The Heart of Addiction

While I agree that our automatic thoughts can provide some insight into what drives our behavior, I question the usefulness of using such techniques for determining what drives addictive behavior. By the time someone has a dependence on a substance, the conditions that led to the continued use of a substance are less relevant to the current situation that someone has great difficulty functioning without substance use. Perhaps gaining insight into what led to drinking in the first place may help someone avoid relapse or to support their recovery later in treatment, but it seems that no matter what someone is thinking/feeling/avoiding when addicted to a substance,understanding that in itself will not rid anyone of their dependence.

Dr. Dodes is right about the importance of trying to identify the "helpless feelings that always precede and precipitate addictive thoughts." Those helpless feelings, I believe, are caused by one's self-defeating emotional attachment to inner passivity, a place of identification in the human psyche. Our inner passivity is the defensive enabler of our superego or harsh inner critic, as well as a default position in the psyche.
As well, seeing the addiction as "the enemy" misses the point and creates more inner conflict. Read "The Negative Emotions Behind Addictions."

In think the old saying that you can run, but you can't hide comes into play in addiction.

Addiction as I see it and have experienced it in some ways be it more daily things as playing games, food addiction or workaholism and in the more fatal things as alcholism and drug addiction, the addiction serves as a crutch and as a dependable but questionable friend.

The addiction is sought towards when the demands of the situation are larger than one thinks oneself capable of meeting. For example, you might think that you have three weeks of hard and out trying to meet demands that you are unable to do in a way you want to and so turn to the addiction to give some comfort and have some relatedness and to numb the pain and anxiety a bit.

When you are addicted to something, anything, a behavior or food/drug/alchohol and cannot willingly stop immidiately for some defined period of time, then the drug of choice becomes God. The drug gives you some comfort and nurture and releases some pain and fear for a short time, because you know what the drug is and you like some of it in some way, and it is one way to counter to the immense weight of the perceived future that one thinks oneself somewhat unable to handle. It is a survival mechanism.

People may be more or less aware of this cycle and mechanism, but still do it. After some time, there also becomes a habitual part to it, I think, that it is just what one does without questioning it oneself so much.

To deal well and finally with an addiction, you must find out what you are running from, face and handle it in a more positive and beneficial way than going to the drug of the addiction. You can keep running, but if you have not dealt with what brings up the need for the addiction, then you will turn to your drug in your hide.

Removing an addiction from your live is about steadily and slowly in a 2 steps forward - 1 step backwards way learning to meet the requirements and demands of your life as you want it and then not be inclined to turn to your addiction, because afterall, why would you do that then? You don't need it and it doesn't do anything useful for you. Getting off of an addiction is about learning to handle life without reaching and grabbing for that crutch. It takes time and is hard and is a up-and-down battle. That is why you see so many people trying to get of an addiction relapsing. Even those who finally stop the behavior, have relapsed many times some times. It is because that when the demands seem too high and you think, I can't do this, that old numbing comfort and nurture seem a little too good.

If you learn to be able to do it, then you will not find the drug useful or wanted in your life.

Thank you for this post Dr. Dodes. I regularly encourage my patients to face their cravings when they pop up, even in early recovery. Supressing those thoughts and feelings by use of avoidence is not really any different than using behaviors while in addiction. "I don't like how I'm feeling or the direction my life is going, so I'm going to use to escape those feelings." "I don't like how I'm feeling because I'm cravings, so I'm going to think about something else to escape those feelings." No different. If an addict/alcoholic uses the same coping mechanisms, even in recovery, they will get the same results they got in addiction and in my experience, usually end up using again.

Learning how to sit in and deal with the uncomfortable parts of life is the point of recovery from addiction. Simple abstinance is NOT the point of recovery from addiction in my view. "Just don't use" my be a nice cliche to quote at an AA or NA meeting and serves as a reminder of where recovery starts, but in a theraputic environment it's not an appropriate or professional clinical modality.

The facility I work in has just recently started pushing the Matrix Model materials, which has several good and interesting tools with which to work patients through; however, their presentation of "Thought Stopping Techniques" drive me insane. I refuse to teach my patients "Oh, just think of something else. Picture a big light switch in your head and turn it off whenever using thoughts or cravings hit you." Give me a break!

How about we discuss the fact that you're having using thoughts or cravings because you're engaging in old unhealthy behavior patterns and instead of working on changing those patterns you just lean on the good old stand by of avoidence.

Sorry for the rant, but I really appreciated this post today. It's nice to see someone else talking about actually dealing with clinical issues with patients vs. avoidence techniques or blaming everything connected with chemical dependency on brain chemistry.

Dr. Dodes, could you say more about your concept of where, from within the psyche, those emotions emerge that produce what you call the "helplessness trap"? From your background in psychoanalysis, what inner conflict(s) would you say possibly produces these intense negative feelings of helplessness? Why are these feelings so powerful? Why does it happen that some people, driven by their compulsion, resort to such self-damaging behaviors instead of behaviors that would not be harmful? Perhaps you have answered these questions already and can direct me to that information. Thanks.