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.