This post recaps a continuing education event hosted by The Dorm, in collaboration with Dr. Carrie Wilkens, PhD, Co-President and CEO of CMC: Foundation for Change, affiliated with the Center for Motivation & Change (CMC).
In 2023, almost 18% of Americans were reported to struggle with substance use disorder (SUD), comprising over 45 million individuals nationwide. Additionally, 94% of people who struggle with substance abuse did not receive treatment. Motivating those with SUDs to receive treatment can be a difficult task, and this can negatively affect not only the individual using substances, but also their families and communities.
As an IOP* and PHP treatment community serving young adults 18-30, we know how difficult treatment resistance can be for families, as young adults with SUD experience an increase in relationship conflicts, symptoms of depression and anxiety symptoms, and sometimes “go underground,” isolating themselves due to feelings of anger, shame, and despair.
To collaborate over the best approaches to SUD treatment, we welcomed Dr. Carrie Wilkens of CMC: Foundation for Change to introduce us to the Invitation to Change model, which helps with not only motivating young adults to attend treatment, but also validates the experiences of families and encourages them to support their loved one in the most effective way possible.
Watch or listen to the presentation on YouTube or view a recap of our time together, below.
What is the Invitation to Change Approach?
Dr. Wilkens introduces the Invitation to Change Approach (ITC) as “empirically based in science and kindness,” a system that holistically looks at the client, their loved ones, and the professionals supporting them.
The approach is broken into three facets: understanding, awareness, and action, with the most important value of practice at its core.
Facet 1: Understanding
It is completely valid to be upset with your loved one’s behavior, especially when that behavior may be destructive to both themselves and others. It is also key to help them with understanding. Thinking from their perspective, however difficult that may be, allows them to be more receptive toward your feedback and accepting of help.
Accept that Behaviors Make Sense
Dr. Wilkens shares that individuals would not turn to substances if they didn’t get something from them, including decreased feelings of anxiety, loneliness, and depression, and increased ability to socialize, focus, sleep, and feel good. They are reinforcing their behavior through their continued substance use, reducing negative thoughts and feelings and replacing them with positive ones.
Do you or a loved one need help with mental health?
The Dorm is here.
To help families and loved ones understand this, Dr. Wilkens explains,
“If I told you I could help you mellow out, reduce your physical pain, help you socialize, make you funny, give you good sleep— if I could give you everything on this list, would you want that? Most people would say, ‘yeah, there’s a lot of things on this list that are really great, and if you could just give me a pill that could give me this, I’d take it.’”
For many, substances are able to provide these things. These are all basic, human wants and needs. Understanding that a loved one using substances may come from wanting these very normal things can help families understand them better, and be better able to support their loved one by stepping toward them rather than away.
One Size Does Not Fit All
Not everyone who struggles with substances is the same. Their reasons for turning to substances are all different, and behaviors are extremely complex. Thus, since their use developed for different reasons, the method of which they will use to get out of it will also be in different ways. Giving people multiple options rather than forcing them to take one specific path helps to increase motivation to change and allow families and their loved ones to more smoothly collaborate.
Ambivalence is Normal
It is crucial to realize that there is no such thing as a delete button in our heads. After learning a specific behavior, it is technically scientifically impossible to unlearn it— instead, one needs to learn a new behavior that overrides the old one, and practice using it until it becomes a habit. That said, when a loved one gives up substance use behaviors, it is natural for them to feel ambivalent about change, and potentially turn back to those old habits.
Facet 2: Awareness
Dr. Wilkens explains that in supporting a loved one, it is likely to have feelings of pain, anger, and fear, but also simultaneously feel love, hope, and a desire to connect with the person struggling. Being aware of your own feelings is key to ensuring you are best equipped to respond to your loved one.
Self-Awareness
When people aren’t taking care of themselves, they may end up having emotional reactions such as shutting down, yelling, or pushing away, which, though understandable, counteracts the care and support a loved one would respond more positively to.
In situations like these, it is important to connect with your own personal values. As Dr. Wilkens posits, “What makes you feel good about yourself, and can you anchor yourself in that as a way to drive what you’re doing with your loved one?” Thinking of these values allows families to prioritize what’s important and plan ahead.
In emotional encounters, it is also completely valid to take a moment to step away and cool off. Giving yourself time to work through your own emotions before interacting with your loved one is conducive to their progress as well, allowing you to be strategic instead of reactive.
Willingness
Families care about their loved ones and don’t want to see them get hurt, and at the same time are also experiencing a tremendous amount of their own pain. To stay connected to both themselves and their loved ones, willingness is a way to help accept this struggle instead of withdrawing or getting upset. In having a relationship with someone who is struggling, you can’t have one without the other. The care you feel for them and the pain you feel because of them are two sides of the same coin, and picking up that coin, with both of its sides, allows for the vulnerability that comes with caring.
Self-Compassion
Though both are important, self-compassion is different from self-care. Self-care includes taking a bubble bath, going for a walk, and pampering yourself in physical ways. Self-compassion is defined as treating yourself kindly as you go on this process of change.
“As human beings, we screw up all the time when we’re learning new things,” Dr. Wilkens says, “and if you react to that with anger, if you react to that with shame… the change process is going to be very difficult.”
Facet 3: Action
Providing families and their loved ones with the skills and tools to help practice new behaviors is absolutely crucial to change. These tools help in guiding behaviors to support the individual struggling with substance use.
Dr. Wilkens likens the use of these tools to a drop of water creating a ripple effect, instead of smashing a piece of glass with a hammer— using these skills allows for a natural approach to change, rather than the less effective experience of forcing change to happen.
Communication Skills
When things get rough, it is normal to want to shout, lecture, or close off, but these actions don’t often have a positive outcome. Learning communication skills can allow the conversation to keep moving forward, allowing the loved one to talk more about their experience without them closing down, reduce conflict, increase the chance of taking the advice to heart, and experience empathy— all around a positive cycle that reinforces itself.
Behavior Tools
As noted above, behaviors are largely reinforced because the individual gets something out of it. Behavior tools allow families to strengthen other sources of positive reinforcement, such as encouraging activities such as yoga or journaling. It also incorporates setting limits, and allowing natural consequences, such as showing up late for school or a job, and having a teacher or a supervisor be upset with them.
It is okay to be upset with a loved one, but it is also important to be aware of when to have that conversation with them. If the individual comes home sober, reinforcing that positive behavior with a positive response will help motivate them to come home sober more frequently; if the individual comes home high, it is counterproductive to get angry at them, as they may in turn become even more upset at your reaction and further use substances. The timing of behaviors is incredibly important to the change process.
Practice, Practice, Practice
At the core of the Invitation to Change approach is practice, arguably the most important part of the change process.
For individuals struggling with substance use, the concept of practice takes away judgment when it comes to setbacks during treatment, including relapse. Additionally, means using new coping skills instead of substances in a variety of settings.
Likewise, families should continuously practice their communication skills and behavior tools to best support their loved one.
“If we can stick with it and practice, and bring some compassion to the change process,” Dr. Wilkens explains, “we’re going to be able to stick with it over the long haul, and that’s where really profound change can happen.”
In conclusion, we were grateful to learn from Dr. Carrie Wilkens, with CMC: Foundation for Change, about the Invitation to Change Approach. At The Dorm, 50% of our young adult clients struggle with substance use, and our holistic treatment helps to teach clients to face potential triggers they may encounter in their lives through individualized treatment plans. Learn more about our supportive services for young adults struggling with substance use disorders.
*In New York State, The Dorm operates as a Group Practice.
Our Locations
- Outpatient support for substance use disorder (SUD) in New York City
- Intensive outpatient support for substance use disorder in Washington, D.C.
Sources
- US Department of Health and Services – SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021
- Mental Health America – Prevalence Data 2023
- CMC: Foundation for Change – Invitation to Change
