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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Working with drug users

The other day I was talking with someone about psychotherapy matters especially in relation to working with people who use drugs or perhaps teenagers who may engage in antisocial and risky acts. I then got up and drew this picture on the board.



This is how I would rate myself as a therapist on that continuum. Clearly up the permissive end especially when dealing with the clientele I just described. With that clientele it is quite easy to use ego states like Controlling Parent or Critical Parent and using Adult facts to support the Parental statements.

The person I was talking with was working in drug rehab. I made the statement that I never tell drug using clients not to use and this was of some surprise to him. Obviously he does make such statements to his clients. This I think makes me quite a permissive therapist at least with clients like this. I would rarely use Parent ego state statements with such clients. This however creates a dilemma.

The reason why I would never tell a drug user not to use or make statements about why drug use is bad is because you quickly loose the client. They will quickly slip into the Child ego state and either stop coming, attend sessions but don’t tell you what they have been taking or take more drugs because they have moved into a rebellious position against you.



On the other hand I am tacitly giving them permission to use drugs and thus supporting their drug use in that way. Through the transference the client will introject me to varying degrees into their Parent ego state. If I am not saying, “Don’t do drugs” then they are not introjecting that so their Parental tape of me is in one way supporting their drug use.

So it seems we have the good and the bad. Obviously I see it as more important not to ‘loose’ the client as I described before, versus providing a Parent tape that is clearly against drug use being introjected into their Parent ego state.



On a side note:

As I looked at the diagram I drew I realised that if I was to rate my parents in this way on how they dealt with me in childhood and adolescence I would put them in almost the exact same position.

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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.

--------------------------

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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Functional drug use

I have written before about the footballer Ben Cousins in the post, Drug use and prohibition. He has done a biographical documentary type of thing which gives some good insight into a particular type of drug use and the psychological dynamics behind it. He refers to himself as a functional drug addict.

The term drug addict is an nebulous term that is used in a wide variety of ways. Functional drug addict, usually refers to a person who can use recreational drugs regularly, in significant quantities and still maintain their life style, in particular their work life, in a functional way. The drugs do not debilitate the person in the place of work in any significant way.

This is a bit of a contradiction in terms because the term addict often means a person whom is consumed by their drug use. The person who wakes up in the morning and the first thing they think of is how are going to get their next hit. And if they manage to find some drugs then they take it. That means they will take it before going to work or even in the work place. This will effect their performance in the work place and thus they cannot remain functional in this way as sooner or later this will be noticed and they will be ‘sacked’ from the job or at least their performance on the job will be significantly reduced.




Ben Cousins functioned at a very high level in the workplace (the football field) over a long period of time. He was amongst the best of the best in that occupation. He states in his biopic that he never took drugs on game day or the day before game day. This must have been true most of the time because any drug use would quickly reduce his level of performance at such an elite sporting level.

So he is not a drug addict in the usual sense of the word. Just go and meet a few such addicts and one quickly sees they are physically wrecked. The drugs quickly take their toll on the physique. There is no way a drug addict can function at an elite physical level. They can’t even function at a moderate physical level. They would struggle to run around a football field a couple of times let alone run a marathon every game of football they play.

The other thing about him which he states in his biopic and has been reported by others on many occasions is his work ethic. It was unparalleled. He would train longer and harder than all other footballers and thus his fitness was at the highest level amongst a group of very fit men. This is where the psychology behind his drug use starts to become apparent.



To train in such a way means he has a driven quality that others do not have. He can deprive his Child ego state more than most others. When others are exhausted and stop he keeps going. To do that he must have a very large internal critic inside his head. It pushes his Child ego state relentlessly and thus he has that driven quality about him such that he can keep training when others can’t.

The problem with such a psychological structure is it can’t continue on for too long without some symptom developing. The Child ego state is being deprived of pleasant feelings and comfort such that sooner or later some symptom will develop and thus we have the psychological basis of such drug use. He even says this, that the drugs were his reward after training so hard. The good feelings provided by the drugs were the relief for his Child ego state. After training so hard he allowed himself to party and thus he could continue on psychologically. The Child aspect of the personality felt looked after and thus the sense of deprivation subsided. In this way he would be described as a symptomatic drug user rather than a drug dependent user. The drugs solved the problem of physical and psychological deprivation.



If he had not found the drugs worked then some other symptom would have developed. This applies for any person who is highly driven in any kind of workplace. It cannot continue on for any length of time with out something happening. If the drugs or alcohol did not work for him he could have developed depression or had panic attacks which is the Child ego state stating that it can no longer handle the deprivation. It is the Child ego state putting up its hand and saying, “Hello!! I am still here, take notice of me” as indeed any child will do when it is being ignored. If it cannot get noticed for being good it will start doing bad behaviour to get noticed.

This type of drug user does not have the ability to self regulate. As shown in the diagram the Critical Parent ego state is so dominant in the personality the Child ego state is overwhelmed and its needs are lost under a tsunami of parental directives from the CP.

Thus the treatment strategy for this type of drug user is clear. Reduce the CP allowing the Child ego state to gets its needs met, then the desire for the drugs looses its importance, or the depression lifts or panic attacks subside. The person learns how to listen to their Child ego state thus allowing them to self regulate.

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Drug use and prohibition

At last Ben Cousins can take as many drugs as he likes. The David Beckham of Australian Rules Football has spent the last 5 years being the bad boy of football. The governing body, the AFL have been drug testing him almost every week for recreational drugs. Never tested positive but he has been banned from playing on a number of occasions for a variety of misdemeanours off the field in a highly publicised way.

However the AFL holds the sword of damocles above all players. If they take recreational drugs and test positive they risk loosing their income and right to play football in that league. Ben Cousins retires in two weeks and thus the sword of damocles disappears and he can take as many drugs as he likes. And you know what, he now has the chance to really deal with the drug issues he has. This raises the issue of the difference between externally driven prohibitions and internal choices in the want to use drugs.

The problem if you have an external force whether that be a spouse, a parent or the AFL, pressuring you to stop using then it does not allow you to make your own decisions. Or at least it makes it harder to make your own decisions as this diagram shows.



If an outside person or organisation gives the directive “Don’t use” (particularly if they are using some kind of punishment like loss of income) then the user is pressured to respond from an AC (Adapted Child ego state) position. They can adapt to the directive in two different ways. They can either conform and don’t use or rebel and the use simply goes under ground and they try and outsmart the detection system.

The problem with both of these responses is neither is about what the user wants. The external prohibitor makes it much harder for the user to find out what they actually want. That comes from the Free Child aspect of the personality and it is here that one gets the possibility of the user deciding that drugs are not for him or he uses recreationally or he is OK with his current drug use. The decision comes from inside the psyche of the drug user and not as a reaction to some outside pressure.

Now the AFL can no longer pressure Ben Cousins about his drug use, he is much more likely to be able to find out what he actually wants in relation to using drugs. And that is his decision.



As I mentioned before, with pressure from out side the person can continue using by rebelling against the pressure and the use simply goes under ground. This is why drug counsellors need to be careful not to present themselves as an outside pressure because the client will simply stop telling the truth about their drug use. Then the counselling starts to flounder.

Others respond to the outside pressure by conforming and do stop using. But this is fragile because the use depends on the other remaining present. In this sense the person becomes addicted to the outside force which at times can be something like a religion. If the person drifts away from the ‘force’ then the risk of using significantly increases and thus we have the new “addiction”.



Having said this sometimes this approach can work in the longer term with AA being an example. In the initial stages the person becomes addicted to AA, the sponsors and uses them to stop drinking by responding from a conforming position to the ‘pressure’. If the conforming non use can persist for a long time then the person can construct quite a solid non drinking type of life style. Such a person is less likely to fall off the wagon because their whole life style and family are structured to ‘pressure’ them not to drink. And some remain sober for the rest of their lives. A good result indeed.

However in my view, by and large it is better for the user to be given the opportunity to take a look at self with no outside pressure. Then they can begin to decide what they want out of life and one is more likely to get longer term change in their drug using patterns. Again it is their decision.

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Drug use and suicide

In the previous post it was suggested that what has been called a gambling addiction may not an addiction. It certainly is different from what would be called a drug addiction. Whilst in the act of gambling the personality is not transformed like it is with taking drugs. With drugs the Parent and Adult ego states are rendered null and void which could be seen to constitute a major personality change. With gambling this does not happen.

Instead repetitive gambling could be seen as more as what is known as the defence mechanism of regression. The person responds to stress by engaging in behaviour where they end up in a child like position such that someone else has to take over for them to cope. Whilst this happens with some drug takers there are those where it does not happen for instance with many recreational users and what are known as functional alcoholics.


The point at hand here questions the definition of addiction. Those people who feel a compulsion to engage in a piece of behaviour that they find very hard to resist. With some discussion it becomes apparent that there are many differing reasons why that compulsion may exist. This would seem to be important to articulate because the way of treating such an addiction could vary considerably than if they are all assumed to be of a similar nature. As mentioned above if this thing that have been called a “gambling addiction” is actually more of a defence mechanism than an addiction how one deals with it will vary. Another example of this is described below.

There are a group of people who use drugs, some of them in a habitual and addictive way that are different and separate from the mainstream type of drug addict. Drug use in this group is more of a suicide attempt than drug use in the usual sense of the word.


The suicidal person has made one of seven suicide decisions:

If you don’t change I will kill myself
If things get too bad I will kill myself
I will show you even if it kills me
I will get you to kill me
I will kill myself by accident
I will almost die (over and over) to get you to love me
I will kill myself to hurt you

To summarise, some people have the ability to be able to take their own life if things get too bad or to hit back at someone and so forth. These people can imagine killing self, they have it in their behavioural repertoire to do such a thing.

For example
If you don’t change I will kill myself
If things get too bad I will kill myself
I will kill myself to hurt you

Some people do not have that. They cannot conceptualise of planning a suicide attempt, obtaining the items necessary and going through by acting out the plan. It is simply something beyond their imagination. However these people may still have made the suicide decision and thus they need to achieve it some other way.

For example
I will get you to kill me

These suicidal people can get others to kill them such as ‘Death by cop’ where the person behaves in such a threatening way to the police that they shoot him dead. They can voluntarily enter into a war zone and behave in such a way that the enemy kills them, or they can behave in such a way in a country that has the death penalty where the state kills them. The suicidal act is carried out by someone else.



Or there is another decision:
I will kill myself by accident

This person engages repetitively and voluntarily in high risk behaviour. This is where the line between accident and suicide gets blurry.


Some behaviour is a bit of both, an accident and a suicide and you can’t clearly distinguish between the two. This can include dangerous sports, driving cars at high speed (Peter Brock), working with dangerous animals (Steve Irwin), working in high risk occupations and also dangerous drug taking.

The type of drug taken and the method of ingestion can vary enormously. Smoking marijuana is quite safe compared to injecting heroin which is much more dangerous. If the person has had a few over doses where they were getting closer to the point of death then one could begin to diagnose that the drug taking has a suicidal motive underlying it. Alternatively one can do a life script analysis and ascertain if such a suicide decision exists in the person’s psyche.

If this is the case then there are significant treatment implications. Why would one work with a drug user to identifying the triggers for use, do motivational interviewing or work on relapse prevention with some one who could easily die a month or two latter by and ‘accidental suicide’ in a car accident.

In these circumstances they are suicidal first and a drug taker second and ones treatment plan would need to reflect this.

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Drug use and regression

Regression historically has been seen as a defence mechanism. It involves the person reverting to an earlier state or mode of functioning. This is done because in the here and now the person is experiencing anxiety for some reason. In order to deal with that anxiety the person ‘escapes’ by regressing and becoming child like.

For instance if the person is involved in some kind of conflict, the person is being approached sexually, or the person is required to look after a child or become responsible for some reason. If these situations result in the person feeling anxious they can deal with their anxiety by ‘running away’ and becoming child like. Once done they don’t have to deal with the here and now situation and the anxiety is avoided.

Usually the stage to which the person regresses is determined by a fixation point. As we grow through our developmental stages we usually have trouble at some of them and thus don’t completely resolve them. These are then seen as fixation points so when the person regresses they will regress to the stage at which they are fixated. That maybe 3 years old for some or 8 years old for another.

Every person is capable of regression, but some are more liable than others. There are many ways to regress. Those with significant fixations can regress spontaneously as in the situations described above. The more pressure and stress applied to a person the more likely they are to regress.

As I have written before

The mechanism of regression is supported by research in neuro-psychology as cited by Johnston (2009). When people are placed under stress they are less able to access the pre-frontal cortex of the brain which is associated with the more developed functions like problem solving, decision making and stress management (Adult ego state). Instead people tend to access the more primitive part of the brain in the amygdala (Child ego state).

In psychotherapy sometimes regressive techniques such as two chair are used. Indeed the therapeutic relationship in itself will pressure the client to regress and become more child like in the relationship with the therapist.

However one of the more efficient ways to regress is to consume alcohol and drugs. When done this situation evolves.


Firstly the alcohol will diminish the Parent ego state and the person becomes disinhibited. The Parent ego state makes us behave in socially appropriate ways and thus people can become aggressive when drinking because their prohibitions against physically hitting out are diminished.

This is also the reason why some men like their female ‘dates’ to drink alcohol because they know it will lower the woman’s own internal prohibitions about sexual behaviour.



With more consumption of the drug the Adult ego state is then decathected such that one is only left with the Child ego state and the regression is complete. Thus we have the link between drug use and the mechanism of regression. It seems reasonable to conclude that some drug users may have this motivation in their substance use. They are unconsciously motivated to regress.

If this is the case then there are treatment implications. As mentioned before the person will regress to that stage of development where they are fixated. Their normal psychological development for some reason got stuck at a particular stage and thus the Free Child seeks to return to that stage in the hope that somehow it will be resolved this time around.

The chronic alcohol user is often fixated at the oral stage of development which would require some kind of therapeutic resolution of the fixation there. That is to work through the developmental issues relevant to that stage with the therapist. If the person is using drugs for the need to regress then one would not expect the usual behavioural techniques to be all that effective.



The thing about regression is that it is a running away or an escape from the here and now. Like the scared young child who simply closes her eyes and puts her hands over their ears as a way to deal with stress. In this sense regression as a defence mechanism is a very child like solution. Compared with intellectualisation which is sort of a more grown up reaction or other defence mechanisms where the Adult and Parent ego states do not disappear.

Of course a person who is regressed will attract others who will take on the parental role in a relationship with them. Thus we end up with people who are called enablers, co dependants and so forth. Of course they will say they want to husband to stop drinking, being child like and irresponsible but the other side of the wife does not.

With regression and drug counselling

Adult and Parent ego state development
Working through the fixation in the therapeutic relationship with the therapist
Altering relationships which encourage the regressive behaviour

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