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To commemorate National Recovery Month, SCV-CAMFT Director-at-Large Vidur Malik speaks with Mary Crocker Cook, a therapist, addiction counselor, educator, and author, about how to support clients in recovery from addiction.

Vidur: Could you introduce yourself and the work you do along with any specialties?

Mary: My name is Mary Crocker Cook. I'm a licensed marriage family therapist and licensed addiction counselor. I have been licensed since 1988, and I have always worked in addiction and mental health at the same time.

My private practice is largely general, but I have always taught and worked in addiction. I teach at San Jose City College and run their Alcohol and Drug Studies program

Vidur: What drew you to working in addiction treatment?

Mary: I became licensed in the late 80s. That was when all of the adult child of alcoholic books came out. My clients were all bringing them in and I started reading them and recognized myself, and started on my own recovery journey. In 1990 or so, I was at a network meeting with the clinical supervisor for the El Camino Substance Use Department. I asked her if I could volunteer because I wanted to know what happened in residential treatment. I wound up staying until they closed for about two and a half years. Out of that, I developed academic programs and my own expertise and addiction and just fell in love with it.

Vidur: Are there particular principles that you think should be part of addiction treatment?

Mary: The main thing is motivational interviewing and making sure that people are engaged at their stage of change. The biggest mistake we've made over the years is mismatching our level of care to people's level of willingness. Then people feel like they fail treatment. That's not true. But they failed that level of care because that's not what they wanted.

I'm an ASAM fanatic. In my own private practice when I work with addicts I do the ASAM because I think the multi-dimensional approach is key.

Looking at people's early attachment style is going to also help you figure out how to engage.

I'm on sabbatical for the year from City College because I'm writing my textbook on Attachment -Infused Addiction Treatment based on my own little outpatient here because I also teach codependency from attachment theory.

Vidur: Was there a moment in time when you first noticed the link between attachment style and addiction?

Mary: I have been teaching codependency from this framework for a long time because I kept seeing a combination of developmental history and then behavioral strategies and then medical or immune system damage in all my codependent clients. About five years ago, I started really focusing on addiction from that perspective.

Vidur: How would you say that framework helps clients get insight into their addiction?

I think it makes sense to them. My tagline is, ‘when vodka makes more sense than people.’ I think they get that. They've been through treatment multiple times, it's not that they have an information problem. The problem is application and how their interactions with other people continue to sabotage their use because usually it's a relationship that takes them out.

Vidur: Something I've heard from clinicians is ‘how do I know when a substance use issue is within my scope of practice? And when do I have to refer out to more targeted treatment?’ Are there ways that you can recommend that a clinician can delineate that for themselves?

Mary: My favorite way to do it, even though I'm a specialist, is to have them evaluated by somebody else, and I say, let's do whatever they recommend. So clinicians can send clients over to a treatment center who will do an assessment. That allows them to stay connected to the client before and after treatment.

The other possibility is to say to somebody, ‘what are you willing to do?’ And you start with that. The thing that kills me is people who had bazillion years of therapy and the therapist never said anything. The important thing to me is that they call it. ‘I see the drinking's part of the picture here. Sounds like you're not willing to do much about that, but when I notice it, I will mention it.’

If you cannot do that, you need to refer. if you're afraid to talk about it, or it's too sensitive, or you're going to be weird about it, OK. Send it to somebody who's not afraid of the topic.

Vidur: When working with someone experiencing addiction, what should success look like? Should it always be about relapse prevention?

Mary: I think moving through the stages of change is the goal. It depends on how the client identifies as a substance user. My question is, what's your relationship to substances? What do you think is going on with you in terms of substances? I'm trying to get a sense of what role it plays in their life. The whole point of addiction is you don't connect the dots. Like life is the problem. Alcohol is a solution. They don't see that it connects.

Vidur: How can clinicians build comfort with calling out clients?

Mary: I think they have to see it as a disease and not a symptom. It kills people. What clinicians are worried about is damaging the relationship. They would if they were blaming, but you can look at it out of curiosity, because my worst fear is I'm missing something. I'll even say to people, ‘I'm going to keep asking you this because my worst fear is you're paying me good money and there's a big piece of this puzzle I'm not addressing.’ It's a piece of the puzzle I have to have to be effective in what I'm doing.

Vidur: Is there anything else you’d like to mention that clinicians should know about?

Mary: Something I want to mention is that I am very worried about how many DUIs are in our CAMFT magazine every month.

I teach ethics and I always start with what not to do. I take out the magazine, and I'm like, Oh my god, DUI, DUI, DUI. I'm worried about us.

I think that therapists really don't see substances as a problem for themselves. If I don't think it's a problem for me, I am surely not going to see it for my clients. I don't recognize that I shouldn't be behind the wheel. I might have a little bit of a blind spot.

Also, we need dually certified professionals. We need therapists to go get certification as addiction counselors. We don't have enough of us. Addiction treatment is an actual animal in and of itself.

Vidur: What can therapists do to get certified as addiction counselors?

Mary: In Santa Clara County, you could come over to San Jose City College and take our classes. They can do the certification program online through the California Consortium of Addiction Programs and Professionals.

back to September 2024 newsletter  

References

Facing Codependence by Pia Mellody

This Naked Mind: Control Alcohol, Find Freedom, Discover Happiness & Change Your Life by Annie Grace

The Science of Addiction: From Neurobiology to Treatment by Carlton K. Erickson Ph.D. 

Understanding Addiction: Know Science, No Stigma by Dr. Charles Smith

(3655) everything you thought you knew about addiction is wrong - YouTube

How Childhood Trauma Leads to Addiction - Gabor Maté (youtube.com)