Substance Use Disorder Forum

Hi friends. This is Chris McLain lead. Pastor at Shady Grove, United Methodist Church in Short Pump and welcome to this community Forum on substance use disorder. We're offering this in the month of February mindful of Valentine's Day. And the message is that all those and their families who are experiencing the difficulties and struggles with substance use disorder. You are loved give yourselves just a big hug. You are loved And cared for. And we're Gathering to learn more to help ourselves help our loved ones and be a resource to our neighbors, to be a help. One to another. I'm not an expert in substance use disorder, but I am a person who understands what it's like to have this as part of family life. And so I really am a resource one. beggar showing others where to find bread. And I hope some of what I've learned can be of help to you or somebody that you know. We're going to begin by talking about the relationship between nature and nurture. It's not one or the other, but it's very much a conversation between the two. And so just see that in the picture of a family relationship. And we're all part of relationships. I want to stay there and just take a look. So you see in the middle layer to the right side, there's a square squares indicate, man, I didn't make this up, this is Bowen, family systems theory. That designates men as the squares but not on guys at all. You're not square. but at any rate you see right there, somebody who it was determined later in life, might have Asperger's. And so there's a potentially strong genetic component there. And, and then a child from that marriage, that had ADHD, you also see up on the left in a circle. So, that's one of the grandmothers in this family. Grouping you see, depression there. And then, if you follow that blue arrow down to the one labeled too overwhelmed, that's also a person who experience anxiety and depression next to that assessor. Who Experienced anxiety and depression and eventually took her own life. And so in that we are seeing some things like Asperger's ADHD anxiety and depression that you seem to have a nature component. Maybe there's some heredity going on in there. But we also see very much the nurturer of things all around. Just how the relationships that we find ourselves in the midst of can have an impact on the qualities that we naturally have from our genetics. For example, overwhelmed person is a person who is very sensitive and if you take a very sensitive person and put that person highly supportive situation than that, sort of nurturer of somebody who could have some Positive result, that said that sensitivity and a negative situation, a little bit. Then start at the top. And you see a grandfather on the mother's side is what we're looking at a grandfather. And the ex is there because he's passed on. Who is a high-functioning alcoholic in a distant marriage? So you see that red color which indicates kind of stopped, like, maybe a little negative here and that the dots, which means Justin in a distant marriage with a severely depressed wife together. They have three children over to the oldest. Child is a line indicating a lot of focus, so you can have a very positive Focus. Oh my special child, or, you can have a negative Focus. Oh I'm so worried about you, either way, I focus is kind of intense. Maybe you can. Put on this oldest son, who is considered in the family, the favorite Child, and then you see these red lines going on with that middle child again. Who did take her life and you see the red and you see the distance dashes and then you see these bars in there. And that indicates a cut off of a relationship and estrangement and that blue line coming down from mother. So in this case, when mother had that second pregnancy, if something major shifted and she really wasn't able to function and so there's errors indicate, so just looking in that family unit since we are thinking about substance use disorder. So you have a dad character With a lot of responsibilities in this case, coming home into a very distant marriage where Mom is struggling to function at all and ask him, you know, why do you enjoy a drink every night and maybe to excess? And if he could have answered us, the answer for my, well, has been to take the edge off to try to ease into the evening and put the stresses of the day behind in case you see just that, that, that sort of emotional environment, the each member of the family finds themselves and okay, if you look over on the right side, you see a dad who was a military service and came home with post-traumatic stress. Disorder. And so you see those distance lines but the memory of that family is at that distance was not particularly negative just benign. So friendly but apart and quiet. And so the wife in that marriage began to focus very intensely on each other members, to all these arrows coming out of her. So that becomes that intense caretaker role. So you can see how she's compensating for post-traumatic stress, taking that out of the picture and then coming down into those two children, a brother and sister they have a similar sort of friendly enough but overall distant relationship, okay? And so let's look at this oldest son, were Middle Line, the one labeled high-functioning alcoholic, so this individual May well have had to ask Very high-functioning and stressful job. And so there's a possibility there that that person needed a little more, an individual in personal time. And then he knew how to ask for and that black dash line over to his wife, indicates the distance on his part. And again, what would his why be? Perhaps his wife for drinking and nightly in such a way that eventually he experienced liver disease, May well over again had to do within me for distant space quieting at any rate. So you see this and so just kind of makes sense, right? From a family in which he was not able to experience. One of the children needs extra attention so you see those black arrows going to that child with ADHD getting an extra attention and arrows, indicating a little bit of neglect and conflict headed toward the two daughters, right? So here's mom like, help me, help me, help me and how are the kids respond over time? You see the child with ADHD, develop a kind of a distant relationship with family. So he has those little light, red dots Pointed out for the family and, and the child that oldest daughter. wants to step away her for her family. And we'll just see if there isn't a better one yet. She also has a tendency to come back and and try to be And then that one in the middle, see all those greens figures, you see that with a yellow a little more caution and maybe a little more true friendship happening. In those relationships to the siblings. But overall, you see each of those children coping with the way stress moves around in their family and maybe see what their own innate ability to handle stressful situations and what not, they're all kind of reacting to what the environment is presenting them. what?

And so what have you learned from this? Is that that you are you are a space like this in the context of your own family, if you had to sit down and draw it out, you could write down who was who was maybe the favorite or where there was conflict or where there is distance them. Maybe you were there some patterns in the face in a generation and how alcoholism or maybe some other form of substance use disorder pops up in the family. So here's you know, the one labeled overwhelm her dad was a high-functioning alcoholic and her husband is also a high-functioning alcoholic, so you might see some more connections. And so the message here is that we do have some onboard That are part of our genetic inheritance that are you know what we've inherited is not set in stone. It's it's time those traits and they are a potential trait and then how that trait is expressed by the environment we find ourselves in as well. So that's the hope what you received from that. Alright, let me tell you more about our resource behind the vast. Majority of this talk is a book called Beyond addiction. It is created by a group called the center for motivation and change and they called craft Community reinforcement and family training. So different groups like Al-Anon that supports families of those who are experiencing substance use disorder and and they have to help those folks. Just the teaching that the folks at the center for motivation and change use and it has as a useful things. And so we're going to be walking through that, just the beginning of it and this session, and then two more sessions that will be available. I hope you join in either in person, in the fellowship hall at church, or check it out online. If you need help right away on that website, where you can talk to a peer to peer counselor, who is well trained to help you figure out how to begin articulating, your needs and pointing you in the right direction for your particular situation. There are support groups available. 4 days a week, really helpful people and you'll find behind that are folks that have really read this book. And so you might even hear about it and they mean the Beyond addiction book. So let's pop-in to that? Can you get this book beyond addiction? Because you are concerned about a loved one. I hope that you will put a bookmark on page 24. It has a section called if you're the one we're talking about and I want to read that to you. It says, if you found this book, your loved one might not know how to tell you that they're worried. And sometimes, scared angry, sad, frustrated hopeless, sometimes, all at once about, what they perceive as you're not. So great relationship to some sort of substance or behavior health, help you, and themselves. What we're telling them in these pages is that people change in different ways and you substances for different reasons, many of which are reasonable though They might be causing considerable harm. We just walked through that. in the diagram, we saw that there were some reasonable situations in which people have been coping with substance use, right? Even though there was some harm as well happening. We're telling you that you are crazy and we're telling them. They're not crazy either for being upset and caring, and not always handling things perfectly. We're teaching them how to care without yelling, how to care without yelling. And we're suggesting that talking and actually listening to your perspective and you to their help, we're encouraging them to take care of themselves as well as help you sort things out. So, the cats out of the bag, please read on, if you choose. And so, that's a little bit about our resource. I put up here relational ethics. This is a class. I took with one of my favorite professors who recently passed away, his name was William shealey, and I don't know anybody, but him and they're going to start at the bottom, I'm outgoing agreeable and conscientious. What is that? If you had to describe in a nutshell, what doctor, she really thought of a good ethical way to be in relationship. With people was at least would be the words. He used. He's start by saying it's hard to have a relationship if you're not in it. So outgoing is, is I that capacity for actually being in it.

Agreeable, in an agreeable a relationship and agreeable relationship would have inherent in that sense of equal Worth, right? That, that there's a mutual given take that there. Is it listen to someone but also show up and share. So those positives of relationship. Benefit of the doubt, not making assumptions, check out your assumptions all that would be what he would have called agreeable Behavior. So you want to show it to the relationship and, and function to the best of your ability, agreeably in that, and listen, Inspire and respond, that sort of thing.

Out there and thinking through are we being controlling or we just speaking for yourself and also taking that time to listen to other right? sticking with that careful work of being agreeable, being conscientious to do that. Conscientiousness, these days might be called boundaries. So that's the work that just keeps you about being outgoing being agreeable being thoughtful about boundaries having a sense of your principles. Other people are you and going about the actual work, it takes consciencious work to be in relationships.

Okay, but here's the truth. We're not always that with each other. Sometimes we get an idea. A negative idea often about how the world is working. Maybe we've developed the idea that people are out to get us, not fair and other people have it easier than us. And that is the story. We started telling ourselves, right? It's like a movie reel, running in our head. And everywhere. We look, that's what we see. We just need. That's unfair. That's unfair. And whatever other people are doing that. We find a way of twisting what they're doing and to that movie with this project, that story on to the situation. Maybe somebody was late responding to a text, you sent them and you had decided that person view. And, and that was just, you know, one more example of the terrible time you're having in life, and that's the story that you're telling yourself lately and then when you got mad at the person, cuz you just projected that and the person says I just lost my phone now it really wasn't about you. So we can understand what projective is. And when were busy being projective, it's not an agreeable space.

It said, you know, not outgoing in a way that's seeking to relate thoughtfully to the other. It's really may be pulled off in a corner feeling. Sorry for ourselves right? Not outgoing and we come out ready to run people over and so we can see how that projected kind of behavior is not part of being outgoing agreeable and conscientious, right? So we are we might need to catch ourselves in those stories that we tell ourselves and say Is that true? it. that true? Am I giving am I giving this individual a chance to really speak for who they are and what's going on, right? Okay. Define. That as relating in a limited way relating in a limited way.

With somebody where it seemed like the other person to do whatever they wanted, but you had to follow a very short script that that you could only do this and you can only do that. And you might like a person is such a hypocrite, you know they can raise their voice at me but I could never raise my voice with them. Where relationship doesn't flow evenly where one person seems to have a high degree of control that we're going to relate this way. example of a hospital. If you have a patient in the hospital, who was just going to be, very compulsive that person might say that only people who wipe their feel this way can come in. That can't be duplicated for each employee in each patient room wanting different things. The hospital will relate to you in a consistent way. Hard to relate to someone operating in a narrow way.

Maybe there are times we get compusive and make people jump through our hoops and walk on eggshells. We put out for them. Again, that's not agreeable behaviour And so we need to be conscientious about be mindful of whether we are getting kind of compulsive. Okay, so here's the thing though if you have someone who's not just everyday worried Somebody who really, really has decided I really am. I really am the victim of sayings. Nothing is ever fair for me. And this phone really deeply into that, or I really am the best. And everybody needs to be quiet. Listen to me in those maybe situation, or maybe situation where that strongly that the person is beginning to lose touch, with reality reality that we have a problem, right? So for example, say you have somebody who's becoming grandiose, who's decided, I know better than other people and I can do what I want in a person gets in the car. Thanks other people should follow the rules.

I Just does whatever they want and then if they get pulled over that, the police should have nothing to say to them, that they are beyond reproach, that person is out of touch with reality. If we had to say when reality entered into that person's day? If people honked at their reckless driving, that's people saying. Dude, you're out of touch with reality when a person gets pulled over by the police. And the reality principle can take a lot of form example.

You know, that you have a student has decided that doing work is optional and their parents are going to get them out of everything. Anyway, so it doesn't matter. And so they don't do their work. And then when the school says: that's not ok, and the student tries to get Dad to to write a letter and undo F and school says they are not here for it. The grade, the telling parents and student no, the principal's office are all the reality principle talking, right? So, if we get projective enough, we get out of touch with reality. If we are deep enough in some compulsive behaviors, take gambling. When somebody's decided, you know, I need to get rich, I need to get rich quick. You know I'm un touchable and begins gambling and losing a tremendous amount of money and Just thinks that it will be on the next one that I win. They comes out of touch with reality and maybe a loan shark. Becomes the reality principle or a spouse saying, Oh no, that was our life savings, right? That person's out of touch with reality. So, you see how there's sort of a very light version of projective and compulsive? And then it can get progressively deeper until we do begin to fall out of touch with reality. And if we do We become dependent dependent on other people to help us understand what reality is, right? And guess who those people need to be. Those people are the outgoing agreeable, and staying in touch, with reality and trying to stay in touch with us. So maybe you can think of a situation where you had to be that person who, stay grounded and said to someone you love or cool, your jets, you know, I'm try to get you back in touch with reality.

But think about this. Let's say this circle is a wife struggline with a compulsive behavior She's decided in her mind that she's too exhausted. She really needs a break and it's to the point that to the tune of months at a time. She's really disappeared from. the family and is absorbed in these novels, and nobody can really break her free from it. And mean while you have maybe the husband coming home meeting to take care of everything cuz the house isn't getting clean, groceries aren't taken care of more books are being purchased every single day, then the family can actually afford on the budget, no one's watching the kids and this example. And so you have one spouse losing reality with what it is to care for a home. and staying in that outgoing and agreeable relationship, right? And here's the other one trying to have that relationship and getting really frustrated with wife's Behavior, okay? And so, in that situation, you know, you can see that you're getting really anxious about that. And so when we get anxious, their short list of things we do when we're anxious, right? Is that top one says conflict and when we come at somebody, there's a small chance that's going to work, but if the person's really deep into it, to the point that it's become disordered compulsion that the stress of that confrontation, is actually can make a person run from it a little bit right now, I'm even more stressed. Now, I need to get deeper into my book to recover. In this case there were being a little playful with okay? And also we can imagine it not working. The response might be fine if she's going to be like that. I'm just going to get away from her and do my own thing or I just can't be with this person anymore and You know, neither one of those Solutions actually solves things for the kids in this case and we still have a compulsive Behavior happening without a sounding board. And then in the Triangle, you bring somebody else into it. And so say that husband character starts calling up this, his wife's friends and complaining about what she's doing about what she's doing all these people talking about her.

put yourself in her shoes, everybody's talking about you and you begin to feel pretty defensive. Feel wronged would probably plays into some of the difficulty. That's already happening. Feeling like, you don't know how to move forward if there's nobody with you. Anyway, and so again, you know, we're throwing in a bunch of anxiety. So far, not helping the situation is also, with the husband, just starts doing it all. I'm doing doing all the cleaning because these kids are involved and what not and you know, beginning to believe that. Wife can't function won't function. Nothing can be done hopeless. And then that dad Figure becomes, you know, the sort of the here are the one having to make it all work and becomes both the esteemed. You know, people like, oh look at him, he's really gone for it and why she such a mess. So he gets the positive regard but he also gets a tremendous amount of stress and is making all the decisions and yet not feelings for you. So you can see that this is a really tough bind and so when things are starting to get out of balance with a compulsive Behavior or substance, abuse is very natural for there to be anxiety as a response. Unfortunately, just getting upset and the different forms that it shows while being natural and doesn't necessarily make things better. For example, even if you end up divorced from the person that's struggling, very often in the midst of divorce, and sometimes we have to regrettably make that choice when the relationship continues to be destructive and marriage is meant to be up building and that said, there is that continueing worry and concern for that, loved one and that, that hurt from that break. So all of this entails, a lot of pain. So if these aren't Solutions their natural reactions, but are not Solutions, how do we get out of reacting and into responding in ways That could be hopeful and productive? And if there's one message you get, I hope that you begin to experience a sense of hope. Okay. So as we get into this thing, I do want to point out right away, what is often called the three C's So, for those of you who love somebody who is in the midst of struggling with the compulsive Behavior or substance abuse, you didn't cause it, you didn't cause it. And you can't control it. and maybe a lot of your response is right now, are efforts to control it, you can't You didn't cause it so I would let go of that guilt. You can't control it. So let's let go of that response cuz it really is that over function response, right? And you can't hear it. You can't cure it, ok, How do we get back to that outgoing agreeable, conscientious kind of relationship? How do we live that out in a way that can be helpful in healing Al-Anon has its way of talking about. It talks about what some called detach with love detach with love. So the love implies staying in relationship, right? And In trying to be agreeable and doing the hard work and consciencious work of that. But at the same time unenmeshed. Stop taking the other person's Behavior. So personally as if it's all about, you probably really isn't all about you. And the further we get in it, the more we feel guilty like we caused it like we can control it, like taking a level of responsibility for what's happening in this just order. It just doesn't work, we can't change anybody but ourselves. And we just get deeper and deeper and enmeshed in something that feels progressively out of control. Our loved ones life seems unmanageable and right along with it. Ours seems unmanageable as well. In place of detach with love, CRAFT model has what it calls a motivational approach and so they're just approaching I think the same thing but it's really trying to do is say there is hope and getting us to focus on motivational research. Motivational research What gives the person motivation In the craft model all people have motivation, but some are motivated to use. How do we move that motivation into a place that can be healing for all involved, right? And so thinking we're all kind of role is there a way that we can live our part in the relationship. That points motivation in a new direction. That invites our loved one, to weight the cost-benefit what's going on with substance used differently and open up new opportunities for them. That's not a way to control We need to have healthy boundaries.

Okay. So what is substance use disorder example, it's a lot of things. So it's not one-size-fits-all people don't all drink the same amount. They don't have the same response to whatever substance or compulsive behavior that they are engaged in. They don't have the same reasons and they don't have the same Solutions and those things are all really important to be aware of.

So it's not a one-size-fits-all thing and also in that is the importance of recognizing that if a person stops using substances, that doesn't mean that that the reason they were using in the first place has been relieved and so whatever might have contributed to their desire to use substances, that may still be present and an absence of doing something to solve that you're going to see that the substance use maybe recurrs because there's other issues, haven't been dealt with. Okay, also important to recognize, there is no such thing as an addiction gene, there are a series of traits we have in each of us, that we've likely inherited that, that might in certain situations tend toward are using. For example, we metabolize substances differently. We experienced pleasure taste differently. We have different levels of impulsivity, and these things are all pretty inheritable. Our Baseline emotions are different. We have different risk tolerance again about and that's important. And so we might find that we have some traits, that kind of, when they come together and in the right environment, perhaps,

substance use comes about for us but it's not an inevitable thing. There's an environment that nature nurture again. Maybe a person has experienced early neglect, or abuse relationships or ready availability. For example some college students have shared a struggle to stop vaping, and are having a lot of trouble stopping. They find, they're addicted to the vaping. And one person actually said to me recently, I just don't know how to breathe unflavored air and there is a store on every corner and they're not carding and so that's hard for them. Availability affects whether a person ends up in a substance use disorder situation, the attitude of a culture, whether it's acceptable to be intoxicated in the culture, how expensive or inexpensive. A substance is a protective positives in the environment. Family can really make a difference in protecting folks from substance use and getting it disorder in that. also what we're thinking about that, we have very flexible brains So if somebody gets in a habit of using it's like they walked across the yard a certain way. I had this need and I walked there toget it met. And if they keep having that same behavior again and again it would form a path. This is what's happing in the brain to form a harmful habit. The reverse is also true if you stop walking on that same path the grass would grow back again. In the brain as we move away from some of the compulsive behaviours maybe that path isn't as readily traveled. as So remember there's hope there's no opportunity for healing. Okay so let's talk about a little bit of science dopamine neurotransmitter and is very much known as the reward center of The brain, some brains have more than others dopamine. Make us feel good and therefore we want more of it. It spikes with pleasurable activities. A caveman rewwrded at a meal is driven to eat to to survive of dopamine's message. The issue is when we get into these compulsive behaviors and when we get into substance, use you're seeing dopamine, flooding, the brain, just flooding the brain. Everything in nature, like balance, including your brain as your brain is seeking balance. And the number of receptors are going down and your brain's Making less natural dopamine. what happens is that the compulsive behavior that substance used is no longer so pleasurable. And so, ask the person is using her going about that behavior. Now, when they do it, instead of getting that high, but just getting to feel, okay? And so you see a little dependence there, right? This is what tolerance is about. As you develop a tolerance for a substance, your brain has made that adjustment and now you need it just to get, okay? Just to feel back to normal. And so with this craving. You have repeated desire for a substance, even if you wish you could quitthat substance, it becomes very difficult to quit because your brain is telling you that you're not okay without it, I need that and I'm because you take away the dopamine flood, your brain is just making less dopamine all together so you don't feel good. so

Recovery means going through that that difficulty until the natural dopamine returns and receptors grow back and it's important to understand what people are experiencing as they try to go through recovery, it is very hard work and is helpful for us to be aware of. It also helps to understand his brain structure. The two things I want to highlight are prefrontal cortex and limbic system. the prefrontal cortex is the brakes of the brain that can say. That's not a good idea. Let's not do that.

The limbic system is Impulse desire and memory. And so for me it would be being very excited by the smell of baking cookies. I would remember the smell and remember how good it is to have a hot chocolate chip cookies, out of the oven and all of a sudden you know, that desire would be reignited. Unless my prefrontal cortex, says whoa, you don't need to have that much dessert here after dinner. Well, if you're using substances, or engaged a compulsive Behavior that's kicking off. A lot of dopamine. One of the effects of these substances is that it reduces the effect that the prefrontal cortex and increases, the behavior of the limbic system. So set another way, you? Become more and more gas pedal with less and less break? And so this helps us understand what's going on. When a person is experiencing disorder, they really don't have the brakes working effectively, the gas pedal really is Mashed in their life. That's why they might not seem to make sense to us and we don't understand what they're doing. But biologically, there's a real reason for what's going on we're able to have more compassion and hope and awareness. And it's helpful for us to know that and begin discovering coping skills our loved one might benefit from some medications, and certainly a new practices. And just time to heal time to heal. Okay?

So when you're dealing with substance use disorder, there is an aspect in which this is in the eye of the beholder remember. And so what matters to the individual and how much are others affected that helps figure: is there problem? I could love games but if I am able to be in in my relationships and pleasant with folks, and make my appointments and do my homework and then Okay, you know, I'm probably going okay with that. But if it gets to a place where I cannot be awake at school and now my health is impacted. Okay. So now you're seeing something a little bit different. So what matters to person and how are others affected? in the book, The Story of a woman named Margaret when her husband was living. They enjoyed having 3 drinks together: pre dinner, a drink at the meal and then a drink after the meal, when her husband died, Margaret continued this practice of the three drinks and understandably. A sense of connection to husband and also there's her daughter, worried about her grieving mother and noticing a couple things noticing a memory problem with mom.

You know, knowing that she's kind of having these drinks in and having them every night and was 2000 miles away. So daughter's worried but Mom isn't right. So, it starts bothering daughter but it's not bothering mom. And so, Mom gets tired of daughter saying and things about drinking and pestering her because You know, mom hasn't figured out whether there's anything that she's worried about with drinking, right? She's not sensing, that there's a particular cost, and there is a benefit of it being something that she did with her spouse. As time goes on, mom get tested for Alzheimer's. And begins talking to a friend that also knew her husband and they make connections around memory and alcohol. She's not comfortable with that that matters to her. And so that's going to be incentive for her to reduce her drinking at the same time. Daughter has stopped confronting her about. Daughter actually asked this family friend to call and what Mom realized in that is, I do care about my memory. I am concerned, whether alcohol is part of it, and mom also experienced the joy. of talking about her her late husband with this friend. And so gradually began to replace one of the drinks that she would often have with a conversation with her daughter instead and about just talking about this missing loved one. OK, So seeing what matters, what was fueling Some of the drinking can sometimes be met in another way And you also see daughter said, maybe maybe support needs to come from another quarter and in other terms that aren't so, confrontational. And there becomes an option there. Okay, you can have substance use disorder without withdrawal. Using a substance, and you can stop drinking without withdrawal. That doesn't mean that you don't have substance use disorders that there's some good online surveys and what not to help you assess whether that's happening for you. And a good example of disordered drinking without necessarily experiencing withdrawal, is binge drinking, binge drinking is very dangerous. That said, one might not experience withdrawal with it. Also, if you are experiencing withdrawal, that can happen at a lot of levels. And so low level of withdrawal irritation restlessness low mood, right? Cuz you have that lowered dopamine or can be very severe where person begins to experience, insomnia, depression, paranoia seizures DT's And so there are times where if a person is going to come off a substance. If there is a high risk for them to be in withdrawal, they really might need medical supervision for what they're going through. Some concerns, you know, when people are kind of weighing like Margaret Margaret wondered, "Is alcohol implicated in my memory concerns.

So there are some things to be mindful of with different substances, for example. Cocaine. It can be associated with stroke and heart attack. Alcohol, liver failure or cancer, blackouts and drink-driving heroin associated with respiratory depression, which becomes overdose. we're seeing a whole new group of folks experiencing drug-related deaths people that are just make me trying for the first time at a party and end up with bad batch. So it's very dangerous meth you have people experiencing depression and then a personality transformation and then suicidal ideation. And so there are concerns and medical reasons to move away from the substances, right? But based on, whatever needs that substance, use is fueling it might be hard for a person to do it.

I'm coming off of substance, you know, Oxycontin Vicodin heroin. These are painful to stop a cocaine, amphetamines there's depression, and emotional flatness in. Coming off of those marijuana. A person can experience a lot of anxiety coming off of these substances and so we just want to be mindful of what people are going through. What are the reasons to stop and at the same time? What sort of support is needed to safely stop, and what's her understanding is needed from those around as an individual, is either stopping. And let me have the sense. It's not one-size-fits-all Margaret could have chosen moderation. Where she could only have been a one night cap. Really every so often pretty spread out and daughter, knew she was safe she's at home. So for some moderation is the answer other people learn that that they need to move more toward abstinence, it's not one-size-fits-all.

I want us to be aware that issues around substance used are not primarily about character if you want to read more about that, look at page 50.

You can be just a terrific person, making a great contribution in the world and struggling with substance use disorder. But sometimes the way others talk about it in the midst of all that anxiety, we talked about early on, maybe there's enough frustration and names. Get called you addict, you loser, what have you. None of that is helpful or productive and it's important to recognize that this is a disorder that people really are struggling in meaningful ways and we want to be understanding and supportive at the same time, you know, boundaries based in reality may need to be set. For example is just not okay, if somebody's not driving safely, It's not a matter of character. And it really is a need for healing the best treatment for your loved one. If you're the one struggling, is the one that's least intrusive but still able to be effective if you are a person who's going to experience significant withdrawal, then you probably need to be somewhere. Medically supervised whether you're going to need assistance with hydration or pain medicines that are substitute medicines to help you come down in the place where that can happen. But other people are in a situation where they can be working on things from home. With a local rehab group, that's helping them sort of outpatient, work on this. And some people just need to have an aha or that, that, that cost benefit of use changes for them and they have a change of mind and they stopped without professional help. So, you know, Margaret didn't need to be put away somewhere for a while to get off alcohol. And something else was the right choice for her. So the least intrusive that's going to be effective and safe, is what people need. And in our final session in 2 weeks, we'll talk about it in the back of the book. That part that helps us look at what resources, there are on how to determine that.

Okay. So is useful to spend a little bit of time thinking about why substance use make sense to you or make sense of your loved one right now and in that you're beginning to see actual motivation and there are two kinds of motivation. One is internal right and so that's inside that loved one who might be saying, I can't handle boredom and that's that's why I use or I just need to calm down or whatever it might be. then there are external motivators like the law company. Policy anybody's thinking, besides ours and others, externals, in the long-term are not going to have the staying power that the internals do. Another thing to be mindful of is that motivation does change over time. So somebody's reason to stop using might shift. Maybe their motivation shifts back towards using. You just see this back and forth behavior. It can be frustrating to see thatShift overtime, the reasons and the intensity of it It's helpful to know that that is normal. Otherwise it would be something that could easily sort of trigger those who are around. and are really concerned for that person and not being prepared for that sort of waxing and waning of motivation, might be a hard thing, so it's good to be aware of that. If we are around somebody who's struggling with compulsive Behavior or struggling with substance use, we might actually be muddying the waters.

Vaping THC, what's in marijuana That student is not likely to be studying very effectively or be prepared for a test, very effectively having used during study time and eating everyone out of house and home with the munchies and so if people load the house full of Doritos. and if Somebody rescues from a failing grade that student doesn't get reality principle of the cost of using: i can't think and I already ate my share of a week's worth of chips and I don't have any in my lunch now.

Don't over function for somebody and hide reality from them, right? example of page 52 53 of a husband who always made dinnerfor his wife and she'd be toxicated and watching her on TV and he knew that they weren't going to have much of a relationship bit early dinner for her and as they were actually learning

He realized that if she was intoxicated he could make his own meanl and not yell and replace yelling and she could go on and make her own meal. She might be intoxicated but she is an adult. Respect her ability to function as and adult. If it's hard to cook, maybe that's clarifying. Right. Also though on the days when she comes home. Sober what can she experience. She can experience dinner for her. She's able to be present to that experience. somebody who isn't angry, cuz he's, he's enjoying some. Social time

Since there is no point in talking to an intoxicated person, Wait until they're not intoxicated. Then we say, "I'm so glad I have you sober" And what that person, begin to experience is that when I'm using things feel ok. When sober, I might have a headache and angry people. So, with that gas pedal on overdrive, what you might learn from that is gosh, I was having more fun when I was using right? And so you can see that the husband in this case by working with the counselor is learning not to play into that, that when his wife is sober, she can experience. A positive relationship with him and have positive associations with sobriety and where there are real difficulties. He doesn't need to hide the real difficulties of using he can let her be and trust her as an adult. Find her own food but we're not hiding reality from people. We're helping them experience their own reality and also when they're sober and you know, not having your only experience be if he was angry at them all the time. That's a really hard place to find those insights. Those aha to start healing. Okay. All right.

Work on some examples.

so we're going to turn to page 40 in the book, and I'll read to you about a gentleman named Kevin.

Okay, it says, when a man with a genetic vulnerability for alcohol problems came across an article suggesting Alcoholics Anonymous wasn't the only option. He began exploring those other options. You share the article with his brother and continue to attend, AA himself, but backed off from assisting on it for his brother. Okay, so these are two brothers, one gets value out of the other dozen. All right, so he's been pushing, all right?

Strategies to stop drinking with spending time, outdoors with his brother which have been a great source of joy for both of them. Growing up and was again now that they mostly stop arguing as adults. Right now. You stop arguing with your brother and start having something positive in your relationship, do with your brother and stop acting. Like a is the only answer for everybody just cuz it was the answer for you. And in this process, you know, he found that his brother was smoking. Last enjoying hiking more and you saw, this is the first response, right? So, you know, when the brother was not even thinking of getting better but he is pushing a a n e realized AAA after reading this article is not the only response. And then begins doing other things with his brother, just reconnecting in the relationship and something that used to enjoy hiking interest in just begins thinking about, you know, what, how about I use less, that's them some contemplation. And then eventually begins thinking more about quitting a little bit more seriously and then that moves into the planning to remember not one-size-fits-all and I'm here's another p. 41 a teenager I Aidan had been using Vicodin tried to stop on its own earned is that he would need help his parents found out and suggested that they come to counseling. We were for the family to an addiction psychiatrist who prescribed an opiate replacement medicine. This lot of time to work with Aiden, on making changes in his life. That would support his not using right, you needed a little medical help and he also needed something to fit in that space. So he join cross country and told her friend that he's been using with it. He couldn't hang out, unless he got help more than a year later. When Aiden gradually tapered off, the opiate replacement medication, he was able to tolerate life without Vicodin and also to enjoy it. I'm like, his first attempt, he gave himself, more reasons, not to use. He got new hobbies, that gave him pleasure, a support system, that included, Psychotherapy. You learn to deal with his social anxiety and he discovered that his parents are actually kind of cool and fun. Okay, I'm 53. The story of a mom that she had been using some pretty regular using them. And then one day is over, how much he liked playing over at that boy's house because at least that boy's mother play with them. And it really stuck with her. So differently for her mother that be able to be present away from painkiller use. So just some examples for you. We're going to wrap appear, two more sessions next week. We're going to talk about how to take care of yourself. If you're in a relationship with somebody with a compulsive Behavior, this matters a lot and we can start putting all the focus on that person with that substance use disorder or that compulsive Behavior. We're not putting focus on ourselves or self care goes down and focus on somebody else's. Usually pretty anxious focusrite and just get anxious attention. If we can put some appropriate attention on ourselves so that we're not putting over attention on someone else's and not losing our whole lives, getting kind of codependent. Where do you want to use for it in the addictive process? We don't need to get addicted to overfunctioning and trying to cure and control something that really is something that the other person needs to move through healing Journey on. We can't do it for them that we that we can be about the business of our own healing journey and do that. Then I side of them in relationship with them and it might prove to be its own helpful example, may be trying to address substance use disorder is going to be this tendency to the pool in two ways at once. And we all know what this is. Like we've all made New Year's resolutions that we're really important to us and we didn't want to do them. If we haven't been exercising in years and this is going to be the year we want to exercise and it hurts, right? Your kind of pulled in two directions. Ambivalence is part of any change and what we want to do is make a safe place for that. Ambivalence to be discussed. Right conversation where I said I really want to exercise. The boy doesn't hurt and the person said yeah I can do a web search for that.