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Contributions from William L. White on Addictions

William L. White & Addiction Therapy

William L. White is an addiction therapist and researcher. After spending time as an outreach worker and counsellor in the 1970s, he was upset with the limited treatments available to those suffering from substance addictions. He also noted many practices in treatment that had little to do with therapy, such as leather restraints and straitjackets, brutal withdrawal procedures, lack of trained counsellors, and negative attitudes of the clinical professionals. Motivated to improve this situation, he decided to “get into the [addiction] field even deeper.”

What makes White particularly interesting is that his career was steeped in the most popular form of treatment. At the time, this was the Minnesota Model or some variation of it (typically called “12-step based treatment”), but it was also the early years of evidence-based drug rehab and alcohol treatment. Although today helping professionals are routinely trained in scientific approaches to treatment, this was not the case when White entered the field.

White has been interested in the evolution of how we have treated those with substance addictions. He wrote what is, perhaps, the most influential book on the history of treatment in the US, called Slaying the Dragon. He sees the addiction treatment field in historical contexts, pointing out how social attitudes affected treatment.

In this blog, we look at four ideas that White has promoted in his career and which have influenced how we treat addictions for the better.

Many Pathways to Addiction Recovery

White is famous for promoting the idea that there is no single route to overcoming addiction. What works for one person may not work for another.

Older forms of treatment did not recognize differences in individuals. They basically provided a one-size-fits-all therapy, under the assumption that an “addict” was a type of person. However, those suffering from addictions are just like your neighbours. They differ in personalities, ages, health conditions, genders, sexual orientations, and so on. White often said arguing that these factors make no difference in therapy is silly.

Some seem to benefit from joining a 12-step program, others from SMART Recovery, and others from attending professional treatment of one variety or another. Our drug rehab and alcohol treatment strategy here in Powell River, BC, is based on a non 12-step methodology.

Confrontation in Addiction Therapy

Since its inception, the Minnesota Model and its many variations has argued that confrontation is necessary in order to break through the client’s “denial” of his or her addiction. As with most well-trained therapists, however, White argued that using confrontation as a style of therapy is inappropriate. Not only has research shown that confrontation doesn’t work, but it borders on malpractice. In fact, for some people, such as abused women, it is clearly malpractice.

Much to my amazement I recently heard a medical doctor certified in addiction medicine defending confrontation. He said that it promotes cognitive dissonance. Cognitive dissonance occurs when a person holds some beliefs or values, but then acts against them. For example, a person might reflect: “I believe that I am a great father, but then I miss my son’s birthday because I’m too drunk”. The person feels mental stress. Because humans need “internal consistency,” (e.g. they need to reduce the mental stress), they change their behaviours.

So, this doctor’s argument was that confrontation promotes cognitive dissonance, which then leads to a change in behaviour. But you don’t need confrontation to create such dissonance, and a focus on dissonance is a very limiting way to conduct therapy. To put it bluntly, the doctor’s argument that confrontation is therapeutic is really just an attempt to justify unethical behaviour in a therapy session by appealing to science.

Ethical Treatment

In addition to his research in addiction treatment, White is an activist. As a young counsellor, he was appalled by professional addiction treatments in the 1970s. With any other population in the health care system, it would have been considered malpractice. After working for a few years in the field, he stated, “there seemed to be a propensity for addiction treatment programs to become closed incestuous systems marked by charismatic leadership, ideological extremism, professional social isolation, and abuses of power that injured both clients and staff.”

White recognized that abusing clients with insults, denying them any say in their therapy, telling them that they couldn’t trust their own thinking, and so on were routine. Sadly, in some programs, such practices still exist.

Attempting to remedy this situation, White wrote a book on ethics for addiction counsellors and promoted the ethical treatment of those suffering from addictions.

Transformation Change and Meaning & Purpose

White’s studies have a remarkable similarity to meaning-centered therapy for addictions and the idea that clients suffer from the way they make sense of their lives, the world around them, and their place in that world. The solution is obviously to shift how they make sense of these three things.

Here’s one example. In one of his research projects, White studied several people, including Bill Wilson and Malcolm X, who found recovery relatively quickly. He called this quick form of recovery a “transformational change”. According to White, a transformational change is unplanned, happens when the person is isolated and suffering emotional desperation, and involves another person (a “messenger”) who says something that triggers the change.

Although we don’t have much research on the nature of the transformation, White highlighted the consequences of change. The experience is “culminated in a deep emotional release, [with] new and profound breakthroughs of understanding, a new sense of purpose in life, and prolonged sobriety.”

If you examine White’s description, you’ll see that transformational change is essentially a meaning-centered change. After their transformational change, Bill Wilson, Malcolm X, and the others looked at themselves and the world through a new and positive lens. This is where they found a new purpose in their lives and, according to White, more positive relationships.

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