Nobody chooses to become an addict. What was initially rewarding eventually becomes a living hell for those ensnared in addiction. Like a python wrapping around its prey, addiction suffocates the life out of the addict. Myriad factors converge in addiction. Predisposing factors can include obsessive-compulsive traits, trauma, psychiatric disorders, relational problems, grief, social isolation, and more.
The objects of addiction are also varied. Stanton Peele wrote about love addiction nearly 40 years ago. Long-term relationships lack the excitement of falling in love, particularly for people who struggle with intimacy, attachment, or self-esteem. The brain chemistry high of romantic “falling in love” may be just as enticing as cocaine. Likewise, people with self-doubts or a need for mirroring may sacrifice trust in relationships for the lure of seduction. Then there are the obvious addictive substances, such as alcohol, heroin, opioids, cocaine, tobacco, crystal meth, ecstasy, benzodiazepines, etc. And, there are addictive activities, such as gambling, sex, shopping, work, video games, overeating, excessive exercise, etc. Dr. Gabor Mate confessed to an addiction to shopping for classical music in his insightful book In the Realm of Hungry Ghosts. A seemingly benign activity became his source of shame and guilt as he compulsively spent vast amounts of money and time pursuing new purchases at the expense of work responsibilities and family relations.
Such is the nature of addiction. It robs the victim of a full, satisfying life while sustaining the victim’s illusion that the substance or activity will continue to be rewarding despite evidence to the contrary. As people in recovery know, Denial is not a river in Egypt. Denial is the cornerstone of addiction. Without denial, the addict would be tormented by cognitive dissonance. “One’s too many; a thousand’s not enough” is one of Alcoholics Anonymous’s (AA’s) slogans that captures the loss of control and insatiability of addiction. Hitting bottom is when the pain breaks through the denial and the addict is “ready for change”, in Motivational Interviewing parlance.
Various theories attempt to explain addiction. One psychodynamic theory is that addictions function as a transitional object (a symbolic replacement for maternal functions). People whose early attachments failed to meet their basic needs for security have difficulty forming trusting, intimate partnerships. The addiction protects them from interpersonal vulnerability by keeping them in the illusion of self-reliance. The illusion of autonomy is comforting, but ultimately robs the addict of fulfilling, whole object relationships. Addictions create artificial needs that prevent real needs from being met. The false need is insatiable. The hungry ghost gets hungrier for what it does not need, and for what cannot fulfill.
Dependency on addictive substances is marked by tolerance—needing more to get the same effect—and withdrawal—physical and psychological symptoms upon cessation of use. To avoid withdrawal, one must continue using in increasing quantities. Couple this with psychological dependency and the addict’s life becomes progressively centered around the object of addiction. Eventually, anything can become a reason to indulge. Most addictions carry guilt and shame. The divide between the private battle and public cover-ups creates an internal chasm. The victim must weave a web of deception to maintain the secret. Eros and Thanatos wage an internal war that becomes a living hell. “I’m sick and tired of being sick and tired,” is another familiar phrase in AA circles.
Amnesia, denial, rationalization and cravings are the lubricant for sliding into addictive behaviours. Rational thinking through to the consequences is temporarily foreclosed. Suffering resurfaces with fortified determination to stop, yet triggers happen and the cycle starts again. Triggers can be intolerable affect states, conditioned associations (e.g., “I always smoke when I drink.”), anniversaries, boredom, loneliness, etc. In AA, they say, “A thousand excuses, and not one good reason.” Over time, more and more things become triggers.
Some people balk at the spiritual component of 12-step recovery programs. Step Two is written: “Came to believe a power greater than ourselves could restore us to sanity.” The fellowship of AA began in the 1930’s with two alcoholics, Bill W. and Dr. Bob. It was based on the Oxford Movement in England in the 1800s, which was a Christian renewal movement using the small group experience. As soon as Bill W. and Dr. Bob were aware that Christianity was a deterrent to non-Christians, they changed the wording to “Higher Power” and stated that it is up to the individual to define their Higher Power. They wanted AA to be inclusive of all sufferers of alcohol dependency. Tradition Two states: “The only requirement for membership is the desire to stop drinking.”
The 12 steps are about letting go of self-will and doing the will of the Higher Power. This could be likened to Wise Mind in DBT, intuition, or executive ego in psychodynamic terms. The strong-willed pulls for indulgence evoke strong-willed superego “shoulds” for abstinence. Good vies with evil. Eros vies with destructive Thanatos. Strong-willed intentions lead to strong-willed defiance. The 12-steps are about willingness, not willfulness. It is a softening of the extremes and a strengthening of the integrated self.
AA is no longer the only option. There are alternatives for people to choose from, such as SMART Recovery, or Rational Recovery. People have to find what works for them. Yet, the 12-Step Anonymous groups offer members recovery tools (learning to live in harmony with self and others), healing fellowship, and a transcendent experience that can sweeten the joys and challenges of everyday life.
Marilyn Chotem, Ed.D., R.Psych. #773
BC Psychologist Journal, Addictions, Volume 2/Issue 3, Summer 2013