A Record Number of Americans Are Struggling With Addiction. Dr. Carrie Wilkens Has a Radical New Approach to Help Addicts And Their Families
When it comes to addiction, we are seeing unprecedented statistics: Nearly 25 million Americans suffer from a substance use disorder. In 2021, there were more than 107,000 fatal drug overdoses in the U.S., the highest number of overdose deaths ever recorded in a single year. The vastness of this problem also has serious implications for the more than 60 million family members, who must face the consequences of their loved ones’ struggles.
Carrie Wilkens, PhD, is the founder of the Center for Motivation and Change (CMC), one of the top addiction rehabilitation clinics in the country. She says the most effective way to treat addiction and to help those addicts’ loved ones navigate the recovery process is actually one of the least utilized: compassion.
Dr. Wilkens is determined to bring dignity and hope back to addicts who have been cast aside or shunned by the people they love most. Her science-backed “Invitation to Change” approach aims to improve communication and strengthen motivation to help those who suffer from substance use disorders reduce or stop using substances—and practice compassion and self-care to create the conditions for lasting change.
The Sunday Paper sat down with Dr. Wilkens to talk about her radical approach to treating the urgent and growing problem of addiction in our country, and what each of us can do starting today to help anyone who is struggling.
A CONVERSATION WITH CARRIE WILKENS, PHD
Your new book is a workbook for family and friends of someone with a substance use problem. Can you talk about the impact of addiction on loved ones?
Impacts can have a big range. There’s often a massive physical and emotional drain, because you’re worried or scared, or maybe even in an abusive relationship. Domestic violence can be associated with addiction, as well as financial drain because the person you care about isn’t functioning well or needing a lot of treatment or support.
The big impact nobody talks about is the shame most people feel. Substance use disorders are such a stigmatized problem. Research shows family members are often seen to be part of the problem because they haven’t been able to “fix” it; other times, family members and loved ones are considered part of the cause.
Loved ones of those with an addiction feel judged. It’s important to realize that people with substance use problems walk around with shame, and their family members do, too.
You write that the research is clear: You can help a loved one struggling with substances by actively supporting them with both science and kindness. Can you explain why these are key?
Part of what we do in this country is try to punish the problem. We think we have to show up with “tough love.” The cultural message is that you have to be tough on addicts—that they have to hit “rock bottom.” The way we talk about the problem leads one to believe you have to be aggressive.
However, there is no research that supports confrontation as a supportive approach. In fact, a single act of confrontation can promote relapse in someone trying to overcome a substance abuse problem.
Research shows establishing trusting relationships and creating an atmosphere where someone can talk increases the likelihood of treatment and desire to change. And remember, when you’re talking to that person, the goal is to decrease defensiveness and help someone find internal reasons for change. You want to help turn their internal motivation “on.”
You’ll also want to take a step back and try to understand how the substance abuse behavior makes sense. Instead of thinking that person is weak or selfish, try to understand how their behavior is giving them something that’s meaningful for them. After all, we don’t repeat things that aren’t meaningful for us.
Once you understand how a behavior makes sense, you can help them work on that. You can help them try to figure out if there’s something else that can meet that need in another, healthier way.
You’ve probably heard some version of “addicts lie.” But really think about it for a moment: You’re challenging a behavior that works for someone and that that person likely has deep shame about. They’re going to hide it and lie about it, because they feel bad about it. They feel hopeless that they can’t stop.
Think about anything we try to change—we go on and off diets, we go to the gym and then skip it. In these instances, it’s easy to admit that change is hard. But when it comes to addiction, we get mad when the efforts to quit don’t stick. In reality, substance abuse is just like any other behavior—except it’s one that influences your physiology and makes you crave the substance you’re abusing. You’re not only asking someone to give something up. You’re asking someone to give something up that their body may be physically dependent on, which makes giving it up more difficult.
What is the antidote to the shame so many addicts—and those who love them—feel?
Self-compassion. But it takes a lot of practice and often a lot of time to show yourself some kindness when you’re struggling.
To really be kind in those moments when you fall off the horse is so difficult, but if you can show yourself some compassion, you’ll be more likely to get back on the horse, learn from your mistakes, and let yourself be a human in the process. This can really heal that shame.
I can’t stress enough how much you need to practice this skill and really work at it. You have to be able to reflect on that inner critic. When you beat up on yourself, does that inner critic help you feel hopeful—or hopeless. Does it make you feel energized—or wear you down. Most people say, “It makes me feel hopeless and wears me down” but they don’t know what to do. So, just start there. Notice that you’re beating yourself up or stuck in shame and practice being kind to yourself.
Repairing shame and learning how to relate to yourself in a different way may take years of practice, which is something we don’t talk about enough. Family members and loved ones of addicts often expect when someone leaves rehab or treatment, the problem will be gone. Yet the reality is that was step one—and there may be 50 more steps to go.
Self-compassion is crucial when someone is recovering. Substances help you manage emotions; they make you feel a certain way. Take the substance away and that person has to learn how to be in relationships, establish new ones, figure out how to sleep, eat, exercise—all these things will feel different, and we don’t give people who are recovering from substance abuse problems enough credit for how hard that work is.
The same is true for family members and other loved ones. You’ve been hurt. It’s going to take you some time to come back from it.
What can each of us do to stop oversimplifying the way we think about substance abuse problems and the complex journey of addiction recovery?
We’re increasingly becoming a quick fix society. We can get everything with the push of a button. We get soundbites. And the message from the media and even the treatment world is this: If you go to rehab, if you go to meetings, you’re going to get better. It’s such a black-and-white view: You’re either an addict or not; you’re in recovery or you’re not.
Yet every single person with a substance use problem gets into it for different reasons and gets out of it in different ways. We need to remember this and talk about substance use problems in nuanced ways.
All of us can be aware of the impact of labels. Word choice really matters. If someone self identifies as an alcoholic, that’s very different from you calling someone an alcoholic. There’s a lot of phrases thrown around as if they mean something—hitting rock bottom, someone needing tough love or an intervention, co-dependency—these are all things people say that don’t really mean anything constructive. Give yourself permission to slow down and be thoughtful about your word choice. Notice if you’re taking a judgmental, stigmatizing stance.
Cultivate curiosity and compassion for people who are struggling. Because people who use substances are suffering in some way. And that struggle is made worse by how our culture responds to it.
You say there’s reason to be hopeful if you love someone with a substance use problem; people do change, and you can help…
People get better! I wouldn’t have survived my career if people didn’t get better!
People change, too. All the time. The key is being able to manage expectations and really hold the awareness that change takes time.
Carrie Wilkens, PhD, is the Co-Founder and President of CMC:Foundation for Change, a not-for-profit organization with the mission of improving the dissemination of evidence-based ideas and strategies to professionals and loved ones of persons struggling with substance use through the Invitation to Change approach. She is the co-founder of the Center for Motivation and Change and co-author of Beyond Addiction and the new The Beyond Addiction Workbook for Family & Friends (New Harbinger 2022).
Question from the Editor: What are some of the assumptions you have about those with substance abuse disorders that you’d like to revise? Are there ways you’ve been more judgmental than compassionate?