Dwight Hurst, CMHC: Hi, everyone, welcome back and thank you for making the choice to be here today. Choice is, after all, what we will be talking about today. This is, of course, a podcast to answer your questions on addiction, recovery and mental health by the Waismann Method Opioid Treatment Specialists and Rapid Detox Center, hosted today by Clare Waismann and David Livingston. As always, glad to be here with you guys. I’m Dwight Hurst, your co-host. And let’s get right into today’s question.
Dwight Hurst, CMHC: Is addiction a choice? I want to say something upfront in case there’s anyone listening who is like, what does that mean by that question? Well, it’s a bigger question. People might think I when I worked in an outpatient substance abuse program one time I noticed a book sitting on the desk of this colleague of mine. And he was very avid. He was like a human Google when it came to facts about addiction and all kinds of things. You know, we’d always go ask Mike, but he had this book sitting on his desk and I said, oh, I’ve seen that book around. I don’t remember what it was about addiction and what did you what do you think of it? And he opened it up and he showed me a line he had highlighted somewhere in the first few pages that said making the choice of addiction or something like that. And he said that’s where I stopped. And so for him, that was offensive almost for him to say just the phrase addiction is a choice. And he lost interest in this book. And so there’s this big question that’s out there where people are saying, you know, what does this mean? What is the role that choice plays with addiction? Right. So it’s a bigger question than some people know.
Clare Waismann, RAS/SUDCC: I think before you answer is addiction a choice, you have to be able to define very well what addiction is. So, you know, is behaving badly a choice? Is, you know, using a substance that is going to harm you a choice? Is being a slave of a substance of choice? So, you know, first, we really need to define what addiction is because I don’t think anybody chooses to be a slave of anything. I don’t think anybody chooses to lose positive things around them. So.
Dwight Hurst, CMHC: Because we certainly don’t choose knowing all of the addiction, all of that, I should say, all of the implications of any choice as far as where is this going to play out 10 years from now if I do this thing, especially if we don’t know how we’re going to react to it yet. And so, yeah, it’s more complicated. And I love that where you’re saying, you know, the fundamental question within the question that we’re starting with right away is what do we mean by addiction before we can classify it? I think that’s a great analysis.
Clare Waismann, RAS/SUDCC: Yeah, because the way people become addicted is so different one from the other. I mean, some people really became dependent on something because of pain issues, emotional or physical. And from there, things just snowballed into addiction. Some people socially played with something, not understanding the physical consequences of it. So I don’t think any bad things in life is a choice. Sometimes is bad decisions that led to a bad situation. But I don’t think anybody starts something thinking, well, you know, I want to wake up tomorrow just sick and looking for this and, you know, stealing and lying. I don’t think anybody has that, you know, negative will. Yeah. For say.
David Livingston, LMFT: This may be a lively discussion.
Dwight Hurst, CMHC: Oh, awesome. Bring it, David.
David Livingston, LMFT: Well, it’s so in many ways I agree, right? I don’t think so. I think if you ask people whether they want to be doing it, they’ll say no. It’s almost always. Not always. I mean, sometimes they’ll say, yeah, I like it and I don’t really care and I don’t want to stop. And if I do this and that, but that’s a new that’s more unusual. But that exists. But. You know, I found part of the way that I look at that life and addiction and and, you know, is that that we have creative elements to us and we have destructive elements to us. We have a conscious and we have an unconscious. I mean, for it. One of my favorite when you think about the question of choice. So Freud’s when he came up with the idea of the unconscious is, you know, and he was a you know, basically all scientists and doctors that said, well, what is your what is your proof of this idea of the unconscious? His statement was, if you look at all cultures, all people and all cultures throughout all time, what you will see is people killing each other. And you if you ask any individual person whether they have homicidal feelings, they will all tell you “No”. So basically what he said is people don’t think they’re destructive.
David Livingston, LMFT: And yet if you look at throughout history in time, you’ll see destructiveness. Now, that doesn’t mean we’re all destructive. In fact, societies based on the fact that primarily we’re good to each other and we want the best for each other. And we built homes and families and friendships and everything because we want the best for each other. And it’s, you know, and there and I think that is the primary mode of what’s there. But when you get into when you deal with trauma, when you deal with injuries, when you deal with things, you have to look at the destructive side, you know, and one of the things that I found most useful is in a very kind and open way, helping people look at that side of themselves and bringing it to consciousness. I mean, that was the idea, was the idea that the more you can bring elements of the psyche into consciousness, the more creative you can be with them, and then the less they will tend to operate automatically and unconsciously. So the goal is to make that which is happening unconsciously conscious so that you can then creatively deal with it. And so. It’s tricky, right, because none of us are ever fully conscious and never, you know, and we’re also never fully unconscious. So I guess I would say yes and no.
Dwight Hurst, CMHC: So so trying to…
David Livingston, LMFT: Get that response…
Dwight Hurst, CMHC: Operationalized? Well, no. I think it’s what’s necessary, though, isn’t it? Like, it’s complicated is a good beginning and there’s a lot of nuance there. So it sounds to me like you’re kind of talking about trying to operationalize the unconscious by saying, like, what choices am I engaging in on purpose? Because if there’s no choice involved, I have no control. But at the same time, there’s that point. Yeah. How much is unconscious that I’m not aware of at first. Yeah.
David Livingston, LMFT: And if we’re doing something that’s not good for us, we can actually work with that side of us. It’s it’s it exists throughout history. It’s an undeniable part of humanity. And so let’s make it cautious. Let’s work with it. Let’s figure out how we can relax around it. Think of those impulses and then do something better with it.
Dwight Hurst, CMHC: Yeah. And how much of this do you think gets wound up? And people say, is that a choice? And what they’re really thinking is they’re linking choice with blame. Like, can I blame someone for having addiction problems or do I have to say it’s all my fault or someone’s fault or this like is the concept of fault? Does that muddy the waters?
Clare Waismann, RAS/SUDCC: I think also we can’t forget the physiological, you know, effects of using a substance for a long time. I think when we talk about, you know, the patient’s conscious or unconscious behaviors, you have to remember that, you know, their Neuro system has been compromised where their capacity to make healthy decisions is not all there.
Dwight Hurst, CMHC: So choice and accountability are both compromised at that point.
Clare Waismann, RAS/SUDCC: Correct, correct. I think you’re right that we are learning more and more, you know, as we can now. They see the brain and see the chemistry of the brain and how it is a different substance affects it that not all the time. You know, we have to blame the decision on patient’s ability, conscious ability to make them.
David Livingston, LMFT: Mm hmm. Well, that’s I’m glad you brought that up, because. That’s right. Because I’m talking kind of more about the psyche or the personality and you’re talking about the brain and those things while they affect each other, also operate independently. Right. So you can be aware of things. And and and yet the brain could be in this reward system and operating the nervous system. And it can just sort of override even our conscious understanding of what’s best for us. So it’s it gets complex.
Clare Waismann, RAS/SUDCC: Definitely, you know, creates a compulsiveness, you know, an uncontrollable need to do certain things that we know are harmful. But I think one time, David, we spoke about that, you know, the short thought process, you know, the thought process without a connection to the next thought process. And I think that’s one of the major consequences of substance is, you know, there’s a very short amount of thought to a decision making. And those are the ones that I’m pretty much talking about right now. You know, when when you ask now is addiction something that people can control? I think often they cannot.
Dwight Hurst, CMHC: I think they say that we have very limited capacity to think about our cause and effect when we’re in a panic mode. And a lot of times we are in a state when we’re in an addicted, compulsive state, we are living in that same part of the brain. Are we I mean, we’re making decisions from a fight or flight or freeze kind of mentality at times.
Clare Waismann, RAS/SUDCC: Correct.
David Livingston, LMFT: That’s right. There is in fact, the frontal lobe is barely even operating at all. So there’s very little decision-making at that point. And, you know, when you move into that state, their choice is very, very difficult.
Clare Waismann, RAS/SUDCC: And I think that that that gives, you know, a tremendous validity to what we do here, because, you know, the thought that nowadays most people that treat addiction have fallen in this mode of keeping people on substances while they treat them, it’s it’s mind-boggling for me, A, because emotionally they are not even present to be diagnosed or, you know, properly treated, and B, because again, you’re really dealing with somebody that is chemically being driven by the substance they’re taking every day.
Dwight Hurst, CMHC: And so I think that’s one of the problems people have with talking about this when you say, you know, it’s both Yes and it’s both No. As far as what is the role, that choice plays its complex and run into this a lot where people don’t want things to be complex. They want they want to be able to say, if I can get this into this box in my head, the “yes” or the “no” box, then I know what I’m going to do. I know how I’m going to proceed. I know how to judge someone or I know that I feel at least less guilty about judging someone and they just go on with that. And I think sometimes simplicity is one of the greatest enemies of self-improvement. It’s one of the greatest enemies of getting healthy, you know?
David Livingston, LMFT: You’re kinder than I am. Right, because a treatment is learning and growing. It’s the development of understanding and learning and growing. And then and then the behavior is sort of becoming a part of that process and reinforcing as you go. So, you know, the truth is sometimes we need to sleep, sometimes we need to exercise, sometimes we’re not hungry. Sometimes I mean, it goes on and on. Everything is a dynamic. We’re complex human beings. And it’s actually if you can hang in there long enough and get comfortable with all this stuff, it does it moves to the back of the brain and it doesn’t feel like it’s burdening you. It actually feels like it’s informing you. And you’re able to be more flexible and resilient. And, you know, in a world that’s hard.
Dwight Hurst, CMHC: Absolutely.
Clare Waismann, RAS/SUDCC: I think human beings are complex by nature, I mean, you can’t try to simplify something as complex as an individual. I mean, it doesn’t get any more complex than that.
Dwight Hurst, CMHC: The complication a lot of times with addiction similar to a lot of psychological illness is that it comes out in behaviors it comes out in. In a way, it’s a disease of choice and it impacts the choices we do make in the way we act. And I think those extreme actions are often the things, you know, that that drive it. I had a colleague of mine who before they got into treatment, they had opiate addiction. And they often talked about this, you know, publicly in training and things of their lowest point was stealing medication from a very, very ill, very much in pain, elderly family member. And to have to admit that was a horrible thing to say, “I made this choice”. But then also the difficulty that people had in understanding that there was a context to that choice as well. Right. To say you’ve got the person who needs to mend the relationship by, you know, addressing and taking responsibility for what they did. But then you’ve also got, on the other hand, the reality of understanding the context that that wasn’t the same as someone who wasn’t struggling or wasn’t ill doing it. And I think that’s very hard for people to wrap their mind around when it comes to extreme actions and extreme behaviors.
David Livingston, LMFT: So if I’m working with somebody, I don’t feel any inclination to judge them. And yet I’m constantly making discernments as to what’s healthy, what isn’t, what I’m saying that’s useful to them. What is useful to them? What’s my responsibility in what’s happening in our dialog? What’s theirs? I may be confronted at times. I may apologize at times. I have to be able to move back and forth as far as with the idea of what’s healthy as the major criteria. So I would say that when I look at relationships, that’s my perspective. Like, so sometimes it’s healthy to hold people accountable, sometimes if they’re being hard on themselves and so forth, to give them a break just to say it’s OK. And so, like we’re talking about in terms of complexity, it’s really about understanding, like what’s needed in any moment or situation is kind of the best I know.
Clare Waismann, RAS/SUDCC: I think the capacity of people for self-reflection is very different. You know, as David was saying, some people are just not able at that moment, you know, to repair, you know, to self-reflect on everything they need. Then, you know, it’s learning. It’s a slow, slow process that takes a lot of care and a lot of handholding, takes somebody to hear you out, understand not just where you’re coming from, but where you are at that moment. And it’s critical to understand people’s capacity to deal with what they need to do. Just because I need to see this doesn’t mean I am ready to see it right now. And I think that’s a major issue with health care providers.
Dwight Hurst, CMHC: Because none of us want to be remembered for our worst choices.
David Livingston, LMFT: There’s a lot of shame with addiction and a lot of times people use substances because they can’t bear the shame. And so if you’re pushing hard for them to just bear the shame and they can’t bear it, it can actually drive them towards kind of a bad cycle. So, you know, it takes a lot of it. You’re kind of. It takes so you have to know where someone’s at…
Clare Waismann, RAS/SUDCC: Yeah, I think it’s a balance. I think there’s there’s a huge balance between, you know, the emotional part of the patient, you know, and the connection he is making right now to the person in front of him. And whoever is guiding the process has to really know how to balance as these emotions start coming out and how much because often the patient is going to try to put as much out there as possible and get all these things solved immediately. Again, they don’t have the ability to drive that safely. So it’s really important to the person listening to them to be able to give them that idea of how much they can handle and slowly balance their feelings with them so they don’t become overloaded
Dwight Hurst, CMHC: And a good reason to have a professional intervention, too, because the professionals involved in your treatment, you didn’t steal from them. And they can give you that with a little detachment, whereas those that maybe were sufferers of some of those actions, they need to work through that on their own sometimes before they can be a different kind of support. So and really…
David Livingston, LMFT: It’s a good point.
Dwight Hurst, CMHC: Makes that this yeah… This whole question of choice is best to sort of personally disentangled is this is what it sounds like and done in treatment where it can be safer.
Dwight Hurst, CMHC: Thank you again for joining us on the podcast. We love to answer all sorts of questions about addiction, recovery and mental health. So if you have things that you would like to hear us discuss, please email us at [email protected], check out our website, Opiates.com, or hit us up on Twitter @opiates, any which way you decide to communicate. We’d love to get information from you on what you would like to hear us talk about on the show. The show, as always, is hosted by Clare Waismann and David Livingston of the Waismann Method. Our music is the song Medical by Clean Mind Sounds. This show is a production of Popped Collar Productions, a company that will help you to get your podcast off the ground and running. We’ll be back again soon with more questions and answers. Our next episode is going to focus a little bit on questions around the decriminalization and legalization of drugs in the United States. We also have an episode coming up soon where we’re going to be talking about opiate-induced analgesia and some of the medical elements with our medical director from the Waismann Method joining us. So we’re excited to have you join us for those things. Until then, make sure that you keep asking questions because if you can ask questions, you will find answers. And if you can find answers, then you’ll find hope. Thanks again for listening. Have a great day.