When Addiction is Terminal!

Are there clients for whom addiction is a terminal condition – individuals who will inevitably die from their alcohol and/or drug use?Alcohol-addiction

The answer is undoubtedly yes, made ever clearer with the death toll from the current opioid crisis.

So what should I, as a mental health professional do with this answer?  Am I able to predict who will make it in the almost always roller coaster journey of recovery?  Should I not ‘waste’ my time with those who have no wish to change their pattern of use? Should I tell their families their loved one will have to “hit bottom” and this may involve death?

What to do when dealing with someone seemingly determined to head, full speed ahead, on a path to self-destruction?  Here are some things I try:

  • I remind myself how poor I am at predicting the future.  I’m no fortune teller. And knowing this allows me to believe change is always possible.
  • I repeat to myself the injunction to “Be kind, for everyone you meet is carrying a great burden”.  Individuals  struggling with addictions are truly fighting a daily battle.
  • If I can, I tag off.  One of the most valuable things with ACT is that you’ve got people around you.  Feeling burned out with a client is a sign you need someone else to take over for a bit.
  • I go back to basics.  I think of what I’ve got in my Motivational Interviewing toolbox. I try listening, really listening to what my patient is saying.  I bite my tongue HARD whenever I hear myself about to point out the obvious value, the life-saving importance of changing.  I explore their life, finding out how they came to be where they are.  I ask about the ‘good’ things that alcohol and drugs provides them before focusing on the ‘not so good’ things.

For some patients the best I can offer is relationship, relationship, relationship.  A limited, professional and non-judgmental relationship. I stop thinking how I can change the person. I focus on learning something about them, and then learn something more, and on and on.

And I keep in mind William White’s words while reflecting on his career working in addictions:

“What we are professionally responsible for is creating a milieu of opportunity, choice and hope.  What happens with the opportunity is up to the addict and his or her god.  We can own neither the addiction nor the recovery, only the clarity of the presented choice, the best clinical technology we can muster, and our faith in the potential for human rebirth.”

If you want to read a bit more consider looking at some of my related blogs such Ultimat-hmms? or What Works? Don’t Know!  or It’s complicated! or Denial Denier.

Even better, do an educational session on basic MI skills and then plan another, and another and another… You got the idea!

Shalom Coodin

Jan 30, 2018

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