Forums 2020-2021 India Narrative Therapy and Community Work Training Program Forum Substance Use (9B) – Aishwarya Chawla

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    AvatarAishwarya Chawla

    Narrative Therapy Reflection: January 2021
    Substance Use: 9B
    Aishwarya Chawla
    30th January, 2021

    In my work with adolescents and young adults especially, substances have been an active part of the therapeutic conversations. When I look back at the readings or my work with substance use, I find myself tackling the larger discourse of language with respect to substances. Terms which seem to be used widely by other psychological philosophies such as addiction, relapse, treatment and so on and so forth – somehow, seem to take away from the agency and commitment of the clients and their willingness to make changes in their lives.
    Over the last few years, my therapeutic conversations have involved working with persons who might struggle with substance use, and exploration of the ways in which alcohol, marijuana and cigarettes have affected and impacted their lives. I recall my conversations with one such young adult, NS (approximately aged 24 years) and the manner in which the therapeutic modalities shifted upon discussing the effects of the substances in different areas of his adult life.
    In the last year and a half that I have been closely working with NS, I have been able to witness the effects and impacts of specific substances (mainly alcohol, cigarettes and marijuana) on his life. Our conversations initially began with understanding and exploring the intention and purpose behind starting the substances, and as he called it “unhealthy coping mechanisms from stress and anxiety”, which later on seemingly moved towards exploring the intention behind stopping (or reducing) the usage of these substances.
    Mapping questions have been helpful to deconstruct the impact of the substances on his life, particularly in his work, his relationships with his parents and other family members, and his romantic relationships (along with his sex life). The therapeutic conversations have evolved exploring the advantage the substance seems to take, what it gets him to do – to which he hesitatingly mentioned, “get back into unhealthy forms of coping when I’m stressed or anxious”.
    Our therapy sessions have involved working with resisting the craving and urges to get back to cigarettes (specifically) and we have collaboratively worked towards creating an identity beyond the usage of such substances. The therapy goals have been reworked time and again towards looking for a preferred identity that he might align with. In one conversation with him, we were able to review his intention and purpose for resisting the cravings, and he mentioned “I want to be able to enjoy the cigarettes (and/or substances) for pleasure but also want to be able to control and resist the urge if and when possible”. This conversation then opened up the room for any skills or abilities he may have undertaken to keep the substances at bay.
    My work with NS has been long-standing trauma within the family context based, along with his romantic/sexual relationships in his life. There have been a few conversations wherein he has tried to resist the cravings (for example, in therapy sessions as he deems it “disrespectful”), or otherwise when the access to the particular substance was limited – and these conversations have helped us work towards the various unique outcomes where he has actively tried to make attempts to let go of the craving for the substances.
    NS has also mentioned that overtime, he is able to refuse opportunities to take substances and this is a conscious decision to align to his larger commitment of “enjoy it for pleasure and be able to control/restrict urges”. We have also tried to assess and trace history of times where he might have been able to stop the urge or disengage from the experience, and these incidents and experiences help to thicken the richer narratives which align with his commitments of pleasure too.
    A few months ago, NS received a diagnosis of ADHD and was prescribed medication along with his regular therapy work. Due to his recent and recurrent experiences with addiction to various substances in the past (apologies for my language) – the therapeutic conversations explored reasons for how medication might be different, what we might be able to do in case he does start to feel addicted, the effects of medication on his life and so on and so forth. These conversations in therapy took a few months after which he felt comfortable to take the prescribed medication daily. Naturally, we will still look at spaces wherein he might feel uncomfortable taking the medication and will consult his psychiatrist accordingly.
    Moving on, the future therapy sessions with NS aim to look at integrity and commitment to keep substances at bay, and help him to create spaces where he might be able to view himself towards developing a preferred identity with an alternative storyline from the one he has heard and believed for so long. There have been various conversations wherein people around him such as his family members have commented on his drinking alcohol daily or smoking daily as problematic within the family network – and somewhere it has infiltrated into the ways he views himself as “the cause for parental conflict”.
    Our personal goals for therapy sessions highlight hope and ability to honor his struggles and for me to be privileged enough to witness his willingness to make significant changes to his relationship with substances in the future. I will try to ensure that the therapy experience leaves no room for any experiences of shame or guilt that tend to be associated with substances of any kind. Our future goals however include exploring more ways in which I can externalize the voice of the substance or keep the search of the experience-near definition for the problem.
    My last few reflections on this are; addiction might be a response to trauma and if we don’t shame people for experiencing trauma, perhaps we don’t need to shame them for how they cope with trauma either. Here’s to looking towards a future where we look at coping mechanisms to just do their job; to keep us alive. Here’s to reducing the judgment we hold on what seems healthy vs unhealthy, because sometimes the coping mechanism I choose is all I know, and that should be okay, right?

    At least for now it should be.

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