FS08. Invite Your Loved One to Enter Treatment

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

Watch: “Intro to CRAFT: CRAFT vs Alternatives” video.

1. One of the main goals of using CRAFT Connect skills and principles is to help encourage your loved one to seek treatment. Treatment for behavioral health disorders helps people learn new behaviors and skills. Getting our loved one into and then staying in treatment for a mental health or substance use disorder takes careful planning and attention to detail. Your loved one may not be open to it right now, but chances are good there will be moments when they are receptive, and when those moments come it is important to be ready.

Discuss: Try to put yourself in your loved one’s position. How do you think they feel about the prospect of treatment or being in treatment? Where do you think they are in the “Cycle of Change Handout” included with this session?

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2. No matter where your loved one is in the Cycle you should explore treatment options and have a few ready to go. If you have insurance, find out what treatment programs may be covered. If you don’t have insurance, know the costs and consider them as you look at different treatment options. There may be no cost or low-cost options available in your area that you can research. (See the “Treatment Resources Handout”.)

3. The two basic types of treatment programs are inpatient and outpatient care. Outpatient care can be high or low intensity that involves daily or weekly treatments such as therapy, counseling, or group sessions, at a clinic or facility. People who choose outpatient treatment can continue to live at home as they recover, allowing them to take care of children or family members, keep up with their jobs, and stay on track in school. Outpatient care typically costs less than inpatient care, and the level of support may be less intensive. Licensed inpatient facilities offer 24-hour/7 support and intensive care with people living at the program facility for a particular length of time.

4. Although there are pros and cons to both, research has shown that people can be just as successful in either form of care. The decision of which is best comes down to your loved one’s needs. Once you decide on the best approach for you and your loved one, take the time to interview a few different providers. Prepare a list of questions ahead of time so that you don’t overlook anything. “Ask the treatment provider to describe their philosophy and give you a detailed description about the treatment itself” (Meyers and Wolfe, 2004, p. 169). Ask how you and your family will be involved.

5. As we read through the U.S. government’s Substance Abuse and Mental Health Services Administration (SAMHSA) principles of effective treatment, think about why each would be important as you consider potential programs for your loved one.

For mental health and substance use disorders treatment:

● No single treatment is appropriate for everyone.

● Treatment needs to be readily available.

● Effective treatment attends to multiple needs of the individual.

● Remaining in treatment for an adequate period of time is critical.

● Behavioral therapies—including group counseling— are the most commonly used forms of treatment. (Look for programs that include phrases in their descriptions such as “social skills training,” “behavioral marital therapy,” “cognitive-behavioral treatment,” “rational-emotive therapy, “motivational treatment,” or “solution-focused therapy.”)

● Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

● An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.

● Many drug-addicted individuals also have other mental disorders (and vice versa).

● Treatment does not need to be voluntary to be effective.

6. For substance use disorders treatment:

● Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.

● Addiction is a complex and treatable disease that affects brain function and behavior.

● Drug use during treatment must be monitored continuously, as lapses during treatment do occur

● Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.

Discuss: Which principles of effective treatment stood out to you as you went through this list? Which ones could be particularly important for your loved one’s success?

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7. The bottom line on all treatments is they cannot work if your loved one isn’t physically or emotionally ‘present’ (Meyers and Wolfe, 2004, p. 167). Put some thought and preparation into identifying treatment options they are more likely to engage with. Try to give them two to three choices of treatment counselors or programs. Have everything ready to go so the moment your loved one accepts the invitation to enter treatment you can present the options and get them into treatment.

8. Often, there are small fleeting moments, “windows of opportunity”, where your loved one will be more receptive to the invitation to enter treatment. You have to have treatment ready to go the instant your loved one says he or she is interested. “That interest will peak and then dissolve if you do not seize the moment” (Meyers and Wolfe, 2004, p. 165). You will want to learn to spot these moments and be prepared to extend an effective, positive, and loving invitation when they come.

Discuss: Why would it be so important to have treatment options ready to go?

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Turn to and begin work on the “Windows of Opportunity Worksheet” accompanying this session. You will finish this worksheet after the session.

9. Once you have recognized the most likely moments when your loved one may be receptive to an invitation; it is time to plan out what you will say. As with most of our communication, we should follow the seven principles of positive or ‘PIUS’ communication. Using PIUS statements helps ensure that what we say will minimize defensiveness in our loved one while still being clear.

EXTEND AN INVITATION ACTIVITY

Step 1: Take one of the potential windows of opportunity scenarios you identified on the worksheet. Imagine that you are in that scenario and you want to extend an invitation to your loved one to enter treatment. Use the “PIUS Communication Worksheet” included with this session to help write out what you will say. (Transfer what you write here.)

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Step 2: Share with the group the scenario and then your “PIUS” statement.

10. There is always a good chance that your loved one will turn down the invitation. That is okay, remember the Cycle of Change. If you continue practicing CRAFT Connect skills and principles, more windows of opportunity will open, and you will be ready for them. If your loved one does turn you down, be careful not to slip into old habits of nagging, arguing, or pleading. Keep the interaction positive and avoid confrontation. If they turn you down, you might say, “Thanks for considering it.” Or, “Okay, maybe we could talk about it again another time.” Changing the way, we interact with our loved one can help set the stage to capitalize on future windows of opportunity when we can invite them to enter or stay in treatment. Remember, change is a process, not an event. Keep practicing your skills and you will be ready to extend the invitation when the right time comes along.

Discuss: Why would keeping the “invitation” interaction with your loved one as positive as possible be important?____________________________________________________________________________________________________________________________________________________________________________________________________________________________

GROUP SHARING SECTION – Maximum time 30 minutes

11. 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

12. 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:

· Complete the “Windows of Opportunity Worksheet”.

· Use the “PIUS Communication Worksheet” to write down and practice how to invite my loved one to enter treatment.

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.

Watch: “Help!” video.

What are the most important things I learned?____________________________________________________________________________________________________________________________________________________________________________________________________________________________

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

Cycle of Change Handout

For over 35 years researchers have found that individuals move through a series of six stages (precontemplation, contemplation, preparation, action, maintenance, relapse) in the adoption of healthy behaviors or cessation of unhealthy ones. Research on a variety of different problem behaviors has also shown that there are certain predictors of progression through the stages of change (e.g., Prochaska & DiClemente, 1983), including decisional balance (Prochaska, 1994); self-efficacy (e.g., DiClemente, Prochaska, & Gibertini, 1985); and the processes of change (Prochaska & DiClemente, 1983).

Where do you think your loved one is at in the Cycle of Change, and why?

Precontemplation, not yet acknowledging that there is a problem behavior that needs to be changed. The stage in which an individual has no intent to change behavior in the near future, usually measured as the next 6 months. PR contemplators are often characterized as resistant or unmotivated and tend to avoid information, discussion, or thought with regard to the targeted health behavior (Prochaska et al., 1992).

Contemplation, acknowledging that there is a problem but not yet ready or sure of wanting to make a change. Individuals in this stage openly state their intent to change within the next 6 months. They are more aware of the benefits of changing, but remain keenly aware of the costs (Prochaska, Redding, & Evers, 1997). Contemplators are often seen as ambivalent to change or as procrastinators (Prochaska & DiClemente, 1984).

Preparation, getting ready to change. The stage in which individuals intend to take steps to change, usually within the next month (DiClemente et al., 1991). Preparation is viewed as a transition rather than stable stage, with individuals intending progress to Action in the next 30 days (Grimley, Prochaska, Velicer, Blais, & DiClemente, 1994).

Action, changing behavior. An individual has made overt, perceptible lifestyle modifications for fewer than 6 months (Prochaska et al., 1997).

Maintenance, maintaining the behavior change. These are working to prevent relapse and consolidate gains secured during Action (Prochaska et al., 1992). Maintainers are distinguishable from those in the Action stage in that they report the highest levels of self- efficacy and are less frequently tempted to relapse (Prochaska & DiClemente, 1984).

Relapse. Returning to older behaviors and abandoning the new changes.

This Transtheoretical Model (TTM) of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made. TTM — currently, the most popular stage model in health psychology (Horwath, 1999) — has proven successful with a wide variety of simple and complex health behaviors, including smoking cessation, weight control, sunscreen use, reduction of dietary fat, exercise acquisition, quitting cocaine, mammography screening, and condom use (Prochaska, et al., 1994).

Treatment Locator Handout

Trying to locate appropriate treatment for a loved one, especially finding a program tailored to an individual's particular needs, can be a difficult process. However, there are numerous online resources that can help you locate a local program or provide other information. These include:

The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a website (www.findtreatment.samhsa.gov) that shows the location of residential, outpatient, and hospital inpatient treatment programs for drug addiction and alcoholism throughout the country. This information is also accessible by calling 1-800-662-HELP.

The National Suicide Prevention Lifeline (1-800-273-TALK) offers more than just suicide prevention—it can also help with a host of issues, including drug and alcohol abuse, and can connect individuals with a nearby professional.

The National Institute of Drug Abuse (NIDA) handbook “Seeking Drug Abuse Treatment: Know What to Ask”, www.drugabuse.gov/sites/default/files/treatmentbrochure_web.pdf, offers guidance in finding the right treatment program.

The National Alliance on Mental Illness (www.nami.org) and Mental Health America (www.mentalhealthamerica.net) are alliances of nonprofit, self-help support organizations for patients and families dealing with a variety of mental disorders. Both have State and local affiliates throughout the country and may be especially helpful for patients with comorbid conditions.

The American Academy of Addiction Psychiatry and the American Academy of Child and Adolescent Psychiatry each have physician locator tools posted on their Web sites at aaap.org and aacap.org, respectively.

Faces & Voices of Recovery (facesandvoicesofrecovery.org), founded in 2001, is an advocacy organization for individuals in long-term recovery that strategizes on ways to reach out to the medical, public health, criminal justice, and other communities to promote and celebrate recovery from addiction to alcohol and other drugs.

The Partnership at Drugfree.org (drugfree.org) is an organization that provides information and resources on teen and young adult drug use and addiction for parents, to help them prevent and intervene in their children’s drug use or find treatment for a child who needs it. They offer a toll-free helpline for parents (1-855-378-4373).

The American Society of Addiction Medicine (asam.org) is a society of physicians aimed at increasing access to addiction treatment. Their Web site has a nationwide directory of addiction medicine professionals.

NIDA’s National Drug Abuse Treatment Clinical Trials Network (drugabuse.gov/about-nida/organization/cctn/ctn) provides information for those interested in participating in a clinical trial testing a promising substance abuse intervention; or visit clinicaltrials.gov.

NIDA’s DrugPubs Research Dissemination Center (drugpubs.drugabuse.gov) provides booklets, pamphlets, fact sheets, and other informational resources on drugs, drug abuse, and treatment.

The National Institute on Alcohol Abuse and Alcoholism (niaaa.nih.gov) provides information on alcohol, alcohol use, and treatment of alcohol-related problems (niaaa.nih.gov/search/node/treatment).

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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.

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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)

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

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(HOW CAN I HELP?) ______________________________________________________________________________________________________________

Windows of Opportunity Worksheet

Often, there are small fleeting moments, “windows of opportunity”, where your loved one will be more receptive to the invitation to enter treatment. These questions can help you think of potential windows with your loved one (Meyers and Wolfe, 2004, p. 171).

When would your loved one be most likely to try something new in the way of treatment? ________________________________________________________________________________________________________________

Is there a particular time of day he/she is most relaxed? ________________________________________________________________________________________________________________

Would your loved one be most open to discussing the possibility of treatment when the two of you are alone or with others? If with others, with whom? _____________________________________________________________________________________________________

Would your loved one be most open to treatment after a few days of sobriety or while suffering the aftermath of a major using episode? ________________________________________________________________________________________________________________

Is your loved one more open to suggestions when the two of you have not fought for a couple of days, or when making up from a fight? ________________________________________________________________________________________________________________

Would your loved one be willing to enter treatment if it helped to strengthen your relationship? ________________________________________________________________________________________________________________

Do you think your loved one would be more open to treatment if it were first focused on a cooccurring disorder like depression, anxiety or substance use? ____________________________________________________________________________________________________

If your loved one has been in treatment before, think about the past attempts to get them into treatment. What worked, what didn’t? ________________________________________________________________________________________________________________

Are there any rewards or reinforcers that might be motivating to your loved one that you could include in your invitation? ________________________________________________________________________________________________________________

Look back over your answers and write at least three of the most likely scenarios where your loved one would be most open to an invitation to enter treatment.'

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Session Online Version

Cycle of Change Handout

Treatment Locator Handout

PIUS Communication Worksheet

Windows of Opportunity Worksheet

FS07. Plan to Change

Anger Management