Focus on the relationship.
Mis-perceptions of addiction, and an overemphasis of drugs, combined with the undervaluing of relationships, majorly impact the outcomes in treating addiction.
In drug use addiction, the drug often overshadows the importance of relationships in any form of recovery. Evolving historical beliefs about substance use frighten people. Society does this on a large scale, by throwing people addicted to drugs in jail and calling it reform. Commonly family’s action responds from a reactive and fear-based state and punishes or tries to control the user. Both approaches miss the point entirely, and neither is supportive or fostering progressive change. Society completely misunderstands substance use and substance users. As a substance abuse counselor who works intimately with society’s most marginalized addicts, I’d like to offer an alternative perspective.
Narrow views of substance use often focus on substance as a form of avoidance, with an underlying shame towards the user. Focusing solely on the drug user’s harmful coping mechanisms usually leaves the idea of substance use with a nasty flavor in our mouths, and furthers judgment towards the users.
While there is significant escapism in drug use, it is only one part of a very complex equation. Many people escape from difficulty feelings all the time, some in more fashionable ways. We tend to rate addictions hierarchically based on a number of factors including, how much harm is caused, and if some corporation profited off of the use. No one ever got thrown in jail because they were addicted to their smartphone or ate too much sugar; many people don’t stage interventions with friends about how much coffee they are drinking. In the drama of society’s problems, illicit drugs are the scapegoat.
As a psychotherapist at a substance use treatment problem, I work with people addicted to illicit drugs. All of my clients have used opiates like heroin, oxycontin, or fentanyl, and many have used stimulants like methamphetamine or cocaine or alcohol to self-medicate their depression, anxiety, abuse, trauma, and post-traumatic stress disorder. Clients often talk about the judgment from family members, peers, and primary care doctors; they even get judged while in recovery. Many families have adopted society’s views towards drug use, and as a result, struggle to understand the complexities of how their loved one is struggling with addiction. Worse, many clients in treatment adopt this judgment towards themself, which makes a recovery a bit more isolating, and strenuous.
No matter where they are in their recovery, clients often make sure to hide aspects of their past or current use from their social circle. It was as if their addiction was a dark cloud hanging over them that needed to stay in the closet of their lives.
Listening to client’s share their family’s views of their use, treatment, and recovery, saddened me. I witnessed clients working towards recovery, finding difficulty addressing their shame, only to be re-triggered by their family’s dysfunctional belief system. Misunderstanding substance use leads to stigma, resulting in a hindrance to recovery.
While often well-intentioned, those in relationship with substance abusers often have difficulty managing their anxiety and shame, and project their fear onto the person addicted. Loved ones can sometimes shame or try to gain control over drug use and the user. Even if they share the intention to find a way out of the drug-use cycle, these attempts at shame and control often lead a person to use more. Neither side wins, and the pattern continues.
We cannot solve the problem with the same approach that created it, and so more understanding of substance use on a collective level is necessary for any real reform to occur. Broadening our understanding of addiction and drug use is a critical first step, especially while battling the opioid epidemic. We can all do our part to understand addiction better.
A significant part of healing in recovery is the support and relationship around the user, and an overconcentration on the drug sidesteps this fact. If you know and care about someone who is battling addiction, offer a different kind of assistance by considering a new perspective:
Understand that addiction and substance abuse is an attempt to coping with pain.
Coping mechanisms are our outlets when we need to manage painful physical or emotional sensations. Have a headache? You could take an aspirin or drink some water; If you feel sluggish in the morning, you might get a boost of energy from caffeine. Stressed after a long day, you might have a drink or decide to exercise. Homeless and concerned about sleeping on the street? A stimulant might do the trick to keep you awake all night. All are varying degrees of coping mechanisms. If we recognize that there is pain involved in addiction, we are more likely to bring a compassionate understanding of the struggle of conflict with the person who is abusing drugs. When we focus on the drug as a problem, we lose sight of how it is a medicine.
People who use substances are navigating a way to manage their emotional pain, often in isolation, and without support. The escape into the drug is self-soothing. It allows the user to avoid the pain that might come without the narcotic.
Shifting your perspective and understanding about drug use and addiction will be a significant step towards helping people in addiction or recovery.
Take the focus off the drug and put it on your relationship.
I work at a medication-assisted-treatment (MAT) program, and at the beginning of treatment, I focus on getting to know my clients as human beings. Using a humanistic, harm-reduction approach, I have no overt or covert views of their use. I don’t attempt to gain control over their use or tell them to stop. I know these attempts would be futile and hinder our relationship. I’m especially mindful of any power dynamics; I focus on creating a relationship where they can talk openly about their use.
I investigate client’s use with them by asking them, “How does use help you?” “When do you feel the need to use? and “What does the drug give you that you can’t find anywhere else?” These questions surprise my clients because not only have they not heard this question before, many have not considered the thought themselves. They often know they are finding relief, but many hadn’t pondered from what? A drive for relief tells us that something is needing to be relieved.
I aim to create a space where clients can trust that I intend to engage in a collaborative relationship with them, not to change their use, but to understand it better. My purpose here is the relationship paired with safety; my goal is not to alter their use but to work with them to understand their use and find safe practices. This approach offers a place where clients end up reducing or abstaining from harmful practices on their own.
After they feel they can trust me to be honest about themselves, clients start relying on me more, disclosing their deeper struggles, and finding healthier practices in other parts of their lives. With this trust, we can talk openly about any cravings, and consider the outcome if they act on their impulse. Through the relationship, we create a space to think through their feelings and reactions to those feelings.
Whenever we heal something, be it a physical wound or an emotional heartache, it comes from the recovery environment. Offering an emotionally, safe, and respectful relationship can help people struggling with substance use and addiction recovery much faster.
Focusing more on the relationship in addiction recovery will often breed much more positive and safer outcomes. We cannot shame or punish anything into sustainable recovery, especially something like substance use addiction, which originated out of shame. We must shine light into the spaces that are frightening and traditionally dark. We can do this to some extent on our own, and we can do it in relationships with one another.
Recovery is the process of regaining something that was lost. In terms of substance use addiction, the primary aspect that needs to recover is a loving and supportive relationship. With love, acceptance, and curiosity, healing can happen in relationships, and finding relief in potentially life-threatening ways is less necessary.
3 thoughts on “How to help an addict”
What a great read! Thank you for the reframe and for expanding my knowledge. Your clients are lucky to have your support.
I want to comment mostly because your post moved me to tears. I am with a severe cocaine/crack addict which feels like there is no hope in sight. My extremely low self-esteem keeps me in this relationship even when he bullies me, verbally abuses me to get money from me. I’ve done the worst thing a partner of an addict could do, and that’s use it WITH him – it was a horrible decision to make but I felt since I was getting bullied out of my money, using with him will at least get me high and I will have something worth the money I spent –
Everyone has advised me to leave him – he’ll get help or whatever – but I can tell from your article, and the compassionate approach you take, abandoning him now and throwing him back into the same broken mental health system in which punishment and incarceration is common and leaving him back in the hands of his mother will fuel him even more to get high or worse yet suicide.
I am no angel myself, I have bipolar disorder, (which is something that was forced on me when I was 24), my drug of choice is alcohol and I spent most of my young years drunk out of my mind, and when I was depressed and went to a psychiatrist he threw Lexapro at me without even caring, so of course when I took them with alcohol it was in and out of the hospital with the bipolar curse slapped to my name when in all my life I never experienced mania or delusions or whatever nonsense that DSM wants to compartmentalize me into.
Anyway, we met in a psych ward so that was the first red flag – that was my second long term hospitalization in two years, and when I left my alcoholism was miraculously controlled, and having such passionate love in my life propelled me into long awaited success – new car, new job, new apartment all came from the drive that was inspired in me from this man I love.
But boy, is his addiction severe – and when I started doing it with him it was so much worse. We’ve just come off an almost $1000 spending binge in which my bank account is now -$700 and the $159.25 that comes from my unemployment will be eaten up for more than three weeks. I am powerless and it hurts.
Thank you so much for your comment and for sharing your story here. It’s clear how brave and self-curious you are and is likely is one of your greatest assets thus far in life.
My compassionate approach towards substance use does not mean tolerating all kinds of behavior and staying in a relationship with people who harm you. An essential component in any healthy relationship, whether in addiction or not, is boundaries and interpersonal needs for safety and respect. Sadly, this is not how most of our relationships have looked. Sometimes people in the middle of their addiction don’t see their impact on others. Until they do, recovery cannot happen.
It’s essential to hold your boundaries by recognizing you are not responsible for saving him, using with him, or making him stop. From what you share here, I imagine that staying with him furthers your low self-worth because you feel dependent on him to change for you to feel better about the situation. It sounds as if you’re drowning inside the cycle of spending, binging, and using, and you’d like something to change.
It might serve you more to shift your focus off of him and shine some light on yourself. It is a difficult shift when you already feel depressed and don’t like yourself very much. By redirecting the energy you’re currently putting into him, back towards you, and you will no longer feel powerless.
You are responsible for investigating your personal needs and setting limits with him around them. If you do not want to use cocaine, you have to stand by that, regardless of what he does to make you feel as if you have to use. You have to take that risk and choose yourself.
There is an opportunity here for you. Consider finding a solid psychotherapist or counselor to help better understand yourself, and your own needs. Needs that have already been ignored and dismissed in your past. Your resilience thus far can carry your forward. There’s more to uncover and recover in yourself. Choose you.