On 4th March 2017 Martin Weegmann joined Brighton Therapy Partnership to explore the role of addiction on our society, media portrayals of inebriation and dependence, and how as therapists we can work with these clients. The following are key points of learning for counsellors and therapists on addiction.
No matter where we look there are references to drink and drugs either as hedonism or debauchery in society – we can’t seem to escape it. Newspapers laugh at celebrities falling drunkenly out of nightclubs, perfumes named after illegal substances sell allure with glamorous imagery, and we the public protest our right to self-inflicted harm when Parliament debates a change in drug classifications. Whether you are a user, teetotal or somewhere in between, every single one of us has a relationship to illicit substances.
Every society has intoxicants, but who decides what is right or wrong? We don’t ever question our perceptions. We don’t ask why we feel disgust for the heroin addict and mirth for the drunken student. We don’t question how we can be strict in our adherence to the law, yet revel in the illicit nature of wearing perfumes named after addictive opiates. But as therapists should we be more aware? More empathic? Less judgemental?
The word ‘addiction’ is used by the media to stir up negative imagery – an uncomfortable truth and a choice to do wrong. And yet in its Latin origins ‘addictus’ literally means to devote or surrender. An obligation to the substance taken out of conscious control with no hint of the moral overtone which arose later on. So what is addiction?
The spectrum of addiction
The public persona of addiction can be seen as very black or white. You use drugs so you’re an addict, or you don’t drink so you’re not. But is anything really black and white? Addiction is presented as a binary state of being, but it’s really a spectrum.
In the world of addiction therapy there are distinctions beyond those polar opposites – an exploration of the many shades of grey between. Put simply though, substance use can be broadly separated into three categories:
Intoxication – Tipsy, inebriated, and somehow almost normal behaviour– very few people have led a life without intoxication, and we as a society see a first drink as a right of passage rather than a fall from grace.
Substance misuse – The word ‘misuse’ marks the beginning of the more negative aspects of intoxication, suggesting a need rather than a desire for a substance, and possibly the start of negative consequences for the user.
Substance dependence – With dependence there is no conscious choice left. Without the substance the user will experience negative side effects known as withdrawal. They may find that the combination of the craving for the substance, and the withdrawal symptoms without it make it very hard to stop using.
The therapeutic triad of addiction
When working with clients with substance misuse or dependence issues it is important to consider that the relationship in the room is no longer between just a therapist and their client, but is instead a triad of therapist, client and substance. Whilst a client is experiencing the most dependent levels of addiction, other areas of their life may be compromised or even completely ignored.
And yet clients can emerge and live healthy and positive lives. With the help of their therapist holding onto hope for them when they can’t hold it for themselves, they can pull away from the long shadow cast by their drug of choice.
A psychodynamic look at addiction
Just as children form attachments to caregivers, addicted adults form these bonds with the substances they feel care for them. These primitive mental states can become more important to us than affectional bonds, as the most intimate relationship the user has may be with their substance.
It is therefore important for therapists working with clients in the process of detaching themselves from a substance to acknowledge the separation distress that this can cause, and to treat this bond with the reverence it deserves. Although an addictional bond with an illicit substance can be seen as a negative association by society, many clients see it as the only option available to them. Their substance is reliable in a way that people may not always be, it is comforting in a way that people may not always be, and it is there (finances permitting) whenever they need it, which people (with their own lives and concerns) may not always be.
Self-soothing with substances
Self-soothing is something we all use to feel comfort or to experience respite from the harsh realities of the world around us. These soothing actions can be small – subconsciously wrapping our arms around ourselves when we are lonely to simulate human contact, or stroking our own wrist when our boss yells at us. Or they can be bigger – going for a walk or attending a dance class when we notice the edges of sadness creeping in.
Substances can also be soothing – depressants such as alcohol can lower an anxious heart rate, hallucinogens like LSD can take us away from reality into a dream world, and opiates like heroin can reduce the intensity of pain signals. Therefore when talking to someone about their reliance on a substance the key question to ask, is what does the drug do for you? What do you anticipate prior to taking it?
The issue which arises from a substance being used to self-soothe is that, with the substance chemically affecting the brain, the user has no need to seek human connection and can therefore stunt their self-growth. Where life is dominated by the substance there is no building of the self and the user can become developmentally stuck, with no flexibility in their defences and coping strategies.
As Donald Hebb said, “neurons which fire together, wire together.”
Developing empathy for the addicted client
For therapists who have never experienced drug use themselves, it can be a wild leap of the imagination to put themselves in the shoes of the addicted client. To help with this, Martin asked groups to create an imaginary client. Develop a profile with prompts and questions like…
- Who are they?
- How old?
- Do they have children?
- Do they have a partner?
- What do they do for a living?
- What is their substance of choice?
- How does their substance use affect their daily life?
The groups in the workshop produced a wide range of clients from young men using drugs as part of the chemsex scene, to stay at home parents, and powerful business women. These emotive stories of how problematic usage arose subtly for some clients, and with a sharp nose dive in others, really brought home to the group the wide variety of clients who are affected by substance use every day. For those therapists in the group who had never worked with addiction, it humanised this client group in a way they hadn’t before experienced.
Working on addiction recovery
Of course, in any workshop focusing on addiction, the biggest question of the day is how to facilitate change.
The difficulty in changing behaviour is that, as with any walk of life, when we deny ourselves something it can become all consuming. It can therefore be easier to facilitate change if, instead of denying something bad, we promote and allow something better in. This more positive outlook on substance reduction means that instead of focusing on what we are denied, we focus on the new positives we are experiencing. Thus, the hold the substance has on us becomes lessened.
It is often said that the opposite of addiction is connection – that with addiction we are isolated. But with recovery we reconnect with the self and the outer world and thus the life without the substance is a more full and fulfilled one. This links to the idea that recovery from addiction is the same as recovery of yourself. The person may have been lost behind the substance. Therefore, it is a journey in which the client learns that ‘it’s ok to be me.’
The therapist’s role in addiction
When we talk about reformed addicts we speak of people ‘in recovery’ rather than ‘recovered.’ This is because, like any path we take in life, the path to recovery is one which takes effort to sustain. It is a constant journey, rather than an end goal, and one that must be chosen again and again, day after day.
As therapists we can only help clients to see that path and to see that they have that option. We can help them to feel whole again and strong enough to take the path. As therapists we may guide clients into seeing their strengths, and offering hope of a life in which they are empowered rather than subjugated. After all, life is a journey, not a destination.