Counselling the Person Beyond the Alcohol Problem

Richard Bryant-Jefferies

• Publisher: Jessica Kingsley Publishers
• Year: 2001
• Print ISBN: 9781843100027
• eBook ISBN: 9781846427060
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

At the heart of Richard Bryant-Jefferies' work with problem drinkers is his belief in the power and effectiveness of the person-centred approach to counselling. He suggests that many alcohol problems develop out of, or are connected with, relationship difficulties. He highlights the importance of building a therapeutic relationship with the person, and of engaging with their individuality to encourage sustainable lifestyle change underpinned by personal growth.

This practical book shows how such client-focused counselling can support problem drinkers who are seeking to develop and sustain a less alcohol-centred way of life. Demonstrating how the client-counsellor relationship can be harnessed to empower the individual to help themselves, Richard

* describes the health risks and effects on family life of alcohol dependency

* considers the differences between young and old problem drinkers

* analyses the support services available to those seeking change

* suggests ways of coping with relapse.

Supported by contributions from clients who have undergone counselling for alcohol reliance, this is a comprehensive and positive guide for people working with those who have a problematic relationship with alcohol.

CHAPTER 1

Entering the World of Alcohol Use

I enjoy my work. It’s hectic with deadlines and stuff. I really live for it. Alcohol is my only way of switching off. It works well and is not a problem. I arrive home late, carry on working, hardly get a chance to eat. Get through a few bottles of spirits a week, and some cans of beer. No problem. I fall asleep about 1am, then up at 6.30am. I work at weekends as well, when I’m not asleep. I think it’s only the alcohol that’s keeping me going. I’m a bit edgy sometimes late morning; a couple of lunch-time beers soon put me right though.

I just sit at home all day drinking – wine, vodka, whatever. Don’t have much interest in anything, never have. Marriage is over. Don’t see the kids any more. What’s the point? Alcohol doesn’t make me feel good, but it makes me feel better. Keeps me away from myself. Go without it? Piss off! It’s what I do. I’m independent, won’t let anyone near me ever again. People hurt you. I don’t want to hurt any more. Alcohol’s all I’ve got, my friend in a bottle.

As these two scenarios show, people are motivated to drink heavily for very different reasons. Both are problematic even though the persons themselves do not recognize this. Each is evidencing signs of dependence on alcohol to cope with very different environments, and within contrasting daily routines. Both have at some point found alcohol to be a solution rather than a problem, yet it is now getting out of control. In my experience, people do not generally choose to have an alcohol problem; they make a choice to take alcohol because it is satisfying a need.

Making choices

It can seem that those who drink problematically are somehow different and that their choices and motivation are hard to understand. Yet we all make choices in our lives, and follow particular lines of behaviour, or develop certain habits. Why do we make a choice to do something? What does it give us? Why do we develop an interest in a particular activity?

A person chooses to join a health club. His or her motivation is to do something that helps him or her feel good at the end of a hectic day, or to relax and unwind. Someone else will join the same club, motivated more by the idea of social contact, joining with a group of friends, not wanting to be left out. For both people, the belief is that they will feel better from joining the club than not doing so. It is meeting a need.

Others make very different choices, shopping to relax and to gain a sense of enjoyment. The ‘bargain hunt’ gives them pleasure along with the actual buying of clothes that they really feel good in. For them, going home with that ‘something for me’ will lift their spirits. Shopping with friends makes it a social event, meeting another set of needs. Again, the choice is being made because it is experienced as satisfying by some part of their nature.

We fall into habits easily, continuing with our chosen method of gaining satisfaction and of feeling good. Why do we continue? First of all, because it works, because our choice gives us what we are looking for. It becomes part of our routine, a habit either associated with certain times or days, or in response to a particular set of feelings. In the above examples, the people highlighted would feel a little depressed or stressed if they were not able to make their choices. The thought of not going to the health club, or to hunt down that bargain, can leave them feeling empty, or more on edge than they might otherwise be.

If the health club closed, the person could react in a variety of ways. If it was their only social outlet, or a way of dealing with stress, they could be at a loss about what to do instead, which could trigger increased anxiety. One reaction would be to seek out another health club, to rekindle their good feelings by a similar method. Or they might feel very low, lose their motivation and spend more time at home, believing that there is little to relieve their social isolation or to get them away from the stress of the day.

The shoppers who can no longer afford the spending sprees may continue anyway – the ‘feel good factor’ outweighing any concern for the mounting debt. If they are told to stop, they might react angrily, affirming their intention to carry on, perhaps spending more, not wanting to be told what to do with their lives, or maybe seeking other methods of obtaining the items that they want. The idea of changing their routine might be too frightening to contemplate.

Others will accept their need to change, will be able to make a fresh choice and seek out something else that brings them a sense of well-being.

We carry powerful feelings towards our choices and our behaviours. We generally like our choices and are used to our routines. Usually people do not want to change unless it seems reasonable to do so and the change promises benefits over and above the current experience. Yet a lot of choices are the product of habit. Much of our daily routine can involve time spent on ‘automatic pilot’, not fully conscious of the choices we are making because, quite simply, we are doing today what we were doing yesterday, or what we always do.

While most habits can get out of control, not all are viewed as being so bad/dangerous or socially unacceptable as an uncontrolled alcohol habit. When alcohol gets into this automatic style of living, problems can arise and what seemed initially like a valid choice can become a regular routine with attendant risks of developing a range of problems.

People start to drink for a variety of reasons, which are generally similar to the reasons why any of us make choices. They divide into two broad categories:

•to gain something: confidence, ‘feel good’, reduced inhibitions, an image, enjoyment of the taste, social involvement, belonging and feeling a part of things

•to avoid something: pain (physical or psychological), memories, stress, responsibility, loneliness, people, or even oneself.

Enjoyment of the taste is a safer motivation than drinking for the intoxicating effect, particularly where this is a means of dealing with difficult experiences. It has been suggested that the only valid reason for drinking alcohol is ‘recreation’, and that you should ‘never have a drink because you need one’ (Cantopher 1996, p.127). Where the motive is experienced as an uncontrollable need then it is highly likely that a problem exists.

Why does the habitual drinker continue? As with other choices, they do so because it works, it provides them with a set of experiences they are looking for, it meets a need.

So what is the habitual drinker likely to feel if told he or she needs to stop, or cut back on his drinking? The reaction is going to be very similar to that of anyone else who is told to change something that is important to them: anger, heightened anxiety, feeling on edge, depression, nervousness, irritability, and generally finding it hard to settle.

For the dependent drinker, there are other factors that will motivate them to continue, for instance, clear signs of dependence when they stop, such as shaking, sweats and, in extreme cases, fits and hallucinations which can, if not treated, be life-threatening. Their experience will be that another drink makes them feel better, which it does – for them it is experienced as a solution rather than as a problem.

It is often thought that alcohol is alcohol, regardless of what form it comes in. However, I have heard people describe how they experience different behaviour triggered by particular drinks. It will vary from person to person. Someone can become fighting drunk on whisky, but simply extrovert on beer. Someone else will fall asleep on wine and slip into deep depression on drinking rum. Another will find spirits send them to sleep while wine makes them extrovert and bubbly. Taking alcohol is an intense experience for the body and the brain. Associations are established between feelings present within the person and the drinking experience: the alcohol content, the flavour, the particular chemical make-up of types of drink, and the setting in which alcohol consumption occurs.

Life as a motorway

An interesting image to reflect on is of life as a three-lane motorway: a slow lane (abstinence), an average-speed lane (safe drinking)¹ and a fast lane (heavy/dependent drinking). Everyone starts in the same place in the slow lane (unless his or her mother has been drinking heavily during pregnancy). During life, people change lanes. It is not always a case of an individual making a free and independent choice in this. Many factors contribute to acceleration into the fast lane, for instance, peer pressure, cultural or family norms and life-events.

On the motorway we can plot life experiences against drinking. While some people are abstinent all their lives and remain in the slow lane, others move into safe drinking as teenagers, increasing to heavy drinking during their early twenties, then reducing their drinking as they ‘settle down’ to a more stable lifestyle. Another person will have had a similar experience but have got into a heavy drinking environment (work or social), developing it as a central feature in their life. They continue in the fast lane with a high chance of health or other alcohol-related problems arising in their lives. Some gently accelerate through life, with an increasing risk of alcohol-related damage as they cruise into, and continue in, the fast lane. Others have been abstinent or in the safe drinking lane for most of their lives, and then, following a traumatic episode, possibly even very late in life, accelerate quickly into the fast lane. People can accelerate each time they are faced with a life-crisis or a significant loss and then ease back after a time, or when the situation has been resolved.

All who have accelerated into the fast lane do have a brake and may be encouraged to use it, returning to the middle or slow lane for the rest of their journey through life. Clients can understand their drinking pattern, and what it is related to, by plotting their drinking ‘journey’ against life events. This can reveal whether a person is at risk of developing a problematic alcohol habit to cope with particular types of life-experience, or whether their alcohol use is linked to environments in which they live or work. It is an idea that I am prepared to offer people, but only if it feels relevant to the client’s interest, motivation and focus. Often it will be in response to a client voicing an interest in his drinking pattern and associations in the past, and how it has affected his or her choices in the present. I will remain mindful of the client’s autonomy in choosing when and how they may wish to make sense of their alcohol use which I believe to be a crucial element of the person-centred approach to working with this client group.

When counselling from a person-centred perspective we have to be ready and prepared to accept the changes our clients choose to make, and to maintain our therapeutic presence alongside them. A key factor with the motorway image is that there is no ‘us and them’ in this model. Everyone travels the same road and we each have within us the capacity to change lanes in any direction. I think it is helpful and realistic to be aware of this. The fact that a client is in the fast lane may bring a particular set of challenges, but his world can be entered and understood. I will reach out to the breadth and depth of feelings that he is experiencing and endeavour to communicate my sense of what the client is experiencing. It can be a challenge to enter into the at times desperate and anguished inner world of the problematic drinker, to take the vital step of allowing ‘us and them’ to dissolve in the immediacy of the ‘I–thou’ relationship.

Multiple issues

I find that people with alcohol problems often have a range of issues that may become a focus for addressing. These may stem from early experiences, such as abuse (physical and sexual), emotional neglect, parents using alcohol problematically, losses of significant people, constant changes of home/schools, pressure to conform to family expectations; or more recent experiences, such as break-ups of relationships, difficulty having access to their children, unemployment, retirement, bereavement, general stress, violence. Some problems will be emotional/psychological, others will be related to environment and daily routine.

Jake’s childhood was one of constant house moves, of never being in one place for more than a couple of years. He never managed to make and keep friends, and was never able to settle down. There were rows at home as well. He felt completely powerless and fearful of what would happen next. Nowhere felt safe. That first drink at 14 made him feel so different. He’d drink when he was feeling angry and frustrated. Arguments were normal for him and yet he also hated them. He yearns for a peaceful and settled life yet nowadays he provokes arguments at home so he can go out and get drunk.

Jake is split between himself as anxious, unsafe and frustrated, and as yearning for a more peaceful existence. He has a habit of argument and it has set up a pattern that is being carried into his adult life, making sustainable relationships very difficult, and bringing a high likelihood that the alcohol use may become increasingly problematic.

Clients may have a ‘mental health condition’, for instance depression, schizophrenia, mania or psychotic states. Some clients will self-medicate with alcohol (or with illicit substances or misuse prescribed or over-the-counter medication) to cope, often bringing relief to their symptoms yet complicating their condition. There is increasing emphasis on this ‘dual-diagnosis’ group in the UK. It has been suggested that up to 45 per cent of those diagnosed with mental health problems have substance misuse problems (ANSA 1997). In these instances counsellors who have not had relevant training are advised to consider referral on to psychiatric services for assessment. I think we have to be realistic. There are states of mind that are rooted in chemical imbalance that require chemical intervention. While this book has not been written to deal specifically with this group, many of the ideas regarding change and forming therapeutic relationships remains valid.

Jodie had heard voices in her head since she was 12. They encouraged her to hurt herself. She had always felt different, as if she stood out and was too visible to everyone else. She was sure they could all read her thoughts. Alcohol helped her to blank out the voices; it worked well for a few years but now she’s even more aware of other people. They always seem to be watching her. Her paranoia is making it difficult for her to go out much. She is drinking all day to try to control it, but it is getting worse.

As Jodie continues to drink to control her problems, they are in fact getting worse. It is likely that she will continue with her alcohol use for it is all she has. However, the effects of the alcohol complicate her mental health condition. Medical intervention is required. It is a classic case of ‘what do we control first?’ While the increasing paranoia is an effect of her alcohol use, the actual origin of the drinking lay with the voices encouraging self-harm and an underlying mental ...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Dedication
• Acknowledgements
• Preface
• Introduction
• 1. Entering the World of Alcohol Use
• 2. Alcohol in the Family
• 3. Application of a Person-Centred Approach
• 4. The Cycle of Change
• 5. From Pre-Contemplation to Taking Action
• 6. Maintaining Change and Responding to Relapse
• 7. Bringing It All Together
• 8. Conclusion
• References
• Further Reading
• Subject Index
• Author Index