Beyond Addiction’s Carrie Wilkens: using science and kindness as motivation for change in your child's substance use
Host: Brenda Zane, brenda@brendazane.com
Instagram: @the.stream.community
Guest: Carrie Wilkens, Ph.D., CMC Foundation for Change
Instagram: @cmcffc
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resources
Beyond Addiction, How Science and Kindness Help People Change
The 20 Minute Guide, the parent workbook that distills motivational strategies and CRAFT concepts down into a quick and easy workbook format. Access all of the sessions are free or you can purchase the workbook in a variety of formats at this link.
The Beyond Addiction Show is a weekly podcast hosted by CMC psychologist Josh King.
Center for Motivation and Change newsletter:
Additional CRAFT Resources:
Show Transcript:
BRENDA
Hello. Welcome to episode three. I think you are really going to enjoy today's chat that I had with a very special guest who is so credentialed. She is an author. She's just so real and so easy to talk with. And we talked about some really interesting topics that I think a lot of parents are going to find very helpful things like enabling versus supporting and what that looks like. We talk about how do you let your child suffer the natural consequences of their actions. We talk about things like relapse and how that can really be an opportunity to learn versus to look at it as a major setback. And we talk about a really interesting, uh, topic on why parenting a kid in addiction is like running a marathon in a jungle, in a storm. So for those of you in the thick of it, you will totally relate with our very special guest.
She is a PhD and co founder and co-executive director of CMC foundation for change. She is co-authored an award winning book that I have a copy of that is completely highlighted, dogeared folded, much loved. It's called beyond addiction, how science and kindness help people change. And she has also contributed to a really awesome user-friendly workbook for parents. It's called the 20 Minute Guide, a Guide for Parents about how to help your child with their substance use. And again, I've downloaded that multiple times and used it. It's a wonderful guide for, for parents, she is working in collaboration with the partnership for drug free kids to bring free resources to parents through this new foundation for change. And she has also helped develop a national parent training program called the parent support network that provides parent coaching to families in need through a free hotline.
So if you're a parent who is needing some support for yourself and your child, we'll put all the resources in the show notes, but they do have a free hotline where you can get connected with a parent who has been thoroughly trained and has been where you are, which is incredibly helpful. She is regularly sought out by the media to discuss issues around substance use and about families. She has been in the company of shows like the CBS morning show, Katie Couric, Fox news and PR. So it is truly an honor to have Dr. Carrie Wilkens on the show today.
All right. Hey Carrie, thank you so much for being here. It is awesome to have you on the show.
DR. WILKENS
Thank you so much for having me and thanks for having this great podcast for families out there. It's really great.
BRENDA
Yeah, yeah, it is. It's such a huge need and your level of expertise and especially the books and the guides that you've written I think are just incredibly valuable for those parents who are out there in a situation that's really so shocking to be in it. You know, at some level you at first are like whoa are things just kind of going downhill and then, and then when you really need some help, it's hard to find. So I'm just thrilled to have you on today. Maybe you can just give us some background on sort of how you came to be doing what you're doing and how the book Beyond Addiction came to be.
DR. WILKENS
Uh, sure. It's a story that's gonna date me. It makes me feel old to tell this story now. But, it's also nice because the world is changing and that's awesome. you know, I went to graduate school to be a psychologist and uh, I tell this story because it was just so painful to me at the time. you know, it was a really good graduate school and you know, you have your first clients, you know that you're there, the very first people you're working with and you're super careful and you're getting tons of supervision. And the last day, I had been working with this woman who for two years and just had, she had agoraphobia. She had a trauma history. She was having a very difficult time leaving her house and you know, she had a lot of trauma and that's what we were working on.
My last session with her, she told me that she was drinking two bottles of wine a day. Which means the whole time I was seeing her, she was in alcohol withdrawal and I was never trained to even ask about substance use at that time, way back when. It wasn't really. Yeah, it was, it's really amazing. I mean, of course like in the initial evaluation you work encouraged to ask about someone's substance use, but most people don't acknowledge their substance use in the first visit. Right. And so, you know, as we went along, it just never came up in supervision. It never came up in my training. I didn't have a single class on addiction or substance use. And so this is over 20 years ago, but, I got so mad and freaked out about that, that I decided to go to internship and fellowship at a place that was, one of the, you know, biggest addiction programs in New York city.
And that's where I met my current partner, business partner, DrJeff Foote, who was, really at that time trying to bring evidence based treatments into that system. And it was a pretty, you know, all treatment programs back then were very 12 Step. They were abstinence-only. Most of the clinicians were in 12 step recovery, you know, there wasn't really use of medications.And so he was trying to bring evidence based treatments, like motivational interviewing, cognitive behavioral treatment into that system. We had some success, but you know, big hospital systems move very slowly when it comes to me changes. And we just got frustrated and decided we wanted to try to build a treatment program and nobody really got it. There was so much pushback. There's just a ton of pushback at the time, of working with people in any stage other than, you know, really like if somebody didn't want to be sober at that point and they kinda crossed the door of an addiction treatment program, you are literally told like, come back when you're ready.
You know, when you're really ready to make changes, you come back. So all of these people who are like, maybe I want to moderate, maybe I want to stop using cocaine, but I don't know how I feel about my pot use. Those people weren't, weren't encouraged to be in treatment. Because you had to be, you had to be clear that you wanted to abstain in order to be treatment. So there's just this huge swath of people that were not being helped, which made zero sense to me. And, and, and there were treatments coming out of research institutions and you know, that were like, look, you can work with these people and you can actually really engage their internal motivation and, you know, internal desire to change. So we decided to start the Center for Motivation and Change to just prove that you could create a treatment program where, um, you could use evidence based treatments with really well trained clinicians and treat the whole spectrum of the problem.
Working at every level of motivation and engagement. So, we started the Center for Motivation and Change about 15, it's almost 17 years ago now. That's the part that starts to date me. And you know, it just grew and grew and grew because we were, and you know, I, I tell this story so much of our initial business was from these traditional programs. You know, when somebody would call in and say, you know, just that like, yeah, I really, really want to stop drinking, but I kind of want to keep smoking pot. They would say, Oh, call Center for Motivation Change. They'll work with you. You know, so, you know, so we got to work with all these people that other programs that were rejecting, you know, and over like if you engage with somebody like that, and oftentimes they'll come to the decision of like, you know what, I should, I should stop smoking pot too.
And you've, what has happened in therapy is that you've actually sped up that process. You know, cause you're, you're giving them tools, you're giving them an understanding and you're giving them all sorts of ways to understand themselves and their relationship to substances and they start to make changes. So now we have 25 psychologists in New York that, and we're, we're staffed with psychologists and very well trained social workers because, so many people with addiction problems have underlying co-occurring issues. And that's the other problem in traditional treatment programs is, you know, they didn't have the psychological, psychiatric sophistication to treat the co occurring disorders with evidence based treatments. There's a lot of programs that say we treat co occurring disorders, they don't really using evidence based treatments. You know, they don't know what exposure treatments are. They don't, you know, they're resistant to using medications.
A variety of problems are around that. They don't know how to treat PTSD. So that's a big part of the system too. Cause I've never met somebody with a substance use problem who doesn't have something else that's actually driving the bus. You know, because substances work, they work in a variety of different ways. You know, people aren't crazy because they use substances, they, they're using substances cause they work for them in some way. So you've got to understand that and you've gotta be able to work with those underlying issues. And then about five years ago, we, six years ago now, we started a 13 bed rehab in Massachusetts that is very intensive, you know, for the people that actually need to kind of get out of their lives for a little bit. And then two years ago, we started the nonprofit, CMC Foundation For Change, which is really what we should be talking about today because that's for families.
And it's kind of our final frontier where we're going to try to get all the, everything that's in Beyond Addiction, our book and the CRAFT strategies further out into the world in affordable, free, easily accessible ways for families. So that's kind of where we are right now. So that's the arc of my story. One of the, I mean, one of the things that we say is that I, you know, everything that we've done, we've kinda done, because we've been angry about what exists. And so we just get frustrated and, and build something new and try to help people understand that there's options, because the addiction treatment world has been very closed up until very recently.
BRENDA
Yeah, no, I think, I think that's exactly right in that you finally see how there's such a lack of either resources or material or community or whatever it is. And it's like, well, if no one else is gonna make it, I'm not going to have to go make, you know, reflecting back on what you said, I think it's really important that people understand that it's not necessarily black and white. It's not necessarily total abstinence all at once or nothing. And I think there is a perception that that's how it has to be. Especially, you know, with parents and you're, you're looking at this child thinking they've got to stop, they have to stop everything. And it's really good just to hear that that's not necessarily the only way to go. Especially, as you said, you can work through it and then might come around on their own to say, yeah, this actually isn't exactly what I need. Right. It's not working for me in some way. Yeah. Yeah. Understand that. I think to hear too from you to say that, you know, drugs and alcohol or substances, they do work, they actually do work for whatever somebody is, is experiencing. That doesn't necessarily mean it's the best thing, but there's a reason why they're doing it. And I think that's, that's really hard to understand as a parent when you see your child doing that. But it's, so that was really interesting to hear you say that.
DR. WILKENS
Yeah. I mean, I think, the other thing about addiction problems and substance use in general is it's a very stigmatized problem to have. You know, there's so much stigma and shame in this country around addiction. And so you end up with these very black and white. You're an addict or not, you're an alcoholic or you're not. You know, like I said, these very black and white, you have to be completely sober. You know, all that kind of stuff and it's just baked into the language and how people understand things at this point. It's not how 12-step intended it, but you know, it's just how the cultural, how people talk about things, but, you know, moral character deficits and you know, there's just all sorts of things that we say about people with substance use problems that we wouldn't say about any other illness.
Which is just shocking, you know, so you have that, that out there in the world. So then when you're a parent and you start to see your kids struggle, most parents have a very kind of understandable, instinctive response to just hope they grow out of it. You know, like, I'm hope that's not a real problem that I'm seeing. Maybe it's just a phase. Maybe it's just a stage, you know, you kind of don't wanna lot of parents don't want to really dive into, wow, I've got to really address this. And then, and then a problem is kind of building. And so by the time they are addressing it, it's a much bigger problem. And then they don't really understand it. So they immediately go into consequences and punishment and trying to control things. One of the things that we've built into a protocol which I can tell you about called the Invitation To Change approach, is helping people understand the problem that they are facing in a completely different way and really shifting it to understanding as a behavioral issue and understanding kind of how behavior works.
You know, because if you think about alcohol, you know, alcohol is one of the best anti-anxiety medications on the market. It takes anxiety away. If you keep drinking, it might make your anxiety worse actually, right? But that initial drink for most people calms your nerves. It helps you relax. If you've got a busy mind that might help you calm your mind down, at the end of the day, you know, if you're somebody with trauma, it helps you not have flashbacks. It helps you not have bad memories. If you're somebody who's socially anxious, it makes it so you feel totally comfortable laughing and talking with people in small talk. Right? So the initial engagement with a substance tends to be around things that people are struggling with. You know, a lot of kids with ADHD end up smoking pot because, you know, they're, the insides of their minds are kind of bouncing around.
They're having lots of thoughts, they're having racing thoughts or jumping around, pot really mellows things out, kind of silences that internal chatter. It helps them sleep, you know, so you know, it helps them engage socially cause it kinda slows them down a little bit. So again, you see a lot of kids moving to substances that initially are helping them in some way. The kid who starts smoking pot regularly, who then is doing terribly in school, you know, it has a terrible effect on motivation. You know, it ultimately doesn't help with concentration, but to the kid it feels like it does. You know. So if you, as a parent, if you can really slow down and think, what is my kid getting from their substance, that's the most powerful thing you can understand. Cause then you can go around and be like, okay, what do I have to help them with?
What are those underlying things that they need that I could be being supportive of in some way? I can think about their environment that they're in. I can think about different treatment options that might help them with those things. You know, you may not getting treatment for your kid that has nothing to do with substance use, but you're, you're, you're dressing the thing that is actually driving the substance use. So it just me slow down and kind of think about it through a different lens. It really can shift the options you see available, and help you have a lot more empathy for the person with the problem. You know, people, we, we tend to get mad at people with substance use problems, right? Cause they're scaring us and they're, you know, they're making us mad and they're spending too much money and there's all sorts of reasons to be upset about it. But I think again, really slow down and try to understand it through this different lens can increase that empathy, that which can then really decrease tension in the household and then you've got something to work with.
BRENDA
Yeah, I think that the concept of really understanding what's the underlying issue versus just looking at the drug use. And I think sometimes, at least I know in our case, you know, I would try to have that conversation like, what is, you know, what is this pot doing for you? And, and I don't know if it's a teenage thing or just what, but sometimes I think the kids don't know necessarily, you know, just know it's doing something that feels right, but they can't necessarily articulate. Yeah, I have anxiety and so I am smoking pot. Right. So I think it's really helpful to have information too, for the parent to be able to say, if this is going on, here are some things that he or she might be experiencing and this is why they're doing that. So, yeah. That's helpful. Yeah. And yeah, I'd love to hear about the Invitation to Change. I think, you know, yelling, screaming, bribing, you know, all the things that we do. Very understandable things. Yeah. Because it's really, unless you have other tools in your toolbox, that's all you know how to do and it's just, it can get, so, you know, there can just be so much frustration and tension in the house that it's just unbearable. So I think learning about how you could invite somebody to change is really appealing.
DR. WILKENS
Yeah. So, we, everybody at CMC, we got trained in community reinforcement and family training, which is the acronym is CRAFT, which is one of the only one of the most effective and only evidence based treatments for family members. And it's the reason why we wrote the book Beyond Addiction because CRAFT has been around for a very, very long time. All the studies, uh, of the effectiveness of CRAFT are actually done almost 20 years ago at this point. It's one of the most well-researched interventions for family members. It's the most effective intervention for family members and the addiction treatment world was not picking it up. Nobody knew about it. You know, five years ago before we wrote the book, I would give lectures to family members and I would say it does anybody know about CRAFT? I do lectures with treatment providers and I would say, does anybody know CRAFT?
And it would be crickets. Nobody knew anything. So, we wrote the book and so CRAFT was developed by Bob Myers, and it's based on community reinforcement approach, which is one of the most effective treatments for substance use disorders because it really, again, it takes what I just said about like, okay, substance use makes sense in some way. You know, persons being reinforced, the substance use is reinforcing in some way, meaning they're getting something from it. So if we're going to take that away from them, if we're going to help them give that up, we've got to think about what in their world is contributing to that problem. And let's look at a very holistic approach. You want to look at their satisfaction in their work in school life, their satisfaction in their ability to be in good, you know, healthy relationships. How do they take care of their bodies?
What's the actual community they live in? You know, are they somebody who's really incredibly motivated to change, but they live in an incredibly high risk community. You know, so you're really looking at the whole person. And so that, the studies on that are 25 years or more old. And Bob is a really interesting, brilliant guy. His dad struggled with alcohol use and he, you know, spent his whole life as a kid, watching his mom do all those things you described, yell at her, yell at his dad, be upset, kicked them out of the house, all of these things. And so when he was doing these early trials on CRA, he's like, why are we not teaching the family members to do the same things we're teaching the therapist to do or teach? We're giving therapists all these good skills.
Why are we not teaching the family members that similar skills? Because they're the ones out in the world on the ground. They're the ones who are most motivated for things to change. Let's give them the skills they need to reinforce healthy behaviors. Learn to communicate differently so that you can lower defensiveness and get your person talking so you can better understand things. You know, how do you let naturally occurring consequences play a role? How do you take care of yourself in the whole process? And you know, so he developed CRAFT. And all the studies on CRAFT were, they would take, so CRAFT was developed for family members who had a treatment resistant, loved one, you know, so your kid has a very serious substance problem and they really don't want treatment or your spouse. So you as a mother or you as a husband can come in, work with a therapist, learn the CRAFT skills and it helps you help your loved one change.
So they would, in the studies, they would take people who had been trained in CRAFT and compare them to family members who had tried to use an intervention and then to family members who had, uh, gone to Ala-Non. And what they were looking at was, you know, what's your, what is the success rate of getting your loved one into treatment? And you know, Kraft is, they were getting their loved ones into treatment. 60% or more of the time interventions are about 30%. And Ala-Non is, like under 10%. Part of that is that Ala-Non is not designed to get your loved one into treatment, right? Ala-Non is a support group where you can go and get support from other people who are struggling with their loved ones. So it's not even designed to do that. The problem with interventions, in spite of what interventionists, say where they get, oh, we have 99% effectiveness.
Okay. That's probably not true. You know, interventions are effective in getting people into treatment, but there's an enormously high dropout at the majority of family members actually don't complete the intervention. Because it's actually so stressful to do. They actually drop out of the process, you know, and then what we see all the time is they may get their loved one into treatment, but then you've got a loved one who's pissed off. So they're in treatment and they're mad about being in treatment and they're now really mad at you as a family member. So, and that's just like a setback, you know? Yes. Interventions have absolutely saved thousands of people. They absolutely do work at times and we recommend them sometimes, but the majority of people can't afford them. Their loved one's not going to take to it, you know, so what else are we going to give those people?
And so CRAFT is really that, because it's something that you can use, you know, every day and over a long period of time and have your loved one change. And then the studies, what was really interesting is that they would get their loved one into treatment. And I'm blocking on the number now, but I think it's like an under, under four, six or four sessions. They would get their loved one into treatment when their loved one got into treatment, their substance use was down before they even got to treatment. And the wellbeing and the life satisfaction of the, you know, the family member who was actually doing CRAFT was improved. You know, so their depression, their stress, everything that a family member struggles with was actually also better. You know, so just had this like big effect on overall wellbeing. And one of the things that we say all the time is like traditional recommendations are distance yourself.
Use tough love, right? Yes. Separate from your loved ones. So that's actually separating a family. CRAFT is like stay connected, stay connected, strategically figure out it's okay to love your loved one. It's okay to stay connected, you need some skills to have that go better for sure. But you can do that and you can actually have a really positive effect. One of the things that comes out in the research again and again and again is that one of the main reasons people do seek treatment is family influence. So as a family member, you have a huge amount of leverage and influence and your love and attention absolutely be part of that. And it's just been the exact opposite messaging from traditional addiction treatment, which is just a tragedy. So, you know, so that's CRAFT. The Invitation to Change.
BRENDA
Sorry. Can you say why? Why do you think it took so long for that too? Like why wasn't that being used in, in other treatment settings? If it's, you know, obviously it's, it is so effective. And it's not like it's a medicine, you know, medication or anything. It doesn't require a doctor other than to be, you know, to learn it. What do you think that kind of the lag was?
DR. WILKENS
It's a thing that makes me really mad and I think it's like a, it's a whole podcast in and of itself in terms of the addiction treatment industry. But, you know, change is hard, right? Change is hard for everyone. And I think there's a lot of there, you know, up until very recently there was a lot of skepticism about the science, like really using research supported techniques. There was just a resistance to it. And I think the, you know, the whole, uh, codependency language had picked up so much steam, you know, that was actually just hard to compete with. And the other thing I will say is that I think because it's really painful to stay engaged with somebody who is really struggling, that the message of distance yourself, cut them off.
It's painful. But I think it's, it's relieving to get that message in some ways because it's so painful to stay connected, and really like to stay connected through the change process. That's incredibly difficult. So I think it's just an easy thing to say. Distance yourself, you know, go take care of yourself, your loved one needs to bottom out. Like those, those are, those are easy things to say, right? To actually say to a family member, you can stay engaged, but you gotta learn a lot of stuff. You've got to learn some skills and you've got to work on yourself and you got to possibly change some of the ways that you react to things. You've got to deal with your emotions and you could totally do it and you'll be better off for it. And your loved one will be better off for it, but it's going to take awhile. That's, that's not a quick, easy sell. Right. So, I think that's, I think I do think that's part of it.
BRENDA
Well it's kind of like if you had a, you know, a child who became, you know, diagnosed with type one diabetes, would you just say, ah, that sucks and that's going to be really hard. So, but I'm not going to change anything about how I feed you or, you know, medication like it. Re it does require intervention in the way that you parent and the way that you know what you've learned.
DR. WILKENS
Well, but I think that's a perfect example though, because like a child with diabetes, that's a less stigmatized problem than addiction, right? So as a parent, you're like, Oh, we've got to change the diet. We gotta change this. We gotta change that because I'm not, not mad at my kid. My kid has diabetes. Like he has a medical problem, so I want to help and I'm getting told how to help. And that's all great. Again, this culture gets mad at addiction. We just do. I mean, that's why the prisons are full of people with substance use problems. Because we've had the impulse of like, just lock them up, lock them up. They deserve to be punished. The only way you can get to them is to confront them and punish them. So that is so steeped into our culture. When a family member like is told, Hey, this is something you can work on, this is something, you know, like you might need to like change some in order to address.
They don't want to have that problem. Like nobody wants to, nobody wants to be an addict and nobody wants to like, it's like there's so much shame and blame on family members, you know, they get blamed for being the cause of the problem. You know, so there's just so many reasons to push away, because it's just so painful. And I think so much of it is just the way we talk about it in this culture. So if we can like start talking about it differently and really support families and really engage in the idea of like, it's okay, you're scared. This is really hard, this is really painful and things can get better. Here's a roadmap, start, start engaging with this roadmap and doing the work and you'll, your, there's a very high chance that your loved one will really stay connected to you and start to change and that's going to feel awesome. And you'll have your family, right?
BRENDA
Yeah. So what is that, that roadmap, the, this invitation to change? I think it's so interesting, just the language around it is, you know, kind of head-scratching like, huh.
DR. WILKENS
Well, so, we took, we've been training parents to support other parents for a hotline for the Partnership for Drug Free Kids. We started that about six years ago and we started out just training them in CRAFT, right? We were like, okay, so let's get parents on this hotline. We had all these parents, who many of them who'd lost kids to overdose, who were just had been through the ringer with treatment programs, and really, really wanted to support other parents with evidence-based ideas. So we had this like super fired up group of parent coach volunteers who are going to get on this hotline, funded by the partnership. And so, you know, you can be a parent out there in the world, freaked out about your kid, you know, using whatever, and you could call this hotline and you'd be talking to a parent who would be giving you advice based on CRAFT, you know, so you wouldn't be getting the tough love advice and all that kind of stuff.
You'd be getting like, Hey, what can you think about reinforcement, what, you know, all these kinds of things. So we did that for several years, and had a fair amount of success. But just in doing the trainings, we realized that family members needed a much bigger shift in perspective. And they needed a lot more self-compassion than what is in CRAFT proper. So, one of the things I like to say about the Invitation to Change approach is that we've kind of put CRAFT on steroids, like amped it up. So you know, the first sections are all about shifting how you understand the problem. So you know that there's behaviors make sense, which I've already talked about a lot. There's a whole section on really understanding ambivalence and being able to know that ambivalence is 100% going to be part of the process and how you respond to ambivalence can really move things one direction or the other.
You know, just helping them understand how motivation works and just helping them understand the whole process better because that's really kind of lays the foundation of this is a problem you're facing and how can you see it as a, as a longer term thing to address? We have a whole section about one size doesn't fit all, you know, because again, you have an addiction problems that people think you gotta be sober, you've got to go to meetings, you've got to go to rehab. Well there's about a million things you can do to change your substance use problem. And every family is different and every person with a substance use problem is different. So we really encourage family members to dig in and think about what does my family need? What does my loved one need? You know, I'm going to be getting a lot of advice here and I've got to be able kind of filter out the stuff that doesn't sound like it's going to work for my loved one.
You know, one of the things I say to parents, parents come to us, so beat up, and you know, they're, they're so second guessing themselves and they just feel like, I don't even know what end is up. Like you said, like I don't know who this kid is in my house. Right? One of the things I say to them is, I know it feels that way. You know, your kid, you have so much information on your kid, let's unpack that. Let's help you understand what you actually know cause you can use that. So there's a big empowering piece of this, of like it's like use information that you have. Then there's a big section. So this is what we've added, which is kind of helping with, uh, awareness. So that's really all about self-awareness, being able to understand your own emotional process, like knowing your limits, like knowing when you're maxed out.
And maybe shouldn't be having the conversation that you need to be having and giving yourself permission to walk away and come back later. You know, being able to really have compassion for yourself and understand the impact of shame and stigma on you as a loved one. And really wrestling with that and learning how to take care of yourself. Being able to widen your social network. You know, a number of people that I've worked with that have never told a soul that their kid is struggling is heartbreaking. You know, they're just in it alone because it just feels so much shame, cause I've never met a parent who if the kid starts to struggle with a substance use problem, they don't think somewhere in there, what did I do wrong? What did I do? Why is my kid doing this? I must have done something wrong.
Right? So you've really got to build a lot of compassion around that. So that they can come forward and be like, okay, like, you know, it's not that I did anything wrong, but I actually didn't know X, Y, and Z. And that's okay. If it doesn't make me a bad parent, it just means I didn't know how to tackle this or I didn't know what to do. And yeah, and just soften all those edges that a lot of people walk around with. And then the final section is more kind of CRAFT proper, which is communication strategies. There's a lot of communication strategies that, like I said before, really lower defensiveness, and can really help you listen in a different way so that you can hear the information that you need and help you talk to your loved one in a way that actually will have them listen to you, which is what most people really want.
So there's a lot of communication and then how do you give information? So if you want to make suggestions, if you want to make treatment recommendations, if you want to, you know, tell them what you're observing, like how can you make those observations to them in a way, again, that they can actually hear. And then the final section is like helping an action, which is like, okay, what are the things that you want to reinforce? You know, what are the things that need to change in your environment that will create an environment to support healthy change? You know, what are the things that you want to reinforce? Either through complimenting it and noticing it, like, Oh, you did a great job on that all the way to, you know, what, like, I'll help you with your rent if you, you know, go to treatment successfully for a month or, you know, whatever.
I mean, just like figuring out what you want to support and then figuring out the naturally occurring consequences, which is where the whole kind of helping them tease apart like what is enabling versus a natural consequence. Because natural consequences are the most meaningful, right? They're the ones that like are the direct outcome of your loved one's substance use. So you know, you sleep in and miss soccer practice. Most parents have the instinct to like, get you up out of bed, get you to soccer practice and all that kind of stuff. Right? What if, what if they miss soccer practice and had to go talk to the soccer coach? You know, that's the consequences having to deal with the soccer coach. If you're getting the kid to soccer practice all the time, exactly on time, the soccer coach doesn't even know anything's wrong and you're just an upset parent pissed off at your kid all the time.
Your kid needs to know if I'm late, the soccer coach gets mad at me and tells me if I'm late again, I might not be able to be on the team. Like that's way more meaningful than my mom being mad at me yet again of which I'm just going to tune out. So, it really helps them understand naturally occurring consequences and how to really use those. Cause if you pair a naturally occurring consequence with positive reinforcement in other areas, you can really like change the environment. And help people realize like, oh my substance use isn't working so well, but when I'm sober, all this good stuff happens and that feels really good. So I want more of that. You know, again, I just described all that in five minutes. That's a lot. That's a lot of learning. Right. You know, but I'm just saying it's a lot. It's a lot for people to take on. What's fascinating and fun about it is that, you know, you just see this like it's people start to have success, you know, and it just feels so good that they're like, Oh I had, this has been really hard, but this is fricking awesome cause it's starting to work. And you know, then people get nice momentum.
BRENDA
Right. So what, just in maybe drilling down a little bit, like what's sort of a real world use case or some language or just like a scenario that parents could connect with. Maybe their kid just came home high again or you know, they saw pictures on Snapchat with them at a party, rolling a blunt. Like what, what are some things like at a tactical level that you might say or do or not do? Based on the invitation to change model?
DR. WILKENS
Well part of that is thinking about all of this stuff in advance, right? Because if you're like, oooh, I just saw you rolling a blunt on Snapchat and I haven't really thought through or told you how I'm going to respond if I see that stuff. There's lots of room for misfiring there. Do that again, I'm going to you out. Well are you really going to kick them out if they do that again, are you prepared to do that? Like people will say that kind of stuff all the time and I'm like, look, unless you're ready to change the locks on your door and really kick your kid out, never let that sentence leave your lips. Cause if you start making kind of threats that you are not actually going to keep, then you've lost all your power. So really working with, you know, the other parent or any other, your other supports to kind of think through like, okay, like how do I want to respond?
What are the consequences that I'm willing to, you know, attach to different behaviors and letting your kid know that, you know, as far in advance as you possibly can, definitely there's times when you're just going to get hit with stuff and you're like, Oh, I didn't even know that was happening. How do I respond to that? In which case it's okay to say, wow, I didn't even know you were doing that. I need a day to think on how I'm going to respond to that and come back to the kid the next day and be like, you know, I thought about that and you know, you're grounded for two days. That's unacceptable. And if I see it again, whatever. You know, there's when you start, when you dig into the Invitation to Change skills, what you're, what you're learning is to kind of tear things or you're like, okay, so how do I talk about my expectations just in general for my kid?
Now how do I talk about substance use? Cause no teenager wants to talk about their substance use, substance use in general with the parent. Right? But you need to be talking about it. And how do you talk about sex with your kid, right? Like how do you have successful conversations with your teenage kid? There's a lot of skill in that, including just not avoiding it. You know, even if it's like an awkward, difficult conversation with it, you feel like your kid didn't hear a word you've said it. And I talk a lot about like, kind of planting seeds. You know, you may like have a conversation with your kid that you feel like, wow, that was a big fail. When actually they took something in. They're not going to give you credit in the moment. I'm not going to show you that they're listening, but they're going to walk away and have your voice in their head.
You know, so it's just really important to kind of lay out your expectations of, you know, what happens if, you know, you use a substance, you can get intoxicated if you come home high. You know, at the, creating an environment where your kid feels like you understand, you understand that they're facing all sorts of tough choices, that you want to be helpful to them. You know, that, you know, if they make a choice that they regret, it's okay to tell you about it. Like if they, if they're getting intoxicated, can they call you to have you come get them? You know, that you're not going to be like crazy mad at them and yell at them all the way home that you'll just come get them and you'll talk about it the next day. And yes, there might be some consequences, but really like what you're most trying to create an environment where your kid can talk to you.
You know, so there's, there's all sorts of kind of like, if there's low level stuff happening and you know, hopefully if you've addressed all that, by the time you're getting to more complicated stuff, got like a bet your kid's got a better sense of, wow, if I come home late, you know, X X is removed or I lose my allowance, or I can't go out the next night, or whatever. Like it just needs to be clear. So many people get kind of into chaos mode and they're responding to the fire of the moment and they're, and so there's just so much room for not taking things seriously for getting what you said, saying things in the heat of the moment that, you know, that makes you the bad guy. You know, there's just so much room for error. So we just try to help people slow down and think, okay, what are my goals with my kid?
You know, and parents and family members get locked in on consequences. They, they often want to go to what's the consequence for this? Right. It's actually way more important in some ways to think about what am I reinforcing, what behaviors am I supporting? You know, am I, am I creating an environment where my kid has things that they can engage in that they care about? You know, do they have sports? Do they have stuff to read? You know, they have, do they have access to like, like other healthy kids who are doing okay? You know, am I helping my kid connect with things that are going to compete with substance use is another really important thing for people to think about.
BRENDA
Well, yeah, I like, I like that it sort of reframes it. And I think it is hard sometimes when you know, your child is doing some bad things potentially and not being the healthiest. And then to find a way to praise them or reinforce them can feel like, Oh, you know, like, I'm mad at them. I hate to do that. But it, but that's a big important part of what you're talking about
DR. WILKENS
for sure. You know, it's called, it's in behavioral traits language it's called shaping, you know, if, and just going back to behaviors make sense. You know, substances feel good, right? So if you're wanting your family member or your kid, since we're mostly talking to parents to not engage with their substance, you can't be mad at them all the time because if you're mad at them all the time getting high will feel better. Right? So if you're, when they're sober, like really like, cause that's reinforcing, right? If they get good attention, if they're really like, you know, if you kind of notice like that was a great conversation we had. It was so nice to talk to you the other night or you just look so great. You know, it's like during a period where they're not using or you know, if there's anything you can compliment or notice during the periods where they're making a healthy decision, a good decision, you've got to really notice that because they've got to start to realize like, Oh, when I'm on this side of the track, mom's really nice to me.
It feels really good. I feel really good about myself. You know, whatever they, you know, if the, if the world feels bad, whether they're using or not, that's platform to just want to keep using because it allows you to know that all out. So, and that's where it is. Like what you said before, it is really hard because you might be really mad and really frightened. And you may be like, God, I was up two nights ago, scared to death. I'm still mad at you. But if two days later they're doing something that is a healthy behavior that you want to reinforce, you've got to notice that. And really be like, that was awesome. I saw you do it. You know, you were really nice to your sister or like, you know, it just saw you really take care of yourself. Or it's great that you came home on time. Thanks. Parental attention and compliments and love. That's all free. And that goes so far with kids. Parents when they're upset, really underestimate that really goes a long ways.
BRENDA
Yeah. Yeah. I think it can feel sometimes, at least when I first started, kind of incorporating these methods into, into our family and in our behavior, it felt a little bit like, man, I'm the one who's got to do all this stepping up here. Right? I have, you know, to learn this stuff and then to not say this or to make sure and say that and it just kind of felt like I'm doing all of the work, but on the other hand, you don't have the choice because that's what it takes. Kind of like going back to the diabetes thing, you know, I wouldn't just not learn how to cook the right food my child had had my baby. So I think it can feel a little bit like, well, this is a little unfair. I'm the one that's having to, you know, to do that, do all this.
DR. WILKENS
Yep. Yeah, that is, that is one of the things that we built into the Invitation to Change addresses that moment that you so eloquently described. There's an evidence based treatment called acceptance and commitment therapy that is really all about helping people build to kind of psychological flexibility and acceptance of their, of all emotions, including the painful ones. And so really as we encourage significant others and family members to kind of really like dig into your values and think about, okay, like what kind of parent do I want to be? And in those moments where you're like, Oh, why am I having to do all the work? Right? Which is completely understandable reaction when you're frustrated and burned out and right. If other things. But to be able to pause in that moment, be like, okay, but is what I'm doing?
Me being the person I want to be, you know, am I being the parent I want to be? Is this, you know, is me shifting this behavior, going to help my kid, which is what I really want to do. I really want to help my kid. I've never met a parent who doesn't want to help their kid, you know? So if you can stay anchored in that as that's why you're doing this. It can really help you get through those moments where you just want to throw your hands up and feel like nothing matters, you know?
BRENDA
Yeah, yeah. You mentioned natural consequences and I think that's a really, that is a very powerful way to approach this. I think for me, I'd love to get your, your thoughts on this. It gets, it can get to a point where it's beyond, you know, soccer practice or your group and it starts to become legal. And I think there is that natural tendency to say, well, I'm not going to have my kid arrested. Or you know, what, when it starts really getting the point where there's something might go on their record or could potentially be physically dangerous, where, how do you know where did, like the boundaries are or is there ever a time when it's a bad idea to let them suffer the natural consequences?
DR. WILKENS
Oh, for sure. So that's part of it. That section is to kind of really know your limits around that and know what's, and be able to give yourself permission to kind of think through, okay, what are the consequences that are actually safe and important for them to have? You know, because the world being their teacher is actually quite meaningful. So you want to think through those. And you want to think through, am I cause that's where enabling is, right? Like if am I getting in the way of some naturally occurring consequences, because I'm just kind of having the knee jerk response to protect them. And then they're not feeling real world consequences. So you really kind of think all that through and then think through what are the consequences that I'm not okay with them having? Because you know, we use drinking and driving a lot. Like, yeah, maybe you don't want to go pick your kid up, you know, at the train station, but if you left them to drive home and they kill someone, that's unacceptable.
Right? So that would be those, those high risk consequences or those ones that, you know, may alter their life forever. Of course, you know, you can't let those happen. You know, or when do I have to jump in and actually like really get them to treatment or, you know, whatever. But like, it's more around like, am I going to keep paying for rent? Am I gonna you know, what, like, am I going to bail them out? You know, the number of times I've like, and it's really hard and that's why family members need support. You know, I have worked with families where we got to the point where we were like, okay, next time he gets arrested, you're not going to, you're not going to bail him out. He's going to stay there and he's going to get a court appointed lawyer and he's going to have to go through that process because you've tried to help a couple of times and he's not learning from that.
So it's horrible and it's scary and this is where you are right now. You know, so families absolutely end up making such difficult decisions. You know, and that family, being able to make that decision in the context of support and help is like, that's what helps. That's what helps you kind of, and I've worked with families who have had to ask their kids to leave the house and they had really have closed, locked the doors. Because they've tried, they've tried, they've tried and the situation is not getting better. So you really do get to that. Like, all right, I am actually going to have to you, you're on your own. And you know, that is a horrific place for a parent to get, you know, but by time, the people that we work with are making that to choices. I think they've really felt like in their heart of hearts, they're able to say, I know I did everything else before I got to this point.
I didn't do this in a knee jerk way. I didn't do this in an impulsive way. I really tried a lot of other things. And for whatever reason, my kid just isn't learning and he's got to have this life experience. And I as a parent need to get a lot of support right now because this is really scary. It's really scary and it's really heartbreaking and I'm a wreck. How can I get my support while I let my loved one go on their journey? Because you know, we can only control so much. And it's actually very little. So be it. That's where all the self care comes in of like, okay, what are your support systems? What are your, what are the things that you do for yourself doing these really difficult moments? Cause it can be quite hair-raising and terrifying like you said.
BRENDA
Yeah. Yeah. And I think the self care part of that is something, especially women and you know, as, as moms, we, we tend to be pretty terrible at it. And I love that there is a whole actually two sections in the book to kind of talk about, you know, it's almost like the triage self care and then there's the more, you know, like purposeful, ongoing and, and I think a lot of times moms especially and dads, you know, have this guilt factor of, Oh, I can't go have fun. I can't go get my nails done. I can't do this because my child is out on the street somewhere. And maybe you can talk about how that is not necessarily, that's not self-indulgent, but that is an important part of the whole process.
DR. WILKENS
It's so important. And with Invitation to Change a lot of the metaphors that we use are like, that's essentially, you know, we kind of conceptually, we, one of the metaphors is like, look, trying to help your kid is like, not like it's a, it's a marathon, not a sprint, first of all. And it's probably not a marathon on a well-paid track. It's probably a marathon through an uncut jungle in a rainstorm. It's like, it's difficult. Right? And so if you go on that journey and you're not putting, you're not checking the oil in your car, you're not looking at your roadmap, you're not putting gas in your tank, you're not going to get very far. Like you've got to take care of yourself. That's the other part of that. What we've shifted in the understanding section is really helping people see that behavior change, whether it's for you or your loved one is a process.
It takes time. It takes practice, it takes trial and error. You know, the, the belief like, Oh, I just got my kid to rehab, or they finally got into treatment, everything's going to be better. That's probably not the case. I use a couple of different metaphors for parents. You know, because we also have all these like pretty crazy expectations for treatment and change when it comes to addiction. It's like, Oh, you went to rehab. Like you're never gonna use again. Right? Yeah. And that's actually what they sell. That's what rehabs often sell. Right. You know, so I'm a pianist, and so I would say like you would never expect your kid to, if your kid had never played the piano, you would never expect your kid to play a Chopin etude.
If you expect your kid to come out of rehab and be sober for good, that's like asking your kid to play a Chopin etude and they've never played the piano. What's actually happening is your kid needs to take piano lessons with a beginning instructor. He's going to earn some learn some easy pieces and work really hard. He's probably going to learn some stuff wrong and he's kind of have to like relearn it. At some stage he might have to get a different teacher because that's, he outgrew that teacher. He's going to have to practice more things. He's going to have to find the music he likes to play, you know, where does he like to play it? Does he like to play by himself? Does it like to play? You know, like there's so much learning. We have so much compassion for the learning process in other areas, we don't have a ton of compassion for the learning process when it comes to behavior change around addiction and substance use problems.
So we really try to help family members kind of see this like a longer term vision of change. Which again, that can be hair raising to go on that journey, right? You just want things to feel better now cause it's distressing. It's probably gonna take a while. So you've got to take care of yourself while you and your loved one learn how to do this. Cause your loved one clearly doesn't know how to do this. They don't know how to get through life without a substance. So they've got to figure out how to, they've got to learn to give that substance up. So that's a lot of learning and then they've got to learn to do something else instead, which is also a lot of learning. You know, so I think that also is a really important shift for people to make is understanding that concept.
BRENDA
Yeah. Yeah. I think that is one of the myths that exists. And it’s so hard because when you do, not only is it the emotional investment and time, the financial investment for families who are, you know, have a, a child going into detox or rehab, you're just like, okay, well this is it. This is gonna work. And I don't, I don't know what the statistic is, you might, but I would hazard to guess that it's over 70% of people that come out of a traditional insurance covered 30 day program are going to have some sort of relapse at some point. And again, that's not a statistic. I just am making that up, but it, it's, it is so high and if you aren't prepared for that, it can just be devastating when, when that next shoe falls.
DR. WILKENS
No, and I think really understanding the relapse process and, you know, thinking, you know, what's so valuable about kind of the harm reduction perspective is, you're really like the goal of like, just reducing overall harm. So when you say like, okay, somebody left a 30 day rehab, and they have a setback, well what kind of setback is that? Did they drink for a night? You know, were they in rehab for heroin and they started smoking pot? You know, like how you respond to each one of those things. You know, it's really like, again, what does my loved one need? What is their change process? What's happening here? How do I want to respond to this? You know, but if I have the “Oh, he's not trying, I might as well give up” response to a relapse. You're, you're toast.
Cause I say to parents who come to our substance use program, like your kid, probably your, I'm pretty convinced your kid will use something that's on point. So how do you want to deal with that? You got to start thinking about that because young adults also just developmentally like it's so hard for kids to think about anything forever. Like what teenager or what person under the age of 25 can think I want to be, I want to be something forever. If they just can't think that way. So it's just so remodeling. It's like the number of things I did before 24, you know, like you just don't know. So you want to create a platform where they can be honest, they can talk, they can talk about the process of change, they can talk about setbacks, you can problem solve. You know, what our treatment programs were really considered a relapse to be like an opportunity to learn something new.
Okay. Like what, what did you underestimate? Like what did you not plan for? What did you not see coming? Like how, how do we need to help you cope with that? You know, not that you did something bad. It's a, we missed something and what can we learn and try to do differently this next time around? So again, it's just, it's a more nourishing, curious process and it, which I think attracts people, you know, that's another reason why people are resistant to seeking treatment traditionally is because people don't want to be labeled. Most treatment programs label you as an alcoholic or an addict. And that's part of it. People don't like labels, they don't want that. So they resist. You know, and then there's all these expectations that again, people, people have a ton of ambivalence and there's no room to talk about that.
So you know, a lot of these evidence-based options really allow for that and encourage people to talk about that ambivalence cause that's where you can really help people change. And you said earlier about finances and family support. So one of the reasons why we started the Foundation for Change is because it is really expensive and insurance doesn't cover things. And this is a long term process for most people. So we're trying to create a platform like a web based platform where people will be able to go and have access to free training videos, free content. You know, we're trying to hopefully creating a platform where, you know, if you're really motivated parents and your community and you want to start an invitations change support group in your community, you can get trained by us, have all the content and be able to start a support, a free support group in your community.
Because, you know, it really is parents helping parents. And parents helping their community understand the problem. If we had first responders understand the problem differently. If teachers, coaches, you know, every, everybody we're talking in this language and seeing this problem through this lens, I don't think we'd have such a big problem in this country. I think things would really change. And there's never going to be enough treatment providers to do this. So we've got to arm family members with this information. Cause they can go back into their communities, their schools, their churches, and really change things. So that's what we're hoping to do at the foundation. It's a big, lofty goal, but I think, I think we can do it if we have enough parents get fired up about it.
BRENDA
Absolutely. Are there any other myths sort of that you like if you could have a billboard that would clear up one myth about either addiction or treatment or, or you know, parenting, what would that look like?
DR. WILKENS
If there's one sentence I wish we could eradicate and that nobody's like in the next decade, if literally no one said this, I would say we've had a huge success. The myth that your loved one has to bottom out, like that is what is killing people in this country. They do not have to bottom out. That really doesn't have to happen. There are so many ways you can influence the change process before your loved one's life is wrecked and your family is wrecked. It just doesn't have to go that way. So I think that's, that's a big one. You don't have to detach. You don't have to use tough love. You can just use love. It turns out. You can be strategic in how you met out consequences and reinforcements. But the love doesn't have to be tough.
Uh, so there's just, you know, there's just a lot of those little sticky phrases that, you know, and codependency, you know, when somebody says to me, they're codependent, I'm always like, I don't know what that means. I don't know what that means to you. Whoever told you that. Like, I don't know what they meant when they told you that. Let's unpack that, you know, because there is no such thing as a disease of codependency. Family members for sure struggle with all sorts of things, you know, and like we were saying earlier, a lot of them have just trauma. They're just traumatized. You know, and they're doing their best and they're scared and depressed and they're financially maxed out and, and they're isolated and, you know, they just need help. It needs to shift in this country as family members just need help.
BRENDA
So yeah, and it sounds like this, the new resources that you're planning and what help with that. And especially for people who are not, you know, I live in a major city, but, and I often forget that there are places where there might not be anybody.
DR. WILKENS
No, I grew up in Western Kansas. And you know, you've got to drive two hours to find a psychiatrist, most lessen addiction. I was out there a couple of years ago and I'm hopefully going to go out there and do a training sometime in the spring, but none of the medical professionals wanted to prescribe buprenorphine or Vivitrol. They didn't want to have anything to do with it. You know, which is just scary and horrifying. So, part of why we want to build this web based platform is because I really, I do, I want the mom in Oklahoma, you know, after she puts her kids to bed at 11 o'clock at night to be able to go on and get evidence-based concepts and ideas that she can like do at in the time that she has, you know, where she is, in an affordable way and be able to take that back into her family.
BRENDA
Yeah, that's, I mean, that's, that's the key is to really get, get down to that level, in a practical way. Yeah. So, well this has been absolutely amazing and so much learning going on. Are there resources outside of, and I'll put links to all of this in the show notes. So for the book Beyond Addiction, I know you have a 20 minute parent guide, that I've downloaded several times. Are there any other resources that you love, either podcasts or books or anything that you would recommend?
DR. WILKENS
Yeah, sure. Dr Josh King, who works with us at CMC has started a podcast called the Beyond Addiction show. And it's pretty great because he has been interviewing it's weekly, and you can download it from wherever you get your podcasts. But, he interviews, uh, experts in the field in all areas, you know, different behavioral strategies, medications, you know, he interviews scientists about different drugs of abuse, different self-help, you know, so he's had women in recovery, he's had smart recovery. He just interviews as, you know, he's like policy people. Like he's just really trying to like create a space where you can go and listen to a podcast from, from somebody who is actually doing good work out there. And it's science-based and so it's just a nice free cause. One of the reasons why we wrote Beyond Addiction is because I think if we arm family members with the information, they need to go back into treatment programs and say, hey, why don't you guys provide CRAFT?
Like, I've looked at the evidence, it's like it wins all the horse races. Why are you not doing it here? You know, or why, why don't you allow medications, you know, like, the science is in, medications help,w hy are you not allowing that? So I think if family members again were armed with information that the treatment landscape will continue to change. So that podcast I think is really great. And then if you go to our foundation website, uh, CMCFFC.org in the next three to four months if you sign up for the newsletter, you'll get nice material yourself. But we'll also be announcing when all this stuff comes up online so that, you know, over the next year will hopefully become a big repository of great stuff for our family members. And if you want, I can send you a couple of other great online resources for family members. Just great websites where there's a lot of information and educate yourself and get some support.
BRENDA
Yeah. Yup. I'll put all those in the show notes for people. So, yeah. Well, thank you so much. I think we probably uncovered like three other podcasts. I appreciate it so much and we'll connect everybody to you in the notes, thank you so, so much.
DR. WILKENS
Great. Thanks for having me and happy Valentine's day. Bye.
BRENDA
You too. Thank you.
I hope you found that as interesting and helpful as I did and if you did, I would love it if you would pop into the area in Apple podcast where you can rate and leave a review that does help more parents find this podcast and get this great information. And for you moms who might be needing a little bit of extra support and love and want to find a tribe of other moms just like us, you can go to www.thestreamcommunity.com and you can check out the 24, seven support that you can get there with both a mobile app and also available on your computer. I thank you so much for listening and can't wait to see you back again on our next episode.