Rethinking Addiction

Posted on: August 2nd, 2018

Bruce F. Singer, Psy.D.
Chief Clinical Officer, Urban Recovery

Addictions are all around us.

Over 15 million Americans either abuse or are dependent on alcohol. Despite more than 50 years of warnings about the health risks, 37 million Americans still smoke cigarettes. Sixteen to 30 million of us suffer from compulsive sexual behaviors and more than 10 million Americans struggle with a gambling addiction. Caffeine may be the biggest addiction of all: Nearly 90% of us, including young children, ingest it every day, whether in soda, coffee, energy drinks, or tea.

When it comes to substances, the truth is, we live in a culture of chemical coping. There seem to be pills for every condition, and we chase after instant relief from everything that ails us. But chemical dependence is not a substance use disorder (SUD), which is the formal name for addiction in the psychiatric diagnostic and statistical manual (DSM-V). Addiction can be defined usefully as an uncontrollable compulsion to keep using despite negative or adverse consequences.

One thing that addiction is not is a defect of character. That view, known as the Moral Model of addiction, is a vestige of the Victorian era. While discredited by professionals in the treatment world, the Moral Model still manages to cast shame and blame on those suffering from the disease of addiction. Disease is not a word to be used lightly: Science has shown us how genetics predispose some individuals to addiction and how substances “reward” the mid-brain with bursts of pleasure-producing neurotransmitters like dopamine.

Overstimulating our reward centers is a bit like turning over the control of your car’s steering wheel to the toddler sitting in the car seat behind you. Rational thinking becomes more and more impaired as primitive pleasure centers and their reward pathways demand greater stimulation. In time, the brain’s motivation to quit using becomes damaged, much as the ability to speak may be damaged by a stroke. Which is why many professionals call addiction a chronic progressive primary disease.

Given our understanding of the brain, it makes sense that we would look to scientists to search for a chemical solution to prevent addiction or the relapses that accompany it. Medications such as Vivitrol or Suboxone have received a lot of public attention since the onset of the current opiate epidemic. Still, the best research, using twin and adoption studies, demonstrates that 50% of the susceptibility to a SUD comes from our genes. The other 50% results from our individual psychology and reactions to our social environment.

Perhaps, it is time to consider addiction not as a disease but as a state of dis-ease. Underlying trauma, a sense of spiritual emptiness, and feelings of worthlessness often drive addictive behaviors and can never be managed by pills alone. Successful treatment needs to be holistic: the psychology and social contexts that drive addictive behaviors are every bit as important as the physical symptoms.

Behaviorally, addictions gain power from both positive and negative reinforcement. The initial feeling of euphoria brought on by drug use or gambling – or even excessive exercise – is powerfully self-reinforcing. At the same time, the crash that follows the euphoric high can be so distressing that a person may do whatever it takes to avoid negative feelings. Often, this means taking more substances, and the vicious cycle of positive and negative reinforcement begins to consume one’s life.

Unlearning such powerfully reinforced behaviors takes time and effort. It takes professional help to overcome the maladaptive patterns of thinking and behaviors that sustain addictive behaviors. For many people, it also takes a strong and supportive social network, which is why 12 Step groups such as Alcoholics Anonymous or Gamblers Anonymous often play a crucial role in sustained recovery and successful relapse prevention.

Long ago, Buddha spoke of attachment as a source of human suffering. In our addiction to drugs, sex, shopping, or money, we cling to past regrets and future worries. Our addictive cravings and urges can best be understood as a desire for things to be different than the way they are. If we can learn to accept ourselves as we are now – whether good, bad, or indifferent – we can recognize when enough is enough and alter our brain chemistry through meditation rather than medication. Or to put it another way, we can use skills rather than pills.

There is no simple solution to the problem of addiction. There is no cure. Recovery is not about denying our addictions; rather, it’s about recognizing how our attachment to the belief that we need something outside of us to feel whole underlies all addictions. When we change our relationship to our lives by understanding our deepest values and engaging in the things that matter most to us, we learn how to live with meaning and purpose despite doubts or fears or cravings.

Addiction is as universal and as individual as each one of us. Look in the mirror. Will you know it when you see it?

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