My last entry in this series was about the idea of recovery, and I mentioned AA and 12 step programs. This time I want to talk about treatment. Addicts may take a long time to decide they need help, and when they do, reliable help may be hard to find.
There is a consensus that addiction is an illness or at least an extreme response to existential angst, boredom, and stress. There is a diversity of opinions on what causes addictions, and when and how to treat addictions. There are no quick and easy treatments, and there aren’t that many treatment options.
The healing professions recognize addictions as a mental disorder – addictions are listed in DSM and in the WHO disease catalogues. There are psychiatric and psychological texts on addictions treatment. However it seems to be difficult to get a psychiatrist to work with a person with an addiction problem, at least where I live. The professional culture of psychiatry tends to favour working with a cluster of diseases that respond to medication and individual psychotherapy. While addiction is a disease, with clearly defined symptoms, it isn’t associated with any particular problems of brain chemistry and there isn’t any clear medical treatment. The medical profession has a handful of empirically tested treatment methods, but there is no particular scientific theory at work. The literature on addictions, as I noted in my last entry, is that group work is the best treatment. Psychiatrists don’t tend to get involved with supporting group therapy for addictions and only a few psychiatrists and medical doctors will work with addicts and addictions.
Psychologists, social workers and other trained professionals will work with addictions, in individual and group treatment, and there are many other self-styled counsellors, therapists and coaches who will offer services. In Manitoba, there is a government funded private agency called the Addictions Foundation of Manitoba (AFM) which offers services to the public. Once we start looking at treatment outside the medical profession and especially when we start looking at professions without licencing standards it gets a little fuzzy. Clinical psychology, social work and psychiatric nursing have licencing requirements and standards. However pretty well anyone can legally call himself an addictions counsellor without getting a licence and without any training whatever. Some so-called therapists get their training from self-help books or by experimentation and trial and error.
Last year, when my estranged wife and I realized that n. had a drug problem, we went through some programs for parents and families of addicted youth through AFM and I started attending meetings of a Families Anonymous (FA) group. There was one AFM programs, called a Parental Intervention Program, delivered through their Youth office on Osborne street and there were family programs through Christie House on River Avenue. AFM’s Parent Program was informative but not all that useful. They had some information about treatment resources.
AFM has a number of youth counsellors on staff and they tried to get kids to go through a self-assessment and into group counselling with their staff. Unfortunately n. was pretty far gone already and he avoided engagement with AFM. AFM ran a residential treatment program, but they are reluctant to take anyone who hasn’t gone through the other programs and who isn’t begging to get in. It makes sense to try other less expensive and intrusive progams first, but that system seems to put obstacles in the path of treatment. Kids like n. may need some intensive intervention and the screening process and preliminary counselling alienates them – and lets them get worse – while they wait.
I have a very dim view of the AFM family programs. None of the counsellors in the AFM Family services section identified themselves as psychologists or social workers, although they had one accredited Marriage and Family Therapist on staff. As far as I could tell, they learned on the job. They used self-help books and training videos in their presentations and apparently drew on the same material for their therapeutic models. They subscribed to diverse and somewhat exotic treatment methods including guided visualization, psychodrama, and reparenting. They were focussed on the feelings of family members. I don’t recall much discussion of harm reduction. I recall sessions on co-dependency with a strong emphasis on romantic and melodramatic jargon. I began to see the counsellors as vested in their methodology and addicted to the emotional gains of helping their clients to get in touch with their feelings, as the AFM workers believed those feelings ought to be. There was a lot of manipulation towards unlocking supposedly repressed emotions.
In their view, just about anything can be an addicting substance or experience – alcohol, prescription drugs, street drugs, gambling, food, sex, work, shopping. They said that addiction is a family system problem instead of an addict’s problem, but they didn’t seem to say too much about fixing the family. They worked predominantly within an abuser-victim model of causality. The main ideas were that addict was a victim of past trauma, dealing with distress by addictive behaviour and thereby victimizing others. The addict was selfish, dishonest, compulsive and oblivious to his own problem. They treated the partners and children of addicts as the victims of abuse. They assumed that addicted children had been wounded. They tended to look for something in the parents’ lives that might be an addiction – work, sports, anything where the parent might have followed his own priorities instead of supporting the emotional needs of his child. There was a lot of emphasis on getting in touch with one’s feelings, a lot of work on getting people to open up, not that much advice on how to live with an addict in the family. I don’t recall much advice on how to get an addict into treatment. The dominant message was to break the “cycle of abuse” by getting away from the addict – in the nicest way possible.
That advice, of course, was the only possible way to deal with an ungovernable adolescent like n., although I found the advice to be nice to rather shallow.
I think the FA meetings helped me with my own emotions, helped me resign myself to the chaos and pain in my life and offered more practical advice on dealing with an addict in the family.