Transformation grounded in the reconciliation of identity, values, and belonging

Yesterday’s post about confrontation as a goal versus confrontation as a style reminded me of a paper I’ve been meaning to blog.

The paper reports on the findings from a study of men currently participating in treatment for opioid use disorder (OUD) seeking to understand their motivators for seeking help with their OUD.

The researchers, Jones & Guirguis, identified a chronological process characterized by 4 themes¹ paraphrased below:

1. Heroin use initiation and continuation were socially embedded in peer networks, which provided belonging and reduced loneliness, but they also represent a sustaining force for their addiction.
2. Their heroin use became the primary strategy to avoid negative emotional states, and avoidance of negative emotional states increasingly narrows their lives.
3. Moral distress and recognition of a discrepancy between their behavior and their values arouse a desire to reclaim self-respect and restore themselves within valued roles, like father, son, friend, etc. The researchers noted that these moral and relational factors were more powerful motivators for help seeking than fear of overdose.
4. Treatment was experienced as an emotionally and physically safe place that offered acceptance, stability, and refuge from the chaos of addiction.

These themes blend into each other, but I was most struck by the third theme and thought it was summarized well here:

Help-seeking among men with OUD is a psychologically transformative process grounded in the reconciliation of identity, values, and belonging. Participants did not primarily seek help due to fear of overdose or physical decline but because continued drug taking conflicted with their moral self-concept and relationships. Treatment services were valued as safe relational spaces enabling this realignment.

Jones, M., & Guirguis, A. (2026). Motivators for help-seeking among people with opioid use disorder: An interpretative phenomenological analysis. Journal of substance use and addiction treatment, 190, 210050.

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The study had a very small n, and it focused on men currently engaged in treatment, but these findings provoke interesting questions about the kinds of professional responses that might prevent seeking help to treat their addiction.

On the one hand, an emotionally safe and accepting environment is critical for attraction and engagement in care. A shaming or confrontive style is likely to undermine engagement and change.

On the other hand, uncomfortable dissonance about the discrepancy between their behavior and their values and role obligations was a driver of the decision to seek help. Providing emotional comfort in a manner that reduces dissonance might hinder seeking treatment.

Additionally, their drug-using social networks were identified as a sustaining force for their addiction. Help-seeking and engagement with OUD treatment required distance or separation from those social networks. Programs that provide care within the context of ongoing contact with those drug-using social networks may undermine treatment and recovery efforts.

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As I ruminated on this, it was actually all very familiar, because Bill White has covered a lot of this ground.

Chris’s post yesterday addressed Bill Whites work (with Bill Miller) on confrontation as a style vs. confrontation as a goal²:

In its etymology, the word “confront” literally means “to come face to face.” In this sense, confronting is a therapeutic goal rather than a counseling style: to help clients come face to face with their present situation; reflect on it; and decide what to do about it. Once confronting is understood as a goal, then the question becomes how best to achieve it. Getting in a person’s face is rarely the best way to help them open up to new perspectives. There is, as Hazelden observed in its 1985 recanting of aggressive confrontation, “a better way.” People are most able and likely to re-evaluate reality within safe, empathic, supportive and nonjudgmental interpersonal relationships that do not necessitate defensiveness.

White, W. L., & Miller, W. (2007). The use of confrontation in addiction treatment: History, Science, and time for change. Counselor, 8(4), 12–30.

Clearly, confrontation as a style threatens to undermine treatment as an emotionally safe place offering acceptance, connecting it to theme 4. But that’s only half of the insight provided in the quote above.

The other half is confrontation as a goal — the importance of helping patients come face to face with their present situation, reflect on it, and decide what to do about it. This ties into theme 3 and the role of dissonance as a motivating force. An approach like motivational interviewing can be a valuable tool for developing discrepancy and continuing to explore dissonance and reasons for change.

Some of White’s earlier work discusses the role of a “motivational crisis” in initiating and establishing recovery^{3, 4} and goes so far as to suggest that “Our job as treatment professionals in such cases is to help sustain the motivational crisis to keep the addict engaged in the treatment process.” He also explored hope and pain as dynamic forces³ for change and maintaining the status quo. In another article, he explores gender differences in the process.²

He also wrote extensively about social networks and cultures playing key roles in initiating and sustaining addiction, which ties into theme 1.

Addiction and recovery are more than something that happens inside someone. Each involves deep human needs in interaction with a social environment. For addicts, addiction meets a multiplicity of needs and the culture of addiction provides a valued cocoon where these needs can be, and historically have been, met. No treatment can be successful if it doesn’t offer a pathway to meet those same needs and provide an alternative social world that has perceived value and meaning.

White, W. L. (1996). Pathways: From the culture of addiction to the culture of recovery: A travel guide for addiction professionals (2nd ed.). Hazelden Publishing

Anyone interested in an exploration of themes 1, 3, & 4 from Jones & Guirguis will learn a lot from White’s work.

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1. Jones, M., & Guirguis, A. (2026). Motivators for help-seeking among people with opioid use disorder: An interpretative phenomenological analysis. Journal of substance use and addiction treatment, 190, 210050. ↩︎
2. White, W. L., & Miller, W. (2007). The use of confrontation in addiction treatment: History, Science, and time for change. Counselor, 8(4), 12–30. ↩︎
3. White, W. & Chaney, R. (1992). Metaphors of Transformation: Feminine and Masculine. Bloomington, IL: Chestnut Health Systems. ↩︎
4. White, W. L. (1996). Pathways: From the culture of addiction to the culture of recovery: A travel guide for addiction professionals. Hazelden Publishing ↩︎