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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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The Problem of Treating Addiction

Allan Schwartz, LCSW, Ph.D. Updated: Jun 11th 2009

freud's image on a postage stampSomeone recently made a comment to me that I thought was particularly meaningful with regard to addictions. I will simply report that the individual who will be quoted here is someone who has struggled with alcohol and drug addictions beginning with her adolescence. She was in a variety of inpatient and outpatient treatment programs that yielded no positive results. While she made a variety of efforts to stop the cycle of addiction she always relapsed and increased her drug use. She finally arrived at a point in her life when she wanted to change, when the suffering was more than she could bear and where she wanted to lead a normal and healthy life free of drugs and alcohol. She began attending AA meetings multiple times per day and week and found additional sources of support in the community to help her recover and maintain her sobriety.

The comment she made was this:

"Sobriety is not simply a matter of ending the use of alcohol or drugs. After you have stopped using, if fail to make additional changes in your life and face up to the problems that lead to your substance abuse, you will end up relapsing. I had to find a way to make life meaningful for me or I would still be haunted by loneliness, boredom and inner emptiness. AA has helped me define meaning in my life."

She went on to explain that one of her problems centered around never wanting to face up to reality, such as going to work on a daily basis. Instead, she wanted to escape from dealing with work and productivity because they caused her so many problems. She is a perfectionist and was extremely successful at work. However, the success and money she earned were never enough. She was driven to more and more achievement. Now she wants to work at giving back to society by helping other people. Another problem she mentioned was the feeling of inner emptiness that was so deep that she wanted to die. Being extremely high, especially on drugs, allowed a kind of death to occur. However, it made her feel more miserable in the end and decided she wanted to stop.

One of the greatest psychiatrists and psychotherapists of the middle twentieth to early twenty first centuries is Irvin Yalom, best known for his book, The Theory and Practice of Group Psychotherapy, now in its fifth revision. He has also published a myriad of other, popular books, on the topic of psychotherapy, but for the everyday and non professional reader, such as Love's Executioner.

According to Yalom, all people, whether therapy patients or not, face four concerns: death, isolation, meaning in life and freedom. This is why his psychotherapy has always been based on the here and now relationship  between patient and therapist. In that real relationship he has always been open and honest, treating his patients with respect and as equals on the journey towards full growth and development. To paraphrase Yalom, psychotherapy should have as its goal the removal of obstacles that impede each individual person's fulfillment in life.

The addicted person also struggles with the four concerns mentioned by Yalom. However, for the addict, these life concerns arouse even more anxiety and depression than it does for others. That is why it is not enough for them to simply stop using their substance of choice. Rather, they need help in their search for answers to the four concerns.

From my point of view, if AA helps people begin the journey towards fulfillment then it is worthwhile. In my thinking, this journey can and should include the process of psychotherapy so that each person can begin to cope with their conflicts with regard to the universal issues of death, isolation, meaning in life and freedom. The problem of treating addiction involves a lot more than no longer using.

Your comments and questions are encouraged.

Allan N. Schwartz, PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    AA & psychotherapy - Ray Smith - Jun 13th 2009

    Doctor,

    Are you aware that there is a very vocal anti-therapy, anti-medication faction in AA? They believe that if a person works the steps properly, there is no need of therapy or medication. They base their beliefs on step 2:

    "Came to believe that a Power greater than ourselves could restore us to sanity."

    As a person who bounced in and out of AA for almost twenty years, having attended hundreds of meetings, and having examined the program for several years after leaving, I believe I should be awarded some credibility.

    You've presented a glowing testimonial for the program, but that's all it is: a testimonial.

    I've heard similar recovery testimonials from Narconon members, Moonies, and those that have found religion. There are also plenty of testimonials from people who were harmed by their experiences in AA. Why should these testimonials count any less?

    Er ... - JR - Jun 12th 2009

    I would not necessarily dissent from the conclusion.  Not sure that I can follow (or even see) the reason leading up to it ...

    Best regards,

    JR

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