I have absolutely no doubt that addiction treatment requires awareness of the situation in which a substance abuser finds him or her self.  Rather than opposing symptoms, I recommend a reflective journaling regimen that provides a mechanism through which a person can see his or her situation in his or her own terms and understanding.  It is through the lens of critical reflection that the challenges of addiction can be addressed.

Power differentials within treatment exist within two separate levels: 1) the power differential between non-abuser and abuser and, 2) the power differential between the abuser and the substance of abuse.  In order to disrupt those power differentials:

  1. Prescription must be eliminated
  2. A person must name the situation in his or her own terms, reflect upon its meaning, and then act upon the situation

When family and friends confront a substance abuser during traditional “interventions,” the Substance abuser’s initial response is often defensiveness and resistance.  From my experience, this response is the correct response.  Too often, the non-abuser’s stance towards the substance abuser is one of prescription of consciousness: My way for your life is the right way.  By all accounts addiction blinds people to the impact of their addiction; really, a substance abuser is mired in a state of non-awareness.  Therefore, he or she cannot possibly understand the prescription offered by the non-abuser.  As evidence of this prescription, for example, is the requirement of twelve-step programs for its member to identify themselves as “addict,” and/or “alcoholic.”  These labels are not neutral terms. Rather, they are in and of themselves terms of prescription.  They lead to self-fulfilling cycles of substance abuse: An alcoholic drinks and an addict uses.

Further complicating the prescription process is the apparent reality that a substance abuser’s thought process is based upon securing his or her substance of abuse, while a non-abuser is focused usually focused on getting the substance abuser to stop using the substance.  This is a direct conflict that cannot be solved through direct confrontation.  When asked to give up substance, a substance abuser will find and create reasons why he or she MUST continue using.  Prescription from an external source will never change a substance abuser’s behavior.

I would rather propose that the Substance abuser: 1), name some aspect of his circumstances in terms from his or her contextual frame of reference; 2) reflect on the meaning of this aspect, also within terms of his or her contextual frame of reference; and, 3) devise a behavior such that the meaning can then be fully understood.

A treatment professional can be instrumental within this process. Not by being another agent of prescripted consciousness, but through guiding the process of: Name, Reflect, and Act.  I may be idealistic, but allowing a person to define his or her own reality and to see the harm to that reality a substance of abuse causes with his or her own eyes is the best way to illicit change.