When Students Resist Change

PART I

Nothing so needs reforming as other people’s habits – Mark Twain

Looks like nothin's gonna change

Everything seems to stay the same
I can't do what ten people tell me to do
So I guess I'll remain the same

This lyric from Otis Redding’s 1968 hit Dock of the Bay suggests that confrontation when admonishing another to reconsider their behavior fails to counter inertia. It is such results of interventions in general that often frustrate practitioners to a point where empathy is diminished if not replaced by cynicism about helping those with a substance use disorder.

I remember reading an article years ago--so long ago that its citation now escapes me--that suggested most individuals with an alcohol problem are aware of its existence several years before deciding to do anything about it. So, why do months if not years pass between one's awareness that drinking has become a problem and deciding to do anything about it? I suspect that there are multiple contributing factors, with several likely working in tandem.

First, Fr. Joseph Martin, back in the early 70s, used to say, “what causes a problem is a problem when it causes a problem.” True, “the problem” caused by substance use is likely apparent to significant others before it becomes obvious to the user. This is the classic “pre-contemplative stage of readiness to change” that Prochaska, DiClemente, & Norcross described when postulating the Transtheoretical Model of Change - see their 1992 article from American Psychologist HERE. That said, this essay is concerned with the delay between a user’s awareness of a problem and a decision to do something about it and our role as practitioners in this process. I will argue that the efforts of significant others, and by extension practitioners to bring this “problem” to the user's attention perhaps result in much of this delay. 

Irrespective of the role that love and genuine concern play in motivating a confrontation with a user, such interventions invariably focus attention on what the user did, the “inappropriate behavior,” and only then mention the confronter's concern about the user's health or well-being. Such confrontations, although understandable and well-intentioned, succeed in first and foremost pointing out the user's faults, mistakes, and shortcomings. Although likely eliciting a promise to “never do it again,” this promise is quickly broken, either because it was never proffered sincerely or more likely because such is the nature of substance use disorders. The irony is that if the promise was proffered sincerely when broken the user experiences what can best be referred to as shame.

Shame is an interesting emotion. It is often paired with guilt and many come to view the two emotions as all but synonymous. Guilt is when I feel bad about something I have done. Consequently, guilt can serve a useful purpose in that it can motivate one to change as one's conscience gnaws away at self-respect. In the beginning, this is what happens when the user is confronted...there is genuine regret about what was done and the forthcoming promise is made with a sincere intent to change. Interestingly, this guilt related to inappropriate behavior often elicits not a promise to stop drinking but rather an assurance to not repeat the objectionable behavior. But when dealing with a substance use disorder, even the sincerest of pledges to change inappropriate behavior can be derailed by one's continued use. Consequently, when the promise to change one’s behavior is broken, repeatedly, the user experiences shame.

If guilt results from “feeling bad” about what I have done, shame is when I feel bad about who I am. It is one thing to regret one's behavior. Something can be done about this by making specific personal changes that result in changed behavior. But when I apparently seem unable to make the promised changes, this leaves me with only one logical explanation...there is something wrong with me…I am a failure as a human being. This is the insidious nature of a substance use disorder. Because attention is placed on the inappropriate behavior rather than on the use, the logical explanation for continued inappropriate behavior is to view the user as defective, hence the shame. So, back to the cited lyric from Redding's "Dock of the Bay"...

"Looks like nothin's gonna change." I tried, failed, tried again...failed again...there must be something wrong with me. Keep in mind, I may still be in denial that my use is a problem. In fact, it is entirely possible that I view my use as a solution for my failings as a human being...or at least a balm to sooth the resulting shame. I clearly cannot see the proverbial “nose for my face” or as Joe Martin suggests, recognize that what causes a problem is a problem when it causes problems.

“Everything seems to stay the same,” croons Redding. I try to change and cannot. I may begin to wonder if my use is a contributing factor but the barrage of confrontations from family, friends, and “others” make it too easy to blame them for my problems...“You'd drink too if you were nagged and badgered like I am!” Redding continues, “I can't do what ten people tell me to do”...the badgering…“So I guess I'll remain the same.”

The irony here is that the more confrontational others become, the more I resist their efforts. Jung once said, “that which you resist persists.” I see my life reduced to a fight to exist...confronted by those who intervene to share their concern. Unfortunately, this tends to suggest they think I am a “bad person” because of the “bad things” I continue to do, or at least that is what I hear. I know the things I do are “bad” and I want to change, but try as I will, I cannot. Like the inebriate looking for his keys under a streetlight rather than down the alley where they were lost because the light is better, I am looking in the wrong place. This is because I continue to look for change as existing somewhere “out there,” outside of or beyond me, something that is done to me rather than by me. As times passes I begin to think that not only am I a failure as a human being but that I am unworthy of the “something out there” that can make things different. In short, I just sit on the dock of the bay and watch the tide roll away, an apt metaphor for the disparity so commonly experienced by those in the later stages of their addiction.

So, is the course of addiction intractable? Must it run its course with only three possible exit ramps...death, incarceration, or having to lose everything, the proverbial “hitting bottom” before being able to turn the corner and pursue recovery? Although this was the view of those treating substance use disorders for most of the 20th century, fortunately, such is no longer the case.

Next time...PART II of When Students Resist Change

Dr. Robert