That’s My Disease Talking: A New Spin on an Old Saying

Last updated on November 4th, 2019

  • "That’s my disease talking”
  • Case Study: Brad

“That’s my disease talking”

A phrase meant to dismiss cravings and rationalizations as irrational, dangerous thinking, can be helpful at times. Such as when substance users in recovery invoke it to remind themselves that a thought is driven by an urge they would ultimately rather not follow. In principle, however, when used in treatment, it can be a dangerous concept.

That “disease” (a word I would rather not use to describe addictive disorders) does indeed talk, and what it says is important to hear. It should not be silenced nor dismissed. It speaks in the voice of need, often in the voice of pain, sometimes in the voice of trauma, sometimes in numbness and boredom, sometimes in panic or grief over the possibility of losing the substance which has been the most reliable soother and friend.

Silencing that voice will not make it go away. It will not make it give up. Silencing that voice will make it go underground…-Debra RothschildSilencing that voice will not make it go away. It will not make it give up. Silencing that voice will make it go underground, make it stop speaking in a way that can be heard and confronted. It will emerge in ways more damaging – in sudden, unexplained relapses or in bodily aches, terrors, tears. Or maybe in a new attempt to soothe, such as an eating disorder, compulsive unsafe sex, eruptions of anger.

How can we listen to that voice, yet still remain safe from following its demand? By exploring it and inviting it into the safety of a therapist’s office.

When my patients are at home or at a social event, if the phrase helps them remember the consequences of using, I encourage them to listen and move on. But, when somebody says that to me during a therapy session, my response is, “Good. Let’s hear what that voice has to say.” If we can allow that voice to speak during therapy when we are working together toward sobriety or safe use, we can anticipate it and prepare in advance. More importantly, we can hear what it communicates and find other safer ways to meet the need it expresses.

Case Study: Brad

Brad had been in therapy with me for several months, struggling with his use of cocaine and alcohol. He was baffled that he continued to have occasional weekend binges when he knew he always regretted it and his work and health always suffered after the binge. When I tried to explore what led up to using, he never quite knew. It seemed to be a sudden impulse he could not understand or control.

One day, we were talking about his upcoming weekend, making plans that would help him not use, and I stopped him. I asked him to be very quiet and focus inward. After a few relaxing breaths I asked him to, “Just listen inside and see if there is any quiet voice of dissent.” He did it and got frightened.

He said, “Yeah, part of me doesn’t want to do that. There’s this urge to get really f*’d up and go out with the guys. But I know where that will lead and I don’t want to listen to that. Can’t we just make that voice go away already?”

We can’t make it go away. I want to hear it. I don’t want you to obey it, but I want us to listen. I want us to know why going out with the guys is so preferable. I want to know what that part wants.-Debra Rothschild

“No,” I said. “We can’t make it go away. I want to hear it. I don’t want you to obey it, but I want us to listen. I want us to know why going out with the guys is so preferable. I want to know what that part wants. I want to give it something so it stops wanting so much.”

We then got into a deep and very moving exploration of Brad’s young years when his father died and his mother got depressed and he had nobody to talk to about what he was feeling. He withdrew from his classmates and started doing poorly in school. Brad moved into adolescence without friends and having lost the ability to make them. He felt damaged and wrong. Drinking and drugging was the first way he found to feel accepted and belong again to a group.

Understanding this was a great relief. He had told the story many times, but never put words on his feelings like that before. It wasn’t a miracle cure, but it helped a lot. Now, when Brad wanted to use, he didn’t say, “That’s my disease talking, I’ll ignore it.” He knew if he was feeling lonely or uncomfortable and he found things to do to help those specific feelings get better. His urges to use became less mystifying and then diminished.

The Whole Client
Clients who come to us for help with their substance use, whether mandated or voluntary, are usually ambivalent. Misusing can cause problems in living, but using can feel necessary or good. We therapists, along with the part of the client who comes seeking help, see substance overuse as dangerous and harmful. It is easy therefore, to collude with our client to keep the other part, the part that benefits from using, out of the room and to label it bad and unwanted.

The result is that the part of the client most in need of soothing and help from the treatment is excluded from it. It also often results in failed treatments. If that part is not allowed to speak, it will act to make itself known, and our client is at risk for feeling ashamed again.

Therapists may feel “lied to” or fooled when clients don’t follow the plans that they made, and clients feel like a failure. Encouraging the aspects of the person that want to use to speak up in therapy can help mitigate this and facilitate growth and success.

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