healthy relationships

Becoming Accountable – Exercise

To begin the process of Taking Accountability for an addiction there are some specific and concrete methods in getting there. An individual can begin by writing a complete “Personal Use History” through documenting impact statements for each age range and each major life area (MLA). MLA’s include family, friends, work /school, financial, legal, physical, psychological/emotional, and spiritual.

Appropriate age-range parameters could include 10-16, 17-20, 21-30, 31-40, 41-50, 51-60, and 61-70. As such, you would have a statement for every age range as it relates to every MLA. This exercise will produce a very clear impact analysis, which permits an individual to see this disorder in its entirety versus small “justifiable” events.

A relationship with substance use may go back a long time. Learning how substances fit into someone’s life can help. In addition to a “Personal Use History”, an individual can take time to write about their answers to the following:

1. What do you notice about how substance use affects you?
2. What will it take you to learn to live without substances?
3. How much is substance use a part of your family and lifestyle?
4. How often do you use substances to celebrate?
5. How often do you use substances to cope with negative feelings?
6. How often do you use substances to provide a sense of belonging (e.g. in a social gathering)?
7. When did you begin using? What did it mean to you then? What does it mean to you now?
8. How could stopping substances change your work performance or work patterns?
9. If you stopped, what things would you have that you do not have now?
10. How do you think you would feel if you were not depending on substances?
11. What relationships might you have or might you improve if you were not using?

Answers to these questions and others engage an addict in a manner that is unfamiliar to most— seeing the totality of their behavior and actions. Addicts are very good at rationalizing and justifying events as one-offs; it is when they explore the whole picture that this exercise in rationalization becomes extremely difficult to perform.


Accountability – Case Example

John came to see me after a referral from his workplace. While assessing John, it became clear that he was over-complaint to this process for someone who was attending an assessment under duress. However this behavioral stance became clearer as our time together passed; he had believed that there would be no other diagnosis then someone who had made “one bad” decision and thus clearly non-dependent. He additionally believed that he could convince me of this belief and that we would spend a pleasant two-hours together. However, things altered at about the 1.5-hour mark when it was clear that this man was experiencing a full-blown dependency disorder that would require intensive treatment. At this point, he became agitated and stated that he would launch a full formal complaint with both his company and my professional association regarding such egregious conduct on my part. In exploring options within his company, he discovered that the assessment recommendations would stand and that he was provided with an option to follow these or seek other employment. To say the least he was appalled at the company’s decision in not providing greater support to one of their most senior employees.

Regardless of his disdain for the process, John contacted an inpatient treatment facility and began the process of following the recommendations as identified in the assessment process. When he entered treatment, he was very clear with the staff that he was there against his better judgment but was required to complete this for his employer; this stance was met with an immediate discharge, as the treatment facility will not admit people who do not believe they have a problem. John was now in a bit of a conundrum as he needed treatment to keep his job yet he had already told the treatment team that he did not believe he had a problem and he had further complained about my professionalism to anyone who was within ear shot for over a week (this information always has a funny way of making it back). Now backed into a corner, he called my office to see if he could have another appointment–which was immediately granted. He was surprised that I was willing to see him again after his original conduct. I informed him that I had seen this type of reaction many times over the course of my career and did not take it personal in any manner.

His first focus in the session was on the unprofessional conduct of the treatment team that discharged him and how they needed to be “as understanding as I was”. John was again under the belief that his smooth talking complimentary behaviour was fooling everyone around him until I brought forward the comments made about me just a few short days earlier that were now being directed at the treatment team and I enquired as to who would be the next focus of his attacks. It become evident that John did not believe he had a problem and that everyone else was accountable for why his life was as miserable as it was… including everyone now trying to assist him. He was looking for someone who would respond negatively to his criticisms as an excuse to state that he made every attempt but he was turned away at every opportunity for care. To disprove this stance I was able to work with the treatment team to have him fast-tracked into the system in order to clearly display everyone’s willingness to assist him and that should this go sideways it would be due to his own decision-making.

John eventually completed his care; he even stayed longer than required in inpatient treatment as he discovered that his problems were much more significant then he would originally explore. A year to the date of his entry into treatment John called me and asked if he could come see me again which of course I obliged. He needed to see me face-face to thank me for “sticking” in with him through the insults, the complaints, and the bad-mouthing of my professionalism. I state this not as a pat on my own back but to show that when we work with the addict initial accountability is often elusive and we must see their story in the bigger picture if we are to help. Here is a man that was now over a year abstinent from mood-altering substances who when he first sought care did everything in his power to avoid that admittance and hoped to accomplish this by distancing the very people that could help him. I was not going to be just another justification in his long history of addiction!


Today’s Marriages

We will begin this week looking at marriage—the history, some of the current realities, and the components needed to have the best chance at marriage being successful. Marriage is a term that goes well beyond the space that we have here for a full commentary; as such, we will be looking at a very small and culturally influenced perspective on this area.

From a historical perspective I have always found it interesting that when marriage first initiated as an institution the life expectancy levels were somewhere in the area of 35 years old—so the “till death do you part” really wasn’t likely to be a long time! Albeit that people were married at younger ages, it still was not likely to be a 60-year union. I bring this up as it relates to commitment (the topic addressed last week). Even a bad marriage could be tolerated for these lengths of time—however, with today’s current life expectancy rates, a bad marriage would be akin to a prison sentence if issues are not resolvable; all the more reason to select well, keep working on it, and understand the appropriate concepts of negotiation and acceptable compromise.

The place where we start with marriage is where we left off last week—commitment. Last week four premises were offered up in relation to what commitment is… It is an action behavior based upon solid cognitive choice making, it understands that emotion is ever changing and ever evolving, it stands steady in difficult times and evaluates along the way, and it does not institute impulsively.

Where the first roadblock presents with respect to marriage is in the area of maturation and development; in today’s environment of lengthy life spans, unfortunately many young people are not fully cognizant to the understanding of what this commitment really means. Since the 60’s I believe we have lived in a world that is much more selfishly focused, things are more disposable, and youth mature at a slower rate due to our attentions to the developmental phase of adolescence. These combinations and others have contributed significantly to an escalating divorce rate. Where people would have struggled and potentially worked through difficult times as a part of their relationship many today throw in the towel and look to start over believing next time it will be better—even though second marriages have a higher divorce rate than first marriages. These comments are based upon the belief that we are talking about reasonably equitable dysfunctional relationships not those where pervasive abuse is a feature. Where patterns of abuse exist, I can fully comprehend the rationale for separation/divorce. What I am referring to above is your garden-variety dysfunctional relationship that through some meaningful work could be agreeable to alteration and thus functionality and health; however, people are walking out before they even explore an option for resolution because “it’s too much work”, “I don’t love them”, “my life is no fun anymore”, and on and on infinitum. What these comments amount to is that this is solely about self (what am I getting out of being here), commitment is too much work (I did not know this would be work), and it is easy to dispose of this and just start new (ask the vast majority of divorcees and you will find it was not that easy and neither is beginning anew).

Where many of these issues initiate is based upon maturation; many young people do not understand or comprehend terms like life-long, commitment, and retention. This is not a statement of blame but a means of understanding why we have come to this place in the world of relationships. Until someone has lived a little, we cannot fully comprehend the above three terms. Next time we will explore the various features of a successful marriage— what are the key foundational pieces for a marriage to thrive?