In the initial stages of addressing an alcohol or drug problem, most people are ambivalent about wanting to gain control of it - they may have some wish to cut back or stop, but the temptation to continue may also be very strong. This is particularly so when someone is either psychologically or physically dependent on a particular drug. The consequences of their substance use may be serious, and they may want to stop, but their dependence makes it very hard to do so.
When a drug user is unclear about their intentions, this is the time when support from a professional counsellor can be very helpful. Acknowledging the conflicting feelings that most people in this situation experience, a good alcohol & drug practitioner can assist the 'user' to clarify their intentions and move through their ambivalence. The point is that having conflicting feelings about wanting to stop is a normal part of the process.
LACK OF TRUST
So many teenagers experiment with alcohol, cannabis and other drugs and find their adolescent anxieties or insecurities are temporarily relieved in the process. If that "experimentation" continues unabated for too long, they may begin to develop more trust in the alcohol or the cannabis as a means of dealing with their problems, than they do in themselves or in other people. This is often one of the biggest difficulties that substance users have to overcome. They become so used to "trusting" their drug of choice to regulate their emotions, it becomes their best friend, and they find it hard to trust human beings.
So when someone is ready to deal with their drinking or drug use, one of the things they may need to learn is how to begin the process of trusting themselves. Part of this process involves learning to trust those people who are trying to provide support. For the 'user', this may begin with the slow development of belief (with the support and encouragement from a counsellor), that they can in fact cope with life without resorting to drugs or alcohol.
LOW SELF-ESTEEM
Another very common underlying issue that many people with alcohol and drug problems have is low self-esteem. Self-esteem is not an easy concept to define, but in general if someone comes from a family background where their psychological and developmental needs were not adequately met as a child, there is a good chance that they will have grown up with feelings of anxiety or insecurity. Such feelings are not conducive to the development of psychological maturity and impact negatively on self-esteem.
When such feelings are combined with or derive from invalidating experiences such as psychological, physical or sexual abuse or extended emotional neglect, the consequences can be devastating. Childhood circumstances of this nature sometimes create such intense on-going emotional distress, that in our society, the use of alcohol and drugs to sooth such feelings is almost inevitable. Your counsellor can help you explore whether or not low self-esteem contributes to your alcohol or drug use.
THE ROLE OF WILLPOWER
Even when someone is ready to stop or cut back their drinking or drug use, they may feel they have to get it under control by themselves by using will power. Most cigarette smokers do this when they decide to quit. However most cigarette smokers try and fail many times before they finally succeed in giving up. The situation is usually no different for those trying to cut back on alcohol or drug use. Most attempt to control their substance use by using will power alone - and usually fail.
Restructuring your environment:
In fact, many 'users' struggle with their drug or alcohol problems for years trying to keep it under control, before they finally realise they can't do it by themselves. This is because when up against an addiction, will power is a very limited resource and will only take you so far. Learning to restructure your environment so that it supports an alcohol and drug free lifestyle is usually the key to recovery. Once a supportive lifestyle is in place, when temptation arises, some will power may be needed; in the right environment it then becomes much easier to exercise the necessary willpower to avoid further drug use.
The need for support: In order to change the drug user's environment, the support of a good alcohol and drug counsellor, and/or the support of a group such as AA, is generally what makes the difference.
Without such support, the average alcohol or drug user is left with nothing but their own limited resources to make what is usually a difficult journey. Add denial, low self-esteem and conflicting intentions to the mix and the odds may seem insurmountable.
The role of courage: Having the courage (or perhaps the desperation) to seek professional help is probably the biggest favour that someone in this position can do for themselves.
DENIAL
When someone has an alcohol or drug problem but is not yet ready to face up to it or do something about it, they are sometimes said to be "in denial". Denial is often a combination of a lack of awareness of the actual consequences of drug taking, combined with a lack of self-belief that the user could stop using even if they wanted to. Teenagers especially tend to deny their drinking or drug taking is a problem, but often do so because they have not yet been 'using' long enough to have experienced sufficient on-going negative consequences to be that concerned about it. On the other hand, those with long term drinking or drug problems may be very concerned about their drinking (or drug use), but feel powerless to stop or control it.
When this lack of awareness, insight or self-belief continues for many years, then it would not be unreasonable to call it "denial". In psychological terms, someone with such little insight into the impact of their substance use may be called pre-contemplative. Pre-contemplation is the first stage in a model (known as the Stages of Change model) that describes the stages people go through when making a significant change in their lives (see below). This model is a useful way of assessing the "user's" readiness to make changes regarding their drinking or drug use.
CHANGES IN MOTIVATION
Substances users may be in denial, they may be ambivalent about wanting to stop, or they may think they should be able to control their substance use by using will power alone. They may also have low self-esteem and lack trust in themselves and others.
The impact of these different psychological factors is that levels of motivation depend on the circumstances and vary over time. They also vary enormously from one individual to another. Often in the early stages of dealing with a drug or alcohol problem, the motivation or desire to deal with it may be low. As time goes by, drug use may escalate or the consequences may get worse, and so the need to address the problem may become clearer.
The impact of a crisis:
Sometimes people only come to the realisation that they need to address their drinking or drug use when there is a crisis - such as the breakup of a relationship or the possibility of imprisonment because of a legal offence such as a drink driving conviction. Those who are required to have an alcohol and drug assessment prior to sentencing in Court are often described as having high 'pre-sentence motivation'. Once the crisis is over, if the individual avoids going to prison, such motivation often does not last. The point is that motivation is not a fixed entity, which someone either has or doesn't have; it varies with the circumstances.
The impact of seeking help:
An indication that someone's motivation may be on the increase is if or when they decide to seek help. They may attend an AA meeting or perhaps ring an alcohol and drug agency. Although this might be a hopeful sign, sometimes people will take this step just to appease a family member who may be expressing concern about the problem. However, the level of motivation involved in addressing alcohol and drug issues in order to please family members or friends is not likely to be sufficient in the long run.
Nevertheless if the person actually engages in the counselling process, this does allow them to become clearer about their own intentions. When someone reaches the point that they wish to address the issue for themselves; when their own intention or goal becomes clear, the necessary motivation required will usually come from within.
ROLE OF THE A&D COUNSELLOR
As described above, there are many factors which impact on the state of mind and level of motivation of substance users. Counsellors are often faced with clients who are unsure of themselves, and unsure of their ability to cope with life without drinking or taking drugs. In simplistic terms, the counsellor's role is to help the client work through their ambivalence, and motivate him or her towards gaining control of their substance use.
Aspects of the role:
(1) Assessment: To assess the extent of the person's "problem" - how bad is it?
(2) Mental health issues: To assess whether there is an underlying mental health problem; a referral may need to be made to a psychiatrist or GP.
(3) Identify triggers: Help identify the situations, thoughts and feelings that trigger the client's drinking or drug taking.
(4) Life style changes: Help the client make appropriate life style changes - paying particular attention to the people they mix or socialise with who may draw them into substance use.
(5) Self-soothing activites: Help the client find distractions or self-soothing processes to cope with cravings.
(6) Suggest treatment options: Make referrals to residential treatment programmes when this is appropriate. Those with substance dependence problems will usually require more intensive "treatment" than those with substance abuse problems
(7) Provide support: Help support and motivate those that want to change, but are finding it hard.
THE CYCLE OF CHANGE
Given that so many alcohol and drug users are in fact ambivalent about wanting to stop, may be lacking in trust, or may just be in denial, the support of a professional counsellor becomes essential. Helping someone in this situation can sometimes be a difficult task. However there are a number of tools at the practioner's disposal.
The following is a model or theory of change developed by two social scientists (Prochaska & Diclemente), and may be used to explain the different decision-making stages that we tend to go through when trying to make a significant lifestyle change. Whether the desired change is to give up alcohol & drug use, or perhaps to get fit and lose weight, the process is basically the same.
The diagram below demonstrates the decision-making process of someone wanting to take control of their substance use.
It begins here (clicking your mouse on each part of the diagram will activate different messages):
A fuller explanation of this model is provided below.
THE STAGES OF CHANGE
Pre-Contemplation Stage:
A state of unawareness where the user has no concerns about the consequences of their alcohol or drug use. Teenagers are generally in this stage and some people may be stuck here for years.
"Denial" might describe this stage for people who have a long history of alcohol or drug use but insist they can handle it.
Contemplation Stage:
The stage where the person has become aware that there are problems associated with their substance use, has begun to think about the issue, but is not yet ready to deal with it.
The consequences are not yet so bad that they feel the need to take action; or the consequences are serious, but the person feels that getting control of the situation is just too hard.
Preparation Stage:
The stage where the client is beginning to try things such as going to AA, looking at the options, and making a plan to stop or cut down.
The preparation stage is perhaps the most important in the process. If you move too quickly and stop using without a proper plan or without putting the necessary support in place, the chances of long term success are not great. Finding the right support is the key to success in any significant personal change.
Action Stage:
The stage where the person is actively attending counselling or AA/NA or both, and has committed to an attempt to cut back or stop using (preferably on a certain date.)
Maintenance Stage:
The stage where the person uses 'relapse prevention' strategies to ensure new behaviours are maintained.
Strategies in this stage might include:
On-going counselling
Attending a support group such as AA or NA
Telling friends and family of their plan
Avoiding friends they used to "use" with
Self-esteem building processes
Finding replacement activities
Relapse:
The process of learning to cope with a "slip" to prevent it turning into a full-blown relapse. Few people are able to get on top of substance abuse or dependence without a "slip", where they start using again. However some of the best learning comes from having a slip which is brought under control before the user relapses completely. In the process of stopping quickly, new skills are learnt which then become part of the user's relapse prevention repertoire.
Final Comment:
This is a theoretical model. Everyone is unique with different skills and strengths, and few people go through the stages from start to finish in a systematic manner. People enter the cycle at different points and many people go through different stages of the cycle a number of times before they finally achieve the outcome they want.
