The Heart of Addiction

How psychology drives addictive behavior.

The Psychology of Addiction

Why do people perform addictive acts?

Marion put down the phone after hearing her husband's command to prepare dinner for him and a group of business guests that evening. Now she would have to shop and prepare instead of go to the gym. As she stood there she felt the familiar, nearly overwhelming, urge to take some of her Percodans. The question is: Why?

In my last entry on this blog I noted that psychology can't be reduced to the biology of the brain any more than biology (life) can be reduced to the chemicals that comprise it. Like other complex behaviors, addiction has to be understood in psychological terms. Marion's story provides a good illustration. Virtually all addictive acts are triggered by emotionally significant events, and Marion's situation is typical. She felt that she was in a trap. For emotional reasons of her own (arising from her past) she was unable to defy her husband's insistent demands. But she couldn't simply comply with them, either. The helplessness she felt was too deeply enraging. She had to do something to feel less helpless. For her, that something had always been taking her pills.

I have found that virtually all addictive acts have this form. This psychology that drives addictions can be summarized in three elements:

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I. Every addictive act is preceded by a feeling of helplessness or powerlessness. The issues that precipitate these overwhelmed states of helplessness are unique to each person (correspondingly, treatment must be individualized toward understanding these issues). Addictive behavior functions to repair this underlying feeling of helplessness. It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered--of regaining control--over one's emotional experience and one's life. Drugs are particularly good for this purpose because altering (and thereby controlling) one's emotional state is just what they do. However, non-drug addictions can be shown to work in exactly the same way, since they are also acts that work to change (and therefore reassert power over) how one feels. The reversal of helplessness achieved by these addictive acts may be described as the psychological purpose of addiction.

II. States of overwhelming helplessness, such as the feelings that precipitate addictive acts, produce a feeling of rage. This rage is actually a normal response to the serious emotional injury of losing a sense that one is in control over oneself and one's life. This rage is the powerful drive behind addiction. And we know something about great anger at powerlessness: it has the capacity to overwhelm a person's judgment while he or she is in the throes of the rage. It is precisely the presence of this rage at helplessness that gives to addiction its most defining characteristics: great intensity with loss of usual judgment and seemingly irrational destructive behavior.

III. In addiction, the rage at helplessness is always expressed via a substitute behavior (a displacement). If this feeling were expressed directly, there would be no addiction. For example, if a man were flooded with feelings of intolerable helplessness when he was unfairly criticized by his boss (because the criticism touched on old sensitivities, for instance), and he then charged into his boss's office furiously complaining, there would be no addiction. But if he displaced his need to reverse his helplessness, and instead of charging in to the boss's office he went home to drink, then his drinking would be driven by the same rage he would have expressed toward his boss. If drinking were the way he regularly dealt with states of overwhelming helplessness then he would have a repetitive, intensely driven, apparently irrational drive to drink. We call such compulsive behavior an addiction.

Marion could not take the direct action of telling her husband to make his own dinner, or find another way to directly address her helplessness. Instead, she reacted with her usual emotional mechanism to deal with the emotional trap in which she lived. She suffered with an addiction.

Treatment for addictions has had a relatively poor success record in large part because the psychology of addiction has not been well understood. But once a person understands how his or her addiction works, the way is open to mastering it. Marion was able to master her addiction and I describe her full story, as well as stories of many others, in my book, The Heart of Addiction. I will say more about treatment arising from understanding the psychological nature of addiction in future entries in this blog.

Lance Dodes, M.D., is an assistant clinical professor of psychiatry at Harvard Medical School.

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