Getting Unstuck Part 2: Working with Road Maps

In my last blog about Community Reinforcement and Family Training (CRAFT) I provided a description of a technique that forms the foundation of CRAFT, the road map (a.k.a., functional analysis). CRAFT trains family members of people with addiction how to non-confrontationally change their loved ones’ use and rebuild lives not centered addiction. Briefly, a road map is an assessment of the triggers and consequences of the addicted person’s substance use. In this post, I’ll offer ideas on how to collect useful information from the family member (the client) to add to the road map. The metaphor is one of creating the compass for the map, so you’ll know which direction you and your client are heading while you’re doing CRAFT.

Benefits and Costs of Substance Use:  Opposing Points on a Compass

A critical part of the road map is the identification of the positives and negatives of a loved one’s substance use, both for the person using and for the family member. It is often easier to talk with the family member about what he/she believes their loved one obtains and loses from using, than to identify what he/she personally gains from their loved one’s use. Some family members are surprised to think about their loved one's alcohol or drug use from the perspectives of their loved one. It can be eye-opening and may even help family members feel more compassion for their loved one, when they view the positives and negatives of substance use from the eyes of their loved ones. When helping a client identify the benefits and the costs of alcohol or drug use from his/her loved one’s perspective, it is helpful to ask about the following areas:

• Benefits (termed “Short-Term Positive Consequences” in the functional analysis described in Smith & Meyer (2004). Motivating Substance Abusers to Enter Treatment:  Working with Family Members):
  • What does your loved one like about using/drinking with the people he/she usually uses/drinks with? (If the loved typically drinks/uses alone, what do you think he/she likes about drinking/using by him/herself?)
  • What does your loved one like about the place where he/she uses/drinks?
  • What does your loved one like about the time when she/she uses/drinks?
  • What pleasant thoughts do you think your loved one has when he/she uses/drinks?
  • What pleasant feelings (physical and emotional) do you think your loved one has when he/she drinks?
  • Costs (termed “Long-Term Negative Consequences” in Smith & Meyer, 2004):
    • What are the costs (negative results) of your loved one’s using/drinking in the following areas (be sure to include costs that the loved one would agree with):
      • Interpersonal
      • Physical
      • Emotional
      • Legal
      • Job/Career
      • Financial
      • Other

There are two important points about helping your client identify the benefits and costs of their loved one’s use. First, make sure to orient your client to the benefits and costs from their loved one’s perspective, not from their own perspective. It can be helpful to have your client take some time to think about his/her loved one and to imagine the positives and negatives from their eyes. Second, explain why identifying benefits and costs of use from their loved one’s perspective is important, for example: 

1. we can then help the loved one find other (non substance using) ways to obtain the short-term positive benefits.
2. we can identify powerful rewards that are lost when the person uses,
3. we can use the rewards that are lost when the person uses to reward the person when they are not using. For example, if Sue values being a good parent, but does not get the opportunity to connect with her children because of her drinking, Joe can set up opportunities for Sue to connect with her children when she is not drinking. Put more plainly, Joe does not let Sue see the kids when she is drunk and schedules activities for the family that build connection, but do not involve drinking (e.g., going to the Children’s Science Museum where no alcohol is served).

Gently explore potential benefits of substance use for the client

Most clients will easily identify the costs of their loved ones’ alcohol and drug use. In fact, many will have identified the costs already if you ask them about the long-term negative results of their loved ones’ drinking or using. It is often more difficult for clients to identify benefits (if there are any) related to their loved ones’ substance use. However, asking about ways in which the client benefits from their loved one's use can sometimes be tricky and most be done sensitively. It is very important that you do this compassionately and be willing to forego the discussion if you encounter resistance or notice that your client begins to use the discussion as way to engage in self-blame. Although often helpful, identifying how your client benefits from his/her loved one’s use is not a crucial part of CRAFT. I include it here because I think it can be helpful for some clients to identify the ways they benefit, and lose, when their loved ones’ use. An example may help illustrate how a client may benefit from a family member’s use of alcohol. In my last blog, I created a road map for fictional client named Joe. I’ve included that roadmap below:

Sue gets home from work and goes to the kitchen to pour herself a drink à Joe is in the kitchen preparing dinner and asks Sue how her day at work went à Sue begins to talk about her day at work and appears more and more irritated as she talks about work. à Joe listens, but is starting to become irritated because Sue has not asked about his day à Sue continues talking about her work and pours herself another drink à Joe, irritated, says “do you really need another? You just finished that one.” à Sue, angry, snaps, “I’m the one who works all day while you get to sit around and collect unemployment. If I want a drink, I’m gonna drink.” à Joe, angry, argues “I don’t sit around all day. You know I’ve been looking for work and that I hate being unemployed.” à Sue tells Joe “when you get a job again, then you can tell me how to spend my time.” She finishes her drink, pours herself another, and walks out of the kitchen. à Joe, still angry but realizing that dinner still needs to be cooked, goes back to preparing dinner. à Dinner is eaten in silence.

How might Joe benefit from Sue’s drinking? The costs seem very clear:  increased conflict in relationship, decreased relationship satisfaction, etc. To inquire about any possible benefits Joe receives as part of Sue’s drinking, you can ask something like, “Some of the clients I work with notice that there are benefits related to their loved one’s drinking. I know it sounds strange and I may be off the mark here, but have you noticed any benefits to Sue’s drinking?” (I’d like to thank one of my colleagues in the CRAFT consult group who pointed out that family members may experience benefits when their loved ones’ use and provided an excellent example of how she recently explored this issue with a client). Joe may then state that  he has taken on more child-rearing responsibilities as a result of Sue's drinking. One of the benefits of Sue's drinking is that he now gets to spend more time with his children.

Again, I want to emphasize that identifying the benefits a client receives as part of his/her loved one’s substance use is a topic that is best approached gently and compassionately. For too many family members self-blame is part of their experience of their loved ones’ addictions. Your goal in asking about potential benefits is to help clarify the compass for the road map, to identify potential ways clients are unintentionally participating in their loved ones’ substance use, and to possibly help them cope with the loss of potential sources of reinforcement when their loved ones reduce or stop using.

In my next post I’ll continue the discussion on functional analysis and discuss how to use the Functional Analysis form, a worksheet that is commonly used when conducting functional analyses in CRAFT.

References:

Smith, J. E. & Meyers, R. J. (2004). Motivating substance abusers to enter treatment:  Working with family members. New York:  Guilford Press.

• CRAFT