Canada Drug Rehab

By Geoff Thompson - MA, CCC
Program Director
Sunshine Coast Health Center

Addicts do not like surprises. That’s why they are, what we affectionately call, control freaks. It’s important for recovery to overcome this desire to control, which means learning to live comfortably in the grey areas of life. The grey areas are those times when there are no immediate solutions to problems, no immediate answers to questions, no understanding of how things will work out in the future…no control.

The AA Big Book makes a big deal about the addict’s desire to control:

“Each person is like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in his own way. If his arrangements would only stay put, if only people would do as he wished, the show would be great. Everybody, including himself, would be pleased.”

Psychologists, too, have noticed that addicts are obsessed with trying to manipulate others and events. Why? If people do what the addict wants, and life happens as the addict wants, then the addict feels better. Those who relapse inevitably tell us that people or things didn’t work out as they wanted or expected; they got stressed out and relapsed.

And that’s a BIG problem: People and things don’t operate according to the addict’s wishes. As the Big Books says, “What usually happens? The show doesn’t come off very well.” And then the addict gets irritated and tries to be even more controlling.

Giving up this desire to control is one of the keys to recovery. But it’s tough. If the addict doesn’t control people, places, and things, then he might get surprised. Those curveballs in life upset him. He might have to exist in a world where there are no immediate answers. He might have to deal with all those unexpected things in life.

And the unexpected can be complicated. Say an alumnus was hurt deeply because his partner cheated on him. They split up, but he would like another relationship. If he gives up his desire to control, then he has to take the risk that he might get hurt again. Or say an alumnus worries about talking in public. He can either try to keep control by never speaking in public, or he can take a risk and give it a shot. But who knows what will happen? Perhaps the audience will laugh at him. Or say an alumnus only likes his job because of the paycheque. He could go back to the job because it’s good money, or he could face all the uncertainties of finding new work.

The idea of giving up the need to control is frightening for most in early recovery. It demands that they learn to live in a world they have little power over. Of course, they never really had control, but the thought of voluntarily giving it up is what stresses them.

In this article we’ll look at why those in early recovery are so desperate to control the world they live in, and then we’ll provide a few techniques that you, as a person in recovery, can use to learn to live comfortably—when you don’t have answers, when you can’t see how things will work out, when you accept that you have no control over life.

Part One: Why Addicts Want Control

It is true that all people need to feel in charge of their lives. Happy people have figured out how to do this. Unhappy people haven’t. The best tactic that unhappy people can think of is to control others and, as the Big Book says, “the lighting, the scenery, etc.”

Addicts have all sorts of tactics to take control. Here are some examples from Sunshine Coast clients: Guilt a family member into doing something: “You’ve never cared about me and what I need.” Blackmail: “If you don’t do what I want you to do, I’ll relapse.” Directive: “You have to learn to quit nagging me, so you should go to Al-Anon or a therapist.”

These tactics show up all the time in Sunshine Coast groups. “You [counsellor] are causing me to get angry.” “I lost 10 days of treatment because you [staff] didn’t do your job.” “If I don’t get to the EI office in one hour, then I’ll have a really bad day.” And so on. Of course, in group, this is fantastic stuff to work with, helping clients understand that they [not staff] determine how they feel.

And others had better change quickly. Few things seem to drive recovering addicts crazy more than not having a problem fixed instantly.

It’s pretty obvious that life does not operate according to what the addict wants. So why does he keep trying to control it? The answer is simple: Fear. What would happen if he did not control others and things? The outcome, life, would be unpredictable. He might get surprised. He may be hurt by what happens. How will he deal with hurt and stress without retreating to the bottle or the drug?

He might even have to accept that he is the author of his life. Yeow! And if he is in charge of his life, then there is no one to blame. No easy way out. If there is no one to blame, then he has to change if he wants a better life. He has to give up all the excuses.

And that’s scary.

Part Two: Step Back and Reflect

One of the best techniques to learn how to live in the grey area of life is to step back and have a look at a situation that is not meeting your expectations. Whenever you find yourself frustrated, take a moment and reflect. How important is it, really? If you don’t get something done immediately, will this have an impact on you five years from now? What is so important about this particular situation that it MUST be resolved immediately?

A typical example with Sunshine Coast clients is when they have an unpleasant phone call with a family member. They or the family member hangs up abruptly. The client often becomes almost panicky—a desperation—he has to resolve the problem. We’ve seen clients phone back half a dozen times trying to settle the issue. And clients often tell us that an unresolved issue “ruined my whole day.”

But when we talk with the client about the situation, we usually discover that there is no panic. There is no need for the problem to be fixed immediately. The client may want the issue resolved but there is no need for some immediate solution (having something settled is why, by the way, we often hear clients say: “I don’t care which way it goes; I just want it settled.”)

One of the reasons that this technique of stepping back and reflecting works is because you get some distance from the situation. If you can reflect on it, then you won’t act in some knee-jerk manner, reacting out of habit. Anyone who constantly blames others for his suffering, like any other repeated behavior, will turn it into a habit. Just look at kids. Most younger kids constantly blame their brother or sister, friends, teachers, parents, and so on for their struggles.

Part Three: Are you making sense of a situation in a way that is responsive to reality?

Under the new program at Sunshine Coast, we stress two things. First, everyone interprets the world in a unique way; that is, everyone makes sense of the world differently. Secondly, each person makes decisions that determine the kind of life he gets.

Based on these two ideas, another technique you can use is to reflect on how you make sense of a situation. Last week we talked about taking time to think about a situation that upsets you—is there really any need to control it? But it’s also important to think about a situation in a way that will help you. When you are feeling frustrated because someone is or is not doing something that you want them to do, or life isn’t working out the way you want it to, ask yourself how you are interpreting the situation. If you are an alumni of Sunshine Coast, you may remember from your counselling this is what your counsellor asked you.

Say you are frustrated with your parents. You get yourself in financial trouble, and they refuse to help you out. You have no idea how to solve your finances other than by relying on your parents. You get angry and tell them, “It’s obvious you don’t care about me. I’m trying to get my life together, I run into a bit of trouble, and you don’t care enough about me to even help me out.”

So, the first question is about how you are making sense of this situation. Have you decided that how you interpret it is the truth; therefore, any other interpretation must be wrong? (This is a very common tactic, by the way.) What is your parents’ interpretation of the situation? Why did they decide not to help you? Is there some merit in how they are interpreting the situation?

The second question is based on the idea that you are the author of your life. Have you accepted that you are in charge of your life? Are you blaming others for your suffering; that is, is your financial problem your problem or your family’s? What are your other options if the family doesn’t help you out?

This is a simple example that probably doesn’t apply to you, even though it comes from a SCHC alumnus. But you likely have your own examples: getting irritated because you got put on hold by Revenue Canada, and you needed some information to finish your tax return; getting upset with a lover because she/he did not listen to you; getting upset with your boss; getting upset while driving because someone cut you off; getting upset with a delay at the airport because you are on a tight schedule; avoiding going to a doctor because you are afraid of what she/he might diagnose; putting off a phone call because you are afraid of how the other person might react; and so on and so on.

Part Four: Shifting how you make sense of the world

The real key to living comfortably in the grey area of life is to make sense of the world in a different way. Rather than feeling the need to take control to protect yourself, recovery demands that you accept that others will do as they choose (regardless of what you want them to do), and things will happen (regardless of whether you want them to).

Those in early recovery generally interpret the world as dangerous. Lovers can hurt them, employers can make them miserable, cars can break down, police can pull them over for a breathalyzer, families can refuse them financial help, friends can betray them, and so on. Because of this danger, they believe that they must protect themselves by controlling others and things. But despite the slickness of their control tactics (and addicts are quite famous for their slickness), this control rarely works out.

Recovery demands a different approach. The 12-step program suggests that addicts “let go and let God.” What AA/NA mean by this is that the addict has to practice giving up control. Life simply works out as it should, and what happens is what should happen—even if the addict does not like the way things work out. The 12-step program puts a great deal of emphasis on allowing a higher power take control because if the addict will allow this, then he or she no longer feels the need to control.

A technique from psychology is provided by the great psychiatrist Viktor Frankl. If you were at Sunshine Coast under the new program, you’ve already heard of it. Go about your day with this question in your head: “What does Life demand of me?” We’ve talked about this technique before, but it’s so good that we can’t emphasize it enough.

Here are some examples of asking life what it demands of you. You are in a hurry, and your car has a flat tire. So, rather than getting bent out of shape, what are your options? Your lover won’t listen to you. Rather than getting bent out of shape, perhaps it’s best to give your lover some time and space to settle down (a day, a week). You get to the airport and discover that your flight is delayed three hours. Rather than getting bent out of shape by this, what could you do the make this time most productive. It’s Sunday afternoon and you have nothing to do. Rather than getting bored, what could you do with this time? And so on.

Notice that each of these situations ends with what YOU could do.

Part Five: Attitude is Everything

In this article I have mentioned that the real key to giving up control—of learning to live comfortably in the key areas of life—is to change the way we make sense of the world. To achieve this, the 12 Steps suggests you “let go and let God.” Viktor Frankl said to ask Life what it demands of you.

Another technique is to change your attitude to life. Most people in active addiction and in early recovery don’t have a great attitude. This is not surprising; their lives are a catalogue of misery and suffering. And most are exhausted from the unrelenting demands of addiction. It’s not as if addicts can take a couple of months vacation from the addiction and go down to Florida for a break. Why would they take a positive attitude to life?

One of the keys to recovery, and to happiness, is to change things from being a chore to some positive effect:
• Cravings are a sign that you are recovering.
• A bad experience is an opportunity to learn and become stronger.
• Parents who refuse to give you money are giving you the space to be your own man.
• A severe illness is a sign that you’d better get on with the business of living.
• Addiction is a wake-up call that you’ve been missing out on life.
• Hitting a wall on your way to a goal is an opportunity to develop creativity and hardiness. (The basis for just about every Hollywood movie.)

Conclusion

Each of these positive ways of looking at problems can happen only with a positive attitude. This was one of Viktor Frankl’s key points. You are quite capable of developing this attitude; the key is whether you are willing to fight for a better life, whether you think that you are important enough to dig deep and overcome adversity. Sadly, many in recovery crash and burn when faced with real challenge.

Cathy Patterson-Sterling, MA, RCC

Cathy Patterson-Sterling, Director of Family Services for Sunshine Coast Health Centre, discusses why it is so important to be aware of the abundance of good things in our lives and to have a level of gratitude.

By Daniel Jordan
General Manager
Sunshine Coast Health Center

Earlier this week, I had a thoroughly enjoyable discussion with Paul Murray, a private-practice psychologist based out of West Vancouver, British Columbia. Our discussion covered a lot of ground but one topic that I found particularly engaging was the notion of powerlessness. Both Paul and I marvelled at how two people declaring powerlessness over their addiction may have two very different treatment outcomes based on fundamentally opposing underlying intentions: one may reflect a preference for the status quo while the other could be ready to turn over a new leaf.

How Powerlessness Became Synonomous with Addiction

Obviously, this idea of powerlessness is not something that Paul and I invented. As friends of Bill W. will tell you, powerlessness lies at the heart of the 12 Steps of Alcoholics Anonymous and it’s first step: We admitted we were powerless over our addiction - that our lives had become unmanageable. Al-Anon has also consoled family members for years by telling them that they, too, are powerless over alcohol.

Over the years, however, Alcoholics Anonymous and other 12 Step programs have had their fair share of critics with powerlessness frequently at the heart of the dispute. For example, SOS, has created an alternative self-help group for “… those people who find that the ideas of reliance on a Higher Power or God, “powerlessness” and the emphasis on character defects to be an obstacle to recovery.”

The addiction treatment community has long since argued for and against the notion that individuals with addictions are ’powerless’. Powerlessness proponents tend to be traditional 12 Step treatment programs, physicians, and psychiatrists while those opposed tend to be psychologists, scholars, and mental health practitioners. The ongoing debate between these opposing camps has only hampered efforts by moderates to find common ground.

Furthermore, the debate over powerlessness and addiction is more than just a trivial concern judging by the vitriol one hears expressed on talk-back radio programs.

Defining Powerlessness

Let’s consider five different ways that powerlessness is understood in relation to addiction:

1) Powerlessness is a Choice

Recently, a book by Harvard psychologist Gene M. Heyman (*), Addiction: A Disorder of Choice, has suggested that individuals choose to be powerless. Dr. Heyman argues that addiction is voluntary rather than compulsory, and that addicts respond to incentives just like most other people. According to Dr. Heyman, interviews with drug users in recovery shows that quitting was preceded by such factors such as finances, family, career, and health.

People who suffer from diseases such as Alzheimer’s or schizophrenia, however, will rarely find improvement in their condition due to good intentions, even when followed by concrete steps. In other words, human beings are only truly powerless when faced with ‘real’ diseases.

One important difference between Dr. Heyman and other opponents to the concept of powerlessness, however, is that while Dr. Heyman believes that to remain powerless over an addiction is a choice, noone chooses to become an addict. As our Program Director, Geoff Thompson, often reminds our clients, children rarely tell their parents ”when I grow up, I want to be a drug addict.”

(*) Note: For more information, see Interview with Gene M. Heyman.

2) Powerlessness is a Lack of Willpower

Society often believes that, with a little bit of willpower, people can simply stop using drugs or alcohol or reduce their consumption to socially acceptable levels. This mistaken belief, however, is actually a failure to distinguish between the separate, progressive stages of compulsive use of chemicals or processes: abuse and addiction. As Carlton K. Erickson points out in his book, The Science of Addiction: From Neurobiology to Treatment, addiction is a failure to stop using in spite of negative consequences. Abusers of alcohol or drugs, most notably college students, will often stop excessive consumption when they are in a new environment where getting high or drunk is no longer encouraged, or when they experience negative consequences. For individuals with addictions, however, drinking or drug use will continue even after job loss, divorce, or illness.

Even for people who don’t struggle with addiction, however,  it is arguable whether simply trying harder is an effective method for attaining any worthy goal. Most who have tried to lose weight or have implored their children to improve their grades know that trying harder may work, but only temporarily. Without an effective strategy and implementation plan, willpower is not enough.

3) Powerlessness is the Same as Helplessness

Helplessness can be understood as the tendency for some addicted individuals to assign blame to external forces and avoid taking personal responsibility. So, when someone says “I am powerless to stop my addiction” they could be actually saying, for example, “my drinking wouldn’t be a problem if only my wife would get off my case.” This lack of accountability is typically obvious to everyone but the individual with the addiction, including those of us working in the field.

However, while it may be easy to spot helplessness in another person, determining the root cause of why someone is so incapable of taking action is far more challenging. For example, helplessness could be a response to childhood trauma, a phobia or depression. Taped recordings of AA Founder Bill Wilson suggest that he understood the link between helplessness and addiction. Following the sudden death of his childhood sweetheart, Bertha Banford, Bill Wilson concluded that “He knew now …. His need, his loving, didn’t matter a good goddam. His wanting, his hunger and desire, meant nothing to the terrible ongoing forces of creation and he would never forget this truth which he saw and accepted that night.” * Helplessness, as illustrated by Bill Wilson’s recollection, may not simply be a result of laziness but a reflexive survival mechanism in respsponse to painful past experience.

(*) Source: Thomsen, Robert (1975) Bill W.

4) Powerlessness is a Symptom of a Disease

The disease concept of addiction found an early advocate in the recovery movement with Dr. William Duncan Southworth, physician to AA founder Bill Wilson. By providing a physiological explanation for why alcoholics are powerless over their use of alcohol and through his close affiliation with Bill Wilson, Dr. Southworth helped shift the balance of power in addiction from organized religion to medicine. 

Dr. Southworth’s observation that alcoholism cycles between mental obsession and physical lack of control (or powerlessness) has stood the test of time. Defined this way, powerlessness is a common criterion used in the assessment of addiction. For example, Sunshine Coast Health Center recommends an addiction test, called the 3 Cs of Addiction: compulsion, control, and consequences. * What the 3 Cs test calls compulsion and control, Dr. Southworth calls, respectively, mental obsession and physical allergy. While the term ‘allergy’ may be arguable, alcoholics do appear to be physically powerless to stop drinking once the obsession to drink overpowers their decision not to drink.

(*) Note: see the Helplessness section above for information on the 3rd C - consequences.

5) Accepting Powerlessness is Critical to Lasting Recovery

First of all we had to quit playing God.
~ Alcoholics Anonymous, p. 62

This last example of powerlessness has been intentionally left to last since, unlike the first four definitions, this last definition will conclude this blog article on a hopeful note. Fortunately, many individuals have successfully come to terms with their addiction and have gone on to lead fulfilling lives in recovery. At Sunshine Coast Health Center, clients learn spiritual principles that often prove helpful as basic action guidelines in recovery. One spiritual principle, acceptance, seems particularly effective and is closely tied to the notion of powerlessness.

In his book, Not-God: A History of Alcoholics Anonymous, Ernest Kurtz suggests that “from the alcoholic’s acceptance of personal limitation [read powerlessness] - arises the beginning of healing and wholeness.” Furthermore, this message of “not-God” is, for Ernest Kurtz, an “affirmation of one’s connectedness with other alcoholics.” At Sunshine Coast Health Center, we wholly endorse the notion of connectedness, however, would extend it further to include family members, co-workers, and friends.

Conclusion

In the early days of Sunshine Coast Health Center, I will always remember how insistent one of our first clinicians was on the importance of making sure clients understand, at a gut level, Step One . As far as he was concerned, without a firm understanding of powerlessness, it is difficult, if not impossible, to properly work the remaining 11 Steps. However, I have learned over the years that words can often have multiple meanings and can trigger certain emotions depending on the perspective of the listener. By avoiding rigid absolutes, Sunshine Coast Health Center believes that it’s integrated approach allows clients to embrace multiple perspectives and, therefore, to appreciate the complexity that is inherent in any meaningful discussion on addiction.