HOW I WORK WITH ADDICTION ISSUES
Riley K. Smith, M.A., MFT
I, along with many people in the field of chemical dependency treatment, think of addiction as a three part problem. The three parts are Biological, Social and Psychological.
THE BIOLOGICAL PART refers to 1) genetic predisposition, 2) how the body processes the drug (alcohol is a drug), 3) increasing tolerance to the drug leading to increased physical craving and larger doses, and 4) the physical damage caused by the drug – especially the brain and liver.
THE SOCIAL PART refers to the influence of culture and companionship on drug use. There are “drinking cultures” and subcultures, i.e.: Russian, Irish, working class British, among others. For companionship most addicts only associate with other addicts so that when they aren’t using, they are isolated and lonely.
THE PSYCHOLOGICAL PART refers to the “Coping Strategy” we develops as children to weather the difficulties of life in our family of origin. Chemical dependency always serves some aspect of our survival strategy, i.e.: numbing psychic pain, checking out mentally, and rebelling, to name a few.
As a psychotherapist, I think of treatment in two phases. The first phase is focused on getting and staying sober for the first six months, focusing on the Biological and Social part of the problem. The second phase is focused on the psychotherapy part and keeping the Sobriety Plan on track.
PHASE ONE. During phase one I refer to detox and/or rehab as necessary. I educate about the process of getting and staying sober and help my client create a Sobriety Plan. I strongly recommend a twelve-step program and explain why and how to get the most out of the program. I normalize the client’s experience of withdrawal, cravings, cognitive impairment and triggers. I become a part of my client’s sober support. I explain the psychological aspect and how it works, but I don’t start the psychotherapy work.
I do, however, make use of a behavioral therapy technique called Solution Focused Therapy (SFT). The technique empowers the client by enlisting his or her own self- knowledge, strengths and desires to create and carry out a plan of action. The self-empowerment that results from SFT helps reduce the shame that is an inevitable component of addiction.
PHASE TWO. Phase two begins once a sober life-style and sober resources are in place, cravings are manageable, mood swings are less intense, and ability to think clearly is returning (usually after about six months of sobriety).
In Phase Two, I support and update the Sobriety Plan, I identify and normalize the symptoms of damage to the body from years of drug use (Post Acute Withdrawal) which sometimes can take years to fully heal, and I begin the process of psychotherapy.
A word about Post Acute Withdrawal. Terrence Gorsky, an expert in Chemical Dependency Treatment, describes Post Acute Withdrawal (PAW) in his book Staying Sober (Independence Press). PAW is essentially the physical, mental and psychological symptoms of the physical damage caused by drug use. It becomes an important consideration once Detox is complete and the body is clear of the drugs and the direct effects of the drugs.
Depending on the drugs involved, there is organ, brain and neurological damage. Some of the damage can heal easily and quickly once the drug use ceases. Some of the damage takes quite a while and some doesn’t heal at all. The extent of damage depends on the kind of drugs taken, the quantity, the length of use, and the overall health of the addict.
Some typical symptoms of PAW are memory loss, memory lapses, extreme mood swings – rages and depressions, hangovers without having used, lack of coordination, using dreams and sleeplessness.
Awareness of PAW is essential for people in recovery. Addicts in recovery need to understanding that the symptoms are normal, to be expected and that they will pass. Without that understanding the symptoms are frightening and the fear greatly increases the likelihood of relapse.
PHASE THREE, the process of psychotherapy. I work with addicts basically the same as I do anyone else. However, when I work with addicts, I focus more on the addiction as a grown up adaptation of a survival or coping strategy from childhood. I am also alert for the issue of shame and how using is to avoid the shame at the same time it perpetuates it. I teach how to track emotional states and self-care so that they don’t get caught in the relapse process. I also recognize and acknowledge that I am part of my client’s sober support system.
I won’t detail that process of psychotherapy here. That’s a topic unto itself and I will cover it elsewhere. (see wikipedia: Integrative Body Psychotherapy)
WHAT I TEACH MY CLIENTS IN RECOVERY.
Withdrawal and post-acute withdrawal
Developing a sobriety plan
Tools for dealing with cravings and triggers
Relapse and relapse prevention
Health issues, diet and exercise
Getting the most out of a twelve step program
TREATMENT ISSUES IN RECOVERY:
ISSUES IN EARLY RECOVERY (first 3-4 months).
Acceptance of the Problem
Decision to Change
Building a Sobriety Plan.
Building a Sober Lifestyle.
Shame Free Sober Support.
New Sober Friends.
Learning Sobriety Techniques.
Guidance and Validation from People Who Know.
Relapses and Starting Again
ISSUES IN MIDDLE RECOVERY (3-24 months)
Post Acute Withdrawal.
ISSUES IN LONG TERM RECOVERY (2 years on)
Sober and Fulfilling Lifestyle.
Ongoing Contact with People in Recovery