Andy and Laura sat across from me on the couch, he slumped over like a question mark, his wife embodying an exclamation point.
“Can I say some-,” Andy tried to begin.
“He’s been drinking, Josh!” Laura said, throwing her arm across him like she was a driver cutting him off.
“This whole time...”
“Not the whole time,” Andy tried to get in.
“Whatever! I don’t want to hear it,” continued Laura. “This whole time he’s sworn he hasn’t been drinking and he’s lying! Are you telling me you haven’t been lying?”
“I don’t know how to explain it,” Andy whispered.
“There’s nothing to explain!” demanded Laura. “I don’t know who I’m with anymore. I don’t feel safe, I’m completely alone, so I know things are stressful, but you need to be a fucking man and stop drinking!”
Andy sat numbly as Laura stared at me, willing me with her eyes to spike what she had just so vehemently set up.
“Okay,” I said taking them both in. “Other than that, Mrs. Lincoln, how was the play?” And Andy showed the slightest sign of coming back to life. I looked at the exclamation point.
“Laura, you know I pretty much agree with everything you just said. Except one thing. I think there is something to explain.”
“Well, I’d looooove to hear it,” said Laura.
“I’d love to tell you.” I said.
Pound for pound, addiction may be the most difficult affliction to explain in the world of mental health. For those who don’t battle with it, it tends to make zero sense, and for those who do...it’s pretty much the same thing.
The first time I met with Andy he confided in me that every day, he was drinking early and often — beginning with a forty around 5 a.m. from the deli on his way to work. When I asked him why he thought he drank in the way that he did, his answer was, “because I do.” Andy wasn’t trying to be difficult — that was the extent of his understanding. As far as he knew, he drank for the same reason that George Mallory climbed Everest: “Because it was there.”
For all involved, this is what can make battling addiction so maddening. To the observer, not only is the behavior wildly destructive, but it seems completely illogical. And for the addict, they tend to feel as lost as those watching. They often have a vague inkling that there is some existential itch needing to be scratched, but beyond that, for most grappling with addiction it is more about the shame of not being able to “deal,” than pursuing deep a understanding of what is going on. This misunderstanding of what is fueling addiction has led to the difficulty in conceptualizing, and ultimately treating it.
The idea that addicts have to “get their act together” and reign in their debauchery has deep roots. Freud theorized in the late 1890s that addiction was the result of an unconscious, insatiable drive for pleasure. Though that mindset still has a foothold today, I’ve never met a patient for whom that theory resonates. There is another way of conceptualizing addiction however, that seems to ring true with just about every single one.
Towards the end of his life, Carl Jung said “[The] craving for alcohol [is] the equivalent on a low level of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God."
The “thirst for wholeness” Jung references is universal. It is not just “the addict” that has an innate need to feel whole and “one with.” We all do. Therefore, the motor powering addiction is not about pleasure, but rather a natural outcome of our unmet need for wholeness.
According to Dan Siegel “the roots of security and resilience are to be found in the sense of being understood by and having the sense of existing in the heart and mind of a loving, caring, attuned and self-processed other.” Having each of these early on is essential for our well-being; they are the vitamins that soothe our nervous system. Their absence is what so often sets the wheels of addiction in motion. Whether it is alcohol, heroin, cigarettes, porn, or social media, the varying landscape of addiction has one powerful common denominator: to the addict, they all offer effortless soothing. They then attempt to recreate that missing effortless soothing from childhood. This idea has resonated with every patient I have ever worked with who has battled with some form, big or small, of addiction.
This is what makes addiction so difficult — it doesn’t matter necessarily how well things are going present day. Andy had a great job, a loving wife, and beautiful new baby. But none of it hit at the part of him that never felt soothed and therefore felt broken. Effortless soothing also lets us know why, for some, battling addiction can feel so impossible. No matter the remedy for sobriety, it always involves effort. And since all addiction comes out of pain, when it comes to pain the effortless almost always wins out over the effortful.
This doesn’t mean the battle of addiction is hopeless — not by a long shot! But without this understanding, we will see addiction as those who are killing themselves or destroying their lives for very curious reasons. In actuality, they are trying to stay alive, and keep their lives together, in the only way their nervous system knows how. But just like a broken ankle, the remedy is healing the brokenness, not just asking people to get up and walk on it.