I was a mere first-year graduate student when I sat next to an older woman on a shuttle heading into the DC Convention center for my first day at the 2004 American Public Health Association Annual Convention. During our 15 minute ride we discussed our work as conference attendees apparently do. I didn't know it when I took that seat, but that woman - who was serving in a distingushed role within the State of Massachusetts' Department of Public Health - taught me something that day that would take me years to fully integrate into my addiction treatment philosophy:
Getting people to stop doing anything is almost impossible. Teaching them to do something else instead is much easier.
I have told many people about that bus ride and about the lesson, but recently it has become my addiction treatment mantra. My clients don't come for help because they want to quit alcohol, drugs, or anything else. They come because there are things in life they want to pursue and the drugs are getting in the way. Unfortunately, so much of the treatment we provide focuses on how to stop using that this simple reality gets lost in the mix. Our clients forget about what they want and focus on what they are not allowed to do and we lose them.
Importantly, examples of the "replace, not eliminate" method abound - Getting people with high cholesterol to stop eating red meat is much more difficult than getting them to replace a few servings of red meat a week with a healthier option. By repeating the process practitioners can nearly eliminate red meat consumption over time with much higher success rates. Getting obese children to stop eating sugar is nearly impossible but getting them to replace some of their snacks with low calorie alternatives works much better. My wife has even been able to replace most of the ice-cream in our house with healthier vegan alternatives - quite a feat for a sweet-tooth like myself - but she has never been able to stop me from eating dessert on a regular basis.
I have written about the link between the neuropharmacological aspects of drug use and the syndrome known as addiction many times. Some people who read the paragraphs above might think that they somehow negate my notion that the biology of drug use is intricately involved in the development of addictive behavior. But thinking so ignores the simple fact that motivation, attention, and behavioral choice are all part of the same biological system. Without neurons, without sodium, pottasium, and calcium flowing in and out of specialized cells there is no "using drugs," no "quitting drugs," and no desire for change. However, by having a clear understanding of the mechanisms at play, we can shape our treatment in a way that is sensitive to the machine that we are trying to treat. We can give our clients treatment that addresses their issues without trying to make them behave the way we'd like them to. We can teach them to be their best selves.
To keep a client motivated in treatment it is important to keep them focused not only on what they are trying to get away from but also on what they are working towards. Indeed, by reframing the treatment goal from "trying to quit drugs" to "trying to introduce more exercise," or "trying to do better in school," or even "trying to have a better relationship with my wife," we can keep them focused on engaging in new behavior instead of stopping old problems. And each of those goals is almost guaranteed to reduce their drug use at the same time.
During one of my recent group sessions, a client who was asked to recount why he was making this change in his life could come up with no reasons why not using drugs would make his life better. He had been sober for a bit but his motivation, commitment, and mood were obviously slipping. For him, a reminder of the bleak past might have been useful but a look towards a brighter future was imperative. Otherwise what's the point?
© 2013 Adi Jaffe, All Rights Reserved
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