Drug Rehab Center

In this final instalment in ‘What works in addiction treatment’, we see another example of people successful in recovery seeing the world in a new way. Getting a new perspective can, however, be more challenging depending on the issue. For example, altering a person’s belief that he/she will die if they get on an airplane is, relatively speaking, fairly straightforward. For more complex conditions like addiction, depth psychology is often required. At Sunshine Coast, we use depth psychology because we encourage the clients to look at themselves in a deep, profound way. Looking into the grey areas of life is part of the therapeutic process. Therapists at Sunshine Coast help clients recognize that suffering is part of life.

Clients at Sunshine Coast are encouraged to try to make sense of their world, to understand themselves at a deeper level. People who feel they are making headway in their therapy find their actions reflect their intentions, that they are being true to themselves.

A Bad Attitude Doesn't Explain Why Addicts Struggle With Showing Up on Time

By Geoff Thompson, MA
Program Director
Sunshine Coast Health Center

Introduction

Weird as it may sound, researchers are beginning to take a long look at how people with addictions interpret time.

One reason for this interest is to better understand a very common phenomenon that all addiction counsellors face. Anyone who has ever worked or been a client at a treatment center knows that it’s almost impossible to get everyone together at a workshop at 9am or have people consistently show up to appointments on time.

Mainstream addiction counsellors often pull their hair out with the lateness and the missed appointments. Interestingly, they make sense of this situation by blaming the addict as irresponsible or, perhaps, passive-aggressive. They think that the self-centered addict is so wrapped up in his own life that he doesn’t care about another person’s schedule. Or they say that addicts’ lives are chaotic (which is why the need a structured program). Or they make sense of the lateness as a typical symptom of those who are trying to assert control over their lives — an unspoken statement that sends the message “You can’t tell me what to do.”

Most addiction treatment programs create structures that leave little opportunity for choice. The argument is that addicts need structure to deal with their chaotic life. Of course, since it’s difficult to get everyone in the same place at the same time, the usual tactic to deal with lateness and missed appointments is, at least in residential treatment programs, to threaten clients: “If you don’t show up on time for programming, then we will discharge you.” But making sense of lateness by suggesting that addicts’ lives are chaotic may not be all that accurate. A growing number of addiction experts tell us that lateness may be more a factor of how addicts make sense of time.

When you think about it, time is actually weird. Of course, we all know that a minute is a minute. It’s 60 seconds regardless of whether it is a minute in the middle of the night or middle of the afternoon, whether it’s a minute in Hong Kong or a minute in Vancouver. (Of course, Albert Einstein said this isn’t true, but for everyday purposes, it’s the same.)

Regardless of this factual knowledge of time, people usually have a different perception of it. For example, you know that time slows down when you are bored. On the other hand, time speeds up when you are absorbed in some activity. Younger people often complain that time moves too slowly; older people often complain that time moves too quickly.

Add to this that we are a very time-oriented society. Almost everyone wears a watch and owns a calendar. It is considered rude to be late for appointments, suppers, and so on. People complain that someone might be “wasting my time.” And there’s the old saying, “Time is money.” It’s almost as if time can be good, bad, or neutral. In fact, we say that we had a “good time” or “bad time.” And “Time management” is very important in our society.

For the nonaddict, time flows from the past to the present and then into the future. But for the addict, only present time is truly important. The present, the now, has the priority. In this month’s online program, we’ll look at the way those in active addiction and those in recovery look at time. Surprising as this may seem, it actually will help you in your recovery. Research is showing that how the recovering person interprets time is linked closely to how well they do in recovery.

Part One – Addicts Want Things NOW

Ryan Kemp, a researcher in the UK, who is interested in how addicts interpret time quotes a passage from the famous artist, Jean Cocteau:
Everything one does in life, even love,
Occurs in an express train racing towards death,
To smoke opium is to get out of the train while it is still moving

Time, for most people in active addiction, is ‘present’ time. What is important is ‘right now’, this moment. “Drugs,” says Kemp, “call out to the addict to be used, and to be used now!” Drugs have no future. How many times have you bought more of the substance that you planned to use—to save some for the future—only to use it all up as soon as possible. Kemp talks about the desire that addicts have to have “now” linger on. They want the present state of being high to linger.

On the other hand, the addict thinks that any state of discomfort will go on forever. If they have to wait to get high, then this is an unendurable wait and seems to go on forever. Drugs can end that miserable state of not being high. The waiting feels like a vacuum—what Sunshine Coast clients have described as feeling a “void” or “hollow.”

Studies on addicts have shown that they will choose a small reward right now, rather than delay gratification for a larger reward later. This is, in part, why many addiction experts say that addicts are impulsive. Similarly, almost everyone in active addiction grabs the immediate reward of using the drug, even though they know it will cause them problems in the future. Getting drunk the night before having to work, getting loaded before having to write a school test, using before the big family supper, getting money out of the bank for the drug even though they know they will have to answer to the family later, and so on are typical behaviours.

The past is not very meaningful for addicts—other than as a source of good stories about how they got away with something or some dumb, but funny, thing they did. For many in active addiction the past is filled with guilt, so they actively work to avoid thinking about it. In any case, it’s not useful for using drugs right now to spend time thinking about the past.

Similarly, the future has little meaning for addicts. Any competent addict knows that it would be useless to think about the future if they wanted to use drugs right now. If they started thinking about the future, then they would think about consequences of their actions, the withdrawal, the guilt, the money spent, and so on.

Part Two — The Problem of the Future for Addicts

Problems with the future give the addict more pressure to live in the present, in the now.

The first problem with the future is that if you live for the future, then you have to have some goal or mission. To really pay attention to the future, you have to be doing something, achieving something, working toward some goal. For example, if you want to learn how to play the guitar—a goal for the future—you have to put in all those hours and months of practice to achieve more competence. Or if you want to get a degree in forestry, you have to put in all those years of study. Addicts have little interest in working to achieve a future goal. They want a state of feeling that is immediate. Now.

Another problem with the future for those in active addiction is that it is not guaranteed. Things may not happen as the addict wants them to happen. The future is uncertain. And one thing that people in active addiction do not like is uncertainty. That’s why we say (affectionately, of course) at Sunshine Coast that all addicts are control freaks. They want to control life, but it’s impossible to control the future. Given that, there is little reason for paying attention to the future.

Part Three — Therapies that Do Not Help with Recovery

There are many types of therapy that are used to help people recover. Every few years, William Miller, a world-renowned addiction expert, ranks how well about 50 official therapies work for addicts in recovery. You may have heard of some of them: solution-focused therapy, motivational therapy (this is Miller’s), cognitive-behavioral therapy, community reinforcement therapy, relapse prevention therapy, and so on.

We have a good idea of types of therapies that just don’t seem to work for addicts. One of the most famous examples of a therapy that does not work is psychoanalysis, the type of therapy developed by Sigmund Freud. This therapy analyzes the person’s childhood experiences to help them understand that their problems are actually rooted in the past.

There’s a lesson here. Therapies that focus on the addict’s past have little success helping the person to recovery. At first, this may seem very odd. It seems reasonable that if the addict could figure out his past and how it left him with poor coping skills or whatever, then this would be useful for recovery. Add to this that these therapies often work well with people other than addicts.

But research is showing that the addict’s perception of time screws up the process. The past is really not the addict’s focus, so focusing on it is likely not that useful. And we’re discovering that any therapy that focuses on the past is not very successful: psychoanalysis, family of origin therapies, and so on.

Part Four — Therapies that Improve Recovery

So we mentioned that any therapy that focuses on the addict’s past will likely not help him very much. Research is showing that therapies that focus on the future are likely to offer much better help.

One of the most famous therapies in the addiction field is motivational therapy, developed mainly by William Miller and Stephen Rollnick. This therapy deals with the present but has a big focus on the future. It helps clients figure out what they truly want out of life and then supports them in achieving their goals.

Another successful program is the 12-step program. If you take a close look at the steps you will notice that they are aimed at the present and the future. This makes sense. Bill W., the driving force behind the 12-step program wanted you to go on and live a great life. He wanted you to feel alive right now, today, the present. The steps that deal with the past are merely there because you need to overcome jealousy and guilt and anything else that would be a barrier to feeling alive each day. But he also reminded you of the future. That’s one of the reasons why the last three steps are called the “maintenance” steps. He knew that you had a life to be lived.

Part Five — Live in the Present but Keep an Eye on the Future

It is interesting that everything we’ve been talking about this month says that recovery demands that the addict make sense of time in a new way.

In active addiction, the addict is concerned only with present time, the now. The past and future have no positive meaning. The past is mainly a source of guilt, and, in any case, it does not help him get and use drugs. Living with an eye on the future demands that the addict accomplish something, follow a plan, live for some future goal. This is not a useful strategy for addicts to keep using drugs. Perhaps worse, the future is unpredictable, and so it can be dangerous. What if things don’t work out? There are no guarantees with the future.

In recovery, on the other hand, the addict needs to live in the now, but be oriented toward the future. For example, he has to work through cravings, which means giving up immediate relief for the goal of abstinence. He might have to put off some immediate reward by going back to school for training, for the goal of getting a new job. He might have to work to take risks and be uncomfortable in the moment, for the goal of meeting someone to love.

If you remember some of the wise people we have talked about in other online blog articles, you’ll recognize how important it is for recovery to keep an eye on the future. The great psychiatrist Viktor Frankl said that each of us has some mission to fulfill, some goal or goals to accomplish in this life. If the person does not achieve this mission or this goal, then they suffer. Joseph Campbell, the famous expert on mythology, said that the recipe for the good life is to “Follow your bliss.” There is a future that awaits you. And, of course, the AA chip says on one side: “To thine own self be true.” You have some life that awaits you if you follow what you truly want out of being alive.

But to find the good life means that you have to live more than in just the moment. You have to keep an eye on the future. This is very difficult for most people in early recovery (and pretty much impossible for anyone in active addiction). But it offers hope. It all depends on whether you choose to pay attention to the future.

Cathy Patterson-Sterling, MA, RCC

Cathy Patterson-Sterling, Director of Family Services for the Sunshine Coast Health Centre, talks about a grieving period in early recovery and why it can be dangerous to bargain with your addiction.

Cathy Patterson-Sterling, MC, RCC

Cathy Patterson-Sterling, Director of Family Services for the Sunshine Coast Health Centre, discusses why it is common to have more than one addiction.

Modern war and major disasters such as 9/11 and Hurricane Katrina have highlighted the horrendous effects of psychological trauma. Here are some rates of post-traumatic stress disorder (PTSD): 23 percent in regions in Israel that have been shelled, 40-70 percent in Gaza, 17 percent of US military personnel, 44 percent in high school seniors in Kosovo five years after hostilities ended, and 30 percent in New Orleans after the hurricane.

Many of these poor souls have turned to alcohol and other drugs to deal with the impact. New research is helping us develop new ways to treat these clients with co-occurring disorders.

The Impact of Trauma on the Brain

Trauma imprints itself in the brain’s memory system. Stress hormones that accompany the emotional intensity of trauma activate the amygdala, which in turn activates other subcortical structures in the limbic system, the primitive, ‘non-thinking’, part of the brain. In other words, emotion mediates how memories are consolidated. The precise mechanisms involved are still debated, but neuroscientist James McGaugh says everyone agrees that “Stronger emotional experiences make for stronger, more reliable memories” (2003, p. 327). Memories of a wartime fire-fight or a collapsed building may intrude repeatedly in a survivor’s daily life or lead to nightmares. Survivors appear to be sensitized that even a door slamming or an image on television can trigger the intense experience. As psychologist David Myers says, “It is as if they [the memories] were burned in” (2010, p. 342). Even months or years later, traumatic memories are so clear that victims recall the event with remarkable detail.

To understand the power of trauma on the memory, think back to 9/11. Chances are that you remember what you were doing on September 11, 2001. But do you remember what you were doing September 11, 1999? Myers reports a study in which victims of car accidents, rape, and other traumatic incidents were given either a placebo or propranolol, a drug that blunts memories. Three months later, half the placebo group and none of the propranolol group experienced stress disorder. “Weaker emotion means weaker memories” (Myers, 2010, p. 342).

Trauma and Drug Use

Statistically, there is an association between addiction and trauma, though much more work is needed to discover what the precise link is. Some say that those suffering from trauma are more vulnerable to addiction; the earlier the trauma, the stronger the association. This may be due to the impact of early trauma on the brain’s development. Others say that the addicted brain makes people more vulnerable to PTSD. Some suggest that traumatized people are more vulnerable to addiction because they want to medicate their condition. Still others say that those with trauma who are addicted to substances are not medicating their pain, but using substances as any addict does—to relieve boredom, despair, guilt, loneliness, and a lack of a sense of belonging. And so on.

Treatment

Traditionally, scientific treatment for trauma and addiction has relied on cognitive-behavioral therapy (CBT). Among the most the most famous for co-occurring additions and trauma is Lisa Najavits’ Seeking Safety (2002) program. But many are questioning whether CBT and traditional psychotherapy are enough. One of the more controversial figures advocating a new clinical approach is Bessel van der Kolk (2005). He has suggested that because trauma affects structures in the brain’s limbic system and inhibits key functioning in the ‘thinking’ brain, that body-oriented and self-regulation therapies may be more effective than traditional talk therapies alone.

Based on brain-imaging techniques that show traumatic memories appear to be mediated or moderated by the limbic system, some trauma experts are using techniques that integrate the mind and the body. James Gordon (2010), head of the college of mind-body medicine at Saybrook University, works with US soldiers and local residents in Gaza, Bosnia, Afghanistan, and elsewhere. Gordon’s mind-body approach focuses on client strengths, builds resiliency, and balances the sympathetic nervous system’s fight or flight response with the parasympathetic nervous system’s relaxation response. Initially, after creating a safe environment, he follows a three-step process: shake, breathe, and move to music. Strange as the idea may first appear, this body-work frees participants sufficiently to deal with the trauma. They often break down sobbing during this somatic process, able to talk about what happened to them. Othre clinicians use EMDR and OEI, various types of body-work, forms of psychodrama, and other cutting-edge techniques.

Today, little of this trauma work is applied in the addiction field. But there is great hope that as addictions clinicians become more familiar with trauma, that their traumatized clients will fare better.

References

Gordon, J. S. (2010, Jan 19). Trauma and transformation: Healing the wounds of war and other disasters. [Workshop]. College of Mind-Body Medicine, Saybrook University, San Franciso, CA.

McGaugh, J. I. (2003). Memory and emotion: The making of lasting memories. New York, NY: Columbia University Press.

Myers, D. G.. (2010). Psychology. New York, NY: Worth Publishers.

Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York, NY: The Guilford Press.

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389-399.

By Daniel Jordan
General Manager
Sunshine Coast Health Center

In one of my web surfing sessions I happened to come across a YouTube video showing an interview with Carl Gustav Jung, the famous Swiss psychiatrist. Not only is this a rare glimpse into the world of a master therapist it is, to me, an account of the ‘inner void’ that seems to lie at the core of addiction. 

For those that prefer not to watch the entire video, the key section of the video (2:22 – 7:54) has been transcribed as follows:

Background

Jung: A case where there was an intelligent, young woman, she was a student of philosophy, very good mind; where one would expect easily that she would see that I am not the parental authority but she was utterly unable to get out of this delusion. And, in such a case, one always has recourse to dreams: it was just as if one would ask the unconscious “now what do you say to such a condition?” You see, she says in her conscious “of course I know you are not my father but I just feel like that; it is like that: I depend on you …”

The Therapy Session

Jung: Now let’s see what the unconscious says. Now the unconscious produced dreams in which I really assume the very curious role … she was the little infant, she was sitting on my knees; I held her in my arms. I was really tender father to the little girl. And, more and more, the dreams became empathic in that respect; namely that I was a sort of giant; and she a very little, very human, thing you know like a little girl in the hands of an enormous being; and the last dream of that series was … I cannot tell you all the dreams; was I was out in nature, I stood in a field of wheat that was ripe for harvest and I was a giant and I held her in my arms like a baby and the wind was blowing that field of wheat. Now you know when the wind is blowing over a wheat field there is waves; and with these waves I swayed as if putting her to sleep and she felt as if being in the arms of a god; of the godhead.

“Now the harvest is ripe, and I must tell her. And I told her, “what you want and what you project into me – because you are not conscious of it – that is, you have the idea of a deity you don’t possess. Therefore you see it in me. That clicked.”

“She suddenly became aware of an entirely heathenish image that comes fresh from the archetype. She had no idea of a Christian God or an Old Testament Yahweh. It was a heathenish God, a God of nature, of vegetation, he was the wheat himself, the spirit of the wind; and was in the arms of that numen.” *

(*) Numen – a god or spirit believed to inhabit a place or being.

Jung’s Interpretation

Jung: That is the living experience of an archetype. That made a tremendous impression upon that girl and instantly clicked. She saw what she really was missing; that missing value, which was in the form of a projection in myself and made myself indispensible to her. She saw he’s [Jung] not indispensible; because it as the dream says, it is in the arms of that archetype … idea. That is a numinous experience. And that is the thing people are looking for: an archetypal experience, that gives them an incorruptible value. They depend upon other conditions, they depend upon their desires; their ambitions; they depend upon other people because they have no value in themselves. They have nothing in themselves. They are only rational, they are not in possession of a treasure that would make them independent.

“But when that girl can hold that experience then she doesn’t depend any more; she cannot depend any more; because that value is in herself, and that is a sort of liberation.”

“And that, of course, makes her complete. Inasmuch she can realize such a luminous experience, she is able to continue her path, her way, her individuation.”

WHY THE FASCINATION WITH THIS VIDEO

Despite it’s title, neither transference * nor archetypes is central to my interest in this video. Furthermore, dream analysis is typically not a technique we utilize at Sunshine Coast Health Center. ** So why, you may ask, the fascination with this video? For me, it’s the “numinous experience” described by Dr. Jung as the moment when his client, the philosophy student, was able to free herself from her unhealthy fixation on Dr. Jung.

Obviously, Dr. Jung is not some sort of drug but, according to Dr. Jung himself, his client was “dependent” on him as a father figure. From my personal experience with our chemically dependent clients, there seems to be an inner void (clients often call it their ‘donut hole’) that finds them grasping for anything external: drugs, alcohol, cigarettes, sex, gambling, anarchy, etc. Those clients that complete addiction treatment and go on to live happy lives seem to discover an inner “treasure” that, as Dr. Jung points out, makes them independent, complete, liberated.

(*) Transference: the emotional bond that develops on the client towards his analyst/therapist.

(**) Note: Sunshine Coast Health Center does, however, use depth psychology, which is related to archetypal psychology in that they both employ the model of the unconscious mind as the source of healing and development in the individual.

BILL WILSON’S ‘WHITE LIGHT EXPERIENCE’

For Bill Wilson, a similar moment of transformation was the beginning of long-term recovery for the famous founder of Alcoholics Anonymous. During Wilson’s fourth admittance to Towns Hospital in 1934, Bill Wilson recalls his ‘white light’ experience: “Suddenly the room lit up with a great white light. I was caught up into an ecstasy which there are no words to describe. It seemed to me, in the mind’s eye, that I was on a mountain and that a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man.” *

Source: Kurtz, Ernest (1979) Not-God: A History of Alcoholics Anonymous, pgs. 19-20.

CONCLUSION

I will be the first to admit that these peak experiences are rare and that holds true for the clients at our alcohol and drug rehab program. For them, addiction recovery is more gradual, with repeated advances and retreats. Regardless of how long it takes, however, the objective of personal transformation remains valid.

Oftentimes, it’s a difference in language. For example, what Dr. Jung calls a “luminous” or “archetypal” experience, we at Sunshine Coast Health Center call “personal transformation.” The end result of such an experience, what Dr. Jung calls “incorruptible value,” we call “meaning and purpose.” However, this video, if anything, further reinforces my sense that our current approach to treatment is heading in the right direction.

Cathy Patterson-Sterling, MA, RCC

Cathy Patterson-Sterling, Director of Family Services for Sunshine Coast Health Centre, shares ways to discuss having alcohol in your home or at family gatherings when a loved one is in recovery, without singling them out or making them feel “abnormal.”

By Daniel Jordan
General Manager
Sunshine Coast Health Center

For the families we are privileged to serve at Sunshine Coast Health Center, starting residential drug rehabilitation can be a roller coaster of emotions. Starting treatment is really about wholesale change since, by the time we get involved, addiction has progressed to the point where everything our clients hold dear – family, friends, health, and home – is in jeopardy. For clients and their families alike, addiction treatment can be symbolized as the light at the end of a very dark tunnel.

Starting Treatment Can Be Overwhelming

Unfortunately, however, clients may be hopeful but can also be awash with conflicting emotions, particularly fear. Regardless of how dysfunctional their addict lifestyle has become, at least it’s familiar. Judging by the questions we get, nothing about treatment is familiar. Where am I going? Who will I be sharing a room with? How long am I going for? Can I use the telephone? These are basic questions but most clients at this point in their recovery are in no shape to go to our website and research our program beforehand.  

In 2008, Sunshine Coast Health Center managed a retention rate of 89.41 percent for clients who were admitted to treatment. So our internal research gives families pretty good odds that their loved one will complete treatment.

Another piece of good news is that the majority of the 1 in 10 that did not complete treatment * left in the first week. Therefore, if your loved one makes it through the first week the actual likelihood of completing treatment at Sunshine Coast Health Center is closer to 93 percent.

The third piece of good news is that there are steps that family members can take to make the odds even better. By following some basic recommendations, family members can actually help keep their loved ones in treatment.

(*) Note: includes clients who left due to either leaving against staff advice (ASA), at staff request due to a dischargeable offense (ASR), leaving without notice (AWOL), or due to medical complications (MD).

Why Some Clients Want to Leave Treatment Early

First off, it’s important to understand why some clients want to leave treatment early. It is easy to dismiss a client’s decision to leave treatment early as nothing more than ‘not being ready’ or an overwhelming desire to get drunk or high. However, as is often the case with addiction, it’s not that simple. Most clients in early recovery struggle with ambivalence. Early recovery offers the promise of better days, the expectations of significant others, the uncertainty of a life in recovery, and the daunting task of cleaning up the huge mess that awaits them back home. Usually, when confronted by reality, the automatic response for addicts is to escape with drugs, alcohol, gambling, or sex. In treatment, however, that is not an option.

Clients Often Call Home Before They Leave Treatment

There is really no prevailing behaviour for clients who decide to leave treatment early. Some don’t hesitate to make their intentions clear the minute they arrive, while some clients keep it such a secret that staff don’t know until they find a note on a pillow the next morning. Somewhere in between these two extremes is the client who calls home first before leaving treatment. If you are one of those unfortunate family members who gets that call in the middle of the night, it is important to remember that you may be the first person who is aware of your loved one’s decision. Staff may be busy performing their duties, unaware that a client in their midst is moments away from ‘making a run for it’.

Why Clients Call Home Before Leaving Treatment

If we take a moment to reflect, it’s actually a huge opportunity for positive change when clients call home before they leave. After all, if someone was really intent on leaving, they wouldn’t complicate matters by calling home first. That phone call can represent one of two things: (1) they don’t have the resources to leave or (2) they are seeking approval before they leave treatment. Either way, you as a family member are far from being a helpless victim to your loved one’s intentions.

Three Possible Outcomes for The Same Scenario

To learn how to effectively deal with a loved one who calls home and is intent on leaving treatment early, one scenario is presented with four different scenarios based on how you, the family member, respond to your loved one.

Scenario: A client calls home late one night wants to leave treatment. You, the family member, have a telephone conversation with Cathy Patterson-Sterling, Director of Family Services, the following day:

Family Member: “Hi there. Keith called me last night and told me that his stay there wasn’t how he thought it was going to be. He complained that he just can’t relate to the other clients there and he just can’t imagine having to stay there for 6 more weeks.”

Cathy: “Oh, that’s unfortunate. Now, remember what we talked about while Keith was on his way to the treatment center? I pointed out that individuals in their first week of treatment have to contend with unfamiliar surroundings and strangers. To complicate matters, they are also going through withdrawal and don’t have their drug of choice to fall back on, so they will often try to think of a reason to leave treatment. Do you remember our conversation?”

Family Member: “Yes, I remember that.”

Cathy: “Right. That is why we reviewed all of the excuses that you could expect were going to come up and one of them was that about the “wrong peer group”. So, when Keith told you he wanted to leave, how did you respond?”

Response A

Family Member: “Well, I thought about what you said but then I thought what’s the point of Keith staying in treatment if he’s just going to be hiding out in his room the whole time he’s there? So I booked a flight for him.”

Conclusion to Response A: The client packs his bags and leaves treatment. The family member pays for his flight. Keith flies home.

Response B

Family Member: “Well, I thought about what you said and I told him that I wasn’t going to pay for his cab or his airfare to come home. Besides, I told him, if he does come back he won’t be staying here and I won’t be paying his car insurance either. Then I hung up.”

Conclusion to Response C: The client, realizing that he’s got nowhere else to go, decides to stay, at least for as long as he can figure out another option. Treatment center staff remain unaware of the situation.

Response C

Family Member: “Well, I thought about what you said, so I immediately hung up the phone, then called the treatment center and talked to one of the night staff there.”

Conclusion to Response B: A counsellor was called in to talk to Keith. It turns out that Keith was homesick for his daughter. Keith feels he has not been much of a father due to his preoccupation with his addiction and was overwhelmed with guilt. The counsellor was able to talk Keith through his overwhelming emotional state. Keith decided to stay in treatment for at least a week and try to work through his feelings of guilt with his assigned counsellor and peer group.

Response D

Family Member: “Well I thought about what you said and reassured him that he was probably just going through an adjustment period. I also told him that there was no way he could come home until after he completes treatment. Then I hung up and called the treatment center.”

Conclusion to Response D: Client feels he has no other option but to stay in treatment. Staff are aware of the situation with a conclusion similar to Response C. However, this time the client, realizing that he is not welcome at home until he completes treatment, commits to staying for the duration of treatment.

Conclusion

Obviously, conversations of this nature are not always as cut and dry as what was presented here. Remember, if a loved one calls home and tells you that he wants to leave treatment, it’s because he needs  your money, your approval, or assurance that life can return back to the way it used to be before treatment.

Regardless of the rationale, you are not powerless in the face of apparently dire circumstances.

Furthermore, taking a firm line with your loved one and partnering with the staff in crisis situations is critical. So, the minute you hang up the phone with your loved one call the treatment center for support. Don’t assume that staff know about your family member’s intentions. Finally, don’t worry about being a nuisance. Typically, these types of calls happen late at night when clients are not busy engaged in the program or have the support of their peers. Don’t worry about it being too late at night to call. Staff are here, 24/7 and are prepared for these little emergencies.

For more information read the Sunshine Coast Health Center pamphlet, Contact Guidelines for Family Members.

By Daniel Jordan
General Manager
Sunshine Coast Health Center

In Part 1 of this article I highlighted the importance of designing a clinical brochure that is current, user-friendly, and comprehensive. Originally, I had planned to jump right in and explain our “integrated approach” to addiction treatment. However, as I was preparing for Part 2 I realized that exploring the complexity of residential addiction treatment is a necessary first step before attempting to explain our unique method of treatment.

Complexity #1: The Living Vs. Non-Living Universe

This may seem obvious but living entities are much more complex than inorganic objects. Neuroscientists point out that there are more synapses in the brain than stars in the galaxy and that the brain is the most complex device in the known universe. * The interesting part, however, is how we approach problems associated with living vs. non-living objects. In his book, Guide for the Perplexed, economist E.F. Schumacher argues that there are two types of problems in the world: (1) convergent and (2) divergent. 

Convergent problems are ones in which attempted solutions gradually focus on one solution or answer. Of primary importance is that convergent problems are those where that all tend to point to the non-living universe. Take, for example, the problem of manned flight. In the early days of aviation, there were many different contraptions that inventors hoped would become the first successful flying machine. Perhaps you have seen the old movie footage of planes with 4 sets of wings, or wings that would flap up and down, etc. Finally, after a lot of trial and error, Orville and Wilbur Wright made the world’s first flight in a powered, heavier-than-air machine on December 17, 1903 near Kitty Hawk, North Carolina. 100 years later, aeronautical engineers continue to improve on the Wright Brother’s original design, however, all manufacturers such as Boeing, Bombardier, or Airbus, build planes that follow remarkably similar design principles. The same is true for automobiles, cell phones, and portable computers.

Divergent problems are ones which we must find multiple solutions to a single problem and are typically found when we are dealing with living organisms, particularly human beings. For example, if you are trying to solve the problem of HIV/AIDS, handing out condoms or clean needles may be a start but it’s not going to completely solve the problem. Another agency may start a 24 hour help line and this may help as well. But these are just 2 of many possible solutions. The ongoing search for a cure to cancer, which is basically a living organism within a larger living organism (us), is another good example.  

(*) Source: Nuts, bolts of who we are, Princeton Weekly Bulletin, May 1, 2000.

Complexity #2: Chronic Conditions Vs. Acute Conditions

While many people may consider addiction a chronic condition *, the truth is that addiction has a lot more in common with diabetes, high blood pressure, and arthritis than it does with acute medical conditions such as a broken leg or appendicitis. This misconception is clearly evident whenever scientists claim to have found the gene responsible for alcoholism or pharmaceutical companies promote a new drug as the cure for addiction.

Even residential alcohol and drug treatment centers that should know better typically operate like hospital emergency wards, throwing everything they have at the client during primary treatment and leaving precious few resources for follow-up or relapse.

(*) Note: for more information on the chronic nature of addiction refer to William White’s articles on bhrm.org .

Complexity #3: Addiction Impacts All Life Domains

Unlike many medical conditions, addiction cannot be treated by localising the problem to a particular part of the body and then treating it. Addiction is a Biopsychosocial condition that impacts all life domains – biological, psychological, social and spiritual. For example, all may be well with a client while he is in the safe confines of residential treatment, however, what happens when he gets home where the same job, family, and old haunts await his return? Furthermore, most addictions impact negatively on the body (liver damaged by alcohol, tooth enamel destroyed by crystal meth or crack cocaine, etc.). Psychotherapy can be particularly challenging if a client is also suffering from cognitive impairment, or mental illness.

Not only does addiction require a diverse team of professionals to be involved in treatment, it means that often treatment often has to be applied concurrently, and that the discharge plan must include community resources that also embrace the Biopsychosocial nature of addiction.

Complexity #4: Addiction Defies Simple Definitions

The origins of addiction have been a source of lively debate for hundreds of years. Is it a learned behaviour or is it a disease? Is addiction a choice or is it a genetic predisposition? Is addiction caused by developmental factors or do some people have addictive personalities? Are addicts created by eating a diet deficient in certain nutrients? Or is addiction a response to feeling disconnected from the world?

As Ken Wilber in his book Integral Psychology states, “The great problem with psychology as it has historically unfolded is that, for the most part, different schools of psychology have often taken one of those aspects of the extraordinarily rich and multifaceted phenomenon of consciousness and announced that it is the only aspect worth studying (or even that it is the only aspect that actually exists).” Dr. David Burns, author of Feeling Good: The New Mood Therapy, calls it the “schools over tools” approach. This tendency towards over-simplification, commonly referred to as reductionism, is alive and well in the treatment of addiction. This is most unfortunate since addiction is a complex condition that impacts all aspects of health and lifestyle.  

Now combine debate among competing schools in psychology with the medical community and you begin to see why the matter of deciding on effective treatment for addiction is far from settled.

Complexity #5: Addiction Requires More Than Mere Abstinence

Even the goal of addiction treatment is a topic of lively debate. Some will reason that if only the addict will stop using his/her drug or process of choice (gambling, online porn, etc.) then the problems associated with addiction will go away. Unfortunately, just as health is more than the absence of disease, recovery requires a fundamental shift that impacts all life domains mentioned in Complexity #3.

At Sunshine Coast Health Center, we believe that abstinence is a by-product, not a goal of alcohol and drug rehabilitation. When an individual discovers his true calling and begins the process of living a life of purpose, we believe that ’external’ solutions and unhealthy attachments will be discarded in favour of being true to one’s self.

Complexity #6: Not Everyone With an Addiction is Motivated to Quit

Another point to ponder is that people with addictions actually need a reason to stop. Having something to lose (health, marriage, career) may work for a brief period of time but, long term, a fundamental shift or transformation is often required for abstinence to become permanent. Unlike most disorders or medical conditions, addiction produces a positive benefit for the individual such as dissociation (numbing out) or escaping from, what Narcotics Anonymous calls, the ”meaningless, monotonous, and boring” life of an addict.

Complexity #7: Primary Residential Treatment Vs. Outpatient Treatment

The last point to make on complexity is that residential addiction treatment, is more than just counselling with room and board thrown in for good measure. Social skills associated with the give and take of living 24/7 with a peer group is an issue for residential treatment while the same can’t be said for outpatient.

Furthermore, group therapy, commonplace in residential treatment, is rarely provided in most outpatient settings. Group therapy is, by nature, a dynamic process that can have remarkable therapeutic effect in the hands of a skilled psychotherapist.

Complexity #8: Addiction is More Than Just Drugs and Alcohol

Cross-addiction (having more than one addiction) is a common occurence for individuals who struggle with drugs or alcohol. Sunshine Coast recognizes this tendency and is redesigning its program to expand the definition of addiction to include process addictions such as gambling, gaming, sex, even eating disorders.

Conclusion

Addiction is a complex condition that requires an equally complex approach to treatment. Sunshine Coast Health Center recognizes these challenges and has been continually finding new ways to enhance program effectiveness. in Part 3 of The Challenge of Writing a Clinical Brochure, I will examine how other individuals and groups are integrating their approach to address complex problems.

Geoff Thompson – MA, CCC

Geoff Thompson, Program Director for Sunshine Coast Health Centre, discusses what reputable sources have to say about addiction.