The Importance of Desire for Change and Therapy
The issue of how therapy can help a person move away from excessive, self-harming use of a substance or activity cannot be discussed meaningfully without attention to the actual intention of the person entering therapy. To use learning a foreign language as an adult as a useful analogy, if the person being instructed does not actually want to learn the language and does not make a real effort to pay attention, concentrate, study, practice, etc., he/she is unlikely to benefit much from instruction. The degree to which the person genuinely opens to the subject matter and the instruction cannot realistically be overlooked (I draw upon my own foreign language instruction experience in high school and college, in which I engaged minimally, resentfully, and inattentively, with predictable results).
In my experience virtually no one begins treatment for addiction on the basis of privately reflecting about their drug use or some activity like internet porn and coming to the conclusion that professional help is needed. On the contrary, there is almost invariably some dramatic development involving other people (spouse, business partner, police’) that throws a stark, unfavorable spotlight on the severity of a person’s use. In the aftermath of the dramatic development the exposed individual is not really free to resume his/her old ways without substantial negative consequences. None the less, what is of great importance is whether or not the dramatic development actually instigates a feeling shift such that the individual him/herself sees and feels the need to figure out how to live in a different manner. Again, in my experience such a feeling shift rarely if ever occurs without concomitant ambivalence, reservation, inner hedging, magical thinking about the possibility of being able to control level of use, etc., but the important point is the person is not just saying he/she wants treatment or agrees to treatment to placate others, lie low for a while, and so on. Like a student who won’t pay attention and won’t study, beneficial therapy also depends on there being two cooperative, engaged parties.
The person who has come to see that their drug or activity use is not sustainable, that is has come to see that continuing on the same path is disastrous, none the less faces a very formidable problem. The problem in a nutshell is that the person had and still has reasons for using as he/she did, compelling reasons that involve the challenge of facing life day-to-day. The person’s pattern of use, in other words, was far from haphazard or simply excessively self-indulgent, it was rather the person’s attempted solution to make life livable. It was not perfect, but it sort of worked. Even if it didn’t work that well, it was at least the devil he/she knew (less threatening than the alternative).
The therapist must get to know the reasons excessive substance or activity use seemed better than any alternative the client could see and work with that. This cannot be done, once again, without the client’s cooperation. I think it is possible to identify some common reasons for addiction-as-a-solution, but whether and exactly how common reasons apply to a specific individual requires in-depth acquaintance with the specific person. There is no getting around this, which is why I think it is unrealistic to believe that any individual’s path to addictive behavior can be known prior to in-depth acquaintance with the individual as such (in other words, talk about ‘the addict’ in the abstract cannot substitute for getting to know the individual).
It is useful in understanding addiction to think about the emotional, interpersonal, and social challenges that everyone must face in living day to day. For example, real friendship and love require trust. If a person cannot bring him/herself to trust another person at a deep level, friendship and love will of necessity be superficial, not something to really count on, not something to really turn to for comfort etc., and in consequence the person who is unable to trust at a deep level is likely to feel lonely despite the appearance of friendship and the formal status of marriage. If real people cannot be trusted, cannot be turned to for comfort, etc., there are alternatives: alcohol, drugs, food, the internet, other activities. No one can contrive to simply excuse him/herself from the challenges of living. What varies from person to person, and what leads some people into serious trouble eventually, is how the challenges of living are negotiated. Every person does the best he/she can, but for some people the legacy of their personal history growing up poorly equips them to negotiate the challenges of living in a manner that does not eventually become conspicuously self-harming.
Therapy must endeavor to ameliorate ways of coping with living that have proven self-harmful. This is the task of therapy generally, none the less so applied to addictive substance use or activities. The therapy, treatment, or remedy for a problem must suit the problem (e.g., there is no use treating a viral infection with antibiotics). This is a way of saying that psychotherapy is the correct treatment for excessive, harmful substance or activity use because the problem is being badly equipped to negotiate some (not all) of the important and inescapable challenges in living and not some other problem (bad genes, a form of medical disease, etc.).