The Heart of Addiction

How psychology drives addictive behavior.

Don't Focus on the Consequences of Addiction

Looking at the results, rather than the causes, of addiction is a mistake. Read More

Great post

I believe that almost all addicts are self medicating. I've never met an alcoholic who didn't have a parent who taught them to drink (this is sort of abuse), or a molesting family member/family frient, or who was not neglected. Everyone recognizes PTSD as something that caused drug problem.
Everyone I have met had something happening to them that should not have happened or something that should have happened did not i.e. kid needs love - mom and dad neglect them and a sexually molesting adult.

I believe it is extremely hard if not impossible to turn yourself into an addict unless you have a mental health issue.

displacement versus avoidance

Dr. Dodes,
I have read 2 of your books and I am starting on the third. I am wondering is your use of the word displacement(as in displaced anger) is the same thing behaviorists mean when they say negative reinforcement or avoidance?

Thank you for your question.

Thank you for your question. I am not a behaviorist but I do not believe the terms you mention are synonymous with displacement. Displacement refers to redirecting some unacceptable feeling or idea from one person or activity to another, often unconsciously. Lady Macbeth suffered a handwashing compulsion which was a displaced expression of her need to undo her crimes by literally washing imaginary blood from her hands. In addiction, the addictive behavior is the displacement, reasserting a needed sense of control in a form that is distant from the original issue (for instance, drinking to reassert power against helplessness rather than taking a direct action to be empowered). It is "avoidance" in the sense that the forbidden or terrifying feeling (such as being more directly aggressive or sexual or close)is kept from awareness and action via this defense mechanism. I don't believe it has any similarity to negative reinforcement.

Thanks for your answer. I do

Thanks for your answer. I do believe that there is a great deal of similarity in the two terms. For instance, negative reinforcement is defined as follows: "In negative reinforcement, a response or behavior is strengthened by stopping, removing or avoiding a negative outcome or aversive stimulus." Steven C. Hayes, who is a behaviorist, and the creator of acceptance and commitment therapy (ACT) has coined the phrase "experiential avoidance" to describe symptoms which allow people to distract themselves from or avoid being conscious their uncomfortable inner experiences. So addiction would be an attempt to use a substance or behavior to avoid the inner experience that creates some type of distress such as feelings like helplessness, rage, etc.

This is a short-sighted

This is a short-sighted article which wildly misses the nature of addiction and human consciouness. As an addict, I was blissfully unaware of the consequences of my addiction ('in denial' in the common parlance of NA), and set about searching for the reasons why I had falling into such a self-destructive pattern, rather than acknowledging the collapse around me. During this search, all the while, I continued to use various drugs at a prolific rate - this is not to say that it was not a useful process for me in the long term, but what I really needed to do was get honest with myself around the consequences of my using. I finally started to do this within NA meetings - THAT was the foundation for the healthy choices that I have started to make in my life over the past four years in recovery, choices that have brought me to a career in counselling, as well as helping me to develop the capacity to be a father, a partner, a friend, and so on. Human nature and addiction includes various levels of consciousness around our choices and the effects of these choices. Part of recovering from an addiction is coming to terms with the impact/consequences of it - ask any one of the millions recovering through AA/NA fellowships how important it was to start recovery with an inventory of the consequences of their drug and alcohol use.

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

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