05/08/2014 12:46 EDT | Updated 07/08/2014 05:59 EDT

As an Addictions Counsellor, I've Met Patients Like Ford

Ford's remarks to Joe Warmington in the Toronto Sun about rehab being "amazing" and like "football camp" had all the markings of a kind of treatment patient I like to call "The Fonz." These are the clients that enter rehab totally cool, calm and collected. They have everything under control. They also tend to be full of compliments.


For an organization that treats the darkest of human despair, Alcoholics Anonymous has an uncanny ability to transform the bleakest of realities into cute little acronyms. For example, FEAR is "f*** everything and run" or "face everything and recover"; ASK is "ass-saving kit"; FINE is "f***** up, insecure and neurotic;" and my personal favourite is SOBER: "son of a bitch, everything is real."

This last acronym speaks to a little understood fact about getting sober: generally speaking, those early in recovery are more cognitively and emotionally impaired sober, at least at first, then they were while stoned.

"Stark, raving sober," is how so many describe those first few days, weeks and months of being without drugs and alcohol. Fueling this newly sober state of crazy is the desperate realities that all addicts find themselves when they seek treatment or are forced into it.

In Gamblers Anonymous, they like to say that no one joins that fellowship "coming off a winning streak." Of course, the same can be said of those suffering from any addiction. The damage that addiction causes is severe, profound and pervasive, and not just in the addicts life, but generally in the lives of all those who love and depend on them. For so many, the shame inherent in seeing that damage in the glaring light of uninebriated reality is just too much. It is why I am not alone in believing that shame is the number one cause of relapse.

It is also the reason why I found Rob Ford's interview with the Toronto Sun's Joe Warmington more then a little peculiar. Though Ford did say, "I am learning about myself, my past and things like that," he also exclaimed, "Rehab is amazing. It reminds me of football camp. Kind of like the Washington Redskins camp I went to as a kid."

To make such an absurd statement, I can only guess that Mayor Ford is suffering from the newly sober crazy mentioned previously. Though rehab can be -- and often is -- exhilarating, to describe it as being "awesome" like football camp is well beyond the barrier of coherent, logical thought. If nothing else, it demonstrates that Ford, at least for now, is totally missing the point of what rehab is about.

Lots has already been penned about what kind of residential treatment centre would allow a patient to have a cellphone, make work calls and, of all things, do an interview. As an addiction counsellor placing clients into rehab, I know of a number of treatment facilities -- especially those catering to high-level executives and other exclusive clientele -- that offer very good programs, but nonetheless allow their patrons these privileges. That being said, I have no idea which treatment centre Ford has entered, though I will take him at his word that he is in one.

The problem here might not be the treatment centre, but Ford's grasp of reality. It's easy to be an armchair counsellor sitting in my office when I don't even know what treatment centre he is in, but I will say that Ford's remarks to Warmington had all the markings of a kind of treatment patient I like to call "The Fonz." These are the clients that enter rehab totally cool, calm and collected. They have everything under control. They also tend to be full of compliments: "Wow, just spending five minutes with you, I've learned so much about myself," or "I can see how good of a counsellor you are. I really look forward to working with you more."

With the other clients, they are quick with a joke or words of encouragement. In just a few hours, they present as if they have a sense of ownership over the place, like they have been there forever. You can almost imagine them standing beside the jukebox at Arnold's restaurant snapping their thumbs up and saying "Aaaeeeyyyy" with a giant grin on their face. Of course, what they are really doing is, well, jumping the shark.

I recently was talking about this kind of client with the Clinical Director of Caron Ocean Side Drive, one of the most exclusive treatment centres in the world. Nestled amongst the mansions lining the beach in Delray Beach, FL, their men's and women's facilities are luxurious in a way that the vast majority of us could only imagine.

It was explained to me that these Fonz-type characteristics are endemic amongst Ocean Side Drive patients, who are disproportionately narcissistic in character. The argument is made that their need to be seen as totally in control and their charm offensive is just further manifestation of an ego defense gone horribly wrong. It is an over-compensation for the reality that their lives are actually fully out of control and that their internal sense of grandiosity has been exposed as a lie; like a snake eating its tail, drugs and alcohol are used as the ultimate defense against feeling the pain of their realities.

The trick for dealing with this population is cultivating a feeling of safety while challenging them to come into the unpleasant realities of their lives. It requires finding precarious balance between confronting distorted thinking and feeling patterns, while building trust and supplying empathy, safety and support.

Only in that balance can you help them deal with developmental issues and other psychological factors that lay underneath the addiction. I truly hope that Ford is at a facility where he can get the help he needs. The truth is he is not like any other client: he is a wealthy, powerful and has lived his addiction as a public spectacle. So far out of his comfort zone, his first instincts will be to rely on the maladaptive ego defenses that got him into this mess in the first place. Cutting through them won't be easy, and no addict is capable of letting go of them on their own. Very few treatment centres are designed to help the crack-smoking mayor of Toronto. This too is his reality.