One Big Change: The Truth About Addictive Triggers

People who suffer addictions are handed plenty of bad advice. "Don't think about addictive thoughts" is one memorable catchphrase. The fact is that addiction has been deeply misunderstood for decades, and in some ways the field is worse off today than ever. Society has failed to understand the psychology behind addictive behavior, which not surprisingly has led to most treatment failures.

Addiction is all about seeking a remedy for overwhelming feelings of helplessness, and the exact form of an addiction, whether drinking or eating, is no more than a focus for the addiction, not its cause. This is why people so often change the form of their addiction, moving from alcoholism to gambling to compulsive shopping. Wouldn't it be strange if people really were powerless over the focus of their addiction? When a person switches from alcoholism to gambling we'd have to say he was now helpless over something new. As the focus shifted there could be no end to the things he was powerless over—it could spread like wildfire. "I used to be powerless over just alcohol, but now peanut butter has me in its grip."

The notion that people are entirely powerless over the focus of their addiction is demoralizing. Addictions are neither more nor less than compulsions, behaviors most people have to some degree. That fact has been a great relief to people with addictions who have been made to feel less than the rest of humanity. But if you buy the idea that you are powerless over a chemical in a bottle—or the peanut butter on the shelf—then you are deprived of this honest relief.

Addictive behaviors arise because they serve as an antidote to feelings of immense vulnerability in specific situations; the addictive behavior is a way to take control against feeling helpless. With alcoholism, for example, instead of taking action (say, confronting an unhappy marriage), the act of drinking becomes a "displacement," or substitute, for dealing directly with the source of the helplessness. As a result of this displacement, all the intense fury at feeling powerless is channeled into the drive to perform this substitute action, drowning in whiskey.

It's essential to pay attention to the first sign of addictive thoughts. That moment happens sometimes hours, or even days, before the act. These key moments can predict when addictive urges will be stronger. I knew a man with alcoholism who tried to push thoughts of drinking out of his mind. His strategy didn't work often, and even when it did work, he regularly drank later. He was still pleased, though, that he was "putting up a good fight" against his enemy—his drive to drink. But this was not a smart fight. If he had realized that addictive impulses are never random, he would have recognized that the moments when they appear provide perfect opportunities to learn what drove his addiction. Any event, circumstance, interaction, thought, or feeling occurring just before his addictive thoughts was a clue to the issues that made him feel so helpless—the feelings for which his addiction was a solution. Distracting himself from drinking was the last thing he should have done. He should have asked himself why he wanted to drink at that point.

Paying attention to any single episode of thinking about drinking may not be enough to see the underlying theme behind all of one's addictive acts. But the more occasions spent focusing on the precipitating circumstances behind that first instant of addictive thought, the easier it is to solve the mystery.

This man also blocked his understanding in another way, by viewing his addiction as an enemy to be stamped out. But that view kept him from seeing it as a part of himself, like any ordinary symptom. Given enough practice identifying the emotional issues preceding each addictive impulse, he could have learned to predict when addictive thoughts would emerge, giving him time to find ways to deal with the emotional precipitants long before feeling flooded by them.

Compulsions aren't isolated events that must be managed only when they arise; the best approach is to think ahead. People can work out just what actions to take to prevent feeling overwhelmed—whether changing future plans or developing a new perspective about what is coming up. The point: Such strategies are fairly easy to marshall in advance of that teetering-on-the-edge moment.

There should be nothing surprising about this. Planning ahead is how we deal with most challenges in life. But you have to know what to look for—not only the specific triggers but the reasons for feeling so helpless in those situations.

Read Lance Dodes, M.D.'s, PT Blog: The Heart of Addiction