Who does this sound like?
· Has a sense of entitlement and require constant, excessive admiration
· Exaggerates achievements and talents
· Is preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
· Expects special favors and unquestioning compliance with their expectations
· Never takes responsibility, blaming others for mistakes, oversights, or poor judgment
· Has an inability or unwillingness to recognize the needs and feelings of others
· Behaves in an arrogant or haughty manner, coming across as conceited, boastful and pretentious[1]
No, I am not referring to a contemporary politician—that is grist for another discussion mill. I refer to Al K. Hall, to Mary Juanna, to C.O. Cain, to Ox E. Contin, to Herr O’Wynn, to P.K. O’Cette…you get my drift. A personification of a substance use disorder, A.K.A. “addiction,” as some malevolent other that possesses an individual is not new. Robert Louis Stevenson’s famous The Strange Case of Dr. Jekyll and Mr. Hyde is semi-autobiographical in which the transformation of Dr. Jekyll when consuming the potion made of a “fine white power” to the murderous Mr. Hyde has become a familiar euphemism for addiction[2].
Although my personifications of a substance use disorder (SUD) may seem silly when compared with Stevenson’s more literary heavy, an important point remains: when characterizing addiction as a malevolent being, doing battle with that anthropomorphized image of an identifiable villain becomes more plausible than attempting to challenge some nebulous disorder. To view addiction as simply a social construction of inappropriate or otherwise described deviant behavior leaves the individual with that disorder little choice but to view the self as at best somehow defective if not a failure as a human being. Likewise, not only do those with an SUD tend to then label themselves as addicted with all that pejorative term implies, historically those who have attempted to provide treatment have tended to treat the addiction rather than the individual with the disorder.
Although interventions with the personification of an SUD may seem logical—who wouldn’t seek to confront the villain in any drama—when the addiction and the individual who has that disorder are indistinguishable in the eyes of the practitioner, such interventions become confrontational with the individual the focus of the practitioner’s assault. As William Miller suggests, this is when practitioners wrestle with their clients rather than attempt to dance with them. When confronted most individuals with an SUD will react instinctively, defensively recoiling from the practitioner whose treatment is perceived as a threat.
Interestingly, there may be two strategies that when employed in tandem may help avoid such
confrontations. The first is a given and has become quite well known over the last 30-years and for that reason not discussed in detail here; motivational enhancement therapy where empathy, collaboration, an appreciation of client autonomy, and evoking change talk are the hallmarks of effective treatment. The second is as yet unknown and argued in this essay as the personification of an SUD as an entity with which the addicted individual has a toxic relationship.
This “entity” manifests many if not all the characteristics of narcissism as outlined in the introduction above. As difficult as treating SUDs may be, inviting individuals to understand their dependency as a conflict with a self-absorbed parasitic nemesis can free one’s client to begin viewing change as a battle that can be won as opposed to a disorder that must be endured. Likewise, framing treatment as a struggle between the individual with the disorder and the personified disorder enables the practitioner to assume the role of mentor, guide, strategist, or counselor but definitely not the client’s adversary.
When seeing clients with SUDs I would often ask them to imaging their disorder as a gremlin sitting on their shoulder, constantly whispering in their ears, saying whatever was necessary to justify taking the next drink or pill or “hit.” I would then ask that they write a letter to their gremlin and tell it everything they ever wanted to say to get it to “shut up.” Once written, I would ask that the letter be read in group and for the group to comment and provide feedback, the point being that the personification of substance use dependence was a bully and that bullies can be silenced but only when confronted and when the one doing the confronting is supported by peers who understand how difficult the bully is to overcome.
What do you think?
What do you think?
To read how Dracula is an allegory for alcoholism/addiction, consider my essay Al K. Hall as Dracula: Film as a Clinical/Pedagogical Device[3]
[2] See Wright, Daniel. “The Prisonhouse of My Disposition’: A Study of the Psychology of Addiction in Dr. Jekyll and Mr. Hyde.” Studies in the Novel. 26.3 (1994): 254–267.
