Harnessing the Freedom to Choose Success

There can be no real freedom without the freedom to fail. ~ Erich Fromm

Arms folded in front of her, Jana tried to remain calm in the face of a challenge from her parentsand me.  Joan and Ron, successful professionals who had grown up in the drug scene of the 1970s, were stuck.  They agreed that her diagnosis of abuse of alcohol ought not to be ignored, but did not want to “crimp her style” or lead her into a rebellion which might lead her to drink behind their backs.  “We raised her to feel free to drink and smoke weed when we did, so what kind of message do we give her if we change our tune now?” Jana’s Mom, Joan, a nurse educator, had concerns about her healthif she continued to abuse alcohol: she knew that abuse is a low level diagnosis that can slide into much more serious concerns about potential alcohol addiction, and Jana’s Mom had been alcoholic for much of her growing years.  Joan had been careful personally to avoid drinking too much over decades of flirtingwith overuse of alcohol and marijuana. But it was really Jana’s father, Ron, who was most vocal in his concern about limiting his daughter’s freedom.  “We have raised her to enjoy her personal freedom and we will sound two-faced if we change that now. I am worried she will rebel and may get into even more trouble if we are too strict now.  I am really not sure what to do.”

The family summered at Cape May, a New Jersey resort with many avenues for personal freedoms under boardwalks.  Jana had grown big each summer at the beach house, loved it, and knew all the best bars to have fun after the lifeguards left the beach. She had been through the beer parties when she was 15, the pot parties as she got a bit older, and now, at 23, considered she adult enough to decide what she drank and when. July 4th was typically a huge party on the beach at about 10 PM. Although it was always possible that the police would come by, Jana and friends had become quite clever about keeping a low profile.  The idea that Jana might be asked to curtail her fun over the holiday seemed hard to swallow. “Hey Mom and Dad, you remember what this is like…you had this much freedom and you are ok now…be fair! Let me decide what I do. I am an adult. Remember?” Angerflared and she calmed herself down...she did not want to alienate these folks.

“Dr Coche, don’t you think we need to remove all alcohol from her possession?” Jana asked me matter of fatly, assuming my answer to be “of course.”  But I was not so sure.  Jana deserved the opportunity to work out her own timing in tackling the pesky diagnosis that could become dangerous left unheeded, but was not a clear and present danger.

I turned to Jana. “Can you limit intake this weekend and maintain self-control? “My question was serious and I worried about her answer.

She thought for minutes. . “No...I can self-limit even if I don’t want to…and I would do that rather than be slapped with the insult of being treated like an underage adolescent. I am in my twenties!”  I asked her how she would limit herself. She said easily: “I’’ cut the beer because it is like water for me. If I have tequila with coke, I can nurse it one drink at a time. I can limit myself to one drink in two hours and that will work. “She looked proud of her strategy, turned to her parents and looked to them for agreement.  Joan shot Ron a long glance. It was clear he was struggling, but, when Joan said, “Ok, let’s agree on that strategy this weekend and see how it goes,” Ron looked relieved, turned to me and asked if I thought that was ok.  I did. I wanted Jana to decide her own way to tackle the alcohol abuserather than buckle under with seething anger.

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“You did a good job, all three of you,” I said to the family.  You are granting Jana the freedom to choose her own way to get control, and have provided her with psychotherapyas a tool to understand what the drinking means to her. If Jana’s feels her life is empty or without much meaning then Jana may turn to alcohol to soothe her unhappiness.  We can work with helping her take charge, but, on a deeper level, we can help her tackle her sense of lonelinessand isolation when she does not drink at a party.  I turned to Jana.  “Is that ok with you?  Jana’s relieved smile showed me that granting her the freedom to figure this out was very important to her.

My framework in work with Jana is dually driven by my understandingabout treating addictions and by my training in existential psychotherapy, the world view that it is necessary for each of us to confront the challenges of living in our world with courage. Existential psychotherapy is a philosophical method of therapy that operates on the belief that inner conflict within a person is due to that individual's confrontation with deathfreedomand its attendant responsibility, emotional isolation, and meaninglessness. These four givens, also referred to as ultimate concerns, form the body of existential psychotherapy and compose the framework in which a therapist conceptualizes a client's problem in order to develop a method of treatment. In The Courage to Be, Paul Tillich reminds us that “You must participate in a self in order to know what it is. But by participating you change it. In all existential knowledge both subject and object are transformed by the very act of knowing.”

I granted Jana the power of choice in setting her own course but Jana has a tricky path to follow.   The National Epidemiologic Survey on Alcohol and Related Condition sampled young adults ages 18–24: over three-quarters of young adults ages 21–24 were current drinkers, as were nearly two-thirds of those ages 18–20, despite the fact that the legal drinking age is 21. More than half of young adult men and 40% of the women exceeded the recommended daily drinking limit.  Because drinking more than the recommended per-occasion maximum is likely to impair mental and physical performance, the increase over the past decade in the prevalence among young adults of drinking five or more drinks 12 or more times per year is related to Increased risk of injury for adults 18–24. In summary, drinkers in the United States tend to have the highest level of alcohol consumption in their late teens and early twenties Binge drinking  (i.e., consuming five or more [5+] drinks in a row at least once in the past month) and heavy drinking (i.e., consuming 5+ drinks in a row on at least five occasions in the past month) are highest among young adults ages 18 to 25, peaking at age 21.

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Jana may have to shift her friendships to shift her drinking patterns.  She may have to do other things with her time off than the pleasant abandon of nearby pubs. But if, in the taking control of her drinking she can also find her future life direction, she will be able to reflect on this time as key in her own development to adulthood. And she will have done it alone, without adult force. And that accomplishment establishes her as a competent adult.

To Consider: which young adults do you know who might benefit from taking their own control of their alcohol and drug use? How can parents and professionals help them do this without surrounding their hard earned freedom to choose their own future?

To Read: Paul Tillich. The Courage to Be. . Second Edition. New Haven, Yale University, 2000 (1st ed. 1952).

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Norris Clark