When I facilitate groups or sit with individuals with a long history of alcohol or drug use the first thing they tell me is their drug of choice. In most cases, the second thing they tell me is that they want to stop; in other instances they're mandated and just have to comply and complete a drug treatment program. However, neither of the first two things they tell me is actually the first step to treating drug addiction. Someone can use drugs, want to stop but not necessarily admit that their drug use is a problem. Their problems may be how they treat their family, neglect their responsibilities or damage their bodies. Without the consequences of drugs, there would be little incentive to come in to treatment or stop using drugs.
Naturally then I ask how the drugs make them feel? Often they tell me things like it helps them sleep, helps them focus, eases their temper, or helps them feel more confident. Addiction expert Gabor Mate pointed out that none of these desires are exclusive to those that use drugs, and that addicts just wants things that everyone wants. Each of us wants to sleep well, focus on our tasks, remain calm in times of stress and to feel confident. He describes that addiction should not be seen as the problem but the addicts attempt to solve a problem. Furthermore, it begs the question as to what is preventing the addict from getting these things in their lives without the drugs?
Although the treatment of intense drug use is slightly beyond the scope of this blog, we can look at the development of an addiction. "Hell is a road paved with good intentions" is a quote I found applicable to the development of an addiction. Often it can begin as an innocent drink on a Friday night after a long week of work. The problem emerges when an individual begins to become physically reliant on the substance and will begin to see it as the primary way of coping with stress. Furthermore, the substance may also arrest the individual's ability to develop new ways to cope for years, eventually leaving things like exercise or social relationships as a seemingly unattainable tool. Substances remain constant, friends come and go, and the addiction strengthens both in the person's mind and in their body.
In particular, the REBT model of psychotherapy disputes that an activating event necessarily leads to a particular consequence. With addiction, this can be described as a trigger followed by drug use. Many drug treatment programs aim to strengthen the recognition of triggers because they can be so powerful that no amount of mental jiu-jitsu can combat the urge to use. This can be incredibly useful, but what happens in between the trigger and the drug use? Usually some thoughts, then some emotions and then the behavior – taking drugs. So a good therapist will help identify triggers, unhelpful thoughts resulting from those triggers, the emotions that follow and need to be ‘escaped from’ and then try to replace the drugs with a new form of coping mechanism that is healthier.
REBT becomes an important way for the individual to begin to develop a voice within them that challenges inflexible beliefs, enforces helpful beliefs and in turn forms new behaviors and better ways to react to stressors.