Is addiction of any kind a disease or does overusing substances, food etc. cause diseases? Is a disease of addiction a mere concept as Jellinek suggested in the Foreword of his book The Disease Concept of Alcoholism(1960) because he was himself reluctant to call this addiction a disease? Or is it a life style issue as some suggest; a character flaw and the result of spiritual depravation? Certainly there are many such views and more in this hotly debated topic.

Having worked, taught, and written about this thing called addiction for 30 years, I have gained a totally different view. And who taught me? None other than every one of my clients. Kierkegaard wrote that “If you label me you negate me” and labeling, my clients taught me, diminishes their being. Consequently, I no longer see addiction as a disease as it is commonly described, but rather a courageous search for meaning and an ultimate quest toward wholeness.

Here are some of my insights I have gained from my clients:

1. The foundation for addictions was laid in early childhood prior to the actual onset of addictive habits, and in the context of the family and social mores. From the beginning the child and care takers co-created behaviors and relationships.

2. Yet, there existed support and use of internal strengths for the child to live long enough to survive and become sober. Strengths in the life of an addict? Absolutely, yes! Consider, surviving a difficult childhood, using one’s own creativity to modulate and survive experiences while simultaneously evolving into full-blown overuse of substances in an effort to assert a self and attempt to make sense out of a senseless life. Then embracing sobriety,  with or without treatment or self-help programs, they still have stamina and drive to want more, fulfill unmet needs,  and design a life to make unrealized dreams become a reality. That demonstrates strengths of perseverance, resilience, creativity, and hope par exemplar.

3. Contributing factors to the onset of addiction:

In addition to the possibility of genetic vulnerability (at this point unproven, however, possible), most people who develop addictive habits come from an environment that disallows for the natural flowering of a child’s developmental potential. Without detailing all possibilities, many children grew up in dysfunctional families and many have experienced to various degrees trauma, familial mental illness i.e. depression, violence, physical – emotional – mental abuse, or poverty. Minimally, the impact of these toxic experiences on the developing child limited their healthy progressive developmental phases. Similarly, at the opposite extreme, are families who overindulge their children without ever-setting limits and teaching age-appropriate responsibility.

Sounds dismal? At first glance, yes, until individual innate human strengths and creativity in action is stressed, surface, and evidenced when making changes.

4. Creative use of options: barrowing from Gestalt Therapy, a creative adjustments is what one does and how one responds to situations and people. It is a creative response, because one chooses from among the possible options available developmentally and in doing so changes the situation in some way and makes it personally manageable. For example, a child may be sensitive and cry easily, rather than being reassured, she is yelled at and told that if ‘you don’t stop immediately, I’ll give you something to cry about’. That little one may hold its breath, not cry, withdraw or start smiling when hurt. Another may be curious, energetic, and enjoy exploring –and – may break a new toy someone just gave him. He is yelled at for being bad and hit, told that he is a terror and hopeless. That little kid may learn to fight back throwing temper tantrums, hit and kick or begin acting and feeling exactly what he internalized and become a loser.

Most of us have memories of some experiences of ‘injustices’ during our childhood. Luckily, human beings from infancy on are wired and capable of experiencing a lot before we actually internalize a distorted self-image. Yet, when these insults are heaped upon the child incessantly, the once adaptive and age-appropriate modulations become automatic and eventually deeply anchored in the child’s reality, behavioral repertoire, and belief system.

When a larger social system like school requires an expanded repertoire of behaving and responding, the children we are describing lack the experience of flexibility and response-ability other youngsters may have or easily learn. Most likely, the school age child will simply intensify what already exists and ironically recreate experiences that are familiar from at home and ironically reinforce what s/he already know and believes about the world and themselves in it.

Adolescence, while difficult for most teenagers regardless of mental health, paradoxically holds the potential for bringing some relief to the troubled kids because they find a cohort of similar kids – lost, distraught, violent, and depressed. Together, they introduce each other to alcohol and substances, form a tight group or gang where they are accepted, experience a sense of belonging, and identity. The shy, quiet child may find alcohol and realize she is funny and desirable and has a ball. The wild kid may become a powerful gang leader, use uppers and or smoke pot to calm down and feel one with the universe. Still others began addictive habits to numb their bodies, or to eliminate boredom, anger, depression. When this population reaches twenty-something, many will become troubled by addictive habits, wind up in AA or other self-help or treatment groups, either self-referred or court-mandated.

Final Thoughts: This all sounds simple, very pat and unrealistic when it definitely is not. A book could not do the topic justice. I intended briefly to demonstrate the complexity and co-created inevitability, almost natural evolution of a path to use and abuse addictive behaviors within the context of family/environment. Throughout this process I wanted to stress the presence of many, albeit unaware strengths of creativity, perseverance, courage, determination and awesome resilience that will assist the client to discover a clean and good life fulfilling his wants and dreams.

Let’s go: A life of freedom from compulsion is ready and waiting to be realized!

When I suggest to addiction trained and mental health professionals that there may be more for a sober client to attain in life than sobriety through the successful completion of the 12-step program in AA, I receive various responses:

1. Looks of incomprehension;
2. Questioning of my expertise and credentials in the addiction field;
3. “You are full of it”;
4. Tell us, please, we are tired of the same old; we have been sober for years and are still compelled to attend AA because we fear relapse if we don’t.

These responses are completely understandable. Personally, since 1981, I have worked long hours in the field of addictions. I developed addiction treatment programs, taught in many countries, and published. I cried with my clients, celebrated their hard-won successes, understood the obvious reasons for having developed addictive life styles, empathized, failed and learned continuously (still am), treated trauma with EMDR and struggled with health insurances. Yes, I know about the addiction field, the patients, and treatment approaches.

Please, hear me: The reality is that AA 12-step programs, other self-help groups, and/or religious affiliations have helped and saved many individuals from death; one cannot argue with these statistics. Others gain periodic sobriety and become caught up in relapse cycles; more are white-knuckling sobriety even while attempting to work the rigorous AA 12-step program but stay stuck; still others are developing cross addictions or, just never stop using. A patient once told me that he is addicted to AA. Addictions are considered an illness and treated as such by therapists, medications etc. The addict is the patient seeking HELP, professionals have the knowledge to help and if the client follows recommendations, he will recover. This is as it should be when treating an illness. However, even when recovery is successful, the client is admonished that “once an addict, always an addict”.

So what have I learned from my clients and what do I mean when I assert that the recovering person can attain a fuller life with life coaching than in recovery alone? That is a fair question and I am eager to share the good news.

What is Life Coaching for the Addiction-recovered Client?

Briefly, what I have learned over many years and other Life Coaches may assume that the sober client has gained a measure of personal and social stability; he is creative, resourceful, and competent. The life coach’s mission is to assist the client toward a satisfying, fuller life, forward moving toward authentic joy and happiness as defined by the client. They have proven that the “whole is greater than the sum of its parts”, meaning, they no longer must be labeled by their bad habits from the past. Recovery Coaches will recognize that the recovered client may still have lingering shadows from the past AND are aware that he has enormous strengths to put these shadows in a healthy perspective with determination, perseverance, courage, and hope. Without these attributes, they could not be where they are today. So where to go next to become more of what one already is?

Life Coaching may be the ideal “next step”. Each individual holds more potential, has more desires, and acknowledged (or not) wants, and needs, if given the opportunity to voice them to someone who truly hears without judgment, foregone conclusions, and the intention to “fix” it. Recovery Coaches are completely client oriented, and assist creating goals that have sound intentions and purpose for the life the client designs. The client will become gradually aware of differences as he lives the coaching process from the “inside out”. Minimally, the client will learn life skills so that he can make more choice-full and rewarding decisions in the future and reducing the engrained fear of relapse. Premier researcher and expert George E. Vaillant (1983), echoes Jellinek’s (1960) that addiction is still not understood and that the magic ingredient to keep the recovering individual in recovery has not yet been identified. Recovery Coaching may just provide that magic.

In summary, clients who have opted for life coaching are ultimately best qualified to comment on the good life they have created beyond sobriety and how pursuing and making meaningful choices have resulted in living a life of their dreams that is real, meaningful, and authentic.

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[1]Vaillant, George E (1995) The Natural History of Alcoholism Revisited.[1] In this text, Dr. Vaillant offers various views on the perplexities of addiction, relapse, prevention, and treatment, given credence to both sides of the argument. Jellinek, E. M. (1960) The Disease concept of Alcoholism. In this books Foreword, Dr. Jellinek voiced discomfort with the concept of Alcoholism as a Disease and considers it a concept just as disease is a concept. He uses the word ‘disease’ reluctantly and under pressure of the Publisher.

Jellinek, E. M. (1960) The Disease concept of Alcoholism. In this books Foreword, Dr. Jellinek voiced discomfort with the concept of Alcoholism as a Disease and considers it a concept just as disease is a concept. He uses the word ‘disease’ reluctantly and under pressure of the Publisher.

Ever since the profession of coaching has entered the arena of mental health services, the topic regarding which profession is better suited to assist which individuals – coaching or therapy continues. Each branch provides evidence in support for their efficacy and pros and cons have become a much debated topic among the various healthcare professionals. The following paragraphs offer a brief expose’ of salient points for each.

The Coaching profession is the new kid on the block. While coaching as such has been around for awhile in the area of sports and performance, offering coaching to the public as a possibility to improve life is a relatively recent development. Coaches consider it essential that the potential client to fulfill the prerequisite that he is creative, competent, resourceful, and whole.  The purpose of coaching is to assist the individual in evaluating and creating a life he really wants according to personal values and potential, and aspirations. The coach-client relationship is one of equality and the client is believed to know best what needs to change and how. A coach assists and supports the client on this path by reflecting, offering feedback, asking questions, is sometimes challenging, and with permission offers possibilities. Homework assignments are also part of this process. The coaching profession encourages its professionals to develop specialization in various areas to better serve a broader range of services. While professional certification for coaches is encouraged, i.e. ICF, it is not required nor is in-depth knowledge of human development. Anyone hang out a shingle claiming to be a coach.

Unlike coaching, therapy has been around for a very long time. Ever since Papa Freud introduced the possibility that emotional suffering can be explored and alleviated with the “talking cure”, the focus was and remained on exploring “what is wrong”. Over time, new developmental theories flourished, as did research (assumptions) and methods to best effect “healing” human suffering. While the roots of psycho-therapy lay in the 18^th century, the focus and practice in the 21^st century is considered to have grown up, so to speak; it  is today hardly recognizable for what it once was. In Freud’s original writings, he considered suffering a matter of the soul, and termed mental illness Seelenkrankheit (soul sickness). Today, however, findings in neurosciences have contributed largely to the change of therapeutic focus and practice. Current therapies generally reflect the values of society that the mind – thinking over doing – being – matters. While there is certainly validity in this research and practice, the humanistic practice of earlier years i.e. Rogers etc. has fallen by the wayside.  Moving away from integration and Holism to fragmenting the whole person into constituent parts and treating separately i.e. body, mind, spirit, behavior, other etc. hoping to effect the whole, has been considered by many to have taken the “soul” out of therapy. The therapist has become the expert and the client is assumed to follow the expert’s advice.

Therapists are State licensed and supported by health insurances that restrict therapeutic application based on the provider’s diagnosis. One can safely claim that today the insurance companies know best, not the therapist or client.

To summarize, coaching works in the here and now toward the future, therapy concentrates on healing or lessening the pain of past or present ills.

Yet, as clear as the above sounds, the determination which service to choose requires careful consideration and frank client/professional consideration to find the best approach to accommodate the client’s needs and wants. Here is an example:

Tom approached me for therapy hoping I could put an end to his misery. He was a soft-spoken, deeply troubled single man, in his late thirties who was sober continuously for eight years after sixteen-years of cocaine/crack and ‘you name it’ addiction. He worked AA’s rigorous 12- step program, very quickly became labeled a ‘Saint’, a role model, and was in great demand as sponsor. He simultaneously spent ‘years’ in therapy to resolve extreme abuse issues from various family members. Once in the process of gaining sobriety, he began and graduated college, interned at a large international firm and within a short time became a top-level executive. “None” was his description of strengths. “If I had any, I would not be an addict.” Yet he remained extremely depressed; still he wanted to figure out what he was really all about and what was missing because he thought that he already had everything – sobriety, money, and was still unhappy.  In addition, he wanted to stop feeling responsible for living the lives of others.  He couldn’t imagine how his life would be different if he would wake up one day and have the life he wanted because he lived one day at a time and hated it.  He hoped that things would change before he relapsed into self-destructive behavior once more (Tom had stopped attending AA several years ago).

As a Gestalt therapist and Gestalt Coach who has worked for many years with the addicted/recovered population, I was struck by his defeated attitude and posture without any awareness of his strengths demonstrating resilience, creativity, and perseverance. After exploring both therapy and coaching as a possibility to proceed, he enthusiastically (good sign) chose coaching because he was tired of “the same old, same old, been there, done that”. He agreed to see a therapist in case coaching would be insufficient.

Gestalt Theory and methodology differ greatly from the above coaching and therapy descriptions. Gestalt Therapy is a model for health. Erving Polster, the Premier Gestaltist of our times, has insisted for years that Gestalt is too good to be used only for the sick. Extremely, abbreviated, emphasis is on the Here and Now, with a holistic focus on the individual in the context of the environment creatively and interdependently cocreating experience each moment of life. Questions are posed in terms of What and How of experience and awareness of self/other is facilitated by the prudent use of experiments in the context of the paradoxical Gestalt theory of Change.

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