What I Learned at ACA

Sharing some thoughts about the 2019 American Counseling Association annual conference in New Orleans.

First, NOLA is such an interesting place. Full of variety in people and food and ways to live. A few days in this city is refreshing.

Picked up some information to share about social media as a process, or behavioral, addiction. The internet, social media especially, provides stimulation to our brains and some folks develop a compulsion to check their feeds that can be intrusive. The presenter stressed the role of self-awareness in both understanding and changing relationships with our connected devices.

Discussed the promotion, prevention, treatment, and recovery continuum of care for SUD treatment. This model starts with the normalization of responsible substance use; the key component is responsible use, which is how most people use. From this responsible use concept grows ideas about de-stigmatizing use and also the idea that not using is okay also.

We talked about the effect of use on families, across generations. Turns out, many people are not aware of how use affects their children and grandchildren. Some mentioned how hidden groups that support Adult Children of Alcoholics and minor children in substance involved homes have become. This supports my thoughts about the limits of education for counselors and the work still left to do.

My Counseling LibraryThing

This post realizes a long-held dream of mine.   A dream that was alternatively nursed and neglected, but not forgotten over the years of professional practice.  I’ve always been a bit of an explorer and more than a bit of a collector.  Ephemera, books, music, video are all over my house.

This collection includes a selection of psychology and counseling books and textbooks.  There are several books on group work and several on substance use disorders.  I collect self-help books and books about understanding personality.  I have several books about research design and statistical analysis–although I am a novice at both of these.  And, last but not least, I collect books about writing.

Today I am introducing my buy/sell/trade/lend library of counseling-related materials.  This library is housed on the website LibraryThing.com.  LibraryThing is a cataloging database and social media site for book lovers and collectors–and libraries.  Here is the link so you can view the dynamic listings for items of interest in my counseling library.  I will continue to update my catalog as I expand the collection.  Some items may be available for sale and will be listed on my eBay page.

If you want to borrow something, then email me and ask.  I am open to lending everything in my library, with a few exceptions.  Because of the nature of lending books–and them never being returned–I will sell the book to you and refund the price once the book is returned in good condition.  We will each pay shipping costs on our end.

If you want to trade or sell a book you own, then email me with the condition, price, and why I should have the item(s).  Let’s talk; I’m always ready to listen.

If you are on LibraryThing, we can communicate directly through the site.  If you are local, perhaps we can negotiate a better way to share than waiting for the USPS.

SMART Recovery Charlotte

SMART Recovery (Self-Management and Recovery Training) is a peer-supported program for promoting change from dysfunctional behaviors that are blocking you from being your best.  SMART offers an alternative to 12-Step programs.

SMART follows a 4-point program:

  • Building and Maintaining Motivation;
  • Coping with Urges;
  • Managing Thoughts, Feelings, and Behaviors;
  • Living a Balanced Life.

Tools and techniques are readily available on the website to help you discover your power to choose to change.

SMART Recovery is a science-based program focused on each individual’s ability to understand how their perceptions affect their actions.  Empowerment and choice are keywords in SMART Recovery.

The underlying theories include the Stages of Change model, Motivational Interviewing, Ellis’ Rational Emotive Behavioral Therapy (REBT), and relapse prevention.

There is a companion program designed to support the concerned significant others of people with substance use disorders and other dysfunctional behaviors (like disordered eating, sex addiction, problem gambling, over-spending, and more).  This companion program is called, naturally enough, Friends & Family, and is built using the Community Reinforcement Approach & Family Training model developed by Dr. Robert Meyers.

SMART Recovery can be found locally and online using the meeting locator.

Two face-to-face meetings are available in Charlotte:

Tuesday 600p-700p
200 Queens Road
Charlotte NC 28204

Friday noon-130p
1515 Mockingbird Lane, Suite 300
Charlotte NC 28209

To learn more about SMART Recovery–because this is a stub page that will be updated as I go–follow the link to the SMART Recovery website.

Relapse Prevention Plan

relapse prevention plan (ARRAY version)

If you are looking for a simple worksheet to create a relapse prevention plan for yourself, with a family member, or a client, here is one I developed.  It is designed to work with the Adult Recidivism Reduction Alternative (ARRAY) program.  If you like this worksheet, please let me know with your payment.

For more information about this and other worksheets, or the ARRAY program, please email me.

Relapse Prevention Plan Worksheet

This one-page worksheet is useful as a tool for thinking through a possible relapse. It includes space to start with your recovery vision, highlights common stressors, includes space for your favorite stress responses, and finishes with reminders of the consequences of using.



Begin With the End in Mind

One of my favorite self-help books is Stephen Covey’s 7 Habits of Highly Effective People.  Habit 2 is “begin with the end in mind”.  By this, he means to take a moment before the start of a journey to get a picture of your destination, to help you visualize where you are going, how to get there, and when you arrive.

What does Covey’s second habit have to do with helping addicted families change? Well, I’ve come to believe in the power of positive change. By positive I mean figuring out how I’ll know when I get where I’m going. Too often people tell me they want to “be happy” or “not be this or that way any longer” without first taking time to visualize the end before they start the journey. I get it, we recognize our current unhappiness and discomfort and want a life. Understandable. However, one of our first recovery tasks is defining how our new, improved life will look. That way, we can avoid creating a different version of the life we are trying to escape.

Visualizing our destination is what I call a positive approach because of the focus on moving toward change, and not just away from discomfort. An added benefit of taking a positive approach is that we recognize our destination upon arrival and can stop looking for what we have. It is easy to focus on the getting there and overshoot the goal.

So, I’ve been thinking about what a healthy family looks like in preparation for this blog post. Actually, I’ve been thinking about what it means to live in a family that was formerly SUD-affected. How does a healthy family look? Once a family member stops drinking or drugging or whathaveyou no switch gets flipped, and suddenly the family is just fine, a model for others to follow. No, that takes some time, commitment, and persistence.

Stopping using from an individual perspective is a different process from a family adjusting to sobriety because there are multiple layers to work through for the family. After all, addiction is a family disease, which means that the substance use occurs within a family system.

Family systems theory begins with the assumption that all the members of a family are affected by the actions of every other member. Like a wheel in motion, the family system seeks a state of balance, called homeostasis, where the system adapts to the behaviors of all members. For a SUD-affected family, the SUD behaviors become the center or hub of the spinning wheel. Later, when the SUD behaviors stop the family can create a healthy value to center around.

The research and the folk wisdom of recovery discuss the long-term effects of living in a SUD-affected family, from mild co-dependency to intergenerational mental illness. One can look at the Adult Children of Alcoholics (ACA)/Dysfunctional Families website and review the Laundry List of 14 common traits learned in SUD-affected families to get an idea of some long term effects.

Although most of the energy focused on SUD treatment is burned to achieve and sustain early abstinence, supporting a family’s transition process to health is the work of a mental health professional using a systems perspective. White (1996) suggests four dimensions to consider in family-oriented SUD treatment: the needs of the individual family member(s), the adult-adult relationships, parent-child relationships, and child-child sibling relationships. Of course, there are generational layers to consider as children mature and start their own families.

So, what is the end? If we assume that living in a SUD-affected family is an example of a poor-functioning family, then we can look to definitions of well-functioning families for guidance in developing a vision for a potential future.

Gladding (2015, p62) lists the following characteristics as common to well-functioning families: “Commitment to the family and its individuals, appreciation for each other (i.e., a social connection), willingness to spend time together, effective communication patterns, a high degree of religious/spiritual orientation, an ability to deal with a crisis in a positive manner (i.e., adaptability), encouragement of individuals, and clear roles” for members.

And, really, this is the place to start: what is the family’s vision for their future?

Desistance, long-term recovery, and second-order change are terms used to categorize the changes families make over time after they stop centering activities and values on the maintenance of SUDs and begin focusing on living healthy values.

Cox Family Wellness can help you visualize the end and the path to that end. We are licensed to provide counseling services if you are in North Carolina or Tennessee. If you live somewhere else we can help you develop a wellness plan for your family and help you locate a knowledgeable counselor near you to bring it to life.

Let me know what you think in the comments section.

Thanks for your time.

Use disorders: A definition for change

A good place to begin to talk about addiction is to think about what it is and how to think about disengaging from the clutch of dysfunctional behaviors; starting with definitions helps ground the discussion and make the topic clear. Starting at the beginning is a helpful process for me; it also is a useful reference technique so that when the conversation gets dense and complicated, I can always return to the beginning for reference and re-orientation. I am grateful for clear definitions.

Definition: Addiction is the compulsive use of one or more behaviors in the face of negative consequences experienced from the practice of those behaviors, which contributes to changes in brain structure and a process of progressive isolation.

Each of us lives in a body that responds to stress through physical and psychological processes, like feeling energized or overwhelmed. For some people, co-occurring mood and anxiety processes exacerbate stress and get mixed up with ineffective stress-coping mechanisms. The use of alcohol, nicotine, gambling, speed, narcotics, shopping, and sex alone or in combination are socially approved ways to relax and unwind that can cause problems when repeatedly relied upon.

Addiction is a label used to indicate that ours, or our loved ones, stress-coping habits have themselves become stress creators. When a behavior is both the cure and the problem, then an addictive process is in place.

Therefore, the real problem with substance and behavioral use for self-care is that for some people at some times using continues well after it ceases to help, which affects everyone around them. Use disorders, the professional name for addiction, happen inside a system—an essential concept for understanding the effects of use disorders on family members to talk about in the future.

So, to wrap all this up neatly, use disorders, addictions, are ways of coping with stress that have taken on a life of their own. This stress-coping model provides us a way to see use disorders as they develop, well before stopping is troublesome, and gives us a way to disrupt the process and re-create our lives. There are several new ideas here that we can return to as this blog gets fleshed out.

A quick word about language: sometimes, as when discussing addiction as a concept, it is easy to forget that the word addiction carries baggage. People-first language is a way of remembering that a person is not equal to their behavior; and that sometimes a more subtle understanding is needed. For instance, some might say a person is an “addict” or a “drunk” or whatever label seems to fit, which makes it appear as if that is all a person was, is, or ever will be. Saying that a person has a substance use disorder is different from saying that a person is a disorder.

The first allows room for identity expansion while the latter creates a situation where change is much more difficult. If we want to encourage change, then we must allow room for change. That room must be found within our understanding of an addicted person as much as they have to understand they can see themselves as more than just their addiction. Expanding concepts of identity is particularly true when we care for someone practicing, even seemingly against their will, behaviors destructive to themselves and others.

This brings up one aspect of my philosophy of change. Each of us has a shorthand way of thinking about who we are that we express in cognitive labels and behavioral habits. These labels and habits show our self-concept. The more restricted our self-concept and the less psychologically flexible we think about ourselves, the more difficult it is for us to complete the tasks of change. By opening up possibilities and practicing flexibility, our change tasks are simpler to complete because we have the brain space play with visions of a better future. So, to change one’s self-concept, we must create flexible self-labels.

A second piece of my philosophy of change is based in hope and possibility. When a vision of a personal future emerges, the journey toward that potential future is underway. Commitment to that future, coupled with persistence and accountability, yields a new identity. We begin to live our future when we understand that we hold the key to the realization of our possibilities. It is kind of scary when we are lifted from natural soil. Then, our roots begin to take nourishment, and new growth occurs. We know we have moved past our previous use disorders and related dysfunctions when we realize that we can choose the soil where we root.

The quote that headlines this post reminds me that I can only control my thoughts and actions. How I conceptualize a situation is within my control. How I respond to a situation is within my control. So that when I focus on living my possibilities, and not someone else’s, my world adjusts to my needs.

Thanks for reading. What do you think? Comment or email. If I can help you focus on your change, let me know.

Toward a Treatment for Substance-Affected Family Members

Addiction is widely recognized to be a family disease. But most treatment and recovery resources seem to go to whoever has been using uncontrollably. Well, let’s change that!

This project arises out of a desire to, as Brene Brown says, walk inside my story and claim it’s [my] power. This story begins with a sudden move, and it includes the introduction of alcohol into the family and my protective adaption to an uncertain and chaotic environment through withdrawal and isolation. This avoidance of all things worked; and, then it didn’t. Over the past few years, enough of the tower crumbled so that not only can I see out, but others are allowed to look in. Now, it is time to mine my story and share both the dirt and the gems with others.

A couple lifetimes ago, so it seems, when I first started my freedom walk and even before the journey became clear, a challenge to define my life’s mission presented itself. As a young man in a library … not so young anymore even though libraries remain a sacred space … there’s a story for another day. My mission statement is to give back to the community that shared so much with me. This project is another way to give back.

A purpose of this project is to support another project: a book for counselors to use in preparation for helping substance-affected families. The mission of this blog is to translate experience and research into a conversation about practical tools for thriving in a substance-use-affected home environment. Holding this conversation means exploring stillness and mindfulness in relationships, as well as talking about other difficult topics. I hope that you enter the conversation where and when you feel comfortable, your experience may even guide what counselors need to know before they leave training.

Just a word about my training and professional experience: I am a licensed professional counselor in NC and TN, as well as a licensed clinical addiction specialist in NC, in my 20th year of practice. I’ve worked with people struggling with addiction across a variety of settings. Outpatient groups, residential detox and crisis stabilization, prison, homeless shelters, peer support groups, and in hospital emergency rooms are all places where I’ve routinely encountered the devastation of substance use. My current work is focused on training counselors to listen to the struggles of substance users and their concerned significant others. The journey is fantastic, both rewarding and frustrating, and enlightening. The strongest lessons are those of quiet and stillness among the noise. After all, you have to get out of the hurricane to dry off. Families coping with addiction are caught up in the chaos and my job, at least partially, is to help them find their way into lasting order.

So, I hope you will join me on this path. Sharing our experience, strength, and hope increases the abundance of recovery for everyone. Your comments and suggestions are welcome.

I hope your day is what you need it to be.