Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services for the Sunshine Coast Health Centre, talks about the importance of setting boundaries and limits with others rather than feeling the need to take responsibility or “own” others actions.
Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services for Sunshine Coast Health Centre, talks about different behaviorial patterns individuals may exhibit during their addiction recovery, especially when approaching milestones.
Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services for the Sunshine Coast Health Centre, talks about the importance of setting boundaries so that your life does not get put on hold if your loved one relapses.
Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services for Sunshine Coast Health Centre, shares why it is so important to have a strong after-care plan and support network after addiction treatment.
Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services at Sunshine Coast Health Centre, discusses how to handle your concerns if a loved one returns to using mood altering substances shortly after treatment.
Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services, discusses “PAWS” or Post-Accute Withdrawal Syndrome and the key points in an individual’s recovery where there may be a higher chance of relapse.
Cathy Patterson-Sterling, MA, RCC
Cathy Patterson-Sterling, Director of Family Services for Sunshine Coast Health Centre, discusses what you should be concerned about if your loved one feels they could handle drinking again after addiction treatment.
Cathy Patterson-Sterling, MA, CCC
Cathy Patterson-Sterling, Director of Family Services for Sunshine Coast Health Centre, discusses options to handle finding drug paraphernalia in your home, when you thought your loved one was in recovery.
By Daniel Jordan
I recently had the pleasure of attending a Jack Hirose workshop on the 6th & 7th of November that featured Matthew D. Selekman, MSW, LCSW. Matthew is a family therapist and addictions counselor in private practice and the co-director of Partners for Collaborative Solutions, an international family therapy training and consulting firm in Evanston, Illinois.
Matthew is probably best known for his collaborative strengths-based brief therapy approach to his work with adolescents, particularly with self-harming adolescents. At first, I didn’t expect much of Matthew’s presentation to be relevant to my primary interest - men with addictions. Surprisingly, however, self-harming and substance misuse have a lot in common.
Similarity #1 - Rationale for Self-Harming
Matthew listed the most common reasons why teens say they self-harm:
Even the comment, “the warm blood dripping down my arms calms me” is similar to some of the physical sensations that people who drink or use drugs may experience. Matthew explained that when an individual cuts there is a rush of endorphins which not only masks some of the pain but helps explain its habit-forming characteristics.
Similarity #2 - Feelings After Self-Harming
Matthew also showed research that surveyed how adolescents felt after self-harming:
Immediately = 70 % feel better, 21% feel worse, 9% no change
The immediate effects of self-harm can be said to resemble substance misuse. In his conversations with youth, Matthew will often ask “why would you stop something that works so well for you?” as he recognizes that so many find immediate relief from their problems by self-harming.
Few Hours Later = 30% feel better, 47% feel worse, and 23% feel no change.
This can be explained that after a few hours of self-harming, the endorphins wear off and feelings of guilt and shame return. The cycle then repeats itself as self-harming becomes a way to get rid of these negative feelings.
Few Days Later - 18% feel better, 50% feel worse, 32% no change
Similarity #3 - Frequency and Duration
Just as there are social drinkers, binge drinkers and regular heavy drinkers, so too with those who self-harm:
Similarity #4 - Co-existence of Substance Misuse and Suicidal Behavior *
Adolescent substance abusers are 3 times more likely to make a suicide attempt than non-users.
(*) Note: Suicidal behaviour and self-harming behaviour are not the same thing.
Similarity #5 - Relapse
The presentation on relapse prevention for self-harming behaviour I found particularly interesting. According to Matthew:
“Clients’ slips are inevitable and go with the territory of change. It is important to predict the likelihood of slips and normalize them when they occur. When someone has a slip, you can respond in the following way:
I do have a problem with the use of the term “slip” as Terence T. Gorski points out that short-term relapses are never accidental. However, I have never heard the term “normalize” used in connection with relapse and I think it is an excellent word to describe an effective response. After all, shame and guilt often follow relapse (see Similarity #2).
Similarity #6 - The Need to Deal With Distress When it Occurs
One great idea that Matthew shared with the workshop participants was the idea of a “chilling out” room as a distress management tool. A chilling out room is a room in the house which is designated by the family as “a safe and sacred space to secure adaptive and positive multi-sensory pleasure when experiencing emotional distress. Second, it serves as an effective pattern intervention for disrupting the problem-maintaining patterns of thinking and behaving that inevitably leads to a self-harming episode.”
Matthew recommends that the chilling out room should:
The chilling out room is also good for other family members as a place where they can decompress.
Conclusion
I haven’t even touched upon the therapeutic approaches that Matthew recommends for dealing with self-harming adolescents, which he calls a collaborative strengths-based brief family therapy approach as well as positive psychology interventions. Matthew offers an integration of solution focused brief therapy, narrative therapy, positive psychology, mindfulness, and multi-systemic family work. His recommendations on using clients’ signature strengths and nurturing resiliency and protective factors are areas that we at Sunshine Coast Health Center have also been exploring with our clients.
Recommended Reading - Matthew Selekman
Selekman, M.D. (2009) The Adolescent and Young Adult Self-Harming Treatment Manual: A Collaborative Strengths-Based Brief Therapy Approach.
Selekman, M.D. (2006) Working with Self-Harming Adolescents: A Collaborative Strengths-Based Therapy Approach.
Selekman, M.D. (2005) Pathways to Change: Brief Therapy with Difficult Adolescents (2nd Ed.)
Selekman, M.D. (1997) Solution-Focused Therapy with Children: Harnessing Family Strengths for Systemic Change.
About the Author
Daniel Jordan is the General Manager of Sunshine Coast Health Center and hopes that these postings will help take away some of the mystery often associated with addiction and its treatment.
By Cathy Patterson-Sterling, MA, RCC
A topic that many people do not want to talk about is relapse especially if, as a family member, you have spent a lot of money on treatment and are waiting for a type of “sunset ending.” The hope is always that your loved one with an addiction will say goodbye to alcohol and drugs as they remain committed to a recovery lifestyle. Many people do well the first time in treatment and are able to remain sober for the rest of their lives. Then there are others who experience a “slip” or possibly a relapse during the recovery process. Some individuals will even encounter multiple slips or relapses during the recovery journey before they find long term sobriety. Bill W. (one of the co-founders of Alcoholics Anonymous) even slipped four times before he wholeheartedly committed to a lifetime of sobriety and recovery.
If loved ones are not careful, the potential for having a slip or relapse can develop into a fear that can even paralyze relationships. In fact, individuals in recovery may be doing very well, yet their family members and loved ones are in panic wondering if such progress will last forever. Loved ones often worry that their happiness will suddenly be crushed with the news of yet another slip or relapse.
In today’s posting I want to demystify what a slip is and to discuss the potential for relapse. When individuals remain sober from mood-altering substances and make a commitment to healthy habits (ie. going to meetings, doing recovery-based readings, finding a counsellor, exercising, etc.) then they are participating in the recovery journey. At some point, such people may return to using their drug or alcohol one time or for a short amount of time (ie. 24hr and maximum 72 hrs). This short return to using drugs or drinking alcohol is called a slip. This is a crucial time because there is an opportunity for a “teachable moment.” Individuals can realize that they may have become “complacent” by assuming they had control over their addictions so there was no need to follow a recovery program or implement healthy habits. Thus, the slip becomes a type of “warning bell” or “wake-up call” that individuals need to take their recovery seriously and work their programs or healthy habits.
In the early stages of relapse quick decisive action is critical
The problem is that individuals will often have distorted thinking from the relapse process as they begin justifying or even minimizing their return to drinking alcohol or using drugs. Therefore there is a strong potential for one slip to turn into another until the person fully returns to the drug using or drinking lifestyle. If individuals minimize their slip then the teaching from this valuable moment is lost. In order to capture this “teachable moment” family members and loved ones need to reinforce their boundaries and remind individuals after a slip that there is no room in the relationship for mood-altering substances. If individuals do not commit to working a recovery program immediately, then family members and loved ones need to take appropriate action either by removing themselves from the relationship or following through with whatever boundaries they have set for themselves. Family members need to be careful that they do not begin bargaining over which meeting an individual will attend. For example, the person who had a slip says “I will go to a meeting on Friday,” which is four days away. This is not soon enough. Individuals who slip MUST recommit to recovery immediately and return to their healthy habits.
There is no “time off for good behaviour” when it comes to recovery
Family members and loved ones may hesitate to implement boundaries because individuals with addictions were doing so well in recovery by staying sober for a length of time. Some loved ones may say: “Well at least he was honest with me and I wouldn’t have known if he had not told me he had used drugs again” or “We just had a really nice week together without him using drugs and this is like starting an argument after having a really nice meal or evening together.” The problem is that just as the A.A. saying suggests: “If nothing changes, then nothing changes.” This means that if family members and loved ones “normalize” a slip by not implementing their boundaries, then they are inadvertently condoning the using/drinking behaviour which gives individuals with addictions permission to continue on with these self-destructive actions. The potential learning opportunity or “teachable moment” becomes lost as individuals slowly or sometimes quickly progress back into active addiction.
Stick to your boundaries when a loved one slips or relapses
Loved ones of people with addiction are not responsible for recovery, but they do need to have clear boundaries in order to change the dynamics that left room for addiction in the first place. Examples of boundaries that you could establish include:
• We cannot live together
• You will need to live in a sober living house
• You will need to return to treatment to complete a relapse program
• I will not allow you to have access to our finances
• I will arrange so that you do not have visitation rights to our kids because I cannot guarantee their safety with you actively using drugs/alcohol
• You must attend regular counselling or this relationship will end
• I will only see you on neutral territory when you are under the influence of drugs/alcohol
• In no way will I support your addiction financially or emotionally
• If you are under the influence of drugs/alcohol, I will have you removed from the house by calling the police and claiming that I feel unsafe
Conclusion
Remember that loved ones are “fighting for their relationships” by setting boundaries. Loved ones must say to individuals who have slipped or relapsed: “ I love and support you, but in no way will I support your addiction. I will not ignore this behaviour and there is not enough room for drugs/alcohol and me in this relationship.” Often boundaries can be inconvenient and it can be difficult when individuals have to change homes or live without the addicted person, but the other alternative is to live in the constant chaos of active addiction as loved ones and family members slowly watch others kills themselves with alcohol/drugs. By implementing boundaries, loved ones are giving themselves and individuals who have slipped or relapsed another chance at a healthy life in recovery.
About the Author
Cathy Patterson-Sterling, MA, RCC, is Director of Family Services at Sunshine Coast Health Center, a private residential alcohol and drug rehabilitation program for men. In this capacity, Cathy is able to provide families of clients the support they need from the moment of the crisis before entering addiction treatment through to their entry into family programming and beyond (family aftercare is also provided). With a strength-focused addiction family therapy approach, substance-affected families are able to transform as they begin their own healing journeys alongside clients.
Sunshine Coast Health Center is a provincially-approved drug and alcohol rehabilitation facility licensed by 
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