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Coping with it all Is this grief? When people talk about grief, they usually mean the loss they feel when someone dies. But other losses bring a type of grief with them too. Family/whānau and friends of people using alcohol and/or other drugs often comment that they wish things were different. Often very different. The feelings associated with this may be very strong. Grief theorists call this grief Chronic Sorrow . This term resonates with many who watch as a loved member of their family/whānau or friendship group struggles with alcohol and/or other drugs. Though family members do not always feel sad or stressed or angry, the frequent reminders that their loved one is coping with the complications of alcohol and/or other drug use, brings with it an ongoing sorrow which often comes to the surface in daily life. The situation brings a sorrow that never goes away completely while there remains alcohol and/or other drug use by their loved one. When I heard that phrase “Chronic Sorrow” I thought, “That’s it! That’s just what I feel.” I’m a pretty positive person, but the sadness about my son is always there, just under the surface. Whenever he slips a notch and there’s one less thing he can do – the sadness that it shouldn’t be this way hits me again. - Parent of a young man using methamphetamine. “It’s always there. But it doesn’t mean you don’t laugh and have fun and good times.” - Mother of a daughter using alcohol. “Chronic sorrow… I’ve got that.” - Sibling of a woman with poly drug use. How is Chronic Sorrow Different from Grief? Loss is part of life for everyone, and most people have found ways of dealing with loss as they grow up. Chronic sorrow, however, is different type of loss as it is a living loss . This type of loss can be a loss of some aspects of oneself, or the loss of some aspects of someone else, particularly someone who is loved and cared about. The losses associated with having a family/whānau member or friend using alcohol and/or other drugs are just such a living loss. This loss, which we call chronic sorrow, is different from the ordinary losses such as a death or divorce or loss of a job. These losses have a finality about them. With chronic sorrow we have a continuing, ongoing loss. The loss is ongoing When someone has died, the loss is permanent and unchanging. Though it can take a long time, people usually find ways to come to terms with the new shape their life has without the person who has died. When a person is a user of alcohol and/or other drugs, there is a living loss. As time passes, and even in the early years of a person moving past alcohol and other substance misuse, the difference between what might have been and the reality of what is , constantly changes. Concerned significant others generally need to adapt to new challenges as the years pass. Financial, housing, relationship and other challenges need to be worked through. The repercussions of legal situations may impinge on work opportunities. Though family/whānau and friends will take pleasure in each new milestone achieved, there often continues to be feelings of chronic sorrow for lost opportunities and challenges to be faced, amongst the hope and possibilities of progress made. The loss is unacknowledged Many concerned family, whānau and friends say that the only people who understand how they feel are other people who have been through similar experiences. There are no rituals to help people acknowledge the loss felt, or to help family members to deal with this loss. Also, because people don’t usually acknowledge their ongoing loss openly, often due to the shame felt in sharing concerns, many people lack support during their ongoing struggle. There are constant triggers Family, whānau and friends often comment that they feel they are coping well, and then something “hits them out of the blue”. Important family occasions, work events and times when families share space may be hard. Occasions such as birthdays, anniversaries and times of death can also be hard. Seeing and hearing of the progress being made by the family members of friends and relations is particularly challenging and painful when contrasted against the limitations that alcohol and/or other drug use places on one’s loved family members’ progress. Setbacks to the health and wellbeing in the person using alcohol and/or other drugs can also trigger feelings of sorrow. Planning for the future can be difficult and opportunities may seem to pass by. The feelings of sorrow that come with having a family member or friend with challenges around alcohol and/or other drugs often seems to be “in your face”. At these times the gap between what the family/whānau member or friend using alcohol and/or other drugs is achieving, and how you and they wish things could be, is hard to deal with. The loss is hard to “pin down” When a member of a family/whānau or friendship group is using alcohol and/or other drugs, it is as if all that one has dreamed of for the person with challenges, and all that had been hoped for the person, needs to be put aside to some degree. Some people talk about feeling cheated. Their loved one’s life is not the healthy or normal life expected. For most people, it’s not that they don’t love the person, but that they find it hard to accept that using alcohol and/or other drugs has robbed them of their fantasies of a family member or friend who will go on to live a full and happy life. Though this loss is “only” of a dream, rather than a reality, it is no less painful for many people. "Chronic sorrow, a normal grief response, is not the same as grief at the finality of death, where the person who is loved will be forever absent. Chronic sorrow is not about endings; it is about living with unremovable loss and unmending wounds. It is about losses requiring – and demanding – energy and persistent courage to cope with crises and making the adaptations necessary in order to live a life of one’s own. It is about year upon year of dealing with the inevitability of a loss that continues and of finding a way to achieve some balance between reality and losing one’s grip entirely.” Susan Roos (from the Foreword to “Chronic Sorrow”. See Further Reading for details) What other factors affect family/whānau and friends as they cope with someone they care about who is using alcohol and/or other drugs? Community attitudes play a big part in the way families/whānau and friends respond to having a person they care about who is using alcohol and/or other drugs. Chronic sorrow is a complex issue though, and there are many factors that affect the way people experience it. What may be a disaster to one person or family may seem less important to another. Some of the factors that may make a difference include: How families see the alcohol and other drug misuse Families may see any family situation as a threat to their family’s stability, a curse, or a burden. Some families see the situation as a time of challenge which can be met together. How people see themselves Similarly, family members may see themselves differently in response to the person using alcohol and/or other drugs. They may see themselves as being a passive victim of circumstances, or as someone who can’t cope with difficult things. Or they may see themselves as resilient and strong, courageous and assertive, loving and accepting. They may have a strong sense of themselves as a worthwhile person, or they may feel shaky about themselves. Seeking to build coping and resilience, however one sees oneself, is an important task. How other people around them respond People’s responses are also shaped by the way their family/whānau and friends respond to the person they care about who is using alcohol and/or other drugs, and by the amount of good support they get, to deal with him or her. Family circumstances and background The social and financial circumstances of the family can play a part in how they experience a person using alcohol and/or other drugs. A family which is already under strain financially, which has difficult living conditions, or existing problems such as alcohol and/or other drug use or abuse may find having another family/whānau member using alcohol and/or other drugs an extra burden. Families where there has already been loss, on top of existing grief from the past, may struggle to cope at times. The nature of the drug used The type of drug use can play a part in the level of intensity of chronic sorrow. The fact that alcohol and prescription drugs are legal drugs, whereas other substances are illegal drugs, can have an impact on family/whānau and friend’s ability to cope with chronic sorrow. If drug use results in sudden and unexpected crises, coping with feelings can be challenging. The level of support from the community There are some organisations in the community which work to provide help for families/whānau and friends who are supporting a person using alcohol and/or other drugs. Groups such as whānau organisations, church groups, and government or non-government organisations offer some support. Support for concerned significant others, however, is not widespread. Having access to a small group of supporters outside the immediate family can provide a different perspective and allow family/ whanau and friends to see they are not alone as they cope with challenging situations. How does chronic sorrow affect people? In a word: differently. Everyone has their own response to loss. Chronic sorrow is like a fingerprint: everyone’s experience of it is unique. Some of the more common feelings are: Feeling guilty Guilt can be a constant companion when there is a family/whānau member or friend using alcohol and/or other drugs. Concerned significant others may feel guilty about their feelings of resentment, or their constant longing that things should be different. They may find themselves thinking about how things might have been “if only…” and feel guilty about such thoughts. Looking for something or someone to blame In addition, many family members feel a sense of guilt that they caused the problem in some way. It’s very hard to live with the idea that very painful and difficult things can “just happen” out of the blue. They may try to regain some feeling of control. They may search for someone or something to blame in an attempt to make sense of what has happened. Where the reason isn’t obvious, people may blame themselves. There may be a rational reason for this guilt or it may be an irrational feeling. Parents can sometimes feel guilty that there is a genetic predisposition to usage of alcohol and/or other drugs. Feeling anxious Watching someone you care about is using alcohol and/or other drugs can cause anxiety at times, and sometimes it can seem as if anxiety is a constant companion all the time. Suddenly, family members and friends are dealing with difficult issues. They may not feel as if they have any control over their life and become anxious about what else might be in store for them. For many people with family members using alcohol and/or other drugs, these kinds of anxieties and fears are part of the chronic sorrow they experience. Family members and friends talk about feeling constantly vigilant, of life feeling relentlessly stressful, and of never feeling they can truly relax and trust that their loved one is OK. Life is unpredictable The unpredictability of life with a family/whānau member or friend using alcohol and/or other drugs adds to the stresses felt. People who deal with stressful situations by planning carefully may find this especially hard. Planning ahead is so often disrupted by those whose behaviour is erratic. For family/whānau members and friends who like to have a strong sense of being in control of their lives, this inability to manage their life can feel very stressful. Never knowing what’s around the corner, and how hard it might be to deal with, is unbearably stressful for many people who are trying to build coping and resilience in themselves and at the same time separate from a loved one’s behavior, while continuing to support them at the same time. “I used to like to plan ahead for holidays and trips, but since our son became involved with drugs, the plans have been disrupted so many times that I don’t bother much anymore. I’ve learned to just take things as they come. I deal with one day at a time, and I don’t plan for the future too much.” - Parent of a son with poly drug use. Time feels different People often measure time in terms of expected milestones in their lives or the lives of their loved ones. When their child or partner doesn’t “fit the plan” they may start seeing milestones differently. Time may be measured instead by key events which are often bad experiences, such as “before she started using drugs” or “after her first encounter with the law, but before her second one.” Instead of a series of happy events to anticipate, life may feel like a story of things in the future to worry about. Feeling numb Some people deal with the feelings of chronic sorrow by shutting down emotionally. They function best by keeping a lid on strong feelings of sadness, anger or fear. Unfortunately, when they do so, they often say they find it hard to feel strongly positive feelings of happiness and joy as well. Life becomes all a bit grey and colourless. Needing to find meaning “Why us? Why our child? Why has this happened?” Making sense of what has happened is one of the hardest issues for family/whānau and friends of people using alcohol and/or other drugs to come to terms with. For some, having a family member using alcohol and/or other drugs feels like a punishment. For others, it feels more like a confirmation of their basic goodness, or of their ability to cope with hard things. However they see it, a life changing event like this is something that has to be fitted into their beliefs about themselves and their lives. Feeling alone Family/whānau members and friends sometimes feel like they are under siege, standing all alone with their back against a wall. Some people comment that they don’t feel comfortable discussing their fears and challenges about their loved one’s behaviour, with “normal” families, where their actions or their loved one’s behaviour might be misunderstood or judged. In a world designed for “normal” people, where their family life is very different, family members often feel very alone. Having family and friends who are unsupportive often adds to this aloneness. “Everybody reacts differently. Some people need to talk about it, others go to ground and just hide or cry or whatever. And that can happen within the same household!” - Family member of a young man using methamphetamine. Do men and women experience chronic sorrow in different ways? People respond in very individual ways to having a family member or friend using alcohol and/or other drugs. Both men and women experience chronic sorrow, but they may show it differently. It’s hard to generalise, because for every generality there is an exception. It does seem, though, that the way men and women are brought up in our society often influences the way they respond to this situation. These differences can shape the way individuals experience, express, and deal with their losses. How does chronic sorrow affect the rest of the family? The wider family/whānau also generally experience chronic sorrow when faced with a family member using alcohol and/or other drugs. For grandparents this can be especially hard, as they grieve for both their grandchild and their own child. Their support can be crucial to the family, but often they find it hard to acknowledge the extent of the challenge faced by someone using alcohol and/or other drugs. Parents may find themselves needing to educate their own parents about the challenges involved, and then needing to do so again as the situation changes over time. In spite of these difficulties, families often provide strength as they work together to support one another. Siblings also struggle with losses of their own when a brother or sister is using alcohol and/or other drugs. Some older siblings talk of a double loss: losing the brother or sister they expected to have a relationship with and also losing their parent or parents as they have known them. Suddenly their parents are often unavailable, distracted, sad or grumpy. Their attention has not only shifted but also changed. The normal issues of the sibling may seem trivial and inconsequential to his or her parents, who are confronted with much larger problems to focus on. Like their parents, they struggle with the sense of life being unfair. They may feel angry about the family financial resources being spent on their sibling and about the times that plans have to be abandoned at the last moment. And like their parents, they feel guilty about these feelings. Parents are caught, trying to meet the needs of their family member using alcohol and/or other drugs and his or her siblings as well. Things aren’t all negative. Families/whānau often find their other children become more tolerant of differences, more aware of the needs of others, and develop a greater sense of empathy and in some cases an increased appreciation of the importance of family support. What helps for siblings? Information makes a big difference. Give brothers and sisters the chance to talk things over and express their feelings and opinions. This will help them to deal with worries and problems that inevitably come up from time to time, especially when things change. Give siblings a say when plans are made that affect them. Even if things can’t go as they’d like them too, it helps with their sense of control if they know you are trying to take their wishes into account. Provide siblings with the opportunity to meet other people who have challenges. Talking with other siblings, seeing how they handle things and what they feel makes it all more normal for them. Set aside time with other children that is just for them. It only needs to be something small like having takeaways together, watching a movie, going for a walk or watching them play sport, but it sends them the message that they matter too, and you are there for them as well. Encourage your other children to pursue their own dreams, so that they are aware that their involvement will be a choice rather than an obligation. Help children to identify someone outside the immediate family that they can talk to in confidence if they want to. Offer older children the opportunity to ask specialists any medical questions they have concerns about too. Often not knowing is far worse than knowing, even when the situation is serious. How do families/whānau and friends cope over time with the chronic sorrow they experience? When faced with the initial realisation that a family/whānau member or friend is using alcohol and/or other drugs, getting to the point where things seem manageable may seem a long way off. Building coping and resilience over time doesn’t mean life is not difficult at times; it means you find ways to separate from a loved ones behaviour, develop your own life and still support the loved family member or friend. The following are some ways that people managing the juggle have found useful. Learning to “live life” When loss of any kind occurs people hear a lot of advice from others about the need to “accept” what has happened. Though people might be able to find silver linings for this cloud sometimes, the fact remains that for many people it is a cloud, at least at first. Sometimes life doesn’t make sense and isn’t reasonable or fair. Developing coping and resilience skills around hobbies, time for self, work/life balance, enjoyable outings, friendships, etc is very important. Making time for these things often takes considerable effort. Having a sense of humour One of the things that often surprises newcomers to support groups, where they can meet with supportive others who understand what they are experiencing, is the laughter. Participants love to have a laugh about the sometimes appalling situations they find themselves in, with someone else who’s been there and understands. Family members often find that having a good laugh relieves tension and lifts their spirits like nothing else can. Developing a positive and cooperative spirit in the family A positive and cooperative spirit is one of the key factors that help families to cope with the stresses of having a person they care about using alcohol and/or other drugs. When families are faced with a lot of demands, it’s worth investing time and effort into building a positive kind of spirit when you can. Prioritising enjoyable things that can be experienced and enjoyed as a family e.g., holidays, games, nice meals, video nights at home, family celebration, sports. Whatever is possible, is worthwhile. A cooperative spirit is also created when families talk through issues and make decisions together. Using your strengths Living with the chronic sorrow associated with having a family/whānau member using alcohol and/or other drugs can leave people feeling inadequate and helpless. It often helps to think about strengths, and how these might be used to cope with the situation. If someone is a people person, for instance, it helps to get out with others, or join or start a support group. If someone is good with the mind, it is good to make plans and goals to work towards. If someone likes to write or is creative in other ways, keeping a journal or making or creating works that express feelings can give pleasure. If someone is practical and down to earth, working on a project may help ease stress. If the computer fascinates, the internet can be used to access information and support for oneself. And if one has good physical skills or wants to have better physical skills, sports or exercise are a way of working through feelings. Don’t forget too, that there is usually someone else in the same boat that you can support. Looking after yourself Ask family/whānau members who are trying to support someone in the family using alcohol and/or other drugs where their own needs come, in relation to everyone else’s needs, and they’ll usually smile ruefully and admit that they put themselves at the bottom of the list. Doing something for enjoyment, getting out and reminding oneself that there is life outside the immediate issues that often overwhelm one’s mind, really helps. Exercise is very important for many people. Making time for a run or a session at the gym can be hard but is worth the trouble. For others it’s cossetting things like a long bath, retail therapy, or going to the hairdresser. Many people enjoy distracting activities like losing themselves in a good book or a funny programme on TV. "Getting out and being adult again sometimes makes the world of difference for me. I have to make myself do it, but I always feel much better for it." - Mother of a poly drug user What are the positives? Many people comment on qualities that they have developed; qualities they are proud of and that they feel have made them a better person. Often they say they have become stronger, or more patient, kind and caring. Some mention developing skills such as flexibility, advocating for themselves or their family member or friend, or developing empathy for other points of view. Some people comment that dealing with health and law professionals has helped them become more assertive and stroppier, and they like that in themselves! And many people comment that this crisis in their lives has changed their perspectives about what really matters; that they don’t “sweat the small stuff” any more, and they have better skills for dealing with other problems that arise in their lives. Meeting other families who are struggling with similar issues is one of the key positive outcomes for many people, although research suggests that seeking such help is very difficult for most people. To this end online support is generally found to be of real use and many people gain new knowledge and skills. Spending time with other people who share newly developed perspectives on what is important in life, who understand that sometimes things change fast, and plans have to be flexible and who realise that nobody’s perfect, is an unexpected bonus. Further Reading Chronic Sorrow: A Living Loss by Susan Roos. Published by Brunner-Routledge, 2002 ISBN10 1583913211 ISBN13 9781583913215 Susan Roos is a psychotherapist who has been in practice for over 36 years. Her daughter Karen died when she was 3 years old, and her daughter Val is severely retarded, autistic and has a seizure disorder. This is the key book to read if you would like to learn more about chronic sorrow. An updated version is now available. (See below) Chronic Sorrow: A Living Loss by Susan Roos Publication date: 2017 Publisher Taylor & Francis Ltd Edition statement 2nd New edition ISBN10 1138230685 ISBN13 9781138230682 This 2nd Edition of Chronic Sorrow, published 15 years after the 1st edition above explores natural grief reactions to losses that are not final and continue to be present in the life of the griever. This second edition updates terminology, pertinent research, and the roles the concept of chronic sorrow has come to play in the nursing, medical, social work, pastoral, and community counselling professions, among others. McLaughlin, Victoria Grace, “Chronic Sorrow In Family Members Of Addicts: An Investigation Of Partners Of Addicts And Divorcees To Explore Chronic Sorrow As A Theoretical Understanding Of The Experiences Of Family Members Of Addicts” (2016). Dissertations, Theses, and Masters Projects. Paper 1499449812. http://doi.org/10.21220/W4R94S Dr Pauline Stewart is an Educational and Counselling Psychologist in Private Practice in New Zealand. She is a member of the New Zealand Psychological Society and the New Zealand Association of Counsellors. She had many years of experience in teaching and management prior to becoming a psychologist. Pauline has a particular interest in the area of grief and loss in families and the challenges of alcohol and other drug use.

A boundary is defined in the Oxford English Dictionary as ‘a limit on what is reasonable’. One of the areas that families of substance users have difficulty with is in setting boundaries that are effective and manageable. All relationships where people live together need boundaries in place to develop trust, stability and respect within the relationship. Effective boundaries give a sense of security and respect. When a substance user lives in a household, boundaries often get stretched to the limit or even broken down completely – giving the family members a sense of helplessness. One mother said “It was like our home had been taken over by a tyrant. We all had to walk around on eggshells while he did whatever he wanted, if anyone said anything he threatened suicide or moving out onto the streets”. Family members firstly need to remember who pays the rent, the mortgage or owns the house. Giving away power through fear or threats is not effective and will only lead to more chaos and anxiety. The truth is that the drug user would be at a disadvantage without a place to stay. They usually know this very well. There are three stages to effective boundary setting: Defining the boundary and consequences that everyone agrees on and can live with Setting the boundary and communicating the understanding of all parties Keeping the boundary Action learning is a useful concept here because the truth is that boundaries need setting and modifying many times. So there is a constant process of setting, reviewing, modifying and resetting. So it is always important that you don’t see boundaries as totally set in concrete. Why set boundaries? They encourage the user to take more responsibility for their behaviour They help the user become aware that their behaviour impacts on those around them They model a healthy and safe way for people to coexist, even when there are difficulties They help the whole family to minimise the harm and negative impact of substance use and the attendant behaviours They help break down the negative roles that members get stuck in i.e. mothers rescuing users, users relying on others to accommodate them, fathers getting angry etc. Remember the key FDS principle – you can never change anyone else no matter how much you want to. What you do have total control over is you, your behaviour and how you respond to situations. The great thing about this is that if you do change yourself it may then provoke change in the other. Defining the boundary Once you understand the reason for setting boundaries, you want to be crystal clear on what the boundary is. What is the issue, circumstance, area of concern? What do you need to achieve? Examine your motive in wanting to set this boundary. Is it in response to clear thinking about an area of concern or is it an angry response to a set of circumstances? If the person wasn’t using substances would you accept the behaviour? In other words it is important not to treat people differently just because they are substance users. Know the distinction between them as a person and their behaviour Even ‘I’ statements can be phrased in more positive ways on occasion. Note the difference between: ‘I don’t want you living at home when you’re using!’ and ‘I don’t want you to use drugs in our home!’ Is the boundary encouraging them to be responsible for their life, the choices they made, their behaviour and the impact on those around them or is it just treating them like a child? What are the risks of the boundary for everyone involved? Using the ‘using at home’ example, the home and people within it may be safer if there is no use at home but the user may be at more risk if they then use outside the home. There is no ‘right’ or ‘wrong’ answer. Options and consequences have to be considered and each family/whānau may take different approaches. Child safety and protection should always be a serious consideration. The rights of young children need to be the most important element. Set clear consequences for what happens if the boundary is breached. Consequences should be negotiated together including the substance user and may be graded from mild to severe. Consequences need to be appropriate to the breach and everyone needs to be able to live with them. Any action tied up in the consequence needs to come from you – the user may not be ‘made’ to do something. Example: ‘Because you used at home twice last week I am going to look for alternative living arrangements for you’ – rather than ‘Because you used drugs last week you now have to go into rehab.’ How will you ‘measure’ if the boundary has been kept? Is there a time limit on the boundary or does it goes on indefinitely? How often and when will you review the boundary? What flexibility – and it will help if there is some – will be made for changes in circumstances? When and where will the boundary be set and commence? Get the whole household involved Other family/whānau members of an appropriate age who live in the home should be party to the agreement partly to prevent ‘divide and rule’ circumstances. It will be no good setting a boundary where the key people involved disagree with the boundary. Is the boundary realistic at the moment in the current circumstances? Can a win/win be achieved? In other words, set the boundary in a way that you, the other family/whānau members and the drug user gain something from keeping the boundary. Boundaries set as revenge or to express your anger or to punish the drug user are doomed to failure. When will the boundary commence? Immediately or is there a need for a commencement date? How will you get support from within yourself or from others to be able to set and keep the boundary? How will you deal with harmful feelings and other issues that may arise? Support groups can be very important for supporting you. Be prepared to compromise Remember we live in the real world and not a fantasy one. The choice of a boundary is likely to be a compromise rather then the ideal you might like. Be prepared to reward the drug user for respecting and keeping the boundary. They often don’t get ‘pay-offs’ and it will encourage them if they see that keeping the boundary is appreciated. Prepare and rehearse the discussion on setting the boundary. Imagine their likely response. Be prepared for negative reactions. Use ‘I’ statements. Rehearse the conversation going the way you would like it to. Remember your needs are equal to not greater or less then those of others. Your needs are worth respecting and you are entitled to set and have boundaries kept. Take your time and get it right. You can’t change other people but you can change your response to them – which may in turn invite them to change. Setting boundaries Having thought about the boundary you would like to set and being prepared to talk about it, the next thing is to set it with the substance user. The skill to utilise is negotiation. It is important to build and maintain a dialogue between the user and other family/whānau members – this will work well if negotiation skills are utilised. Effective dialogue involves: Listening to each other. Being open and honest. Respecting the other person – not necessarily liking their behaviour. Accepting and understanding their point of view – even when you don’t agree. Use ‘I’ statements. Start everything you say with ‘I’. I think, I believe, I feel, I would like etc. Take responsibility for your actions and contribution to the situation. Not taking responsibility for other people’s behaviour, actions and choices. Acknowledging both your own feelings and the other person’s feelings. Appropriately expressing your feelings e.g. ‘I am really angry that you are using in front of your brothers’ rather than exploding and becoming aggressive. Recognising the need for all to exercise their rights and responsibilities. Work to collaborate rather than confront. Stay calm and focused on the task of setting the boundary even if the user loses control. Modelling appropriate behaviour may bring them back on track. Effective dialogue builds trust Effective dialogue builds trust, which can lead to people taking more risks with being honest, open and taking responsibility. Use the transactional analysis model we are trying to work with – Adult to Adult dialogue rather than Parent to Child or Child to Child dialogues. Developing effective negotiation skills includes: Always looking for win/win outcomes. Asking for what you want – not demanding or avoiding asking. Acknowledging power differences between you and the drug user. Checking their response to your request and how they feel about it. Not making assumptions regarding their feelings, thoughts or desires. Collaborating and being flexible. Being prepared to give some ground and compromise. Holding onto what is really important while being willing to let go of what is not important. Starting easy and if necessary finishing strong. Use your negotiation skills and then move onto imposition if necessary. Agreeing the terms of the boundary – when it will start, when you will review it and the consequences of the breach of the boundary. Make sure the substance user is fully involved and understands what the consequences will be. Making a clear agreement of what has been decided. If a boundary is broken You can expect boundaries to be broken by substance users – especially when they are first put in place. They will: often react to changes by pushing you and other family/whānau members to previous ways of behaving probably be less motivated to change than you are usually hope that you will be unable to keep boundaries in place based on their previous experience of you giving way. If a boundary is broken you need to respond quickly, appropriately and assertively. How to respond if a boundary is broken The first step is to recognise and acknowledge that it has happened. Then take a step back as you consider your response. It is really important to take time to consider everything rather then reacting from feelings of frustration and anger. Responses: I believe our agreed boundary regarding ——————– has been broken I feel ————————– about this We need to discuss this. (You may need to negotiate whether right now is the time to have a discussion or to set a more appropriate time.) In making your initial statement you need to include: What behaviour is unreasonable (focus on behaviour, not them as a person) What your feeling is about the behaviour (feeling not blaming response) Say what you want to do now or restate the boundary For example “When you broke the agreement about using in front of your brother I felt let down, sad and angry. I ask again that you honour our agreement”. It may be necessary then to restate and/or renegotiate the boundary. You also then need to implement the consequence for breaking the boundary. It is really important that you don’t let them off the hook for the consequences. You may need to develop a ‘broken record’ technique – especially if they become defensive or start justifying their actions i.e. “Yes I hear what you are saying about why this happened but I still need you to keep to the agreed boundary!” It is important to comment on disparages in the substance user’s words and their behaviour – example – “I notice that every time something like this happens you always say sorry but then you carry on as if we didn’t have an agreement”. You should then request that things be put right – repay money taken, apology to an affected family/whānau member, repair damaged property etc. Be consistent. Tips for dealing with a boundary that has been broken When making the above statement it is important to remember a few things because as with any new skill it needs to be developed, practised and refined. Be assertive but not aggressive Begin with the word ‘I’ Maintain eye contact Speak from the same level – don’t stand over them. Avoid pointing, jabbing your finger or raising your voice Be prepared for them to try and put you off track, appeal to your emotions, argue, get angry etc You may even need to have another person as a mediator or negotiator but if you do it is important that they trust the other party and the other party doesn’t take sides You are neither all powerful nor powerless. You do have influence and you do have bargaining power. You can ask for what you want, say no to what you don’t want and invite them to do the same. If they apologise, be gracious but consider both their words and how they say it. Actions speak louder than words though. Keeping a boundary The last stage in the process is keeping the boundary. This is done by: Observing if the boundary is being kept Acknowledging that it is being kept or if it is broken Responding appropriately if it is broken Written and adapted by Tony Trimingham FDS Australia from various sources, especially the website of Adfam, UK. Adfam is a similar organisation to Family Drug Support Aotearoa New Zealand and Family Drug Support Australia.

Some things we choose to share with our whānau/family, friends, and acquaintances. Things such as our successes, family members’ successes, holiday plans and even just small everyday matters may seem easy to share. There may, though, be other things we feel less comfortable sharing because there may be a stigma attached to them. A stigma is a sort of secret which causes us shame and makes us want to conceal or hide it. This is called a “concealed stigma”. If you have a concealed stigma - why would it not just be an excellent idea to keep the details to yourself, end of story? Humans are extremely social. It is suggested that this may be why we have such a large brain-to-body ratio, compared to other animals; purely for social concerns! We can understand how others are feeling by listening to what they say, but we can also interpret the distress of others just by observing tiny fleeting facial expressions. It takes quite a lot of effort for humans to attempt to keep secrets. While our mouth may say one thing, our faces may tell another story. This can confuse and worry those around us. It can become hard to keep hiding these secrets from people. When we conceal a stigma, we must think about everything we say, and remember who knows the “secret” and who doesn’t. We may worry what will happen if someone we are hiding our secret from, finds out the secret anyway. It is very easy to underestimate just how many other thousands of people are also concealing the same stigma and distress. One interesting article by John E. Pachankis¹ discusses the downsides of concealing any type of stigma. Many different stigmas are discussed. Pachankis talks about the way a person’s thinking may be altered if they are bearing the burden of concealing a stigma. People may start to notice things relating to the stigma everywhere; in the newspaper, on the television, seemingly everywhere they look. Concerns about being “discovered” may be constantly on the person’s mind. The person affected may become preoccupied, hypervigilant and even suspicious when the innocent mention of things which may be related to the stigma or its concealment are discussed. This in turn may result in shame, anxiety, depression, and even hostility being felt. In normal circumstances these feelings may be relieved by talking with others who may help us “put things in perspective” and tell us the truth: that alcohol and other drug issues extend to all areas of New Zealand society from the high to the low and everywhere in between, and that, in fact they also have a brother/daughter/father/uncle, or otherwise, with exactly the same problem. When someone else is told they are often glad you mentioned it, because keeping their own stigma concealed, is affecting so many areas of their life too. Unfortunately, life being what it is, it may become easier to just avoid socialising and instead isolate oneself, which negatively impacts relationships and friendships, and whānau/family functioning. When people are not able to discuss their concealed stigma, the stigma can even cause people to downgrade the way they value themselves, and can make them see themselves differently, even viewing themselves as a “lower quality person” despite this not being true. This unfortunate and entirely inaccurate self-assessment is reported to be a side-effect of concealing virtually any stigma you care to name, including having a whānau/family member using alcohol and/or other drugs. Because a “concealed stigma” is by nature concealed, finding others with the same concealed stigma is usually difficult. This is where a support group may be useful. It can be particularly good to see and talk to other “normal” people who are experiencing the same issues. This is called “feedback”, and this may be very helpful for all areas of functioning. Feelings of isolation may be relieved, and there is likely to be a decrease in social avoidance, depression, shame, and anxiety, and even the frequency of intrusive thoughts regarding the concealed stigma. One of the most important improvements is likely to be that the closed loop of: worry→upset→social isolation→feeling negative about oneself→increased worry, is broken. Coming out about a concealed stigma to carefully selected people, is predicted to bring great relief, and enable one to build coping and resilience. A support group is a great place to meet with others in a safe, confidential situation. Telling one’s story, and hearing the story of others, can be very helpful. You may then reflect on the experiences of others, to help inform your own decisions. You may need to take some tissues: it may be a huge relief to finally feel ‘normal’ again and be able to share your feelings with others who understand the challenges you are facing. Sharing what you have learned during your own journey supporting your whānau/family member or friend who is using alcohol and/or other drugs, is likely to benefit others on their journey. Hopefully a focus on self-care will be offered. A final word comes from another interesting article by the personality and social psychologists Deborrah E. S. Frable, Linda Platt, and Steve Hoey². These scientists advise that the way to lift “self esteem and mood” and reduce “negative cultural messages” related to a concealed stigma, is to associate with people sharing the same stigma. These researchers found that those hiding a stigma experienced much lower self-esteem, self-regard, social confidence, self-ratings of physical appearance and physical abilities, and even slightly lower confidence in their academic abilities than people with a stigma which was not concealed. People concealing a stigma rated higher for levels of anxiety, depression, and hostility, than those with a stigma which was not concealed. The advantages of attending a support group were found to be many: when associating with those sharing the same concealed stigma as oneself, self-esteem was significantly higher, anxiety was significantly lower, and depression was also significantly lower among members of groups sharing concealed stigmas. It was suggested that these benefits arise because one stops feeling so alone with the hidden stigma, and ceases feeling like the “only one”. Mostly these authors suggest, that by meeting similar others, we are reassured that we are OK too. Elizabeth Stewart is Family Drug Support Aotearoa New Zealand’s guest contributor. She is a health professional with an interest in personality psychology. The 5-Step Programme is a great starting place to build coping and resilience as outlined in the article above. ­­­­­­­­­­­­­­­­­­­__________________________________________________________________________________ ¹ Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133(2), 328–345. doi:10.1037/0033-2909.133.2.328 ² Frable, D. E. S., Platt, L., & Hoey, S. (1998). Concealable stigmas and positive self-perceptions: Feeling better around similar others. Journal of Personality and Social Psychology, 74(4), 909−922.

This webinar describes the challenges faced by families and friends of those struggling with addiction and introduces an online support program for families and friends of addicted loved ones, which integrates the 5‐Step model (SAFE), developed by Professor Richard Velleman in the UK. This is what the New Zealand 5-Step Programme has been modelled off. Key benefits from watching this webinar include: • Get strategies to cope with and respond to a loved one using methamphetamine • Gain an awareness of a novel online support package • Explore sources of support for yourself and your loved one Presented by A/Prof Frances Kay-Lambkin.

This webinar explains in plain language the effects of methamphetamine (including ice) on the brain and body and the resulting impacts on functioning. Understanding the effects can assist family/whānau to adapt and develop more effective strategies to respond to people who use methamphetamine. Presented by A/Prof Nicole Lee (15th November 2017) Please note: some of the videos played within this webinar were distorted. These clips were taken from a TV episode, which can be viewed by copying and pasting this link into your browser: http://iview.abc.net.au/programs/you-... For more information and to download a PDF handout of the slides go to: https://cracksintheice.org.au/webinar.

Due to the generous support of Family Drug Support Australia, Family Drug Support Aotearoa New Zealand is able to present an online counselling video which allows viewers to sit in on a counselling session which addresses many of the concerns faced by family/whānau and friends of people using alcohol and other drugs. Whilst all of the services that are available in Australia are not yet fully available in New Zealand, the issues faced by families in New Zealand are the same, and this video addresses them with sensitivity.

Marc Lewis’s relationship with drugs began in a New England boarding school where, as a bullied and homesick fifteen-year-old, he made brief escapes from reality by way of cough medicine, alcohol, and marijuana. In Berkeley, California, in its hippie heyday, he found methamphetamine, LSD, and heroin. He sniffed nitrous oxide in Malaysia and frequented Calcutta’s opium dens. Ultimately, though, his journey took him where it takes most addicts: into a life of desperation, deception, and crime. But unlike most addicts, Lewis recovered to become a developmental psychologist and researcher in neuroscience. In Memoirs of an Addicted Brain, he applies his professional expertise to a study of his former self, using the story of his own journey through addiction to tell the universal story of addictions of every kind.

Clinical psychologist and author of The Defining Decade, Dr. Meg Jay reveals the world of the "supernormal" - those who soar to unexpected heights after childhood adversity. Whether it is bullying, the loss of a parent to divorce, drug use or death, an alcoholic or mentally ill family/whānau member, domestic violence, neglect, or emotional, physical, or sexual abuse, early adversities are experienced by nearly 75% of us. Yet, often such experiences are kept secret as are our courageous battles to overcome them. Dr. Jay tells the tale of everyday superheroes who have made a life out of dodging bullets and leaping over obstacles, even as they hide in plain sight as students, teachers, doctors, artists, actors, athletes, parents, and more. These powerful stories, and those of public figures from Andre Agassi to Jay Z, will show readers they are not alone but are, in fact, in good company. Marvellously researched, this extraordinary book narrates the continuing saga that is resilience as it challenges us to consider whether – and how – good wins out in the end. ISBN 9781455559152

Passive Communication During passive communication, a person prioritises the needs, wants, and feelings of others, even at their own expense. The person doesn't express their own needs or stand up for them which can lead to being taken advantage of. Common signs of passive communication include: Quiet/softly spoken Allows others to take advantage Poor eye contact / looks down or away Lacks confidence Aggressive Communication Through aggressive communication, a person expresses that only their own needs, wants, and feelings matter. The other person feels bullied and their needs are ignored. Signs of aggressive communication include: Speaks in a loud or overbearing way Wants their own way Frequently interrupts or does not listen Use of criticism, humiliation, and domination Assertive Communication Assertive communication emphasises the importance of both peoples’ needs. Assertive communication looks like: Willingness to compromise Confident tone / body language Good eye contact Listens and does not interrupt Practice Helps Communication challenges are very common between the person using substances and their family/friends. It is unlikely that they will be capable of changing their communication style in the short term, but if you can work on improving yours, you may be able to improve your overall communication and relationship. If you are struggling to communicate with your loved one, you might find it helpful to look at the scenarios below and consider what a passive vs aggressive vs assertive response from yourself or your loved on might look like for each of those scenarios. Once you have identified which style/s are more likely to be used by yourself and your loved one, you could think about common situations you find yourself in, and practice responding in an assertive manner so you are able to draw on that practice when you find yourself in the heat of the moment. Example Scenario A friend asks to borrow your lawn mower. You need this each weekend. Passive: I don’t know, I guess its ok. When do you need it? Aggressive: No! Don’t be stupid. Get one of your own. Assertive: I need the mower at the weekends but you could borrow it during the week. Practice Scenario 1 Your daughter stays out late. She never turns up to meals. Passive: Aggressive: Assertive: Practice Scenario 2 Your partner left a mess in the house, and you’re worried about what you have found. Passive: Aggressive: Assertive: Practice Scenario 3 When you go out your partner always drinks more than others, Passive: Aggressive: Assertive: Practice Scenario 4 A person showed up at your house uninvited to see your son. You’re suspicious about his motives. Passive: Aggressive: Assertive:

Professor David Best is the Director of the Centre for Addiction Recovery Research at Leeds Trinity University in the United Kingdom and is a world expert in the field of recovery, how it develops and how it is maintained. He has extensive knowledge about how alcohol and other drug use impacts whānau/family and how recovery of the focal person develops and grows. Join Family Drug Support Aotearoa New Zealand founder, Pauline Stewart, as she hosts Professor David Best in a webinar that takes us through how the recovery process works and the importance of whānau/family in that process.

When confronted with the news that your child is using drugs or alcohol, normal parental worry quickly escalates to fear. Many parents often feel helpless and out of control, especially when attempts to intervene fail. It can be like trying to drive your car from the back seat, or even worse–from the trunk. Fear and parenting don’t mix well. What we do know is that flexibility and being open to different approaches is the cornerstone to effective parenting. My work with teens, young adults, and their families embraces the principles of harm reduction. This approach is grounded in public health and it can help the parent remain in the driver’s seat of family control. The philosophy of harm reduction is based on our knowledge that human beings will always be engaged in behaviours that carry risks, like using alcohol and other drugs and unsafe sex. This premise parallels psychological theories of normal adolescent development, during which taking risks and challenging authority help children establish independence and identity. Harm reduction looks to shift the focus from attempting to restrict or prohibit risky behaviours to reducing the negative consequences associated with them. The good news is that we don’t need to reinvent ourselves as parents. Consider these harm reduction principles and how they can empower you to more effectively manage your child’s drug and alcohol use and problematic use. Reasons for drug use Our brains are hard-wired to move toward pleasure and away from pain. Substances help us relax, sleep, have fun, improve creativity, and cope with the pain associated with more serious mental health issues. You can improve communication with your child by thinking of substance use in these terms - and of the user’s “relationship” with the substance. So rather than starting with a warning about dangers, try focusing on the child’s own experience, such as: “How do you feel when you take this drug? What does it do for you?” This is more likely to engage your child in a mutual exploration. Teenagers have their own reasons, which likely reflect common issues that most kids face, such as stress, depression, and pressures to “fit in.” Parents often forget that they were teenagers once, facing the same challenges. Meeting people where they’re at Engage your teenager in a supportive process of change by starting with his or her beliefs and attitudes about drug use. Meeting “where they’re at” requires parents to put aside their own opinions in order to listen. Listening encourages open, honest dialogue. Teens in conflict with parents over drug use are often mired in distrust and defensiveness, having long ago tuned out lectures and warnings. Think about saving your breath when launching into lecture mode. I’ve found in my work with teenagers that even when they continue to deny the extent of their substance use, many teens will admit that they want to regain fractured parental trust. Meeting “where they’re at” is a good place to start. Small positive steps Harm reduction looks to shift the focus from attempting to restrict or prohibit risky behaviours to reducing the negative consequences associated with them. I’ve found in my work with teenagers that even when they continue to deny the extent of their substance use, many teens will admit that they want to regain fractured parental trust. Even if change is desired, the process of change is frightening and it can sometimes feel overwhelming. Most people tend to resist changing all at once, and research shows that change occurs in predictable stages. Family problems usually take some time to develop and some time to resolve. Small steps leading to small improvements in behaviour - the experience of success - can give everyone some confidence and hope, which drives the process forward. Even a high-achieving child’s self-esteem is vulnerable, so it’s important to voice appreciation and encouragement for any positive change he or she makes along the way. No need to hit bottom The notion that everyone with a serious alcohol or other drug problem has to “hit bottom” before they’re ready for change is a myth with the potential to do great harm. Research shows that most people enter treatment or make positive changes in their substance use without hitting bottom. The concept of tough love embraces this myth and can damage or even destroy a child’s life-sustaining connection to the only people who truly care. In the absence of violence or abuse in the home, kicking a child out of a family could potentially be disastrous. Parents learn about the evils of enabling when support groups and counsellors, in the interest of creating healthier boundaries, encourage us to directly confront our kids and not back down to the often self-destructive manipulating that some teens will engage in. Enabling can become a badge of shame and failure that many parents wear when they repeatedly fail in their attempts to affect the course of their child’s addiction or mental health problems. Meeting people “where they’re at” and making small positive steps are realistic strategies to replace tough love and the assumption to “hit bottom.” Flexibility and compassion When confronted with drug use that’s worrisome, parents will frequently jump to a zero tolerance approach, often accompanied by “lockdown” mode - grounding, no cell phone, no online access - in an attempt to eliminate all risk. Recently a teenager, in his own wisdom, said to me: “If my parents think these punishments will stop me from getting high, they’re wrong!” Indeed, we can’t prevent children from using drugs if they’re determined to. That fact, combined with zero tolerance’s zero flexibility, keeps anxiety high, often locking everyone into a destructive cycle. Certainly compassion can be sorely tested when parents feel angry, hurt, and raw in response to their child’s destructive opposition. But research shows that when parents connect with their teens and lead them with a light but stable hand, staying engaged but allowing independence, they generally do better throughout life. Human beings respond more favourably to harm reduction’s compassion and flexibility – characteristics essential to effective parenting. Reality-based education Teens want reality-based drug information given with honesty and the faith that they can make up their own minds. They prefer to learn from their friends, but whether they admit it or not, the wisdom of therapists and parents resonates with them because they appreciate that adults have already faced the same difficult issues. You know your children the best. If you need help in dealing with your child’s substance use, seek the professional guidance of a specialist. Working with a professional will help you regain confidence and empower you on the right path for effective parenting. You can learn to establish healthy boundaries that will balance your needs and the needs of your family, while always providing a safety net for your troubled teenager. By our Guest Contributor Barry Lessin Barry Lessin is a licensed psychologist and drug policy reform advocate in Philadelphia USA. He with a passion for working with young people and their families who have been impacted by substance use. He has forty years of experience as a clinician, educator, administrator, researcher and public health advocate. 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.

A practical handbook for anyone who suspects (or knows) someone they care about is a drug user. Drawing on the tragic loss of his own son to a heroin overdose and over 20 years working as a counsellor, Tony Trimingham cuts through the media hype and politicking to address the real issues facing the families and friends of someone struggling with addiction. Filled with constructive suggestions and strategies, Not My Family, Never My Child is aimed at supporting parents, family/whānau members and loved ones of drug users and the users themselves through the difficult journey of drug dependency. It includes detailed information on warning signs, early intervention, coping and survival strategies, treatment, and where to go for additional advice and support. ISBN 9781741755251