This summer I attended a luncheon for professional addiction counselors. During that
luncheon, the speaker talked about the need for addiction counselors to step out of the traditional approach for treating active addiction. He challenged us all to continue to learn additional methods and theories to broaden how we address each person that comes to us for help and guidance. I felt so validated!! Coming from a sociological, psychological, research based background, I have approached counseling the addict with a variety of tools which I carefully choose for the individual based on the need of that person and their circumstances. In the world of addiction counseling, I have maintained that each person that seeks help is an individual and that cookie-cutter-type counseling doesn’t work—thus the ongoing relapse cycle. My approach takes into consideration all of the components considered using the American Society of Addiction Medicine (ASAM) criteria which helps to identify challenges in cognitive, physiological, and behavioral components including social, financial, and environmental. Identifying the individual’s challenges allows me to create a treatment approach that allows the person to
cognitively become aware of negative thoughts and behaviors, decide they want to
change these thoughts and behaviors, then offer them the tools they need to make
changes leading to a choice of a healthier lifestyle.
There are studies that estimate the rate of recovering people relapsing is as high as 74percent! This would lead us all to agree that, in fact, the traditional approach for treating active addiction is not working. Working with survivors of addiction and life transitions,I recognized a pattern of underlining core issues that appeared to keep people stuck—unable to reach their full life potential, and chronic relapse. Traditional treatment programs and 12 step support programs are often successful encouraging sobriety, but do not appear to identify and address old deep core issues. ‘Issues” such as child abuse, both physical and emotional, other PTSD issues similar to traumas experienced by military personnel, and ongoing loses experienced through their lives. Depending on the age the addiction became chronic, the individual may not have acquired the tools necessary to deal with what life throws at them on a daily basis. Often the result is a reaction to undefined fears and the lack of capacity to deal with feelings. The reaction is to deal with
a tool that is familiar: their drug of choice. The addict becomes stuck in their cycle of relapse. Providing some basic tools for the addict to help them identify, name, and face the fears, identify and understand the feelings, and move on to a healthier lifestyle, becomes the challenge for the counselor.
A non traditional tool I have found very effective with clients proan to chronic relapse is Elisabeth Kubler-Ross’ Cycle of Grief and Loss. Elisabeth Kubler-Ross, M.D. bestselling author of On Death and Dying and To Live Until We Say Good-Bye, was
the recipient of more than twenty-five honorary doctorates. Her books have been
translated into more than thirty languages. Her research and writings were
primarily around death and dying; she developed the Cycle of Grief and Loss to
guide those dying, and their loved ones, through a healthy grieving process. Her
cycle has been adapted as a cognitive tool for processing healing of all losses. In
substance abuse recovery programs, this cycle is often referred to as the
Forgiveness Cycle. I initially learned this tool while in nurses training in the early
‘70s. It appeared to be simple to utilize; it eventually became a thought process
that is utilitarianly subconscious to me now. There have been variations of this
cycle throughout the decades; this is a starting point I wish to use to help
understand for our journey through your loss process.
Kublar-Ross identifies five stages of grief:
Kublar-Ross’ stages of grief can be viewed in a cycle–a sieve-type process that
allows losses to cycle through, then recycle through the process as many times as
you need to in order to MOVE ON. Each time you allow the loss to cycle through
this process, a little more of the pain is caught, AND, YOU COME OUT A
Let me provide a simplified overview to each stage; I will use the loss of
substance abuse—alcohol and/or drugs– as an example:
-the shock absorber of the soul
defense against reality
try to deny an event actually happened–pretend it isn’t real
example: child sex abuse
-feelings associated with shock, disbelief, numbness
coping mechanism for survival
Denial is a term that is often associated with addicts prior to going into treatment.
If we look deeper at what other denials there may be, we might be able to help the
client identify other loses associated with denial. The example I used above as
child sex abuse is a common core issue often found with chronic relapse.
-the “what if……” or the “if only…..”
-feelings associated with: excited, wishy-washy, anxious
We have all heard, or dealt with, the active alcoholic that wants to prove that
alcohol is not a problem for them. So they vow to only drink on weekends, but
will easily slip into the rest of the week.
-angry at the event, at yourself, at others, at God
-feelings associated with: rage, resentment, confusion
Interventions often moves the addict to this stage. As the addict is forced to enter
treatment, they begin to redirect their anger to themselves for allowing ‘this to
happen’ to them. Blaming others, a characteristic of addict behavior, manifests
even greater at this stage.
-exhausted from denial
-bargaining didn’t work
-expended anger–sick of angry
-finally acknowledge what life socked to us
-start to really feel the pain
Often the addict will teeter between anger and depression. One of the withdrawal
symptoms an addict experiences is depression, particularly for alcoholics. If the
addict remains between, or on, either of these stages for too long, relapse becomes
inevitable because the addict does not have the tools necessary to deal with all the
feelings associated with these stages. These two stages is where the hard work is
really done to uncover any core issues that may exist.
-careful not to mistake for ‘happy stage’, or ‘pink cloud’
-void of feelings, pain is gone, the struggle is over, feel “centered”
-WE ARE FREE!!!
-we get to MOVE ON
It could take up to 18-24 months for someone in a good recovery program to reach
acceptance. Part of the problem is that loses of all types are happening all the
time—day in and day out. In addition to helping the addict work through their
major loss of the substance of choice, they must also recognize that life goes on
and loses will continue to occur: marriage breaks up, kids leave home, death of
loved ones, etc. Perhaps for the first time in their life, the addict has to feel, learn
to act instead of react, and not hide behind a substance—the artificial world they
created with their addiction suddenly becomes reality. The important fact that I
keep emphasizing to my clients in recovery is that if the cycle is allowed to
happen, each time the loss cycles through the sieve, a little more of the pain is
caught, and they will emerge stronger.
Some things to keep in mind about this process are:
-You will not move neatly from one ‘stage’ of grief to another.
Life happens. You will be experiencing a constant daily, hourly,
movement of losses through the cycle. You will be experiencing
more then one loss at a time. Each of these losses may be in
different stages; you won’t always enter in the same order; and you
may visit stages more then once.
-Your feelings and emotions may ebb and flow, like the ocean’s
waves. By learning to identify and acknowledge these feelings, you
can move through the process at your own pace.
-You will, more then likely, recycle your losses.
You may think the loss is resolved, but then, something will eke out
of your subconscious, you’ll experience a smell, sound, see a
picture, one of your senses will trigger the loss–AND THE
PROCESS WILL BEGIN ALL OVER.
-You can expect upheaval, emotional chaos, and unpredictability for
a period of time while consciously dealing with your loss: the perfect
fuel for relapse.If you can learn to STOP, identify the FEELING,
and remember what LOSS you are cycling through the process, you
will be able to feel more in control of your emotions. YOU CAN
CHOOSE TO BE CENTERED. How you deal with the loss is up to
you: HEALTHY OR UNHEALTHY.
-Healing doesn’t always travel down a freshly paved road that you
can see miles ahead. Healing is like a journey over a mountainous
road: you start climbing, then plunge into despair; you may seem to
go two steps forward, then three steps back; sometimes you may feel
you are back at the beginning and you have to start all over. This is
all part of the healing process. YOU WILL HEAL. Be patient with
yourself. Continue the process. DON’T GET STUCK.
In grief you are in the depths of hopelessness and helplessness. How you deal
with your losses determines your ability to live a FULL HEALTHY LIFE. If you
allow yourself, and use the strategies you have read here, you will EMERGE A
HEALTHIER, STRONGER, MORE CENTERED person capable of dealing with
infinite possibilities of the universe.
Please keep in mind that this is a simplified overview of the Kubler-Ross grief and loss
process. You will be able to read a detailed description with additional tools that will
help you through the grief and loss process in my new e-book that will be available in
January 2008. This book will be one of three offered next year based on my successful
workshop series MOVING-ON: A HEALING SERIES devoted to creating a
HEALTHIER LIFESTYLE. If you would like to learn more about the workshop series,
please contact me through http://www.lifestylechangescounseling.com.