This is a long standing controversy in the field of addiction treatment. On the one hand, it seems a silly thing to suggest. After all, we don’t require our cardiologists to have had heart attacks and we don’t require our psychiatrists to be depressed. But on the other hand, there has been a phenomenon noticed, from the very early days of addiction treatment, that people with addiction seem to do better talking to other people with addiction.
This idea is reinforced by this quote from Alcoholics Anonymous:
“Highly competent psychiatrists who have dealt with us have found it sometimes impossible to persuade an alcoholic to discuss his situation without reserve. Stangely enough, wives, parents and intimate friends usually find us even more unapproachable that do the psychiatrist and the doctor.
“But the ex-problem drinker who has found this solution, who is properly armed with facts about himself, can generally win the entire confidence of another alcoholic in a few hours. Until such an understanding is reached, little or nothing can be accomplished.” [italics in the original]
But one wonders why. Especially in this day and age, as we’ve discovered so much about the biology of addiction and have new treatments to offer. Does it still make sense that only “the ex-problem drinker” can get a patient with addiction to really open up. I think not. And my source for this thought is the very next sentence in Alcoholics Anonymous:
“That the man who is making the approach has had the same difficulty, that he obviously knows what he is talking about, that his whole deportment shouts at the new prospect that he is a man with a real answer, that he has no attitude of Holier than Thou, nothing whatever except the sincere desire to be helpful;”
That sentence gives us 5 qualifications to gain and keep the attention and confidence of someone with addiction. Let’s look at them:
1. That there is a common problem
2. That it’s obvious that he knows what he’s talking about
3. His whole deportment shouts that he has a real answer
4. No Holier Than Thou attitude
5. Nothing but a sincere desire to be of help.
If you are someone who thinks it’s better for counselors to have addiction you’re probably saying right now. “I gotcha. Look at number 1. Common problem.” Yep, you got me. But what is the common problem? It doesn’t have to be drinking. In fact focusing on drinking as the common problem is what keeps people in AA from helping cocaine addicts. The common problem for the patient and the counselor without addiction is that they are both humans with limitations. It doesn’t matter how young or healthy the counselor is, they have limits. We all do. The bottom line truth for anyone starting addiction treatment is that they have something they don’t want to have. They have a limit placed on their lives they don’t want. That is a problem common to all humans and any human can relate.
Maybe you’re relenting at this point, but maybe you’re just getting your second wind. “Wait a minute. What about number 2. If he’s never had addiction how can he know what he’s talking about?” There’s a lot to know besides the common problem of feeling the pain of meeting a limitation you can’t get past by your own will. Addiction has a known neurobiology. It’s a real illness with a known natural history. Anyone wanting to attract and keep the attention of a patient with addiction will need to be able to have the answers that person needs. Not academic answers to the question of why, but real practical answers and those aren’t limited to counselors with addiction.
And how will the patient know that his counselor has the answers? Because the counselor’s whole deportment shouts that he has a real answer. How would that look? Well, behavior as well as words would have to say that the counselor understands that they are an equal child of the universe no greater or lesser than the patient. They would be calm because everything is going to be alright. They would be honest which means they’d answer quickly because they don’t have to remember the last lie they told. They’d say, “I don’t know,” when they didn’t know. And they’d treat the patient with respect.
That respect would come across as someone without a Holier Than Thou attitude. The counselor would be aware that the patient has an illness, and, therefore, “There but for the grace of God…” That’s a sobering thought. I could be on the other side of the table. I could be the patient. How would I hear best. I would I like to be spoken to? Is there any evidence at all that I could run this guys life better than he has if I had the same disease? No one will listen to you when your message is, “You just don’t know how to handle life. Do what I do. Be like me,” even if you are a recovering person. If you hold the patient in unconditional positive regard, it won’t matter what’s wrong with you; you’ll be heard.
And the culmination of all of this? It is that the counselor will feel such humility in the face of the illness that they are filled with no motivation other than a sincere desire to be of help. “I have to get this person sober so I can feel good about myself,” will not work. “This one has to make it or my boss will think I’m no good,” will not work. No matter how good the cause or the outcome we have in mind, it won’t work. Our goal can’t be to get to a goal. The goal has to be the journey of helping. When we bring expectations to the treatment, not only won’t the patient hear us, we won’t even be in the room with our patient; we’ll be in our fantasy with our goal.
So do I think addiction counselors need to have addiction? I answer with a resounding, “NO.”
But what everyone needs who wants to do this work is the 5 qualifications above which I’ve found rare in counselors both with and without addiction.
copyright Howard C Wetsman MD 2012