Drug Rehab Center

Geoff Thompson, MA, CCC

Geoff Thompson, Program Director for Sunshine Coast Health Centre, talks about the importance of connecting with others on a deep human level rather than just on a superficial level.

Geoff Thompson, MA, CCC

Geoff Thompson, Program Director for Sunshine Coast Health Centre, discusses how to “fill the void” when you are an addict and don’t believe in a higher power.

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

Movies provide good lessons on what it means to be an addict and what it means to recover. Thoughtful movies, that is, not the sanitized and simplistic versions of recovery promoted in, for example, 28 Days with Sandra Bullock. This month on the alumni online program we’ll look at four thoughtful movies: Leaving Las Vegas, Under the Volcano, Hurlyburly, and Barfly.

These four movies don’t bother with superficial aspects of addiction or recovery. None of these movies is interested in what ‘triggers’ the addicted character’s cravings or their ‘maladaptive coping skills’. None of these movies labels addiction as a ‘disease’ or some sort of escape from life.

Rather, they provide us with a deep psychological understanding of what it means to be addicted. Like so many thoughtful works on addiction, they see the addict at a human level. The main characters are simply individuals who are struggling to make sense of their lives.

If you were at Sunshine Coast Health Center (“Sunshine Coast”) under our new therapy, you heard about the great psychologist, Viktor Frankl. These movies confirm Frankl’s explanation of addiction: “[A]lcoholism…is not understandable unless we understand the existential vacuum underlying [it].” The term, “existential vacuum,” means that a person struggles to find any satisfying meaning or purpose in life. Because of this, life seems boring and dull.

If you were at Sunshine Coast under the old therapy, the 12-step program agrees with Frankl’s idea. Narcotics Anonymous’ version is that the addict’s life is “meaningless, monotonous and boring.” Alcoholics Anonymous calls this feeling the “God-shaped hole” in life. Bill Wilson believed, of course, that this existential vacuum was why alcoholics drank, though he didn’t use Frankl’s term. The alcoholic was trying to fill the vacuum with booze. Remember that Bill W. said at the Shrine Auditorium in LA in 1943 that the alcoholic is the fellow “who is ‘trying to get his religion out of a bottle’, when what he really wants is unity within himself, unity with God….”

So many people in early recovery do not really appreciate how profound this idea is. They truly believe that if they quit the drug and get over their anger, depression, or whatever, then they will lead the good life. And they seem very surprised when they realize that this plan isn’t working too well for them.

But Bill W. and Frankl would not be surprised. They understood addiction at a human level. So, we’ll examine our movies and see if we can find in them any nuggets to help you fill that ‘God-shaped hole’ or that existential vacuum. 

Movie One—Leaving Las Vegas

Nicholas Cage (as Ben) and Elizabeth Shue (as Sera) do a wonderful job bringing to life John O’Brien’s novel, Leaving Las Vegas. This movie won 17 major awards and was nominated for 25 others. It’s a sad movie, but not depressing. And the great thing is that it doesn’t have all those stereotypical comments and scenes that we find in the sappy Hollywood versions of addiction.

As a sideline note, the late film critic, Roger Ebert, wrote his review of the movie on November 10, 1995, and said: “The practical details are not quite realistic—it would be hard to drink as much as Ben drinks and remain conscious….” Ha! Ebert obviously didn’t hang out with alcoholics.

One very interesting point about Leaving Las Vegas is that we really know nothing about the main characters. We don’t know about Ben’s ‘issues’; we don’t know why he’s drinking. All we know is that he is drinking himself to death. When this is pointed out to Ben, he turns it around, saying that his dying allows him to drink.

Ben knows exactly what he is doing. The movie is a plea for us to care for each other. It is a love story, and Ben and Sera care for each other even if the rest of society dismisses them. Ben knows that he could find happiness with Sera. But something makes him take another drink. This isn’t because he has a ‘disease’ or poor coping skills. Ben is struggling to find some sort of answer to suffering.

Ben’s real problem seems to be that he isn’t willing to fight for himself. Frankl said that happiness demands the “defiant human spirit,” the willingness to fight for your life. Ben recognizes his own suffering, he recognizes that most people live superficial lives, he recognizes that what advertisers call the ‘good life’ is all nonsense. But he is unwilling to take a heroic stand. Instead, he clings to his belief that only through drunkenness can he be free to be himself.

You should know that O’Brien committed suicide two weeks after signing the rights to make his book into a movie. His father said Leaving Las Vegas was his suicide note.

Movie Two — Under the Volcano

This movie with Albert Finney is based on Malcolm Lowry’s famous novel, Under the Volcano. There’s a BC link to the story. Lowry wrote the novel in Deep Cove, where he sobered up. And, interestingly, Nicholas Cage said that he studied this film as a role model for his character, Ben, in the movie Leaving Las Vegas.

Under the Volcano is one day in the life of Geoffrey Firmin, an alcoholic British consular officer in Mexico. We spend the day with him as he tries desperately to stay drunk, despite pleas from his doctor, friends, brother, and wife. 

The setting is the Festival of the Dead, which foreshadows Firmin’s fate as well as his life. He’s not very happy. He has lost his wife to the booze, his brother thinks he is crazy, and his doctor repeatedly warns him that an alcoholic death is not far off. Firmin struggles desperately to figure out a future where he can find peace of mind.

The year is 1939, when the world was plunging toward world war. The Western world seemed to have gone insane—another world war, one generation away from ‘the war to end all wars’. Safe in the obscurity of a small town in the south of Mexico, Firmin has tried to run away from the craziness only to find that he, too, is no better off.

Movie Three — Hurlyburly

Originally a famous play by David Rabe, Hurlyburly brings together several small players in the Hollywood film business in 1980s (the film version was updated to the 1990s). All the characters exist in an ‘existential vacuum’—there is a ‘God-shaped hole’ in their lives.

Eddie is the main character. He’s a drug fiend and is soon to hit bottom. The other male characters are in little better shape. There aren’t any real connections between the characters, which they openly admit. And women are useful mainly as sex objects and as presents to give to other male friends.

Eddie talks a lot, desperate to find some meaning in his empty life. A typical example is this dialogue between Eddie and Mickey:

Mickey (Kevin Spacey): You don’t know what you’re saying. You don’t.
Eddie (Sean Penn): I do.
Mickey: No. I know you think you know what you’re saying, but you’re not saying it.
Eddie: No, I know what I’m saying. I don’t know what I mean, but I know what I’m saying. Is that what you mean?
Mickey: Yeah.
Eddie: Right. But it’s not like anybody knows what anything means, right? It’s not like anybody knows that. So at least I know I don’t know what I mean, which is better than most people. They probably think they know what they mean, not just what they think they mean.

This little exchange highlights Eddie’s dilemma of trying to figure out how to live a meaningful life. People only think they have meaningful lives, according to Eddie, but they’re just fooling themselves.

In the film, drugs (and sex) are distractions from coming to terms with his “meaningless, monotonous and boring” life, as Narcotics Anonymous would judge Eddie’s existence.

Movie Four — Barfly

Barfly is a novel written by the addict-writer Charles Bukowski. He based it more or less on his own life. Bukowski became famous writing lots of poetry and short stories and novels about the addicted ‘down-and-outers’. The film version of Barfly (with Mickey Rourke) has become a cult classic about the American subculture.

The central setting of the film is a bar, where Henry (Rourke) is at home, drunk as usual and getting into fights as usual, particularly with the bartender. But Henry also has a talent for writing poetry. A healthy-minded socialite appreciates his literary genius and convinces him to sober up and get serious about his writing. He agrees, and she organizes his life for him, including providing him with a place to stay and making sure he is introduced to the movers and shakers in the artistic world.

But Henry soon realizes that he has given up control of his life to her. Eventually, he returns to the bar and his old lifestyle.

A typical healthy-minded person would likely be perplexed why an addict would choose to be an addict, especially after tasting the ‘good’ life. Henry has a new wardrobe, is well fed, is making new healthy friends. So why return to drunkenness and fighting the bartender?

The problem for Henry is that, clean and sober in his new clothes and going to formal parties, he realizes that he has lost control of his own life. If a person is to be happy, says the movie, he must feel in charge of his life. For Henry, the only place where this is possible is in the bar, drunk and fighting. 

Obviously, coming to some place like Sunshine Coast is not even in Henry’s mind. But if he did come to Sunshine Coast, he would hear us tell him: “You are the author of your life.” That would make sense to Henry.

By Daniel Jordan

With my wife and two of my three kids away on vaction in the Philippines (my oldest son, Spencer, and I will be joining them on Christmas day), I have had an opportunity to catch up on some reading. Thankfully, the book I have chosen, The Happiness Trap: How to Stop Struggling and Start Living, is helping me cope with not having Gina, Andi, and Harry around and the deafening silence in our normally boisterous home.

Some Background on the Happiness Trap

The Happiness Trap, written by Russ Harris, is based on Acceptance and Commitment Therapy (ACT) which was developed by Steven Hayes, Ph.D., out of the University of Nevada. Back in November, I had the opportunity to attend a two-day Steven Hayes workshop sponsored by Jack Hirose and Associates in Vancouver. So I have did have some understanding of ACT beforehand. Unlike the Steven Hayes workshop which was designed for a clinical audience, The Happiness Trap is more of a self-help book that anyone could apply to their own situation. To be honest, ACT was a bit bewildering until I read the Happiness Trap.

The basic premise of ACT is that happiness is more than just a matter of feeling good and that trying to hold on to happiness leads to the opposite effect. Instead of teaching new techniques to pursue happiness, ACT teaches ways to end the struggle that keeps us from realizing happiness. While ACT has been found effective in the treatment of depression, anxiety, chronic pain and addiction, it can also help anyone who is dealing with negative thoughts that lead to low self-esteem, stress, etc.

The Origins of the Need for Happiness

According to Dr. Harris , our need for happiness developed out of our primative need to (1) predict and avoid danger and (2) have a sense of belonging. While both of these needs were a matter of life or death in prehistoric times, for modern man these same needs are now creating much of our mental anguish.  According to Dr. Harris, the modern mind is “hardwired to suffer psychologically by comparing, evaluating, and criticizing ourselves, to focus on what we’re lacking, to rapidly become dissatisfied with what we have, and to imagine all sorts of frightening scenarios, most of which will never happen.”

Defining Happiness

Harris defines happiness in two ways:

TEMPORARY/EMOTIONAL – Pursuing the first form of happiness will, ultimately, lead to unhappiness because, like all emotions, happiness doesn’t last. Getting more toys, degrees, and admirers will only bring “temporary” relief. The solution becomes more of the same and eventually becomes a vicious cycle.

LIFELONG/MEANINGFUL – The second type of happiness will lead to a “sense of a life well lived” and a powerful sense of vitality. However, meaningful happiness is the less popular of the two because: (1) you have to work at it, (2) is a lifelong pursuit and (3) requires our willingness to experience uncomfortable emotions such as sadness, fear, and anger. As Dr. Harris puts it,” if we live a full life, we will feel the full range of human emotions.”

While most self-help books focus on “emotional” happiness, the Happiness Trap invites us to consider “meaningful” happiness. Therefore, Dr. Harris’ book is for those brave enough to pursue the latter.

Conclusion

As I read this book, I couldn’t help thinking that no matter what I do, I will eventually experience grief, loss, and fear just as I will also experience joy, success, and love. I already know from experience what it means to pursue “temporary” happiness, where each day becomes a sort of balance sheet and a good day is judged as having more assets (good feelings) than liabilities (bad feelings). Would it be so bad to spend the rest of my life focused on creating a life of meaning and purpose?

Today’s blog posting was an introduction of sorts. In future postings, I will continue to explore The Happiness Trap and how the exercises included in the book are helping me come to terms with being separated from my family.

By Daniel Jordan
General Manager 

Every month or so when I am heading down Granville Street in Vancouver I will stop by the Salvation Army Thrift Store located in the Marpole District. As I have mentioned in previous blog posts, I am a used book nut and am always on the search for interesting self-help or psychology books. This past week I came across a book titled, “Leadership Secrets of the Salvation Army,” written by former National Commander, Robert A. Watson. 

I have known for some time that Salvation Army is also the oldest drug rehabilitation treatment provider in the world thanks to their network of Harbour Light rehabilitation centers. So what can a charity like Salvation Army teach a private addiction treatment center? Lots, as I was to learn:

Lesson #1 – Combine Seemingly Incompatible Corporate Values Into A New, Superior Synthesis

The Salvation Army is part evangelical, part Good Samaritan as exemplified by their mission:

“The Salvation Army, an international movement, is an evangelical part of the universal Christian Church. Its message is based on the bible. Its ministry is motivated by the love of God. Its mission is to preach the gospel of Jesus Christ and to meet human needs in His name without discrimination.”

In other words, Salvation Army has managed to combine religion and social work in a way that reminds me of what Roger Martin called in his book, The Opposable Mind, integrative thinking, or “the ability to hold two opposing ideas without panicking or settling for one or the other idea.” The result of this is a “synthesis that contains elements of the opposing ideas but is superior to each. (page 15).” The opposing ideas in this instance are religion and social work. In the mid-1800s, neither the Church nor government wanted any part of East London where disease, drunkenness, and child abuse were rampant. By distancing the Army’s work from the limitations of both church and state, its founder William Booth was able to create a uniquely powerful charity committed to service without discrimination.

Lesson #2 – Help Employees and Clients Connect to a Sense of Meaning and Purpose

People often talk about their work lives, their family lives, and their spiritual lives as if they are distinct sectors they must somehow keep in balance. Robert Watson points out that human beings cannot be one person at work, another with friends and family, yet another in their spirituality. We are, each of us, one person.

Mr. Watson suggests that a way to pull these “fragments” of our lives together is by finding a meaningful, transcendent purpose. Salvation Army encourages its employees strive for a healthy reintegration of work, friends, and family and a connection to principles that give meaning to life. Salvation Army is quite candid about the modest financial compensation they provide employees, explaining that life is more than personal gain – salaries, perqs, bonuses, and fancy titles – or corporate objectives – earnings, dividends, or market share. Mr. Watson suggests that Salvation Army provides its employees something much more important: meaningful engagement in challenging arenas and soul-satisfying service of people in need.

When clients come to Salvation Army for help, they often have addiction or relationship problems. While Salvation Army is committed to help their clients face and overcome these problems, the “real secret of success” is by helping clients connect with purpose and integrating their hearts, minds, and souls with this spiritual connection. Many of the clients that get help at Salvation Army are far from the stereotypical homeless and helpless. A lack of purpose can be an issue for those who have attained professional achievement and material success.

Lesson #3 – Help Clients by Offering a Variety of Services

Clients with addictions rarely come with just an addiction problem. Many also have a need for housing, job training, life-skills counselling, transportation, and clothing. For single parents comes the need for daycare, after-school recreation, health-care counselling, and parenting instruction. Each of these hurdles can be an insurmountable barrier for the person in recovery. Salvation Army provides all of these through their various businesses.

Lesson #4 - Five Criteria of Effectiveness

Peter F. Drucker, perhaps the world’s most famous management authority, calls the Salvation Army “by far the most effective organization in the U.S.” This is based on what Mr. Drucker calls the five criteria of effectiveness:

1. Clarity of Mission – the dual mission of “salvation and service” has not changed since its inception in 1850. This is the anchor that has allowed Salvation Army to expand from 8 people with no assets when they arrived in America in 1880 to an organization with an annual budget exceeding $2 billion and a work force of officers , employees, and volunteers approaching 3.4 million people. Mr. Watson explains that this laser-like focus on mission has benefits on both the revenue and cost side of the income statement: (1) donor support (public donations are often double that of runners-up like YMCA and Red Cross) and (2) employee and volunteer devotion whose faith in the mission makes low pay and long volunteer hours worthwhile.
2. Ability to Innovate - Peter Drucker referred to the Salvation Army not so much as a charity but as venture capitalists. What he meant by this is that the investments Salvation Army makes in people get huge returns. By awakening an awareness in clients to their ”divine purpose” what often follows is an acknowledgment to serve others, often in new arenas. For example, Salvation Army services include  retail (over 1,600 thrift stores), housing providers (65,000 beds spread across the US), and social service specialists (ranging from disaster relief, long-term drug and alcohol rehabilitation, correctional counselling services, summer camps for kids, day care, community recreation programs, medical services, job training and placement, missing persons services, etc. This innovation is also done with a minimum of management involvement: a core management group of 5,000 oversees a work force of 3.4 million people.
3. Measurable Results – Salvation Army embraces the idea of accountability with specific, measurable, achievable, and mission-related goals. Outcomes are tracked for clients in their residential drug and alcohol programs as well as those in the pre-release transition programs for federal prison inmates. Every New Year’s Eve, Salvation Army holds open meeting Victory Reports on the year’s achievements and new program announcements for the coming year.
4. Dedication – volunteers and paid staff are inspired by the dedication modeled by Salvation Army officers. These officers are trained not as managers and counselors, but as ordained ministers. Officers sign a covenant, renouncing alcohol, drugs, and tobacco. To avoid the stress of competing careers on officer families, both spouses must be officers. The covenant of an officer is life-long (in  the year 2000, over 30 percent of the 5,326 member officer group was retired).
5. Putting Money to Maximum Use – of every dollar Salvation Army receives, at least 83 cents goes directly to services to people. At National Headquarters in Alexandria, Virginia, a staff of less than 100 oversee operations in four regional territories that extend from Maine to Florida to California to Alaska and the Pacific Islands.

Conclusion

Sunshine Coast Health Center, as a private treatment facility, will never be able to secure nor want the dedication demonstrated by Salvation Army officers nor will we ever have much of a volunteer work force or be able to pay our staff less in exchange for a commitment to public service. However, many other concepts such as clarity of mission, ability to innovate, and measurable results are certainly doable and worthy goals. I have read countless books stressing the importance of having a mission statement but this book was one of the first to explain that it is critical in today’s world of constant change. Furthermore, having a mission statement that has an overarching sense of meaning and purpose that extends to staff, clients and the community appears to be key in explaining Salvation Army’s longevity.

Additional Readings or Viewings

4 Questions for Roger Martin - a YouTube video

Commissioner Francis Speaks About Sally Ann Services in Canada – a video

By Daniel Jordan

I must confess that I love used books. It doesn’t matter whether it’s used books on Amazon.com, used bookstores, or Salvation Army thrift shops. I love picking up an addiction, psychology, spirituality, or self-help classic for a buck or two. I can’t say my wife, Gina, appreciates my hobby as I come through the front door with yet another bag of books and my office is struggling for space to accommodate my latest purchase. All the same, it’s one of my favourite things to do even if I my ability to purchase used books far exceeds the time afforded to read them all.

I read a poem this weekend that I thought I would share with the many “bookworms” out there …

Used Books

I like them dog-eared and lawnsoft,
and savor the character of winestain
and thumbsmudge,

the tear-warp between pages,
scrawl lolling down margins,

x’s, question and check marks
scratched out as anchors.

They kindle affinity with readers
who’ve leafed through before, house

a kinship of signatures, conjuring towns
and streets in states I’ll never visit.

They preach the economy of timber
and purses, while scribbled dates

evoke evenings spent couch-lounging
through past springs and winters.

Though they come off the press crisp
and unsullied, I like them used

for the gust of tinder and sawdust,
the waft of feathers adrift in a hayloft.

I turn the yellow hem of the pages,
a hue half neon, half tubercular,

like the wallpaper of a motel
nicotine-thick with confessions

where with the fray, I find repose
under covers well plumbed
and sepulchral.

~ SaraJ

My thanks to Goodreads.com for posting this poem, which was voted poem of the month by its readers.

Finding Classics

Have you ever wondered what books are considered the classics in psychology, spirituality, and self-help? Here’s a couple of titles you may want to borrow from the library to help you get started:

1. Self Improvement: The Top 101 Experts Who Help Us Improve Our Lives (2004) David Riklan

Note: David also has a website devoted to the topic called SelfGrowth.com .

2. 50 Spiritual Classics (2005) Tom Butler-Bowdon. The first and only bite-sized guide to the very best in spiritual writing, this one-of-a kind collection includes personal diaries and compelling biographies of such diverse figures as Gandhi and Malcolm X.

3. 50 Self-Help Classics (2003) Tom Butler-Bowdon. A survey of the very best self-help philosophies available combs the classics of the genre for useful advice on how to find love, change a life, find inspiration, and break bad habits. Butler-Bowdon defines self-help as the search for authentic happiness and a sense of purpose.

4. 50 Psychology Classics (2007) Tom Butler-Bowdon. Draws on the counsel of fifty classic psychology references to offer insight into what the science’s founders believed about human nature, in a lay guide to popular psychology that is complemented by practical tips and brief introductions to such authorities as Sigmund Freud and Carl Jung.

5. 50 Success Classics (2003) Tom Butler-Bowdon. This book highlights classics dealing with authentic or meaningful achievement. According to Butler-Bowdon, “success is not an event or a result in isolation, but an expression of the best that is within you.”

Sunshine Coast Health Center is also developing a Personal Growth page that has additional links to resources including videos from some of the authors you will find in the books mentioned above.

About the Author

Daniel Jordan is the General Manager of Sunshine Coast Health Center and hopes that these postings will help  take away some of the mystery often associated with addiction and its treatment.

By Daniel Jordan

I was at an addiction conference yesterday in beautiful Nanaimo, British Columbia sponsored by our friends over at Edgewood, a private drug treatment center located on Vancouver Island. The keynote speaker of the conference was Dr. Carlton Erickson, Ph.D., Professor of Pharmacology, and director of the Addiction Science Research and Education Center in the College of Pharmacy at the University of Texas at Austin. Dr. Erickson, a research scientist, has been studying the effects of alcohol on the brain for over 40 years and he did a commendable job of trying to summarize all of his knowledge in a 3-hour presentation.

Here’s what I learned from Dr. Erickson:

Lesson One: Addiction is a “Brain Disease”

It’s not surprising that a neuroscientist would suggest that addiction is a brain disease but Dr. Erickson does make a compelling argument by comparing chemical dependence to several other diseases such as Type 2 Diabetes, hypertention, Parkinson’s Disease, and Attention Deficit Hyperactivity Disorder (see page 11 of Erickson’s book, The Science of Addiction ).  The presentation included some very colourful, scientific images of the brain and it’s good to know the latest in addiction research on the brain and the exact brain area that is affected in the chemically dependent person, the mesolimbic domamine system.

At Sunshine Coast Health Center, we have found that clients love the psychoeducation classes on the brain since, for the first time, many can start to understand why they have the thoughts, feelings, and behaviours normally experienced with a dependence to drugs or alcohol. With this  biological, rather than a moral, explanation clients begin to question their attachment to detrimental emotions such as guilt and shame.

Lesson Two: Our Terminology Needs Fixing

More than the scientific presentation showing how addiction impacts the brain, I was particularly fascinated by Dr. Erickson’s claim that many of the the words, or terminology, that the general public and the treatment field use to describe drinking and drugging are leading to continued prejudice and discrimination in North American culture. This stigmatizing, Dr. Erickson argues, is a big part of why governments are not providing adequate funding for addiction research, prevention, and education.

“Addiction” is a Vague Term

The term “addiction,” for example, has been used for way too many behaviours and things including but not limited to cell phones, television, work, food, sex, exercise, oil, shoes, “crackberries,” etc.  As a result, Dr.  Erickson suggests that “addiction” is an imprecise, unscientific term. The term addiction is now used in popular vocabulary as a way to describe something desired such as “I love the Oprah Show so much I think I’m addicted to it.” Obviously, the negative impact of watching too much Oprah and smoking copious amounts of crack cocaine cannot compare. The use of “addiction” to describe America’s over-reliance on foreign oil shows how far the term has been adopted beyond its original intended use.

Another problem with the term “addiction” is due to the umbrella-like nature of the term which fails to distinguish between conscious drug abuse and pathalogical chemical dependence (see Lesson Three below).

Alcoholics Anonymous has Broadened the Term “Alcoholism”

Alcoholism is another term that should be replaced due, unintentionally, to its popular use at Alcoholics Anonymous meetings. If you have ever attended AA or watched a video such as Clean & Sober (starring Michael Keaton) you will have witnessed participants starting off their testimonials with the words, “Hi, my name is ____ and I’m an alcoholic.” The truth is, suggests Dr. Erickson, many of these people standing up are problem drinkers and not necessarily dependent on alcohol since joining AA is open to any problem drinker seeking to get better.

 ”Abuse” is a Perjorative Term and Should be Retired

In his book, The Science of Addiction, Dr. Erickson calls the term “abuse” the number 1 myth that prevails in the treatment field or in the minds of the public. The word abuse * is an inappropriate term for several reasons, such as:

1. the term being used, for centuries, as a morally sinful act such as child abuse, sexual abuse, spousal abuse
2. the implication that alcohol, an object, is being abused by someone just like a child is being abused by someone (a preferred term in Europe is misuse)
3. the use of the term substance abuse does not distinguish between voluntary use (“misuse”) and uncontrolled use (“dependence”) similar to the generalized use of the term “addiction” 

By continuing to refer to people as drug, alcohol, or substance abusers, according to Bill White *, “misstates the nature of their condition and calls for their social rejection, sequestration, and punishment.”

More myths can be found at the the University of Texas website. 

(*) Note: See page 4 of “The rhetoric of recovery advocacy: An essay on the power of language,” written by WIlliam White.

To summarize, Dr. Erickson idetifies the terms “addiction,” “alcoholism,” and “substance abuse” as sloppy and stigmatizing because they do not distinguish between intentional, voluntary use of drugs or alcohol (“abuse”) and the impaired control over drug use (“dependence”).

Lesson Three: Drug Misuse and Dependence are Two Different Conditions

I have always understood that someone who “abuses” drugs or alcohol is not necessarily chemically dependent but Dr. Erickson really drove the point home by making several important distinctions.

To start this important discussion, Dr. Erickson made reference to DSM-IV critieria and pointed out to the audience that abuse of drugs or alcohol needs to show a maladaptive pattern of drug use leading to impairment or distress presenting as one or more of the following in a 12-month period:

1. recurrent use leading to failure to fulfill major obligations
2. recurrent use which is physically hazardous
3. recurrent drug-related legal problems
4. continued use despite social or interpersonal problems

On the other hand, dependence on drugs or alcohol needs to show a maladaptive pattern of use leading to impairment or distress, presenting as three or more of the following in a 12-month period:

1. tolerance to the drug’s actions
2. withdrawal
3. drug is used more than intended
4. there is an inability to control drug use
5. effort is expended to obtain the drug
6. important activities are replaced by drug use
7. drug use continues despite knowledge of a persistent physical or psychological problem

Source: Adapted from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text Revision, 2000.

If you have just one or two symptoms, it is not dependence. For example, you may think you are dependent on coffee but it is unlikely that your caffeine use has led to anything beyond symptoms one and two in the list above.

However, the implication of making a clear distinction between the two conditions has one clearly controversial implication that has been hotly debated in the treatment field: ”abusers,” unlike people that are dependent, can go back to moderate or controlled drinking (see pg. 17 of the Science of Addiction) *.

(*) Source: Wallitzer, K.S., & Connors, G.J. (1999). Treating problem drinking. Alcohol Research & Health, 23, 138-143.

How treatment providers like Sunshine Coast Health Center make the distinction between clients who are pathalogically dependent and those that are merely voluntary misusers is another matter. Clearly, however, this information needs to be handled, if at all, with clients. It does, however, explain why many addiction professionals claim that there is a cure for addiction since, in their research or clinical experience, they may have been working with “abusers” rather than truly chemically dependent individuals.

Lesson Four: Some Drugs are More Addictive Than Others

Dr. Erickson calls the likelihood that a person will become dependent on a drug its “dependence liability.” Some drugs have a dependence liability while others do not. The criteria for dependence liability is how it acts on the mesolimbic dopamine system. Caffeine, antidepressants, and newer anti-seizure medications do not have dependence liability. However, some drugs do and the following chart shows that a certain percentage of people (depending on the drug) will become dependent *:

Drug / Percentage of People Who Become Dependent

Nicotine – 32%, Heroin – 23%, Cocaine – 17%, Alcohol – 15%, Stimulants – 11%, Cannabis – 9%, Sedatives – 9%, Psychedelics – 5%, Inhalants – 4%.

Source: Anthony, J.C., Warner, L.A., & Kessler, R.C., (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the national comorbidity survey. Experimental & Clinical Psychopharmacology, 2, 244-268.

Lesson Five: There are Different Types of Alcohol Dependence

Dr. Erickson presented compelling research showing that some types of alcohol dependence occur early in life while other types occur late in life:

1. Early Onset – some adolescents are at higher risk for alcohol dependence, especially when they drink at an early age
2. “Instant” Onset – some people become “instantly addicted” to alcohol or cocaine with the first use of the drug, that they “feel normal” for the first time in their lives.
3. Late Onset – after age 25 for some, or geriatric age for others.
4. Absence of Onset – just like some people eat a lot and never get fat, some people can misuse drugs or alcohol forever and never become dependent.

In this way, alcohol dependence is not onlike other diseases that have different onsets such as diabetes, leukemia, and heart disease. Dr. Erickson did point out, however, that more research is needed to confirm these findings.

Conclusion

Regardless of whether you were a professional who advocates a harm reduction or abstinence-based approach, Dr. Erickson’s presentation had some good news and some bad news. With his clear support for research validity, however, one thing that the treatment field should not do is dismiss his work out of hand. Kudos to Edgewood for presenting Dr. Erickson, an addiction professional who is clearly an advocate for change.

For More Information

For those interested in learning more about addiction and the brain, Dr. Erickson recommends the following websites:

University of Texas Addiction Science and Research Center

National Institute on Drug Abuse (NIDA)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Join Together Online

Faces & Voices of Recovery

Brain SPECT Imaging (Daniel Amen, MD)

NIH/NLM Publications

For those that want to learn more about this important topic, pick up a copy of The Science of Addiction: From Neurobiology to Treatment.  I have since found a criticism of this book by Harvard University psychiatrist Edward J. Khantzian, M.D. and it’s worth a look for those interested in the polarization in the field of addiction between psychiatry and addiction medicine.

About the Author

Daniel Jordan is the General Manager of Sunshine Coast Health Center and hopes that these postings will help  take away some of the mystery often associated with addiction and its treatment.

When people with addictions quit drugs or alcohol, they are usually left with a huge hole in their lives. They often feel lost. What do you do on a Sunday afternoon when no one is about and you have to entertain yourself? In active addiction, the answer was easy. But in recovery, it is a lot more challenging.

This posting offers some useful tools to overcome boredom. A famous psychologist, Mihaly Csikszentmihalyi (pronounced chick-sent-me-high-ee), developed a theory that he calls “Flow.” The basic idea of ‘flow’ is that when we are in the flow we are totally absorbed in whatever activity we are doing. In fact, being in the flow is much more than simply giving you something to occupy your time with. It’s much more than simply cutting the grass or watching TV. It is necessary for contentment, accomplishment, and creativity. In short, being in the flow makes life worth living.

To give you a sense of how powerful flow is, one psychologist has described flow this way: “Flow reminds us that the truest approach to making ourselves feel and function better is to look within.” Another said that flow is a “prescription for happiness in our indifferent universe.” We are at our best when we are totally absorbed in something: listening to music, working on a challenging problem, learning how to fly, dancing, making love, and on and on.

Addiction as being in the flow

Csikszentmihalyi, himself, said that flow is what gives meaning to an individual’s life. But here’s an interesting thing: when we’re high on alcohol or drugs, we are also in the ‘flow’; in fact, being in the flow is the very power of drugs. Lots of things become fascinating when we’re high: addicts can play video games for hours, think about life, become one with a motorcycle when riding, enter a trance-like state while dancing, make love at the level of ecstasy, discover music that makes the hairs on the back of your head stand up, and so on.

The idea of flow was developed by studying how contented, creative people live their lives. Csikszentmihalyi noted that flow has eight components. One example is that the experience is intrinsically interesting (what he calls “autotelic”). Another is that our perception of time changes.

Remember back to being high. Likely, you had the feeling of being totally absorbed in the drug high, the passage of time might have slowed down or sped up, the experience of doing something seemed to be interesting for its own sake. For example, chores that might bore you when you’re sober can seem fascinating when you’re high.

But there’s one component necessary for flow that is missing in addiction. Csikszentmihalyi emphasized that the activity must have meaning and purpose every step of the way. Because addiction lacks any meaning and purpose (we go against our values and beliefs when in active addiction), all the effort getting and using drugs accomplishes little more than make us suffer in the end.

Living Creatively in Recovery

Now that you’re clean and sober, it’s important to make your world come alive. And this demands that you be creative. Being in the flow is essential for creativity. In fact, to help us find this creativity through flow, Csikszentmihalyi wrote a book called Creativity: Flow and the Psychology of Discovery and Invention.

Creativity is what makes us human. It is what separates us from animals. science, art, religion, and so on are the work of creative people throughout the ages. Culture is creative effort. All this creativity is the product of individuals being in the flow.

You don’t have to paint or play music or discover a cure for cancer to be creative, although talented artists and scientists experience flow all the time. You can be creative, says Csikszentmihalyi, even while brushing your teeth or organizing a party. Being creative provides a sense of accomplishment, a sense of having spent time in a worthwhile activity. If you learn to play the guitar, you will take great pride in your achievement, and others will be impressed. If you learn another language, you will find great satisfaction as you progress. If you learn to fly a plane, you will find that you feel better about yourself. If you can make dull activities more interesting, such as brushing your teeth, you will feel better.

Tip One: Live Each Day with Childlike Wonder

The first thing you have to do is to reawaken a sense of wonder at the world. Children are much better than adults at this. Kids seem fascinated by all sorts of things: watching an insect crawl, the wrapping on a birthday present, a tool in Dad’s toolbox. Many adults have lost that sense of childlike wonder.

It’s important for you to regain this sense of wonder, and one of the best ways to accomplish this is to open yourself up to new experiences.

“Try to be surprised by something every day,” is one bit of Czikszentmihalyi’s advice. This is an attitude that you have to practice because most people assume that they already know about things. When you look at an unusual car, examine why it appears unusual to you. How is it different from other cars? When you go to a restaurant, order something new. Or order the same dish at two different restaurants: how are they different? Examine the color scheme at a fast-food restaurant; why did the interior designer choose these colors?

Tip Two: Plan to Accomplish Something Each Day

Figure out one thing you’d like to accomplish each day. Most people don’t do this, yet every person is quite capable of finding something. Think about meeting someone new, buying something that interests you, googling a new recipe and picking up the ingredients at the grocery store.

One more trick is to realize that to maintain interest, an activity must get more complex. If it doesn’t, you’ll get bored of it. So if you’re doing something you enjoy, make it more complicated. For example, if you like to watch movies, start watching the interviews with the director and actors on the DVD, and then watch the movie. Or start watching the camera angles: why did the director choose the angles that he did?

Tip Three: Experiment with new “Internal States”

By ‘internal states’, Csikszentmihalyi means certain personality traits that you have developed. Most people develop personality traits in their early years: shy or outgoing, quiet or talkative, intellectual or intuitive, safe or reckless. We hold on to these traits because they provide safety and predictability in our lives. Changing an internal state doesn’t mean that you lose your current internal states; what it means is that you become more than simply what you currently are.

Changing internal states takes courage and time; we have to be aware of our unique internal states and then challenge ourselves to change. Think about yourself. On a piece of paper, write down words or phrases that describe you. If you are struggling to do this, think about what makes you different from someone you know well.

Once you are aware of some of your internal states (shy, quiet, loud, and so on), then choose one trait and make a deliberate effort to do the opposite. For example, if you are normally quiet and shy at parties, then at the next party, go out of your way to tell a joke. If you are normally shy at an AA meeting, make a deliberate effort to speak up at the next meeting.

About the Author

Geoff Thompson, MA, is the Program Director at Sunshine Coast Health Center, a private addiction treatment facility for adult men. His book, A Long Night’s Journey into Day, explores Eugene O’Neill’s life to uncover the truth of addiction and recovery.