Okay, good afternoon. Thank you for joining us today. We are very happy to have Kelly Farrell from Overdose
Lifeline joining us today as our presenter. And she'll be talking about the family disease of addiction
and utilizing compassionate non-confrontal approaches to encourage loved ones into treatment using the
CRAFT model.
a quick housekeeping item before we get started. If you're planning on getting the CEUs or continued
education credits, make sure you sign in and out on the sign in sheet at your table. That will help
mark your time and make sure you also sign out and please stay until the very end to scan the QR code
and enter the six digit code at the close of the session that will be on the slide. So, Kelly, thank
you for joining us. Do you want this or? Nope. Signed up. Okay.
Thank you, Kathy. Hi, everybody. We're almost till end of your day, so home stretch, stick with me.
We're gonna have some dialogue, some conversation, opportunities to do some activities. Not to put anybody
on the spot, but you'll get to use your brain. So, like Kathy said, my name is Kelly. I'm Kelly with
a Y, the 80s version. And I'm from an organization called Overdose Lifeline.
I'm the director of family programs there and my job is twofold. One part is to help build families
and friends in recovery systems across our state to enhance the likelihood that individuals find and
maintain recovery. The other component is overdose bereavement services. So I'm the overdose bereavement
coordinator for Marion County and work in collaboration with our coroner's office to ensure that
individuals who are navigating the loss of a loved one due to substances has support as well, knowing
that those folks are at also increased risk for overdose death. So we're trying to take our intervention
and put prevention in there as well. So as you already know, brevity, not my strong suit. So the title
is really long and I apologize for that. But the short version is that today we're gonna learn about
how we engage families in recovery using a model called CRAFT. So I am from Overdose Lifeline and we
as an organization are in every county in the state of Indiana.
and work with at least one organization in every state in our country. So we're a tiny but mighty crew.
My region is Indiana. So if you met me before, I've probably been in your little town doing training
or capacity building. Indiana is a fascinating place. And part of this job, not only do we get to talk
about addiction and recovery and things like that, but I also get to learn things like Martinsville
is the goldfish capital of the world.
And Peru, Indiana is the circus capital of the world. And yes, I have magnets to commemorate both places.
So our work at Overdose Lifeline, I'll share briefly, is separated into three pillars. So we started
with our advocacy pillar. If you or your organization disperses naloxone in the state of Indiana, it's
most likely come from Overdose Lifeline. Not all of it does, but most of it does.
We also have our education pillar, which you all are a part of today, and then the support pillar, which
is where I live most of the time. So we'll talk a little bit about these areas, and then there's more
information on our website. So as I mentioned, the majority of naloxone distributed in Indiana comes
through Overdose Lifeline, and that is because that is a core foundation of our organization. Our CEO,
Justin Phillips, created our organization
in the grief process after losing her son Aaron to a heroin overdose. And then soon after learning that
if naloxone was in the home that could have potentially reversed his overdose and he would still be
here with us today. So our goal is to ensure that no one else experiences those things. So we have over
Right now we're at 719 nalox boxes, which are these clear acrylic boxes, all across the state of Indiana
on outside walls of public buildings where folks can receive naloxone and test strips depending on the
area for free at any time without having to speak with another human being. We also have 18 naloxone
vending machines across the state.
The only difference between the two is capacity, where a nalox box can hold about 10 doses and our vending
machine can hold 350, but they provide those supplies just the same. Our goal with the vending machines,
because they are kind of expensive, is to be intentional about those
Populations that are at higher risk for overdose, people who are coming out of incarceration, people
who are transitioning out of the hospital, or people who are unhoused or maybe utilizing the library
services. So most of those vending machines are in county jail lobbies, emergency departments of county
hospitals and libraries. And then we have over 150 individuals who are also distributors of naloxone.
If that's something you're interested in, let me know. I'll get you connected. And then we also have
a program statewide that individuals can request naloxone to be mailed to them for free anywhere in
Indiana. We also currently have fentanyl test strips, xylazine test strips, benzodiazepine test strips
also for free. We don't report to anybody. So like I live in a county that is not kind about test strips,
but you can order them on our website and we'll get them to you.
All right, so the reason that you're here, and thank you for being here. You could have seen the tall
cop, but instead you're gonna see the short social worker, so welcome. By the end of our time together,
you'll be able to understand the impact of addiction on a family and recognize that you don't have to
be utilizing a substance to be deeply impacted by it, as well as the benefit of engaging families in
recovery work. You'll understand at least
briefly what the craft model is and what it stands for and who it might benefit. And then lastly, you'll
walk away with at least one skill that will enhance your work with everyone that you come across. Hopefully
you'll have more than that, but hopefully at least one sticks. That's the goal. Now, while this seems
all fancy, because I got the mic and the clicker and everything, I want this to be a conversation. Craft
itself is a conversation relationship-based model. So let's have some dialogue if you have
questions, thoughts, ideas, experiences, share whatever you're comfortable with. Not an expectation,
but certainly something that's welcome. So first, let's just get ourselves oriented. If we don't already
recognize this, addiction is a chronic disease. It impacts over 48 million Americans directly, and all
of us are impacted indirectly. What
is challenging about addiction, particularly on the family and friends side, is that we see the side
effects of the addiction and take it personally, not recognizing the amount of change that's happening
in our addicted loved ones brain and body. So for instance, them losing their job as a side effect of
their addiction wasn't because they woke up and decided that they wanted to ruin their life, right?
It's a side effect of a chronic disease.
So helping families make that adjustment is important because if we're angry, we're not going to be
able to connect with our loved one. And if we're not making connection in relationship with our loved
one, we're not going to be able to support their healing. So anyone familiar with the hand-brain model?
Couple of us? Okay, great. So everyone come on this journey with the four of us that have heard this
before. I want you to put your hand up in the air like this.
like you're asking a question, you're gonna cross your thumb in the middle of your hand, close your
fingers over that. This very simply represents our central nervous system, with our arm being our spinal
cord, our palm being our brain stem, our thumb and thumbnail representing our limbic system, and our
fingers representing our prefrontal cortex. So what we often assume is that when people are utilizing
substances, they're using their prefrontal cortex
or that logic rationing problem solving part of our brain to make choices. In reality, our brain has
flipped our lid and we're living in survival mode when addiction is on board. So survival, or our survival
brain, our brain stem is that fight, fright, freeze. It's also what keeps us, you know, our temperature
regulated, digests our yummy lunch so I didn't have to cognitively think about that.
So oftentimes, individuals, again, are assuming that our loved ones are making conscious decisions.
But I don't know about you. I'm 40. I've met a lot of people. And I have yet to meet the person who
woke up one day and was like, you know what's a really great idea? Get a felony so I can never have
my own apartment, ruin my chances of the job that I want, and sever every relationship that I've ever
had with the people in my life. Has anybody met that person? Yeah, because that person doesn't exist, right?
So what instead we're seeing is the side effects of the chronic disease of addiction. So it's important
to help family members and friends understand what's happening, understand that mechanism. And yes,
those things are impacting you. Your person isn't consciously trying to ruin your life or theirs. So
if you were in this room earlier when Kara was speaking, we learned about neuroplasticity. So that's
our brain's ability to continue to rewire and restructure, which stays in place our entire life.
So that old adage of you can't teach your old dog new tricks, not true. We can continue to learn all
the time, which is great for an old lady like me. What's important for us to recognize, though, is that,
yes, 40 is not old. You're right. Thank you for the reframe. Although when I wake up and my back hurts,
I'm like, oh, mama.
What's important for us to remember, though, is that neuroplasticity doesn't just happen. There has
to be certain conditions in place for our brain to be able to learn. So there are two things that need
to be true in order for us to learn new information and integrate it into our brain. Any guesses of
what those two things might be? What needs to be true in order for us to learn and remember? So we need
our basic needs met.
So we need to be safe. And then what else? Any other thoughts? We've got to be regulated. So in order
to be regulated, we've got to be safe and what? Why do we go to school? Why is school effective? What's
the difference between a good teacher and a not so good teacher? They make us feel connected, connection.
So in order for us to learn and remember things, we need to feel safe and connected. So it's important
for family and friends to understand that in order for anything that I say or do to get into my loved
one's brain, we both have to feel safe and connected. So you'll see that as we start to talk about the
craft model, that this is about owning your shit, okay? We're gonna own our own shit. So, which is so
fun, so fun.
Anyway, stigma is what oftentimes gets in the way though. We still live in a society that has a moral
judgment about people who are living with addictions or who have disabilities or live a life that's
different than what you expect them to. In reality, addiction is the only chronic health condition that
we have criminalized. We're not putting people in jail who have diabetes that use insulin.
but yet we criminalize people who are trying to manage an addiction with Suboxone. So stigma is something
that survives because we don't talk about it. So the more that we acknowledge when stigma is there,
the more that we challenge those assumptions that are not accurate or true, the less power that stigma
has. Because about 78% of Americans believe that addiction is a moral failing.
as opposed to recognizing that it is a disease. And that statistic is actually higher in the Midwest.
So we still got a lot of work to do. So stigma not only impacts the person living with the addiction,
but the family as well. We have, for many decades, delineated that a person with an addiction comes
from a bad family. A child living with an addiction has bad parents.
The truth is that's not accurate whatsoever. The world is way more complicated than that. And show me
a situation in which that harsh judgment has motivated any change. Doesn't happen. That's not how we
work. So what's really challenging about the disease of addiction though is that stigma makes us wait.
We minimize, we internalize, we don't talk to other people. That means that that disease has time to
continue to worsen or intensify in our life and it makes it harder to reach out for help down the road.
So when we have the opportunity to work with people who are actively in addiction or their family members,
that's a gift because they're overcoming the massive amount of stigma that's been replicated for potentially
decades, sometimes generations.
So one thing that I always mention in my trainings is the importance of us thinking about our language.
And when we're engaging in this work with family and friends, we are going to use slightly different
language than if I'm working individually as a recovery coach with somebody with that addiction. So
regardless of who I'm working with, I'm going to use my person first language.
part of any of this work is separating the person from the problems that they're experiencing and remembering
that we are human beings at the end of the day and none of us are perfect. And by adjusting the way
that I speak about the disease, the people impacted, and those experiences, that addresses the stigma
and adjusts our approach. So we're gonna call it what it is.
it's substance use disorder or alcohol use disorder or opioid use disorder depending on if we know our
loved one's substances or not. We don't have to know what they're using and how often in order to be
a beneficial ally in their life. We also want to stay away from those judgmental terms like junkie,
addict, wino, boozer, things like that. That totally depersonalizes and devalues that person's whole life.
We were all defined by the hardest part of our lives. I would be the kid who puked every day in fifth
grade. Like how does that set me up for success, right? It doesn't. We also wanna be mindful of clean
and dirty talk. It is easy for us to say I'm clean and sober or I had a dirty drug screen. We wanna
stay away from clean and dirty because that comes with some value judgments or some assumptions. So
instead we say that somebody
you know, had a positive drug screen or a negative breathalyzer result and just totally staying away
from those judgmental words themselves. We also want to adjust our language a little bit when we're
talking about setbacks. So we at Overdose Lifeline and in doing this work use the term setback as opposed
to lapse, relapse, binge.
you know, defining or diagnosing our loved one's use patterns or our own, and instead recognize that
we all experience setbacks. Anytime that we're looking to make progress in our lives, we're going to
experience setbacks. I set my alarm for 7.30 this morning. I snoozed it till 8.30 and then got up. That
was a setback from my plan. Does that mean I failed?
No, I still got where I needed to go with pants on, by the way. That's a success, right? So just by
adjusting our language and saying things like setback as opposed to elapse or relapse or getting into
the nitty gritty of that, we're opening up this recognition that we all have work to do. We all have
those setbacks. And it doesn't mean that we failed or we suck. It just means that we're human beings
doing complicated stuff.
And then lastly, we don't wanna hold people to their pasts. So if somebody has entered recovery or is
working on that, we're gonna call them a person recovery or a person seeking recovery as opposed to
a former addict or an ex-con or things like that that hold them to the form of themselves in the past.
So let's talk a little bit about why
Some of our old faithfuls maybe don't work as well or are not as effective as they have been in the
past. So part of it is this assumption that many of us have been raised with, that until our loved one
hits rock bottom, there's nothing we can do. What is potentially problematic about this statement? Rock
bottom has a basement. Everyone's different.
What else? Death, did I hear that? Absolutely. Your low K&N will get lower, 100%. Also, if I am basing
my well-being on that of another person that I cannot control, what does that say about my life? Right?
I know, right? You're like, oh crap, yeah.
It's important for us to recognize that if I am in a place where I want my life to look different, then
I get to make the steps to make my life look different. And by doing that, I'm one, taking some pressure
off my loved one, but two, I'm leading the way. It is not, it does not work for us to say one thing
and do another. Learn that if you've got kids. It doesn't matter how old your loved one is. We've got
to model the things that we want to see.
So if we think about recovery capital, which is the fancy word for saying, the more legs on a table,
the more steady and stable it is, the better we can get through hard times. If we broaden our understanding
of what recovery capital is, and not only include those services that are specifically and directly
serving the individual with the addiction, and also broaden that to recognize that
resources for food stability and housing stability, as well as your mental health resources and dental
care and all of that. Enhance recovery capital. Let's also put family and friends in the mix as well.
If you are serving people who are currently living with addiction or who are in early recovery, who's
bringing them to their appointments? Their family members. Who's sitting in the lobby of the jail waiting
for a visit?
or picking them up. They're family members. Who's in the gallery of the court during their status hearing?
They're family members. So we are here. Family members are here. We want to be helpful. And we don't
know how. It's where those aren't natural, innate tools that we're born with. The conundrum, though,
is that those folks who are best set and
Can be prepared to support their loved ones recovery are the ones that are most upset and frustrated
and tired by it Right where I've tried 50 million things. I've picked your ass up from jail multiple
times max out a credit card paying your bill I'm frustrated and I'm doing those things because I love
the crap out of you and I want you to be okay, right? So we're working with people who are in You know
a difficult difficult space So again
recognizing that you don't have to have taken the substance yourself in order to be impacted by addiction.
We are all impacted by addiction. And so in this work we use this metaphor and in public health we use
this metaphor that we imagine that we have an ecosystem that all of a sudden is having
Situations in which we're seeing trees die or the moss is not growing or there's no longer animals It
makes us wonder what's going on and I could look species by species and say why did that specific tree
die or I could go to that whole Ecosystem and say what is going on here and it's important for us to
adjust our
our framework and look bigger because we're not dealing with individuals who are sick. We're dealing
with chronic health conditions as a community. And so let's say I decide I'm going to take one of those
sick trees out of that sick environment and put it in a healthy ecosystem. That tree will likely get
better. But eventually, that tree goes back because it's got to live with its family. Trees get sad
if they're not with their own people. So it's going to get sick again.
So we are the same way. We have long thought, I will remove that person with the addiction from their
environment, I'll send them away to, you know, passages in Malibu, have them go through a treatment
program, and then where do they go after that? They come back home, right? So unless that environment
has changed and the folks that they will be cohabitating with have a wider view of what's happening,
we're likely going to replicate those same patterns.
So it is important for us to not only have services that directly address the person with the addiction,
but everyone that interacts with them. That includes individuals and systems and our community organizations
to better understand how we can be allies in the recovery process.
And like I mentioned, these are not innate skills. These are all things that we have to make a conscious
decision to do, just like a person in recovery has to make a conscious decision to maintain recovery
every day. You don't ever get to a point where you're like, I don't think about it. That doesn't happen.
So, craft is a tool or is a model that can help us make that adjustment and support our loved ones,
regardless of whether they decide they want to enter recovery or not.
So craft is unfortunately not arts and crafts, but it stands for community reinforcement and family
training. So it operates under the idea that what I practice and model is what the people that I'm serving
will practice and model, which is what they will do within their family, with their loved ones, and
then that will create a ripple effect outside of the home into the broader community.
Fundamental paradigm shift with craft is recognizing that the only thing the only thing I have control
in this world of is myself and That I can have hopes and dreams and wishes and wants for my loved one
and until those are their own That will not happen. And so for a lot of us I had this epiphany, you
know a couple years ago when you realize I don't know what I want in life and
I don't know what I enjoy. I don't know what I dream about, because my whole life's identity has been
trying to get my loved one sober. And then you realize, well, that's pretty shitty. I've lived 40 years,
and I don't even know what I want. We all deserve to figure out what we want and what we need. So the
paradigm in craft is that we're shifting away from trying to control our loved one, because we want
them to be safe.
And instead, we're going to control our behavior to enhance our own safety and well-being. So with that
paradigm shift, we help family members and friends build their sense of self, their community, their
connections with others outside of their family. And in doing so, we're addressing that stigma. We're
removing that sense of don't talk about that. That's a family matter. Keep it to yourself. And instead,
recognizing
We all deserve to have social support from other people, and it is easier to find that social support
from people who are not related to us, because we don't have to carry the family stories. Because oftentimes,
addiction is a tradition that's been handed down in our families from generations. So how we celebrate
Christmas to how we deal with drinking, or don't. So the three main goals.
the craft program are independent, but the first is to reduce our loved ones use. However, however that
looks. It isn't that we are controlling and punishing our way through it, but it's recognizing that
harm reduction is an important approach. It's recognizing that
For some folks, an abstinence-only approach is not something they will ever do. And that idea, and I
don't know where we got this from, but I also grew up with this idea that if a person wants to enter
recovery, we rent a hotel room, they sweat out the drugs, and three days later we pick them up and then
we move forward. Don't do that. That can be really, really dangerous and devastating. And some folks
need medical care in order to
detox, other people don't. And so it's important for us to recognize every situation is different. And
if I am not the one who is seeking recovery for myself from the substance in that moment, my opinion
about what that recovery should look like is irrelevant. It's that person who gets to decide what that
what's going to look like. Doesn't mean I don't care. It just means I don't want anybody telling me
what to do. Neither does my love.
The next is to engage our loved one into treatment, not through forced or coercion, but by highlighting
that this is an available, accessible option, because I've done my homework and research and know what
we can do. And I'm taking accountability for my own behavior, because I've already entered treatment
as a family member. And then the last is to improve our overall family functioning, to reduce conflict,
to increase collaboration, and
find opportunities to celebrate our relationship, as opposed to rehashing all the terrible things that
have ever happened in the context of it. Because we're good at that, right? You tick me off, I'm going
to pull up a list of everything that you've done to make me mad, just to remind you. And then where
does that get us? Both of us are in our brain stem, because we're both angry and triggered, and we cannot
learn or grow. So we're going to disrupt that cycle. So for families specifically,
There aren't very many options. Family counseling is available in certain places, but not as widely
accessible as we had hoped. We also have things like Elanon or Naranon, which are growing in the state
of Indiana, but still are not everywhere. And then what most people have had exposure to
either on Dr. Phil or the show on A&E called Intervention is what's called a Johnston Institute Intervention
and it is a very specific protocol where a third party is hired, the family writes ultimatum letters,
you get your addicted loved one in the room under unclear or false pretenses and set an ultimatum for
them that unless they
you know, go to the place that you've picked for them, you're going to disconnect from them. And while
in certain cases where the safety risk is really high, that might be your final option for the majority
of families, that's not the option that they want to take. Because one, your family member's gonna come
back home. Two, if I love the crap out of my loved one, and I do, he's very important to me, I'm not
going to be able to create an ultimatum like that. That's not the way that I want to interact with him.
So craft gives us another option. It recognizes that the disease of addiction is complicated, and all
of this lives in the gray. There is research that has shown the efficacy of craft, and the studies were
done in 2010, 2015, and then replicated again recently. And I've shown that the craft approach is the most
effective in engaging people who were previously resistant to treatment to at least engage in some sort
of recovery behavior. So here's your, if you're a numbers person, which I am not, there's your data. So
As I mentioned earlier, CRAFT is a harm reduction approach that utilizes a motivational model.
So historically, we have, and still do, try to use a punishment model, right? You mess up, you go to
timeout. You mess up, you get arrested. You mess up, we shun you. And realizing if that method worked
for everybody, our jails would be empty, right? Because we arrest you once,
You set your tush in jail, you get out and you're like, I never wanna do that again, and you don't.
Why doesn't that approach work? What does real life tell us? Yeah, I don't have the skills to live outside,
or I don't have the support. Yeah, we're dealing with a chronic health condition.
It doesn't care where you are. Any other potentially challenging things that we've seen in trying to
punish our way through this? Yeah, I'm gonna just try not to get caught. Just now I'm gonna add another
layer to my stigma by trying to withdraw even further. So hot mess. So the motivational model,
does not negate the fact that there are safety concerns and risks involved in addiction. We're not pretending
that those things aren't true. That's why I carry my naloxone. That's why I carry test strips. If you've
never touched or seen those things, I have them so that you can look at them. They're demonstration
ones, so there's no medication in it, but that way you can see it.
saying that everything's fine, but it is recognizing that the more that we try to scold our way out
of the problem, the harder it is to treat. So, if we can instead of punish all of the bad things that
we don't wanna see, and instead celebrate the things that we do wanna see, we're going to create healthier
patterns of behavior. And then we feel better, right? No one wants to be the bad guy. No one wants to
be the nasty guy.
That motivational approach is not our reflex, because that lives up here, not back here. So it takes
practice, which is why there's a whole model about it. So the model of craft that we're using in Indiana
is a 12-week educational model. It originally came from our friends in Utah, Yusara, who created the
first iteration of this.
And then when we brought it to Indiana in 2020, we added some additional content to make it a little
more user friendly. And the model itself is to be facilitated by peers. So that could be a peer recovery
coach. It could be a clinician. It could be a member of clergy. It doesn't matter what the letters are
behind your name. It matters that you have a heart and an openness to listen. So I love that model that
I never check your credentials.
if you are compassionate and non-judgmental. And the focus of the craft sessions is learning a skill
and implementing it in life. So this might feel different than other, you know, weekly support groups
or things because we are not focused on what has happened. We're not rehashing or retelling the stories.
You're also not there to talk about your loved one's addiction.
You're there to identify how you feel, what your experiences and what your options are to move forward.
So everything is based on learning a skill, acquiring the skill and implementing it in our lives. So
some of the skills that craft itself provides are how do we build strong, true, deep relationships with
the people that we love? How do we positively reward healthier, safer behavior? That's harm reduction.
How do we reflect on our own patterns of communication to identify times where we have created conflict
and instead how can we create collaboration? Our approach makes a big difference. Also, how do we address
problems by separating facts from feelings and objectively looking at what are our other options? We
also look at how to build our own motivation to change.
Change is hard, change is scary. And if I'm expecting my loved one to change their whole life, me first.
We've got to lead by example. We also look at patterns of behavior to identify when are the better times
for us to have a tough conversation? When are the times where I'm not regulated enough or settled enough
to have that conversation? What are some of the warning signs that my loved one isn't in a place to
listen? Again, just to reduce that potential for conflict.
We also identify red flags for safety concerns. So what are the experiences that you've had in your
family or in your dynamic that have told you maybe we need to separate ourselves from that situation
or make a different plan regarding safety along with other things. So key components of the model. The
first is that it's an open group model, which is a little bit different than the language for AA or
NA. In this case, it means that people can join at any week.
So they don't have to wait until you are facilitating session one to join. If you're on session five
and that person is ready, let's get them in that week. That way we don't lose that momentum and that
interest. So whenever that person is ready, let's get them started.
It's also important to recognize that it is not a tool for reunification. So there would not be a time
where that addicted loved one and their family member would be in group at the same time. We need our
own space to process and think through things. It's also when I'm facilitating
and I'm meeting folks and making those referrals, it is rare that I have family members from the same
family attend at the same time, because while we might be impacted by the same loved one's addiction,
the way we are impacted is going to be different. So my relationship with my brother is different than
my sister's relationship with him. So the way that we need to learn those skills and things that we're
thinking about are going to be different, and so I try to create space for everybody.
It is not therapy. It might have a therapeutic benefit, but it's meant to be facilitated from peers.
So we're not doing things like, you know, pulling back the curtain on co-dependence or measurements
or things like that. Cause that is what a trained clinician would do. It is evidence-based and the research
continues to be replicated.
And then lastly, it's specifically for people who have some sort of contact or interaction with their
addicted loved one. It doesn't mean that you have to see them every day. They could be incarcerated
and you send them emails. That still counts, but it's hard to help motivate somebody and celebrate their
healthier, safer choices if you're not interacting with them at all. So these are the 10 messages that
are shared and reinforced throughout.
the craft model that give you a sense of this paradigm shift and this adjustment that we're making in
our interactions with others. So the first is that we can learn new things. That I've tried the same
things over and over again, not because they work, but because it's all I know. And it might be all
I know because that's what my mom knew and my grandma knew and so on. So I'm able to reflect and learn
new things.
The next is that I'm not alone. Stigma tells us that we're bad people, that's why we're experiencing
these things, and we need to keep it to ourselves. Instead, when we're in a group of others who are
like, I totally get what you were saying, it addresses some of that stigma, brings some relief, brings
us out of the darkness. The next, and potentially most important, we can catch more flies with honey
than vinegar. You're allowed to be angry.
You're allowed to be disappointed. But if you talk to somebody like an a-hole, you're going to get it
back, right? And then you're going to be upset that they don't want to have a conversation with you.
Were you pleasant to them to start with? Probably not. The next is, I have as many tries as I want.
If you are still interested in making changes in your life, we still have attempts to make things better.
This really speaks to the fact that
The previous things that we've tried were not a failure. It's just information of the things that do
not work. The next is that we can live a happier life regardless of what our loved one does. That if
I have based my identity and value in the well-being of other people, I've missed the opportunity to
take care of myself, and I need to readjust. Next is that it helps my family when I help myself.
Stepping away from that hover mode, if you will, for my family member, recognizing that's not helpful.
And instead, putting that time and energy toward myself is productive for the family. Next is that no
one in these situations is crazy. We might have been exposed to things that are hard to believe. I have
seen things that I would have never imagined before, trying to find my loved one in trap houses in Marion
County. You learn a lot really quick.
But that doesn't mean any of us are crazy. We're dealing with the side effects of a chronic disease.
The next is that the world of substance misuse is not black and white. There's not a one size fits all
solution. And this is really challenging, particularly if you are a person who is in recovery from substance
use disorder. You absolutely know what works for you. And that's legitimate. And it's not likely to
work for your family member. And that is really frustrating. Because you know it works.
The next is that labels do more harm than good. So as family members and friends, we need to stay out
of diagnostic land or label land and instead acknowledge that we're dealing with a chronic disease.
And then lastly, we have nothing to lose. So oftentimes, people feel like this shift away from controlling
our loved one or trying to control their choices is like letting them go. And instead, it's not. We're
just letting go of the things that we cannot manage or control.
so that we can keep them. Because if I continue to try to control them over and over again, I further
lose myself. So, are we ready to practice some of these skills? See what this actually means?
Make it live, if you will. So, before we talk about that, the curriculum itself is meant to be facilitated
in person or virtually, so you can best meet the needs of the people in front of you.
We also have it available in English and Spanish. And currently, we just got it extended. So for a whole
nother year, we have grant funding through Overdose Lifeline for the facilitator training, the materials
for facilitators, and the materials for your group participants. So there would be no fee to implement
this as an asset to your program. And I found that out this morning. So that's exciting. So thank you
for our grant funders.
So this is the recipe, if you will, for a craft session. There is consistency with each of the sessions,
one, to ensure that there's fidelity to the model, and two, to ensure that regardless of when a person
joins, they have a good experience and are set up for success. What I'm handing out right now is a cheat
sheet for a skill that we're gonna learn here in a moment called pious communication. It's gonna help
us practice making that adjustment from punitive
collaborative and who doesn't like a cheat sheet right so while I'm handing these out any thoughts or
questions that have come up so far just like let's work smarter not harder thank you yes please correct
correct because the those
periods of readiness might not align. So like, you might be ready to make a change and your loved one
with the addiction might not be ready yet. So yes, this would not be for your addicted loved one. This
is just for the family member or friend that's providing support or coworker or neighbor or your aunt
who's really your mom's best friend. Family is a family of choice situation. Yeah.
delete a group. Yeah. Absolutely. Great question. So the question was, what if I have somebody who would
potentially want to access a craft group? So on the overdose lifeline website, overdose lifeline.org,
there's a page about craft and I have a map that has all the existing groups in Indiana that are running
with the location and the facilitator name so that way they can reach out and get connected.
So the training would be if you want to facilitate a craft group. And I do that too. That's why I travel
across the state. So as I mentioned, people can join at any point. That way we don't kind of lose their
momentum if they're ready to make a change. But each session, we spend a significant amount of time
in both the homework review and the group check-in talking about implementing the skill in our life.
So this is, again, we're not rehashing past things. We're not talking about our loved one's disease.
We're talking about our own life, how this is showing up, and the things that we can do to make things
feel healthier and safer for ourselves. So each session is supported by excerpts from the book, Get
Your Loved One Sober, as well as activities in a workbook. So we're being very intentional on providing
the skill,
Opportunity to understand the skill and implement the skill so that way that keeps our Our lane out
of therapy world and very much in psychoeducation world And here's an overview of each of the Sessions
and topics so you can start to to see what we're looking at but the first session is Understanding that
change is a process and that we've done the same things over and over again not because they work But
because it's what we know how
The next is about communication. So in this week we look at the impact of our communication and take
some accountability for that, because sometimes our intention and our impact are not the same thing
and we're accountable for both. Then we spend some time looking at past patterns of behaviors to see
where have I recognized that
things get a little more tense or when my loved one is more likely to use than not and how can I use
that information to inform my decisions moving forward. Then the fourth session is about safety and
past experiences of violence, figuring out how do we set boundaries or a safety plan in place depending
on what those experiences have been.
Session five is an opportunity for us to reflect on our own well-being, our own happiness, and start
to take responsibility for how we feel, or to even acknowledge how we feel. And then with that we look
at how we can make healthier and safer choices to model that for our loved one. And then we learn about
how to celebrate our own wins and successes so that we can
navigate session eight, which is recognizing that, again, what my intention and my impact are different
things, and I'm responsible for both, and that things that I have done that I realize might have allowed
my loved one's substance use to continue weren't malicious, that's coming from a place of love, and
I have an opportunity to reflect on what that looks like and make the next best choice moving forward.
Because yeah, when your family member calls you and they're like, hey, we need food to pack in your
niece's lunches, my first instinct is, of course, Venmo you 50 bucks so you can get groceries. The impact
is that they went out and bought drugs. It doesn't mean that I'm a bad person because my intention was
that you have
food for my nieces, right? The impact is that they were able to continue to support their addiction,
right? Because that is what makes sense to them. So now I have a responsibility to look back at that
situation and make a different choice moving forward. So I'm going to take my nieces that will go buy
the groceries that they want. And yes, they can have goldfish for breakfast because I don't care, right?
This is food. And that's what I eat for breakfast.
Then session nine is about problem solving, where we separate fact from feeling and look at, what are
my other options? What are the other things I can do? What is an outside, what feels like outside of
the box option? Because we've gotta do something different. And then session 10, we put all those things
together and figure out,
How can we help our loved one build motivation to change? How can we celebrate their wins and successes
and recognize when things are healthier and safer as well? Then session 11, we have our group participants
do some homework to recognize that treatment can be many different things. There are different types
of treatment. Not everything is accessible everywhere. Some things are expensive.
figure out what insurance covers, what as a family can we afford, not because we are creating the plan
for our loved one, but instead, we're going to have that information in the back of our head. So if
our loved one opens the door and says, hey, I need help, that's not the moment that you talk to Google
and figure out what we're doing. Because the top three things on Google are the places that pay to be
on the top three things in Google and aren't necessarily the resources that are local or available.
And then lastly is talking about setback prevention. So recognizing in the past, what are those indications
that our loved one is likely to have a setback? What are the indications that we are likely to have
a setback? And how can we strategize for that? Okay, so now we get to practice. So we're gonna come
back to this. So I want you to look at your card.
your cheat sheet that I gave you. So with communication, oftentimes we find ourselves in a place where
we are trying to nag, scold, berate, remind, or logic our way into our loved one's brain. And that might
work if our loved one is living in their prefrontal cortex. But we know when they're living with an
addiction, they are in survival brain.
So it's not going to listen to those things. But it is going to listen when we are safe, regulated,
connected, stable, consistent. So we have a responsibility to regulate and be mindful of what we are
saying to our loved one to increase the likelihood that they hear us. So this is how we do that. We
use our seven positive communication components. When we're talking about positive communication, it
does not mean that everything is rainbows and sunshine, because it's not.
People don't want to be spoken to that way. Instead, it's talking about what we want to see or what
we need as opposed to listing all the things that we don't. Because if the listing the don't list worked,
we wouldn't be here because we've all tried that. The first is to be brief. We're focusing on one thing
at a time. Otherwise, we sound like Charlie Brown's teacher.
The next is to be positive, again, identifying what we want to see as opposed to listing what we don't.
And the really challenging part of this is to extend the best possible interpretation. We're going to
believe what people tell us until their behavior communicates something differently. I have to believe
that change is possible and there's an opportunity for it to happen, for it to happen.
The next is to be specific and clear. We're working with a chronic disease. We are all tired and exhausted,
sometimes financially overwhelmed. We've got to keep it simple, focus on one thing at a time. We are
responsible for identifying and labeling and expressing our feelings as opposed to assuming that our
loved one is going to mind read and understand what they are. So that's our responsibility.
We can also share some understanding, not that we know exactly what it's like to live with the addiction
that they're living with, but to show some empathy. Empathy is not weakness, it's quite the opposite.
Next, and this is oftentimes the most difficult part, second to feelings, is taking responsibility.
Part of this,
Healing and helping our loved one create the foundations for recovery is recognizing that we have also
done harm. I have cussed my sibling out on the phone. I have ignored them for long periods of time.
That was harmful. So I'm responsible for taking accountability for that, recognizing that harm, and
making a different choice moving forward. And sometimes it is, I love you and I can't talk to you right
now, as opposed to just hanging out.
And then lastly is to offer to help. If we know that the antidote to addiction is connection, then the
hope is that we can figure out ways to interact moving forward that are not surrounded by me rescuing
or trying to fix or solve my loved one's problems, but instead doing things that we thoroughly enjoy
together or can at least tolerate. So what you have on your card in front of you is the acronym PIAS.
which is a communication model that helps, one, helps us slow down, and two, communicate intentionally.
The goal is to reduce the likelihood of conflict and create collaboration. It does not mean we're going
to agree. It does not mean that everything that we say is going to land with our loved one, but it does
mean that we are taking steps to change those dynamics. So the first is to say it in a positive way.
So list what we want to see as opposed to all the things that we don't. We're going to use our I message
to express a feeling and be mindful because it's easy to say, well, I feel angry when you come home
late. That's still pretty blaming. So we're going to try to figure out how do we say that in a kinder
way. We're also going to offer an understanding statement. Again, this is not I totally understand what
it's like to be you, but it's offering some sort of compassion or empathy.
So I remember the first time I had a conversation with my addicted loved one, I said, hey, dude, I've
been thinking the last three days of how to even talk to you about this. I sweat through my shirt. I'm
so anxious. And this is really important to me. So that showed I don't have everything together. I'm
not coming from a holier-than-thou place. I'm coming from a this is important. I'm also overwhelmed
and uncertain. Here we are.
And then lastly is to share the responsibility. It is not taking responsibility for the addiction, but
instead, what are we going to do moving forward? What am I willing to do? Because we're trying to maintain
and build relationship. So let's practice. So here's something that you might say. So we're going to
read this first. So do you really have to hang out with your friends after work tonight? You know that
I don't like you hanging out with them.
You always wind up drunk when you go to happy hour. So if you were the addicted loved one, what is your
response likely going to be? What am I going to hear? That's right. Yeah. So not like a collaborative
kind thing. Cause now I'm triggered. I'm in my brain stem, right?
What else might you hear from an addicted loved one? If this is your, how you meet them at the door.
They might ignore me and walk away. I heard you say something. Yeah. Yeah. I don't have to go to the
bar. I'll just go in the kitchen. Right. Yeah. So then what did we accomplish? My behavior reinforced
that pattern.
Right? They're gonna continue to drink. I'm gonna continue to fester in my anger. We didn't make any
progress. So instead, if we look at using those pious communication techniques, we're gonna try to take
the sting out of things. It doesn't mean that I'm pretending that things aren't happening or that I'm
not impacted by it whatsoever, but I'm going to reduce the likelihood that I get the F you or the ignore you or
Watch it watch me. I'm going to prove prove you wrong kind of thing or prove you right in this case
so what might a positive approach a catching flies with honey versus vinegar approach sound like any
thoughts there's not one right answer, but What might start to make this adjustment? Yeah?
So recognizing that your loved one having friends, whether you like the friends or not, is a strength.
And that's what we can build upon, 100%. What else? What's another strategy? What's another way that
a pious statement could sound? Yeah? Yeah. Because it's a normal assumption that
your loved one is going to assume that you're angry at them. So to be able to clarify that is a huge
adjustment. Yeah. So either way, we didn't make progress forward. Right. What else could we try? My
approach has been, and this is when
I can have time to sleep, but I'm the DD till 10. Safety is important to me after that. You gotta figure
out something else, right? So I'm still allowed to set boundaries of what I'm willing to do. Harm reduction
is important to me, and I gotta go night-night. Otherwise, I'm very cranky in the morning. Okay, what
about this one? I hate what you've done to this family.
Your selfishness is embarrassing and people keep asking me questions about why you are the way that
you are. I must be the worst parent ever. What's potentially problematic about this? Because we said
it, right? Yeah. Yeah. You are. Yes. You're terrible. Yes. So what's potentially problematic about this
statement? Yeah. Easily a defense.
I remember you were glued right back at you. And I want to be clear that those responses, that's not
addiction behavior. That's being a human being. We all do that. That, you know, turn it around and throw
it back, right? So I want to be clear about that. What else is potentially problematic about this approach? Yeah.
Yeah, so now I feel guilt or shame about how my mom or my dad feel. Now I feel responsible for taking
care of them. That is outside of what I can actually manage. So now I have a risk factor for continued
use. Right? Well, the assumption that it's about my selfishness as opposed to my private selfishness.
That's right. Selfishness has nothing to do with it.
So we're also making some assumptions and mind reading here. So if we use our pious approach, what could
this sound like instead? Remembering that it doesn't mean that our loved one is going to totally agree
with us or even listen to us, but reduce the likelihood that it gets thrown back at us or is harmful.
You wouldn't say anything at all because you don't have to.
So very insightful. And that is the key component of craft, that instead of responding in a negative
way, we either respond in a positive way or we don't. And that is hard, right? Because we haven't been
taught that setting that boundary or creating some distance is a good thing, but that's essential. I
don't have to respond to everything. What else could we try?
totally changing our dynamic, totally changing our approach. Do I need them to know that their behavior
and their disease has impacted our family? Guess what? They already know. I don't need to project my
assumptions or perspective on them. So what do I need to communicate?
So we might ask an open-ended question to gather some feedback from them, as opposed to making an assumption.
What else?
learning. Thank you for that feedback. I'm learning 100%. That is not fun. But it's super important.
Other things that are important to say, I love you. You're important to me. It feels good when you're
in this house. I love walking home or coming in from work and seeing you on the couch. Good, you know,
giggling at a YouTube video. Love that. So I don't need to remind my loved one that they have an addiction.
They know that I don't need to remind them that it impacts me.
They know that, because I've certainly told them. So instead, I need to reinforce the things that they
likely haven't heard from me or from anybody in a while. They matter. They're important. We care about
them. Their safety is important. We love that they're a part of our family. So that totally changes
things. What's it feel like to think about that adjustment? Scary.
What else comes up when you're like, instead of addressing the addiction, I'm asking you to tell them
that you love them? Rewiring of the brain. So which means it's not a one-time thing. We've got to practice.
We've got to build that muscle. And these are not reflexes that we are built with. So it takes intention.
Part of this communication adjustment as well sometimes means,
I hear you end, I use the restroom, and then let's have this conversation. Or I'm gonna take a walk
around the block because I wanna lock in on this conversation, that's important, because we
have a responsibility to be regulated as well. All right, so, Craft, the model itself, can be facilitated
as a support group or skill development one-on-one with folks.
So if you are facilitating within a support group, these are some of the things to be mindful of that
ensure that we as facilitators are modeling the skills that we want our participants to utilize with
their family members. So the first is that we have to figure out what our boundaries are, what our limits
are, and stay within our scope. And stay away from the
reflex of trying to fix things for people. Our job is not to fix things for people. Instead, it's to
help create an environment where they can reflect and figure out what's right for them. The world is
way more complicated than we even can imagine. And so any time that I'm going to make an assumption
about what you need, I'm going to be wrong. Because sometimes I can't even find socks that match. So
how on earth would I know what's going to be best for you? There's no way.
We also want to make sure that in doing any work with folks unless we are a licensed clinician that
we're focused on the here and now on the present and implementing those skills. And I think that's something
that I've.
found that has been a challenge for family members that I work with now that have maybe gone to a different
style of support group and they feel really stuck in what has happened because they haven't
had an opportunity to recognize that what is happening right now is also important. So making
that adjustment. And then flexibility.
So even the schedule for today adjusted a little bit because life happens and we as facilitators need
to recognize we cannot control the group or the participants. We can guide, we can prepare, and then
we're going to adjust because that's what we want our group members to do with their loved one.
to ensure that there's fidelity to the model, and there's way more about this than the facilitator training,
but we want people to be able to share information and resources amongst each other, have empathy and
support for each other within the group, that way they can practice that with their loved one when they're
outside of group, and work together to implement the skills in their life, build that sense of community,
to enhance their coping and self-efficacy, to recognize that they are allowed to have their own
interests, their own hobbies, and it doesn't have to be specifically focused on supporting their loved
one, that they're less socially isolated because we're actively addressing that stigma, that they have
some joy and levity in life, and it doesn't mean that we don't care about our loved one, but it also
means that we care about ourselves, and that we are able to start to create and implement our own boundaries
to enhance our sense of safety and well-being within our family.
So, some things to think about in implementation. First is that if a person has access to mental health
resources through a community mental health center or a certified community behavioral health center,
Medicaid reimburses for family skills training without client present in an individual or a group setting.
Medicaid will also reimburse family members for transportation to and from appointments, which includes
skills. In addition to that, we have an opportunity to use our socio-ecological model and think about
how do we create networks within our community to connect people to the resources that they deserve?
Who are the service providers who are already working with families impacted by addiction? 65% of DCS family
involvement is due to substance use disorder in Indiana. So every one of those cases has at least one
impacted family member who could benefit from this because our goal is reunification, right? We have
entire drug courts or problem-solving courts whose whole caseload are people impacted by addiction.
We've got families who are available and needing that help. So we also know, you know,
School resource officers are oftentimes dealing with truancy cases, but when we actually look at what's
going on, there's chaos in the family, and addiction is oftentimes part of that. We've got people who
could benefit from support. So thinking at all those levels, getting outside of our typical box, and
thinking about how we can build intentional systems of connection. So that was a lot of information,
and this is something that I live every day.
But we have a couple minutes if you've got questions or thoughts. And then I have also got literature
up here if you want more information on my card. But any questions for the good of the group? Yeah.
So there are different types of boundaries. So there are rigid boundaries, there are permeable boundaries,
and then there are ones that are more moderate. And so boundaries, the key element that I see that is
a challenge in the folks that I work with is that there's an assumption that a boundary
is a consequence or a punishment, that because of your behavior, I've had to put this boundary in place.
Instead, if we're thinking about creating healthy relationships, a boundary says that I care about you,
I care about me, I want us to have a connection, and do that in a way that's safe and appropriate for
everybody. So there are different types of boundaries, and for some folks, you've gotta put that rigid
boundary, because they're gonna
emotional vampire, you know suck all the life out of you and that's okay and For other relationships,
they don't have to be that way Yes, and we cannot be all things for all people and so
That's really important when we are in a service provider role to keep ourselves in check because we're
here because we're empathetic, right? Otherwise we would not have driven, I wouldn't have driven two
hours to get here and do this work every day. So it's important for us to reality check that empathy
and recognize, am I taking that step forward with them or am I pulling them along?
And if I feel solely responsible for their well-being, I need to reality check that, because that's
not sustainable. But it's really easy to do. Yeah. Yeah, absolutely. And we've all had those moments,
and I know you have, where you walk into a home and you're like, if you would just do these things,
everything would be better, right? Because I want the kids to be happy and healthy. Yeah, yeah, yeah.
Well, and here's the thing. It comes in building rapport before you even enter in any therapeutic work,
because you're clinical psych, right? Okay, so before you even enter in any clinical work, we're building
clear communication expectations and boundaries, and I'm making it clear that I'm on your page, I'm
on your timeline, this is your session, or this is your appointment, or whatever, and that I'm not an
adversary, that I'm an ally.
You are the driver and that totally changes those dynamics. Yeah. And then yes, sometimes anger comes
out, anger about the disease and so being able to validate. I would also be pissed if I was in this
situation like you. It makes so much sense that you're upset. Of course you want, of course I've had
those times where I love my person so much I just wanna hug him really tight, right?
or keep you in the house and make sure you don't go anywhere. So just to be able to validate those are
just normal experiences. Any other thoughts or questions? Well, part of my job is technical assistant.
So if there are any questions or thoughts that come up down the road, let me know. Otherwise, thank
you for sharing your part of your afternoon with me. And I think the rest of the group is going to come
in here to wrap up the day.
We're going back out there. Okay. Perfect. Well, thank you all so much.