The Heart of Addiction

How psychology drives addictive behavior.

Do Not Suppress Addictive Thoughts!

Knowledge is better than ignorance.

Recently, a man suffering with alcoholism told me how he approached his problem: when he had thoughts of drinking, he tried to push them out of his mind. This didn't always work of course, and even when it did he regularly drank later. But he was still pleased that he was "putting up a good fight" against his enemy — his terrible drive to drink. He asked me if I agreed with his plan, and whether I thought that his intermittent success was a sign that he was making progress. I was sorry to say I did not. Pushing away thoughts of performing addictive actions is, in fact, a terrible idea. His technique was not just doomed to failure but actually interfered with ever mastering his addiction.

Addictive thoughts are never random, so the moments when they occur provide critical opportunities to learn what drives an addiction. Whatever event, circumstance, interaction, thoughts or feelings that occurred just before the appearance of addictive thoughts will be a clue to the issues for which addiction is a solution. To distract oneself at just that moment is the last thing to do if you hope to gain control of addictive behavior.

Naturally, paying attention to any single episode of thinking about drinking or another addictive act may not be sufficient to see the underlying theme behind all one's addictive acts. But the more occasions spent focusing on the precipitating circumstances behind that first instant of addictive thought, the easier it becomes to solve the mystery.

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Focusing on these key moments when addictive thoughts first arise also has an immediate value. Even if the precipitating factors are unclear, just thinking about them at these times creates a helpful separation from the helpless feelings that always precede and precipitate addictive thoughts. After all, to think about oneself is to stand beyond one's inner world and observe it, not be immersed in it. Self-observation is an antidote to feeling helplessly trapped.

Suppressing addictive thoughts is also part of another problem. The man I'm describing tried to squelch his addictive thoughts because he viewed his addiction as an enemy to be stamped out. But seeing addiction as his enemy kept him from seeing it as a part of himself: an attempt to resolve intolerably helplessness feelings by taking an action that would restore an immediate sense of power. Instead of thinking of his drinking, or even his thoughts of drinking, as the enemy, he would have been much better off seeing his addiction as a symptom with an understandable emotional purpose and drive. Instead of looking away from his problem, he could have looked toward it and learned about it.

Working to suppress thoughts involves yet another mistaken notion: the false and destructive idea that addiction can be mastered through willpower. The idea that people can control addictions just by trying hard is a longstanding myth that has led to denigration of people with addictions as "weak" or lacking in "character." Of course, people with addictions have as much willpower as anyone else. Like every other psychological symptom, addiction arises from internal, at least partially unconscious, emotional issues and is an attempt to deal with them. Emotional symptoms (which we all have to one degree or another) are not treatable simply through conscious effort. People with addictions can no more stop their symptomatic behavior through willpower than can people with depression, anxiety or phobias. And beyond the unwarranted criticism directed at people with addictions, those who themselves believe that their addiction can be "defeated" by force of will (for example, suppressing addictive thoughts) are setting themselves up to feel worse about themselves when willpower inevitably fails.

It does take work to deal with addiction, but not the work of pushing away thoughts. It is the work of observing one's complex feelings, motivations and conflicts, especially at the time of first thinking of performing an addictive act. Self-observation is not easy for anyone, and is especially hard if thoughts are quickly followed by strong urges to act. But this is where learning about the underlying issues precipitating addiction pays dividends down the road. Once you have identified the specific emotional factors leading to feeling overwhelmingly helpless — and then to addictive thoughts — it becomes possible to predict in advance when these thoughts will arise. That allows time to find ways to deal with these emotional precipitants before feeling flooded by them, not by crushing your own thoughts, but by understanding them.

 

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

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