When I was in graduate school, I worried about becoming a good psychologist. It’s a pretty common worry, I think, that often takes the form of: “am I saying the right thing? Am I saying the wrong thing? What’s the exact, perfect thing I’m supposed to say right now?”
Since that time, I’ve seen a lot of interns, and young therapists having the same worry, trying to find just the ‘right’ word, phrase or intervention, to help their clients recover. And I’ve seen, time and time again, that it’s not a very realistic concern. [article updated March 2023]
Step 1: Stop Worrying About “Getting it Right.”
I remember how I started to overcome that anxiety. Unsurprisingly, it required the help of someone I trusted, one of my great mentors—a psychologist with 30+ years of experience. He said something that stuck with me.
He told me, “there’s not just one way to be helpful. There are a lot of things you can say and do to help people get better.”
It made intuitive sense, and it reassured me. When I embraced that idea, I was able to let go of my anxiety, and work on developing the type of compassionate, and complete, presence that’s needed in my line of work. As I’ve moved through my career to this point, I’ve seen this principle proved, over and over. If I show up, and I mean really show up, for my clients (and more importantly, if they show up for themselves), they will get better. This is a kind of presence, a quality of relating. If this quality is met, then when it comes to the specific things you say or do, there are lots of things that can be helpful.
Recovery from substance use, addiction or mental health challenges is the same. If you are ready to show up for yourself, then there are a lot of things that can be helpful.
What it means to ‘show up’ for yourself, is an important question—one that I’ve addressed in videos, papers, talks — anytime someone will listen to me, really. It means fighting to get a handle on your addiction. This involves working hard, of course, putting in the effort to stay abstinent (or cut back or take a break from drinking, if that’s your goal). It means facing discomfort, and ‘staying with’ your emotions. But how you do this work is a rather open question indeed.
Step 2: Understand Your Needs
I have some colleagues who are dogmatic, and take a one-size-fits-all approach. Some of them went to in-patient treatment (more widely known as ‘rehab’) themselves and think everyone else should go to. I often have good-natured debates with them about this, because I believe that inpatient treatment is a sensible, and needed, thing for some people, but not all people.
In fact, I’ve had a lot of clients come to me after going to treatment, and it’s not uncommon for me to wonder: “why did you start with inpatient? Outpatient probably would have been just fine.”
In some instances, they’ve wondered why they went to treatment, when the key to recovery was sustained, steady work, with an addiction psychologist they could trust (while there are many ways of approaching recovery, there are some things everyone needs, and support is typically one of them).
There are others, the frequent flyers, who have been through treatment or five times, sometimes more. I admire their perseverance, though it’s obvious that something’s not working for them. I don’t think it’s weakness. And I don’t think their addiction is stronger than they are. But there’s something missing in their approach.
To find that missing link, I often find it helpful to be pragmatic and methodical. I think in terms of a hierarchy of intervention, measured in terms of intensity.
Step 3: Understand Your Options
1. The lowest level of intensity is infrequent recovery coaching or addiction counselling. Going to see a recovery coach or addiction counsellor, for a short period or infrequent check-ins, is good enough for some people. Typically, this works best for people who have strong recovery skills already, or those who have had a short, and minimal addictive history (psychologists like myself would diagnose this as a “mild” substance use disorder).
2.The next level of intensity would include recovery coaching or addiction counselling alongside group-based support. This group support might be 12-step [AA or NA], SMART Recovery, LifeRing Secular Recovery, Recovery Dharma, She Recovers or another model. In my opinion the key component, at this level, is the community element, which provides added support and helps you stay accountable to your peers.
3.The next step up would be an intensive outpatient [IOP] option. Home Based Recovery in Victoria BC, and similar models, fall into this category. The purpose of this type of program is twofold: first, it provides an intensive experience, much like you would get in treatment. There is structured and facilitated recovery work every day in HBR, and nearly every day in other outpatient programs. By keeping your focus on recovery, you build and maintain motivation and self-confidence. This option is useful for those who need more than just weekly or bi-weekly recovery coaching. It’s for people who need help every day. The second purpose of this type of program is to teach, or refresh, your recovery skills. Just like any type of work, recovery requires skills and tools.
4.The highest level of intensity, of course, is alcohol or drug rehab [also known as in-patient or residential treatment]. I consider this the necessary option for people who need a lot of external barriers to prevent them from accessing drugs or alcohol. If you’re the type of person who would need a strong, burly bodyguard to knock your drug of choice out of your hands, in order for you to stop, then residential treatment is probably the right thing for you. It’s also useful to help you establish recovery skills, and connect with peers. But the key is to ensure that you have a good plan, with excellent supports, in place when you discharge.
But the key is to ensure that you have a good plan, with excellent supports, in place when you discharge. Known as aftercare plan or continuum of care plan – clients would normally develop this with their treatment team before discharge.
I’ve seen countless people have amazing, and successful, experiences with treatment, when they have a good recovery coach or counsellor waiting for them in the community. And, sadly, I’ve seen just as many people fall back into old patterns, and lose the momentum they’ve built, if they don’t have good support back home. If you, or a loved one, are planning to go to treatment, I strongly recommend that you ask: what will they do to help you with your discharge plan? What kind of aftercare options can they connect you with? Can they help you line up a counsellor, after you’ve completed your treatment?
Step 4: Follow the “Rules of Thumb”
Basically, I think there’s a valuable role, and a need for every rung on the ‘ladder’ of treatment intensity. I’d recommend the following rules of thumb:
- No one can do it by themselves. I’ve seen lots of people try to trick themselves into the idea that they can, or should, go it alone. Trust me. It doesn’t work. You will need support, in the form of recovery coaching, addiction counselling, a recovery group (like Alcoholics Anonymous, Narcotics Anonymous, Smart Recovery, or LifeRing), or some combination of these.
- If you haven’t developed a skill and knowledge base in recovery principles yet (for instance, if you haven’t learned about concepts like post-acute withdrawal, identifying triggers, the window of tolerance, and managing high risk situations), then intensive outpatient treatment, or Home Based Recovery, would be helpful. Similarly, if you have tried addiction counselling, but need more support, then one of these programs would be a good option.
- If you have tried repeatedly to quit, unsuccessfully, and if your use is extreme and dangerous, then inpatient might be the right level of intensity for you.
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