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Archive for the ‘Addiction Research’ Category

Themes from the Personal Meaning Conference

Monday, September 8th, 2014

Our clinical staff from Sunshine Coast Health Center attended the 8th International Meaning Conference this July. The conference is a gathering of psychology researchers and therapists who are attracted to the idea that living a meaningful life is fundamental to human well-being. And there were several speakers on the topic of addictions.

Meaning is not a single idea. The experts have different interpretations of what is needed to live a meaningful life. But they share some common ideas.

Here are four of the common themes that emerged from the conference:

Self-awareness

Most clients at SCHC want to DO something—find their purpose or a mission. But how do you go about this? Research tells us that the first step is to get to know yourself. This is important because you have to know what is important to you if you are to find goals and pursue them.

It is an interesting phenomenon that those suffering from addictions don’t know themselves very well. In fact, they usually rely on the outside world to tell them what is important. But the real issue to ask yourself is what YOU think. What is important to you? What are your strengths and weaknesses?

An example from the conference is “How do you appraise a situation?” Do you appraise something emotionally or are you more intellectual? Another example is to ask yourself why you like one movie and not another. Why you like one food and not another. How you choose friends. If you had to choose a pet, why would you choose one over the other?

Awareness of the Importance of Meaning

The experts at the conference agreed that it is important for well-being that a person become aware of how important meaning is in their lives. Every human being is a meaning-seeking and meaning-making person.

Because we all naturally look to find meaning and make meaning, it is important to keep this in mind. Psychologist Dr. Paul Wong calls this a “meaning mindset.”

What is the most important thing about, for example, getting a promotion at work? Perhaps it means more money. But it may also mean less time spent with the family because the new job demands more hours at work. Dr. Wong recommends that you think about whether the promotion will help you live a more meaningful life.

Meaning is Everywhere

One of the conference themes is that meaning is everywhere. This was one of key ideas that the great psychiatrist Viktor Frankl talked about. He said we can find meaning in every situation.

We seem to be born with the need to make sense of things. It is so natural, our second nature, that we often forget it is central to our well-being. In fact, psychologists tell us that 90 percent of our decisions are not conscious. But this does not mean that we don’t make sense of things. When I drive my car and come to a red octagon sign, I don’t consciously think, “Oh, that means I must stop and then proceed only when it is safe to do so.” I simply react. But I still make sense of the red octagon sign, even if I’m not really thinking consciously about what it means to me.

Other times, we have to consciously make sense of things. Artists are useful role models for learning how to detect meaning. A poet can write a profound poem about a flea. A painter can detect meaning in a flower. People like you and me have found meaning even in brushing teeth.

Self-Transcendence

Viktor Frankl said that the key to finding a meaningful life was to live your life for more than yourself. Many psychologists at the Meaning Conference agreed with him.

Their argument was that attaching your life to something greater than yourself was the best way to know yourself and to feel more alive. The reason for this is that in order to figure out what to attach your life to, you first have to know our values, your strengths and weaknesses, etc.

Some things they mentioned were volunteering for a cause you believe in, helping your family grow and develop, using your job as a way of helping the world, and offering the world some advice on how you overcame suffering—for example, by writing about it on Facebook.

Viktor Frankl said that asking the question, “Is this good for me?” is a recipe for suffering. Much better to ask “What am I good for?” This last question helps you give your gifts to others.

Addiction as Agency

Saturday, February 15th, 2014

One of the more interesting findings in the major research project that we just conducted here at SCHC is that all participants told us that drug use was their choice.

If you read a great deal of expert literature on addictions—or if you read the popular media or watch TV on the topic—the idea that drug use is a choice will likely seem very odd. Almost everyone it seems, from Time magazine to HBO specials on addiction, tells us that addiction is a disease or, at least, a disruption in the brain. “Addicts are powerless over their addiction” is the mantra.

It seems that our research participants disagreed with this expert literature. How can we make sense of this? Those who participated in the research project told us that they had heard addiction was a disease. All knew that the 12-step program states they are powerless over addiction. Those who had previously attended addiction treatment before coming to SCHC said that the addiction professionals told them they were powerless. So, it’s not lack of awareness.

There is something about a drug-induced altered state of consciousness that is very appealing to addicts. So what is this appeal? Why are addicts willing to suffer the inevitable consequences of drug use—financial, social, occupational, physical—for that feeling of being high?

When we asked those who volunteered for our research why they used drugs, at first, they gave us answers that we typically hear about on television or read about in magazines or newspapers.

Some said it was to get rid of the stresses at work and home. Others said they were using drugs to medicate a mental health issue, such as PTSD. Some said that they used to relax after a hard day’s work. In this sense, it appeared as if drug use was a deliberate act of the client, not the result of being powerless.

Asked how drug use got out of hand, they were a bit baffled. Participants knew they were competent men with good values. Most succeeded in whatever they did (if they really tried). They were intelligent. So trying to figure out how the self-medicating got out of hand was confusing. Several suggested that they simply associated intoxication with feeling good, and, since they liked to feel good, they used regularly.

Drug Use as a Mystery

After initially telling us that they used drugs to alleviate negative emotions, we asked a simple question: “Did you ever use drugs when you were not medicating negative emotions and moods?” Of course, they answered, “Yes.” Birthdays, winning a business contract, New Year’s, parties—all were times to get intoxicated.

When they recognized that they used drugs even when they were happy, they realized that their story of medicating negative emotions and moods was not good enough. The participants seemed to be thrown into a bit of a quandary. They tried to find new explanations, but none were very convincing.

They thought there must be some mystery factor at work. Some suggested they had, perhaps, an undiagnosed mental health problem. Others suggested that maybe the drugs had altered their brain chemistry. Whatever they suggested, it was clear that, for the participants, these ideas were just dead husks. They just tossed out these ideas and didn’t really believe them.

In fact, after we talked with the research participants for quite a while about why they used, almost all admitted that they didn’t really know why they were addicts. They were confused; their addictive use of drugs made no sense to them.

Drug Use as Attending to the Self

In the research project we recently completed at SCHC, only one participant said he used drugs because he didn’t really like himself. He thought that his “real” self, his sober self, was so dull that others felt burdened by being around him. He preferred the “fake” person, who was intoxicated. The intoxicated person was funny and outgoing and a pleasure to be around.

But the other participants liked who they were. Of course, they didn’t like a lot of behaviors they engaged in while seeking and using drugs, but they were okay with themselves as people. These participants used drugs for other reasons. Analyzing the data, we discovered that the one time in their lives when they paid attention to themselves was in active addiction. This may seem a bit odd, because the popular idea is that addicts are only interested in themselves.

We discovered that the real issue is that addicts have a weak sense of who they are as individuals. All the research participants paid very little attention to themselves. They rarely thought about their lives. They rarely took a step back and asked themselves if the life they were living was acceptable to them. They hadn’t really thought about what they wanted from life. They had no real goals.

Content people know who they are and what they want out of life. They have developed an anchor within themselves, from which they reach out into the world. This was not the case with our participants. They relied on the outside world for guidance on how they were feeling, how to structure their lives, and what they should do.

Drug use was their way of taking time for themselves. The participants told us they would arrange time for intoxication when it would not interfere with work or family (and were very upset when their careful arrangements were disrupted). Or they said when they noticed they were too anxious or depressed or stressed then they would turn to the drug for relief.

Drug Use as Agency

Francis Seeburger, a very fine philosopher, has written about addiction. He argues that addiction is “agentic” behavior. What he means by “agentic” behavior is agency—those things we do to assert ourselves. Everyone needs to feel in control of his or her life. For addicts, intoxication is the vehicle they use to give them perceived control over the way they feel.

This is why they looked to drug use. It was their time for themselves. It is a time when they stopped listening to the outside world and did something only for them.

It’s an odd kind of thing, but it was true for all our participants. And our analysis is very close to what Seeburger said about drug use. Seeburger quotes Augusten Burroughs’ famous autobiography about addiction. Burroughs said he used drugs “as an escape hatch” but also as a “destination.” The destination is some place they want to get to. Seeburger pointed out that addicts consciously use drugs to reach this destination. They cannot find it in their sober lives.

 

Watch the video series of “Addiction as Agency” here

Q&A: Most People Have a Weak Understanding of 12-Step Programs

Sunday, February 9th, 2014

Dear Geoff,

I continue to watch your support videos and find them interesting. This week’s video raises many questions for me though.  

The part I struggle with the most: basing conclusions for this particular study on the feedback from clients or former clients vis a vis their perspectives on “powerlessness” and/or 12 step programs. 

I personally have met with and spent time with dozens of these people. While they almost all claim to know about 12 step programs, I find that, overwhelmingly, these people know very little about the programs. Many in fact, state that they chose SCHC because it is marketed as a “non-12 step approach”. As someone who has a good deal of experience in this area, I found that these people have generally very limited knowledge of the programs (though, as you state, they claim to be very aware). I think therefore, that this research starts with some faulty premises. In other words, that the subjects really understand whether they are powerless or not.

My experience (non-scientific to be sure and perhaps somewhat antecdotal) is that far more people coming from 12 step treatment centres are staying clean and sober. Again unscientifically but nevertheless true, of the people whose track record I know personally after SCHC, I count 15 in total including myself, only 3 stayed sober during their first year post SCHC. I previously attended a 12 step centre where 8 of the 13 I maintained contact with have stated sober over 3 years. I sometimes worry that this research is done with a conclusion already formed and with research protocol designed and skewed to prove these conclusions. 

Just some thoughts and observations.

- SCHC Alumnus

Yes, this is a bit of a tricky one.

First, any study has limits. But it’s important to be faithful to what participants believe, even if it were to disagree with the majority of people. The study is the study, whatever the results. It is not intended to be anything more than a single study. If there were a hundred studies giving the same conclusion, we would have greater confidence in it. In fact, there are a growing number of empirical studies arguing that those with addictions are not out of control. As for bias, my own observations of the current research is that your argument that designs are skewed applies more to 12-step research than to the non-12-step research. Being overseen by a lot of researchers and an ethics committee, this particular study is, I hope, not a skewed one.

I agree that the participants have a weak understanding of the 12-step program. Still, because their opinion is their opinion, and since we need fidelity to the data the participants give us, this is not a bad thing. It simply is what it is. And, I think most people, including those who are AA/NA members, have a weak understanding of the steps. The issue of powerless was originally conceived of as an act of humility. Bill W. was very big on humility. This makes sense because he borrowed Harry Tiebout‘s ideas. Tiebout was trained in Freudian psychology and was Bill W.’s psychoanalyst for a time. The Big Book version (p. 64) is that the addict’s essential problem is self-centeredness (not drug use). Humility, the foundation of the steps, makes sense if one believes that the actual problem is self-centeredness. Scientifically, there is no evidence that this focus on self-centeredness is accurate. As I mention below, Bill W.’s personal belief was that alcoholism was a counterfeit attempt to find God and feel whole.

Today, the powerless argument comes mainly from brain pathology models. These models argue that once the drug is in the brain, it hijacks the thinking part of the brain, thus rendering the person powerless over drug use. The argument is popular mainly because the US government likes it. Although everyone agrees that addiction has a physical substrate in the brain, the powerless model is supported only by those who think we can reduce a human being to brain chemicals, and even then not all of them agree with it. Most addiction experts do not support it. And there is a large amount of research that directly contradicts it, such as the placebo experiments, which show similar results to those using the real drugs.

I appreciate your observations on those staying clean after treatment. A similar phenomenon happened to the people I entered recovery with. For whatever reason, many of us in the recovery house stayed sober a long time. If any program found consistently 8/13 cleaned up for three years, we’d all be using it. But it’s dangerous to generalize from personal experience; this is known as anecdotal evidence. Your argument that far more people coming from Minnesota Model treatment are staying clean is true for your experience. In my personal experience, going through 12-step based treatment, being a member of AA for many years, and working in 12-step based treatment centres, I observed the opposite. I found very few were clean and sober at a year.

But regardless of your or my experience, the research for decades has shown that 12-step based treatment is not better than other treatments, including the 12-step program. And the US government has just removed 12-step based treatment (known as the Minnesota Model) from its recommended list because there is no evidence to support it. This is all the more interesting since the Minnesota Model is used in more than 90% of residential treatments and is historically the oldest form of treatment in the US.

It’s very important to differentiate professional treatment that is “12-step based” (Minnesota Model) from the 12-step program itself. AA says it has “no opinion” on professional treatment. Many people are quite upset that this distinction has been lost, because we now know that 75% of AA/NA members have gone through Minnesota Model treatment and have brought with them ideas that have distorted the spirit of the 12-step program.

I, Dr. Wong, and many others still maintain that meaning theory provides a scientific interpretation of the 12-step program (not the Minnesota Model, which we both think is out of date and, often, unethical). I don’t think it possible to study the historical account of Bill Wilson and AA (not the mythology promoted in 12-step programs, but the actual historical record) and not see it as meaning-centered. Wilson was clearly in search of meaning in his life. His belief that alcoholism was a counterfeit pursuit of religion, his attraction to Carl Jung and William James, his use of LSD with Aldous Huxley and others, the focus on attaching one’s life to something greater than the self, and his insistence that AA members get a life are all indicative of a meaning-centered approach. If we set these ideas in the context of the world Bill W lived in–the 1930/40s northeastern US, and his rebelliousness against the mainstream, etc–we have the 12-step program.

Anyway, this is just the abbreviated Reader’s Digest response to your observations.

Geoff

Treating Addiction at a Human Level

Friday, January 24th, 2014

Toronto mayor Rob Ford’s admission of smoking crack cocaine and drinking has been something of a goldmine for comics and political commentators. The Star newspaper published an online article on what treatment would look like for Ford if he were admitted to a residential addiction facility. The Star’s article was typical of the kind of treatment we see in Hollywood portrayals, such as in the movies Clean and Sober or 28 Days. It is also the main treatment in the US, with estimates of more than 90 percent of facilities using a similar version, known as the Minnesota Model.

According to the article, addicts (1) have lost control, (2) are in denial of their addiction, (3) cannot trust their own thinking because they are delusional, (4) are immature, and (5) are extremely selfish. The solution to this problem is to enter treatment, since the addict cannot recover without professional help. Since he is out of control and in denial, health care professionals must take control of him or her. In treatment, the addict must be “serious” about his recovery.

There are some questionable assumptions with the treatment described in the article. For example, the Star’s description of treatment contradicts much of what is taught in counselling graduate schools, with its scholarly examinations of theories and practices and systematic training in counselling ethics. Much of the article seems to fly in the face of modern research on addictions and recovery.

Rob Ford

The article gives the impression that the addict is defective; “emotional immaturity . . . is inherent to the ailment.” The idea that addicts are immature is a curious one. Some psychologists, such as Abraham Maslow, claim few people achieve emotional maturity; thus, pointing this out for an addict does not seem to be very revealing. In fact, scholarly research on therapists who judge clients as emotionally immature has shown that this judgment says more about the therapist than the client.

There is also an arrogance attached to the description:

  • “Treatment centres are in the business of smashing delusions”
  • “The wounded man-child”
  • “The genius for the addict is of self-deception”
  • “The client will be confronted with a terrible fact. He will be told that the mind that brought him to this state will hardly be the tool to get him out. He will have to follow instructions”

Granted, the author is not a psychologist, but it is interesting that The Star would interpret this version of treatment as an accurate description how addiction psychologists and counsellors make sense of addiction.

We suggest another form of treatment that the mayor (or anyone) could participate in; one that is steeped in science and ethics. It does not believe that someone suffering from addiction is defective or incapable of making healthy decisions. It does not view them as immature or delusional. Rather, it focuses on helping clients find a new way to make sense of themselves, their world, and their place in the world. It focuses on taking control of their lives, accepting strengths and limitations, and acting according to what is authentically important to them.

Rob Ford is a Complex, Whole Person

The Star article does not present Ford as human being, with all the complexities and ambiguities of human beings. Rather, because he may have an addiction, the article reduces Ford to an “addict.” To be labeled an addict is to be seen almost as a stereotype. By virtue of having an addiction, the addict has specific personality traits (e.g. “monumental selfishness”) and uses specific psychological defense mechanisms (e.g. denial).

The scientific origins of these simplified perceptions are in the work of Harry Tiebout, a Connecticut psychiatrist trained in Freud’s psychology, who was a “side-line observer” of AA since its inception in 1939. In 1944, Tiebout assessed the character of the alcoholic in active addiction. “The so-called typical alcoholic is a narcissistic egocentric core, dominated by feelings of omnipotence, intent on maintaining at all costs its inner integrity”. Tiebout later described the ego factors as a sense of omnipotence, inability to deal with frustration, and the tendency to do everything quickly.

What is remarkable is that Tiebout’s work is still publicized in some treatment facilities, but decades of research in addictions and therapy has given us a different picture. For example, it is now clear that the personalities of addicts are as various as the wide mix of society. We now know that the most successful therapies see the client as unique, complex human beings.

Rob Ford is the Author of his Life

In all healthcare “codes of ethics” is a principle known as autonomy. Therapists are bound by their ethics code to promote the client’s taking responsibility for his or her life. According to The Star article, Ford would be told he “will have to follow instruction” and “told he has to fly right or be kicked out.” This taking control of the client contradicts the principle of autonomy.

In fact, telling a client what to do suggests the therapist actually knows what is best. This is a rather arrogant assumption in psychotherapy. Indeed, the vast research on therapists makes clear that therapists don’t have the answers for other adults. Of course, those who believe they know best what is right for the client will argue that addicts are special; they are not like other human beings. However, there is nothing in addiction research that confirms this.

Professional ethics and healthcare systems assume the client is the author of his or her life. It is the individual’s job to make decisions for himself or herself. More and more, the public is learning that they are in charge of their health and their lives.

Rob Ford has a Right to Informed Consent

All health care codes of ethics stress the principle of informed consent. Informed consent means health care providers must help clients understand the treatment, the risks, and benefits. This is not a one-time event. Informed consent is always ongoing and the information has to be presented to the person in a way that the person can understand it.

It is clear, then, it would be unethical for a treatment professional to simply impose therapy on a person without helping him or her to understand the scientific basis, success rates, the benefits, and so on of that therapeutic approach. Simply telling a client with an addiction problem that “you are in denial” or “you are emotionally immature” is hardly realistic given all the different theories and practices in addiction psychology.

Once the client understands there are different treatment approaches available, then he or she can make an informed decision on whether to continue treatment. The provider would, then, be bound to help the client find a therapy that resonates with him or her. To provide informed consent is to respect the principle that the client is the author of his or her life.

Therapists Work with Rob Ford

Motivational psychology has shown that imposing a way of thinking and acting on clients is a very weak way of changing behaviors. If externally imposed ideas are going to work, clients must absorb them.

Psychologists have described what happens when individuals do not really accept such frameworks. If the external motivation and goal is not completely integrated into the individual’s understanding—“endorsed by the self”—then they have limited effect. When externally regulated, people are likely only to act when prompted, rewarded, or controlled, and they do not ‘own’ their behaviors or values they enact. Others, who have only partially absorbed the external motives (“introjected regulation”) act to avoid shame and guilt or, oppositely, to feel self-glorification or pride.”

Professionally trained therapists work with clients to help clients find a new way of living. One of the tactics is for the therapist to get curious. If the client says that he wants to continue drinking after treatment, the therapist does not tell him “that’s dumb.” Rather, the therapist gets curious about what the appeal of drinking retains for the client. Perhaps the client thinks that if he does not drink then he is less of a man, he is defective, or he is afraid that life without alcohol will be too boring. These issues of masculinity, defectiveness, and boredom are the “stuff” of therapy.

Therapists see Constant Confrontation as Malpractice

The Star article said that if Ford entered treatment, he “will be called to account by others who know the game, the con.” Confrontation as an acceptable counselling style is remarkably prevalent in addictions treatment. Psychologists, Miller and White, reviewed the scholarly research on confrontational counselling and concluded this did not work. This confrontational approach could be considered malpractice. (It is, of course, important for therapists to confront clients, but this is an occasional technique, certainly not a style of counseling and nothing to do with being “called to account”.)

Generally, those who practice confrontational counselling argue that addicts are in denial, and therefore the therapist must be confrontational to break through this denial. The whole idea of “denial” is a curious one. The main criterion for diagnosing addiction is that the person continues to use despite knowing that it is causing chronic and severe suffering in many areas of life. SCHC research has shown that those suffering from addicts have a remarkably weak sense of self. Any “denial” of addiction is a simplistic, and misleading, description of a pervasive dynamic: a weak sense of who they are and how they fit in the world around them.

Treatment at a Human Level

The Star article made it sound as if going into therapy was the mental equivalent of having a root canal. The addict must first be beaten down, and the article points out that this is unpleasant. This old idea is so pervasive in the residential addiction treatment, one wonders if it is causing problems.

Estimates are that 80% of those suffering from addiction refuse to seek help. Would more people choose therapy if they knew they would not be shamed, or confronted, or told what to think and do? Would they be more willing to enter treatment if therapists respected what they thought?

Similarly, many rehab centers have a high discharge rate. These discharges typically occur because the client did not “follow instruction”. Since one of the scientific markers for successful recovery is completing a program, it seems odd that clients would be discharged for not following rules, which, frankly, often have little or nothing to do with therapy.

One wonders what our success rates would be if treatment providers (1) saw the client as the author of his or her life, (2) treated a whole and complex human being, and not an addict or an addiction, (3) worked with the client rather than imposing a framework on the client, and (4) provided space for the client to feel free to be himself or herself, with no need to distort or deny experience.

 Watch and learn more about Rob Ford and treating addiction at a human level.

Most Addicts Believe Rob Ford is Responsible for His Actions

Wednesday, November 13th, 2013

Last week, Toronto mayor Rob Ford admitted to smoking crack following confirmation that police had obtained a video proving the allegation. A few days later, Mr. Ford hoped to minimize the consequences of using an illegal substance by attributing it to being “extremely inebriated.” And so the Toronto media circus continues:

If you were paying attention to the video, you might also notice that reporters were equally split on what Mr. Ford should do; some calling for him to step down while others were asking him to get help. It seems that reporters, like the rest of society, are split over whether Mr. Ford should be punished or treated. Is Mr. Ford responsible for his actions or does his addiction excuse him from responsibility?

What Our Clients Say About Responsibility

Many believe that, yes, addicts* are responsible, including addicts themselves. For example, we received this e-mail about the Mayor Ford controversy from an SCHC alumni living in New England:

” You can’t make this stuff up! I didn’t want to rib any of my Canadian friends for this – Lord knows we have enough to be embarrassed about with governance in the States. But really!!?!  He’s caught on film smoking crack – after repeated denials – and when he finally admits his error his reason for expecting leniency is that he was in a drunken stupor at the time and didn’t know what he was doing? I am not laughing.  This is no laughing matter. What does Ontario’s constitution provide for evicting an official who lacks the decency and shame to leave when he should… but won’t? This makes me sad. I hope somebody manages to do the right thing.”

Research** conducted at our facility shows that many of our current clients also agree with this statement, even though they were also actively drinking or drugging only a few short weeks ago. Yes, clients feel a lot of shame about the impact of their addiction on friends and family, but most tell us they still want to take responsibility for their actions.

Admittedly, this feedback from our clients was a surprise. After all, many people that work in treatment simply assume addicts would prefer to believe they are not responsible. It seems logical that attributing problems such as lack of work, marital strife, and poor physical health to a disease would ease the burden of their addiction. That’s what many treatment professionals like about the disease model of addiction. However, our clients tell us that this absence of personal responsibility is one of the biggest problems with the disease model.

Our Evolving Understanding of Addiction: From Character Defect to Disease

So why, one could ask, is there a disconnect between how addicts and the treatment industry perceive personal responsibility? To answer this question, we need to see how the disease theory came to be in the first place. On page 178 of his book, Slaying the Dragon: The History of Addiction Treatment and Recovery in America, addiction expert William L. White shows that addiction as a disease was a necessary step in helping advance the treatment of addiction:

“Between 1930 and 1955 a radical redefinition of the nature of alcohol problems in America was forged. Credit or blame (depending on one’s perspective) for this change is regularly attributed to what has been called the “modern alcoholism movement…It shifted America’s construction of alcohol-related problems from a religious and moral knowledge base to a secular one. It transformed the alcoholic from a morally deformed perpetrator of harm to a sick person worthy of sympathy and support. Within the American mind, it moved this diseased alcoholic from Skid Row into our own neighbourhoods and our own families. The movement declared that this disease was treatable.”

I would agree that the redefinition of addiction as a disease instead of a character defect helped ‘professionalize’ addiction treatment. It is also obvious that the disease model has helped bring medical expertise and government funding to the field. However, based on testimonials of our clients who have previously attended 12-step treatment, staff at these programs may say that addiction is a disease but their interactions with clients show otherwise.

For example, when I attend conferences with 12-step therapists I still hear them describe their clients as ‘liars, cheats, and thieves’ in denial and not to be trusted.*** Many treatment centres continue ‘hot-seat’ tactics where non-compliant clients are subjected to verbal abuse by their peers. There’s also the trump card used by treatment centres with so many non-compliant clients – early discharge. We should know, because when SCHC followed the disease model of addiction, we were doing the same thing.

Responsibility as a Place to Stand

“Responsibility means authorship. To be aware of responsibility is to be aware of creating one’s own self, destiny, life predicament, and, if such be the case, one’s own suffering.” - Irvin Yalom, author and existential psychiatrist

Nowadays, when clients at Sunshine Coast Health Center hear about taking personal responsibility, it’s not about whether they are to blame for, or in denial about, their problems. Blame and labelling some as ‘in denial’ only feeds into their sense of shame. There’s another way to define personal responsibility: a place to stand where you, ultimately, are in the driver seat of your own life.

Clients Are Not the Cause of Everything in Their Lives

At Sunshine Coast Health Center, we spend a lot of time with clients discussing spiritual principles, particularly humility. Along those same lines, we remind clients that they are not the cause of everything in their lives as if they are some sort of all-powerful god. So when we say responsible for everything in your life it means a declaration, not a fact.  On the flip side, when clients take responsibility for their recovery it doesn’t mean taking on some sort of heavy burden, that they should be criticized when life isn’t working.

When You Are Being Responsible You Give Up the Right to Be a Victim

One of the more uncomfortable aspects of being personally responsible for your recovery is that you give up the right to assign cause to the circumstances, or to others. In other words, clients at Sunshine Coast Health Center learn that being responsible means giving up the right to be a victim.

Mayor Ford needs to take responsibility for his addiction. Not so he can be punished for any wrongdoing, but because it’s the best thing he can do to get himself back on track. Should he step aside while he gets treatment? That’s a decision better left to Toronto-elected officials.

(*) Note: the term ‘addict’ here is used as shorthand to describe an individual who is addicted to drugs or alcohol. The term is not meant to imply any judgment on the individual with an addiction.

(**) Note: for more information see Geoff Thompson’s article, “Addicts Take Personal Responsibility for Their Drug Use.”

(***) Note: For an example of this attitude look no further than a recent Toronto Star article on Rob Ford: “In [treatment], he will be called to account by others who know the game, the con, the emotional immaturity that is inherent to the ailment, the monumental selfishness that goes with the territory.”

Recommended Reading

Should We Feel Sympathy for Rob Ford? By Yahoo! Canada News | Pulse of Canada – Fri, 8 Nov, 2013

Much of the philosophy outlined in this article is based on the following:

Erhard et al. (2013). Introductory Reading For Being a Leader and The Effective Exercise of Leadership: An Ontological/Phenomenological Model. pp. 43-44. San Francisco, CA: Landmark Worldwide LLC.

Wong, P. T. (2001). Freedom, Responsibility and Justice: the Cornerstones of the Good Life.

Frankl, V. (1986). The doctor and the soul: From psychotherapy to logotherapy. New York: Second Vintage Books.

Recommended Listening

Great Courseshas a wonderful audiotape series on the subject of existential responsibility: No Excuses: Existentialism and the Meaning of Life by Robert C. Solomon, Ph.D. Dr. Solomon is quoted from the series as saying, “Existentialism, unlike that of many more obscure and academic philosophical movements, is about as simple as can be. It is that every one of us, as an individual, is responsible—responsible for what we do, responsible for who we are, responsible for the way we face and deal with the world, responsible, ultimately, for the way the world is.”

Identity, Meaning, and Recovery

Friday, October 4th, 2013

One of the most common observations of those with addiction problems is that they lack a solid (and positive) sense of themselves. For example, clients entering SCHC often tell us “I don’t even know who I am anymore.”

Given that addicts live lives that are, as Narcotics Anonymous says, “meaningless, monotonous and boring,” it seems likely that this life has something to do with their poor sense of identity. After all, how can you live a meaningful life if you have lost touch with yourself. At SCHC, we’ve noticed clients have difficulty figuring out who they are and where the fit in the world around them; especially after hearing their life story. It is readily apparent that clients struggle to understand themselves. They do things that go against their values, they’ve numbed themselves to a point where they are disconnected from their physical bodies, and they generally need a lot of time to answer the question, “How are you feeling?” They have a tough time figuring out what makes them happy or sad, angry or serene and they seem perplexed when trying to describe what direction they want their lives to take.

Although psychologists don’t all agree on what “identity” is, we can gain a good understanding from the work of Dan McAdams. McAdams is famous for his ideas on identity and personality. He tells us that identity is the combination of (1) how we define ourselves as individuals, and (2) how we relate to others. These two components—self-definition and relatedness—give us a sense of ourselves. They also help us understand what we hope to achieve in life (our sense of purpose).

Identity is who we are underneath the different roles we play and situations we are in. I may act one way around my mother and another way around my friends. I may act one way at work and another way at a New Year’s Eve party. Despite these different ways of acting, I’m still me. I have no doubt that when I wake up each morning, I am still the same person I was when I went to bed the night before.

Of course, if you don’t really have sense of identity, then you will likely run into problems. In his studies of men and addiction, psychologist Jefferson Singer discovered that the men he worked with didn’t know who they were or how they fit in the world.

Singer also recognized these addicted men did not really know themselves and, as a result, didn’t have any tangible goals or a mission that they wanted to accomplish. Because of this, Singer ultimately concluded that addiction is “a problem of meaning.” He pointed out that identity was intimately connected with living a personally meaningful life. The idea that identity and meaning are powerfully connected seems intuitively obvious. If you don’t really know who you are or how you fit in the world, then how would you ever be able to live a life that you find fulfilling?

We’ll now explore some of the ideas that psychologists have come up with on the nature of identity and living a meaningful life.

Identity and Comprehension and Motivation

To live a meaningful life, psychologist Michael Steger says you need two components: comprehension and motivation. Comprehension is the “cognitive component of meaning in life”. This is the thinking part. When you look at your life, the thinking part provides answers to who you are, what you think the world is like, how you relate to others, and how you fit into the big picture of life.

The other component of living a meaningful life is “motivation”. Motivation provides you with purpose, goals or a mission to accomplish. You have to make plans and direct your energy to outcomes you desire. This sense of purpose is now a key feature of what psychologists call “well-being”; in other words, how good you feel about your life.

Understanding who you are provides you with the information needed to pursue goals and desires. Of course, if you struggle to understand yourself, then you’ll be hard-pressed to figure out what you would really want from life.

Identity and Self-Determination

Psychologists Richard Ryan and Edward Deci are famous for their Self-Determination Theory (SDT). Basically, SDT says that you have three basic needs: (1) you need a sense of competence, (2) autonomy, and (3) relatedness. Living a meaning life, according to Ryan and Deci, is more or less a result of satisfying these three basic needs.

This is the key difference between SCHC’s and Ryan and Deci’s understanding of meaning. They think meaning arises from satisfying basic needs. SCHC believes that meaning is more fundamental, more in line with Frankl’s idea that meaning is the fundamental force in human nature. Human beings need to make sense of their lives.

Of course, if you have a sense of autonomy—you feel you are the author of your life—and competence—you feel you can achieve what you realistically want—then you would have a good sense of who you are. You know your strengths and weaknesses and you would know what is important to you. The idea of relatedness is all about connecting with others, the need to care for and be cared for, and the need to feel a sense of belonging with others.

Although Ryan and Deci did not directly address the issue of identity, we can see some similarities with those psychologists who did. For example, Ryan and Deci’s emphasis on being the author of your life and connecting with others is very similar to Dan McAdams’ definition of identity, which is the answer to Who am I and How do I fit in the world around me.

Identity and Goal Striving

 

Psychologist Eric Klinger argues that evolution has given us the need to strive for goals and have a purpose in life. He notes two types of living things on the planet: those that are stationary and those that move. The stationary types are plants; they don’t move. Plants have to figure out how to get nutrients and keep the species going based on where they located.

Animals are the other type. They move. The things they need to live and to keep the species going cannot be found in one place. Animals have to go out and find food, shelter, and mates. So animal activity is always directed toward a purpose.

Klinger says purposeful striving is what people do since we, too, are animals. Of course, people are very complicated animals. Our social structure is far more complex than other animals and we have to figure out how to live in it. As well, people are the only animals that are aware of their own impending deaths. This puts a particular pressure on people that other animals don’t have. As a result, our goals are more than simply eating, sleeping, shelter, and mating. We have goals of achieving justice, searching for truth, a desire for seeing the beautiful, and so on.

Klinger does not talk about identity directly, but it’s easy to see that identity plays a huge role in purposeful activity. To have a purpose, I have to know what is important to me. If making a lot of money is important to me, then I will probably pursue a career that gives me a high salary (or buy a lot of lottery tickets). If being a good citizen were important to me, I would not pursue being a bank robber or cheating on my taxes.

Identity as What Society Gives to Us

Roy Baumeister, a world-famous social psychologist, thinks about identity differently than the other psychologists we’ve mentioned. He argues identity is something society imposes on us. Identity is based on particular cultural and social conditions.

For example, someone born in Shakespeare’s England would have a much different understanding of identity than we do today. Back then, the world worked in a specific way. God was in Heaven, and people were born into a certain position in life, such as a noble or a peasant. So the peasant just assumed he or she was a peasant for life. If a person tried to change who they were or their place in the world, then disaster would hit. As Shakespeare said, any attempt to change would upset the natural order of things and doom the person to great suffering and, usually, unnatural death.

Baumeister’s idea of identity as something society imposes on a person is very interesting. Lots of research in addiction and recovery interprets the addict as having an “addict” identity and their recovery demands forming a “non-addict” identity. It’s curious that those with, say, a heart condition are not labeled as such, but society seems to have imposed the label “addict” onto those who struggle with substances.

 

This blog is a compilation of, Program Director, Geoff Thompson’s video series on identity. Click here to watch the series!

Parallels Between Sex and Substance Addictions

Tuesday, October 1st, 2013

New research suggests sex addiction isn’t really an addiction at all. When sex addicts are shown pornography, their brain images differ from images seen in drug addicts shown photos of drugs. Despite this new claim, at Sunshine Coast Health Centre we still believe people can develop addictions to anything (substance or process).

A few months ago, before this research was released, I attended a sex addiction conference. Being my first conference, I took diligent notes and listened intently to all the presenters. While it was still undecided whether sex addiction differed from any other addiction, I noticed many parallels between it and the well-known substance addictions like drugs and alcohol.

Similar Triggers

For ‘sex addicts’ two of the biggest influencers for relapse include 1. Travel time and 2. Unstructured alone time. These two things are similar; both don’t have a lot going on. They allow for boredom. The example used in the conference was ‘driving home from work’. In both sex and drug addiction, a person will ‘multitask’ on the way home and stop to pick up a bag of cocaine or schedule a sensual massage before they pick up their kids from soccer practice.

Unstructured alone time is similar to boredom and increases the risk of relapse because people in addictions use substances or processes to relieve themselves of boredom’s unpleasant effects. In recovery, boredom constantly challenges people to find ulterior ways to address the negative feelings they’re experiencing.

Obsession

Obsession is evident in both sex and substance addiction. With drugs and alcohol, this obsession is noticed in the constant search for the ‘high’ they got the first time they used. In sex addiction, it’s a little bit different. It’s not the orgasm individuals are constantly in search of. If that were the case, masturbation could quickly solve the issue. Instead, it’s the search and desire for the activity and behaviour that feeds the obsession. As said before, people will find a way to make it happen. Daily tasks like using the internet, buying groceries and running errands, going to the gym, and travelling to and from work are all opportunities for a person to obsess over their addiction.

Withdrawal

While the physical symptoms may differ, the experiences and feelings during withdrawal are similar for people with both substance and process addictions. Life can often be overwhelming and stressful when not regularly using drugs or engaging in sexual behaviours. For both substance and process addictions, it is a coping skill. Engaging in their addiction allows them to blur and escape the negative feelings they experience in sobriety and abstinence.

In the Moment

Our Program Director, Geoff Thompson, talks about this experience all the time. When intoxicated, research suggests it’s not about losing inhibitions, but rather becoming absorbed with or extremely focused on whatever is happening immediately in front of you. The things they do while intoxicated are much more enjoyable than when they do them sober. The same can be said for people with sex addiction. Life is much more enjoyable when a sex addict is constantly searching and creating opportunities to engage in their sexual behaviours. When they’re doing these things, life is ‘enjoyable’ and survivable.

Nature + Nuture = Epigenetics in Addiction

Friday, August 16th, 2013

In the addiction treatment and recovery world, there is a constant banter about the origins of addiction. If you frequently read news, blogs, and research on addiction, you know what I’m talking about. Is it a disease? Is it a choice? Is it related to morale? Is it genetic? Is it the house we grew up in? Is it the war on drugs? Maybe it’s one of them, maybe it’s not, and maybe it’s a combination. In the end, does it really matter? Do you really care? No matter what theory you believe in, recovery from addiction for yourself or loved one presents many challenges and changes, but also many successes.

Still, knowing the possible causes of addiction, substance abuse, and similar unhealthy habits can help professionals in the field better treat and support individuals with addiction. It can help change society’s understanding of addiction and enhance support and advocacy for those with it. For those and many other reasons, the addiction field continually researches the different ways addiction can develop. Recently, I came across an theory I think many don’t know about. It’s called “Epigenetics”.

What’s “Epigenetics”?

Epigenetics suggest alcohol and drug abuse/addiction is a result of the interaction between inherited individual predispositions and the environment. This theory is rapidly emerging as a leading ‘contender’ for addiction development theories.

According to Epigenetics, certain mechanisms induce changes in the brain that underpin addiction’s persistence. These include actual exposure to drug use and genetic makeups associated with drug-seeking and dependency behaviours. Understanding the mechanisms associated with drug-taking behaviours is fundamental for unlocking the neurobiological changes linked to causes of addiction.

How Epigenetics Influence Addiction

In the beginning, drug use is often impulsive. At this stage, a drug or alcohol is positively reinforcing because it mediated by the pleasurable effects of the substance. After repeated exposure, drug or alcohol use becomes compulsive and negatively reinforcing. Drug seeking behaviour is no longer desired for pleasurable affects, but rather to eliminate aversive emotional states experienced while sober.

As a result, our genes can change dramatically in response to these external factors. If addiction seemed voluntary at one point, it no longer does after chronic exposure. While this information does reinforce beliefs surrounding addiction as a disease, the Epigenetic theory suggests these changes in DNA structure can be reversed and return to normal function after long-term withdrawal. Withdrawal promotes gene function through non-mutagenic mechanisms; essential for normal cell development.

Some genes are more resistant in returning back to normal. These genes can reactivate when exposed to environmental stimuli associated with drug or alcohol use (i.e. this is what a trigger is). The activation and repression of certain addiction transmitters can be influenced by environmental cues.

Still confused about what Epigenetics actually does? The following video gives an excellent and entertaining explanation of how Epigenetics works.

Why is This Important?

This theory shows that, yes, people can have predispositions to addiction passed down from many generations ago. It also shows that not everyone with that predisposition will develop that addiction; it requires outside stimuli and influencers. So while we call addiction a disease sometimes, it’s not exactly the proper term. If it were a ‘true’ disease, everyone with the genetic makeup for addiction would have one.

I like this theory because it blends many different addiction models together. It’s a brain condition, it’s affected by the environment, is influenced by choice, it causes and reinforces certain behaviours, it can be genetically passed to other generations, and more. I like it because it makes the causes of addiction “grey” instead of black and white.

At Sunshine Coast Health Center, we value all treatment models. While we favour certain ones, we know that each therapy has a place in specific, unique situations. While psychotherapy may work for one client, it won’t necessarily work for the next because they each have very different needs. For this reason we focus on offering individualized treatment programs for each client. While many programs are alike, none are identical.

 

 

Sex Addiction Isn’t Real According to Brain Researchers

Tuesday, August 6th, 2013

A Study out of UCLA suggests that brain images of sex addicts exposed to pornography appear differently than drug addicts exposed to drug photos. Based on this, researchers are questioning whether sex addiction is even an addiction.

From our perspective at Sunshine Coast, we don’t define addiction based on brain images. Instead, we have a simple addiction test that goes like this:

1. A person engages in an unhealthy substance or process (such as gambling, shopping, watching porn, etc.), and

2. In spite of negative consequences, the person continues to engage in the unhealthy substance or process.

We highlight negative consequences because it is important in distinguishing between casual use and addiction. For example, if you have a few too many drinks, get behind the wheel and then crash your car, the negative consequences you might face could include the cost of repairing your car, losing your license, higher insurance costs, fines, etc. For most people, that would be enough consequences to moderate their alcohol consumption. Not so with addicts.

A Different Theory on Addiction Was Also Used To Disprove Marijuana Addiction

This is not the first time people have denied the existence of addiction based on research. For example, past research also suggested that there was no such thing as marijuana addiction because pot smokers didn’t experience many withdrawal symptoms after quitting. Measuring addiction based on the amount of withdrawal a person experiences was quickly discredited by noted expert Alan Leshner, former head of the National Institute on Drug Abuse (NIDA)*. NIDA, by the way, is the world’s largest research body for the study of addiction.

You can read more about this here… 
http://www.naabt.org/documents/The_Essence_%20Addiction.pdf

(*) Note: cocaine is another drug that has minimal withdrawal effect even though few people question that it’s addictive.

Conclusion

Brain research (aka neuroscience) is making important contributions to our understanding of addiction. However, let’s not forget that there are real people suffering with real problems that cannot be explained away by one study or a brain photo.

 

 

Intoxication is Being Absorbed in the Moment

Monday, June 17th, 2013

A common theme in the SCHC research about the experience of intoxication is that addicts are absorbed in the moment. They seem to focus on whatever has captured their attention. If they are in a bar, they become absorbed in the noise and energy. If they are locked away in the basement, they may feel isolated and lonely.

There is a growing amount of research that, for example, the real power of alcohol is not in losing one’s inhibitions but, rather, in becoming absorbed in whatever is immediately facing the person. They relax and enjoy the flow of things during intoxication. As Malcolm Gladwell said, the real effect of alcohol intoxication is not “disinhibition. It’s myopia.”

Perhaps this is why addicts routinely say that life is richer when intoxicated. Music seems to be fuller, movies seem more engrossing, and sex seems better. Even the monotony of the daily work grind is more bearable under the influence. Even high school students who have succumbed to addiction tell us that, for example, math class is so boring that if they didn’t smoke a joint beforehand they wouldn’t make it through the period.

  1. When intoxicated, were you absorbed in the moment?
  2. When intoxicated, did music, movies, etc, seem richer and more interesting?
  3. Now that you are in recovery, have you been able to gain this experience without the drug?

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