Family members of those struggling with opioid dependence or other substance abuse often ask, “What should I do to help my loved one struggling with addiction?” There are no easy answers to these problems, and every situation is an individual one.
In this episode of the podcast, we discuss techniques, tips, and important principles to help you work with your family member in a respectful, effective, and more likely way to move to a more healthy outcome.
Episode 8: Family Relationships and Addiction
Helping a Family Member Struggling With Substance Abuse
Dwight Hurst, CMHC: “So what do I do?” Pause and wait for you to respond to that question. That’s a very stressful moment. Whenever anyone comes across that question, “What do I do?”, “Tell me what to do!” Anyone who has ever worked in or around substance abuse treatment of any kind is familiar with that question.
Dwight Hurst, CMHC: Also, anyone with a lot of empathy in anyone who has ever been in the shoes of a loved one or someone who has an addiction problem is also familiar with that question on either side of it one way or another the other. It’s a very difficult question. What do I do if I have a friend, a family member, or a loved one who is struggling with drug addiction, dependence, or overuse? And if I’m suffering from dependence and addiction symptoms, what should I be aware of in the relationship dynamics of what goes into treatment? How do I approach the people who are wondering how they should approach me? Well, we’re going to take a crack at that today. We’ve got some excellent information to share with you today from a great conversation with David Livingston and Clare Waismann. We’re going to talk about families and the things that you can run into that become obstacles to entering treatment that can help to facilitate recovery and some of the perceptions and traps that we fall into all around these issues with relationships and addiction.
Dwight Hurst, CMHC: How do I approach a family member to talk about their drug use? That can be a very touchy issue to bring up with people, especially if it’s connected with being concerned about their use of intoxicants.
Clare Waismann, CAODC: I think starting with “timing” is everything. So it can’t be in a time of conflict; it can’t be in a time of anger. It has to start the conversation when the conversation was chosen as a helpful, two-sided conversation, where the person, the user, is being heard, is being allowed to speak, and the user is given options. When you give people options, you allow them to be a bit in control of the situation, which is very welcoming to people to start a conversation. What do you think, David?
David Livingston, LMFT: One of the things that I think can help is just to approach it from the perspective of health. Right. Just to almost move it away from the person a little bit, just in terms of I’m concerned about your health type thing and what’s going on and so forth, and allow, you know, so that it doesn’t feel like a personal confrontation as much as it is a genuine concern about an individual’s health. And I think it’s often heard better and can move into, you know, the idea of, you know, what’s going on that’s healthy and not healthy. And there’s some distance between, you know, the what, you know, could be a person feeling embarrassed or ashamed or other things. And because it is all about health, I think that can be helpful.
Dwight Hurst, CMHC: It’s easy to come across as very attacking in those conversations to say and to feel very attacked, especially because there’s already a lot of defensiveness. I mean, it’s usually not a news flash to a person that where that someone’s concerned about their use or even that their use is unhealthy. But there’s a very fine balance there between saying, you know, to get someone to hear that message that, hey, I’m worried about your health. And they might already be sensitive to the idea that, oh, you’re going to judge me. And so the problem then becomes a lot of people jump right in with a very judgmental approach. Right. I mean that. So we already sensitive if someone says, hey, listen, hear that, then it can already go badly before you even started.
Clare Waismann, CAODC: Right then, once those defense blocks come up. It’s very, very hard to get through it.
Dwight Hurst, CMHC: Yeah, a lot of times you mentioned “timing,” you both mentioned that and I think that’s huge because a lot of times when there is the elephant in the room, we go back and forth between when we bring up something that’s in a fight, it’s a bad time to get anything done. And then sometimes, when we’re not fighting, we’re slow to mention the elephant in the room because we don’t want to rock the boat. Suppose today’s a good day. You know it doesn’t seem like my partner is high today, then I don’t want to ruin the Saturday. We’re finally having a good day. And then if it’s a bad day, I know they’re not listening to me because they’re already, you know, they’re already “on” something. So that’s a really tricky issue. You have to be willing to pull the trigger during a good day, ruin the good day, even if you have to, to have the conversation or start having the conversation.
Clare Waismann, CAODC: But wouldn’t that apply to any relationship or any issues with the relationship, including with, you know, your wife, your husband, your kids? You know, there is an issue in the relationship, but you’re having a good day, so it’s a good time to talk. But you really don’t want to destroy that moment because there are so many bad moments. I mean, I think that would apply pretty much too, you know, it does this confrontation.
Dwight Hurst, CMHC: No, you’re right. So it’s kind of a false start there to block ourselves from doing it. It becomes a bigger obstacle because we make it one then as what you’re saying. I think that’s a good point.
Clare Waismann, CAODC: Yeah. Because eventually, you’re going to have to deal with it anyway and delaying it. It is just going to bring that bad moment again. And then you think they know I should have brought that up? It’s really just delaying it.
Dwight Hurst, CMHC: Do you guys see that a lot where people have already cut off the conversation or avoided it for a long, long time?
David Livingston, LMFT: Yeah, I think so. I think. Generally, people want to feel like they can manage it. And it’s usually once it reaches a point where their life is really being affected detrimentally. There is a moment of pause and really being able to feel and understand that things are heading in their direction. There’s a loss of control and loss of things that are important and valued and also some fear that starts to come in. You know, that’s very often when patients call us and come in for treatment. And usually, one of the things that come out and is that they’ve been suffering for far longer than they wanted to or needed to, and they wish they hadn’t have waited so long. And almost inevitably, I hear that you know, because they feel ashamed. And then also it’s hard to take that step, that leap of faith and trust in other people that they’re going to care about, you know, that they’ll aid in your help in recovery and your health. And some people don’t feel valuable enough. It really is a big part of it. So you know, usually families and friends respond well.
Dwight Hurst, CMHC: I find that sometimes I talk to people about what I call an “ongoing” conversation that if I can’t resolve a conversation right away and this goes back to your point, Clare this is normal. It’s normal to talk about big, heavy things several times before we make a large decision. I mean, how many times do we talk about a home purchase or moving somewhere? You know, we don’t just say that in a ten-minute conversation. So being willing to have an ongoing conversation that we are going to revisit, I think that’s a huge pressure relief sometimes to these conversations to say I want to share my concerns with you if you feel attacked. Let’s stop talking for a while. We’ll talk again tomorrow or, you know, think I just ask that you think about it. And being willing to do that about a big problem, I think, is healthy.
Clare Waismann, CAODC: It is it’s healthy. It’s important. But not to undermine – it is far from being easy. Yeah, it is difficult, actually. Most people that are in this position are exhausted. They know are spent. The user himself also feels shame, feeling fear, feeling fear of not coming through, feeling fear of failing treatment, feeling fear of what’s expected after treatment. So they know a lot of people end up, you know, using addiction as a clutch for everything. So there is a lot of transformation that is very scary for everybody involved. But David touched on most patients that we spoke about a few months ago or a year ago that did not follow through. That’s the first thing they say when they call, “I wish I had gone in when I called you the first time.”
Clare Waismann, CAODC: So regarding getting help, there’s never a better time than “now,” that’s for sure. There is, you know, finding a good time where you can actually be heard. But regarding getting treatment, you know, especially nowadays that is so risky out there, there’s no better time than now.
Dwight Hurst, CMHC: I wanted to get your guy’s opinion on something that I hear people still talk about sometimes, which is the idea of kind of the classic intervention where, you know, someone comes home and their entire, you know, their family and friends and extended family and their racquetball team, whoever everybody is like in their house and says, “We all love you. We got a car waiting outside. We want you to go to treatment right now.” I mean, people talk about that and still have a perception. I don’t. I wonder what your guys’ thoughts are about those kinds of interventions that are fairly high pressure right off the bat for people.
David Livingston, LMFT: It’s risky, but sometimes they go well, and sometimes they go poorly. I think you need to really know the person well as to how they might respond. I think there are probably certain situations where it can be effective, but it wouldn’t be my first thought out of the gate, that’s for sure. I think what you want to do is begin a dialog and ask questions like, you know, you know, why are you taking it? What are you interested in getting off it? What you know, when I’m speaking to people before they come in for our treatment, I’m asking them questions I really want to get a sense of where they’re at and because it’s more important than what anybody says to them, because in the end, what sustains people is it’s what’s inside them, their commitment to what they’re feeling about it, you know. If you really ask them without pressure, you don’t tend to want to tell you, and you’ll hear there’s almost always some ambivalence, which is understandable. In fact, a lot of people getting better is is how you manage and deal with ambivalence. There might be situations where an intervention could be necessary if someone’s in really, really unreachable and in real danger. I could see where that could be kind of something that you would go to.
Dwight Hurst, CMHC: I’m with you.
Clare Waismann, CAODC: I agree with David. I think that this should be the last recourse. Hmm.
Dwight Hurst, CMHC: That’s my feeling, too. I guess, you know, the way I sort of phrased the question probably showed my bias to you. But I think there are so many other forms of communication to try first.
Clare Waismann, CAODC: If you picture in your mind, you know, an intervention, you see the person in this corner feeling really small and everybody confronting them. I mean, this person already feels alone, misunderstood, scared. So just see the picture. The format of it makes whatever they’re feeling so more intense for me. It makes them want to hide more, wants to shut down more than afterward, which is even scary because if it goes south now, you’re feeling more alone, more desperate, and they will use more drugs. So there is the risk of, you know, what happens after with intervention.
Dwight Hurst, CMHC: Yeah, if I don’t go into the car that’s idling outside to take me somewhere, then what do I do? Do we just sit down to dinner after that?
Clare Waismann, CAODC: Right. Correct. Yeah, right.
Dwight Hurst, CMHC: Kind of burned a bridge there. I think that sometimes things like that come from desperation, which we’ve mentioned, you know, people being exhausted and saying, I don’t know what else to do. And I think, as you put it, that’s hard. It’s fair enough to say people are willing to try almost anything. I think having that attempt at communication, sometimes finding a different kind of approach, like trying to get someone to maybe even come to some outpatient family counseling or couples counseling to talk about things if they’re not willing to go into their own specific treatment. If you can’t do 100 percent of the healthy thing, try to do 90, try to do 50, try to do 10, you know, do what you can and whatever someone’s willing to engage in.
David Livingston, LMFT: I think often there’s confusion because so if someone’s struggling with using, you know, a substance, it can affect the people around them and often does. And so they could feel upset and angry and so forth. There’s a desire to kind of get the behavior changed because of how upset and how it’s affecting them. And, understandably, they’d want that end. The problem is that when the person who’s using the drugs feels I’m sick of this, I’m tired of this. It’s not working for me. I’m not doing this anymore. It’s their own disgust and feelings about sort of what’s happening and how it’s affecting them that well, that’s sustaining. So it’s a difficult balance between the two because, you know, people are affected. But really, that’s sustaining in principle is from the inside out, I think. And then and then you can work with them, in many ways.
Dwight Hurst, CMHC: I think there becomes an idea that gets kicked around among people where they talk about someone who’s a user saying once an addict, always an addict. And what’s the old joke? I have unfortunately even heard professionals say this where it’s like, how can you tell if and if a drug user is lying because their lips are moving, right. Or something like that, and it becomes this very, very big shaming kind of thing. And I think it contributes to that frustration where if I lose hope that my spouse or parent or child can ever be more healthy and not be using if I lose hope in that it’s very, very difficult to invest in the relationship. And that’s where you see people jump to say, yeah, I have to cut the person off, I have to kick them out, I have to do that kind of thing. And that’s tricky because it’s not to say that that’s not ever something that people have to do, maybe for safety. But I think sometimes people get there really quickly because they have people in their lives who tell them, oh, well, if that’s the problem, you just get them out of your life now. Get them out of your life – they’ll never do better, and I think that’s very damaging.
Clare Waismann, CAODC: I think is not just damaging; I think is cruel. And I think the people that and let me tell you, I have heard this through the last 20 years more often than I would like to believe from professionals, you know, once an addict, always an addict, if their lips are moving, they’re lying. They know how many parents call and say, oh, they told me to wait until he hits bottom.
Dwight Hurst, CMHC: Yes, exactly. And that’s a really tricky thing with vague ideas. And I know you’re not a fan of the concept of rock bottom, and for that reason. Right. Because what does it mean? It doesn’t. It doesn’t have an objective meaning, first of all. And then, as you said, is the person who gave you that advice can come to the funeral or.
Clare Waismann, CAODC: Correct. Somebody is injecting heroin. Wouldn’t that be bottom enough for you? The people guiding these families, these loved ones, truly do not understand what a human being is, what a human being needs. They just, you know, heard or read somewhere that this is what to respond, but to zero attachment or responsibility to somebody else’s life.
Dwight Hurst, CMHC: I sometimes believe those answers, the overly simplistic, bad answers that people get. I know that there’s the pressure when someone looks at you and says, tell me what to do about my kid. Tell me right now, tell me what I do, what I do, what I do. There is pressure to answer that is like do this, this one- or two-step thing. Just do that when in reality, I think you can always be assured that if someone’s patting you answer that applies to everybody, it’s bad. You know, the real answer is going to be nuanced. And to be honest, nuanced is often frustrating because it’s like, well, it’s case by case, and you have to use your judgment. We have to have some conversations about the difference between tough love and just setting boundaries and protecting yourself and lashing back. And all of that is a difficult conversation, but that’s a healthy conversation. And if you have even a professional who’s telling you some pat answer, they’re probably not out, not your friend; they’re not helping you.
Clare Waismann, CAODC: More than that. I think what you said is absolute that more than a friend. I think the professional is not being helpful or honest. You know, sometimes you have to be humble enough to say, I don’t know. I am not sure.
Dwight Hurst, CMHC: Yeah, exactly.
Clare Waismann, CAODC: Let’s think about it together.
David Livingston, LMFT: Right. Right.
Dwight Hurst, CMHC: One of the things that I thought would be good to talk about, too, is what about on the brighter side when people are getting better, and they’re not using anymore, and they’re healthy? One of the things I think people aren’t always prepared for is that change is always difficult. Even healthy change is difficult. There’s that old country song, right? Like “You Ain’t as Much Fun Since You Quit Drinking.” And unfortunately, sometimes it’s really good changes happen. But some of those changes feel very awkward, like their place in the family may change or the way that they engage with things may change. What kind of feedback do we have for people when they’re moving into a relationship where the user in their life is not using anymore? What kind of things should they be ready for? What helps?
David Livingston, LMFT: The end of successful treatment or help is, is creativity that if the person was phoning one on the alcohol or whatever, they’re still funny. The substance is overrated. They’re just going through something, and they’ve got to become creative again in their life. The problem with substances is it makes you lazy. I hate to say it, but it’s because it kind of they need to manage and develop ourselves and have things correlated from the inside, out in the outside, in nature that we’re doing things that stimulate us. And I know from, you know, working with just my own kids, as soon as they’re bored, they become creative again. They actually start to do things. If you just you know, you can see that with, you know, vending machines, you take those away, and suddenly they start to do creative things. So you take away something from someone then. And then the next thing is, first of all, to not overestimate, you know, that didn’t make somebody funny or fun. They’re they can be funny or fun without it. And to help them realize that and find that part of them that’s creative because they want to feel alive. And I think that’s part of the goal of it. And so I really try to help and remind people that potential and sort of pulling them out of the whole cloud of just being, you know, and minimize what the chemicals or the substance are. It’s I think it needs to be emphasized more.
Dwight Hurst, CMHC: I think I’m glad you mentioned “fun” because that’s so hard to get that back online. I think to say intoxicants are out of my life, opioids, and out of my life. What do I do now? And you just hit it right on the head, I think, which is all you still do what you do. You still have passions, you still are funny, and you still are smart. But it can take a minute for it to kick back online and say, oh, yeah, that’s right. The world is still here, but I have to get back in touch with how it feels to be in it.
Clare Waismann, CAODC: And let me ask the question, David. Don’t you don’t believe there is patience after detox also, you know, they miss that intensity of feeling everything? Like when they get high during a tense when they get emotional, they feel very within themselves, almost a feeling of missing that intensity of feelings that the drug brought to them.
David Livingston, LMFT: You know, we’ve had professional athletes and so forth come through. We’re like, I’m worried I won’t be as good as this or that, whatever they’re doing. And I’m like, don’t worry; you’ll be better at it. Your instincts will be sharper so far. And inevitably, they report that. So I think that in my experience, there is a massive overestimation and whatever the substance is doing for people. In fact, I really think about a part of getting better and staying better is that insight like to deeply realize it really isn’t doing as much as people think? And but it feels that way. The perception is that, you know, it’s helping, and maybe it does at times lower inhibitions. I think alcohol can do that, and it can increase energy. I know opioids can, you know, give people energy and sometimes lower anxiety or inhibition. That’s part of it for a short time, right? For a short time. But that that first experience of it registers in the brain as if that’s the reality. And the truth of it is in terms of its longevity and the course of it; it actually depletes the ability to do those things. And so I think that first experience registers ultimately in the brain. So, you know, profoundly that that becomes a perception, but it’s far less of the reality than people think.
Dwight Hurst, CMHC: Being situated where you guys are in California, around L.A. and the Hollywood area and stuff with a lot of creators and creative types, there becomes a myth there, too, doesn’t there? If I’m a creative person, that part of that is that out of control-ness of being like the sort of fractured genius and all that, that, you know, I’m better because I have fewer boundaries in my life and I’m kind of out there.
David Livingston, LMFT: We have a need to change your consciousness like, you know, it’s existed throughout time. I think good relationships help with that. I think having things that we enjoy that, you know, stimulates us; there are all kinds of ways to shift our consciousness. Right. You go to a concert with, you know, that does it. There are many ways you can do that now, but there are many ways to shift our consciousness. But it takes creativity. We have to get back into a mode of living a more creative life again.
Dwight Hurst, CMHC: I often try to prep people for the idea of parenting and household management. So especially if people have kids, I often say that it might you know, nothing is right for every single person. Still, I often say it might be good to even plan on some kind of communications or even maybe even planning on having some couples counseling on the back burner, because you’ll find that when someone is sober, they may have a whole different attitude of like parenting, of like but being more involved and saying they have interests and opinions now. And it’s a huge strength. But it can feel weird if I’m a person who has been handling all the responsibilities in the House for fifteen years to suddenly have my partner be responsible and want to take part in things. I can feel threatening even.
Clare Waismann, CAODC: Actually, you know, then there is the other side where, you know, a family member might have pushed somebody in to get treated and complained about, you know, their substance use. And once they get treated, things change to such an extent that they were not prepared for that they kind of sabotage somebody’s recovery.
Dwight Hurst, CMHC: Yeah, I think that happens often.
David Livingston, LMFT: Those there’s the first part of which is, you know, dealing with the unwanted substance and then there’s everything else. Right. And so, but I, I think people underestimate how strong they can be if they just hang in there and just keep going to step at a time and dealing with things. And you can actually get to the point where you want to deal with things. It’s easier. You want to have the conversations and, you know, not always sometimes, you know, there are situations that are untenable. And I think people feel that a lot. But I think people underestimate how strong they can actually be.
Clare Waismann, CAODC: I agree with David.
Dwight Hurst, CMHC: Yeah. And I think that’s a great takeaway message for people to have, is that all of these things seem so daunting, like even starting the conversation, if I’m struggling with that, is to say one thing that might be a great takeaway from our conversation is to, first of all, assume that you’re stronger than you think you are and that once you start this process that you’re going to find you have more resources then than you believe you do.
David Livingston, LMFT: I think that’s it, and the world wants to aid people who are trying and being conscientious to being forthright, conscientious and trying to… generally, it’s appreciated. And so I think can you can move from that perspective. And if nothing else, just ask that of yourself and just a step at a time. Things tend to get better.
Dwight Hurst, CMHC: We’re going to leave it there today on that hopeful note that you’ve been able to find some hope and some courage from today’s conversation as well. I know that I have, and I always do when I’m on the show. If you’d like to learn more about the Waismann Method advanced treatment for opiate dependents, go to www.opiates.com, call us on the phone at 1-800-423-2482. Or send us an email at [email protected].
Dwight Hurst, CMHC: Any way you reach out, just make sure you reach out when you need it. So today was hosted by Dwight Hurst, Clare Waismann, and David Livingston. The music for the show is the song Medical by Clean Mind Sounds. The show itself is produced by Popped Collar Productions, a company specializing in creating podcasting and creative solutions for health care, nonprofit, Human Services, and pretty much anyone else who wants to have a podcast. Thanks again for listening to us as we try to answer some of your and our questions about opiate dependence. Remember, keep asking questions because when you ask questions, you’ll find answers. And if you can find answers, then you can find hope. Bye for now and we’ll talk to you again soon.
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