Reflection

The Container That Was Taken Away

This follows on from an account of why recovery is so hard to sustain — the part of a person that never comes to the session, and the state it leaves them in: ashamed of the past, irritated with the present, frightened of the future, with no time left over to stand in. The substance was the only thing that silenced all three at once.

So what replaces it?

The container that was taken away

One thing worth holding in mind, because it changes what this looks like.

For most of human history, psychoactive substances were used inside ritual. Not privately and not casually: on particular occasions, in particular quantities, for a declared purpose, in the presence of people who had decided in advance what the experience was for, how far it would go and when it would end.

The ritual was the container. The substance was held inside it.

That is not a romantic claim about older cultures, and dependency certainly existed in them. But the mechanism is well described, and Norman Zinberg gave it its standard formulation in Drug, Set, and Setting: what a drug does is determined not only by the drug, but by the state of the person taking it and by the setting — which includes the social rules governing when, how much, with whom and why. Change the rules and the same molecule behaves differently.

What the modern arrangement removed was the container, and kept the substance.

And the container’s job does not simply vanish when the ritual does. Something has to do it. So the drug takes it on: the substance itself becomes the container for the person’s emotional life. It decides when feeling is permitted to start, how much of it is allowed through, and when it stops.

That is a fairly exact description of what people actually report, once you get past the language of enjoyment. Almost nobody in my consulting room is describing pleasure. They are describing regulation — the thing that ends the day, that makes the dinner survivable, that lets the feeling out at six o’clock and shuts it off again by eleven.

Which is why recovery cannot only be subtraction. Take the substance away and the container goes with it, and a person is left holding emotional material with nothing whatever to hold it in. That is the state most relapse happens from, and it is why the first weeks are not merely uncomfortable but genuinely unsafe.

Something has to take the container’s place, and it needs to be a structure rather than a resolution.

Why the rooms work, which is not the reason people assume

I suggest a twelve-step fellowship to almost everyone at the beginning of recovery, and I want to say what I think it is actually doing, because it has little to do with the arguments people have about steps and higher powers.

The mechanics of a twelve-step programme amount, in effect, to a treatment for insecure attachment.

Look at the components rather than the doctrine.

The home group. The same meeting, the same room, the same evening, every week. The word the fellowships use for it is home, and that is not sentimental, it is precise. What is being constructed is a secure base: somewhere reliably there, which does not vary according to how well you are doing, and which you can return to on the bad weeks without explaining yourself.

The sponsor. One person, in a close relationship, who knows your history because you have told them all of it, who can be telephoned between meetings, and whose function is to take you through the work. That is an attachment figure, chosen deliberately in adulthood, by someone for whom the original ones did not do the job.

The slogans, which sound like fridge magnets until you notice what each one is treating.

Just for today. The entire future is lifted out of consideration. Nobody is asking you never to drink again, which is an unbearable proposition and produces exactly the dread described above. You are asked about today. If today is too much, the next hour. That is a direct intervention on one whole side of the triangle.

You are where you need to be. Aimed at the other side — the standing conviction of being behind, of not doing enough, of not being enough. It is not encouragement. It is an instruction to stop scanning.

And the service position. Making the coffee. Greeting people at the door. Putting the chairs out.

That is the smallest available version of the change of position I described above, and its genius is that it is available on the first evening, long before anyone feels they have anything to give. You do not have to become a giver. You have to arrive twenty minutes early and fill the urn. In my experience it is among the most reliable indicators of who is still there in a year.

None of this requires believing anything in particular. It is a structure that supplies four things to people who largely did not get them: a base that stays put, one person who knows everything, a method for surviving the future, and a role.

It is also why the rooms are not sufficient on their own, which I have written about separately. They do this part better than any clinic and they do not do the depth work. But at the beginning, this is the part that keeps people alive long enough for the rest to become possible.

The hour is a ritual too

The same is true of what I do, and it is worth being honest about it rather than presenting it as clinical technique.

The frame of analysis — the same hour, the same day, the same room, week after week, starting and finishing at a fixed time whether or not the material is finished — is not administrative tidiness. It is a ritual container, and a substantial part of the work is done by it before either of us has spoken. The reliability is not the setting for the treatment. It is a good deal of the treatment.

Which brings me to what I see most often in people who have already thought very hard about themselves.

They arrive with awareness. Frequently a great deal of it, accurately arrived at, often from years of previous therapy. They can describe the pattern, trace it to its origin, and explain precisely why they do it. And nothing whatever has changed.

That is not a failure of insight. It is the absence of a ritual to put the insight into.

Awareness on its own is information. It becomes change only when something repeats — a practice, a structure, something done at the same time in the same way regardless of how one feels about it that morning. The meeting. The hour. The walk. The call to the sponsor made on Tuesday whether or not there is anything to report.

People resist this, and they resist it on aesthetic grounds. It looks mechanical, and they came here for meaning. But meaning does not survive unhoused. Anyone who has sat through a funeral done badly, and then one done well, already understands the principle: what lets the feeling through is the form.

“I am an addict”

Before any of that, there is a problem of language, and it decides everything after it.

A person is not an addict. A person suffers from an addiction. That distinction sounds like delicacy and it is not: it is the difference between a condition you have and a person you are.

Almost everyone arrives fused with it. Not there is a thing in me that drinks but this is me, this is my character, this is what I am. And you cannot fight something you believe yourself to be. Every attack on the addiction lands on the person, who defends it, because defending it is self-defence.

So the first task is separation. Not persuasion — separation.

Putting a face on the part that waits outside

Which brings us back to the part that does not come to the session.

It will not attend by invitation. But it can be given a face, and once it has a face it is in the room whether it wanted to come or not.

This is where art therapy earns its place, and it is the reason I trained in it.

I might ask someone to go to the sand tray and choose the figure that is the addiction. Not a figure representing them: the figure that is it. Or to draw it. People hesitate, and then they are quick, and they are almost never vague — it has a size, a posture, an expression, and they knew all of that before they were asked.

And now it is on the table. Outside the body. Three inches high, in front of both of us, where it can be looked at.

Then I ask for the speech.

Write down the best argument it makes. Not the feeble version you would report to a doctor — the good one. The one that works. You have had a hell of a week. One will not restart anything. You are not like the people in that room. You will start properly on Monday, when the quarter closes.

Written down, in the person’s own handwriting, outside the head, it reads differently. It is still persuasive — that is the point, it has been persuading them for twenty years — but it is now a text with an author, and an author can be argued with. Inside the head it was simply the truth arriving.

That is the whole of the technique, and it is worth being clear about why it works. Inside a person, the addiction is not a thing at all — it is simply what they think, indistinguishable from their own judgement, arriving in their own voice. Nothing in that position can be disagreed with, because disagreeing with it means disagreeing with yourself.

Three inches high on a table, with a posture and a face, it is something else entirely. It is over there. And what is over there can be looked at, described, imitated, argued with, and eventually recognised on the pavement outside at half past six.

Who is fighting whom

Which brings me to the thing that actually determines the outcome.

At the beginning of this work, the alliance is the wrong way round. It is the patient and the addiction, together, on one side, and the therapist on the other. Everything I say is heard by both of them and answered by both of them. The reasonableness, the agreement, the good session — a good deal of that is the two of them managing me.

The whole task is to turn that around: the patient and the therapist, together, against the addiction.

That reversal is the treatment. Everything else — the structure between sessions, the fellowship, the honesty about relapse — becomes possible once it has happened and is largely wasted before it has.

And it does not happen through insight, or because I have explained it convincingly. It happens slowly, and it happens through things like a figure on a table that both of us can see, which allows the person to point at it and say that rather than me.

Somewhere else to stand

I said earlier that the substance was the only thing that silenced all three sides of the triangle at once, and that anything which works has to give a person somewhere else to stand. This is what I mean by that, and it is the part of my own recovery I would keep if I could keep only one thing.

It is a change of position, and it is almost embarrassingly simple to state. From taker to giver.

Active addiction is the purest form of taking. Me, my need, my feelings, now — and the world quietly arranged so as to attend to them. I have written elsewhere about that reversal and what it asks for.

What I would add here is the consequence, because it is the part that surprised me most. Once you are giving, relationships become possible.

Not as a reward for good behaviour. Mechanically. A taker cannot have a meaningful relationship, because there is only one person in it and everybody else is supply. Giving makes room for the other person to actually be present, and it is only then that anything comes back at all.

And relationships are what hold recovery, far more reliably than resolve does. Look again at the three sides — ashamed of the past, irritated with the present, frightened of the future. There is no room in any of them for another person. That is the whole trouble with the shape. Relationships are what break it open, and giving is the only door into them that I have found.

What the work is, then

Not persuading the part that comes to the session. That part is already persuaded, and persuading it further achieves nothing.

It is getting the other part into the room — named, externalised, taken seriously as a competent adversary rather than a failure of character — and then changing who is standing next to whom.

It also means structure during the hours nobody is watching, because that is where this is decided. It usually means fellowship alongside therapy, for the simple reason that a group contains people who cannot be fooled by the argument about being special, having made it themselves. It means treating relapse as information rather than as a verdict. And it means saying at the outset that this will hurt, so that the pain is not later mistaken for evidence that it is not working.

Nearly everyone can tolerate pain that means something. Almost nobody can tolerate pain they have been told they should not be feeling.

Addiction work is available in London at Harley Street and online: addiction counselling and therapy, or get in touch. Dr Philippe Jacquet trained as an addiction specialist at the Hazelden Foundation and is an HCPC-registered art psychotherapist.

Related: after detox, when the real treatment begins, the history of the twelve steps, and why AA alone is not always enough.