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How Addiction Makes Strangers of Those We Love

Why addicts don’t care about anything or anyone except their drug of choice.

Photo purchased from iStockphoto, used with permission.
Source: Photo purchased from iStockphoto, used with permission.

Addiction can turn those we are closest to into people we don’t recognize —people who lie, steal, manipulate and who appear to value their drug of choice much more than they value us.

As we watch in anguish as they turn their backs on all that once had meaning for them, we find ourselves asking, “Why don’t they care?”

It’s a question that has no single, simple explanation, but it can be answered in part by understanding that drug and alcohol use has the power to change the brain. Addicts may well care, but they can’t always act on that caring. In many cases, they have lost access to a critical emotional function: empathy.

The Biology of Empathy

Empathy is central to what it means to be human. It’s the rock upon which moral behavior is built and the crux of social organization, helping us navigate the conflicts between our needs and those of others. Through empathy, we are able to feel what another is feeling. It’s a capability that confers a distinct evolutionary advantage: Individuals are better able to form successful groups if their members have empathy for each other – and group cohesion means a greater chance of surviving and thriving.

Empathy has been found to have a strong biological/neurochemical basis. It’s been linked to the hormones oxytocin and serotonin and to the aptly named mirror neuron system in the insula, the part of the brain that fosters social emotions such as guilt, shame and embarrassment. If you witness a colleague getting dressed down by the boss, for example, your mirror neurons “mirror” the pain of that public humiliation as though it were your own. Mirror neurons explain why we feel sad or depressed after consoling a friend over a breakup or job loss. People who rank high on the empathy measuring scale have particularly active mirror neurons systems.

When substance use becomes part of the picture, however, it can block these biological and chemical processes, effectively disrupting empathy and even eliminating awareness of others’ feelings. Combine the addict’s desperate cravings with this inability to feel the pain they are inflicting, and it becomes easier to see how a once caring mother could let her children go hungry so she can get her next fix or how a teen could steal money for drugs from his mother’s purse.

The reality of addiction has led some to conclude that addicts are no different than sociopaths. The truth is far different. Sociopaths understand the distinction between right and wrong but do not care about such knowledge or the consequences that spring from their morally and socially inappropriate behavior. Most addicts, by contrast, do care but become powerless to feel the emotion or to act upon it.

Embracing Service and Altruism

For long-term recovery from substance abuse, that capacity for empathy must be restored. The good news is that the brain and body are capable of significant healing with each reduction in drug and alcohol use. When substances are no longer calling the shots, the door is opened to a return to empathetic feeling.

The recovering addict can help along the process through a simple step: undertaking acts of service and altruism. Doing so not only reacquaints them with the rewards of empathy, but it can also help them get and stay sober. Research shows, for example, that participating in community service makes a recovering addict much less likely to turn back to substance use. It also boosts their mood. It’s why a commitment to helping others has long been a central tenet in 12-step mutual support groups.

The challenge, of course, is how to get a person who is struggling with addiction and a loss of empathy to acknowledgment that they must change – for their own good and for the good of those around them.

There is no one-size-fits-all guide, but my experiences helping those with drug and alcohol problems have taught me this:

  • We can’t fix them, but we can influence them.
  • A person doesn’t have to want to be in treatment to benefit from it. Those who resist addiction treatment are just as likely to recover as those who enter a program willingly. Studies of those ordered into treatment by the courts confirm this.
  • We help most when we set limits on what we are willing to accept. Most addicts don’t reach out for help because they’ve seen the light; they reach out because they’ve felt the heat. Many is the success story that begins with descriptions of being forced by loved ones to make a decision about treatment.

Most important, remember that although the person you love may seem completely obscured by their addiction, they are still in there. Calling upon your empathy can help them reclaim their own.

David Sack, MD, is a psychiatrist, addiction blogger and CEO of Elements Behavioral Health, a nationwide network of addiction treatment programs that includes The Sundance Center drug rehab in Arizona. He recently wrote a blog with tips for developing empathy.