I was recently speaking at an event for marriage and family therapy students and emerging professionals. It was the kind of event where students could meet others in the field who have gone in a variety of different directions and ask any questions they might have.
Some students asked about the various job opportunities available, some about how to handle the emotional stress. One question directed towards me, though, stood out. As I had been hosting the event, I previously introduced myself multiple times and touched on my own line of work. Besides working at Seattle Christian Counseling, I work in a community mental health setting, working mostly with people with substance abuse issues. The question brought to me inquired about my language, “people with substance abuse issues.”
“I noticed you never said you work with alcoholics or addicts. Why is that? Is there something that’s changing about the language in the field?” the current student asked me.
See, she is currently a chemical dependency professional branching out into the marriage and family therapy field. Her experience has been working with addicts and alcoholics, and that’s how she has always referred to the people with whom she worked.
She asked me about the use of my “person first” language, which cued me off that she already had some further understanding about where I was coming from. I went on to explain that whether for chemical dependency issues, or for mental health issues (another topic for discussion is the false distinction made there), it’s my practice to always try to identify the person first.
When talking about my work, I identify that I work with people struggling with depression, people struggling with schizophrenia, people struggling with substance abuse., etc. I don’t tend to say I’m working with depressed people, schizophrenics, or addicts. By just tweaking this language, although a small difference, helps to orient my thoughts so that I always remember the humanity of my clients, and helps my clients to understand this fact about them is not all encompassing; there is room for change and growth.
However, I also identified that I would want to respect the understanding of whoever I work with. Therefore, if a client wishes to identify as an addict or an alcoholic, I would respect that and use that language, but I always like to have that conversation first.
For some, it can be helpful to use the language of “alcoholic” to really take ownership of it and work to change it. In those instances, I would use their language. More often, though, I have found the labeling language that often accompanies chemical dependency issues to zap a lot of motivation from individuals in their recovery process.
My Background and Perspectives
Let me tell you a little bit about myself. I set out to work with individuals, couples, and families from a “systems” perspective. That’s just a fancy word the marriage and family therapy field uses to say “we care about how families, jobs, school, culture, biology… affects you.”
As humans, we don’t tend to live in isolation. Without understanding our context, it’s hard to make effective change in our own lives. When I graduated from my Master’s program, I had no inclination I would end up working with people who have substance abuse issues. Not that I had an aversion to it, it just wasn’t on my radar.
Often the people who get into this line of work have intense personal or family histories entrenched in chemical dependency, and I do not. Further, I should also note that I am not a chemical dependency professional (CDP). CDP’s deal with the sort of “front line” when it comes to chemical dependency. CDP’s will often work to address the direct using of the client and focus on coping skills to stop using in any given moment. Often they carry a high case load (100+ clients) and only get to see their clients once a month. As a result, they often don’t get to address some of the underlying issues which led to using in the first place.
To be fair, some CDP’s are doing a great job at this, too, and this is probably a significant simplification of their work. I still receive most of my chemical dependency referrals from CDP’s who want their clients to address some of the underlying issues and maintain a more active engagement in their recovery.
My career took me to working in a setting that has both a mental health and methadone/chemical dependency clinic. Most of my clients are people dealing with addiction, specifically to opioids. If you’re unfamiliar, methadone is a drug that works on the same chemical receptors as heroin and some prescription pain killers.
After extended use, these drugs have major withdrawal symptoms, and, when an individual may want to quit, the physical symptoms of withdrawal present a significant barrier. As such, methadone can work to get rid of the cravings and withdrawal symptoms, but not get clients high. However, going off methadone will result in the same withdrawal symptoms, so some clients choose to take it regularly for a very long time, and tapering off can take multiple years to do so comfortably.
Working with clients with substance abuse issues has given me a better understanding of the problem of chemical dependency as a whole. While entire books are written on this topic, my goal here is to maybe expand your thinking a little bit on the subject. If you’ve found your way to this article, there is the chance you or a loved one are struggling in this realm, and if that’s the case, then maybe I can give you some hope and direction.
What is Chemical Dependency?
So, what is chemical dependency, actually? It is a term thrown around a lot, so even I have become a bit desensitized to it, but the Seattle area is truly in the midst of a heroin epidemic. Access to heroin, especially among low income and homeless populations, is easy to come by. Many started out with prescription pain killers and blew through their savings on the pills, then moved onto the cheaper heroin. Further, more and more people are dying literally every day from overdoses. While yes, heroin is easy to come by, the problem is likely larger than just that. Chemical dependency and addiction is steadily increasing as well.
This brings up a distinction, or perhaps it’s better to say I want to sort of debunk a distinction. Often alcoholism and substance abuse disorders are thought of separately. While yes, different drugs have different biochemical mechanisms, there are similar psychosocial processes in all sorts of chemical dependency. I’ll touch on the similarities further shortly.
In general, I do not tend to think of alcoholism as something entirely different from other chemical addictions. All sorts of chemical dependencies generally result from some sort of underlying pain mixed with an environment not built to handle said pain. However, there is one big distinction between alcohol and other drugs, and that is the ease of access. Simply put, it’s “legal” to struggle with alcohol addiction, whereas other drugs require a lifestyle that skirts the law. When you’re wanting to get clean, this can be a major barrier to seeking effective treatment.
When thinking about what exactly chemical dependency is, there exists a myriad of opinions. A classic view of chemical dependency looked at things like heroin and saw them as having “chemical hooks” that cause someone to be addicted. Some look at it as a moral issue, with many churches indicating chemical dependency issues as existing entirely in the spiritual realm. Others will say certain individuals have “addictive personalities.” But what do we actually know about addiction?
We know that if it runs in your family, you’re more likely to experience it yourself. This seems to indicate there exists an element of genetic predisposition (or is it that families tend to have cultures that foster addiction from one generation to the next?). Additionally, most drugs have withdrawal components, adding to the biological side of addiction. From a Christian perspective, it seems that Christ urges us to “not be drunk with wine,” so our loving Father sees this as something that is harmful to us. However, the “chemical hooks” theory of addiction seems to be outdated.
Much of this next section is summarizing a TED Talk given by Johann Hari entitled, “Everything You Think You Know About Addiction is Wrong.” It is a fantastic talk and I encourage you to check it out, or check on the abbreviated, cartoonized version created by the channel Kurzgesagt entitled simply, “Addiction.”
Hari postulates that the chemical hooks theory of addiction is outdated. That theory came from an experiment wherein rats were given the choice between water and heroin-water, and they almost always chose the heroin, then couldn’t give it up. This was then spread to the understanding of the human response. However, another experiment with the same variables was conducted, but instead the rats were no longer isolated in boring cages, but lived with a lot of other rats and had a very lively, stimulating environment.
In this cage, rats hardly ever went to the heroin. Although we can’t run the same experiment with humans, the Vietnam war served as a sort of pseudo-experiment along the same lines. Basically, a lot of soldiers were using a lot of heroin. The fear is upon return, we were going to have a lot of individuals addicted to heroin. However, most were able to go back to their families and just give it up.
If the chemical hooks theory were true, this doesn’t make sense. However, thinking about it in terms of their surroundings (their cages), it makes a lot more sense. When in a bad surrounding, heroin seemed the good option, but when living a more happy and fulfilling life, the soldiers didn’t have the desire to check out.
So the question is, then, what do we do with this implication? Addiction is a multifaceted problem, and one of the overlooked elements of it thus far has been its social components. In working with clients with substance abuse issues, I try to focus on their environments. This means finding people who support them, having a job or volunteer position so they have something to do with their time, and ultimately finding fulfillment.
One client put it best: he told me he “wanted to have a life worth being sober for.” At the end of the day, if your life and your surroundings are not fulfilling and providing meaning for you, it is hard to find the motivation to not check out and turn to drugs. This connects with alcoholism as well as heroin, and goes beyond chemical dependency as well.
Often when we talk about things we can be addicted to (such as our phones, drugs, pornography, food, etc.), a lot of it boils down to a discontentment with life. Therapy, then, looks to explore the pain experienced and in what context it was experienced that led to using drugs to cope with that pain.
My goal for anyone who comes into treatment for chemical dependency issues is to work with you towards 1) achieving sobriety; and 2) creating a life conducive to staying sober. However, that can look daunting and seem a difficult reach. As such, I would want to work with you towards first a decrease in your use, and then baby steps towards having more social connections in your life.
I believe God made us social creatures for a reason, and any sort of recovery from mental illness or substance abuse will require creating impactful, positive relationships.
“Man in the Mist,” courtesy of unsplash.com, pexels.com, CC0 License; “Barbed Wire Fence,” courtesy of Marivi Pazos, unsplash.com, CC0 License; “Moody Day,” courtesy of Christy Joseph, unsplash.com, CC0 License; “Me and You,” courtesy of SHTTEFAN, unsplash.com, CC0 License