Are all addicts the same?
I recently attended an addictions conference in London. One of the presentations that caught my attention focused on the problems presented in treating high net worth individuals, or more often, their children. We are talking about Saudi princes, political kleptocrats, Kazakhstani royalty, popstars and real-estate billionaires. People whose money supply is literally endless. The talk was hosted by an outfit that caters to the treatment needs of these souls and therefore biased in favour of making out a strong case as to why the treatment challenges of these clients are fundamentally different.

Some of the claims made in favour of differentiating this treatment cohort is that they often suffer from affluent neglect, their parents are too busy flitting around the world to devote sufficient attention. They are brought up by au pairs and nannies. Many are victims of “affluenza” in that they have never had to deal with the consequence of any misdemeanor, as the family lawyer has always been around to make good. They suffer from a lack of purpose and boredom because there is no need or incentive to do anything creative and they often live isolated lonely lives because they never know whom they can trust. An excessive financial dependence on their families makes true independence difficult and ongoing public scrutiny makes their lives the fodder for the tabloid press, often coupled to generous doses of schadenfreude arising from an envious audience. This discourages disclosure, no matter how hard they are hurting. And finally, the classic rock bottom is somewhere in “never-never land”, for these addicts can buy their way out of any gridlock.

As therapists, we are often awe struck by their wealth or celebrity status. We are often flattered by their attention and generosity and so strict supervision is the key, lest our counter-transference leads us astray. And of course, their money and prestige often buys our goodwill.

The clinical focus needs to remain on the client’s true needs and I suspect many of these clients actually want to be treated like any other patient, with respect and dignity. Perhaps behind it all, they crave normality. The same problem in a different guise arises with patients at the other end of the socio economic spectrum – the down and outs, where the same sense of hopelessness about their odds for recovery often clouds our clinical judgements, albeit for different reasons.

So, are all clients the same? Obviously not, but the triangulation between the client, the counsellor and the disorder remains the same. Cutting through the defenses, whether they are solid gold or rusty tin remains the therapeutic challenge. For an addict, sleeping in a palace can be as lonely as sleeping in homeless shelter.

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