Addiction, Needs, & Compassion

For many people – those working in the addiction field, or those experiencing an addict in their lives – it can feel frustrating that the addict keeps using.  We might feel they are being selfish, lazy, and irresponsible. We ask ourselves, “who would put up with not showering, living on the streets, stealing, selling themselves for sex, injecting their heroin with dirty puddle water, and on and on?”  “Those people are disgusting!”  “I can’t stand addicts!”  “I hate working with addicts, they’re always trying to get something from me!”  These are just some of the lines running through our heads at times.  The last thought is “why don’t they stop?”  The million dollar question.  Some answer through a biological explanation, others an adaptive explanation, others a spiritual explanation, and some a social learning explanation.  It is all of these.  But for this essay I want to focus on a more adaptive explanation and one that is more concerned with an ongoing internal process in the here and now, one that concerns itself with the meeting of human needs.

It’s obviously hard to have compassion for those abusing substances.  But, really, that is the easy reaction to have.  Staying there only keeps one in the dark about the addict and about themselves.  Dr. Wayland Myers, PhD, has written a document about “Defining a Nonviolent Communication Approach (NVC) to Addictive Behaviors.” In this he explains how Marshall Rosenberg, the founder of NVC, tries to approach the addict by using empathy and trying to understand what needs are being met by using.  He does not try and get addicts to stop using.  Substance abusers are usually quite perplexed by his approach because they are used to everyone trying to get them to stop.  His focus is on needs so that he can proceed in helping that person meet those needs in ways that are “more effective and less costly.”  This is not easy for many people in our society as we want to FIX people.  It is tough to give up coercive measures, confrontational approaches, and parental directives.  As helpers or loved ones we can often feel helpless, out of control, and frustrated within the paradigm of judgment and control because it becomes a negative feedback loop. Pushing our goals onto someone else may work in the short term, but usually, though, backfires, and can often perpetuate disconnection, a need all humans value.

 So why do we continue to stay in this place where we NEED substance abusers to stop? Why do we work so hard FOR SOMEONE ELSE?  Why do we feel so out of control? Why do we get frustrated, angry and hurt by their use?  It is usually more to do with our own needs not being met.  As helpers, we must connect with our own needs in order to connect with another’s.  It is also a paradigm that we are in that using is wrong and we must “intervene”, we must “challenge” them, we must, we must, we must.  “They don’t know how to live life”, “they are irresponsible”, “they have mental health issues”, “they have a brain injury”, “they are still a child”, “they experienced trauma” – ultimately we are invading their sense of humanity, their internal world, their “creative adjustment” as described in Gestalt psychology. Using, for many, has been a very creative way to cope, adjust, and stay alive.  It has become an organismic adaptation to life experiences. Why do we want to pull this carpet out from under them so quickly and harshly??

 Instead of making all these assumptions and judgments, we need to “connect” with addicts as in NVC, or make “contact” as in Gestalt psychology. Take away the stories, take away the judgments, and learn what is there.  What need is being met by all this using.  Can we help this person make contact with their own internal world so that they can at least value their own world?  Shame is the result of continuously denying one’s own experience.  We can blast away shame by listening, connecting, and helping those who use to become more in tune with their needs and their internal worlds.  We must remove our judgments and need for control so that we can offer humanity to someone.

 From an existential point of view, it is that person’s responsibility to take control of their life how they see fit.  From a person-centered and gestalt psychology point of view, all human beings are moving toward growth in some way.  We can either help them get there taking which ever roads fit best for them, or we can weigh them down on the road of addiction. The more we focus on getting them to stop the addiction, the longer they only focus there and stay on that path.  The quicker we begin walking with them on that path instead of hurrying them off, the quicker they will want to explore other options.  Once someone feels truly supported and understood they will feel the energy to take on new experiences.

 So, what are their needs? How can you help them connect to their needs?  If you are addicted, how are you not connecting to your self?

 Lastly, I want to make a quick point here about boundaries.  Nowhere in this approach or understanding does it say let substance abusers or anyone for that matter treat you however they feel like it.  You do not have to just sit there and accept all behavior toward you to be compassionate.  It is important for all humans to connect to their own needs and express these honestly.  So if you are feeling manipulated, hurt, taken advantage of, etc, then calmly express this to the person so they understand.  We must meet our needs as helpers as well and do not need to allow dysfunctional ways of relating to hurt us for the sake of “compassion.”  This is not how it works.  The compassion and connecting are to the person and the unmet needs, not to allowing yourself to be treated in ways you don’t want.

Compassion: what are we waiting for?

I know I said I was going to visit the existential theme of Responsibility next, but I have been motivated to write on a different topic.  I will write plenty on responsibility, believe me. Moving along….

I was reading a book that my wife took out of the library the other day called Above All, Be Kind: Raising a Humane Child in Challenging Times, by Zoe Weil. I know, my posts are starting to have a theme of starting off with some passage of a book or some idea from a book.  It’s a good place to start – someone else’s ideas that is. I was just sitting with my 2-year-old daughter as she was in her bath this evening, and picked up that book to glance around.  I ended up reading a story the author told about a boy with mental and physical disabilities who wanted to play baseball with a team.  Up until that point his father was protecting him from embarrassment and only played ball with him in their back yard together.  One day the father came home and began to play ball with his boy and the boy just stood there with his head down.  His father asked what was wrong and the boy said, “I want to play on a team daddy.”  The father realized he had to take a risk and took his son to the local baseball park.  There was a game going on with the boy’s peers and one of the coaches allowed the boy to bat for their team.  The pitcher of the other team, not knowing the boy, realized his disabilities and walked closer to offer slower, under hand pitches, and after the boy finally hit one that did not go very far, they allowed him to run all the bases and score a run.  The boy was just ecstatic!

The point is that we can raise children to be like that pitcher and the rest of his team.  What stands out to me is why do we have such a hard time being this humane with one another in everyday life? We are so mean, cold, and cruel to one another. To be honest, I would normally read that story and feel manipulated to “feel compassionate”, but for some reason it struck me this time as a phenomenon that does not occur enough in our lives as humans. Instead we get angry driving, we react to coworkers in negative ways, we complain about our loved ones, and we assume others will hurt us. Many of us have experienced moments of compassion at some point in our lives but it happens much less than moments such as the story above.  What if our world could bottle up this type of understanding, compassion, and love, and spread it around? Even writing about this feels overly sentimental and my “realistic” side says, “oh cmon, that’s not going to happen.”  Why not?  Why do we have to live with so much negativity, anger, and divisiveness?

Addiction brings about the entire continuum of compassion, or lack thereof. Many humans in addiction find community, belonging, and friendship in other “users”. They take care of each other in more humane ways than the “together-folk”. We judge what we don’t know and feel uncomfortable with, and this happens quite a bit toward a community (addicts) that craves connection, love, and humanity. Granted, substance abusers can also live on the other side of this continuum and hurt others, steal, abuse, and neglect those they love. But working in addictions brings this need to life like no other. Working in a treatment center brings this to life as well.  Sometimes I watch clients be so gracious and helpful to one another, or hear stories of the like, that re-establish my belief in the goodness of human beings. One of my hopes is that we can facilitate this type of compassion in our center and program that wakes up and enlightens our staff and clients to remember our deepest human need: connection.

As people, can we not push through our own bullshit, our own past hurts, our own projections, and find ways to connect with one another? We can, but ultimately it is one scary endeavor for many.  If we truly connect and love, this requires transparency and vulnerability, which could end up in us being hurt. Most humans, addicts or not, have been hurt by other humans, whether it was in childhood, adolescence, or adulthood.  More times than not, it has been deep hurt. This makes it quite difficult to allow one’s self to connect deeply to another, and yet this is one of the very things that helps us heal. Group therapy is very healing for our clients who find themselves sharing with strangers more intimate details than they ever have before?  Why is this? Because we all crave closeness, intimacy, and authenticity, and once we see it we are willing to risk. There is nothing more powerful than numbers and many times there is nothing more healing and powerful than a connected and transparent group of humans sharing from their hearts their deepest hurts and regrets. This, in turn, brings out the raw humane compassion that occurred in the story at the beginning of this writing, and something I hope for in the relationships I find myself in, and the world at large. A man can dream.

Life is Difficult

M. Scott Peck wrote in his first page of The Road Less Traveled:

Life is difficult.

This is a great truth, one of the greatest truths. It is a great truth because once we truly see this truth, we transcend it. Once we truly know that life is difficult – once we truly understand and accept it – then life is no longer difficult. Because once it is accepted, the fact that life is difficult no longer matters. Most do not fully see this truth that life is difficult. Instead they moan more or less incessantly, noisily, or subtly, about the enormity of their problems, their burdens, and their difficulties as if life were generally easy, as if life should be easy. They voice their belief, noisily or subtly, that their difficulties represent a unique kind of affliction that should not be and that has somehow been especially visited upon them, or else upon their families, their tribe, their class, their nation, their race or even their species, and not upon others. I know about this moaning because I have done my share.

Life is a series of problems. Do we want to moan about them or solve them? Do we want to teach our children to solve them?

This is an issue that runs rampant in our North American society and is most aptly represented in the social issue of addiction. It is also quite a stumbling block to healthy living and lasting recovery for many substance abusers. We can offer many tools to help with relapse prevention, we can offer tools for better communication, emotional expression, and spiritual connection, but there are some fundamental, or existential, truths that are a part of human life such as “life is difficult,” and without these we are not truly helping some people.

“Pain.” “Fear.” “Difficulty.” “Uncomfortable.” “Anger.” We tend to call these “negative emotions.” Isn’t that interesting? We should be embracing all emotions as messages from our true self, our soul, our inner being, whatever you want to call it. Why do we run so quickly from pain or difficult emotions? Many people run from happiness for all its worth! But as Peck describes, we must accept that pain is a part of our existence, and when we do accept it, it becomes a non-issue, it dissipates. Next time you even feel physical pain, go into it, sit with it, explore it – let it wash over you. Do the same with fear, anxiety, or anger. You won’t die, but what you will find is a sweetness in your connection to a deeper self. We are so afraid of ourselves that we ignore the messages we are communicating to ourselves. The times I have truly allowed myself to sit in pain, it has actually felt good – like a unexpected positive aftertaste.

There is a large part of addiction that begins with “pain management.” Listening to the stories of substance abusers offers many reasons why one would utilize pain management. The abuse, the neglect, the abandonment, the grief – the injuries and chronic health problems  - it is all horrific, sad, and unfortunate. In following, one who has experienced these things must then grow up in a society that does not know how to deal with pain. We want to medicate it, diagnose it, or avoid it all together. The most logical explanation in that type of world? Anything, and I mean anything, that will dull the pain that everyone is so afraid of. Welcome Addiction, to our society. Granted, addiction is somewhat more complex than just an overall avoidance of pain, both physical, emotional, and spiritual, but it is a very, very large part.

So, it is my hope that we as a society, and the work that goes on in the treatment center where I work, begin to see pain and difficulty differently. We need a paradigm shift. We need to embrace all of human experience and emotional responses. We need to have parents and teachers feel more comfortable with a child’s pain so that children can grow up and not fear pain. I’m not saying that pain would then no longer hurt. We cannot escape hurt and pain, but we can certainly embrace them more authentically.

I, like Peck, have done my fair share of moaning and groaning. I probably do it everyday. I love moaning and groaning as though it were a past time of mine, but I’ll tell you what – it gets me absolutely no where! I end up powerless to whatever I am moaning about. I give away my power. I give away my responsibility. The desire to avoid pain and difficulty also moves us to blame others. I will visit the existential concept of responsibility next.

Self Esteem: its importance in addictions and life in general

Every now and then I like to get black and white and dogmatic.  Usually, most dogmatism doesn’t really make much sense, because everyone is so different, experiencing the world in unique ways.  But, there are times when I knowingly contradict myself, and here’s a time I’m going to do that. 

Self Esteem is the number one biggest trait to develop in a person with addiction.  It is the number one “problem” killer.  It is what any person struggling with life should look to improve.  I listen to clients everyday express their lack of self esteem, but they may not always explain it that way.  Other times, many clients know they have poor views of themselves.

What is self-esteem, anyway?  Is it just feeling good about ourselves?  Is it feeling confident?  Is it loving ourselves?  Is it just accepting who we are?  It’s all of that and more.

Nathaniel Branden breaks self-esteem down into six key pillars in his definitive work on the subject, called, The Six Pillars of Self-Esteem.  If you are looking for a comprehensive look into what self-esteem is, how to notice it in your life, and how to improve it, then his book is the way to go.  

Branden’s Pillars are:

1. The Practice of Living Consciously
2. The Practice of Self-Acceptance
3. The Practice of Self-Responsibility
4. The Practice of Self-Assertiveness
5. The Practice of Living Purposefully
6. The Practice of Personal Integrity

This view of self-esteem is more of a philosophical orientation to life.  If you are practicing these six concepts, then you are on your way to strong self-esteem. 

In terms of addiction, or anyone struggling, self-esteem is the foundation that we need.  It was also the foundation that was never built.  We cannot work on our relationships, without a better sense of self; we cannot work on our careers without a better sense of self; we cannot work on our communication skills, our assertiveness skill, our boundaries, or our inner life, without an improved sense of self.  That being said, working on some of the previous mentioned things, help contribute to self esteem.

Why is it so important in terms of addiction?  For two reasons: 1. Humans struggling with addiction usually had some sort of trauma, abuse, or overall dysfunction in their lives that directly worked against their healthy sense of self.  Their experiences told them they didn’t deserve better, that they were not worthy of better treatment or better lives, and that overall, who they were didn’t matter.  2.  The second reason is because for a long time now, those struggling with addiction have been told they are powerless, and have been treated poorly by our society.  If someone is told that they cannot help themselves, and that they must live with this “affliction” for the rest of their lives, how are they going to get to a place where they feel good about themselves; good about their accomplishments; good about being a responsible human being?  How are they going to be able to help themselves?

Even if one would like to argue that God is ultimately in control and we need His help to grow and change, and live with our problems, one must also remember that Jesus told the lame man to “pick up his mat and walk.”  Jesus didn’t walk for him.  Jesus enabled that man to believe in himself, that he actually had the power to walk.  That lame man was just wallowing in the pool of helplessness.

To do any changing in our lives, we have to do the changing.  We have to listen to our emotions, we have to notice our irrational core beliefs, and we have to change the ways we react to situations.  Change also needs motivation, and believing and understanding that we have the power to control our lives (granted there are things outside of our control) is going to propell us into a state of self-responsibility, freedom and autonomy.

I love Branden’s pillar, The Practice of Living Consciously.  The opposite of that is living obliviously.  Those struggling with addictions are living obliviously, as they cannot possibly be consciuos in the fog of addiction.  Living Consciously means paying attention; being aware; being present; and being in control.  Living Consciously means that we notice when we are over-stressed and need to make changes; it means we notice that living in alignment with our gifts and abilities strengthens our lives, so we put them into action; it means reflecting on our wishes and desires, as well as practical issues when making decisions.  Overall, it shows you care.  It shows you care about each aspect of your life with which you are consciously aware.

Simply stated, self-esteem improves the more you get back in touch with who you are.  Who are you?  Only you can answer that question.  Do you accept yourself, and do you believe you deserve a good life – a life that is created from the depths of you?

Hopefully you can see how important self-esteem is, and why developing it will greatly increase one’s ability to stay clean, or break through roadblocks.  It may not remove one’s cravings completely, but it certainly will give you the energy and ability to care for yourself in such a way that manages those cravings.

Consequently, self-esteem is not so simple.  Many who think they are confident, or look confident, actually are not so much.  Self-esteem also runs deeper than confidence, and is rooted in many different facets of our lives.

So start pouring that foundation by taking care of yourself, and beginning to learn how to get in touch with your wishes and desires; begin to live more consciously instead of obviously.  And begin molding that foundation by putting some of these life-concepts to work.  Branden’s Pillars are great places to start. Remember – to change, you have to change.

Finally,it will be hard to build your self-esteem if necessary grieving has not been done.  If there is unresolved pain inside, and we are not honoring that by expressing it somehow, then we are always working against ourselves.  That will be a topic for another day.

Go take care of yourself. Pay attention. Stay conscious.

The Bio-Psycho-Social Approach to Addiction: An Introduction

Why have an alternative to 12 Step if it helps so many people?  Good question.  It does help many people stop drinking and drugging, but it also has not helped countless others.  The 12 Step approach is quite specific with its focus and quite narrow in its scope.  Addiction is an intensely complex problem that needs a broader, more holistic approach.  The Bio-Psycho-Social model of addiction brings just that – a broader, multidisciplinary approach to the treatment of one very complex problem.

There is no one-size-fits-all approach to treating addcition because everyone has different needs and different history and different personality constructs.  The whole idea of a one-size-fits-all approach is very modern in its philosophical orientation, and our times have changed.  Our world and our thinking is much more complex, with many more options, and new problems, that we’ve had to grow out of a modern way of thinking to a postmodern way of thinking.  Life is not as simple as it was in the 50s, where a simple approach like the 12 Steps may have worked just fine.  Life has changed, and so too has our problems.  With this, we need to see the importance of more holistic approaches to life’s issues, and a broader understanding of our lives today.

The Bio-Psycho-Social (which will be referred to as BPS from now on) approach says there are biological reasons for addiction, psychological reasons, and sociological reasons as well.  Taking this into consideration, we must attack this problem multidimensionally.  We cannot just look at someone’s drinking, or drugging.  We cannot just look at someone’s emotional life.  We cannot just look at someone’s relationships.  We need to look at all these major aspects of human life for some answers to our issues, whether they be addiction issues, or other life problems.

Biological

At the present time, it is still a mystery whether or not there are specific genes passed down that determine whether or not someone will develop a substance abuse problem.  We do know that there are likenesses among the chemical makeup of people with addictions.  We also know that we are chemical people, and that the chemical addiction can become quite strong for an addict.  So whether it’s hereditary or not, doesn’t really matter.  What matters is that we respect the fact that we have natural chemicals in our bodies and messing with that can become harmful.  Also, not taking care of our physical bodies, can lead to relapse, as we may become fatiqued, stressed, or malnourished.  Biological explanations can neither be worshipped, nor ignored.

Pyschological

For a long time, the focus on applying psychological principles to the problem of addiction, has been minimal, if not scarce.  Because many have believed addiction to be a disease, the idea that some of our psychological construct might contribute to addiction has been missed. 

A large percentage of the clients I see everyday have experienced either serious to severe abuse in their childhoods, or, at the very least, a problem of overall family dysfunction to the point of pain.  It can easily be followed that these very individuals eventually turned subconsciously to drugs or alcohol to cope with, or adapt to, the inner pain they felt.  Many people have “stuffed” their emotions, or found ways to block out their pain.  These same people also developed irrational beliefs from the abuse and dysfunction since they were only children and did not know any other reality.  It is to be followed, that one would need to look at the way they have processed emotions, and the way they have developed their core beliefs, in order to better understand themselves.  When they better understand themselves, they can better deal with some of the reasons why they may be using.

Sociological

We are also very social beings.  Whether we hate society and groups of people, or find ourselves craving the attention of others, we are affected by people.  One of the biggest “frustrators”, or stressors, for clients dealing with addictions, is their relationships.  A bad argument, or relationship in general can leave one with a substance abuse very frustrated and exhausted at running into the same “wall,” taking them out to use.

We all see ourselves differently within the society which we are a part.  Some identify as minorities, some as women, some as men, some as lower class, some as upper class, some as outsiders, some as different, some as special, and some as just being a part.  How we see ourselves within the society around us has a very heavy influence on our self-esteem; and our level of self-esteem has a very heavy influence on the contribution to using substances in order to cope or adapt.  

As we can see, life in general for human beings is complex.  Substance abuse is complex.  Therefore, the treatment and understanding of addiction should be complex, or multidisciplinary.

Again, it is not my point to put down 12 Step philosophy, but to express the need for this very effective alternative in an age of ever growing complexity.  The 12 Steps have many helpful steps, and their overall focus of community is extremely important.  There are though, some fundamental and philosophical problems with certain Steps, and I will go further into these as we go along.

Until then, let the idea of an alternative approach sink in for those of you looking for one.