You’ll recall from the first chapters of the book how the decision to use mood-altering substances is a choice that people make, even if at later stages the behavior is so automatic that it no longer looks like a choice. As you know now, this choice does not result from craziness, immorality, or bad character. It is informed by a unique combination in each person of genetics, environment, physiological and psychological variables, life experiences, and learning and habit formation.
At the crux of all these factors is a choice, conscious or unconscious, that is based on the results a person expects to get or feel by making that choice. These results—physical feelings, pleasant emotions, social ease, and, significantly, the lessening of bad things (including withdrawal symptoms), to name a few—are what behaviorists call “reinforcers.”
Reinforcers affect everyone’s behavior, though they’re different for different people: “When I nap . . . I feel refreshed.” “When I eat . . . I stop feeling hungry.” “When someone thanks me for a favor . . . I feel good.” “When I read . . . I feel interested.” You can use your loved one’s reinforcers in the service of change.
The first part of this chapter explains how reinforcement works and why it is the single most powerful tool you have. The second half of the chapter will help you first identify specifically what is reinforcing to your loved one, then strategize to reinforce alternative, positive behaviors that support health and well-being in your life together.
You may have seen a New York Times article that went viral in 2006, “What Shamu Taught Me about a Happy Marriage,” describing a woman’s success using animal training techniques on her husband. Besides being funny and cute, it illustrated the power of behavioral strategies, particularly positive reinforcement, to promote change. People aren’t dogs. Or rats. Or orcas. But reinforcement is a staple of some of the most effective therapeutic approaches with humans. People, as well as other animals, like treats.
The chain of events in reinforcement goes like this: a person takes an action and what follows either increases or decreases the likelihood that the person will repeat that action. Anything that increases the likelihood is called a reinforcer. Mood-altering substances (and some behaviors) are powerful reinforcers due to their effect on the brain. “When I drink . . . I feel relaxed” is a description of reinforcement in action, assuming relaxation is a desirable state for that person: drinking leads to relaxation, and relaxation makes drinking more likely. Reinforcers can also take the form of something negative not happening, or going away. “When I drink . . . I don’t think about the chaos at home”—in this case drinking is reinforced by the absence of unpleasant thoughts.
In the same way, reinforcement can make any behavior that you do want more likely to happen again: “When I got home on time . . . my husband was delighted and cooked dinner for us.” Delight and dinner are the reinforcers in this situation. Or, in a variation that hinges on the removal of something negative, the husband could allow his wife a half hour of quiet time before she joins the fray of the family and their three rambunctious kids. In this case, the reinforcer is the removal of stress. If he uses either of these reinforcement strategies when she is sober, he significantly increases the chance that she will come home sober more often. Reinforcement works on all behavior.
Reinforcing constructive, non-substance-related behavior is the core strategy of CRAFT. You can choose to respond to your loved one’s positive, nonusing behaviors in a way that will increase the likelihood of these behaviors reoccurring. At the same time, you can choose how to respond to his negative behaviors, including but not limited to substance use, in a way that reinforces it or not.
The two most powerful things you can do to help promote change are:
1. Reward your loved one for positive behavior.
2. Ignore or withdraw a reward for negative behavior.
Remember Ivan and Lucy from the previous chapter? Lucy’s father had a serious alcohol problem when she was growing up, and her husband, Ivan, was raised in a culture of heavy drinking. When Ivan kept his drinking to two or three drinks, Lucy made a point of being warm and affectionate toward him. She had identified the behavior she wanted and defined it in specific, measurable terms. She stopped paying so much attention to what she didn’t want—how his voice got louder and his jokes less funny after three drinks, which she had often called “being an idiot”—and focused on what she wanted and how to encourage it.
Asking for the behavior she wanted with her new positive communication skills was one approach to her goal. In another, complementary, strategy she reinforced the behavior she wanted from her husband when he did it. She picked out two things that he found rewarding (her affection and attention), and made sure to give them to him when it counted—when he stopped after two or three drinks. Sometimes she made the link between his behavior and her response explicit, but more often it didn’t need saying; they were too busy enjoying what was happening to talk about what she didn’t want to happen.
In time, Ivan understood that when he drank less he felt closer to his wife. She laughed at his jokes and he loved making her laugh. He knew when they went to bed at the same time that they were more likely to have sex—and the sex was better when they had been enjoying each other’s company and he didn’t have as much alcohol affecting his body. While he liked drinking, he liked these times with his wife more. The balance shifted in his mind, and he changed the way he behaved.
Reinforcement is happening between people every second, consciously or unconsciously, planned or unplanned, with more and less positive results. We are social creatures and we influence each other in every interaction we have, whether we mean to or not, and whether or not we succeed in the ways we meant to. When Lucy called her husband of ten years an idiot, she was hoping to discourage the “idiotic” behavior. Until Lucy learned how positive communication and reinforcement worked, she did not know what else to do. After all, she had learned from her mother, who had been doing the best she could with the skills she had. When you understand how reinforcement works you, like Lucy, can use your influence for good in all your relationships. If reinforcement is happening all the time anyway, why not harness it to change things for the better?
Currently, you may find yourself in a cycle of punishment, nagging your loved one to stop using, giving him the silent treatment, slamming things around, yelling, and so on. Unfortunately, these (understandable) responses create a negative reinforcement loop. As you carry your distress around with you and fixate on the problem, you naturally end up nagging, withdrawing, and otherwise punishing . . . even during the times when he is not using. Still mad about the last time he was high, you’re punishing him two days later. The situation often deteriorates to the point where people with substance problems get the same punishing reaction from those who are worried about them whether they are intoxicated or sober, using or not.
Not only does this pattern not work to decrease the substance use, it can indirectly influence your loved one’s decision to continue using. Seeing that he gets yelled at when he uses and yelled at when he doesn’t use, he may decide to go and use because “it doesn’t make a difference anyway.” Meanwhile, the substance itself continues to have a powerful reinforcing effect on your loved one and his choice to use. Reinforcement got you into this loop—and it can get you out.
Time, energy, and resources are limited (you’ve noticed?). Did you ever think that this could be a good thing? Since there is only so much time in a day, you have to choose. This is true for your loved one, too. She can’t be hungover every day and train for a marathon. He can’t get high and be attentive to the kids. She probably won’t have a second date with the nonsmoker who is turned off by the smell of her smoking. In each of these examples the person will have to choose.
In the rest of this chapter, you will learn how to identify activities that compete with your loved one’s substance use. You can help reacquaint her with interests that she may have given up and reconnect her to the people and things that she values. These activities take the place of substances, and are reinforced because she enjoys them.
Understanding behavior as a system of choices, actions, and reinforcers is relatively straightforward. It will help you identify what’s relevant, focus on the things you can change, and give you something much more definite to work with than an irrational, unpredictable, overwhelming mess. The first step to creating a reinforcing environment is to identify the rewards you will put in place for the behavior you want to encourage. Here are some general guidelines for selecting and applying reinforcers.
Know what he likes.
The reward should be rewarding to your loved one. The most common mistake people make in reinforcement is choosing rewards they would like rather than what’s most rewarding for the person they want to reward. You know what he likes. Take some time to think about this and write down as many ideas as you can (in other words, brainstorm). A “special” dinner of all-organic root vegetables may be your idea of a treat at the end of the week, but if he’d rather eat a porterhouse steak, that would make a more effective reward. If your daughter wants to play drums, it doesn’t matter so much that you would prefer that she learn violin. Perhaps you can learn to like her drumming when you see how motivated she is to take lessons and practice rather than hang out with her drinking friends. Evaluate the rewards on your list from her perspective.
Keep them (mostly) free, inexpensive, and accessible.
A reward shouldn’t cost a mint or take a village to produce. Do not confuse reinforcement with consumerism that depends on big gifts, new electronic gadgets, or lavish swag for impact. Choose rewards within your budget that expose your loved one to healthy activities and communities: membership to the local YMCA, a backyard barbecue with new friends, foot rubs, favorite foods, or coffee at the bedside after extra minutes to sleep in. The power of rewards to effect lasting change comes from their integration into the fabric of your lives together, so they should be affordable and sustainable. Also, don’t forget the value of warm greetings, sincere thanks, or an affectionate touch. Simple appreciation goes a long way—when it is expressed. So often, under stress and on autopilot, we forget to make these gestures.
The rewards you choose to give should feel comfortable to you. If a gift feels like too much, a gesture doesn’t feel genuine, or words don’t feel honest, keep brainstorming until you identify a reward that is both rewarding to your loved one and comfortable for you. If you feel too hurt or angry to get into the spirit of reinforcement, try scaling back. Reinforcement is not about pretending everything else is fine or cutting someone slack he has not earned. Remind yourself of what you are trying to accomplish.
Positive communication is in and of itself one of the most powerful reinforcers available to you. People respond well to clear communication, kindness, understanding, and offers to help. In reinforcement terms, they are more likely to repeat behavior that was rewarded with positive communication.
I could see it wasn’t easy for you to say no when your brothers wanted to do shots with you. (Specific, understanding.) I want you to know how much I appreciated that. I feel very optimistic right now. (Labeling feelings.)
Good morning! It’s so nice to have company at breakfast. (Specific.) I was thinking of going to the hardware store later and I could drop you off at your appointment on the way. (Offer to help.)
Don’t forget nonverbal communication. Verbal communication can seem like a minefield when you are attempting to extract yourself from entrenched negative patterns. A kiss, a hug, a pat on the arm, a touch as you walk by, a smile, a knowing expression that says you feel the same way—these are the pictures of communication, and worth a thousand words.
The next part of the reinforcing environment you’re creating involves the specific behaviors you want to reinforce. For this, you need to take out your Behavior Analysis form from chapter 2 (pages 67–68). If you haven’t worked through it already, you should do so before you go further into this chapter. A behavior analysis will help you pinpoint the reinforcers of your loved one’s substance use; in other words, what exactly he or she gets out of it. Under the heading “Short-Term Positive Consequences” you might have written things like: “to relax,” “to tune out,” “celebrate”; whatever is rewarding for your loved one about her use. These are the reinforcers that are already in place.
Next, brainstorm a list of alternative behaviors with benefits that can compete with the reinforcers of using. For example, if one reason she gets high is to “relax,” alternative behaviors with similar benefits could include taking a nap, sitting on the sofa and reading a magazine, going for a walk . . . and you would reward this behavior in addition to its intrinsic, relaxation-promoting benefit because, at least for now, it’s not a fair fight. Substances are powerful and change is hard. People need extra encouragement, especially at first. You’re looking for activities, hobbies, or experiences that are healthy and positive, that you can reinforce, that can then compete with substance use.
Think of including friends and family and community, and brainstorm ways to help your loved one build a social life that does not include substances. You may have to dig into the past if more recently substance use has eclipsed other activities she used to enjoy. A behavior analysis will give you even more ideas—we’ve tailored one for healthy behaviors at the end of this chapter.
Once you have put together a list of several ideas, ask yourself the following questions for each (we recommend writing down your answers as you go along):
Would your loved one enjoy it? Would he enjoy it in general and also enjoy particular benefits that he would otherwise get out of using substances?
Jake and Minnie, the parents we met whose daughter, Emily, smoked pot every day, considered what she would be doing if not smoking pot. Were there hobbies or activities they wanted to encourage? Which of these could compete with her pot-related behaviors? They listed getting to school on time each morning, exercising three times a week, taking guitar lessons and practicing daily, and meeting with a tutor twice a week. Which of these activities would Emily enjoy? They didn’t doubt that meeting with a tutor, for example, would be good for her and compete with substance use, but it would be a nonstarter if she wasn’t motivated to do it. Worse, it would end up on the pile of things she “should” be doing but wasn’t, adding to her (and their) sense of failure. They settled on guitar lessons and planned how they would positively communicate their offer. After months of arguing about the pot, they wanted this conversation to go differently, and it did: Emily was excited about learning guitar and readily agreed to their one condition, that she would not be high for lesson time. Finding something they could all agree on was not a small victory for them. It opened the way to discussing other goals, and the tension in their house, which they’d started to believe was permanent, noticeably eased.
You might be thinking that life is not all fun and games and guitar lessons. True, less enjoyable or less immediately enjoyable activities may eventually be necessary to further positive change. We just don’t recommend starting with tutoring—or job hunting, or back-tax filing—as you identify alternative behaviors to reinforce. Starting with less enjoyable behaviors, no matter how good they are for your loved one, won’t directly compete with the immediate gratifications of substance use. Ultimately, the environment that you create will contain a balance of shorter- and longer-term rewards, but all in due time. Believe it or not, the self-confidence and coping skills required for a successful job hunt may start with guitar lessons.
Does the alternative behavior compete with the substance-using behavior in time and function? Again, the goal is to build, bird by bird, a life that competes with substance use. If your loved one typically uses with her best friend on Friday nights, is there another activity you can support that she and her friend would enjoy together at that time? Or something that she would enjoy doing on Saturday mornings to influence her decisions about what happens Friday nights?
While it can seem chaotic from the outside looking in, decisions to use substances are usually well-grooved routines. In your original Behavior Analysis you probably noticed that your loved one’s use happens at certain times of day and on certain days (even a daily habit usually has a pattern over the course of the day). A positive behavior competes with this use pattern, then, when she can do it during the time she would have spent using and/or recovering from the effects of use.
For even more competitive edge, the new behavior should fulfill a similar function as the substance use. If drinking is the way she connects with other people, you can create other opportunities to socialize. If it’s to cope with stress, you can reward activities that are healthier and reduce stress. Finally, consider whether the behavior is functionally incompatible with using, that is, requires fine motor skills, like a cooking class, or fine mental skills, like reading, or vigor, like exercise or getting up early. Consider settings where substance use is not allowed or readily available, such as gyms, parks, choirs, museums, or meditation groups. Try to involve people who don’t use with your loved one and don’t encourage use.
Would the opportunity to engage in the new behavior occur often enough, or could it occur often enough in the future? A onetime or once-every-ten-years positive behavior is certainly worth having on your bucket list, but you’ll want to include mostly behaviors that are regular, routine, or at least repeated with some frequency, so that their continuation will make a difference over the long run. Think: weekly classes, regular exercise, getting up in the morning or coming home at night, or practicing a skill.
Is the new behavior or activity something that you could enjoy too? This could be an opportunity to start enjoying time together again, as the life you are building to compete with substance use includes you! If spending more time together before he stops using would seem to put the cart before the horse, remember the evidence. CRAFT studies have consistently shown a connection between enjoying time together and decreased destructive behavior on your loved one’s part as well as an increased sense of well-being on yours in this order. Improvements in the quality of everyone’s life can and usually do happen even before substances are fully out of the picture.
You don’t have to enjoy doing all the same things or force yourself to do anything you don’t want to do, but sharing an activity can make both of you feel better. Doing things together that you both enjoy also reduces overall tension and distance, which may inadvertently act as a reason for using. (To repeat: it’s never your fault, and at the same time, an unhappy home can be a reason for using.) Generally, having fun together contributes to a collaborative atmosphere that is more conducive to change.
While we don’t use the word enabling much (because it confuses people about doing anything positive or rewarding for their loved one), you won’t fully understand reinforcement until you understand the difference. “Enabling” refers to anything you do that reinforces or increases the likelihood of your loved one’s substance using behavior, or any other behavior you don’t want to support. A positive reinforcement strategy works to reinforce your loved one’s positive behaviors. You can see enabling in the following example: you decide to cook a steak dinner on the evening that your partner plans to pick up the kids and put them to bed, behavior that you think is incompatible with using. The behavior is well targeted, the reward is well chosen, and the evening is going according to plan as he tucks in the kids while you cook. But while you are setting the table, he disappears into the basement for ten minutes and returns red-eyed and high. The sky would not fall if you served the steak, but in strict behavioral terms it would be counterproductive and “enabling,” because he would get the reward (steak) following his negative (getting high) behavior. A screaming fight might also be enabling, as it could give him all the reason he needs to justify smoking more pot.
Ideally, as you problem-solved for this night, you prepared for this possibility and have a plan B. For example, you could put the food away and calmly say (as you rehearsed): “Thanks for dealing with the kids. I’m not comfortable eating dinner together when you’re high, so let’s try this another night.” Or leave the meal and simply say, “Feel free to eat. I’m going to read instead because I’d rather have dinner with you when we can talk and you haven’t been smoking.”
If your loved one is intoxicated, you should use positive communication skills to remove yourself from the situation as speedily and uncontentiously as possible. This is not the time to hash out your feelings of disappointment and betrayal, however warranted. The next time your loved one is sober may not be the time either, since this could do the opposite of reinforcing that sobriety, in effect punishing it. With other outlets for unburdening your feelings (self-care, friends, family, counselors, and so on), you can stay with your plan to reinforce the behavior you want and ignore the behavior you don’t want. (There’s more on the power of ignoring in the next chapter.)
At this point, after understanding what new behaviors can compete with substance use, and developing strategies to reward or reinforce these behaviors, you have all the information you need to effectively reinforce positive change. The following are tips to help you in this process:
Time it right: speedy delivery. Don’t wait to deliver. To forge the strongest possible association between behavior and reward, time your reward to follow immediately, or as closely as possible, after the behavior. If the target behavior is coming straight home at the end of the day, for example, the reward could be designed to happen as soon as your loved one gets there—an hour of quiet time for a spouse to unwind, or an hour of “screen time” for a teenager. You can also gear reinforcement to longer-term, cumulative goals, with weekly rewards for a week’s worth of target behavior, in which case the timely delivery of the weekly reward would be key. A dual strategy could include both on-the-spot and over-time rewards: say, smiles and thanks every time a task is done, plus something bigger when it’s done regularly for a month. Note that in cases involving ADHD, immediate delivery is particularly helpful.
Reward in proportion. Make a big deal out of a big thing, but scale back for more minor behaviors. To reward your loved one for getting out of bed without having to be dragged, make her coffee, and bring it to her with a smile. Save a four-day spa vacation for bigger achievements or a consistent run of smaller ones over a period of time. Base your rewards on how difficult you know the new behavior to be for your loved one, and how valuable it is to you. Don’t underestimate the power of a kiss or kind word.
Switch up the reward. This will help keep her interest. Some animals never tire of the same treat day after day, year after year, for the same behavior, but humans are more easily bored. When in doubt, refer to the first point of reward selection: you do know what he likes, and you can think of more than one thing. Reinforce him in different ways that all mean something to him.
Make the connection. Or not. It is not always necessary to announce what you are doing. (“I will be rewarding you with affection when you don’t drink.”) Or you may want to make the connection very clear, depending on whether you think he can hear it without feeling defensive. Reinforcement works without discussion, but your loved one may wonder about a change in your behavior and ask you (“Why are you being so nice to me?”), in which case it would be good to be prepared. You might plan to say something like “The effort you’ve been making to not smoke in the mornings is not lost on me. I really appreciate it, so I just wanted to let you know that I notice!” Use your positive communication skills to make sure your loved one understands the cause and effect. There’s a big difference between “You’re going to have to earn this” and “This is something you could earn.”
You needn’t mention the substance use if that feels too “hot” or likely to provoke a defensive reaction. Just keep your focus on the behavior you want—“I’m so happy you’re playing basketball again that I wanted to come and cheer,” as opposed to “I’m so glad you’re not too hungover to play basketball,” or “I appreciate your playing basketball instead of drinking yourself to death.” With practice, you’ll learn to sense when it would be safer to say “I had a great time with you tonight,” and when the mood can handle “Thanks for stopping after two drinks like we talked about.”
Beware the competition. As you set out to reinforce nonusing behaviors, you’ll be competing with everything your loved one enjoys about using. There may be other people working against you or people who have interests in her behavior staying the same, such as friends she uses with or dealers. Keep adding weights on the nonusing side of the scale, in the form of enjoyable alternatives and rewards, and hang in there—eventually it will tip.
Reinforcement goes far beyond changes in substance use. Other reinforcement-worthy behaviors you could consider include: your loved one’s self-care efforts, his kindness or generosity to you or others, and honesty. You can reinforce your own positive behavior, too. You could reward yourself for the work you’re doing in this book, for example. What could you give yourself for a week of tracking or some other exercise? Is there one you’ve been avoiding? You could give yourself a special treat for following through with a challenging reinforcement strategy involving your loved one.
Once you’re attuned to it, you may notice reinforcement happening (or not happening) around you in the world: the person who sells you your muffin in the morning is especially friendly and you smile back at him; the bus driver stops for you when she sees you running and you thank her profusely; someone in HR helps you through a particularly thorny issue at work and you bring her flowers when it’s over; your child eats all the creamed peas and corn your mother prepared for him and you sneak him an extra cookie after dinner. Behavior change with substance use is often more complicated, and it may not come easily to your loved one—or to you—but it can be helpful to remember that you have as many chances as you want to take. Try and try again. Try to appreciate the small changes—small increases in positive behavior that happen even if “the problem” isn’t “fixed.” Small changes build confidence and create a foundation for substantive, long-lasting change.