Addiction counselors meet with addiction treatment patients on a regular basis. Do those interactions provide a complete understanding of addiction? Does that add up to seeing, hearing, and feeling addiction in its fullness? Or measuring addiction in its totality?
One counselor’s reply might be, “Of course not. We’re not with the patient while they’re using.”
But that reply dodges what’s being asked. And doesn’t address the question. The question being asked is if meeting with patients equates to a complete understanding of addiction as a nosological entity.
Another counselor’s reply might be that given their own addiction and recovery, they do understand addiction. For example, their answer might rest on their lived experience as a person who formerly used drugs and is now in recovery. Or rest on their experience as a close family member of someone who had addiction illness, and is now in recovery.
But that reply doesn’t address the question being asked. The question being asked is if we have a complete understanding of addiction as a nosological entity.
Can our personal experience of life (our own addiction, our own change process, or our own provision of counseling) provide a complete understanding? I would suggest it cannot.
A structured approach
We can develop a structured approach to guide us toward a more complete understanding of addiction illness.
What approach can we develop that is more systematic and covers more facets than our own personal or clinical experience?
We could develop a methodology that is structured normatively, yet allows for individualization. And that could include aspects of addiction that are objectively real, as well as those that are subjectively experienced.
Can such a method be developed? If so, what might it look like?
The approach I propose breaks it down in 3 ways.
- One way is to include things that exist only subjectively as experiences. And also things that exist objectively regardless of whether they are experienced or not.
- Another is to include both objective and subjective ways of knowing.
- The last one is a list of categories from philosophy, through biology and down to math.
All three of these are presented in a grid. The challenge is to fill in every box within the grid.
Some caveats
Before I share the grid, I’d like to provide some caveats.
First, I want to stress that there is no superiority or hierarchy of explanatory power in the vertical list of row headers. “Math” is not “better” than biology or psychology or philosophy.
Another is to stress that there is no implied “verification” of what’s in one box by what’s in another. Whatever is in each box of the grid stands alone as a fact, plus nothing.
Further, every clinical discipline can complete the grid in its entirety. Every discipline can and should. No discipline “owns” some quadrants while being encouraged or allowed to ignore others. No box on the grid is “outside the scope” of any clinical discipline.
A profound truth
This accumulates to a profound truth – that a more complete understanding of addiction can result from two kinds of effort.
One is to start the work of filling in the grid, and working to completion. (But realize this – what we would include are only examples. Filling in the grid would never be “complete”).
The other is to associate with people from other clinical disciplines that are also seekers of awareness, knowledge and understanding as outlined in the grid. And to combine the awareness held across disciplines into a more complete understanding of what addiction illness is.
Are you ready to see the (empty) grid?
Looking at the grid might initially be a bit overwhelming.
- Realizing what it shows might be like seeing the Grand Canyon for the first time.
- Or you might struggle with some of the formal academic-style words I’ve chosen to use.
- On the other hand, you might realize both the scope and detail of what can be filled in. And when thinking about getting started, you might realize how limited you are when trying to fill in some areas.
Those were my reactions when I first got started building the grid. And they got even worse when I tried to start filling it in.
But I found the exercise of building and filling in the grid very helpful.
Ok, the grid appears immediately below.
| Subjective and objective existence and truth across levels of considering | Subjective Existence Exists only as an experience. Example: an itch. | Objective Existence Exists independent of being experienced. Example: a mountain. | Subjective Knowing True as determined by individual experience. Example: one’s taste preferences. | Objective Knowing True as determined by outside verifiable means. Example: thermometer. |
| Philosophy | | |||
| Sociology | | |||
| Psychology | | |||
| Biology | | |||
| Chemistry | | |||
| Physics | | |||
| Math | |
I’d like to extend these ideas into two additional areas. One is the unconscious. And the other is addiction recovery.
The unconscious
I enjoy demystifying the unconscious. One of the main reasons I enjoy demystifying it is the way I was brought up in radical behaviorism.
Concerning the unconscious, let me keep it simple and say it this way. There doesn’t have to be anything odd or mysterious about the unconscious. We can consider it as simply as things and processes we are not aware of, in self and others.
Thus, doing the homework of attempting to fill in the grid, over time, can help raise our awareness. For example, we might realize things we knew, but didn’t know we knew. Or, on the other hand, we might have to put in some effort and learn new information. But guess what? Learning means we are doing discovery. It does not mean that what we learn is true for the first time when and while we discover it.
Putting in the work can cause material to rise from the status of “unconscious” to that of “conscious”.
Addiction recovery
Further, one could fill out the grid concerning the topic of addiction recovery, rather than active addiction illness.
The relative paucity of empirical literature evaluating large numbers of people, prospectively across decades of recovery, is interesting to me. For reasons like that, I find literature such as Living Clean: The Journey Continues compelling.
Below you can find a draft of the grid in a “completed” form. I hope you find your own way through the challenge and fill the grid out out in various ways over time.
| Level | Exists subjectively | Exists objectively | Subjective knowing | Objective knowing |
| Philosophy | Using is a human right | Addiction treatment that is not smoke-free is harm reduction | Tell me your notion of how to live the good life | Time study of behaviors |
| Sociology | “I don’t like non-drinkers.” | Signs and symbols of using culture | Tell me what people and people groups are important, and how | Time study of relationships |
| Psychology | “I’m going to cut back and quit.” | Rationalize | Tell me why you use | Functional analysis of using behaviors |
| Biology | “My medication isn’t holding me.” | Associated features | Tell me how your gut feels | Toxicology & blood work |
| Chemistry | “Let me cook this bag up for us.” | 24-hour substance, OTC, and prescription schedule | Please rank this list of opioids in order of preference | Controlled substance query |
| Physics | “I like smoking it. I never eat it or shoot.” | Track marks. | “That’s a waste.” | Blood level: peak and trough. |
| Math | “Can I have one more? Make it a triple.” | They should be home any minute. | I can hold one more. | Collateral source: number of quit attempts |
The grid can also be completed by clinical disciplines other than addiction counselors, from their perspective(s): addiction medicine physician, psychiatrist, clinical psychologist, spiritual care, family system therapist, nursing, recovery coach, etc.
And lastly, below, I show a figure that contains two grids. One is “above” the limit of awareness and labeled “conscious”. The other is below that limit and labeled “unconscious”. But remember, it’s up to you whether you want to do the project on the topic of “addiction”. Or the topic of “recovery”. Or both. I’ll be filling out a “recovery” one next.
Conscious
Unconscious
References and Suggested Resources (in chronological order)
Jaspers, K. (1913). Allgemeine Psychopathologie. Springer. Jaspers, K. (1997). General Psychopathology. (J. Hoenig & M. W. Hamilton, Trans.; Vols. 1-2). John Hopkins University Press. (Original work published 1913).
Reik, T. (1948). Listening with the third ear; the inner experience of a psychoanalyst. Farrar, Straus & Co.
Luft, J. & Ingham, H. (1955). The Johari Window, a Graphic Model of Interpersonal Awareness. Proceedings of the Western Training Laboratory in Group Development. Los Angeles: UCLA.
Johnson, S. M. (1994). Character styles. W W Norton & Co.
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory. Guilford Press.
Narcotics Anonymous. (2012). Living clean: The journey continues. Narcotics Anonymous World Services, Inc.
Galanter, M. (2014). Alcoholics Anonymous and Twelve-Step Recovery: A model based on social and cognitive neuroscience. American Journal on Addictions, 23: 300-307. doi.org/10.1111/j.1521-0391.2014.12106.x
Searle, J. R. (2015). Seeing things as they are: A theory of perception. Oxford University Press.
Park, S. C. (2019). Karl Jaspers’ General Psychopathology (Allgemeine Psychopathologie) and Its Implication for the Current Psychiatry. Psychiatry Investigation. 16(2):99-108.
Coon, B. December 26, 2020. Recovery: Let’s Do the Math. Recovery Review.
Coon, B. March 03, 2022. Addiction: Understandings and Enactments of the Current Era.
Coon, B. November 14, 2022. Comments on the Task of Interpreting. Recovery Review.
