Residents are admitted to the Canadian Centre for Addictions for treatment of substance abuse issues. The Canadian Centre for Addictions directly addresses the underlying character pathology that fuels the addictive processes.

As a treatment team, we need to identify the Resident’s dependency of choice, as substance abuse is frequently a symptom of other dependencies. This identification, or assessment process, involves getting to know the Resident from three major perspectives:

• Behavioral or Personality Organization. The disposition of a Resident needs to be identified and addressed. Distorted perceptions and beliefs can leave the resident in chronic conflict with the world, continually misinterpreting relationships and situations. For example, one individual might vacillate between extremes in relationships, first overvaluing and then devaluing others, never able to maintain a stable perspective. Another might demonstrate total disregard for people, and even for his or her own health and safety. The end result is that the individual, trapped in a distorted belief system, is only able to have a relationship with him or herself. Without challenging the distortions and consequent behaviors, the Resident will be unable to develop the interpersonal relationships necessary for recovery.

• Affective Experience. The affective experience of an individual refers to how one experiences oneself on a feeling level. Affective disorders, such as depression, mood or anxiety disorders, are often manifestations of a dependent personality. The Resident will rarely recognize his experiences on a feeling level as being connected to development difficulties while moving through life’s challenges. In addition, past traumas, whether chemically induced or by perpetration, can set the stage for trauma bonding and the tendency to exhibit an obsessive-compulsive process, exhausting the individual’s mental energies. Individuals in this state can experience extreme difficulty identifying or expressing emotions, leading back to an over-reliance on others. Individuals, especially early in recovery, can have overwhelming and confusing emotions. If not addressed, these affective states can trigger a return to the addictive cycle.

• Family-system dynamics. All families operate according to spoken and unspoken rules; family members adopt and adapt roles, communication styles, and boundaries. The dynamics of an individual’s family system help explain the “authorized” experience of the family and, sometimes, the chosen “Identity” of an individual Resident. The dynamic of spousal child/family hero/scapegoat/lost child all put people at risk of being assigned a dependent role within the family system. As it is common for individuals to recreate the dynamics they experience within their families in other relationships as well – be they with friends, lovers, co-workers, and even therapist – the re-creation of dependent roles, and the subsequent pattern of interactions, are specifically detrimental and can contribute to the relapse process.

While in treatment, we, as a treatment team, must also identify the strengths and competencies of Residents in order to help them confront the issues that serve as obstacles to the recovery process. When one develops identification with their strengths, they can serve as the regulators of anxiety, depression or grandiosity. In fact, our definition of sobriety is the ability to manage feelings without a return to chemicals or other addictive behaviors. The goal is for Residents to build upon their strengths, work through their issues, and move from dependency to inter-dependency.

Dependent vs. Interdependent

The dependent position, with its chief emotional components of feelings of entitlement or perverse grandiosity, fuels anxiety, depression, anger, and fear. An individual in this position believes success or failure is due to someone else’s behavior or to circumstances that are imposed on him. Any encouragement of the dependent position reinforces and fuels that addict’s delusional system. “If I take something from the outside and put it inside, I will feel, be and work better!” With this belief system in place, it will make sense to the addict that the external world is at fault or to blame for any unhappiness, problems or discomfort, and by extension, is also to blame for the addict’s behavior. Most Residents have had this “fixed” delusional system for many years. “If only I had a better counselor, treatment centre, roommate, job, set of parents, car, girlfriend, wife, partner, boss; if only I could get that thing out there and incorporate it, I would feel better!”

Using someone else’s behavior as one’s regulator of feeling is doomed to fail. Addiction serves as a way of regulating a Resident’s emotions, and in this sense, it is similar in process to the dependent position. Both addiction and the dependent position provide a substitute for developing the capacity and the necessary competency to regulate one’s own internal emotional processes.

The interdependent position reinforces and fuels the addict’s recovery by merging the patient’s internal dialogue with the logical consequences of his behavior; this includes success and failure, experienced positively or negatively. When Residents experience honest, realistic views of their self-worth and begin to assume responsibility for their own behaviors, it facilitates the development of personal integrity, which we define as the congruence between one’s inside world and the outside world. One begins to see oneself as part of a larger whole. An interdependent position requires individuals to discard the delusion that outside sources are responsible for one’s actions, and yet, emphasizes the reality that we do not live in isolation and that individual choices affect the environment and our lives.

External stressors, jobs, relationships, money, trauma, parenting styles, and family of origin issues do not cause addiction. However, some relationships and family of origin issues can interfere with the internal personal resources an individual needs to draw upon to effect recovery. Therefore, outside concerns, especially current family or family of origin issues, are relevant to recovery, but not to addiction. Family and friends can either serve to contribute to their loved one’s recovery or the perpetuation of the disease.

If a Resident in early recovery is blaming external situations or exploiting family of origin baggage, how can he truly believe that addiction is a functionally self-directed process? When a Resident gets into blaming, they are coming from a dependent position, and the likelihood is that he still harbours, perhaps unconsciously, the fantasy that if these issues are resolved, then one can drink, drug, or engage in other self-destructive behaviors successfully again.

Therefore, family, group or individual therapy sessions should proceed very cautiously, especially when discussing family of origin issues, due to the potential of reinforcing the dependent position and its concurrent externalization of responsibility for life’s successes or failures.

Paradoxically, the very process of exploring family of origin issues can open the door for discovering the ways in which the Resident has developed habits of externalizing and assigning responsibility to others. However, this process is only valuable as a means of confronting, reframing, and reversing Residents’ ideations from externalizing to internalizing. In short, Residents must be moved from taking others’ inventories to developing the ability and motivation to take their own. Unless attention is paid to these points, the dependent position will be reinforced.

Parent as codependent is the normal position for parents. To provide for, to protect and defend, are normal, healthy instincts that are integral to parenting. These same instincts are also basic in spousal, significant other, and close family relationships. The disease of addiction perverts and distorts the healthy process of defending and protecting and can produce, as a result, the unhealthy behaviors of rescuing and enabling. These behaviors serve the dependent addict and perpetuate the addictive process.

Without guidance or external support families can adopt many of the same defense mechanisms as the addict and assume roles that keep the addict in a dependent position. For this reason and others, some professionals view addiction as family-centred, and family members, like the addicts themselves, can engage in a recovery process. Recovery for families often means going against one’s own instincts in order to allow the addict to experience the consequences of his behavior. We, as a treatment team, believe that it is important to address and challenge the family’s perceptions and behaviors. This is a much needed and healing process, yet can be difficult. We believe that the skills necessary for recovery must be taught and consistently supported. For most families this is not instinctual. Many families choose to engage in their own therapy with a knowledgeable professional while others participate in self-help groups such as Al-Anon. These groups offer important tools and support and allow family members to feel okay about themselves as they redefine what it means to have a healthy and loving relationship with a recovering or active addict.

But remember, addiction is a functionally self-directed process. Families do not cause addiction. Our Toronto drug rehab program can overcome this. The significant people in an addict’s life are often filled with feelings of guilt, anger, or confusion. Some even project those feelings and believe that we, as professionals, are judging them as unfit or think that they are actually to blame for the addictions-something they may have heard from the resident. As a treatment team, we believe in giving families an enormous amount of support, clarification and validation. Families are not responsible for the addictions. Our goal is to develop a therapeutic alliance with family members. The value we place on the relationship between families and the resident cannot be underestimated.

Recovery, as opposed to abstinence, is an adult undertaking. It takes an integrated, mature, emotionally accessible psyche to respond to life’s events without picking up a drink or drug, or engaging in other addictive and destructive behaviors. Our Toronto alcohol rehab program will lead you to develop a healthy, drug- and alcohol-free lifestyle. While in treatment, there is only a short period of time in which to initiate and foster psychological development in our residents. Our goal is for residents to develop consistent internal frameworks to emotionally process their life events. This is accomplished by asking them to stretch into adulthood from their childlike dependent position.

• We consistently ask the Resident to take responsibility for whatever is happening in his or her life.

Again, the development of personal integrity begins with residents accepting the choices they make in responding to life’s events, made consciously or unconsciously, and are entirely their own and bring about consequences that they themselves create.

• We have the Resident earn before receiving, whether emotional support, financial support, spiritual support, physical support.

Addiction is sustained by the unconscious fantasy of life without consequences. Recovery is the acceptance that one is responsible for consequences earned, be they experienced positively or negatively. Anything given to the addict before it is earned simply serves to reinforce the dependent position and fuels the unconscious and childlike magical thinking that one is somehow entitled to things and is pardoned for the logical consequences of one’s actions. When parents or partners do for loved ones what they could do for themselves, they are deprived of an opportunity to develop appreciation for themselves. It is this appreciation that will come to serve as the regulator of anxiety or depression. This ego or identity enhancing development cannot be handed down verbally, theoretically, or experientially from one person to another. It must be internalized through an individual’s direct experience.

• We ask Residents to assume adult responsibilities while in treatment, including work and homemaking for themselves and others.

Work and home responsibilities are part of the therapeutic process. Having been in a chemically dependent position with its regressive or childlike process, the adult addict has little or no stable sense of the world of adult responsibility and may view it as being harsh, overly demanding or without joy. When Residents engage in blaming their environment for their problems, they are frequently expressing these views. Our therapeutic process asks that Residents have direct experience with the calming and ego building world of adult mastery. We continually expect Residents to rise to the level of adult responsibility, from simple self-care to appropriate work within the community.

• We ask Residents to do unto themselves and others as they would have others do unto them.

This well-known saying has some unique applications in treatment. Not only are Residents given the understanding that they help themselves by helping others, but by actively engaging in this process, they can reverse the effects of the previous dysfunctional relationships. Residents can change the past-or how they are experiencing the past-through changing current behaviors.

As one’s internal dialogue becomes healthier, one becomes capable of joy without mania, of feeling good rather than grandiose, of feeling calm rather than numb; one has realized integrity of thought and deed, of intellect and behavior, and is capable of caring for others without care-taking. In order to have this come to fruition, we, as a treatment team, employ the therapeutic tool of psychological relapse. A Resident’s success in recovery depends on success with negotiating through crisis after crisis and developing the necessary internal resources to effect lasting change.