‘Overcoming craving: The use of narrative practices in breaking drug habits’

• Included one or two groups of your friends who offered you free drugs in order to make you fall addicted to drugs. Once this took place they squeezed money out of you.
• The ‘Craving’ unceasingly lured your friends to take drugs (offering them free of charge at the beginning) in order to embed you all into a sticky environment in which you would be circumscribed by substance use.

3. The methods adopted by ‘Craving’:

• The ‘Craving’ always hid himself in discos, camps and karaokes where you had many friends.
• The ‘Craving’ tried to get you to go to the discos, camps and karaokes by means of the birthday parties of your friends.
• The ‘Craving’ harnessed the exciting atmosphere of ‘everybody takes drugs’ in discos to induce you and your friends to purchase drugs.
• The ‘Craving’ encouraged you to use further substances by offering you more economical prices and by telling you:

• ‘Just take a little bit to get a special sensation!’
• ‘It doesn’t matter if you only take a little bit!’
• ‘It is nonsense that you can come to the disco without either drinking or taking drugs!’

4. The influences of the ‘Craving’ on you:

• It spoiled your goal of achieving a drug-free life
• It was harmful to your health.

Based on your understanding of the ‘Craving’ as mentioned above, we started to explore the ways in which you could resist the ‘Craving’ and you mentioned three conditions in which you found this easier to do.

• When there was poor quality music in the disco
• When you were ‘on duty’ the day after you went to disco you would frustrate the person who tried to sell you drugs with repeated ‘No’s’.
• When you wanted to save your money you just frankly told the trafficker: ‘I have no money!’

You told me that you thought that this third condition was the most significant. You told me that you thought yourself to be a ‘frank person’ and we explored what this meant to you. We discussed the various situations in which you handle matters in a frank manner. For example, when you were being manipulated by your boss or ridiculed by your colleagues, you frankly expressed your discontent in order to stop their further bullying. If you had not been able to do this, you think that the bullying would probably have continued. These skills of being able to be a ‘frank person’ have a history and I look forward to hearing more about this.

You told me that you thought that this quality could help you in coping with the temptation from the ‘Craving’ and that if you were able to frankly express your discontent that it would eventually get the message of your insistent rejection.

As a first step you decided upon a good method: ‘just reject the people who try to sell me drugs’. While this would require a lot of ‘frankness’, you expected that this would be a very powerful thing to do in the disco, karaoke and camp.

Ken, throughout this entire process of self-exploration you told me that you could sense the degree of your determination to quit using drugs was increasing. In fact you said that if you were to rate it, your determination would have jumped from a four out of ten to a nine out of ten.

You mentioned something else that had assisted in this. After you had stopped using drugs for a time you put on some weight and you believe this has made your appearance and body shape look better. In fact you said that it now perfectly matches with your dream.

Harris

Letter # 2

Dear Ken,

While you strove to fight against the ‘Craving’, you gradually felt unsatisfied with the rest of your life. During the period of unemployment, you found your everyday life which was consumed with playing electronic games which were highly monotonous and what you felt most unacceptable was that your life lacked ‘personal growth’. You aspired to:

• Enhance your general knowledge
• Get more friends
• Acquire more living skills.

We then discussed your past experiences and you discovered that you possessed a high adaptability which was cultivated from your past working experiences.

Your story started in a fast-food restaurant where you were employed in the past. There were only two staff in the restaurant. You were delegated to the duties of both a cook and a waiter. At the initial phase, you found yourself overloaded; however, you later developed by yourself an effective management style which you named ‘Ken’s Kitchen Theory’:

• Easy tasks should be given the highest priority to be finished while lower priority given to the difficult ones. For example, customers will be first catered for drinks and breads, followed by hot dishes which will take more time to prepare.
• Important tasks should be first completed. For example, if there were a great demand of chicken meats, you would prepare them in a great amount.
• Tasks should be completed promptly. For example, there were many people who ordered coffee and tea, therefore, you would pour milk into cups in advance to speed the brewing process.
• Making preparation beforehand. For example, if you were making fried rice, you would prepare spoons and rice in advance.

After articulating ‘Ken’s Kitchen Theory’ to me, you felt very excited and determined to apply this theory into the process of hunting for a job.

A month later, you told me that you had got a job! And you conveyed to me the changes that had taken place in your life:

1. You have become more energetic because you are involved in more activities.

2. You have become happier. You described how ‘more smiles now hang in my mouth’ because of the greater interactions with others.

3. You have become more confident because:

• You get more exercise
• You have more learning opportunities
• You receive significant encouragement from your supervisors.

4. You have fostered a normal and regular living style which involves you going to bed at 9 pm everyday.

You told me you were fond of this ‘normal life’ because:

You are no longer available to go to discos and this prevents you from:

• Being implicated in gangs’ fighting
• Being falsely accused of possessing drugs by police
• Relapsing into using drugs.

You are also no longer available for night activities and this prevents you from:

• Wasting money
• Fighting with others after you have got drunk.

You are able now to consider designing a saving plan.

Instead of desiring drugs and being disturbed by cravings, you are now concerned about your future.

You are very happy now since you have the opportunity to learn how to actually make Chinese snacks rather than just preparing the materials which is all you have been able to do in the past.

You now hoped to seek other jobs with better rewards and higher responsibilities.

You then reflected on the changes that you have experienced in the past four months:

• You have become happier, more spirited and know more how to smile
• You are now more courageous in expressing yourself
• You have quit taking drugs for several months
• Your memorizing capacity has been restored to a great extent
• You have got an insight into what it means to pursue a drug-free life (I am very interested to knowing more about this in our future conversations).

You contributed your big changes to the following factors:

• You got a job.
• You could manage to have regular meetings with a social worker.
• You could stand on your own feet.
• You had your own volition.
• You could think clearly before taking any action: for example, you thought thoroughly about the effects of substance abuse when you were confronted by the craving.

You have told me that you deeply cherish all of these changes and that you wish to further develop them. Specifically, you mentioned how to you have planned to take some special measures to resist the possible temptation of substance abuse in Christmas and New Year. We decided that you and I will cooperate on developing these special measures in the coming sessions.

Harris

Responding to any return to drug use

With assistance, many persons can resist the craving for a long time, for many months, but then may succumb and return to drug use for a further period of time. When this occurs it can be very frustrating and disillusioning. As I mentioned earlier, it’s important to forecast that this is often part of the migration process away from the influence of substance use. This makes it much more likely that a person will be able to tell me if they have begun using again.

At these times, I do everything I can not to construct this return to drug use as failure. I seek out elements from the story of their recent lives to construct a story other than a totalized story of failure. For instance, before they came to see me they may have taken drugs every day, but now they have stopped their habit for a very long time and have only taken drugs again once or twice. I ask them questions to elicit the differences between the time when they first came to see me and what is happening at present.

Some of the things they might say in response include:

• ‘Before I came to therapy I just took the drugs without any struggle. I didn’t even try to fight the craving.’
• ‘I didn’t feel the intensity of sadness, of loss that I do know after I use.’
• ‘I now take drugs much less often than I used to.’
• ‘ I was using for three years before I sought assistance. Now as soon as I start using again I come and talk with you.’

We take time to identify many distinctions between their current experience and what was once the case. In doing this, they come to the conclusion that this is not a ‘full-blown relapse’. They have not gone back to where they were. Instead, this is a part of the journey of migration that they are on.

These distinctions are very important. If we do not make these clarifications it will be possible that they lose hope. If they believe they are back where they started then it is likely that the power of the cravings will be greatly increased and they might rapidly lose ground.

I ask questions to enable the person to describe in detail what has changed between now and when we first talked. I ask what they have learned, what different strategies and ideas they have now. I have found this to be vital at these times when they have again begun using. These sorts of questions can re-energise people. It can put them in touch again with a different territory of their identity. It can enable them to reclaim an understanding of their competence.

We then also investigate carefully the particular strategies that the craving used to influence them this time around. It is important to do this in some detail. To describe this I will share a story.

Last week one of the young women consulting me, Amy, told me that she had broken her habit and resisted the craving for four months until her relationship with her boyfriend broke down and her friends criticized her body-shape. Many times when people stop using certain drugs they put on weight. This can have effects on a person’s sense of identity and make them more vulnerable to the voice of craving. In this situation it was the dominant ideas of the broader culture, about a woman needing to be in a relationship with a man, and needing to be a certain body shape, that made Amy more vulnerable to the voice of craving.

In response, Amy and I had some conversations about the effects of these societal discourses to ensure that she was not locating the problem within herself. When we came back to the precise moment when she experienced the rejection from her boyfriend, we discovered that it was at this moment that the craving returned and Amy lost the ability to control it. Together we examined this in detail to work out what could be learned from it.

In this way, Amy’s return to using drugs was understood as due to the effects of specific circumstances that the craving took advantage of. By learning about this, Amy gained new knowledges and skills to protect her in the future. While Amy was deeply regretful about starting to use again, she began to see this in the broader context of a longer-term migration away from substance use.

Drug use in the broader context of someone’s life

In the so-called drug field in Hong Kong there are a number of prevailing dominant discourses which pathologise and totalise ‘drug users’. Often the pathology is also located in the person’s family. A secondary dominant view in the field is that if drug use is an issue, then it must be seen as the dominant issue and addressed as a priority above all other concerns. This is not the approach that I take. When a young people who uses drugs comes to talk with me I do not want to only explore the issue of substance use. Their lives consist of much more than substance or drug use. When someone comes to talk to me I understand that they are here to talk to me about the things that are important to them in their life at that time – whatever these may be.

Recently, Susan, a young woman of 18 years old, was referred to speak with me. In fact, she was forced to see me by probation order about her drug problem. Working with any involuntary client can be complex. It is especially complicated, however, where drug problems are concerned because any honest conversation can have legal implications. In the first session she attended, Susan was very angry and silent. She didn’t say much and I said a lot!

Susan was angry because she didn’t want to see me, so I tried to engage her in talking about something interesting. I think she was also trying to find out if I was going to be as strict as her probation officer! I tried to convey a kindness that perhaps she was not used to and this seemed to make her more comfortable. I did not impose any ideas about what we were supposed to talk about. I didn’t assume that we would be considering the problems about which the probation officer had referred her. Instead, I asked her what she might be interested in discussing and Susan told me that what most concerned her was her temper.

I was delighted that Susan thought there was something we could usefully talk about! Susan told me that she often loses her temper and tries to attack her boyfriend. A number of relationships had broken down on account of these temper attacks.

So we started talking about the problem of temper and used the statement of position map in the process. I asked her when the ‘quick temper’ (this was her naming of the problem) came to her, when was it most commonly around. Interestingly, Susan said that the ‘quick temper’ often came to her when she was sleeping. It would come to her and talk to her in her dreams. In fact, sometimes the quick temper took such control of her that she attacked her boyfriend in her sleep.

Before we managed to externalize the quick temper, Susan was always late or she missed her appointments. But once the ‘quick temper’ was externalised she came energetically to therapy. She would even call me on the phone to check up when her next appointment was.

Over time, because it is a part of my job responsibility, I asked Susan whether she thought the ‘quick temper’ was relevant to her drug-taking behaviour. And she said yes. Susan estimated that 40% of the times in which she took drugs were to calm herself down when the tempers came to her.

Our conversations then continued to address the ‘quick temper’ and as Susan got more of a handle on this, not surprisingly her drug-taking decreased.

Links to culture and history

Not only is it relevant to talk with people about issues broader than just drug use, I also believe it is relevant for us as therapists to address issues of history and culture in our work.

In Hong Kong, we have internalized many Chinese traditional values and we have also been influenced by British and western values. As therapists, I believe that we need to continually question which values are shaping our work and to take care with this. We need to be asking ourselves how our cultural beliefs are shaping our assumptions about what sort of lives people ought to be living. I do not want to impose my values upon those who consult me.

At the same time, my local cultural context influences my work with people in positive ways. Earlier in this piece I mentioned the importance of ensuring that experiences of shame do not occur in the therapy room. ‘Face-saving’ is an important value in Chinese culture. This is an element of Chinese culture that I value and that deliberately shapes my therapy practice.

There are also some practices of professional culture that I engage with but wish to question. For instance, sometimes, rather than having the patience to ask questions, I may fall into directly suggesting to a person what they ought to do, what actions they should take. This of course, represents an imposition on my part and this is something that I am trying to resist.

Summary

In this paper I have tried to convey some of the ways in which I work with young people here in Hong Kong to assist them to overcome the craving associated with drug use and to break their habits. I have described some of the narrative practices that assist in this process, particularly the use of the migration of identity metaphor and externalizing conversations.

I would very much appreciate feedback and welcome conversations with others around these issues.

Note:

1.  Har Man-kwong is a social worker in Hong Kong who has a great interest in postmodern ideas, especially the realm of micro-politics in therapeutic contexts. He has worked in the area of substance use for seven years and finds narrative practices are very helpful in this work.  Har Man-kwong can be contacted via email: harris_hmk@hotmail.com

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