The use of substances can create problems in the lives of even relatively well-adjusted folks. In fact, folks whose character was reasonably healthy before they succumbed to a problematic use pattern can change in some horrific ways. But when someone has a significant character disturbance to start with and abuses substances on top of it all, life can quickly become a living hell. As I mentioned in last week’s article (see: Disturbed Character and Substance Abuse: A Complex Picture), the interrelationship between substance use and character is often complex and poses many challenges for providing the right kind of help. And in today’s article I’ll be giving two examples (once again with possibly identifying details altered for the sake of anonymity) that should not only provide the readers circumstances with which they can readily identify but also should help make the distinction between the kinds of problems tied primarily to substance use vs. the problems that can arise when individuals of significantly disturbed character abuse substances.
“Shelley” was always the happy child who seemed to have everything in balance. She was not only a good student but also had an active social life and many friends. She had a joy for life that was infectious, and had that proverbial “heart of gold.” And while no one would understand it for many years, her life changed dramatically the day that heart of hers was so deeply pierced by the stepfather who molested her. Shelley desperately wanted someone to know, but when she gingerly broached the subject of something not being right in the way her stepfather had been treating her, her mother seemed to brush it off as just another example of her not being able to accept the reality that her biological father, who was the real cad, had abandoned the family, and she was, as always, displacing her anger about that. There seemed no one to turn to and no one to trust. One day, after a sip of wine after a family dinner, she found the nagging pain within her diminish for awhile and she really liked that feeling. She felt even better – if only for a short while – when she accepted a “hit” or two on her brother’s marijuana cigarette. But before long, she was using a lot, using often, and hiding it as best as she could. One thing she couldn’t hide, however, was the change that had come over her. She began failing in school, had fights with several of her friends, and seemed to have an uncharacteristic edge to her. It wasn’t just that she was behaving differently. She seemed to be a different person. One day, her best friend let her have it: “I just don’t know who you are anymore!,” she proclaimed. “Where in the world did my sweet, dear friend go? I miss her so much it hurts!”, she lamented, and broke down. That did it. Shelley couldn’t bear it anymore. She broke down herself, embraced her friend, and said she really needed help. She was, as many caught in her trap have said before her, sick and tired of being sick and tired. Eventually, both she and her family would recognize both the root of her pain and the less than optimal ways she tried to “medicate” it. And after years of therapy, the successful prosecution of her stepfather, and her regular participation in a sobriety maintenance program, the Shelley everyone once knew seemed to come back, only this time in a somewhat better and stronger version. Trauma and substance abuse are a truly toxic mix. They can cause a person to change dramatically, which is in large measure what Post-Traumatic Stress Disorder is all about.
“Shelley’s” case differs markedly from “Marty’s”. Marty had always been somewhat of a “rebel without a cause.” His caring and patient family did all they could help get the youngster through school without strangling him first. He was also by nature an ambitious sort, so even though he took a pass on college, he entered the sales field with enough drive and moxie to make a fine living for himself. And even though he married a woman (whom we’ll call “Ellen”) who was the envy of many, and had just about everything a person could ask for, he seemed chronically discontented. His impatience was legend. When making telephone sales calls, if he encountered the slightest resistance he’d simply hang up and move on to the next prospect. Why should I waste my precious time?”, was his rationale. He was tough enough to live with even when he wasn’t drinking. But things could get ever so much worse when he did drink. And that was especially true if he was irritated about something. The pattern had become all too familiar: something would happen at work and he would become irked. Then he’d stop at the bar on the way home “just to chill” a bit but would somehow end up in a brawl. Strangely, this generally made him feel a little better. But sometimes this wasn’t enough. He’d burst through the front door of his home fuming. Then you could hear the tops of the beer cans popping one by one. Oh, how Ellen hated that sound! She regarded it as a signal to stay out of his way. One day, however, she couldn’t get out of his way fast enough and found herself badly bruised and beaten. A judge gave Marty probation and ordered him into both rehab and “anger management.” At the end of his stints, things were better for a little while but gradually got worse again, even though Marty was remaining sober. And although Marty tried to tell the folks at the treatment center and the anger management program that he was a “really decent guy” when he wasn’t drinking, Ellen knew in her heart there was more wrong with him than just his drinking. She didn’t trust him and was still afraid of him. When she left him and problems increased at work, he found the motivation to come in for a visit with me. But he didn’t like what I had to say. I suggested to him that contrary to his (and his anger management group’s program leader) belief, his anger rarely preceded his aggression but rather his aggressive personality style frequently begat anger. And he especially didn’t like it when I said that if there were ever to be any meaningful changes in his life, he’d have to come to terms with that aspect of his character and work like hell to change it. So, I didn’t see him for years, until one day, after having come to some appreciation about the shipwreck character of his life, he came to see me ready to work. And I’m as certain as anything I’ve ever been sure about that the main reason he came to see me out of all the other places and programs to which he could have (and had in the past) gone, was because I dared to call out both the nature and extent of his character disturbance. As I assert many times in Character Disturbance, trust is the undeniable foundation of a sound therapeutic relationship, and for there to be trust, a troubled character must know in their heart that you have his or her number and stand ready to deal with their real issues.
The vignettes presented above illustrate how very different the picture can be when it comes to a person’s substance abuse pattern. The presence and extent of character disturbance, no matter what the other environmental factors might be, always complicates matters and heavily influences both their prognosis and their likely response to various courses of intervention. Next week I’ll present more scenarios illustrating the interrelationship between character and substance use. And I’ll be talking about these and related matters on Character Matters this Sunday evening at 7 pm EDT (6 pm Central).