Alchemy of Addiction

1. Alchemy of Addiction A Fresh Look At Dual-Diagnosis

2. The Flame of Addiction “The Moth don't care when he sees The Flame. He might get burned, but he's in the game. And once he's in, he can't go back, he'll Beat his wings 'til he burns them black... No, The Moth don't care when he sees The Flame. . .The Moth don't care if The Flame is real, 'Cause Flame and Moth got a sweetheart deal. And nothing fuels a good flirtation, Like Need and Anger and Desperation... No, The Moth don't care if The Flame is real. . . ” ― Aimee Mann

3. “Lord got to get me some smoke but shit . . . I am broke” * The Lies around addiction (especially in the field of psychology) are as egregious and insidious as the lies the actual addict is operating from. * A perfect example of this is the “therapeutic” use of “why” questions to the addict. * If an addict knew precisely why they were addicted they would not be in counselling in the first place . . . And yet this is common practice to focus on the origin of addiction to get to origin of mental illness.

4. You’re an Addict . . . Trust me on that one! * Assuming that someone is an addict before consulting their own perception of where they are at is another damaging fallacy. * One plus two does NOT equal three in the world of addiction. The imperative of making “logical” sense for the sake of the client is often times about making the counsellor feel better. * Addiction is NOT limited to substances and/or behaviors. Addiction can include ideological, religious, political and other “conventional” outlets.

5. Addiction & Transcendence * The conventional state of the ego is a kind of insanity. This is why since ancient times human beings have been devoted to realizing some other kind of condition, even though they might not be able to name it yet. Everyone is motivated toward release by the inherently disturbed sense of self. In fact, this is our great advantage. This is the native siddhi of all beings. We already transcend the ego through our disturbance. It is not something we should be suppressing, therefore. Master Da Free John (aka “AdiDa)

6. Who’s insane here? “I admire addicts. In a world where everybody is waiting for some blind, random disaster or some sudden disease, the addict has the comfort of knowing what will most likely wait for him down the road. He's taken some control over his ultimate fate, and his addiction keeps the cause of his death from being a total surprise.” ― Chuck Palahniuk, Choke * “Jim” was a firefighter in my Hell’s Kitchen neighborhood who I began seeing after 9/11 for dual-diagnosis

7. Just Let it burn . . . Let it burn man! * Jim had, in his own words, “a nasty little devil of depression,” that could only be managed “with an equally as nasty little pill” . . . Oxycontin. * My plan of attack was getting Jim clean and sober so we could deal with his depression (which turned out to be bi-polar 2). * Toward this end I hounded him about sobriety, NA groups, anything to get him to see the insanity in taking these pills.

8. You didn’t listen to me, you just didn’t listen * About a couple of weeks into our work together I received a call from Jims supervisor at work imploring me to come down to the station right away. * Jim had tried to hang himself in a closet and was fortunately found by a co-worker quickly. * When I asked Jim what he needed he replied “I need you to listen to what is not there and stop trying to make me sober first.”

9. Drugs, Depression and Duality . . . Let’s get metaphysical! * Jim really forced me to take a long look at my counselling approach . . . Especially with regards to dual-diagnosis. * His focus on listening to “what is not there” is key because in addiction the impulse is to pave this over and construct a therapeutic fortress, a positivistic way out. * What wasn’t there turned out to be a connection with anything tangible and the sadness and hypomania of his bi-polar. There were “gaps” that needed a voice, an expression.

10. The horizon of being: from object to opening * The building of self in childhood or therapy, in this vision, is part of the unproblamatic , organic world. Almost no thought is given to the political functions served by such a concept of the self: the consumer metaphor of development (the self-object is consumed and metabolized in order to build self-structure) Phillip Cushman * I have found creative and action modalities to be incredibly powerful for helping the dually-diagnosed discover the power of self-inquiry and inner-work.

11. Finding common ground for addiction and mental illness * While it is automatically assumed that addiction has a synergistic relationship with mental illness I would contend that more times than not this is not the case. * That is why when the question comes up which to address first: addiction or mental illness . . . I balk at responding because I think it is misconstrued. * Let me demonstrate this with the following example that I use with clients all the time.

12. Your Crazy Papa-T . . . Crazy! * “Ed” was a Dominican in his early 20’s who served to mark another important milestone in my understanding of dual-diagnosis and the relationship between mental illness and addiction. * He had recently lost his job at Kennedy Airport for failing a random drug test with opiates and cocaine. * Instead of asking “why” I asked him “what” the drugs provided him, to which he replied “It gives me time to relax and open my mind before the anxiety and worry settle in.”

13. The De-Shame Game * Ed had been to multiple treatment centers and mandates counselling throughout his years. * The first thing I did in working with him was to find out what gave him joy and freedom (besides the drug use!). He loved photography and I used this as my in to invite him to work psychodramatically with his addiction and anxiety. * Just as objects, figures, people, memories are captured on film . . . So to is our internal world replete with a rich landscape, shades of color and light, etc.

14. This isn’t any Kodak moment! * We began a series of exercises designed to take “pictures” of Ed’s internal world, of his psyche in action so to speak. * One picture for example was with the anxiety and the other without. Still another photo was of the drugs and that is where things got really interesting! * Every picture with the drugs in it was what Ed called “washed out,” akin to opening the back of a camera and exposing the film rendering no images or color.

15. Over-Exposed * Ed was adamant he didn’t know what the “wash out” was about until I had him dialogue with the pictures of the drug. * “It is shame, crippling shame and it fucks up every picture on the roll.” Instead of trying to change the shame or pictures we slowly began to invite them in, to welcome the shame and see what it had to say.” * Ed began to see that the shame and “wash out” was just as important as the other psychic pictures if not more.

16. Nut’s & Bolt’s of Counselling Dual-Diagnosis * Diagnostic/assessment skills are vital first step. Utilize but don’t rely exclusively upon prior clinical perceptions. * Listen for what the client puts emphasis on when disclosing history (addiction proceeding mental illness or vise versa) * Look for what is not spoken or reported. If a client does not disclose anything about their addiction and/or mental health issues that is valuable communication. * Difference between Abuse and Dependency key!

17. Nut’s & Bolt’s Continued * Don’t laminate your own notions of sobriety and mental health on the client but rather . . . Have them define what if anything these mean for them. * Don’t assume any direct connections between self-medication and a DSM diagnosis. Remember . . . Medicating is often a way to fabricate a substitute means of accessing one’s psyche. * Find out what if any psychotropic medications the client is using in conjunction with any recreational drugs as this can be a huge and potentially dangerous factor.

18. CBT? Existentialism? . . What modality to use? * If you operate from a solution focused orientation you are going to be in for a rude awakening! * Find out if the client learns and reflects tactilely, analytically, kinesthetically, and then adapt approach to this. * Approach mental illness and addiction as inexorably linked phenomenon. * Good to have a mix of processing work followed by action methods, such as art-therapy or somatically based therapies to ground the realizations.

19. Alchemy and the compensatory psyche The most outstanding symbolism pertaining to the creation of consciousness is found in alchemy. The alchemist must find the right material to start with, the prima materia. He must then subject it to the proper series of transformative operations in the alchemical vessel and the result will be the production of the mysterious and powerful entity called the Philosopher’s Stone. The alchemical myth tell us that consciousness is created by the union of opposites. _ Edward F. Edinger

20. Addiction as convoluted alchemy * I believe that addiction is almost always the result of apparently irreconcilable opposites in the psyche attempting to be unified via the ingestion of substance, belief, behavior etc. * This plays out largely unconscious, which is why most addicts “have no idea” why they are addicted and/or suffering from depression, anxiety etc. * The case of “Chris” highlights this. A crack smoker who I worked with off and on for over 2 years using alchemical symbols to create his own “Prima Materia” to stand on.

21. Power of Myth * One of the realities of addiction and chronic mental illness is inner poverty, or the absence of any meaning and value. * A powerful therapeutic exercise is having the client articulate (writing, art, movement, etc.) their personal myth, or story. * This provides both a Deconstructionist and Re-Constructionist approach and allows the dual-diagnosis client to see they are more than the narrative of “addict” or “bi-polar.”

22. The Infection . . . Watch Out! * What if you, as a counsellor/mental health professional, or graduate student, suddenly and inexplicably found your self self-medicating for no apparent reason? * What if you were working with addicts and dually-diagnosed when this commenced? * What if you did not view your self-medication on the same playing field as your clients: “I just get high on the weekends while these people can’t function.”

23. One Toke Over The Line . . . * I bring these questions to light as a means of highlighting a very uncomfortable reality that is typically not addressed. * There are many in this field with mental illness who are self-medicating and this only tends to intensify when working with dual-diagnosis clients for obvious reasons. * The kicker is a blind spot “I am providing the counselling so that must mean that I am not that bad off and can help myself at any point.”

24. CLOSING COMMENTS * Dual-Diagnosis treatment is a team effort. Many counsellors don’t get community resources and other specialists on board who can help. * Educate, Educate yourself about drugs and other addictive presentations. You don’t have to be an addict to help an addict but having information and basic background is key for building rapport. * Don’t bullshit! If you don’t know something or have questions ask! This goes for your clients and peers.

25. Closing Comments * Rule Out!!!! While many are quick to make a diagnostic assessment it is better to sift through and rule out what it is not because dual-diagnosis is complex and frequently over or miss-diagnosed. * Harm Reduction. Frequently the impetus is on stopping the addiction outright. This can be dangerous if a medical detox is needed or if the drug is replicating a physiological action. * Research. Have your clients do research in their drug of choice and their mental illness. This empowers them with clear unbiased information.