Are We Setting the Right Goals for Our Clients?
As addiction treatment professionals, we may decide on setting goals for our clients based on what we believe is in their best interest. We mean well – we really do. But what if, in doing this, we are overlooking the real reason our client sought out help in the first place? Could we have overlooked their goals, because we were too focused on searching for a diagnosis and accompanying treatment plan to fit our own expectations of what “therapy” should look like?
In the addiction field specifically, the answer is a clear and resounding “YES!”
Long before I began working in the addiction treatment field, an expert in the public health field told me that “getting people to stop doing anything is nearly impossible; teaching them to do something else instead is much easier.” And after ten years of working with and studying addiction, I am reminded of this lesson every time I see a person drop out of treatment and return to familiar patterns of drug use and abuse.
Assuming that a client wants to stop or quit using said drugs is sometimes presumptuous when what they’re telling us is that they would like for the drugs to stop interfering with their life.-Adi Jaffe
When clients enter treatment, we assume that by virtue of soliciting our “help,” the client’s intention is to quit using alcohol/drugs or acting out other compulsive behaviors. But if we look beyond the obvious “problem” and really listen to the person in front of us, we may find that they have other definitions of success in treatment. Clients are often asking us for help in pursuing their life goals, a process that may have been hindered at some point by their substance use or perhaps by a traumatic experience. It is likely that this person’s idea of a “better life” (however defined) is one in which goals can be achieved without their drug or alcohol use getting in the way. Assuming that a client wants to stop or quit using said drugs is sometimes presumptuous when what they’re telling us is that they would like for the drugs to stop interfering with their life. This presumption may result in the client feeling as if they are not being heard and, before long, losing hope and motivation.
Anyone can rationalize disengaging from treatment if they believe their true intentions will never be met, supported or understood.
Many professionals will look at the circumstances that bring a client in and see a rather simple solution: eliminate the drugs = eliminate the problems. If the client can manage to stop using, they rationalize, then it should be smooth sailing from there, right? Except that giving up a habit is difficult and people rarely do it – the only evidence we need to review are mountains of data showing just how few people quit anything for life (smoking and diabetes, for examples). When we insist on total abstinence we become fully focused on what the client can’t or shouldn’t do and, pretty soon, everyone has lost sight of what they wanted to begin with. The idea is not to guarantee that substance use will indeed remain a part of a given client’s life, but it moves away from focusing solely on making sure that it doesn’t.
When we insist on total abstinence we become fully focused on what the client can’t or shouldn’t do and, pretty soon, everyone has lost sight of what they wanted to begin with.-Adi Jaffe
For most people addicted to drugs, alcohol or other compulsive behaviors, there is (or was) a perfectly good reason for starting.
They had found a coping skill that is effective, efficient and reliable. One cannot purport to take away such a coping skill and believe that the person’s life functioning is going to magically improve. Not without putting another skill – hopefully, one just as reliable and effective – in its place. This “replace, not eliminate” approach is just what my public health expert was talking about all those years ago. There is evidence of this method’s utilization everywhere we look – in dietary interventions for cholesterol or sugar, in sex addiction treatment and more. We know the method works in other settings so, why do we have such a difficult time implementing it effectively for changing or reducing a person’s drug or alcohol use?
Too often, treatment becomes about the pain of giving up a substance or behavior that the client has relied on for ages. But to keep a client motivated in treatment, we are better off maintaining the focus on helping them reach their goals – not only on taking away their most frequently used coping method. This can be done by introducing the client to new behaviors – new ways to have fun, new ways to cope – instead of, or in addition to, looking to eliminate the established problematic habits. Practicing alternate behaviors tends to result in a decrease in a client’s drug use, more often than not. Practicing alternative behaviors will, more often than not, result in decreased reliance on drug use as the clients get engaged elsewhere. More importantly, it keeps the client focused on what they entered treatment for.
We know that you can’t force help on anyone; a person must ask for it and be ready to do the work. So let’s allow our clients to define their own recovery, and actually listen to them when we’re asked to provide “treatment.” They might just stick it out long enough to get better.
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