The Kind and Scientific Way to Help Your Loved One Change Their Drinking with Dr. Jeffrey Foote

Episode 118 June 21, 2023 00:56:57
The Kind and Scientific Way to Help Your Loved One Change Their Drinking with Dr. Jeffrey Foote
Alcohol Tipping Point
The Kind and Scientific Way to Help Your Loved One Change Their Drinking with Dr. Jeffrey Foote

Jun 21 2023 | 00:56:57


Hosted By

Deb Masner

Show Notes

Are you frustrated with your loved one who drinks too much? Do you feel powerless and unsure of how to help someone who has a drinking problem or other addiction? Are you sober now and struggling with your partner who still drinks? Learn how you can help someone change with a science and compassionate-based approach. You don’t have to be “enabling,” use “tough love” or wait for them to hit “rock bottom.” Dr. Jeffrey Foote joins the show today to show us how we can help a loved one make a positive change and keep our sanity. 

Dr. Jeffrey Foote, Phd, is cofounder of the Center for Motivation and Change (CMC) outpatient programs on the east coast. He is also cofounder and executive director of the CMC: Foundation for Change, a nonprofit organization with the mission of improving the dissemination of evidence-based ideas and strategies to the families of persons struggling with substance use. Additionally, he is coauthor of the award-winning book, Beyond Addiction-How Science and Kindness Help People Change and the new book, The Beyond Addiction Workbook. 

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Episode Transcript

Pod Jeff Foote Thank you for listening today. I think this episode is kind of like part two of helping a loved one. We had parenting coach, Heather Ross on a prior episode, and she was talking about her experience, helping her daughter with substance use and helping parents. Uh, whose children struggle with addiction or drinking. We also talked about helping your loved one in general when they are struggling with drinking. And this episode is just a deeper dive into the concepts and tools behind helping a loved one change. And so I think you're going to find it really helpful. If you are frustrated with your loved one who drinks too much, if you're feeling powerless and unsure of how to help someone who has a drinking problem or other addiction. Maybe you're sober now. You're not drinking now. And you're struggling with your partner who still drinks. So I think this will be really helpful for you to just learn how you can help someone change with a science and compassionate based approach. And you don't have to be enabling or using tough love or waiting for them to hit rock bottom. So on the show today, I am just delighted to have Dr. Jeffrey Foote. He is a co-founder of the center for motivation and change outpatient programs on the east coast. He is also one of the authors of a book. I highly recommend it is called beyond addiction. How science and kindness help people change. He also has a new workbook out. That is just so wonderful. It's so usable, easy. And it's called the beyond addiction workbook. I'll make sure to link to both of those books in my show notes, but it is just like an honor to have this expert on the show. Someone who uses science and kindness to help people change. He does a great job of speaking to. Not just the person who is struggling to help their loved one, but also if you are struggling with your drinking, I think you're going to find it really helpful to this may be an episode that you want to share with your partner or spouse or a loved one, just so that they can get a different perspective in how, how to relate to you when you're trying to change your drinking. And it's really tough. And then if you're on the other side of things and you're the one that really wants to help your loved one change, and you're just so frustrated, then this will also be a really helpful episode for you. So. Thank you for listening. Let's get started. Deb: Well welcome Dr. Foot to the show. I am just really honored to have you here. I finished your workbook, the Beyond Addiction Workbook for Family and Friends, and I just thought it was so helpful. So just you, you say it yourself, science plus kindness equals change. So really wanna thank you for all the work you're doing around helping people who have loved ones who struggle with addiction. Dr. Foote: Yep. Yeah, absolutely. Yep. And it's, it's coming from having the first 30 years of my career being not working with families, just working with people who are struggling themselves and taking a lot of the ideas of what's helpful to people and how to help them think about the struggle they're in and, and, and explain that to their families in essence so that there's a, a greater understanding. On both sides of that street, you know, so. Deb: Well, I appreciate that and as I was reading it, you know, because I've been the one that has struggled with drinking and I think a lot of the people who are listening are people who are struggling to change themselves. And I was reading your workbook and I'm like, this is just so helpful for everyone. I mean, and, and it, not even just if you're struggling to help your loved one, but if you, if drinking is your thing, or even, you know, there's so many good communication tools in it that as a parent I was like, oh, I'm, I need to do this with my kids. This is gonna help me communicate Dr. Foote: better. Yeah, yeah, yeah. No, I, I mean, there's. The, we, we can talk about the whole approach, the invitation to the change and the different elements of it, whatever. One of ones of those might be helpful or interesting to talk about. But I literally just stepped out of a training we're doing with family members 10 minutes ago. And the topic that we were on at that moment, Was as a family member you experience all kinds of emotions, including shame and and then you isolate and, and these kind of things that are sort of natural human responses to a struggle. Especially a, a struggle that in this culture is highly stigmatized. So either the person who's struggling themselves or the person who's trying to help them, everybody feels stigmatized. Everybody feels like I'm not supposed to talk about this. This is not okay. I'm a, I'm a bad person. I'm a bad person for struggling and I'm a bad person for loving somebody who's struggling. So you said everybody gets the bad news there. And to the point we were making 10 minutes ago in this training was you as a family member may feel a lot of. Of shame about that. I'm involved in a struggle like this and, and was this my fault? But if you also look across the street at the person that you're trying to help or your family member guarantee you that person is, is doubled down on the amount of shame that they're experiencing. And they may not express that. And they're not walking around with that on their sleeve saying, I feel ashamed, but so much of this kind of struggle. Results in people feeling bad and feeling other and, you know a failure and I can't believe I'm still doing this. And again, as a, they may not express that to the family member, but the sense of like, I'm hurting everybody. I'm messing everything up. I can never get this right, is such an intense part of this whole thing for, for people when they're in the middle of that struggle. So I think these, this invitation to change idea is an invitation to everybody. I mean, that's what it's about is. How can we help you? This person who's in this struggle, start to think about this in other ways and understand your own behavior in ways that are less stigmatizing, that are more uplifting for you and, and that are real. You know, the kindness is not like, just be kind. The kindness is like, this is a hard thing. You deserve kindness. You know, you, you're so. I think it really applies to both. Deb: Yeah, absolutely. And, and so what do you think we've gotten wrong about trying to help Dr. Foote: people? Well that is a long list. I'm sorry to say as a psychologist and as a human, I don't think we do that so well. But it's interesting when you just, when you just ask that question like that, that's. What do we do wrong in helping people change? One thing I would start with is helping people change anything. So this is not specific to substance struggles. It's really this whole invitational idea about helping someone change really is about changing any kind of behavior. And, and it's not that all behaviors are the same and, and have equal difficulty in terms of changing and so forth, but it is true that a lot of the. Of the barriers to change. A lot of the things that people struggle with about any kind of change are similar. For instance, real, real basic ones like the behavior I'm engaged in, whatever it is. I work too hard. I can't get motivated to work. I drink too much, you know? I'm I'm not kind to my family and I don't know why, you know, and I'd like to change any of those things. To start with the basic idea that that behavior makes sense in some way. So if we start often in the encouraging of change process, what happens, especially if it's behavior that I, as the person asking you to change, if I don't like your behavior or it scares me, or I don't understand it, or, or it's making me mad. I am often likely to come at it from the perspective of you need to change that. And that behavior, it doesn't make any sense and that behavior is bad. So it was pretty clear, you know, you need to change it. It's sort of like if somebody is smoking and you approach them and say, well, I don't know if you've ever read the label by the way, but this, it turns out the smoking cigarettes is dangerous and you just really need to have that information so you can stop now. Right. Like, yeah, no, and that's not how this works. Like, yeah, I, I knew the information, you telling it to me either nicely or in a, with a raised voice is not actually helpful to me. But what actually could be quite a bit more helpful for me is for me to pause you too. But for me to pause and say, well, what, what's, what about this behavior is helpful for me? What about this behavior is important for me in, in, in, in psychology language? What about this behavior is reinforcing for me? You know, we sometimes say this expression if, if, if using substances was like putting my hand on a hot stove, I, I wouldn't have done it more than once. You know, I would've stopped. Us human animals don't continue stuff. That's only bad for us, that only has a bega negative reaction. So we do stuff cuz it gives us something. It may have destructive downsides, bad things may be happening, the wheels are coming off the car and I'm fighting with my spouse. I'm, you know all those things may be happening, but I'm still getting something from this. And what I'm getting is immediate and it's reliable and it's mine and I can do it on my own and hell with you all. And you know, that's, those are all like positive features for human beings about behaviors and it makes me relax if it now, it used to make me relax all night. Now it makes me relax for half an hour, but I still get something out of it. It used to help me sleep through the night. Now it helps me sleep for four hours cuz I have withdrawal from alcohol when I wake up in the middle of the night. But at least it gets me to sleep. So this behavior makes sense and boy is it helpful if my spouse could understand that, not as an excuse so to speak, but as a, actually this is actually what happens here. So if I can let myself have that room to understand, right, I do this cause it helps me sleep. I have chronic pain from my, you know, back problems. I have PTSD from being in the service. I have, whatever the things are. This helps me. And can I give myself the room to recognize that, allow that and, and give myself a break here a little bit. Like, you know, this, there's the kindness part, right? Which is like, I'm not an evil person. I don't, I'm not a liar. I may not tell people what's happening. I may lie about stuff, cuz not a real popular thing to say. Yeah, I'm sorry I didn't show up for work this morning cuz I was just using a bunch of cocaine all night. Like, that's not a good thing to be honest about. So, It's not rewarded to be open in these ways. But the point is, can I, can I have the room to go? This is what makes sense about this behavior. Are there other ways I could get this that don't necess necessarily include drinking or using substance of some sort? You know, and that's just sort of a foundational idea in behavior change. Can I understand what the behavior is about? That will help me start to change it. It certainly helps other people have a little bit gentler, more empathic approach to me, which helps me as well. If they actually kind of walk in my shoes and understand what's going on here, and again, that can get confused with like, I'm not going to, you know, cut a, any slack. I don't want to. That's just making up excuses. Well, it's not actually, there's a difference between making of excuses and, and having reasons. They're not the same thing. And people do things for reasons, not for no reasons. Deb: Absolutely. And yeah, I, I appreciate you saying that. So having. Just an understanding of like, okay, why, why am I still drinking? Because I'm, I'm struggling with it. I know I'm better off without it. And I like to remind people like, your brain is wired for this. Like it's wired to move you towards pleasure and away from pain in the quickest way possible. Yeah. And alcohol does that. Yep. And I think that's so helpful for people to understand because they're always thinking like, I'm broken, and I think like, you're not broken. No, Dr. Foote: you're human and you're reacting to the way our brains are wired, as you just said. That's exactly correct. Yeah. Do Deb: you think a lot of addiction then is like a learning problem? Yep. Yeah, I did. That's what I was kind of gleam. I'm like, oh, this is just, you know, we, because this book is a lot about like learning and unlearning behaviors and habits that we've gotten into, and so then it's like, how do we unwind the habit and not just the habit of the person who's drinking, but the, the how the other person responds to the person who's drinking. Dr. Foote: Yeah. You know, it's an interesting question always, and it's, it's actually in our world of highly politicized, everything has gotta be a fight about everything. Coming, being in this field for many, many years you know, there's an idea that addiction struggles, substance struggles is a disease. And I've been around long enough to remember when that was a good new idea. And. That's not a model that I use. Or usually what we, how we talk about this is if that's a helpful model to you, go for it. It's not particularly scientifically supported. You don't really define a disease when it manifests in, in a hundred different ways, in a hundred different people. That's not usually what we think of as a disease process. Usually a set of common variables associated with the disease. This is what liver cancer is, you know and these are the signs and symptoms. This is what addiction is. How I got into this was, you know at age 60, my wife passed away and I felt a huge amount of grief and mourning, and I didn't know what to do with myself. And alcohol was really useful to me, and I am. 15 and my friends all smoke pot and I love smoking pot with 'em cuz it's the only way I can feel relaxed in the social setting. And I use a bunch of heroin cuz I have chronic pain and I started with Vicodin and then heroin is better and faster. And boy, other than that, I'm not sure how I fit into this disease. And how do we all fit together in the same category? Yeah, so, so it's more complicated than just learning, I think, but. Because I mean, we, we think of it as a, the, the larger idea here being bio psychosocial. The bio psychosocial model, meaning there's biology involved for sure. Difference between you and me might be that my father had severe alcohol problems and my genes are such that alcohol has a different impact on my brain than it does on your brain. So when I drink, I don't feel it so much. So I need to drink more. That's a difference, that's a genetic difference. That might predispose me to, to use alcohol more. I also had a set of experiences growing up that are different than yours. So I had a terrible childhood with lots of trauma and I don't want to think about that stuff. And alcohol really helps me with that. And you don't need that particular relief, you know? But we can go on and on with that list. The, I have depression, really bad depression, so that's the psychological part. I hang around with people who whole drink really, really heavily. So that's the social part. And those are all different for different people, but those are all elements in, how did I get here? You know? And it's gonna be different for different people. So that's, that's why sort of calling it a disease or even calling it addiction is sort of like, eh, Well, it's really different for different people, you Deb: know? Totally. And, and that makes me think about labels and can you speak to labels and how they can be harmful? Dr. Foote: Yeah. Yeah. Well, that's the simple version. Labels could be harmful. And, and really in that way, which is that they categorize people as if everybody was the same. So that, that, that doesn't offer me a lot of hope cause I don't feel seen or heard in that description. Then, oh, this is what addicts do you hear that all the time? Well, that, that's not what I do. That's not how I got here. That, so am I not part of this group or I am, are I supposed to accept that this is how I act? Cuz you just included me in this group called addicts. And the more that happens, the more I'm not actually. Gonna participate. I'm not being spoken to. This is not actually about me, it's about some other group you're talking about. But the other way labels show up is that because substance issues are such a stigmatized thing in this culture labels for people who are struggling and then extrapolating that to labels for their family members. They're all labels that don't have a lot of meaning. That's they, they might have started with some meaning around them. I'm thinking of terms like codependent or enabling that are, those are terms often used for family members. And what has happened though is that they, that that might have meant something actually on a, like, on a technical level, like codependent might mean that I feel everything that you feel and think that if I change. Anything, it has to be okay with you. I mean, there might be an, a process of us blending together that's not so helpful for either of us, but the term codependent is more, become like a curse word. I mean, families feel the impact of that. You go to a treatment provider and I'm like, okay, by definition, because your husband drinks you're co-dependent. Oh, really? I, I, okay. Why is that? Because you're, you know, you love an addict. And you're enabling them by staying with them. All this stuff that's just sort of like this form fit thing that doesn't actually fit most people. No, I love my husband and I'm trying to help him. So what, what, why wouldn't I do that? Of course I am, you know I, I may need some new ways to help him, but I'm not gonna leave and I, this is hard and. Help show me how to stay connected and help, which, which is what the invitation to change is about. Which is what things like motivational interviewing and craft are about. Those are all approaches that are more about, can I stay connected? Can I stay true to my values? Do I have to do this thing called tough love, for lack of a better term, where I need to. And again, all the words in the culture, all the language, all the labels where I need to quote, let them hit bottom. Where I need to detach. Like those are actually not particularly helpful as it turns out. Well, yeah, they're part of the culture, you know. Deb: Definitely part of the culture, and I'm really passionate being, you know, from the healthcare world, trying to change the stigma and the labels and all of that. Well, let's get into helping people then. So invitation to change. Tell me about that and how that works. Dr. Foote: Sure. So you know, as we were talking about a little bit earlier there's, there's. What are some methods what are some strategies for me as somebody who's struggling with substances that are helpful to me? And then there's also strategies around can the people in my life learn some stuff that's helpful as well. So, so there's something called Craft that was developed by Bob Myers and Jane Smith, about 25. 30 years ago. That's to help family members. And it's usually around when I, as the person struggling, don't want to hear about it. Like, leave me alone, I'm okay. And like, as a family member, what are you supposed to do with that? So it's just a, a, a way, a bunch of ways to help stay engaged and not be in this sort of like contentious fighting mode all the time. And, and I'm like, you know, I'm throwing you out and all these kind of things that again, are not actually particularly helpful. We, we took that approach, which is really a bunch of great ideas and that are e evidence-based ideas that have been tried in in research studies and found to be very helpful as ways to encourage change. And we just elaborated that. So over the last 10 years in working with families around the country, and this is like really literally traveling, traveling around the country, talking to families, training them in these things, coming back and going, this doesn't work for them. They don't get this part. This doesn't speak to their experience. How do we keep modifying this? I this set of ideas that grew into this, this invitation to change, which is what we talk about in that, in the beyond Addiction Workbook. So that has a bunch of ideas from craft, like how do you use positive reinforcement? How do you notice positive changes instead of just staying har focused on the negative stuff that's happening all the time, which is a very easy place to go and the person struggling is expecting all that negative pushback constantly. I'm messing up. I know she's gonna be mad at me. You know, this is not gonna go well when I get home tonight. All that stuff is like the, the, the fabric of what's going on. So can we start to work in a way that allows the family members to not go there all the time and to notice other things that are starting to change and finding ways to encourage that change. So that's, that's where we began. Then we added in a bunch of stuff from something called motivational interviewing, which is just how do you talk to people in a way that's actually. Encouraging of, of non defensiveness, but it's not judgemental. That makes room for each, each person is collaborative and is respectful. So this, this approach, the invitation chain includes lots of ideas from motivational interviewing about how do we talk, you know, how do we speak to each other? And it also includes a lot of information, a lot of. Ways of going about this that have to do with noticing myself in this change process also. And again, that really applies to both, both the person who's struggling with the substance and the person who's trying to be helpful around that, the family member. And that comes from acceptance and commitment therapy or something called act. And that has more to do with pain, actually, to tell you the truth. And again, either, either for the person who's struggling with the substances or the person who's trying to help, which is if I'm engaged in some process of trying to change and figure out how to do that, it's not gonna be comfortable. And how do I sort out, like what matters to me, sort of establish some North stars that I wanna walk towards knowing I'm gonna stumble along the way, not it, knowing I'm gonna get lost along the way. Knowing how uncomfortable all that's gonna be, if I'm actually gonna start to make changes in my life, it's not gonna be comfortable. It may be actually painful at times. I'm, I, I'm not drinking anymore and I, and I look at my wife and I realize she doesn't trust me. Well, what does that make me wanna do that makes me wanna drink? Cuz that takes it away in the short term. So if I'm going to change, I'm probably gonna have to learn something about. Changing my relationship to pain and discomfort, I'm gonna have to start to tolerate that and accept this is hard. It's gonna take us a couple months before she trusts me. Every she, every once in a while and when I come home, she's still gonna smell my breath. And I, she's pretending she's not and she is, and it pisses me off and makes me feel untrusted. And can I breathe through that and go, okay, this, this makes sense. I get it. It, it's painful to me. This is where we are still, but. My values are to move forward in a way that's constructive for me, cuz it's important to me to, to change my drinking. And it's important to me in our marriage, for me to change my drinking. And that's what I want to try to stay with even though it's uncomfortable. So that, that's a very deep, heavy thing to try to start to learn about how do I, how do I stay there? Even though it's, even though it's un really uncomfortable, you know, and change is uncomfortable. That's not usually part of. Change models, cognitive behavioral treatments and so forth are more about literal behavior changes and, and, you know pointing out that this is a more positive path and so forth and so on, it still sucks to make changes, you know, and it's still hard. And can we slow down long enough to acknowledge that, but not have that be a red light where we have to turn around and go the other way based on how uncomfortable it is. So those are some of the elements in the approach. Deb: Yeah, I appreciate that. And I like how the center, cuz there, there are nine components. Is that right? Nine for Dr. Foote: eight. Yep. Deb: Eight and then one in the middle. Invitation to change. And then in the middle. What I love is practice, practice, practice, practice. And that's kind of my thing. I say like, I help people practice not drinking cuz you're learning new tools to not drink. So So good. You give an example, and I think this will be really helpful for people who are focused on the negative parts of things and focused on their loved ones. The negative parts and the example like metaphor is the garden analogy. Hmm. Can you go into that and explain the purpose of that? Dr. Foote: Sure. And there's a, a number of people involved in our, in our foundation and our group in developing this over time. So one of them is a psychologist named Ken Carpenter who, who first developed this idea of this garden metaphor. Another person involved is Carrie Wilkins. Who gives Ken a hard time about the garden metaphor every time he describes it because she's from Kansas and grew up on a farm and she says you don't understand gardening at all. But anyway, we like the garden metaphor regardless of the Kansas farmer objection which is just the idea that if you're trying to help in this change process with someone they're gonna be behaviors that are happening that are positive changes. They're gonna be behaviors that are the older behaviors still. Again, if we start from that idea that, that the older behaviors make sense again, we may not like them. They may have a destructive downside, but they, they still make sense. I still get better asleep initially when I drink. That behavior may pop up. And I'm trying to learn a new behavior, which is what I, I do a meditation tape before I go to sleep, and I don't look at my phone for two hours. Okay. And that helps me. It's not as good as drinking, but that helps me. So that's a positive behavior. So in the garden metaphor, we have plants that we want to have grow, and these are the flowers we're trying to have sprout up and we have weeds that they are just part of the garden also. And what do we do with that? And as Ken describes that, like you can just cut off all the water for everything and kill everything in the garden. And those weeds are gonna die for sure. And what you get for that is no flowers also. So as a strategy for encouraging new behavior, which is really what change is about, it's not just about stopping the old, what I would think, you know, I'm looking at you and I say, that's bad behavior. I want that to stop. Right? That's a much harder thing to do just on its own. It really is a much more likely thing to encourage change, to adopt new behaviors and rewarding behaviors. So the degree to which I can have those new behaviors start to happen and have get positive feedback from the world, I'm gonna want to continue those. And my wife says, I know this meditation thing is hard and it's weird for you. I'll do it with you if you want, if that's useful. Cuz I think it's really cool that you're doing it. Okay. That's positive reinforcement. That makes me feel like, okay, somebody's noticing I'm trying to do something here. That's nice. It's not a big deal. It's a small little thing. Didn't cost a hundred dollars, it's just somebody said, that's cool. What are you doing? That's nice. And that's useful. So that's watering the plants, that's watering the flowers. And when I don't do the meditation and I drank then last night instead. If she comes in and hammers me in the morning and says, yeah, this is all a bunch of crap. I knew this meditation thing was just a bunch of, ma ma you are not really interested in this, are you? You just want a drink. Right? That, that is hammering me backwards. And is once again, sort of like trying to tear all the weeds out instead of just, I, I drank. We're not gonna pay a lot of attention to it. We understand why that happened and we're just gonna leave it alone, and we're gonna encourage the, the flowers again, we're gonna encourage the meditation and, and we're gonna, I'm gonna say, is there anything else I can do to be helpful about getting back on that track? You know? And that mixture of not getting entangled with the negative stuff and positively reinforcing the positive stuff is what the garden metaphor is about. How to grow a garden that you want. Without having to be filled with weeds and without killing everything. And so it works in lots of ways and, and positive reinforcement is, is a, is what we know to be the most powerful tool for encouraging change. People really respond to something happening that feels good to them and feedback they get about that. So as much as we can find ways. To encourage the behavior or have the behavior, the new behaviors be stuff that is rewarding to the person? Yeah, I mean, so I go to AA meetings and I go there because I get to sit with a bunch of people and hear feedback, and I feel at home and I don't feel judged. And that's like the only place in my whole life that I don't feel judged about this. Okay, that's cool. I, I could say I have objections to AA or this and that doesn't work about it, but who the hell cares? It works for you. It's positively reinforcing for you. It's really touching a nerve is really helpful for you. You feel at home and you feel cared about and you don't feel judged. Someone else could go to an AA meeting and feel demanded upon and like a failure, and they have to go underground. So that's not a positive reinforcing place for that person. So don't go. You know, find some other way to reinforce positive behaviors for yourself. And again, that old is really different for different people, you know? Deb: Yeah, I appreciate that. So you, you in the book talk about three ways to change behavior. One is the positive reinforcement, and then the other ones are natural consequences and limits setting. Can you give some examples of those? Dr. Foote: Yeah, so that, and that, that's more about what, what family members or outside people can, can be doing, how they can responding in a way that's respond in a way that's helpful. But if I just speak to the experience of the person who's trying to change, I'm trying to change my drinking or I'm trying to not use prescription drugs, overusing them anymore. The, the idea of natural consequences is it's a really interesting one in terms of the natural change process. Cuz what's true about change and what's true about substance use issues is that most people come in and out of it on their own and never get treatment, never talk to, to a professional about it. They just change. And you know, if you look at different groups of people like the mo, one of the more striking examples of that is college students and binge drinking. So if you look at the statistics on binge drinking, which is heavy drinking and very consequential, like really bad things are happening. You know, 1500, 2000 people, young people a year die related to acute issues of alcohol use, falling downstairs, crashing cars alcohol poisoning, these kind of things. It's just staggering numbers. So if we said, so those people are alcoholics, right? Well, no, they're not actually. They're using alcohol at this in this moment in their life and in this context. Because they're being encouraged to and because they aren't particularly consequences for that. They're young, they're not having health problems, everybody else is doing it. They're getting by in school, not as well as they could, but they're doing okay. So there, there aren't natural consequences. Three quarters of those people who you could, if you just looked at their use pattern while they're a software or junior in college, you would say, you qualify as having alcohol use disorder. Totally hands down, you qualify. And then this idea, so then two years later you look at them and now they're working in their new job as a teacher. And do they have alcohol use disorder? No, they don't. Three quarters of them, like not even close. So there's still a good chair, a quarter of them who go on to continue to a, a destructive relationship with alcohol. But three quarters of them don't. Well, what, why, if they had a disease, that wouldn't happen, right? Oh, is that natural remission? That's kind of a stretch. It's natural consequences. So I'm not getting rewarded for this now in my life where I moved away from college and I'm trying to get show up for work every day as a teacher, and I'm nervous about that. And I have new friends and they don't drink very much and so forth. So the natural consequences would be, I, I'm gonna start to be late for work if I drank the way I drank in college, or I'm not gonna be able to get my plans stuck together for my class today. So that's bad. That makes me feel bad. I don't want that to happen, so I'm not gonna drink so much anymore. So that would be a natural consequence. I didn't do my treatment, my, my study plan for the class today, cuz I drank too much last night. So I didn't have time to prepare it and I felt really bad and the next day I felt embarrassed. The kids were like, what the heck? And that's a natural consequence and that's, that is the most powerful shaper of people's behavior the world. Giving them a lesson, saying, yeah, that doesn't work. Can't do your lesson plan if you do that. Sorry can't show up for work three days late cuz we're gonna fire you. That's a natural consequence, you know. Nobody had to tell them that, that's just what happened in the world. So allowing natural consequences for people as a family member can be quite helpful instead of getting in the way of those natural consequences, because then it is not about me. It's not about I'm just looking over your shoulder and trying to, you know, give you a hard time all the time. It's like, I, I don't, nothing to do with this. Like, this is your job saying stuff to you, not me. And that just a, it's just a way to stay connected and not be in that battle yourself. With the person. And as I said, for people trying to make those changes themselves, it is the most natural form of change. Deb: I appreciate that and I, I, going back to the people who drink in college and then, you know, two-thirds do not end up continuing to drink in that way. I also am reminded of, I, it was like a c d C study asking people who had substance use disorders. If they are in. Recovery, whatever that means. Yeah. And 75% said yes, they were over it. And I don't think that is talked about enough that most people recover. Right. And, and that to me is just hopeful and truthful. Yeah. So I appreciate that. Dr. Foote: Hopeful and truthful. Yes. That's a nice way to put it. Yeah. Yeah, there's this I'm forgetting what ne stark stands for. National, I forget what, but anyway, national survey of lots of different behaviors and so forth. Mm-hmm. In which they find over and over again. Every time they do that, people who qualified as heavy drinking probably had alcohol use disorder. Next time you ask them, they don't, didn't do anything specific. Didn't go to treatment. Nothing. Just, and that would be, yep, this doesn't work. This is not rewarding enough. Other things became more rewarding for me and that's how change occurs. So that's in this invitation to change model. That's a lot of what we're trying to actually do is say, how do we invite this? How do we help the person evaluate this in ways that are meaningful to them instead of demanding change and insisting that their behavior is bad and they have to knock it off. That's not a helpful way to help people change. That's a way to get people you know, back on their heels, pushing back, saying, leave me alone. Deb: Yes. Yeah. I mean, you need to make being alcohol free, more beneficial and pleasurable than drinking, and that's gonna tip the scale. Right. Okay. How about, how about limit setting? Can you speak about that? As a Dr. Foote: family member type of thing. Deb: Both. I love how you're doing both examples. That's really Dr. Foote: helpful. It's frying my brain though to try to do brain notes. You're doing Deb: ama. It is so helpful. Dr. Foote: Thank you. So from the, from the family's perspective, I think and again, this is not about substance issues. So we're talking about substance issues right now, but this is about relationships. This is about change in general. So can I have an awareness of myself in this process? Because I'm part of this change process, so I, I want to be here, I wanna be useful. I want to encourage change cuz this is hard. What's, what's happening? It's hard for you. It's hard for us. And. And I'm going to be trying to pay attention to when you're making positive changes, to notice that, and to give you that and to acknowledge those things. And certain things that happen like aren't cool, don't, are not okay for me. And when you yell at me or when you come home drunk and want to sit and have dinner with me, like I, I don't wanna do that. And can I start to, to be clear about those things that don't work for me? Because what often happens is I'm only clear in the way in a, okay, I'm just blown my last gasket here. This is the third time this week that you came home drunk and wanted to have dinner and wanted to watch tv, and it's like, I don't freaking wanna watch TV with you when you're drunk. It's like, it's no fun. So can I not take that moment on the third time when you're intoxicated to start yelling at you and storm out, not as effective. Can I talk about it the next day when you're not intoxicated and say, you know what? I get, I get why you're drinking after you leave work. I understand you hang out with your guys and so forth and you know, that's a, it's been a hard thing. We've talked about it and you know how I feel. I'd rather, I'd rather you weren't doing that, but I'm just trying to be helpful in helping you do that, make those changes. But as we go through this process, the drinking and having dinner thing, it, it just, it's too uncomfortable for me. So I'm not tell, I'm not like demanding that you don't drink anymore. I'm just saying I, I don't wanna do that part anymore. But when you come home without drinking, I love having dinner, so I'd love to do that. So if that's what happens, I'm, I'm there. I'm, I'm totally cool with that. But just so you know, ahead of time, if you're drinking, I don't, I'm not gonna do that. I'm just gonna read on my own and do that. So that, that way we're not hammering the person, we're not dumping a load of judgment on them and shame and so forth. But we're also saying this, this, this is, this doesn't work. This is not sustainable for me. Makes me feel disrespected, makes me feel not collaborated with, and I, one of my values is respecting myself. And so I'm gonna respect myself by not doing that with you. You know? And I, you know, that'd be one of a hundred thousand examples, but that, that's sort of the idea. This, this is the stuff that I'm happy to be there for. This is the stuff that I'm not gonna do. Deb: That's a great example and it, one of the questions I had for you was a lot of the people that I work with who have given up drinking or they are in the process of changing their drinking. They have a partner that. Still drinks. And this has become really difficult because their partner has been their drinking buddy and now they're doing something about their own drinking. Yeah. And then their partner is still drinking. And so yeah, this kind of relationship dynamic has been very difficult for a lot of people. That example you gave is, is something I think would be useful. Can you think of other ways when, when you're the person changing your drinking and your other person still drinking other ways that we can help? Dr. Foote: Yeah. I mean, again, I think the, the, the, the ideas and, and tools we've talked about are, are, you're just sort of like taking those and reflecting them back, back in the other direction. Then again, you know I can be coming from a place as the person who's making these changes and looking across the living room and seeing that you're not making those changes. I can. Come from a place of understanding what, what's important to you about doing that still? I can certainly understand what it's like to have somebody go after me and insist that I change. So I'm probably not gonna do that cuz I know that doesn't work for me. And I may be setting limits and saying, but since I'm, I'm really working at this and some really important to me, I don't want to hang around together when you're drinking cause it's just really hard for me. Makes me wanna fall back into that so quickly. So it, that's for me, again, nothing to do with what you need to do or a demand on you, which is just important for me to protect myself in those ways, you know, so that the limit might come in there, in that way. Might come in in the sense of, so now that I'm trying to do this thing and changing my relationship to alcohol and, and they're not really can I Increase my self-awareness. Can I and can I increase my self-compassion? So that in the awareness part of this invitation to change idea is can I notice myself? We talked about noticing that it's painful to do this, so it's actually, it's painful for me. I don't wanna lead my partner, but she's still drinking and that's painful for me. So I can acknowledge that to myself. And what would be a compassionate way for me to approach this for myself, for starters and for them as well? Well, I, I need to actually not hang around in the evening with them when they're doing that. That's a act of self-compassion for me. I'm not gonna storm out, I'm not gonna tell 'em what a jackass they are. I'm just don't wanna be around for that, you know? And, and I need to mind myself in this process, cuz this is hard, you know? So I think all those elements, being able to understand where they're coming from, but also being able to include myself and, and show myself some compassion here. And then in the action part of this of this invitation to change wheel, maybe just noticing that I, I need to set some limits, you know Deb: I, I love the quote that said, limit setting is, is a direct act of compassion towards yourself. Yeah, it Dr. Foote: is, it's really noticing where you're coming from and saying, I, I want to pay attention to that. Mm-hmm. I get to be part of this equation. I get to matter here. You know? Deb: And I think some of what you were sharing about was that the, the other side of the coin, you can, because there, there can be a lot of, Anger and resentment towards your loved one. And there can be, like you said, you can find compassion and understanding. Yeah. Is that kind of what you mean by looking at the two sides of the coin and being willing to relate to pain differently? Dr. Foote: Well well, I mean, I, me actually, I'll say two things about that. Wh when you were saying two sides of the coin there there is this coin metaphor that we use, but, but. In a different way than that. Okay. I do think that that setting limits and so forth can be, can be the compassionate part, even though it looks like it might be a painful thing. But it's but to the, I'm sorry, but to the, to the coin, part of what you're asking is specifically in this invitation change model the, what we are talking about with that coin metaphor is If I'm going to notice myself, notice what I value, notice how I wanna show up, either as the person trying to help you or as the person trying to help myself. When I'm connected to stuff that matters to me a lot I'm going to experience discomfort and pain. So sort of the idea that it's gonna all be positive and we're gonna get through this and, you know, let's look on the bright side. That's not actually how humans work really. It's sort of like love is the, the most common example. To be in love means to be in pain. It's not the romantic version of it, but it's true. You know, I'm gonna be vulnerable, I'm gonna be open, and then I'm gonna get hurt. Sometimes not cuz they want to, not cause whatever, because of my own history. I get hurt by things that, you know, whatever the reasons are. If I'm gonna be open and vulnerable and in love, I'm opening myself to being in pain also. And it's going to happen if I'm going to really try hard to change my relationship to alcohol. Cuz it really matters to me cuz it's really hurting my family life and it really makes me feel bad about myself. And there's stuff about this that's just so painful and I really wanna put an effort into this. I'm not gonna succeed sometimes. Like a, a, a, a version here, I I, I run an inpatient facility and people come here and, you know, two weeks in, they might say, but I'm still having cravings. And I'm like, yeah, in what? Like, and you're gonna walk out having cravings. You could be here for two weeks or six weeks or three months. This is not gonna extract that from your brain. That's gonna be a painful part of this process for you. So staying connected to wanting to change is gonna keep you connected to the other parts that are still hard and still uncomfortable. And can we change our relationship to it and think of it as a coin? So that's the metaphor there is you can't really take one side of a coin. It has two sides. You can't erase the, the hard parts on the other side. It comes with the, with the territory. Helping somebody in this kind of a struggle, I'm pouring myself. I wanna stay connected to my wife who's struggling to do these, make these changes. And it's so heartbreaking sometimes when she can't or it makes me mad, or I'm, so, I feel betrayed or de disappointed. Okay, so I can put down the coin. I can say, I'm not gonna help you anymore. You need to go to rehab. You know, I'm, you know, I'm out of there. And what I'm losing is the parts that I value, which is I love my wife and I wanna stay connected, and I want her to feel supported. And that matters a lot to me. So I can put that coin down and say the hell with it, I'm not gonna deal with this pain anymore. It says You got drunk again. Okay, I get to do that, but I'm gonna lose another part of the other side of that coin there. And if I wanna stay helpful and I wanna stay connected and be there for that person, cuz that matters to me. I'm gonna experience pain. Sometime it's not gonna go well. Sometimes I'm gonna be disappointed. Okay? Can I allow for that also? And stay still? Stay there. Still stay connected. So that's the kind of the coin Deb: idea. Yeah. Yeah. Thank you. I, I think that this concept has been really life changing for me. And that's, that whole kind of life is 50 50. Right. Sometimes it's awful and sometimes it's awesome and, and you can't, you only, you can't like dim the dark parts to only have light. There's just this contrast between day and night. Right. But that is just, And learning to accept that. A, also having been a drinker where I was just, I had a quick release for pain that was my escape valve. And so when you don't have that release anymore Yeah. You, you do experience pain and, and it goes away. Right. But that is part of what makes life life. Dr. Foote: Right. But that's such a great way to put it exactly as the person you're saying yourself. In that case, who's. Attempting to make this change. What is, what is the painful, hard part of this? It might include, I don't have my way of dis of, of getting rid of discomfort anymore. If I'm not gonna drink, I'm not gonna be able to have that way to get rid of it anymore. I maybe I, over time I can find out other ways. Now I do yoga and now I, whatever. Now I do therapy. Now I talk to my friends. Okay. But it doesn't work the same way. And I don't know how to do that at first, and I'm gonna be uncomfortable making this change. So on the value side of this coin is, it feels important to me to make this change for whatever reasons, and it's gonna be uncomfortable. It is not. It can't possibly happen without discomfort, you know? Mm-hmm. Deb: Yeah. Embrace the suck. Dr. Foote: Yeah. Right? Yes. Deb: Well, let me see. Well, when do you, as a family member or someone who is caring for a loved one, is there a point where you are done with that relationship and how do you know? Dr. Foote: Well, so that, that would be a, again, as a family member, the encouragement as part of the model. So the, there's these three sections. There's helping with understanding, by trying to let yourself understand them, there's helping with awareness. So that's understanding myself and letting myself be part of this equation. And then there's helping with action that's like communication and watering the garden and reinforcement. But in the awareness part includes what's this like for me? How does my body feel every day? What are my thoughts and emotions? What are my values? Am I being able to live with them and allow for them? And I may come to a place where in this relationship, I, this is too painful. Mm-hmm. And I, I, that, that's part of the equation. I get to allow that information as part of my decision making, you know? This isn't like a selfless act and I'll go to my grave until I help you change. Like that's not, that's not a reasonable expectation. And at some point I may step away or I may step away today, or I may step away this month. Sometimes people say, well, I kicked my kid out of the house and I'll forget for forever regret it. And that's not part of this model, this invitation to change. Right. And my response to that is it can be. You know, the, the tough love, the generic knee jerk response of kick 'em out, let 'em hit rock bottom. They gotta find, they can't do it. Nothing will change until they want to change all that crap. That's not actually helpful. Part of what's not helpful is it's one size fits all. I may get to a place where in natural limit setting and so forth, it just doesn't work. I have someone in our, in, in a group of mine a while ago who said, I, I'm in recovery. I was using substances for, you know, 40 years myself, and I've been in recovery for a long time. I have PTSD and my kid coming home and bringing drug dealers in the house and chaos and so forth. Like, it's, I've realized it's a, it's kicking up my ptsd. T S D. But, and at first they were like, but I gotta hang in there with them. I know I gotta be kind. I gotta, I'm like, wait a second. So you're paying a price that's probably too high for you and you need and get to set a limit cuz you're part of, this is a two way thing here. So for you to say, I love you, this can't happen anymore. If it does, you have to not live here. Not generically. You're, you're out, you hit rock bottom, deal with it. But in these circumstances I can't do it. I have to take care of myself as well as you, and I can't do that. So whether that means ending this relationship, having you move out, ending this relationship for now, no reason it needs to be black and white, you know. If you can come back to this relationship in a different way, here's what I need to have, be different. I'd love to have it be different, you know? And let's try some more. And I'm willing to try again in a month. But here's what I need to see for me. Mm-hmm. You don't have to do it. I'm just telling you what I need, you know, and what I, what limits I have around this. Deb: Yeah. Thank you for sharing that. Before we wrap up, is there anything else you wanna share that we haven't talked about yet? Dr. Foote: You know, I just think that the thinking, being able to think about this change process in these ways is just much more hopeful for people. Whether it's the person who's trying to make the changes themselves so that I'm not just jammed in a corner of stigma and blame and shame like I don't wanna live this way. I get something out of my substances and that's hard to let go of. And I'm not a crazy person. I'm not an evil person. I'm, I'm somebody who's getting something out of this behavior and I'd probably like to change it some, and I'd be certainly be willing to consider that. And if you're approaching me by, in a way that's understanding of that and is encouraging of that change, that's really appreciated. You know? And for family members, they love their family member. They, they wanna stay connected and all this stuff about detaching and letting 'em at rock bottom and stuff, it's just so brutal for families, you know? They don't want to go there. They regret it years later having been directed there. They, they don't know what else to do. Because there's not a blaming thing there. It's just like, that's what they're told by the culture. And it's really grievous for people to be told that kind of stuff. And then they act on it and then things go badly and everybody feels horrible and betrayed and, you know, it's like, it's, so this, I think this Invitation to change approach is just a respectful, collaborative An effective way that allows people to stay in connection with each other, you know, while these changes are happening. So, and, and to say to people, and no one ever taught you this, you know, there's no reason you would know that this would be a useful way to go about this, and you'll never see it in a movie cause it's not sexy. You know, this is the, this is the creating conditions for change model, not the how did I. Bust his jobs and make him change. And it was real dramatic and off we went. You know, the top of the steps in Rocky, like that's not what this change process is like. Slower, more incremental. There's, there's going backwards and forwards and it takes patience and compassion, you know. Deb: Well, a tremendous amount of gratitude for you and your colleagues. I cannot recommend these books highly enough. So there's the workbook called The Beyond Addiction Workbook for Family and Friends. And then if you wanna take a even deeper dive, there's the Beyond Addiction Book, how Science and Kindness Help People Change. I will put links in the show notes. Are there any other ways to find you, Dr. Foot? Dr. Foote: Our foundation is the supports. A lot of this work. We train people all over the country, virtually now. Family members. We do trainings for professionals. We do trainings for, we have a training coming up in May of this year for professionals and family members actually. So that's our, at our website cmc You can get resources, you can see videos, training materials, and also the. The links for, for trainings that are coming up. So those, I think they're just really helpful materials for people. Deb: I agree. Well, thank you. Thank you so much for taking the time today to have this conversation. Thank you. I think it's really gonna help a lot of people. So Dr. Foote: thank you. Thank you very much. I appreciate it. Appreciate the time.

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