Winning the Tug-Of-War Against Substance Abuse Disorder

Motivating Recovery in a High Functioning Person with a Substance Use Disorder

As a professional who specializes in treating high functioning persons with a substance use disorder (SUD)**, I spend a lot of time assessing what motivates people to seek treatment, and what motivates people to stay engaged with habits and activities that support the bio/medical/psych/social/neural changes necessary for contented sobriety.

I find that I often come up against the Myth of Readiness, which I addressed briefly in the linked blog post. Today, I want to elaborate on that idea using the metaphor of a tug-of-war and the pushing and pulling that characterizes that game.

As pointed out in the Myth of Readiness, the myth that a person with a SUD needs to be “ready” or to have “hit bottom” persists. There is no research that supports this, and “readiness” and “bottom” are vague terms that are difficult to quantify.

Instead, let’s look at substance use disorder as a tug of war. The disorder is on one end pulling away from wellness and treatment. The pull comes from the substance use disorder: the brain’s neurochemistry. The brain of a person with a SUD is structurally and chemically changed and different from persons who don’t have a SUD; that is precisely why logic-based guidance such as “just stop” or “you have so much to live for” do not “work”; these statements do not impact brain chemistry. Just like the pancreas of someone with diabetes is different than someone without diabetes, it helps to understand the bio/physiological realities of SUD. The power a that an untreated brain has over your thoughts is enormous; I am careful to never minimize or dismiss it. A brain with an aggressive addiction** can and does lead people to destruction, decline in health, isolation, and even death. In the case of high functioning persons with a SUD, though, the context of their lives masks the severity of the addiction. The disease is playing tug-of-war, but the high functioning person has less on his or her team to pull back.

Bottom? What Bottom?

For an person facing a stereotypical bottom (for example, losing a marriage, facing a bankruptcy, chronic unemployment, legal issues), the pull away from the disease is aided by life consequences OF the disease. While the disease side of the rope is clearly aggressive and strong, avoiding the continued pain, fear, and consequences of the addiction are factors that line up to pull the rope away from disease. In the case of my clients, while they are spared the life impact of the most egregious indications of substance use disorder, they are also without the benefit of life consequences “teaming up” to pull against the disease. The LACK of major and obvious consequences become a barrier to treatment and recovery.

This presents a challenge to me and my clients. We need to identify team members to help pull these persons away from the disease and towards a contented sobriety. We can’t use what does not exist (such as unemployment, marriage loss, loss of property). We need to amass tug of war team members with sufficient strength and force to wrench the client away from the pull of the disease.

I have found that developing enthusiasm towards recovery, moods, mental states, and integrating a client’s potential with their reality can become team members on the recovery side of this tug of war. Ultimately, it is more powerful to work towards something than to sustain energy to avoid something; the high functioning person with a SUD may have to BEGIN at that stage.

Team Members

What are some specific team members that a high functioning person with a SUD can add?

1. Many of my clients feel like their life is a lie or that they are an imposter – Working towards feeling worthy of their life through being sober/clean can be a team member.
2. Many of my clients feel like an imposter; that if “people” knew who they really were, they would be exposed – shedding the imposter can be a team member.
3. Many of my clients border (or sometimes cross) the line legally in efforts to secure their drug or drink – moving away from choices that make the client and their life vulnerable can be a team member.
4. Many of my clients lack authentic joy in their lives – Many of my clients participate in the community, their kids’ lives, church or other activities, but they lack authentic connection and emotion with those activities (the disease is a barrier). Experiencing authentic joy can be a team member.
5.  Many of my clients feel under-productive and distracted – The pull of the disease (needing the substance, securing the substance, interacting with the substance) can be a consuming task, taking even high functioning persons away from their to-do list, priorities, and objectives. Moving towards being the family member or professional they want to be can be a team member.
6.  Legacy – a significant percentage of my clients wanted to be a different parent, professional, and person than their own parents or grandparents but they find the pull of the disease shapes them into having and exhibiting the very behavior and characteristics they hoped to avoid – Becoming who they WANT to be can be a team member.
7.  Gratitude and Appreciation – It’s common for people aware of the substance abuse to remind that person that they have so much to live for, to be grateful for, so much to “lose.” That’s all true, of course, but in and of itself it is not enough of a team member against the pull of the disease. However, standing with the team members above, a high functioning person with a SUD can develop habits of gratitude and appreciation that literally change the brain on the other side of the rope and not only pull away from the disease, but weaken its pull.

So, Now What?

Metaphors are useful, but imperfect. Nonetheless, let’s continue with this one. Let’s envision a high functioning person with a SUD lining up in a tug-of-war against their disease. Let’s imagine that the high functioning person is ambivalent (a common mental state, given the tug of the disease). Without the dramatic life consequences lining up behind the substance abuse, it’s the brain against the high functioning person and it’s likely that person has lived in that place for years. Adding desired self-concepts, habits, experiences, mental states such as those above, the high functioning person begins to have sufficient force against the diseased brain; enough to be a catalyst towards initiating treatment and the opportunity of transformation of the brain, atrophy of the muscles behind the other side of the rope, and the development of the muscle necessary to win.

Contact me to discuss this concept and how I can be part of your team in the tug-of-war against addiction or alcoholism.

**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.