Coming Up for Air — Families Speak to Families about Addiction

Self-care is a pillar of CRAFT; helping yourself is essential to helping your loved one. A lot of CRAFT focuses on a parent trying to help an adult child, so how do we shift things in a partner relationship so we're able to play the starring role in our own lives? Is there room to focus on ourselves when our loved one is not showing up in the relationship, family, or household?

When your partner suffers from Substance Use Disorder, what are realistic expectations in your relationship? Are your expectations setting you up for frustration? Which of your needs can you meet for yourself? Kayla Solomon and Isabel Cooney explore the often sticky nature of partnership when SUD is involved.

A listener writes that she wonders about staying with her husband, who struggles with alcohol but hasn't responded to CRAFT thus far. Would leaving him constitute "natural consequences?" Isabel Cooney and Kayla Solomon examine this important question. Kayla, an IMAGO couples therapist, explains the dynamic of pursuer vs. avoider—which are you with your loved one?

The original CRAFT is outcome-driven and behavioral-based, aimed at getting people into treatment. Allies has made it more connection- and relationship-oriented, focused on listening and communication. The same skill set Allies focuses on -- validating, not arguing, not giving advice or challenging someone's reality or perception -- often works with someone dealing with mental health challenges. Creating that space helps that person feel calm and heard.

What happens to the 30 percent who, in the traditional, research-based CRAFT model, don't make it to treatment in 12 weeks? The Allies version -- "applied" CRAFT -- goes beyond the 12-week version and focuses on change, not just going to treatment. By making changes, starting with yourself, you are engaging in the same work as "treatment." CRAFT focuses on stepping back, listening, reframing, and communicating well, all starting points for long-term change.

What do these terms mean? Should we use them? And are they disparaging? "Dry drunk" comes from Alcoholics Anonymous, and refers to someone who's abstinent, but may not obviously be doing more than remaining abstinent. And "manipulation" is often in the eye of the beholder; CRAFT can help take the judgment out of it. The only fact you have is what is internal to you. CRAFT aims to help you get to know your process, and make choices on how you feel, what you need, and the boundaries you can live with.

How do you work with anxiety so it's of service to you? Sometimes, anxiety is information akin to intuition, a sign that maybe you need to set up a boundary. At the same time, the only completely accurate fact in moments of anxiety is that you don't know. Part of the work we need to do is getting comfortable with and coping with not-knowing.

Approach the question of capability with awareness and connection. Look at your own awareness of what they'e capable of or struggling with. You may be doing too much, leaving you unaware of what they can truly do. Do mini-experiments when they want to do things, and collect data. Help them have an opportunity to succeed or fail. Foster connection by not being critical or having huge expectations. Try to help them with their own awareness -- without expecting that they'll do the same, tell them what you're working on, and what you've learned gets in your way.

Our hosts speak with Dr. Julie McCarthy, Associate Psychologist at McLean Hospital and Assistant Professor of Psychology at Harvard Medical School. She completed her bachelor’s degree at Tufts University and clinical psychology doctoral training with a focus on schizophrenia research at the University of Maryland, College Park. She completed her pre-doctoral internship and post-doctoral fellowship in addiction research at McLean Hospital, and she is currently a principal investigator in the Division of Psychotic Disorders.

Dr. McCarthy has received funding from the National Institute of Mental Health, National Institute on Drug Abuse, Harvard Medical School, and philanthropic support. Her research aims to identify biopsychosocial treatment targets and develop and evaluate interventions for individuals and families, such as Community Reinforcement and Family Training for Early Psychosis and substance use. She is a CRAFT-certified therapist, supervisor, and trainer. Dr. McCarthy uses a multimodal telehealth approach to better understand and address barriers to care and promote recovery initiatives informed by people with lived experience through community-engaged research.

Celebrate the small victories, so they become bigger. Take yourself out of the story so your loved one can write their own. Trust that they can function on some level. They have the skills they use to navigate the difficult world of substance use, and those skills just need to be translated to a different lifestyle.