Dr. Barry Dworkin

Originally published in The Ottawa Citizen February 3, 2004

Original Title: The betterment of the family

Last of two parts

Deborah decided she had had enough of smoking marijuana. Last week’s column reviewed how her addiction affected her psychosocial development. Deborah was pondering why she continued to smoke four to 10 joints a day to the detriment of her health, desires and life goals.

The Adolescent Toolkit provides a solid framework to provide insights into the reasons behind particular behaviours. Deborah returned with her answers to these three questions in early November:

What do you like and dislike about yourself?

What are your good and bad qualities?

What are your definitions of a friendship and relationship?

Her answers that follow reflect years of unrecognized inconsistencies and conflicts.

Deborah embraces her adventurous and creative spirit. She is musically and athletically inclined. She takes pride in her trustworthiness and organizational skills, and fulfils her responsibilities at work. Her independence lets her successfully adapt to new situations. She feels she is self-sufficient and does not have to depend upon others for assistance. Empathy, compassion and generosity are cornerstones in her friendships.

She dislikes confrontation, avoids contentious problems and buries her emotions to minimize interpersonal conflicts. She admits she “cares too much about what people think of me.” There are some regrets when she says, “I never really followed my passions/goals/dreams. I gave up at everything too soon. I got relatively good at lots of things, but not great at anything.”

Her behaviour and reactions to conflict parallel the actions of her 15-year-old self. Indeed, many of her social skills stalled at age 15 because of her drug use. She hates that her cannabis use takes priority over her friends and family. “I’m smart enough to know better, but not smart enough to quit.”

Her definitions of friendship and relationships reflect the normal idealism of the teen years. There is a tendency to focus on the positive attributes of each and omit any consideration of the potential conflicts, hardships and frustrations inherent in close relationships. Her desire to avoid confrontation combined with a need to be liked by people paralyses her ability to make decisions in her best interest. Her fear of rejection makes it difficult for her to say “no.”

When people decide on a course of action that runs contrary to their conscience and sense of propriety, they can become angry with themselves. This anger can damage a person’s self-respect. Others will pick up on this; some will take advantage of this vulnerability. We all know people who share these characteristics.

Drug abuse is a means for some to escape from problems. This escapism became so ingrained in Deborah that it buried her true spirit. People always do things for a reason. For Deborah, her inability to face the fact that she was giving in to her false self (not following her conscience), not having the tools to change her approach to problems and her anger were compelling reasons to escape. This insight is the first small push forward to change her life. Using this knowledge she began to assert herself in an atmosphere of support from friends and family.

My advice to her in late November was to use her excellent organizational skills to create a new “life agenda.” Deborah’s agenda included spending more time with her family, losing weight, exercising, singing, helping her sons with their homework, practising her bass guitar every day, participating in theatre, photography, developing an outreach program to help adolescents in rural area high schools, and buying a motorcycle.

By Dec. 4, she stopped her daytime smoking. She returned with a prepared calendar of events that included her goals, family activities and a cannabis cessation date of Dec. 19.

Upon her return on Jan. 9, she was smoking one joint every four to five days instead of the usual 16 to 40: remarkable progress. She was spending more time with her sister, mother, children and friends. Her urge to smoke was waning. Indeed smoking was no longer a pleasurable experience. Other, more meaningful, humanizing activities were soul-cleansing. Indeed, Deborah said, “I thought I was happy when I smoked, but the difference is night and day.”

Sometimes you have to take that first difficult step by brute force of will. No one else can do this for you. Counselling and psychotherapy have their place, but ultimately the agent for change comes from within. There are no magic answers, only support, dignity and honour to guide us all. Deborah returns next month for a follow-up visit.

Life continues.