For the past 15 years I have been working with persons with co-occurring mental health and substance abuse issues. One of the things that strikes me is that, even in this day of information overload, there are still several common misconceptions about substance abuse, addictions and recovery. Over the next few minutes, we will discuss each of these.
Misconception #1 Drug addiction, alcoholism, eating disorders, sex addiction, exercise addiction and being an adrenaline junkie are all separate and distinct issues.
Reality: They all can be addictions. Addictions are behaviors that people continue to engage in, despite negative consequences as a means of escaping from physical or emotional distress. This distress can be anything from utter boredom to major depression or chronic, unrelenting pain, and everything in between. To meet the criteria for an addiction, the behaviors have to have all three characteristics. It is also important to remember that people do the best they can with the tools they have at any given time. It is when their anxiety, depression, boredom gets to be so overwhelming that they turn to something outside of themselves for relief.
Misconception #2 People with addictions are “sick” or “lazy.”
Reality: The majority of people have occasions in which they use a substance or activity to escape from negative feelings. The difference is that they either stop before it starts to cause problems, or as soon as they realize it is causing problems. People with addictions “cannot” deal with life on life’s terms without the buffer of the substance. All of their coping and survival skills have, for some reason, been overwhelmed. They are not lazy or gluttonous, they are desperate and hurting. Secondly, many people who start using do not have a mental health issue when they start using. Drugs like alcohol, cocaine, opiates and amphetamines mess with the chemicals in the brain, often leading people to become depressed and/or anxious. Once they have some clean time under their belt, their brain chemicals return to normal and they start to feel better. Think about how you crash after eating a bunch of sugar, then you want either more sugar or a good strong latte to pick you back up again. So goes the cycle of drug use.
Misconception #3 The only treatment for addiction is attending and working a 12-step program.
Reality: The most effective treatment will help people identify what thoughts, situations or issues are are causing them distress, and develop alternate ways of coping with those things. Often this involves identifying what strengths and skills the person already has, and building on those. 12-step programs provide an excellent framework for doing this, but they do not appeal to everyone. Rational recovery and cognitive behavioral therapy provide alternatives to 12-step programs, however, many in the recovery community have failed to embrace the alternatives. In this day of individualized treatment and cultural sensitivity, I believe it is imperative to provide people choices in recovery. Cognitive Behavioral Therapy (CBT) helps people objectively examine the thoughts and behaviors that may be contributing to their distress, and develop alternatives. It does not have to be about bearing your soul to a bunch of people you don’t know that well, or lying on a couch and talking about your mother. To the contrary, CBT looks at how the past may be impacting you now and changing your behaviors in the present. It is solution focused and generally provides rapid relief from symptoms. Like the 12-steps, or any behavior change such as good nutrition or getting in shape, it must be a life long commitment. Once you have the tools, you cannot let them collect dust in the shed. You have to use them every day, continuing to reflect on your thoughts and actions, identifying and accepting the things you cannot change and changing the things you can.
In my practice I encourage people to identify what is going to work best for them. The 12-steps encourage people to live a life full of honesty with themselves and others, hope, faith, courage, discipline, integrity, discipline and brotherly love. These principles are relatively universal regardless of whether you are an Agnostic or a Zionist. The difference is how you embrace them. Whereas everyone needs a sober social support, what, in 12-step programs, is called a sponsor does not work for everyone. Some people prefer to have their spouse, best friend or therapist be their sober support. I find that, during their first year of sobriety, while they are developing their sober coping skills and supports, many people who reject a traditional sponsor, are more successful maintaining their gains if they see their therapist at least once per week. For people with extremely high stress situations or who have been using heavily, it is also helpful for them to be able to contact their support at least once per day for 15-20 minutes to get focused. Regardless of the method you choose, it is imperative to remember that addictions can be treated, and many people who are in recovery go on to maintain very successful career and family lives.
