Alchemy of
Addiction
A Fresh Look At Dual-Diagnosis
The Flame of Addiction

“The Moth don't care when he sees The
Flame. He might get burned, but he's in the
game. And once he's in, he can't go back,
he'll Beat his wings 'til he burns them black...
No, The Moth don't care when he sees The
Flame. . .The Moth don't care if The Flame
is real, 'Cause Flame and Moth got a
sweetheart deal. And nothing fuels a good
flirtation, Like Need and Anger and
Desperation... No, The Moth don't care if
The Flame is real. . . ” ― Aimee Mann
“Lord got to get me some
smoke but shit . . . I am
broke”

* The Lies around addiction (especially in
the field of psychology) are as egregious
and insidious as the lies the actual addict is
operating from.

* A perfect example of this is the
“therapeutic” use of “why” questions to the
addict.

* If an addict knew precisely why they were
addicted they would not be in counselling in
the first place . . . And yet this is common
practice to focus on the origin of addiction to
get to origin of mental illness.
You’re an Addict . . . Trust me
on that one!

* Assuming that someone is an addict before
consulting their own perception of where
they are at is another damaging fallacy.

* One plus two does NOT equal three in the
world of addiction. The imperative of making
“logical” sense for the sake of the client is
often times about making the counsellor feel
better.

* Addiction is NOT limited to substances
and/or behaviors. Addiction can include
ideological, religious, political and other
“conventional” outlets.
Addiction & Transcendence

* The conventional state of the ego is a kind
of insanity. This is why since ancient times
human beings have been devoted to
realizing some other kind of condition, even
though they might not be able to name it yet.
Everyone is motivated toward release by the
inherently disturbed sense of self. In fact,
this is our great advantage. This is the native
siddhi of all beings. We already transcend
the ego through our disturbance. It is not
something we should be suppressing,
therefore. Master Da Free John (aka “Adi
Da)
Who’s insane here?

“I admire addicts. In a world where
everybody is waiting for some blind, random
disaster or some sudden disease, the addict
has the comfort of knowing what will most
likely wait for him down the road. He's taken
some control over his ultimate fate, and his
addiction keeps the cause of his death from
being a total surprise.” ― Chuck Palahniuk,
Choke

* “Jim” was a firefighter in my Hell’s Kitchen
neighborhood who I began seeing after 9/11
for dual-diagnosis
Just Let it burn . . . Let it burn
man!

* Jim had, in his own words, “a nasty little
devil of depression,” that could only be
managed “with an equally as nasty little pill” .
. . Oxycontin.

* My plan of attack was getting Jim clean
and sober so we could deal with his
depression (which turned out to be bi-polar
2).

* Toward this end I hounded him about
sobriety, NA groups, anything to get him to
see the insanity in taking these pills.
You didn’t listen to me, you
just didn’t listen

* About a couple of weeks into our work
together I received a call from Jims
supervisor at work imploring me to come
down to the station right away.

* Jim had tried to hang himself in a closet
and was fortunately found by a co-worker
quickly.

* When I asked Jim what he needed he
replied “I need you to listen to what is not
there and stop trying to make me sober
first.”
Drugs, Depression and
Duality . . . Let’s get
metaphysical!

* Jim really forced me to take a long look at
my counselling approach . . . Especially with
regards to dual-diagnosis.

* His focus on listening to “what is not there”
is key because in addiction the impulse is to
pave this over and construct a therapeutic
fortress, a positivistic way out.

* What wasn’t there turned out to be a
connection with anything tangible and the
sadness and hypomania of his bi-polar.
There were “gaps” that needed a voice, an
expression.
The horizon of being: from
object to opening

* The building of self in childhood or therapy,
in this vision, is part of the unproblamatic ,
organic world. Almost no thought is given to
the political functions served by such a
concept of the self: the consumer metaphor
of development (the self-object is consumed
and metabolized in order to build selfstructure) Phillip Cushman

* I have found creative and action modalities
to be incredibly powerful for helping the
dually-diagnosed discover the power of selfinquiry and inner-work.
Finding common ground for
addiction and mental illness

* While it is automatically assumed that
addiction has a synergistic relationship with
mental illness I would contend that more
times than not this is not the case.

* That is why when the question comes up
which to address first: addiction or mental
illness . . . I balk at responding because I
think it is misconstrued.

* Let me demonstrate this with the following
example that I use with clients all the time.
Your Crazy Papa-T . . . Crazy!

* “Ed” was a Dominican in his early 20’s who
served to mark another important milestone
in my understanding of dual-diagnosis and
the relationship between mental illness and
addiction.

* He had recently lost his job at Kennedy
Airport for failing a random drug test with
opiates and cocaine.

* Instead of asking “why” I asked him “what”
the drugs provided him, to which he replied
“It gives me time to relax and open my mind
before the anxiety and worry settle in.”
The De-Shame Game

* Ed had been to multiple treatment centers
and mandates counselling throughout his
years.

* The first thing I did in working with him was
to find out what gave him joy and freedom
(besides the drug use!). He loved
photography and I used this as my in to
invite him to work psychodramatically with
his addiction and anxiety.

* Just as objects, figures, people, memories
are captured on film . . . So to is our internal
world replete with a rich landscape, shades
of color and light, etc.
This isn’t any Kodak moment!

* We began a series of exercises designed
to take “pictures” of Ed’s internal world, of
his psyche in action so to speak.

* One picture for example was with the
anxiety and the other without. Still another
photo was of the drugs and that is where
things got really interesting!

* Every picture with the drugs in it was what
Ed called “washed out,” akin to opening the
back of a camera and exposing the film
rendering no images or color.
Over-Exposed

* Ed was adamant he didn’t know what the
“wash out” was about until I had him
dialogue with the pictures of the drug.

* “It is shame, crippling shame and it fucks
up every picture on the roll.” Instead of trying
to change the shame or pictures we slowly
began to invite them in, to welcome the
shame and see what it had to say.”

* Ed began to see that the shame and
“wash out” was just as important as the
other psychic pictures if not more.
Nut’s & Bolt’s of Counselling
Dual-Diagnosis

* Diagnostic/assessment skills are vital first
step. Utilize but don’t rely exclusively upon
prior clinical perceptions.

* Listen for what the client puts emphasis on
when disclosing history (addiction
proceeding mental illness or vise versa)

* Look for what is not spoken or reported. If
a client does not disclose anything about
their addiction and/or mental health issues
that is valuable communication.

* Difference between Abuse and
Dependency key!
Nut’s & Bolt’s Continued

* Don’t laminate your own notions of sobriety
and mental health on the client but rather . . .
Have them define what if anything these
mean for them.

* Don’t assume any direct connections
between self-medication and a DSM
diagnosis. Remember . . . Medicating is
often a way to fabricate a substitute means
of accessing one’s psyche.

* Find out what if any psychotropic
medications the client is using in conjunction
with any recreational drugs as this can be a
huge and potentially dangerous factor.
CBT? Existentialism? . . What
modality to use?

* If you operate from a solution focused
orientation you are going to be in for a rude
awakening!

* Find out if the client learns and reflects
tactilely, analytically, kinesthetically, and then
adapt approach to this.

* Approach mental illness and addiction as
inexorably linked phenomenon.

* Good to have a mix of processing work
followed by action methods, such as arttherapy or somatically based therapies to
ground the realizations.
Alchemy and the
compensatory psyche

The most outstanding symbolism pertaining
to the creation of consciousness is found in
alchemy. The alchemist must find the right
material to start with, the prima materia. He
must then subject it to the proper series of
transformative operations in the alchemical
vessel and the result will be the production
of the mysterious and powerful entity called
the Philosopher’s Stone. The alchemical
myth tell us that consciousness is created by
the union of opposites. _ Edward F.
Edinger
Addiction as convoluted
alchemy

* I believe that addiction is almost always the
result of apparently irreconcilable opposites
in the psyche attempting to be unified via the
ingestion of substance, belief, behavior etc.

* This plays out largely unconscious, which
is why most addicts “have no idea” why they
are addicted and/or suffering from
depression, anxiety etc.

* The case of “Chris” highlights this. A crack
smoker who I worked with off and on for
over 2 years using alchemical symbols to
create his own “Prima Materia” to stand on.
Power of Myth

* One of the realities of addiction and
chronic mental illness is inner poverty, or the
absence of any meaning and value.

* A powerful therapeutic exercise is having
the client articulate (writing, art, movement,
etc.) their personal myth, or story.

* This provides both a Deconstructionist and
Re-Constructionist approach and allows the
dual-diagnosis client to see they are more
than the narrative of “addict” or “bi-polar.”
The Infection . . . Watch Out!

* What if you, as a counsellor/mental health
professional, or graduate student, suddenly
and inexplicably found your self selfmedicating for no apparent reason?

* What if you were working with addicts and
dually-diagnosed when this commenced?

* What if you did not view your selfmedication on the same playing field as your
clients: “I just get high on the weekends
while these people can’t function.”
One Toke Over The Line . . .

* I bring these questions to light as a means
of highlighting a very uncomfortable reality
that is typically not addressed.

* There are many in this field with mental
illness who are self-medicating and this only
tends to intensify when working with dualdiagnosis clients for obvious reasons.

* The kicker is a blind spot “I am providing
the counselling so that must mean that I am
not that bad off and can help myself at any
point.”
CLOSING COMMENTS

* Dual-Diagnosis treatment is a team effort.
Many counsellors don’t get community
resources and other specialists on board
who can help.

* Educate, Educate yourself about drugs and
other addictive presentations. You don’t
have to be an addict to help an addict but
having information and basic background is
key for building rapport.

* Don’t bullshit! If you don’t know something
or have questions ask! This goes for your
clients and peers.
Closing Comments

* Rule Out!!!! While many are quick to make
a diagnostic assessment it is better to sift
through and rule out what it is not because
dual-diagnosis is complex and frequently
over or miss-diagnosed.

* Harm Reduction. Frequently the impetus is
on stopping the addiction outright. This can
be dangerous if a medical detox is needed
or if the drug is replicating a physiological
action.

* Research. Have your clients do research in
their drug of choice and their mental illness.
This empowers them with clear unbiased
information.