It takes a lot of courage to admit when we’re beat and need help. This is especially true for those struggling with addiction. After all, addicts and alcoholics don’t usually get much sympathy from the general public. You only have to listen to call-in shows on the radio for proof. Unfortunately, too many people still confuse a lack of willpower with addiction. This stereotyping of people with addictions as lazy is one of the reasons that our clients stop calling or emailing our addiction treatment center when they relapse. They feel ashamed, like one big disappointment. Just when they need to reach out, they hide out. It’s a problem that faces every drug rehabilitation program.

One of the biggest misconceptions about relapse is that it means that previous treatment episodes weren’t effective, that it was a waste of time. Many believe that going back to treatment is basically like starting over. Surprisingly, I find that even a majority of doctors and therapists hold this view. And, since even healthcare professionals struggle with a clear understanding of relapse, I decided that there must be something more to it than just a lack of education.

The Influence Of ‘Worldview’ On Society

Sometimes we need to look at the big picture to explain why people think and act the way they do. Our worldview, or the way we as human beings see the world, is influenced by the culture we inherit. Unfortunately, our worldview is so pervasive and hidden that most people don’t even realize it exists. Since I became aware of its effect on my thoughts and behaviour, I have tried to understand it and, hopefully over time, have some control over how I respond to it.

How Classical Astronomy Has Shaped Our Notion of Life

Interestingly, I have found that you can look at just about every discipline and see its influence on our worldview. Astronomy, for example, can provide clues to the mystery of why we are stuck in an outdated, unexamined understanding of life. In this video, scientist Nassim Haramein concedes that while most of us no longer believe the earth is flat, we still see the solar system that way (think of a photo in a magazine).

As the video shows, the earth is actually spiralling, not orbiting, around the sun with the other planets (see 0:40 to 1:26). Until I saw this video, I must admit that I had this image of the earth and the other planets orbiting around the sun in a circular motion (see 0:20 to 0:39). In other words, my view of the solar system was flat and static.

Extending The Flat-World View of The Solar System to Society’s Understanding of Relapse

So I am going to go out on a limb and suggest that our one-dimensional, static understanding of our solar system also influences the way we see relapse.

Here’s my analogy:

The Dimensions of our Understanding of the Solar System
- 1-Dimensional – Earth orbits around the sun in a flat plane
- 3-Dimensional – Earth spirals around the sun in three dimensional space

The Dimensions of our Understanding of Relapse
- 1-Dimensional – Addiction is simply a matter of quitting, anyone can quit if they want it bad enough
- 3-Dimensional – Addiction is a complex condition that is caused by multiple factors

Movement of Our Solar System Through Time and Space
- Static Perspective – Earth returns to the same point in space after one full orbit (one year)
- Dynamic Perspective – Earth is never in the same point in space, it moves millions of miles every year

People Who Relapse Moving Through Time and Space
- Static Perspective – Clients who relapse haven’t changed, they are back to square one in their recovery.
- Dynamic Perspective – Clients who relapse are like every other human being – they are constantly evolving. A relapse indicates that not all contributing factors have been addressed (although some may have been resolved in previous treatment episodes).

How A More Contemporary Understanding of Relapses Shows Up in Treatment

For clients who return to Sunshine Coast following a relapse, staff make a point of thanking them for coming back and remind them that there’s no shame in relapsing. They need to hear those words. Unfortunately, identifying relapse with failure is so deeply engrained in our society that the message doesn’t always get through.

At Sunshine Coast Health Center, when clients relapse and return for treatment we do not have them repeat the same program with the same length of stay. Instead, the clinical team acknowledges areas where the client has succeeded, identify areas where more attention is required, and work with them to create an individualized treatment plan.

Oh, and we manage to pull it off without so much as a mention of classical astronomy!

Barb Struch is a long-time high school teacher residing in Powell River, British Columbia. Barb and I both share a concern about the way schools and families are preparing youth for adulthood, albeit from different perspectives based on our professions. Barb has written a poem to highlight some of the dangers she sees in modern parenting:

What a Child Would Say If He Only Knew
by Barbara Struch, B.Ed., M.Ed.

When you tell me that I cannot fail, you are setting me up for failure. So, when
I actually fail for the first time, I will blame anybody else because you have
taught me that I cannot fail. Instead, help me to understand that failing is a
positive thing because it teaches me what not to do the next time around.

Above all, know that I love you, and I am a most forgiving child. When you
mess up, talk to me about it, admit it. I will have great respect for you and
when you ask to be forgiven, I will forgive you, hug you, and love you as though
none of it had ever happened.

Obviously, Barb is not talking about neglect but, rather, the other extreme which is the tendency of modern-day parents to ‘over-manage’ their kids. Naturally, the consequences of over-managed kids at home carries over to the classroom and, for an unlucky minority of youth, into addiction treatment as well.

A Sense of Entitlement/Lack of Motivation

Clients who have been raised by over-managing parents often lack motivation. Why? Because motivation is not necessary when every need and threat is anticipated and dealt with beforehand by an overzealous parent. Over-managing has a debilitating effect on a child’s growth process. Since recovery from addiction is inherently a growth process, therapy cannot treat addiction without addressing entitlement.

Cathy Patterson-Sterling, Director of Family Services at Sunshine Coast, has written about entitlement in another article posted in this blog, “The Cost of Rescuing.”

Perfectionism

Clients who have been raised to think they can do no wrong are notoriously critical of others. As adults, clients learn to use perfectionism as a way of avoiding painful self-reflection by noticing the shortcomings of staff, their peers, the facility, the food, etc. Anything is fair game and keeps the client in his comfort zone.

Why Parents Over-Manage

In her article, The Gift of Adulthood, Cathy Patterson-Sterling finds that many parents who over-manage their kids do so out of fear. Fear can be a powerful emotion, often blinding parents to the negative consequences of their over-managing tendencies.

Fostering Resilience as an Alternative to Over-Managing

It may seem obvious that it is difficult for parents to remove all potential sources of pain, increasingly so as their children reach maturity. However, fear often makes it difficult for a parent to think rationally when they see their children suffering. Fortunately, there is research showing the effectiveness of fostering resilience – the positive capacity of people to cope with life’s challenges. * While resilience can’t prevent painful events from occurring, teaching children to courageously face life’s twists and turns does nurture personal growth.

(*) Note: Resilience has been extensively researched in psychology. A good book for parents is Raising Resilient Children: Fostering Strength, Hope, and Optimism in Your Child, written by Robert Brooks, Ph.D.

When All Else Fails, Role Model

Nearly half of Barb’s poem is dedicated to the importance of parents serving as good role models for their children. Fortunately, being a good role model is one of the few things over which we have control. If we look after ourselves, our kids tend to follow suit. In fact, when parents ask Cathy what is the best thing they can do to help their addicted sons, Cathy advises them to practice good self-care. Such advice may seem counter-intuitive but it is not when one remembers the replicative nature of role modeling.

PS

Speaking from personal experience, I recognize that there is a difference between over-parenting and over-scheduling. Growing up in Edmonton in the early 1970s, I don’t remember getting rides to school nor having so much structured leisure time. However, I don’t think this change is due to overzealous parenting so much as it is a response to the hectic pace of modern life.

Daniel Pink is a New York Times bestselling author who has written a number of books on the importance of creativity in business. He also has a few things to say about motivation. His book, Drive: The Surprising Truth About What Motivates Us, highlights the shortcomings of using money to motivate employees for all but the most basic tasks such as picking fruit or sweeping floors. At our residential addiction program, we regularly encounter clients who report being miserable at work even though their salaries far exceed the national average. Their employers would be well advised to read this book. That aside, Daniel Pink has some interesting things to say about motivation that applies not only to business but addiction treatment as well.

What Really Motivates People

Social science researchers have found that, once people make enough money to live comfortably, ‘carrots’ (rewards) and ‘sticks’ (punishments) don’t work. Instead, intrinsic motivators (as opposed to the more traditional, material variety) can lead to greater creativity, enthusiasm, and job satisfaction:

AUTONOMY – the urge to direct our own lives
MASTERY – the desire to get better and better at something
PURPOSE – the yearning to do what we do in the service of something larger than ourselves

Any client who has attended Sunshine Coast will tell you we pay particular attention to meaning and purpose, particularly the transcendent variety where the focus is less on the individual and more on making the world a better place for family, friends, community and society.

Compliance vs. Engagement

Apart from meaning and purpose, what may not be so obvious to clients is how much we encourage autonomy. That’s probably because it’s less a topic of discussion as it is our philosophy. In other words, everything we do at Sunshine Coast is designed so that clients and their family members are able to access their own internal resources rather than counting on us to fix their problems.

According to Daniel Pink, traditional ways to motivate people are great if you want compliance. In addiction treatment, compliance means lots of rules and lots of control over clients. Daniel Pink himself would probably be shocked to learn the ‘dirty little secret’ of addiction treatment: clients are routinely discharged for failing to keep their bedroom clean, not getting up on time, missing group, etc.

At Sunshine Coast, we recognize that people with addictions are naturally ambivalent about working through their problems. Therefore, if a client is non-compliant it is expected that the clinical team will pull its resources together and work with the client regardless. Counsellors are not allowed to resort to ‘sharp sticks’ such as kicking a client out of treatment. Actually, we really don’t place much stock in compliance since it does little for a client after they leave treatment.

As an alternative to compliance, Daniel Pink recommends autonomy as the way to engage clients. At Sunshine Coast, we have long since learned that treating clients like adults means greater participation from clients. And, contrary to popular opinion, the percentage of clients leaving early or relapsing while in treatment has dropped since we switched to a model that encourages autonomy over compliance.

Contingency Motivators

Similar to compliance, social science research has shown that people do not respond effectively to contingency motivators. Contingency motivators follow a cause-and-effect pattern that, again, does not work for complex tasks. An example in addiction treatment would be a counsellor advising a client that if they go to 90 meetings in 90 days they will have a high likelihood of staying clean and sober. Such simplistic advice for a task as complex as staying clean and sober is a good example of why most contingency motivators don’t work. That is why therapists at Sunshine Coast follow a client-centered approach where clients come up with their own recovery plan that acknowledges their unique challenges and strengths.

Conclusion

Daniel Pink’s basic message is that business must do a better job of discarding concepts that are ‘outdated, rooted more in folklore than in science’. Like business, addiction treatment would be well advised to break with tradition and find new ways to motivate the people they serve.

Ever since I read The Opposable Mind: How Successful Leaders Win Through Integrative Thinking, I have been a big fan of Roger Martin, Dean of the Rotman School of Management in Toronto, Canada. In his book on the problem-solving power of “integrative thinking,” Martin profiled several leaders of successful companies to demonstrate how the “opposable mind” – Martin’s term for the human brain’s ability “to hold two conflicting ideas in constructive tension” – can synthesize “new and superior ideas.”

In this video, Dr. Martin claims there is a ‘crisis of meaning’ in the world of business, especially for the Millenials or Generation Y (the generation with birth dates from the mid-1970s to the mid-1990s). Millenials are leaving for other occupations because, according to Dr. Martin, they are finding little purpose in the workaday world of business. For example, when a Millenial asks ‘why am I doing this?’ management will often respond by pointing out how it benefits shareholder value. That’s not good enough, according to Dr. Martin.

So what, you may ask, does this have to do with addiction? What struck me about this video was how glaringly obvious the question of ‘why am I doing this?’ is for the clients we see in addiction treatment and how rarely it’s addressed. Yes, we tell clients how destructive drugs and alcohol can be and, yes, we can explain to them how to stop using these substances. However, if we don’t answer the question ‘Why am I doing this?’ or ‘Why should I quit?’ then perhaps we’re spinning our wheels. The client probably won’t be very motivated, not for long anyway. Assuming that the client knows he is hurting his family, ruining his health, etc. is not good enough. We need to dig a lot deeper.

A second consideration to the question ‘why am I doing this?’ is about why clients use drink or get high in the first place. Interestingly, (and this is something I have learned from our Program Director, Geoff Thompson) we never ask how clients benefit from drugs or alcohol. We just focus on the bad things that result from drug use. Maybe counsellors are afraid that they will trigger their clients if they talk about why they use or maybe the counsellor just assumes he has the answer. Either way, we are selling the clients short.

When I talk to addiction professionals and family members about what is unique about Sunshine Coast I often sum it up by saying we work with clients so that they have a reason to quit their addiction. Over time, we believe, clients who find a reason to quit will stop, not because someone pressured them to quit or not because it was ruining their life, but because drugs and alcohol no longer fit into their plans for a better, more satisfying life. Motivation is a critical piece of the recovery puzzle so that’s why we spend so much time talking about finding meaning and purpose. The ‘how-to’ books can come later.

Perhaps the great existential thinker, Friedrich Nietzsche said it best: “He who has a why to live can bear almost any how.”

In this 3rd instalment of the six-part series on goal setting, Cathy Patterson-Sterling discusses the SMART formula for goal setting and the importance of making your goals achievable.

SMART stands for:

Specific
Measurable
Attainable or Achievable
Realistic
Timely

In part 4 of this 6 part series on setting successful goals, Cathy Patterson-Sterling discusses the need for realistic goal setting; a component of the SMART formula. SMART stands for:

Specific
Measurable
Attainable
Realistic
Timely

Cathy Patterson-Sterling shares part 5 oh her 6-part series on Setting Successful Goals. In this video she stresses the importance of examining time in goal setting. Do you have the time to achieve your goal? Have you set a time frame or is your goal open-ended?

SMART stands for:

Specific
Measurable
Attainable
Realistic
Timely

In this 6th and final instalment on setting successful goals, Cathy Patterson-Sterling discusses the nature of stress as it relates to feelings of overwhelm, thought monitoring and the bigger perspective.

“In order to change, one must first assume responsibility.” ~ Irvin Yalom

“How can we learn to know ourselves? Never by reflection but by action.” ~ Viktor Frankl

In the first instalment of this 4-part series, Geoff emphasizes the important of committing to change. In his years working with clients in residential addiction treatment, Geoff has observed that clients often have personal stories that excuse them from taking action towards achieving their dreams and desires. For example, many clients want to be sure that going back to school is going to pan out. They may rationalize their inaction by suggesting the possibility that they may not end up with a job after completing their degree or that they may lose interest in their studies after a few years. Geoff has found that many clients have been thinking about going back to school for 5 years or more without having committed to a single course, never mind a degree.

In part 2 of of this 4-part series on taking action in recovery, Geoff Thompson talks about the struggle of taking action in recovery. It’s human nature that we prefer talking about or planning for change than actually doing it (think of Nike’s commercial, ‘Just Do It.’). We often imagine this type of avoidance as a form of laziness, like watching TV when we know we should be, for example, shovelling snow. However, we can just as easily avoid doing what needs to be done by doing something else admirable or what society thinks is time well spent. Geoff calls this ‘action as avoidance’ in that we keep ourselves busy to justify not doing that which is uncomfortable. For example, many men needlessly work late night after night while their home life is in tatters. While hard work is an admirable quality, it is often used as a way to avoid the discomfort of, for example, reconnecting with family. So, procrastination isn’t necessarily sitting around watching TV – we can procrastinate while still taking action. For example, does the lawn really need to be mowed tonight or, truthfully, are you just using it as an excuse not to go a meeting? Those in recovery need to ask themselves if what they are doing is contributing to their recovery or living a fulfilling life or just a way of avoiding making substantial, meaningful change in their life.