I’ve spent a good part of my career helping people recover from addictions—whether the addiction is to alcohol, drugs, tobacco, food, gambling, sex, or other compulsive behavior. Whatever the addiction, most of my clients have discovered the same thing: changing the behavior is only one step toward meaningful recovery. Oddly, changing the behavior is the easier step (and even that is not very easy). The harder work centers on changing the thinking and relationships that have evolved in tandem with the addiction. Addictions have a compulsive quality about them; addictive behaviors continue despite the losses that typically accrue as the addiction progresses. Patterns of thinking and behavior develop with addiction; these patterns of thinking and behaving impede optimal functioning and typically eventuate in a narrowing of the addicted person's world. (Loss is a hallmark of addiction: loss of family, friends, money, time, and health are unfortunately only the most obvious losses. There are many, many others.) Neurologically, addictions actually change the brain’s chemistry and make-up. (I recall the first time I saw PET images of the brain of a person who used cocaine, thinking “No wonder addiction is so hard to treat; I can see the patterns of conditioning being laid down in the brain.”)
In and of itself, addiction is an enormously complex problem. Addictions develop for a variety of reasons. Compulsive behaviors always serve a purpose—however dysfunctional it might be—but the purpose may not be readily apparent. For example, many people use substances or engage in a compulsive behavior in order to “feel better.” Whenever I hear a client tell me that he or she uses alcohol, for example, to “feel better,” I usually ask, “better than what?” The answer reveals additional issues: depression, anxiety, social disconnection and isolation, conflicted family relationships, histories of trauma (physical, emotional, sexual), grief, confusion, loss of a sense of self-efficacy and control. However, there are often even deeper issues—issues that go to the core of one’s sense of self and relatedness to the world.
Addictions frequently mask very deep issues--all of which must be addressed and treated. Therapy typically requires work on multiple levels. Understanding the meaning of the compulsive behavior is an important step toward changing it, but it is only a step. Careful exploration of how the addiction has impacted the client’s perceptions, thinking, beliefs, and relationships is the focus of a great deal of therapeutic work. Treating underlying psychiatric disorders is yet another layer of treatment. Helping clients enlarge their perceptions, develop awareness of distortions in thinking, and correct their distorted thinking patterns is a significant part of the work. Similarly, challenging the belief systems that arise from the addiction is an important component of the work. Learning, practicing and mastering new coping skills, and applying those skills to everyday life is still another level of work.
In addition, therapeutic work can extend to intimates and family members: families need help because addiction affects them in overt and subtle ways. Effective clinical work with family systems impacted by addiction often parallels the work with the addicted person. The family must recover too. In fact, it’s been my experience that sustained recovery from addiction can only occur when both the addicted person and the family recover together.
At the most fundamental level, though, therapeutic work must center on discerning addiction’s deepest roots. Such careful exploration and analysis is essential for meaningful recovery, healing, and enduring wellness.
Over the next few blog postings, I’ll reflect on various aspects of addiction. It’s huge, many tentacled issue—and one that affects many more people than might be apparent.