At the facility where I work, we define addiction as a result of living a life that lacks personal meaning. The solution is, thus, obvious: Help clients begin the process of pursuing a meaningful life. But how to accomplish this? We’ve been working for more than a decade answering that question. One conclusion we’ve come to is that focusing directly on the pursuit of a meaningful life doesn’t work very well. We have to go about the task indirectly.
Approaches that Don’t Work (with Addiction)
Over the years we’ve examined many approaches that the literature suggested might help clients pursue a meaningful life. Below are some examples.
Restoring meaning. Many psychologists who use meaning-oriented therapies have little experience with an addicted population. They often talk, for instance, about a client’s suffering as a “loss of meaning,” and see therapy as a vehicle for “restoring” or “reconstructing” meaning. Yet addiction psychologists have pointed out that those suffering from substance use disorders typically have never felt their lives were meaningful. It’s not a matter of once having meaning and then losing it. Rather, those suffering from addiction—with rare exceptions—have never had sufficient meaning in their lives to begin with. Restoring meaning does not make much sense to them.
Yalom’s existential therapy. In the book, The Psychology of Meaning, Zafirides, Markman, Proulx, and Lindberg (2013) looked to Irvin Yalom as a practical guide to help clients pursue a meaningful life. Yet Yalom, himself, singled out alcoholics as different from his other patients. His one attempt to conduct therapy with a group of alcoholics left him questioning if he had provided any help.
Spiritually focused therapy. Those suffering from addictions are fascinated by spirituality, and more than 1500 research articles have shown increases in spirituality are positively correlated with addiction recovery. Yet treatment programs based directly on religiosity/spirituality (RS) research have had little or no statistically significant effect on outcomes. Perhaps the most sophisticated RS program is Miller, Forcehimes, O’Leary, and LaNoue’s (2008) 12-session, manualized Spiritual Guidance program for alcoholics based on empirical studies of spirituality among the addicted. The program had no effect on outcomes. White (2008) wondered, among many other questions: “Does the essence of spiritual experience get lost in efforts to artificially define and replicate it within a professional treatment intervention?” (p. 443).
In our facility, we also discovered that a focus on spirituality had little effect on how well a client did in recovery. Sadly, a spiritual focus often resulted in a spiritual bypass, a term coined by Welwood (1984/2000) to describe clients who used spirituality to bypass what they needed to work through, such as their fears.
Versions of logotherapy. There are several meaning therapies developed for addictions, and most are based on Frankl’s logotherapy, such as Crumbaugh, Wood, and Wood’s Logotherapy: New Help for Problem Drinkers. The key stage in their 5-stage program is dereflection. Dereflection is one of Frankl’s therapeutic techniques and, according to Crumbaugh, Wood, and Wood (1980), “is the core of the logotherapeutic process of searching for meaning and purpose in life” (p. 103). This technique helps the person shift focus from failures and shortcomings to abilities, successes, and aptitudes. The shift is necessary if one is to find new goals and “discover tasks that will bring him into sufficient relationship with the ‘significant others’ in his life” (p. 103). Unfortunately, logotherapy, like most addiction therapies, has not produced any inspired results in outcome studies.
12-step model of spirituality. Alcoholics Anonymous (AA) interprets a meaningful life as a connection with what it calls a higher power or God. Harry Tiebout, a Connecticut psychiatrist, provided a clinical interpretation of the AA program, which aligns with how AA, itself, defines spirituality. According to Tiebout, “The so-called typical alcoholic is a narcissistic egocentric core, dominated by feelings of omnipotence, intent on maintaining at all costs its inner integrity.” But, he concluded, the alcoholic who followed the AA program was able to tame this defiant individuality and grandiosity because the program helped them “truly accept the presence of a Power greater than himself.” The acceptance of a higher power forced a new perspective on life, one in which the alcoholic was no longer the center of their own universe.
Yet outcome studies based on recovery through AA have shown little effect. It may be that AA’s version of spirituality is too limited, created as it was by middle-class, middle-aged, white men in the 1930s in the northeastern United States, with no intellectual background. The outcome studies may also confirm Hoffman’s (2017) argument that imposed or artificial forms of meaning rarely lead to a personally meaningful life.
What Does Work
Our inductive research (Thompson, 2016) at the center found that clients entering treatment had poor self-awareness, weak relationships, and goals that were given to them by the external world. Meaning therapy as practiced at the facility helped clients begin to reverse these factors. Clients gained a more sophisticated understanding of their values, beliefs, strengths, limitations, how they made choices, the meanings they ascribed to their suffering, and other issues of self-awareness. They also developed authentic relationships with peers and staff at the center, though this positive relatedness did not necessarily extend to families or friends.
The research also showed that pursuing personally meaningful goals in treatment didn’t work very well. The vast majority of clients were baffled by the very idea of pursuing a meaningful life. One client put it this way: “How can I set goals or figure out what I want from life if I don’t even know who I am?” Another client pointed out that that the only thing he felt confidant about was what he didn’t want from life, because his life was largely a series of miserable experiences. But he had no idea what he did want to do or accomplish.
Yet the therapy had an effect on their pursuit of meaning. Essentially, it helped clients recognize that their suffering had purpose. They recognized that how they lived their lives—the choices they had made and goals they pursed—did not resonate with personal values and beliefs. Although most were angry at themselves for wasting so many years in active addiction, many said they were “grateful” to have suffered because it forced them to appreciate the value of living. Clients who played with the idea of becoming addiction counselors typically interpreted their suffering as a requirement to help others who were suffering.
What was most noticeable was their belief that if they could begin doing things that matched their values, then they could live—for the first time—an authentic life. They knew this new life would take years of work to gain self-awareness and connect with others, but they had confidence that they could achieve it.
Crumbaugh, J. C., Wood, W. M., & Wood, W. C. (1980). Logotherapy: New help for problem drinkers. Chicago, IL: Nelson-Hall.
Hoffman, L., and Paige, J. (2017). Varieties of suffering and meaning: Clinical implications. Proceedings of the 2016 Meaning Conference. Journal of Existential Psychology & Psychotherapy, Special Issue. Toronto, ON.
Miller, W. R., Forcehimes, A., O’Leary, M., & LaNoue, M. (2008). Spiritual direction in addiction treatment: Two clinical trials. Journal of Substance Abuse Treatment, 35(4), 434–442. Doi:10.1016/j.jsat.2008.02.004
Thompson, G. R. (2016). Meaning therapy for addictions: A case study. Journal of Humanistic Psychology, 56(5), 457–482. Doi:10.1177/0022167815585913
Welwood, J. (1984/2000). Toward a psychology of awakening. Boston, MA: Shambhala Publications.
White, W. L. (2008). Spiritual guidance, addiction treatment, and long-term recovery. [Editorial] Journal of Substance Abuse Treatment, 35(4), 443–444. Doi:10.1016/j.jsat.2008.05.010
Zafirides, P., Markman, K. D., Proulx, T., & Lindberg, M. J. (2013). Psychotherapy and the restoration of meaning: Existential philosophy in clinical practice. In K. D. Markman, T. Proulx, & M. J. Lindberg (Eds.), The psychology of meaning (pp. 465–477). Washington, DC: American Psychological Association. Doi:10.1037/14040-023