Addiction provides temporary relief -- emotional regulation that was otherwise unavailable. It can make the addicted person feel temporarily "regular".
The first “regulator” in any person’s life is their caretaker(s), who contains or modifies the baby’s anxiety or distress by providing emotional safety as well as comfort, soothing, joy and other essential psychological experiences. Mother and child constitute what we might call a “system,” meaning that you cannot look at one individual in isolation. A crying baby who is neglected by his mother cannot be blamed for not “controlling himself.” If this neglect is habitual, the child learns eventually that his feelings or needs within this system are “bad” because they are ignored or met with anger, irritation, etc.
Ideally, the child is provided for within a caring environment, and learns that caretakers can be counted on to help when needed. But what happens when the environment is neglectful, erratic, frightening or otherwise injurious (overtly or covertly)? In this case the system is experienced by the child as rigid, abandoning, chaotic and/or punishing. This is the genesis of toxic shame and an unshakeable inner “badness.” Such a child learns that she is on her own, and that others cannot tolerate dimensions of her very existence; her desires, needs and wants have to be amputated, tucked away somewhere hidden. This traumatic separation from essential desires for connection results in depression, anxiety, isolation and/or physical symptoms such as headaches, disturbances in appetite, sleep or other somaticizations.
To add insult to injury, the child is often rebuked or punished for “complaining” or “making trouble” by drawing attention to his or her pain and despair. Such pain is dismissed, minimized or ignored. Thus to even acknowledge the pain of the abandonment or injury is “wrong,” since it rocks the boat, draws the risk of being exiled, perhaps forever.
Such terror makes an imprint on the nervous system that is hard to change; a traumatized child must develop maladaptive behaviors and beliefs to survive this dark and chaotic world, to avoid “burdening” those close to her with her very human developmental needs. Best if these needs just go away and never come back.
Of course, they don’t. They can’t; they are an inseparable part of us, even if represent a threat to one’s primary relationships. They demand soothing, and will find it, even unconsciously, via drugs or alcohol.
Thus drinking or using becomes a “provisional” relationship to fill in the psychic cavities left by these early traumas. The fractured, wounded person is able to satiate, soothe or stimulate himself to the point of finally feeling whole! This is the euphoria reported by those who learn to love booze or drugs, which become so much more reliable than anyone or anything else before. Finally, one is able to regulate and not feel so out of control, fractured or wounded.
This is why I find it crucially important to understand the regulating function provided, however fleetingly, by drugs or alcohol. Very often an addicted patient knows that what he is doing is destructive; at the same time, drinking or using is the only thing that has worked. Behind the machine-like compulsion is an unconscious set of wishes and hopes that are not and have never been safe to express. If a patient senses he will be giving up his only effective means of regulating feelings and states of mind, with no known substitute in sight; if he thinks that sobriety will require yet another amputation of his most tender yearnings and wishes, he will be highly reluctant to give up his most historically reliable friend. Without a replacement for the provisional functions of that relationship, motivation for therapy fades. I try to provide an environment within which at least some of those needs can be met, in order for therapy to proceed in a way that, despite the rough patches, ultimately feels vitalizing for the patient.
Consider Stan, a 22 year old undergrad who binged chronically on pot. At first I encouraged him to attend Marijuana Anonymous (MA) meetings, considering his failing grades and shaky employment and housing status.
But he was adverse to MA and refused to go, telling me he preferred to try and quit on his own. This to me sounded like egotism and machismo, so I gently but persistently kept encouraging him to try MA. We got nowhere, even when he withdrew from school and began living in his car.
Things finally shifted when I began to honor his choices and autonomy, anxious though it made me. In other words I surrendered my agenda – which, I eventually realized, echoed that of his smothering, controlling mother, who had been nagging him for years to stop. My tone and demeanor couldn’t have been more different, but it felt to Stan like a repetition of his experience with mom. No wonder he wasn’t interested in the meetings!
I began to encourage his attempts to stop on his own, and over a few months he actually did. This encouraged him to open up and trust me a bit more, a real challenge for him given his literal abandonment at a young age by a self-centered, narcissistic father. Stan was able to begin to meet his previously hidden needs for encouragement, guidance and parental approval within a trusting environment.
I found that marijuana was how he and his peers “bonded”; Stan had never had a stable group of friends growing up, given his mother’s wandering in search of stable work. (I later learned she was an alcoholic.) This brotherhood of guys loved him without demand or condition and was phenomenally important to his self-definition.
The more I understood the risks Stan was taking in trusting me, and his new girlfriend, Alice – and in being honest by asking both his mother to back off and his dad to be a part of his life – the more our work deepened, and the better his life got. This was sometimes a rocky process, to be sure. Still, his grades improved over time, and he had a mostly satisfying relationship with Alice, with whom he was honest and who appeared to respect his wishes, even though she scared him a bit with her own vulnerable yearnings for closeness.
Once I entered Stan’s experiential world without a hard-cast “agenda,” well-intentioned though it was, I began to better understand his agenda of defining himself in a collaborative way that felt neither intrusive nor abandoning. (Note that such an agenda may be necessary if the person is in some kind of acute crisis.) It reminds me again of the strange paradox that the more a patient and I accept drugs or alcohol as providing some kind of essential emotional/relational function, rather than being simply “wrong”, the easier it is to give up. The goal is to begin replacing the abuse/dependence on substances with actual human connections; my relationship with the patient serves as a model, a way of relating honestly and intimately, working through whatever conflicts inevitably arise, and building trust.
The tragedy for so many of my addicted patients is not that they live in isolation and both yearn and fear closeness to others; it’s that they’ve come to the conviction that this is the only way to proceed. My great hope is to become a catalyst in providing a different, sometimes uncomfortable but ultimately healing relational experience.