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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 dilemma, 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.
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