Back to Basics

So what really drives our clinical decisions in the field of addiction? How do we end up ascribing to a particular clinical philosophy, therapeutic approach, or modality? Our graduate education, early career mentors, and entry level experience could definitely have played a major role in our professional identity. But at the same time, we must go back to basics and ask the fundamental questions that have profoundly shaped us as addiction professionals.

These fundamental questions are:

1. What do I think addiction is?
2. How do I think addiction develops and is maintained?
3. How does one recover from addiction?

Those entering the field as university students hold ideas in regards to their answers to these questions. It is also important to consider the prevalence of individuals in recovery themselves who enter the field of addiction treatment. They have their answers to these questions as well. And sometimes, these answers are held with strong conviction.

We know that the answer to these fundamental questions could have been informed by society, by family experience with addiction, by personal experience with addiction, and by media exposure; all these, even prior to any formal education on the topic.

A common pathway for those entering the field is to ascribe to a therapeutic approach or modality that validates their pre-existing answers to the fundamental questions. We can be quick to cherry pick research findings that support what I already knew. And this is OK. You would want the work you do to be aligned with your personal beliefs. In this sense, the person is attempting to reduce cognitive dissonance.

We could imagine the differences in answers to the fundamental questions between a professional that believes in abstinence based recovery versus one that believes in harm reduction. Between one that believes in an acute model of care versus one that believes in long term self-management.

As one progresses through their professional development, one could be encountered with diverse therapeutic approaches, shifts in society’s view, a supervisor that will push the envelope in a different direction, new research, and maybe a different job that implements a different clinical philosophy. The one constant is change.

Can I allow my answers to the fundamental questions to grow and change over time? Do I still believe addiction is the same concept I believed in 20 years ago? Do I still believe people recover in exactly the same way as how I thought when my career began? Or am I changing and evolving my views?

How we remain open minded and are able to embrace this change becomes a necessity in our fast-evolving world. Not only for our professional sake, but more so for those we serve. At the end of the day, it becomes a question of ethics.

This is not only an addiction professional issue. Those we serve, our clients, are also fellow travelers in this journey. They also present themselves to the treatment episode with answers to the fundamental questions of what they believe addiction is, how it was developed and maintained in their specific cases, and what they could do to recover. The answers to these questions are not always overt or ordered neatly in their minds, but even in cases as such there are underlying beliefs about these issues that directly affect their engagement in treatment.

The work that I can do as a helping professional in understanding the client’s answers through their perspective can go a long way in the development of the therapeutic alliance and in a positive outcome. How flexible and adjustable I can be as the professional is key. For this flexibility to seem authentic as it translates to a helping relationship, I must have been witness to diverse experiences that can enrich my capacity for multi-level empathy.

As you close your eyes and reflect, how can you answer what addiction really means to you today? How do you think it develops? And how do you think people really recover? The answers really matter to what we do as helping professionals and to those that seek our help.

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Increase your happiness in a powerful way: Gratitude

Knock, knock. Who’s there? It’s gratitude!

One day, a few years ago, I was directed towards a challenge: I was asked to think about a person that had been kind and had done something beneficial for me, but that I had not thanked properly. I was told I could think far back into my life, but to think of someone who was still alive.

After reflecting for some time, I began to think about a high school teacher that had been particularly impactful for my life and my world view. I remembered how this teacher challenged my thinking and helped me remain true to myself and my opinions. He was for sure not part of the status quo; a man not afraid to shake it up and get in a little trouble while doing so.

So I wrote a letter that described the profound impact this teacher had on me and my history. I looked this person up and I found a university newspaper article from Ohio which was titled “He’s not your usual professor.” Before starting to read, I knew it was him. I wrote an e-mail and we establish contact.

Luckily enough, we were able to set up a meeting for dinner. I had my chance. I expressed openly and whole-heartedly the content of my letter. It was a highly emotional experience for me. I felt overwhelmed with gratitude and joy. The experience helped me realize that I had not been alone, not only as it related to this encounter but with many others in my life. There had always been individuals that had help guide my path, although I had not been aware of it at the time.

The man sitting in front of me, my teacher, seemed taken by what was going on. He responded by saying that he had no idea of the impact he had on my life. After seeing hundreds, if not thousands, of students in the previous eighteen years it could be difficult to discern who got the message and who did not. I hope he understood how his message transcended with me and is still with me in some shape or form.

This exercise I was challenged to complete is called “The Gratitude Visit.” If you feel up to it, maybe you can give it a try. Research has shown that this exercise provides a strong boost in happiness and a decrease in depressive symptoms after a person completes the exercise.

As a summary, the steps to follow are:

• Think of a person that is alive and that has done something positive for you. You have not thanked this person properly.
• Write a letter describing what the person did and how this has been beneficial for you. The letter could be about a page or page and a half.
• Contact the person and schedule a visit to deliver the letter and express its contents. Try to do this within one week if possible.
• Reflect on how this exercise made you feel.

Those in recovery from addiction are used to scheduling a time to admit their wrongs and “make amends.” That is an essential component of 12 step recovery. But reaching out to those that have been positively influential in our lives also seems a worthwhile effort that can contribute to our recovery and well-being.

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