"Mainly, I am a Proud Enabler of HOPE!"

An Interview with Dee-Dee Stout, MA; Harm Reductionist

Dee-Dee Stout is one of the earliest members of Moms for All Paths to Recovery.  She is a harm reduction counselor & family coach with over 35 years of experience.  As someone with a long personal history of addiction, traditional recovery, chronic pain, & multiple other (mostly incorrect) psychiatric diagnoses including PTSD, Dee-Dee has also recently discovered she is autistic.  No matter, she always brings her personal story, her advocacy, and her wicked sense of humor to the conversation.   She is the author of “Coming to Harm Reduction Kicking & Screaming” and maintains a training & counseling practice in the Bay Area of California. For more than 30 years, she has been Faculty at several Universities and colleges in the Bay Area teaching harm reduction and addiction courses.  She is the author of Coming to Harm Reduction Kicking and Screaming: Looking for Harm Reduction in a 12-Step World. 

Question: How did you get involved with Moms for All Paths to Recovery (MAP)? 

Dee-Dee: 

I was the speaker at the first Heart of the Warrior Woman retreat that Kathleen held for MAP for some 50 - 75  moms.  (The retreat this year will occur on September 10 - 13.)  I could see that the retreat was very healing for these moms.  All of the moms there had some degree of experience with their kids around problematic substance use. What I really loved was seeing how these moms were supporting each other!  And with each others’ help, they were able to turn their completely understandable pain and anger into something positive.  I don’t have an official title in the group; I think I just became their resident harm reduction expert.

Question: What is the first thing you tell a family when they come to you with concerns about their loved one’s substance use?

Dee-Dee: 

The first thing I tell families is that what I’m going to do with you is driven by you.  It isn’t a one-size-fits-all counseling.  Families sometimes look at me and say, “Wait, you’re supposed to be the expert,” but I remind them that while I’m the expert in many areas, they’re the expert in their own experience and lives.  

Unfortunately, by the time that a family gets to someone who does non-traditional, harm reduction based treatment like me, things have often gotten very bad.  The usual places where we would start, such as coming up with a communication strategy to engage their loved one back into the family in some form or have delicate conversations about treatment (be it rehab, counseling, some sort of support groups, etc.) sometimes aren’t even possible.  I try to determine the severity of their loved one’s substance use and then work with the family to come up with a way to open up communication in the family.  

I also tell them that this will likely be a long process.  When I first started out working in traditional treatment 30 years ago, families would drop their loved one off and essentially say, “I’ll be back in thirty days,” as though they expected their loved one to be “fixed” in a month!  That’s not how change works.  30 days can be a start, but it’s a drop in the bucket.  One of my favorite quotes from the late Dr. G. Alan Marlatt, PhD, of the University of Washington Seattle is, “We don’t budget enough for change.”  Change takes time and energy.  When I went to rehab more than 35 years ago, I spent a year in “continuing care.” We didn’t call it “aftercare” because we didn’t view the end of inpatient rehab as the end of care; we saw it as the start of a journey.  Thursday night became our family recovery night.  I would go to my meeting and my family members would go to theirs. No one said “This is just her problem.”  I believe that the facts that my entire family engaged in the process and understood that it would take a long time for me to heal and change are among the top reasons I have been able to maintain continuous abstinence since then.

Question: How do you talk with a family about making changes to support their loved one?  

Dee-Dee: 

To take somebody out of a system, put that individual into any kind of treatment, and then return them to the same system expecting them not to return to old behaviors makes no sense.  I often say to families, “What if your loved one ended up in the hospital with complications of diabetes? Likely a few things would happen that involved you all.  For instance the dietitian would likely meet with everyone.  There would be conversations about things like, “Do you, Loved One, want us to remove all the sugar from the house?”  When a person goes to rehab, they are often told to remove all the alcohol from the house for instance.  Instead, there needs to be a conversation with their loved one to ask them, “What do you need from us as a family?  How can we support your recovery?”  

For me, it all comes back to communication.   How can the family communicate with their loved one who’s using substances in a way that scares them before the situation gets so bad that they are unable to get out of bed or function?

Lastly here, transparency is HUGE!  I don’t do anything hidden and therefore the family shouldn’t either.  Their loved one may not want to join a conversation with me and the family, but the conversation will not take place without their loved one’s knowledge or without an invitation to join us.

Question: What have families been told that they should not believe? 

Dee-Dee:

Families have been told that they’re enabling drug use if they’re not threatening the person with severe negative consequences.  That’s not the way that I approach things.  I am a proud enabler.  I’ve been a professor for thirty years and during that time I sure hope I’ve enabled students to learn something.  I’m a proud enabler of people to think differently about addiction but mainly, I’m a proud enabler of hope.  

Often parents have also been told, ‘You need to throw your child out, cut off their money, those kinds of things.  I’m an old bridge player, and in bridge we have things called trump cards.  Sometimes you only get one chance to use a trump card to change a game.  Throwing a child out or cutting off their access to money is like a trump card and there’s a couple of bottom line rules to how you use it.

First, if you make a statement like, "If you come to this family reunion and you’re under the influence, we’re not going to pay your rent as we’ve been doing,” there can be no negotiation if the person then shows up under the influence.   You can only use a trump card or threat once and if you do it, you must follow through on your threat.   Otherwise it will have no power, and in fact it will often backfire.  So while those trump cards may be a strategy, I always suggest they be used as the last strategy, not the first one.  

Second, throwing a child out of the home or cutting off their finances as a first strategy is like performing a radical mastectomy the week after being diagnosed with breast cancer. While there may be a handful of people with severe breast cancer for whom that’s the correct treatment, for most it should be a biopsy or perhaps radiation only.  What we’ve done in traditional drug treatment is we’ve gone to the ‘radical mastectomy’ immediately.  It’s inappropriate, it’s bad medicine and often it causes more harm than the addiction did.   Bottom line: these kinds of threats should be the last thing we do rather than the first.

Families have heard, “You’re giving the person permission to use by not engaging in severe consequences or what we call ‘tough love’.” I know in my twenty years of using drugs, including alcohol, I never once asked for permission!  Plus, if we look at that statement, it makes no logical sense.  People don’t ask for permission to drink/use, and besides that, it’s not my permission to give someone else.  Even with my own child, it’s not my permission to give. The whole idea of ‘permission to use’ just isn't helpful in any way.

Question: What about the family who wants to help their loved one but is completely exhausted, and has already drained their emotional and other resources? 

Dee-Dee: 

I really appreciate it when families come to work with me because they are indeed exhausted.  Most of the time I get maybe one or two sessions.  That’s it.  They’ve been trying for years - sometimes longer - to help their loved one, who’s often been using for a long time.  Often they’re thinking,  “You’re asking me to make changes?  Wait a minute, I’m not the one doing drugs!”  As much as I understand that, I have to say, “I know what I’m asking of you is a lot, and yet this is the work that needs to be done. But this time I’ll be here to help you through it. You won't be alone.”

The narrative we’ve been fed in this country is that drugs are the problem, so logically the person who is using drugs is the problem.  In some treatment settings where I have worked, they don’t just refer to the patient as the “identified patient”; they call them the “identified problem.”  So in this narrative, if we can fix the problem, meaning the person using substances, then everything will be fine.  And we’re still coming up against this narrative in 2023.  In harm reduction we know that drugs are not the problem - often for the person using them, they are a solution - and drugs aren’t even what leads to addiction.  Drugs may lead to a physical dependence, but drugs are never the reason “why”someone developed an addiction. 

John Bradshaw, a family therapist back in the 1980’s who was all over public television at the time, had a mobile he would hang in the corner of the stage and say, “Pretend this is a family system.”  Then he would touch the mobile in just one spot, and say, “This is what happens when you change one thing in the family system: everything moves.”  It’s not just the person using substances who needs to change in order for a change to be lasting.   If we understand that that person is using drugs for reasons - often reasons unknown to the rest of the family - we can see why we need to have these open and evocative conversations.  That way the entire family can become a support for each other, and therefore move or change together, like the mobile.  

Question: Do you have some final words for moms who are trying to help their children? 

Dee-Dee: 

Every family is different.  If anyone tells you they have the one and only way to solve addiction or family communication, run!  Every family experience will be different based on their culture, finances, size of the home, whether or not there are other kids in the house, if there’s been violence in the home, and many other factors.  We need to think about and discuss all of those things and then come up with a unique family road map.  While there are some similarities within some of the strategies, each family’s ultimate box of strategies will be different.  One of the places I like to start is with something called the Personal Values Card.  What is of value to each member of this family?  Finding out what those values are is a guiding principle of the work I do with folks, individually and with families.  My job is not to tell families what to do, but to help them sort out what’s best for them at this unique point in their journey.  What are they willing, able, want to do?  What are they nervous about but willing to try? The more severe the addiction is, sadly, it tends to limit what strategies are available.  This is why I wish people could get into non-traditional, harm reduction based treatment work faster.  

What’s one thing you’d like people to know more about?

Dee-Dee: I’d really like people to know that there’s far more non-traditional information out there today.  Allies in Recovery is wonderful for one, and they have a lot of free material on their website that’s all CRAFT (Community Reinforcement and Family Training) based.  The Center for Motivation and Change has many great resources, including The Beyond Addiction Workbook for Family and Friends, the 20 Minute Guides, and more.  I also recommend SMART (Self-Management and Recovery Training) Recovery’s resources.  Bottom line:  there’s a lot more choices today than ever. Tough love isn’t the only choice today and that’s a great thing. Let’s all become enablers of hope and keeping our Loved Ones alive.

Dee-Dee Stout can be reached through her website: www.deedeestoutconsulting.com

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