When To Surrender: A New Definition for Veterans in Substance Abuse Treatment

By: Heidi Peck, LCSW

Substance abuse counselors often find clients unsure about sobriety. There are many ways to process ambivalence in the therapeutic setting. Achieving a strong foundation to support sobriety calls for a firm commitment and steadfast willingness to adapt former thinking patterns. Addressing ambivalence is an integral part of the treatment process, and not addressing it can welcome the likelihood of returning to active using in the future.

    Chronic relapse plagues many substance abusing veterans. Trying over and over to walk the same path of treatment while aspiring to acquire new insight into one’s own addiction can be tedious and frustrating. One area in which ambivalence habitually runs rampant is with the concept of “surrender,” a term that is used in treatment centers universally. Among the veteran substance abusing population, this struggle seems to be further complicated by the intellectual track-work laid down early in their military careers.

Surrender—What Does It Mean?

    The word “surrender” can evoke fear and resistance from anyone trying to recover from the devastating grips of addiction. For veterans, this is not only an uphill battle, but they can stay paralyzed for years, even decades, by applying consciously or unconsciously an old definition of the word. Witnessing this cycle of confusion led me to recognize the benefits of taking a more comprehensive look into the word “surrender.”

    When I mention surrender and ask what this means from their understanding of a recovery-based or 12-Step Model perception, many veterans report they think of the following: admitting powerlessness or unmanageability in life, taking a suggestion, or accepting help. When I ask what they think of when hearing the term “surrender” from a military standpoint, many often reply: Give up, fail, quit, or retreat. They express a strong fixed notion to “Never surrender!” Originally this was taught, probably in basic training, as a military tactic. And throughout the time they served, this evolved into a belief that holding to this steadfast decree would preserve their unit’s honor. This was often portrayed to be a last resort strategic move. Years later, many veterans continue to abide by this mantra as translated to become true devotion to their comrades and country, believing that surrender is for the weak. This attitude adopted in the past can be at the root of their ambivalence today. Not reconciling this, I believe, contributes greatly to the vast recidivism rate of veterans returning to treatment.

Does Surrender Equal Defeat?

    “Who cares to admit complete defeat? Practically no one, of course.” These are the first words of the chapter on Step One in the book AA often uses, Twelve Steps and Twelve Traditions. There are some similarities associated with both terms. For instance, in the military, surrender is a tactic that can be used if death seems more than likely but probable. Similarly, people often come voluntarily to treatment when death seems close. Both are tactics that preserve life when terror evoked by the sudden awareness that death is near becomes present.

    “Historical references have shown that even though the troops were trained one way, triumphant military commanders were trained another—they knew how to surrender. Or at least we know that the successful ones did,” says Joe McQ. in The Steps We Took. Throughout history, the names Custer and MacArthur are often brought up when referencing this topic. Not only was surrendering an option, but the act of deciding when to deploy this approach was crucial. MacArthur exemplified the belief that choosing to surrender didn’t mean to quit. In fact, unlike Custer, MacArthur’s choice kept his troops in the battle only to finish victoriously.

    Often, resistance toward surrender remains in the unconscious mind of the veteran, and old notions of “Never surrender!” turn into fixed behavior. So how do we help them reconcile this conflict?

A Group Intervention

    The group intervention I developed while working with outpatient veterans in abstinence-based substance abuse treatment can be utilized in various treatment modalities. I begin this intervention in a psychodynamic group, by dividing the members into two teams. I assign one team to represent the concept of surrender from a military standpoint, and the other to represent surrender from a recovery standpoint. I ask each team to pull their chairs together, appoint a recording secretary, nominate a spokesperson, and answer the following questions: What is a definition of the word “surrender” from your team’s perspective? What are similarities between both standpoints? And what are the differences?

    Once these have been answered, I ask the group members to move their chairs back into the usual formation, and I set up two chairs next to each other toward the front of the room. I ask the two spokespersons to sit in these two chairs. Then, using answers the teams recorded, I have each spokesperson represent the team’s perspective in a mock trial.

    As we go through their answers, I am mindful to ask the team members whether they have anything to add, and whether their spokesperson is accurately representing the work of the team. This facilitates maintaining everyone’s attention and also prevents the spokesperson from giving impromptu answers. In the trial, I pose the question, “Which is the correct definition of the word surrender?” I then have the group members engage in a debate representing their respective teams.

    After we finish the debate, we start to process the activity. I ask if there were either any barriers or an additional level of comfort when they were asked to break down the larger group. Together, we speak about changes in communication patterns that occurred by moving chairs, working in smaller groups, and being assigned a task. Working with the camaraderie of the teams, I give the group members an opportunity to advocate for each other by asking, “Did any team member offer an answer you were surprised by, changed your opinion, or provided new insight?” This is usually an opportunity for some of the more vocal members to highlight work of the less talkative members in the group. Often, certain individuals experience intimidation and/or social anxiety in the large therapeutic group setting, but when charged with a specific task in a smaller group, they emerge as leaders. It is important to acknowledge this strength. This often helps these individuals feel more comfortable actively participating in the larger group setting, and it encourages their peers to elicit future participation from them based on their meaningful past contributions in the smaller group setting.

    Next, I ask each of the members to share when they were discharged from the military. We point out how many years each group member has held the military, or “old,” definition of this word. And for those veterans in active duty or recently discharged, it’s likely they are still actively functioning by this military mindset. In my experience, these members have the greatest struggle with adapting a new concept. At this point, I turn to the group members for confirmation that they have been associating with the military definition since the time of their service. Asking if they agree with this statement provides an opportunity for breakthrough. Members commonly become enlightened and share that they have not thought about this conflict before.

    I ask the group members to speak about how their definition of surrender has changed as a result of this activity. As a facilitator, I remain open to both positive and oppositional feedback, understanding that some may not agree with adapting a new connotation. I ask the group members to explain struggles that not embracing the recovery concept of surrender have posed in past treatment episodes.

Associations and the Brain

    Also, I provide a psychoeducational component regarding how associations work in the brain. We speak about the definition of Hebbian Theory (see http://tinywiki.org/Hebbian_theory.html ) and the statement, “Cells that fire together, wire together.” I provide the following example: “Have you ever passed kids playing on a playground and suddenly wanted ice cream?” When people see a child on a playground, they may consciously or unconsciously recall their own childhood, playing in the playground, and buying a snack from the ice cream truck. Although these activities are different, they become related through the power of association. At the point when someone wants ice cream, or even in the present as I am illustrating in this example, they may picture the ice cream, see an ice cream cone melting in the sun, have the illusion of how the ice cream would taste in their mouth, and so forth. Associations are common in addiction. Often, addicts and professionals refer to them as “relapse triggers.” For example, this is why an alcohol dependent person may experience an intense craving to drink a beer on a hot summer day. Even though he is sober and alcohol is nowhere in sight, the person associates the beer with the weather, and consequently is increasingly triggered to drink.

    Finally, I ask the group to remain mindful and share feelings of comfort or tension release that they experienced during this activity. Often, bringing this conflict from the unconscious to the conscious results in tension release. When trying to permanently reconcile this conflict, first we must begin by talking about it. Then we can point out disparities to break this association. For example, I might say, “In the military, you surrender as a unit, while in recovery this is an individual action. In the military, surrender is the last line of defense, whereas in recovery, we learn this is the first line of defense. Surrender and the rest shall follow.”

    As we prepare to end this activity, I bring to mind embracing a gradual change. I tell the group if they are aware that something has changed slightly, remain confused, or still feel ambivalent toward fully embracing this new concept,  that’s okay. I remind them of how many years they were abiding by one strongly ingrained military definition of surrender. Changing this word’s meaning will be a personal process, but becoming aware of this conflict is the mission of this intervention.

    I encourage the group members to continue to think about this concept, allowing time for the process of accepting the recovery definition to gently unfold into the conscious and unconscious mind. Ultimately, if veterans remain in isolation still grappling with this concept, they fail to avail themselves of many benefits of group cohesion. However, once the veterans are able to accept this term into their recovery process, they are welcomed by others who have also chosen to do so. Many veterans will share that the bonds formed with sober peers in treatment are reminiscent of their time in the service. Depending on their comrades in matters of life and death once again creates a unique level of trust. Encouraging feelings of inclusiveness can promote a healthy social network through the common bonds of both military service and addiction, which fosters a supportive environment in which veterans can be successful in attaining long-term sobriety.

    Learning new perspectives and utilizing different terminologies or word meanings can be uncomfortable at first. Breaking old associations and forming new ones can open the door toward acceptance of concepts that ultimately will provide the cornerstones of one’s recovery. For many, working to resolve internal conflicts and gain acceptance of a new perspective is vital to successful treatment. And for the veteran, not changing the word “surrender,” but adapting its connotation, may just cut off the central lifeline fueling ambivalence toward sustaining long-term sobriety.

References

Anonymous. (2007). Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services, Inc. (Original work published 1952).

McQ, J. (1990). The steps we took. Little Rock, AR: August House Publishers, Inc.

Doidge, N. (2007). The brain that changes itself. United States: Viking Press. pp. 427.

Heidi Peck, LCSW, graduated from New York University with her MSW in 2005. She has worked for the VA Medical Center in New York since 2007. Prior to that, she held the position of Senior Counselor in the Intake Department at Realization Center, Inc. She has provided clinical services for the Su Casa Methadone-to-Abstinence Therapeutic Community’s Pregnant Women and Infants Program, Lower Eastside Services Center’s Mental Health Clinic, and Somerset Youth Services Commission for Juvenile Justice in New Jersey. Heidi completed a fellowship at Eagleton Institute. She would like to dedicate this article to the memory of her father.

From The New Social Worker, Winter 2012, Vol. 19, No. 1.