If Suicide is a Risk, is CRAFT Still Appropriate?

Member worriedinwa follows up on her brother’s heroin use, and the how the family is approaching the situation, having only recently learned about the use. Worriedinwa wonders how to apply CRAFT when suicide is a real concern for the Loved One.

“I finally had an opportunity to speak with my middle-aged brother, who has been using heroin for (months?), opiates for years, and pot since high school. My family only recently learned of the heroin use. I am encouraging the entire family to learn about the CRAFT method, but I have a question about suicidal talk. It is really clear that my entire family has helped my brother avoid natural consequences of his actions for decades. We would like to start changing this. At the same time, when we talked my brother kept referring to the fact that everyone dies, their time comes, I should get used to him being gone, etc. (I had opened the conversation by saying I was worried about him because he is going through a divorce.) His tone was defensive, but he also clearly cared about me and recognized I was upset, holding my hand and giving me a hug. He has not expressed a clear plan for suicide, but he owns guns. We are all scared he might take his own life at some point, and this makes us scared of allowing natural consequences to play out. Right now, only one family member still gives him a little money from time to time, but he is allowed to come to my parents’ house for laundry, showers, dinner, and to see his daughter.

I guess my question is about how to apply CRAFT and any other advice when someone might be at risk for suicide. Or perhaps, this sort of talk is common and not necessarily a real expression of suicide intent? I didn’t see the topic on the list of discussion forum topics.”

The talk of suicide is indeed very worrisome and can stop families from allowing natural consequences. The fear is that taking away money, or not answering their phone calls, or leaving them alone when high will lead the Loved One to suicide.

To this I add two other frightening behaviors that stop families in their tracks when it comes to instituting changes in the family dynamic towards the alcohol or drug use. The first is the threat of overdose (or for that matter, any dangerous behavior like driving drunk) and the second, in adolescents and teenagers, is the threat of running away.

There are a couple reasons to worry about your brother’s situation. The risk of suicide is higher among older males, those with the means for suicide (like guns), and the crisis he is going through with his divorce. Suicide is also higher in those who abuse drugs or alcohol.

The first suggestion I would make is for you to get the advice of a psychotherapist. Your family is going to need the help of a professional to assess the degree of risk and how the family should respond to it. Getting a psychotherapist on board now helps you and sets the stage for your brother to be assessed. Take the suggestions we give in Learning Module 8 on how to get your Loved One to enter treatment and engage your brother to agree to be properly assessed. Explain that this is just a one-time meeting—he doesn’t have to continue if he doesn’t want to. You will go with him if that helps…..

It sounds like you were able to talk to him. He was defensive but appreciative to know you care. In a moment when things are calm, talk with him again. Use the outline of how to make a request (Exercise 21 in Module 8) to help frame your talk. Leave out the talk of drugs. This is about his safety and you learning how to care for him.

It is possible that your brother isn’t suicidal. His talk of not being around, etc. might instead be a way to gain your empathy or attention or needed handouts of money, etc. He has learned along that way that this is the quickest way to maneuver you to where he wants you.

The possibility of a drug overdose or running away does that same thing. It makes family members cross their own boundaries, whether it be by protecting the person from the potential of hurting themselves or by avoiding hard, angry or hurt feelings by giving them what they ask for. The Loved One doesn’t even have to say a word. You are so worried about overdose or running away, you are stifled from acting in a way that best addresses the alcohol or drugs.

I’ve reprinted below some sound advice from Kate Thieda, a psychotherapist and author of Loving Someone with Anxiety (https://blogs.psychcentral.com/wellness/2011/11/manipulated-by-suicide-threats/).

What to do when someone is threatening suicide as manipulation

• Express concern for the person, but maintain your boundaries. Threatening suicide is very manipulative, and the other person is expecting you to yield to his demands. By saying, “I can tell you are really upset right now, and I want to help, but I will not [fill in the blank],” you are showing that you care, but are also not giving in.
• Put the responsibility for living or dying back in the hands of the person who is threatening you. Say to the other person, “I don’t want you to have a relationship with me just because I am afraid of you dying and you think I can’t live without you. Our relationship should be based on mutual love and respect, not threats. I love you, but I can’t stop you from making this choice, even though I wish I could.”
• Don’t argue with the other person about whether he is serious about dying. Assume all threats are serious, and act accordingly. If you argue the point, he may make an attempt just to prove you wrong.
• Remember that contrary to what the other person is saying, you don’t have to prove anything. He may be saying, “If you loved me, you’d stop me from killing myself,” but the truth is, unless the core issues of what brought him to this place of wanting to end his life are addressed, giving in to his demands over and over again will not fix anything. You will still be angry, and the other person will still be vulnerable to wanting to self-harm again. The cycle will not break unless a trained professional steps in.

There is no easy answer here. With the advent of strong opioids, every episode of getting high is potentially deadly. Losing your child to running away has the same effect.

As Thieda says, your best chance of ending this cycle is to get your Loved One to accept to go to treatment. The drug and alcohol use should be seen as one core issue that must be addressed. If you’re on this site, the chances are good that things are serious and will not resolve without help. There are no shortcuts. You can’t have your Loved One locked up, not for long anyway. What you can do is mapped out in the Learning Modules on this site. If certain natural consequences seem too dangerous to try, then don’t try them. You are going to have to be the judge. There are probably dozens of little natural consequences that are safer….like not providing companionship in the moment, or a hug, or a warm loving smile.

I was at a parent support group last fall when a couple talked about there not being time to do all these things we talk about with CRAFT, their daughter was in real danger, continuing to use heroin despite being put on methadone. They needed to act now to limit her independence somehow; to protect her from herself. The parents in the room were quiet for a moment, and then the facilitator spoke up:

You may think this is the long way around, to make these changes in your behavior, you may not see how this can work in a timely way, but for how long has your daughter been using and what all have you tried to limit her use? Has it worked? Taking 8 weeks to gain these skills and approach your daughter differently is the shortest way to your goal, trust us, we’ve been where you are: ready to build fences around our Loved Ones to save them. Our Loved Ones jumped over those fences. You can’t control your way out of this.

It appears some family members have stopped giving your brother money, without calamity. Finding a way to limit your brother’s access to your parents’ house when he is high would be important, especially because it also means he wouldn’t get to see his daughter. Asking him to respect your elderly parents by not showing up visibly high could be a start. Again, seeking counsel from a professional, who  can guide the family with the risk and the stance you should take, who can help you with how to communicate with your brother, and who can eventually assess your brother, is an important first step.