Broken or restored? Drug and alcohol dependency

Alcohol and Drug Addiction

The bowl above has been repaired using a Japanese technique involving metallic lacquer. Do we now think of it as damaged and faulty, or as beautifully restored and just as functional as before?

Working in substance use units down on the Sussex coast left me with a general impression that clients were choosing to self-medicate, finding distraction or oblivion regarding past or present pressures. Some did not even like the taste of what they chose to drink but were consuming precisely measured volumes to achieve and maintain a state where they were able to cope. My impression was of people suffering in their own private hells, finding fixes to help them get by.

Working in substance use units down on the Sussex coast left me with a general impression that clients were choosing to self-medicate, finding distraction or oblivion regarding past or present pressures. Some did not even like the taste of what they chose to drink but were consuming precisely measured volumes to achieve and maintain a state where they were able to cope. My impression was of people suffering in their own private hells, finding fixes to help them get by.

Although perhaps tempting to stick metaphorical labels on clients’ foreheads labelling them all as dysfunctional addicts in need of professional help and a standard path of treatment, working as equals together seeking to find the cause(s) of their dependency was usually productive. Separating the person, their substance use and the cause of this dependency allowed us both to identify and focus on the underlying issue(s). A simplistic formula would be ‘Person + cause = behaviour’; remove the cause and the behaviour goes away, leaving just the core person. Therapy can aim to be a helpful period of change, rather than a life-long restriction or obligation.

A couple of clients were angry about previous experiences elsewhere, feeling that they were required to think of themselves as permanently broken to the point of having to abdicate their autonomy and submit to a ‘higher authority’ – once an alcoholic, always an alcoholic, no longer responsible enough to even go into a café if alcohol was sold there. This felt uncomfortable for me as well, we can all use a helping hand at times but hopefully to move us on in our lives rather than hold us back at a fixed level of development.

Replacing one dependency with another, less damaging one for a brief time can be a good halfway stage for substance users to break a habit. Apart from the benefits from cutting back on their drug(s) of choice, it can provide an opportunity to address the original cause(s) of use and tackle these rather than the symptom. Giving a man a fish whilst he learns to fish for himself feels better than telling him he cannot be trusted with a fishing rod again and must constantly remind himself of this.

Indeed, clients play a significant role in effective therapy. Miller, Duncan and Hubbard (Escape from Babel, 1997) explore the shared areas where different therapeutic disciplines prove to be effective, and how results are achieved. Interestingly, they suggest that the single most effective factor in therapy outcome is the client (roughly 40%), with other factors being the quality of the relationship between therapist and client (30%) and the placebo factor (15%). Only the remaining 15% can generally be attributed to the method used by the therapist, and colleagues have agreed that, after a couple of years it can be hard to tell the difference as we often seem to be working in the same ways regardless of our original training.

The importance of clients being involved in the process is highlighted by Carl Rogers, one of the founding humanistic psychologists. Focusing the attention on the client in a person-centred way, Rogers view was that the therapist helped and supported the client explore and resolve personal issues whilst avoiding leading or directing them in any way. He considered the client to be an expert on themselves and their needs, with the therapist only able to glimpse parts of their internal world from the outside, never able to enter or understand it fully. Rather than joining the many voices telling the client what to do, or to pull themselves together, we instead give them a ‘damn good listening to’ – the chance to explore anxieties, acknowledge past or current hurts or losses and just simply to have their voice heard for a change.

After intensive extra training in drug and alcohol awareness, our group was somewhat shell shocked by the end, but the lead tutor advised us not to worry or panic. If ever stuck and not sure what to do, we should just follow Rogers’ three core conditions for therapists. This has proved to be excellent advice, often there is no need to go beyond these simple but effective requirements. Interestingly, they also figure strongly not only in the effective strategies mentioned in Escape from Babel (see above), but also in the new guide written by Christians and other theists for pastoral support and chaplaincy workers but intended for use with all patients (Psycho-spiritual Care in Health Care Practice, Guy Harrison).

These core conditions simply require us to always extend empathy, congruence and unconditional positive regard. Being honest, open and respectful to clients, their views and their anxieties and concerns can come as a novel experience at a time when social media and the pressures of modern life have altered the way many of us communicate. Change and progress come from the client as they realise and accept not only their current position, but also the challenges they face and the options and resources available. Giving people the time and space to hear themselves think, the understanding that they are valued and respected can help them realise and accept their potential to change, adapt and grow based on inner strengths and abilities perhaps previously discounted.

Sometimes clients want to tell their experiences, to pass on bad memories in a ‘problem shared, problem halved’ way. Often, they need someone to recognise and confirm their progress and achievements, to acknowledge and validate small successes as they build up over time to form a larger pattern. Rather than playing a game of snakes and ladders where there are no ladders and many snakes that all lead right back to the start, a lapse (common in recovery) can be put into context rather than seen as a requirement to start all over again. If getting lost driving in a distant town, would you go all the way back home and begin again, or instead go back to the last place you recognised and start again from there?

We can help those who are struggling with a dependency to take pride in how far they have come, to recognise and celebrate that. A single lapse after three months can be taken as resetting the counter to 000, or else as 1/91, the next day can be counted as either 001 or as 1/92. The latter recognises that as humans we are not perfect and will probably have the odd set back or glitch in our lives. Our path probably won’t be smooth, and we’ll pick up honest wear and tear along the way as we knock about and are knocked about by life. We can choose to think of ourselves as damaged and broken and ‘stuck’, or else recognise and celebrate our achievements and potential, and keep moving forwards.

Paul Hurst