Overcoming Addiction

A daring approach to therapy puts substance abusers where they belong—among family and friends. Knowing the effect they have on their loved ones motivates many addicts to live a substance-free life.

By Marc Galanter, published on November 01, 1992 - last reviewed on October 01, 2009

There is an addictive personality.
Most of the aberrations of personality and the poor adaptations we see among addicted people are the product of years of substance abuse, rather than problems that predated their reliance on drugs. No significant failings shared by them earlier in life have been found. This has been found in reviewing objective psychological tests that were done on college students decades ago. Students who developed alcoholism in later life were compared to those who did not, so that early personality factors could be evaluated. By and large, people are more likely to show dependent or sociopathic traits as a result of chronic substance abuse than they are likely to have been dependent people or sociopaths when they were young.
Ethnic groups vary in their vulnerability to alcoholism.
In epidemiological studies, we find that certain groups, such as members of traditional Chinese or Jewish communities, are less likely to develop alcoholism. Whereas Native Americans are more likely. Nonetheless, as these groups assimilate into the mainstream, their patterns of drinking come to resemble those of other Americans. Interestingly, a fair portion of people of Japanese extraction actually develop a metabolically-grounded discomfort after drinking alcohol. Most of them, however, when acculturated into a society of heavy drinking, drink heavily nonetheless.

A better understanding of oneself helps to overcome addiction.

While is always useful to have a handle on your own motives, such insights are usually no more than rationalizations in the addict's hands. All too commonly, one hears alcoholics at AA meetings speak of spending years in insight psychotherapy while they continued to drink. It is not that hard to hide a pattern of addictive behavior from a therapist, and one is just as likely to hide such a pattern from oneself. A well-structured program of abstinence is generally worth more than a thousand words of introspection.

Psychologists and psychiatrists don't do much good for addicted people.

Although insight has limitations, mental health professionals can be very helpful to the addicted person, so long as they are conversant with basic principles of addiction treatment. It is essential that they secure abstinence from the outset of treatment, and organize a therapy around the active prevention of a relapse. If this is done, a very effective addiction treatment can be built around the professional psychotherapeutic encounter.

The best way to start on recovery is to go away to a "rehab" for a month.

Inpatient hospitalization is sometimes necessary to the initiation of a stable recovery, as when patients are seriously psychiatrically disturbed, or when they have no stable residence. Otherwise, most alcoholics and drug abusers can achieve a stable abstinence with careful and expert outpatient management, supplemented by family supports and AA. This observation has led to declining support for inpatient care among insurance carriers. Unfortunately, though, most mental health professionals are not yet well versed in outpatient treatment of addiction, so the selection of a therapist must be made very carefully.

AA is virtually a religious club for alcoholics.

In actuality, AA embodies highly systematic and well thought-out procedures for securing and stabilizing abstinence. Although it is oriented toward spiritual aspects of recovery, those who developed the program did so with implicit attention to social psychology, and considerable experience in stabilizing fellow alcoholics. In fact, many of AA's techniques have been adapted and applied in professional treatment settings.

AA is the only way to achieve recovery.

Although AA is a valuable resource, it is not the only one. Many people secure abstinence by means of professional assistance alone. Community studies show that some do so by sheer will-power. Furthermore, some self-help groups, like "Rational Recovery", have emerged, offering alternative modes of self-help. Nonetheless, AA still is the most widely used resource for abstinence in the United States.

Understanding Addiction

The causes of relapse to alcoholism and drug dependence are rarely obvious to the family of an addict, the therapist, or the addict himself. For an understanding of drug craving and relapse, we must examine the particular psychological vulnerability on which addictive drugs usually act. We also arrive at a model of motivation quite different from those used in most psychotherapies, and which explains why most therapies fare poorly in treating the substance abuser.

All addictive agents have two principal characteristics: they generate craving—a desire for repeated use—and they produce discomfort when they are withdrawn. With regard to the first trait, we say that an addicting drug is a reinforcer; it produces a reaction in the central nervous system that leads the exposed individual to take it more often. For example, drinking alcohol initially produces euphoria and a release of tension; caffeine produces a mild stimulation, perceived as positive. These responses lead to further consumption.

Alcohol, for example, can produce a reward of tension relief for a period of time, and can thereby lead a drinker to turn to it with regularity. Under the right circumstances, the drinker, perhaps by now an alcohol abuser, may begin to suffer its ill effects, with a life gravely compromised by consumption. Nonetheless, because of the reinforcing qualities of alcohol, the drinking continues, and the incipient alcoholic may crave alcohol in its absence.