Experimental drug use

Experimental drug use is common with teenagers. The gateway drug idea focuses on this type of drug use. Alcohol and marijuana are the gateway to a life time of drug use is the argument. For the vast majority that is not the case but there is a small group it does happen with.



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Drug and alcohol use history of the therapist - Part 2.

A comment in the previous post (here), provided interesting insight on how to respond to a client who asks a therapist:

“What is your drug and alcohol use history?”

I have found that other groups do ask similar questions. A client going through a divorce may ask if I am married and have I been divorced. A client with problem teenagers may ask if I have children and teenagers. I don’t find the question all that odd in itself.

It is interesting to read your response. If I asked the question as a client of yours and you said you preferred not to answer it as you felt it was personal, how would I respond? First I would feel validated and respected. That is I have asked a direct question and you have acknowledged it an answered it. Or at least dealt with it by saying you preferred not to answer. I would have no problem with that and feel respected in the transactions.

The response I would have trouble with is when the therapist only responds with:

“Why is that important to you?”

I find this an underhanded response. The therapist finds self feeling awkward with the client and they side step out of it by pathologising the client. I find that disrespectful to the client. Their response is to jump into the safety of their therapy and get out of it by indicating to the client that their question must be the result of some unconscious conflict in them. When their motive at least in part is their own feeling of discomfort and unwillingness to deal with it in a direct way with the client, unlike you did.

Having said this you still have not answered the question and the client may then ponder if the reason you gave is the real reason. There could be other reasons you may have

1. You do have an extensive drug and alcohol use history and are ashamed of it.

2. If you have used drugs and excessive alcohol in the past you may feel the client disrespects you for that.

3. You have no drug use history and fear the client may loose confidence in you because you don’t really know what you are talking about.

However as a client I personally would find these minor issues and it is more important that you have validated me originally by dealing directly with my question as you did.

One other point I would like to mention that I referred to in my previous post is the response that the question is not relevant. When you think about it is not all that irrelevant.

In the transference, what a therapist does in their personal life can be most important to the client.

Whilst I said that I have been asked the question only infrequently I think it is quite likely that lots of clients have pondered the question and just not verbalized their musing. If one is a transference figure then the client will think about the therapist and their personal life. Indeed their personal life can assume considerable importance to the client. So it is not irrelevant in this sense.

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Drug and alcohol use history of the therapist

In my book I discuss a situation that all drug and alcohol counsellors fear. It lurks in the back of the mind and can surface at any time. The client can raise it at anytime and leave a conundrum for the counsellor. The client can ask, 

“What is your drug and alcohol use history?”

In my experience I have not been asked this question often but it does happen from time to time. How does one answer? There are two schools of thought on this.

Should I choose the red or the blue?

First the counsellor can in essence refuse to answer the question and say that it is not relevant and move onto another topic. Others may use the distraction technique and answer the question with another question:
Client:  “What is your drug and alcohol use history?”
Therapist: “Why is that important to you?”
Sooner or later however the client will realize the therapist is not going to answer the question.

Second the counsellor answers the question and does some self disclosure about their history of alcohol and drug use.

I think the first response is not a wise one to take. It in my view builds intrigue you do not want. The client is left wondering why you ‘really’ refused to answer. Is there something you are ashamed of or maybe your drug and alcohol use history has been extensive. Also you are asking the client to disclose many things, some of them quite intimate and then you refuse to disclose something to the client. This may leave them feeling problematic emotions about your refusal.

If you take the second option and answer that you have had little or no history in this way then some clients will feel you are somewhat ignorant about such matters. To most it probably make little difference but there is a group to which it is quite important and it can damage your potency as a therapist in the eyes of the client.

If you answer that you have used drugs and alcohol at times in the past then that can leave some clients feeling that you do know what they are talking about. However it is also permission giving to the client to take drugs. If you are a strong transference figure to the client this can be particularly so. If you stopped using drugs when you were 30 and the client is only 25 some could take this as permission to keep using for 5 more years. Other clients may view you as hypocritical. You are suggesting a client do something that you did not do yourself. 

Then of course there is the situation of the counsellor who is currently using significant amounts of illicit drugs or abusing alcohol. That can also provide permission to the client and is a more delicate clinical scenario.

On the positive side it can engender trust in the client towards the therapist. If the therapist reports a history of drug and alcohol use the client may respect the therapist for being honest with them by reporting previous ‘bad’ and ‘unprofessional’ behaviour. If you say you don’t have any significant drug and alcohol use history the client is going to wonder if that is true or are you lying to them. To tell such a truth can build respect of you in this way.

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Aspects of drug use ambivalence

Since the release of my book Working with Drug and Alcohol Users a number of people have raised an interesting theoretical question with me. It relates to this diagram of drug use ambivalence.

Some have asked why is it the Free Child that does not want to use drugs and the Adapted Child aspect of the personality that does want to use drugs?  This is a good question and has highlighted a need for more clarification.

My response is that the diagram shown above is for those who have problematic drug use. Those people who are using drugs in such a way that it advances some negative aspect of their life script. Those people who are using drug so that they suffer psychologically.

However as I mention in my book there is quite a sizable group who use drugs and alcohol in a non problematic way. They use drugs and alcohol such that their life script is not advanced and they and their relationships are not damaged in any significant way. The best example of this would be the recreational drug user who I discuss at length in the book. For this type of drug and alcohol user the following ego state diagram would probably be a better representation of the theory behind the recreational drug user.

As the drugs are not being used in a destructive fashion it would not be seen as a function of the Adapted Child ego state. Therefore one could put it as a Free Child activity. Also with this type of user there is little or no ambivalence as the drug use is not a problem and thus the person has little motivation to stop it.

Other ambivalence

With further consideration one can also formulate another kind of ambivalence where two ego states are in conflict with each other. Some people and indeed certain groups think that drugs (and at times alcohol) are wrong. It is wrong or immoral to use drugs regardless of whether they harmful to the individual or not. 

These views it could be said to reside in the Parent ego state thus making the following form of drug use ambivalence. Thus the person would experience some kind of internal conflict. Two different aspects of the personality both want opposing things. In this case to use drugs and to not use drugs. This view can be found in some religious groups or temperance leagues in particular.

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Drug using careers

In my book working with drug and alcohol users I highlight the point that people use drugs for a variety of different reasons with the 6 most common being:

Experimental use 

Rebellious use 

Recreational use 

Situational use 

Symptomatic use 

Dependent use

Each of these represent quite different clinical situations. As a consequence they require quite different approaches and often have quite different goals of treatment. Clearly one of the first things the drug counsellor must do is determine which type of use is apparent.

One of the most problematic types of drug use is dependent use or the drug addict type of drug user. These people can be said to have drug using careers. That is these people will use in a very habitual addicted manner but eventually grow out of it and their career is said to come to an end. Considerable research has been done on this and it has been determined that the average length of such drug using careers is 10 years (or 9.9 years to be exact).

However it should be noted there is considerable variation on this 10 year average. This can best be explained by two graphs as shown

With this type of drug use there are three main avenues for treatment. One is to facilitate a more rapid ending of the career with certain therapeutic interventions.

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Drug counselling - authoritarian or permissive?

I use this diagram in my book - Working with drug and alcohol users - to illustrate the position I take on the continuum when counselling drug and alcohol users. It would also be typical for me when I counsel clients for non drug related issues although there may be more instances when I am less permissive in my overall approach.

As I mention in the book there are positives and negatives being authoritarian just as there are positives and negatives with the more permissive approach. Obviously in my view there are more positives up the permissive end than the authoritarian end and hence my decision to be where I am indicated on the diagram. The negatives of the permissive approach are a problem but in my view less of a problem than the negatives of the authoritarian approach.

I wish to add some further considerations to this diagram. At the authoritarian end the counsellor will of course be using more CP (Positive and negative CP). When this occurs the following will tend to happen as shown in the diagram

As the counsellor uses more CP as shown in line 1 there will tend to be a similar increase in line 2 in the client. They will tend to respond to the therapist from either the CC or RC ego states as shown in line 2. If a ‘parent’ like figure (as a counsellor often is) gets critical or controlling, those around will tend to become more conforming or rebellious or switch between the two at varying times.

At the same time the likelihood of FC involvement decreases. The FC in the client will become less prominent and play less of a role in the clients decisions and transactions as line 3 shows. The more CP then the less FC. The problem here is the more FC there is in decision making around drug use the better the long term prognosis. Being CP makes it harder for the client to stop problem drug use in the long term.

However the CP approach can be seductive. If the counsellor says, “Drugs are bad. don’t do drugs, only abstinence is acceptable...” then the client may move into CC and stop using. When people see this reaction they think this is all very good and obviously is the approach to use in the future. The problem is the likelihood of a relapse is very real because the shift from CC to RC is possible even highly possible at some time in the future. When there is a switch to RC obviously then comes the drug use. The long term prognosis is not good in these circumstances.

Also if it is a CC decision to stop the drug use then there has to be a CP some where nearby for that to last. The CP approach can be found sometimes in religion based drug treatment approaches that are residential. The drug user lives in some kind of drug rehabilitation facility. This can allow for a more consistent CC response because the CP is there consistently in their life. If they leave or significantly reduce the contact with the CP then the CC response will tend to wane and relapse is more likely to occur. If there is more FC in the decision to reduce drug use then this is less likely to happen.

In addition to this I would like to highlight an exception to the idea of the more permissive type of approach that I did not mention in the book. There is a type of drug user where this is not helpful and indeed has serious limitations. This type of drug user is not uncommonly found in counselling or in the health system in some way. It is the drug dependent user who is living out quite a tragic life script. They may be homeless in varying degrees, their lives are chaotic and maybe quite non conventional in that they may be unemployed and exist within the criminal world in varying degrees. Often they have quite poor Parent and Adult ego state development

When I worked in drug rehabilitation people would make appointments to see me, usually once a week. This type of drug user would keep the appointments about 30% of the time. They simply did not have a life style that allowed them to plan and structure their lives the way the average person can such that they can keep an appointment they organized a week before. They simply do not have the Adult ego state development to achieve that. 

With these people the counselor needs to seek them out in their homes and places where they hang out like with outreach work. The permissive approach that I describe is not very useful for them. Some of these people do respond to an authoritarian approach. They can take it on as their Parent ego state for a period of time and in some cases stay sober for long periods of time. They need to be told in a clear and direct way what to do and what not to do. The permissive approach does not do this and as a result is not that useful with such clients.

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Drug counselling approaches

In my book - Working with alcohol and drug users - I make the point that there is no such thing as drug counselling instead there is a group of drug counselling approaches. People use drugs for a variety of reasons and the drug counselling approach varies for each differing reason. I discuss this in chapter 4 when I list the 6 main reasons or types of drug use. These being:

Experimental drug use and counselling. 

Rebellious drug use and counselling. 

Recreational drug use and counselling. 

Situational drug use and counselling. 

Symptomatic drug use and counselling. 

Dependent drug use and counselling.

If one is working with a recreational drug user, what one does is quite different compared to working with a dependent drug user. Indeed we have a somewhat odd situation when it comes to counselling drug users. By far the largest group in number are the recreational users but one rarely sees them in drug counselling. They rarely seek drug counselling because they do not see they have a drug problem and indeed the drug use does result in very little disturbance in their life. One only tends to see them in counselling when they come for some other reason and the drug use gets mentioned as a sideline to the counselling for other difficulties.

A much smaller group is the dependent drug user who is the ‘addict’ type of user. One sees them much more often in counselling even though over all they represent only a small group of drug users. In counselling these people, in my book, I focus on the relationship the person has with their drug of choice. 

In this sense the drug counsellor becomes like a couples counsellor but working in reverse. Instead of counselling the ‘couple’ to repair their relationship the drug counsellor is working with the drug user to end his relationship with the drug. Working with how to break the attachment to the drug, just like one can have an attachment to another person. I highlight three main ways this can be done.

This approach does provide some insight for the average person on what the life of the dependent drug user is like. Think of a time when you were in a relationship that was not good for you but you stayed in it despite that. Recall how difficult it was for you to leave and how hard it was to break the attachment to the other person and all the pain and grief you experienced when it ended. Recall how you went back to the relationship knowing that it was the wrong thing to do. If you have had this experience then you are given some insight into what the dependent drug user feels and what they experience as they endeavor to give up the drug.

It is very easy to sit on the sideline an have the view that the drug addict is simply a weak willed individual who is a loser and just a drain on society. Have you ever stayed in a relationship which you knew was not good for you and may have even been quite destructive for you and the other party? If you have then you know that is not just a matter of being weak willed. Leaving a relationship where there is a significant attachment is not an easy thing to do and that is the dilemma for the dependent drug user.

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Habit - friend or foe?

Kahless makes a good point with her comment

As for switching addictions, how can you switch a food addiction when you still have to partake in it everyday? 

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Humans are habitual creatures, very much so. Habitual drug use is no exception. One part of the reason why some people use drugs excessively is because the drug use becomes a habit. To stop using one has to break the habit. 

However habit is both the drug users worst enemy and best friend depending on the timing. 

If one has used marijuana almost everyday in the previous two months then there is a strong habitual urge to use again today.

If one has not used marijuana in the previous two months then there is a strong habitual urge not to use today.

Breaking a habit is a waiting game that turns habit from your enemy into your friend. If you can just not use long enough then the new non using behaviour becomes habitual. One becomes a habitual non drug user and thus it is easier to not use.

Of course one can not use any marijuana at all and still exist but one cannot stop eating completely. Thus the habitual aspect to eating can never stop. Thus one can argue that a food addiction is harder to break than a drug addiction. 

Of course how and what one eats will be in part determined by habit, but it is harder to stop a food addiction because one cannot stop eating completely.

UK politicians who admit to using marijuana

Current Prime Minister of the UK, David Cameron has stated that he is “not issuing denials” about newspaper stories which claim he had used marijuana

Jacqui Smith

Alistair Darling

Ruth Kelly

Andy Burnham

Harriet Harman

Hazel Blears

Vernon Coaker

Caroline Flint

Patricia Hewitt

Tony McNulty

Mo Mowlam

Boris Johnson

US politicians who admit to using marijuana

George W. Bush

Bill Clinton

Newt Gingrich

Al Gore

John Kerry

Barack Obama

Sarah Palin

Arnold Schwarzenegger

Jesse Ventura

Australian politicians who admit to using marijuana

Julia Gillard

Malcolm Turnbull

Kevin Rudd

Wayne Swan

Peter Garrett

Tony Abbott

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Client change

This chart comes from a book that was published in 1978. A basic transactional analysis text at the time. It is one of those things you find in a book that you notice for some reason and kind of never forget. It always struck me as an interesting chart.

It’s great when you get a client who is in the first and second groups and they attribute their change to you the therapist.

One of the reasons I noticed it was that it is based on the assumption that everybody is help-able. That all clients can be helped. It assumes that all people can be helped as long as the therapist’s skill is high and there is enough time and energy put into the client. I have my doubts that this is true at least at times. Some clients at some points in time can not be helped. That can and often does change over time for the same person. For instance a person who is in the 5th 20% is likely, over time to move up the list and therefore become more capable of being helped. I would add a 6th category - at this point in time no change will occur no matter what the therapist does or the amount of energy put in.

Another feature is that it is based only on the client and the therapist characteristics. I would add in a third criteria and that is the psychological condition being presented. Some things are easier to treat than others regardless of the client’s motivation. It is easier to treat a tightwad than a spendthrift. The tightwad does not have enough Free Child and the spendthrift has too much Free Child. People naturally do not like giving up their FC. The antisocial personality is too hedonistic whereas the OC personality is not hedonistic enough therefore the antisocial generally is harder to treat.

Then of course value judgements also creep into what is considered abnormal. It was only 40 years ago that homosexuality was considered by mainstream psychology to be an abnormal psychological state. Some kinds of illicit drug use are considered abnormal behaviour whereas the reason why it is illicit is for political reasons not psychological reasons. Hence they are considered psychologically abnormal because of a political judgement not the natural state of the human psyche. In these types of conditions perhaps one needs to consider more than just the client and therapist qualities.

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Drug harm assessed - Part 2

Here is another interesting graph from the same article I referred to in the previous post. 4-MTA is an ecstasy like drug.

This can be seen in more detail here.

Here is a quote from them in the discussion: 

Our findings raise questions about the validity of the current Misuse of Drugs Act classification, despite the fact that it is nominally based on an assessment of risk to users and society. The discrepancies between our findings and current classifications are especially striking in relation to psychedelic-type drugs. 

(i.e. ecstasy, LSD & 4-MTA)

We saw no clear distinction between socially acceptable and illicit substances. The fact that the two most widely used legal drugs lie in the upper half of the ranking of harm is surely important information that should be taken into account in public debate on illegal drug use. 

(i.e. alcohol & tobacco)

Discussions based on a formal assessment of harm rather than on prejudice and assumptions might help society to engage in a more rational debate about the relative risks and harms of drugs.

(end quote - I added the information in parentheses)

This is based on the UK system of drug classification. Class A drugs are the meanest and nastiest with Class C drugs being the most benign. The Australian system would be very similar. They also note that 3 class A drugs are clearly in the bottom half of the list with ecstasy being third from the bottom. This is a glaring anomaly that defies logic. To understand why this anomaly exists all you have to do is read my book!

Tobacco would usually be higher but shows up lower as a consequence of how harm is defined in this research. For physical harm they use three criteria

Intravenous use - tobacco gets a zero

Acute use harm - tobacco is low here as well

Chronic use harm - tobacco scores very high.

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Drug harm assessed

I came a cross and interesting diagram today on the internet.

 In my book to be published soon on counselling alcohol and drug users I talk about the dangers of various drugs and this diagram is consistent with what I hypothesize. This is a good thing as what I have said is a bit controversial. Not overly so but some people may have trouble with it.

 I talk about why some drugs are illegal and others are legal concluding that governments make such legislative decisions based on a complex array of factors. One small part is the dangers of drugs but they portray to their constituents that this is the main reason.

 If it was the paramount reason then alcohol and tobacco would quickly be made illegal and cannabis, ecstasy and LSD would be made legal. These three are the safest of the drugs currently doing the rounds.

In the diagram above the closer the drug is to the top right hand corner the worse it is and the closer it is to the bottom left hand corner the better it is. So you can see this does provide some support for my contention in the book. They add in the concept of dependence which makes it a little bit different from what I am saying but it generally agrees with my proposal.

 If I should come in for some criticism then it will be good to have references that back me up. This chart comes from some serious research reported in the Lancet, which is a reputable journal. So it would be nice to have the article.

 Anyways I clicked on the link and it took me to the journal article abstract which I read and it sounded good. Then I discovered to get the whole article I had to pay $31.50. Yes $31.50 for a single journal article! That seemed like a lot to me and I wondered if anyone actually will pay that much for one journal article. Did I need it that badly to spend $31.50?

Feeling a bit despondent I googled the title of the article and the second link I clicked on gave a PDf of the full article which I have now downloaded. The exact article in full! I now have the article and will cite it should that become necessary. Just goes to show you that it pays to look around on the internet!

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Drug use ambivalence

Using the drug use ambivalence technique with those drug users who are in remission.

I have been using this technique now for some time. I have developed it over a number of years and kind of did not realise that until I spoke with my supervisee the other day and she raised some concerns.

It is a two chair exercise where the client sits in a chair and experiences that part of their personality - either the FC or AC.



I have used it recently with two women who had been clean for some time but they had both expressed some concern about relapse. They were fine doing the FC chair and gave the usual responses of why they do not want to use - their lives are better, healthier, save money and so forth.



When asked to go to the AC chair both expressed an instant strong fear reaction. One woman even stated,

“That bit does not exist..... if it does exist it is only very tiny”.

After a bit of discussion she stated that she did not want to acknowledge that it existed because then she might use again. Indeed we had spent a good deal of time in the previous weeks discussing the idea of relapse and she was quite open about it. She was fully aware in her Adult about her desire to use drugs again but to actually experience that part of self was an entirely different thing. Her statement about it not existing or only being very small was highly incongruent. This however does show the difference between her Adult being aware of her desire to use again and her first hand experience of that part of her personality that wants to use. Which supports the validity of this technique.



However this raises an interesting question, What was she actually scared of? Does the bigger fear reaction mean the more likelihood of relapse or the closer the person is to a relapse.

Or it may simply mean that the person is scared of relapse even if they are not at any great risk of doing so.

I do not know the answer to that question. However my supervisee expressed some concern at this technique. She reported that by asking the person to experience the part of self that wants to use drugs may in fact increase the likelihood of them doing so. Another interesting proposal and one that I do not agree with.

The fear reaction, along with the reluctance to ‘be’ that part, (with one person even denying its very existence) means that she had repressed that part of her personality. She had become unintegrated in that way. She had locked away this part of her personality and kept it hidden from her conscious.



Psychological theory states that the more you integrate parts of the personality the less trouble they will be. By keeping it unintegrated the more likelihood there is that she will relapse. By experiencing it and integrating it, the less problematic it remains in the personality.

Also with her being the AC part of self it allows me to relate to it directly. This is a most important thing to do. Whilst sitting in the AC chair I can dialogue directly with it. Thus we have the opportunity to develop some relational contact. It allows us the option of building up some kind of relationship. This is a very good thing as it allows the AC to stop feeling so isolated. It defuses it and people are always in better psychological shape when they feel they are in some kind of relational contact with others.

Any time I come across some kind of self destructive aspect in a client my first goal is to establish some kind of relational contact with it.

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Using drugs dangerously

In order to use drugs dangerously such as with injecting drug use one has decommission their Adult ego state whilst doing so. This can be done by using what are called defence mechanisms. Humans are very good at lying to themselves and defence mechanisms are one way they can do that.

If a person has the Adult ego state information that sharing injecting equipment is a most unwise thing to do then in order to do it that, the Adult needs to be tricked some how. The Child ego state in some way needs to temporarily trick the Adult. If it can not do this then the person will not share injecting equipment on that occassion.



Below is a statement by a 37 year old doctor who shared needles on this occasion.

“Never in wildest dreams did I EVER IMAGINE that I would share needles. Some of the details around these circumstances I can’t recall. I spose it was so traumatic, having a medical background and a deep moral code around sharing fits it still seems unbelievable.

I would ask the people who had used the fit before me if they had HIV or hepatitis and I chose to believe their response of no. Truth has no place in this world, if it shows up then is gets distorted, ignored or disproven because truth and drugs cannot be in the same room. The thought of not being able to get the drugs into me as quickly as possible especially when watching the others getting relief from their angst was something I could not take. This anxiety/fear far outweighs the fear for my own health and life. It was like trying to resist the sound of a newborn baby crying when you’re breast feeding.

I would disassociate from reality, time and space changed. I would wash the fit out with alcohol or bleech the whole time repeating a mantra of please God please God. I would think who cares anyway, you’re fucked and life is fucked and you’re all fucked. Self loathing and the fear of not getting that rush would fuel me on.

Then the ritual of mixing up would begin and my mind would start bargaining “you’re not really going to do it” “you’ll stop before you whack it” but there is no stopping by this stage you’re like a robot and this thing has you in its grasp. I would cry as I found a vein, wishing I could stop, jacking it back, holding in the sobs so I didn’t shake too much, then pushing it down the relief flooding over like a lover holding you in their arms no more aghhh and once again I’m cleaver and funny, all worries dissolve, I am a sex goddess and philosopher, brave and complete, all fears drift away.” (end quote)



Can you spot the defence mechanisms?
Or the ways her Child ego state temporarily tricks her Adult ego state.
I can count 4, possibly 5.

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Gender bias in drug use and impact

One thing I have noticed over the years of studying drug use and drug counselling is the bias towards males. In any statistics you come across whether they be rates of use, rates of ODs, rates of viral infections invariably males will be higher. Not always but in the vast majority of cases males will be at the higher rates.



For example see these charts of illicit drug use in Australia. These are typical of the statistics one comes across over and over in terms of gender bias.







I have always wondered why this would be so.
Why should males very consistently be the ones to use more and use more dangerously and so on?

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Book update.

With the negotiations completed and the contract signed I am in the process of writing the next book. Although the title is yet to be decided it is about counselling drug users.

The last book - Working with suicidal individuals - was meant to be 70,000 words and it ended up being 90,000 and I was asked to reduce it. I finally got it down to 87,000 words and it was accepted. This time however I have been asked to keep it to 70,000.



The first chapter I have almost completed is probably going to be chapter four and it is on Harm Reduction. This topic will be found in the vast majority of books on drug counselling. It is usually quite dry and has been said a hundred times before but you really do need to have it in there.

I thought it was going to be about 1,500 words but it ended up being 7,000 and I am really happy with it. I mean really! It has ended up with a really good structure, looks at the overall area and then has lots of new and applicable stuff on the area. Most of it I have never seen in the literature before.



It was one of those situations, that as you start writing you begin to find out that you knew all this stuff, you did not know you knew. It just kept coming out as I wrote along. Problem is one tenth of the book is taken up with this one chapter!

Other than this, as with the first book the initial stages are quite taxing and hard. I have the outline of the book and I keep thinking of things I have written or know of in the literature and frantically putting them in all sorts of folders on my computer. But it’s like at times you have to keep four different things in your head at the one time as you don’t want to miss any. This happened with the last book and should slow down a bit soon I hope as I get most of it together in the right places.

But all in all it is good to have a new project like this. It certainly has my interest and I am motivated to do it. As with the last one when I write I have to let my Free Child run wild at times and then get it all down and together in the right structure and format.


Free Child


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Goals of therapy - practical

Kahless says:

Well I look at where I am at the moment. I am in my early 40s. I exist in a state of not happy and not unhappy thanks to the medication propping me up. I am thankful to the anti depressants that I am not in that low point of nothingness that I felt earlier this year.
I don't know what I want not what I don't want. You suggest a don't get my needs met injunction, but I don't even know what my needs are. I am by most people's standards, successful. I don't have to worry about money and I have a successful career and am in stable relationship with a partner who cares deeply for me.
But I am not happy. I do not know what will make me happy.

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Her comment raises three interesting points for me.
I will address the first one here and do the other two at a later time.


I saw a piece of research once that outlined the best predictors of the outcome of psychotherapy. Or the importance of things in psychotherapy. It isolated three aspects of it
1. the techniques employed
2. the relationship between client and therapist
3. the practicalities of one’s life at the time

The results were something like
1 = 20%
2 = 40%
3 = 40%



However you can’t quote me on this because I can’t find it so these may not be fully accurate. I recall looking at it and being a bit surprised about the practicalities of life being that influential, but after some consideration it does make sense. This includes things like having a decent income, having relationships in life that are reasonable, living circumstances are OK such as having a home that is reasonable, diet that is OK, having a social life and so forth.

The more one has of these the better the prognosis when the client enters therapy. This is a bit sobering because it is easy for therapists to get lost in their fancy therapies and fancy techniques and so forth. It notes that therapists should initially at least focus on such practicalities in the treatment plan. This may seem a bit basic, and it is, but it is most important at least at times.



Many years ago I recall working in drug rehab with this guy who had a long term heroin problem. He was a nice guy and we established quite a good working relationship over some time. I recall we used to laugh a lot together. At one point he came into quite some money. Of course I did not ask how he came across the dollars, I just noted that he did.

Since our first meeting I had noted that his top front teeth were not too good, being quite discoloured and somewhat decayed. He had never mentioned them as a problem. I was the one who brought it into therapy. I suggested that he use some of the money to have his teeth repaired, whitened and so forth. He responded that he did not care what his teeth were like and he was unconvinced by my suggestion. I persisted with the suggestion through a couple of sessions and he finally did seek out the appropriate dental work, had it done and it did look decidedly better. Whilst I did think it was a good idea, one reason I suggested the dental work in the first place was because if he did not spend the money on his teeth it is highly likely that it would go on drugs.

However the surprising thing was the therapeutic results that it caused. He said that after it was done he felt so much better about himself. He reported that when ever he looked into the mirror he saw a reflection of himself that he liked. He had not not even aware of how this had effected him for so long. That he had disliked the image of himself every time he looked at it almost everyday.



I have never forgotten that. I could have spent my time doing fancy relationship building and fancy techniques to assist him to express his anger at his mother and so forth, when one of the things which turned out to be significant in the therapy was getting his teeth fixed. Something that simple. One of the simple practicalities of life turned out to be a significant factor in his recovery.

And my point is?

When Kahless says:
“I don't have to worry about money and I have a successful career and am in stable relationship with a partner who cares deeply for me.”

I know this is a good prognostic sign should she ever decide to take up therapy with a male therapist

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Why are some drugs legal and others not?

I bought a new book the other day on addictions counselling. It is quite good and has some useful information in it. It is the usual sort of thing reflecting mainstream thinking on the topic at the moment. In chapter two it makes a statement that one would not uncommonly find in such a document.

“Contrary to popular belief, most people who use substances do so in ways that cause them relatively little harm”
(end quote).

Why would this be so? Not that it causes relatively little harm but that it would be contrary to popular belief. Why would the wider community have a contrary belief to this?

There are a number of reasons for this which in part answer the question which is the title of this paper. The Australian Psychological Society (APS) has done a position paper on substance use. Now the guys that put these position papers together hard nosed MFs, who eat, sleep and s**t science. You can be sure they know the area very well, they are relatively free of any political pressure so you are going to get a pretty good statement about the science of the area under investigation.

To quote them:

“In Australian history, laws regarding the legality or illegality of certain drugs have been politically driven, and had little to do with the level of use or possible harms that the substances themselves might cause.” (p3)



This creates a problem for government because they say to the public that they are making some drugs illegal because they are dangerous to people’s health. They profess that it is a health issue and what they are doing is for the good of the public. Unfortunately this is not so. They are doing it at least in part for their own political well-being not for the good of the public.

To sell this to the public they then have to set about demonising illegal drugs. They have to exaggerate the dangers thus trying to convince the public that they are acting for their well-being and not for their own political survival.

Thus they demonise illegal drugs in all sorts of ways and hence one ends up with the contrary belief in the wider community that I mentioned earlier. The general public believe illegal drugs are much more dangerous than they actually are and the government has made them illegal to protect us.



From a pure lethality point of view consider this chart below. This was put together by two psychologists who work at Liverpool University in the UK. They looked at the official causes of death through the 1990s and then calculated the risk of death per 100,000 people. They came up with a chart that shows which things are risky for us and which things are less risky for us. Included in it are various drugs.

Very high risk
Tobacco, methadone, injecting drug use, BASE jumping, grand prix racing, cancer, heart disease, space travel

Quite high risk
Heroin, Morphine, barbiturates, alcohol, hang gliding, parachuting, motorbike racing, sudden infant death, working in mining, asbestos poisoning, strokes, prostrate cancer, shaking of babies, off shore oil work

Medium risk
Solvents, benzodiazepines, motor sports, water sports canoeing, diabetes, skin cancer, influenza, suicide, giving birth, helicopter travel, liposuction, working in farming, being in police custody, working in construction

Quite low risk
Ecstasy, MDMA, speed, cocaine, contraception pill, GBH, fighting sports, snow sports soccer & rugby, Asthma, AIDS. meningitis, cervical cancer, food poisoning, air travel, being murdered, chocking on food, electrocution, drowning, passive smoking, factory work

Very low risk
LSD, magic mushrooms, viagra, fair ground rides, swimming, riding sports, food allergies, syphilis, malaria, appendicitis, pedestrian crossings, clothes catching fire, falling out of bed, vaccination, abortion, storms, terrorism

Extremely low risk
Marijuana, cannabis resin, indoor sports, playgrounds, peanut allergy, measles, insect stings, copulation, starvation, dogs, lightening, nuclear radiation, police shootings

Negligible risk
Caffeine, nitrous oxide, ketamine, computer games, masturbation, small pox, leprosy, sharks, cats, meteorites, executions, volcanoes




If the government was acting purely for the health of the community it would change the laws on which drugs were illegal. It would make tobacco and alcohol illegal and make marijuana, LSD and ecstacy legal. There is as much chance of dying from ecstacy as there is from choking to death on your dinner or being blown up in a plane by a terrorist. In addition as far as drugs go marijuana is the safest drug you are going to get.

Then some will argue that marijuana may not kill you but it can make you go crazy with a cannabis induced psychosis. Unfortunately as time rolls on the science has simply not backed up this hypothesis. Yes it is very unwise for a person with a propensity for psychotic symptoms to use marijuana and the vast majority of marijuana users will suffer no mental health problems at all. Hence back to the original quote from my newly purchased addictions counselling book and the APS position paper.

Is a government going to make such legislative changes with illegal drugs? I don’t think so. If they did they wouldn’t be in government for very long which is why they have to exaggerate the dangers of illegal drugs and thus mislead the public in this way. Pretend to act for the good of the public when they are actually acting for their own political survival.

However despite all the politics this does raise some interesting questions for the drug counsellor and indeed parents of children who may use drugs. Does a drug counsellor (or parent) use scare tactics with the client (child).





One way to try and stop a person using drugs is to make such a thing very scary for them. Get them to believe that drugs are much more dangerous than they actually are so they get scared and don’t use. Commonly known as scare tactics.

To do this you have to lie to them even if only lying by omission. Is it OK and therapeutic for a counsellor to lie to a client? Most would argue no. To my mind you have to tell the drug user the truth even when you don’t like what the truth is.

If you tell them that marijuana can make people go crazy the first thing they will do is make their own observations. With the vast majority of marijuana users they will think - “Well I have smoked marijuana and I haven’t gone crazy”. Then they will look around at all their marijuana using friends and see that none of them have not gone crazy as well. After making these observations what is the drug user going to think - “My counsellor is lying to me”, as indeed he is.

As a result trust is broken, the therapeutic relationship is damaged and the counselling suffers, at times significantly. Besides this most drug users have heard it all before anyway. Their parents, teachers, the police, the press, the government and drug counsellors have all exaggerated the dangers of drugs to them many times before. So if you, the current drug counsellor comes along and tells the user the truth and the WHOLE truth they are going to be surprised and maybe even shocked by such a transaction from you. Thus the therapeutic relationship is placed on a much more robust footing and the drug counselling is more likely to be successful.


If you lie to the teenager can you expect them to tell you all of what they are doing?

In particular they are more likely to be truthful with you about what they are doing and why they are doing it. Can you really expect a client to be truthful with you, the counsellor, when you are lying to them in the first place. If you lie to them you have to expect them to lie back to you.

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