The term ‘addiction’ is quite broad, and attempts have been made to define it in various ways at different points in recent history and literature. Even today, there are diverse and, to some extent, overlapping definitions mentioned in the relevant literature (EMCDDA, 2013). Some definitions of addiction focus exclusively on substances/drugs, although it is now well-known that other behaviors, such as gambling, can also be problematic and dominate people’s lives. Some other definitions refer to withdrawal symptoms, even though these are not necessarily present, nor do they constitute the primary motivation behind the compulsive behavior characteristic of addiction. Similarly, some other definitions focus on the development of tolerance to substances, even though this is not always necessary. Others focus on the brain abnormalities associated with addiction, even though individuals can exhibit all signs of addiction under certain conditions and the same individuals, with the same brain, may not exhibit them under others. The loss or dysfunction of control constitutes some of the common themes of certain theories, although this would exclude the possibility of addiction when no attempt was made to exercise control (EMCDDA, 2013).
The aforementioned ambiguity in the definition of addiction is also reflected in the different models developed for its interpretation, justification, and treatment (Netos, 2021). In this text, I will briefly attempt to outline the ways in which addiction is addressed from the perspective of narrative therapy, also providing some personal experiences from my work with individuals facing problems with substance use and abuse or addictive behaviors.
In contrast to the various, and as we have seen, overlapping definitions of addiction, narrative therapy is interested in the definition that the individual themselves gives regarding the ‘problem’ of addiction they are facing. Specifically, it is interested in the individual’s own experience of facing problems with substance use/abuse or addictive behaviors, meaning how they feel about themselves within the context of use, as well as the effects of addiction that concern them most in their life, based on their own experiences, views, and opinions.
Narrative therapy, being a humanistic approach, approaches the very act of an individual deciding to seek help in their effort to cease substance use in their life with great curiosity and admiration. Knowing and not overlooking the various emotional, personal, family, and interpersonal consequences that substance use has on people’s lives, narrative therapy genuinely curious about the decision itself and how it became possible. One of the questions I have found particularly helpful at this point is the following:
“Given the substance use in your life, how was it possible for you to develop the desire to stop and be here today?”
This question shifts people’s discourse from a discussion that would focus on the problem, the consequences, and the omnipotence of substance use in their lives, to a discussion that focuses on and is interested in their own capacity for influence throughout their journey in the world of substance use and the ways (skills, abilities, knowledge) they used and found to be here today and pursue change.
Initially, the decision itself to begin an effort is something that should be thoroughly discussed with individuals who are negotiating a new relationship with addictive substances or behaviors. This discussion aims to provide space and time for people to prepare, before starting an effort, for the potential obstacles they may encounter during their separation from the substance or behavior and everything surrounding it (people, contexts, social circles, habits). Furthermore, at this point, particular emphasis is placed on mapping the forces/influences that contribute to the individual’s use or behavior and can also hinder their efforts. These forces are referred to as cultural forces and include the individual’s network of friends, family, environment, cultural context, as well as social injustices that individuals have experienced and to which substance use may be a response. These discussions are particularly meaningful when one considers that there are people for whom the identity of a substance user or someone engaging in addictive behaviors has monopolized a significant part of their self and their life for many years, overshadowing other important identities for them, such as that of a parent, partner, and/or spouse.
Negotiating a new relationship with addiction and its associated substances or behaviors presupposes a radical shift in the individual and their habits, something narrative therapy likes to describe with the term ‘migration of identity,’ as the individual willingly and intentionally leaves behind one identity, that of the addicted person, and seeks other identities important to them in the world. That is, they seek different ways to exist and be in the world and different landscapes/areas for the establishment of their identity. This shift of the individual from a familiar landscape, that of use, to an unknown landscape away from it, constitutes a complex and quite difficult process often characterized by uncertainty and confusion for the individual (Antony, 2004).
For a better understanding of the above process, narrative therapy borrows and uses the metaphor of the ‘rite of passage.’ The rite of passage is a metaphor used by one of the founders of narrative therapy, Michael White, to help people facing problems with substance use and abuse, and it consists of 3 stages (White, 1997).
The first stage of the individual’s rite of passage is that of separation, and in the case of addiction, it means the individual’s separation from the substance. This stage marks the beginning of the individual’s ‘journey’ towards new identities and unexplored landscapes. The second stage is called the liminal phase. The reason it received this name is because in this phase, individuals are in what we call ‘in-between and among,’ meaning a stage where the familiar sense of use, with which one has become accustomed to being in the world, is absent, and they seek new ways of connecting with the world and new identities. This phase is often characterized by confusion, disorientation, and despair for individuals. However, at this stage, hope also begins to emerge for the individual as they see new horizons for their life being created and appearing, new ways of connecting, new possibilities, and preferred ways and identities to exist in the world. In addition to the difficulties of the above phase, withdrawal syndrome also comes into play, which most often hinders the individual’s efforts to find different ways to exist in the world. This stage is perhaps the most difficult stage of the entire process, as physical difficulties coexist with psychological and social-interpersonal ones for the individual. For this reason, as emphasized above, it is crucial to discuss with the individual the potential obstacles they may encounter throughout their ‘passage’ through each phase-stage of this process, also focusing on the appropriate skills, abilities, and knowledge they can use to cope with them (White, 1997).
At this point, I consider it crucial to mention that narrative therapy does not deny the importance of physiological factors in addiction (such as withdrawal syndrome). On the contrary, it recognizes them and tries to negotiate a new relationship with them, always focusing on the individual’s capacity for influence and agency in their life.
The third stage-phase of the individual’s rite of passage from the world of substance use to a different world is called the reincorporation phase. This stage is achieved when the individual realizes that they have reached another landscape in their life, a preferred landscape, where the individual experiences connecting with their values, intentions, and the ways they want to exist in the world from now on, leaving behind their previous behaviors, such as substance use. In this stage, individuals regain the sense that they themselves exert influence over their lives and not the substance, shaping it in the ways they desire, thus contributing to an increased sense of self-agency in their lives (White, 1997).
Bibliography
Antony, C. (2004). Narrative maps of practice: Proposals for the Deconstructing Addiction League. The International Journal of Narrative Therapy and Community Work, 1, 1–10.
European Monitoring Centre for Drugs and Drug addiction. (2013). EMCDDA insights Models of addiction. European Monitoring Centre for Drugs and Drug Addiction.
White, M. (1997). Challenging the culture of consumption: Rites of passage and communities of acknowledgement. NewPerspectives on ‘Addiction,’ 2-3.
Netos, D. (2021). The experience of repeated admissions of addicted men to addiction treatment programs: A multimodal interpretive-phenomenological investigation (thesis). Rethymno, Crete.
