Published in The Australian Journal of Clinical Hypnotherapy & Hypnosis, Volume 39 Number 1, Autumn 2017.
By Dr Tracie O’Keefe DCH, BHSc, ND
Clinical Naturopath, Medical Nutritionist, Hypnotherapist
Abstract
One of the major social and health problems across the world is drug and alcohol abuse. It is endemic to many societies. This has been the case for thousands of years with the use of cocaine in ancient Egypt, alcohol in ancient Rome, opium in China in the 19th century, and a new plague of cheap recreational street drugs now flooding the modern world.
Hypnosis in its different forms has also been used for many millennia in healing the body and mind, as well as changing behaviours and human experience. Historically, the use of hypnotic techniques has been prevalent in ancient Egyptian healing temples, Greek Asclepeion temples, the salons of Mesmer in Paris, American Pentecostal churches, and in the modern-day practice of clinical hypnotherapy and medical hypnosis. Today, hypnotherapy is utilised as a potent treatment modality for many presenting problems and in particular has helped tens of thousands of patients in the field of substance abuse cessation.
This paper examines four case studies of long-term drug abuse where all patients ceased their addiction after one two-hour session of the Clinical Hypnotherapy Stop Drugs and Alcohol 6 Step Program (6 Step Program) created by the author, with the patients transitioning from drug and alcohol dependency to becoming clean and sober. The first case was a long-term methamphetamine user. The second case is a daily cannabis (also known as and referred to in this paper as “marijuana”) user who imbibed through a pipe for 36 years. The third and fourth cases are two brothers who used marijuana three or four times a day for five years and enabled each other in their co-joint addiction. In all four cases, the clients attended one initial session, as well as follow-up sessions.
Keywords: Dependency Syndrome, Substance Use Disorder, Substance Abuse Disorder, chemical dependency, drug addiction, alcoholism, addiction recovery, medical hypnosis, clinical hypnotherapy.
Introduction
From the analysis of geometric painting patterns found in caves throughout the world, Froese (Froese, et al., 2013) surmised that ancient cave dwellers used psychedelic plant substances. Lindesmith (Lindesmith, 2008) proposed that the ancient Sumerians used opium 5,000 years ago after he discovered a representation to that effect in an ideogram. Fort (Fort, 1969) tells us the earliest record of an alcohol brewery appeared in an ancient Egyptian papyrus. Balabanova (Balabanova, et al., 1992) found cocaine, nicotine and hashish in the remains of 3,000-year-old Egyptian mummies. Baumler (Baumler, 2001) traced records of opium use for medicine back to 7th century China, and noted that the Qing dynasty emperor issued edicts to curb addiction in the 1700s. In more recent times, the United Nations World Drug Report 2016 (United Nations Office on Drugs and Crime, 2016) estimated that a quarter of a billion people, aged 16 to 64, used a minimum of one drug in 2014, culminating in at least 207,400 drug-related deaths.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM V) (American Psychiatric Association, 2013) classifies addiction under a clarification called ‘Substance Use Disorder’. It combines DSM IV’s categories of Substance Abuse and Substance Dependence into the one singular category, measured on a continuum from mild to severe. The DSM is American and its diagnosis may not translate to other cultures or even other disciplines such as hypnotherapy, particularly as its classifications can be controversial and based on mainly biophysiological dysfunction above psychological or behavioural dysfunction and because psychiatry tends to be a heavily focused drug-based therapy.
The World Health Organization (World Health Organization, 2011) in the International Statistical Classification of Diseases and Related Health Problems (ICD 10) describes addiction as a Dependence Syndrome where the individual rates the use of or need for the substance as a high priority.
The Sydney Morning Herald (Aubusson, 2015) reported a plague of inappropriate and unjustified psychiatric drug prescribing that could be harmful, particularly to children. Furthermore, this practice also grooms children for later life dependency because it teaches them to rely on substances rather than to work through their problems.
Erickson (Erickson & Rossi, 1981) described hypnosis as the induction of an altered state of awareness when the conscious mind is put to one side and the vast resources of the unconscious mind become available as the person enters into a trance-like state. Gauld (Gauld, 1992) tells us that hypnosis in various forms was used in healing temples in ancient Egypt and Greece where the sick sought help. Mesmer (Mesmer, 1997) made the use of hypnosis for healing popular again in Paris in the late 1700s. Hammond (Hammond, 1990) showed us that clinical hypnotherapy and medical hypnosis is commonly used in medicine and remedial psychotherapy today including cessation of
Traditional Hypnotherapeutic Approaches to Treating Addiction
Over the past 100 years, hypnosis has been used in substance abuse and addiction cessation. In 1910, Bramwell (Bramwell, 1910/2017) reported the successful use of hypnosis and direct suggestion behavioural modification in cases of stimulant and alcohol abuse. Wollberg (Wollberg, 1948) wrote about his use of psychoanalytical hypnosis with alcoholics. Rosen (Rosen, 1991) tells us how from the 1920s onwards Milton Erickson successfully used hypnosis with psychodynamic psychotherapy approaches to help clients overcome addiction. Lovern (Lovern, 1991) also wrote about Ericksonian approaches to successfully stopping chemical addiction in the form of a brief therapy solution-focused model.
The idea of the hypnotisability and hypnotic susceptibility of people, as considered by Weitzenhoffer and Hilgard in 1962 and modified by Kihlstrom in 1996 (Kihlstrom, 1996) in The Stanford Hypnotic Scale, is an academic construct that often does not always relate to clinical practice. The concept was designed as a measurement tool for experimental hypnosis. In my opinion, nearly all clients, except for extremely manic psychotic patients, have the ability to experience hypnosis. Trance is a natural phenomenon that people drift in and out of all day long. The hypnotherapist’s job and skill is to utilise any available aid for a willing person to enter the trance state.
Suggestibility as described by Barber’s Suggestibility Scale (BSS) (Barber & Wilson, 1978) is also a misnomer. Suggestibility changes with variables such as how near a person is to crisis point, their present life circumstances, whether the client does better with direct or indirect suggestion, how they see the clinician, what the present perceived benefits of change are through hypnosis, and what the secondary gains of resistance are to suggestion. In treating people with addiction issues a clinician must be mindful of how reactive a patient is to suggestion at each stage but not restrict treatment to only those who initially seem highly suggestible.
Martin, Williams, Hazard, and Dimeter (Martin, et al., 2005) reviewed patient compliance as a major factor of good healthcare outcomes. In hypnotherapy, however, it is the backbone of treatment. Technique and patient presentation alone does not create compliance as in hypnotherapy it is also the hypnotherapist’s personality and skills level that are further key factors in delivering successful treatment, particularly in addiction recovery. Rapport, high levels of communication, clear instructions, and testing and measuring the client’s progress, then altering treatment as it progresses, increases compliance and results.
Stop Drugs and Alcohol Clinical Hypnotherapy 6 Step Program Treatment Method
This paper reviews four cases of severe long-term substance addiction treated with the 6 Step Program to produce fast substance cessation. The treatment includes the use of hypnosis, clinical hypnotherapeutic techniques and psychotherapy following naturopathic principles.
The 6 Step Program focuses on cognitive behavioural programming and transforming and maturing the personality. The program operates on the proposition that chemical dependency is the reliance on exogenous substances, other than the self, to establish wellbeing. When the person develops a fully mature personality they no longer need those substances. The method is based on an abstinence model with the withdrawal of all potentially addictive substances from the client’s life. Since the program incorporates a naturopathic perspective, it also involves withdrawal from all unnecessary psychiatric medications (under the supervision of a relevant medical practitioner), unless the person displays active psychosis.
The 6 Step Program I have developed pays attention to many different useful strategies used in a variety of therapies. It begins with clearly defining the verbal and written contract between the hypnotherapist and the client, stating the client’s duty to therapy, so the client is always held accountable. All addicts must learn contractual life accountability.
All communications between the hypnotherapist and the client are presumed to be hypnotic and responsible for initiating and maintaining change. The therapist is continually bombarding the client with intra-hypnotic and post-hypnotic suggestions, even in a supposedly casual conversation.
The hypnotherapist guides the client during goal setting and therapy towards one primary, single goal, which is to live their life clean and sober without exception. This includes changes in the way the person eats and exercises, lifestyle and taking care of themselves. Since I work from a naturopathic point of view, the wellbeing of the body ranks equal to the healthy function of the mind, which needs to become more developmental towards a mature, self-sustaining personality.
The six steps of the program are based on hypnotherapeutic and psychotherapeutic aims:
1. The client must learn how to stay out of denial about their addiction. All relapses for addicts begin with an addict reverting into the delusion that the substance of abuse is not dangerous to them, so self-monitoring mechanisms must be installed in the unconscious mind.
2. Addicts must immediately stop using the substance without compromise. This requires them at times to go through withdrawal with the aid of a supported network and the hypnotic work they will do at home. Interrupter patterns are installed hypnotically and it is important for the client to understand that we do not grow in our life when we experience comfort but when we seek alternatives to discomfort.
3. Breaking addictive patterns requires the client to start to live each day differently, positively and constructively other than the way they lived as an active addict. Addicts who go back to the lifestyle they had when they were active addicts will highly likely relapse. Here the therapist must be congruent in teaching the client to be clean and sober.
4. It is important during regression to find the root causes for the addiction in the first place. Becoming cognitively aware of the previous drivers of addiction helps the addict avoid those triggers in future. Active addiction had become an unconscious habit, so sobriety must become both an unconscious habit and conscious choice.
5. People who do not suffer addiction tend to have better boundaries than addicts and are clear in their thoughts, mindsets and behaviours about when, where and who they interact with in life. We need to teach the client to model this way of living and the best way to do that is to act as a model for them to copy.
6. The non-active addict needs to become proud of who they are and their sobriety achievements. Through post-hypnotic suggestion this can be a permanent sense that they are living their whole lives in the very best clean and sober way they can, with absolute self-agency, and have a commitment that those changes are for life.
The essence of the program is that cessation and withdrawal of substance of abuse happens fast and immediately.
Harm reduction is not a useful model in substance abuse and dependence recovery, as people can never have one quarter or half of an addiction. Addicts do not need a thousand and one choices because they have lost their analytical skills. Instead, they need clear indications of what is expected of them and how they can recover from their addiction.
From my clinical experience in working with people with substance abuse problems, recovery from addiction requires the client to have structure, repetition and new behaviour patterns to de-potentiate old addictive habitual behaviours. Furthermore, in my opinion, self-monitoring is always the most important step in any recovery program.
In working with clients I ask them not to use the substance of abuse the day they come to see me. Addicts can do this, even heroin addicts. It is impossible to work with intoxicated clients as they have reduced cognitive abilities, which operate insufficiently for them to comprehend hypnotic instructions. If they are intoxicated it is also difficult for the therapist to gauge their levels of comprehension.
Case Studies
Tom
Tom was a 42-year-old male carpenter/builder who had a long history of recreational drug use over the past four years, giving rise to a daily methamphetamine addiction. He lived in a northern Australian city with his wife and two children, and flew into Sydney for five days every week to run a crew of five carpenters on a building site where he worked 16-hour days. He had a history of depression and recently began to suffer from erectile dysfunction due to chronic drug use and stress. At this stage in his life he was earning a large income, and used the methamphetamine to give him energy but complained he had lost control and could not stop taking the substance. Tom was also suffering a physical and cognitive decline, whilst still being highly organised in his business.
Barr (Barr, et al., 2006) state that methamphetamine (Ice) is a highly addictive drug whereby repetitive and frequent use can become habitual. It can lower the ability to think analytically and to assess risk, and profuse use can lead to paranoia and aggression. The initial effects are an increase in dopamine, which leads to increased heart rate, respiration and a feeling of excitement. However, long-term use can result in brain damage and reduced production of dopamine and serotonin, which can make users feel depressed and experience panic attacks.
Tom came to me because he needed to be guided to a clean and sober life by someone who knew how to live that life—he needed a strong guide, not a sympathetic ear.
When you give a carpenter a project, he or she will methodologically and systematically follow a step-by-step process to construct an object or complete an assignment on time, and will monitor every variable to a very narrow margin. Recognising that I could utilise this project management aspect of his profession as a perfect metaphor for evaluating his recovery in line with Step 1 of the 6 Step Program, I suggested to Tom while he was under hypnosis that he would use the same process to constantly monitor his own behaviour and reject all addictive substances, including drugs, alcohol and caffeine.
It was also suggested to Tom that if he found himself in a situation when he was around or offered drugs or alcohol then he would remove himself from the setting and immediately reject those substances as unacceptable for this new phase in his life. Although direct suggestion was utilised, it was not prohibitive. Rather, it was perceived as positive action in alignment with Tom’s goals, which were to choose to be addiction-free and ‘clean and sober’. It is made clear to clients as part of Step 2, consciously, somnambulistically, and in deep trance that they stop taking the substances immediately and permanently.
I saw Tom for a two-hour first session, plus three other one-hour sessions. He stopped taking drugs and drinking alcohol after the first session, which focused on the first three steps of the 6 Step Program. During the second session we reinforced the work of the first session and worked with Steps 4, 5, and 6 that helped mature the personality and prevent relapses. In sessions three and four we also resolved the problem of the erectile dysfunction. Tom began to enjoy his life and remained clean and sober at the six-month follow-up, and changed his life to a simplified, less pressured work situation.
JJ
JJ, a 51-year-old long-term unemployed male on welfare, had used cannabis through a pipe every morning for 36 years since he was 14. He was also homeless, sleeping at his parents’ house and was receiving $750 from the government every fortnight. The fee to see me was $735 (for the first two-hour session and the follow-up session), leaving him with $15 for the next two weeks. He had a chequered history of being treated by a psychiatrist who had never addressed his addiction issues after seeing him every few weeks for several years. At the time of presentation JJ was taking no medications.
In talking to JJ it was clear he was intelligent but had only been exposed to a minimal level of education, which had shut down his life options at an early age, leaving him with few career or job opportunities. Furthermore, the lack of bonding with his father had left him without a healthy role model. Added to this, being unequipped to understand a healthy relationship and attachment, he chose to hang out with other drug-taking teenagers who accepted him simply because he took drugs. The cannabis had also undoubtedly led to a lower level of brain and intellectual development.
Jacobus and Tapert (Jacobus & Tapert, 2014) reviewed findings that showed there was evidence of disadvantages in neurocognitive performance and changes with heavy users of cannabis during teenage years. Neuroimaging also showed macrostructural and microstructural brain development abnormalities and alterations in brain functioning. Our personalities mature, provoked by the life challenges we face, but due to the intoxication, dissociation and derealisation that cannabis produces, people like JJ fail to adapt to adulthood at a time of life when most teenagers are developing coping skills and strategies.
As a naturopath, I teach my patients that the healthy options for living are the right options for them. I do not preach but teach, as it is evident to clients that I lead a clean, sober and healthy life. Step 3 of the program is giving people other options such as eating well, exercising and daily self-hypnosis, so they are able to create their lives in ways that are healthy and very different from the confusion and physical deterioration of addiction.
JJ’s psychiatrist had simply sat and listened to him for years, and collected the fee from the Medicare system. Rather than facilitating JJ and guiding him to a healthier, better life, the psychiatrist had allowed his aimless client to meander from one life disaster to the next. JJ diligently followed suggestions I gave him from the program because I gave him clear guidance and instructions on what he was expected to do between sessions.
JJ stopped smoking the cannabis immediately after the first session and, despite still mixing socially with people who used the drug, was not tempted to use it again. His major issue seemed to have been that he had had a profound lack of confidence and, having never bonded with his father as a child, had no strong male mentor to model. I saw him three times and in the last session worked on increasing his confidence. At three months he was still clean and sober and determined never to take drugs again.
Max
Max was a 26-year-old male delivery driver who worked for his father in the family business. He had been smoking marijuana several times a day for five years after having been introduced to it by his brother-in-law. Previously he had been studying medical sciences at university but a year after he became addicted was unable to concentrate anymore and lacked the motivation to continue his studies. He spent $25,000 on marijuana a year and had no savings or property. He came from a close-knit family who were also Christian. His mother, who was deeply worried about his future, introduced him to my practice. He said he did want to stop smoking drugs.
Peer pressure is one of the biggest drivers of addiction, particularly in teenagers. Johnson and Jones (Johnson & Jones, 2011) explain that the neurons in the prefrontal cortex of the brains of teenagers have not yet been fully coated in their myelin sheath until the early twenties. This leads to developmentally higher risk- taking, particularly in males, giving rise to risk to greater possible injury.
In looking at Max’s drivers of his addiction under hypnosis, which is part of Step 4 of the program, he became aware of how he felt—he did not want to disappoint his new brother-in law, who was older than him, from whom he was seeking approval.
Habits and addictions form for many different reasons but in teenagers it can frequently be from the emotional discomfort arising from the fear of rejection. Teenagers will go to extremes to fit into the pack. For Max, he started to sit around smoking marijuana several times a day simply to appear cool. The need to have that feeling of acceptance and validation from older males at that time became a greater motivation than his desire to live a healthy life and to continue diligently with his studies to the point where he could no longer cognitively process his university course work because he was so stoned.
Max came from a home where drugs were not used, although his mother was a heavy smoker, and did not see that as an addiction. His home life was full of love and acceptance and he had been brought up with a strong Christian code, which he had lived by until he became a marijuana addict. Indeed, it was his mother who made the initial call to the clinic for help. Of late, however, Max had experienced internal conflict between the part that drove him to addiction and the part that was angry he had abandoned his pursuit of a career in healthcare. The only resolution for this conflict became the need to change his life once again, as he no longer needed his brother-in-law’s approval.
After the first session on the 6 Step Program with the aid of hypnosis he stopped smoking marijuana and refrained from drinking alcohol. He had also re-enrolled in university with the explicit aim of completing his studies and working in the health profession. He commented how easy he found not using drugs, and that he felt a lot more excited about life and would now have the money to complete his studies. As instructed, he also changed his social network so he only mixed with clean and sober people.
Kevin
Kevin was a 22-year-old male and also the brother of Max. He had also been smoking marijuana for five years, saying that he was close to his brother and that they spent a lot of time together. He had been an athlete—an Australian football player—but had sustained a knee injury for which he was facing a serious surgical reconstruction, which resulted in him being depressed. Having trained as a plumber, he was unable to bend his leg sufficiently to work in the profession, so he also worked as a delivery driver for the family business. He was unable to proceed with the surgery because he spent $500 per week on marijuana and was unable to pay the medical expenses. The joint addiction was a clear case of each brother enabling the other’s addiction.
In reflecting on his brother Max’s need to gain his brother-in-law’s approval by smoking marijuana, Kevin in turn sought Max’s approval and followed his lead into addiction. It was a case of following-the-leader and normalising of crowd mentality.
All addicts are immature personalities who rely on sources other than themselves to satisfy their daily needs—they are not independent self-sufficient organisms. In working with Step 5 of the program it was necessary to get Kevin to separate from others by erecting good psycho-imaginary boundaries inside his mind that allowed him to have healthy, more independent attachments to other adults and choosing how he interacted with them in order to maintain his own wellbeing.
Step 6 involved teaching him to reconnect with his healthy body in a clean and sober way of living. He had been an athlete so he knew how it felt to be in supreme health but the addiction and injury had robbed him of his self-image as a strong, healthy male. Helping someone stop their addictive behaviour has to go further than just stopping taking the substance they are abusing. A hypnotherapist must replace those self-images of addiction with positive values, drivers, beliefs, thoughts, behaviours and emotions around living life in celebration of leading a healthy, happy and fully rewarding clean and sober life.
Like Max, the hypnotherapy also helped Kevin stop the addiction immediately after the first session. Psychotherapeutically I also used the close relationship between the brothers to set each brother monitoring the other’s sobriety. At the second session after two weeks Kevin proudly told me he had saved $1,000 towards his surgery, which would enable him to bend his leg and resume his career as a plumber. Both brothers talked about the years they had lost to addiction and were resolute in their commitment not to use drugs or alcohol in the future.
Conclusion
Clinical hypnotherapy can be highly effective in helping people stop substance dependency and abuse. The four clients reported in this paper were good hypnotic subjects, suggestible, self-motivated, compliant to treatment protocols and carried out their homework of diligently listening to daily hypnosis recordings at home between sessions to stop their addiction. Each was preselected as being suitable for this treatment method during a pre-session telephone interview to test suggestibility. All needed professional assistance to change their habits of addiction. They are four of the thousands of patients successfully treated for drug, medical prescription addiction and alcoholism with the Stop Drugs and Alcohol Clinical Hypnotherapy 6 Step Program.
In conclusion, the variables involved for successful cessation of addiction using clinical hypnotherapy include client motivation, treatment method, the skill and experience of the hypnotherapist, and the ability to tolerate intense therapy. The Stop Drugs and Alcohol Clinical Hypnotherapy 6 Step Program proves to be expediently successful for clients as it addresses a broad spectrum of issues such as the client being cognitively aware of their thoughts and actions, stopping taking the substances, operating replacement behaviours, analysing why the addiction happened in the first place, addressing personal boundaries, and learning to live a satisfying clean and sober life as a mature, independent personality.
Critique
This method has only been trialled in private practice even though it has been used successfully with patients from different social economic classes. Due to the complexity of the hypnotic skills required the success depends on the hypnotherapist being highly trained. Ninety percent of my clients report the program to be successful for them. The remaining 10% failure rate is made up of patients with co-pathologies such as Borderline Personality Disorder, unregulated schizophrenics, Self-Destructive Disorder, Bipolar Disorder II that are manic or deeply depressed, none of which were present in the cases featured in this paper. The 10% of addicts who are not suitable for the 6 Step Program need more intensive therapy over a longer period.
Further study of the success of the Stop Drugs and Alcohol Clinical Hypnotherapy 6 Step Program would lend itself to qualitative analysis. Quantitative analysis would be unable to track the large number of variables present during these kinds of successful hypnotherapy sessions.
These case studies were presented at the Australian and New Zealand Addiction Conference 15-17 May 2017, Queensland (hosted by the Australian and New Zealand Mental Health Association).
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