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Do Clients in Addiction Treatment Need to be Controlled?

Popular portrayals of people suffering from addictions show them as untrustworthy or incapable of making healthy decisions. They assume that anyone with an addiction is a liar or con artist. There’s even an old joke in the addictions field: “How do you know an addict is lying? His lips are moving.”

Many residential treatment facilities tell clients not to trust their own thinking. They tell clients they have “a committee of idiots in their head”. These facilities also argue that clients have some sort of personality problems, or “character defects” as Alcoholics Anonymous has declared. If that wasn’t bad enough, clients are told that drugs have mucked up their brains, so they also can’t think straight. In these treatment programs, counsellors take control of clients under the assumption that the client’s “best thinking got him into treatment”.

At SCHC, we occasionally receive phone calls from family members warning us about how manipulative their loved one is or puzzled about why we do not take away cell phones or computers. We even receive a rare phone call from the community asking if clients are “supervised” on outings. Those who call us with these issues typically believe inpatient addiction treatment centres are or should be lockdown facilities or boot camps.

In this blog, we examine whether interpreting a person who is addicted as incapable of or unwilling to make healthy decisions is accurate or, even, realistic.

Clients Struggle with Personal Responsibility

The popular idea that residential treatment centres need to supervise clients, remove cell phones, erect high fences, and put locks on the doors assumes that external forces are needed to control the client.

Apparently, many people with addictions also believe this popular idea. In fact, they seem to rely on others or their environment to keep them in recovery. One client in our couples program even stated that his partner would have to figure out how she would work full-time and yet save him if he relapsed and overdosed!

Here are a handful of things we’ve heard from clients over the years:

  • “I’m quitting smoking, so if I snap at you that’s the reason.”
  • “I relapsed because I got into a big fight with my wife.”
  • “I couldn’t help myself.”
  • “I need you to call my wife because she doesn’t believe anything I tell her.”
  • “I’m still angry at my girlfriend for forcing me to come here.”
  • “He started it.”
  • “I paid a lot of money to be here, and that guy’s ruining my recovery.”
  • “I’m late because I asked my roommate to wake me up, and he forgot.”
  • “I can’t believe my family still doesn’t trust me.”

In these and a thousand similar statements, clients seem willing to pass their responsibility onto stress, a partner, another client, or their family.

The Problem is the Program, Not the Clients

An interesting nine-month study was conducted at a Canadian treatment facility where the clients tended to lie to and manipulate staff. The researcher studied this client’s behaviour and concluded it was actually a response to staff attitudes. Staff members did not treat clients as individuals or as important human beings. Rather, they saw clients as defective and in need of fixing. The staff was very controlling, believing that clients were untrustworthy and needed to be supervised. In turn, clients felt they were being belittled. According to the study, the clients’ lying and manipulating were merely their attempt to redress this power imbalance.

In the last 50 years, hundreds of studies have examined whether controlling clients leads to better outcomes in healthcare facilities.

The answer: It doesn’t. Research tells us that the real cause of problematic behaviour among clients is that they are not engaged in treatment. Smuggling drugs into a facility, blaming others for problems, and dropping out early indicates that the client doesn’t value the therapy. On the other hand, clients who believe therapy is valuable to take personal responsibility and rarely behave in problematic ways.

Lack of engagement is not a problem with the client. It’s the problem of the facility, which treats clients as “addicts,” not as important human beings. In other words, the apparent lack of personal responsibility is the direct result of poor treatment—not the result of some addict behaviour. If staff members see each client as an individual human being, rather than lump all clients under the label “addict,” and treat them with dignity and respect, clients do better quitting the drug.

Helping Clients Feel Free to be Themselves

The key to helping those suffering from addictions is not to control them, but to help them appreciate that they are the authors of their lives.

A good way to promote this active authorship is by encouraging the client to feel free to be himself or herself. Psychologist, Carl Rogers, provided the method to accomplish this.

  1. Treat the client as someone who is in charge of his or her life.
  2. Understand the client from the client’s point of view.
  3. Accept the client as a valuable person, regardless of behaviour.
  4. Be open and honest with the client.

Carl Rogers argued that these were the necessary conditions for clients to feel free to be themselves. And if clients felt this freedom, they would feel no judgment and feel valued as unique human beings. According to Rogers, they would naturally assume responsibility for their lives.

Compare the environment that Carl Rogers promoted to a facility that attempts to control clients. Locking doors, taking away cell phones, and the rest obviously work against this sense of freedom. These tactics send a message to clients that they can’t be trusted and need to be controlled.

For example, a client truly believes that he can drink after treatment because, in his mind, cocaine was his problem, not alcohol. If he feels others will judge him for saying this, or they’ll jump on him, calling him delusional, he’ll probably keep this thought to himself. That’s a huge problem, according to Rogers. We need clients to open up in therapy, to be honest, otherwise, therapy will be a wasted effort.

Having Faith in the Individual Client

William S. Burroughs, who had decades of experience with drugs, said that no one ever wants to be an addict. It just doesn’t make sense to do things that drain bank accounts, cause problems in the family, put employment at risk, and cause any number of health conditions. So something is preventing clients from being themselves.

On the other hand, if clients actually felt free to be themselves, to follow their natural instincts and inclinations, then they would likely not do something that causes them and their loved ones so much suffering.

Allowing clients the freedom to be themselves demands that counsellors have a lot of faith in clients. It demands believing that clients are experts in their own lives. It demands believing that if clients truly followed what they personally thought was important, they would make good decisions for themselves.

It’s precisely that leap—having faith in the client—which is so difficult for counsellors who believe that all who use drugs are incapable of or unwilling to make healthy decisions. If research contradicts the idea that clients require supervision, then, perhaps, the real issue rests with those who provide treatment.

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