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I am a cancer survivor and just completed my M.A. in mental health counseling in December 2012. By chance, I interviewed to do my internship at a residential treatment facility for individuals who are mandated by the courts to seek treatment for their drug or alcohol addictions. Most of my clients have several felonies and misdemeanors due to their addiction. My original thought was that if I could work with addicts, I would be able to counsel almost any kind of client. Little did I know how much in common I would have with my clients.
In December 2010, I was diagnosed with advanced endometrial cancer. At the time, my doctor gave me a poor prognosis and told me not to expect to live for long. I had surgery, did standard chemotherapy treatment for six months and then went into remission for another 10 months. The cancer came back in April 2012. I have been in treatment ever since.
What kept me going was finishing my degree and doing my internship. When I first started working in the residential treatment facility, my supervisor had me observe various groups. Two weeks later, I was running three groups: one on parenting, another on recovery awareness and a third therapeutic group called “Thinking for a Change.”
I had never run any groups before but quickly realized that the clients were anxious to share their stories and express their opinions. One group in particular, “Thinking for a Change,” follows a strict curriculum. Often, one or two clients want to dominate the conversation. Others talk about subjects unrelated to the curriculum. I need to intervene to give other group members a chance to speak, to redirect the conversation or to provide therapeutic feedback.
“Thinking for a Change” is a cognitive behavioral program developed by the federal government. Its objective is to help clients change their criminal thinking and behavior so they won’t end up in the criminal justice system as a result of their addictions. Clients learn to use a “thinking report,” in which they describe a particular situation, their thoughts and feelings, and their attitudes and beliefs about the situation. By changing their thoughts and feelings about a particular situation, clients find out they can turn negative outcomes into positive ones. To be successful, clients must literally change their lifestyle and even their personality. Part of an addict’s treatment is to find new housing, new friends and a sponsor from Alcoholics Anonymous.
What could I possibly have in common with my clients, and what could I learn from them? First of all, I learned to live one day at a time. People with addictions know that tomorrow may never come. The same is true for me. I don’t know when my treatments will stop working and when I will have to go into hospice. I try to make the most of each day. One can make plans for the future. Often, such plans do not come to fruition.
At the end of every group, we always say the Serenity Prayer: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and the wisdom to know the difference.”
Before I had cancer, I was a Type A personality and was always in a whirlwind of activity. I didn’t know how to set boundaries. I let other people tell me how to run my life. I tolerated people I didn’t even like.
Clients with addictions must change “people, places and things.” They are encouraged to throw away their old cell phones, which contain the names of drug dealers and using friends. Contact with such people almost always leads to using the drug again. Drugs are everywhere, in both poor and wealthy neighborhoods. Addicts often need to change their addresses and move into new neighborhoods. Some move across town or even to a new city. They learn to recognize the triggers that could lead them to use again, such as too much stress and boredom. Boredom is one of the biggest triggers because these clients often don’t have enough to keep them busy, such as a job.
I haven’t changed “places” and “things” in my life, but I certainly have changed “people.” Stress is not good for me because too much of it might weaken my immune system. Certain people from my past have been toxic. I have deleted their numbers from my cell phone. If I see their number on my phone, I don’t answer. Making the decision not to see such people has made my life more calm and peaceful. I am a happier person.
At the residential treatment center, possessing religious or spiritual belief is very important for recovery. Many clients come to treatment with no religious affiliation at all but leave with some kind of spiritual belief. I don’t believe a person battling addiction can make a full recovery without a spiritual orientation.
All my life, I have struggled with my religious beliefs. I have never been baptized but have attended a Methodist church for over 20 years. Previously, when I had a problem I could not solve, I would go to church to pray. When I was first diagnosed with cancer, I was mad at God. “Why me?” I asked. Neither the Orthodox Jewish rabbi nor the Presbyterian minister had an answer for me when I first asked this question during my stay in the hospital. Even the doctors could not provide me with an answer. But saying the serenity prayer after every group helped to enrich my spiritual life. I do not attend church every Sunday, but I do rely on prayer in times of need.
Unfortunately, many people with addictions return to their former lives right after treatment — the same “places, people and things” — especially because they don’t have many non-using friends or family members. In other cases, family members and friends have given up on the client. The recovering addict needs support from family and friends. He or she also requires good medical care, therapeutic follow-up, an exercise plan, a daily schedule, a job, hobbies and so on. Treatment does not end when the addict leaves the residential facility. It is just beginning. I know that my clients who have support from family and friends and decent medical care have a better chance to abstain from drugs.
Caring for cancer patients properly is expensive. They need an integrative approach, which includes medical treatment, individual and family counseling, an exercise plan, nutritional advice and even career planning. Treatment does not end when the cancer patient goes into remission. It is ongoing. Many cancer patients experience other side effects from chemotherapy and radiation, such as osteoporosis, neuropathy, heart problems, depression and anxiety.
Most people with addictions also have serious medical problems, including hepatitis C, malnutrition, chronic pain, arthritis, asthma, depression, anxiety or other conditions. As a group, people with addictions are very unhealthy. During treatment, most of them rely on coffee and cigarettes to keep going. Not only does a counselor provide individual counseling but also tries to ensure that the client will have suitable medical, family and social networks when he or she leaves residential treatment. Often, the clients’ friends and family have deserted them, and they find themselves all alone in the world. Without outside support, they will often find their way back to old people, places and drugs.
Studies have shown that people who have had heart attacks and have strong family and social networks recover more quickly and live longer. I am convinced that the same is true for cancer patients. Social networks give people hope and a reason to survive. Without the support of my family and friends, I would probably not be here.
Last of all, death is something that both cancer patients and clients with addiction face on a daily basis. “Can I have just one more drink?” the addict asks. The answer, of course, is “no.” The cancer patient never knows when his or her illness will recur or whether another treatment will be available to kill malignant cells. In any case, both cancer and addiction end lives. The disease takes over. Doctors and family members stand by helplessly as they watch the patient slip away into a deep, eternal sleep.
I am passionate about my clients. They don’t know that I have cancer. They have no idea that my private life is not so different from theirs. Will I be here tomorrow, a month from now or next year? My clients have taught me to live just for today, to set my boundaries and to rid myself of unhealthy relationships. I am grateful for my family and friends, who have supported me through my two-and-a-half-year struggle with cancer.
The treatment of both clients with addictions and cancer patients is expensive. It includes the knowledge and professional experience of doctors, nurses, counselors, psychiatrists, physical therapists, nutritionists and more. People with addictions go to Alcoholics Anonymous for support. Family members find consolation in Al-anon and therapeutic groups. Addiction affects the entire family and community. A diagnosis of cancer is devastating for family members and close friends. Family members often need some kind of therapy to deal with the nature of the illness. When the addict or cancer patient finishes initial treatment, he or she will need continuing services over the course of a lifetime. Neither the addict nor the cancer patient can recover without the help of professionals, family and friends. By accident, I found a population for which I am passionate. I understand them because, actually, I am walking in similar shoes. I just have a different diagnosis.
Susan Brachna graduated with a counseling degree from John Carroll University in Cleveland and acquired her PC license in March.
As ACA members reflect on the recent acquittal of George Zimmerman in the fatal shooting of 17-year old Trayvon Martin, it is important to realize that – no matter what each of us might think about the outcome of the trial – this case has serious implications for the counseling profession. Specifically, the political climate that has surrounded the case reflects the current state of affairs in the U. S., one steeped in polarization and toxicity.
