Reflection

The Part That Waits Outside

Something happens in this work that I have never entirely got used to.

A man sits in front of me for fifty minutes. He is honest, he is intelligent, he can see the shape of his drinking with real clarity, and he means every word he says about stopping. I believe him. He is not performing, and by the end of the hour something has genuinely moved.

Then he leaves, and by the evening he has drunk.

For years I found this hard to make sense of. It looks like dishonesty, and it is not. It looks like weakness, and that is not it either. What I have come to think is much simpler, and it changes how the work has to be done.

Who is actually in the room

The person who comes to the session is the healthiest part of the patient.

That is who makes the appointment, finds the money, arrives on time and does the work. That part is real. It is not a performance put on for the clinician, and it wants to get well.

But it comes alone.

The other part — the part that uses, the part that will not be reasoned with, the most disturbed and least negotiable part of the personality — does not attend. It has no interest in the conversation. It waits outside for the hour to finish.

And it does not spend the hour idle. It has been to the gym. It is in far better condition than the part that has just spent fifty minutes being sensible, and when the two of them meet on the pavement, it wins.

I do not offer that as a metaphor for something else. It is the most accurate description I have of what happens between one session and the next.

Why it wins so easily

Partly because of what it tells the person, and what it tells them is flattering.

Most people arrive at addiction treatment not believing they are ill. They believe they are different. Special, in a way that is difficult to say out loud. Cleverer than the people telling them to stop, cleverer than the group, cleverer certainly than the literature. They have not failed at controlling it; they simply have not applied themselves to it properly yet, and when they decide to, it will yield.

This is not arrogance in the ordinary sense. It is often held by people who despise themselves. But it does a specific job: an illness would have to be treated, whereas being exceptional requires nothing but a better plan.

And there is an uncomfortable grain of truth underneath it, which is why it holds. These are frequently people of genuine ability. The intelligence is real. It has simply been recruited.

Take the crutches off

Imagine someone who has walked on crutches for fifteen years, and is now told to put them down and place the full weight of the body on the leg.

It will hurt. It will hurt immediately, and it will go on hurting for a while, and every instinct will say that something is being damaged. Nothing is being damaged. That is what an unused leg feels like when it is asked to carry a person again, and there is no version of this in which it can be avoided by trying harder or waiting for a better week.

That is what early recovery is, and I say so at the start rather than letting people discover it. What is being asked is not that you feel better. It is that you feel, without the thing that has been carrying the weight.

Anyone who promises the first few months will be a relief is either selling something or has not done this work.

Why growing up late hurts more

Here is the other half, and it is the part that surprises people.

A baby cuts its first teeth through soft gums. It is clearly painful and the child protests, but the tissue is designed to give way and it does.

Now picture the same process in the mouth of a forty-five-year-old.

That is emotional growth arriving late. Development that should have happened at seventeen, in a body and a life built for it, has to happen instead at forty-five, in tissue that has hardened, in a diary with no room in it, and in front of people who believe you completed this long ago.

And there is a second injury that the child is spared. The baby does not have a view about teething. The adult does. He watches himself struggling with things a teenager manages and concludes that he is pathetic — and the contempt costs more than the growth does. I hear that word more than almost any other in this work. Pathetic.

So the honest description of the task is not “stop drinking”. It is: complete an adolescence, at forty-five, in public, while holding down a job, and without the anaesthetic.

Forty-five outside, seventeen inside

Emotional development largely stops where the using starts. Somebody who began drinking seriously at seventeen may be, at forty-five, a person of considerable sophistication in every measurable respect and about seventeen in the parts that were handed over.

Both numbers are true at once. That is what makes it confusing for everybody, including the person concerned, and especially for a partner who cannot understand how someone this capable can be like this about a change of plan on a Saturday.

The strongest professional self I ever meet

In central London this takes a particular form, because a great many of the people I see are exceptionally successful.

The professional self has not merely kept developing — it has become the whole load-bearing structure. It is competent, admired, decisive, and it is holding everything: the income, the identity, the marriage’s material basis, the family’s sense that things are all right. It is also where the person goes to feel normal. Achievement is not vanity here; it is the evidence that nothing is wrong.

Behind it, largely unaltered since adolescence, is the other one.

That combination is unusual and it is difficult. An emotional seventeen-year-old with a chief executive’s resources can act on impulses at a scale a real seventeen-year-old could never reach, and has an organisation, a household and often a small number of dependent people arranged so as not to contradict him. The ordinary correctives that slow a problem down have been managed out of the environment, mostly without anyone intending it.

And the professional self, being the thing that works, is the last thing anyone is willing to examine. It is doing too much.

Ashamed of the past, angry in the present, frightened of the future

Narcotics Anonymous has an idea it calls the triangle of self-obsession — resentment, anger and fear. Resentment is how we deal with the past, anger how we deal with the present, fear how we deal with the future.

What I hear in the consulting room is a close variant. Shame about what has already happened. Irritation with almost everything that is happening now. Dread of what is coming.

Look at the three of them together and something becomes obvious: there is no time left over. Every direction is occupied. There is no present tense to stand in, which is unbearable, and the substance is the only thing that has ever silenced all three sides at once — instantly, reliably, and for about four hours.

That is what is actually being given up. Not a drink. The only working solution to an intolerable relationship with time.

Which is why replacing it with willpower does not work, and why anything that does work has to give the person somewhere else to stand.

So that is the difficulty, and I have described it at length because it is almost always described too lightly. What follows from it is a practical question: if the substance was the only thing holding all of that, what can possibly replace it?

That is the subject of the second half of this, which is about containers — the one that was removed long before any of us were born, and the ones that have to be built to take its place.

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, worked inside private residential treatment for nine years and supervises clinical teams in it today.

Related: relapse is not a moral failure and the addictive personality.