Addiction Therapist Interview
written by, Leah White
Dustin Straight, a therapist working in treatment for drug and alcohol addiction was interviewed by yours truly. Coming from the expressive therapy and therapeutic poetry standpoint, I want to hear more from clinically trained therapists. What do therapists have to say about the psychology of addiction and the nuances of treating it?
Therapeutic Approach to Addiction Treatment
L: I want to hear about your therapeutic approach to treating addiction and what specific aspects of addiction treatment are particularly of interest to you.
D: Because I’m in recovery from addiction myself, I use my personal experience a lot more than other therapists do. The disease model I subscribe to is the bio-psycho-social-spiritual model.
So, we have four contributing factors to the disease of addiction. You have the biological predisposition. I’m actually a third generation alcoholic. That would check the biological box.
The psychological component would be co-occurring disorders—if you have PTSD, Depression, any of the garden variety—your chances of having substance use disorder are much higher. In some cases, we don’t know which came first, so we always arrest the addiction and then we can tell if it was pre-existing or substance induced.
The social factors are massive and difficult to evaluate. Was it genuinely acceptable to smoke crack where you grew up? If it was totally normal, then you are more likely to smoke crack—obviously an extreme example. Some families are fine with very young underage drinking.
The spiritual component is the part that is, I think, probably the most important in recovery. When you are using drugs, you are getting a synthetic form of spirituality. When you look at the behavior of an addict or an alcoholic, they are incredibly dogmatic: everything is ritualized, and it’s this synthetic kind of spirituality. We are not meant to live like that; we need to have an authentic experience of meaning and purpose in order to be happy.
With the biological, I can’t really too much for my clients. Psychologically, if you have co-occurring disorders we can totally work on that. Socially, that is where the aftercare plan comes in and it’s such a huge deal. Helping that person, though, realize the role of spirituality for them and where they find peace, where they find that kind of connection… that is the more fascinating part of treatment for me.
L: Is there one or two specific therapeutic approaches that you focus on and utilize more than others?
D: Rational Emotive, CBT [Cognitive Behavioral Therapy], and Mindfulness are the three that I pull from. Rational Emotive and CBT have a lot in common, though.
Closer Look at Behavioral Therapies
L: What is Rational Emotive?
D: Rational Emotive Behavioral Therapy came from Albert Ellis. He pulled directly from stoic philosophy to argue that taking emotion out of the situation and bringing in rational thought was the way to treat psychiatric disorder. He was really kind of an a**hole. He was very blunt, but that is the kind of approach I use with my patients, and then I use humor and levity to soften the blow.
L: What is the distinction then between REBT and CBT?
D: CBT is more refined. When you look at Rational Emotive, they use an ABCD model—the event that has happened, the belief you form as a result of that event, a consequence of that belief, and from there you need to dispute that consequence rationally. An example: you stub my toe, so then you believe that today is going to be a horrible day as the consequence. Now I need to dispute that using rational thought: you are not going to have a horrible day just because you stubbed your toe; you just stubbed your toe and that’s it.
Behavioral Therapies in Practice
L: How do you practice these in your therapeutic sessions?
D: I use the Socratic questions a lot. One example of a question is: “is the thought black and white, or is it more complex?” A client says, “I’m stupid,” and I’ll teach them to ask “is the thought of me being stupid black and white or is it more complex?” It’s far more complex, because no one is just stupid. There is more to their intelligence than their understanding or expression of intellect on some specific topic. Another question is “If I asked someone for their interpretation of the same event, would it be different?” Once they become proficient with using these questions, it can totally change their outlook. In therapy, we teach people how to think differently.
Mindfulness in Practice
L: How do you, in practice, frame your therapeutic sessions with mindfulness?
D: I encourage clients to focus on staying in the present. If you want to try something that will keep you occupied, try staying in the present moment for an entire day. It’s incredibly difficult, but the more people can spend time in the present: one, they’re less likely to dwell on the guilt and shame associated with past behavior; two, it keeps them out of future tripping or anxiety and fear related to the future. Presence, in my mind, is one of the main coping skills and protective factors that a person can develop in their recovery.
The Ego Problem in Addiction
L: Is there anything in your therapeutic practice that repeatedly baffles you, is frustrating or particular difficult about treating addiction?
D: I think we are a pain, because of our egos and our ability to manipulate. That with a healthy sense of entitlement, just generally speaking, turns people off to working with addicts. What’s interesting is, as people with addictions, we don’t like those qualities either. Sometimes we don’t know we’re doing it. A fish doesn’t know it’s in water, and I don’t know that I am walking around thinking the world owes me something. It’s just my default. It’s hard to watch sometimes, because these amazing people could succeed and go on to great things if a little humility and self-awareness on that front would take.
L: Why do you think that people with addiction are so likely to also have this ego problem in the way you’re describing? Is there any study behind it or is it just observed a lot?
D: Well the language that AA (Alcoholics Anonymous) uses is ‘an ego maniac with an inferiority complex.’ I mean, I use myself as an example, I have a massive ego and for a long time I was never satisfied with anything I did.
L: Do you think that’s something inherent in personality that a lot of addicts happen to have or do you think it’s something that substance abuse can cause in someone? In my experience, I’ve speculated about the cycle of shame that happens with addiction—in knowing using drugs is bad, continuing to use, feeling out of control, wanting to be in control—maybe contributing to those ego problems. That’s just my take, though; I’m interested in what you think.
D: Well, I believe that is absolutely a part of it. There is also the part of us that loves the high wire and just breaking rules. These are characteristics that you must have or develop in order to sustain an addiction. The guy I just had a session with is struggling with identity and emasculation. He’s kind of aware of it, but super afraid to actually admit it. Simultaneously, he goes on and on, pumping himself up about how he’s highly educated and capable, but just because of the way life worked out… he’s not a doctor. He still has this ego even though he’s unemployed and life hasn’t worked out, and he’s constantly using overly colorful language and obviously trying to be impressive. He doesn’t have to do that, though. It’s okay to just be a human being.
It’s difficult to get clients to the point where they’re just okay, so that they can build up from there.
Seek Therapeutic Treatment for Addiction
If you want to find out about getting treatment for addiction, call (877)670-8451. The person who answers can help you find therapeutic treatment that will help you overcome substance abuse.