It’s never convenient to discuss the elephant in the room. Whether it be concern over someones substance use or the need for change it’s always uncomfortable. The elephant in the room is that we stigmatize addiction. We stigmatize most all mental illness to be frank, but addiction especially because it requires a choice. Instead of looking at it as a preventable, curable, disease some view it as a moral deficiency because it requires this initial choice.
The elephant in the room might be a loved one needs help with mental illness or their indulgence in drugs. Addressing the topic (the elephant in the room) becomes intimidating because we don’t know how they’ll receive our message. We don’t want to get cut off, upset anyone, or start a fight so we might stay silent. The elephant in the room might be facing the internal dilemma of not wanting to enable a loved one when they ask for money during active addiction. We might concede the financial support to appease the addict, buy them food (try meeting their financial needs), or firmly say no depending on the situation.
Over the weekend I attended an eight hour class, Recovery Basics for Parents, put on by CCAR the Connecticut Community for Addiction Recovery. The course- which was fantastic- is intended for parents to be a supplemental training for the CCAR Recovery Coach Academy. Anybody dealing with a loved one who has an addiction, or anyone looking to improve on their communication skills, can benefit from the topics discussed in this course. Since you’re unlikely to attend, I wanted to share some fantastically helpful takeaways. Here is a brief summary over some of the topics discussed as well as practical tools on how to implement them into your daily communication.
Google active listening and you’ll come across this definition, ”Active listening is a technique that is used in counseling, training, and solving disputes or conflicts. It requires that the listener fully concentrate, understand, respond and then remember what is being said”. It’s possibly the most important skill we can learn to help someone struggling through substance abuse disorder. The technique breaks the insanity of the monotony that our conversations with loved ones turn into.
Have you ever initiated a conversation with an addict only to have it turn into some kind of grandiose argument over some seemingly unrelated issue? For example when a request for food turns into a demand for cash, which then becomes a debate over the depths of your love. This is the insanity of addiction. Be mindful of the fact that people in active addiction suffer from a brain disease. Addicts are often their hardest critics, so oftentimes we don’t need to remind them of mistakes. Active listening is all about talking someone through the decision making process, while trying to get them to understand the impact of their actions.
Here are some best practices, courtesy of CCAR, when practicing active listening:
Focus your attention on the subject (stop all non-relevant activities)
Avoid Distractions (A window, a talkative neighbor, noise, etc.)
Seat yourself appropriately close to the speaker
Acknowledge any emotional state
Set aside your prejudices, your opinions
Be other-directed; focus on the person communicating
Follow and understand the speaker as if you were walking in his/her shoes
Be aware: listen with your ears but also with your eyes and other senses
Let the argument or presentation run its course; don’t interrupt
Be involved: actively respond to questions and directions; use your body position (e.g. lean forward) and attention to encourage the speaker and signal your interestCCAR
Stages of Change
The Stages of Change, a model developed by Prochaska and DiCliemente in 1982, offers incite into what it takes to shift perspective. According to the model there are five stages of change: precontemplation, contemplation, preparation, action, and maintenance. For most people this thought process is cerebral, for addicts it is not. In fact some people may bounce between stages depending on the day. The Stage of Change break down as follows:
Stage One: Precontemplation
Precontemplation is when a person doesn’t believe change is necessary and has no intent to change the behavior. People in this stage may come across as defensive and argumentative. They’ll alienate anyone who even suggests a problem and usually if they go to treatment it’s forced. Communicating with a person in the precontemplation stage is easy in theory but frustrating in practice. That’s because individuals in this stage generally view others as objects to fulfill their needs rather than people or resources. This type of person becomes easily bothered, so when an issue arises ask open ended questions aimed at getting to the root of the problem. For example someone is complaining they don’t have the money for food. Respond with, “Man that really sucks that you don’t have money, why don’t you?” Keep asking why to an addicts problems and it will inevitably come back to drugs.
Stage Two: Contemplation
Someone in this stage recognizes a problem and is contemplating a change. They start becoming cognizant of the impact their actions have on others. People in this stage come off as distressed, they tend to be their own biggest critics, and beat themselves up. When communicating with a person in this stage it’s important to be reassuring. When a person is down on themselves it can be a trigger to use so it’s important to stress the importance of looking at the big picture, “if you go out and do what you always do then what will change?” Doing so will prevent a person from becoming impulsive. Instead guide them towards action, “what can you do to make a change?”
Stage Three: Preparation
The preparation stage is the proverbial “dipping of the toe” in regard to making a change. Someone in this stage will begin monitoring their behavior and may even make some small changes. They may appear empowered with their newfound intent and on the brink of change. When communicating with this person, be mindful to keep your loved one level headed. When we get too high or too low we run the risk of relapse, try keeping them conscious of the good work they’ve done while recognizing the work ahead of them.
Stage Four: Action
Action, the most important of the stages, is when a person actively changes their habits. A person in this stage has thought about their actions and, as a result, they’re motivated and committed to change. Someone in this stage is open to suggestions for changing their behavior. This is the easiest stage to communicate with because of the newfound open mindedness. Suggest your loved one start to take up healthy new hobbies.
Stage Five: Maintenance
Maintenance, the last stage of the process aims to maintain the upkeep needed for the new norm. For example, writing about and doing a podcast on addiction. The maintenance stage is all about sustaining a new behavior. People in this stage practice the basic skills needed to ensure they don’t relapse. They’ll typically develop a routine. It’s common for people in this stage to feel anxious and afraid in high pressure situations or over the thought of relapse. Over time maintenance becomes innate. Communicating with someone at this stage should focus on all the new positive things that have come into your life.
Stages of Recovery
CCAR’s definition of recovery, “a person is in recovery if they say they are”. I like this definition because it doesn’t center around use. If we view addiction, substance abuse disorder, as a disease we shouldn’t define it by use. This is important because it encompasses medically assisted treatment as an avenue for recovery. As a disease addiction is both preventable and treatable.
Stage One: Stabilization
Stage one occurs during the first year of recovery and centers around learning about addiction, staying clean, and developing new social patterns. We learn to break the patterns that lead to substance abuse. For example we reassess our social circle, develop self-awareness, and stop isolating. During this stage we learn about ourselves, how to socialize around people, and how to manage stress and anxiety.
Stage Two: Deepening
Stage two occurs during the second year of recovery and it’s an emotional detox. During this stage we learn to move beyond our instinctive, innate, responses to feelings and reassess ourselves objectively. We become more tolerant of our feelings and evolve beyond the fight or flight responses that dictated our past. Furthermore, we develop the ability to recognize and distinguish between our feelings.
Stage Three: Connectedness
Stage three typically occurs between years three and five of recovery. This is one of the more difficult stages to navigate because it is here where our emotions return in full force. Experiences of both joy and misery can feel overwhelmingly intense so it’s important to remain level headed. During this stage we learn to stop creating drama in our lives.
Stage Four: Integration
Stage four usually occurs from year six to ten of recovery and is basically a return to normalcy. During this stage we begin basing our relationships on love rather than need. Put another way, we begin developing healthy relationships rather than codependent ones aimed to satisfy the perception of a need. We also work to use our recovery tools automatically. Lastly, we must avoid getting stuck in this stage.
Stage Five: Fulfillment
Stage five generally takes place in recovery after year ten. This is where we “discover” our purpose, forgive ourselves for the past, and understand acceptance. People who make it to this stage of recovery live within an aura of peace and serenity. Worry reduces dramatically during this stage and people who reach this level live fun and joyful lives.
We have two avenues for change; direct and indirect. We can only implement a direct change when it falls within our realm of control. For example I want to quit smoking cigarettes I am the one smoking therefore quitting falls within my direct realm of control. Any change out of our realm of control can only be impacted indirectly. Getting someone else to make a change would be an example of this. In other words you can only control what you can control and you can control your response or if you enable someone. When we practice active listening we are better suited to influence change in the world around us.
Remember the power of your words. After all, our interactions can influence a person to the point of life or death when you’re dealing with an addict. Depending on where your loved one is in the Stages of Change impacts how you approach an interaction. The Stages of Change and the Stages of Recovery are excellent tools to assess the progress of an addict as well as indicators to gauge personal growth. Check out this link on motivational interviewing If you’re interested in learning more about how you can better communicate with a loved one who’s addicted.