My response to a discussion group on "Is Addiction a Disorder of Choice," being discussed on the "Linkedin Addictions Professional Group.

I have not read in these comments (please inform me if I have missed them) the role that co-occurring disorders may play in relapse (self-medication). In Gene Heyman's book, "Addiction: A Disorder of Choice," the research implies that those with multiple relapses more often than not, have a co-occurring disorder also present. Try telling a person with Bipolar Disorder off his meds; that has been awake for three or four days; has attended six meetings to, "just go to another meeting." I realize having worked in this field for nineteen plus years now that a clinician has to be cognizant of "substance induced mood disorder." However, if there is documentation of substantial sober time where "symptoms" of other mental health issues are present, all the twelve step meetings in the world are not going to insure sobriety. I am not twelve step bashing, actually the meetings can still be the main modality with other treatment for the co-occurring disorder. I find that twelve step meetings such as DRA and DBSA meetings can be even more beneficial then traditional twelve step for those with substance abuse and co-occurring disorders. Again, the key is recognizing the co-occurring disorder in the first place.
As far as brain imaging goes, is the imaging the result of sustained use of a particular drug? Would this be the resultant imaging for anyone with continued use? The imaging is interesting, but how does it assist me in helping the client to help themselves to maintain sobriety? It really doesn't. Interesting, but useless from a counseling/therapist aspect.
Disease or not, the issues remain the same to be dealt with.
By William R. Drinkwater, M.Ed, LADC-I, CADAC-II - Adjunct Professor UMASS-Boston/Cambridge College

Healthy vs. Unhealthy

Among the conclusions that I have arrived at after 18 plus years in the field of addiction and mental health, is the concept of Healthy, versus Unhealthy. This concept has formed the cornerstone not only of my interaction with clients, but as a guide in my personal life.

Morals, beliefs, and value systems, can vary from person to person. I have found over the years that young counselors in particular, may not be aware as to how much their own convictions may color how they perceive their clients and their clients needs.

Right or wrong should not come into the therapeutic relationship equation ever.

Although people can differ on issues of morals, values and beliefs (greatly for that matter), usually people can agree if something is healthy or unhealthy.

For example: If a person drinks a quart of scotch for breakfast everyday, perceptions regarding this can vary depending upon the ‘values’ of those making the observation. For instance, if I were an 18 year old and in a college fraternity, my fellow fraternity brothers might view this as a positive; “wow, how can he do that, awesome.” Then again, if I was 25 years old, married with children, people might have a different perception; “what a loser, how can he subject his family to that?”

In both cases, I feel relatively confident that the people making the observation would both agree that what the person is doing is definitely “Unhealthy.”

This is the reason why I try to always think in terms of healthy vs. unhealthy. Whether it be in my therapeutic relations with clients, or, in my relationship with myself.