ERP 165: How to Manage Substance Abuse Issues and Recovery in Relationship, with Dr. Robert Navarra
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Hi, thank you for joining today’s episode. Today’s episode is 165, “How to manage substance abuse issues and recovery in relationship, with Dr. Robert Navarra.”
Before we get started in today’s episode, I wanna invite you to take a moment and join me in setting the intention for the Empowered Relationship Podcast… And that is to improve the quality, the connection and the bond in relationship. As we explore relationship topics on this show, it’s all in the interest of growth and healing, and sometimes this requires us to look at the hardship, the upset, the fear, the insecurity, and also looking at how to maintain the security and the stability in everyday living with a significant other. And additionally, learning how to expand our capacity for more love, more joy, more happiness, and believing in the capacity of that. Up-leveling and working towards that, so that we can experience, again, that more love, that more connection, that more joy in relationship.
If you would like access to today’s show notes, you can visit my website, DrJessicaHiggins.com, click on Podcast and you can find all the episodes there. Click on the most recent episode. Today’s episode, again, is 165, “How to manage substance abuse issues and recovery in relationship, with Dr. Robert Navarra.” There you can find all the links mentioned, as well as a brief description of today’s show notes, as well as a transcript. Let’s get started in today’s episode.
Dr. Navarra, Certified Gottman Therapist and Master Trainer has co-authored book chapters with Drs. John and Julie Gottman. Recently he published an article on systemic approaches in addiction treatment and co-authored three articles on Gottman Therapy with Dr. John Gottman for the Encyclopedia of Couple and Family Therapy. Dr. Navarra created “Roadmap for the Journey: A Gottman Workshop for Couples in Addiction Recovery”, and “Couples and Addiction Recovery: A Gottman Approach for Therapists, Counselors, and Addiction Professionals.”
Dr. Robert Navarra, thank you for joining us today.
Dr. Robert Navarra: Well, thank you, Jessica. I am very appreciative to be able to share some ideas with your listeners, so thank you for the invitation.
Dr. Jessica Higgins: Okay, so what got you into the field of studying substance use and addition, if you’re open to sharing? And then possibly how that relates to couplehood.
Dr. Robert Navarra: Sure. I’m imagining that a lot of my initial thoughts and impressions about working in the whole area of substance use issues – I wasn’t that interested, frankly. Way back when I went through the licensing exam in California, they used to have the oral exam with the board, the licensing people… So one of the questions – they don’t have this anymore, so I go back a ways… One of the questions was “Are there any groups that you feel like you don’t work well with?” and it took me about a half a second to go “Yeah, people with addictions.” And the panel – there were three of them – kind of shook their head in agreement, “Yeah, that’s really tough.” So I passed; it wasn’t like that was a deal breaker. It was like, “Yeah, they’re really tough to work with.”
o it turns out that some five years later I’m looking at my practice – a very full practice at that time as well – and it looked like literally 80% of the clients I was working with had some substance-related issue. So either currently, past, or concerns about the future, and I was pretty clueless on what to do, because the training was pretty inadequate, as it typically is for therapists… So I decided to get some additional training, and that’s exactly what I did. It was a certificate program at University of California Santa Cruz, Advanced Drug and Alcohol Training, so I completed that. I heard about Stephanie Brown, who is an amazing researcher, therapist, who has written a lot about families and about addiction, alcoholism specifically… So I got into a consultation group with her, and then eventually went on to be part of the addictions institute as one of the providers, and I got hooked on the field. It was like, “Wait a minute, there actually is a technology to help couples, to help individuals identify substance and behavioral problems, and to actually make movement through it.” So then I got hooked. It was like, from a group I didn’t wanna work with, because I didn’t know how to, basically, to “Oh, there’s a way to do this!” I think that’s just a really common kind of experience, I’ll say, for a lot of therapists… Would you agree?
Dr. Jessica Higgins: Yes, absolutely. When there’s a confidence in being able to help people really transform, not just help them improve and help them process, but actually really help them create change it’s highly motivating and encouraging, and definitely I think adds a whole level of trajectory to the work.
Dr. Robert Navarra: Yeah, yeah. I teach an addictions treatment class at Santa Clara University, and I had a class last night, as a matter of fact… And starting with the students, it’s like “Who’s interested in working in this field, of basically working with substances and behavioral problems related to compulsive behavior stuff?” There’s not a lot of activity in those hands going up. But we’re like into week eight now, and just presenting these students with like “Here’s how you do an assessment. Here’s how you help have a conversation. Let’s look at your own attitudes towards addiction”, it’s been a tremendous shift for a lot of students, I have to say, to begin to see that it’s possible to actually work with and feel like “This is a population I can work with.”
Dr. Jessica Higgins: And how did that start connecting with relationship and couplehood?
Dr. Robert Navarra: Yeah, so I kind of leap into things, full bore… [laughs] So after I got this training and had some level of competency, I ended up working at Sequoia Drug and Alcohol Treatment Program as a therapist, and ran some men’s group, and then moved, over time, into clinical director, actually, of treatment program. So what I was doing was working with individuals primarily, except in my private practice I was working with couples, and the transition from “Oh, there seems to be a substance issue” to actually getting into recovery, the norm is for — when that happens, like to identify a substance issue in a couple/relationship, kind of the norm is to say “Okay, well you’re not really ready for couples therapy. You need to concentrate on your own recovery issues.”
I bought into that model, until I discovered that “You know what, I’m working with couples from before addiction is identified; addiction is now identified, and now I’m continuing to work with them in the transition from active addiction into active recovery”, and it started really to occur to me that there isn’t any reason to stop the couples therapy. That in fact it’s when couples need guidance and they need the structure of “How do we move from all this trauma stuff, from addiction, into kind of this new trauma”, because recovery brings with it a set of changes that feels uncertain and scary to people, that also has a certain level of trauma… And I don’t think I’m overstating that.
So it really occurred to me this evolving model of relationships need attention in this transition, and continued transition. So let’s not abandon couples at the time they need us the most. That’s how it sort of developed over time. That was on the heels of my own dissertation, of specializing in what happens to couple relationships after recovery; this was through the family recovery project, and so I got my doctorate based on that thesis, basically, and that’s what I’ve continued to work with now for the last 15 years… And I’m completely sold on the idea that couples need attention, so we should not discontinue working with them.
Dr. Jessica Higgins: No kidding… Especially if they’re living together during this whole transitional phase.
Dr. Robert Navarra: Yeah.
Dr. Jessica Higgins: They don’t have the tools, and definitely are living together, so they’re interacting, and why not help support their interaction? Okay, that brings me to my other question, just to help listeners orient to your vantage point, your outlook… And I know you can’t do this probably full justice, but in a nutshell, about how you see substance abuse or addiction? Because there’s a lot of orientations, whether or not it’s the opposite of addiction is just not sobriety, but connection, or that it’s a disease, or that it’s a coping strategy… There’s a lot of different models. Can you help us a little bit with where you’re coming from?
Dr. Robert Navarra: I really like this question. Here’s my position, that could be helpful for couples. One is to look at substance use — and when I say “substance use”, I’m also including behaviors like compulsive spending, or struggles with pornography, shopping… There’s no end of possibilities here, where behaviors become compulsive and problematic.
Dr. Jessica Higgins: Over-eating…
Dr. Robert Navarra: Yes, there we go. Right, so we can name a number of them. But to think about use on a continuum. So the debate is “Is addiction a disease? Is it trying to fill a void? Is it really a disease?” The answer to just those few questions is “Yes, and it’s more than that, because sometimes it’s not.” [laughs] So here’s what I mean by that. We learn from the research that somebody could meet basically the criteria for a use disorder with two of the eleven symptoms that are listed in the diagnostic and statistical manual. This is, as you well know, the diagnostic criteria for meeting — you have to meet a certain level of symptoms to meet the diagnosis of whatever; so we have that for addictions. What we’ve learned is that people who are diagnosed with alcohol use disorder are not gonna meet that criteria in four years; so what that means is it’s not really meeting the criteria for a disease process. It’s symptomatic of misuse of substances that cannot be attributed to changes that have taken place in the brain, because people can either moderate their drinking, or somewhat not have problematic drinking in a way that they did previously… So there’s that.
It still needs treatment, still needs attention, people need to deal with the impact of their drinking because it’s problematic in their life and in their relationship, but they may not meet that criteria (most won’t) in four years. When we get to the severe end of the symptomology, then probably we are meeting the criteria for the disease, because we have clear evidence that there’s structural and functional changes that have taken place in the brain, that are really well documented in the science of addiction… So it’s indisputable that for some people at the severe end of what I would call addiction, rather than a use disorder, that is pretty indelible. That’s kind of a life-long diagnosis most likely. That’s the controversy – is it a disease or not? For most people no, for some absolutely, because of the changes in the brain.
Dr. Jessica Higgins: Gotcha. Thank you, that’s super-helpful. And I’m wondering, do you have an example of clients that might fit in that substance abuse, versus an actual disease?
Dr. Robert Navarra: Oh, yeah. I can actually think of a number of cases right off the bat. There’s one couple I worked with where she was concerned about his drinking; this goes back a ways now… She was like, “You know, you drink a lot with your brother.” He goes, “Yeah, I do. My whole family drinks a lot. I drink like my family.” He’d get together with his brothers they would drink pretty heavily, and she was concerned about that; it was showing up as an issue between them. So what I did is to explain this continuum of use, from non-problematic to heavy use, to problematic, to an actual use disorder, to addiction. I gave them some guidelines for safe drinking guidelines that have been established now for a while, and said “You are drinking at levels that would be considered risky.” He said, “Oh, I didn’t really know that. Okay, so what are the consequences of that?” and we explored both the physical, relational consequences of his drinking at the level he was doing, that if you continue it could lead to additional issues that are gonna be more severe than what you’re experiencing now.
So he basically said, “I didn’t know that.” So he changed his drinking, and it was gonna be interesting — so when he’s with his brothers, how is that gonna go? We talked about it over a period of time, and he said, “You know, actually, I told them. At first they kind of laughed at me”, but one brother said “Well, you know, maybe I’ve been drinking too much, too.” So one of the brothers also kind of followed suit, and drank at what would be considered low or moderate levels, and then the other brother was drinking at heavy levels again, and kind of risk-behavior levels… And the guy was able to maintain that level of drinking. It didn’t escalate. He was able to control it, and I think that’s really typical. Not a disease.
Now, I have another couple I worked with where they’re camping, drinking all day, driving home from the campground, and just before they get home gets pulled over. And did the sobriety check, did a blood alcoholic concentration level, and blew like (I think it was) 0.3, which is really high… I mean, REALLY high. And his level of tolerance was extremely high, so there were long-established patterns of that kind of drinking, and problematic drinking, and uncontrolled drinking that clearly were meeting the criteria for a use disorder severe, and would meet all the criteria for the disease. So there we go – we have sort of this contrast.
Dr. Jessica Higgins: Right, right. Okay, grateful to have that visual and that kind of story to help us mark that. It sounds like you’re really talking about this whole effect that it has not only on the brain structure, but this whole systematic change when it’s actually at that level, and I think one of the things I’ve just personally really taken issue with in the using substances is changing your state of consciousness. So if you had a hard day, or you had something upsetting happen to you, and you turn to a drink or some type of substance, you’re actually using the substance to deal with the difficulty, so you’re not actually learning the tools to manage and to work with the hardship, so you actually don’t ever really grow emotionally in that way. But it sounds like you’re speaking to — that’s just one aspect; there’s so much impact that if there’s heavy, heavy use, it actually changes our constitution on many levels.
Dr. Robert Navarra: It does. But you know, what you’re saying also is really important, I think, to highlight. We’ll just say the substance for the behavior really does supposedly moderate some of the effects of stress and depression, so people will use substances for that reason. However, you’re right, what’s problematic, particularly with alcohol, is that alcohol actually increases stress in people. There’s neurotransmitters associated with heavy alcohol use that reinforce the stress system in the body, so what happens is people get more stressed drinking, and then drink more to relieve the stress; it becomes cyclical. So there’s better ways to relieve stress than alcohol… And I’m not saying this from the pulpit, it’s just that’s just a neuro-biologic fact, so it triggers the stress system at certain levels. It can be a good relaxer at low levels, but not a good relaxer at higher levels. So if people can develop other coping mechanisms, that’s better. Less risky.
Dr. Jessica Higgins: Right. A lot of side effects.
Dr. Robert Navarra: Yeah, that’s right.
Dr. Jessica Higgins: Okay, so I mentioned to you that I had two listeners submit questions related to substance use, and possibly addiction. One listener is in recovery, and I’m not quite sure how newly recovered she is. I get the sense it’s within the first year… And she’s really struggling with her husband continues to drink, and she’s struggling with that and wanted to know what kind of support or input we might have to offer.
Dr. Robert Navarra: Oh yeah, that is such an important question. The typical advice — you know, the relapse rates, realistically, here’s what they look like, numbers-wise… They’re the highest in the first year, and actually in the first three months. What happens is that literally 80% of the relapses, we think, take place even within the first three months. And what will reinforce the idea of continued sobriety is continued support from family members. That’s a very important dynamic. So this isn’t just about her not drinking or not using, it’s about really both of them understanding that this really needs to be kind of a team effort to maximize success.
So she’s responsible for her own recovery and managing the impulses – that’s her recovery – but it’s very important to involve the partner to understand that it’s tough this first year. So when people make that first year recovery, then the statistics change. More than 60% who are committed to recovery stay sober after one year, as opposed to thirty-something-percent. And when you get to three years, it’s a remarkable 86% of folks stay sober for the rest of their lives. So that’s considered a durable point of recovery. So the first three years are setting the stage for life-long recovery, basically.
So if he could understand, if they could have a conversation… This is the kind of advice you’re likely to hear from a treatment program if she were in a treatment program – let’s see if you can make an agreement to have the house alcohol-free. It’s a trigger, and we wanna minimize them when there’s options to minimize them. It’s tough for partners, because they typically don’t understand that. It feels like, “Well, just because you’re not drinking doesn’t mean I can’t.”
Dr. Jessica Higgins: I just am listening and I’m like, it seems like such a different setup if it’s really framed at how critical this first year is, and that possibly the spouse or the partner could recognize it’s a short-term (relatively) process… Not the recovery process, but the first year being a shorter term process of transitioning, and that there could be some real attention and support and focus on that sobriety, and then possibly incorporating, if that person is like “I can’t commit to not drinking for a wife, but possibly I can really commit to a year, and really being mindful about whatever exposure, or if I drink at all.” You’re just really illuminating how important that first year is.
Dr. Robert Navarra: It’s critical, and what we’ve learned from relapse patterns is that we know that there’s a thing called emotional memory, as you know. The midbrain is the part that has to do with surviving the next 15 seconds, so what happens is that when there’s a memory that’s stored, and there’s associations with drinking… Like, at a couple I worked with – one of the first couples, actually, research couples – he goes “Beer and sushi go together.” Beer and sushi. He gets into recovery with an alcohol use disorder severe, couldn’t go to a sushi restaurant anymore, because the association was so strong.
So what we had to do is talk about alternatives, and that’s what this couple — it would be helpful most likely for this couple to say “So let’s talk about what it would be like to have an alcohol-free home. We have to decide and have an agreement about what we’re going to do when we invite people over. Is this gonna be alcohol-free? How do we manage that? Is it okay to have wine?” These are the issues that absolutely need to be talked about, and if I were in a room with them, I would say that first year particularly, it’s a really good idea just to remain in an alcohol-free environment to the degree that you can… Because when the brain sees the bottle of wine, it goes “Reward is imminent”, and it bypasses the frontal cortex, which is the decision-maker impulse control part that says “Wait a minute, wait a minute.”
So those initial impulses in early recovery are really hard to manage, for most people. When it’s established, not so much, maybe.
Dr. Jessica Higgins: Right. Well, it kind of sounds like once you have your foundation built, then possibly you can look at testing how much you feel like you can actually manage… But why test those limits if you don’t even have your foundation built?
Dr. Robert Navarra: That’s it, yeah. And things will change, maybe, over time. But I think initially it’s really important to be conservative, and there’s a lot at stake here. What sometimes happens is that if partners don’t understand that, they might even say things like “Oh, one glass of wine won’t hurt you”, which would be a really bad thing to say to somebody in recovery, because they don’t understand… So getting education about what this disease is, and how these triggers are so strong and involuntary, I think is an important part of a couple conversation.
Dr. Jessica Higgins: Right. So it’s not just your willpower. There’s so much more…
Dr. Robert Navarra: Oh, definitely.
Dr. Jessica Higgins: But possibly, that could just be on first blink what someone’s assuming, if they don’t really know.
Dr. Robert Navarra: That’s right. And you know, I think the other part — a great question is “How do you conceptualize this?” As a therapist, here’s how I conceptualize this, and I think this could be really useful for this couple – look at alcoholism or alcohol use disorders as invading their relationship. This is my model. It’s the uninvited guest; it’s not her fault that she developed this addiction, and there’s things that she can do to manage that, which is what she’s doing, and that they have to account for this uninvited thing in their relationship.
So what I do with couples is say “Let’s talk about how this uninvited thing, this addiction, has impacted you, partner one, you, partner two, and the impact on the relationship.”
Dr. Jessica Higgins: I love that.
Dr. Robert Navarra: It removes blame. It’s not to blame the person with the addiction.
Dr. Jessica Higgins: And what I also like about it is that it holds space for the partner to the person that is in recovery, that they also have a hardship as well. Like you’re saying, there’s an impact.
Dr. Robert Navarra: Oh, yes.
Dr. Jessica Higgins: I don’t know that people in relationship — hence Al-Anon, and there are a lot of supports, but sometimes people really don’t always validate how hard that is, and so to have a model that really on the front-end supports that is, I think, so healthy.
Dr. Robert Navarra: It’s really important. And if you look at the alcoholism or alcohol use disorders – same thing. It’s something that has so much moral stigma for so many people, that there’s shame, and there’s this internalized sense of “I’m a bad person. Look what I’ve done to this family. Look what I’ve done to our relationship.” So that’s already kind of in place, and what we want people to understand is that this really is a disease at the level we’re talking about. It’s not really a choice in the moment. People have this involuntary thrust towards using, because their brain has been hijacked, and the stop-go mechanism in their brain is messed up, and we know exactly where that takes place now.
So dealing with the shame and the self-recrimination is really important, and to help people sort of understand that this is a disease, and if you had another disease, like God forbid cancer or something, you wouldn’t want your partner to smoke around you, for lots of reasons. You don’t need to have cancer to not want that. But the notion is that there’s self-care and then there’s relationship care that needs to facilitate how people can best mange this disease. If you consider it as a disease, then it doesn’t have the moral stigma that addiction has.
Dr. Jessica Higgins: And what I love about your model too, Bob, is that there’s a lot of opportunity to really shift into “How do we learn appropriate ways of being with each other, reaching for each other?” Healthy relationships skills – communication and building trust, and taking care of each other. These are sometimes things that haven’t maybe had as much focus and attention, and they’re crucial.
Dr. Robert Navarra: They are crucial. And what I really encourage couples to do is to think about two big things, two processes to kind of manage. One would be what has the impact of addiction been? And we need to figure out ways to talk about that in a non-blaming way, because this thing has impacted both of us, the uninvited guest… And what is the impact of recovery? Because that also brings its own set of traumas, as I said earlier. It brings all the uncertainty of “Well, now what?” and “Things are different, but I don’t really know what to expect. Will this last?” and all the uncertainty that recovery brings is pretty anxiety-provoking. The proverbial elephant in the living room refers, of course, to something you can’t talk about, that’s there, that everybody sees, but you can’t talk about it.
One of the cardinal features of an active addiction – we can’t talk about what’s right here. That’s traumatic, but unfortunately we kind of reinforce that with recovery. We have recovery in the room, in the house, but we can’t talk about it because we’re told we’re not supposed to, and I think that’s harmful to couples.
Dr. Jessica Higgins: Do you have any vignette or story that can help people relate to more of what that trauma would look like? You’ve just said how difficult it is to deal with the uncertainty, and the change, and the lack of support… Is there anything else you can help people relate to, with the traumas of recovery?
Dr. Robert Navarra: Well, this would be difficult, I think, for a couple to do probably without guidance.
Dr. Jessica Higgins: Okay. I meant more just an example of what that trauma would look like.
Dr. Robert Navarra: Okay, so in this couples workshop that I developed – Roadmap for the Journey is this two-day workshop for couples in recovery; not where there’s active addiction, but actually in recovery. One of the exercises I’ve developed is helping to deal with trauma related to the addiction. It’s healing emotions from addiction-recovery trauma. HEART is the acronym. And when I’ve done this in different treatment programs – and it was done about five different times, so it’s kind of a new version of things – but we’re looking at the impact… For instance, one guy was sharing… The person with the alcohol use disorder – he’s in an outpatient treatment program; his wife is there, they’re here at this retreat for couples in recovery that I’m facilitating… So he shares with her one of his traumatic instances of his own drinking, where he had totaled his car, and the car was something he had wanted his whole life.
He and his dad had talked about this car, I think the father had helped to even build it with him… Father died, and so this car was meaningful at that level, and he gets drunk and he crashes the car. So he’s telling his wife about how painful that was, because it was more than the car, it was the association with the father, and memories, and another failure in his life, I guess… And the wife had no idea that her husband was traumatized by his own drinking. When she heard that for the first time — which is common; partners don’t really think about this. It’s like, “Oh, I’m the one that’s been traumatized. The kids have been traumatized.” It doesn’t occur usually to the partner that the person with the addiction is traumatized by their own addiction. So once she understood that at a whole different level – it isn’t to make excuses, it’s just to say he was traumatized by that event as well – that she understood and was able to develop a little bit more compassion for the impact of this thing on him.
Dr. Jessica Higgins: Nice. That’s beautiful.
Dr. Robert Navarra: Right. He was just kind of sharing, “Well, that was really hard for me.” So if couples can have conversations like that… It would be really hard, but maybe there could be a version of that. And I can tell you another quick story, too – there was a wife who had the drinking problem, and the husband was sharing “One of the difficult memories I have of your active drinking is when you got intoxicated at a Halloween event. We had a block party with our neighbors, and the kids were going out together, and I recall you drinking a lot, and slurring words, and that was really embarrassing and hard for me.” And she was actually able to hear that… Now, I was in the room with them, helping them out with this conversation, but it’s an example of if the person with the addiction can hear their partner’s response to some event in the past, one event… “See, this is an event that was particularly difficult for me. And I’m not trying to blame you, I’m just letting you know”, and it helps to process trauma, which helps people to let go some of that trauma. And that’s the intention, to be able to talk about some of that, but in a non-blaming way.
Dr. Jessica Higgins: Yeah, it’s so key, and I get what you’re saying – having really good support to be able to facilitate these conversations is so (I’m sure) helpful to get the scaffolding of how to do that, and then possibly they could start to continue to have more of those conversations… But I can imagine that if someone really felt alone in that trauma, and then their person to be able to have them be able to hear it, understand it, empathize with it – that brings them closer, despite the pain of it.
Dr. Robert Navarra: It was very difficult… And I didn’t know if this would work. I didn’t. But what I’ve found is really good success in treatment programs with people who were under that year of sobriety. I can think of maybe half a dozen couples right off the top of my head; six, seven months of continued sobriety, having these conversations… And it really does help heal the past. But it all depends how it’s done. If a person says “You were never there for me and the kids”, that’s harmful. As opposed to “I felt alone when you were drinking, and it was painful for me to feel that aloneness.” It’s not blaming, it’s sharing a feeling about the impact of this uninvited guest. Huge difference.
Dr. Jessica Higgins: Huuuge difference.
Dr. Robert Navarra: [laughs] Yeah.
Dr. Jessica Higgins: I mean, I’m just thinking that not only is it helping them heal some of the trauma and the pain, it’s also helping them build a new way of relating. There’s vulnerability and the ability to share in a way that’s really revealing, that I think allows them to feel that connection, despite the pain, and then hopefully they have some sense of what that feels like and looks like, so they know how to be with each other and can continue to repeat that, that creates connection.
Dr. Robert Navarra: Yeah, that is a great summary. Because what we’ve learned from the research is — well, we also know it; you don’t know research to know this… Addiction creates all sorts of trust issues, because people with addictions lie, and bad things happen and they lie about it, they hide it. So there’s a lot of trust issues that are built into early recovery and beyond… And what we know is that what helps establish trust after there’s been what feels like a betrayal is this concept of emotional attunement. This is out of the Gottman research… And what that means specifically in this instance is that emotional attunement is really fine-tuned when the listener is willing to listen to the other partner’s negative emotions. It helps facilitate trust faster than any other interaction. “It was hard for me to feel so alone with the kids. I can’t imagine what that was like for you. Yes.” No excuses, no “I didn’t know what I was doing. I didn’t mean to hurt you”, none of that. Just staying with the partner’s emotions helps that emotional attunement and helps build trust… Because the speaker says “Wow, I can share painful emotions with you that I’ve never been able to share – certainly not while you were using – and maybe I can begin to feel like we can have a relationship again.” Hard to do, but that’s the work. At some point, that’s the work.
Dr. Jessica Higgins: Beautiful. Thank you for what you’re doing.
Dr. Robert Navarra: Well… Yeah.
Dr. Jessica Higgins: Okay, so if we have time – and this might just, in part, segue to a really powerful article you recently wrote, but… The second listener was really feeling a tremendous amount of conflict about dating a guy, and their approach and their personalities are very different. She describes herself as much more type A, and he’s way more relaxed, and he uses marijuana, and she doesn’t. And he and his friends – because I think that the community that they’re in marijuana use is legal, and that she gets teased for being too strait-laced, or kind of buttoned up… Where for her, she’s like “Is this a deal-breaker? Are you gonna grow up? Is this something you’re gonna continue to do?” and she’s just at a loss… “Am I being too hard on him, or is this just a real fundamental issue?”
Dr. Robert Navarra: Yeah. So we’ve gotta think about that continuum of use. The article you’re referring to, I’m thinking, is “Cannabis and couples”, right? On the blog.
Dr. Jessica Higgins: Yes.
Dr. Robert Navarra: So that article lays out when to be concerned, and literally lists what cannabis use disorder is, and the symptoms… Or how to find it anyway. So I think when there’s an issue of concern – if there’s a concern that a partner has about their partner’s substance use, marijuana in this case, then there has to be a conversation that says “Here’s what my concerns are. Here’s what this means to me. Can we talk about that?” So it starts with just the invitation, saying “This is important”, and hopefully her partner won’t come back with some sarcastic kind of “You’re all buttoned up.” That’s not a good sign.
What you’d wanna hear is “Okay, I don’t think it’s a problem, but tell me what your concerns are.” And if they could have a conversation about that, about what the concerns are, perhaps depending where he’s at on this continuum, they can come up with some agreement, if temporary anyway, to maybe moderate his use, if he could, and if he can’t or isn’t willing to do that, then that would suggest there’s more to look at.” That’s what I’ve discovered with couples.
A lot of times a person’s use is feeling problematic and says “Well, if bothers you that much, okay.” When somebody’s not willing to do that, you’d wanna say “Why? What’s driving this behavior that’s impacting your relationship that you’re not willing to change, or look at? Maybe there’s something that needs more exploration here.”
Dr. Jessica Higgins: And when you say “more going on”, can you name a few things that might be going on?
Dr. Robert Navarra: Yeah, so can you get addicted to marijuana? Yes, you can. Most people who do smoke or use marijuana in some form or fashion are not addicted to marijuana, but I think you’re looking at risk factors. So if there’s addiction in the family background, if there’s a long history, if there’s increased use over time, if there’s daily smoking – these are all factors that would be considered higher risk… So I think sometimes what happens is a therapist will suggest “Well, let’s see if you can moderate your use or stop using, and see what happens, get a baseline.”
So it would be interesting to see how much he’s actually using, and whether he’d be willing to either stop for a period of time, or moderate it in a way, if he can. And if he can’t or isn’t willing to do that, then I think he might be further down that continuum of use, that might be inching its way – if not already there – to an actual use disorder. That’s a possibility.
Dr. Jessica Higgins: Yeah, it’s tricky, depending on their friend group, and the culture, and the age… I mean, a lot of things can contribute to the perception of how much use is problematic or not. But it sounds like you’re really encouraging just an invitation to dialogue about this, and I’m just wondering, for this listener, if even having the conversation is fraught with a lot of conflict, to create that safety where both people feel like there’s a space to really be honest and have non-judgment. That in itself feels tricky.
Dr. Robert Navarra: Well, the article I wrote was designed for exactly this kind of scenario. What I tried to cover in the article was some information about cannabis, when to be concerned, and literally questions at the end of the article, as you may recall, to say “Well, how about if you as a couple grapple with these questions? Not to make a decision, but just to share your thoughts and your perspectives on this particular issue.” So there’s a structure that needs to take place just to have a conversation.
I’m thinking about an individual I worked with some years ago who was on a migraine medication that he wasn’t sure he was addicted to… So I referred him to an addictionologist, which is an MD that specializes in addiction medicine specifically… Because I wasn’t sure either. And the physician said — basically, the counsel was “I don’t think you’re addicted, but it’s definitely clouding, it would seem, your ability to be present with your partner and in your family.” So there’s that. You could have problematic substance use not because you’re addicted, but because it’s clouding something in your thinking, or an insulation between your and your partner, that has an impact. I think that’s really worth talking about and exploring with people.
Dr. Jessica Higgins: Absolutely. Well, I love that you have that resource for that couple, and so much that you’re providing today… Do you have anything you wanna say in closing, or just underscore about anything you would recommend for couples that are faced with negotiating this territory?
Dr. Robert Navarra: I guess I can talk about the website I just launched last week…
Dr. Jessica Higgins: Woo-hoo!
Dr. Robert Navarra: Yeah, so it’s CoupleRecovery.org. On that website is information, and I’m starting blog articles, sort of reissuing old ones and rewriting them and kind of updating the whole thing based on current research, and stuff like that… So getting information — there’s a resource page I have on there, and there’s the National Institute for Drug Abuse; it’s a good website for couples, for individuals and for therapists just to get information about addiction… And all these different substances are listed on that website, and when to be concerned. So you start with the information and trying to understand when to be concerned. That’s the first thing.
The second thing would be to try to have an agreement with your partner to say “I just wanna talk about the differences – if we have differences – in our perspectives on this substance and the impact it’s having on our relationship.” And that can start with a conversation, just to say “It’s important for us to talk about this, if we have different perspectives.” And the more information you get about when to be concerned, and what you might be able to moderate without help, that would be the first step. And hopefully, partners are willing to have those conversations, to say “Well, okay…”, like my guy did – “You know, I’m drinking a lot with my brothers. I thought it was normal, but it’s impacting my relationship, and by the way, there’s health factors here that I ought to consider… Okay, then maybe I need to look at that.”
A good number of couples and individuals I work with actually fall in that category. It’s not you’re addicted or not addicted, it’s “Are you using in a way that’s problematic? How severe is that problem, and is it actually moving into an addiction?” For most people probably not, but if it’s in a problematic area, it needs to be talked about and addressed.
Dr. Jessica Higgins: Right, and even for this listener, I’m thinking she might be struggling with their respective definitions of a problem, but it sounds like what you’re really pointing to is if one person has a problem, it’s impacting the relationship, and that in and of itself, if one person has a problem, then there is a problem.
Dr. Robert Navarra: That’s exactly right, and it needs to be identified and talked about.
Dr. Jessica Higgins: Yes. Well, thank you for what you’re doing and the resources that you have available. On your website, is there a way for people to find out about your workshops, for the couples that might want to do a recovery workshop with you?
Dr. Robert Navarra: The CoupleRecovery.org is sort of a general resource. I have an upcoming couples workshop that’s sponsored by Hazelden Betty Ford. That will be happening in September… I think there is a link on that website; if not — I can’t remember, but I definitely have a link on my other website, which is drrobertnavarra.com.
Dr. Jessica Higgins: Excellent.
Dr. Robert Navarra: I list my workshops there for sure.
Dr. Jessica Higgins: Okay, perfect. I will make sure to put the link to the article, your new website, and your Dr. Robert Navarra website as well, so people can have different ways to access the services and the information you have to provide.
Dr. Robert Navarra: Great.
Dr. Jessica Higgins: Excellent. Well, thank you so much. Again, I really appreciate the work that you’re doing in assisting people and healing and really recovering.
Dr. Robert Navarra: Thank you, Jessica, and I appreciate the work you’re doing to get the word out there and to support your listeners in ways that are really helpful.
I hope you have enjoyed today’s episode, again, with Dr. Robert Navarra. Again, “How to manage substance abuse issues and recovery in relationship.” Again, if you would like access to today’s show notes, you can visit my website, DrJessicaHiggins.com click on Podcast, and you can find the most recent episodes there at the top. Again, today’s episode is 165.
Until next time, I hope you take great care.
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