Why Are Addicts So Needy

It has been claimed that public speaking is the #1 fear of people in our nation. I would argue that public speaking comes in at a close second. However the number one fear is the fear of being vulnerable. When a person enters a therapeutic relationship, he is facing a fear head on that several are crippled by. There is a sense of trust in the therapist to handle this fragile experience with care. Trust that has most often been lost due to experiences, circumstances, behaviors, etc. while in active addiction.

Motivational Enhancement Therapy (MET) is the process of addressing ambivalence about engaging in treatment and discontinuing substance use (National Institute on Drug Abuse, 2012). There are several steps to this approach. The first session involves assessment and building rapport. This is not the time to inform the patient of how his “poor decisions has ruined his life”. If he has arrived at your office, he is at least partly aware of this. This time is more effectively utilized by fostering a safe environment for open discussion about the implications of substance use and getting him to think about how change would be advantageous. This initial process is often accomplished in the average of 1-3 hours following. Most often if the patient agrees to treatment, he will be placed in a group therapy setting. Group therapy has been noted as the premier form of treatment for this populations, albeit other severe physical and mental health issues might impact this decision. He will be asked to engage in discourse about feelings, thoughts, needs, desires, transgressions if following 12 step model, and so forth. You now? The things more than half the country does not breach conversation on all year. Might I add with complete strangers. This goes on as long as considered medically or therapeutically necessary. In summary, we meet individuals who have been engaging in problematic behaviors, sometimes for decades. Inquire about their life history, while revealing little to none of our own. Then we provide our clinical impression and recommendations with hopes of follow through.

Some of the phrases used to describe mind altering substances by former patients: “Best friend, partner in crime”, “partner in crisis”, “other half”, “nocturnal mate”, “my everything”, “the only thing that has been there consistently”, “soul arouser”, “noise quieter”, “pillow/shoulder to cry on”. We figuratively remove these coping skills, and assert that we are safe places/people to explore, develop, and employee new coping skills with. With this new change comes vulnerability.

So why are addicts so needy? Maybe they are needy because we as helping professionals worked hard to convince them to make a change that they might not have otherwise considered. Or possibly because we have told them that this space/facility/etc. is a safe place and often mumble off the obligatory “let me know if there is anything you need” without the galls to step up when they actually reach out. Or, maybe, just maybe, we are the first persons to offer an extended arm without it being accompanied by a closed fist.

I recall discussing a ‘resistant’ patient with a supervisor, and being encouraged to embark on a journey of introspection. In short I was professionally told that my perceived resistance had more to do with my thought process and feelings, rather than the patients behaviors. It was tough to swallow, but clinically necessary to address. I believe the patients’ perceived neediness has more to do with the helping professionals than the patients themselves. I would encourage my fellow comrades to practice regular self examinations. Practice in your realm of expertise, and seek knowledge in areas of weakness. Our own personal knowledge, values, beliefs, and experiences inform our practice every day. What’s informing your practice?

Note that I have used the term ‘trust’ several times throughout this post. This is not for lack of an extensive vocabulary, but rather to illustrates its significance in the therapeutic process. In times so unpredictable, we are literally trusting strangers with our lives on a daily basis. We must continue to observe what sets us apart from the stranger someone could talk to on the subway or a park bench. We must remember our ethical oath to do no harm and maintain the patients’ dignity. Lest we fail a nation of people; and ultimately the world.

Resources About This Topic

National Institute on Drug Abuse. 2012. Motivational Enhancement Therapy.

Compassion Fatigue and Addiction Treatment Providers – The Cost of Caring