Everybody who works successfully with substance users learns to set and hold good boundaries. These protect the work of treatment, and guard against manipulation on the part of the person with addiction or alcoholism.
As a professional, you have an agenda to fulfill. So too does the person in active addiction. Their agenda is very different, but they’re even more committed to it. They may have convinced themself that their life depends on it. And they’re willing to use your agenda to achieve their own.
Some years back I gave a talk on addiction to medical students. A bright bunch, but I found myself frustrated by their inability to understand the reality of manipulation. Until I used the following example, that is. “Imagine it’s a Saturday evening shift in the ER,” I told them. “You’re sitting in a consulting room across from someone with heroin addiction. You want your patient to see you as a concerned, competent medical professional.” Nods of agreement around the room. “But to that addicted person, there’s this big neon sign flashing above your head that reads: All Night Pharmacy. We Never Close. And they can’t take their eyes off it.”
It got their attention.
One person recovering from addiction told of an incident involving several drug users who shared a rented house. At one point a member of the household developed a festering wound that required regular prescriptions for pain meds. The group held a house meeting to plan the best way to keep the wound from healing — in order to insure continued access to the meds.
Difficult if not impossible for somebody who’s never been through that experience to imagine it. Nonetheless, everybody who works with addiction runs into something comparable.
One psychiatrist explained to me that she felt compelled to accept as the literal truth everything that her addicted patients told her. “It’s the foundation of our therapeutic relationship,” she insisted. A year or so later she found herself in trouble with the state medical board for overprescribing.
We see manipulation as wrong, but the addicted person doesn’t necessarily share our values. To them, it’s a matter of necessity. They need something, you have it, so they mean to make certain you give it to them.
Caveat emptor, the saying goes. Buyer beware.
There are skills you can develop that allow us to work successfully with addicted people, including how to establish and maintain boundaries in the face of manipulation. It’s worth our time to learn them.
