Survivors of Addiction

Narratives of Recovery

Mary Addenbrooke

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781136739200
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Addiction is something that affects many different people from all walks of life and can be difficult for a therapist to treat, and the client to conquer. In this book fifteen people who have formerly had serious addictions speak about their experiences.

Survivors of Addiction draws on first-hand narratives to provide an overview of how and why people become addicted, and explores what happens after the addiction is left behind. Divided into four sections it covers:

• being caught up in addiction
• how and why users stop being addicted
• the early days after surviving addiction
• long-term outcomes.

By considering psychodynamic and Jungian perspectives as well as the clinical vignettes, this book examines the process of recovery from addiction. It will be key reading for therapists, clinicians and healthcare workers who encounter addictions in their day to day professions and will also be of great interest to those who are, or have been addicted, and their families.

Chapter 1

Setting the scene

In Western society, availability and use of alcohol and drugs is widespread and increasing, as are the problems associated with misuse. Much has been written about the multiplicity of causes of addiction but in this book the focus is on what happens to the individual at and after the end of addiction. How is it that some people who appear to be inextricably trapped in long-term addiction actually come to a point of stopping? What happens then? What challenges face them, and how do they succeed in facing them? Where do they go from there? Is life forever marred by their past addiction?

While many people experiment with chemical substances and do not become addicted, for a variety of reasons others do. They may or may not seek help, but they commonly feel ashamed of what has happened to them. Is it all self-inflicted? While people love to enjoy the euphoric results of being drunk, high or spaced out, they tend to frown on those who fall into the trap of addiction. This is partly because it is not easy to know how to deal with someone who is intoxicated. It is frightening. How do you respond when someone is out of his or her mind? So people with drug addictions tend to be feared and scapegoated. Sometimes they do indeed live up to their worst reputations, but when someone who has been chronically addicted comes to the end of the line with their drinking or drug using, it is fascinating to discover what actually happens. All the narrators here said that one of the reasons they did not mind what they had said being made more generally public was that it might help somebody else. Looking back, they were appalled at the way they behaved when they were in the worst throes of their addictions.

The attitudes and expectations of family, friends and society at large have a powerful influence on the outcome for the individual, as with many other psychological problems. In the case of addiction the problem has been brought about to some degree by the person’s own choices so it may not be easy for those affected or for bystanders to get away from a punitive, intolerant attitude. Extremely negative expectations tend to predominate. In the narratives that follow, the reader will have the chance to consider how much personal choice and responsibility is involved in addictions and in overcoming them. This is of profound importance in finding one’s own way of relating to people who are addicted. Some professionals, for example, have misgivings about engaging with people who are or have been addicted, either because they are rightly wary of people who are liable to turn up in intoxicated states, or because addiction can recur even after a long period. The intention is that by presenting the experiences and views of people who are now successfully rebuilding their lives free from former addictions we can see that those who have been addicted can not only recover, but thrive and develop. An important question is why this should be so and how it comes about. It goes against the common assumption that the outcome for addicted people is inevitably hopeless.

The narrators

In the course of work in a National Health Service Drug and Alcohol Treatment Service over a period of years, a group of us, all interested in discovering more about the long-term outcome of treatment, had the opportunity to trace the progress of former patients, in many cases long after they had finished treatment. They each have their own ideas about the challenges that faced them and about what helped them. The narrators are not people who have merely dabbled in drugs or been binge drinkers. They were all chronically addicted to either alcohol or heroin, in addition to other psychotropic drugs which can be taken orally or injected, or to all of these. They speak from their own particular perspectives, formed by time, geography, their childhood backgrounds and their social setting, as well as by their personalities. It is inspiring to talk to people who have overcome great hardship and suffering. In the course of recognising their own vulnerability and finding ways to deal with it, many of them have re-evaluated their lives. If you look at a section in a library about addiction, the vast majority of books will be written by theoreticians or those who offer treatment. At the hospital we wanted to restore the balance and let the words of patients and former patients be heard.

The narrators have all been addicted to either alcohol or heroin, or to both. In addition, they nearly all smoked tobacco, and the heroin injectors would use cocktails of drugs according to what was readily available and affordable. They sometimes injected other drugs, such as Ritalin or cocaine, instead of or in addition to heroin, as well as taking other drugs orally, particularly benzodiazepines, such as Valium, to give them an added hit. If at certain times they couldn’t get drugs, they drank more.

Alcohol and heroin share certain unique characteristics. Both, if taken in sufficient quantity over a period of time, will induce a need that is both mental and physical. In cases of chronic use, they produce physical withdrawal symptoms which can be so severe that they require medical intervention or special care in the first days after stopping. These drugs share the characteristic of producing physical tolerance. This means that you need to keep increasing the amount you use or drink to produce the effects you experienced when you started experimenting. This tends to lead to physical, mental and social problems. Both drugs, when used without due caution, cause harm which can be life threatening, as can withdrawal from alcohol (see Appendices 1 and 2). Other drugs that are commonly misused, such as cocaine, ecstasy and amphetamines, produce psychological withdrawal symptoms, but because alcohol and heroin both produce physical as well as psychological withdrawal symptoms, there are added complications in stopping using them. If an individual comes under the thrall of any of these drugs, his or her lifestyle is likely to be radically affected, which means that they will need to make a radical readjustment when they stop. Many people, but not all, need help to stop. When people stop without formal treatment, this is called spontaneous remission or self-initiated recovery. Some of the narrators talk about their experiences of this.

Treatment perspectives

The treatment of patients consisted of outpatient or day-patient care to offer a forum in which to consider the need for change and help in reducing risks. Inpatient care was offered, either in cases of overdose or treatment of serious health problems arising from the addiction, or for detoxification. After patients had completed this initial stage of their treatment, there was a long-running weekly group, mainly for people who were intent upon achieving and maintaining abstinence from either drugs or alcohol. This was not a time-limited group, for once a person had been accepted into the group, they could attend again without a formal assessment. We intended this to create a sense that there was somewhere they could come when they felt desperate, either because they had had a lapse or a relapse, or because they were afraid they were about to have one, or because of a new crisis in their lives. The group set its own rules, one of which was that if someone who came had a positive breathalyser reading for alcohol, they spent time with one of the group leaders individually. They were then either encouraged to come to the next meeting without having taken any drugs or alcohol, or were offered an individual outpatient appointment at another time. At that time there was no available test for drugs other than alcohol which would give an immediate result, but members of the group were pretty astute at spotting signs of drug use. Their suspicions were voiced and became part of the proceedings of the group. We learned an enormous amount from being facilitators of this group, and over a period of ten years there were only five main facilitators – another factor which helped build a sense of trust all round. Quite a few of the members of the hospital group were members of the Alcoholics Anonymous (AA) Fellowship, which could at times arouse bitter arguments in meetings. The positive aspect, however, was that these members could help to introduce others who wished to try AA or, later, when it was established locally, Narcotics Anonymous (NA). The significance of the influence of AA is an important part of the story and some relevant features of its work and ethos are described below.

One aspect of the service was unusual: there was no prescribing of methadone or any other opiate substitute. The psychiatrist in charge of treatment did not believe in its efficacy. Therapy and one-to-one support were the means of treatment, before and after inpatient or outpatient detoxification under medical supervision. In thinking about how best to help someone who came for treatment, we kept away from dogma by keeping one very clear idea in mind, which was the parity of importance between the person and the problem. The relationship between therapist and patient is ever changing and is, in our view, the key to treatment. When treatment of people who are addicted becomes rigid and stereotyped, there tends to be poor attendance at clinics. Patients want to be regarded as individuals, and they need to feel valued by their therapists. It is unlikely that the narrators would have been so generous in giving interviews had they not felt that their views were taken seriously and were regarded as useful in adding to an understanding of addiction.

Addiction has physical, psychological and social effects because people not only become addicted to the drug itself but also become entirely enmeshed in the addicted lifestyle. Cognitive therapy, in its aim of requiring the individual to think about what they are doing, plays a vital role at many stages of treatment. The specific cognitive approaches of motivational interviewing (Miller and Rollnick 2002) and of relapse prevention (Marlatt and Gordon 1985) were employed at different stages, but it became apparent, when talking to colleagues, that behind the cognitive approach there often lies an enduring curiosity. This relates to the paradoxical picture presented by someone who seems unwilling or unable to escape from a path of enslavement to favoured drugs, while doing him or herself considerable overt harm. Unconscious motivation speaks loud and clear in people’s actions, and therefore it is hoped that the psychodynamic perspective will also be of interest to those who work primarily in other ways because it enriches an understanding of what is going on throughout any treatment process. Of the three principal therapists at the time when these narrators received treatment, the lead psychiatrist had had a Freudian analysis, one facilitator of the relapse prevention group had group analytic as well as nursing training, and the other facilitator, the author, is an analytical psychologist. Coming from different analytic schools and different professional disciplines, we each brought our own perspective as therapist and as research writer.

Psychological principles

It may be helpful to outline here the most relevant psychological concepts which informed our understanding of these patients, especially for those readers who are less familiar with this field. Although cognitive approaches were part of our repertoire, especially in motivating patients to think about the need to change and in aiming to prevent relapses, behind this lay a constant awareness of the power of unconscious factors to undermine rational thinking and ‘catch us out’ in our well-laid treatment plans. On the other hand, unconscious factors of a different colour were clearly of great benefit in our interactions with the patients. What follows is a personal choice of concepts which are particularly relevant in considering the process of addiction, treatment intervention and recovering. I have chosen to use everyday terms wherever possible because some psychodynamic terms seem to me to be mystifying to all but specialists in that field. For readers who wish to pursue the ideas further I have added a few key references in Appendix 3.

The field of psychodynamics is basically concerned with elucidating the positive and negative psychological influences on the human developmental process in terms of psychological growth. Intrinsic in this picture is the varied character of our relatedness to others. On the positive side, it is recognised that good enough care and nurture from the beginning of life to its very end provides a containing or stabilising function. From this springboard can arise not only development of human potential, but also resilience in situations of difficulty and particularly the capacity for looking after oneself, i.e. self-care. Deficits or disruptions in nurture, on the other hand, produce a need to protect oneself from unbearable anxiety or distress, and then defence mechanisms spring up. These play a part in the development of an addiction – people want to compensate for and blot out their woes, as will be apparent in many of the narratives. Of course we all need psychological defences to survive in life, but sometimes these defences can come to rule our lives.

If all goes well enough in an individual’s development, he or she can develop a sense of self-agency and purposefulness in life. We can have long-term, rather than immediate goals. If things go well, we become able to tolerate frustration, to accept the reality of imperfections in others and to take account of our own weaknesses. Such capacities enable us to relate to others and to be confident that we have a continuing place in the minds of others.

Relationship with others, including a need to be intimate with them at certain times and to distance oneself at other times, goes alongside relationship with oneself and a capacity to be self-aware, a capacity diminished during addiction, as many of the narrators describe. This includes tolerating the fact that we all have many facets to our personalities, a sort of network of varied facets which sometimes feel cohesive, sometimes divisive, which can make us feel torn or conflicted. In addiction there is a curtailment of this variety, as only the addicted part of the personality thrives at the expense of other aspects of the individual.

In relation to others, we may at times need to identify strongly with someone else, to take something we need from them, just as we did in our infancy. There are times, too, when we find ourselves re-enacting elements of an earlier relationship with someone in the present. In a treatment setting, this is called transference (on the part of the patient), or counter-transference (on the part of the therapist). This implies something very different from a rational response to the other person. We may find ourselves unwittingly reacting to them according to what we once felt towards someone significant in our early lives. The reaction can be of a fluctuating and infinitely varied complexion. According to how aware of this factor therapists can allow themselves to become, this phenomenon can be of great benefit in the treatment; but if, as therapists, we remain in its grip without due awareness, it causes unforeseen trouble. Unacknowledged transference or countertransference often lies at the heart of the reason patients fail to turn up for appointments.

If development proceeds sufficiently well in an individual’s childhood, adolescence and adulthood, two further benefits accrue, the first being the growth of the capacity to imagine. Things’ don’t need to be concrete – we can picture them as images, hold them in mind, and, as it were, play with them. Further to this is the capacity for symbolic thinking, where we can appreciate the interplay of the real with the imaginary in the arts or indeed in everyday life. In addiction, these capacities either fail to develop or they are suppressed, so that life loses its sparkle and the need to take more of the drug grows stronger in compensation.

Other relevant concepts are fixations (attachment to certain objects or rigid patterns) or repetition compulsions (seemingly becoming unable to escape from re-enacting former patterns of emotion and behaviour). These can make us lose heart and feel blocked in life, overwhelmed by our problems. Time and time again, in spite of our best intentions, we find ourselves trapped in situations which replicate unhappy times from our earlier days. We can become stuck in these rigid attitudes or in repetition of former patterns, against our better judgment. This could be said of many people who are addicted.

Finally, throughout the narratives, there appear certain patterns which are archetypal in human life. Three that recur are the archetype of the lost child, embodied in those who have been abandoned and deeply traumatised in childhood; the archetype of the negative hero, embodied in those who followed an exciting but reckless path during their adolescence; and the archetype of the wounded healer, embodied in those who are no longer addicted and who, though damaged by their previous addiction, work tirelessly to help others. Archetypal patterns hold a special power to affect us, whether we observe them in the lives of others or realise that we are held in their sway ourselves. They are powerful unconscious motivating factors for good or ill in life.

The contribution of C. G. Jung

Jung had a particular interest in development in adult life. To describe this, it is necessary to say something about his view of the psyche. He observed that many people are restricted by their need to meet the demands or supposed demands of the outside world by presenting a fine persona to the world. He also saw that there are parts of ourselves, not necessarily ‘bad’, of which we are largely oblivious. These he called the personal shadow. Some of the narrators in this book were initially plagued by the need to present a fine persona, and so drank or used drugs to assuage their disappointment in themselves – so making matters worse. Others fought against any awareness of their shadow side, so in fact ended up omnipotently fighting the world. They were terrified of their own vulnerability. These are somewhat simplified examples of what promoted their addictions, but give some idea of what they had to face when they left their addictions behind. Accepting shadow aspects of the psyche, hitherto only glimpsed, is part of what Jung had in mind when he wrote about individuation. Those narrators who left their addictions behind many years ago illustrate the effects of individuation in practice. They not only allowed themselves to know and accept their weaknesses, but also put them to good use. They have discovered how they really want to lead their lives, using their true strengths, which for many years had become obscured or had never developed.

Jung treated many patients who were addicted to alcohol in the course of his working life. However, as he wrote in a letter only a few months before his death in 1961 to one of the founding members of AA who had contacted him, he had not committed his ideas in writing earlier for fear of being generally misunderstood. He intuitively sensed that as well as being a defence against anxiety, addiction to alcohol represented a ‘spiritual thirst’ which had gone awry (Jung 1976: 623). The reader is invited to consider to what degree this applies to the narrators here. A further idea of Jung’s was that the isolation in which an addicted individual exists puts him or her ‘outside the protective wall of human community’ (Jung 1976: 624). This is a vital but little-mentioned aspect of addiction, which also has repercussions at the stage of leaving the addiction behind. In practical terms, Jung sa...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgements
• Introduction
• 1 Setting the scene
• PART 1 Lost in the labyrinth of addiction
• PART 2 The turning point
• PART 3 The new task
• PART 4 In the long term
• References
• Appendices
• Index