These Patients Require Patience

“Patience is a virtue.” Sage counsel for sure. For addiction professionals, however, patience is a requirement, because some of the people we serve are simply not ready to get well. Others do get well, only to break our hearts by relapsing or even dying.

Although every patient is unique, I have painted (with a very broad brush) a few “client types” that pose difficult challenges to those trying to help them. In no particular order:

1) The thinker

Very bright people often have a difficult time getting and staying sober. They’ve used their intelligence and will power to get their needs met and generally to succeed in life.

They’ll be mad at themselves for not being able to solve this “minor” drinking problem. “I’ll figure it out, I just need a little more time.” They’ll accuse themselves of moral weakness—unaware they have a brain disease. The thinker needs to stop trying to figure it out. He should be encouraged to understand the normalcy of cravings and to focus more on behaviors than intelligence.

2) The good talker

The strong speaker has a long history of talking herself out of jams. She’s usually a good debater with a compelling presentation style. Winning the argument is important to this patient.

The addiction professional should respect the talker’s opinion and validate her feelings. Motivational interviewing might help this person exhaust her “talking points” and eventually discover the next appropriate steps. With luck, she’ll recognize the discrepancy between her words and her behaviors. To quote Benjamin Franklin, “Well done is better than well said.”

3) The introvert

Most recovery programs rely upon a degree of socialization. Mingling with others is usually part of the experience. And then there’s the expectation of speaking in front of others! What could be more threatening to an introvert?

In the interest of brevity, I’ll refer the reader to my article on this topic from the September/October 2013 issue of Addiction Professional. Bottom line: Introverts need help navigating uncomfortable social situations. Addiction professionals can model basic communication skills (such as how to say “hello”) and rehearse behaviors that will allow the introvert to become more comfortable in the world of recovery.

4) The chairman of the “bored”

Many patients struggle to imagine life without the drugs. “What’ll I do with my time?” becomes a common refrain. Most patients who stay sober will eventually develop a full life, Some, however, will retreat into a world of switched addictions such as video games, food, Internet porn, gambling, etc.

Our job is to encourage the patient to embrace healthy behaviors, which might include night school, a new hobby, employment or volunteering. Recovering addicts need to stay busy . . . to have identity and purpose. They will ultimately enjoy learning to have safe, sober fun, and addiction professionals are well-positioned to help them open those doors. People who are employed seem happier than those who remain idle, and this is true even for those who hate their jobs!

5) The time traveler

This is the guy focused on either the past or the future. Many patients fall into the habit of regretting the past and/or fearing the future, while missing the importance of living one day at a time.

The time traveler is usually self-indulgent, lacking in gratitude and unable to be of service to others to obtain the “gift of giving.” Booker T. Washington said, “If you want to lift yourself up, lift up someone else.”

Focusing on the past or the future is a “thinking” habit that can be addressed in treatment. Progressive relaxation techniques, meditation skills and expressive arts therapy can help bring the patient back into the “here and now.”

6) The person with unsafe friends

A sign in my office reads: Tell me who your friends are and I’ll tell you who you are. Whether it’s family or longtime buddies, patients may have to remove themselves from those unsafe connections, creating a new network of people who understand the disease and support recovery.

This is a lot easier said than done. Addiction professionals will have to be patient, encouraging the smallest baby steps toward creation of a new “family” of safe people. We must validate the pain of making these difficult decisions, and praise the patient when unhealthy relationships are discarded.

7) The hopeless romantic

Early recovery can uncover raw emotions, loneliness and often a sexual awakening. Romantic feelings can be joyful, but also can be a distraction from the business of recovery. We must help patients distinguish lust from love, tolerate the pain of rejection when it comes, and validate the confusion that accompanies every romantic relationship. A sign in my office reads: Happiness is enhanced by others but does not depend upon others.

I often invite my younger patients to consider the person they’re dating and to imagine what that relationship would look like 30 (or 40) years from now, sitting on the front porch of their retirement home. My question: “Will that person, 30 years from now, still have what it takes to keep you mentally engaged—as you sit hour after hour on the front porch of your retirement home?” This exercise encourages patients to view relationships through a lens of friendship and companionship.

8) The over-achiever

I’m always concerned when a patient gets too well too soon. Although there’s no ideal timetable of recovery, I’ve seen too many overnight successes crash and burn.

I encourage my over-achievers to slow down, be patient, participate actively in therapy, avoid complacency and proactively build a defense against relapse. In short, we must remind our over-achievers of how easy it is to forget the pain and consequences of the recent past—and that going to recovery meetings offers a great way to be reminded of why they got sober in the first place.

I present these categories as a way to consider the populations we serve and to remind addiction professionals that the challenges we face every day require a variety of skills, with patience being foremost.

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