The New You

Finding the motivation to change.

Lessons a Teenager Taught Me About Addiction

The disease model of addiction, celebrity addictions, sport psychology and more.

 I may be a clinical psychologist with over a decade of experience treating addictions, but I still just got schooled by a high school student.

This 17-year old—let’s call him Jay--contacted me through my website. Would I be willing to answer some questions about addiction for a project he was working on?

Bring it on, I said.

I have to admit here that honestly, I expected one or two brief and cursory questions—something I might answer in a couple of minutes before I left the office. Instead, Jay asked me one eye-opening question after another.

Ever since we talked, I’ve been thinking about his questions and my answers. I’ll save those reflections for the end; for now, here’s the interview itself.

 

Why is addiction called a disease rather than just bad behavior?

In fact, I don’t think it should be called either of those. I think it should be called an unwanted or problematic behavior if it comes with negative consequences.

The “disease model” has been favored for many years due to how difficult-to-treat addictions can be—to say nothing of the biological bases for certain addictive behaviors. However, I find this concept can be unhelpful in treating people who are struggling with addictive behaviors. I prefer instead to interact in a non-judgmental way with such people in order to help them find the motivation to change; I’d prefer to prevent problems related to addictive behaviors by working with them to find personal motivation to change their thought and behavior patterns.

Why is it so difficult, if not impossible, for an addict to help themselves out of addiction?

You know, I don’t think that’s necessarily true either. Addiction is very challenging; the behaviors are difficult to change because they’re prone to biological, psychological and social influences. However, with a good, kind clinician who is practicing evidence-based therapy in a non-judgmental way, many people can be helped to change their addictive behaviors. In every recovery, the bulk of the heavy lifting is done by the client, not the doctor or therapist.

Does having a religion, a God to depend on and seek forgiveness from and be accountable to, make it easier to break addiction?

I don’t think of addiction as something you “break”. Staying away from a problem behavior is more analogous to tuning a guitar. The addiction never just evaporates if you follow the right steps, though it would be lovely if that were the case. When you’re an in a problematic relationship with a substance, your addiction is constantly there, lurking behind you like a second shadow, just waiting for an opening to strike. As a person working on this, you will have to be working day and night to choose actions, thoughts, relationships, etc. that will help you to stay away from high-risk situations. I applaud you if you are personally taking any step however small to work on this in your life. Reading this post is a step!

So the question then becomes: what can aid me in that process? And it’s my own experience in working with people in changing their behaviors that any affirming, deeply held belief can be very helpful in that process, including—but not limited to—religious faith. When a person says, “I haven’t used since I began to believe in God,” the crucial word in that sentence is believe.

 

Can sport psychology techniques help an addict to overcome or better understand their addiction(s)?

I’ve been working on a book about sport psychology lately—and one of the important parts of the book is to give people clarity as to what sport psychology even means. In my opinion, sport psychology can be thought of as a highly specialized form of cognitive-behavioral therapy (CBT).

In both scenarios, your goal as a psychologist is to coach people into developing skills in thought and behavior that will help them confront challenging situations—and to help them practice and reinforce those skills once they've been acquired.

Working in addictions, I believe that one of the most useful strategies is called “relapse prevention”.  Developed by my friend and mentor, Dr. G. Alan Marlatt. One of the main aspects of this approach is that it is designed help individuals who have chosen to change their relationship with alcohol or drugs anticipate high-risk situations and then develop and practice a “game plan” to deal with those situations. I see this as being very much like what we do in preparing athletes to perform at their best, so there is definitely some overlap in my view between addiction psychology and sport psychology.

 

What types of people are more susceptible to addictions?  Why do celebrities, who appear to have it all, succumb to addictions?

While there’s some evidence for genetic predisposition for addictive behaviors, in my view, just about anyone can be subject to an addictive relationship--with alcohol, with drugs, with gambling, technology, food, you name it. I’m not aware of any research that’s documented a higher rate of alcohol and drug abuse in celebrities compared to the normal population. But it may be true that because of the overwhelming prevalence and exposure to alcohol and drugs in those highly affluent circles, there may be a higher tendency to experiment with drugs and alcohol. Perhaps celebrities, by virtue of their access to these vices, have a harder time with relapse prevention—or even initial avoidance—to addictive substances. Perhaps it’s the very fact that they “have it all” that makes them particularly susceptible to addictions and addictive behaviors. On the other hand, it is also possible that it seems that people in the spot light have more problems because they are in the spot light! In other words, we notice their addictions more. 

Why do people develop addictions? What is the point of an addiction?

I’ll answer that question with one of my own: What is the point of feeling good? What many, including prominent people in our field, sometimes forget to acknowledge is that drugs and alcohol—really, any addictive substance—have a profound ability to create pleasure in human beings and other animals.

I mean, let’s state the unfortunate truth here. People may drink alcohol because of postive expectancies (to socialize, loosen up, relax). They may use heroin for the euphoric feeling or to escape. Gambling creates pleasureable arousal. Each carries the perils of addiction. All have ruined lives and destroyed relationships in tragic and ugly ways. But people would not get hooked on them if they were boring, nondescript experiences. There’s a reason nobody ever gets addicted to doing laundry or filing their taxes.

Typically in treatment of drug and alcohol addiction, we as clinicians focus on the prominent negative effects, because clearly, in our minds, they outweigh the benefits. And believe me, I’m not challenging that—make no mistake that for most of us the negative consequences of drugs far outweigh the benefits.

But at the same time, we do ourselves a disservice as we miss acknowledging to our client that they must give up a great, substantial pleasure to pursue what we consider a healthier lifestyle. My personal belief is that most clients, especially those who are “resistant” to treatment for addiction (and actually, I prefer to say “ambivalent about getting help”), will find it hard to develop a motivation to change unless and only unless their therapist or doctor can acknowledge without judgment the role that alcohol and drug currently plays in their life. 

As for why people develop addictions, I’ll have to write a book  to properly answer that question. However, I can say that in my belief, one of the most profound factors in the initiation and development of experimentation and use of alcohol and drugs is the influence of peers. Many studies have pointed to the powerful predictor of the peer variable in the development and maintenance of problematic relationships with alcohol and drugs.

What constitutes an addiction?

On a biological level, many clinicians see the hallmark symptoms of tolerance and withdrawal as signs of physiological dependence on a particular substance. However, in my judgment, what I really look for is if the use of a particular substance or participation in a particular behavior causes marked impairment or distress in a person’s social or occupational life. For more information about the specific criteria for a substance-related disorder see the Diagnostic and Statistical Manual, Fifth Edition (DSM-V).

The most powerful tool in treating addiction? Empathy.

I have to admit that Jay made me really work to come up with answers that satisfied myself. In the course of answering his questions, I was forced to articulate my own feelings on addiction. It's a humbling reminder that even as an expert, you still need some prodding every now and again. Props to you, Jay!

The other interesting aspect of all this: the questions Jay asked reveal worlds about how addiction remains a controversial and nuanced topic--and how much work there is left to be done to arrive at a full understanding of its true nature. You can see that in a few cases, I challenged the basic assumptions underlying his questions, or approached my answers in ways that answered questions he might not even have realized he was asking.  The Give-and-take that went on in that interview reflects the need for a larger discussion on what addiction really is and how to approach: as a disease, or as a harmful behavior? As something to vilify, or something to understand?

That kind of interrogation is crucial as we move forward in treating addiction; after all, our view of addiction as a society should be a discourse, a dialogue—not a broken record. Students like Jay are leading that charge. Personally, I can't wait to see the strides we make in the years to come.

Follow me on Twitter for more resources on addiction, motivation, sport psychology etc!

 

Jonathan Fader, Ph.D., is a psychologist and an assistant professor of family medicine at the Albert Einstein College of Medicine.

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