Substance and alcohol abuse have a highly destructive effect on both the abuser and his/her close friends and family. Addiction, however, does not have to ruin lives indefinitely – there are steps that can be taken to recovery.
Addiction, including alcoholism, is widely accepted as a primary, progressive illness sustained by processes on the physiological/biochemical, psychological, interpersonal and spiritual levels of existence. As it progresses, it has devastating consequences on all these levels, including the lives of significant others in the addict/alcoholic’s life. In order to maximise the possibility of a sustained recovery, treatment requires intervention on all these levels. The following case illustrates such an integral approach.
DAN’S STORY
Dan (a pseudonym) is a 30-year-old man whose partner was on the point of leaving him as a result of his repeated humiliating behaviour when intoxicated. His close friends siblings and parents were extremely worried that he would lose not only his partner but his job and everything else as well. All previous attempts by these people to get him into treatment had failed, leaving them feeling powerless and desperate. They had consulted an addiction counsellor at a treatment centre who had helped them to create a ‘constructive crisis’ for Dan, which provided the leverage to finally get him into treatment. This is an orchestrated process called a structured intervention: His closest friends, family members and a colleague had prepared for a session where Dan was presented with specific examples of how his substance abuse had affected them in various ways and had committed their support if he agreed to treatment. They had also committed to withdrawing from his life if his addictive behaviour continued. Their motive was to protect themselves from the chaos and distress of being involved in his destructive process rather than to punish Dan.
CONTRIBUTING FACTORS TO THE ADDICTION
Dan’s history showed that he had started experimenting with cannabis and alcohol in his early teens and had progressed on to benzodiazepines and cocaine. In his case alcohol and benzodiazepines had remained his primary drugs of choice. There was a family history of addiction as well as seriously distorted family boundaries, with one parent consistently enabling his addictive behaviour by rescuing him from debt and other compromising situations. One of his siblings had reached saturation point and had completed the classical triangle of ‘Victim’ (Dan), ‘Rescuer’ (the enabling parent) and ‘Persecutor’ (brother). Nearly everyone close to Dan had been hooked into one of these roles, which were part of the social dynamic that maintained his problem.
MANAGING WITHDRAWAL
A low dose of diazepam was prescribed for a period to prevent complications (e.g. seizures) during the withdrawal phase of his treatment. Withdrawal from long-term benzodiazepine dependency needs to be gradual and well monitored. In addition, Dan received deep tissue massage and took mustard baths to ameliorate the physical discomfort accompanying his detoxification. This was supported by supplements, particularly Thiamine (vitamin B1).
THE POWER OF THERAPY
By his fourth day in treatment Dan was able to start intensive group and individual therapy aimed initially at penetrating and dismantling his well-developed and rigid denial system. Although he felt angry about the structured intervention, it had the effect of ‘waking him up’ from his denial. Through the process of listening to, sharing and identifying with others, he was able to see that his own perception of reality around his substance abuse was a distorted, minimising version of what had actually happened. With considerable support he was able to start understanding the impact of his substance abuse on himself and others – a painful process which initially exacerbated his latent shame, low self-worth and fear.
Nevertheless, the support of his therapist, peers on the programme, family and friends allowed him to reflect on his life so that he could eventually deeply acknowledge his powerlessness over his addiction, and accept that his old ways of trying to fight and/or camouflage his addiction had kept him trapped.
This process of surrender was enhanced by the further involvement of significant others who elaborated on their experiences of his addiction. As some of them had been traumatised by his behaviour, their involvement in a safe, facilitated process enabled them to start their own healing. Simultaneously Dan started to replace his pent up resentments towards others with greater empathy and understanding. He was appropriately moved, indeed humbled, by the willingness of many of his loved ones to forgive his hurtful behaviour. Guidance was given to the family throughout to help them understand the nature of addiction, and especially to help his enabling ‘Rescuers’ to realise that their behaviour had actually fed his addiction. They too needed to break through their old denial patterns and co-dependency. Some of them realised that just like Dan, they needed counselling to help understand their motives for rescuing Dan and to find ways of changing entrenched behaviour patterns in their lives.
A NEW BEGINNING
Having reached a point of surrender, Dan was willing to try a new approach to life in order to sustain a chemically free, more purposeful life. During a meditation on forgiveness, he had a powerful inner experience that gave him a real sense that unconditional love and acceptance were available to him. By doing exercise, spending time in nature and practising Mindfulness Meditation his sense of inner connection and spirituality were strengthened. Mindfulness practice also helped him gradually develop greater frustration tolerance and the capacity to regulate his emotions more effectively. Having reached the point of surrender, he was sufficiently open-minded to try new ways of relating to himself, others and a higher power of his understanding. He also received hope and guidance from others who had trodden a similar path of self-destruction, but who were further along the road of recovery than he was.
RESTORED IDENTITY
His identity was in the process of changing from that of an angry, shame-based using addict living a double life, isolated from himself, others and the world, to someone in recovery, more connected to himself, others and a higher power. His ability to get honest with himself and others started to restore his sense of self-worth, although he needed to continue his therapeutic process for some time after he left treatment. As someone who had grown up in a family affected by addiction, he needed to do more inner work to safely reprocess early traumatic experiences and to reclaim access to his vulnerabilities and repressed memories and feelings. Gradually this process helped him become a stronger, more authentic and com- passionate human being.
Dan continues to work his programme within the fellowships of Alcoholics Anonymous and Narcotics Anonymous, and spends a little time every day on meditation and reading. His partner also attends a support group to help her recover from the consequences of Dan’s active addiction and continues to work on her co-dependent tendency to try and control everyone and everything in her life. Dan has been out of the treatment programme for 14 months, and although ‘life on life’s terms’ is not always easy, he generally feels grateful for where he is at and values the self-respect that comes from having no secrets from himself or others.
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