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The cost & courage of caring - stories that spark resilience.
Welcome back to the Caregiver's
Podcast.
I'm your host, Dr.
Mark Ropaleski, and you can call
me Dr.
Mark.
Before I begin today, please take
a moment to subscribe or follow
the Caregiver's Podcast wherever
you're listening or watching.
It's free and it really helps
support the show.
It helps these conversations reach
more caregivers and families who
are really trying to protect
someone they love.
When we think about caregiving, we
often picture someone caring for a
parent with dementia,
a spouse with cancer, or a family
member living with a serious
illness.
But addiction creates a different
kind of caregiving.
The person you love may lie to
you, they may disappear, they may
promise they're done and then
relapse.
They may need help and reject it
all in the same conversation.
And that can put families in a
painful position, loving someone
they can no longer fully trust.
Somewhere inside all of that, the
person trying to help starts
living with impossible questions.
Am I helping?
Am I making this worse?
If I say yes, am I enabling?
If I say no, will I regret it for
the rest of my life?
Families are often told to set
boundaries, stop enabling, detach
with love, or let someone hit
bottom.
But those phrases can feel very
different at two o'clock in the
morning when your loved one is not
called back and every part of you
wants to do something.
Our guest today is Dr.
Nicole Kosanke.
Nicole is a clinical psychologist
and the clinical director of the
Center for Motivation and Change,
and co-author of Beyond Addiction,
How Science and Kindness Help
People Change.
But today, this is not a training
episode about addiction management
and treatment.
This is a conversation about the
people who love someone with
addiction,
the fear they carry, the broken
trust they live with,
the guilt they feel, the rescue
patterns they get pulled into,
the grief of losing someone who's
still alive,
and the possibility that you can
love someone deeply without
disappearing inside their illness.
Nicole, welcome to the Caregiver's
Podcast.
Dr.
Nicole Kosanke, welcome to the
Caregiver's Podcast.
We're so happy you're here to join
us from New York City today.
Thanks so much for having me.
Well, in the tradition of the
podcast, we like to jump right in.
So let's do so.
Nicole, can you tell us, when
addiction enters a family,
how does everyone else begin
organizing their life around the
person using,
often before they even realize
what they're actually doing?
Well, addiction doesn't pop into
being sort of out of nowhere.
There's usually quite a long
period of time where things are
getting worse and better, worse
than better.
There's sort of an evolution.
And with that, the relationships
among family members are also
shifting and accommodating in ways
that are not so helpful
or sometimes helpful during
periods.
But it's usually quite gradual.
And so people don't have
necessarily an awareness that one
thing is causing another thing.
They're just sort of adapting to
the circumstances.
And oftentimes, you know, if you
have parents who have adult or
teenage children who are
experimenting,
let's say there can be an initial
feeling of like, okay, maybe
there's some normalcy to this.
Maybe it's developmentally
appropriate.
Maybe pushing boundaries is part
of growing up.
And then if things get worse, and
then over time, more and more
problems are developing,
then it sort of like impacts the
family more and more.
And so it evolves over time.
But ultimately, if things really
are developing into a problem,
then you have everybody sort of
being impacted.
What are the early signs then that
the addiction has sort of decided
what family and caregivers
actually say
or what they avoid, what they'll
pay for, or how safe they feel in
the home?
Yeah.
So, I mean, I think the early
signs are oftentimes partly about
accommodation that feels maybe
initially
like I'm putting myself out in
ways that feel like, okay, well,
this person needs my help.
And so I am the parent, so I'm
going to go ahead and help them.
And then if that feels more and
more like it's encroaching upon
normal functioning of the family,
of my own well-being, if I feel
like my boundaries are getting
extended too far as a parent,
that the asks of me to function
more and more in ways that my
child or adult child can, should
be able to do for themselves, then
those are signs that people are
adapting to a substance
problem that in not-so-healthy
ways.
But initially, of course, parents
in particular are eager to help
their kid.
That's been their whole role,
their, you know, the child's whole
life.
So it makes a lot of sense
initially.
So it's not immediately a parent,
nor is a substance use disorder
immediately a parent.
It evolves over time.
How's that different when the user
is a spouse, for example?
So, I mean, all of these different
roles make a huge impact on how
things roll out and how
the roles get impacted.
So a parent and child, as I was
just saying, like, really, it's
sort of inherent in the
relationship.
I, as a parent, am helping develop
this person into a human being,
and I have more responsibility
to sort of guide them, whereas I,
as a spouse, expect that my spouse
is going to be a peer
with me and is going to help me as
much as I help them.
And there's some kind of equal
back and forth about this.
So when there is increasingly not
a parity around who's responsible
for what and what
the roles are, then that can
begin, those are certainly early
warning signs of this is
not healthy.
There is something really
unhealthy going on here.
But, you know, in many caregiving
situations, we witness the illness
and how it changes the
person you love.
But with addiction, the illness
can also break trust.
What happens to a caregiver when
love and distrust have to live in
the same relationship
in the same room?
Yeah, it can be very devastating
and painful to care about someone
that you can see is suffering,
that you too are suffering, and
there is often lying involved.
And, you know, a person with a
substance use problem is often
hiding from themselves as
much as they're hiding from other
people, trying to imagine that
what is happening is normal.
And to be fair, or I don't know if
it's fair, but, like, to be clear
about, like, the societal
role here, like, there are many
groups of people that in which
using substances, drinking heavily
is the norm.
And so, you know, there may be a
long history of thinking, okay,
well, this is how my family
does it.
This is how my people do it.
This is how my group of friends do
it.
And so it doesn't feel that
different.
Maybe it's causing more problems,
but that'll probably go away.
So there's a lot of sort of
rationalizing, depending on what
the social environment is,
depending
on what the history is.
And that can cause real problems
in relationships when it feels
like you're perceiving something
that feels, like, off, but the
person is saying, no, no, I
haven't been using, or no, I
haven't
been drinking.
And then you begin, over time, to
realize, like, wait a second, this
is not what's happening.
There's more to the situation that
I suspected, but I didn't know for
sure.
So I think there can be a lot of
divides in the relationship that
is quite painful and evolves
over time.
So how does that broken trust
change the way a caregiver
listens, watches, checks,
questions,
reacts to the person they love?
Right, right.
I mean, exactly, exactly what
you're saying, that there is a
shift over time of the person
using substances becoming less and
less functional over time.
And the person who cares about
them, the caregiver, being more
and more functional, like
over-functioning,
doing more of the
responsibilities, taking over.
And sometimes this is a safety
issue.
You know, the parent who is a
caregiver is doing all the
driving, is, you know, picking the
kids up, is doing more of the
cooking or cleaning or what have
you, because it seems like their
partner is just, like, kind of
falling off.
And sometimes that is immediately
apparent, you know, that this
inequality of roles and
responsibilities are occurring.
And sometimes it's not because
people go through waves of feeling
like, okay, well, I'm doing
this more now and the other person
isn't.
So I think that in general that
this over-functioning of the
caregiver is really hard on the
caregiver
and is eventually a problem for
the person using substances as
well, because they have fewer and
fewer responsibilities and they're
feeling more and more like their
role in the family or in the
relationship is becoming less and
less important.
So I just wanted to get back to
one point because it really
intrigues me.
So before the addiction crisis, so
to speak, that makes everything
undeniable, many families
live through like a long period of
that suspicion and worry and
making up of excuses and dealing
with broken promises.
What does that slow erosion
actually do to the caregiver who
feels something wrong, but
they just can't fully name it?
Yeah.
I mean, I think it makes people,
the caregiver, less confident
about their own perceptions.
And sometimes it can increase the
caregiver's feeling of...
Support, certainly support from
others because they are feeling
more and more alone.
But if they're not able to trust
their own perceptions, it's hard
to ask for help around
that.
It's hard to identify what's
really wrong if you are thinking,
well, maybe this isn't really
what I think it is or what is it.
Meanwhile, you have the entire
culture around us emphasizing that
this is kind of a moral
problem.
Like, this is a weakness and
there's such stigma and pressure
of that stigma that it's very hard
to go outside of the family and
ask for help or even within the
family to express concern.
And people start talking around
the problem because it feels like,
to name it, would be
indicting the person with this
problem.
But also, the caregivers and the
family around them are sort of
guilty by association.
It almost sounds like there's an
element of cognitive dissonance
during that phase where
you're sort of negotiating with
the different thoughts and
perceptions of where this is going
or where it may lead and the
circumstances that may lead to
everything just getting reframed
with a new lens as you just put.
But does that period set families
up to blame themselves later
because they look back and
wonder, like, what did I miss?
You know, look what we excused,
what behaviors we permitted.
What should we have controlled
sooner?
Yeah, I mean, I think any time,
whether it's a substance use
disorder or a psychiatric problem
or other really bad habits, let's
say gambling, et cetera, anything
along those lines,
behavioral problems, certainly
parents end up looking backwards
and going, okay, what just
happened here?
Like, could I have averted this?
Like, was this inevitable or did
it have to do with that one time
that I did this or that
or, you know, that vacation we
took and I allowed them to do
things I wouldn't have normally?
And you sort of, like, try and
make sense of it.
I think the human brain is always
trying to make sense of, like,
where's the storyline?
What's, how do I make sense of
this situation?
And so it's quite natural to be
doing that.
At the same time, it's quite
detrimental to spend a lot of time
in the past in regret, in worry,
in doubt, in self-incrimination of
what I could or should have done
differently.
And depending on the circumstance,
some people are more likely to
dwell there than others,
depending on how much
responsibility you felt in the
past, how much responsibility you
feel now,
how bad it has gotten, all those
things, like, influence how much
people are really
getting stuck in the past instead
of moving forward and, like, okay,
what can I do differently now?
While all that thinking is going
on, though, the family caregiver
can also start becoming the
investigator,
the banker, the crisis manager,
the peacekeeper, the person who's
absorbing everybody else's
emotions.
And how does that, how does
addiction slowly replace the
ordinary role of the parent,
spouse, sibling, or adult child?
Yeah, I mean, I think what you're
describing of the different roles
is exactly what happens,
is that the caregiver ends up
taking over all of those things
because no one else is doing it,
because the person who's
increasingly consumed in a
substance or alcohol is lost, is
absorbed,
and so there are needs of the
family, of the relationship that
continue on.
And so, yes, the caregiver is
taking over in all these different
ways.
And when you have one hat is,
like, I'm the banker, another hat
is, I'm the, you know, parent,
I'm the cook, I'm the person who
checks the car, is, you know, up
to date, and like,
if you are carrying more and more
different roles around, the
overwhelm increases, obviously,
but also there is less and less
intimacy and fun that might be
involved in the relationship,
let's say in a peer relationship,
siblings, partners, spouses, et
cetera.
Like, there's less and less of the
sort of connective tissues of
intimacy that really help
relationships bounce through
difficulties.
So if we're having to do all of
these, you know, really focused,
administrative,
responsibility-focused activities
as a caregiver,
we're getting less of the sort of
juice and refilling of the tank
that we need in order to feel like
we can be resilient through these
difficult times.
I mean, a lot of that applies to a
lot of caregiving scenarios that
we hear of.
But how does a parent, spouse, or
sibling, or even adult child know
that they've crossed that line
from loving someone
into living as the emergency
response system for that person's
life who's living with addiction?
Yeah, I mean, we have very
dangerous substances in the world
right now.
And, you know, that's always been
true.
People have always, you know,
overdosed.
There are very famous people that
are out in the world who overdosed
many, many years ago.
So it's not like there's some new
substance problem.
But there are new substances, and
they are lethal.
And when you are a caregiver and
you realize that that's a risk
that your loved one is taking,
then it's natural to have the
concern that this is something you
should be paying attention to,
since they are not, apparently.
And so, you know, it would be
different if you had a loved one
who was using substances
and coming home and saying,
I'm going to be sure and bring my
Narcan with me because, you know,
I do want to be,
I can't stop using right now, but
I'm going to make sure that we
don't die.
My friends and I don't die when
we're in the process of using.
I would be a very responsible
person in a certain way.
It would be still risky.
But usually somebody using
substances, part of the deal is
that there is such a compulsion to
use
for all the reasons.
You know, it might be obliterating
the negative internal experience
that someone has that they're
trying to get rid of.
They're trying to escape some kind
of psychiatric issue.
Lots of different reasons that
people develop these problems.
But for whatever reason, the
compulsion is so great that the
downsides are really minimized,
both intellectually and
practically.
So they aren't walking around with
Narcan necessarily.
So, of course, the caregiver is
starting to take these things more
seriously.
And honestly, I think the
caregiver is in a clearer state of
mind to be thinking about the
possible
downsides, the possible risks, et
cetera.
So I don't think someone ever
stops.
There isn't like a dividing line.
I'm loving this person.
And now I'm the, you know,
emergency response system.
I think the two go hand in hand.
There is an emergency response
urge because you're still loving
the person and because you're
worried
and you have more sort of
cognitive resources because you're
sober, that you're not, that
you're aware of the risks in a
different kind of way.
But it doesn't make it like a fun
experience to be constantly aware
of risks that your loved
one seems to be not taking as
seriously as you are.
Well, between that and just all of
the newly assumed responsibilities
and roles and hypervigilance
and then that emergency role that
becomes a hat that's probably worn
more often than not
in terms of just being on the
lookout for what could be around
the corner.
You can understand that many
caregivers just feel exhausted,
angry, terrified and guilty all
at the same time and yet feel
ashamed for feeling that way.
I mean, why does loving someone
with addiction create so many
conflicting feelings all at once?
Well, I think that there's a lot
of explanation around the way our
culture at large thinks about
these issues because if we thought
about substance use disorders as a
medical problem that had a medical
solution and there were treatments
available that people felt like
they could go to without being
condemned and critiqued on a moral
failing level, I think we'd be in
kind of a different
scenario.
I think it would not be the kind
of conflicted environment that
caregivers find themselves in.
So if I'm a parent with a teenager
smoking pot and I don't know what
to do about that,
I might talk to the pediatrician,
ask them.
They might tell me, go to Al-Anon.
You should, you know, cut off
their money.
You should let them hit bottom.
There's all sorts of actually
completely opposite pieces of
advice that caregivers are given.
You should have an intervention or
you should let them hit bottom.
So if there's like these vastly
polarized responses that society
and individuals that are meant to
be
helping caregivers give that
advice that are so different, it's
pretty confusing.
And it ends up, I think, for
caregivers feeling like maybe this
is on me.
You know, maybe I created this.
In fact, many times, you know,
professionals end up, I'm sorry to
say this as a professional myself,
but I do hear these stories all
the time that caregivers feel like
they were actually directly
told that they were at fault, that
they should be doing this or that
or the other thing.
So there's a lot of pressure on
caregivers to feel like they are
responsible.
And so all these conflicted
emotions that you're describing
and that make a lot of sense based
on all the pressures we've been
talking about so far, like those
feelings get intensified when
you feel like it's all on you and
likely you did something wrong to
cause this.
Well, some of that controversial
advice, which you might yourself
argue is antiquated,
kind of makes the caregivers feel
responsible for the outcomes in an
environment where really
they didn't have the control to
steer the outcome.
Is that, am I heading down the
right line there?
Yeah.
I mean, that's what I would say is
that there, it is antiquated
advice and it's very condemning
of, of caregivers when they're
really in a really difficult
position that deserves a lot more
guidance and support than we tend
to give people in these
situations.
It's, it's, it's very painful to,
to hear the stories that I have
heard where caregivers
are seeking out support and they
end up getting a lot of blame.
So that's very different from the
CRAFT framework that you were an
important contributor to
developing
and framing.
And it's certainly very present in
North America and I'm sure around
the world.
maybe you could introduce the
listeners to that as, uh, I think
it's a good that we get
that sort of on the table because
I think that's really important.
Yeah, sure.
I mean, CRAFT is, is an approach
that is specifically designed to
help caregivers, it's, which is an
unusual therapeutic approach,
right?
You would normally have a
therapeutic approach that's
targeting the person with the
problem.
Patient-centered, yeah.
And so this is targeting the
caregiver, like what can we do to
help you?
So CRAFT stands for Community
Reinforcement and Family Training.
And it's been around a long time,
has so much solid evidence that
they don't even study it anymore.
It's very well-established
research-wise as being super
effective.
And when I say effective, I mean
that it helps people to feel
better, their well-being improves,
and, uh, and it helps get the
loved one into treatment.
So those are two things that
people really want, right?
There is, there is a disconnect
sometimes with, I go to ask for,
what do I do?
My kid is doing this, or my spouse
is doing that.
What should I do?
And the answer is often like, go
to a support group for yourself,
in which you'll learn how to take
care of yourself.
And really, I want to hear, how am
I going to get this kid into
treatment?
How am I going to get them to
agree to treatment?
How am I going to try and reduce,
how do I respond to them when
they're upset, or they're telling
me they're going to use again?
Like, what words do I use?
And so those kind of support
groups aren't going to help with
that.
But CRAFT is an approach that
really does address that.
So the approach I use actually is
called the invitation to change
approach, which pulls from CRAFT
and acceptance and commitment
therapy and some CBT and
motivational interviewing.
A lot of gobbledygook psychology
words, but basically the
invitation to change approaches
pulls from those strong
research-supported therapeutic
models and specifically is
targeting the kinds of things that
parents and spouses usually want
to hear.
What do I say?
How do I say it?
What am I going to do to manage my
own unwellness in this process so
that I can be a better caregiver,
so that I can, you know, manage
this crisis situation?
So I think it's important for
people to know that there are
alternatives and there are things
that they can do that are very
concrete and actionable.
I mean, when you love someone and
that person's living with
addiction, rescue can feel like
the most obvious form of
caregiving.
But why are love and rescue not
the same thing?
Yeah, I mean, rescuing, if you
have somebody who's standing on
the edge of a cliff, you want to
pull them away from the cliff.
And we would call that rescuing.
But if the person is, you know,
getting into their car with, you
know, a glass of wine or weed or
whatever it is, are you going to
take the keys away?
Do we call that rescuing?
I think rescuing can encompass a
lot of different things.
And what we don't want is for
caregivers to walk around 24-7
feeling like their only role is to
be following around and putting
bubble wrap around their loved one
to try to control what is not
within their ability to control.
Why do we not want that?
First of all, it doesn't work.
People don't respond well to that
kind of effort around controlling
and rescuing.
But secondly, you're eviscerating
your own life.
You're throwing away your own
goals on a day-to-day level, on a
macro level.
So we don't want people to be
constantly in the role of
rescuing.
But I do think that there's a
place for that.
You know, I work with a lot of
families and parents will tell me,
well, I simply can't allow X, Y,
and Z to happen.
That's a mortal risk.
But they could actually lethal.
They could be in a lethal
situation.
And so in those situations, yeah,
we are talking about how to
rescue.
We are talking about how to be in
a position where you are
preventing really potentially
lethal situations to occur if you
can.
You can't always do that.
And in most situations, you can't
adopt that as a way of life.
It's just not effective.
Do you think that rescuing
actually becomes the caregiver's
way oftentimes of just calming
their own inner terrors, even when
it may not actually help the
person they love?
Yeah.
So there are many situations where
I think that caregivers end up so
terrified about the risks being
taken that regulating that
emotional experience is really
challenging.
And the increasingly, the
increasing challenge of that
regulation causes them to do all
sorts of things that are not
helpful to them or anyone else.
You know, staying up all night,
for instance, waiting for their
loved one to come home or worrying
about whether or not they're going
to come home or tracking them on
their phone, et cetera.
None of those things are
increasing the health and safety
of their loved ones.
But it's pretty tempting to do
when you're filled with anxiety
and doing something, even if it's
just worry, even if it's just
ruminating, feels better than
doing nothing.
And oftentimes people can't sleep
anyway during that.
So that's an example of figuring
out how to assess what can I do,
what's under my control to do.
And that's a question of, like,
how can I have an influence?
But it's also a question of how
can I have an influence over
myself?
How can I make sure that tomorrow
morning, no matter what is in
front of me, I'm actually going to
be resourced enough to be able to
do something about it for myself,
for my family, for my loved one?
And what does that look like?
Does that mean taking a hot bath
and meditating and calling a
friend or, you know, playing a
stupid game so I can distract
myself?
Is it kind of self-regulation
stuff?
Or maybe it is like getting in my
car and going to get them and
bringing them home.
That might look like rescuing, but
it might be the best answer if
that's actually going to help the
situation.
If you know your loved one will
get in the car with you when you
get there, that's different than
you knowing in your bones, if I
get there, he's just going to
scream at me and this is all for
naught anyways.
Then that's an individualized, an
example of an individualized
variable that really impacts and
influences whether you take one
path or another.
I really hear influence as being a
big word, a big driver of the
framework here.
Correct me if I'm wrong.
Yes, absolutely.
I mean, because control just isn't
a thing we get to do with other
people.
And sometimes we wish that we
could, but it's not a long-term
strategy.
It might be a short-term emergency
cutoff found, but it's not a
long-term strategy.
Long-term strategies involve
really shifting dynamics and
increasing healthy habits over
time.
And they're about small behaviors,
changes.
They're about reinforcing
healthier behaviors, healthier
relationships, healthier
communications.
It's like a lot of small pieces
adding up to a larger wave of
health.
It sounds like a fertile ground
for individuals with addiction who
want to take a stride to actually
feel that it's a place where they
can actually initiate change.
Yeah, I mean, the thing that
happens with substance use is that
when you're really deep into
problematic behaviors, it's very
hard to imagine how it would look
differently.
And so the family does have the
ability to be kind of a beacon of,
like, this is what healthy
behavior looks like.
It looks like this, and we're
going to invite you sometimes to
it, and it looks like this, and
we're going to keep doing those
healthy behaviors.
We're not throwing our entire
lives out the window while we're
focused on you, the problem.
We're continuing to go on
vacation, exercise, make healthy
meals, talk to each other in kind
ways, elicit emotions, talk
through problems, et cetera, as a
way of being a beacon for, like, a
healthier way of being.
And that's quite meaningful.
Role modeling is really helpful.
And it's not necessarily,
sometimes people think, well,
isn't that obvious, you know,
isn't it obvious that these ways
of being are easier and better and
healthier?
It's not necessarily the case that
it's so obvious.
And it's certainly not the case
that someone deep in a problem
believes they can get there.
So continuing to offer, invite,
role model is super helpful.
And getting back to something you
mentioned a little bit early,
families who love someone with
addiction are often told, don't
enable them.
But that word can really haunt
every decision that a family
caregiver loves someone who's
dealing with addiction faces.
So like the money you give, the
call you answer, the door you
open, is enabling really still a
useful word in 2026?
Or has it become just too loaded
to actually keep caregivers
thinking clearly as they're trying
to navigate all this?
Well, you're asking me, so I'm
going to tell you that I do think
that it's really outdated.
As I also think that the word
codependency is outdated.
These are words that I think make
people feel really bad and make
them worried, like we were talking
about earlier, about having caused
or created problems in the
relationship.
Make them feel like they're sick
for just caring about their loved
one, that there's something
maladaptive about that.
And I think that it's really not
helpful.
On the other hand, sometimes I'll
use the word enabling in the
positive sense, like because
there's often an understandable
but overemphasis on the problem
behavior.
So we all understand that drinking
a liter of vodka a day is a bad
idea, bad for your body, it's
causing all sorts of problems in
the family, etc.
No-brainer.
But the question of what would
this person be doing if they
weren't doing that?
What are the healthy behaviors
that we could enable?
What could we invite this person
to be doing?
What could we support when they do
do it occasionally?
When they do not drink one day or
for even one hour, how can we
support and encourage and
reinforce those things?
That is a kind of enabling, right?
You're enabling something.
But the way that our culture
usually uses that word, I think,
just ends up making people feel
responsible and bad in ways that
are neither, they are neither
should be responsible nor bad
about their loved one's behavior.
And I think that refocusing to
what are the positive behaviors
that you want to see more of that
would replace this thing, then I
think those are really helpful
ways to focus caregivers'
attention.
I'm sure this has come up in your
experience, but when a family
member says, I gave them $40 for
groceries, but now I'm wondering,
am I enabling?
How do you help them move past
that sort of label and understand
whether that choice actually
helped, harmed, or changed
anything at all?
Yeah, that's a great example
because, yes, it does come up all
the time that there's, whether
it's I gave them $40 or I paid
their rent or I made them
breakfast or I gave them a ride to
work.
Those are all things that I think
the answer to whether or not they
were healthy or unhealthy
behaviors is what happens next.
So you gave them $40 for
groceries.
Did they spend it on groceries?
Do you know in your bones that
they're not going to spend it on
groceries?
Do you have any reason to believe
that they're really going to feed
themselves with this money?
Do you think that them keeping a
roof over their head when it comes
to paying rent or something is
better for them because being
unhoused is going to create all
sorts of other problems?
I mean, I think those are the
questions that help you assess a
decision and what you want to be
doing moving forward is what
happens next?
What do you know?
Caregivers know a lot.
Caregivers know a lot about their
loved one.
They know about how they think,
what motivates them, what their
habits are.
They have tons of information.
And in the invitation to change
approach, we use something called
a functional or behavior analysis
where we really like write out all
the things the caregiver knows
about their loved one's behavior.
What motivates them?
What's, you know, what do they
think the consequences are?
What are the situations that
they're likely to use and what are
the situations they're likely to
not use and what are the healthy
behaviors we want to increase so
that people really have a roadmap
for understanding, okay, this is
how I'm going to assess whether or
not I want to give $40 for
groceries.
This is how I'm going to assess
whether I want to pay for rent is
by looking at this kind of roadmap
and thinking through for my loved
one specifically, not just people
in general.
What I know about my loved one, is
this a good idea?
Can it start to feel like the
recovery, relapse, or survival of
a loved one really depends on what
you as a caregiver do next?
How do you help them separate what
they can truly influence from what
they just can't control?
Is that where, in addition to that
analysis, CBT comes in, like where
you really get people to reshape
their thinking approach to the
scenario?
Can you expand on that?
Because I know you alluded to
several approaches that you use in
your adaptation of the framework,
but I think it's important for our
listeners to understand that.
Yeah, so, I mean, you're
highlighting, like, how to make
decisions in the here and now, how
to assess whether or not there is,
I mean, to me, I focus on,
understanding.
So, how do we understand what this
behavior, what is the function of
this behavior that we find so
upsetting, right?
Whether it's alcohol use,
gambling, sexuality, like,
whatever is being compulsive and
negatively impacting, the family,
the relationship, like, how do we
understand why this is happening?
So, we think of substance use
disorder problems as a
biopsychosocial problem.
It's not just, you know, like,
genetic.
They were always meant to be that
way.
We know that's not the case.
There are plenty of people with
big family histories of substance
use problems that don't develop
problems.
So why is that?
Because it includes all of these
other elements.
So once you have a better
understanding of what the function
of the substance use is, then you
can focus yourself in a more
productive way around kind of
creating game plans for yourself
around, okay, now I understand my
husband is using marijuana because
of anxiety.
So I can educate myself about
anxiety.
I can talk to them about anxiety.
I can think about what are
solutions for anxiety that I can
then make a game plan about how to
speak with him about that.
That is sort of getting underneath
the problem and sort of directing
the caregiver's attention to the
thing that could be most
impactful.
Having said that, you know,
there's a lot of ways that people
can get derailed into focusing so
much on problem solving that they
ignore their own needs.
And I think that's really the
balancing act that we're always
dealing with.
How do I continue as a caregiver
to pay attention to and take
seriously my own needs and do
what's under my control to do to
influence change?
And always balancing those two
things.
It's like the example of putting
on your oxygen mask on the plane
before you help your partner.
That is not human nature when
you've got a kid sitting next to
you or somebody who's disabled.
You're going to help them first,
right?
Or some people might be their
nature.
But I think the reason why we have
to say that to people on every
plane that anyone gets on to is
because it is important to
remember to do that.
And it's not necessarily your
first impulse.
And that gets played out in these
kinds of relationships all the
time.
Are you putting on your own oxygen
mask first?
Because you're going to be a
better thinker if you do that.
You're going to be a better
problem solver.
Oftentimes when I'm working with
caregivers, they don't really hear
the rationale of just attending to
their own needs as being the most
important thing.
They hear the rationale of like,
okay, if I take care of myself,
I'll be a better caregiver.
That feels like it holds more
water.
Now, that might sound kind of
distorted, but the fact is they've
been living with a house on fire.
So it makes a lot of sense that
they say to me, as they often do,
listen, I know how to take care of
myself.
I will do that eventually.
But this is the real problem.
This we got to take care of.
We got to get him into treatment.
Then, yes, yes, I can do all the
things to take care of myself,
which is understandable.
But we want to try and shift
people around so that they really
take seriously their own needs.
Because that can just compound in
itself as well.
And then before you know it, there
is no self-care and it's
perpetuated.
Then again, sometimes you pull
down the mask, then, you know, it
almost sounds cartoonish, but
you're holding the mask.
Then you see that the oxygen line
come down and there's no feed.
There are all kind of variations
to that theme.
It pops up in so many
conversations.
But when you pull down the mask,
it almost symbolizes a sense of
control.
But can you tell us from your
experience working with
caregivers, why is it so painful
that you can develop and even have
influence, but you don't have the
ultimate control over whether
someone with addiction actually
gets well?
I mean, I think it depends on the
person, but I do think that when
you care about someone, your fate
is attached to theirs.
And when you see them not taking
care of themselves at baseline and
maybe really risking their life,
then they're really, you're going
down with them in some ways.
So it feels like a shared outcome,
a shared fate, and you can begin
to detach from that as some people
need to do.
But I think most people get into
relationships because they want to
be linked.
They want to have a shared
reality, a shared future.
And that's a pretty natural human
wish.
So, of course, the fates are going
to feel linked and pretty
important to focus on the problem
and solve that problem.
Even though it's technically not
under your control, it feels like
it's having a big influence over
your life.
Getting back, again, it really
intrigues me, because you touched
on this earlier, but many families
have been told to, you know,
detach with love or let someone
hit the proverbial bottom.
But when the person you love could
die from use, those ideas can
actually feel pretty unbearable,
especially today when substances
are, in many instances, more
dangerous than others.
Or how does that reality change
what it feels like to try to set a
boundary?
So a couple of things that come to
mind with that question.
I mean, first of all, you know,
there are these very obvious ways
that there are high-risk
substances and, you know,
potentially lethal outcomes.
And then there are these slower
burn problems that we're learning
more about now.
For instance, cannabis is legal in
however many states now.
Even though, supposedly, you're
not meant to be able to buy
cannabis as a teenager, still in
every state that passes them,
passes it being legal, the rates
of teenage use go up.
Because that's what we're role
modeling, the availability,
access, all that stuff increases.
So that use of cannabis at teenage
years is linked to greater
problems down the road in a
variety of ways that we wouldn't
necessarily anticipate.
In terms of executive functioning,
in terms of increased risk of
psychosis, these are things that
it's not necessarily evident,
especially for parents who have
had their own experiences with
cannabis potentially at a lower
dosage level, intensity, etc.
So their image of what that is, so
their image of what that is, is
quite different.
So I use that as an example
because there are ways that
substances are now in the
zeitgeist of our world that appear
normal or part of normal
adolescence, which are going to
have a really negative impact for
a certain number of people.
And we can't predict that exactly,
but it's going to happen.
And so the parent that is coping
with that is really in a tough
position.
How do they treat this like an
emergency, treat it seriously,
whilst the entire world around
them is saying, this is like kind
of normal, it's legal now.
You know, these kids are doing
this, it's not a big deal.
And yet we know that there are
these risks for kids.
Is it going to be every kid that
smokes weed that ends up with a
psychotic problem?
A hundred percent not.
But it is a bit higher risk.
So it's a matter of like how much
risk are you willing to live
within your family and what
boundaries are you going to put in
place?
How are you going to communicate
the importance of this and what
your values as a parent are while
not making the kid feel like she's
really out to lunch?
Like that, that's all my friends
smoke.
So I don't know what she's talking
about.
Like that is a really tough
balancing act.
Well, seeing that if you start at
15, that's 10 years of brain
development, that's still a lion's
door.
And I think that's a big unknown.
Absolutely.
At the other end of the spectrum,
what do you say to a parent,
spouse or sibling who's so afraid
that the next boundary they create
would be the last thing they ever
say to the person they love?
Yeah, yeah, that's so tough.
And that really the whole approach
that we use, the imitation of the
change approach is really so
useful for this very question
because you are paying more
attention to the quality of the
relationship, the way in which
you're talking to each other, the
words you're using, open-ended
questions, attending to
validations.
What you can, reinforcing the
positives, you're really enriching
the relationship in order to have
more leverage when you need it in
setting limits or boundaries or
making requests, etc.
And all of that makes you feel
much more grounded in what you
might say at any given moment.
And to your point, when you set a
limit and you know that someone
might then go off and use
something that is potentially
lethal, you want to be really
grounded in what you've been doing
with them in the relationship.
You want to have spent a lot of
time thinking about your values
and what matters to you most so
that if the most horrible thing
that any parent can imagine does
happen, they have a sense of, I
did what I felt was the most
important thing to do.
I focused on my values, I focused
on my values, I enriched the
relationship in the ways that I
could, I used all the skills that
I could to manage this, and this
is what I thought was the right
thing to do.
But they had a path, they had a
rubric, they had a game plan that
was really based in their own
values, that was an action plan
they could endorse.
And then, of course, tragedy
happens.
That's part of these problems.
Is your adaptation of the Kraft
framework over time actually
reflected by the changes in the
potencies and different drugs that
are out there?
I mean, has Kraft had to have been
reinvented a little bit along the
way to adapt for 2026?
So, the adaptations that we made
to Kraft were really designed to
help family members have a greater
awareness of what motivation is.
Like, how do we understand
motivation?
What is the function of substance
use?
What is the nature of treatment in
general?
How do you think about treatment
and fit that into what your goals
are?
Because oftentimes people have a
clear sense that their loved one
needs treatment, but what does
that look like?
What are the options?
What should I, if I have like one
chance to get this person to agree
to do something, I want to get the
best scenario in place.
And the way to do that is to think
about what is motivating your
loved one to use in the first
place.
What are the underlying problems
so that we can sort of have a
motivational hook, we would call
it, that the person using
substances would actually agree is
meaningful and worth paying
attention to.
So, if they think anxiety is the
problem, then we're going to have
a better chance of getting them
into treatment that addresses that
anxiety.
I read so many comments on your
loved one to use in the first
place, I read so many comments on
our social media and there's so
much concern among caregivers in
different domains about just the
ability to self-care or the
system, the environment.
The situations don't really create
a permissive space for self-care
for so many reasons, but here it
seems to be and play an important
place.
So, what does self-care actually
mean at two o'clock in the morning
when someone you love is living
with addiction and they may not
have answered the phone or they
may not have come home and your
body is telling you something may
be terribly wrong and every
instinct is telling you just do
something?
So, what does self-care mean in
that moment?
What can it be?
Yeah.
So, I think it really depends on
the person and the circumstance.
And to me, one of the big pieces
to incorporate into any answer to
questions like that is compassion.
Like, do you have compassion for
yourself enough to be able to
distract yourself?
Are you?
And do you have a sense of like,
okay, I walk around in the world
feeling in my bones like something
terrible is going to happen.
This is no different.
It's two o'clock in the morning.
It's five o'clock in the morning.
It's noon.
I always feel this way because my
loved one is doing some dangerous
things.
That's a very different
circumstance than like, I woke up
in the middle of the night and I
have a really bad feeling.
And that bad feeling is maybe
based on sort of subtle things
I've noticed over the last week
and the shifts in their behavior.
And it actually is information
that I should act on, that I
should text them or call or do
something right then and there.
That, I think, is about really
assessing.
That's a self-assessment, right?
Asking yourself, okay, what's
happening here?
Is this how I always feel?
Is there something different about
this?
And how, to me, an action plan is
self-care.
Because you are figuring out how,
what can I do in this moment
that's going to be helpful and
what do I need?
What do, what is my body telling
me that I need?
Is my nervous system completely
shut?
And really what I need is to get
into a hot bath or a cold shower,
like shock my body into feeling
differently?
Or do I need to, like, cuddle with
my partner?
Do I need to get some oxytocin to,
like, calm my body?
Or do I need to actually do
something?
And oftentimes the doing isn't
really the answer.
But sometimes it is.
It really depends on the person
and the circumstance and how
you're assessing for yourself.
I know what the situation is.
I have more information than
anyone else about the situation.
So let me ask myself, what are the
variables?
Is there something that I should
do?
People don't always know the
answer, but oftentimes there are
some answers in there if you just
pause and breathe and ask
yourself.
So invitation to self-explore
those moments and find some
things.
We're going to take a little
break, folks, and hear from our
illustrious production team who
always have a couple of good
questions for our guests.
One of the things that we've been
sort of talking sort of a little
bit around in terms of the word
influence is, I think, cultural
influence and the impact that the
broader culture is having on
addiction.
We've seen, you know, obviously
we've seen smoking and alcohol use
be normalized across films and
television, you know, glamorized
for sure.
If you've been watching sports
lately, all of the sports
broadcasts have been taken over
with gambling promotion.
They're now giving you the odds,
you know, in the break so that you
can make those bets.
You know, pornography we've seen
also explode and become
normalized.
I think it was Pornhub that did a
mainstream advertisement campaign
on television.
I think it was Thanksgiving a
couple of years ago that's come
out and it's all over social
media.
So how do these, how does culture
itself impact these issues in
terms of opening up the doors and
inviting people to come in to
potentially incredibly addictive,
I guess you could say they're
addictive products or addictive
behaviors.
And is that treated differently in
your profession than substances
are?
Great question.
Big question.
Big question.
So I think that everything you're
describing is super important.
In my field, what we are
anticipating, unfortunately, is a
tsunami headed our way in terms of
gambling.
It is profound.
What you're describing of, you
know, many people have been
watching basketball, soccer, all
these things.
And it's everywhere, everywhere.
You can't avoid it.
And, you know, kids are seeing
this.
Kids are absorbing it.
Forget about that.
Forget about that.
You also have, like, video games
that are gamifying gambling and
bet on this or bet on that.
It's embedded in video gaming now.
This gambling sort of way of
thinking and integrated into their
games.
So it is completely being
normalized.
And I think it's only a matter of
time before we're going to see,
like, a huge, huge problem.
And the thing about gaming or
gambling is that it's sort of
invisible to the rest of the
family until it's not.
So there can be a huge negative
impact that is just, like,
slamming into a brick wall that
you really don't see it at all, at
all, at all.
Maybe the stress is increasing and
you're not sure what you're
seeing.
Why is he so stressed out?
What is happening here?
Like, why is he so worried about
this game on, you know, that kind
of uncertainty?
But you're not seeing them
intoxicated.
They're not disappearing places.
They just seem distracted a lot of
the time.
So people don't even know what
they're looking for and they don't
know what they're seeing.
So then a big bet is lost and,
like, potentially really big
problems are impacting the entire
family.
So there is no question that this
is coming for us as a society
because we've opened these doors
in advertising, social media, all
the things you're describing.
So how do we deal with that?
I personally feel like we are not
at all prepared for how this is
going to impact our society.
And I fear for everyone at large.
I feel for kids developing this
idea that this is normal.
And I think that to get ahead of
it, we really need to be paying
attention, really noticing how,
like, for instance, I used to talk
with parents about, like, just be
aware of how you talk about your
stress level.
And what you describe as needing
at the end of the day to take the
edge off, right?
So it used to be that parents
would come home and say, like, oh,
I need a drink.
Or, oh, I'm going to go, you know,
smoke.
I'm so stressed out.
And they would role model that for
their kids over and over and over
again and for themselves.
You know, that was the narrative,
the internal narrative.
So that's still important to
notice as a parent and to be
attentive to how it is that we're
role modeling, managing stress.
But there are other things that
we're role modeling about, like
placing bets on things or
guessing, you know, what is this
going to be?
What is that going to be?
Oh, you want to put money on that?
That's a sort of part of our
culture now in a way that is
really accelerated recently.
So I think we can be much more
attentive to those things in our
vernacular, just casually, but
also publicly and in our social
circles.
Like, really, and it doesn't have
to mean that it's, you know, it's
completely off limits.
No, no, no, we don't place bets in
our family.
But to just talk about it, to talk
about it critically.
Wow.
I don't feel like we used to bet
on games in the past.
Like, are you guys betting more?
Like, having more of a dialogue
about it out in the open so that
it's not completely hidden.
Because right now, I think a lot
is hidden, and that creates more
potential problems down the road
if we're not talking about it
openly.
Just a quick follow-up to that,
though.
Do you think that increased
propensity to gambling addiction
is just about the dopamine fixed,
or do you think it's actually
evolving in a much more complex
way as a mechanism to deal with
collective angst?
Yes.
All those things.
I think, I think that it's really,
it's really complex.
Like, right now, as we're sitting
here, my phone is buzzing.
So, my phone is next to me all the
time.
As a therapist, I try and, like,
hide it places while I'm in
sessions.
But it's really addictive.
It's addictive.
It's, like, the place that I read
my news.
I am in touch with friends.
I hardly use it to communicate
verbally, but it's everything
else.
And there's an impact of that.
There is a real impact.
And I think that it is changing
the way we use technology and how
we relate to each other, how we
relate to getting a fix, you know,
having that dopamine hit.
Absolutely.
But I think there is something
that's changing in general.
Yeah, I think so, too.
Graham, did you have something?
Yeah.
I was watching one of the FIFA
games in a bar in Toronto here.
And in some of the bars, in the
bathrooms, they have these screens
that display different
advertisements.
And as I went to use the bathroom,
I was sort of disgusted when I saw
that three out of four of the
rolling advertisements in a tiny
little 8x8 bathroom are rolling
gambling ads every time.
It's impossible to get away from.
It's everywhere.
Especially, I'm 29.
I'm squarely in the demographic
that is being constantly targeted
by these advertisements.
And it's suffocating.
Further, you touched on something
earlier in the show, which was
that cultural effects and your
peers really have quite an effect
on what the culture is of
substance use or, you know, what's
normal in your society.
I came from somewhere where
recreational drug use and heavy
drinking were quite normalized,
particularly party drugs like
ecstasy or cocaine.
And as I've come into my later
20s, I've struggled a lot with
watching friends of mine sort of
go deeper down the hole of using
these what was once fun drugs for
them and drinking a lot more.
And it really is sort of taking
over them.
And time and time again, I've seen
having these conversations or
broaching these subjects with
people I know that may have an
issue can really tarnish the
relationship that you have with
them, especially if it's a close
friend.
Because that sort of puts them in
an out group.
You know, it alienates them.
Or, you know, maybe when you
broach the subject, they may reply
with a subdued response when
they're on a come down or they're
hung over.
And they say, you know, yeah, I do
really have to lay off of the
booze or stop doing so much
cocaine, but then no change is
really ever made.
So my question is really, how does
one navigate bringing up an issue
like this to a closer friend?
And how do you balance letting
them know that you're there to
support them and you don't want to
cause any guilt or shame towards
them, but you also want to let
them know that, you know, you
don't want to see them putting
themselves through something like
this anymore.
That was lovely.
Thank you.
You can say that.
I mean, I think it is, I'm
serious.
Like, I think being able to share
really directly about the
observations you have and the
worries that it gives you and the
ways that you want to be available
to them and that you care about
them.
And you don't have, you don't have
the wish to make them feel worse
or, you know, feel ashamed or
something.
Like, I think being able to talk
about it in a non-shaming way is
really a skill.
And it's one that you can get
better at over time as you're
practicing.
But the other piece that I think
beyond conversation that is really
helpful in a peer group and a
friend group is activities.
You know, are you, is your friend
group going to, not you in
particular, but is one's friend's
group going to the bar?
That's the main way that they hang
out.
Are you going to play a game, you
know, of soccer?
Are you meeting to play ping pong
in the park?
Are you going to an amusement
park?
You know, some of those activities
are much more conducive to having
a drink or using substances than
others.
And you sort of, you steer around
the, the problem by just going
directly to what is the healthy
behavior we would be doing if
nobody wanted to drink?
What would we be doing?
Like, if nobody wanted to be high,
would we go to the climbing gym
where you really can't be high and
be effective climber?
Or would we, you know, go hang out
in the park and drink?
Like, thinking through together as
a group, maybe directly, like, we
were all like in this situation
where we're hearing, I don't know
about you guys, but I, I'm
attentive to this kind of thing.
I see articles all the time about
how alcohol is not healthy for
you.
We used to have all of these
different myths about how red wine
is really good for your heart,
actually.
And, you know, French people don't
ever develop problems and all that
kind of stuff.
And we now understand that that
research was flawed in some
particular ways and can see that
alcohol is a carcinogen.
It is clearly something that's
going to cause problems in your
body.
So there's, you can drink this
much or this much, you're causing
problems.
So that is not something that
we've always understood clearly
from the science.
And it's certainly nothing that
the, the broader culture has
promulgated in terms of an
understanding of what's healthy.
So I think there are lots of
things that you can do in terms of
the activities themselves that can
be super helpful, just like
orienting yourselves because a lot
of, and it takes some creativity
and effort to do it because our
culture is really, I mean, I live
in the city in New York and in
Manhattan, the apartments are this
big.
So people are not socializing in
their apartments, they're going
out, where do they go to a bar,
because those, those are the
places to hang out, right, or to a
park or what have you.
But you have to work to get an
activity that is not focused on
the central substance of choice.
And so, and that's a cultural
problem.
That's a larger problem.
And acknowledging that it's a
larger problem is helpful because
it takes less pressure off of the
individual and helps us all
remember like, okay, we're role
models for each other.
We all are little instruments of
culture, but there's a larger sort
of pressure at play here.
Well, I appreciate it.
Thank you.
We're back from a really
interesting discussion with our
production team and our guest, Dr.
Nicole Kosanke.
Nicole, can you tell me, as time
goes on, families often describe
with repetition, they describe
addiction as almost becoming a
kind of grief, even when the
person they love is still alive.
I mean, what happens to a
caregiver when they look at
someone they love and they see the
addiction first before they can
see the person they used to know?
It's so painful.
Really painful to have that
experience of an addiction
clouding the personality and the
relationship that you once had.
And over time, that can happen
more with some sort of substances
than others maybe because of how
much it impacts the personality.
And some things are more prone to
be physiologically, create
physiological dependence.
So there are different ways that
this plays out.
But I think that what you're
speaking to is the psychological
impact of grief and loss.
And like we were talking about
before, that people are in
relationships, they tie themselves
to each other purposely because
they want to be united.
They want to have company in this
life.
And so to begin to see their loved
one as more of a problem and the
negative aspects of who they are
when they're using are more
prominent than the positive
aspects, it becomes more and more
painful.
And understandably, people turn to
others or other things, other
activities, other ways of soothing
themselves outside of the
relationship to sort of manage the
loss of that and the loss of the
intimacy.
So you might have increased
attention with friends or having
more focus on hobbies or
activities because you're really
lost out on the gifts of the
relationship that you used to get.
Are there, and I'm sure there
exist, sad stories of where
caregivers turn to addiction
themselves?
Oh, sure.
I mean, I think one of the things
that can feel so painful is to
recognize that your loved one is
really in a bad way with a
substance.
And yet there's a feeling on the
part of the caregiver that at
least they get a break.
How come they get a break and I
don't get a break?
And so that can lead towards a
caregiver ending up using the same
kind of way or leaning into
checking out with a substance,
which is pretty understandable.
It's an easy cognitive trap for
sure.
Yeah.
So when a family is caring for
someone with addiction and they've
tried all the tools, they've
changed their own behavior,
they've stayed connected, they've
tried to be positive influences
and setting boundaries.
What do you tell them when the
person they love still doesn't
enter treatment or get better?
So, first of all, treatment isn't
synonymous with getting better.
Like, it's not the end-all,
be-all.
It is helpful.
I obviously think so.
As a treatment professional
myself, I believe that it's
helpful, but it's not helpful for
everybody.
It's not everyone's cup of tea.
And many people, in fact, most
people with substance use
problems, the research tells us,
they have what's called natural
recovery.
They don't enter treatment, but
they do get better.
And I attribute this to, you know,
family and, you know, peer
relationships, that people support
each other and find ways to get
out of the problem.
Just as they got into the problem
in a unique way, they find their
way out of it in a unique way.
So I think that, you know,
treatment is, I believe treatment
is helpful, but it's not for
everyone.
But when people don't get better
and you've done everything you
can, I think the question for
peers, you know, like a friend or
a sibling or a partner,
the question, of course, is on the
table, like, are we going to
separate?
Am I, how long do I wait for this?
And that's a very individualized
answer, you know, how you, how you
grapple with that question.
But the question is there.
And with a parent and a child,
maybe when the child is older and
adult and, you know, there might
be psychiatric issues, et cetera,
or there's, there are
circumstances where that question
is still applicable.
But for most parents, they're not
even entertaining that question,
you know.
So I think, but in different
relationships, there are different
options available.
And I think it's important to
recognize that, to be honest with
yourself and with other people
about that as, you know, a
possible outcome that there might
be divorce, we might be estranged,
that might just be the way our
relationship goes.
And I will know as a caregiver
that I've done what I could do.
And, and that, I think that's also
a part, the person Bob Myers
created the craft approach.
And he, we used to do trainings in
which he would describe some of
the examples of success.
And some of them for him were
caregivers who decided to leave
their husbands or decided to have
an estranged relationship with a
family member that just wasn't
repaired.
And that was a success story
because they learned how to take
care of themselves and they ended
the pain for themselves.
And the other person may or may
not get better eventually, but
they did what they needed to do.
And that approach allowed them to
feel okay enough about what they
had done and what their efforts
were and that they had put their
best foot forward in a way that
allowed them to then decide, okay,
I'm, I need to be done with this
relationship.
And that's okay because I'm in a,
in a solid place myself.
Do you think it's the realization
that as a caregiver, you're truly
disappearing and that is one of
the biggest signals for making a
move for change?
I mean, it can be a really
positive impact on a substance
using person at times, not always.
But if you're in a situation where
you really don't think your
partner or the people around you
are ever going to leave, like they
just always come bouncing back and
they make a lot of threats, but
they don't really follow through
on them.
That's one of the things that we
really work with caregivers around
is like, do not say that you're
going to set a limit and not
follow through with it.
Really, really careful about what
that limit is that comes out of
your mouth, because what we don't
want is to breed, like erode your
sense of leverage and ability to
be reliable basically around your
words.
So if you're going to say
something, you want to be able to
follow through with it, which
might mean that you don't set
limits for a while because you
have to figure out what you're
really able to follow through
with.
But if you're a person that you
don't really believe that people
are going to follow through with
things, it can be quite a shock
when people actually do.
And that sometimes has a positive
impact on the behavior patterns
because it shocks them into, you
know, changing for the better.
But how do caregivers in those
scenarios avoid seeing themselves
as failures when the person they
love continues to use and doesn't
get better or doesn't choose to
get better?
I mean, I think part of this
process that we're talking about,
all these different tools that
people have with CRAFT or
Invitation to Change approach,
like there are so many pieces of
it that attend to what the
caregiver's values are and what's
really important to them.
And how they can build on that and
have a roadmap that's really
aligned with their values.
And that all leads to less guilt
because you're really clear about
what's important and what you've
done and what you can control and
what you can't.
So that when you're really clear
about that, there isn't a sense of
overextending your boundaries to
be responsible for all this stuff
over here.
You're really more clear about
what you're responsible for.
You know, and further defining the
language of self-preservation so
our listeners can really
understand.
Can you just tell me, when is
leaving the caregiving
relationship truly the healthiest
decision?
And can leaving in itself ever
actually be an act of love?
Yeah, so we were just talking
about examples where that leaving
might be really helpful to the
loved one.
I think that you're in a, you can
only make a decision like that
when you feel really clear for
yourself.
If you are making a decision to
leave someone because you're
hoping they're going to change and
that will finally be, you'll
finally realize how important it
is, that is not what I recommend
be the motivation.
If the motivation is that you have
had enough, you are estranged, you
don't feel connected in the way
that you want to feel connected,
then that's an indicator that it's
time to think seriously about
this.
And if it's gone on X amount of
time, if you've set up plans for
yourself, I'm going, if this
happened, if this line in the sand
gets crossed, I'm not, you know,
I'm not going to stay in this
relationship.
If this is still going on at this
point in our lives, I'm going to
leave.
If those things keep saying those
things to yourself and you keep
crossing over them or your loved
one is crossing over them, that's
another indicator that it's time
to have those kinds of hard
decisions come up and be debated.
As caregivers are working through
those thoughts in their head, how
can you help a caregiver tell the
difference between abandoning
someone they love and refusing to
disappear with them?
I mean, I think that part of what
we're talking about is that
relationships are really
impactful.
They're really impactful.
And that's the power.
There's great power in
relationships and influence and
people who care about each other
want to help each other.
And you're not going to erase that
by leaving the person.
So sometimes what we talk about
when we're working with someone
using substances is can we take a
break?
Can there be like a period of
abstinence that we just experiment
with how it feels, what it's like,
what skills are required to get it
done?
And that could be a week, could be
a month, could be longer.
But with the loved one, with the
caregiver, we can do something
similar.
What would it be like to really
take a break from caring, doing
the caregiving in the way that
you've been doing it for a week, a
month, a day, whatever it is that
the person can manage?
And it isn't about stopping
caring.
That's not usually on the table.
What's usually on the table is,
could you stop making dinner every
night?
What would that be like?
Can we start to envision what it
would be like to not be always the
one that's in charge of all these
eight different hats you're now
holding?
So that's the kind of sort of
experimental attitude that can be
really helpful because you try
something on for size.
How does it feel?
Does it feel liberating?
Does it feel frightening that I'm
losing my role in the
relationship?
Does it feel like I'm abandoning
them?
Are they telling me that I'm
abandoning them?
Like it's very, you know, one
situation to the next is going to
be different.
So you want to sort of experiment
and help people expose themselves
to what it would be like to make
some changes.
Now, after more than two decades
of working with families affected
with addiction, what do you wish
every caregiver truly understood
about loving someone they can't
control without losing themselves?
I think I said this before, but I
feel like compassion is such a
huge element of importance.
There is a new book called Fierce
Self-Compassion.
What is it called?
I'm forgetting the whole name, but
this idea that,
that self-compassion is quiet, is
passive, I think is only one part
of what self-care looks like.
And the other part of
self-compassion is really having
good boundaries, being able to be
assertive, having clarity about
what your values are, and being
willing to fight for them.
So for me, I think caregivers
really benefit from having that
game plan, having that map for
themselves that includes what's
really most important to them.
And having a sense of compassion
for themselves, so much so that
they're willing to fight for
themselves, and they're willing to
fight for things that matter.
And sometimes that's about being
assertive with language.
Sometimes it's about setting a
boundary, setting a limit.
But it's all wrapped into a sense
of, we are human beings, we make
mistakes, we influence each other,
we can have a positive impact, and
let's try and be purposeful about
what our steps are that we're
taking.
I think that's a wonderful
definition of self-compassion or
expansion of what perhaps we might
be used to thinking is that sort
of putting your arm around your
old shoulder and saying, you know,
it's okay, it's not great, it's
not working out, but just being
kind to that person experiencing
that.
But this has more to it, and I
love it, actually.
It's like, no, no, no, no, no.
I have a role towards myself that
involves active choices, active
self-determination, active agency,
and my act of compassion to me is
actually embracing those active
processes as well as the passive.
Wonderful.
I think that's probably one of the
most inspiring things I've heard
in a long time, and I think it
really befits a conclusion of a
wonderful conversation today that
really took us places that we're
not used to going.
I thank you so much for joining
us.
This wraps up this week's episode
of The Caregiver's Podcast.
I'm your host, Dr.
Mark Ropolesky, and we'll see you
again next week.
Thanks.
Nicole, thank you for helping us
have a conversation that so many
families live every day but rarely
get to say out loud.
I think one of the clearest
reminders from this conversation
today is that addiction does not
only affect the person using, it
can reorganize an entire family
around fear, broken trust, rescue,
guilt, hope, and crisis.
And for the person trying to help,
one of the hardest truths may be
that love matters deeply, but love
is not control.
That doesn't mean that families
are powerless, it does not mean
they stop caring or stop hoping,
and it does not mean every family
will make the same choice about
staying close.
But it does mean the caregiver's
life cannot become the price of
someone else's recovery.
For anyone listening who loves
someone with addiction, I hope
this conversation helps you feel
less alone.
I hope it gives you language for
the fear, guilt, anger, grief,
exhaustion, and love you may be
caring all at once.
And I hope it reminds you that
protecting yourself is not the
same as abandoning the person you
love.
You can love them without
disappearing.
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