Written by Lara Just – March 2017…
This month I came across and interesting animation film on the meaning of addiction. I thought it was very good and though this ‘new way’ of thinking about addiction has been around for a few years, it is still surrounded by quite a lot of controversy and misunderstanding.
In this blog I will look at addiction, what it means, what is helpful and not so helpful and what we can do about it.
When we think of “addiction”, here we can mean anything from substance abuse to behaviour addictions – e.g. like drugs, sex, gambling, food or shopping.
Addictive behaviour can develop into addiction cycles which means certain “repetitive cycles” that are preceded by a thought pattern, craving and an action pattern, relieving the craving.
When I see clients in my clinic with addiction issues, I see it more as an addiction to those thinking and behaviour patterns, from which clients feel the need to escape using drugs or other activities.
But why does it happen? Why do we do it? What gets us there? What keeps us there?
In his book “The Mindful Path to Addiction Recovery” (2013) Lawrence Peltz describes addiction as “a trance state, where the user repeatedly dissociates from painful emotions via (…) self-medication.” (p.45).
And there is a fine line between the moment of pleasure that makes life feel liveable and a pattern of dissociating or checking out.
Peltz also describes how craving is a common occurrence to all stages of the addictive cycle. The experience of craving can be very different depending on the intent of the person.
Just thinking about the drug or substance or the mere promise of gratification, is enough to initiate the reward process in both mind and body. Actual physical sensations can be felt and muscles relax. In this case craving is a pleasurable experience psychologically and physically – it leads to a predictable outcome. The brain knows this before the drug or behaviour is introduced.
This works really well. Until it doesn’t.
In early recovery this experience is no longer pleasurable. When trying really hard to stay clean and fighting against upcoming cravings, inner conflicts and difficult emotions will come to the surface.
The struggle becomes all about the craving. Between the pain that the craving isn’t going away fast enough, and wanting it to go away, makes it even stronger psychologically as well as physically. This intensifies the newly felt aversion to the craving and increases the risk of relapse despite best intentions. This in turn results in more physical, emotional and psychological stress.
So ‘using’ or gratifying our addiction makes us feel better. At first. And then it doesn’t.
Unfortunately the side effect is that the addiction to the pattern itself becomes painful and a physical and emotional stressor.
It is this addictive cycle and pattern that is called an addiction. And we can see that this could involve many more things than just substance abuse.
Currently, the medical profession sees addiction as a disease. This is because addiction changes the wiring of our brain; our brains physically change with addiction.
However, Marc Lewis, neuroscientist and professor of developmental psychology, describes that our brains constantly rewire depending on what we learn.
In his book “The Biology of Desire: Why Addiction is not a Disease” (2015), Lewis describes brain change (also known as neuroplasticity) as the fundamental mechanism “by which infants grow into toddlers, who grow into children, who grow into adults, who continue to grow.”
“Brain changes underlie the transformations of thinking and feeling. Brains have to change for learning to take place. Without physical changes in brain matter, learning is impossible.”
He therefore argues that addiction is not a disease but a developmental issue – a learnt habit. With this in mind, it must then be also possible to unlearn the habit.
Yes – this seems to be true. But of course this is never easy, like kicking any other habit, and especially if there is a biological component to substance dependency.
Because of this new theory, Professor Lewis believes “quitting” is not “recovery” from a disease but should best be seen as a further development (e.g. = new or re- learning).
Anxiety and depression states can actually act in similar ways to other types of addiction. Lewis argues that this is partly because it gets us into similar cycles and patterns of thinking and behaving.
Often this may be linked to previous trauma, early adversity and “attachment injuries” (i.e. early caregiving challenges and childhood trauma).
Flores explains in his book “Addiction is an Attachment Disorder” (2011) that this is because addiction is a disorder in self-regulation. Individuals who are addicted have substituted some of their attachment needs to a chemical solution or a type of behaviour solution.
People who become dependent on addictive substances are unable to regulate their emotions, self-care, self-esteem, and relationships. Flores reviews much evidence to underpin his theory and advocates that the key to the solution is human connection.
From neuroscience we now learn that supporting an individual to find emotional regulation allows the experience of more secure attachment, as Kathakis (2012) describes with cases of female sex and love addiction.
Supporting emotional regulation is one of the key elements in psychotherapy.
Trauma plays therefore a key part in this addictive cycle. Whether it is social, psychological or sexual trauma, early adversity or PTSD (post-traumatic stress disorder) – it often underlies anxiety and depression. Substance abuse amongst those with PTSD is as high as 60-80 (Lewis, 2015).
In the work with my clients I utilise many sensorimotor (body-focussed) approaches to help with emotional regulation and embodied awareness via sensory experiencing. This is also key in supporting the processing of trauma that is stored in our bodies mainly as procedural memory (Ogden & Fisher, 2015).
In journalist Johann Hari’s New York Times best-selling book ‘Chasing The Scream: The First and Last Days of the War on Drugs’ (2015), which the animation video above is adapted from, addiction is defined as the lack of us human beings going back to basics: to seek and have connection.
He says very succinctly at the end: “The opposite of addiction is connection.”
I like this idea, because a lot of our lives nowadays are no longer as they were for millennia of our evolution. Our culture in human terms has changed dramatically with the advances of technology and faster processes in a very short time. When we think of our modern cities, we have created new artificial and virtual playgrounds. Despite the sheer volume and number of people living in these places, it doesn’t mean people connect intimately with each other. Competition is high amongst individuals, as are feelings of loneliness and lack of supportive loving connections. We also don’t live in big families within communities anymore. We are often disconnected from others and particularly form ourselves.
So addiction can be seen as cycles and patterns that emerge in our lives when we cannot reduce the anxiety or pain we carry through natural means – e.g. loving and intimate connections with people. Addiction has also been described as “the only prison where the locks are on the inside.”
The reason why I think the idea of “lack of connection” is so important, is because we know now that even the “genetic” scapegoat is highly overrated.
From science we know that the environment can change our genetic expression (also called the study of epigenetics). These environmental influences include how things make us feel, our thoughts, our social interactions and connections, and what we eat, drink, the air we breathe, and much more. Multiple factors play a role in the potential to modulate genetic expression and make us more or less susceptible, if we have addiction in the family or not.
Lewis explains that addiction is a developmental process. Our brains change (= neuroplasticity) for new behaviours and learning to take place. Hence, we can imagine that neuroplasticity and epigenetics will have their role to play in the process of addiction, and if we stay addicted or are able to get out of it again.
The biggest factor that can help us out of this, is what we are nowadays lacking the most: connection. We are out of sync with connecting to ourselves, to our own bodies, practice “healthy selfishness” and develop and maintain healthy intimate and loving connections to others.
So looking at the video, the next question you might ask yourself is: “How do we get close to creating and joining something like ‘rat park’?”
When we shared the video on our Facebook page, it raised a lot of comments. Some people argued that the “rat park” study described in the video used the wrong rats or rats that didn’t like sugar or morphine in the first place or that rats in general should have nothing to do with humans.
However, we could forever look at all the scientific theories – the biological theory, the genetic theory, the environmental theory, nurture versus nature theory and all the other theories that have something to say about this. But the important thing is that it was illustrating a point.
The problem is always to rationalize, analyse and to try to “scientifically” prove things that are hard to prove. Of course it also comes down to individuality. We are all unique – genetically, neurologically, metabolically, biologically, psychologically, emotionally, mentally and physically… This idea can make us, and the scientists, more often than not feel out of control, as we cannot find the single one or two answers that can provide the one magic solution.
So in science, we narrow down our search, compartmentalise our inquiry into smaller aspects of scientific study – reduce it down to more manageable chunks. This is a well known “reductionist approach”, particularly in medical research and drug testing. But it doesn’t give us the full answer either. It is very difficult to design scientific studies that are able to deal with multiple variables at the level of human complexity in an effective way.
In the end it depends on the subjective experiencing of the individual.
How the individual perceives their world is what makes reality for them and the physicality of it.
What other people’s opinion or views about it – their addiction, their situation, their life from the outside (which may even ‘look perfect’) is or what they believe becomes completely irrelevant. This is where institutions and well meaning organisations can fail, as some recovery stragedies can be seen as just another thing that is put upon them by others.
It therefore becomes even more important to be able to join a person’s subjective internal world, to really aim to connect with them, and then work from within that.
In the case of people behaving in addictive ways, it is important that they are ready to change and want to be helped.
I guess that’s why I have my job as a psychotherapist. To help people find that for themselves, and what it means to them.
We learn that it comes back to addressing things from the inside out first.
And that can be very hard without support even for those who want to connect to themselves and others again. There may be underlying beliefs like they can’t or don’t have a right to or don’t deserve to have that connection.
As Lewis states, addiction is a learning and developmental process, it becomes a learnt habit. With the knowledge of neuroplasticity it can therefore be “unlearned” with the right conditions.
Assuming then that with the right external and internal conditions, there would be less of a need for anyone to have to create a reward boost in their brains or numb their feelings with substances. These reward boosts and good feelings would be created by natural substances (like endorphins and oxytocin) from love and connection to others as well as animals and nature.
But also to connect to ourselves is important in order to be able to connect to others authentically and in a grounded way. That often means that we need to learn to have self-compassion, self-acceptance, and empathy as well as forgiveness towards ourselves first, to also be able to give this to others.
Peltz believes that “addiction and recovery both begin with “selfishness”, and a wish to feel better and save oneself. Yet only through empathy and compassion can recovery be fully known and understood.” (p.90)
In the context of addiction, Peltz believes psychotherapy is the study of self-deceit and its motivations.
However, psychotherapy also aims to help us learn how to be aware of our emotions and be with our feelings, in a stable enough way to really connect with them. To help release them and express them honestly (to ourselves and others) and have them heard.
This is probably why with good psychotherapy we aim to work towards connection – the way we connect to self and others and the relationship between the two.
In Peltz’ opinion, mindfulness can be an effective alternative to this sort of reactive functioning (the addictive cycle) and to create connection. He sees mindfulness as having four main elements:
- of the mind-body-process
- in the present moment
- with acceptance
Whether you believe addiction is a disease or not, addiction in the light of being an attachment disorder becomes then perhaps more of an “attachment to the way of operating in the world. The drug may not be the problem in itself, but our relationship to the drug as a means of escape. “ (Peltz, 2013).
Peltz believes that it is helpful to utilise somatic (body) focussing examples, similar to those, which I often use with my clients in sessions (pp.20):
- Where in the body are you feeling this resentment (anxiety, depression, anger, sadness, craving)?
- What is the quality of it?
- Does it change as you pay attention to it?
- Are there any other stories you are telling yourself about this?
This line of inquiry can be extended much more. This way of questioning is not for the purpose of feeling better immediately. It is more for the purpose of inquiry itself and starting the process to get a glimpse of what is going on inside. It is an inquiry of the present moment, of what it means to be in the now. It can help us understand the difference between living in the past (= often linked to depressive patterns), the future (= often linked to anxiety patterns) and the now.
Acceptance here does not mean to accept the problem or to have to live with it. But it also doesn’t help if you continue to beat yourself up again and again after you have tripped up – yet again. It’s more about ‘self-compassion’, empathy and forgiveness for yourself. Accepting that it is really hard to break the cycle and forming new habits and that you are trying your best. And to just keep going. Peltz calls it a “continuous meditation on the subject of acceptance”.
In his book he describes various exercises that may be useful, from deep breathing through to meditation and creating new behaviour cycles like “stopping – seeing – self-understanding – choosing”. Or in other words, becoming present, cultivating awareness, increase self-understanding and compassion, and as a result enhance our ability and capacity to chose (e.g. to repeat or not to repeat the cycle).
It is therefore possible to take some refuge in the present moment for some relief and to lay the foundations for enabling new habits.
Mindfulness can serve as a bridge in helping this process of “re-learning”.
In this way it can be a useful adjunct to additional psychotherapy support to help increase the effectiveness of your path to success.
We would love to hear from you how you have experienced addiction and the “re-learning” of it.
If you have any questions or would like any support, please get in touch with us.
Flores, P. (2011). Addiction as an Attachment Disorder. UK: Jason Aronson.
Hari, J. (2015). Chasing The Scream: The First and Last Days of the War on Drugs. UK: Bloomsbury.
Kathakis, A. (2012). Chapter 7: Best Practices for Addressing Attachment Injuries. In: Ferree, M. ed. Making Advances: A comprehensive guide for treating female sex and love addicts. USA: Society for the Advancement of Sexual Health (SASH), pp. 188-214.
Lewis, M. (2015). The Biology of Desire: Why addiction is not a disease. Australia: Scribe.
Ogden, P. & Fisher, J. (2015). Sensorimotor Psychotherapy: Interventions for Trauma and Attachment. Norton Series on Interpersonal Neurobiology. USA: W.W. Norton & Company; Cs med.
Peltz, L. (2013). The Mindful Path to Addiction Recovery: A practical guide to regaining control over your life. USA: Shambala