In 2020, more than 40.3 million people in the United States struggled with Substance Use Disorder (SUD). For every individual battling it, there are circles of friends, family members, and whole communities that feel its impact.
In recognition of Alcohol Awareness Month, we talked with Mass General Brigham Health Plan recovery coach Barry Shelton to discover more about the journey to recovery and how he helps those who struggle to find their path.
How do you begin to help someone struggling with something as powerful as substance use disorder?
Everyone is different, and there are many ways to support someone who is in recovery. I start with where they’re at. I try to understand what challenges they’re facing, what motivates them, what’s important to them, where support systems exist for them, and what kind of pathway of recovery appeals to them most. With that information, we can start a plan.
Is there one consideration that is more important than others?
In recovery, motivation is key. What moves one to want to be on this difficult journey? Is it about their physical health, mental health, their connection to their family, their kids, their work, their community? And just as important is understanding where a person is starting from. To be most helpful, I would try to understand their challenges as well as their motivation.
I explore the physical, psychological, social, and environmental challenges they face, and what kind of recovery capital might be available to them. Recovery capital refers to a person’s internal and external assets that they can bring to bear on the problem. The whole picture is important, and just as important is what pathways of recovery they think will work for them. But it all starts with motivation.
How do you get clients to share what could be very personal details?
Build trust. I listen reflectively, reflecting back and summarizing what they’re saying, so they feel heard. In effect, I try and be a mirror, so they see themselves reflected in me. Then I ask what can I do to help you succeed at this? If they aren’t sure, I ask, can I share with you some methods that people I've worked with have used successfully? I begin talking about treatment, medications, therapy, mutual support groups, peer recovery centers, and so on. Together we explore what might work for them.
How do you help someone who has relapsed?
Relapse is often misunderstood and stigmatized, but it is a common part of the recovery process. I try and help put it in perspective for them. The fact is, slips happen. Sometimes people snap back quickly, but sometimes it takes people a while to get back to recovery. And there can be a tendency to want to hide it because of the shame involved.
Why does relapse happen? How can we better understand that?
The present thinking about relapse is that it happens in stages. There's an emotional phase to it, a mental phase, and then a physical phase. And so obviously from the point of view of relapse prevention, you want to try and intervene at the earliest part—at the emotional stage, and the hallmarks of that are often isolation, irritability, poor self-care, not keeping up with your meetings, etc. A lot of it comes from bottling up your emotions.
What’s helpful and important at this stage is to ask, what happened? What did I learn from the experience, if anything? And how quickly can I get back on track? It’s sad that many people see it as a failure.
You mentioned there’s shame involved. Why is it such a part of the experience?
To begin with, substance use disorders are heavily stigmatized. The World Health Organization has identified that the number one health condition that is stigmatized in the U.S. is drug addiction. And alcohol is number four. These conditions, in and of themselves, carry tremendous stigma. And a lot of times when someone slips or relapses you get a reaction from people, such as the families or loved ones, who might be thinking, we’ve been through this time after time, and you know they're frustrated, and they're hurt, and they don’t understand. And so that only exacerbates the situation and makes it even more shameful for the person. Criticism or nagging does not help.
Is there any upside to a relapse?
I remind people that anytime that you've spent time in recovery is good, even if it’s only 24 hours. You have started the healing process. Sometimes relapse is part of a cycle that many experience, recovery, relapse, recovery, relapse, and in living through it, you learn how to better prevent it. When people snap back quickly after a slip, it may suggest that the desire for recovery is growing stronger than the addiction. That’s when you can really start to see change happen.
What do you find helps people get back on their feet sooner?
I try to find out what works best for them because everyone has unique interests, convictions, situations, and beliefs. The idea I share with them is, whatever you think is going to work for you, let me try and help you do that. If you fall on your face and we're back to relapse, okay. If that path doesn't work out, then we'll try something else. I tell people early on, I'll work with you until we find what works for you.
Barry Shelton, CARC, CPS peer recovery coach, advises members of Mass General Brigham Health Plan in their recovery journeys. He stresses that recovery is always possible, and it is possible at any stage. Members looking for help can email Barry at bshelton@mgb.org.
Want to help a family member struggling with Substance Use Disorder?
Some widely held best practices are:
- Educate yourself: Understand their specific recovery journey. Different addictions or health issues have different recovery processes.
- Be a good listener: Sometimes, just listening is enough. Provide a non-judgmental space where they can share their feelings and experiences.
- Encouragement and positivity: Celebrate their progress, no matter how small, and keep reminding them of how far they've come.
- Consistency: Be reliable. Your consistent presence can provide them with the stability they need.
- Set boundaries: It’s important to support them, but also to maintain your own well-being.
- Encourage healthy habits: Promote activities that support recovery, such as exercise, healthy eating, and regular sleep.
- Be patient: Recovery is a long and often non-linear process. There will be ups and downs.
- Avoid enabling: Support their independence and avoid actions that might enable previous behaviors.
- Connect them with resources: Assist them in finding support groups, therapy, or other resources that might benefit their recovery.
- Practice self-care: Supporting someone in recovery can be challenging, so make sure you’re taking care of your own mental and physical health too.