Drug Rehab Center

In this 4th instalment of Addiction According to Meaning Therapists, Geoff introduces us to Dr. James Crumbaugh who created a model of alcoholism treatment based on the philosophy of Dr. Viktor Frankl. His treatment model can be summarized as five stages:

Stage 1 – make a decision on how you are going to view life. For example, are you a machine? Are you more than a machine? Your choice will determine what options you have available to you.
Stage 2 – develop self-confidence. You must have a belief that you are capable of overcoming your addiction. Remember! Millions of people have
Stage 3 – persevere, think creatively. You are going to have some difficult days and you need to work through these times in order to achieve your objective of sobriety.
Stage 4 – encounter. You need to have a relationship with people. We are relational beings. Our job is to connect with other people. We need other people to give us feedback and validate our existence.
Stage 5 – dereflection (borrowed from Dr. Frankl). You need to stop looking at your life as a failure and start focusing on your strengths, your successes, the times in life when you were courageous.

These five stages, according to Dr. Crumbaugh, are key to overcoming alcoholism and, Geoff believes, can be extended to drug addiction as well. For more information on Dr. Crumbaugh’s program see Logotherapy: New Help for Problem Drinkers.

In part 3 of Addiction According to Meaning Therapists, Geoff Thompson highlights the work of addiction researchers Barbara Ballinger, Robert Matano and Adrianne Amantea whose work is based on the teachings of Dr. Kirk J. Schneider. Dr. Schneider’s form of therapy is called Existential Integrative Therapy. This form of therapy emphasizes that therapists working with clients need to create an experience of deep emotional connection. Therapy sessions are framed to allow the client to experience negative emotion in order to expand their world and participate more fully in their world. After all, negative emotions are part of life, as much as positive emotions.

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.

In part 1 of this new 5-part series, Geoff Thompson introduces us to therapist and author of Narrative Means to Sober Ends, Jonathan Diamond. Jonathan Diamond believes that ‘we are the stories we tell ourselves’. According to Dr. Diamond, our stories are how we make meaning out of our lives. Dr. Diamond believes that individuals struggling with addiction need a new, more empowering story. Our new stories need not be fabrications or falsehoods but can be empowering just by having a different perspective.

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

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.

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

The 2010 INPM conference with the theme of “Creating a Psychologically Healthy Workplace” turned out very well for all involved. It was great to hear from some of the leading experts about how well-being depends on meaning and purpose in life. And there were several experts in the addiction field talking, such as Ken Hart and Alan Marlatt. And many of the speakers talked about research on the treatment of addiction.

Most of the speakers geared their talks to the workplace but what they said applies to all aspects of life. A big topic was the difference between “happiness” and “meaning.” As you know from looking at the self-help section of bookstores, finding “happiness” is very big today. But the conference speakers did not have much faith that this would lead to a better life. The problem of making the goal of life to “be happy” is that human beings suffer. And some suffer terribly. If your goal is to be happy, then what happens when you’re having a bad day? What happens if your teenage son acts out or crashes the car? What happens if work is causing you grief? If your goal is to be happy, you’re going to fail a great deal of the time.

But if your goal is to find meaning, then you don’t expect to be “happy” all the time. One of the things the speakers pointed out is that to be human is to suffer. It is as natural to life as a heart beat. At Sunshine Coast, all of our clients have suffered because of addiction. But those with good recovery actually tell us that they are “thankful” they were addicts. They are thankful for suffering because it helped them discover a more satisfying way of living. That’s a truism of human nature. We grow by overcoming our problems. Without problems, how would we grow? On the other hand, if your goal is to be happy, you certainly wouldn’t be thankful for suffering. You’d see that as a total failure.

Another problem that many of the conference presenters pointed out about trying to be “happy” is that it is self-centered. If your goal is happiness, then you have to walk about the universe asking yourself, “Am I happy?” Think about that. If your concern is your own happiness, how much attention will you pay to others? And if you don’t pay attention to others you’ll be lonely and isolated.

There were lots of interesting speakers at the conference, and in this article we’ll talk about four, whose talks are relevant to addiction and recovery.

Part One—Todd Kashdan

Dr. Todd Kashdan is a remarkable research psychologist. He’s only 35, and he’s published 100 articles and book chapters, all about meaning and purpose. And he’s written a book, “Curious.” At the conference he talked about one study he did with alcoholics, which should be of great help to understanding addiction and recovery.

The research projected asked drinkers to carry around a beeper. When the beeper went off, they wrote down what they were feeling. And there were also specific times that he asked the drinkers to write down their feelings, such as just before they were going to drink.

The results were fascinating. It turns out that all the participants had intense feelings. Some were happy, some sad, some mad. But there was no link between the intensity of the feeling and the amount of alcohol they drank. This seems to contradict much of our belief about why people drink. Clients at Sunshine Coast often claim they get loaded because of an angry outburst with their partner or bad feelings at work or because they felt good and wanted to feel better.

According to Dr. Kashdan’s study, however, the real link with drinking was whether the person could describe his or her feelings. For example, if the participant wrote, “I feel bad,” then he would likely drink a lot. “Feeling bad” is not very descriptive. No detail. The person really couldn’t make sense of what he or she was feeling. But those who wrote, ‘I was feeling guilty because I raised my voice to a friend, and that’s not who I am’ would not drink that much. In other words, if the person could make sense of his emotions, he would drink significantly less.

So the link between emotions and drinking is not the intensity of the emotion; rather, it depends on whether he or she could name and detail what they were feeling. In other words, the key was whether the person could find meaning in the emotions. This ability is a big part of finding meaning and purpose in life.

Part Two—Alex Pattakos

Dr. Alex Pattakos is known as “Dr. Meaning.” The Fanny Kiefer show in Vancouver learned he was speaking at the conference and interviewed him, just to give you a sense of Dr. Pattakos’ reputation. He’s written a famous book called, “Prisoners of our Thoughts.”

Pattakos basically takes Viktor Frankl’s theories and boils them down to make them understandable for everyone.

In past articles I have mentioned Frankl’s belief that each of us is free to choose the attitude we take toward something or someone. An example here is addiction. Most clients at Sunshine Coast are angry at their addiction. It has caused them lots of suffering. Later, in recovery, many people change their attitude toward the addiction. Some people even say that they are “thankful” for their addiction. The key to a good attitude is if it works for you. If being angry at your addiction is helpful, then it’s a good idea to stay angry at it. But if your attitude toward your addiction is that you really miss alcohol and drugs because you love to get high, then this likely won’t work out well for your recovery. But the point is that you have the freedom to change your attitude.

Pattakos also talks about Frankl’s idea of “de-reflection.” Basically, de-reflection means changing your focus on some matter. He uses the example of “complaining.” Complaining is a common pastime for those with addiction problems. But the problem with complaining is that it does not solve anything; in fact, it usually reinforces a belief of being a victim. In his book, Pattakos relates the story of where he used to work. The staff complained so much about conditions that they went on strike. Pattakos’ boss said, “Good for them! However, the show must go on, so let’s see what we can do without them.” His boss used de-reflection, switching the focus from dwelling on all the problems due to the strike to dwelling on solutions.

Frankl also stressed the need for action. Pattakos provides exercises at the end of each chapter for the reader to consider. Although the topics are different, the key question is ‘What did you actually do about the problem’. It’s not enough in life to simply think about things you don’t like or wish for something better for yourself. You actually have to DO something to change your life. This is a common problem for those in recovery. Clients often have a good intellectual knowledge of what they have to do and still suffer. The key is to act, not merely think about it.

A third example in Pattakos’ book is that people often work against themselves. This is very true for those in recovery. They may know that they have to make new clean and sober friends, yet they keep in touch only with their using buddies. They may be trying to recover but refuse to give up going to the bar for their social life (they try to get away with drinking soda water). They may want a better relationship with their spouse, but they are always ready for an argument. In each of these cases, the person is working against himself.

Part Three—Paul Wong

Dr. Paul Wong, whose ideas form the basis for the new program at Sunshine Coast, gave a talk on meaning-centered therapy.

To help the audience understand this therapy, he volunteered a psychiatrist to show how a psychiatrist works with patients, and Geoff to show how a meaning-centered therapist conducts therapy. When Dr. Wong asked the audience what differences they saw between the psychiatrist and Geoff, they observed that a meaning-centered approach treated the client as a human being first. The psychiatrist was more interested in keying on the patient’s problem.

At Sunshine Coast, we see the client as a unique human being, who happens to have an addiction. We see the human being first, rather than some patient that needs to be diagnosed and fixed.

After this little demonstration, Dr. Wong talked about “basic human needs.” These needs, according to his research, are: meaning (vs emptiness), virtue (vs destructive way of life), resilience (vs. giving up), relationships (vs. loneliness and alienation), hope (vs despair and depression), faith (vs. fear), and well-being (vs. boredom, brokenness).

If a therapist sees a client as a human being, then the therapist is interested in these basic needs. The problem is that each client has to find his own way of satisfying these needs; if he doesn’t, he will suffer unnecessarily. This is why, at Sunshine Coast, therapists never tell clients what to do or how to live their lives or what they should think. No therapist can provide the answer to a client’s basic needs. That’s their job. It’s just not possible for a therapist to give a client well-being if they are bored. It’s not possible for a therapist to give a client a relationship, if they are lonely. No therapist can ‘fix’ a client.

Part Four—Alexander Batthyany

Dr. Alexander Batthyany is head of the science and research department at the Viktor Frankl Institute in Vienna. He is also a professor of psychology at the University of Vienna.

Needless to say, he’s one of the world’s leading experts on Frankl. In his talk, he spoke about how Viktor Frankl interpreted what it means to live a good life. Clients at Sunshine Coast are told the story of Frankl’s experiences in the Nazi death camps. From these experiences, he developed the idea that human beings can choose how to live their lives. Even though the prison guards controlled their bodies, Frankl said that prisoners could still choose to control their minds.

Dr. Batthyany said that if someone punches you, and you are angry about it, you still get to choose how you will react. If, out of anger, you punch him back, then you choose to be aggressive. On the other hand, you can choose not to punch him back and find another way of dealing with it. So you have choices, or, as Dr. Batthyany put it, “There are lots of potential selves” you can choose from; which you choose dictates who you are. This is also what Frankl called “freedom.” You are free to choose your life.

In other words, it is not the circumstances that dictate your life, but how you react to the circumstances.

Dr. Batthyany also said it was a waste of time to pursue happiness, and anyone whose goal is “to be happy” will soon discover that this is not a good approach. Batthyany said that people whose goal is happiness ask themselves two questions: “Did I get what I want?” and “Am I feeling good.” Since it’s impossible always to get what you want and it’s impossible always to feel good, then these people are doomed.

Geoff Thompson, Program Director for the Sunshine Coast Health Centre, concludes his four part series on the link between meaningful work, happiness and recovery. One of the things that Geoff has noticed with clients is that most (but not all) who have found happiness also have work that they find to be fulfilling.

Geoff Thompson, Program Director for the Sunshine Coast Health Centre, talks about overcoming fear to pursue your dream job or life’s ambition. Famed mythologist Joseph Campbell is discussed in regards to his classic phrase, “Follow Your Bliss.”

Geoff Thompson, Program Director for Sunshine Coast Health Centre, discusses the importance of finding balance when it comes to work – making your job a part of your life, but not your identity. Geoff discusses the situation of many people with addictions that tend to focus on work because that is what they are good at or where their addiction can continue without too much interference.