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Chapter 1 : Fundamentals Of Addiction

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  • Chapter 1 : Fundamentals Of Addiction

THE GOALS OF ANY INTERVENTION

There are many common misconceptions about an intervention and its goals. A common misconception is that an intervention is solely getting them to go to treatment or rehab. Even though one of the goals is to get the loved one into treatment, it is not the only goal. Getting someone to go to treatment is not necessarily a difficult thing to do. Getting your loved one to stay in treatment, increasing their willingness to apply the fundamentals of recovery, having them complete treatment, and applying the principles of recovery after treatment are the true goals and are more important than just getting them there.

If we want to achieve a long-term solution, we must achieve several goals in addition to getting them to go to treatment. Outlined below is a summary of these goals:

THE 7 GOALS OF A SUCCESSFUL INTERVENTION

  1. Empower the family through education on addiction and enabling.
  2. Remove any enabling factors that are contributing or allowing the addiction to continue.
  3. Set healthy boundaries within the family so that they are no longer negatively affected by the drug or alcohol use of the addict.
  4. Create a solid team within the family that works together instead of independently.
  5. Change the dynamics within the family to more effectively handle the addiction and increase the willingness of the addict.
  6. Formulate and implement a long- term recovery plan to increase the chances of permanent abstinence and then adhere to the plan as a family.
  7. Learn effective tools get their loved one to treatment, help keep them there, and focus on recovery after returning home

ALCOHOL, DRUGS, THE A.M.A. AND THE “DISEASE CONCEPT”

The American Medical Association (AMA) endorsed the concept of alcoholism as a disease in 1957. In addition, other organizations across the country (the American Psychiatric Association, the American Hospital Association, the American Public Health Association, the National Association of Social Workers, the World Health Organization and the American College of Physicians) have also classified alcoholism as a disease at various times. The findings of investigators in the late 1970’s led to explicit criteria for an “alcohol dependence syndrome” which are now listed in the DSM-IV and the ICD manual. In 1992, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published a definition for alcoholism that defined alcoholism as, “a primary chronic disease with various factors influencing its development.”

Although there is some controversy surrounding the idea that addiction is a disease. Some feel that addicts are victims of a disease while some feel that they are not. However, there are some points of which it is important to be in complete agreement:

  1. That untreated addiction has a group of common symptoms that can be observed as it progresses over time.
  2. That untreated addiction is progressive and gets worse over time. 
  3. That untreated addiction is chronic and/or eventually fatal.
  4. AND MOST IMPORTANTLY…. That addiction is treatable and can be put into “permanent” remission with adequate treatment and recovery.

It has been theorized that almost every major form of treatment and recovery (whether 12-step, cognitive, faith-based, or psychotherapeutic) can be successful if the client is willing. Although there are no studies to prove this, observation does suggest a correlation between willingness and recovery.

It is because of this connection that increasing the willingness of the client is a major focus of the intervention process.

THE 3 BASIC TYPES OF ALCOHOL OR DRUG USERS

It is also suggested by some that there are 3 basic types of addicts. Granted, there are certainly all kinds of gray areas in between, but most addicts can be categorized into one of the following three groups that we have listed below:

 A SOCIAL OR MODERATE USER

A social user seems to only use socially, occasionally having a glass or two of wine, or even the occasional hit off a joint. There have even been known to be social users of hard drugs who never seem to develop a problem with it (i.e. the person who does a line or two of cocaine once every few years). Understand, however, that even the social user can become addicted to drugs or alcohol with enough use.

A HARD USER

A hard user appears, at first, to be an addict if you look at a particular time frame in their life. However, when a negative consequence occurs because of their substance abuse, they often quit without the aid of treatment. For example, someone who drank heavily in college but was taken advantage of while under the influence and has never picked up a drink since. Another example is someone who gets married and stops smoking marijuana because their significant other tells them to. If the person does not seem to quit no matter how often or how many negative consequences pile up, then there is a good chance that they are.

A REAL DRUG ADDICT

A real addict has periods of abstinence with heavy binges or is a continuous user and does not seem to summon up enough willpower to quit no matter what the negative consequences are. The real addict drinks for an underlying reason, as opposed to just enhancing their life. No matter what negative consequences happen, they usually cannot quit permanently without the help of some form of treatment and recovery. Left to their own devices, the addiction will progressively get worse while destroying the hopes and dreams of their loved ones and eventually killing them.

THE BASIC NATURE OF ADDICTION AND THE REASONS FOR MANIPULATION

To understand and predict the actions and reactions of your loved one during the intervention process, it is first important to understand the nature of addiction itself. In almost every case of addiction, it is not the substance that is the primary problem, although its use is causing problems. But rather, the alcohol or drug use is but one of many symptoms of an underlying problem.

An effective treatment program focuses on the underlying causes and helps heal them. What is an underlying problem? Quite simply, most addicts are usually only about one thing – and that thing is usually about avoiding discomfort at some level and to some degree. Whether it is emotional or mental discomfort, physical discomfort, or external stress, it is a diminished ability to confront these things that dictates almost every move an addict makes.

We cannot emphasize enough that the operating basis of an addict, sober or not, is about avoiding discomfort.

Imagine that you are going to sit down with your loved one and have a discussion. You are going to talk to them about their drinking or drug use; how it is affecting you, how it has affected them, their life, and their future. Also imagine that you are going to discuss an adequate treatment solution (usually in the form of a comprehensive inpatient program) to solve the problem. Now, no matter how loving and caring you may be during this conversation, they will most likely find this topic very uncomfortable, sober or not. For them, it may feel confrontational rather than a simple discussion, and for them it will be a rather unpleasant situation to be in.

In addition to this, going to a treatment facility is an uncomfortable option. As we described before, the operating basis of an addict or alcoholic is about avoiding discomfort. We are going to describe all the various methods of manipulation that they may use to make this uncomfortable situation(treatment facility or conversation) simply “go away.”

Note: There are several reactions an addict may use during an intervention and on the following pages we have listed them to help you to gain a better understanding as to exactly why they behave the way they do, whether they are sober or not.

THE REACTIONS OR MANIPULATIONS OF AN ALCOHOLIC OR ADDICT DURING AN INTERVENTION

As the interventionist covers the various behaviors below, check off any that you feel your loved one would exhibit to deal with an uncomfortable intervention.

  • ADAMANT DENIAL:
    • The first method they may use is adamant denial. They may minimize or deny their use of alcohol or drugs with such sincerity that you find yourself questioning whether you are mistaken.

“I don’t use drugs. I did before, but not now. A doctor prescribes my medication. I’m not that bad. I don’t need rehab. I’m not a junkie. I don’t drink every day. I can quit anytime I want to, I just don’t want to right now. It wasn’t my drugs; I was holding it for a friend. I am fine. Everything is ok. There is no problem.”

If you believe or accept their adamant denial, then this uncomfortable conversation/confrontation is over, right? Of course, the uncomfortable treatment facility has magically gone away as well, for it is no longer needed. Your loved one has successfully found a way back into their comfort zone.

  • OFFERING OF HOPE:
    • Most addicts have gone past the adamant denial stage. After years of use, it is often pointless to deny that the use exists. So instead of adamant denial they may use what is referred to as an offering of hope. This is the most commonly used and most deadly of all the methods of manipulation. You, as a family member, so desperately want to believe in the hope that the problem can and will be fixed that your loved one may use that hope against you.

“Yes, I screwed up, but I will never use drugs again. I promise. I can beat this on my own. I don’t need rehab. I’ll go to an outpatient clinic or see a counselor or maybe one of those meetings next week. I’ll see a psychiatrist once a week. You can drug test me every day. I just need to get a job, and you can even hold on to my paycheck. Just give me another chance. I’ll stay at your house. I can quit. I just need your support. I swear to you it won’t happen again.”

Remember that every criminal standing before the judge awaiting sentencing is usually quite sincere when they say, “Your Honor, I’ll never do that again. I’ll be good. I promise.” However, that sincerity will fade as soon as the consequences are no longer present. In most cases, the offering of hope is not an offering of recovery or treatment, but rather just a temporary band-aid – an extremely minimal and non-intensive solution with no long- term gain.

If you accept the offering of hope, then the uncomfortable conversation/confrontation is over. That is until next month when you are in the same situation as you are in now. Never accept a minimal solution in the hopes that “something is better than nothing,” for the minimal solution has only one motive – to make the intensive treatment facility “go away.”

In recovery, minimal solutions often have minimal results even if your loved one is sincere. Be very wary of the offering of  hope, it is usually nothing more than a very convincing manipulation. Many parents have walked in on their loved one dying of an overdose because weak promises were enough for them instead of them going to treatment.

  • BABY STEPS: 
    • A subset of the offering of hope, baby steps are when your loved one manipulates you into accepting a lesser version of what you are offering. For example, if you offer a 90-day inpatient program, they will counter by saying “I’ll only commit to 30 days, but if I like it I’ll stay longer.” Or if you offer a 30-day inpatient program, they may counter with “I’ll try detox for a week and then consider staying longer.”

This is their way of minimizing the uncomfortable options by cutting them in half and then offering you the hope that they will stay longer. Many families make the mistake of thinking that if the addict goes into treatment and begins to feel better, they will stay longer and finish the program. This is a fallacy. An addict who goes into treatment with the intention of only doing 30 days and thinking about it will only do 30 days, especially once they begin to feel better.

  •  FEAR: 
    • Another attempt to eliminate this uncomfortable situation is trying to use fear to end this uncomfortable confrontation. These include hints or threats of: suicide, leaving “forever,” living on the streets, moving in with druggie friends, saying that they will never speak to you again, and more. These are all designed to influence you with fear. The reason that our loved ones can use this manipulation so well is because they instilled it within us. If they can effectively manipulate you with fear, you may be tempted to halt entirely.

In addition to using fear against you, it is not uncommon for an addict to alternate between using fear and offering you hope in the form of minimal to no treatment. If they achieve this, you will recoil from the fear and grab onto the minimal hope as a last-ditch effort. Many times, families fail in the intervention process because they are stuck in the middle of fear and hope. Fear that if they continue standing their ground their loved one may be gone forever; and the hope that tomorrow things might change. This is one of the associative factors as to why most people do not find sobriety; their loved ones are unwilling to make a move. If you do not make the necessary changes and instead wait for them to change, you will lose them to their addiction.

  •  EXPLOSIVELY REACTING AT: 
    • Having an explosive reaction comes in many different forms. They may begin yelling at you with threats and coercion with the goal to end the conversation. In the worst cases, they may become verbally and physically abusive. Since they have developed unhealthy coping skills, they believe that threatening those things that make them uncomfortable will cause them to disappear. This is a way of drawing a line in the sand; telling you that certain subjects are off limits, especially treatment. You back off and never bring up treatment again.
  •  NOT REACTING AT ALL: 
    • During the intervention, your loved one may simply not react or speak with you at all. Sitting there with their arms crossed refusing to speak or budge; simply waiting it out. They believe that if they do not interact in the discussion, it may go away. Eventually, you get frustrated , talking to the walls and eventually you give up. They always win the waiting game, and they know it. Problem solved. The uncomfortable conversation is over because it never really began.
  •  AVOIDING, HIDING OR LEAVING: 
    • An additional way of handling an uncomfortable life situation is to avoid it or hide from it completely. Locking themselves away and refusing to come out or getting up and running away. This abruptly ends the conversation/ confrontation and might even dissuade you from confronting them again for fear that they might go out and drink/use again as a result of something you said or did.
  • INVALIDATION: 
    • Different from threats or coercion, they may simply invalidate your stance or argument. “Those rehab programs don’t work. I know 6 people that went to them and all of them still use drugs. They’re just after your money. You don’t know what you’re talking about, you’re not an addict.” If you believe them or allow them to invalidate your treatment solution, then it no longer becomes viable. In other words, if they can make a treatment program or recovery a bad or unhealthy idea then you will never bring it up again.
  • SHIFTING THE FOCUS: 
    • Since the confrontation is on them, one method is to eliminate the uncomfortable situation by shifting the focus onto you or another family member. “If you would’ve treated me better I wouldn’t have these problems. What about Dad, he drinks. What about Mom taking her pills? You never hugged me as a child. Did my wife tell you about her little boyfriend?” If they are skilled in this tactic, you are not aware of the fact that you are now arguing about events that may have happened years ago and have little or nothing to do with his current problem. Coincidentally, the confrontation is now on you, not them.
  • SEPARATION: 
    • Separating the primary enabler from the interventionist or the group is another common tactic. “I’ll only talk to mom.” Trying to manipulate the one who always crumbles, gives up, or “gives in” is always easier and more comfortable than trying to manipulate a group. Sooner or later, the enabler will give in and the rest of the family gets upset because nothing has been done once again. Of course, that is perfectly fine with the addict if the pressure is off once again.
  • SYMPATHY PLOY: 
    • To minimize, diminish the strength of the confrontation, or eliminate it entirely, the loved one may attempt to evoke sympathy from you so that you back off. “Fine. I’m a loser, is that what you want to hear? I fail at everything. Do you think I don’t know that? I’m the worst father and husband in the world.” While they are saying this, you may even see a tear shed. During this you may find yourself backing off, reassuring your love, their worth, and that this is not meant to be critical. In most cases of an intervention, there is not usually criticism or judgment from the family. Instead, it is an objective portrayal of the truth. Rather than accepting and taking accountability for their actions, they will try to prevent you from illuminating the reality. Sympathy causes you to back off or stop the confrontation completely.

  • STALEMATE:    
    • Another manipulative attempt that may be used is in the form of a stalemate. A complete and total refusal to do anything about the problem. “Too bad, I am not going to stop. Get over it.” This is their way of saying that it is you that needs to change and not them. Baffled and confused, you eventually give up because you do not know how to handle it.
  • POSTPONEMENT: 
    • Postponing the topic at hand until a “later time” is another tactic that can be seen during an intervention. “I’m really busy. I’ve had a rough day. Can we talk about this tomorrow? I promise that we’ll talk. I’ll think about it and get back with you later.” In some cases, they may listen to you but postpone the decision to accept treatment, knowing that if they put it off until another day, they can always get out of it again. Based on an independent study, we found that 96% of alcoholics and addicts who convince their family that they “need a day or two to think about it” do not go to treatment. Their decision to think about it is simply a way to make the confrontation and treatment program go away.
  • SEDATION OR OBLIVION: 
    • The final method that we are going to mention is the most obvious: drinking or using drugs to sedate the discomfort. If the situation becomes uncomfortable enough, they may retire to the bathroom to get high. For them, any situation is more bearable if it fades away under the effect of a mind-altering substance. Therefore, it is not uncommon for some addicts to show up at family functions under the influence; especially when dealing with an alcohol, opiate, or benzodiazepine use

Although there are many different types of manipulations that an addict may use during an intervention, most of these reactions can be found in the previous list. Hopefully this demonstrates to you that an addict behaves much like any other addict. They are not as unique as you or they might think. Their behavior is quite predictable and with the information in this section, you should be better prepared for any major reactions during the intervention itself.

SUMMARY OF REACTIONS AND MANIPULATIONS

We have covered several of the most common reactions or methods of manipulation that an addict will use to avoid facing an uncomfortable life situation, using an actual intervention as an example. It is interesting to note that the problem is not so much a drug or alcohol problem as it is one of how they handle uncomfortable feelings or situations. Every method that we have described really has one thing in common: What can I say or do to make an uncomfortable situation go away?

An addict can be quite skilled at telling you exactly what you want to hear just to avoid the situation. Understand that in addiction and recovery, words and promises without actions mean nothing. These are his survival mechanisms that have worked in the past. For them, these are the same methods that they will also use to make the intervention and its goals disappear.

To make a comparison, if a family member was stricken with cancer and collectively as a family you sat down with them to talk about the problem and an effective solution, then odds are that they would be receptive considering their condition. Would they use any of the previous methods we have described? Even though it would obviously be a very uncomfortable topic? The answer is no. In addition, they would probably be willing to participate in a comprehensive solution. The more intensive the treatment, the more encouraged they would be about it. It is the cancer that is the problem and there is a solution.

In comparison with a drug or alcohol addiction, it is not necessarily the substance itself that is the problem. It is how they deal – or more importantly – do not deal with an uncomfortable life situation that is causing the substance abuse. Even if your loved one is completely sober at the time and you do decide to confront them, you may witness many of the manipulation methods or symptoms that we have outlined. To effectively get your loved one into treatment, you must determine an adequate treatment solution and never compromise that solution.

Do not allow yourself to be manipulated out of a successful solution. An intervention should not be a negotiation. Watch carefully for the reactions described and understand that each manipulation has only one result for the addict – to continue their lifestyle of substance abuse. An emotionally sick addict has very little healthy emotional coping mechanisms to determine the best form of treatment. Some argue that they are the least qualified to make such a decision. Although some of their ideas may have temporary abstinence potential, none have a degree of merit in terms of long-term recovery and are manipulations created by the addict.

THE PROGRESSION RATE OF ADDICTION

We have outlined the idea that the problem is not a drug or alcohol problem as it is one of impaired coping mechanisms. The drug or alcohol use is just one of many symptoms of this failure to deal with uncomfortable feelings and life situations in a healthy manner. As an addict uses substances to cope with the uncomfortable, they slowly become unable to deal with these situations sober. Over time, this failure to deal with life manifests itself in the form of many classic symptoms that can change over time.

The best visual representation of how substance abuse damages the body is best seen on the “Jellinek Curve” or Progression Curve of Addiction (which is demonstrated on the previous page). Understand however, that progression rates vary due to: substances used, the frequency, the amount, and other factors. For your information, we have supplied a breakdown of the average progression rates for the most commonly abused substances in the list below:

SUBSTANCEPROGRESSION RATE
Alcohol10-30 years
Barbiturates (Phenobarbital, Seconal, Nembutal, etc)2-7 years
Benzodiazepines (Xanax, Valium, Klonipin, etc)5-10 years
Cocaine 2-10 years
Crack 1-5 years
Marijuana10-30 years
Methamphetamine2-7 years
Opiates (Heroin,Oxycontin,Vicodin,etc)2-7 years 
Club Drugs (Ecstasy,LSD,GHB,Ketamine,etc)Unknown

 

 

 

 

 

 

A common misconception is that if an addict switches from one substance to another, they start at the top of the progression curve again. In actuality, if someone changes substances, the downward progression continues where the other drug left off.

For example: someone spends 10 years drinking and is somewhere in the middle of the alcohol progression curve. Then they decide to quit drinking but switch over to a much more rapid progression substance such as cocaine – they would progress more rapidly but would continue at the middle of the progression curve even though they had never touched the new substance before.

Oftentimes we will see an addict who has been drinking alcohol or smoking marijuana for years at a slow steady decline and then he switches to opiates or crack cocaine and then the progression speeds up. The family then mistakenly feels that their loved one “has a crack or heroin problem” because the decline is so sudden, but the problem has existed for years at a much slower rate with a different substance or activity.

SPECIAL NOTE: Most interventionists consider methamphetamine the most dangerous of all interventions due to their explosive, random, sometimes violent nature. These interventions are more difficult because by the time a methamphetamine user reaches the bottom of the progression curve he is oftentimes delusional, psychotic, or even insane.