Some time ago I was sitting with a patient, recently discharged from a dual-diagnosis program. He asked if I wanted to know how far along he was in his "recovery" and then proceeded to talk about which "step" he was on, give a count of his days clean, the number of NA meetings he's attended, his frustration in finding a sponsor, and so on. It became obvious he was trying to do the "right" thing, but there was something missing. And then it dawned on me — actually it hit me like a ton of bricks: what was missing was him. He was somewhere in there beneath the diagnoses heaped upon all the other stuff that had obscured him for years. Through its formulaic approach, our current model of recovery has inadvertently built itself on covering over and covering up, leaving too little room for the individual to fully emerge.
Stopping him midway, I heard myself say, "I'm not interested in your recovery" and then waited for this to sink in (for both of us). "You know what I am interested in? Your un-covery of things and discovery of where you are in the midst of all of this."
At first he didn't know how to respond (which is actually what I was going for). I wanted him to step away from the addict story and lingo. He visibly relaxed, shifted back in the chair (away from the edge where he appeared eager to please and/or ready to run), took a deep breath and said, "Oh, OK, I get it." Then he showed up.
This session set the tone for the rest of our work together, a process of personal discovery. Sometimes it was messy, but that's how life is. If we don't sweep them under the carpet, our messes can be our finest teachers and impetus for radical shifts. He discovered the power to say no to what didn't agree with him, to allow himself more yeses (as he got reacquainted with his own values, and desires), to ask for help and to increasingly realize the unique attributes he could bring to the world. He grew to express the full breadth of his emotions — including when something angered him, not waiting until he was about to explode from days/years of repression.
Our current treatment paradigm expects recipients of care and providers to embrace a specific, rigid illness model, primarily relying on the Alcoholics Anonymous tenets of lifelong meetings, abstinence, sponsorships and referring to oneself as an addict above all other self-descriptors. Yet, certain research indicates this model may only work 5 percent to 7 percent of the time in the long run. If a person does not succeed, they're typically told they haven't hit rock bottom yet or are resistant. This is a travesty. Where else in medicine would we dispense a treatment with such a low efficacy rate and hold the patient solely accountable when it is not successful? We must do better than this.
This is what research indicates actually helps. Nine studies have followed up with over 2,000 people over a period averaging 20 years. They found the majority of people diagnosed with a major mental illness do get better. They also discovered that helping people focus on self sufficiency, fulfilling connections, social roles and personal discovery and growth provided the highest rates of permanent improvement. All of us do better when we're moving toward something that inspires us rather than living a life of "management mode."
Corroborating this, a recent review focused on different modalities for adolescent substance use, including 12-step Alcoholics Anonymous models, cognitive behavioral therapy, motivation-based therapy, family-based intervention and other approaches. A consistent pattern emerged where family-based intervention, and cognitive and motivational enhancement therapy had the best outcomes. After all, addiction is much more a psychological response than a disease, as addiction researcher Lance Dodes has pointed out, rooted in denial of one's personal power and uniqueness.
These are the same dynamics I've noticed in working with people with addictions. I've found the majority of people who suffer emotionally tend to defer themselves in the interest of others; they are typically the ones who absorb the distress around them and bury it away. Who they are as individuals is lost beneath this. Oddly, the attention their addiction gets often casts this person in a selfish light, which just leads to increased misunderstanding.
It is highly likely that when the AA model is effective, it is because of the connection and "purpose" this approach temporarily offers. But what if we addressed other options for connection and offered alternate paths for attaining meaning that did not necessitate lifelong identification as an addict? What if we more readily offered lifestyle and biochemical support for healing a highjacked brain? My guess is we would see much higher rates of lasting success. The "addict" would be free to discover the full gamut of who they are, and self agency is a powerful healing force in all illnesses. Systems that encourage continued dependence on professionals or external structures and cementing a lifelong identity of "addict" actually thwart a person's full healing.
We need to educate and re-educate people regarding addiction and the central issues of powerlessness, and refrain from further marginalizing those with addictions from the "family of man" into a segregated family of "addicts."
Heidi Waltos is a psychotherapist in private practice; her email is hwaltos@gmail.com.