Addiction is in us and between us. Those who work in early recovery and in treatment centres know the struggles that clients have with controlling their urge to use alcohol or other substances even when they understand how devastating the results may be on their life and that of their families. It is as if they know what is good for them, accept it, and do the opposite.
We are aware that plenty of well-researched, evidenced-based programs that do an admirable job helping individuals in early stages of recovery. I use many of these therapeutic modalities when I design programs, and in my practices as a clinician. As Calleja (2011) writes, new treatments have “woven together many narrowly focused methodologies to create multifaceted programs that help addicts achieve sustained, balanced recoveries” (p. 93). It is also encouraging to see that new integral recovery modalities are being developed and implemented (Shealy, & White, 2013; Dupuy & Gorman, 2010; du Plessis, 2012).
Indeed, I find the diversity and depth of current research in the field of addiction worthy of celebration, and acknowledge that the common therapeutic interventions in recovery are narrow by choice. Practitioners in each therapeutic protocol and intervention carve a niche by promoting their unique view of evidenced-based recovery. This specialized approach enhances depth in research and practice.
While specialization is necessary, the concern is that in some cases the result of these therapies overlooks not only the complexity of creating a truly effective multifaceted program (which is a blog post by itself), but it may also overlook a few of the core issues in recovery.
What this blog is trying to present is that sometimes forgotten in the specialization of addiction theory and practice is the “bigger picture” (or foundations) of human complexity and the forces at play within all aspects of life. Think of a house as a metaphor for what I just discussed above: some of us may be so intrigued by the design of each room of the house (its unique color, the different shapes of the space and what kind of furniture is needed to make the house functional and ‘warm’) that we may forget to pay attention to the foundation of the house—the thing that keeps the house standing! We all agree that when designing a house, a proper foundation should be installed– but because we take the foundation, the land on which the house was built, and even the engineering skills needed for granted, we eventually forget about all those initial and critical matters and become transfixed on the interior design and living conditions.
If this were the case for the conceptualization of a house, would it not be true when we design a recovery program or a clinical intervention? There are forces that are foundational in any recovery program and they not only influence the ‘what, how, where, and when’ of the program, they also affect how clients and clinicians interact with each other. The effects of these larger (and mostly forgotten) principles defined by the macro-systems have a cascading influence throughout the interactions of all other layers (Paquette & Ryan, 2001).
From an integral perspective, observing recovery from only one recovery modality inevitably results in a fragmented understanding of the human experience, which may lead to limited outcomes in recovery (Shealy & White, 2013; du Plessis, 2012; Dupuy & Gorman, 2010). Because each modality is a lens on reality that produces distinct theories, truths and perspectives, clinicians can miss whole aspects of human life to the extent that they only focus on one.
When program developers and clinicians address only one modality (e.g., focusing only on neuropathology and neuropsychology or only on the spiritual or psychological factors of addiction), they are in jeopardy of reducing human experience to only one “truth.” By fully opening and embodying the spectrum of what an integrative model can provide, people can grow into becoming closer to a sense of wholeness. ‘Whole’ does not mean a “final destination.” The term ‘whole’ in this context speaks to the richness of human experience, which is always changing, developing and evolving.
If we wish to help our clients stay in long term recovery, we need to not only address interpersonal concerns, but also the inter-subjective dimension, theMacrosystems and the Mesosystems—this is to say, we need to take into consideration the degree to which we are relational beings with social and ideological blueprints. This is both in regards to other humans and to our ecology. Moreover, and I do not say this lightly, it is imperative that we assess the dramatic effects we all share due both to social and ecological disintegration (Divecha, & Brown, 2013; O’Connor, 2013; Alexander, 2015) and to the loss of psycho-cultural diversity. As this statement may seem when we read it, there is a tendency to overlook its impact in day-to-day after care programs because of the hyper-attention and natural bias we invest in individualist treatment plans.
Finding the way to integrate all of the above into a recovery program is not an easy task. Each perspective is a lens; when immersed in each we can easily forget that it is only one way of knowing and seeing the world. And yet, in my view and the view of others (Patten, 2013; Divecha, & Brown, 2013; Jung, 1976; Woodman,1990; Hillman, 1997; Roszak, 1995; Orr, 2004), the planet, society, and human beings need to be healed together as our psyche cannot be separated from its environment, be it the natural world or socio-cultural context.