The following article was written by a good friend and professional colleague of mine, Steve Parrett. Steve is a retired vocational rehabilitation counselor, who worked with alcohol and drug addicted clients for over thirty years. He was considered one of the best counselors among his peers, and his words put a slant on addiction that the public does not hear about in the general media. My hope is that anyone reading his article, who is struggling with addiction themselves, or is associated with a friend or loved one with this disorder, can put in proper perspective what needs to be done to arrest this disease and begin to lead a normal life. It will also give assistance to professional caretakers who work with addicted clients.
VOCATIONAL REHABILITATION AND THE DISEASE OF ADDICTION
A Severe and Permanent Disability
By
Steve Parrett, M.Ed, M.Div.
The disease of addiction, including chemical dependency and other addictive disorders, definitely belongs in the category of permanent disabilities. Even when addiction is in a state of remission, it presents barriers to social and vocational functioning, because it is a chronic, progressive, potentially fatal disease, which can never be cured, although it can be controlled in the context of a lifelong recovery program that must be worked every day.
During the course of human development, the addictive individual has either never learned, or has lost touch, with the normal, appropriate ways to feel good about oneself: acceptance by and interaction with others (social), and a sense of personal achievement or accomplishment (primarily vocational for adults in our society). This brings about low self-esteem and creates a painful emptiness within the person. In order to fill this void and to feel better, the potential addict finds a vehicle that will instantly produce a change of mood that is pleasurable, intense, stimulating, exciting. Behaviors used to achieve these results are most often the use of alcohol and/other drugs, but could involve compulsive acting out of one or more pleasurable behaviors, such as eating, gambling, sex, spending money, or winning the approval of others. As the behavior is repeated, it becomes habitual and creates the illusion of control and direction in an otherwise fragmented life. Although the pleasure derived from the behavior decreases over time, the behavior is perpetuated to avoid pain (withdrawal) and to try desperately to recapture the familiar “ high.” At this point, the abuser has become an addict and has formed an intense emotional “relationship” with a chemical (mood-altering substance) or event (acting-out behavior).
As the abuse progresses to dependence and addiction, there occurs regression and deterioration in adult responsibility and functioning in all areas of life. As more and more time and energy is expended on and around the addictive behavior, the addict becomes increasingly isolated from other people and less capable of fulfilling responsibilities. There are definite functional limitations to employment. Using chemicals or acting out on the job causes impaired judgment and decreased work tolerance, resulting in sub-standard quality and/or quantity of work accomplished. An addict’s ability to concentrate and fulfill work duties can also be impaired by an obsessive/compulsive craving to feed the addiction and/or making plans to do so. Practicing the addiction off the job can cause excessive absenteeism from work due to several factors: related physical problems (including withdrawal), legal difficulties, impaired sense of timing and prioritizing, and a general loss of motivation to get to work due to an excessive pre-occupation with the addiction.
Addictive behavior becomes a habitual way of life and is continually repeated in spite of self-defeating and even self-destructive consequences. Addictive thinking replaces the logic of common sense as it becomes embedded in one’s personality structure. This delusional way of thinking includes persistent denial that this destructive process is taking place. Problems and consequences are explained away by blaming others and by a variety of creative excuses. On a deeper level, however, there is self-blame, guilt, and shame—painful feelings that can be relieved temporarily by more addictive behavior, which in turn causes more harmful consequences and pain, and so on in a vicious cycle. During this process, permanent and irreversible personality traits develop and grow, becoming more significant and basic to life itself than any specific addictive behavior. (This explains why addicts frequently add different types of substances or non-chemical addictive behavior to their life style and often switch from one prominent acting-out behavior to another). The key concept here is that eventually the addict forms a dependent relationship with his or her own addictive personality! At this point, the addict is powerless to change the behavior and will continue to deteriorate to total incapacitation or death, unless he or she in utter desperation relinquishes the illusion of control, admits that life has become unmanageable, and surrenders to outside help.
Recovery begins with becoming and learning to stay abstinent from addictive behavior, through medical treatment, counseling, addiction education, self-help groups, etc. However, a recovery program must go much further than abstinence. It is a process of learning (or re-learning) and practicing normal, healthy behaviors: first social (open and honest human interaction) and then productive/vocational (gradually assuming more independent adult responsibility). However, the addiction has made a permanent impact on the individual’s personality, creating tendencies to circumvent the difficult, often painful, recovery process by interacting with other people in more immediately gratifying, immature, controlling ways. Thus, the addict will likely use and manipulate others and exhibit impatience, inflexibility, impulsivity, and poor judgment. Self-esteem is still relatively low, so assertiveness, stress management, and decision-making skills are poor. In a job situation, these behaviors often result in dissension, disruption, and inefficient productivity, and can cause conflicts within co-workers, resistance to supervision, and decreased work tolerance. Obviously, termination from the job could result. Furthermore, the option to activate the original destructive, addictive behavior remains embedded in the core of the addict’s personality. On some level, the addict continues to believe that there is a mood-changing substance or behavior that can provide immediate nurturing, comfort, pleasure, and for a time help one to feel better and more adequate. The addictive behavior itself lies dormant during remission, but is always there potentially to be activated as a desperate coping mechanism in the face of a highly stressful situation. Because stressful situations can occur in life at any time, relapse is always a distinct possibility. And when a relapse of addictive behavior occurs, life again becomes impaired by the aforementioned limitations of active addiction.
One common highly stressful life situation that is especially pertinent to the vocational rehabilitation of an addict is the persistence of underemployment beyond early recovery. The nature and timing of productive responsibility is tricky and crucial in the addiction recovery process. Stress can cause relapse, and the kind of work that causes stress changes for some individuals as recovery progresses. For the first six months to a year (or longer in some cases) in recovery, an addict works to support his or her recovery program, not just economically, but also as an integral part of the therapeutic process itself. At this stage, employment brings one into the re-learning process of acquiring and handling more responsibility that is productive. The work should be on a relatively low stress, often menial job, while the individual is putting more energy into the basic recovery issues of acceptance, healthy dependency, trust, honesty, and intimacy with other people. However, after about a year in recovery (varying among individuals), increasing self-esteem, by way of more appropriate and challenging personal achievement, becomes a key issue. This usually means a shift into, or taking positive steps toward, satisfactory employment that is commensurate with one’s intelligence, interests, abilities, education, and previous experience. At this point, crucial to staying in recovery, are both stimulation during the hours spent productively, and the identification of a suitable “vocation” or “career” as an integral aspect of one’s self image. Achieving this goal without the help of professional vocational rehabilitation assistance can be extremely difficult, if not impossible. This is due to the negative impact of the disease of addiction on the person’s physical and mental health, work history, work habits, finances, family and community support systems, and self-confinence to sell oneself as a valuable, productive worker and to earn the respect of both self and employer. The frustration, boredom, and poor self-image perpetuated by under-employment, can indeed create enough stress to bring about a relapse of the addictive behavior. Because such a relapse could easily render the individual incapable of working at any level, a recovering addict in such a life situation (as determined through appropriate counseling and evaluation) certainly has a vocational handicap, even while in recovery and after having been employed at some level for a length of time.
It is true that addicts can often benefit from some short-term assistance while in early recovery. However, when considering actual “vocational rehabilitation” in this disability group, it is crucial with many individuals (not all) to maintain a distinction between the temporary interim jobs of early recovery and the longer term vocation objective pertaining to the personal fulfillment of a rewarding occupation or career. The situation is analogous to that of a high school or college student who works part-time in summer jobs, but whose primary objective is formal learning—getting an education. In many cases the interim jobs have little or no similarity to longer term career goals. No one would deny this young person the benefit of an education because he or she can function on a lower level job, while the primary objective is to learn to live and cope in the world again without the crutch of the active process of the disease of addiction.
In fact, in most cases, working an interim job for several months should be a requirement for vocational services, because it demonstrates the responsibility and motivation to maintain a solid recovery program—a critical factor in assessing an addictive individual for feasibility for rehabilitation services. On the other side of the coin, the counselor should be very careful not to offer vocational (i.e. “career goal”) services too early in the client’s recovery. Doing so would “enable” the addiction and actually interfere with the recovery process. The addictive nature is to seize every opportunity to distract oneself from dealing with painful, basic recovery issues by diverting attention and energy to something he or she wants that seems less painful to pursue. A “rewarding career,” like a geographical change in residence, and many other distractions, can be pursued by the manipulative nature of the addict as a false “quick-cure,” with the rehabilitation counselor or other helpers being “set up” as manipulative enablers of the disease process. After the first year of recovery, the addict has usually grown to the stage where suitable vocational or career choice is a legitimate recovery issue, and in some cases is crucial to the maintenance and progression of the recovery process itself.
Therefore, in terms of eligibility, the rehabilitation counselor and other helpers should then be free to appropriately serve the addicted individual, as long as they are knowledgeable of and respect the nature and timing of the recovery process, and what services are appropriate to a particular stage of recovery.
THE END
(Steve Parrett and I worked with addicted clients for many years. We provided vocational rehabilitation counseling and other needed services as appropriate after our clients completed the initial phases of their recovery process. This initial period consisted of detox, outpatient treatment, 12-Step Program participation, halfway house residence, counseling, and whatever else the clients needed. Almost all were required to remain clean and sober for one year before any in-depth vocational testing and counseling was provided. The reason for this extended period of time is the fact that alcohol and drug abuse alters the brain is such a way that it does not return to normal for about a year. Most psychologists do not do personality or IQ testing until after about a year of sobriety, because they will otherwise get a false impression of the client and his or her abilities. Joe Wilkins)