addictions getting help1) The person has to be motivated for treatment to work. 

I have been an addictions therapist for over 15 years.  Nothing irks me more than to hear that a person has to be intrinsically motivated to change, for counseling to work, prior to starting the counseling.  The reason addictions are so difficult to treat is due to the confusion regarding the

benefits of quitting versus continuing to use.  Part of the addiction thinking errors, is the inability to see how life can be satisfying or fun without the drug of choice.  When I hear other therapists say, “He is just not motivated…,” I typically disagree and challenge this statement.  Part of how therapy for addictions works is by helping the person work through their ambivalence to decide that sober living could be tolerable, and even enjoyable and satisfying.  If people were motivated to quit and did not have reservations they would not need counseling, would they?  In my experience people start by being extrinsically motivated to change.  For addiction counseling to work, there has to be a shift in some point of the therapy from extrinsic to intrinsic motivation.  That is to say, if a man comes in for therapy because of their spouse confronting them about their alcohol use ruining the marriage (extrinsic motivation), at some point in the counseling, the husband may recognize the benefits from change such as: saving money, overall well-being, improvement in relationships, a more meaningful spiritual connection, etc.  This is intrinsic motivation.  To sum up, one does not have to be fully motivated to change, they just have to be willing to consider the possibility of change. Let the therapist take it from there…

2) One has to be strong willed to quit.

In my opinion, the opposite is true.  Part of what promotes addictions is when people are strong-willed.  Think about it, would anyone one who is not strong-willed and stubborn hang on to a regressive coping style like an addiction with all of the negative consequences that it brings?  Just as it is stigmatizing and not helpful to make recovery from addictions a moral imperative, so is the person with an addiction himself often stuck with mixed messages of, “Am I weak-willed if I can’t quit on my own?”  What I say at this point in the therapy, is are you weak-willed if you used electricity this morning when you were shaving?  Using therapy to help you achieve a better way to live in the world and to cope in a more healthy and adjusted way (in this case, without relying on substances), is analogous to using electricity to shave in the morning.  You can try to shave in the dark and would probably be ok but it would take longer, and possibly the quality of the grooming would suffer. Trying to quit is complex. Serious addictions without participating in counseling is not about being weak-willed, but about getting the best, quickest, and healthiest outcomes.  You are stilled doing the work, you are just using the best available means to help yourself get to where you want to be.

3) Treatment doesn’t work, most people relapse after therapy has concluded.  

For many people I work with relapse, multiple attempts to change, and battling shame and resistance, are part of their path to recovery. We cannot judge success of the therapy by taking a single snap shot in time.  If a person relapsed in between sessions, that is not suggestive that the therapy is not working. This is precisely where the rubber meets the road in the treatment.  How can we stop use after the relapse and regain the path to recovery?  Getting the person to learn from the relapse or the negative consequence is vital in terms of the timing of interventions in the therapy.  My point is, that in the end, if the person resolves all of their problems with addictions and co-occurring disorders, no matter how many treatment attempts, and setbacks along the way, it is a successful outcome.


1 Comment

  • Dr John Benedetto Posted April 21, 2016 2:56 pm

    Do you work with opioid addiction and what is your opinion of MAT and buprenorphine based treatment?

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