Do Addiction Counselors Need to Have Addiction?

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

 

10 Responses to “Do Addiction Counselors Need to Have Addiction?”

  1. Christy D. says:

    If you found the above qualifications to be “rare” in counselors, then you must be working with some pretty sad counselors, some pretty inexperienced counselors or something else, “both with and without addiction”.
    (Stumbled across your blog via your company’s website this afternoon)
    I have worked with many counselors over the years, some in recovery, some not. I’ve seen some fall out of their recovery, also, and lose some of the sympathy (their “5 qualifications”) that they began with, therefore stepping out of counseling by either their own choice or by having the decision made for them. Of course, I know others that have the empathy of the “5 qualifications” and have no addictions that I know of, and are the most admirable peers/mentors ever for me. Rare? I must be blessed then by a great team of co-workers over the years. I remind many of my co-workers the same that you point out, however, such as my neurologist does not have to have experienced a seizure for herself to be able to treat my epilepsy. I am suprised sometimes when some of my clients assume that I am not a recovering alcoholic–when they ask me which other counselors besides myself “aren’t in recovery”. Sometimes I don’t know which way to take that….I don’t wear mine on my sleeve like others do where I work, and they (the clients) are taken aback when they learn of my fifteen years of sobriety.
    I look forward to checking in on your blog occasionally now that I have run across it. Hope you get a chance to associate more with counselors that have some of the 5 qualifications you mentioned above.

  2. Eben Jones says:

    thank-you, Doctor Wetsman…many I’ve known were also, lacking…esp in #4

  3. AddictionDoctor says:

    Thanks Eben
    h

  4. AddictionDoctor says:

    Christy,
    I actually have the opportunity to work with some great counselors, and I’m sorry if my choice of words offended you. I don’t mean to reflect on either the empathy or intentions of most people in the field, but rather the education process of addiction counselors in the US currently. And while I’m at it, don’t let me let my own profession off lightly. The training most psychiatrists receive seems to take the five qualifications out of them as well.
    When addiction treatment is taught currently, there seems to be an emphasis on behavior. It seems to leave the graduating counselor or physician with a few ideas that seem to be antithetical with the 5 qualifications in the big book. One of those ideas is the idea of “addictions.” It makes the illness not an illness, but rather a set of behaviors. It creates an expectation that the person will get well when they are abstinent and if they pick up something else, they have a more complicated disease or an “addictive personality.” It also sets us up for judging the patient for drinking or using while ignoring our smoking or overeating.
    Another idea is that the cause of addiction is somehow related to drugs and drug use. This sets up the expectation of the usual treatment team that the person makes themselves worse when they use rather than the using being an indication that the treatment is not correct. Even very compassionate and experienced counselors and psychiatrists find themselves blaming the patient. In fact, I think one reason that counselors are taught to call the patient a client is to distance the relationship. Rather than a patient (from the Greek for sufferer) coming for treatment of an illness, we are faced with a client asking for help with a behavior. It’s a slippery slope, especially for the person who has stopped that behavior, to handle the situation without losing the “there but for the grace of God go I” thought when the patient uses again. And when he uses again, we are at risk for falling into the “he didn’t listen to me” trap rather than looking at our treatment to see what we could improve.
    I think, with ASAM’s new definition of addiction, that new training will eventually be instituted and real treatment for the real illness will be taught more commonly. Until that time, we re-train each counselor we hire think of the illness of addiction and the patient in ways that don’t present the slippery slope towards losing the 5 qualifications whether they have addiction or not.
    Thanks for reading, and for writing,
    h

  5. Raju Hajela says:

    Thanks, Howard, for articulating so clearly where our challenges lie! It is hardest when providers think they know when they don’t even know that they don’t know and patients get confused by so many providers coming from so many different angles… I think everyone starts with 1 and 5; and so many people think they have 2, 3 and 4, while being caught up in rhetoric not reality! I appreciate all that you say and do to keep shedding light on reality :) Raju

  6. AddictionDoctor says:

    Thanks Raju,
    h

  7. Dr. Wetsman,
    In speaking of counselors in recovery, I never hear of counselors being treated themselves. I’ve heard of several of my previous counselors relapsing, but never hear of treatment specifically for this group of people. Do they enter treatment among there own peers or hide in unwarranted shame and try to recover themselves as many in the healthcare fields tend to do? They obviously know what is expected as far as psych testing, what to say and write for assignments. I may be wrong, but it seems to me their very title somewhat inhibits them from being honest with themselves.? Just curious.

  8. AddictionDoctor says:

    Mike,
    I think what you’ve outlined is common for anyone in shame. The extra risk for any who treat addiction is, if we place ourselves above others in a futile attempt to find an easier softer way out of symptoms, to block off the most effective avenue for escape from active disease, asking others for help. What’s most important for anyone working in this field who has addiction is to understand that it is an illness that they have no more control over than the newest patient. If that person stays humble and continues to work an active program, they won’t find themselves in shame if there’s a symptom relapse or a return to using. In fact, if they are in active recovery, they’ll be continuing to discover on a daily basis how they use things other than chemicals to feel normal and constantly be working to become abstinent from those behaviors. I think that’s true for anyone in recovery, counselor or not.
    thanks,
    h

  9. Cal says:

    Dr. Wetsman,

    After reading your response to Christy it reminded me of a class i took in my counseling graduate program called “Substance Abuse.” i don’t think my school had the intention of leaving addiction out of the course….so i guess it was to be seen as all one in the same. I think the required text was titled substance abuse as well. My professor bought each and every student your book (out of his own pocket i assume) and brought us to see you. It was one of the best courses i took in my program…too bad it was an elective and not everyone took it. It should be required in my opinion. Thanks for your work, wisdom and dedication!

  10. AddictionDoctor says:

    Callie,
    Thanks for the kind words. Glad it was helpful.
    h

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