The Heart of Addiction

How psychology drives addictive behavior.

Don't Focus on the Consequences of Addiction

It's a waste of time.

Throughout my career as a therapist I've heard people describe the effects of their addictions — drinking, eating, gambling — with deep regret, shame, and anger. Anyone can understand their pain. And effects do matter: They color how we relate to the people in our lives, and how we gauge the risk of future behaviors. But focusing on consequences does not help to stop addiction. Indeed, it is a waste of valuable time that could be spent looking at its causes.

Looking at consequences also induces guilt. It's understandable that those who have been hurt by addictive acts will confront those who have hurt them. But no good therapist would make this mistake. Over the past 40 years I've never encountered an addict who was not already sadly aware of the damage he or she was causing. People suffering with addictions are neither evil nor stupid, and adding to their guilt is simply pointless. If guilt could solve addiction there would be no addicts.

It is far better to focus on the fact that addictive actions are not random. They are precipitated by emotionally meaningful factors: loneliness after being abandoned by a boyfriend or girlfriend, shame and anger after being treated disrespectfully, embarrassment after a humiliating loss, or a repeated feeling of being unheard, with a helpless sense you have no control over your own life. These emotional precipitants are what people need to recognize, explore and understand, so they can predict when they will next arise, always followed by addictive urges. If people can predict when their addictive drive will occur, they are much closer to being able to control it. (I described this process in detail in my book, Breaking Addiction.)

There are two other problems with focusing on consequences rather than causes. Since different addictive acts have different consequences, we have been misled into thinking they are different phenomena. Of course, this is not so, as we know from the fact that people regularly shift their addiction from one behavior to another. A variant of this misconception is that the dangerousness of the consequences matters to the cause of an addiction. I've heard people say that alcoholism couldn't possibly be basically the same as compulsive housecleaning, because alcoholism can kill you and housecleaning can't. But that's the result, not the cause, and in fact that very switch does occur (I wrote about one such case).

The closer we pay attention to the emotional reasons for the psychological symptom we call addiction, the closer we can get to mastering it. And in so doing, we save the time we would have wasted focusing on its consequences.

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

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