The Heart of Addiction

How psychology drives addictive behavior.

What Does Dropsy Have to Do With Substance Abuse?

When doctors don’t know the cause of an illness, they're stuck having to “diagnose” only its symptoms, not the source of the problem. That is just where we stand today with substance abuse, and it’s ruining our chance to treat it effectively. Read More

I really enjoy your post. I

I really enjoy your post. I was an opiate addict for 3 years. Oxycontin. I quit 2 years ago. I went into rehab and they drilled in my head I was an addict and I had a disease. I am starting to think they are correct because I think about opiates still all day everyday. I do not want to relapse and I wont, but if it is not a disease then why does the brain constantly crave and crave even after 2 years out?


Good question anonymous. I'm reading Dr. Dodes book now. The book is exceptionally excellent.

Dr. Dodes: "Addiction is a behavior intended to reverse a profound, intolerable sense of helplessness. This helplessness is always rooted in something deeply important to the individual. Addictions are all substitute (or displaced) actions. They take the place of a more direct response to feelings of helplessness in a particular situation."

Your thoughts are perhaps in your, "helplessness."

Reply to comment | Psychology Today

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Could'nt agree more with your

Could'nt agree more with your thoughts Mr. Dodes

Completely agree

I used alcohol to try to self medicate the hopelessness of having OCD (Pure obsessive variety), General Anxiety Disorder, and Depression which psychiatrists back in the 1980s didn't appear to be able to either diagnose properly or to effectively treat at all. I had one Psychiatrist tell me when I was 18, and literally thought I was losing my mind with the OCD, tell me I should feel this way since I was young and had a scholarship to a good college.

returning to controlled using

what are your thoughts on previously addicted people returning to controlled using after periods of sobriety? it sounds that if people can manage their feelings better then they can return to using drugs or alcohol safely.

Interested in reading this response.

I've read the understanding of true addiction. This is why this is such a good question. If Lance can direct me to a article explaining the "loss of control" and inability to control consumption after periods of sobriety, as you say find the reason, or trigger behind the intense emotion that ended up with them with a bottle in their hand.
We may be able to repair the damage emotionally and learn why we used in the first place. And identify the trigger in order to prevent a relapse on the substance or behaviour.
How does science eplain the loss of control after a relapse?
Anyone clean had to have stopped for a reason, usually negative emotion, based on consequences.
Someone that has been physically addicted, then relapes, struggles to control their use.. Why? If we learn the reason behind our using, why can't we use saftely? I mean go ahead and have one or two drinks a christmas party? I mean compulsive eaters still have to eat? right lance? Since addiction is actually a behaviour tied to an emotion, and a true addiction, like lance states, is psychological, "in the mind" as we decide in the mind to stop. Then an addiction to a chemical, gambling, sex, eating, could be controlled?


The idea of "loss of control" can be confusing, because its meaning is different depending on whether it is just physical addiction or what I've called "true" (psychological) addiction. Physical addiction can happen to anyone and leads to intense cravings which subside after withdrawal. But when the problem is caused by a psychological compulsion to repeat some behavior, it doesn't go away even when the drugs are gone. As James noted, a person with compulsive eating still has to eat, and nobody would say that person is enacting addictive behavior just because he isn't starving himself. This is an example of the fact that what is important in understanding any behavior is the reason for doing it, not the behavior itself. But to resolve the problem it's not as simple as just "deciding" to stop. Even if folks have some sense of the issues behind their addiction, working out the feelings is neither purely intellectual nor quick. It helps to have a good psychotherapist who is focused not on behavior, but the causes of behavior. When people do work out their issues, they generally entirely stop their addictive behaviors since they have caused them a lot of pain and they have no interest in performing them again now that they don't (emotionally) have to.

Reply :

Here i would like to share prevention of substance abuse...Substance abuse may start in childhood or adolescence. Abuse prevention efforts in schools and community settings now focus on school-age groups. Programs seek to increase communication between parents and their children, to teach resistance skills, and to provide information in order to correct children's misperceptions about cigarettes, alcohol, and drugs and the consequences of their use. Most importantly, officials seek to develop, through education and the media, an environment of social disapproval from children's peers and families.

Life changing blog

Dr. Dodes,
I want to personally thank you for finally giving me a framework to understand my compulsions that does not involve viewing myself as lacking in morals. The AA model, which asks that I make a moral inventory of myself, did nothing more than drill the shame I already carried deeper into my psyche. I was reading about learned helplessness earlier this evening. While I am now sober, my life is in total chaos. I know now, after reading your blog, that it is because the way that I was viewed due to my addiction led me to believe I was so deeply flawed that I gave up on life. I was defensive of my view of being incompetent. Because if I were to change those thoughts to a more positive script, I'd have to actually do more than simply exist. And going out and living is far too dangerous for the addict, who has no better framework for her thoughts than to think she is selfish, hurtful and diseased. On an unconscious level, I realized that if I did nothing challenging in life and totally isolated myself, it wouldn't bring up the compulsion to drink. Now that I know which triggers to look for, I can get back to living my life. Thank you, from the very bottom of my heart. I will be getting your books.
- Victim no more!

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


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