Help patients break the chaos habit

Although much has been written about people being addicted to a chaotic lifestyle, this article is not influenced by formal research. These are merely my own observations and experiences dealing with clients who seem to choose (or create) a chaotic environment. For simplicity’s sake, I’ll divide “chaos addicts” into two groups.

Group one: chaos via the sandbox

Here, we’re talking about those whose family of origin was riddled with uncertainty. In these families, rules were always changing, anger and depression were omnipresent, and adults were emotionally unavailable. Coming from this environment, people learn that anger, tears, noise and threats can be useful to get one’s needs met. To compete with all the distractions in the household, one must demand attention—even if it means acting out in a negative way. Understandably, this lifestyle becomes their “normal.” They can’t imagine what a more stable home life would feel like.

Many people come from this type of dysfunction and never develop a substance use disorder, or any other problematic behavior. If they seek treatment, it probably will be later in life, when they begin experiencing problems with relationships, career or serenity. By this time in the life cycle, they are heavily invested in their coping strategies, making it difficult to break old habits that used to work but are now creating unwanted consequences.

Group two: chaos via a substance use disorder

These individuals become addicted to chaos as a result of their relationship with drugs. Chances are, many from group one will end up in group two.

Many individuals with addictions grew up in stable homes with a strong work ethic and a socially responsible set of values. But they quickly learned that lying, conning, scamming, cheating and stealing became easy and necessary to continue a “using” lifestyle. The consequences of these behaviors became acceptable over time. Most addicts never thought they’d be prostituting themselves or breaking the law, but addiction re-prioritized their brains and made bad behavior the norm. With these learned behaviors come consequences and chaos.

Unfortunately, the person with an addiction becomes adept at settling for less, justifying his behavior in a gazillion ways. It’s the disease of denial. Although he probably won’t see it when actively using, a bit of sobriety might allow him to begin to connect the dots.

In early sobriety, a patient might recognize himself as the frog in a pot of room-temperature water. You know the frog: It continues to swim around, although jumping out is an option. When heat is gradually applied, the frog won’t notice its worsening situation, and ultimately will die. Our clients don’t fully recognize the amount of chaos they’ve created—the depths to which they’ve sunk.

Most recovering addicts will miss their drugs, because there certainly were some good times associated with use. Many also will miss the criminality—the thrill of scoring on the street, the rush produced by jumping over the counter to rob a convenience store, or the more subtle excitement of manipulating others to behave in a certain way. In short, chaos often becomes an attractive switched addiction.

Whereas people from group one might adopt a persona of victimhood, blaming others for their circumstances, group two is populated by individuals who (if honest) will ultimately blame themselves for their predicaments. In my experience, the most painful consequence of being an addict is self-loathing: “I want to stop the madness, but I keep screwing up. I’m a loser. I have no will power.”

Treatment strategies

A medical doctor might ask a patient, “Where does it hurt?” Addiction professionals need to ask the same question, from a psychological perspective:

• What is the nature of the pain?

• When is it worse?

• What are its triggers?

• Are we making realistic assumptions?

Bottom line: Can we connect the dots, and discover the causes, benefits and consequences of the chaos habit? Can we learn if there ever has been sober time and, if so, how it was achieved? Most important, we need to explore how our client is going to have fun in the future, without the drugs and without the chaos.

Cognitive restructuring

Let’s assume our patient is at least in the contemplative stage, ready to examine her thinking and maybe even make some behavioral changes. We might use cognitive-behavioral therapy as well as motivational interviewing, looking at the thinking habits as well as the behaviors. To address cognitions, we help patients to challenge their assumptions, to identify when they’re “catastrophizing,” to remember that feelings are not facts.

Living life one day at a time is a skill learned over time, and the good old Serenity Prayer is always useful, stressing the importance of accepting things beyond our understanding. I use the Serenity Prayer liberally in my practice, treating mood, anxiety, psychotic and, of course, substance use disorders. Relaxation techniques, including meditation, guided imagery and expressive arts, also can help keep our patient in the here and now.

Behavior modification

Although addressing thinking habits is an important component of treatment, I believe behavioral modification offers the strongest opportunity for long-term success. But breaking the chaos habit can be slow going. The unproductive behaviors probably have been on board for many years, so we must be patient and ready to applaud even the smallest steps in the right direction.

Whereas anger and impulsive behavior are common threads of a chaotic lifestyle, we work with the patient to distinguish between anger (a normal feeling) and aggressiveness, which is usually unproductive and a manifestation of the chaos habit. We also examine the patient’s exercise routines, nutritional needs and participation in social activities, community service or spiritual fellowships.

As with any addiction, we must identify and avoid high-risk situations that could trigger a relapse to chaotic behavior (or to the original drug of choice). And if there is a situation that cannot be avoided, we will devise a relapse prevention plan, which might include asking for help or practicing self-soothing exercises.

As addiction professionals, we understand the challenges of helping people break any habit, whether it’s a substance or a behavior. But the process remains the same: The patient must examine the pros and cons of the addiction, agree that change is necessary, learn new ways to view the world, associate with safe, sober people, and learn to be comfortable with (and have fun in) a non-chaotic environment. No one ever said it was going to be easy.

Brian Duffy, LMHC, LADC-I, is a mental health counselor at SMOC Behavioral Healthcare in Framingham, Mass. His e-mail address is bduffy@smoc.org.