Here, you’ll find different kinds of help:
• More About CRAFT – Community Reinforcement and Family Training
• Additional Evidence-Based Psychological Help – individual and group
• Medications to help Battle Substance Use Disorder
• Studies which support the science in Wasted, the documentary
• How to deal with Safety Issues
If the interactive guide inspired you to seek more help for your loved one battling a substance use disorder, here are a few more offerings from The Center for Motivation and Change in New York, our partner in building the Interactive Guide.
CMC is such a big believer in the transformational power of family involvement that we wrote a book specifically for you: Beyond Addiction: How Science and Kindness Help People Change. It is a resource for families, intended to be a roadmap for navigating in territory you may well have never been before, and is full of the latest information that science has given us about how the use of substances affects the brain/body, reward/memory systems, and motivation and learning. It also provides principles of the family approach called Community Reinforcement and Family Training (CRAFT), critical communication and behavior change skills for constructively moving forward. The CRAFT approach has been proven time and again in well-conducted research studies to positively affect the whole family system.
We also created The 20 Minute Guide, a workbook that distills motivational strategies and CRAFT concepts down into a quick and easy workbook format. You can go directly to the website www.the20minuteguide.com and access all of the sessions for free, or you can purchase the workbook in a variety of formats here.
Additional CRAFT Resources:
Dr. Robert Meyers is the father of the CRAFT approach and he has created several ways you can find CRAFT support:
• WEBSITE: The website has a list of certified CRAFT providers. http://www.robertjmeyersphd.com/craft.html
• ONLINE: Recently, Bob teamed up with Cadence Online to launch Parent CRAFT, an online training for parents concerned about changing drug and alcohol behaviors in their children. The innovative online program takes the empirically-studied behavioral science of CRAFT and brings it to life in an interactive film-based course. We recommend that you go to https://www.cadenceonline.com/ to access these CRAFT strategies.
Canadian CRAFT Resources:
• Mike Pond is now certified in CRAFT – he can be reached at his Vancouver office at 604-922-5060 or by email at firstname.lastname@example.org.
• In northern Nova Scotia you’ll find Greg Purvis, M.Sc., C. Psych. Purvis can be reached by phone at 902-301-7767 or by email at email@example.com. Purvis is also a CRAFT trainer.
• The Salvation Army in Ontario is moving toward using a Community Reinforcement Approach, which is akin to CRAFT, in all its locations. You can contact your local Salvation Army for a centralized assessment and referral to treatment centers. A contact there is Tom Tuppeny, Salvation Army Ontario. Thomas_Tuppenney@can.salvationarmy.org
• In the Toronto area, there is a referral agency set up through the Sunnybrook Health Sciences Centre, that can be helpful in investigating options for those aged 13 to 26. It’s called the Family Navigation Project. www.sunnybrook.ca/familynavigation
Evidence-Based Psychological Services in Your Community
Mutual Support Groups:
For a support group that relies on evidence-based therapies, SMART Recovery is a free non-12 step group that’s growing in popularity in Canada. It’s built upon some of the same therapeutic approaches used in the interactive guide like Motivational Interviewing and Cognitive Behavioural Therapy.
Check here to see if there’s a SMART Recovery group near you. http://www.smartrecovery.org/meetings_db/view/show_countryca.php
We also found the U.S. website for SMART Recovery very helpful. Lots of good resources here: http://www.smartrecovery.org/resources/articlesessays.htm
Finding a Therapist to help battle a Substance Use Disorder:
Recent research has shown that the key to success in any therapy is empathy. If you feel heard and understood by your therapist, that’s the foundation for great work to begin.
To find a therapist who is schooled in new ideas and fresh approaches, here are some questions to ask as you shop around:
• Do you have graduate degree (Masters/PhD) in social sciences or psychology?
• Do you belong to a professional regulatory body?
• Do you have any training in Motivational Interviewing?
• Are you trained in Cognitive Behavioural Therapy?
• What treatment models or approaches do you use?
• What’s your definition of success in treating addiction? Substance Use Disorders are now diagnosed on a continuum of mild, moderate and severe. Abstinence may well be the best way to manage a severe addiction, but your therapist should first help discern where you are on that scale, and be open to things like moderation management and sobriety sampling if the problem is not severe.
• What if I relapse? (Should not treat relapse as a fail)
• Does he or she have any additional training in treating trauma? Many of those who battle a substance use disorder have experienced trauma.
• How does the therapist treat those battling concurrent disorders? (Both addiction and another mental illness should be treated concurrently.
• Does the therapist consider working with the family/spouse essential? (Strongly recommended when working with addictions)
Medications to Treat Alcohol Use Disorder
There are now three medications approved to treat alcohol use disorder – Naltrexone, Campral and Disulfiram.
There is also growing evidence that other drugs now being used off label diminish the discomfort of withdrawal from alcohol: Topiramate, Gabapentin and Baclofen.
These one-pagers on medication are courtesy of the Centre for Addiction and Mental Health. Those in the Toronto area can find out more through the CAMH’s Addiction Medicine Program.
Medication to treat Opioid Use Disorder ( For example, heroin, Oxycodone, morphine)
In some communities like Vancouver, methadone is no longer the first line choice for those seeking treatment for their opioid addictions — instead, it’s a drug called Suboxone, or buprenorphine. Buprenorphine is six times safer than methadone in terms of overdose risk, has fewer side effects, and unlike methadone, patients are often not required to pick up the medication from the pharmacy on a daily basis. It has limited street value, so using it as a first line treatment could lead to fewer overdose deaths. Suboxone is now part of treatment at the Centre for Addiction and Mental Health in Toronto.
Think you might have a drinking problem? Take this quiz:
Our thanks to Evolution Health Systems for use of this quiz.
Research that Supports Conclusions Made in the Film Wasted.
1. Study supporting percentage of those with Alcohol Use Disorder who also suffer from another mental disorder: JAMA re: comorbidity: http://jama.jamanetwork.com/article.aspx?articleid=383975
2. Studies that examine relationship between alcoholism and suicide: http://www.ncbi.nlm.nih.gov/pubmed/2529288 http://www.drrichardhall.com/suicide.htm
3. Studies that illustrate the discrepancy in how effective AA is:
• Cochrane Collaborative http://www.ncbi.nlm.nih.gov/pubmed/16856072
• Project Match http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008319/
• AA’s 2014 membership survey http://www.aa.org/assets/en_US/p-48_membershipsurvey.pdf
• Opinion of Scott Tonigan, world AA expert http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851049/ (Scott Tonigan’s quote: “If we look at the outcomes of 12-step-oriented treatment in general, or any treatment that tries to engage patients in AA attendance, it is less encouraging. There is an AA dropout rate of about 70 percent in the first 6 months after discharge from active treatment.”)
4. Assertion doctors know very little about how to treat addiction:
Closing the Gap:
5. Studies that support effectiveness of Vivitrol: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376083/
6. Study that shows Gabapentin works to control effects of coming off alcohol: http://archinte.jamanetwork.com/article.aspx?articleid=1764009 – Dr. Mason’s Gabapentin trial study
7. Studies that show connection between meditation and diminished side effects of coming off alcohol:
8. Proof Community Reinforcement and Family Training works:
9. Early research that suggests some people are genetically predisposed to do better on Naltrexone than others:
Staying Safe While Dealing with a Loved One’s Substance Use Disorder
As you think through ways to help your loved one change, it is important to also think through the safety issues that often come with substance use disorders. There is always some risk in using substances, and there are many variables that contribute both to your loved one’s safety and your own. We recommend that you spend some time thinking through the following issues and ask for professional help if you need it.
Risks for your Loved One: When it comes to assessing risk for your loved one, you should not do it alone, as there is no substitute for an assessment from a qualified professional. Everyone reacts to substances differently. One person may be able to drink a significant amount without any obvious impairments, while the person next to them drinking the same amount may black out and decide to drive home intoxicated, with terrible consequences to themselves and others. Similarly, some substances require a medical detox in order to be stopped without risk of death or medical consequences. Still others involve risky routes of administration (i.e., intravenous) that carry risk of longer-term medical problems like HIV or Hepatitis and a short term risk of overdose. Additionally, some combinations of substances are more lethal than others and any heavy use can lead to falls and other unforeseen injuries. To add to all of this complexity, substance use can enflame underlying issues like depression or anger, putting your loved one more at risk over and beyond their substance use. Using the Interactive Guide can be a great way to start thinking about the problem with your loved one differently. It will hopefully give you the skills you need to talk about the problem more effectively. You should however, not hesitate to reach out for professional advice/feedback as you think through the level of risk your loved one may be putting themselves in by using substances. Understanding the level of risk will also help you figure out the best treatment options for your loved one.
Risks for You: Unfortunately, your loved one’s substance use can also put you in harms way: physically, emotionally, and financially. Substance use is almost always involved in incidents of domestic violence and child neglect/abuse. As you think through ways to use the skills in the Interactive Guide, it is important that you keep your own safety and well-being in mind. It may be that your loved one is taking financial risks to support a habit; risks that put you or the rest of your family in harm’s way (potentially losing housing etc). It may be that your loved one is prone to becoming violent when they are intoxicated or the next day when they are recovering from use. It is also not uncommon for there to be a “behavioral burst” when you try to change a behavior pattern. As you change your responses to your loved one or your actions, your loved one. In other my escalate their negative behaviors to try and keep you within the status quo words, “if I scare you enough or bully you enough, you won’t really make any changes and things can stay the same” (often because your loved one does not know how to change or is afraid of change.). While these bursts of old behavior are normal and to be expected, in some cases they can be very risky in terms of your safety. If your loved one is the type to threaten or engage in physical violence, we recommend that you seek professional help as you think through the ways you want to change things in your household.
Always err on the side of safety. It’s not likely you are a professional equipped to deal with emergency or critical situations (and even if you are, your loved one is not your patient). If you are afraid for your loved one or yourself, please do not hesitate to call 911. As you walk through these issues, it’s also important to talk to other people who might be able to help you (neighbor, friend, therapist, priest, family member, physician). Getting other people’s perspective can be really helpful. It can also be helpful for them to know about your situation so they are more likely to help if an emergency really does emerge.
Come up with an emergency plan in advance. You will be much more able to cope effectively in a crisis moment if you have already done some advance planning. While you can’t plan for everything, there may be some things you can put in place that will improve your chances of keeping you and your family safe (i.e., a naloxone kit to prevent an overdose or a to-go bag if you are worried about your own safety.) You can identify the nearest hospitals and treatment options in advance and can also get names and numbers of people in the area who might be of support to you or your loved one in a crisis (i.e., he is not answering the phone for days.) While you can’t control all the variables, you will feel more grounded and ready to cope if you identify resources in advance.
Emergency Help Canada:
• British Columbia
• New Brunswick
• Newfoundland and Labrador
• Northwest Territories
• Nova Scotia
• Prince Edward Island
Suicide hotline (U.S.): 1-800-273-8255
Domestic violence hotline (U.S.): 1-800-799-7233
Educate yourself. Be aware of overdose risks, such as mixing substances like opiates and benzodiazepines or having reduced tolerance after a period of inpatient treatment or Incarceration. Know the signs of an overdose: blue lips or fingertips, loss of consciousness, strange snoring or gurgling sounds, slow or no breathing (fewer than eight breaths per minute). Learn rescue breathing. Lack of oxygen is what makes overdoses fatal; rescue breathing could be the difference between life and death.
If your loved one is using opiates, get a naloxone rescue kit. In the event you discover your loved one unconscious or starting to lose consciousness from overdose, information will not suffice; you will need to actually have this kit to save them at that moment. These kits are available through overdose prevention programs (http://www.overdosepreventionalliance.org/p/od-prevention-program-locator.html) or with a doctor’s prescription (http://prescribetoprevent.org/ has information to help your doctor write a prescription).
About drug effects: www.drugabuse.gov/drugs-abuse