Addiction; illness or indulgence?
As an addiction counsellor I have long been aware of the above dilemma, and indeed, had it shoved in my face and down my throat by a multitude of variegated individuals who all share the same dubious distinction of knowing what is best for others. They assemble around the same totem of core beliefs that in various ways all propagate naming and shaming and tough love (the tougher the better) as advocates of healing.
I have been variously vilified as an enabler, a bleeding heart liberal, a namby panby do-gooder and a hippy, to name but a few, because I refuse to bow to to this most fundamental and unthinking and uncaring set of views propagated by those who carry some sense of grievance towards those who appear to have taken leave of their sense of involvement in society as a broad church.
Is addiction a major life threatening disease?
A chronic illness?
Or an indulgence by weak willed, wounded, irresponsible people who wallow in self pity and play the victim to garner sympathy?
Are addicts low life ne’er do wells who drain the country, their families and society of resources energy and patience by their long suffering indifference to work, ethics or morality other than filling their systems with junk, skunk, booze and barbiturates?
Should we feel sorry for them or burn them at the stake for crimes to humanity and decent folk all over the world who suffer the same slings and arrows of outrageous fortune but hold it together and don't burden others with their problem? That problem being the inability to cope with setbacks and failures, rejection and tough treatment at the hands of others.
Anyone who thinks they have the answers to the above questions is either divine or dangerous. My personal opinion sides very much with the latter.
Addiction is a difficult and not very helpful term. We’ve all used it to refer to many things hardly connected to real addiction in the clinical sense of the term, but then that’s a characteristic of life itself not just addiction or addicts or chemical dependency. We all use terms technically, literally and figuratively interchangeably throughout the course of the day and sometimes our wires become somewhat crossed when it becomes necessary to be consistent in our usage of terminology in order to seek a possible treatment for a specific condition.
We live in an age where gratification has become more and more instant as technology and science opens the doors on worlds and possibilities we never would have thought possible just a few decades ago and this instant gratification is a feature of addictive behaviour. The ‘want’ or desire to get something to make us feel different goes to the heart of the matter; wanting and craving and satiating that desire becomes a need that demands satisfaction time after time and insists on higher and higher doses to return similar results, although ultimately nothing will ever restore the initial high experienced at the beginning of the addiction or behaviour, it just isn’t possible and if the addict doesn’t ‘get that’ they will overdose before they can ever quit.
Dopamine production as a chemical in the brain that creates feel good sensations goes to the heart of the matter for many neuroscientists. According to this view dopamine production causes feel good sensations and without these feel good sensations we feel only partially alive. An iconic photo of the brain published by NIDA sometime ago shows areas of the brain firing up with dopamine production.
In four different photos four different brains are shown firing up different amounts of dopamine and the brain of the addict shows less production than the so called ‘normal’ brain. Neuroscientists and many addiction therapists say this proves addict’s brains are different to those of heavy users and moderate to light users. This argument holds that addicts are developed rather than born; nurture rather than nature.
Plasticity refers to the development of the brain's pathways, receptors and neurotransmitters in response to the environment made for us by our caregivers. The development of the brain relies on physical sensation generated by psychical interaction with our surroundings. If we experience a nurturing, receptive environment in which we are rewarded consistently and judiciously the reward circuitry in the brain will be regularly fired up and will develop into a robust and reliable mechanism to provide us with the capacity to self soothe, or self reward or feel inwardly ‘good enough’ with our environment, both the internal and the external environment. In other words our need to be rewarded will be innate and internally accessed as and when we need it to be called upon to replenish our sense of self, others and the future.
Without this internal facility working satisfactorily, however, a lot of neuroscientists and therapists working in the field of addiction maintain that the addict needs to look outside for his or her rewards and they find them in substances and rituals. They then belatedly experience what a healthily developed brain has already undergone and become hooked to those ‘discovered’ behaviours and rituals believing them to be, in and of themselves, the answer to their feelings of inadequacy and worthlessness because of a meagre to non existent experience of self rewarding dopamine production in their brains.
The reason they’ve never consistently experienced gratification is because their reward centres weren’t well enough developed in infancy, adolescence and young adulthood and therefore couldn’t produce dopamine to give themselves an internal, free, and entirely natural and repeatable and satisfying high. The discovery of alcohol and drugs and food and sex and gambling and anything else that is indulged in is a result of a deficiency of reward centres in the addict’s brain.
They feel they have to access their drug of choice to feel whole again, or normal, and when physical chemical dependency kicks in as a result of the continued and heavy use of the substance that will become a self fulfilling prophecy and the disentangling of that muddled thinking becomes a job of therapeutic urgency and intensity and calls upon the practitioner's skills, patience, virtue and integrity to forge a working alliance with the sufferer to initiate and maintain a joint enterprise designed to restore logical, rational thinking in place of erratic, demanding, illogical emotional logic shot through with impulse and instinct, prejudice and myth.
Alistair Mordey of ‘The Cabin’ organisation headquartered in Thailand describes this dichotomy as one between the reptilian brain and the thinking brain.
One has a long history of longevity – the reptile, the other is relatively short numbered in terms of years – the thinking brain, and it is the older brain that will always hold out he maintains unless the other is brought back into the equation through a combination of 12 step fellowship, meditation and mindfulness and lifestyle changes cognitively and rationally thought through and applied, systematically and insistently throughout treatment. Everything takes time to develop in both addiction and recovery. They both take repetitious execution in and of to establish primacy in the person’s life. Practice makes permanent and that applies to recovery as much as addiction. Neither will take hold unless practiced enough, and that means a lot and often. We have to tell ourselves to get well. Albert Ellis puts it like this;
“What do you think you’re telling yourself to make yourself this way?”
Rational Emotive Therapy; It works for me, It can work for you
Prometheus Books New York
Addicts make themselves sick before they indulge in their drug of choice because they’re telling themselves they’re worthless, non entities, or conversely that they’re giants, superhumans, beyond the restraint and restriction other mere mortal people have to adhere to. Either way what they’re telling themselves fuels what they do and how they regard themselves and others and this re-thinking ties in with a recovery programme that looks at the whole human being in context and amongst others not a reified mythology pedalled by the doom and gloom brigade who would hang ‘em high and tolerate only slavish obedience to a ruthless iron fisted application of an insistent dogmatic tyranny that has all bowing down before it in mindless obedience under threat of punishment and annihilation. Ellis tells us in the same book that;
“Studies show that when people change their irrational beliefs to undogmatic flexible preferences they become less disturbed” Ibid p.187
The power of the pen has been accepted by many, for a great length of time, as being greater in varying degrees than the sword. In the same way the power of the mind can free one from compulsive enslavement to what an addict often sees as a no choice event. Putting oneself back in control of one's emotions, actions and choices is the greatest liberation one can feel and easily the most powerful. At the root of addiction is anticipation. The expectation of salvation through the satiation of ones intense desire through the indulgence in an event or ritual (and often the two are inextricably intertwined) produces a reward in the form of dopamine production in the brain that mirrors the healthy functioning ‘normal’ brain and creates the illusion of a habit that heals and redeems the lost addict. It doesn’t, it merely creates that illusion. In full blown addiction anticipation is all the pleasure and creates ‘normal’ hedonic tone.
The people I have worked with over the years have arrived, variously and in many different ways at this realisation. Often the realisation is wordless, soundless, non theory based and creeps up on one without full recognition until it is noticed that the intensity for the indulgence has waned. The addict has learnt how to blame themselves for their failures without feeling destroyed in the process and in their acceptance of their imperfection comes a peace that surpasses all understanding and yet palpably enables full living.
One hears talk of unconditional positive regard and sees those desperate to be seen as ‘person centred’ vigorously and sagely nodding their heads, yet one hears little these days of unconditional self acceptance, unconditional other acceptance, or indeed the all encompassing and pre Rogerian, unconditional acceptance as espoused by Paul Tillich, and I think that’s a shame.
If addiction is the reaching for something we bestow with powers of restoration and healing then the AA’s philosophy of a surrendering to a higher power must be the ultimate addiction, must it not?
For me the surrendering to a hidden power would work better because that hidden power lies within, not without and gives us a permanent sponsor and counsellor within to call on at any time of the day or night. It is the inevitable end result of USA – Unconditional Self Acceptance and is optimistic, forward looking and uplifting; it puts us in touch with that still, small voice within and allows that bright white burning light covered by flesh and bone to radiate through us and out into the world to show us the way forward.
In today’s modern world we are constantly told what is best for us and it can be very difficult to remember that we are actually the best source of what is right for us, not external agencies, politicians or media personalities despite their hectoring insistence that they are. Following our own way forward can sometimes then be felt and seen as a form of rebelliousness that flies in the face of the notion of the good citizen and therefore good and successful person.
Therapy can help overturn that misconception and put us back in touch with the real driving force of our meaningful existence; ourselves. In so doing we can find the motivation and belief that external props like alcohol and drugs can bestow meaning on our otherwise dull, drab and meaningless existences and find the true joy in simply being.
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