By: Nicole Kosanke, Ph.D

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When I tell people what I do for a living — therapy with substance-abusing individuals and their families — people often have two reactions: First, they get uncomfortable and self-conscious, and might say something like, “Oh boy, I better watch myself!” And you can almost see the whirling time travel in their minds, searching for what I may have noticed about them, counting the drinks they might’ve had in front of me, etc. I used to find it kind of funny and I’d joke about changing my profession for the sake of dinner party conversation just to make people less nervous. But over time, I realized just how much this reaction is about the true shame, embarrassment, and stigma our society has about addiction.

The second reaction people often have is a kind of dread or awe: “Wow, that must be so hard… isn’t it really depressing? I could never do that…” with a face full of fear, disbelief, or more simple distaste. Addiction is perceived almost universally as shameful, even by association. As we see in all the recent discussions about whether people with substance abuse problems “deserve” the troubles they incur, even having empathy for someone with these issues is suspect and denigrated by many. At best, people tend to feel uncomfortable about substance abuse, and at worst feel shame, denigration, fear, and disgust about it — in themselves and others.

How I actually feel about what I do for a living is so far from these reactions… the truth is that I really like my work: I love my colleagues and find the work itself challenging, fascinating, and really inspiring. But most people couldn’t fathom how this could be true because when thinking about how one might address substance abuse, people tend to feel hopeless, ill-equipped, and depressed.

The big difference in how I feel is simple: I have hope. Not hope like wishful thinking or blind faith, but real optimism based in the research about what is effective and based on the changes I’ve seen happen for both individuals and family members. The road of change is rarely a straight path and often has bumps along the way, but more often than not, the trajectory is a positive one.

Knowing how motivation works and how it can be influenced, the reason for hope is clear. Given appropriate, individualized tools and an environment supportive of healthy change, transformation is possible. Psychiatric issues need to be addressed, motivational issues deserve attention, and individualized issues of goodness-of-fit for type and modality of treatment improve treatment outcomes. There are options available for different needs and this alone should instill hope — a single path of recovery is not required. Multiple paths are not only possible, but important to consider and know about. For instance, 12-step programs help a lot of people, but they are not required for people to make positive changes. More people will get the help they need if we have a cultural environment where different options for change are both advertised and embraced. People rarely start a project — especially one as daunting as changing a longstanding pattern of substance use — unless they feel relatively confident they have the skills to be successful or can learn them. But if people don’t feel they have the skills and don’t feel there is a pathway available for them to acquire those skills, this is what leads to hopelessness. Tools exist to help people recover from substance abuse problems. Tools exist to support loved ones in being effectively helpful. And the more we talk openly about options, about hope, about the success stories as well as the tragedies, the more we all participate in changing the conversation from hopelessness and dread into one of optimism, courage and mastery.

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