Talking To Teens: Expert Tips for Parenting Teenagers

Andy: I read this book, Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. A lot of this stuff in here I thought was brilliant and is so in line with what we teach about parenting teenagers, because it leaves the other person autonomous, but still steers them in a different direction. It's so cool, I wonder how you came up with this CRAFT system that you have in here and what inspired you to do all of that?

Robert: The reason that I invented CRAFT was, when I originally started doing therapy in 1976, I was trained in the Community Reinforcement Approach with CRAFT, is part of that. The CRA beginning comes from the alcohol program. The original one is called Community Reinforcement Approach, I added FT at the end, Family Therapy. How I got there is, I was doing therapy with couples back then we called it Marital Therapy, now it is Partner Therapy. When we were doing it back in the 70s I realized that some of the spouses of the drinkers, typically it was drinkers at that time coming in. I saw that the spouses has still had some part of their relationship that they could still maneuver a little bit and had a supportive effect on the drinker. I was thinking, I wonder if we could get the spouses in more frequently so we could talk to them and teach them some different skills.

Robert: The original part of this really came from, I grew up in an alcohol abusing home. My father was a heavy drinker, he would be gone a lot and wouldn't come home sometimes. My mother, I always watched her sitting in this chair crying and being sad and many, many years with that. When I got into school, I was getting a Bachelor's in Social Work with my first degree and you have to do practicums. I found someone that was looking for folks to work at the Anna State Hospital in Southern Illinois, which was part of, or people there also worked at the university where I went to school at Southern Illinois University. That's where I met Dr. Nate Azrin who taught me how to do the Community Reinforcement Approach with his group. I went down to do my practicum and believe it or not, before I even finished my practicum, I was asked to apply for a job in the addiction field and I did.

Robert: I was a little older because I had been in the military, I'm a Vietnam veteran. Actually a disabled one, at least according to the VA because of PTSD and stuff. But the whole thing about it was, when I came off from the service and I saw my mother still having problems with my dad. About two years later at 45, my mother died. When I saw this woman saying, "Let's go to this alcohol unit and you guys can do a practicum there." I jumped right on it. Again, I started working with the spouses in couples therapy and I thought they would be great. We know in psychology that women do better in therapy than men do. I know that's the way we were raised and the way men and women change.

Robert: I thought, maybe we could get to them in. I started Program DAWN in Southern Illinois and it was called Concerned Persons Program. I started getting those females in, they were all women at the beginning. Working with them, I saw some success in them having their husbands or their other partners, whatever it might, be changing their behaviors a little bit in the couples counseling and trying to do things differently. That's how I really got started doing CRAFT. When I moved to New Mexico to be closer to my brother and his family, one of the first people I met with Dr. Bill Miller, who has developed Motivational Interviewing, we've become very close friends over the last 30 years. I started doing grants with Bill, writing grants with Bill and we had several grants. Then we started doing grants on CRAFT. That's where the fun came in, as trying to see how many people we could get into the CRAFT program and see how successful it would be.

Robert: One of the key issues of CRAFT for me is that we help the individual who comes in to treatment to help somebody else in their family, their daughter, their son, their husband, wife, whatever it may be. But when we look at our data over a period of a year, we see a gradual reduction in anger, a reduction in anxiety, a reduction in depression. My favorite one is that we had a really big reduction in negative physical complications, like migraine headaches, upper and lower GI problems and anxiety again. Even after the first program we did and we saw this, I was shocked that we had such an impact on some of those psychosocial behaviors. It was kind of a win, win situation because even the women who came in, and we got 65% of the women that came in, got their husband or their child into treatment, and did quite well.

Robert: But there was still a percent that didn't, but those women still had the same reduction in anxiety, depression, anger and losing some of the physical problems that they had. Just by coming into therapy and having somebody support them in a positive way. We never called anybody enabler, we never call anybody codependent because those are negative terms. When someone comes into CRAFT and we're really trying to help someone, I always say, "Let's not give them a label that might put them down or make them feel bad, because they didn't cause the problem."

Robert: Most of these women were just trying to help their family members doing the best they can, that being a psychologist or some type of a social worker. They're regular folks who had never dreamed that it would come to this. Try to help those individual people just like my mother. I knew if she was sitting there crying five nights out of seven, I imagine there's lots of other women around the world in the United States doing the same thing. That's what we've seen in all of our studies, studies done in Philadelphia, studies done in Oregon, studies done in Holland and studies done in different parts of the world where we do get a really good success using the CRAFT model.

Andy: It doesn't surprise me that it had such positive impacts on people's lives, because it seems like it really gives you a sense of control and shows you areas where you really can make changes. Then it shows you how to map those out, then how to track your progress so that you can see that you really are having an impact incrementally. I think all that stuff is really empowering and it's a cool method. I wonder if we could break it down a little bit, specifically in the context of teenagers, because a lot of the examples in the book are like what you're saying, a husband and wife kind of a situation. I found myself trying to figure out, how would you do this with a teenager?

Robert: I'll tell you what, Holly Waldron at the Oregon Research Institute and Hy Hops is the director. They did a CRAFT study with strictly adolescents, kids that were anywhere from 12, 14 years old, all the way up to 18 years old, they got the same results that we got with mostly, actually the people who had the best job, when we look at all of the three studies we did here and even incorporate some studies done in Philadelphia and other places like Oregon. We really find that it had to be the mothers of adult children or teenagers that are still living at home, or 25 years old that are acting like teenagers still living at home. They had the best success rate at engaging people to come into treatment, stay in the treatment.

Robert: Holly's study was really nice because she got 71% of the individuals into treatment. In her study only 49% of the household had two parents. It was strictly a mother taking care of these kids. The mothers are the ones who came in, and the mothers are the ones who got those people into treatment at 71% by going through a CRAFT program. That's pretty earth-shaking I think, to me anyway, because most of us who work with adolescents quite a bit, know that a lot of times the adolescent runs the home.

Andy: Getting 71% of them to do anything is hard.

Robert: Exactly. You can't even get them to make their, or take out the garbage or something, let alone stop using marijuana or whatever drug that they're abusing. But when I first started, there was a couple of rationales that they were really important to me. Substance abusers often report that family pressure prompted them to go to treatment. You've already got some idea that individuals have some influence over the drug user. Another rationale for me, for helping people is, the families also need help from domestic violence, from verbal assault, from money problems, from marital conflict and different problems.

Robert: Having them get involved in treatment, whether it's a recovery coach or whether it's a THC psychologist. I think if they follow the program, that they'll really be able to start changing a little bit about how they deal with life and so on. Because one of the problems when a CSO, the Concerned Significant Other comes into treatment. A lot of them feel it's their fault, they say, "Oh, if I was a better mother" or "If I was a better husband." Or a better wife and on and on and on. Sometimes it takes a while to get them to understand that they didn't cause a problem.

Robert: Just because they can't control this person who's using drugs and obviously out of control, it's not their fault. They're just doing the best job they can do. We really emphasize that and focus on self care for the individual. Part of CRAFT is teaching the family member how to take care of themself, how to get back in church maybe, maybe get back to a job, or a part-time job, or get involved in other things in the community that make them feel good. Start seeing their friends and family again, because a lot of women, when they have a son or a daughter or a husband who's doing horrible things, what happens is the family gets on them.

Robert: They say, "Why don't you kick him out of the house? And why don't you this? Why don't you do tough love?" So on so forth. Most people don't want to do that because they love their family, especially tough love. We know tough love doesn't work. I mean, there's no way it works so why I do it. But they don't know that because they haven't been to a therapist or they haven't read a good book that talks about this. They're just doing the best they can.

Robert: CRAFT really is there for a family support. We focus on the family, we focus on the individual who comes into treatment first, is using the Concerned Significant Other, what we call her. By the way, I'm using female gender, not because I'm a misogynist or not a misogynist or whatever, but I'm not trying to put down men because our studies show that between 97% and 88% of the people coming to all of these studies I've seen around the world are females. There are very few males that have been involved in these programs. Whether it's in Australia, or it's in Ireland, or it's in the United States, I get the same feedback from the folks that I've trained over the last 20 years.

Andy: We see the same thing. This is why I think there's a lot of parallels with this and what we do with teenagers, because you have the highly motivated, caring, significant other. We just see the same thing with these moms that are like so highly motivated to find something for their teenager. That's what makes it work I think, it's just that huge motivation. A big part of your method is Alternatives, that's what you start out with in the first part of the book, it's explaining how you can provide alternative routes after there's the trigger that normally triggers use. You can somehow kind of map out what the sequence of events is that leads to use, and then provide alternatives. How, if you were a parent, how would you go about doing that?

Robert: First of all, when the folks come in, we have had young people in some of the studies I've done. What we try to do with the CSO that has a 16, 17 year old that's smoking marijuana every day, is to start off by trying to find something that he does well. Some days when he comes home and he's not been smoking and you can't smell marijuana, or see his eyes dilated, or whatever it might be. When I reward them for not doing it by just saying, "I'm glad to see you, I'm glad you're home, I really love you, what would you like for dinner? I'll make you something special." If they come home stoned and really messed up, instead of attacking him, I would suggest to the family member to say, "Well, I'm glad you're home safe. I'm glad you're here. I can see you've been out with your friends. I guess I'll just probably go up and finish that book I was reading and I'll talk to you later on."

Robert: Being an operant conditioning guy, I used the principles of positive reinforcement and putting people on extinction. But I don't use those words typically with clients. But what we're really trying to do is to get the family member to start looking back at what a wonderful child that is. One of the ways we've decided to do that is to ask them to bring in a scrapbook or a picture book of the child as they were, baby pictures and so on and so on. Then when you hear the spouse start saying, or the CSO starts saying, "Oh, she was so cute when she was... Oh, she was so good at this, when she was..." Everything is past tense.

Robert: I say, "Well, did you teach him how to ride a bicycle?" She says, "Oh yeah, yeah. We taught her how to ride bicycle." Did you teach her this, that and the other? Of course the answer is yes. I said, "Well, this is just another problem. It's like a problem learning how to potty train your adolescent and so on or your child. But this program is set up to help you fix other problems or help work on other problems. The cool thing is that we help them learn how to do different things, approach the individual a different way, try not to get angry.

Robert: If you see yourself getting angry, just walk away and say something like, "It hurts me when I see you like this." And walk away, I suppose. "You're a horrible kid. What the hell are you doing? Why do you do this stuff? I told you a hundred times." All that stuff does is push them away. If you want to bring them back, you need to start finding positive stuff, talking about things that he used to do, or she used to do. So here's the thing, I've been in the addiction field for about 42 years now. What I've seen is that the American population is fairly good at getting people detoxed. We can get them sober, but we can't keep them sober, okay.

Robert: My thing is that when somebody does go through a program and start diminishing the use of his alcohol or other drugs and gets to a place where they stop, or it's using very little amounts of that, is get them involved in school, get them in jobs and hobbies, get them involved in any kind of activities that they see as a fun, cool thing to do. See my idea is, if you can make your sober life more rewarding than your drinking life, then maybe they'll give up their drinking. Now, you don't lie to clients and say, "Look, this is going to be way better than drinking, drinking does nothing good for you." Because that's crap because it does do something for them that they're like, or they wouldn't keep doing it.

Andy: There's a reason that you're doing it every day, right? Yeah, yeah

Robert: Exactly, there's a reason. If we could get them to slow down and start doing things differently and talking to him at the right time, then the right places, we could maybe get him to cut down all the way to zero and not be using anything at all. But in the meantime, we need to be helping him set up with things in the community. Whether it's recreational, or whether it's a hobby, or whether it's learning how to do a new skill.

Robert: We'd have to get them involved in some things that are meaningful to them, and away from the people that they're using dope with or using alcohol with. The big key is, really to me is, to try to help them start getting back to, or rearranging again, their lifestyle because it's a lifestyle change. If you just say, "Okay, you're sober now, get out of here, good luck, don't drink anymore." That's not going to do much good, right?

Andy: No, of course not. You're going to go straight back to the same patterns of behavior that were driving use before.

Robert: Absolutely, that's what I tell folks. The number one reason for relapse, according to the literature, is negative emotional state. The biggest negative emotion I see a lot of times with teenagers is boredom. I mean, how many times have we heard from teenagers, there's nothing to do here? There is stuff to do, wherever they are, I don't care if it's in Finland where I've been, or if it's in Scandinavia. I've been to Africa, I've been to Australia, I've been everywhere, all over in 39 different states. I've done trainings in the United States, including Alaska and Hawaii. It's the same everywhere, all the teenagers said, "There's nothing to do here." You and I know the reason there's nothing to do here is because they're getting high and not looking to do anything else. Yeah, we got to try to figure out a way to entice them to do things a little bit differently and start one thing at a time, just a little bit at a time.

Andy: Get them motivated a little bit to go out and find something to do, right?

Robert: Right.