One Size Does Not Fit All

I am a Pastor. For some, even myself as I went through it, that statement seems at odds with the events that unfolded in Lauren’s life, especially her addiction. I would be the first to acknowledge that the church, in a general sense, has not always handled mental health and addiction as effectively as we could have. I am grateful that like every healthy entity we, the church, is learning, growing, and getting better.

In my function as a Pastor, I share a message from the Bible every Sunday at my church. As part of a church that has multiple locations, each location shares the same message on any given Sunday. On Father’s Day June 18^th 2017 I was sharing a message about a boy who had left his family in a painful way. He ended up in places he never wanted to go. A million miles from those he loved and God. At least that is how he felt, he was wrong! In the story, he eventually returns home not really in hopes of being restored in relationship with those he loved, and who loved him, but with the hope of getting a place to sleep, a little food and maybe a bit of warmth. He ended up getting a lot more than he thought he would, it appears in the section of the Bible called Luke 15:11–32. It is well worth the read, especially if you are fighting an addiction or love someone that is.

On the Father’s Day I mention, the main idea of the message was from the perspective of the Father, who knew he needed to approach his two sons pain in very different ways. As I shared the message with the congregation that morning, I could not help but see in my heart and on the faces of my wife, son, and daughter that this message was helping each of us in different ways. For my son and wife, who thankfully, have never known what addiction is, it addressed many of the struggles each of them had in why Lauren could not stop. For Lala (Lauren), the story was having a deep impact on her. I could see it. As I did of course I thought of and wondered where my daughter was in her relationship with God. How could I not? As I was bringing the service to a close, in the language of my faith and denomination, I gave people the chance to give their lives to Christ, you can read an explanation of what that means here. As I was bringing that moment to an end I again looked at Lauren. As I did, she lifted her head, looked at me, and raised her hand, the response that often indicated a person was in fact committing their lives to Christ. As I saw this tears streamed down my face. Knowing Lauren, and knowing that she understood all that was happening meant, I knew she was sincere. She would never fake it, that wasn’t who LaLa was.

My wife, my son, and I of course hoped this event was the start of a new path for Lauren that would finally bring her to full recovery. We never expected that she would pass away, but we do have great assurance that she is with the Lord because of what she did on Father’s Day. That helps us a lot!

What the father in this story from Luke knew is a truth all of us who love someone facing addiction should know. One size does not fit all! Sadly, too many people in the treatment/recovery world believe this, or at least function this way. We must find the treatments or combinations of them, that work best for our loved one.

There are many different approaches to recovery today, to learn what many of them are I highly recommend the book “Inside Rehab” by Anne Fletcher, it is extremely informative and helpful. Today I would like to look at three major categories of treatment that are available, but please remember, all of these work, what is important is finding what works for your loved one.

Twelve-step programs: Honestly, 12 step programs are still at the heart of most available treatment plans today. Most of us are familiar with the best known of these called Alcoholics Anonymous. I have friends who are very active in 12-step programs and they have saved their lives. Many people are benefited from these programs over many years. For Lauren, 12-step programs were not effective for her.

PROS:  12 – Step Programs are available everywhere at no cost, they provide a very valuable support system for the individual, they are available in a variety of wrappers: Christian, alcohol, drugs, gambling, other issues.

CONS: They are not supported by any evidence-based studies, groups must be carefully vetted since they are often as good as the people involved like many things in life.

For more information visit: https://www.aa.org/  ,   www.smartrecovery.org (Smart Recovery is a 12-Step hybrid that incorporates some evidence-based approaches mentioned below and often are run by trained facilitators)

Personal Addiction Therapy – This is a very personalized treatment provided by licensed therapists, counselors, psychologists or psychiatrists.

PROS: Addresses the issues driving the addiction and coping well. Customizable to the individual. For some people very effective. Individual treatment was the most effective in helping my daughter Lauren

CONS: Can be expensive and only use private insurance (not always but often). It is a process that takes time. It is important to be sure that there is a good fit between the counselor and the impacted person.

For more information visit:  https://www.samhsa.gov/  ,

Evidence-Based Treatments – Evidence-based treatments are a collection of approaches to addiction treatment that are supported by research and studies as to their effectiveness. The most notable of these approaches is called Community Reinforcement Approach (CRA) and its counterpart Adolescent Community Reinforcement (A-CRA). There are many other evidence-based methods that help in the treatment of addiction like Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Dialectical Behavior Therapy, and Community Reinforcement and Family Training (CRAFT). The Community Reinforcement Approach (CRA), was originally developed for individuals with alcohol use disorders, it has been successfully employed to treat a variety of substance use disorders for more than 35 years. Based on operant conditioning, CRA helps people rearrange their lifestyles so that healthy, drug-free living becomes rewarding and thereby competes with alcohol and drug use. Consequently, practitioners encourage clients to become progressively involved in alternative non-substance-related pleasant social activities and to work on enhancing the enjoyment they receive within the “community” of their family and job. In one study of A-CRA 114 adolescents (76% male) who were dependent on marijuana (90%) or alcohol (57%) were randomly assigned to one of two types of aftercare conditions once they had remained in a residential treatment center for at least a week. The first condition, Usual Continuing Care (UCC), was a referral to local outpatient providers for continuing care after discharge. A variety of services were available through these programs, including self-help groups, urinalyses, relapse prevention, skills training, and counseling for both the parents and the adolescent. The second condition’s treatment was based on CRA, as outlined by Meyers and Smith (1995) and adapted for adolescents by Godley and coworkers (Godley et al., 2001). Adolescent CRA (ACRA) followed the philosophy and procedures of CRA, but it was modified by adding adolescent-relevant components such as a school-related problem area, several standard caregiver sessions, and increased time for trust-building. At the time of the 3-month assessment,  ACRA group members were outperforming the UCC in terms of both treatment attendance and substance use. Specifically, the ACRA participants had attended significantly more treatment sessions (92%) than the UCC group (59%). The ACRA group also had significantly fewer days of drinking and marijuana use than the UCC participants (Godley, Godley, Dennis, Funk, & Passetti, in press). The promising results from this first empirical test of CRA with adolescents suggest that ACRA merits further study.

PROS: Very effective in keeping individuals in treatment and recovery. Builds effective life and coping skills. Builds better relationships between impacted persons and the people arond them.

CONS: It requires engagement from concerned significant others. It may be hard to find someone certified in the complete CRA or A-CRA process. Many Evidence-based approaches have become marketing words for various treatment programs.

For more information visit: https://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf  ,  https://newmexico.networkofcare.org/mh/content.aspx?cid=7542  ,  https://motivationandchange.com/

I did not learn about evidence-based treatments until after my daughter LaLa lost her life to an overdose. I do believe that these approaches would have been very effective for LaLa and our family.  I am currently in the process of being certified in CRAFT and training in CRA. Our family’s hope is to help others win the fight over addiction and how it impacts their families.

This weeks featured image is by Brooke Shaden called “Begin Again”