An Interview with Morteza Khaleghi, Ph.D. on Treating Emotional Trauma in Addiction
In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews Morteza Khaleghi, Ph.D. on the importance of addressing emotional issues underlying addictions. Dr. Khaleghi is a Clinical Psychologist, provider of inpatient addiction rehabilitation services, and author of the book, Free from Addiction: Facing Yourself and Embracing Recovery. He runs the Creative Care inpatient rehabilitation facilities in the Los Angeles, California area.
In the early part of the interview, Dr. Van Nuys and Dr. Khaleghi discuss Dr. Khaleghi's background and the events that led him to have the career he has pursued. His mother died when he was 17 years old. Shortly thereafter, he emigrated from Iran to the United States, where he pursued his studies, ultimately attending psychology graduate school at the California Graduate Institute in West Los Angeles. At that time, an older brother who had been suffering with depression and alcohol abuse ended up accidentally killing himself via overdose. This sad event, and the wish he experienced to have been able to prevent this death from occurring, motivated Khaleghi's future interest in helping addicted and emotionally troubled people recover.
Dr. Van Nuys remarks about a particular interesting feature of the California Graduate Institutes's psychology program, namely that they require students to complete 50 hours of psychoanalytic psychotherapy. Participation in psychoanalytic therapy is not a typical requirement of psychology graduate training anymore outside the actual analysis institutes themselves, of which CGI is not. Dr. Khaleghi responds by saying that he has found his participation in psychoanalytic therapy to be one of the most beneficial experiences he has had in his life; that he has spent 18 years of his life attending analysis sessions three times a week; and that he credits this participation in psychoanalytic therapy (as a patient; not as an analyst) as being the major source of his expertise as a psychologist practitioner today, more than what he learned out of books or directly through his graduate program.
Unlike many addictions specialists, Dr. Khaleghi does not characterize addiction as a disease, at least not in the simple sense of an illness one contracts and can then be cured of. Instead, he understands addictions as complex and chronic conditions with both biological and psychological aspects that cannot be cured but instead, only managed. Viewing addiction as a typical disease leads to an unhelpful and unwarranted passivity on the part of both the treaters and the patient, both of whom must realize that recovery is possible, but only to the extent that the patient actively accepts and maintains responsibility for making life changes which will support recovery.
In Khaleghi's view, two components must be present in order for an addiction to occur. First, a person must be vulnerable to addiction at the biological level. Second, a person must be exposed on a consistent basis to emotionally traumatic circumstances, such as substantive abuse, stress and family dysfunction. The addiction process develops in response to that trauma, and also as a response to dysfunctional relationships and to dysfunctional coping strategies modeled by peers and adult caregivers. Collectively, he calls these enabling factors the "ripe environment", suggesting that they cause an otherwise latent process to come into bloom.
A consequence of this particular understanding of the origin of addictions is that Dr. Khaleghi views all instances of addiction as dual diagnosis situations. The term "dual diagnosis" is conventionally used to describe a condition where a patient meets DSM criteria for two or more mental disorders, one of which involves addiction. So, a dual diagnosis patient might meet criteria for both Schizophrenia and Alcohol Dependence. Here, Dr. Khaleghi uses the term more loosely, suggesting that the emotional trauma that is always present in cases of addiction should be understood as an important part of the addictions diagnosis picture, even if that condition does not meet criteria for a disorder. Through the use of the term, he means to suggest that recovery from addictions is not typically possible until the second part of the addiction, namely the emotional trauma, has been explored and dealt with. The dominant coping mechanism employed in addiction is avoidance, according to Khaleghi. Addicted people "avoid, deny, minimize". It is only when addicted people are willing to look at what they are avoiding and come to terms with it that they can hope to get better.
Dr. Khaleghi has a generally positive view of the model of recovery promoted by Alcoholics Anonymous and popularized as the "twelve steps". He agrees that it is important for addicted people to have a crisis and experience a moment of surrender in which they admit to themselves that they are out of control. He agrees that fellowship, or at least socialization is an important aspect of recovery, and that things like AA's use of sponsors to offer guidance is an important aspect of recovery. He agrees that the goal of treatment for addictions needs to be absolute sobriety and that anything less than absolute sobriety is risky; will ultimately lead back into addiction. Where he disagrees with the twelve step philosophy has to do with his emphasis on the need to process emotional traumas that accompany addictions. Twelve step programs promote the idea of making restitution to people who you have harmed. Khaleghi goes further to suggest that it is also necessary to do psychotherapy type work sufficient to identify and process through one's own issues before effective recovery can be sustained.
In addition to promoting the idea that it is vital to address past emotional trauma when working with patients in recovery from addictions, Khaleghi also suggests that it is important that treatment last a long time. A 28 or 30 day inpatient recovery program is associated with a 30% or so relapse rate in the first year. Longer durations of inpatient rehabilitation are associated with longer lasting sobriety outcomes, he suggests.
Dr. Van Nuys closes the interview by asking Khaleghi what family members of addicted people can do to help their relatives. Dr. Khaleghi responds by reiterating the important role that family members play in creating (or unleashing) addictions in the first place. He suggests that family members can best support another family member's recovery by not enabling that person's addiction; not turning a blind eye to their substance use or otherwise allowing them to get away with substance use. In this aspect, Dr. Khaleghi appears to be in tune with the message of the Al-anon program affiliated with Alcoholics Anonymous. It isn't clear if he supports family members attending that fellowship, however.
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About Morteza Khaleghi, Ph.D.
Dr. Morteza Khaleghi is the author of Free From Addiction: Facing Yourself and Embracing Recovery and has over twenty-five years of experience treating the dually diagnosed. Trained at the California Graduate Institute, he earned his doctorate in clinical Psychology. He founded Creative Care in 1989, a facility devoted to providing highly specialized treatment for the dually diagnosed client. He is an ongoing resource for The Dr. Phil Show, offering treatment at Creative Care to challenging patients, and appears on the show to offer advice and updates on patients' progress.
Founder of Creative Care, a facility devoted to providing specialized treatment for those who suffer with both an addiction and a psychiatric disorder -- dual diagnosis -- Dr. Khaleghi argues that within the medical establishment, the tenets of dual diagnosis are not well understood. Not only do many medical and psychiatric professionals view addiction as needing to be treated separately from underlying emotional issues, our traditional healthcare system is simply not designed to treat dual disorders.
Although Dr. Khaleghi believes Alcoholics Anonymous and its famous 12 Step Program was revolutionary when it was introduced in the 1950s and still provides structure for millions, it is based on a Disease Model, which views addiction as a physical condition akin to heart disease or diabetes. Consequently, many treatment experts see little reason to delve into the psychological underpinnings of addictions. Despite the myriad of emotional issues or even genetic factors that trigger addictions, they are often far less obvious than the behavior-control issues exhibited by the addict.
Khaleghi further explains how and why addicts - whether they are alcoholics, drug abusers, over-eaters, compulsive shoppers, etc…, and their typically distraught families and friends -- can benefit from his parallel approach to treating addicts for their addictions and the emotional issues they feed on. As Dr. Khaleghi stresses, "Treating addiction while not dealing with the addict's interior life is a recipe for failure."