The Heart of Addiction

How psychology drives addictive behavior.

I Used To Be Addicted and Then I Quit—Am I Still an Addict?

The answer to a common question.

This question comes up fairly often. It is the kind of question that cannot be answered if you look only at the surface of addiction: at the behavior itself. But if you peek beneath the surface, the question and its answer becomes obvious.

As readers of this blog or either of my books knows, true addiction is neither more nor less than a psychological symptom, a compulsion like any other. Of course, there is such a thing as physical addiction due to creation of physical tolerance to certain drugs, but that has nothing inherently to do with true addiction. Many people have physical addictions yet can quit their behavior once they decide to do so (as did millions with physical addiction to nicotine). Conversely, many people with true addictions never have a physical addiction, such as binge drinkers, people who addictively use drugs like marijuana or LSD that are incapable of producing physical addiction, and all the people with non-drug addictions such as compulsive gamblers or compulsive eating. No, physical addiction is simply not a part of true addiction even if it is sometimes also present. And neither is the false “chronic brain disease” neuropsychological model as I’ve discussed extensively in previous posts. 

Once it is clear that addiction is a psychological symptom, we can begin to see how the wording of the question itself makes it impossible to answer: whether people were or still are “addicts.” It is misleading and confusing that we label people “addicts” when they have the kind of compulsive symptom that we call “addiction.” After all, when the compulsion is different, say, compulsively cleaning the house, or shopping or eating, we don’t use their symptom to name them! We don’t call them “cleaners” or “shoppers” or “eaters,” as though their symptom defined something about their essence as human beings. Symptoms come and go, even addictive symptoms. So, the original question needs to be re-thought.

Let’s rephrase it: “If I ever have addictive symptoms and they go away, does that mean they will ever come back?” Obviously, this is a much easier question to answer: just like every other psychological symptom, they might not, but they could. And this raises the main practical question: how can I prevent this symptom from returning? Part of the answer to that one will involve tackling another question: What made the symptom go away to begin with? 

What makes any symptom come and go? Symptoms are the mind’s way to solve emotional problems. So, they arise when the problem is at hand and disappear when it is not. Depressions, anxiety, compulsions, and so on rise and fall with the factors that cause them. Here is an example. Bill had always suffered with poor self-esteem. From an early age, and now deep inside, he believed he was less valuable and important than others. Since this was a lifelong feeling, he usually did have symptoms: low-grade depression and some anxiety in situations in which his self-image was going to be challenged. But sometimes things worked out great for him. He got a promotion, caught the eye of an attractive woman, won a game of tennis. At those moments he wasn’t depressed or anxious. And if Bill’s main symptom were an addiction, like gambling or drinking, his compulsion to do these activities would also fade in good times, only to return later. But things could go even better for him. After years of feeling like an outcast, he might find a wonderful woman to marry and his self-esteem would receive a long-lasting boost. He might go for years without the compulsion to drink or gamble, though he would have a permanent risk of returning to those symptoms. This is the sort of thing commonly observed with another symptom: depression in old age. When sources of self-esteem end (such as meaningful work or relationships with friends and relatives), depression, anxiety, addictive behavior, and other symptoms can return after a long absence.

Life changes are only half the story, though. Symptoms arise because of internal factors. What if Bill’s low self-esteem could be repaired? Then it wouldn’t matter so much whether the circumstances of his life – his job, his relationships – changed or not. Then he would have the best protection against the slings and arrows of life, and the best protection against return of his addiction. This is the job of psychotherapy. I have written extensively about psychotherapy of addictions in this blog and two books, so I will not repeat that here. But the main point for our original question is this: If you have ever had a true addiction, it is an excellent idea to find a good therapist to talk with in order to figure out what that symptom was treating. Mind you, you will want a therapist who can do this work, somebody trained and experienced in human psychology who will focus on the emotional factors that produce the compulsive need to drink, gamble or eat. Unfortunately, most addiction counselors have little training of this sort. If you find that the treatment you are receiving is focused on advice about avoiding stress or urging you to join a 12-step program then you are in the wrong place. If you are examining the emotional story of your life then stick with it and you can truly break your addiction. 

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

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