Addiction and Being

The word ‘addiction’ started life in Roman times. A slave was addicted to a master by a formal contract. In mediaeval times monks wre similarly ‘addicted’ to God. In both the case of slave and monk, the whole being was given away. One’s will, one’s desires, one’s idetity were no longer one’s own. Every thought and action was under the sway of Master or God. One had given oneself away, one had lost oneself. All choices, all decisions such as they were in a very limited spectrum were determined by the Other.

Similarly, today, we talk of addicts to substances or behaviours as having lost their self, having given themselves away. All thoughts, feelings, actions are determined by the centrality of the Master, God, Other. Just as every aspect of a slave’s or monk’s life was determined beyond themselves, so the modern addict is enslaved in every aspect of their life to the object of their addiction.

That is why those who talk of the addict’s responsibility and choice are not only cruel, they are ignorant of the nature of addiction. Addiction is a state of being in which one has disowned oneself. A slave would have many moments of hating the Master, of wishing to be free, yet they were bound firmly. A monk may waver in his faith, wish to be free of the strict demands of God, but having given himself over he must endure.

We do indeed talk today of an adict’s being enslaved to the object of their addiction. We may say too, for instance, that alcohol is a drinker’s god.Yet there is a big difference between today’s addicts and the original ones of slavery and monasticism. An addict today can become free.

The experience of most addicts who start on the road to freedom is important. Often, usually, by will power alone they can stop the behaviour they wish to be free of. But then they relapse. Clever scientists suggest that the brain has ‘pathways’ which strongly affect our behaviour. Addictive pathways are literally, biologically laid down in the brain and are powerful. Linkages between the parts of the brain that control impulses are weakened. The good news is that these ‘pathways’ can be altered. The brain is said to be ‘plastic’. It is not fixed, but constantly changing in the light of new learning.

Some evidence suggests that relying on will power alone to defeat addiction can be counter-productive for every time you fight the brain pathways they fight back! There are evangelical claims that such and such a therapy – 12 steps for instance – is the one and only way to ‘defeat’ addiction. Yet words like ‘defeat’ suggest fighting, using yourself to fight yourself. All addicts know this dreadful experience of inner struggle, trying not to do what they don’t want to do while at the same time wanting to do it!

Another aspect of addiction, depending on how long it has lasted, is that every part of life has adapted to it. With the object of desire as the central command all else revolves around it: relationships, work, money, leisure, love. An addict may function in society, have a job and family, but she will place these as second to the object of desire. That is why we hear of ‘trusted’ employees stealing from work, husbands stealing from wives, betrayal, broken promises, bankruptcy. Substance addicts will slowly be committing suicide via the damage to their bodies. Actual suicide may occur in the case of addicts who have struggled so hard for so long against themselves and lost.

An addict who starts young will never learn healthy relationship and social skills, monetary skills, impulse control skills. Recovering from addiction needs much, much more than simply stopping. It may mean learning from scratch what was never learned through natural maturation. On the other hand, those who have been addicted for a short period may have the foundations from earlier life to return to and build upon.

It is often overlooked that there is a strong recognition that most addicts recover by themselves, without any input from specialist services or support groups (and it is sadly worth pointing out too that many who enter specialist services and support groups do not recover. There may be something very naive – if very profitable – in private clinics’ offering 12 weeks ‘recovery’ cures). Young people who are addicted in their energetic teens and 20s are known to ‘mature out’ when they start a family, settle into employment and replace one way of being with a healthier way of being. The famous study of Vietnam soldiers, addicted to heroin in Nam, shows that 80% of them recovered naturally when they returned from the war to their families. A ‘bad’ thing is wiped out by a ‘good’ thing.

One of the great potential benefits of any recovery method is that the addict has taken responsibility for owning their condition. Remember, there are many millions of addicts who deny their condition at first: some will go to the grave denying it. For some, and by now means all, group meetings provide a weekly or daily regularity that has been missing in life. For some, by no means all, the very sociability of groups takes the addict from the well known deep self-centred thinking to the beginning of entering the world of social interaction. These benefits, rather than the particular programme, may be what accounts for their success for some, but by no means all.

There is absolutely no such thing as a typical addict. Somebody with an addiction has a unique history, is a unique person. Yet one may perhaps allude to a certain common problem facing some in the early stages of recovery. It’s almost like dread. You’e done three, six, twelve months but you feel empty, lost, nothing grabs your interest. Not uncommonly there is a state of clinical depression and/or anxiety. Underlying mental health conditions which brought about addiction in the first place may surface. These can be treated clinically. But there is also often a deep unease at the level of being. After years sealed off from life, what is life? What is my life? I’ve stopped drinking or gambling or my sex addiction but my life doesn’t feel any better for it. What’s the point? Remember that such feelings will amost always be accompanied by intense negative feelings of guilt, shame and bitter self-recrimination.

The bad news is that there is no magic answer, whatever evangelical gurus or sellers of this or that method say. Addiction is every bit as devestating as cancer in those cases where statistics show the numbers that sadly don’t make it out. The better news is that most people do recover, more often on their own than not. And one thing seems to help above all others. Whether with or without support, it’s finding healthier, deep meanings to life. The psychiatrist Viktor Frankl survived most of the second world war in concentration camps because he was used as a doctor. He wrote a book* in which his central insight is that the dreadful conditions of the camps brought people to their kneees, physically, mentally and spiritually Yet some died very quickly. Others in identical circumstances survived. Those who survived, he said, had deep within them some core meanng to their lives; for some it was religion, for others it was their family outside the camps, for some it was music or literature or writing, for some it was helping others. This idea of having a deep meaning for being (or reasons to be alive) is seen as crucial to surviving the sufferings life throws our way.

Addicts by the nature of addiction have developed a specific sense of time peculiar to addiction. The time of the ordinary world is filled with boredom or threat, but the immediacy of engagement with the object of desire shuts out that ordinary world. In the ordinary world the biggest dread is not of pain but of meaningless, something much deeper and more intense than boredom. Unease with time is relieved by triggering the addictive process which provides not only a relief from unease but a sharp and powerful pulse of energetic feeling. (This process is described particularly acutely in the experience of playing electronic gambling machines: it’s called ‘being in the machine zone’. Note the word being).

Recovery has to come to terms with recovery from that addictive way of handling time. It means finding meaning in long term feeling, thinking, doing, being. For some it may need no more than becoming ‘addicted’ to the love of one’s children and grandchildren. For others, trainspotting is enough. But after the years of fury, and the early period of srtuggling recovery, it is true that, after all, time heals.

 

* Viktor Frankl, Man’s Search for Meaning

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12% of UK Doctors are Addicts

According to this site for sick doctors, 10% of the general population are estimated to be addicts. The figure rises to 12% for doctors in the UK. These figures refer to drug and alcohol addiction and do not include other addictions such a s gambling addiction. Both figures are probably highly surprising to most people. Addiction is certainly one of the most pervasive of all mental illnesses. The costs to individuals and those near them is huge in terms of grief and suffering; the cost to the nation runs into may billions of pounds.

Doctors and other front line health workers generally work under very stressful circumastances. One stressor must surely be that those they are helping or trying to help often turn against them, blame them, may be even physically violent. This may be true especially among addicts who ahve a tendency before they start on recovery to externalise their pain,  and blame whatever or whoever comes to hand. Doctors are often in a position where they can do little for a patient except refer them elsewhere. Often, when recovery from addiction has begun and the patient has gained some ownership of their own recovery, doctors can help with things like depression and anxiety.

However, going back to the figures at the top, if doctors themselves have such a high rate of addiction it seems reasonable to suggest that there is no easy medical ‘cure’ for addiction, no magic pill. If doctors cannot heal themselves, or not easily by use of medication, it follows they cannot offer easy solutions to anybody else. Doctors have to embark on recovery in the same ways as anyone else.

It’s the case that ‘addiction’ is classed as a ‘mental illness’, yet perhaps it’s true also that there is no straightforward and medication based treatment.

It may be that recovery is not a medical matter. Although medicine can help with the complexities of addiction on an individual case basis such as whether a comorbid mental health disorder needs treating initially or during recovery, by and large recovery takes place in non-medical contexts. 12 step programmes (AA,GA,NA etc.) is an obvious example (although as is well known, while some swear by the programme, some evidence regarding its efficacy suggests low success rates, and many people find it is not for them). Psychological therapies are used too, but accessing them can be very difficult, involving a long wait for treatment which is not necessarily successful.

A large number of people – in cases of alcohol addiction, for instance, maybe as many as a third of people – recover with no recourse to doctors, psychologists, 12-steps or any other agency. A well known example is that when soldiers became addicted to heroin fighting in Vietnam, 805 of them recovered without intervention on returning home to America where they were in the environment of family, home and friends. Inversely, studies show that drug addicts who stop using while in prison, sometimes for many years, resume upon release when they return to their old social networks. Environment in its broadest sense seems to play a big part in recovery.

Addiction Musings (2): THE SOUL OF ADDICTION

Everyone’s an ‘addict’ these days if you believe everything you read in an ever increasing number of articles. People say jokingly, of course, things like they’re addicted to doughnuts or Facebook. Ingesting too much of anything or spending too much time on anything may be bad for your health and quality of life but that doesn’t make them addictions.

Certainly, some activities share things in common with addictions. Children whose life revolves around social media, who feel miserable and irritable if deprived of it, are said by some to be ‘addicted’. Yet heavy usage of a substance or activity does not in itself describe addiction. Many heavy drinkers, for instance, are giving a lot of time to drinking, damaging themselves and others, but that doesn’t make them alcohol addicts. A lot of people run into problems gambling: they run into money problems, and a host of other difficulties – but this doesn’t make them ‘gambling addicts’.

Heroin is used ‘sensibly’ by a surprisingly large number of general healthy and financially stable with good employment and quality of life. The substance itself does not contain a demon which guarantees addiction. On the other hand, cannabis which as a substance causes little or no physical dependence, may for some people lead to what is truly addictive behaviours. The characteristic which makes cannabis possibly addictive is its becoming the centre of a person’s life. All else is secondary. The days and weeks are spent ensuring supply, and being in a cannabis induced state (interestingly, one that need not be, and often is not, pleasurable). On the other hand, the vast majority of people who use cannabis represent a spectrum: like alcohol for instance, it may be used occasionally or regularly but without disrupting life: without it, life goes on pretty much as normal.

When it comes to fixed odds betting terminals, there’s a somewhat pointless debate about whether or not they are ‘addictive’. For most people they are not, that’s a fact. For a significant number of people they are. Their design make sthem so. In this respect they are electronically enticing the most vulnerable, which is the basis of campaigns against them. They are unfair and unjust. However, that is a separate issue from the question of what addiction is.

There are thousands of ways of asking and answering this question. One thing that seems agreed is that addiction seems to seriously impact on every area of life. Breakdowns of various kinds, physical and mental health deterioration, misery and so on. Yet what about the concept of the ‘highly functioning’ addict? Somebody who is successful on most measures, thriving, healthy, and so on.

Questions, answers, theories and explainations go round and round ending up in a tangle and a mess. But what follows suggests a description of addiction which many may recognise. It’s not a medical or psychological or other expert viewpoint. It’s abot the being and meaning of addiction in an addict’s life. (In philosophy, questions about being and meaning are ‘existential’ questions). This description applies to both those who have not admitted or realised that they are addicts, and to those who know too well that they are in addiction’s grip, those who feel trapped, enslaved.

Enslavement is actually the original meaning of addiction. In Roman times, a formal legal contract would addict a slave to a master. A slave, of course, has no freedom; his or her identity is simply being a slave. Everything the do, everyhting they think, everything they are is in terms of the master, has the master at the centre. The slave’s life revolves around the master.

Interestingly, in mediaeval times, this meaning was tweaked slightly with monks who ‘enslaved’  themselves to God. This voluntary giving over of one’s whole being to God was also called addiction.

Through metaphor, addictio has come to signify the state of enslavement. Just as a Roman slave’s life was totally determined by the master and the condition of enslavement, and the mediaeval monk’s life revolved around God with all else subsidiary, so the modern addict’s whole life and being revolves around the object of their compulsion. The object may be a substance or a behaviour. While the addict functions in many areas of life or not – employment, family, relationships etc. – these areas are always secondary to the object of addiction. An addict may lie, cheat, steal, do things that they utterly detest doing because their whole being revolves around the object of compulsion.

If this description is on the right lines it offers the intriguing possibility that a ruinous addiction may be defeated not by will power but simply by replacing what is important to being and meaning in life. Certainly there is much evidence that many severely addicted people come to ‘recovery’ not by any method or treatment but by finding meanings and values in life that are more positive. So, for instance, 80% of military heroin addicts in Viet Nam stopped using when they returned home to their families, the latter being the positive meaning and values system that defeated the destructive one. Evidence shows that many young people with addictions ‘mature out’ of them without treatment when they find richer meanings to life, for instance throughs tarting a family or a career.

To employ a somewhat hackneyed word, addiction is holistic. It is a state of being that involves every single part of a person’s life.

 

Ade Johnston