Couples and Addiction. Recovery. Andrew Counts, MA, LPC Certified Gottman Method Couples Therapist

Transcription

1 Couples and Addiction 1 Recovery Andrew Counts, MA, LPC Certified Gottman Method Couples Therapist Kanawha Pastoral Counseling Center

2 Welcome! 2 Please introduce yourself: Your Name Your Work Setting Your Work with Couples One thing you hope to learn today

3 Introduction 3 This workshop aims to provide an overview of a research based program designed by Robert Navarro, Psy,D to help professionals support couples in developing couple recovery from addictions.

4 Learning Objectives Identify the following: 4 The characteristics and benefits of a Couple Recovery Development Approach Three types of Couple Recovery Secondhand Effects of Addiction The Difference between Codependency and Interdependcy

5 Learning Objectives 5 *Identify how to use various screening tools in the assessment of addiction *Learn to utilize Motivational Interviewing techniques when giving couples feedback about the state of their relationship. *Learn how to use two powerful interventions to help couples manage conflict effectively. *Learn how addictions affect the Sound Relationship House and what to do to rebuild each level of the House relationally.

6 80% 6

7 4 x 7

8 Couples and Recovery 8 Couple relationship often neglected Prevailing paradigm emphasizes Individual Recovery Fears relapse based on relational conflict

9 Yet 9 a satisfactory family relationship is one of the best predictive variables for longterm sobriety. - Humphreys, Moos, and Cohen (1997)

10 Recovery Capital 10 Internal and External resources that increase the likelihood of beginning and sustaining recovery from severe substance abuse disorders. Includes: Personal Recovery Capital Family and Social Recovery Capital Community Recovery Capital

11 Family Recovery Capital 11 Includes intimate, supportive partner relationships as part of recovery Reinforces importance of couple relationship as a support Combines individual and family treatment to maximize long term success.

12 Couple Recovery 12 Development Approach Based on Robert Navarro s doctoral dissertation research on: Family Recovery Project, directed by Stephanie Brown and Virginia Lewis, Mental Research Institute, Menlo Park, CA.

13 CRDA Applies to 13 Any couple experiencing chronic medical or psychological illness or disorder Couples need to talk sooner rather than later about impact of chronic issues and managing recovery process

14 Three Facets of CRDA 14 Shifting towards the relationship Reworking Generational Patterns Attending to Self and to Other

15 CARE: Couples Addiction 15 Recovery Empowerment A new movement that addresses both individual recoveries and the couple recovery Each responsible for individual recovery. Both responsible for the relationship

16 Couple Recovery Typology: Type I: Both in Recovery, separate programs Type II: Only one in Recovery Type III: Neither in Recovery: dry drunk, or White knuckle sobriety

17 New Category Proposal 17 Type 1+: Both partners are in recovery and they are working on couple recovery

18 A Relational Approach to 18 Addiction Recovery Three levels addressed concurrently: Person(s) with SUD Partner s recovery Couple recovery: interdependence

19 19 Codependency vs Interdependency

20 Defining Codepndency: 20 Manipulating and assuming responsibility for another s problem use. Enabling continued drinking by protecting the other from negative consequences Minimizing or ignoring one s own needs

21 Codependency 21 Avoiding and discounting feelings Low self-esteem related to perfectionism often because of history of being blamed or criticized

22 Antidote: The Three C s 22 You didn t Cause it. You can t Control it. You can t Cure it.

23 Interdependency: 23 Characteristic of all healthy relationships Defined by couple's ability to express their thoughts, feelings, expectations and needs. It s all about Honesty

24 Interdependency: 24 Self Care &Relationship Care A relationship where needs can be expressed and responded to without sacrificing one s own health or well-being Expectations include accountability to the partner and the relationship

25 Concern for 25 each other s welfare and recovery THE OVER-RIDING CONCERN OF CRDA

26 Three Differing Responses: Which one is not like the others? 26 Taking Control Expressing Feelings Offering Support

27 Second Hand Addiction 27 Refers to harmful impacts of addictions on society, family and significant others Trauma informed: includes PTSD type brain changes for partner Harmful effects not automatically sign of Codependency or pathology

28 Need for New Language 28 Codependency focus may overlook Second Hand Addiction Need to destigmatize SUDs for families, and to provide hope.

29 Addiction or Not? 29 Alcohol Use Disorder (AUD): 30% Lifetime Prevalence 70% of those: Episode of less than 4 Years About half of that group continues to drink at low risk levels. 75% of those who do recover, do so WITHOUT help! Source: Dan Hungerford, DrPH, CDC Epidemiologist

30 Use doesn t mean 30 addiction 23% of heroin users become dependent 9% of marijuana users become addicted (NIH) 25-50% of daily smokers become addicted Overall: 5-10% of users addicted to substances Source: NESARC February 12, 2013

31 Evaluation and Disease 31 The number and severity of symptoms associated with the disorder helps to determine if there is evidence of a disease process: An interruption or cessation of the body, system or organ structure of function, with a recognizable set of signs or symptoms. Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. - American Association of Addiction Medicine

32 32 Bio-Psycho- Social-Spiritual- Cultural Model of Addiction (DISEASE MODEL)

33 Three Developmental 33 Stages: Binge and intoxication Withdrawal and Negative Affect Preoccupation and Anticipation

34 Addiction is like other 34 diseases: Preventable Treatable Changes Biology If untreated, can last a lifetime

35 A Catch-All Question: 35 Is there any behavior that might seem compulsive and has created a problem in this relationship for one or both of you, such as: over-spending, gambling, substance use, sex or using porn?

36 Tools for 36 Assessing Addictions AUDIT CAGE Brief Michigan Alcohol Screening Test (BMAST) PATHOS Brief Biosocial Gambling Screen (BBGS)

37 Method: Motivational Interviewing 37 A Directive, Client-Centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.

38 Problem? What Problem? 38

39 Talk about Change! 39 The more we hear ourselves talk about change The more likely we are to change!

40 Benefits and Costs! 40

41 Admission into Action 41

42 Break

43 43 Relational Assessment: Overview Multi-Method Assessment in Three Parts Part 1: Conjoint Session Part 2: Individual Sessions Part 3: Feedback & Contracting

44 Three Domains: 44 Constructive Conflict Friendship/Intimacy/Positive Affect Systems Shared Meaning

45 45

46 46 The Four Horsemen of the Apocalypse 1. Criticism 2. Defensiveness 3. Contempt 4. Stonewalling

47 Eliminate the Four Horsemen Replace Each One with Antidote Criticism Gentle Start-up Defensiveness Taking Responsibility Contempt Describe Your Own Feelings and Needs Stonewalling Self-Soothing 47

48 Spot the Four Horsemen 48

49 49 Understand the Partner s Point of View Gottman-Rapoport Intervention Postpone Persuasion Until Both People Can State Partner s Position to Partner s Satisfaction What s This? Mode vs. What The Hell Is This? Mode Speaker s Job No Blaming, State Feeling, and Positive Need Listener s Job Take Notes, Summarize, and Validate Speaker s Position, Ask Questions

50 50 Move from Gridlock to Dialogue Help the Partner Understand the Underlying Dreams Getting at Underlying Dream or Meaning Behind Position on the Issue Speaker State Position without Blame, with Depth Listener Ask Questions About History, Meaning, and Dream Within Partner s Position (Don t Try to Solve the Issue)