Addiction Management Blog

Archive for the ‘Action 4: Resolve’ Category

Ah-hah moments to move beyond addiction

Saturday, May 11th, 2013

Not long after my wife and I were married, we decided to proactively increase our chances of staying together by enrolling in one of Dr. John Gottman’s weekend couples workshops in Seattle. At the time I was deeply immersed in my graduate studies in counseling and was excited to spend some time with the world-famous marriage guru. What I had not realized was that 1000 other people would be crammed into the Seattle Center taking the workshop as well, so my chances of a little one-on-one time were not so good. Fortunately, he circulated around while we all were doing exercises and I told my wife that if he ever came within 200 yards we should wave our hands wildly and grab his attention.

The moment came and sure enough my plan worked. He sat down and we began talking about some martial issue that escapes me now. During our conversation I began challenging him a bit about how people really change behavior, at which point he brought up focusing. Because I had told him I was nearing completion of my graduate program he assumed I would know all about focusing, but my deer-in-the-headlights response gave me away. I had to admit that never in any of my classes had the word focusing ever been mentioned. I was clueless and a bit embarrassed. He said it was the key to behavior change and I needed to know about it.

focusing_book_2007_medCoincidentally, the relative I mentioned a couple of blog posts ago who had given me a bunch of psychology books, had included the book  Focusing! Written in the 1970s by Eugene Gendlin, the book is based on about two decades of research analyzing what happens in therapy sessions that explain good outcomes. What Gendlin found is that it has little to do with the therapist or the specific type of therapy one gets, and far more to do with what happens inside the client. In essence, he discovered that positive outcomes occur when clients have “ah-hah” moments during sessions that awaken them to deeper truths about themselves and life. These moments occur when we (and clients) go inside and connect with what he calls a felt sense – a pre-verbal inner knowledge or awareness that comes from paying attention to an integrated and holistic aspect of our being that we can access at any time. If this sounds a little new-agey it really is not, it is just hard to describe something that cannot be easily put into words.

Have you ever lost your keys and banged your head against a wall trying to remember where you left them? No matter how hard you try nothing seems to work. So you go on to something else and then, in the middle of folding laundry, it hits you. You remember exactly where you left them! That moment of remembering is what Gendlin would call a felt-sense, an ah-hah moment that awakened you to an answer that previously was outside your awareness. While focusing can help you find your keys, it really has the power to change your life.

Focusing is the name Gendlin uses to describe the six-step process he developed for helping people – both and in out of therapy – have felt-sense experiences to solve a multitude of life problems, including addiction! If you have never heard about it, I really encourage you to check out the focusing website and read one of the many books written on the topic. What started as a little research project in Chicago in the 1950s has evolved into one of the greatest tools we have for overcoming addiction.

Siddhartha’s path out of addiction

Saturday, June 30th, 2012

I’m not sure how I missed reading Hermann Hesse’s Siddhartha (Hilda Rosner translation) in high school, but I did. It’s one of those enchanting books I wish I would have read earlier! If you are unfamiliar with the story, I encourage you to read it and soak in its many wonderful messages about life. I have no intention of recapping the story here, but instead want to use parts of the story to illustrate one path out of addiction.

Siddhartha is a man on a mission, on a journey to the center of Self, to a place where Self is merged into unity, or the All. On his way to enlightenment he has many interesting adventures, including a period of time where he hangs out with the beautiful Mistress, Kamala. “She played with him, conquered him, rejoiced at her mastery, until he was overcome and lay exhausted at her side.” She enticed him into the world of the ordinary, a life of attachment. “The world had caught him; pleasure, covetousness, idleness, and finally also that vice that he had always despised and scorned as the most foolish – acquisitiveness. Property, possessions and riches had also finally trapped him. They were no longer a game and a toy; they had become a chain and a burden.

I find it interesting that as Siddhartha descends deeper into his attachments, Hesse beautifully describes addiction. “He played the game as a result of a heartfelt need. He derived a passionate pleasure through gambling away and squandering of wretched money….He won thousands, he threw thousands away, lost money, lost jewels, lost a country house, won again, lost again. He loved the anxiety, that terrible and oppressive anxiety which he experienced during the game of dice, during the suspense of high stakes. He loved this feeling and continually sought to renew it, to increase it, to stimulate it, for in the feeling alone did he experience some kind of happiness, some kind of excitement, some heightened living in the midst of his satiated, tepid, insipid existence.

And like so many who suffer from addiction and relapse to numb the pain and despair of an insipid existence, Siddhartha too experiences the consequences of his actions. “And whenever he awakened from this hateful spell, when he saw his face reflected in the mirror on the wall of his bedroom, grown older and uglier, whenever shame and nausea overtook him, he fled again, fled to a new game of chance, fled in confusion to passion, to wine, and from there back again to the urge for acquiring and hoarding wealth. He wore himself out in this senseless cycle, became old and sick.

For those who struggle with addiction, and their family and friends forced to endure a life on the edge, there is an insightful lesson in the story of Siddhartha.

I have had to experience so much stupidity, so many vices, so much error, so much nausea, disillusionment and sorrow, just in order to become a child again and begin anew. But it was right that it should be so; my eyes and heart acclaim it. I had to experience despair, I had to sink to the greatest mental depths, to thoughts of suicide, in order to experience grace, to hear Om again, to sleep deeply again and to awaken refreshed again. I had to become a fool again in order to find Atman in myself. I had to sin in order to live again.

For someone who reaches enlightenment, it’s strange imagining Siddhartha sitting by a river thinking about suicide. But he does. And in the pain of the moment, “he understood it and realized that the inward voice had been right, that no teacher could have brought him salvation. That was why he had to go into the world, to lose himself in power, women and money; that was why he had to be a merchant, a dice player, a drinker and a man of property, until the priest and Samana in him were dead. That was why he had to undergo those horrible years, suffer nausea, learn the lesson of the madness of an empty, futile life till the end, till he reached bitter despair, so that Siddhartha the pleasure-monger and Siddhartha the man of property could die. He had died and a new Siddhartha had awakened from his sleep. He also would grow old and die. Siddhartha was transitory, all forms were transitory, but today he was young, he was a child – the new Siddhartha – and he was happy.”

So often when addiction is the problem we believe heading off to treatment is the answer. No doubt treatment can be helpful and at times life-saving. But this story is a powerful lesson in how change, even the most challenging of changes, are possible when we access what is already inside us. Atman. The All. “To much knowledge had hindered him; too many holy verses, too many sacrificial rites, too much mortification of the flesh, too  much doing and striving.” Too much treatment, too many self-help meetings, too much reliance on evidence-based practices and medications. Too much action. Sometimes, the path of no-action, the path of contemplation – of sitting, listening, and just being is the path out of addiction.

 

All you need is love, love, love is all you need.

Tuesday, August 30th, 2011

At a training not long ago on CRAFT, the presenter, Dr. Robert Meyers, told a story that I want to pass on to you. But first, if you have never heard of CRAFT, it stands for Community Reinforcement and Family Training which is an evidence-based approach that family members (or friends) can use to facilitate getting an unmotivated loved one struggling with addiction into treatment. I am most fond of this approach because, unlike traditional interventions that rely upon coercing a person into treatment through harsh group feedback, CRAFT relies upon using basic behavioral strategies to rearrange the world of the addict so he or she internally reaches the decision that treatment is necessary. We have known for a long time that external motivation gets the job done; interventions do often lead to treatment. But unfortunately, once there, the person we so badly care about does not engage in treatment, does not really want to be there, and often drops out. We are back to square one and saying that treatment does not work. It is a vicious cycle.

In these situations, treatment fails because of a lack of internal motivation. Those who need to change their behavior have to want to change their behavior, which is why CRAFT is so powerful. It works to increase internal motivation for change by eliminating the positive reinforcement for acting out in an addiction, and enhancing positive reinforcement for non-acting out behaviors. If you don’t understand basic behavioral approaches to change using reinforcement, then it is time for Dr. Meyers’ story.

A woman who had been admitted to a psychiatric ward was driving the staff crazy. From the time she woke up until the time she went to bed in the evening she would scream her head off. The staff tried everything they could think of to get her to stop screaming, but nothing worked. She had to be placed in a room alone, away from the other residents, and restrained at times. Although medications could have been used to sedate her (and probably were at times), they were not the answer. After many frustrating weeks of listening to her loud cries, a doctor was brought in to see if he could help. His name was Nathan Azrin.

Nate walked down the hall to the woman’s room as staff likely snickered about how he possibly could make a difference given all that had been tried. When he arrived, the woman was sitting on the edge of the bed rocking back and forth screaming like she did throughout the day. He stood at the doorway for quite some time. He may have thought about why she was screaming, but also knew that whatever the driving reason, she could not speak and exploring the why would likely be a long journey. Instead, being a behavioral psychologist, he considered her behavior and what he wanted her to do instead of screaming. Well, this was easy, he wanted her to stop screaming. Then, he considered the times when she was doing what he wanted her to do: eating, sleeping, and breathing. During these activities she did not scream. As he stood in the doorway, he began to focus more on the immediate moment to moment rhythm of her screaming and breathing. Then he got an idea…

Right at the moment when she stopped screaming to take a breath, he walked over to her and gently stroked her hair. After she inhaled and began screaming again, he slowly moved back to the door and waited until she had to take another breath. He then repeated the movements with every breath: move close to her, look her in the eyes, gently stroke her hair, and then move away as she screamed. Nate knew, that at our core, we all have one unifying need: love. And he believed that by reinforcing the moments when she was not screaming, even though they were just seconds, with loving touch, that just maybe…maybe, he could alter her behavior. While staff had isolated her, restrained her, and stayed clear of her, he moved closer to her. And his approach worked. By that evening, he was sitting next to her on the bed, gently stroking her hair, and the screaming had stopped. He told the staff that when she woke up the next morning and started to scream, someone was to sit next to her and gently comfort her. In fact, anytime she began to scream, the antidote was the same.

I love this story because so often when we are challenged in life we tend to overlook the obvious. We seek out expensive treatments, elaborate self-help strategies, or engage in complex change regiments only to become frustrated when change eludes us. Dr. Azrin is among the most cited psychologists of all time, and although he may go down in history for his popular read, Toilet Training in Less Than a Day, for me, he will go down as an individual who taught me about love.

Race to Nowhere

Monday, April 11th, 2011

Last week I watched the independent film Race to Nowhere that has won numerous awards for its strong messages about our broken educational system. Through interviews with students, parents, teachers, and others, the movie illustrates the dark side of being a kid in school. The race to nowhere for students is paved with an over-scheduling of activities, too much homework, too little sleep, and increased stress that is resulting in health problems, drug abuse, eating disorders, and suicide. What is even more troubling, is that for all the effort kids are putting into their school work and extracurricular activities, many are being churned out of our educational system lacking some of the most important qualities of a good education, including:  the ability to reflect deeply on topics, handle difficult emotions in the face of stress, and successfully engage in a wide range of healthy relationships. The film points the finger at numerous perpetrators, but in the end, fails to hit home that no one individual person or group is to blame, but rather it is the entire educational system that we must examine more carefully if we are to find the truth behind the worrisome outcomes.

When I think about the fact that over 80 percent of those who end up struggling with addiction begin their behaviors prior to the age of 15, this film frightens me even more. When did school become so competitive and stressful? Much of the over-scheduling of extra-curricular activities and hours of homework is in response to the demands, both perceived and real, associated with getting accepting into a college or university. What is sad is that the stress and pressure begin long before high school. My wife and I spent a couple of years tearing our hair out (the little I have left) trying to identify and enroll our son in the best possible elementary school. I put more time and effort into researching options, attending open houses, completing enrollment packets that included writing lengthy essays, than I ever did applying to graduate school! The process was absolutely crazy, and I know we were not alone. And now I know it was just the beginning.

Race to Nowhere illustrates painfully many of the current antecedents to addiction, and why we absolutely must reexamine our understanding of what education means and how we are going about educating our children. Failure to do so will only lead to a new generation of addicts.

 

A long walk to Tucson

Monday, February 28th, 2011

As I laid in bed thinking about the next day, about my turn, fear flooded my entire body. I was like a pressure cooker with no relief valve, and I knew I had to do something fast. I dressed quickly and left my room, walking outside into the cold Arizona night. The black sky was speckled with a million shining stars lighting up the desert floor, casting shadows on giant, prickly cactuses. I walked quickly along the side of the road, exhaling fear with every breath. I began to feel better, more grounded and intent on making it into town. Every few minutes I would squint as a car’s oncoming headlights blinded me, but I never missed a step. After some time, I felt a sharp pain in my side. Then my left calf began to tense up and I wondered how far I had walked. I wondered even more about how far I had left to go, whether walking alone in the middle of the night on a dark road was such a good idea, and whether I would survive confronting my fears in an experiential therapy group the next morning.

My week-long experience in Tucson was only one of a number of therapeutic journeys I have taken during the past two decades. At the time I took my long walk in the Tucson desert I understood very little about how professional therapy ultimately translates into a better life. I was there because that is what I thought I was supposed to do to get better. It was a challenging experience, like many of the therapeutic journeys I have been on, because the essence of the therapeutic work was emotional. Since I had lived much of my life in my head, learning to connect with my body and feelings was not natural, particularly when I felt I had so little control over these things. Although I can honestly say it was not the most enjoyable week, after it was over I felt more complete, more integrated, more able to be in the world in a broader context. Some of the emotional pressure had been released safely, and I felt more alive. Such outcomes have always been the reason I keep going back for more, even to this day.

What I now realize after years of personal therapeutic work, counseling patients, and studying the research on treatment outcomes, is that good therapy advances developmental capacities that make healthy relationships possible. In addition, by expanding developmental skills, it becomes possible to optimize overall mental and emotional functioning, leading to an expansion of life opportunities, a better alignment between innate talents and employment, and a more meaningful life. What I have also realized is that advancing developmental capacities does not necessarily require professional treatment, but can result from a number of life experiences.

Although medications and various cognitive-behavioral therapies so often used in addiction treatment play an important role in solving the problem of addiction, they fall short of a permanent solution because they are not intended to progress emotional development. When I reflect back on the many therapists I have worked with, self-help groups I have attended, experiential programs I have endured, and the wide range of therapeutic approaches I have subjected myself to, it is clear now that the most important ingredient in all of them was people, not specific therapies, medications, or programs. Treatment works best when in the context of relationships, the skills necessary to initiate, develop, and maintain healthy relationships – skills underdeveloped because of time spent with objects – are nurtured.

The good news is that anyone, at any stage of life, no matter how badly addicted to objects, can evolve their developmental capacities and engage in life in a deeper and more meaningful way.

 

Mark Girard, LCSW & Certified Jungian Analyst: Working with Altered States

Tuesday, December 7th, 2010

For the past few years I have taught a foundations course on addiction treatment to graduate students. An important aspect of the course is helping students understand that longterm successful outcomes  necessitate resolving underlying drivers of addictive behavior, namely, adverse childhood experiences. In an effort to illustrate concretely how this may be done, I enlisted the help of a good friend and colleague, Mark Girard, who is a master at knowing how to help people heal from deep, traumatic wounds. As a Licensed Clinical Social Worker and certified Jungian Analyst with years of experience, he is incredibly skilled at working with a wide range of altered states, or emotional constrictions due to trauma. What impresses me most about Mark is how he uses himself as a tool in therapy. He walks his talk and maintains a presence with patients that is the essence of what a good therapeutic relationship is all about. During his recent visit to my class he agreed to have me videotape his lecture. The approximate 35 minute presentation is a gift to us all. I encourage you to take the time – quiet, focused time – to sit and hear what he has to say.

In the presentation, Mark mentions an article by Dr. Bruce Perry from the ChildTrauma Academy that was required reading in class. The article is titled Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized children and is a nice adjunct to his lecture. He also makes reference to Babette Rothschild’s wonderful book on trauma, The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment, and the classic article on trauma by Bessel van der Kolk, The Body Keeps Score – both among the very best reads on the topic of trauma.

“Calm Energy” as an antidote to addiction

Monday, October 18th, 2010

I have mentioned Dr. Robert Thayer before on this site, but have not dedicated a blog entry to his ideas until now. When I first read his book, Calm Energy: How People Regulate Mood with Food and Exercise, I was immediately impressed by the implications of his  work for those struggling with addiction. In a nutshell, he provides a very strong case that many of our moods and unhealthy eating habits have in common two biopsychological dimensions that he calls energy and tension. In an earlier book (The Origin of Everyday Moods, 1996) he describes how the dimensions can be used to create the illustration below.

The above four states represent different expressions of our energy and level of stress. Calm Energy is the quadrant where we find our best moods. We have energy and no tension. It is similar to the states people call flow or being in the zone. It is a place we want to be, where our attention is focused, we are productive, and we feel good about life. It is not a place where addiction is found, and in fact, is really the antidote to cravings and addictive appetites. The opposite of Calm Energy is Tense Tiredness. This unfortunately is the place many of us find ourselves these days, in large part due to the speed of life, decreases in sleep, and increases in stress. It is a place of low energy, bad moods, anxiety and depression. It is also the state where addiction thrives. When we feel tense and tired there is a natural tendency to want move away from this state, and addictive behaviors are among the most powerful, reliable, quick, and easy ways to disconnect from Tense Tiredness. I say disconnect because engaging in addictions does not really provide an antidote to this state. Instead, it may in the short run give us more energy, and change our mood, but only temporarily. When the addictive behavior ceases, chances are good that what follows will be more tension and lack of energy, perpetuating the relapse cycle.

I like to think about Calm Tiredness as a lazy Sunday afternoon. In general, it is a pleasant state, but often not as productive or positive as Calm Energy. Nothing wrong with it, and in fact we need down time to recharge our batteries. The final state, Tense Energy, is a state where we are quite productive and busy, often due to deadlines and being rushed for time. Many Type A personalities fit this state, as well as those who like to live on the edge and seek out thrills.

In my own life I find the model incredibly useful in helping me understand my own eating, exercise, sleep, and mood patterns. One of the best things you can do for yourself is take a day (or two) and track your level of energy and tension by the hour. Rate each on a scale of 1 to 10 and then plot the results on a graph. It is revealing to see just how significantly these states change in the course of an average day. The graph also helps to identify intervention points for: (a) preventing relapse, (b) developing optimal times for exercise, and (c) determining whether we are getting enough sleep. In addition, the graph can help you understand how time of day subtly influences how we think about life problems.

In sum, addiction most often shows up when we are tense and tired, but can also occur in the other states as well. Among the most significant points Dr. Thayer makes in his book is that the single best way to cultivate a life of calm energy is by developing a regular habit of exercise. Perhaps that is why the National Institute of Drug Abuse has already invested over 4 million in research into the connections between addiction and exercise.

The end of Mr. Roger’s neighborhood

Friday, October 8th, 2010

As a young boy, I remember venturing out on summer evenings to play hide-and-seek with the other neighborhood kids. We made up teams, sought out secret hiding places, and took full advantage of the local woods that surrounded our corner of the world. Our parents all knew each other, and while we were expending our energy running around in the dark playing games, they were talking around tables and sharing food and drink. There was no internet, cell phones, or other multimedia distractions competing for time. Life was simpler, slower.

Now, more than thirty-five years later, I find myself married with a young son and challenged to provide him the same care-free childhood that I experienced. Despite living in a pleasant, middle-class neighborhood, it is rare to see large groups of kids playing together outside. There are no local woods within walking distance, and even if there were, most parents (myself included) would be hesitant to allow their children to play unsupervised. Although everyone I encounter on my daily dog walks is friendly, there is a lack of deep intimacy among neighbors. Some have never even met despite living within blocks of each other for decades.

The stark contrast between life today and just a few decades ago is surreal. The year I was born the handheld calculator was invented, and today, handheld devices are minicomputers capable of video-conferencing around the world. But for all the benefits technology affords, there is a cost that gets lost in the frenzy of Facebook, YouTube, and Amazon.

In 1985, researchers set out to understand the degree to which people have family and friends they can rely upon to discuss matters that are personal in nature. A national survey was done, and in 2004, the same group decided to repeat the study to determine how core discussion networks had changed over two decades. The results are frightening.

  • 25% of all Americans in 2004 reported they had no one in their life to discuss personal issues, compared to 10% in 1985
  • The modal (most frequent) number of discussion partners in 1985 was three, but in 2004 that number plummeted to zero
  • The average social network size has dropped from 3 confidants to 2
  • The number of people who reported that their spouse was the only person they trust with personal issues increased by almost 50 percent since 1985

These outcomes paint a sobering picture of the price we may be paying for our technology-enhanced life. The lead researcher has said, “we know these close ties are what people depend on in bad times. We’re not saying people are completely isolated. They may have 600 friends on Facebook.com and email 25 people a day, but they are not discussing matters that are personally important.”

Source: Social Isolation in America: Changes in Core Discussion Networks over Two Decades, American Sociological Review, June 2006 71:353-375

Uncovering the pervasive roots of addiction: Part 2

Monday, July 12th, 2010

“Addiction in the modern world can be best understood as a compulsive lifestyle that people adopt as a desperate substitute when they are dislocated from the myriad intimate ties between people and groups – from the family to the spiritual community – that are essential for every person in every type of society.”

Bruce K. Alexander, The Globalisation of Addiction: A Study in Poverty of the Spirit

In the previous post I discussed how adverse childhood experiences (ACEs) to a large extent play an important role in the development of addictions. Given that over 80 percent of those who develop addictions begin adaptive behaviors to cope with ACEs prior to the age of 15, we as a society need to place a greater emphasis on identifying at-risk kids and intervening as early as possible. But there is another insidious root to addiction that I believe goes beyond individual ACEs and plays an even greater role in the development of addiction – free market society.

Bruce K. Alexander spent decades as a distinguished addiction researcher in Canada before becoming so frustrated by a lack of progress in helping those who struggle, that he completly changed careers and decided to focus on teaching history instead. Despite doing everything he could to avoid topics around drugs and addiction, the more he studied history, the more he discovered insights that began to change his entire perspective on the nature of addiction.

In general, when we think about addiction, we think about it as an individual problem. Individuals are exposed to a host of risk factors, including ACEs, peer group influences, and the availability of objects of addiction in communities. The more risk factors an individual is exposed to, the more likely the chances are that he or she will develop an addiction. Conventional wisdom also suggests that the antidote to addiction is intervention and treatment. But when Dr. Alexander began studying history, he discovered cultures and societies where common objects of addiction were present (drugs, alcohol, sex, food), yet addictive behavior was minimal or nonexistent. ”Addiction can be rare in a society for many centuries, but can become nearly universal when circumstances change – for example, when a cohesive tribal culture is crushed or an advanced civilisation collapses (Alexander, 2008).” Throughout history, the primary factor responsible for the societal change leading to pervasive addiction is the introduction of free market society. Why?

When a society introduces free markets, exchange of goods and services optimally are not encumbered by family ties, cultural traditions, religious values, or anything else that may impede free play of the laws of supply and demand. In other words, free markets create an “every man (or woman) for yourself” dynamic that puts me in competition with everyone else for jobs, insurance, a house, goods, services and Lady Ga Ga tickets. One consequence of this system is that people become dislocated, or disconnected from one another because of the time and energy necessary to keep up with the Jones. Free markets are incredibly profficient at knowing how to keep people focused on stuff over experiences. Flashy ads, mass media, and the latest gizmo from Steve Jobs keeps us always wanting more. In the pursuit of the American dream, what many get instead is isolation, fear, and dislocation, which ultimately leads to compulsive lifestyles where people develop addictive relationships to stuff and get further and further disconnected from nurturing human relationships.

Dr. Alexander’s Dislocation Theory of Addiction is well documented in a paper titled The Roots of Addiction in Free Market Society (highly recommended reading) and a more extensive read: The Globalisation of Addiction: A Study in Poverty of the Spirit. His work is extremely important in helping us all understand many of our current societal ills beyond addiction, including: divorce, single parenthood, children in poverty, obesity, unemployment, and excessive time in front of the TV. Until we as a society place relationships and experiences over materialism, consumption and stuff, Thoreau’s observation that ”the mass of men lead lives of quiet desperation” will ring ever more true.

What is the solution to mass dislocation? I believe part of the answer lies in making some tough societal changes including ending the senseless war on drugs (a big topic for another time). But for the individual struggling right now with addiction, the answer is much more about restructuring life in a way that emphasizes relationships over stuff. To do this, one must have the developmental  capacities necessary to know how to initiate, develop, and maintain healthy human relationships.

Uncovering the pervasive roots of addiction: Part 1

Wednesday, July 7th, 2010

“For every thousand hacking at the leaves of evil, there is one striking at the root.”  – Thoreau

In my life there have been many times when I felt isolated, lonely, disconnected, and alone. These times have never  been pleasant, and in the absence of nurturing relationships, close friends to call on a dime, or a tribe of my own, I coped by engaging in substitute relationships with work, money, entertainment, food, hobbies, and exercise (just to name a few). For years I felt shame about many of my behaviors, and my inability to connect in deep ways with others. Now I understand that so much of my adaptive behaviors were a response to underlying root problems, problems that needed resolving and hampered in significant ways my ability to intiate, develop, and maintain intimate and nurturing relationships with people. I also believe that now, more than ever, those who struggle with addiction share similar root causes that need to be addressed if successful longterm outcomes are to materialize.

The roots of addiction go much deeper than the adaptive behaviors that so often are the focus of intervention efforts. This is because dealing with the symptoms (addictions) are easier than dealing with the root causes. I have long believed that addiction is a problem best managed over time like other chronic illnesses. But successful management necessitates addressing what drives the addictive behavior in the first place. It requires knowing how to turn down the flame, dig out the roots, and resolve problems that are solvable. These underlying roots come in many shapes and sizes, but there are two forms that I believe are the primary drivers of addiction today. This post will address the first form: adverse childhood experiences.

Adverse Childhood Experiences
In the mid 1980s, physicians from Kaiser Permanente’s Department of Preventative Medicine in San Diego made an interesting discovery. Those who were losing the most weight and succeeding in the weight loss program were the ones most likely to drop out and quit. Was it because they no longer needed the program? Nope. Further investigation revealed that the majority of dropouts did not maintain their weight loss and went back to struggling with problems of overeating and obesity. Why did they quit if they were succeeding in the program? A deeper look revealed that overeating and obesity were used as tools to cope with unresolved adverse childhood experiences (ACEs). In most cases, overeating was an unconscious behavior utilized as a protective solution to these unresolved childhood problems.

How was it unconsciously protective? In many cases, the ACEs involved sexual, physical or emotional abuse. Developing a relationship with food was safer than developing intimate or nurturing relationships with people who might abuse again. Being obese unconsciously deterred romantic interests and physically enhanced protection of the body. The finding that most of the participants in the weight loss program had prior ACEs led Kaiser to collaborate with the Centers for Disease Control (CDC) to explore the link between ACEs and general health outcomes.

The study involved over 17,000 middle-class Americans and has produced over 50 scholarly research journal articles. Among the most signficant findings in the study was that two-thirds of the participants reported at least one ACE, and more than one in five reported three or more ACEs. In addition, the higher a person’s ACE score, the more addictive behavior was utilized as a coping response. For example:

Here you can see that as the number of ACE scores increase, so too does the percent who meet criteria for alcoholism. This finding is detailed in an insightful paper titled The Origins of Addiction by the lead researcher of the study, Vincent Felitti. What the ACE study helps us to understand is that the roots of addiction are real, diverse, and if left unaddressed, will continue to fuel the behavior we are so badly trying to manage (or end).