Drug Rehab Center

This is the first instalment of a new topic on what we can learn from the research on works in addiction treatment. How do we gauge the effectiveness of therapy? This question has been the focus of researchers for a long, long time. In the old days, for example, the expert therapist would tell us that treatment was effective because of an observed change in personality (think Sigmund Freud). The client wasn’t considered competent enough to report on clinical matters. Nowadays, in contrast, we get feedback from clients as opposed to the person treating the client. For example, researchers will ask the client to report on how they cope with challenges to their sobriety both before and after treatment. Another example is whether a person who is shy (introverted) may become more outgoing (extroverted) after treatment. Anger (or the tendency to resort to anger) and impulsivity are also measured as clues to a change in personality.

This is the second instalment on this topic of what works in treatment. Dr. William Silkworth, stressing the importance of change, was quoted in the Big Book as saying “recovery demands an entire psychic change.” In the research of Dr. William R. Miller, he observed that those who experienced a radical or “quantum” change after treatment was due to a shift in values, or a reprioritizing of what is important such as from wealth-building to nurturing important relationships.

The research tells us that The easiest way to determine whether addiction treatment has been effective is to observe behaviour. The biggest change, of course, would be if the person stops using or drinking. This is the most obvious but researchers also want to know if the person hasn’t been abstinent then how much drinking (amount consumed) or how many days has a person been clean and sober compared to before treatment. Researchers also want to compare how people are spending their time before and after treatment such as going to meetings, going to the bar, reducing absenteeism from work, reducing problems associated with the law, etc. Researchers are also interested in the relational component. For example, is the person spending more time with loved ones or if they feel a greater affinity to their family and friends. If there is a change then researchers then become very interested in what therapies in treatment may have led to the change in behaviour.

In part 3 of ‘What works in addiction treatment’, Geoff discusses one of the keys of successful recovery – getting a sense of connection with others. It is probably the most consistent finding of research and the most consistent factor from feedback from our clients. In practical terms, this would mean connecting to their counsellor or to their peer group. This need for meaningful connection may also explain the success of support groups such as AA, NA and Lifering.

From a psychological point of view, we know from research that we are ‘relational beings’ that are ‘hardwired’ to connect with others. Researcher Roy Baumeister theorizes that human children take much longer than other animals to reach maturity because they have to learn how to be ‘social’ animals. Many clients in our program express feelings of loneliness, of isolating. This is a key characteristic of addiction. Forming an authentic, deeply emotional connection is, apparently, key to breaking the addiction cycle.

Welcome to the 4th segment on what researchers have observed when addiction treatment works. A common thing researchers find is that there is often a shift in thinking, that people begin to think in a new way. This new way of thinking involves the ability to see another perspective, even someone else’s perspective. For example, those successful in recovery may no longer take it personally when they get cut off in traffic, realizing that it is a complete stranger in the other car. In those instances when it may be personal, for example when a friend offers them a beer after completing treatment, instead of getting offended or hurt they may consider the possibility that the person thinks that treatment cures addiction, that those cured can drink again. Maybe the world is not out to get you.

Psychologist Dr. Albert Ellis used to say that if a person can change the way they think about things it will help them feel better about themselves. When a person feels better about themselves the way the react in life (their behaviour) will also change for the better. The technical term for a shift in thinking is ‘cognitive restructuring’.

By Geoff Thompson, Ph.D. (cand.), CCC
Program Director

It’s very interesting that most research in the addiction field—at least, research in the US and Canada, though not so much in other places — ends up with the same conclusion.

Here’s the conclusion: The drug takes over the person, leaving them more or less powerless to control themselves. Some of the bad things about addiction are that it mucks up the chemicals in the thinking part and in the reward part of the brain, it empties bank accounts, it breaks up family, it causes liver damage and other problems, it causes problems at work.

If this is true, then why do people continue to use drugs? The answer: People succumb to drugs because of some defectiveness. In the old days, this was a moral defectiveness. Addicts were sinners and irresponsible lay-a-bouts. More modern interpretations of defectiveness say that addicts have a brain disease or disorder or that they have maladaptive learned behavior.

Here’s an example from a textbook on Abnormal Psychology, by Durand and Barlow. The authors quote an alcoholic explaining why alcoholics drink: “When I drink, I don’t care about anything, as long as I’m drinking. So when I’m not drinking, the problems come back, so you drink again. The problems will always be there. You just don’t realize it when you’re drinking. That’s why people tend to drink a lot.” As the book title suggests, this is an example of those who are not normal.

What is odd about this is that it’s a pretty weak explanation of why millions of people continue to drink and use drugs, and have done so for thousands of years. When we listen to addicts themselves and when we read about addiction in works written by addicts we find a much different story. The famous drug users in Victorian England did not reduce addicts to being defective. They described many of the positive experiences of intoxication. A typical example is Charles Baudelaire, who even wrote a poem about hashish. A more modern example is Eugene O’Neill, the Nobel-prize winning addict-writer. O’Neill provided us with an in-depth understanding of addiction that had nothing to do with being powerless over alcohol or self-medicating some mood disorder or being irresponsible or suffering from a disease. O’Neill explained the reason why he drank was that he could never find a sense of belonging, except when he was drunk.

What Baudelaire and O’Neill and hundreds of others have in common is that they examined drug use at a human level. They did not reduce the addict to having a disease or a defective personality or a bad habit. They saw them as normal human beings who were searching for something to feel whole, feel more energized and vital, make more sense of their lives. Many of them talked about intoxication as a spiritual experience.

And, of course, Bill W., the main force behind the development of Alcoholics Anonymous, was convinced that the thirst of the alcoholic was his thirst to feel whole and find some connection with the universe. Remember that speech he gave in 1948 at the Shrine Auditorium: “An alcoholic is a fellow who is ‘trying to get his religion out of a bottle,’ when what he really wants is unity within himself, unity with God. . . .”

In this blog article, we’ll examine the pervasive idea that addicts are addicts because they are defective. If you or a loved one are struggling with addiction, this idea will help you appreciate the influence that the stigma has had on your or a loved one’s recovery.

Part One: Hollywood Movies & Stigma

Believe it or not, researchers have examined how Hollywood movies have portrayed addiction and its treatment. Curt Hersey, for example, has written on how Hollywood portrays addiction and recovery from addiction. In an article examining 28 Days, Clean & Sober, and When a Man Loves a Woman — which take place mainly in treatment centers — he concluded that the films offered only “one conceptual framework for addiction” and that the portrait of recovery was “unrealistic, when compared with the availability and realities of real-life programs.”

Addicts portrayed by Sandra Bullock in 28 Days and Michael Keaton in Clean & Sober are presented as suffering from defectiveness. This defectiveness means that once the drug enters their brain, they lose control. This is, of course, the disease model of addiction. They are selfish, intolerant, in denial, and so on. It’s not that Sandra Bullock is a horrible person; she’s just got a disease. And Michael Keaton’s lying and manipulating is not because he is evil; he, too, has a disease, and he will do anything to get the drug.

Part Two: Popular Opinion & Stigma

Popular opinion sees the addict, even in treatment, as defective. When treatment centers open in neighborhoods, it is inevitable that the neighbors are against it. The typical excuses for wanting to shut it down are that the center will make property values drop, that it is too close to schools (don’t want all those nasty addicts near vulnerable school kids), that the clients will make the neighborhood “unsafe,” that the clients will get up to all kinds of mischief in the neighborhood, and so on. (FYI. Research studies on these complaints have shown they are not valid.)

Even many of those who agree that addiction is a health issue, often carry with them this idea that addicts are out of control. There is a famous documentary called The Fix: Story of an Addicted City about Vancouver’s notorious downtown eastside. In the film, a non-addicted person said that she believed addiction was a disease and addicts needed help — just not in downtown Vancouver. She suggested they should go to Surrey! (I’ve often wondered what the mayor of Surrey thought when she heard this.)

According to popular opinion, one of the biggest problems with the addict is that he or she appears to be out of control. Many experts have recognized that people in our society are very uncomfortable around others who appear unable to control themselves. We tend to like the John Wayne or Sarah Palin type of person, or someone like Terry Fox, who overcame his struggles. We tend to shy away from people diagnosed with mental disorders or HIV or, even, cancer.

Part Three: Mainstream Research & Stigma

Tens of thousands of research studies seem to confirm that addicts are defective. Studies have shown that those trying to overcome their addiction have high levels of anxiety and depression, low self-confidence, poor image of themselves, have mucked up the thinking part of the brain that controls, for example, not acting on impulses, and so on.

It’s possible to argue that all the studies are simply discovering the “truth” about addiction. They have similar conclusions because all this defectiveness is what addiction is all about. But then how do we make sense of, for example, Eugene O’Neill, that Nobel-prize winner? Even though he won the Nobel Prize, do we simply dismiss him because he suffered from a disease or maladaptive learned behavior? Do we conclude that all his ideas on addiction were just plain wrong? That all his ideas were just excuses to justify his drinking?

To understand how all these studies come up with the same conclusion, it is necessary to understand how this research is conducted. Basically, the researcher comes up with an idea then designs an experiment to see if the idea is true. What this means in real life is that it is the original idea that is the key, so researchers design studies to discover level of criminal involvement, anger and aggression, antisocial personality traits, and so on. If the researcher thinks that addiction is a disease, he or she will design an experiment that focuses on disease. But what happens if that is not really what is going on? Unfortunately, the method does not allow for other interpretations.

This is one of the reasons why many experts, such as XXXX, have lamented that “the prohibitionist spirit is still strong.”

Part Four: Other Research & Stigma

Another kind of research does not use statistical analyses. This research is interested in understanding the subjective experience of, say, addiction. Usually, the researcher talks to a handful of people to understand their experience of addiction and recovery. The odd thing is that even most of this research focuses on defectiveness.

A typical example was a study of an alcoholic woman by two researchers, Drs. Shinebourne and Smith. The woman talked about how she was a different person when intoxicated and that she did not like this person. At least, that’s what the researchers focused on. But it is interesting that she also talked about the benefits of being intoxicated: “feeling creative, you know, some feelings of like fun and excitement. . . like unlocking some sort of artistic feeling.”

But the researchers didn’t pay attention to these feelings of creativity, fun, and excitement of intoxication. Rather, they dismissed this and focused on the bad stuff. After all, if addiction is bad and the person out of control, then the woman’s comments on fun and excitement and being more creative probably were not all that important.

Conclusion: Stigma as a Barrier to Recovery
In this article we’ve examined remarkable power that “addict = defective” holds on people. This sort of thinking is at the root of the stigma of addiction.

Almost all clients at our residential program, Sunshine Coast Health Center, have internalized the stigma. They call themselves “drug fiends,” “drunks,” and other derogatory labels. Many clients think that they must have a mental disorder because this is the only way they can understand why they keep using substances, even knowing that this behavior was causing them serious problems. And, of course, there’s always the declaration, “Of course I lie and manipulate. I’m an addict. That’s what addicts do.”

But here’s the problem. If you believe in this idea that you are defective, then your recovery will suffer. Several researchers have shown that the stigma of addiction is a problem. Jason Luoma is one such researcher who has written about how the stigma of addiction causes problems for those who want to clean up and actually can weaken their recovery.

Over the past four videos in this series on Addiction According to Meaning Therapists, Geoff Thompson has been reviewing the work of meaning-oriented therapists Jonathan Diamond, Jefferson Singer, Kirk Schneider and James Crumbaugh. Their work is by no means identical, but all of these therapists share four core principles:

1. We must treat the whole human being. Human beings are complex and unique. We are not going to separate out their addiction and forget the person with the addiction. Therefore, we don’t treat the addict, we treat the person.
2. You must connect with others. In this era of neuroscience, we are finding that humans are ‘hardwired’ to be in relationship with other people. Evolution has created us this way.
3. You must live life. We need to do something in our recovery. We need to put it into practice. We need to experience life fully. Taking risks is part of recovery. All of these therapists we highlighted in this five-part series pointed out that dangers of isolating and being a couch potato.
4. Start looking at positive things in life. Stop dwelling on negativity. This point reminds us of the importance of attitude. Build your resilience, or what Dr. Frankl calls the defiant human spirit.

In part 2 of addiction according to meaning therapists, Geoff Thompson discusses the work of addiction expert Dr. Jefferson Singer, author of Message in a Bottle: Stories of Men and Addiction . Dr. Singer believes that stories that we formulate about ourselves form our identity. Dr. Singer worked with relapsing clients at a facility called Lebanon Pines. In Dr. Singer’s research on men with addiction, a common thread that the stories shared by the clients he worked with reflected (a) a feeling of not fitting in with society and (b) an apparent lack of a cohesive sense of identity.

By Geoff Thompson, Ph.D. (cand.), CCC
Program Director at Sunshine Coast Health Center

In his new book, The Human Quest for Meaning, Dr. Paul Wong brings together a number of authors all talking about meaning and purpose in life. In this blog article, we’ll examine some ways that psychologists — who specialize in meaning therapy — have treated those suffering from addictions.

At Sunshine Coast, much of the therapy is based on the work of Dr. Paul Wong. But Dr. Wong is not the only expert in this kind of therapy. In the beginning, it was Viktor Frankl, who said that addiction was a response to living a life that had little personal meaning. Frankl influenced many therapists, who designed treatments either based directly or indirectly on his ideas.

As you will discover, none of the therapists we’ll talk about treat an “addict” or an “addiction.” They do not believe that a complex individual can be reduced to a single condition. Simply because some people succumb to addiction does not mean that they suddenly stop being complicated human beings with their own personal experience of the world. They still need to love and be loved, feel a sense of accomplishment, live up to their own standards for themselves, feel they are the authors of their lives, believe that their lives are worthwhile. So, these therapists treat a complex, unique person, who happens to have an addiction problem. The focus is on the whole human being, not on the condition.

Treating an “addict” might make sense if all addicts had common personalities, ways of thinking, and so on. Some people do believe that all addicts have an “addictive personality” — it’s remarkable how popular this idea is — it does not, in fact, exist. People who suffer from addiction do not have any special personality type or personality traits, which make them all in denial or narcissistic, and so on. As William R. Miller, one of the major experts in the field reminded us, five decades of scientific research trying to discover this mysterious “addictive personality” have shown that there is no such thing. The research is quite clear that those who succumb to addictions are as unique and complex as everyone else. To put it another way, they’re human.

Being human means they have needs and desires. It means that they have all sorts of emotions: guilt, joy, sadness, anger, pride, and so on. It means that they have formed some identity of themselves. It means that they have formed some sort of understanding of how the world works.

So let’s have a look at how expert therapists treat addiction. This will give you some clues to your own recovery. Although these therapists did not talk to each other, they interpreted addiction and recovery in very similar ways.

Jonathan Diamond

Dr. Diamond wrote a famous book called Narrative Means to Sober Ends. He believes that we are the stories we tell ourselves. This is a fairly new type of psychology, known as narrative psychology.

Diamond argues that we discover who we are through our narratives, through the stories we tell ourselves about our lives. We do not first have meaning in our lives and then tell a story about it; rather, we discover our life’s meaning through our stories.

The alcoholic might say to himself or herself such things as “I need a drink” or “I’m powerless over drinking” or some other comment that makes it sound as if alcoholism is some external force that has taken over the person. The alcoholic who believes this has, basically, given up the very thing that makes them human: the responsibility to make decisions that will help them live the kind of life they want.

Diamond’s therapy helps clients create a new story of their lives, one in which they are not at the mercy of the addiction. The therapy can be seen as helping clients understand what it means to be human, because Diamond proposes is that the experience of addiction is a human experience.

Jeff Singer

In this blog, we’ve talked before about Dr. Jefferson Singer, who wrote Message in a Bottle: Stories of Men and Addiction. He worked in a residential treatment center that admitted only clients who had detoxed at least seven times and been in treatment at least six times. (Dr. Singer is no longer at the center.) He was interested in why male addicts would return to drug use even after being exposed to several mainstream addiction treatments.

Like Jon Diamond’s ideas, which we examined last week, Dr. Singer believes that the stories that addicts tell themselves about who they are and their place in the world is a major problem for them. Singer says that addicts have a very poor sense of who they are (identity) and a very poor sense of fitting in the world (they have weak relationships with others). In fact, it is because of this that addicts use substances. The alcohol and drugs serve as a doomed attempt to deal with the poor sense of self and poor sense of fitting in the world.

His therapy helps clients develop a positive identity and connect with others at a deeper emotional level. If they can achieve a more positive view of themselves and what they truly want from life, then they can finally discover what makes their lives meaningful. This is why Dr. Singer says that addiction is basically a problem of “meaning.” As one reviewer described it, Dr. Singer’s approach is “deeply humane.”

Ballinger, Matano, and Amantea

Drs. Barbara Ballinger, Robert Matano, and Adrianne Amantea worked with an alcoholic, whom they called “Charles.” They pointed out that mainstream treatments for addiction have very low success rates. They suggested that the reason for these poor success rates was that what the addict really needed was to learn to be comfortable with negative emotions, because negative emotions are as much a part of life as positive emotions. These negative emotions are not superficial ones, such as getting angry at a motorist who cuts you off. Rather, they are the result of deep anxiety over death, loneliness, and so on.

According to Ballinger, Matano, and Amantea, there’s no sense trying to have only positive emotions because human beings are not built that way. This was the power of the drug—it allows the addict the feeling of being in control of his emotions. But the long-term problem was that the client lost a sense of who he is and where he is going. In fact, all that using meant that he wasn’t paying much attention to himself. This also influenced his relationships, which revolved around drug use and not around the security and contentment of being with others.

Their therapy consists of helping clients live with many uncomfortable emotions. They are not very interested in providing information on how drugs affect the brain or the pros and cons of getting a new job. Rather, they try to help clients realize that it is okay to be angry or sad or feel guilt—and no need to use drugs to get rid of them. The therapy also helps them connect with others (in this case, with the therapist). Addicts are not very good at connecting with others. Clients learn to be attentive to others, to meet them on a level playing field, to experience what it means when two people form an open and trusting relationship.

James Crumbaugh

Dr. James Crumbaugh developed a treatment for alcoholism based on Viktor Frankl’s form of therapy known as “logotherapy.” (Logo equals “meaning,” so this is meaning therapy.) Crumbaugh wrote a famous book, Logotherapy: New Help for Problem Drinkers (and Frankl wrote the foreword to this book).

Crumbaugh believes that we all need each other. He suggests that Frankl believed the same thing. As he writes in his book, “everybody has to have somebody in order to find a personal identity as Somebody.” What he means by this is that we feel important only if someone else treats us as if we are important; you can’t feel important if you are alone. We thus need to love and to be loved, to feel that others think we are worthwhile, to feel that others think we are accomplishing things in our lives, to feel that others think we’re good people, and so on.

His treatment is a five step process: (1) Choosing your view of life, (2) building self-confidence, (3) creative thinking, (4) encounter, and (5) dereflection. Crumbaugh says that you have two choices on how to view your life: “Man is merely a machine” or “Man is a machine, but he is also infinitely more than a machine.” The second and third steps refer to the belief that you are capable of overcoming addiction and that you have the determination to do so. The fourth step, encounter, refers to connections with other people According to Crumbaugh, it’s a mistake to think that you can find meaning by having the perfect job or playing music alone or any other thing that is not people-focused. The value of these things for meaningful living is that they are vehicles that bring us into contact with others. Dereflection, the fifth step, is one of Frankl’s therapeutic techniques. According to Crumbaugh, dereflection “is the core of the logotherapeutic process of searching for meaning and purpose in life.” This technique helps the addict shift focus from failures and shortcomings to abilities, successes, and aptitudes. Paying attention to these positive attributes is, of course, necessary if one is to find new goals and ”discover tasks that will bring him into sufficient relationship with the ‘significant others’ in his life.”

Conclusion: Lessons from the Expert Addiction Therapists

In this article, we’ve been discovering how different expert therapists, who believe addiction is a response to a lack of meaning and purpose in life, provide treatment to help their clients overcome addiction.

By now, you’ve likely realized that these therapists share many ideas on what it means to be addicted and what it means to recover. In a nutshell, they are convinced that addiction (and recovery) can be understood only at a human level. Any idea that addiction is something imposed on a person—such as addiction is a disease—has no place in their thinking.

Here are four common themes that these therapists help us understand.

First, they believe that therapy for addiction is all about helping clients appreciate that they are complicated, unique individuals—not just drug users who need to be fixed.

Second, they believe that addicts in recovery must learn to form strong emotional connections with others. Evolution has hard-wired us to be with others. In fact, we discover who we are by how others treat us.

Third, they believe that recovery is all about having real-life positive experiences. Recovery is not merely learning about new ways of living; it’s not some intellectual exercise. It’s about actually living, experiencing the world.

Fourth, they believe recovery demands that you make sense of yourself in a new, positive way. We’ve all fallen below the standards we set for ourselves. The key is to learn from “failures” and “shortcomings,” not see ourselves as failures.

By Geoff Thompson, Ph.D.(cand.), CCC

Program Director at Sunshine Coast Health Center

For the past few decades, researchers have trying to figure out what is it about therapy that helps people change. In the old days, we used to think that the therapist was somehow responsible for any change in the way a client felt, thought, or acted. Clients would often lie on a couch or sit in a chair and talk, while the therapist listened, analyzed their problems, and prescribed solutions.

We don’t do that type of therapy anymore, though it’s interesting that many of our clients at Sunshine Coast often think this is the way therapy “works.” And a lot of the general public thinks this as well … maybe from watching Dr. Phil. Today, we believe that the client does most of the work in therapy; therapists walk alongside the client, helping the client change what he or she wants to change.

Sometimes when we study how well programs work, we focus on what we think is happening in therapy to see if our ideas are accurate. If we were to study meaning therapy in this way, we would single out what we thought was effective in the therapy and then check this out with the client.

The problem with this type of evaluation is that we may be blind to what is actually going on for clients. For instance, perhaps what really helped a client was that he gained hope for the future. If we just focus on whether he changed some behavior or learned new coping skills, we may miss just how important his newfound hope is.

Because they don’t want to miss important information from clients, a growing number of researchers ask clients what they think they got from therapy and then see if these answers match what the researcher thinks. To let you in on a secret, it is well known from research that therapists and clients disagree at least 90 percent of the time on what was important in a therapy session. At Sunshine Coast we listen to clients because we believe that each client is the author of his life. In any case, however the client makes sense of his life will lead to the quality and type of life he lives.

In this article, we’ll examine five things that we’ve learned from research on what clients tell us is important in therapy. If you are in recovery (or know someone who is), some of their answers may be helpful to you. They might even help you figure out how well you are doing in your recovery.

Part One: Personality Change

The idea that we could use a change in personality as a way of figuring out if therapy helped people is an old idea. Sigmund Freud, generally regarded as the father of psychology, believed that only the therapist could decide if a client changed and made this decision based on whether the person changed his or her personality characteristics.

Although the idea of personality change took a backseat in psychology for decades, it has recently made a comeback. Today, some researchers give clients some tests that measure certain components of personality (not personality itself) to see if they have changed. A typical example would be coping styles. Perhaps a person who tended to react without thinking might experience a change if he or she thought about something before acting.

A change in personality is a common idea in the treatment of addictions. We’ve talked before in the online program about those who believe, with Dr. Silkworth in the Big Book of Alcoholics Anonymous, that recovery demands “an entire psychic change.” Other experts have different names for this. William White calls it “transformational change.” William R. Miller calls it “quantum change.” Miller interpreted this personality change as a change in values—what the individual believes is important to him or her. He conducted research which showed, among other things, that the values of people before and after recovery were different.

You should know that whether personality changes in adults or stays the same is a topic of great debate in psychology. But regardless of what you believe, the idea that we can change core things about ourselves in treatment is important to know. Sunshine Coast alumni who are doing well in recovery often tell us that they are more open to new ideas, less impulsive, are slower to anger, rely more on their intuitions, and so on.

Part Two: Behavior Change

Most of the public determines how effective treatment is based on whether the client abstains from alcohol and drugs.

Interestingly, this is not a big priority for researchers. The researchers have a much broader way of looking at behavior change. They are, of course, interested in discovering if clients abstain, but they are much more interested in learning whether clients reduce drug use after treatment, even if they don’t quit entirely. A typical survey asks for the number of days per month a client used before treatment and then after treatment. In terms of drug use, they are also interested in the amount and frequency of the drug use and whether the person lapsed on his or her drug of choice or used some other drug.

But drug use is just one of many behavior changes the researchers are interested in. They are also interested in learning if the person’s physical health is better after treatment, whether the person went to work everyday instead of calling in Monday morning with the “flu,” whether the person’s emotional/mental health improved, and whether the person’s family relationships were getting better. In the US, particularly, researchers usually want to know whether treatment clients had fewer problems with the law.

Sunshine Coast alumni who are doing well in recovery usually tell us they have made new clean and sober friends, started working out, have a safety plan in place when they go to places that serve alcohol (weddings, hockey games), make sure they keep in touch with other alumni, built up a good support network, faced their fears such as speaking in public, and so on.

Part Three: Relationship Change

A more recent trend to determine if treatment helped is to ask clients what they think is the most important thing responsible for their more positive mood, attitude, behavior, etc. Interestingly, the most important component always seems to be building trusting relationships with the therapist or other members of a group. It doesn’t seem to matter what the therapy does, this relationship building is consistently reported as the key.

This makes sense. One of the damaging consequences of addiction is that it isolates the individual. The typical pattern that occurs in addiction is to keep pushing people away. It’s easier to hang out with others who use than to keep relationships with non-addicts. And the addict’s own guilt and shame over his behavior usually makes him feel less than worthy to be around others.

Bruce Alexander, one of Canada’s foremost addiction experts, said that “Addiction in the modern world can be best understood as a compulsive lifestyle that people adopt in desperation as a substitute when they are dislocated from the myriad intimate ties between people and groups—from the family to the spiritual community—that are essential for every person in every type of society.” This points out that all of us have a need to form relationships.

Alumni who run into trouble usually tell us that they feel isolated and alone. Those who are thriving seem to have formed trusting relationships with others.

Part Four: Making Sense of Struggles in a New Way

A well-known indicator of helpful therapy is the client’s ability to make sense of a personal struggle in a new way. The fancy term that psychologists use for this is “cognitive restructuring.”

A typical example is the client who discovers that addiction has a physical basis in the brain. A client might have thought that he was making a clear choice in using drugs, without realizing that the brain adapts to the drug, thereby making it much more difficult to abstain. With this new knowledge, he might feel less guilt and shame. Similarly, many new Sunshine Coast clients seem to think that they are at the mercy of their cravings—they won’t be able to deal with a severe craving. But they learn that they can control cravings by using techniques they discovered at Sunshine Coast.

New clients to Sunshine Coast generally bring with them all sorts of ways of making sense of things that went wrong in their lives and what they need to do to get over hurdles. Many of these ideas are not really based on reality. In fact, they can often be a barrier to living a good life. For instance, a remarkable number of clients seem to believe that their recovery depends on their family. “If my family would just get off my back, I’d be okay” is a typical statement. After discovering in treatment that they are the authors of their lives, they may start making sense of their struggles in a new way—one in which they rely on themselves and not their family for recovery.

Another example are those new clients who believe they have no choice over whether to use drugs. After learning about the famous Rat Park experiments (where rats avoided morphine if they were free to be themselves), these clients might appreciate that recovery demands that they be true to themselves.

Sunshine Coast alumni confirm what the researchers have found. Those who are doing well actively change how they make sense of things in their lives. They tell us they listen rather than jump to conclusions, they reflect on alternative ways of understanding a person, and so on.

Part Five: Finding Meaning in Life

Of course, at Sunshine Coast, we pay a lot of attention to how clients discover or create a meaningful life. Last week, we pointed out that clients often report a helpful part of treatment is to make sense of their struggles in a new way. We called this “cognitive restructuring.” Finding meaning in life is not the same as cognitive restructuring; it’s much deeper. It’s not so much about making sense of this situation or that situation; rather, it is about making sense of the big picture view of life.

The big picture depends on how the person makes sense of his life. And how the person makes sense of life—the big picture—will be reflected in the little things he does. If a person believes that the world is a dangerous place—a big picture view—then he will carry this idea everywhere in his life. He may get very defensive if someone questions him, but he’ll also get very defensive in any situation where he feels a threat, such as in his car, at work, and, even, at home. If a person doesn’t think much of himself, then this will color how he interprets situations and people in his life.

But what if the big picture was more positive? One participant in therapy put it this way: “Therapy helps because you see yourself and your situation in a new way. It helps you to see your history a little bit from above, or from the outside, or from a different angle.”

This comment is typical of those we ask about how therapy has helped them. They gain perspective on their lives. Narcotics Anonymous says that addicts are famous for making mountains out of molehills. Therapy seems to help them keep the molehills as molehills.

Gy Geoff Thompson, MA, CCC
Program Director
Sunshine Coast Health Center

Everything one does in life, even love, occurs in an express train racing toward death. To smoke opium is to get out of the train while it is still moving. It is to concern oneself with something other than life or death. ~ Jean Cocteau

According to Geoff, how addicts interpret time is one of the keys to recovery. For example, when one experiences a craving, does one give in to them or does one look toward the future and let the craving pass because to do otherwise would sabotage their hopes and dreams for the future.