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Vicky's Story My youngest child has always held a special place in my heart. Like most mothers to their children, my son and I have always been connected to each other through a sweet love and complex bond. There was nothing I wouldn’t have done for him… but I couldn’t follow him down a path of destruction and harm, the direct result of his drug addiction. This child of mine is now a 25 year old man struggling with a heroin addiction, a criminal past which included a year in prison, and a record that I still cannot believe belongs to him. During the past 8 to 10 years, I slowly evolved into someone I no longer recognised. Travelling that nightmarish journey of my son’s addiction found me fearful all the time, never knowing if he would overdose and die or be the cause of some other kind of heartbreak. My pain was obvious, the isolation from family/whānau, friends and activities felt safe to me. I barely laughed or even smiled anymore. It was a crazy way to live. Shame, anxiety, fear, sadness, depression, sleeplessness, or too much sleep became the new normal to me. The raging inside of me and dealing with the craziness of a drug-addicted son took me so far down that I was certain I would never know a peaceful breath again. Slowly and eventually, I was fortunate enough to recognise there were others around me who also walked the same path with me and, if just for a short while, that showed me ways of coping. Probably my greatest advocate was my own certified addiction therapist. This was someone who gave me a place to feel safe in saying whatever I needed to say, knowing I would not be judged. As well as being someone to listen to me, therapy was an invaluable educational, mental and emotional resource. Stumbling my way to safer ground, old positive habits began to emerge. I went back to prayer and joined a meditation group – two things that are particularly soothing to my soul. Through prayer and meditation I began to feel some peace and hope and was less isolated from others. Journaling is another tool that is useful for me to sort through my thoughts and feelings. In doing this I learned how important it is to identify the bevy of emotions that washed over me. Personally, if I can understand the dynamics in play rather than allow myself to be tossed carelessly around, I heal much quicker. As important as anything else I learned to align myself with those I could talk to about my son. The positive aspect for me is that addiction tends to run in families and mine is no different. I have two sisters I can talk to who really ‘get it’ and bounce ideas off and cry to. At the end of the day I know they still love me and my son, and in return I try to be a safe compassionate shoulder for them. At the time of this writing my son is in his third month in a long-term residential drug programme. I have the most hope I have ever had for him with this program. This is his fifth or sixth drug rehabilitation program stint. I miss him more than I can express, but to be honest, I know that nothing will ever be the same again. He can never come home and live with me. Just because nothing can ever be the same again also means it can be much better than I can imagine right now. Our bond remains intact and my love and hope for him is a constant in my thoughts.

“Love means never having to say you’re sorry.” If you remember that phrase, you were around in 1970 when the film, Love Story, came out (starring Ali MacGraw and Ryan O’Neal) and this phrase about love was the tagline in the studio’s advertising that, using today’s language, went viral. Even then I wasn’t very fond of the phrase. To me, love was quite the opposite: it meant I could make mistakes and saying you’re sorry was part of the healing process – and love would always still be there; it was a given; it had no limits – even if I do. We’ll return to setting limits later. I’ve been reading a lot of things about love/tough love/etc, preparing for this contribution. In a piece from the HuffPost in America from 2012, writer Sheryl Paul states that if there are conditions on love, then it’s not love but approval – either trying to get it or give it. I hadn’t thought of it in quite that way but she’s absolutely right. And love is NOT the same as approval. In fact, the challenge of love is to love. Full stop. Anything else is based on approval and doesn’t feel like love to the person on the receiving end – because it’s not. Real love isn’t conditional. A popular phrase in 12-Step/AlAnon is “you have to let them hit bottom.” We are told as family members that this is “letting go with love.” However, what if “their bottom” is death? Or jail/prison? Or something else traumatic? How is letting someone “hit their bottom” showing love and not simply trying to control or give approval for “doing the right thing” and not “enabling”? And what evidence do we really have that hitting bottom works? None, save some individual stories of such (side note: I just googled the phrase “hitting bottom” and found a disturbing number of articles and treatment centres advocating this approach). Dr. William Miller, the developer of Motivational Interviewing has shown us, as has CRAFT (Community Reinforcement Approach and Family Training, an excellent and well researched programme developed by Dr. Robert Meyers), that standing by and letting a problem alcohol or other drug user get to the absolute worst place they can, does little to actually help them seek treatment/change. In fact, it typically makes things worse (the late Dr. G. Alan Marlatt showed this in several studies and discusses this in his seminal books, Harm Reduction and Relapse Prevention). Anecdotally, when I was in more pain (of all kinds) and things got even worse, that made drug use even more attractive, no matter the negative consequences. And this is typical. This doesn’t mean family shouldn’t allow for some natural consequences. What those are and how one decides when enough is enough must be decided by each individual family and needs to be discussed with the alcohol or other drug user beforehand, so there are no surprises. So, where did we get this idea of “tough love”; especially if it’s harmful? And why is it still such a popular approach? Although tough love is a concept used on adults as well as teens, according to Szalavitz’ book, Help at Any Cost, the phrase “tough love” was first coined by Bill Milliken in his book of the same name in 1968 that discussed parenting approaches. There is also another book of nearly the same name, ToughLove by Phyllis and David York from 1985. Either way, the phrase started out as a term for parents to describe interventions to be used as their teenagers began to act out – perhaps using/misusing alcohol and/or other drugs – and engage in other less-healthy/desirable behaviours. Unfortunately, typical adolescent separation/developmental behaviours became pathologised (still often are….more on that perhaps at another time). Before the phrase “tough love” caught on in parenting circles, the concept was used in California by a group long gone but whose long reach can still be felt in drug treatment facilities in America: Synanon. Synanon was a Californian institution. It was founded in 1958 in the then sleepy beach town of Santa Monica, by Charles (Chuck) Dederich. I have seen the outcomes of Synanon up close and personal through my work in treatment facilities, many founded by former Synanon members. Several ideas of these persuasive and talented people were sensible. Sadly, though I believe all meant well, many of their ideas were still too infused with the highly confrontational concepts of Synanon. Having worked and been trained in some of these treatment centres, I am saddened to know that while I helped many people in the dozen or so years I worked in this confrontational style, I am aware that I harmed many others. But Synanon was more than highly confrontational. It was far worse. Today we may not see toilet seats around clients’ necks (I heard reputable reports that this was done in some drug treatment facilities up to the late 1990’s, to demonstrate that a client had behaved like a ‘piece of shit’) but we certainly continue to have the ethos of stigma, shaming, and harsh confrontation we inherited from Synanon, in some programmes today. Tough love does not work. Full stop. Real love isn’t conditional. By Dee-Dee Stout Dee-Dee Stout is Family Drug Support Aotearoa New Zealand’s Guest Contributor. She is a pioneering harm reduction therapist, educator, advocate and author. Dee-Dee has worked in the addictions/mental health worlds for more than 30 years and continues to maintain a busy clinical practice where she works with a variety of clients whose behaviour goals include abstinence, moderation, and “anything they want and in any way they want” to achieve their goals. Her book, Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World is widely available and has received positive reviews. With acknowledgement to Families for Sensible Drug Policy US. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of Family Drug Support Aotearoa. We welcome the views of our professional contributors.

This is a self-help recovery guide for parents in the devastating situation of realising that they are powerless to stop their children from self-destruction through abuse of alcohol and/or other drugs. It is dedicated to letting parents know when it is time to start saving themselves from being dragged along to destruction as well, and to providing skills that prevent it. The book relies on spiritual but practical teachings and the message is for parents to attain a healthy balance in their lives through the letting go process. While showing parents how to safely distance themselves from the child’s destructive patterns, it also shows how to recognise and support healthy requests for real help, if and when they come. It includes anecdotes and quotes from parents who have had to cope with kids using alcohol and/or other drugs. ISBN 9780967979052

Co-author Dr. Robert Meyers spent ten years developing a treatment program that helps Concerned Significant Others (CSOs) both improve the quality of their lives and learn how to make treatment an attractive option for their partners who are substance abusers. Get Your Loved One Sober describes this multi-faceted program that uses supportive, non-confrontational methods to engage substance abusers into treatment. Called Community Reinforcement and Family Training (CRAFT), the program uses scientifically validated behavioural principles to reduce the loved one’s substance use and to encourage him or her to seek treatment. Equally important, CRAFT also helps loved ones reduce personal stress and introduce meaningful, new sources of satisfaction into their life. Dr. Meyers has worked in the substance abuse field for over 27 years and has published several books and dozens of articles. ISBN 9781592850815

Through the vivid, true stories of five addicts, a neuroscientist explains how addiction happens in the brain, and what we can do to overcome it. The psychiatric establishment and rehab industry in the Western world have branded addiction a brain disease, based on evidence that brains change with drug use. But in The Biology of Desire, cognitive neuroscientist and former addict Marc Lewis makes a convincing case that the disease model has become an obstacle to healing. Lewis reveals addiction as an unintended consequence of the brain doing what it’s supposed to do – seek pleasure and relief – in a world that’s not cooperating. Brains are designed to restructure themselves with normal learning and development, but this process is accelerated in addiction when highly attractive rewards are pursued repeatedly. Lewis shows why treatment based on the disease model so often fails, and how treatment can be re-tooled to achieve lasting recovery, given the realities of brain plasticity. Combining intimate human stories with clearly rendered scientific explanation, The Biology of Desire is enlightening and optimistic reading for anyone who has wrestled with addiction either personally or professionally.

I miss you in my life and you are still important to me Growing up, we are not taught what to do if family/whānau or friends use alcohol and/or other drugs. Sometimes we have to think of our own ways to fix things. And sometimes the ideas we think of are different to those of our family/whānau and friends. Often, we come up with ideas under very challenging circumstances, so conflict is not unusual. Generally, we all have similar aims though. There are two important aims that most people can agree on. The first aim is to ensure that the family member using alcohol and/or other drugs has a functioning family to return to. The second aim is to build coping and resilience within the family to aid their challenging journey. Have you thought of restoring communication with family/whānau or friends? We have provided a sample letter in an editable format that might help you write one for your own unique situation. It can be personalised however you like, but could be a helpful starting point. When you have made it right for you, just email it; or print it, sign it, and pop it in the mail.

With over seven million copies sold, Melody Beattie’s 1986 best seller, Codependent No More: How to Stop Controlling Others and Start Caring for Yourself, is considered a self-help classic and continues to sell well in a new 2022 edition. The book popularised the idea that partners and parents of people with addiction have their own disease: codependence, which causes them to act as “enablers,” contributing to their loved ones’ continued use of substances. Like a drug, the relationship and its drama help distract codependents from their own problems, and so they resist change. The concept has penetrated American culture. The word itself frequently appears in media and pop culture. TikTok videos on codependent relationships have hundreds of millions of views. And therapists and rehabs teach about it, as if it is a genuine psychological phenomenon. But the influence that the concept of codependency has had on addiction treatment and policy has been toxic — and its tenets are not supported by data. Codependence has long been part of the dominant addiction treatment philosophy in the United States, which is based on the 12 steps of Alcoholics Anonymous. In this approach, people with addiction are taught that they have a disease and that recovery requires surrender to a “higher power,” moral inventory, making amends for wrongs done and attending meetings. (Although its influence has declined slightly, around two-thirds of addiction treatment facilities are still 12-step-focused.) Lois Wilson, who was married to an A.A. co-founder, Bill Wilson, helped found Al-Anon in 1951 to support wives and other family members of A.A. members. The idea that relatives of addicted people have their own disease first took root here. In 1976, Ms. Beattie, then an addiction counsellor, created a new therapy group to help them. Before long, family members were being taught that “tough love” was the only way to manage addiction. Being kind was enabling, and for everyone to recover, parents and partners needed to back off. As cocaine addiction rose in the 1980s, the concept of codependence offered a path to support and treatment. By the mid-1990s, treating it was an established part of therapy and residential facilities sprang up that specialised in it. A new 12-step group, Codependents Anonymous, formed in 1986. Soon, codependence became a household word, with publications musing on whether America was codependently enabling President Bill Clinton’s sex addiction. Its ideology about using tough love to fight addiction settled into conventional wisdom. There is little evidence, however, that codependence actually exists. The diagnosis was rejected by psychiatry’s diagnostic manual, The Diagnostic and Statistical Manual of Mental Disorders, or D.S.M. And unfortunately, what the concept actually enables is harmful treatment. Codependence doesn’t make the grade as a psychiatric disorder for many reasons. For one, there’s no accepted way to measure it. Other diagnoses better integrate personality traits like being controlling and overly self-sacrificing that are sometimes ascribed to codependency. Moreover, feminists have long noted that the idea itself maligns caring - and by extension, women - by blaming people for their partners’ addiction and failing to recognise that women may “enable” their partners because they need their economic support. Parents have even described being labeled sick because they refused to leave their kids homeless or have them arrested, even though both situations can worsen addiction. When someone is ill with any other disorder, relatives are not shamed for obsessively caring or rearranging their lives to help. Instead, those who abandon suffering loved ones are stigmatised. But when it comes to addiction, parents are told that their loving kindness is pathological because they somehow benefit psychologically from keeping their children addicted. Only letting them hit rock bottom will allow recovery, the thinking goes. When one woman, Susan Ousterman, tried to comfort her son by sending him care packages in rehab, she was told by addiction counsellors and others that she was “going to love him to death.” Detach and let him hit bottom, she said they insisted. Her son, Tyler Cordeiro, died of an opioid overdose in 2020 at age 24. “The tough love narrative taught to parents was absolutely a factor in his death,” she said, describing how being rejected by his family left him hopeless and demoralised. These days, she spends her time advising other parents to think differently. Policymakers and professionals would do well to follow her lead. Research does not support the idea that families of people with addiction have a unique syndrome that drives them to enable it. Worse, concern about enabling is frequently used to bolster counterproductive tactics like arrest and incarceration and stymie compassionate, proven harm-reduction strategies like medication treatment and syringe service programs. Even the idea of “enabling” is poorly defined. Haranguing people to quit is viewed as enabling, because it sustains a dysfunctional cycle: He nags, so she drinks; she drinks, so he nags. But being supportive, particularly financially, is also suspect because it might prevent someone from “bottoming out.” The only way codependent people can be sure they aren’t enabling is by leaving, proponents argue. “It just pathologises relationships when what we need to be doing is helping people see the power in our relationships,” said Carrie Wilkens, a psychologist and co-author of a forthcoming book on how families can compassionately promote recovery. “People do not need to hit bottom to change. People change at all of the steps before they get to bottom, and bottom for many means death.” Psychologists now recognise that needing others is normal: Human brains and bodies rely on social contact to soothe stress, and we become dysfunctional without warm relationships. Basically, everyone is codependent. And the last thing atomised America needs is more reinforcement of the idea that individuals alone determine their happiness. The main problem in addiction isn’t needing someone or some drug to function; many people rely on medications and relationships without being addicted. Instead, the core of addiction is compulsive behaviour regardless of harm, which is why the D.S.M. no longer labels addiction as “dependence.” The success of strategies commonly seen as enabling drug use by the state — providing clean needles, safe spaces to take drugs, housing that doesn’t require abstinence, and even prescribing heroin — also undermines its central claim. Research shows that people who engage with these types of programs are often as or more likely to seek abstinence or more traditional medications, or are otherwise healthier, compared with those who don’t. Research also shows that people with resources and social connections are more likely to recover from addiction than those who are at the bottom and have nothing. None of this is to say that people with addiction can’t have destructive relationships or that being too dependent can’t be problematic. But such issues are not unique to addiction. Families should not tolerate stealing or other abusive behaviour. People need to protect themselves and other children, and that may involve cutting contact with addicted loved ones. Setting firm boundaries can keep relationships healthy. But it shouldn’t be done based on the false idea that getting tough is the only way to spur recovery. Dr. Wilkens and others who use evidence-based therapies - like CRAFT and motivational enhancement, which use gentler tactics and do not pathologise caring relationships - want families to know that there is hope. “Studies show time and again that families are the biggest reason why people want to change and do change over time,” she said. Link: https://www.nytimes.com/2022/07/08/opinion/codependency-addiction-recovery.html Opinion piece article by Maia Szalavtz, July 8 2022. Published as a guest essay on The New York Times. Also by Maia Szalavtz: Szalavitz, Maia. The Unbroken Brain: a Revolutionary New Way of Understanding Addiction. New York: St Martin’s Press 2016.

Wondering if you have depression, or are just a bit down? Everyone goes through periods of life where they are not at their happiest, but how can we tell if our feelings are just normal sadness, as opposed to depression? Depression is a mood disorder that's characterised by a persistent low mood, sadness, and feelings of disinterest. It can be mild or severe, and can last for short periods of time or be ongoing for many years. It can look different in different people and have symptoms that vary in type and intensity. What all types of depression or depressive episodes have in common, though, is symptoms that affect our ability to function in daily life. This depression self test is a handy tool to help you gain more insight into whether you may have depression. The tool can not diagnose depression - only a mental health professional such as a psychologist, GP, or psychiatrist can diagnose depression. But this tool can give you an indication of whether or not you might benefit from seeking professional help. Take this online depression test. If you decide you would like some professional help, these New Zealand based organisations can help: New Zealand Psychological Society New Zealand Association of Counsellors

As the popularity of mindfulness grows, so too does our understanding of the ways we can apply this to decrease stress, and increase mental wellbeing. What is mindfulness? Paying attention in a particular way: On purpose In the present moment Non-judgmentally Appreciating the present moment by purposely and continually paying attention to it. Why practice mindfulness? It helps you to become more aware of and therefore to better understand areas of your life you are out of touch with. It helps you to accept things as they are. What does it involve? It involves stopping everything for a few moments just to observe what is happening (without trying to change anything). Try: Stopping, sitting down, and paying attention to your breathing a few times throughout the day, just for a minute or two. Don’t try to change anything – just breathe. Allow yourself to fully accept the present moment. There are many helpful books, websites. and apps such as Headspace on mindfulness. Below are a few Youtube videos you might find helpful.

To let go doesn’t mean to stop caring; it means I can’t do it for someone else. To let go is not to cut myself off; it’s the realisation that I can’t control another. To let go is not to enable, but to allow learning from natural consequences. To let go is to admit powerlessness, which means the outcome is not in my hands. To let go is not to try to change or blame another, I can only change myself. To let go is not to care for, but to care about. To let go is not to fix, but to be supportive. To let go is not to judge, but to allow another to be a human being. To let go is not to be in the middle arranging all the out comes, but to allow others to affect their own outcomes. To let go is not to be protective, it is to permit another to face reality. To let go is not to deny, but to accept. To let go is not to nag, scold or argue, but to search out my own shortcomings and correct them. To let go is not to criticise and regulate anyone, but to try to become what I dream I can be. To let go is not to regret the past, but to grow and live for the future. To let go is to fear less and love more. Anonymous

This could mean that the first boundary to ask for is that there is to be dialogue and negotiation. If your attempts to achieve negotiation have not worked you may then have to impose it. This can be done verbally and/or in writing, e.g. ‘I notice that whenever I try to discuss your drug using in the house you seem unwilling to talk about it. I tried to talk to you twice last week and you said “later Mum” but it still hasn’t happened. I cannot stop you using drugs even though I don’t like it and am fearful of about what might happen. I am worried that something illegal is happening in our house but am particularly concerned that you do it even when your young brother and sister are here. I assume now that you are unwilling to cooperate with me on this and therefore as a consequence I am not going to buy food or cook meals for you. Further, I have said that if there is one more instance of your siblings seeing you use I will have to ask you to leave. I regret it has come to this and would prefer it if we could now have an open discussion about your drug use and the impact on the family/whānau. I love you and will continue to no matter what and I will continue to have contact with you!’ You will note that this letter: Addresses their behaviour rather than attacks them as a person Gives the impact of the broken boundary Uses ‘I’ statements and not ‘you’ statements Asks for the boundary to be respected Is honest, open, direct and assertive Is not aggressive Is balanced Sets out the boundary clearly as well as the consequences for breaking it Leaves things open for further discussion, dialogue and negotiation Gives the substance user responsibility for their behaviour and the choice they made Communicating this way has three benefits. You get to say what is important to you You say it in a way that is easier for the other person to hear it Models good communication to the other person “It does not matter how slowly you go as long as you do not stop” – Confucious

When a person feels that they are being blamed – whether rightly or wrongly – it’s common that they respond with defensiveness. “I” Statements are a simple way of speaking that will help you avoid this trap by reducing feelings of blame. A good “I” statement takes responsibility for one’s own feeling, while tactfully describing a problem. “I feel emotion word when explanation.” “I feel…” must be followed with an emotion word, such as “angry”, “hurt”, or “worried”. Careful wording won’t help if your voice still sounds blaming. Use a soft and even tone. In your explanation, gently describe how the other person’s actions affect you. Examples of turning blaming statements into "I" statements Blaming statement: “You can’t keep coming home so late! It’s so inconsiderate.” “I” statement: “I feel worried when you come home late. I can’t even sleep.” Blaming statement: “You never call me. I guess we just don’t talk anymore. You make me upset.” “I” Statement: “I feel hurt when you go so long without calling. I’m afraid something is wrong.” It can be helpful to practice re-wording things from blaming statements to"I" statements. Here are some situations for you to practice on. Your son always cancels plans at the last minute. Recently, you were waiting when they called to say they couldn’t make it. Blaming statement: “I” Statement: Your daughter takes all phone calls in the middle of the night. you have repeatedly been woken up. Blaming statement: "I” Statement: Your partner keeps borrowing money from your joint account, the balance is becoming a real issue and you are continually going into overdraft. Blaming statement: "I” Statement: Try to use “I” statements to reduce emotional confrontations "Sometimes you have to let go of the picture of what you thought it would be like and learn to find joy in the story you are actually living." – Rachel Marie Martin