Which version of practice do you think is best?

New Ways	Old Ways
Person Centered	Practitioner Based
Strength-based	Problem-based
Skills Based	Deficit Focused
Collaboration	Professional Dominance
Quality of Life	Cure/amelioration
Community Integration	Acute Treatment
Empowerment/choices	Dependence
Community Integration	Acute Treatment
Least restrictive	Episodic
Preventative	Reactive

 

Which do you agree with more in treating addiction?

Well like all forms of treatment, and being more person centred, it depends on the individual.

Many people whom I’ve worked with over the years, depending on their circumstances, who they are and what they do with themselves, can either tolerate some forms of treatment or find some methods of treatment ineffective  on their substance use.

Addiction can be rather difficult to address, it’s often cloaked with a  level of denial that remains unseen to an individual. There may be issues for that person that remain totally unseen and these “new ways” (which in fact come from details of treatment from the Californian government in 2005, so not so new being 14 year old) may lack a level of confrontation that is needed in addressing addiction. Especially when it come down to community integration Vs “acute treatment” (in-patient rehab).

As a practitioner in this field we walk a very fine line between unconditional positive regard and confrontation.  Sometimes as a individual going against a person and their full blown addiction we can be seriously out-gunned and outnumbered.

When a person is very heavily in the thralls of using, their addiction can be a very powerful force to go up against. Sometimes an individual will be completely unaware they are defending or protecting their addiction.

This behaviour and defending of addiction will often lead to people lying and denying parts of their life.  In order to address this type of behaviour – SOME (not all)– addicts will need a group of others to help the recognize this as a part of their life and have multiple people point this out to them.  This unfortunately can be quite confronting. As a therapist alone with an some addicts they may not take too kindly to this level of confrontation, they may try to pick holes in the individual therapist.  There may even be some transference, they might see this like the way they were treated at school, they may see the therapist as some disapproving father-like figure (remembering that all these processes happen usually very subconsciously).  In addiction treatment as a therapist we do try to get people to own their part in their addiction and addictive behaviour, a therapist cannot ignore this or else they run the risk of colluding with a person’s addiction.

Collusion with addiction.

Colluding with addiction is when a person is too soft or wilfully ignores aspects of their client’s addiction which will lead them to relapsing back to using drink and drugs. In some cases in may be very overt:

For Example:

Client: I’ll never use cocaine again but I’m thinking about going to Glastonbury festival after treatment, yer know just to prove to myself I can do it sober.

Counsellor:  Glastonbury, sounds nice. There’s a sober fellowship at Glastonbury you might like to link up to them.

The above statement is an example of collusion that is quite overt, although the counsellor is being helpful in suggesting that Glastonbury Festival does have a sober community in attendance. However, the counsellor is over-looking the fact that Glastonbury is a very hedonistic festival with drink and drugs all about the place.  Although the counsellor is showing resources and unexplored opportunities in remaining sober. The client is potentially entering a high-risk area.  There is a risk that the counsellor is also doing the “recovery thinking” for a client by making well-meaning suggestions the client has yet to even consider.  This may make the client feel like they are falsely going to be okay in that environment.

What might be a better…

Client: I’ll never use cocaine again but I’m thinking about going to Glastonbury festival after treatment, yer know just to prove to myself I can do it sober.

Counsellor: Hmmmm, when was the last time you did a festival sober?

Client: Never, that’s the point. 

Counsellor: How is this time going to be different?

Client: Because I just paid f**king $8,000 for your bloody treatment. Pffft.  You work it out !

Okay, so that’s an example of how it can go wrong with just you and a client.  It might be a little extreme but I’ve actually had worse in a similar example. Immediately the defence systems go up and the client begins to externalize rather than look within. This is resistance to change in a nutshell.

Let’s look at another example:

Counsellor: Hmmmm, when was the last time you did a festival sober?

Client: Never, that’s the point. 

Counsellor: How is this time going to be different?

Clive – Group member:  I think your counsellor is right, you were saying the other day that cocaine is the only problem you’ve had, you can still do ecstasy. I’m not so certain you will find that is still the case now.

Client –But in this case…

Clive-Group member: I wouldn’t last two minutes in a place like that. I know what I’m like around those kinds of places. 

Natalie-3rd Group member: I often thought I could put myself in high-risk situations like festivals, but I was always proven wrong. I kept going back expecting things to be different after treatment, but they never were.

In the above example the group member shares with the client that their plans might not live up to the test of real life. The group member shares their own personal issues in dealing with addiction, at some point the counsellor could build upon this also in getting them to reflect or for Clive to speak directly to the client and share with him where he was seen specific concerns. The counsellor could also put it to the group, the counsellor could state “let’s put it to the group? What does the group think about…?”   This opens the matter up for process so that the group can get to the heart of the matter.

This method is also of benefit for the group because they may be planning to put themselves in high risk situations without considering how it will impact their recovery and ultimately land them up in treatment again. This is what I mean by being out numbered and out-gunned when dealing with some addicts on a 1:1 basis.

This could be done in a community setting without being in-patient managed, but what if the group went wrong? For instance if the client was fixed in their denial, not only that, but due to the emotional fragility of coming off drink and drugs the client was deeply upset by being confronted.  Ok, group’s over, go home. Back to the same environment, back to the same people, same triggers and difficult situations. Well I don’t have to point out the obvious to those in the know, but anyone with a really powerful addiction issue is going to fail at the first hurdle at such an early stage in their recovery.

To be continued in part 2…