Many years ago, when I was working as an Addictions Therapist in an Intensive Outpatient Program someone said something in a group setting that was quite insightful and ingenious as it related to treatment and recovery – “I have been in and out of treatment for most of my life. I have been in treatment in several inpatient and outpatient programs. I am now seeing that I don’t know how to live and I am terrified!” 

This person went on to say that it often assumed that just because adults are grown-ups, that they do not always have the skills to live effectively – That it was assumed that the drugs or alcohol curtailed functioning and the goal was to restore it. But, as he said , “When I try to remember how to live, there is not anything to recall. It is not that I am ignorant, but I never learned anything about how to manage myself and my life in a way that worked for me! Addicted people are not always in need of rehabilitation but we often need habilitation! In a way, addiction fills a gap and it is my way of coping in the world. Sometimes I am aware that I am digging my heels into the ground, because I don’t know how to move forward and I’m scared.”

It is often assumed that adults know how to do things and are skilled enough to be effective in life – That somehow the “know how” was lost along the way presenting the need to get that knowledge and skills back. This is not always the case. As a Behavior Therapist and Addictions Specialist, I am aware that despite my clients success in other areas of their lives that they are are often starting from scratch in some fundamental areas. Knowledge and skills are being taught and learned for the first time or in such a way that they as recovering people (can be applied to recoveries from addiction, depression, chronic pain, etc.) can learn and integrate new material in order to apply it to their lives in an effective manner.

Building new skills reduces stress and confusion, while building more productive coping skills and ultimately makes way for eradicating relapse behavior. It may seem too basic, but not any less important.

Sometimes the obvious is easily overlooked; we judge what we think we ought to know. However, life requires a lot of teaching and learning – Managing ourselves, relating to others, organizing, and problem-solving are not necessarily skills that are totally inborn. We learn them.

 I often think of the man who shared his insight about needing habilitation noting and respecting his complete honesty and candor. He was able to get beyond the human ego and self-examine with such transparency. He also made a lasting impression on others and gave permission to be human and to accept imperfection and the need to learn. He also reminded me to be aware of the danger of assumptions and how they can negatively impact the delivery of quality treatment that is appropriately tailored to the individual.

Hence, rehabilitation is a process of rebuilding and taking a foundation and restoring it. Conversely, habilitation is development from the ground up – the putting into place for the first time. Although adults have life experience and points of strength – perhaps successful in business, popular with friends, a strong athlete – There may be significant skill gaps or other issues, medical or otherwise, which the person has been subconsciously trying to compensate for or work around. This impacts the ability to self – manage and regulate thoughts, emotions and behavior.  The absence of such skills negatively impact one’s ability to function and be effective in life.

Although there is a strong genetic component to addiction, addictive behavior can be utilized as a coping strategy, although not a healthy one. Repeated use of substances can become habituated behavior and ultimately grow into an entrenched and highly destructive disease process that when not treated gets worse and can become terminal.  Comprehensive and effective treatment matters.

Next week we will talk about what makes for Successful Drug and Alcohol Treatment with focus on assessment and choice of treatment with emphasis on dual diagnosis/ co-occurring disorders.