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Abstract. Addictive behavior
attempts to repair a state of bad feeling but is a Faustian Bargain
that perpetuates itself and often asks the ultimate price. Addiction
can be compared to an unhealthy, fanatical love. Unnatural and arbitrary
hedonic management by substances or stereotyped processes distorts
and cripples the psyche and places the individual at a grave survival
disadvantage. The addict is double-minded because he cannot really
and truly desire recovery until he already has it. Recovery is about
restoring natural, spontaneous and healthy regulation of mood and
feelings. Because addicts may be seriously impaired in their pre-addictive
self-care and self-management they often require prolonged help
learning to feel well without resorting to the "tricks"
of addiction.
Addictive behaviors such as smoking, drinking,
drug use, overeating and other "quick fix" maneuvers aimed at
rapidly and dramatically changing the individual’s emotional and
hedonic state are natural and common targets for resolutions of reform,
whether at New Year’s or any other time, to "do better," to
"turn over a new leaf" or to "quit once and for
all." And even more than in the case of the typical New Year’s
resolution, the solemn promise of the substance(alcohol, nicotine, other
drugs, food) or process(gambling, spending, sex) addict is well known by
just about everyone familiar with such matters to be, more often than
not, ‘writ in water.’ In addiction perhaps more than any place else,
"The best laid plans of mice and men gang aft aglay."
Such natural and only too well justified
skepticism about promises of reform on the part of those familiar with
the addict does not necessarily include the addict himself, who may
fervently and sincerely exclaim "I know I’ve said this before –
and I know that you don’t believe me and that you are entitled not
to believe me. I wouldn’t believe me either if I were in your shoes.
But this time I really mean it. I swear it will be for real. Wait and
see if I’m not telling the truth!"
But in spite of this and other equally inspired
proclamations of intent to reform, in the vast majority of cases of
definite and well-established addiction, nothing whatever changes – at
least not for long. Or if there is change, it is change for the worse:
the addict’s outrageous addictive behavior sometimes seems almost to
feed upon and draw nourishment from his passionate promises that
"it will never happen again." This phenomenon leaves those who
have to deal with the addict in a confused, discouraged, angry and
usually depressed state.
It is difficult to change any behavior to which
one has grown accustomed unless there are powerful and consistent
immediate rewards for doing so or equally persuasive penalties for not
doing so. In many cases, e.g. that of commencing and maintaining a
physical exercise program, the rewards of such a behavior change are by
no means immediate, while the costs of them –the discomfort occasioned
by exercise to which one is unaccustomed- are up front and unavoidable.
Individuals who succeed in getting over the hump of such habit change
usually do so by making themselves look ahead to a future and more
desirable state which will be the actual and lasting reward of their
present, unrewarded efforts. Everyone knows how difficult it is to do
this – and how easy it is to succumb to excuses and rationalizations
which permit one to abandon his efforts while managing to save face by
telling himself that "I’ll get back to it later" or
"Now is not a good time to be doing this – but in the future,
when circumstances are more favorable, I will certainly resume my
efforts." Addictive thinking is notorious for its smooth and
lawyerly ability to "plead its case" and to make the afflicted
individual actually believe that he is making a rational decision in his
own best interest, when in fact he is simply being yanked around by the
addiction like a puppet on a string. "Wait until after the holidays
to stop drinking," addiction coos into the ear of the alcoholic who
has become seriously concerned about the consequences of his drinking.
"That way you will actually have a much better chance of stopping
and staying stopped than if you went ahead and stopped drinking right
now. This is not a good time to try to stop drinking – but next month
will be perfect!"
In the case of addictive disorders all of the
usual resistances to habit change are found in full force – but there
are other obstacles as well. For in most cases the addict is deeply
divided and double-minded about his very desire to change his behavior,
even when he is perfectly aware that the behavior is damaging both to
himself and others. The addict knows that he ought to want to
stop engaging in addictive behavior, but he is powerless to make himself
really and truly want to do so. His intelligence and his reason
may point him in one direction, that of recovery from his addiction; but
the force of the addiction itself points in another, quite opposite
direction. The result is a kind of ongoing internal civil war in the
mind of the addict, who is thus a house divided against itself, pulled
in two contradictory directions and as a result, double-minded to the
tips of his toes.
Even to attain such a stage of more or less
conscious double-mindedness is for many addicts a sign of significant
progress. For in the early stages of addiction, and in all cases in
which people are simply unable or unwilling to be honest with
themselves, such a definite and clear-cut distinction between the
addictive want and the rational should is seldom available
to the conscious mind of the individual. Such dissonances as exist are
smoothed over and rationalized away by the extensive armamentarium of
the addict’s psychological defenses, with the happy and fortuitous
result that what the addict wants –to continue his addictive behavior-
turns out to be precisely what is both justified and best for him, at
least in his own mind. But even here, beneath the threshold of
consciousness and behind the obscuring screen of mental defense
mechanisms such as denial, projection, rationalization and others, the
addict is usually deeply divided against himself.
Addictive double-mindedness means that the addict,
even, indeed especially when he has attained a reasonable
consciousness of his plight, remains between the proverbial rock and a
hard place. He knows that his addictive behavior is not good for him or
for those around him; and he knows that the wisest, sanest, most
sensible and indeed the only rational thing for him to do is
therefore to abandon it immediately and to never look back. But this the
is one thing that he is not prepared to do. He might do almost anything
else to be rid of his addiction – but he won’t do the one thing
needful, and the only thing that counts: desist once and for all from
the addictive behavior itself.
Why not?
For the addict the prospect of giving up his
addictive behavior and the feelings it brings him activates profound
feelings of loss, deprivation and despair.
The addict is attached to his addiction in a primitive and pre-rational
fashion just like a lover is attached to his beloved – or an infant is
attached to its mother. Because there are no longer any clear boundaries
between his love object –in this case, his addiction- and himself,
each merges imperceptibly into the other so that it is impossible to
tell precisely where the addict stops and his addiction begins - and
vice versa.
The psychological consequence of this blending,
merging and fusion between the individual and his addiction is that any
threat to the continued vitality or existence of the addiction is
immediately experienced as an equal and corresponding threat to the
self. The addict cannot really imagine a worthwhile life sans his
addiction – or if he is somehow able to
conceive such an existence, he finds it to be unbearably weary, stale,
unprofitable and empty, a kind of living death that is more of a curse
or a punishment than anything to be valued or preserved. Thus it is
perfectly natural for him to say to himself, imagining as he usually
does a future free of addiction that is also and as a consequence
destitute of every enjoyment and meaning that make life worthwhile, that
quantity of life is not so important as quality, hence it is reasonable
in his mind to persist in his addiction even if it shortens his life substantially
because at least he will be happy during the time remaining to him.
Unless one understands this inability of the
addict to envision in any depth and for any significant duration a
meaningful and worthwhile future for himself without what to him has
long since become the comfort and security of his addiction, he will not
be able to make sense of the ways in which the addict is constantly and
usually successfully drawn back to his addiction like the moth to the
candle flame. Nor will he be able to comprehend why the addict often
appears to sacrifice his life, his fortune and his sacred honor –usually
in the reverse order- to the demands of his obviously absurd
monomaniacal obsession.
Addiction is a process that over time encroaches
upon and over time invades the normal, healthy "tissue" of the
addict’s personality in a manner strikingly similar to the way a
malignant tumor crowds and infiltrates the tissue around it. And just as
in many cases the Dilemna for the treatment of a bodily cancer is how to
remove or destroy the cancer while simultaneously sparing as much as
possible of the nearby non-cancerous and often vital host tissue, so
does recovery from advanced addiction require a similar separation of
"tissues," with destruction of one and protection of another.
The process of recovery from addiction in fact quite often resembles the
radiation treatment and chemotherapy of a grave malignancy during which
the individual often experiences side effects and feels quite ill from
the treatment.
It has been often and truly observed that the
addict in many ways resembles a lover with a fatal attraction to an
injurious, possibly even a deadly love object. Such destructive and even
fatal love of one individual for another is of course by no means
unknown. It has many enduring literary representations, from the poems
of the Roman poet Catullus to W. Somerset Maugham’s novel "Of
Human Bondage." Just about everyone is familiar with this
phenomenon of unhealthy love – if not from their own experience, then
from that of their friends or acquaintances. Individuals in the grip of
such a pathological obsession are "unable to live with" and
"unable to live without" the object of their affections. Such
relationships are stormy, painful, often violent – and always unhappy.
In some cases the lover is perfectly well aware of being abused,
misused, deceived and maltreated by the one he loves – but he seems
strangely powerless to stay away from a relationship that is obviously
unhealthy and injurious to him.
Such lovers, like all lovers, are of course
obsessed with the object of their love. They long for it, pine away when
deprived of it, and think constantly about ways to reunite with it. The
beloved becomes the center of the lover’s mental universe, the center
from which all radii emanate and around which all circumferences are
drawn. Everything is organized in a hierarchy on top of which the
beloved reigns supreme and secure and to which everything, absolutely everything
else is now subordinate. Nothing that seriously threatens the beloved
object is likely to survive for long – and even everything that does
not pay it sufficient homage or which is even suspected by the lover of
being critical of it is likely to retain respect or regard that once
were unquestioned. Friends, family, traditions, even ethical and moral
values once held sacrosanct: all must and do give way if they threaten
the continued relationship with the beloved. By means of a "transvaluation
of all values" the addict now finds himself truly "beyond good
and evil" – at least when it comes to his relationship with his
beloved.
If a lover in the grip of such a dire obsession
for his beloved is advised by others to give up the relationship
"for his own good" or for the good of others –one thinks of
the Montagues and the Capulets of "Romeo and Juliet" here- he
will recoil in anger and disgust from the very thought of a life without
his beloved – and he is surely apt to distance himself, even to regard
as actual or potential enemies those who dare to give him such absurd
and intolerable advice. He may even declare that since life would not be
worth living any longer if deprived of his beloved, he is perfectly
prepared to hazard every danger, even if necessary to die in an effort
to prevent what for him would be the ultimate and irreparable disaster,
the loss of his beloved. And whether his "beloved" is a person
or an addiction, he may upon occasion do just that.
Although it is the rare addict who thinks
consciously of his relationship to his addiction in terms even remotely
resembling those just described, an analysis of addictive behavior and
values reveals many remarkable similarities between a certain type of
love of one human being for another, and the love of an addict for his
addiction. Common to both experiences is what might be called a totalizing
tendency to reshape not only the world of the lover but even his very
identity in a manner congruent with the object of his love. The very
existence of the addicted individual can often be divided, both
subjectively and also objectively, into "Before the addiction"
and "After -actually during- the addiction." Of the
experience of what truly comes "after the addiction," i.e.
recovery from addiction, the addict as a rule has no conception whatever
beyond the projected state of perpetual mourning and living death
described above.
It is worth dwelling for a moment longer upon the
remarkable attachment of the addict to his addiction – and upon his
profound sense of loss when he is - or even imagines himself to be-
deprived of the comfort, solace and sense of security he derives from
it. For in a psychological sense this track takes us very close to the
lair of the addictive beast itself.
Although breaking the bonds of a serious addiction
is actually a huge step toward personal freedom and a richer, deeper and
more satisfying life for the formerly addicted person, it is almost
invariably experienced by the addict himself as a massive, often a
catastrophic loss and resulting state of permanent deprivation.
Even the faintest threat of such a potential loss is often enough to
activate frantic emergency behavior designed to head it off at the pass.
The long habit of addiction has made the addict accustomed to it and
caused his other coping strategies and tools to wither from disuse
atrophy. In many if not most cases he literally does not know what to do
with himself without his addiction.
A large part of the addict’s double-mindedness
about recovery results directly from his longstanding intimate
relationship with his addiction as a security object –in fact, as a
soothing and comforting parental surrogate- and the painful negative
emotions that are inescapably connected to the loss of such a familiar
and, as the addict sees it, protective relationship. For strange and
even starkly opposed to the actual facts of the case as it sounds, the
addict actually feels sheltered and protected from danger by his
addiction. Without his addiction the addict feels terribly insecure,
exposed, and liable to all kinds of harm. For the addict, his addiction
is a kind of pacifier that can always be depended upon to produce the
feelings associated with safety and security – even though in his case
these feelings, because they are artificially derived and thus bear no
relationship to the addict’s real circumstances, are dangerously
misleading.
Addictive behavior aims to modify the emotional
and hedonic(pleasure) state of the individual directly by artificially
creating positive feelings and avoiding negative ones. This means that
the addict’s own internal guidance mechanism, his "survival
compass" becomes progressively disconnected from his actual
internal and external environment with its constantly shifting and
changing stimuli and cues, and is replaced by the "false
compass" of the addiction whose needle is always pointing toward
itself and hence bears no relationship at all to what is good or bad for
the individual who attempts to navigate by it.
Pleasure and pain, the two "sovereign
masters" that the Utilitarian philosopher Jeremy Bentham claimed
rule the lives of all men, are obviously instrumental in steering not
only human beings but every sentient creature toward certain goals and
away from others. One need not be a crude utilitarian nor a rank
hedonist to see that a significant disruption in the "guidance
system" of the pleasure-pain sensors could have negative, even
fatal results. For example, if it felt good rather than bad to thrust
one’s hand into a fire there would certainly be a lot of badly burned
and permanently crippled people around, still struggling against the
temptation to "do it just one more time." And in the other
direction, if the sexual reproductive act were an intensely painful
experience for all parties involved, it is not likely that the problem
of overpopulation would ever arise.
Thus in some rough and certainly inexact fashion
the sensations of pleasure and pain seem to act as guidance systems and
channel markers to steer the individual in a safe direction and away
from harm. And it is also difficult to deny that under most
circumstances a feeling of well-being or happiness most often indicates
that "all systems are go," i.e. that the individual’s inner
and outer milieu is at the moment stable, healthy, and conducive to life
and growth. A pervasive bad feeling, on the other hand, or any sustained
state of negative or so-called "emergency" emotions(fear,
rage, guilt &etc.) suggests that an unhealthy condition exists
either internally or externally and that some action is called for to
restore the conditions necessary for health and its associated positive
feelings.
The syndrome and process of addiction involves
what might be regarded as a sustained manual override by artificial
means of the "autopilot" of the addict’s natural and
interactive hedonic(pleasure-pain) regulation. The addict, that is,
learns to take control of his hedonic state by direct chemical or
behavioral means, thereby short-circuiting its connections to his actual
inner and outer environment and rendering it worthless or even harmful
as a "compass" to steer by. By means of a kind of Faustian
Bargain he manages to attain good feelings and to avoid bad ones, not in
a natural and healthy fashion that is intimately related to the ongoing
reality of his life and behavior, but by the manipulation of his
addictive substance or process. As time passes he strays further and
further from the true path of health and sanity until at last, and
usually before he realizes what has happened to him, he finds himself
lost in a dark wood of addiction with no guide to show him the way back.
For by this time his own "compass" has been so damaged by his
addiction that he is very apt to fear and avoid just those things that
would be good, even lifesaving for him, while instead steering and
steaming with all his might directly into the jaws of the very addiction
that is destroying him. His feelings are no longer reliable guides to
rational and healthy action but in fact quite often the very reverse.
Thus while the motto of addiction itself might be "If it feels
good, do it!" the motto of recovery, certainly not in all cases but
in more than a few could be "If it doesn’t feel good, do it
anyway."
The addict’s Dilemna, then, comes down in the
end to this: what he feels like doing is seldom good for
him, while what he doesn’t feel like doing, e.g. stopping his
addiction, getting treatment, engaging in healthy behaviors &etc.
often is. In most cases of well-established addiction the emphasis has
long since switched from the so-called "positive
reinforcement" paradigm in which the addictive behavior is
primarily motivated by a search for pleasure or good feelings, to a
"negative reinforcement" model in which the goal is mainly to
avoid the bad feelings that the addict knows are in store if he fails to
perform his accustomed hedonic manipulations by means of his substance
or process of choice.
Such considerations help to explain the fact,
well-known to professionals who deal with individuals suffering from
serious addictions, that lasting recovery, when it begins, quite often
begins in the context of a crisis of sufficient magnitude to overwhelm
the addict’s natural and well-entrenched aversion to recovery by an
even greater fear such as the loss of an important relationship,
a job, health or freedom(the threat of jail for addiction-related
offenses).
It is therefore not at all the case that
alcoholics and addicts "have to want to get better" before
recovery can commence, much less that they must "want to get better
for themselves and not for someone else." For the addict’s
double-mindedness makes such "pure" motivation all but
impossible for the vast majority of addicts. Luckily for the addict,
recovery is just as likely, perhaps even more likely if he is in effect
marched at bayonet point in the direction of behaviors that are good for
him and which he would therefore, owing to his addictive hedonic
disorientation, normally avoid like the plague if only he were not
afraid that by so doing he would incur an even more unpleasant
consequence. For it is one of the many
curious paradoxes of addiction and recovery that genuine and sincere
motivation for recovery is a result of and not a prerequisite for
recovery.
When addictive behavior is suddenly interrupted or
suspended –usually by circumstances beyond the addict’s control, but
occasionally as the result of a rational decision- there is an immediate
hedonic backlash effect as the "bills" begin to come
due for the prolonged artificial manipulation of mood and feeling state
that is a central feature of the addictive process. The addict suddenly
feels worse – much worse. Depending upon the specific substance
involved he may undergo so-called "withdrawal symptoms." But
regardless of the substance or process involved, when an addiction is
suddenly interrupted the addict is plunged into a negative hedonic state
that may last days, weeks, or even months. During this period of time
–early recovery or early remission- he is obviously extraordinarily
vulnerable to a return to his accustomed "old reliable" means
of directly manipulating his feeling state, the very addiction that has
brought him to the unpleasant predicament he is presently in and is
trying to escape from. As he begins to abstain from his addiction he
feels bad – but he is doing well. In fact the negative hedonic state
of bad feelings the addict encounters as the consequence of suspending
his addiction is the very first step in the direction of health and
normalcy. For the first time in what is often a very long time his bad
feelings have a natural and ultimately healthy origin: his mind and
brain are attempting to re-establish their own autonomous equilibrium
after the withdrawal of the artificial external mood changers that his
addiction has relied upon to manage his hedonic condition. All that is
necessary in many cases is for the addict to abstain from his addiction
long enough to permit his own resources to begin to take over again.
Given sufficient time –usually to be measured in months rather than
days or weeks- the natural resilience of the nervous system "works
through" whatever abnormal changes or deficits resulted from the
prolonged artificial mood regulation of addiction and restores the
abstinent addict to his pre-existing, pre-addictive status.
Yet many times this pre-addictive status itself
may be an abnormal one, in fact a condition of dampened or diminished
mood and pleasure-capacity that may be a precursor of the florid
addictive disease that later breaks out as a consequence of the addict’s
often unwitting efforts to repair his pre-addictive condition by means
of drugs or other behaviors that make him feel better. For
in the last analysis, addiction is nothing but a miscarried and often
tragic attempt on the part of an individual who does not feel good to
feel better.
The newly abstinent and recovering addict
therefore is frequently in a kind of hedonic "double
jeopardy." For the discontinuation of an addiction always involves
"payback time" as the individual’s own internal regulatory
systems struggle to get back on line; and the addict’s
"normal" pre-addictive state may itself have been
significantly impaired – in fact, one of the reasons he was ensnared
in the addictive cycle to begin with.
The exact causes of the future addict’s
pre-existing abnormal hedonic state –a state of not feeling good- are
seldom known with any precision. Most likely a combination of "Nature"(the
inborn physical constitution) and "Nurture"(environmental and
life experiences beginning at birth) are responsible.
The interaction between Nature and Nurture can be
subtle and bi-directional: an infant that was born with a hedonically
compromised nervous system may be unusually fussy or less emotionally
responsive than average, behavioral qualities that in turn may elicit
differing responses from its caretakers and, when older, peers. An
almost infinite series of combinations and permutations is possible
depending upon individual factors and circumstances. Simple answers in
this complex area are frequently misleading.
In fact, thanks to the peculiar emphasis of much
traditional thinking about mental health upon origins rather than
remedies, even the questions themselves are frequently beside the
point. Not "where did this difficulty originally come from?"
but "how can it be changed for the better?" is the more
pragmatic and usually the more productive question to ask in regard to
human beings and their vicissitudes. For in addiction, perhaps more than
in any other area of abnormal human behavior, insight is not enough.
At best, insight provides a pretext and an inspiration to proceed with
the actual behavioral changes required for recovery from addiction. But
insight is not really required, at least in the beginning.
All that is usually required for recovery to
commence is willingness to perform the necessary work – even if that
willingness is partial, incomplete or coerced. As long as the work gets
done, the recovery has a chance to begin. In the optimum case both
insight and motivation develop later on - as a consequence of the
original, frequently grudging spadework of early recovery. "Begin
recovery first," the motto here might be, "and ask questions
afterwards." Failure to acquire the motivation for sustained
recovery and at least a minimum amount of insight may of course
predispose the individual to later relapse after a promising beginning.
But first there must be a beginning, however it is brought about.
And at this stage of things, one method seems to be about as good as
another – though those that are most dramatic, painful and undeniable,
as well as those with still imminent and even more dreadful consequences
if the addiction continues seem to yield the most initial impetus and
momentum to the early recovery process.
Although abstinence from the addictive substance
or process is the sine qua non of a lasting recovery from
addiction, experience with addicted individuals shows plainly that
abstinence alone is often not enough. For although a certain number of
addicted people do succeed by simply giving up their addiction, a large
number do not. What happens to them is reminiscent of Mark Twain’s
famous remark about smoking: "It’s easy to quit – I’ve done
it a hundred times!" Such individuals stop their addictive
behavior, hold on by their fingernails for a while, and then relapse –
sometimes with extra added momentum from the negative energy of their
"deprivation." This familiar addictive cycle causes shame,
guilt, despair, disgust, hopelessness and helplessness both in the
addict and those who are affected by his addiction.
Sustained recovery from a well-established
addictive disorder requires a major realignment of the psyche away from
the artificial, unnatural and over-specialized dependence upon a
substance or process for hedonic management, and towards a more natural,
environmentally-attuned and above all flexible responsivity to internal
and external stimuli. Instead of manipulating his mood and feeling state
by the artificial means of chemicals that are completely unrelated to
what is actually going on within and around the individual, the
recovering addict gradually and often painfully learns to operate on his
own resources. And because his own resources are many times inadequate
for satisfactory mood and hedonic control, he must also acquire new
methods of cultivating good feelings and avoiding bad ones.
The fellowship, interpersonal and social
learning, and the spiritual and cognitive resources of 12 Step and other
recovery programs can be of enormous assistance in helping the
recovering addict to learn such new coping strategies. A kind of
Catch-22 frequently develops here, however: many addicts are so impaired
in their capacity to take care of themselves and manage their moods in a
healthy fashion that even participating in an interpersonal recovery
program may initially be beyond their resources. Thus it is often quite
a challenge and stress for them merely to begin regular attendance at
helpful support meetings – and many people who might benefit
substantially from such meetings simply avoid them, offering as excuses
for doing so a variety of familiar and predictable rationalizations. The
characteristic addictive response is along the lines of "I’d
rather do it by myself," an attitude that itself signals what is
usually a longstanding difficulty in recognizing the need for help and
in being able to request and accept it when it is in the best interest
of the individual to do so. back to top
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