Substance misuse and abuse is a complex topic, especially in a divorce situation in which children are involved. Today’s guest helps to unravel complexities surrounding addiction issues to help families navigate these complex situations while keeping children’s well-being at the forefront.
On this episode of Children First Family Law, Krista sits down with Lorraine Bockman, a licensed clinical social worker and addiction counselor who has worked in the mental health and addiction field for more than 30 years. Lorraine works in private practice in the Denver area, is recognized as a Master Addiction Counselor (MAC) with the National Association of Addiction Counselors (NAAC), and is part of the Association for Addiction Professionals. She has served as a program director, manager, staff developer, and clinician in public and private institutions and has specialized training as a telemental health therapist, interventionist, expert witness, and substance abuse professional.
Krista’s conversation with Lorraine covers several important topics related to substance misuse and addiction issues, including the differences between clinical and forensic substance evaluations. Lorraine explains how a Substance Use Evaluation (SUE) works, the disease elements behind substance use, and the cognitive distortions common in this arena of mental health. Krista and Lorraine also explore the impact of Adverse Childhood Experiences (ACEs) on children, including the effects of divorce but also the effects of addiction, both of which deeply impact kids’ futures. They highlight, though, that there is a lot of reason for hope through stories of people who have chosen to heal and change, acknowledging that while some individuals can overcome these challenges, not everyone does.
For an insightful take on the ripple effects substance use can have on families and children, don’t miss Lorraine Bockman’s expertise on this complicated topic.
In this episode, you will hear:
- Lorraine Bockman’s extensive background working with children and families, which ultimately led her to addiction work
- The difference between clinical and forensic evaluations
- When a Substance Use Evaluation (SUE) is most useful
- The impact high-conflict relationships can have on substance use evaluations
- A consultation in a child custody case versus a complete evaluation
- Taking care not to put a parent in the role of “watchdog” over the other parent
- How Lorraine creates connections with her clients and her experiences helping clients before they hit “rock bottom”
- The behavior stages of change related recovery from addictions
- Lorraine’s use of the term “courage” related to substance abuse recovery and the biology underlying a propensity for addiction
- Cognitive distortions and their impact on recovery, such as black-and-white thinking
- Adverse Childhood Experiences (ACEs), including addiction and divorce, and how they impact attachment in children
- Measuring relapse
- The hope Lorraine has to help people get better
Resources from this Episode
- Comprehensive Addiction Solutions: addictionsolutionsllc.com
- 15 Cognitive Distortions and How to Challenge These Negative Thoughts: www.goodrx.com/health-topic/mental-health/cognitive-distortions
- The Stages of Change Model of Overcoming Addiction: www.verywellmind.com/the-stages-of-change-model-of-overcoming-addiction-21961
- Adverse Childhood Experiences (ACEs): my.clevelandclinic.org/health/symptoms/24875-adverse-childhood-experiences-ace
- www.childrenfirstfamilylaw.com
All states have different laws; be sure you are checking out your state laws specifically surrounding divorce. Krista is a licensed attorney in Colorado and Wyoming but is not providing through this podcast legal advice. Please be sure to seek independent legal counsel in your area for your specific situation.
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Expert Insights: Guidance from an Addiction Counselor Podcast Transcript
Lorraine Bockman 00:00
Throughout my career, I’ve seen how substance use impacts individuals, children, family members, all of those kinds of folks. And so it isn’t, as you said, I think when we started, it’s not a simple, easy kind of, let’s put a band aid here and that’ll fix it. It’s really much more complicated than that.
Intro/Outro 00:21
Welcome to the Children First Family Law podcast, our host, Krista Nash is an attorney, mediator, parenting coordinator and child advocate with a heart to facilitate conversations about how to help children flourish amidst the broken area of family law. As a child advocate in demand for her expertise throughout Colorado and as a speaker on these issues at a national level. Krista is passionate about facilitating and creatively finding solutions to approach family law matters in a way that truly focuses on the best interests of kids. Please remember, this podcast is provided to you for information purposes only. No one on this podcast is representing you or giving you legal advice as always. Please enjoy this episode and be sure to like, subscribe and share the podcast with others you think would benefit from this content.
Krista Nash 01:10
Welcome to today’s episode of the podcast. I’m so glad you’re all here and listening. I am really grateful today to have with us Lorraine Bockman and I will just give a little bit of bio so that you all know all the wonderful things in which she has worked. Lorraine here works in Colorado and is a licensed clinical social worker and a licensed addictions counselor. She has been recognized also as a Master Addiction Counselor with NAAC and Lorraine help me. What does that stand for?
Lorraine Bockman 01:39
Again, National Association of Addiction Counselors, basically.
Krista Nash 01:41
Okay, great. So she also is part of the Association for Addiction Professionals, and has worked in the mental health and addictions field for more than 30 years. She currently works in private practice in the Denver area, specializing in addictions and related issues. She has previous experience also working as a program director, manager, staff, developer and clinician with a variety of public and private nonprofit agencies in the Denver area. And has additional specialized training as a telemental health therapist, interventionist, expert witness and a substance abuse professional under the Department of Transportation guidelines. She is also past chairperson and board member of a variety of legislative efforts that have been made in Colorado. And she’s a current member of Denver’s Metro Interdisciplinary Committee, MDIC, and a professional member of the Colorado State Board of Social Work Examiners. I know Lorraine from having worked with her in the family law community on cases in which I’ve had the need to have some expertise in substance use. And so I am very grateful to have you with us today. Lorraine, thanks for doing this.
Lorraine Bockman 02:50
Thanks. I’m coming to you from my private practice, not from any other kind of related entity.
Krista Nash 02:57
Yes, absolutely. Thank you for pointing that out and clarifying that. I always say the same thing too. I’m not offering you any legal advice. We’re just having a conversation. So thanks for clarifying that. So you have a lots of information, and I’ve been explaining, as we were preparing for this, that this podcast now has had, I think, four different episodes involving issues of addiction and substance use from both the individual story side, really from both sides of that equation coming to family court, one with someone who was trying to be protective, the other that was trying to get over some substance use. And then I’ve done two episodes that have been more about some typical approaches to Substance Use Evaluations and different ways of approaching addiction issues in family courts, and then also some more recent work with Dr Tabashnik on things that we’re seeing maybe emerging more recently. So I know Lorraine, you think about these things all the time, so let me just turn it over to you, because I really had hoped that you would be somebody would help synthesize some of this for us, recognizing how hard all these topics are and how delicate a balance we’re dealing with in terms of human need and children’s issues and all of those things in the family court. So tell me, sort of what are your initial thoughts about this. I want to know how you got into this work, but you know, you can start sort of wherever you feel comfortable in terms of sharing your perspective.
Lorraine Bockman 04:21
Well, so pretty much all the work that I have done has been substance use related. I did kind of take a detour, perhaps in the 90s, and do a little I started out working in with kids, and so I took a detour into the Department of Social Services system, as it was then, but it’s all been, you know, for the most part, primary substance use. And so I have a wide variety of backgrounds. I’ve done work in the hospital emergency rooms, and I’ve done DUI groups, and I’ve worked with kids in the DYS system as it was back then. And you know, so a lot of that background comes into play. And then I started working with adults, and, you know, kind of got into that sort of realm of addiction work. And I’ve been in private practice for quite a long time. And so I think, you know, you and I met through doing substance use evaluations, right? Because you’re working in the family courts, and so that’s kind of how I got involved. I got interested in the forensic side of Social Work and addiction work, and have kind of done some, a lot of learning and exploring in terms of what that should look like for substance use professionals. And, you know, there’s not a lot of standardized kind of realm out there. There’s not a lot of writing and all of that, you know, it’s much more CFI-PREkind of focused, and so it’s been, I’ve kind of adapted, you know,
Krista Nash 05:53
just to remind our listeners that CFI-PRE are the Child and Family Investigators and the Parental Responsibility Evaluators who are for those beyond Colorado, those are typically just parenting plan evaluations. But honestly, even when I would get appointed as a CFI, they’ll say, if there really is a serious substance issue, you need to tell the court, and you need to get somebody who actually knows what they’re doing, which is somebody like you, right?
Lorraine Bockman 06:17
So, right, yeah. So I do that side of the world, but I also still have a therapy practice, and I work in that side of the world too. And I, you know, throughout my career, I’ve seen how substance use impacts individuals, children, family members, all of those kinds of folks. And so it isn’t, as you said, I think when we started, it’s not a simple, easy kind of let’s put a band aid here, and that’ll fix it. It’s really much more complicated than that. Yeah, exactly.
Krista Nash 06:48
And I mean, I think as I’ve gotten more experienced, it ends up being, you realize the nuance of these cases, right? They’re not the same. Now, when you’re working in this area, are you doing all different types of addictive behaviors, or is it just substances?
Lorraine Bockman 07:05
So my primary work is with substances. I do say, do some process addictions. You know, I can generally say what I say specifically, for example, for sexual addictions and for eating disorders. I often will say there’s a specialty and a specialty, and it’s not mine. So if you know those come up in my work, I refer them out well,
Krista Nash 07:28
As I was introducing this topic and explaining sort of where we’ve been, you know, I know we are, we’re talking a little bit. I want to cover kind of what your perspective is on Substance Use Evaluations generally, and kind of what you when you get appointed, kind of, how does that work? What happens? Maybe we should just start there briefly, and then I want to get into the meat of it more, which is really how we approach the human and the children and all those things. But maybe just give a brief set, since you’re in the seat of doing those, if you get appointed, what is the process that you use? And, kind of, how long does it take, and what does that serve for? Because, and I’ll just say, too, part of what I sometimes see is people will go get these evaluations that are just self reported. So I guess I want to understand that too, like the dynamic between self reporting and something more thorough, that’s, you know, a broader what are the differences between those two things?
Lorraine Bockman 08:18
Sure, so I would characterize them as clinical evaluations versus forensic evaluations. Okay, and you know this again, this characterization is kind of taken from the parenting time. You know, the custody evaluations to borrow the old term, you know process, which is a forensic a clinical evaluation is one where they’re really looking for treatment recommendations as a part of the process, right? So the process is really kind of interviewing the individual. Maybe they’ll do some, you know, testing, maybe they’ll do a drug test, but it’s really mostly self report, as you said, and the purpose of that type of evaluation is really to get clinical recommendations for treatment. You know, the individual is saying, or someone is providing them outside motivation to say, I need to do something here, right? And so the person goes to get this assessment, and then they have some treatment recommendations that they can choose to follow or not. A forensic evaluation is really an investigation. It’s looking to answer a question for the court, or multiple questions for the court.
You know, in the case of family law, it’s looking to answer the question about, How is this person functioning, and how is their functioning with the children being impacted, and so that investigation is bigger than just an interview with the individual who’s being evaluated. It’s important to look at all other sources of collateral information in a forensic investigation. So you’re talking in a family law case, you’re talking to the other party. In this case, you’re talking to professionals who are involved. You’re talking to, you know, maybe you get some personal references. Maybe you’re looking at records. So perhaps you look at medical records and legal records and previous treatment records, if there are any, and maybe you talk to a therapist or the doctor and all of those kinds of things. And then also, as a part of that investigation, you do some what I call pen and paper testing, right? Think psychological testing, but about substance use. So you’re talking about, you know, pen and paper testing that looks at what the level of substance use and or addiction is, and those tests are, you know, ideally, they’re standardized and reliable and valid, and all the things that you know you look for in good clinical testing. And then at some point, I sit down and write my report, right, and I put all the things together. And then, you know, as you’re putting things together and putting it on paper, it talks to you, and you are like, Oh, okay, so here’s what we have. And then I identify the concerns that are kind of prevalent in the case, and you can make some recommendations based on what is best on two fronts, one for the individual to either get some healthy coping skills, or, you know, obtain sobriety, or, you know, whatever, stay away from relapse, or, you know, all of those things. And then you’re also looking for again, because you’re responding to the court’s question, you’re also looking for monitoring in order to keep the children safe. If that’s appropriate, right? Like, if both of those things are appropriate, then those are in their recommendations.
Krista Nash 11:43
So how long does it generally take to do a Substance Use Evaluation, to do that kind of work? Everybody’s different, right?
Lorraine Bockman 11:49
Like, I think if you talk to people all across the US or all across the world, you know, I think different folks are doing different pacing, right? Some people are doing super, super in depth kinds of stuff, and looking at, you know, childhood stuff, and how’s that impacting?
Krista Nash 12:08
And you know, me, the adults, childhood, yeah, that’s impacting, okay, yeah,
Lorraine Bockman 12:12
Yeah. What’s all the history, what’s all the background? And how is that impacting what’s happening today? Some people don’t go that far in and so, you know, I think probably a good forensic evaluation, maybe is, you know, 60 days, six months. I think probably I’ve had some take a year that was more based on ability to pay than actually based on the investigation. But, yeah, you know, it’s always a problem. Yeah, that can go on.
Krista Nash 12:40
So this might be a silly question, if it is, just tell me, but I’m curious if, do you think that substance use evaluations are most useful or most needed, or, I’m not quite sure the right question, but when someone is denying they have a problem, or other spaces in which you know, if somebody comes to you and they don’t realize the extent of their problem, even if they’re like, What kind are you usually seeing in those kind of categories?
Lorraine Bockman 13:04
Well, I would say that the cases that get involved this far are high conflict, and that’s the underlying driver, right? But I would say that it is, of course, appropriate in a case where someone has not recognized their substance use as a problem. That is a good time for an evaluation, where, if someone is struggling to understand the extent of their impact, perhaps is another good time to, you know, maybe have an evaluation. I think times that I’ve seen it be, I don’t want to say unnecessary, but more on the unnecessary side, let’s say are times when someone is acknowledging that there’s a problem, or there’s been a problem, and maybe they’re even in the process of doing something about it, but the conflict is so high that there’s been a struggle to acknowledge any movement.
Krista Nash 14:00
Oh, I see. Okay. So just to say that a different way, sure, from my So, for example. So one potential use of this kind of service of getting somebody like you involved in, if it’s just a substance use evaluation type work, would be if the person is like, I have no problem. This is not a problem. I don’t have a problem at all. Another might be the person’s like, I do have a problem, but this other parent is not acknowledging that I actually have done things that are working, and I want to make sure that what I’m doing is appropriate, or everyone’s you know, that that’s the level that we’re going into. So there might not be a denial of a problem, but whether or not the person is sufficiently moving in the right direction, right
Lorraine Bockman 14:39
I think that family member has a lot of history, and probably there’s been a significant level of dishonesty, you know, through the process, and so they have reason to mistrust. I’m not discounting that at all. I just think that that’s a grayer area, necessarily,
Krista Nash 14:57
The trust stuff sometimes, like I had one, where. Where, like, the little kid was blowing into the interlock device. I don’t even know if that was true, but that was what everybody was concerned about. You know, I don’t think that’s necessarily. I don’t even know if that’s possible anymore. Do they have facial recognition on those? I don’t know. That’s the device that’s on cars some of them do. I think it was a voluntary device. It was like something that was more like, bought off the street somewhere, you know, was it was like something that the person’s parents had put on, like the grandparents had put on, and so the kids telling his mom that he’s the one that has blown in this thing like 100 times or something, you know. But I think it’s interesting when you think about in high conflict cases, the need for this incremental trust building, and when you have these addiction issues, of course, that protective parents would say, especially when the kids are really little, right? I don’t trust you. What’s going to happen if you mess this up, right? So I appreciate saying you understand that?
Lorraine Bockman 15:51
Yeah, absolutely, absolutely. I think that sometimes when it’s more challenging is when someone is acknowledging the extent of the problem. They’re actively working on recovery in some form or fashion. And again, the conflict is so high. I think those cases could be maybe a consultation kind of thing rather than a full suit. But again, the conflict ends up being challenging in those cases.
Krista Nash 16:20
Yeah, I agree. Sometimes we jump. I mean, I’m learning as CLR, and maybe this will help us move sort of in this direction of how we do this in a nuanced way. I’m learning that in a variety of our typical approaches that we use, whether it’s the custody evaluations, which I don’t even want to call it custody. I know I just interviewed Fran Fontana, who is like, I worked so hard to not use the word custody in legislator, but you know, when you look at what people are searching for, that’s what they’re searching for, like they actually still use it. So we all respect that. I don’t like the word because it sounds like you’re talking about an ownership of something. It is what parents generally use out in the world, you know. And it’s kind of just the nomenclature that gets used. But you know, I think that there are ways to approach these things that are short of these massive, many months approaches, you know, like we can do, for example, psychological evaluations without the full pre when you have a CLR involved, right? Like when you have a best interest attorney, I can make that jump to the parenting time recommendations. Now, it’s an important caveat with the Substance Use Evaluations that you can’t make those parenting time so many people who can’t do it, like there’s so many people who cannot do it. Therapists can’t make parenting time recommendations. Substance Use Evaluators cannot make parenting time evaluations, which is sometimes why you get multiple experts involved with CFI, PRP, SUE, all the acronym people. But I’m finding that, like that you said, you know, maybe an evaluation is done that is short of, that’s more of a consultation. So tell me about that. I mean, what kind of ways would you be brought on to a case, like, what would that look like? How is that different, you know, than the full Sue report?
Lorraine Bockman 17:55
So a CLR or an attorney might call me and say, look, I’ve got this person, and this is what they’re doing. And you know, both parties agree that there’s an issue, and both parties agree so far that, you know, things are proceeding the way that they should be. What do we do next? You know, what if? And so it’s really kind of just a conversation about planning for the What If. And how can you include that, again, as a protective mechanism for the kids.
Krista Nash 18:22
Yeah, let’s talk before we pivot into sort of these broader conversations about, you know, attachment and, you know, just the impacts of substance use on children and families. I’m curious if you could give just sort of a little bit of information about the different types of testing that people can do. You know, maybe there’s people listening who actually are going through this on their own or in their own family. I mean, I’m always thinking, I wish we could reach people earlier, right? Not when they’re in the high conflict divorce, but when they’re in the middle of their family system still, and they aren’t even talking about divorce, necessarily. But maybe this actually catches somebody who is earlier in the process, you know, what kinds of things do you think that they could be looking at earlier on, you know? Or what kind of testing should they be going and getting? You know, I find people like, never heard of PEth testing, for example. You know, is that a good thing to go get? Or, you know, can you just buy, like, urine tests off of Amazon, you know, like, where is that? Like? How do you describe the testing to people for whom it’s unfamiliar.
Lorraine Bockman 19:22
So it’s a little bit of a challenge, because you don’t want to put somebody in a monitoring role. You don’t want to put the other partner in the relationship in a monitoring role. It’s like having them look for the alcohol every night, right? You don’t want to have them do that. I do want to say that as just a word of caution, right? You’ve talked about the testing. There’s pet testing, which is a blood spot test, and there’s urine testing, you know, there’s hair testing and nail testing, and there’s a sober link, you know, like a breathalyzer type testing. There’s the intoxic type testing on the car, you know. So if you know. Two adults can come to some agreement about what the substance is, and somebody’s willing to do the testing. There’s certainly lots of options for that, and depending on the substance, and depending on how far back you’re wanting information, and all of those kinds of things, I think you do have to be careful about putting the other party in the role of being kind of the watchdog.
Krista Nash 20:22
It’s hard too, because you know, when you’re in my shoes and you end up getting, you know, either individuals who are coming to you and they’re, you know, they’re doing their own testing or whatever, or you’ve got a full on substance use evaluation, it’s hard to not make that other parent be in those shoes, because they’re the ones that are 24/7 watching out for these kids. So it’s really, it’s hard. Like, sometimes we get parenting coordinators who will take on a little bit of a role, but it’s hard because it’s like, who’s going to be that person I know I as a CLR is, I’m like, Well, you can send it to me. That’s fine, but I’m not going to be your alcohol police. Like, if you’re drinking and it’s positive at 10pm on a Saturday night, you’re not likely to get me to be the one calling mom and telling her that, right, right? So it gets rough, but I do hear you, because I hear so much about this sort of cat and mouse game, because there’s so much hiding, there’s so much hiding going on, right?
Lorraine Bockman 21:14
Secrecy, part of it, secrecy and lies. Yeah, sure, yeah.
Krista Nash 21:17
Let’s talk a little about- like I was looking earlier at your website, which I just love your tone. I’ll link to your website in my show notes, but I really think that it’s like, ahead of its time in like, I love how it starts off, like, wonderful to meet you, you know, and and really like you say, it might sound strange to hear me say, it’s wonderful to meet you. You’re visiting my website right now because something feels seriously wrong in your life. So chances are, when you think of words to describe our meeting here in cyberspace, wonderful is nowhere near the top of your list. And then you say, it’s wonderful to meet you, though, because in deciding to browse my website, you’re moving a step closer towards healing whatever brought you here. So this is really in your addictions counselor role. Yeah, so I think that’s really interesting. You talked about how finding a therapist is like finding a good pair of shoes. It’s got to be a good fit, and you give a sense of who you are and all of that. Tell me about that part of your work, like when people come to you, I mean, obviously it’s a very different role. It is a very different role, forensic. So explain that and kind of what that. Again, I’m all about just trying to find solutions for people. Tell me how you fill those shoes and what that relationship looks like with people,
Lorraine Bockman 22:22
Sure, so that does go back to the clinical role, right? That step, that’s a step outside of the forensic role. And that’s just, I do individual therapy with folks who are struggling with addictions, and I do individual therapy with the folks who are struggling with the folks who are struggling with addictions. And so, you know, my role there is very different. I’m not a neutral right in a forensic evaluation role, you’re a neutral party as a therapist, though, we’re not neutral, we’re our clients advocates, right? And we’re helping them to create change and do those kinds of things. And so it’s more meeting people where they are, and much less, you know, formal recommendations and dictating kind of, if you will, it’s much more about, what do you think about that, and is that a good fit for you? And here’s an idea, and here’s a suggestion, and how does that work for you? Kinds of things, and there’s lots of family events, by the way, you know, like lots of different theoretical bases for how people approach therapy. I tend to be a cognitive behavioral therapist, which is kind of an evidence-based model for addiction.
Krista Nash 23:31
What are the other kinds of events that can be used?
Lorraine Bockman 23:35
So you can be an Eclectic Therapist. You can be a Fruitionn, you know, Psychoanalyst. You can be, you know, that kind of that’s a Gestalt Therapist. So those are the kinds of things I’m thinking. Yeah.
Krista Nash 23:47
So when you do the addictions counseling work, are you ever involved with more than just one client?
Lorraine Bockman 23:54
That’s most of my work. I don’t do family work necessarily. That is a thing I would I have lots of different kinds of training. And so I will meet, like, let’s say I’ve met with a couple different parent family members, and, you know, they’ve kind of been like, what do we do? Or how do we proceed? Or, you know, those are one offs. I don’t- it’s not something I do on a regular meeting every week with them. And so most of what I do is individual therapy.
Krista Nash 24:21
With that approach you just talked about, even though you rarely do it. Would that be? Maybe somebody comes to you who’s one of the family members who’s affected and then they are like, Hey, can you help us talk or let’s say…
Lorraine Bockman 24:31
I’ll have a parent, you know, couple that comes in and says, what do we do about our kid? You know? And it’s not a magic wand, right? Necessarily. It’s not what we end up talking about more is not, what can you do about your kid, but what’s in your hula hoop to do? Right? Because we don’t have control over the kid. We don’t have, you know? Or maybe it’s two young adults who have a parent. That’s substance using, right? And it’s the same kind of thing. What can you do because you don’t have control over this other individual? And how can you raise the bottom, you know, for them, rather than waiting until they lose their house and their car and their job and their finances and everything about that?
Krista Nash 25:15
You use that term when we were preparing to like this idea of raising the bottom. It’s a phrase I think I intuitively understand based on what you just said, but it’s not a phrase I’ve heard before. So explain that, like she said about rock bottom, like, rock bottom doesn’t really need to be like, let’s make the rock higher so it’s not so low.
Lorraine Bockman 25:35
Okay, so you know traditional 12 step treatment, right? We’ll say you can’t help somebody unless they’re willing to help themselves, until they’re ready, right? So they have to hit rock bottom before they will make any changes. I don’t tend to believe that’s true, and I think fewer people in the field these days tend to believe that’s true, or at least there’s a group of us out there. And really that is, how can you take care of you? How can you set boundaries? How can you hold boundaries so that the other person doesn’t have to fall all the way, so they don’t have to hit that bottom again, losing the family, losing the house, losing the car, losing the job, like losing the bank account, right? I mean, people do fall that far, and that’s, you know, some people have to, and that’s okay, but I think that there are things that people in their lives can do. I think there’s things that the systems can do, the attorneys and the courts can do to help raise the bottom for people.
Krista Nash 26:41
So maybe this is a natural place to talk about what you shared with me about the stages of change. I don’t know. Does that show here like, I mean, I will link this on my site or and resources so people can see it, but it goes through essentially various stages. I mean, maybe just tell me about it looks like it’s from the NCBI which is, I might not remember what that stands for.
Lorraine Bockman 27:04
I think originally, that’s from Prochaska and DiClemente, right? And William Miller did a lot of work around that, The Stages of Change. And really it’s what they realized is they were, I think the original study was around nicotine, and they were looking at how people make a change, how do people change their smoking behavior? And what they realized was, oh, there’s these kind of well defined stages. And then they realized that it’s not just with nicotine, it’s not just with alcohol, it’s not just with substances, right? This is kind of this standard way that people change their exercise behavior, or change their diet, or, you know, like it’s all kinds of changes that people say. So there’s pre-contemplation. Yeah, yeah, go through it. Tell me about it. Sure. There’s precontemplation stage, there’s a contemplation stage, there’s a preparation stage, there’s an action stage, maintenance. And then there’s in the substance use world and others, right?
Krista Nash 28:04
There’s a relapse stage. So you can imagine that with exercise, right? You know where it’s like, okay, you’re all like, where are we now? When we’re recording this, it’s February, people have stopped their New Year’s resolutions, right? Yes, so how have you seen this fit into the work that you do in addictions for people, are they just following those same like, or do you tell people you’ve got to know where you are in this? Like, do you tell them that it seems to me, still in contemplation? Or you’re still like, how does this actually get used?
Lorraine Bockman 28:32
I think it depends on who you’re working with, right, as a therapist, if I’m working with someone that’s interested in the language around it, and interested in the kind of the science around it. I’ll talk about that. I’ll bring it up, and we’ll talk about where you are in the stage of change. You know, I think when you’re working with someone, part of the goal, if the goal ultimately, is to work with them around their substance use, is to help them move from one stage to another. So, you know, someone who’s in contemplation, if you label that and talk about what that means and and talk about the next stage, then you’re helping them, right? You’re providing them education to help them to get to the next stage.
Krista Nash 29:16
Usually its interesting, you know, I’m in the seat where I’m obviously, I’m talking to parents, but as a best interest attorney, I’m talking to the kids a lot, and they’ll sit there and just be like, I do not understand why my parent choose this over me. You know, you must kind of get that sense too, like and I guess maybe that also makes me think about on your website, you talk about the courage that it takes for people to really address this. Maybe talk about that a little bit. I mean, what do you see? You’ve got so many different hats on. I do too. You know where you’re seeing what people are going through. Obviously, people love their children. It’s not like they’re trying to choose what the substance is over their children. But what makes you use the word courageous? And how do you articulate how difficult this is? You know, because people share. Don’t you just stop, right?
Lorraine Bockman 30:01
People do say that all the time, right? So you’re asking the question. Makes me think of two things. One is that there is still a lot of stigma and a lot of shame around addiction, right? And mental health in general, right? And so I think it’s challenging for people to step up and say, I’m struggling with this. Because who knows what kind of reaction they’re going to get, right? And there are still a lot of people out there that will just say, Well, why don’t you just quit? And it’s not like that, right? Which brings me to the other thought, which is, you know, according to the American Society of Addiction Medicine. Addiction is a chronic brain disease, right? Just like any other chronic disease, right? So you talk about diabetes in the same breath that you talk about addiction, right? And again, there is at times disagreement in the field about whether that’s true or not, but that’s what the physicians have said, and they are doing the research to show that right there’s clearly more research, you know, regularly coming out about how substance use impacts your brain. And so I think, for the crowd that says, Well, why don’t you just stop to say, look, this is a chronic brain disease. This is, you know, the folks with diabetes who are not medication regulated, right? Those folks, too. Why don’t you just stop? Well, it’s not that simple. It’s just not that black and white.
Krista Nash 31:34
So what then makes you use the type of language like that? It takes courage.
Lorraine Bockman 31:39
Well, again, stepping back into the therapy process, right? I want people to understand that taking that first step or walking into the office is hard. I don’t know what you’ve gone through on the other end, but you didn’t get here overnight. And so I get that, I understand that this is a challenging process for you to even take a step into the room, and is challenging, right? Much less to take a step into the room and say, I am struggling with my alcohol use and I don’t know what to do next.
Krista Nash 32:14
Yeah, I’m curious too about this idea about disease, because, I mean, I’ve talked about this on a couple different podcasts. Now, do you think, and this is truly mean just not knowing, is the idea that it’s probably both and but help me and listeners understand, when I looked at what the work of Dr. Tabashnek and talked through that on my podcast, and I’ve shared some PDFs of on my website with resources about what happens to the brain, right? Of addicted people, and what happens with dopamine and all the things that are actually happening in your brain, it always feels a little bit like the piece though about how you got to that point, feels more voluntary, right than diabetes would, right? So is it that there’s more proclivity toward it because of genetics? Like, if you never drink, you would not be in that situation, right? That your brain might be in that disease state.
Lorraine Bockman 33:05
Yes. Well, let’s say, let’s call it a biopsychosocial model,
Krista Nash 33:09
Okay, right? That sounds a lot fancier than what I’m saying. Yeah, thank you.
Lorraine Bockman 33:14
But it’s the same thing. It’s what you’re talking about, like, it’s genetics and environment, right? Okay, and so let’s say that you have this genetic predisposition, right? And then your environment, whether that’s growing up in an environment that is really permissive or just even has regular substance use, or maybe you get into school and you get, you know, in a crowd that’s running around with substances, and you know, whatever that environmental exposure is, and you partake, maybe your bell is rung right. So then you’re kind of, some people are off to the races, right? Some people start pretty early and pretty young. And for some people it starts later. But I think there’s all of these factors that impact how it gets started, so to speak.
Krista Nash 34:06
And what was that thing you said? Maybe your What was your bell was wrong?
Lorraine Bockman 34:11
Is that what you said, Love, right? Yeah,
Krista Nash 34:13
I wasn’t sure you said, okay, so then it does the research show. And I’m only pausing because I’m really, genuinely trying to make sure I understand what I’m, how I’m even trying to articulate this. It’s complicated. Do you think all people have that like it’ll affect people differently? So, meaning, based on the bio part, the genetics part of it, like one person might drink this much and it might not create that kind of reaction, the other person’s biology is different. So it’s just you’ve got different outcomes.
Lorraine Bockman 34:41
I mean, that’s what it seems, that’s what the research is seeming to show.
Krista Nash 34:45So a person may have voluntarily gotten involved in something, but this now impacts. They have a genetic proclivity to it. There’s something biological going on with them, and now we are off to the races in terms of your brain actually being injured. Yeah. So this idea that you can just quit, and also it kind of makes sense why marriages might fall apart, right? Like, as I think about the dopamine part, I’m like things that are supposed to give you pleasure are no longer giving you pleasure. Whether that’s a great job, rewards, children’s smiles, sexual activity, the joy of being in love or whatever, right? Like, you don’t get that. Is it fair to say that just affects the dopamine to a level that a person can be deeply changed? Yeah, you’re seeking it elsewhere. Yeah? I mean, it’s very interesting. Dr. Sebastian talked about that at that Family Light Institute. I know you and I talked about that before that. She’s like, what’s the basketball team here? That’s the big basketball we’re all. She’s like, we’re like, oh, the Nuggets, whatever, you know, the Denver Nuggets. And she said, Okay, imagine, you know, you’re really into the Denver Nuggets. And you know, it’s your main thing you’re interested in. And the first day you go to a game, it’s like the highest high you could ever imagine when you got to go be on the floor in the best seats and whatever. And she said, then think about somebody who, you know, they get this dopamine hit, and it takes you up to X percentage of whatever X number or whatever of dopamine. Well, the same person who would have been experiencing the alcohol or, you know, the addiction like they literally cannot, it does not create that in them anymore. They cannot get to that point. And it just changes it. I mean that really, I think it, you know, for lay people, I think it really helps make sense of somebody’s lack of joy, or the way that they’re presenting, or their lack of enthusiasm, or any of these things. You know, I don’t think lay people really understand that very well. So it is interesting to see the scans and say, Wow, there is something going on here. Whether you want to believe it was voluntary or bio, what did you call it? Again?
Lorraine Bockman 36:38
Biopsychosocial Model.
Krista Nash 36:41
See, I need to, like, really up my game. Like, I’m like, it seems like it’s a one stop shop self reporting. You’re like, well, that’s the difference between clinical and forensic, right? And then I’m like, I don’t know about this, you know? So I appreciate you. I’m learning a lot too. So that’s all really, really good. Okay, so let’s talk a little bit about you also sharing with me these cognitive distortions? Yep, tell me about that. Tell me about cognitive distortions and how that impacts your work.
Lorraine Bockman 37:08
Sure. So people get stuck in ways of thinking right, and they’re, you know, somebody somewhere came up with lists of cognitive distortions right, of things, of ways that people are thinking that cause problems for themselves, for example. So let’s say black and white thinking, right? So this is where somebody is very either or, and there’s no gray in the middle. And so folks who struggle with addiction, and, frankly, family members, get to the point where, you know, everything is good or bad, right? We see this a lot in high conflict, of course, right? The other person is all bad, you know, and the person where there’s been substance use, the person is having trouble, you know, kind of remembering what there was any good in there, but, and that’s black and white thinking, right? You know? And so that causes problems for folks who are struggling with substance use, causes problems in relationships and all those kinds of things.
Krista Nash 38:14
What are some of the other ones that I mean, I’m peeking at your list here, but tell me, what are some of the other ones you see that are frequent? Because I think it’s really interesting to think of that black and white thinking as a distortion. Like, I like that, because when you think about it, I’m constantly, as a CLR, saying, This person is not all bad, this person is not all good, you know, right? Why can’t we kind of meet more? I’m always trying to draw people into the middle, right? You know, not everything has to be imputed with the worst possible, you know, in the worst possible intentions, you know, right? Even with kids, I’m like, your parents love you, you know. I mean, even if we’re talking about alcohol or drugs or whatever, you know, I actually just got off with a kid today, whose parent is, I’ve got to actually call Child Protective Services here today, still, and explain something that occurred. It’s not urgent, right? Everyone calm down, or I would have done it already instead of recording this podcast right now. But I do, as a mandatory reporter, have to make a call, because there’s been some things that have occurred that I have to report, but I was able to look this kid in the eye, at least over zoom today, and say, your parent loves you, okay, like the kid is saying, the kids a teenager say, I want to never have anything to do with this person again. You know, this person is all bad, right? And I’m like, that’s not true. There’s something broken in your parents, probably, and we need to work on that, and we’ve been working on it, but you know, you need a relationship with this person, and there is love there. And I’m trying to help them not have that black and white thinking, even though victimized for
Krista Nash 39:39
Yeah. But I love thinking about that, just remembering that it’s a distortion even in our own lives. You know that people aren’t that way too simplistic. And I actually think that also could be part of the problem with attorneys in these cases. Don’t even get us going on this, because there’s such a propensity to drink the Kool Aid of a client and have this black and white thinking and not welcome the best. Attorneys welcome the nuanc