Dr Chris Wurm spoke at the July Sanctuary Meeting on Tuesday, July 10, 2018. Here are Judy’s notes from his talk:
Dr Wurm has a very different way of tackling the issue of substance abuse from what I expected. However now that I have heard his methods, they seem to me to be much better than using an authoritarian approach that I see many clinicians using. Certainly that has never worked for my daughter when they tackle her eating problems, which are a form of addiction for her, and her related diabetes issues.
Dr Wurm does not see addiction as only being related to drug and alcohol issues and his questions to his patients include-
- How many days a week do you use alcohol?
- Do you ever have a bet on horses?
- Do you buy lottery tickets?
- Do you play slot machines?
- Do you use over the counter meds (Ford pills, Codeine, diuretics or other people’s meds)
- Do you have eating issues?
He suggests that people make a decision to drink alcohol, binge eat or gamble etc, or not.
For example in the case of alcohol abuse, the decision to drink will lead to people drinking alcohol, which can lead to intoxication, which leads to social dysfunction and narrowing of options in their life. This then leads to guilt and feelings of emptiness and despair, which they then soothe by drinking more alcohol and so the cycle goes on.
Much of Dr Wurm’s philosophy when helping people with substance abuse is based on Victor Frankl’s work “The Meaning of Life.”
“Viktor Frankl wrote about feelings of meaninglessness leading to widespread depression, addiction, and aggression, … even if he did not have BPD in mind, Frankl was certainly interested in the issues, which trouble people with BPD today. It typically involves powerful feelings of emptiness.
This has led me to look forward to seeing people with BPD, in the hope that they will be open to gently exploring the empty feelings. BPD tends also to involve attempts to block out distress by alcohol or other drugs – and self-harm.”
(Paper presented by C Wurm. Meaning Oriented Therapy Conference 2016)
Lack of meaning often creates a void that addiction fills, whether that is addiction to alcohol, food, drugs or gambling. They may also abuse their drug of choice because they are distressed, angry or anxious.
Dr Wurm asks consumers what it is they want from life (Meaning Oriented therapy. R Miller). Most often they say they want reliable housing, help with finances, social networks, physical health and coming to terms with their problems. He prefers to talk about the here and now, rather than what happened in the past. I find this interesting given that there is so much talk now about trauma therapy and the need for therapists to go back in time to find out what may have caused trauma early in the life of our family members.
Dr Wurm uses Motivational Interviewing to help motivate his patients to change. Motivational Interviewing is now established as an evidence based practice in the treatment of people with substance abuse disorders. Using this method he doesn’t give people directions but asks them to tell him what they could do differently. He doesn’t impose change but rather supports change in a way that is important to the person’s own values and concerns.
The first principle of Motivational Interviewing is to have empathy for the patient.
“Empathy is seeing things through the client’s eyes, … feeling things as the client sees them.”
Empathy is also one of the validating essentials that Valerie Porr suggests we should have when interacting with someone with BPD. Motivational Interviewing seems to me to go hand in hand with validation. An excellent way of helping people with BPD who have substance abuse issues.
Dr Wurm says that for the people who are not able to, or don’t want to completely abstain from their drug, or alcohol or eating habits etc. he looks at what he can do to at least minimise the harm their actions may make on their physical health and other aspects of their life. This was another interesting approach for me. He accepts that we may not be able to make someone completely drug or alcohol free etc but rather we accept where they are at. They may be prescribed Thiamine (Vit B) to minimise or stop brain damage in the case of alcohol abuse, or in the case of drug addiction, they may be enrolled in a methadone programme. Needle exchange programmes help minimise harm from sharing needles. Some patients may be ordered only a week’s supply, or sometimes even only a day’s supply of meds, to minimise the chance of overdosing.
I found this talk very interesting and it gave me a completely different perspective on what might be considered a successful substance abuse programme. I hope it has helped those of you whose loved ones have a drug or alcohol abuse problem, which also of course becomes your problem.
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