Professionals: Read drafts from the next book - Talking to Your Clients About Quitting Forever.
Talking to Your Clients about Quitting Forever
There are two different ways you talk to clients about quitting forever: teaching and experiential. Teaching clients about quitting forever is providing information about what can be done. Someone engaging in the process of quitting forever may require repetition of information and assessment of what was learned so remedial learning can take place. But, just because someone learned the information does not mean they have completed quitting forever. Information about the client learns by reading the book and talking with the counselor paves the way for the experience of quitting forever. The experience of quitting forever is portrayed graphically in the model. The model of quitting forever is the guide for assessment of what is to be taught, what the client has learned and what remedial learning is required. The model also is the guide for assessing the client’s experience of quitting forever and for the counselor to provide experiential exercises during the session along with homework assignments the client can carry out to re-experience on their own what was demonstrated during the session.
For example, teach the client about the concept of ambivalence. Ambivalence is where your mind goes back and forth between two or more alternatives. Showing the ambivalence illusion helps some people get it faster than a providing a verbal explanation alone. Ambivalence may be part of choosing where you make up your mind and decide what to do. The mind is going back and forth because that is what minds do and because you have not resolved what to do. So the ambivalent person participates in the ambivalence of a roving mind in the process of choosing or remaining stuck and confused. The unresolved outcome is the responsibility of the client, but an experienced therapist can often facilitate movement to resolution more rapidly than a client left to their own resources.
The above paragraph is a truncated lesson teaching ambivalence to the client. You may have to go over the concept more than once and ask questions to assess the client’s degree of learning next week or at a later time. But, the understanding about ambivalence is not the experience of ambivalence. The experience therapist provides experiential exercises for the client to observe their own ambivalence to assist movement to resolution. When working on quitting forever, ambivalence can easily be found by asking the client to think about never using alcohol and drugs again by thinking the words of the sentence in their mind, “I will never drink alcohol or use drugs again.” Remind them the sentence is not a commitment but an experience exercise. Ask them to observe thoughts in their mind that are contrary to the sentence. If the client does not recognize any words in their mind contrary to the sentence, then directly evoke contrary ideas by asking the client if they have actually quit forever at this point in time. The client usually comes back with hesitation and then hems and haws about not knowing. That is the therapist’s opportunity to introduce the client to their ambivalence. Evoking the experience of ambivalence in the client also teaches them about the concept, but now the reference point is not just words but the client’s own experience.
Educating the Client Means Educating the Professional
Education is an important part of Quitting Forever. Unfortunately, there is much information provided in recovery if followed or believed inhibits the learner from the act of quitting forever. The counselor might begin to pay attention to Prochaska and DiClemente (1982). The ‘trans-theoretical model of change’ is presented in continuing education classes presented by substance abuse professionals. Continuing education classes often leave out permanent exit from the original model. Without permanent exit, the model supports endless relapse without permanent behavior change. But, the research supports permanent behavior change. The trans-theoretical model was how to talk to people using motivational interviewing skills to help them bring about a behavior change they desire. Leaving out the end result of permanent behavior change is hopelessness on the part of the providers. If no one is teaching permanent behavior change, and no one expects it will happen, the research shows those expectations alone are enough to prevent behavior change (Miller and Rollnick, 1991).
Quitting forever is something someone does. It is an important event in someone’s life when they reassert a value. Alcohol and drugs change one’s values whereby alcohol and drugs become more important than other things. Quitting forever re-establishes values alcohol and drugs will not be more important than. The event of quitting forever is the point in time when the individual decides on the value of abstinence and uses it to guide behavior when it comes to further alcohol and/or drug use. But, why would anyone ever set a value that was unachievable? For example: If you had a disease that kept you from walking, would you ever promise yourself you would run? That may seem like a silly question but if you are incapable of doing something, the best you can say to yourself is I will try. But, you know the odds are against you. If you believe you have a disease that makes your arms pick up things when you do not want to, how could you ever say to yourself you would not pick up alcohol or drugs? If you believed you were genetically wired to pick up alcohol or drugs when you did not want to, they how could the event of quitting forever take place? If you believed the feeling to use or thoughts in your head would make you pick up alcohol or drugs when you did not want your arms to move, you would be reluctant to say to yourself, I will never use alcohol or drugs again starting right now. And, if you believed the best way to abstain was by only telling yourself you would not drink alcohol or use drugs only for one day, you would not be able to bring yourself to the event of quitting forever. It is important that the professional first and then the client see quitting forever as a sensible goal that is viable (Miller and Rollnick, 1991.)
Education reviewing disease concepts along with genetic factors is important. Basic understanding of brain anatomy and neurology helps clarify how the brain and body works together. A review of what, ‘one-day at a time’ means and what abstaining by following the 12 Steps and relapse prevention as a contrast to quitting forever provides a choice for the person wanting to end alcohol/drug abuse or addiction. With education and choice about method of remaining abstinent, there is vision driven change where goals are clarified based on client choice.
Questioning the Disease Concept
The questions about the disease concept are rational and empirical. They can be thought through to the outcome once logical questions can be posed. As of this time, no one teaching the disease concept of addiction has adequately been able to answer the questions. Logical contradictions are ignored and teachers of the disease concept go on like there is no questioning the disease concept. Disease concepts have been extensively addressed in the book: The Natural Process of Quitting Forever: Explicit Instruction. Stanton Peele has done a fine job of addressing disease concepts in the book: The Diseasing of America. I will talk about how to have a discussion with a client or a group about disease concepts of addiction.
Infectious Disease Concept: The logical contradiction with the disease concept is that bacteria and virus multiply once they are in ones system. Alcohol and drugs do not multiply but become less once in the system. How can this be like an infectious disease with these two important differences?
Disease bought on by continuous use like diabetes or high blood pressure. The logical contradiction is the difference between the natural resting baseline conditions if nothing is done to change it. Take a diabetic and alcoholic and sit them side by side. If you do nothing but feed them, the diabetic becomes sicker and dies. The alcoholic become healthier and lives longer. The diabetic has to do something to change their condition so they will not be sick. The alcoholic will not be sick unless he does something to change his condition by drinking to make him sick. How are these to diseases alike and how are they different?
Obsessive Compulsive Disease: Obsessive means one thinks about it again and again like a song stuck in the mind. Compulsive means a behavior has to be carried out. There is no way to measure when someone who is sober or detoxed compulsively drinks or drugs to determine that it was not carried out voluntarily. The logical contradiction is how can it be an obsessive compulsive disease when compulsion cannot be differentiated from a voluntary action?
Genetic Factors: The genetic factors discovered show why someone gets more pleasure when they drink or use drugs. The genetic factors show why someone might have a better ability to hold more alcohol or use more drugs than another person. The genetic factors show some people like being more intoxicated than others. Genetic factors do not explain that someone has to use when they do not want to. Further, the question for the client and the therapist is this: Was a genetic test done on this client to determine they have the genetic markers? Family history does not determine the presence of a genetic marker in any individual. How can anyone say they have or don’t have the gene without a genetic test? It is not rational to assume the gene is present. The onus of proof is on biological evidence. It is irrational to assume gene positive without the evidence. Why would you assume you had a genetic disease when there were no biological evidence you had one?
Brain Recovery Model: The brain disease concept evidence is in and it is undisputable that alcohol and drugs change the pleasure pathways of the reward circuit in the lower brain. The evidence explains why someone who want to use again and again because alcohol and drugs and why they can be so rewarding. The disease concept explains why one starts to think about alcohol and drugs more and why their values about alcohol and drugs change. The evidence about the change in the reward circuit explains why the bodies non-voluntary systems start to react as cues in the environment become classically conditioned with alcohol and drug use. The evidence explains how voluntary behavior would be come operant conditioned to be a dominant response to use alcohol and drugs. The brain disease concept does a fine job explaining why someone could never be forever quitting alcohol and/or drugs. The logical contradiction is why would someone helping another person who wanted to end their alcohol and drug use go into so much explanation to convince them they could never quit forever? What the disease model ignores is how voluntary movement takes place on a neurological level.
The brain recovery model is explained in detail in the book: The Natural Process of Quitting Forever: Explicit Instruction. It is important to be able to educate the client in the brain recovery model. Jack Trimey ‘structural model’ explains a version of the brain recovery model in his book Rational Recovery the New Cure. Anyone can go to textbooks of brain neuro-anatomy and trace the nerves coming from the lower brain where the pleasure circuit is affected by the use of alcohol and drugs to the motor-cortex part of the brain controlling movement. The brain disease model fails to explain how the pleasure circuit makes the hands move when the person does not want them to use. The pleasure circuit hijacks the brain is chanted again and again by disease model proponents. However, the pleasure circuits send a message to the prefrontal cortex, not to the motor-cortex. This explains why thought and feelings to use would come to awareness involuntarily. It does not explain how the hands would be made to move against the person’s intent to move them. How can alcohol and drug use be a disease when it is a voluntary action?