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.