The Heart of Addiction

How psychology drives addictive behavior.

Failures to Understand Addiction Are Everywhere

Even so-called experts often misunderstand the nature of addiction

Jonathan Rhys Meyers, star of Bend It Like Beckham and The Tudors, was hospitalized recently due to an alleged incident involving alcohol, possibly mixed with prescription drugs. It didn't take long before speculation began to focus on the question of whether this was a "relapse" or even a suicide attempt. As an addiction psychiatrist, I fielded a number of questions about this news from patients and colleagues alike.

One quote came from the CEO of Promises Treatment Centers, Dr. David Sack, who went on the record with People magazine to discuss his take on the intimate details of this alleged incident:

[T]o recover, an individual has to believe they have a problem. The fact that Rhys Meyers was trying to send away the ambulance suggests he didn't recognize the seriousness of the problem and that he was still hoping to conceal it. If on reflection he decides to re-engage in treatment, his prognosis could be very good.

This statement reveals something about the mistaken way our society thinks of addiction. First, I think it's safe to say that Mr. Rhys Meyers is aware that he has a problem: he has been in and out of trouble with the law for years surrounding alcohol-related incidents. Of course without knowing him, I cannot say whether or not he has an addiction. But I can say that nearly everyone with compulsive or addictive behavior is aware that something is wrong.

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But acknowledging this problem by name ("I have an addiction") is another matter altogether. Why is this so hard? Probably because of our culture's mistaken view of addiction. After all, if you believe addiction to be a pleasure-seeking behavior due to some defect in character, or the modern version of this error, that addiction is a pleasure-seeking behavior due to a "brain disease" that biologically enslaves you into seeking the pleasure of drugs, then of course you will deny that you have an addiction. Who wouldn't?

But addiction is about something entirely different, and people with addictions are no different from anyone else. Addiction is about taking active steps to reverse an intolerable sense of helplessness. When this response is directed toward a displaced or substitute behavior, we call that behavior an addiction. This essential fact - that addiction is just a healthy emotional response gone awry - makes it far easier for people to "admit" this problem and name it accordingly.

That said, acknowledging the problem by name is hardly a prerequisite to getting well. If that were true then therapists would turn away anyone who didn't begin treatment by agreeing to the label. On the contrary, it is often necessary to start someplace that makes sense to the person seeking help. That doesn't mean ignoring the addiction. But in order to treat it you have to understand the people who suffer with it. Since addiction is no more and no less than a psychological symptom, like other symptoms we all have, getting to know people with addictions and helping them to understand themselves usually turns out to be the best way to help them with their addictive behavior.

Unfortunately, the same therapists who think a person must "admit" his problem before embarking on treatment often also believe that there simply isn't time to treat addiction as a psychological problem, even though that is exactly what it is. The result is frequent treatment failures caused by treaters focusing exclusively on how bad their behavior is for their patients, trying to rationally convince them to stop that behavior, focusing on superficial advice ("Avoid walking into a bar"), or applying a 12-step approach whether it seems to fit that person or not.

The only thing we really have no time for is ineffective treatment. We should discard platitudes such as having to "admit" you have a problem before you can get better, and focus instead on making sense of this surprisingly understandable behavior. Perhaps if Mr. Myers understood that addiction is simply a comprehensible - and reparable - issue, he might be quite willing to talk with someone about the troubles he has suffered.

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

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