Addiction is about three relationships
There has been a push to understand and define addiction in our society as a brain disease, primarily because of the strong evidence from neuroimaging studies that have identified clear changes in the brain for those who struggle with addiction. At the same time, others have provided evidence that addiction is an adaptive response to underlying, unresolved, adverse childhood experiences (i.e., the ACE Study). We know the truth is that both are right. Roughly 80 percent of those who go down the path of addiction begin prior to the age of 15. So early life experiences are critical to understanding this problem. Although the ACE study provides significant insight into the roots of addiction, we must also factor in to the equation a wide range of risk and protective factors, as well as genetic vulnerability. While I support incorporating all of these perspectives into our understanding of addiction, I believe how we understand this challenging problem should link directly with how we treat it. For me, this has led to a reconceptualization of how I understand and define this problem, one that I want to share with you.
Addiction is about three relationships with Self, Others, and the All. Let me explain.
The relationship with Self is best characterized by shame. Early adverse childhood experiences (and other risk factors) set-up a belief system that something is wrong with Self, and addictive behavior over time becomes a powerful way to manage the trance of feeling unworthy. To add fuel to the fire, when attempts to stop addictive behavior fail (due to changes in the brain), shame and feelings of unworthiness deepen even more, creating a destructive cycle that results in great pain for the Self and those around the person struggling. The relationship with Others is best characterized by isolation. I have written about this particular relationship in past posts. Isolation occurs because the developmental capacities necessary to initiate, form, and maintain healthy relationships with others become constricted over time, due to spending considerable time with objects of addiction (e.g., alcohol, drugs, porn, food) instead of people. In essence, adults who struggle with addiction are childlike in their ability to be in relationship with others. This makes it hard to hold jobs, parent kids, remain in committed, intimate relationships, and build community. It also helps explain why about 80 percent of those behind bars struggle with addiction, as well as many who return home from war and feel isolated and disconnected from those who have not had similar war experiences. The third relationship is that with the All (e.g., God, Atman, the One, Yahweh, Brahman, Allah), or what 12-step programs call higher power. It is a relationship I have devoted little time to on this blog, but one that I intend to give far more attention to in the future. It is best characterized by Truth and Love. The truth comes from experiencing all that addiction is – both its pleasures and pains. It is no coincidence that at the moment of orgasm, the instant the body feels the sensations from a drug, or the second one realizes they have had a Big Win on the craps table, the words “Oh God” come forth. Going deep into addiction is a search for the All, for truth, and ultimately for love.
These three relationships require attention and healing if we are to be successful at helping those who struggle with addiction. Our interventions should target all three relationships, which I should add, are hardly independent, but linked together in a seamless system. Work on one relationship impacts the others. There are two broad paths or categories of interventions: 1) the path of action, and 2) the path of non-action or contemplation. The first path is what we are accustomed to associating with typical interventions and treatments. The path of action happens in our waking states, when we “do” things. I believe there are five broad actions that are important on this path: motivate, evaluate, manage, resolve and create. The path of non-action or contemplation is equally important, and involves using meditation practices to detach from objects of addiction and embrace our spiritual nature. If you consider meditation an action, then I guess you could make an argument that perhaps there is only one path. But doing contemplative work in essence is about “just being” which takes us back to a path of non-action. If it sounds a bit confusing, it is to me too. And to round out this discussion, both paths meet in consciousness. More about this to come.
As a parting thought on this topic, engaging all three relationships allows us to incorporate all we know about addiction. We can incorporate insights from neuroscience, medications, and healthy living into our treatments and interventions. And, we can evaluate outcomes more holistically when we consider how our interventions impact and change the three relationships.