Meaning of Life Group – a Group Application of Logotherapy for Substance Use Treatment.

 

Article Citation:

Somov, P.G. (2007). 
Meaning of Life Group: Group Application of Logotherapy for Substance Use Treatment. 
Journal for Specialists in Group Work, 32 (4), 316 - 345.

Abstract

The rationale for the use of logotherapy in the context of substance use treatment is introduced. The article reviews prior group applications of logotherapy and offers a clinical curriculum for a group application of logotherapy tailored to the substance use treatment context. Furthermore, the article provides a discussion of the specifics of the group format and role induction to the “Meaning of Life” group, as well as a detailed discussion of eight themes that constitute the proposed logotherapeutic group intervention for substance use population.

Key words: logotherapy, addiction, group therapy, substance use

Meaning of Life Group – a Group Application of Logotherapy for Substance Use Treatment

Logotherapy, a meaning-oriented therapy developed by Victor Frankl ( 1955 ) as an individual therapy modality is, in its pure form, a comparatively rare therapy of choice in contemporary clinical practice. Logotherapy as a group modality is even more rare.

Joseph Fabry (1988), in his book Guideposts of Meaning: Discovering What Really Matters , suggests that despite its fundamentally personal nature logotherapy is, in fact, suitable for a group format. A few “sharing” groups have been developed and described by logotherapists over time. Fabry’s own “Finding Meaning Every Day” group protocol is a better known group application of logotherapy and is designed to provide clients “with tools for restructuring their lives in ways that are meaningful to them, so that their daily behavior more nearly expresses their values” (1988, p. 123).

While logotherapy authors such as Lukas (1979) and Crumbaugh (1979) wrote about the application of logotherapy to substance use treatment, a structured logotherapy group that is thematically tailored for the substance use treatment setting, has not, to the knowledge of this author, been proposed until Somov and Somova (2003). The present article introduces the Meaning of Life group protocol as a motivation-enhancing and relapse-prevention application of logotherapy for substance use treatment.

Rationale for Using Logotherapy in the Context of Substance Use Treatment

In delineating the scope and goals of logotherapy, Frankl (1955) juxtaposed it with psychoanalysis by defining it as “existential analysis” that “seeks to bring to awareness the concepts of the mind,” in the goal of helping the client “toward the consciousness of responsibility” as “being responsible is one of the essential grounds of human existence” (1955, p. 29). Existential review, search for meaning, and assuming responsibility are pivotal to the substance use recovery arc. Recovery, in itself, is not a goal, but a means to a goal, a means to facilitating a meaningful life. Consequently, the Meaning of Life Group is an attempt to help clients place their substance use in the existential context. Lukas (1979) notes that upon completion of treatment, substance use clients are likely to “ask themselves if there was any sense of their being cured and what they will do with the life that was restored to them” (p. 263). Indeed, a person coming out of an otherwise successful rehabilitation may ask of him or herself, “Ok, so I got clean… Now what?!” Leaving this question unanswered seems to be an invitation to relapse. While incentive-based motivations can help a client initiate a change, a meaning-based motivation may assure the maintenance of clinical gains. Consequently, clients are invited to start the recovery process by taking a look beyond the recovery, beyond the myopia of “getting back on track,” towards the destination of the life-track. This is accomplished by priming clients’ consciousness with the “meaning of life” questions, i.e. existential and philosophical questions that allow clients to broaden their motivational search from short-lived, tactical, and often cliché motivations to person-specific, meaning-centered motivations that serve as a buffer against the turbulence of change.

Logotherapy can help normalize the angst of recovery as a normal existential “vital sign.” When clients are asked to ponder the interplay between meaninglessness (the all too familiar feelings of emptiness) and substance use, they are offered a normalizing, de-pathologized perspective on substance use as an escape from meaninglessness and a legitimate albeit sub-optimal form of trying to resolve noogenic neurosis or noogenic depression (Frankl, 1978). As such, the Meaning of Life Group introduces validating existential language into motivational enhancement that frees the client from the paralysis of self-deprecating guilt and refocuses the client on regaining meaning through recovery.

The Meaning of Life group protocol attempts to awaken the philosopher inside a given client, providing a substance use client with an opportunity to strategically zoom out, to reset his or her existential compass, to place both substance abuse/misuse and recovery in the trajectory of one’s life journey, to resuscitate the anesthetized and deadened will-to-meaning in the hope of giving recovery more than tactical importance. As such, logotherapy in the context of substance use treatment not only facilitates motivation for change but also serves as an important lapse/relapse prevention factor. There is more to life than recovery. Recovery is but a means to an end, not an end in and of itself. Clients for whom recovery becomes an end in and of itself are at added risk for relapse should they lapse in the first place. And, indeed, if being in recovery has become a defining part of one’s narrative, if recovery has become an end in and of itself, catastrophizing interpretations of a lapse (as an end of everything that matters) are inevitable, and so is a relapse.

This can be best understood in terms of Linville’s (1985) research on self-complexity. Linville (1985) suggests that narrowly defined self-concepts are less stable than self-concepts that consist of multiple roles that are well differentiated from each other. Metaphorically, stable self-concepts are like submarines that are buffered from sinking by the fact that they consist of multiple hermetically separated compartments which isolate a leak in a given compartment from the rest of the submarine, allowing even a damaged, leaking submarine to remain afloat. A person in recovery whose life consists of multiple well-differentiated meanings, for whom recovery is but one of several means to a particular life-goal, would appear to be better buffered from stress and psychological “sinking” than a person in recovery who has turned recovery into a life-long cause and found a life’s meaning in staying “clean.” Life-long recovery-oriented socialization, life-long self-definition as an “addict” or as always “recovering” or through “years clean,” or excessive enmeshment of recovery and spirituality, run the risk of a single-track self-concept with recovery turned into a life’s meaning. When the treatment goal of recovery becomes a life goal, little leaks (lapses) become gushing catastrophic floods (re-lapses). Consequently, logotherapy, in addition to priming and enhancing motivation for change, can be invaluable in relapse prevention by helping substance use clients not substitute a narrow self-concept of an “addict” with a similarly narrow self-concept of being “a recovering addict.”

Meaning of Life Group Format

The Meaning of Life Group is a professionally-facilitated, secular, content-based, structured group that raises questions, facilitates a non-judgmental discussion of various issues of existential significance, and involves various experiential exercises. While the content is philosophical in nature, intellectualizing is discouraged. Facilitators follow the method of Socratic inquiry, a discourse method of preference in logotherapy, the goal of which is not “to pour information into the students, but rather to elicit from the students what they already know intuitively” (Fabry, 1988, p. 9). In this process, facilitators are encouraged to remain attuned to what Fabry referred to as “logohints,” or phrases, facial expressions, intonations that indicate “what is meaningful to the seeker,” clues to clients’ “positive attitudes and values” (1988, p. 12). Furthermore, facilitators do not educate but facilitate clients’ self-discovery; facilitators do not provide meaning but point out “meaning possibilities” (Fabry et al, 1979, p. 265). As noted by Lukas (1979), the final responsibility for the found meanings and their implications rests with the clients.

Facilitators remain mindful of the natural interplay between meaning and spirituality, but avoid direct discussion of religious topics, redirect clients’ from direct questioning of fellow group members’ religious pronouncements and defer direct discussions of religious beliefs to more appropriate non-secular forums. The facilitators, of course, avoid imposing their values or endorsing others’ values with the emphasis of the group being on raising the questions, rather than on answering them. Facilitators explicitly recognize and help clients recognize that while there might be the question, there isn’t always the answer.

Client Role Induction/Group Rules

At the outset of the group, the facilitator delineates the following parameters and group rules: a) Meaning of Life group is an opportunity to discuss the meaning of life and how it relates to substance use and recovery; b) group members will express opinions and avoid imposing or “pitching” their beliefs to others; c) group members will attempt to remain open to exploration of the life implications of the opinions they express; d) specific religious questions or religious opinions are best reserved for spiritual counseling and are not appropriate for this forum; e) group members will exercise respect and tact in relating to each other; f) no self-disclosure is required to participate, silence is accepted. The facilitator explicitly positions him or herself as a person with questions, not answers.

The Eight Theme Curriculum

Frankl (1955), discussing the scope of logotherapy as existential analysis, emphasizes the exploration of meaning of life, meaning of death, meaning of suffering, meaning of work, and meaning of love. The following are eight discussion themes that structure the curriculum of the Meaning of Life group:

Theme 1: Meaning of Meaninglessness

Theme 2: Meaning of Adversity

Theme 3: Meaning of Self

Theme 4: Meaning of Presence

Theme 5: Meaning of Death

Theme 6: Meaning of Freedom

Theme 7: Meaning of Substance Use

Theme 8: Meaning of Transition

The reader should be aware that the theme content presented in this article differs from the original Meaning of Life group theme curriculum, as described in The Recovery Equation: Motivational Enhancement, Choice Awareness, Use Prevention, an Innovative Clinical Curriculum for Substance Use Treatment” (Somov & Somova, 2003). The original Meaning of Life group did not include the discussion of the meaning of freedom as this topic was addressed through a stand-alone Choice Awareness Training treatment module.

Theme 1 – Role Induction and the Meaning of Meaninglessness

The first session pursues three tasks: to provide role induction for the group, to normalize meaninglessness, and to facilitate positive expectations regarding the relevance of the group to clients’ recovery efforts. The role induction into the Meaning of Life group begins with a description of the rationale for the group and the presentation of the group rules. The five core existential questions may be briefly presented to stimulate interest and engagement. The other key ideas at this point are as follows: a) search for meaning aids in search for motivation for recovery, b) recovery, while a treatment goal, is not a life goal per se, recovery is a means to end, not an end in and of itself, c) substance use is normalized and humanized as an understandable but problematic search for meaning, for some, and, for others, as an understandable, albeit problematic, form of coping with meaninglessness. In presenting the rationale and the ideas above, the facilitators model a contemplative, non-judgmental atmosphere, and reinforce the idea that philosophizing, i.e. thinking about meaning of life, is not a luxury but a necessity.

To further set the mood for the group, group members might be asked to recall times when they gazed at the stars. In eliciting clients’ accounts, star-gazing, as an experience, is recognized as an attempt to somehow integrate one’s life with the seductively overwhelming universe outside, as a moment of self-transcendence. Clients are also asked to recall if after an episode of star-gazing, they felt an inspired, motivated eagerness to change, to somehow bring their life in order with their realizations. Star-gazing can be also offered as a metaphor of navigation or finding the way for those who might feel lost or without direction. The answers to the meaning-of-life questions presented in this group can be metaphorically likened to constellations of meaning that help clients navigate towards their life-goals and, at times of confusion, to re-assess their existential coordinates.

A key task of the first session is to normalize clients’ sense of meaninglessness. While facilitators are encouraged to normalize meaninglessness throughout this intervention, the first session aims to explicitly de-pathologize clients’ possible feelings of emptiness and meaninglessness. The search for meaning is recognized as work in progress, as a kind of existential hypothesis-testing in which people try out different models of meaning in search of the best existential fit. Consequently, lack of meaning, lack of answers to life’s fundamental questions is hardly evidence of a deficit of wisdom but, if anything, a reflection of the complexity of questions posed.

Theme 2 – Meaning of Adversity: What is the meaning of pain and suffering?

Frequently, admission to substance use treatment is precipitated by adversity. Making sense of adversity, therefore, taps into the most immediate phenomenology of a person in treatment and serves as an emotionally validating, meaning-finding and motivation enhancing opportunity. Making sense of random adversity and adversity that resulted from clients’ failures can help clients see that their suffering had not been all in vein. In the words of Elizabeth Lukas, a logotherapeutic approach allows “failures become retrospectively filled with meaning” (Fabry et al, 1979).

Coping versus Meaning Focused Suffering. Coping is designed to reduce suffering. Coping literature distinguishes two approaches to reducing suffering: problem focused and emotion focused coping (Folkman, 1984). Problem focused coping reduces suffering through behavioral problem-solving. Emotion focused coping aims to reduce suffering by controlling and suppressing the corresponding negative emotionality.

Both problem focused and emotion focused coping strategies represent an attempt to solve a problem, either through a behavioral or attitudinal solution. In achieving that both of these coping approaches appear tactical and neglect the bigger picture, that of the existential meaning of having a problem in the first place. Meaning focused suffering, while akin to coping, does not automatically view a given problem as a problem; instead, meaning focused suffering attempts to place a given problematic event or occurrence that had resulted in suffering in a broader existential context. Depending on a person’s particular existential interpretation of meaning, a person may reject the idea of suffering as a problem altogether and see the fact of a problem not as a problem per se but as a “vital sign” of life or a consequence of his or her freely made choice. Consequently, meaning focused suffering does not replace problem-solving (or solution focused) coping but compliments it by viewing suffering as an opportunity to manifest attitudinal values.

Facilitating Meaning Focused Suffering. In developing the Meaning of Suffering theme, the facilitators may briefly introduce the distinction between problem focused and emotion focused coping, as a prelude to a discussion of the meaning focused suffering. Following this, facilitators open discussion with a question along the lines of: “What do you think is the meaning of suffering, pain, adversity, hard times?” The discussion may result in a variety of meaning-focused interpretations of suffering. The following is a summary of common existential interpretations of suffering.

Adversity as Contrast:

Pain and suffering create contrast for happiness and well-being.

You can’t know pleasure without knowing pain.

Adversity as a Normal Part of Life:

Adversity is a normal, unavoidable, part of the human experience.

Pain is a vital sign, a sign that we are alive .

Adversity as a Learning/Growth Opportunity:

No pain, no gain.

There is a silver lining (an opportunity for growth) to every cloud (adversity).

Adversity as Consequence and Manifestation of Our Freedom:

Adversity is an occasional consequence of our choices.

Adversity is an occasional cost of our freedom.

Adversity as Punishment or Misfortune:

Adversity is punishment and penance.

Adversity is a result of misfortune and bad luck

Adversity as Preparation and Inoculation for Greater Adversity:

What doesn’t kill us, makes us stronger.

Coping with adversity is a skill, adversity is an opportunity to practice coping.

Suffering Focus and Substance Use Interplay. To consolidate the theme of Meaning of Adversity facilitators are advised to invite clients to examine the interplay between the suffering focus and substance use episodes. For example, problem-focused suffering may catastrophize suffering as intolerable and unacceptable and, therefore, can lead to chemical coping. Solution-focused coping also views adversity as a problem and may guide a person to cope with pain and suffering by escaping into substance use. Meaning-focused suffering may reject the view of suffering as a problem altogether and see the fact of having a problem, at a minimum, as a normal part of life, and, at a maximum, as an opportunity to manifest one’s life-values.

The Suffering Vice-Grip Exercise . In his book The Doctor and the Soul , Frankl talks of “squeezing” meaning out of suffering (p. 300, 1955). The facilitator introduces the notion of “squeezing meaning out of suffering.” Facilitators may offer a metaphor of an existential vice-grip that wrings the meaning out of suffering. Clients are asked to think of instances of suffering in recent past and to put them, metaphorically, through the Suffering Vice-Grip to squeeze out the meaning.

Theme 3 – Meaning of Self: Who/What am I?

“Who/What am I?”, as a question of great ambiguity, is a litmus test of a person’s

tolerance of existential discourse. Therefore, to leverage group participants’ interest in this seemingly impractical question, the facilitator would do well to begin by inviting group members to explore the possible utility of knowing who/what they are in the context of their recovery. This initial approach to the topic is a good opportunity to reiterate the view of recovery as a means to an end rather than a goal in and of itself. The key point of the current theme is to broaden clients’ view of themselves beyond their often narrow view of themselves as an “addict” or a “recovering addict.” This can be accomplished by the examination of who/what clients were prior to their substance use as well as by encouraging clients to consider who/what they are aside from their substance use and aside from their recovery (“You say you are an addict, or a recovering addict, okay… and aside from that, what else are you? What else can you say about who you are? What makes you you?”).

Exploring Addiction Self-Definitions . Clients in substance use treatment frequently define themselves as “addicts” or “recovering addicts/alcoholics.” Exploring these treatment-endorsed self-definitions as well as such derogatory addiction slang terms as “junkie,” “crack-head,” “pot-head” allows clients to evaluate the impact of these self-conceptualizations on their self-esteem and recovery potential. More specifically, clients are asked : “When you call yourself an addict, what does that mean? What is the meaning of you saying that you are always going to be a recovering alcoholic?” Facilitators may also offer clients to evaluate and compare such alternative addiction self-definition alternatives as “habitual substance user” or “chemical coper.”

Finding Self through Past. Fabry (1988) recommends examination of one’s family history as a means to finding meaning in everyday living. Consequently, inviting clients to explore their family history might be useful in helping clients appreciate where they came from and where they are going. Exploration of one’s roots may help clients feel connected and grounded in the past, and to see their role and responsibilities in the trans-generational transmission of family values and traditions.

Value Hierarchy . Assessment of one’s values may also prove a useful tool in the search for the meaning of “who I am.” Fabry (1988) offers a formalized assessment of one’s value hierarchy that allows clients to track the actual origin of their values by source (family, society, self, etc.). Such value assessment can help clients also explore the extent to which who they are is a product of cultural, familial programming, and to what extent who they are is a function of their own values and philosophy of living.

Highlighting the Discrepancy between the Real and Ideal Self . As the clients explore the meaning of who they are, they might be also encouraged to evaluate the degree of correspondence between who they actually are (Real Self) at the present time against who they aspire to be (Ideal Self). This juxtaposition between the Real and the Ideal Selves creates a state of cognitive dissonance similar to what Saunders et al. (1991) term as a psychological squirm, a state that further facilitates motivation for change.

Theme 4 – Meaning of Presence

The emotional parcel of this theme is to awaken a sense of appreciation for being alive, right now. The goal is to try to facilitate emergence of a sense of urgency (and even angst) about the need to at least pose and ponder existential questions, in order not to miss the opportunity for meaning. The primary method of the session is that of infusing an awareness of time. In my experience, any discussion of existential issues without the psychological “squirm” of time awareness is likely to remain a purely intellectual exercise. Infusing a here-and-now awareness of time passing into the discussion of the existential issues sets a tone for an affectively-laden and, therefore, motivationally-priming and personally-relevant experience.

On a technical note, the facilitators arrive for the session with an hour glass and offer a pensive opening: “The sand of time… clocks ticking… moments passing… as I sleep, as I go to work, as I sit in the traffic jam… time’s passing… life’s passing… someone’s dying… someone’s just being born…” The facilitator waits in silence, allowing the metaphor and the imagery to take hold. He or she then continues: “You are alive right now… by historical standards, you will be gone in a flash of time… What does it mean to you to be alive right now, in this moment, a moment after so many have already died, and a moment before so many are yet to be born?”

Following this “contemplative narrative,” the facilitator defers to the group for thoughts and reactions. The facilitator “moves” the process by re-infusing the awareness of time whenever the sand of time runs out: “right now, in this very moment, someone’s life is coming to an end, they might or might not know it, their clock is about to stop… and someone’s life just beginning… what does that mean to you, right now?”

Facilitators wrap up the session by checking for feelings. Feelings of urgency, restlessness, desire to be productive are not uncommon. Facilitators may validate this yearning “to do something” as a common (‘manic”) defense against concerns of mortality and may encourage clients to stay with the restlessness, to not rush to do something, but to wait and explore opportunities for meaning that become more apparent when the blurring and dizzying carousel of escapist behavior slows down and the confusion of not-knowing paradoxically offers moments of clarity.

Facilitators aim to leave some time for appreciating life as it is happening right now for each and every group member in the room. They offer gentle guidance: “This is it… right now, this is your life… passing… are you present?” The facilitator should be prepared that some clients will find this invitation for mindful presence as a gift, while others, feeling the “squirm” of mindfulness, may resist such an invitation by whispering or giggling.

Theme 5 – Meaning of Death: Where am I going?

Meaning of life and meaning of death are intertwined. Our beliefs about death define our approach to living. The “meaning of death” question, however, is often a surprise to the non-philosophizing public. Facilitators, prepared for this surprise, simply ask: “What is the meaning of death? What does death mean to you? What are your beliefs about death? What do you think happens next, after you die, if anything? If life is a journey, where do you believe you are going? What do you believe to be the destination of this journey that we call life?” The answers to the “meaning of death” question is likely to reveal clients’ religious beliefs. With this in mind, it is important to avoid any evaluation of the expressed beliefs. Therefore, for example, facilitators are encouraged to avoid such probes as “What do others think about what so-and-so said?” Having done this existential “roll-call” on the issue of death, facilitators summarize the stated themes and offer a discussion of the interplay between clients’ beliefs about death and their substance use.

Destination: Somewhere vs. Nowhere. Some people view life as a prelude to after-life, while others see life as containing no destination other than death, and, thus, being a destination unto itself. In my experience, the difference on this point has the potential of being quite emotionally divisive. Consequently, in helping clients explore their beliefs about the meaning of death, facilitators have to be on their “process” toes to minimize any aggression in debate. The facilitators should be prepared to understand and summarize the following three common perspectives on death: 1) death as the beginning of an after-life, 2) death as the ultimate end of life, and 3) death as rebirth (reincarnation). Naturally, the facilitators may also run into an agnostic perspective of “not knowing” what death means, which could be then constructed as death as an unknown.

Substance use as Transcendence. The recovery “business” is often a judgmental business. The humanity of substance use, with its ancient roots in various world cultures, is, unfortunately, under-recognized and moralizing abounds. The Meaning of Life group facilitators should be prepared to recognize and validate a view of substance use as a spiritual search for transcendence. To clarify, validation is not an expression of values about a given position or an endorsement of a particular position. Validation is acceptance of the phenomenological logic of a given position. Being clear on this point allows Meaning of Life group facilitators to offer their clients a rare opportunity not to “demonize” their substance use but to openly reminisce about its existential value. On a practical note, the sub-theme of substance use as transcendence can be facilitated by such questions as: “How has substance use changed your attitude to death, if at all?” or “In what ways, if at all, has substance use helped you resolve your fears or questions about death?”

Death as Discontinuity of Self. Beliefs about death are also intertwined with the idea of continuity of “I-ness” or continuity of self. This seemingly heavy-duty philosophical angle can be introduced with relative ease along the following lines: “Some people suggest that you are your consciousness… With this in mind, are such states as sleep/unconsciousness/coma a form of psychological death?” The idea here is to look at death from the stand-point of loss of sense of self or self-control such as in the case of unconscious or substance-induced behavior. In this context, life then could be defined as “being awake, being conscious, being your usual self,” and death as “being asleep, unconscious (as in coma), not your usual self.” Extending this idea further, facilitators may explore the idea of being intoxicated or under the influence as a temporary death/cessation of one’s usual self (“When you are high, are you you?”). The overall vector of this sub-theme is to explore the perspective of substance use from the stand-point of temporary loss of selves. While for some this idea might appear too esoteric, for others it may lead to an insight that if life means being awake, and death means sleep, then extreme states of intoxication may, in fact, represent a loss of conscious, a loss of self, i.e. a loss of life that is, therefore, to be mourned. To further facilitate this discussion, therapists may simply inquire: “In what ways is substance use similar to death?” In my experience, this particular sub-theme is a clinical Klondike of potentially motivating insights.

Substance Use as “Reversible” Death. Most substance use treatment providers are familiar with the escapist, avoidant, if not para-suicidal function of substance use. Some individuals, at times of adversity, consciously look for a means to “numb out,” to escape pain and suffering, and, not uncommonly, to escape themselves. Drugging and drinking as a “reversible suicide,” as an escape from one’s self is a likely theme to come up in the context of the discussion of the meaning of death.

Death and Dying. In discussing the meaning of death, facilitators should be prepared to encounter a theme of grief and loss. Direct elicitation of this sub-theme is not recommended since grief-related disclosures are likely to monopolize group time. Therefore, facilitators should be prepared to redirect client’s disclosures about their grief. This can be accomplished by acknowledging the comment and broadening the scope of potential reply by inviting the group to relate. For example, the facilitator may say: “Jake here mentioned about losing his Mom, about how painful and hard that was… I am sure many of you in the group have had similarly painful losses. How do you think these deaths changed your beliefs about death? What do you think these deaths had to do with your substance use?”

Theme 6 - Meaning of Freedom: Am I free?

Meaning of freedom is one of the pivotal existential questions for anyone and, particularly, for anyone embarking on substance use recovery. “Am I free or is everything predetermined?” – the answer to this question often determines the client’s conceptual map of recovery. The current theme is designed to approach the issue of freedom in a concentrically-focusing manner, beginning at a broader level of abstraction, gradually zooming in on the personal and practical implications of one’s beliefs about the issue of freedom, with an eventual close-up on how beliefs about freedom interface with one’s approach to recovery.

Philosophical Level of Abstraction. Facilitators introduce the topic at the broadest level of abstraction by simply asking: “What is freedom?” The discussion can be further enhanced by the introduction of the distinction between freedom and determinism. Facilitators may, for example, introduce such a “truism” as the idea that “everything has a cause” and then challenge clients to try to reconcile the seemingly deterministic causality of everything that happens with the phenomenologically convincing sense of freedom of choice. Clients might be further stimulated by such probes as: “What are your thoughts about the notions of destiny, fate, or a Grand Plan?” Clients might be also offered the distinction between hard determinism and soft determinism (predisposition for a particular course of action with an option of volitional override). For example, facilitators may offer an example of someone with a so-called “short fuse,” who, under usual circumstances, might be “easy to fire up,” but who is, nevertheless, able to manage their anger much better, say, at a gun point, or during an important job interview with much at stake. Such a discussion can help clients tease out the distinction between causes, predispositions, and actual behavioral choices. This particular sub-theme can be further consolidated by offering a definition of freedom as awareness of options available to an individual at any given point (Somov & Somova, 2003).

Ethico-Practical Level of Abstraction . At this level of abstraction, facilitators shift the discussion towards ethical and practical implications of client’s beliefs about freedom. This is accomplished by asking clients about the interrelationship between “freedom” and “responsibility.” More specifically, facilitators inquire along the following lines: “This is a question to those of you who believe that everything has a cause and that your current behavior is predetermined by your prior actions and behaviors… If what you are right now is a function of who you were yesterday and so and so forth, then, how can you be held responsible for what you are doing at any given point?” Additionally, the facilitators explore the ethico-pragmatic implications of clients’ beliefs about the interplay between socio-economic factors and problems of poverty, violence or substance use. In conclusion of this sub-theme about freedom and responsibility, the facilitators may offer the following two perspectives: a) if you believe that everything is pre-determined, then you belief you are not free, and, therefore, you are not responsible for what you do (even though the society and the legal system will hold you responsible for your actions); and b) if you believe you are fundamentally free, despite any bio-psycho-social predispositions you might have, you are also ultimately responsible, with responsibility being the cost of your freedom.

Personal/Substance-Use Level of Abstraction . As with any discussion, progressing from philosophical to personal tends to be accompanied by the risk of increased emotionality which is in proportion to insecurity of our beliefs. One such belief that lies at the core of the existential notion of freedom and responsibility, is the belief that addiction is a disease. Facilitators are cautioned to tread carefully around this issue as mere questioning of the disease model of addiction is tantamount to “sacrilege” in certain substance use settings. Yet, the issue of whether substance use and dependence is, indeed, a disease, in a technical, rather than metaphorical, sense is a bone fide existential issue. Prior to embarking on this subject, facilitators are encouraged to do preliminary readings on the history of the disease model of addiction (Jellinek, 1972) as well as of the criticism of conceptualizing substance use as a disease (Peele, 1999). Viewing addiction as a disease is a form of determinism which makes one no more responsible for the disease of addiction than for the disease of cancer. Conceptualizing substance use as a habit represents a form of “soft determinism” that views substance use as a behavioral predisposition (reflective of past behavioral choice and conditioning) that is, nevertheless, subject to volitional control.

Eliciting these distinctions from clients can be accomplished by such questions as: “What is a disease? What are some examples of diseases? Are you responsible for, say, having cancer? Are you free to not have cancer by merely choosing not to have it? Is addiction a disease? What does viewing addiction as disease mean to you about your responsibility for substance use? What does viewing addiction as a disease mean to you about whether you are free to recover from it? What is the difference in viewing substance use as a disease versus viewing it as a habit? Are you free to choose to not act in accordance with your habitual inclinations and your habitual predispositions?” Challenging clients to evaluate the interplay between their beliefs about freedom and responsibility and their model of addiction is one of the key guideposts to meaning on the path to recovery.

Theme 7 – Meaning of Substance Use: What does drinking/drugging do for us?

The process of change cannot begin with a conviction that one is irrational. Substance use is not evidence of irrationality but is merely evidence of a person’s search for an optimal form of coping with a personally acceptable cost to benefit ratio. The present theme allows participants to review the interplay between substance use and various existential issues and to recognize substance use as a legitimate attempt at solving the challenges of existence. Make no mistake: the point of the theme is not to endorse substance use but to recognize its partial rationality as a coping strategy. Helping clients see substance use as a creative, albeit problematic, form of existential coping, allows them to regain the belief in themselves as rational creatures and to move away from a self-critical, demoralizing, depressogenic view of themselves.

The following is a sample of questions that can be used to provide the overview of the interplay between substance use and search for meaning:

How does substance use help you feel free?

How does substance use help you understand who/what you are?

How does substance use help you deal with lack of meaning?

How does substance use help you feel connected with others?

How does substance use help you transcend the routine and the meaninglessness of life?

How does substance use help you deal with confusion, ambiguity, and complexity of life?

How does substance use help you deal with pain and suffering of adversity?

How does substance use help you deal with your mortality, death and non-being?

Theme 8 – Meaning of Transition

The final topic addresses the meaning of transition, the existential challenge of closure, the existentiality of ambiguity.

The Search Continues, Dealing with Ambiguity . The theme begins with a review of clients’ “journey” in the group. More specifically, facilitators encourage clients to review what, if anything, they have learned and understood about themselves, what, if anything, has changed about them. As clients are helped to tally up the tentative answers in their search for meaning, they are also encouraged to take an inventory of the questions that remain to be answered. Facilitators may further ask: “Where do you go from here?” While mostly rhetorical, this question acknowledges the unavoidable, inevitable ambiguity of the continuing search for meaning and of life as a journey. Facilitators may invite clients to process what this ambiguity “feels like.”

Dealing with Transition and Closure. Closure, termination, parting, ending, and separation are unique existential moments. Substance use clients are invited to explore the meaning of such transitions and are helped to recognize that such transitions present opportunities for existential meaning. The facilitators are likely to encounter references to past abandonment, lack of closure, resulting sadness and loneliness, and personal vows to never open up and get emotionally close to anyone. To help clients find solace in meaning-focused suffering, facilitators may use such questions as: “From the existential standpoint, what can we learn/gain from things coming to an end? What existential sense can we make of the sadness we experience when something ends? From the existential standpoint, what opportunities do departures offer? What beginnings do endings offer? If you follow on this path to recovery, what you are leaving behind and what are you moving towards?”

Conclusion

Logotherapy is a uniquely valuable pre-rehabilitation and post-rehabilitation substance use treatment modality. As a pre-rehabilitation clinical tool, logotherapy, as an existential analysis of one’s values and attitudes that is “particularly concerned with making men conscious of their responsibility” (Fabry, 1955, p. 29), serves to complement the process of motivational enhancement for a client embarking on the path of recovery. As a post-rehabilitation clinical tool, logotherapy is “prophylactic in preventing a relapse” (Lukas, 1979, p. 264). Indeed, as noted above, there is more to life than recovery. Recovery, just like substance use, is but a means to an end, not an end in and of itself. The proposed Meaning of Life group treatment protocol offers substance use clients a systematic approach to examining the purpose of their recovery.

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