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A Guide to Working in the Drug and Alcohol Field for Non-Addicted Persons, Part One: Be Aware
In order to succeed as a professional in the drug and alcohol (D & A) field, you need to learn to increase the consciousness of your surroundings. As my mother used to claim, you'll need to have eyes in the back of your head. You'll be dealing with clashing personalities, unhealthy interactions, and, frequently, a patient mentality that pits "us" against "them."
Your job will not always be easy, but it is important. What follows are some things of which you should be aware.
It's a lifestyle
If you work in a D & A rehabilitation-type facility but are not an alcoholic yourself, you may find yourself with more than you bargained for. Working with addicted people is a frustrating job that requires a lot of patience. The first thing you can try to get accustomed to is this idea: the problem isn't simply that your patients are drinking too much. This is so important that I'll say it again: the problem isn't simply the substances. The problem is their lifestyle overall.
The reason most people who "get hooked" can not stop and stay stopped is not because of physical addiction (though that is a large and significant element as well). The reason that they can not stay stopped is because their lifestyle does not allow for it. Life is now centered around getting the next one--whether that one be a drink or a pill or a powder or a hit.
Be aware of the fact that a patient's thinking is highly focused with regard to his or her favorite substance. It is weighing upon their mind heavily, and often whatever you are saying or asking them to do is serving only to distract them from thinking about it.
Let's get on the same page
Alcoholism and drug addiction are, at root, the same issue. To simplify things, the language of this article may at times make use of the words "alcohol," alcoholism," and "alcoholics," or "drugs," "addiction," and "addicts," with the knowledge that they can be used interchangeably without altering in any significant way the validity of any statement.
It's all connected
Every aspect of an alcoholic's life is connected to his or her drinking. When they're at work, they're thinking about the next drink. Their jokes are about drinking. The music they like best is the music that plays at their favorite bar. When they think about sex, they imagine having a few drinks first. Drinking isn't some specialized behavior that only happens when they're bringing the glass to their lips. Their entire life is alcoholism.
So what does that mean for me? As a healthcare professional in the D & A field, part of your responsibility is likely to ensure that the environment of your patients remains conducive to their recovery. That means sharing about how you had "one too many" on Friday night is not appropriate. That means when your patients start talking about where they buy their drug of choice, the manner by which they administer it, and all the great fun they had under the influence (and trust me, they will talk about it), you are doing them a disservice by allowing it to continue.
Between addicts with only hours or days of clean time under their belt, the discussion of drugs almost never leads back to one person making the observation that it's their love for drugs that have brought them to their knees in their relationships, work lives, physical health, and emotional well-being. No, rather that conversation ends up looping back into an ugly cycle which gets them excited about using drugs again. You need to be aware that every aspect of an addict's life--even those little side conversations--are connected to their addiction, and you need to intervene on the patient's behalf when the downward cycle begins.
They are lying to you
Now, let me preface this section by stating that, truly, each and every one of your patients is a unique and beautiful snowflake. They have their own cultures, their own familial circumstances, their own history. However, it remains that snow is still snow.
What will a patient lie about?
- Where he/she is going
- Feeling ill
- Being hungry
- Having permission to behave outside of the rules
- Having his/her items taken
- The behavior of others
- Discussions with other staff members
- Motivation for treatment
- Drug, or substance, of choice
- And everything else!
Addicts and alcoholics are nearly always people for whom lying, manipulation, and deception (including self-deception) have become second nature--and they are good at it! The reason why is simple. The other people in their lives are unhappy with their decisions and that unhappiness may provoke their loved ones into attempting to stop them from using drugs or alcohol. As we've already discussed briefly, drugs and alcohol are at the forefront of an addicted person's brain and allowing them to be taken away just isn't acceptable. Therefore, if he wants to get a few beers, he needs to come up with some reason to get out of the house, and so he will lie. If she wants to justify her abandoned work ethic and lack of money to her questioning parents, she'll blame them for smothering her.
Working with deceit becomes habitual for an addicted person, and just because a patient finds their way to a facility for help does not mean that all of their bad habits are gone. In fact, sometimes those negative behaviors become amplified in the absence of the chemicals that were keeping them sedated.
So be aware that your patients are liars. Good ones. They do it all the time without thinking twice. The patient who cried in your arms today will frequently lie to your face tomorrow.
Recognize the goals of your workplace
There are many different types of healthcare facilities that could play a part in the care of a patient who is an addict or alcoholic and you could be employed at any one of them! A few of these include hospitals, in-patient treatments, methadone clinics, and detox units. Each type of a facility has a different idea of what is required before a patient may be discharged. For example, whereas a hospital's primary goal will be to stabilize a patient physically, an in-patient treatment facility will focus on psycho-education and post-treatment planning to maintain sobriety.
Even within a particular category of facility, there may be different interpretations of "success." Some facilities believe it is acceptable for a patient to be discharged with a prescription for medicine designed to assist them. Other facilities would frown upon such practices.
If you are to be beneficial to your patients, I would advise you to quickly learn the business practices of your employer and to familiarize yourself with them. Furthermore, be aware of your role in advancing those practices, because you do not want to express beliefs that fly in the face of your workplace. In most instances, it is problematic for the patient to get advice from one staff member only to have it contradicted by another. Do not be that contradicting party. If you cannot support the practices of your facility, discuss them with your manager in private, or seek a new employer.
Get super cozy with the rulebook
For many addicts there already exists a significant component of criminality just to maintain their habit. That means tiptoeing around the rules or ignoring them completely is not at all unlikely. Your patients will break the rules and they will challenge you on every one that they do not like.
It is important, if you are to be respected by your patients, to have a firm understanding as to what behaviors are permitted in what places and at what times. Letting the patients run amok may earn you praise of being "cool," but it does not help advance these individuals towards sobriety. Stand firm in your application of the rules of your facility. A reliable and healthy environment is going to become crucial for many of your patients.
Be aware of the importance of structure for recovering people. As a non-addict or alcoholic, you may not immediately see the connection between bending the rules and long-term sobriety, but consider this: in his active addiction, an addict will do whatever it takes to get the drugs he is searching for--it is his perception that nothing is fixed and reliable, everything can be manipulated. In sobriety, however, it is important for him to recognize that in reality rules and order are a very significant part of day-to-day life. Be aware of the need for this transition and be sure to encourage it when possible.
Do you know someone whose life was seriously affected by drugs or alcohol?
You're surrounded by sick people
As was discussed earlier, the people you've joined on to help are dealing with something that has infiltrated every aspect of their lives. If you personally know someone who struggles with addiction, this may come as no surprise, but addiction isn't just bad decision-making. The American Medical Association has defined alcoholism as a "chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal."1
Alcoholism requires that pursuit of the next drink be prioritized over everything else. All reasonable measures of personal success including the relationships a person has with their loved ones decrease in value. Such rabid pursuit is already unhealthy. Couple it with any of the frequent symptoms or co-occurring disorders found within an addict or alcoholic (low self-worth, overwhelming fear of failure or judgment, inability to deal with emotions in a healthy fashion, ADD, depression, bipolar disorder or any number of mental health issues) and we are beginning to talk about a person who has serious mental imbalances. Such people are not uncommon in treatment facilities--and you are part of the team that is responsible for treating them.
Want to see Part 2?
- A Guide to Working in the Drug and Alcohol Field for Non-Addicted Persons, Part Two: Hit the Books
Working with addicts and alcoholics is difficult work. Trying to do it without firsthand knowledge of addiction can be even more difficult. Learn how to handle yourself while helping others.