Why Treatment Works When It Challenges 'Staying Sick' and Focuses on 'Being Well'
- Brainz Magazine
- Jul 21
- 9 min read
For nearly 14 years, I've helped individuals navigate the complex landscape of addiction in order to achieve recovery. Nicknamed "The Casual Counselor", my approach is unconventional but undeniably effective.
Our primal, primitive brain, the ancient part of our brain that receives information first, is strictly reactive, and it has one job, and one job only: to keep us alive. Thus, it is always on the lookout for what can go wrong, that which can hurt us, injure us, or kill us. That which threatens our well-being. It’s an important part of our brain in that it allowed those old primitive hominids to evolve into the more intelligent, big-brained, carbon-based life-forms you walk by and talk to on a daily basis.
Our thinking brain moves against the grain of the feelings, triggers, thoughts, and beliefs that our primitive brain informs us of, and it has the power, with practice, to offer a more insightful, measured, and thoughtful response to whatever difficult situation we might be facing. Be it a craving, getting our asses reamed by our supervisor at work for a missed deadline, an argument with a spouse, or the initial instinct to raise holy hell on the roadway at the reckless driver who just cut us off and made us momentarily fear for our safety. Our thinking brain, with some practice, gives us the ability to pause and make the “better” decision, whatever the problem.
Cognitive Behavioral Therapy is built upon this principle: training and bolstering the thoughtful, thinking mind to overcome the reactivity of our emotional mind in order to make healthier decisions, with the hope of experiencing better outcomes. But that’s not really what this article is about.
Well, it sort of is, to some extent. Read on. It's woven into CBT to a degree.
When the soldiers fighting in Vietnam returned to the States after we lost to the Communist Viet Cong Army, many thousands of them were chemically dependent on very high-grade, pure, and powerful heroin, the king of them all, many decades before the scourge of fentanyl started poisoning the drug supply. They ticked every single box, in accordance with the American Medical Association’s criteria for a diagnosis of an individual with a “severe opioid use disorder,” one that would most certainly require a high level of care and intervention in order to effectively treat.
But something weird happened. The vast majority of them, we’re talking numbers in the thousands of these “addicted” servicemen, just up and kicked the habit without ever stepping into a doctor’s office, a psychiatrist’s office, a therapist’s office, or a methadone maintenance clinic. Sure, they felt lousy for a period of weeks or months, and likely tossed and turned in bed for a while before starting to feel like their healthier selves again, but they got through the discomfort of it all, and at a very high ratio compared to those who needed professional treatment to treat the disorder.
According to the AMA, “Addiction is a chronic (life sentence/never goes away) disease, with no cure, that can only be arrested,” often with the assistance of replacement therapies like methadone or suboxone, and with the help of professional addiction specialists and self-help groups, and so on. They define it as fatal if left untreated, which it often is, but they also imply that one cannot simply stop without some modicum of professional and peer support in order to achieve recovery.
I’ll tell you, the longer I do this work, the less I know about this thing we call “addiction,” and whether or not it’s a disease, or a by-product of environmental factors, like having a shitty life, a job you hate, a toxic relationship with your partner, a bad diet, no activity or regular exercise, perpetual boredom, and sedentary activities.
The list goes on and on. And this isn’t just relegated to “addiction”, I wonder these things about many of the clients who report that they believe themselves to be ‘clinically depressed and/or anxious,’ along with a number of other conditions that we are quick to label, diagnose, and treat (typically with meds) in this American culture. Let’s face it, we’ve got a pill for everything. And if that pill gives you weird side effects, we’ve got a pill for that, too. I’ve had clients walk into my office, and when I ask them if they’re taking any psychotropic medications, they report to me that they’re taking twelve different pills every day.
I always tell them, “I don’t even know who you are. It’s like chemical warfare happening in your brain.”
Diagnosing mental health disorders is a “soft science,” unlike diagnosing diabetes, heart disease, or cancer, and not all individuals respond to the available treatment modalities with the consistent efficacy of treatment options for other specific illnesses.
But let’s get back to Vietnam. My apologies for getting sidetracked. We need to ask ourselves a couple of important questions regarding these thousands of soldiers who quit 'heroin' without any professional care, which is generally regarded as nearly impossible to do.
The first question is: Why were they using heroin to begin with? The answer is simple: They were fighting in a living hell zone in the jungles of Vietnam and Cambodia, in constant fear for their lives, and witnessing some of the most horrific things up close and in real time that the mind can conjure. Why wouldn’t they be using heroin?
The second question is the more intriguing one: How did they just up and stop without any formal care? The answer, like the first, is surprisingly simple. When they were permitted to leave the hell of that war zone and relocate back home, to a place where they had family and friends waiting to receive them with love and fellowship, and, most importantly, safety, there really wasn’t any need anymore to continue self-medicating, even with a drug as potent and hard to stop using as heroin.
Back in the safety and comfort of their homes, their jobs, and their “good-enough” lives, worlds better than the ‘Nam, they just didn’t feel compelled to use.
Easy peasy.
Most Americans, at some point in their lives, will experiment with drugs and/or alcohol. Only about two out of ten will develop what we can diagnose, with our current diagnostic criteria, as having a substance or alcohol use disorder. That’s not a high ratio. On a grand scale, it’s a whole lot of people, but on a small scale? 2%? It ain’t much. But are the unlucky two out of ten stricken with an incurable disease? Or are they using it in a disordered fashion because, well, their life just sucks?
I have personally seen what seems to be examples of both. I’ve worked with clients who, if they have just a tiny bit of any mind or mood-altering drug, are off to the races and don’t seem to have an off-switch. Their use increases rapidly, their tolerance grows steadily, the consequences pile up, and they generally need professional intervention at a high level of care in order to stop and stay stopped. These are the clients who are typically better off abstaining from substance use and abstaining for good.
Conversely, I’ve worked with clients who were able to reshape their relationship with substances and to moderate, learning how to decrease their use and use more safely, without a need for that high level of care, replacement therapies, or other medications and long-term treatment resources. They did this by reshaping other aspects of their lifestyles, things like diet and exercise, leaving the toxic job or relationship, relocating to a new home, and finding some kind of meaningful purpose or connection to a hobby or something similar.
So, it can go both ways, I suppose. As life tends to be, it’s a veritable mixed bag, and it always depends on the individual's level of commitment and their ability to be honest with themselves and with me about which group they’re likely connected with.
But whether the client is part of the first group or the second group, the people who get better are the ones who are supported in such a way that it is driven home that they are not going to be perpetually “sick” forever, and that they never really have been, honestly. Do they have problematic issues? Sure. Are they wounded and traumatized by things that have happened in their lives? You bet. Are they a little cracked? Of course. But aren’t we all?
“Everything is cracked, that’s how the light gets in,” Leonard Cohen. One of my favorite lyrics of his.
What bothers me as a therapist is that in my field, it is still commonplace to drive home the point that clients who are in need of treatment are sick, they’ve always been sick, and they’ll always be sick in perpetuity, end of story. Even if they stop using it completely for decades, they’re told by more seasoned and experienced treaters and peers that “their disease is doing pushups in the parking lot,” growing ever stronger despite the hard work they’ve put into abstaining from its use. They’re told that they “have a brain they can never trust,” and that that will always be the case. It’s what I describe as “problem-focused treatment.”
I practice “solution-focused treatment” in an act of rebellion because the “you’ll always be sick” thing just pisses me off. So, I proudly refute it. I’m someone who has struggled with a substance use disorder for many years (17, all told) before finding recovery. Linked to other co-occurring issues, once the commitment to doing some emotional work on myself was made, you know what I found out? I found out I wasn’t actually sick. Perhaps I had been, to some extent, for a handful of years, but now I was beginning the process of healing, and I was getting better.
That’s why I sobered up. I didn’t sober up to stay sick or to reinforce the idea that I have a brain I can’t ever trust. I’m well today, and I’ve been getting well for the past 16 years as a person in recovery. I do have a brain I can trust today, and that’s been true for a number of years now.
I sobered up to get healthy, and wouldn’t you know it, I did, and I remain a healthier man than I was 16 years ago. With new coping strategies and ongoing therapy, I’m still going and growing stronger.
A colleague recently posted a social media diatribe that began with the words, “...So, you want to work in this field? You want to sit with the sick and the dying?...” and it goes on from there, but with nothing but negative connotations about the fact that the hundreds of people I have worked with in this field were “at risk” when we were first acquainted, but couldn’t otherwise be described as sick individuals.
They had some wounds that needed tending to and a lifestyle that needed some reshaping, but once they made the brave decision to switch up the formula of how they were living, be it by learning to moderate or abstain, both benchmarks of harm reduction, by the way, they found, and were able to maintain, their healthier selves, upon which they built beautiful lives. They're still living those lives in gratitude to this very day and have been doing so for many years since.
We, as professional helpers, need to dispel the notion of being problem-focused when helping our clients navigate whatever their journey of recovery is going to look like. We need not lead them with a fear-based attitude. We need more positivity, more validation, more empowerment, more tenderness, more kindness, and more love. We need less of the “tough love” approach and the message that we send to those who are struggling with substances, that they are always going to be struggling, despite being healthy.
After all, we are what we tell ourselves we are. If we tell ourselves that we’re sick, we shouldn’t be surprised if we find ourselves making misguided and “sick” decisions, even in our healthier new identities as persons in recovery. If we tell ourselves we have a brain we cannot trust, we shouldn’t be surprised if and when we make unhealthy decisions, despite living healthier lives.
If we tell ourselves that we’re well, that we’ve done well, and that we can keep doing well, well, guess what? We keep moving in a positive direction, oriented toward wellness.
Enough with the doom and gloom. In active addiction, there was enough of that to last ten lifetimes. It should never be an element of the story of how our clients heal. That should always be a story and message of hope, resilience, and success.
Read more from Joshua Bennett-Johnson
Joshua Bennett-Johnson, Licensed Addictions Therapist
After working for 7 years in an amazing clinic, I launched into private practice in 2018. I love my job. I can say that without reservation. Watching people rebuild their lives is something that is worth more than any dollar amount.
