The Memory Nodus
A nodus is a complication or difficulty, and the addiction field has one. It has to do with the memory of our clients and the ability to obtain an accurate assessment from those clients. Accurate assessments, as you know, give us vital clues for instituting the best treatment for each client. That is why reliable evaluations are so important.
Arguably, most treatment programs today rely on the memories of clients to obtain some semblance of their history and issues. In other words, they rely on clients’ memories to get their story. That information comes from program-created intake questionnaires or from some standardized versions. The central point here is that programs rely on a client’s memory. Sure, some programs use psychometric tests and even rely on supplementary information such as family input, past employment, and criminal justice system records, among other sources, to put together an accurate client history.
Yet, the question is, how accurate is the memory of our clients?
Memory research is extensive. Justice cannot be done to that vast literature in this limited column. But for our purposes, what has been discovered about human memory may be a bit disconcerting to our profession. For starters, and let’s make this very clear, human memory is never perfectly saved somewhere in the inter alcoves of our brain. It is nothing akin to a computer hard drive, where you can click a file name and voilà there is the exact file (memory) as we last left it. It just doesn’t work like that. There is no such thing as a perfect human memory (Travis & Aronson, 2007). Our brain did not evolve to be a computer file. If some of you already know this, good for you. For the remainder of you, drop the perfect human memory idea! That is pure fiction (Damasio, 2012).
Additional research indicates that memories undergo modification as they move from in and out of long-term storage. Each time you think about some old memory in your life, any new associations you ponder as to that old memory gets enmeshed with the old (Burton, 2013). The old memory gets entangled with newer associations, thus leaving the older memory less accurate.
There are other researched discoveries that show human memory recall is less than accurate. For one, your memories are essentially bits and pieces of information that your brain serves up to you. It does this not to depict the past as accurate as possible, but to provide you with information that you will find useful in the present. Functional value, not accuracy, is the priority of memory. Our brain evolved to construct and interpret the world around us (Harrison, 2013). Construction and interpretation is not accuracy. Rather than an honest and accurate account of the past, our memories provide us with a highly selective version of our past that just happens to fit nicely with whatever personal outlook we have at a certain time (Fox, 2012).
Moving on, research has found that personal experiences rarely happen in organized ways. Stories of one’s past are really reconstructions, an important term to note, that give structure and improve the likelihood of those personal experiences to be better understood later on. If memory is a reconstruction, then it is subject to confabulation (Travis & Aronson, 2007). Turning a remembered experience into a narrative is sure to differ from the actual experience no matter how hard the storyteller strives for accuracy (McGuire, 2013). Consider that addiction counselors are listening to a client’s narrative, not an accurate portrayal of what has occurred in their life.
For another, we have a self that needs to be protected. Our memories are often biased to produce results that are self-serving (Trivers, 2012). Our memories are prejudiced by our past history and beliefs. We often recall context rather than isolated things (Damasio, 2012). Hallinan (2010) cites research that clearly shows that human memory is not only reconstructed, but often provides one with a more positive and self-flattering slant. And if that’s not enough, research from Tvershy and Marsh (2000) found those who tell their life’s story mislead others as well as themselves. As the storyteller tells their story, any alterations introduced gets incorporated into the memory of the storyteller, so much so that some things remembered are not really true. In other words, once we have a description about ourselves, we shape our memories to fit the narrative. We spin the story of our lives. That’s not accuracy.
Substance Abuse and Memory
Now add to all this human memory research a client who has abused substances for years or decades, which then results in even more inaccurate memory. There can be no doubt that our clients often recall specifics of their history through a haze of chemicals. Alcohol, cannabis, cocaine, and methamphetamine seem to have gained a particular reputation for that haze. That fog obviously distorts memory, not to mention induces periods of complete loss of memory, which we call blackouts.
Uncomplicated alcoholics often have memory disorders affecting selective components of their memory. This includes the following:
- Episodic memory, the memory of yourself
- Working memory, the part of memory that holds and processes new and stored information
- Semantic memory, the memory of facts and general knowledge
- Procedural memory, the memory for preforming certain actions
While these deficits are partially reversible with abstinence after a few weeks of sobriety, memory deficits can persist and potentially interfere with activities of daily life and therapeutic efforts. Most memory deficits that occur in uncomplicated alcoholics also occur in alcoholics complicated with Korsakoff’s syndrome, which is characterized by a severe to profound deficit in episodic memory (Pitel, Sullivan, Beaunieux, Desgranges, & Eustach, 2010).
The point of all this substance-induced, memory distortion data is to point out that it further impedes a counselor’s ability to gain an accurate client history.
If that wasn’t enough, we have to deal with memory distortion caused by thinking biases; biases that people and our clients carry around all day long. A major example is the confirmation bias (Kahneman, 2013). By definition, confirmation bias seeks information that supports a particular view and ignores information that does not support that view. Using this bias, many of our clients see only behavior that supports their view that they don’t have an addiction problem (e.g., they still have a job or have not been arrested for a while, among others). After years of utilizing this bias, true memories become distorted as to what is really going on. Sometimes even clients can’t tell the difference.
All this presents you and me with a problem. There is going to be a memory margin of error in every intake we do, and in every session we conduct where the session delves into the client’s past.
Memory Problem Proposals
Delay an intake especially if the client has recently used substances or has come straight out of detoxification. I know the insurance companies are not going to like that, but if given a bit more time, the fog of substances might lift and give you a better history.
In some cases, not even standardized tests may improve the accuracy of a client’s history. If the client can’t accurately remember things or gives flawed information on the test, then flawed information will come out of the test. The literature on how to retrieve accurate memories from those with addiction is rare.
The addiction field really needs to research this memory problem. I searched and could not find anything, but doesn’t mean it’s not out there. The question is: How accurate are our intake procedures? Several independent projects should be able to shine some light on this issue. For the interested parties, rest assured that such projects would get published and should furnish needed treatment practice recommendations.
One Last Troublesome Matter
There is one remaining problem to consider. You cannot visit many standing addiction treatment programs today and not hear one or more counselors entreat their clients to “be honest.” Given what the memory research has uncovered, the call for honesty may not be completely possible. To press a client to be honest requires an accurate memory, and we have seen that does not exist.
It would appear that at intake and throughout the course of treatment you the counselor need to play with the client cards with which you were dealt. To expect more in terms of accuracy and honesty is not completely possible given what the research has discovered about human memory. It appears we need to work with what we have, not something that cannot be given.
It is a nodus.
Burton, R. A. (2013). A skeptic’s guide of the mind. New York, NY: St. Martin’s Press.
Damasio, A. (2012). Self comes to mind. New York, NY: Vintage.
Fox, E. (2012). Rainy brain, sunny brain. New York, NY: Basic Books.
Hallinan, J. T. (2010). Why we make mistakes. New York, NY: Broadway Books.
Harrison, G. P. (2013). Think: Why you should question everything. Amherst, NY: Prometheus.
Kahneman, D. (2013). Thinking, fast and slow. New York, NY: Farrar, Straus, and Giroux.
McGuire, M. (2013). Believing: The neuroscience of fantasies, fears, and convictions. Amherst, NY: Prometheus.
Pitel, A. L., Sullivan, E. V., Beaunieux, H., Desgranges, B., & Eustach, F. (2010). Memory disorders in uncomplicated alcoholism. In G. F. Koob, M. Le Moal, & R. F. Thompson (Eds.), Encyclopedia of behavioral neuroscience (pp. 215–21). Burlington, MA: Academic Press.
Travis, C., & Aronson, E. (2007). Mistakes were made (but not by me). New York, NY: Harcourt.
Trivers, R. (2012). The folly of fools. New York, NY: Basic Books.
Tversky, B., & Marsh, E. J. (2000). Biased retelling of events yield biased memories. Cognitive Psychology, 40, 1–38.