Gotta Have It Now – Part Two

Part One | Part Two

Part Two: New Pathways into Treatment

By: Jean Johnson for Body1

“Back when I tried all this talk therapy for compulsive eating,” Jane Nombra from Portland, Ore. said about her experiences in the early ’90s, “the woman I saw finally stared at me one day, practically waving her box of hankies in my face. Here’s what she said: ‘the bottom line is you’re going to have to start feeling your feelings.’”

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Get Help That Works James Mol, Ph.D., program manager of adult outpatient behavioral health services – Providence suggests that when looking for a therapist people ask about their theoretical framework (the therapist and counselors approach to change and how they view what helps in therapy) or if they use the stages of change model. The National Library of Medicine suggests the following signs as indicators for possible addictive behaviors: Change in friends Hanging out with a new group Reclusive behavior - long periods spent in self imposed isolation Long, unexplained absences Lying and stealing Involvement on the wrong side of the law Deteriorating family relationships Obvious intoxication, delirious, incoherent or unconscious Changes in behavior and attitude Decrease in work or school performance

Nombra says even the sound of the words “feeling your feelings” seems corny if not creepy to her. More, she admits to being quite threatened by the Kleenex box and the apparent expectation that she was going to march into a therapist’s office and “spill my guts.” Currently she is in Overeater’s Anonymous and works a 12-step program, but there as well, Nombra has found little solace. “All their little sayings are so insipid. What’s worse, I don’t see people really getting a handle on their food problems. It’s sort of like a fat person’s social scene. I just go because I don’t know where else to turn.”

New Pathways into Treatment

Even though addictions often seem impossible to resolve, psychologist and program manager of adult outpatient behavioral health services at Providence Portland Medical Center in Portland, Ore., James Mol, Ph.D., offers hope.

“From the perspective of psychology, there is generally more a person can do to help manage the symptoms of psychological problems than they can do for medical problems.”

For starters, Mol observes that insight alone or self-reflection that enables people to understand themselves at a deep level is useful. “We don’t live in a culture where people examine their lives adequately. So this is a way people can seek help through things like 12-step programs or by working with trained professionals to gain understanding into their thoughts and behaviors, and how to cope with them in better ways than they habitually do.”

So far, the Nombras of the world are probably not very encouraged. Still there are relatively new theoretical models that some professionals, including Mol, are finding to have considerable validity and usefulness. Developed by Prochaska and DiClemente in the 1980s, the “stages of change” model departs from the old “disease” model of addictions in significant ways.

“In the extreme version, professionals operating under the disease model of addiction tended to confront the person in denial and when clients denied that they had a problem, the counselor would conclude that the person wasn’t ready and move on to someone else they thought might be,” said Mol. “Black and white thinking characterized this approach, but as treatment providers started to acknowledge that people with addictions are at different stages, they became better able to develop strategies of engagement that worked.”

If all the “strategies for engagement” are starting to sound like a battle plan, you’re getting the message. Finding a way into the door of dealing with addictions does indeed take some doing. That there is a door – of sorts – and that professionals are looking for less authoritarian and less confrontational ways to open it, however, is cause for great heart.

Indeed, perhaps the approach James Mol describes might be the ticket for people like Nombra. With the new model, professionals first try to establish what stage a person is in – pre-contemplative, contemplative, action, or maintenance. “The first is when the person is not interested and says they don’t have a problem – for example that their wife sent them in. Then in the contemplative stage it’s more like ‘I’m not ready to give up my drug, but I have noticed there’s a problem to some extent and I’m considering making some changes.’” Action and maintenance stages, of course, are fairly self-explanatory.

Mol goes on to discuss various approaches that professionals can use to help addicts move through the stages of addiction into freedom from their substance or behavior of choice.

“It really helps if I talk with my client about what’s positive about their addiction, not just what’s negative. That way they will see me as someone willing to really listen to their truth and through that our dialogue might lead to opening a door. Also, then it’s not just the therapist driving the agenda with their assumptions.”

The gist here is “to meet the person where they are,” said Mol. “For example, if they are convinced they have an alcohol problem, then you start engaging them at their high level of motivation to make behavioral change.” Similarly, if Mol is working with a client who says ‘I don’t want to talk about this any more,’ he might ask ‘well, what would you like to talk about?’ The idea, Mol explained, is that looking for segues into a conversation “rather than bumping up rather aggressively about a person’s denial” is more helpful.

In addition to respecting a client’s willingness and particular stage, Mol and other progressive psychologists who have kept abreast of recent developments in their field are finding that pointing out discrepancies can help addicts come to terms with their problems. Situations in which discrepancies are apparent “are opportunities to ask questions about things that don’t quite fit together,” said Mol. “Like gambling in pool halls on weekends. A client might talk about the friends they meet there and the excitement and pleasure the activity brings, and then I might say, ‘but I remember when we first met, I thought you said you’d been losing a lot of money for months now, so how does that play into this?’ There’s not just a confrontation here, but instead pointing out the observation that the client has previously made themselves that there’s an upside and downside to the behavior.”

Chinese Philosophy Related to Addiction

“In Chinese medicine they say one of the reasons for human existence is the cultivation of self,” said doctor of naturopathy and licensed acupuncturist at Providence Integrative Medicine Clinic in Portland, Ore., Loch Chandler, N.D., L.Ac. “It’s the idea that painful events are opportunities for growth – for cultivation.”

Chandler explained that in his opinion, “addictions are typically ways to mask pain or distress or discomfort. The addiction helps distract the individual from dealing with whatever’s bothering them. The problem is that part of basic biology is avoidance behavior. Simply stated, we avoid pain and seek pleasure.”

Consequently, Chandler suggests that people with addictions benefit from counseling. “Seeing a counselor or psychologist gives people the opportunity to work through their challenging issues since the therapist can carry the belief possibility of wellness for the client until they are ready to. In these settings,” said Chandler, “instead of trying to avoid the discomfort, clients can ask themselves why they are feeling the way they are. This kind of inquiry – as opposed to judgment – can in a sense free the individual from the power their pain has over them.”

It’s not easy, though, Chandler cautions. “I talk to my patients about how the process is an opportunity for learning – for cultivation. It was Thomas Edison who said, ‘opportunity is missed by most people because it is dressed in overalls and looks like work,’” he said. “Going back and talking through difficult situations in one’s life and self esteem issues and loss of love can be a bitter pill to swallow. Life is a balance of the pain and pleasure. That’s the yin and yang of our experience. We can’t have good without pain. We can’t feel what soft is unless we’ve felt something hard.”

As far as why some people are prone to addiction, Chandler again draws on his training in Eastern philosophy. “Addictive tendencies often occur when there’s a family history and addictive behavior is modeled during someone’s early years.” Then again the naturopath thinks it would be a mistake to overemphasize the nurture argument.

That said the main thing Chandler returns to over and again is that pain is an opportunity to cultivate oneself; the painful times are the richest times of learning. The idea is to get professional help in order to begin to open whatever can of worms it is that troubles. Indeed, for addicts that don’t, the prognosis is poor.

“In the instance of drug use, for example, – which in my mind is no better nor worse an addiction than all the others including the workaholic – people typically don’t go straight to using heroin. They start out with alcohol and marijuana, and then maybe to sprinkling some heroin on a joint, and so on,” he said. “What happens is that they build up a tolerance to the substance or behavior or the pain-numbing effect lessens. Whether they realize it or not, they are saying, ‘this isn’t covering what I’m trying to cover, so I need more.’”

Last updated: 12-Jul-06