is that it reinforces positive action and communicates the fact that there is a partnership involved. But other functions that contracts perform for the addict are as follows:
· They help to develop a sense of responsibility.
· They reinforce trust, because everyone has a written, rather than vague, assumption to refer to.
· They help those involved to be aware of progress or the lack of it.
Implicit in any contract are basic issues which are non-negotiable, including agreement not to use alcohol or drugs of any description. It should also include what consequences are forthcoming if the contract is broken. It is vital that a contract is signed by the person who needs to agree to abide by it.
Contracts should have a limited ‘shelf-life’ in that, if they are entered into positively, they will result in real progress. If they are discovered to be too difficult to live with, or too easy in that they fail to bring about any appropriate change, they can be altered. Here is a sample of a basic contract you might use:
I _________ agree to abide by the following conditions from __________
until __________, and I promise that:-
1. I will not drink alcohol of any description
/ I will not use drugs of any
description other than those prescribed.
2. I will not verbally and physically abuse anyone.
3. I will attend school between ________ and ________
4. I will agree a time to be home before leaving the house each time.
5. I will do my homework before ____________________
The consequences for not abiding by the agreed rules could include:
· Restricting the times they are allowed out.
· Refusing access to the family vehicle.
· Limiting TV to certain times, e.g. until after homework is finished.
· Reducing their pocket money or allowance.
These are only examples, and the agreed consequences need to be tailor-made for the family member and circumstances. It's also important that, if the contract is continually broken, you will need to review those consequences and think very seriously about making them more uncomfortable. If on the other hand there is very real progress in terms of attitudes and action (not just words), then you can write a new contract which reflects this fact.
Contracts are Two-way
Contracts should not be one-sided, i.e. where the addict does all the work. It may be important to draw up a contract which reflects conditions for both parties, for parents as well as for a child. For instance, it may be very appropriate for everyone to agree that:
· No one in the family uses drugs or alcohol.
· There is a specific night, each week, when everyone stays home.
· No one is physically or verbally abusive to anyone.
· Everyone agrees on the amount that each person will provide for housekeeping etc.
The important issue in all of this is to work together for mutual change, respect and understanding. None of it works through threats or bullying, or because someone promises something they can't realistically deliver. But, when it’s all been agreed, someone has to pay the cost of making it work, and that's painful.
How far do you really have to go to bring about real and lasting change? It's really summed up in a story told by Gerry Dunn in God is For the Alcoholic:
‘A couple who faced a situation of this sort came to me some time ago and asked me to marry them. Although they were both in their fifties, neither had been married before. Moreover, the man was an alcohol addict who had been dry for only six months. I knew him well since I had been counselling with him for three years.
”Sally has wanted to marry you for five years,” I reminded him, “but she has refused because of your drinking. If you are going to get married there has to be an agreement that you will not drink.”
He nodded readily.
“If you take so much as a thimbleful of liquor, you should be out of the house.’ Both of them agreed that this was the only basis upon which they could have a happy marriage.
They had been married nine months when Tom took a glass of wine. Tearfully Sally asked me over the phone, “What should I do now?”
“You know what the agreement was,” I reminded her.
She packed his clothes and put him out of the house. “When you're through drinking and ready to try to live a sober life again, you can come back,” she said. “But not before.”
She threw him out of the house ten different times in two and a half years before he finally yielded to the Lord. “I was lying on a hospital bed alone,” he said, “when I realised that there was only one way I could be free. So I said, “God, you take my life.”
Today he has been completely delivered from addiction, and there is joy in that home because a wife stood firm.’
I do hope you don't have to go through the pain described in that story. It isn't an easy process helping someone choose real freedom from addiction; but there's plenty you can do to help them.
Phases of change
Change, in anyone's life, is almost always gradual rather than immediate or dramatic. And a well planned process can result in longterm, positive change, especially in the case of breaking free of drugs or alcohol. But recognizing that it is a process of gradual rather than rapid change can be liberating for everyone involved, and save us all from unrealistic demands and expectations.
The following process is given as an outline, and it therefore needs to be read, agreed and adapted, preferably by both parties involved. It involves four different phases:
· Phase One - Thinking about Giving-up
· Phase Two - Making Preparations
· Phase Three - Giving-up.
· Phase Four - Staying Free
It's not a process which can be forced upon anyone, and I would therefore repeat that it's well worthwhile, at the right time, spending a lot of time discussing how the addict is going to work through the different phases.
Phase One - Thinking about Giving-up
‘Risk is the tariff for leaving the Land of Predictable Misery’, says Howard Figler. It is because there are no magic cures or easy answers to addiction that you need to help the addict face reality about the real cost of giving up drugs or drink.
Realism about themselves and their real condition is no easy option for someone to face; but we have to help them see that it is better than living in a fantasy world, while life slowly drains away from them. I don't only mean their physical life draining away, but their mental and spiritual capacity - their whole potential in life. It means helping them see they have demeaned themselves by their addiction, and have denied that which is unique in them. It means helping them see that they are not in control, and much of their life is a sham. But they (and especially we) also need to learn that giving up drink or drugs is going to be harder than giving up other things that people get hooked on. Addiction to gambling, sex, pornography or food are difficult enough to break free of; but the drug or alcohol addict also has to cope with the fact that chemicals are involved. They have to get their head around the fact that, when they stop taking the drugs, their body is going to take time to adjust.
Thinking about giving up means everyone spending time working out their real motives. If they are giving up for someone else’s sake, then they need to seriously ask whether that will sustain them through the withdrawals. Will doing it for someone else help them cope with everyday life without the drink, or without a regular fix? Giving up because you nag them is not a good reason either - but thinking about what a real difference it could make to them personally is a different matter. Helping them see that being straight will also bless others is a part of it too. There's something profoundly fulfilling about loving others selflessly which will bring a very powerful sense of fulfilment and meaning to their lives.
Phase Two - Making Preparations
No matter how desperate the addict - and you - may be about them finally giving up on drugs or drink, you both need real patience for Phase Two. It's all about building foundations, and the more care and time everyone gives to build those solid foundations, the more likely there is to be real and sustained success.
Phase Two is about changing their thinking, but also about taking practical steps. Thinking about all the benefits of giving up is vital; but they can also begin to cut down on the cigarettes, or the drink, or drugs, trying to reduce by a half, a quarter or a tenth of their normal intake every week or every month. Spend time getting them to work out options which are realistic, and so stand a much greater chance of sustained success.
Phase Two is putting into practice actually saying NO rather than talking about it. They can begin by saying, ‘No thanks I really don't want to go out tonight’, or ‘I am going to give it a rest tomorrow so don't call for me’. This phase is all about them learning to be true to themselves by saying NO and meaning NO. It is going to prepare them, and other people, for the fact that this is a very serious commitment to a drug- or alcohol-free future.
Breaking the fantasy cycle
The addict or alcoholic has a fantasy cycle - like the rest of us! Our fantasy cycle relates to the time when they have actually given up, when life is going to be completely trouble free! For them, their fantasy cycle is thinking about their next fix or next drink, building it up in their mind to be something really special. Deep down they know it’s not really going to be that good, but fantasy has become part of their survival routine.
Helping them break their fantasy cycle is helping them to choose to be more realistic about the facts, not the fantasy. It’s getting them to talk about the hangovers, the withdrawals, the vomit, the chaos and confusion. It's patiently helping them to look at the sheer hassle of finding money to pay for their drink or drugs, plus the lying, the cheating, the always looking over their shoulder. The difficulty for you will be helping them to do that without being condemnatory and exposing your own frustration at how long it's taking them to break free.
Breaking the fantasy cycle is also about learning that what is submitted to grows stronger, and what is resisted grows weaker. The addict needs you to help them think about life differently, that they can actually resist, by:
· Working out how they will avoid temptation by keeping away from certain places or specific situations.
· Beginning to mix with different people, choosing to build relationships with people who are drug or alcohol free.
· Making use of those services which will help them make the decision to stop, e.g. self-help groups.
· Starting to talk differently, on the basis that ‘they are what they talk about’.
· Honestly looking at their habits and getting into different ones, e.g. taking a pride in their appearance.
· Reorganising their diary or timetable so they begin to fill their spare time with more positive things, e.g. keeping fit.
· Starting to take more interest in their work, how they can do it better.
· Starting to care for others more.
· Taking responsibility for who they are and what they do, instead of blaming everything that's wrong on everyone else.
The final part of Phase Two is to plan the actual period when they will give up, often called the detox period (de-toxification process). In order to ensure this is as successful as possible they need help to work out the right time to do it. They may for instance need to take time off work or school. They may also need to work out the right time in relation to other activities (e.g. make sure it is not during A levels!). If they have been addicted to drugs or alcohol for more than a year or two they will need to allow at least two weeks for detox. To maximise on success they will also need to consult with a doctor so they can verify the realistic amount of time needed.
It will also help if they build up plenty of solid support from yourself and from other people who care. So too they will need to choose to ignore any of those people who try to put them off. They may need help to find the right environment in which to go through ‘cold turkey’. If they have got their own place, then help them prepare it well by making it really warm and comfortable. They can prepare for the fact that they may not feel like food to begin with, by making sure the cupboard and fridge has their favourite ‘goodies’ in. Stock them up on books, tapes, videos (ensuring however that there are none which remind them of the ‘old’ life), and give them a few other treats to make life more comfortable.
Help them particularly to make up their mind to do it opiate-free, if it's at all possible. Planning to do it drug-free needs thinking about carefully, but doing it this way will help to avoid a new dependence on sleeping tablets for instance. If they have been through ‘detox’ before they may need a hospital or a clinic, which will need planning well in advance, not least with their GP and local drug agency.
Phase Three - Giving Up
If they have prepared themselves well then they will pick a date and DO IT on that date! Once they have done it, help them to think positively about the new person they have become. Help them to see that, whilst they may feel lousy because they are withdrawing, they are also drug free. If they are not at your home, ensure you and some positive friends spend lots of time with them, as well as phoning regularly.
Work out with them how they can break the time up into one day at a time, or even one hour at a time. Help them see that they will go through some stages which are more uncomfortable than others, but reinforce to them that these don't last for ever. When it comes to thinking positively, help them think about all the good things they can start to be and do, not least with all the spare time and money they are going to have.
Phase Four - Staying Free
Staying free is not automatic or guaranteed, no matter how long or detailed the preparation period has been. They are going to have to keep making the decision to stay free, for the rest of their lives. The fundamental reason for this is that they have discovered a way of experiencing instant pleasure, through drink or drugs, and that will always be there as an option. I get really nervous when someone tells me ‘I have cracked it, I am free of drugs or drink forever.’ I get nervous because phrases like that show they do not realize how strong is the hold that drugs or drink has over them. They may well be feeling good and confident now, but in a few weeks, months or even years they could be feeling low or fed up, and drugs or drink could become a valid option once again. Having said this, I would stress that they really can be drug and alcohol free for the rest of their life, if they continue to make that choice, day by day, to be free.
I am also absolutely sure that they should never drink again if they are an alcoholic. I don't think it's worth the risk. I also don't think they should drink alcohol if drugs were their original problem; I know too many ex-addicts who have gone on to become alcoholics. Whatever their problem, the simple fact of life is that even one drink can lower their inhibitions. One drink simply means that the next drink is easier to accept, and after that it’s easier to say yes to just one more drink or just one joint. They need to be strongly encouraged to actively resist any thought of ‘controlled’ use or the ‘I'll have one now and again’ routine. All these will do is to maintain or feed the ‘craving mechanism.’ Giving up completely increases the chances of them staying free a thousand fold. But, if they do slip up, help them see that as a reminder as to how vulnerable they really are, and start afresh.
Whichever phase they are on I would suggest you reinforce the need to be very alert to the fact that certain places, faces, or written or visual material will trigger a craving. They can't avoid those situations totally, but they can minimize the risks before they happen. It's also important to remind them that temptation rarely comes ‘full frontal’ but will be much more subtle. It will often begin with a thought, which they can either choose to allow to grow to the point where they are tempted to do something wrong, or they can get into the routine of replacing it with a much more positive thought. Also remind them that if they ever start to ask themselves whether it is really worthwhile being sober they have got a real problem - and they need to talk to someone urgently.
Danger - from other people
Help them to be prepared for the fact that it’s those who care for them the most who may be the most dangerous to their new life, especially after they have been free for a time. People like this will tell them ‘One drink won't matter, after all this time.’ Or someone will say, ‘Don't offend Fred, have just one drink.’ Help them to keep saying NO! The most effective weapon they have is that they know how easily they can slip back into addiction; but if they have forgotten, you may need to remind them that it is as messy down there as it was before. No addict or alcoholic ever went back into addiction slowly; they always start back where they finished.
If it is remotely possible, help your loved one find real fulfilment, when they are ready, by choosing to help other people. I never cease to be thankful for the lives of ex-addicts and alcoholics who have reinvested so many wasted years in doing just that. You can't turn the clock back, these men and women still have to live with the consequences of what took place; but, whilst their lives still aren't perfect, there is a quality of purpose and graciousness and strength that many people who have never touched drugs would be thankful for.
Whatever happens, you, as the person helping them, will also change positively - even though you won't always be able to see it. But you always need more wisdom and strength, and our final section points towards finding the resource YOU need.
This feature is written by David Partington. David is general secretary of ISAAC, the International Substance Abuse and Addiction Coalition, www.isaac-international.org.
© David Partington 2011.