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Crucial parts of the process of recovery from addiction are tied to the restructuring of meaning in the addict's life. Indeed, the entire process seems linked to a series of personal redefinitions. Such cognitive restructurings have been described as reframes. In the following article, the author explores several levels at which changes in meaning impact the addict's life. These include whole life reframes (the redefinition of one's self concept in religious and other awakenings), reframes of specific situations (changes of meaning about situations and events), and concepts (changes of meaning related to specific ideas). The idea of reframing as a tool for change is then applied to several places in the progress of recovery where the manipulation of meaning can powerfully impact the addict's life. Conceptual tools are provided for the reframing of higher powers, the disease concept and other standard ideas in recovery into concepts which provide a solid informational base for change.
It appears that we are often unaware of the nature of the perceptual shifts necessary to make a satisfactory change in life. We recognize that some change is needed but often remain unable to state with any degree of precision those changes that are necessary. At other times we formulate the change in terms of a system that may have little actual relevance to the problem itself. In certain approaches, the failure to grow beyond a system of rote instructions is often framed in terms of a failure to grow into or through a step. This is often less than useful: an intellectual acknowledgment of the proper formula is qualitatively different from the experience of its reality. Rather than focusing on an adherence to an external formula, the study of addictions must focus on the more profound issue: how do we move ourselves and others to the next higher logical level that provides the proper insights for personal growth away from addictive substances and into productive behaviors.
Crucial parts of the process of recovery from addiction are tied to the restructuring of meaning in the addict's life. Indeed, the entire process seems linked to a series of personal redefinitions. In the following article the author explores some of the important crossroads in the progress of recovery where the manipulation of meaning can have a powerful impact on the life of the substance abuser.
In order to maximize our effectiveness as change agents we must develop an awareness of the crucial changes in meaning structure as a patient moves through the process of recovery. We must also develop the necessary repertoire of tools to foster those shifts. For many practitioners this is an intuitive process, handled more or less on a "gut" level as the individual works through the steps or other process. Effective praxis requires clear identification of stages, steps, and conceptual transitions along with sufficient skills for the manipulation of those transitions.
Not only are we in need of a clear sense of the cognitive tasks for growth beyond active addiction, but we alsoneed to identify the kinds of cognitive tasks assumed by each remedy. There are underlying assumptions in the 12 step programs no less than in rational recovery, cognitive-behavioral, or stages of change formulations. Whatever the program used, we must understand the clear cognitive goals which are assumed within the system.
Finally, our effectiveness is partly a function of our own flexibility. So long as we refuse to reconceptualize our tools to fit the patient we will fight a losing battle. We all know conceptual rigidity as a symptom of addictive mentation. We, as much as our clients, must beware the specter of denial, especially here. The capacity to reach individuals depends upon our capacity to meet them within their own worldview. If we cannot understand their view, and respect it as such, we cannot expect them to understand ours (Washton and Stone-Washton, 1993; Grinder and Bandler, 1971).
Recovery from addiction may be understood in terms of a total redefinition of the meaning of the addict's life. Just as his or her entry into the addictive process redefined who and what they were, so their emergence from that world of addictive definitions and meanings is an important part of the process of recovery. We might say that the addict’s life was reframed--redefined--by the experience of addiction. The task of recovery itself is reconstituted as redefining the life of the substance abuser so that reframed, or recontextualized, his life can proceed without addictive substances.
Meaning impacts the substance abuser on multiple levels. Prochaska, Norcross, and DiClementi (1994), authors of the transtheoretical stages of change model, have shown that one of the crucial predictors of failure in recovery is the identification of the self with the addictive process. One who accepts the identity of "addict" is far more likely to fail in treatment than someone who identifies themselves as a "recovering addict." The difference is crucial. Here, the life of the substance abuser is given new and destructive meaning when it is reframed or contextualized in terms of our cultural definition of an addict.
A client expressed his dissatisfaction with his recovery group. He had acknowledged his inability to control his cocaine abuse, but could not admit that he was an addict. "I never lost my home or hit anybody over the head. I work hard and care for my family. I have a problem, but I’m not an addict. "The cultural definition of the word "addict" would make him a criminal and a degenerate. He saw himself as none of these things. To acquiesce would be to admit the possibility of committing these acts --NOW.
For many people, their belief about the nature of their problem is crucial in the determination of the course of their treatment. People who believe that they are addicts often respond less well to treatment than people who do not (Peele, 1996).
Prochaska, et al., have also shown that the largest number of negative outcomes in addictions treatment correlates with a failure to accomplish a crucial series of redefinitions. Among them is a move from a negative, past oriented, self-loathing orientation to a positive future orientation. This is the specific task involved in movement from precontemplative denial into readiness to change--the development of positive futurity. Their information suggests that 80 percent of all clients coming into recovery programs have not made the decisions necessary to make change a possibility. Most of the programs, however, assume that they have (Prochaska, et al., 1994).
Stanton Peele, the iconoclastic addictions researcher from Rutgers University, essentially makes the same argument when he points to treatment readiness as a crucial element in recovery. His self-changers, the 85% of substance abusers who needed no external treatment, were all individuals who succeeded in a crucial piece of cognitive reframing ( Peele and Brodsky, 1991).
The first step of AA/NA and every other 12-step recovery program is a reframe, a change of meaning, understanding and belief. "We admitted we were powerless over our addiction--that our lives had become unmanageable." This admission of powerlessness and lack of control is a crucial passage. According to the doctrine of the disease model, it marks the transition between delusional complacency and the possibility of change. It is a redefinition of self and of the meaning of one's actions. Unfortunately, in light of the research cited above, it may be altogether wrong-headed.
Jungian theory suggests that addiction fills the purpose of initiation -- the transition from childhood to adult status through symbolic death and rebirth -- in an overrationalized, secularized world. Unfortunately the initiatory process stops short of the rebirth to selfhood or adulthood. This leaves the addict trapped in the death phase of initiatic process with no hope of rebirth. As a failed initiation, addiction dooms its victim to an eternal cycle of immature dependence and consumerism (Henderson, 1984; Zoja, 1989).
In the world of secular recovery, Rational Recovery reframes addictions by personifying them and teaching the addict to listen for and recognize the addictive voice. In their perspective the addiction is a normal expression of a well-functioning organism (Trimpey, 1992).
Even when one begins to look at religious conversions-- of whatever variety-- it becomes immediately apparent that one of the crucial elements in recovery is a transformation of meanings. The Muslim convert, as does the Christian, goes through a rebirth, a personal redefinition. In fact, the familiar English words, convert and repent are, in the King James Bible, verb forms of the Greek word, metanoia, meaning a change of mind. This is essentially a cognitive reframe. The Gospel’s "Repent and believe." might be paraphrased, " Reframe!".
Without discounting the power of religion, similar reframes appear in cases of finding one's self and changes of environment. Peele recalls, that many American soldiers stationed in Viet Nam developed marked heroin dependencies during their tours of duty. The government made extensive preparation for their treatment but were surprised when the vast majority returned to give up drugs with minimal withdrawal. Many of them never used illegal drugs again (Peele and Brodsky, 1991).
Peele also recounts animal studies where biologically appropriate environments seemed to eliminate any craving for the addictive substance. He indicates that rats, originally raised in crowded cages and isolated from each other, were given heroin water to drink until they displayed significant symptoms of withdrawal when the drug was removed. Some of the addicted rats were moved to spacious "rat parks" where they had open territory, access to living greens and a sexual mate. Almost as soon as the addicted rats were transferred to the "rat parks," they refused to drink the heroin water, preferring plain water, and showed no signs of withdrawal.
Wherever one turns, meaning, beliefs, and personal definitions seem to lie at the heart of change. In the following we will briefly explore the idea of reframing, its application to addiction and some specific examples for its application.
Neuro Linguistic Programming is a discipline which arose in the 70s at the University of California, Santa Cruz under the influence of John Grinder, Richard Bandler, Robert Dilts and Judith Delozier. It is essentially an integrative discipline drawing successful strategies for communication and change from various sources. Closely related but intellectually distinct are the researches emerging from the Mental Health Institute in Palo Alto California as developed by Paul Watzlawick, John Weakland, and Richard Fisch. Both often see changework in terms of changes in meaning. In these perspectives a central tool is represented by the idea of reframing.
A reframe is a change of the meaning of a specific stimulus event either by manipulation of its context or content.
To reframe ... means to change the conceptual and/or emotional setting or viewpoint in relation to which a situation is experienced and to place it in another frame which fits the "facts" of the same concrete situation equally well or even better and thereby changes its entire meaning (Watzlawick et al, 1974 p. 95).
Meaning shifts in a reframe depending upon the affective context against which the original stimulus is perceived (Grinder and Bandler, 1982).
A client tells the story of his willful daughter, who at the age of 3 was faced with the unpleasant task of taking a spoonful of medicine. The child refused every attempt at coaxing and cajoling until, frustrated, her mother sat her on a stool in the middle of the kitchen. "Well," said the mother, "Now you can just sit there until you are ready to take the medicine." The little girl sat down as instructed, arms folded and her face creased in a frown. An hour and a half later, the frustrated mother shooed the unmedicated child from the room. When she later remarked on the stubbornness of her daughter, someone reminded her that in years to come when some young man tries to make a move on her that she does not invite, that same attitude will become quite a comfort. This is a simple reframe. Something which is perceived as negative in the present context takes on a whole new meaning when projected into the future.
On a less dramatic level, reframes appear as contrasting values. The adage "I complained about having no shoes until I met a man who had no feet" expresses a reframe when values are redefined by comparison with more severe cases.
Reframes can also be understood in terms of permissions. John Walters, author of Solution Focused Brief Therapy, tells the story of a man with a severe gambling problem that had destroyed his life. At one point in therapy he was told that he didn’t have to enter the gambling hall. The permission came as a revelation and he never gambled again.
Permissions form much of the strategy in assertiveness training. The simple expedient of giving the client permission to say no, to not be nice all of the time, or to express their own desires and opinions are clear reframes. They change the meaning of the situation.
Reframes often entail a move from one logical level to another. Logical level and logical type are elements of mathematical set theory defined by Alfred North Whitehead and Bertrand Russell in their Principia Mathematica. The concepts were popularized by Gregory Bateson in Steps to an Ecology of Mind among other works. In Steps, Bateson notes that in order for a logical classification to have meaning, it must differentiate itself from a class of the same logical type. Logical level relates to the hierarchy of sets and their logical comparability. Imagine a set of hollow, square containers. This set may contain matchboxes, candy boxes, tea boxes, etc. Each kind of box is a logical level within the broader type. The set of square hollow boxes is comparable to the distinct type consisting of the set of all hollow, round containers. This, in turn, contains the subsets, levels, of snuff-boxes, ice-cream containers, and hat boxes. Together both sets may be seen as members of the larger unity comprising hollow containers. The nested hierarchy of categories, each containing the last is an example of logical level. (Bateson, 1979, p.122ff ; 1972, p.280,ff.)
In the context of reframes, meaning changes when the basis of comparison, logical level, or type, is shifted. Thus, the little girl who will not take her medicine is a stubborn, naughty child. When, however, her behavior is seen in terms of the class of people who stubbornly protect their personal safety against sexual intrusion, she is possessed of strong character.
In the same manner, the substance abuser who has used his or her associations at the firehouse, the local pub, or the VFW hall as a central part of their identity learns to redefine themselves in terms of sober associations. Thus, the shift in identification from drinking groups to non-drinking groups is also a reframe that moves to a different (logical) type of group.
Reframing -- the capacity to shift our understandings and definitions -- becomes more important when we recall that conceptual rigidity is one of the crucial indices of addictive thought, "stinking thinking." It is sometimes the result of an inability to move to a different logical level or type. Normal living entails a good deal more flexibility, while creativity entails a relatively free-ranging ability to move to parallel types and different levels for a new basis of comparison. In the rigid world of addictive thought, the world tends to split into good and bad, friend and enemy, us and them. Breaking free of this simple-minded rigidity is a crucial element of recovery.
Reframes are often limited in scope; yet in other circumstances, whole lives are redefined by significant experiences. Religious conversions are reframes in which the revelatory power of vision or the simple message of love and belonging puts things "in perspective." Much of the basic doctrine of AA and NA flows from the religious fervor of evangelical Christianity and the ultimate reframe of being "born-again."
In the context of classical recovery, the same kind of shift represents a move from working the program as a series of discrete practices or actions, to living the program as an attitude towards life. Here, as in the religious awakening, the original mitzvoth of the discipline, the rules of good behavior and right practice, are left behind in favor of an experience in which the preceptsof the organization are exchanged for a natural expression of personal wholeness. All of the individual practices and efforts must one day coalesce into the internalized reality of personal sobriety. There is a shift of emphasis as the individual who operationalized the saying, "Fake it till you make it." emerges on the other end of addiction as a committed member of sober life. The same process is generally true of any personal identity. In each case the identity arises as the emergent property, the synergy, that arises from the interaction of learning, experience, and practice. In the general parlance of recovery, those who fail to make this transition are labeled "dry drunks"(Gray 1996).
As a psychological phenomenon, the whole-life reframe was first defined by Milton Erickson, MD. Erickson was one of the important modern sources of the idea of reframing. Indeed, many of his interventions were particularly aimed at the transformation of meaning either within specific parts of the individual's life or of life as a whole.
More popularly, one type of whole-life reframe can be expressed in terms of self discovery, finding one's self, discovering a personal theme, purpose, or intent. By coming into alignment with the natural proclivities of the self, the world is transformed and meaning restored. Joseph Campbell, in The Power Of Myth, expressed it as following one’s bliss (Campbell, 1988).
From the Jungian perspective, addiction is framed as a search for transcendence and personal redefinition. It often takes the place of initiation as a transition from one stage of personal life to another. Unfortunately, in the West, where our traditions have allowed initiation to wither on the vine, the person seeking redefinition is all too often pulled down into bondage by the very tool he sought for release. If the early stages of addiction mark the initial outreach in search of personal redefinition, the turn to recovery and the redefinition implied by it represent a further restructuring of meaning. In Jungian parlance these are conceived as reconfigurations of the ego complex after confrontation with archetypal energies that ultimately arise from the Self. Their aim is a reformulation of the ego at a level that is more capable of balanced expression of the needs of the whole. In each stage of development these changes are marked by reformulations; whole-life reframes which mark the progress on the path to individuation (Jung, 1976; Henderson, 1984; Zoja, 1988).
A more specific pattern of whole life reframe implied by Jungian theory is the realization of the path of individuation, finding one’s self and aligning one’s self with the innate potentials and energies which always represented the "Tao" of self-realization. This is expressed as a submission to the deep call of the Telic Self, the full expression of personal potential and individuality (Gray, 1997B).
On a general, behavioral level, the goal of recovery is a set of behavioral changes whose central aim is the end of addictive behavior. The drug addict needs to stop using and to regain choice when the urge arises. The alcoholic likewise is seeking to reestablish a level of control in his or her life.
Accordingly there has arisen a culture of change that is centered on the addictive process. At one end the culture is characterized by spiritual and religious practices aimed at personal transformation and spiritual growth. These include religious awakenings, 12-step programs, and other spiritual and pseudo-spiritual belief systems and paths. On the other hand are arrayed various cognitive and behavioral interventions which seek to deal scientifically with the problem. These include cognitive-behavioral interventions, behavioral therapy, and certain hypnotic and metaphorical interventions. In the wide range between there is an unimaginable jumble of promises, aids, programs, and intervention strategies.
Upon close examination, however, there are certain cognitive elements which are common to all. Whenever they work, it is precisely because they emphasize or succeed in producing the following kinds of cognitive restructuring:
Whole-life reframes, religious, and spiritual conversions. In the Evangelical world there are innumerable testimonials to the saving power of religion. It is not uncommon at any revival meeting for one to hear multiple claims of miraculous deliverance from drugs, alcohol, sex, sin, and other addictions. Without considering the claim of supernatural intervention, the efficient agent of change is a radical restructuring of meaning in the convert’s life. In some cases this occurs as a confrontation with grace and Divine Love. Here the contrast between what I am and what Thou art is a defining factor. In some cases the addict is brought to confront, on a deep emotional level, the consequences of his or her actions (both temporal and eternal). In the heightened emotional context of the revival meeting denial is often broken and the addict comes to a point of readiness for change. In others, the reframe is accomplished by the experience of community, belonging, and acceptance, elements that are often intentionally fostered by the use of music, chanting, emotional outbursts, and careful staging. Here the addictive isolation is brought into sharp contrast with the experience of a loving community.
Outside of the evangelical Christian world, similar phenomena are not at all uncommon. Prison authorities are almost unanimous in their praise of the Nation of Islam as a change agent within the African American prison community. Inside the prison walls, significant numbers of transformative experiences have followed as a nameless, powerless man becomes, perhaps for the first time, a member of an historical community that provides his life with meaning, order and direction.
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