FS04. All Behavior is Caused

Session Online Version

CHECK IN SECTION – Maximum time 20 minutes

Mindful Minute -- take a break from what you have been doing, breathe deeply, relax and recharge.

Step 1: Find a comfortable seated position with both feet grounded on the floor. Put a hand on your stomach. Close your eyes.

Step 2: Take a deep breath in through your nose and out through your mouth. Notice your thoughts and feelings and any tensions in your body.

Step 3: As you inhale and exhale, breathe deeply so your belly fills and empties with air. The hand on your stomach helps you practice belly – not chest breathing.

Step 4: For the next minute make breathing in and out your only focus. Let your thoughts come and go without trying to control them. If you find an area of tension in your body, relax it and let the tension go.

Step 5: At the end the minute slowly open your eyes. Gently bring your presence back to your surroundings.

Our Purpose

CRAFT Connects’ Family Support groups are for parents, partners, families and other Concerned Significant Others (CSOs) who have a loved one that is struggling with a substance use or mental health disorder. We know from first-hand experience that loving someone with these challenges can be a difficult, lonely journey. To create a safe place for honest sharing of our lived experience we use appropriate language and behavior. We are empathetic, nonjudgmental, genuine, respectful, steer clear of confrontation and imposing our own solutions. We encourage hope and compassion for all. CRAFT Connect helps to reframe and energize connections between you, your loved one and behavioral health professionals into a “therapeutic alliance” that leads to progress and healing. There is a lot we can learn from one another.

What experience did you have practicing CRAFT Connect principles and skills?

____________________________________________________________________________________________________________________________________________________________________________________________________________What did you do to purposefully take care of yourself and show self-compassion? ____________________________________________________________________________________________________________________________________________________________________________________________________________

LEARN SECTION – Maximum time 30 minutes

1. “He just does that out of nowhere!” “She does it for no reason!” It’s easy to point out our loved one’s unwanted behaviors. In order to be able to help them change we need understand the context in which their wanted or unwanted behavior occurs. A common misconception is that behaviors happen for no reason. Well supported scientific evidence shows that all behaviors is caused. One of CRAFT Connects’ major objectives is to teach us to change our behavior toward our loved one, so that in turn our loved one alters their behavior in response.

2. Our loved ones “learn” to engage in specific behaviors in order to fulfill particular needs. Feelings, thoughts, and behaviors are all connected and influence one another. For example, if our loved one is feeling sad or depressed, they might have thoughts like they aren’t worth much and might do behaviors like isolate all day. Most people with a behavioral health disorder develop patterns to their behaviors. In this session you are going to learn how to create a ‘road map’ that supplies important details about why your loved ones’ engages in behaviors.

3. This kind of “mapping” or information gathering begins the process of finding creative ways for you to help your loved one find new responses to problematic triggers and healthier ways to obtain some of the rewards associated with their unwanted behaviors. Knowledge that helps to more effective shape your interactions. Your analysis doesn’t have to be perfect, just a starting point to build on as you continue your CRAFT Connect study.

4. Following the 6 steps in the “Analyze Behavior Worksheet” accompanying this session will help you begin to establish a framework for understanding factors that can influence the occurrence of any particular behavior. To help guide you through this process let’s read through a case study or sample analysis of Natasha who is seeking treatment for her 35 year old husband’s drinking problem. They have been married 10 years and have two children. Her response to the 6 steps are underlined.

5. Describe the Behavior, something your loved one does on a fairly regular basis that has a discernable pattern. Be as complete and specific as possible regarding what you know about this kind of episode. Remember to provide information on What, How often, and How long. Drinking a shot of tequila or whiskey. 6-7 12 oz beers. Cocaine use? Alcohol consumed over 5 hours, cocaine over 2 hours. 3-4 times month.

6. What are the External Triggers? Describe the environmental triggers that lead up to the behavior. Who is your loved one usually with when their behavior starts? Friends (not coworkers) Phil, Doc, Steve. Where does the behavior usually start? Starts drinking at Red’s Filling Station bar then moves to Doc’s place. When does the behavior usually begin? Friday nights. Drinking starts at 6:00 pm. Cocaine after 11:00 pm.

7. What are the Internal Triggers? Make your best guess about what you believe could be the internal triggers – thoughts and feelings -- that lead up to the behavior. Remember that thoughts are ways of dealing with feelings. What do you think your loved one is typically feeling right before the behavior? Pressured. Embarrassed. Happy in anticipation of using. Happy he’s part of that special group. In control, powerful. What do you think your loved one is thinking about right before the behavior? I earned this celebration. If I go it will shut Phil up. Natasha will be mad, but I’ll make it up to her tomorrow. I’ll save face if I go.

8. What are the “Red Flags” or warning signs? Assuming that in some way you have witnessed your loved one’s behavior think about the physical, emotional, behavioral indicators that signaled its start. Include words, voice tone, context, and non-verbal cues. What are some physical signs that tipped you off that your loved one’s behavior started? Doesn’t come home after work on Fridays. Goes straight to Red’s Filling Station bar. Stops answering my calls or texts. What changes in your loved one’s emotions did you witness? Doesn’t want to connect with me. What is the last thing your loved one says or does before the behavior? “Don’t wait up for me.”

9. What are the Positive Consequences? What do you think your loved one likes about the behavior? Remember to provide information on Who, Where, and When. They’re “crazy” different from coworkers. Feels safe there. Nobody will bother them. Likes to celebrate the weekend. Pleasant routine (feels cheated if he doesn’t go). Makes him feel special. What pleasant thoughts do you think your loved one has while doing this behavior? This is fun. It’s great to be part of this group. What pleasant feelings do you think your loved one has while doing this behavior? Feeling like he “belongs”. Getting high. Feels special, the guys really like him. Excitement. Not stressed.

10. What are the Negative Consequences? What do you think or feel are the negative results of your loved one’s behavior? Try to include the interpersonal, physical, emotional, legal, job, financial areas of their life. Note with a * any negative results that your loved one would agree with. Strained marriage* (from my worrying and his moods). I’m unhappy. He’s tired, hungry.* He’s irritable. Criticizes himself for not getting stuff done. He’s down (depressed). He’s afraid he’ll get caught and end up in jail.* He’s afraid people will find out and he’ll lose his job.* Money spent on coke. Sperm damage.*

11. Now let’s turn to and complete (after session) the “Analyze Behavior Worksheet”. Begin by describing the unwanted behavior, something your loved one does on a fairly regular basis that has a discernable pattern. Be as complete and specific as possible regarding what you know about this kind of episode. Remember to provide information on What, How often, and How long. If you need help choosing a specific behavior to focus on see the “Common Unwanted Behaviors Handout”. Please note, if you or a loved one is taking prescription drugs you need to separate the side effects of those drugs from the behavior. If you are not sure of the side effects one of these government websites will help https://dailymed.nlm.nih.gov/dailymed/, https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm.)

Discuss: Share what you wrote. ______________________________________________________________________________________________________

12. There are a number of tangible benefits of ‘mapping’ our loved one’s behavior. One of the first is learning as much as possible about our loved one’s Internal and External triggers. How could this be helpful in minimizing the likelihood of their unwanted behavior? ______________________________________________________________________________________________________How does knowing the “Red Flags” or warning signs help in not making matters worse or encouraging your loved ones’ unwanted behavior?______________________________________________________________________________________________________How would knowing what your loved ones consider to be the Positive Consequences of their unwanted behavior be helpful in changing their behavior and yours? ______________________________________________________________________________________________________How could identifying the Negative Consequences of their behavior that your loved one agrees with be helpful?______________________________________________________________________________________________________

GROUP SHARING SECTION – Maximum time 30 minutes

13. We will now begin the sharing portion of the meeting. You are invited to share from 3 to 5 minutes about your experience as it relates to your loved one’s recovery, this week’s session or what you are currently working on. Please focus your sharing on potential solutions rather than the problems. We will conclude the sharing five minutes before the end of the meeting. Who would like to begin?

MY COMMITMENTS SECTION – Maximum time 10 minutes

14. Please remember that what has been shared here is confidential and that the opinions expressed are of the individuals who shared them. These are our group commitments, we will start the next CRAFT Connect session by reporting on them. This week I will:

A. Do the in-between session assignments:

● Use the “Analyze Behavior Worksheet” to map one of my loved one’s common unwanted behaviors. Refer to the “Common Unwanted Behaviors Handout” and “Sample Analyze Behavior Handout” as needed.

B. Share what I am learning with my family, friends, and community.

C. Show kindness for myself by self-care.

As you listen to a song about connection, take a few minutes to quietly think about what you learned in this session. Write your thoughts and personal commitments below.

What are the most important things I learned?______________________________________________________________________________________________________

What will I do differently because of what I learned?______________________________________________________________________________________________________

Analyze Behavior Worksheet

The following question should help you begin to establish a framework for understanding factors that can influence the occurrence of any particular behavior – wanted or unwanted.

Step 1: Describe the Behavior, something your loved one does on a fairly regular basis that has a discernable pattern. Be as complete and specific as possible regarding what you know about this kind of episode. Remember to provide information on What, How often, and How long. (See Note below.) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Step 2: What are the External Triggers? Describe the environmental triggers that lead up to the behavior.

Who is loved one usually with when their behavior starts?______________________________________________________________________________________________________

Where does the behavior usually start?______________________________________________________________________________________________________

When does the behavior usually begin?______________________________________________________________________________________________________

Step 3: What are the Internal Triggers? Make your best guess about what you believe could be the internal triggers – thoughts and feelings -- that lead up to the behavior. Remember that thoughts are ways of dealing with feelings.

What do you think your loved one is feeling right before the behavior?______________________________________________________________________________________________________

What do you think your loved one is typically thinking about right before the behavior?______________________________________________________________________________________________________

Step 4: What are the “Red Flags” or warning signs? Assuming that in some way you have witnessed your loved one’s behavior think about the physical, emotional, behavioral indicators that signaled its start. Include words, voice tone, context, and non-verbal cues.

What are some physical signs that tipped you off that your loved one’s behavior started? ______________________________________________________________________________________________________

What changes in your loved one’s emotions did you witness?______________________________________________________________________________________________________

What is the last thing your loved one says or does before the behavior?______________________________________________________________________________________________________

Step 5: What are the Positive Consequences? What do you think your loved one likes about the behavior? Remember to provide information on Who, Where, and When.

____________________________________________________________________________________________________________________________________________________________________________________________________________

What pleasant thoughts do you think your loved one has while doing this behavior?______________________________________________________________________________________________________

What pleasant feelings do you think your loved one has while doing this behavior?______________________________________________________________________________________________________

Step 6: What are the Negative Consequences? What do you think or feel are the negative results of your loved one’s behavior? Try to include the interpersonal, physical, emotional, legal, job, financial areas of their life. Note with a * any negative results that your loved one would agree with. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Note: If you or a loved one is taking prescription drugs you need to separate the side effects of those drugs from the behavior. If you are not sure of the side effects one of these government websites will help https://dailymed.nlm.nih.gov/dailymed/, https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm.)

Common Unwanted Behaviors Handout

Mental Health Disorders

Trying to tell the difference between what expected behaviors are and what might be the signs of a mental illness isn't always easy. There's no easy test that can let someone know if there is mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness. Because they are disorders of the brain, many symptoms of mental illness are expressed as complex behaviors. Although each illness has its own symptoms common behaviors of mental illness in adults and adolescents can include the following (https://www.nami.org/learn-more/know-the-warning-signs):

Excessive worrying or fear

Feeling excessively sad or low
Confused thinking or problems concentrating and learning
Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
Prolonged or strong feelings of irritability or anger
Avoiding friends and social activities
Difficulties understanding or relating to other people
Changes in sleeping habits or feeling tired and low energy
Changes in eating habits such as increased hunger or lack of appetite
Changes in sex drive
Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don't exist in objective reality)
Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia)
Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
Thinking about suicide
Inability to carry out daily activities or handle daily problems and stress
An intense fear of weight gain or concern with appearance
Abuse of substances like alcohol or drugs

Watch: “10 Common Warning Signs of a Mental Health Condition in Teens and Young Adults” video, https://www.youtube.com/watch?v=zt4sOjWwV3M)

Substance Abuse Disorders

Figuring out if your loved one is using drugs or alcohol can be challenging. Many of the signs and symptoms are, at times, typical teen or young adult “unwanted” behavior. Many are also symptoms of mental health issues, including depression or anxiety disorders which appear to be under our loved one’s control, but are not (https://drugfree.org/article/look-for-warning-signs/):

Behavioral Changes

Has changed relationships with family members or friends

Uses chewing gum or mints to cover up breath
Often uses over-the-counter preparations to reduce eye reddening or nasal irritation
Frequently breaks curfew
Has cash flow problems
Drives recklessly, and has car accidents or unexplained dents in the car
Avoids eye contact
Locks doors
Goes out every night
Makes secretive phone calls
Makes endless excuses
Has the “munchies” or sudden appetite
Exhibits uncharacteristically loud, obnoxious behavior
Laughs at nothing
Has become unusually clumsy: stumbling, lacking coordination, poor balance
Disappears for long periods of time
Has periods of sleeplessness or high energy, followed by long periods of “catch up” sleep

Mood & Personality Shifts

Exhibits mood changes or emotional instability

Sullen, withdrawn, depressed
Shows loss of inhibitions
Silent, uncommunicative
Hostile, angry, uncooperative
Deceitful or secretive
Less motivated
Unable to focus
Hyperactive
Unusually elated

Hygiene & Appearance Problems

Smell of smoke or other unusual smells on breath or on clothes

Messy appearance
Poor hygiene
Red, flushed cheeks or face
Track marks on arms or legs (or long sleeves in warm weather to hide marks)
Burns or soot on fingers or lips (from “joints” or “roaches” burning down)

Health Issues

Unusually tired

Lethargic movement
Unable to speak intelligibly, slurred speech, or rapid-fire speech
Nosebleeds
Runny nose, not caused by allergies or a cold
Frequent sickness
Sores, spots around mouth
Seizures
Vomiting
Wetting lips or excessive thirst (known as “cotton mouth”)
Sudden or dramatic weight loss or gain
Skin abrasions/bruises
Accidents or injuries
Depression
Headaches
Sweatiness

School and Work Concerns

Absenteeism or loss of interest

Loss of interest in extracurricular activities, hobbies, or sports
Failure to fulfill responsibilities at school or work
Complaints from teachers or supervisors
Reports of intoxication at school or work

At Home and in the Car

Disappearance of prescription or over-the-counter pills

Missing alcohol or cigarettes
Disappearance of money or valuables
Receiving unusual packages in the mail
Smell in the car or bottles, pipes or bongs on floor or in glove box
Appearance of unusual containers or wrappers, or seeds left on surfaces used to clean marijuana
Appearance of unusual drug apparatuses, including pipes, rolling papers, small medicine bottles, eye drops, butane lighters, or makeshift smoking devices, like bongs made out of toilet paper rolls and aluminum foil
Hidden stashes of alcohol

Sample Analyze Behavior Handout

Step 1: Describe the Behavior, something your loved one does on a fairly regular basis that has a discernable pattern. Be as complete and specific as possible regarding what you know about this kind of episode. Remember to provide information on What, How often, and How long.

Drinking a shot of tequila or whiskey. 6-7 12 oz beers. Cocaine use? Alcohol consumed over 5 hours, cocaine over 2 hours. 3-4 times a month.

Step 2: What are the External Triggers? Describe the environmental triggers that lead up to the behavior.

Who is your loved one usually with when their behavior starts?

Friends (not coworkers) Phil, Doc, Steve.

Where does the behavior usually start?

Starts drinking a Red’s Filling Station bar then moves to Doc’s place.

When does the behavior usually begin?

Friday nights. Drinking starts at 6:00 pm. Cocaine after 11:00 pm.

Step 3: What are the Internal Triggers? Make your best guess about what you believe could be the internal triggers – thoughts and feelings -- that lead up to the behavior. Remember that thoughts are ways of dealing with feelings.

What do you think your loved one is typically feeling right before the behavior?

Pressured. Embarrassed. Happy in anticipation of using. Happy he’s part of that special group. In control, powerful.

What do you think your loved one is thinking about right before the behavior?

I earned this celebration. If I go it will shut Phil up. Natasha will be mad, but I’ll make it up to her tomorrow. I’ll save face if I go.

Step 4: What are the “Red Flags” or warning signs? Assuming that in some way you have witnessed your loved one’s behavior think about the physical, emotional, behavioral indicators that signaled its start. Include words, voice tone, context, and non-verbal cues.

What are some physical signs that tipped you off that your loved one’s behavior started?

Doesn’t come home after work on Fridays. Goes straight to Red’s Filling Station bar. Stops answering my calls or texts.

What changes in your loved one’s emotions did you witness?

Doesn’t want to connect with me.

What is the last thing your loved one says or does before the behavior?

“Don’t wait up for me.”

Step 5: What are the Positive Consequences? What do you think your loved one likes about the behavior? Remember to provide information on Who, Where, and When.

They’re “crazy” different from coworkers. Feels safe there. Nobody will bother them. Likes to celebrate the weekend. Pleasant routine (feels cheated if he doesn’t go). Makes him feel special.

What pleasant thoughts do you think your loved one has while doing this behavior?

This is fun. It’s great to be part of this group.

What pleasant feelings do you think your loved one has while doing this behavior?

Feeling like he “belongs”. Getting high. Feels special, the guys really like him. Excitement. Not stressed.

Step 6: What are the Negative Consequences? What do you think or feel are the negative results of your loved one’s behavior? Try to include the interpersonal, physical, emotional, legal, job, financial areas of their life. Note with a * any negative results that your loved one would agree with.

Strained marriage* (from my worrying and his moods). I’m unhappy. He’s tired, hungry.* He’s irritable. Criticizes himself for not getting stuff done. He’s down (depressed). He’s afraid he’ll get caught and end up in jail.* He’s afraid people will find out and he’ll lose his job.* Money spent on coke. Sperm damage.*

Reinforcement Matrix Handout

Wanted behavior is increased by consequences that our loved one wants, likes or will work to get (a reward) or that stops or reduces an unpleasant painful condition. Unwanted behavior is decreased by consequences that our loved one dislikes or will work to avoid or when something our loved one wants is withheld until the unwanted behavior is corrected (Meyers and Wolfe, 2004). All reinforcers, pleasant and unpleasant, increase the likelihood of your loved one’s wanted or unwanted behaviors continuing. (LO is shorthand for your loved one.)

PIUS Communication Worksheet

There are seven principles to positive or PIUS communication:

1. Be brief. Resist the urge to bring up too much. Keep it simple.

2. Be specific and clear. Focus on one thing.

3. Be positive while communicating what you want. Avoid blaming, name calling and over generalization

4. Label your feelings. Describe the emotional impact on you in a calm, nonjudgmental, non-accusatory way.

5. Offer an understanding statement. Try seeing it from the other person’s point of view.

6. Accept partial responsibility. Share a small piece of the problem.

7. Offer to help.

Write down a verbal/text or email interaction between you and a loved one.

________________________________________________________________________________________________________________

Using the seven principles write what you might communicate with a loved one the next time the same situation occurs, in a way that limits defensiveness and does not lead to an argument. Be sure to refine and practice your PIUS statement before using it.

I… (HOW DO YOU FEEL?)

________________________________________________________________________________________________________________

when you…(DESCRIBE THE BEHAVIOR OR CONDITION) ________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

because… (WHY DO YOU FEEL THIS WAY?)

________________________________________________________________________________________________________________

I would like… (WHAT DO YOU WANT TO HAPPEN?)

________________________________________________________________________________________________________________

I know… (YOU UNDERSTAND THE OTHER’S POSITION)

________________________________________________________________________________________________________________

Let’s try… (YOUR WILLINGNESS TO SHARE RESPONSIBILITY)

________________________________________________________________________________________________________________

(HOW CAN I HELP?)

________________________________________________________________________________________________________________

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Session Online Version

Analyze Behavior Worksheet

Common Unwanted Behaviors Handout

Mental Health Disorders

Substance Abuse Disorders

Sample Analyze Behavior Handout

Reinforcement Matrix Handout

PIUS Communication Worksheet

FS03. Enrich Your Own Life

FS05. How to Increase Wanted Behavior