We asked a psychologist questions about drug addiction and recovery. Here is what she said:
People receiving treatment for a substance abuse disorder, such as alcoholism or drug addiction, often attend treatment facilities staffed by peer support counselors and master’s level counselors and social workers. Occasionally, treatment is provided by psychologists, but traditionally, this has been an exception rather than a rule. Treatment for drug addiction has never been a focus area in the discipline of psychology, and, unfortunately, continues to be the case. However, there are some psychologists and psychotherapists who do work in addiction treatment.
We interviewed Dr. Valerie Ignatenko about her views on drug addiction and recovery. Dr. Ignatenko holds a PhD in Counseling Psychology and has been working in the field of psychology and mental health services for over 15 years. She has provided substance abuse counseling to adult addicts on both an inpatient and an outpatient basis.
Why do you think that psychologists traditionally have not worked with substance abuse issues in their work?
I think that substance abuse counseling is often thought of as a specialty area, in which additional training is necessary. Substance abuse counseling is not part of the common curriculum I don’t think, at least it was not when I completed my doctoral program. I recall speaking with my advisor about a potential practicum placement at a drug and alcohol facility, and he told me that psychologists do not work in those types of settings because our skills are better suited elsewhere. Working with people in recovery does require a special set of skills, though. I feel fortunate that my work experiences have allowed me to gain these skills, but I know that not all practitioners have the same background.
I also think that psychologists tend to shy away from substance abuse treatment because they do not believe that recovering addicts or alcoholics are good therapy candidates. There are many negative stereotypes surrounding drug addiction, and unfortunately, psychologists are not immune to believing some of those stereotypes. I have heard other psychologists state that they do not believe that specific people with an addiction will be able to recover. It is as though they gave up hope for the person because of the addiction, even when the person is seeking treatment for the addiction. It is very strange. I have also gotten a sense that some psychologists believe that substance abuse treatment is a lesser form of therapy. Perhaps this is because of the difficult presenting problems and the frequent lack of insight-it’s hard to say. I am not one of those people.
Is there a need for psychological services for those suffering with drug addiction and/or who are in recovery?
Absolutely! Psychologists have the skills necessary to help people deal with the emotions that sobriety may present, and to find more appropriate coping skills to utilize in times of stress. We are well trained in providing empathy and warmth, and using active and reflective listening. Addiction in itself is psychological in nature; the habits, the compulsions, the numbing of emotions.
Drug addiction is a social problem. People are dying from overdose, accidental death due to intoxication, suicide… People also make poor choices when they are high or drunk. They are more likely to commit crimes against others, or to be of danger to themselves and others while under the influence. Psychologists should be helping with this, as it effects our whole society. We have had so many accidental overdoses of celebrities in recent years. Those are just the deaths that are publicized. There are so many deaths by overdose that do not make the news.
What do you find is the most challenging thing about working with people with addiction problems?
Addicts are a challenging bunch! When someone is truly motivated to work on their recovery, that is great. People who are ambivalent about recovery are even good therapy candidates. But then there are those people who are completely unmotivated. They may have been mandated to attend a certain number of therapy session by the court system, or think that participating in therapy will increase their chances of being discharged from a facility. These are the people that I find the most challenging. They will often say what they think you want to hear, and lie to your face about their thoughts or motivations. They may have used the night before, but will come into sessions and tell you how important it is for them to remain sober. I have seen people put on very good shows, sometimes even with tears, until the drug test comes back positive and they are forced to tell the truth. In these cases, I feel as though I am working harder than they are, and that frustrates me.
What is the most rewarding thing about working with people with alcoholism and drug addiction problems?
There was a young woman I worked with about 5 years ago- let’s call her Jane D. She was inpatient in a psychiatric facility, however the issues that brought her there were mostly addiction related. Jane was in her early 20s, and spent about three years in this facility because she could not manage her addiction. She would break rules, sneak contraband, use things that you would never think of to try and get high (ie: overusing coffee, smoking poppy seeds, etc). She and I had therapy once, sometimes twice a week for most of her three year stay. I honestly became very frustrated with her, because she clearly was not motivated to change. One day, though, something happened. It was like she had an “a-ha” moment, and became motivated. She was discharged shortly after that. Upon her discharge, she wrote me a very long letter thanking me for my patience with her, and about how much my work meant to her, even when she didn’t show it. She explained her “a-ha” moment to me, and I could not have been prouder at that moment.
Moments like that, as few as they are sometimes, are the most rewarding thing about working in this field.
Some people say that you cannot effectively treat a substance abuse disorder without having experienced addiction yourself. What do you think of that?
(Laughing) I can’t tell you the number of times that I have been asked whether or not I’ve been an addict. There have been times when clients have refused to work with me because they felt certain that I had never experienced drug addiction or even drug use, for that matter. I have had clients become irate with me as I try to teach them about addiction, and they tell me that all I have ever done is read about it in a book. I never disclose my addiction status- whether I have used drugs in the past or have suffered with a alcohol or drug addiction. I have been able to compare substance abuse addictions to other types of addiction, like coffee or food, and use that as a relevant example.
Many treatment centers and substance abuse programs employ peer counselors who have “been there” and can speak with others about their recovery. 12 step programs are built on the premise that senior members offer guidance and mentorship to those new to sobriety, as they both share the common experience of addiction. These types of interactions are priceless on the road to recovery, I think, but they are not enough.
I have seen many new counselors and psychologists be discredited in a substance abuse group because they tell the group that they never have personally experienced addiction, but they know someone who has, or they have read about it in a book. There is definitely a piece lacking in the understanding of drug addiction when you have never experienced that yourself. But, there is also something lacking for former addicts who have never been trained in helping people sort out the issues that initially led them to substance abuse. While many people have the predisposition to become addicts, environmental circumstances are often the determining factor in developing an addiction. These environmental factors are things that can be dealt with in therapy. Events such as childhood traumas, grief and loss issues, difficulty coping, poor distress tolerance, are things that are handled and should be handled by a skilled, trained therapist.
So I guess I’d say that both professional help and support from those who understand your experience are what is necessary to effectively treat drug addiction and alcoholism. There are many other factors that are beneficial as well, which I’m sure you will ask me about soon enough.
What are these “other factors” you speak of that are beneficial to successful recovery from addiction?
Number 1: Motivation and purpose. An unmotivated person is not going to recover from drug addiction or alcoholism. It is just that simple. I think it is important that people are working toward recovery, that they know why it is important to them. If they are doing it for someone else, that’s probably going to decrease motivation. If recovery doesn’t mean anything to them, motivation will remain low.
Number 2: Social support. Having people around you who care about you and who understand what you are going through is critical. The path to recovery opens you up to vulnerability. That is the beauty of 12-step programs. They welcome newcomers with open arms, have events that everyone can participate in, provide support and acceptance.
Number 3: Openness to change. This falls along the same lines as motivation, but it is a little bit different. It is taking personal control out of the equation and accepting the outcome, regardless of what happens. Control is a big issue for many people, especially those who struggle with addictions. Relinquishing perceived control can be such a challenge, but can also be so freeing. People who are not open to change or to failure may have a harder time adapting to a sober lifestyle.
Number 4: Openness to failure. If you mess up, you do. Just get back up and start fresh. While it’s not a requirement, relapse sometimes happens for those in recovery. Sometimes people get very angry with themselves about relapse, or give up trying altogether. Don’t do that. How you respond to the relapse is the important thing. Don’t give up, and utilize your supports.
What is the best form of therapy for treating alcoholism and drug addiction?
Like any therapy, it really depends on the person. Each person is going to respond to something differently, and not all interventions are going to work the same way for different people. I’d say that the best treatment for addiction is the one that the person is willing to do. The one that makes sense to the person working toward recovery.
There are many different types of treatments out there for substance abuse counseling. Many people prefer to attend an intensive inpatient program, and many professionals recommend this. The focus is on treating the addiction, and there are no distractions from this focus. Others prefer to receive outpatient counseling, which takes many forms. A person can see a substance abuse therapist weekly, or attend substance abuse therapy groups. They also may be able to attend drug and alcohol day programs, or may receive treatment in a hospital setting.
My current treatment modality is outpatient therapy with individuals. Some methods that I find particularly useful include motivational interviewing, cognitive-behavioral therapy (CBT), and psychodynamic/interpersonal therapies. Motivational interviewing work’s with the person’s readiness to change, and treats them according to their stage of readiness. Motivational interviewing offers techniques that assist with managing ambivalence and increasing motivation for change.
CBT focuses on thoughts, and how thoughts influence moods and behaviors. CBT provides interventions to help people identify and challenge negative thoughts, and better understand the way in which thoughts influence behavior. Psychodynamic/interpersonal therapies are not always the first thing that you hear about when you hear about addictions treatment. These therapies have their roots in Freudian psychoanalysis in which the past is reviewed upon to determine the cause of current behaviors. My belief is that the person’s environment has contributed to the addiction. The emotional things that the person was unable to deal with were avoided and instead medicated by drug use. Sometimes the addiction gets out of control. However, there is always something that happened right as the person started to use. Sometimes it is a trauma, other times it is something less severe, like self-esteem issues or undiagnosed depression. I also like to look at the ways in which the person’s addiction affects her/his relationships with others and her/his current environment.
What are some general things that a person can expect when they begin substance abuse counseling?
When a person first comes in for a session, I will get to know them a bit by using a semi-structured interview format. I ask questions about the presenting problem, family history, history of addictions treatment and mental health treatment, and other standard intake questions. I make special efforts to identify and recognize the strengths of each individual, as strengths are important to remember when in difficult situations. The first session is about building rapport, and making the client feel comfortable. Usually in the first or second session, I work with the client to establish treatment goals: what they would like to get out of therapy and what interventions I plan to use to help them accomplish these goals. I also outline my expectations of the client during the therapy process.
In subsequent sessions, we will work to help clients reach treatment goals. I will help them better understand their drug addiction, triggers for using, and the underlying need that is being met by the addiction. We will talk about things like childhood experience, feelings, fears, and hopes. I teach clients coping skills for managing cravings and difficult situations, and help them better understand their motivations for using. I use a client-centered approach, and try very hard to make sure that clients feel comfortable and do not feel pressed to talk about things they are not ready for. I will offer suggestions on the best course of action for treatment. For example, I may recommend going to AA meetings and getting a sponsor. Clients are free to take or leave my suggestions. They are fully in charge of their treatment.
Is there such a thing as a “healthy” addiction?
I wouldn’t go as far to say “healthy addiction,” but rather health behaviors, interests, and tendencies. I do believe that people may be born with a genetic predisposition to addiction. In order to manage this predisposition, it is important to find outlets for natural tendencies. For example, if a person were born with the propensity to enjoy doing mathematical problems, that person would find ways to fulfill this desire and would likely do math problems in their spare time. Healthy behaviors, such as exercising, spirituality, and artistic expression allow people to redirect their addictive nature onto something that is less harmful to themselves and to others. Focusing on a healthy behavior, as opposed to an unhealthy one (i.e. drug use) would be considered a coping skill.
There is a risk, though, of going overboard with these behaviors, to the point that it interferes with daily life, and is potentially harmful. For this reason, it is important for people working on recovery to continue with treatment and to talk about their newfound interests. However, without the influence of drugs and alcohol, people will be better able to self-monitor and make better choices about how these things can interfere with daily life.
Some people who have healthy addictions have never had unhealthy addictions. I must admit that I may have an addiction to bicycling. The difference is, that these people don’t have the predisposition toward addiction. An addiction becomes a problem when it interferes with daily life, including work, home, school, relationships, etc.
Is it possible for a recovering alcoholic, to walk into a bar and have one drink without resuming alcohol abuse?
No. Not a chance. I would even go as far as saying that if a recovering alcoholic were to walk into a bar, she/he would have a hard time staying away from old habits. Alcohol is that person’s kryptonite. It may not happen right at first. The person may be able to have a drink here, and a drink there. But those drinks soon will become more frequent, and one drink turns into three drinks, which turns into 6 drinks, which leads to daily drinking…. And it goes on.
In the same way, an alcoholic cannot “cut down” on alcohol use, and expect that this is going to improve the impact that alcohol has on her/his life. Cutting down is always temporary.
Why do you think people have so many relapses? What is so hard about staying clean/sober?
Addiction has a powerful draw. Some drugs have more of a draw than others. I have had recovering addicts tell me that they dream about their drug of choice; sometimes it calls to them in their dreams; sometimes they feel like they can actually taste or feel it. This is not at all uncommon. Humans are creatures of habit. When facing a difficult situation, a recovering addict may revert to old habits as a means of self-comforting.
12-step programs encourage recovering addicts to change their “People, places, and things”. In other words, make friends who don’t spend all of their time at the bar, do not visit bars, and get rid of mementos from around your house that remind you of your old lifestyle. However, it is very hard to make all of those changes. Sometimes, the people you need to stay clear of are your family members or dearest friends. This is a task that is easier said than done. But there is a reason why it is said. People are more likely to relapse if they put themselves back into the same situation they were in before when they were using.
Another reason people relapse is because feelings rush back that were repressed for so long and that were numbed by addiction. For the first time, addicts have to feel the things that they tried so hard not to feel, and many of these feelings do not feel good. Relapse is common to avoid feelings.
How long does the process of recovery from drug addiction and alcoholism normally take?
There is no quick fix for alcoholism and drug addiction. People must be motivated and willing to do the work in order to recover. Too often I see people give a half-hearted attempt at recovery, and then realize that it was too hard and go back to old habits. There is also no prescribed amount of time that people need to recover. Every person takes recovery at her/his own pace.
Why do 12 step programs always use those catch phrases like, “one day at a time”, and “it works if you work it”?
While it may sound silly to people outside of the NA/AA rooms, those phrases act as a common bond between members. They are something that everyone can understand and relate to. “One day at a time” helps people remember that they don’t have to think about staying sober forever. That is too long! And too big of a goal. In the programs, people make the commitment to stay sober for one day, “just for today”. That goal is smaller and more realistic. It is easy to get through one day without alcohol; it is not easy to get through forever.
The phrase, “It works if you work it” reminds people that recovery is not an easy process. 12-step programs have a solid curriculum for people to follow as they go through recovery, but it is no easy task. Recovery from addiction takes work. However, the 12-step programs are excellent at demonstrating that the results of the hard work is worth it, and recovery is possible. They offer members sponsors, who are members also in recovery but with much more clean time than the new member. People who have been clean and sober for decades continue to attend meetings and share their stories with others, so that others can benefit from learning from their mistakes. They also like the feeling of community that the meetings bring.
I know a man who has been sober for probably 30 years at this point, and he never, ever misses his Thursday morning meeting. He volunteers at a local treatment center, providing education and words of wisdom to people still in the early phases of recovery. It is important to him. He uses all of the catch phrases, even in general conversation. These things have meaning to him, he has found them useful in his recovery, and he wants to share that with others.
What is your #1 recommendation to people in the process of recovery?
“Be kind to yourself.” Recognize that you are going through something that is very challenging, and that you are doing something profoundly healthy and good for you. Feel the feelings that come up for you and do not be ashamed to ask for help. Take care of your needs, and even pamper yourself sometimes. You deserve it!
Contact Clearbrook Today
If you or someone you love is struggling with drug addiction or alcoholism, help is available. For 45 years, Clearbrook Treatment Centers has been a nationally recognized leader in treating individuals who suffer from chemical dependency. In doing so, we have had the privilege to watch countless people recover from a seemingly hopeless state of mind and body. If you are ready to take the first step and get your life back, contact our Admissions Specialists today. There is hope…and it lives here!