I am very proud to have worked as a psychologist at the Navy’s Substance Abuse and Rehabilitation Program, also known as SARP. I recall living for my patients, my team and the work; I’m pretty passionate about healing and the recovery process. My past leadership in that clinic and current position in training at Portsmouth Naval Hospital and the Center for Deployment Psychology means that I spend a great deal of my time teaching others how to care for their patients.
I recently thought about this within the context of training up treatment providers - especially new providers - who are treating our Veterans and Service members suffering from alcoholism or a substance use disorder (SUD). What would I tell someone who is beginning to work with patients with SUDs? I want to share a little bit of what I have learned along the way.
The following points are some things I believe are important to consider when working with Service members struggling with a drug or alcohol problem. Some seem pretty obvious, but are still worth mentioning in my humble opinion.
1. Understand that addiction encompasses more that just behavior.
Addiction is a whole-person experience and can feel all consuming for a reason. It’s important to look at the complex interplay of neurobiology and biopsychosocial factors impacting abuse and recovery. Some say addiction has a spiritual component and I would not doubt it. So look beyond behavioral change and focus on holistic treatment for sustained recovery.
2. Look at addiction as a health problem first versus a legal or disciplinary issue.
Sometimes it can be difficult to refrain from being punitive; however, we know that punishing someone for their addiction does not often lead to them being healed or changed. Instead, treating addiction as a physical and psychological disorder requiring specialized care can lead to desired change, depending on one’s motivation. Thankfully, current legislation is working to help those requiring treatment vs. punishing them as a deterrent to use.
3. Aim to focus on treating the addiction first and not just as an afterthought.
Substance use disorders do not occur in a vacuum. Usually, other problems and co-occurring mental health issues come along with the addiction. Some providers think that by dealing with the patient’s depression or trauma or whatever first, they will automatically or subsequently heal the addiction. Those things are important to treat concurrently and, in fact, research supports concurrent treatment as best practice. Just please do not overlook prioritizing treating the substance abuse issue at the beginning of treatment.
4. Attitude adjustments are necessary for progress & advancements in SUD treatment.
I’m talking about changing attitudes for the providers here, not the patients. While I am all about a live and let live mentality, I will say that within addictions treatment there is a great divide between “old school” and “new school” providers. Then there are those who either swear by 12-Step or swear at 12-Step recovery. While the “old school” SUD provider may feel that blazing a patient on the hot seat is the way to go, the “new school” provider may be overly focused on other issues, to the detriment of accountability and challenging addiction thinking and behaviors. Research has shown that therapist toxicity may lead to short-term change under duress but not long-term gains. A combination of some old school and new school techniques is warranted and I have seen best results when using a combination of both.
5. Don’t forget the LOVE in tough love.
Check your countertransference at the door. When someone is struggling with addiction they can pull us into that suffering – or so it feels like it. They can be challenging, angry, unmotivated, “manipulative” and ungrateful – or so we think. While you may feel you are doing the patient a favor by going hard on them, it’s important to notice where this might be coming from. What are your true feelings about addiction and the addict? Be real with this and note that working with addictions is not for everyone. For those who choose to work with SUDs, regular countertransference checks are a must. And if you yourself have struggled with an alcohol or drug issue or come from a family where this has been an issue, seeking out regular consultation can be helpful.
6. Know your real thoughts on Medication Assisted Treatments (MATs), etc.
To thine own self and own ways of thinking be true. Please. This goes for also knowing your real thoughts on harm reduction measures and relapse and recovery. Some providers do not support MATs for any substance use problem. Others believe that one relapse means the patient failed. I love the billboards speaking to opioid addictions that note “It’s Chemistry not Character”, which I agree with. How much of that do you believe? When treating addictions it is important to know where you stand on these issues, so read up and ponder away.
7. Talk to someone in recovery or someone who loves an addict.
Stay in touch with your humanity and the suffering a substance use disorder can cause. Stay sensitive and compassionate to the struggle experienced by the individuals and their family members. Alcohol and drugs wreak havoc, we know, but sometimes we can forget to keep trying with these patients. When their willpower wavers, when their families lose courage, we need to remain persistent and these encounters can help to keep us fighting the good fight.
8. In addition to EBPs, look at healing modalities addressing Spiritual and Cultural factors impacting addiction and recovery.
There is an art and a science to treatment and within SUD recovery, we would be remiss if we did not think to address core issues such as resentment, forgiveness, guilt and shame. Let us not forget about SUDs and moral injury either. In looking at these issues, we must also look more closely at each individual patient’s experience: looking at SES, gender, race and culture as impacted by addiction is extremely important and will provide valuable information to help with conceptualization, treatment planning and understanding barriers to recovery for a particular patient.
9. Focus on building your expertise in addiction and substance use.
Pursue professional development opportunities and continuing education in SUDs to develop expertise in this area. Depending on your specific occupation, there may be certifications for addictions counseling/medicine that you might be able to work towards and obtain. In this way you will stay on top of your game and be able to provide your patients with the best SUD treatment available. And last but not least,
10. Remember to be a “Hope Dealer”.
We must be prepared to provide a substitute for the “dope”, whatever it might be. And that is no easy task, when you think about how easily and quickly alcohol or drugs can dull many of our patient’s pain. So be a “Hope Dealer”. Don’t forget to maintain hope for your patient (and their families) when they lose hope in the process. It will happen and you will need to be the container providing compassionate care, a balance of empathy and challenging towards change, and endless amounts of hope, as required. The secret to this is self-care and surrounding yourself with others sharing the same philosophy of treatment and healing. By preventing burnout and modeling balanced living for your patients, you will be able to help them with the recovery and rebuilding of their lives.
These points are by no means exhaustive and I hope by the time you read the aforementioned, you may have come up with others you feel are important as well.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kimberly Copeland, Psy.D., is the Center for Deployment Psychology's Military Internship Behavioral Health Psychologist at Naval Medical Center, Portsmouth, VA.