In the realm of substance abuse, there are three types of people who walk through the door at an inpatient treatment center, an outpatient clinic, or a clinician’s office: 1) People ready to stop, 2) People not ready to stop, and 3) People on the fence. The first group tends to turn it around quickly. They follow advice. They may relapse after treatment, but they quickly learn from a mistake, and they take the necessary steps to treat their alcoholism. They are action oriented. This type of person usually gets better regardless of where they receive treatment, sometimes even despite where they receive treatment. They naturally find the solution that works for them and make it a consistent part of their life.
The second group, the people not ready to stop, have a very hard time listening to advice. Substances still work for them; the relief they get from ingesting chemicals sufficiently blots out the negative consequences of their addiction. These people are very difficult to reach, and furthermore, they sometimes adversely affect their peers, particularly the third group.
The third group, people on the fence, comprises the agnostics of addiction treatment, metaphorically speaking. They haven’t made up their minds. Such people may genuinely acknowledge that a problem exists, but be unsure about how severe it is. Or they may fluctuate about whether the problem really needs to be addressed. These people have varying degrees of willingness. They are the crux of the addiction treatment field, the people who deserve the most attention- as proper guidance may push them to the right side of the fence. In other words, their willingness can be cultivated.
In the course of over a dozen treatment centers I was always in the one of the latter two categories (most often the middle one). When I wasn’t ready to stop, sometimes I pulled the fence guys down to my level, getting high in treatment with them, or outright running away with them. When I was on the fence, usually I gravitated towards the not-ready-to-stop guys, getting high with them or shirking treatment principles because it was what felt familiar. Several times there was a man or woman who worked at a treatment center that I respected, but even the most magnanimous authority figure couldn’t outrank the influence of my peers. It is fitting then that when I finally made a solid effort to turn my life around, it was in a place with both authority figures that I respected and peers who were responding positively to the same authority figures.
The point here is that willingness cultivation is a dynamic process for the fence people. It doesn’t rest solely on a clinician’s shoulders. It is up to the group- as sometimes peers have greater influence than the people in power. The greatest clinicians, in this addict’s un-humble opinion, inspire hoards of people, who in turn inspire each other.
The good news here is that most people who enter treatment for substance abuse fall into the third category, the fence people. It is also the bad news. And it is why it is of utmost importance that people find the right fit when seeking treatment- that they enter a good place, where a strong emphasis is placed on making sure the fence people are tipping to the right side.
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