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Should People Who Need Addiction Recovery Have Choices?

Aug 8, 2008
Imagine talking to your child or partner, who is obviously drinking or drugging too much.

"Why don't you get it? It's SO obvious! You are becoming addicted! Look at the damage you are causing, to yourself, to me, and to everyone who cares about you. YOU NEED TO STOP! I'm arranging to send you to treatment."

And imagine an angry response, perhaps something like "This is my life, I'll live it the way I want...You just don't respect my lifestyle...You are blowing this way out of proportion...Just because you are a prohibitionist doesn't mean I have to be one...You can take your treatment program and..."
Looking in from the outside, we could say that this drinking/drugging individual is "not making good choices." The obvious solution is to step in, take some control, and make their choices for them, at least for awhile. To put it another way, if you act like a child, we're going to treat you like one for awhile (and maybe a long time, depending on how you respond).

How well does this obvious solution work? In fact, not very well. Need evidence to support this fact? Can you think of a more tightly controlled environment than a prison? Is there drug use in prison? Of course there is! Can you think of a stricter institution than the military? Is there drug use in the military? Of course there is (and there is government data to prove it). How about prohibition? Did drinking stop in the US between 1919 and 1933? Drinking occurred at a lower rate, but the law was repealed because it was broken so often it was a farce and law in general was in danger of becoming a farce.

How about people living in residential addiction treatment facilities? Although facilities don't publicize this fact, residents are routinely discharged because they have violated the rule about not using substances. Doubt this? Call any addiction facility and ask them, "I want to send my child to your facility, but I'm concerned that someone else will use, and jeopardize my child's recovery. If someone began drinking or using, what would you do?" Notice how quickly they assure you that if a resident used the resident would be discharged and your child would continue to be secure. Then ask "how often do you discharge someone for using (or having sex, or other major rule violations)?" Now the response gets interesting! The specific answers will vary of course, but I predict that you will notice in all cases an increased level of stress in the conversation. The stress is there because even in the supposedly safe haven of residential treatment, all is not as it appears on the surface.

OK, so if forcing them to change doesn't work so well, isn't that better than nothing? Not necessarily. Raising the level of defensiveness in the user is not likely to increase their openness to new ideas or new ways of living. How likely is it that a process of change will begin if someone is busy defending the current way of living?

The alternative approach that we use at Practical Recovery is to work with our clients. It is usually possible to get the individual with addictive behavior into our offices for one meeting, as a favor to the concerned family member. We emphasize that this is a one-time meeting, and that what happens after that is up to them. In some cases, these individuals come directly. Either way, we begin by finding out what they like about their addictive behavior. Then we acknowledge that what they are getting (or used to get) is worthwhile. For instance, addictive behavior can lead to relaxation, a reduction in social anxiety, a sense of companionship with others, increased productivity, better sex, and so forth.

We acknowledge that addictive behavior as an adaptive effort, one they have engaged in to improve their lives. It becomes relatively easy at that point to elicit the negative aspects of the addictive behavior, and to observe that the initial benefits may not be present anymore. For instance, stimulants can make you more productive when you first use them in small doses, but later they make you exhausted.

Although every individual's situation is different, in general when individuals with addictive behavior understand that our job is to help them get the benefits of addictive behavior (such as relaxation and the other benefits just mentioned) without having to actually engage in the addictive behavior, they become open to receiving some assistance or at least making needed changes on their own. We don't label them as addicts or alcoholics. We don't insist on any particular means to ending their negative addictive behavior. We give them a way to understand the choices they have already made, and point out choices they could make now. Emphasizing choices does not look like the obvious solution when someone is making such unhealthy choices in the present. However, in the long run emphasizing choice works better for most people. Otherwise they spend their energy rebelling against being controlled instead of focusing on finding out how to make recovery work.
About the Author
A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery (Alcohol Addiction Treatment Center in San Diego), an addiction treatment facility in La Jolla (San Diego), CA, focusing on collaborative care and self-empowerment.
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