Some Thoughts on Addiction

Since I inherited a few of Elizabeth’s clients, my practice has been considerably more focussed on addiction. I can’t help but notice how much love plays a part the addict’s prognosis. Of course, this holds true for all of us: being loved and being able to feel, accept, and return that love is likely the core component in anyone having a productive and happy life. Looking deeply at and working with the distinct pieces of this equation then is an essential part of any therapeutic process. An initial “contract” with one’s counsellor involves a particular kind of love: I, the counsellor, will hold you within a space of non-judgemental acceptance and of encouragement of your strengths and your efforts. In a sense being in loco parentis for the “adult child” who seeks help, one must be kind but also firm, not shying away from difficult questions about using nor accepting the sloppy excuses anyone accustomed to self-abusive behaviour will proffer in order to side-step responsibility. This is not an easy relationship for anyone afflicted with the scourge of addition to maintain. It can only be attempted at the point when he or she has gained some knowledge of him/herself and some repulsion for the dire realities of a life progressively centred on the addictive substance.

That substance has over time become the source of “love,” in the sense that it is the place of comfort and solace, the reliable friend that eases pain, tension, anxiety, and the seemingly irresolvable conundrums of life. But, of course, that friend, that lover, gives with one hand and takes even more with the other, exacerbating one’s troubles even as it seems temporarily to solve them. Coming to the counsellor the struggler attempts to reach out with one hand for a different connection while the other is still quite firmly held by the addictive substance. And so the dance of therapy begins.

Many questions need to be answered to fill in the background of the current situation: preferred substance(s)?; beginning of use?; current usage?; source of substance?; source of income for substance?; triggers and cravings?; familial relationships?; work history?; general health?; mental health diagnoses, treatments, and/or medications?. These and other threads of the story emerge over time in regularly held meetings that establish a rapport and connection within the therapeutic dyad. This engagement can form a bridge enabling the client to consider the possibility of life without the crutch of his or her addictive substance. Like all therapy, it is in its essence, relational. Its success or even relative success depends not only on the willingness and capacities of the client to make difficult changes but also on the therapist’s ability to be engaged with another in an authentic fashion. If we come to our work cloaked within a “professional” aura, rather than as another human who lives and struggles with the realities of her life such as they are, no sense of “us” working together can be imparted to the client. Rather he or she can never overcome a sense of inequality in our relationship, or for that matter, the inherent shame about addiction that consciously or unconsciously is suffered. These two conditions alone constitute insuperable obstacles to the client’s progress, replicating as they do so many earlier unhappy and discouraging involvements.

Being with another in an open and encouraging fashion will most often lead the therapist to genuine feelings of caring for the client. When it doesn’t, the work is unlikely to be successful or prosper. Neither party will find the meetings satisfying and the relationship will in some fashion be terminated. So, starting from an assumption that the therapist is able to develop this form of “love” toward her client, what are the difficulties to be overcome in the process of their work together? In essence I believe them to be those to which I alluded at the beginning of this post: whether the client, the one who is bringing his or her self to the therapeutic endeavour, is able to feel, accept, and return the love of others. This is no simple matter. Standing in the way of the human experience of love can be a host of factors. Early childhood trauma, abuse, rejection, or betrayal can immunize a person from any belief that he or she is loveable, or, that there exist people who are capable of unself-motivated caring. As well, serious mental health issues that confuse one’s thought processes and emotions are enormous obstacles to love. Also, the impact on one’s entire physiological being by the protracted use of alcohol or chemicals cannot be discounted as a powerful inhibitor of the flow of healthy emotions.

I don’t mean to imply that the relationship with the therapist (or the AA sponsor in many cases) is in itself sufficiently stable ground for someone struggling to free themselves from addiction. But along with other pieces of this complex situation, over time it can provide a major assist. The work in which therapist and client are engaged encompasses many areas of concern because the whole person is involved. It spans all the various elements of being human: physical and mental health; work and leisure; friendships, family, and/or lovers; the past and its ramifications, dealing with the ever-constant present, and what of the future? Those who have the consistent backing of others who care about them and who have pursuits or interests that are important to them are the most likely to persevere in their quest for a life free of addiction, not a life free of the temptation to use which rarely happens, but a life in which choices are more properly their own.