Dealing with Addiction

11 03 2015

Recently I saw a couple of encouraging articles in the news which inspired me to write a brief post about dealing with addiction. I will link to the two articles at the end of this post.

Addiction is an issue that comes up all the time in therapy. Sometimes it appears in very overt and obvious forms – such as substance misuse, gambling, or sex addiction – but often in more covert and subtle ways as well, such as compulsive exercise, workaholism, or obsessive thoughts and habits. In many ways all humans are addicts, as we are creatures of habit; we thrive on things that are familiar and comforting, and carve out repetitive patterns for ourselves. This is no bad thing, as it means that we can create healthy routines, or stick to a structured approach when making changes or adjustments; but it can also be dangerous and become an unhealthy, destructive force where a reliance on a certain way of thinking or behaving can start to interfere with the rest our lives.

addictionhelp

So, why is it that some people can keep their habits under control and choose healthy routines for themselves, whereas others find themselves losing control to harmful urges? What decides whether we will find a healthy or an unhealthy outlet for our need for comfort? This is a complex issue, with numerous answers (see Gabor Mate’s talk on The Power Of Addiction for some great points), but I think these three are the most important:

1. Psychobiology. Some people inherit genetic traits or learned behaviours from their ancestors, where they may be predisposed to certain ways of thinking or doing things, or have a particular physiological ‘weakness’ for a certain substance.
2. Environment. We are hugely influenced by our surroundings, and by our social networks (see Nicholas Christakis’ wonderful talk on The Hidden Influence Of Social Networks for more information). The people around us shape our ideas of accepted norms and influence the behaviours that we establish; we often look to see how others are coping with their lives, and then we copy them.
3. Early attachment experiences. Our early experiences shape our identities and also, crucially, our emotion regulation strategies. If we have positive attachment experiences then we learn that we can rely on others, and turn to them during times of need; and this also teaches us that we are ‘worthy’ of other people’s care and attention. However, if we have negative attachment experiences then we learn that we cannot rely on others, and instead have to develop our own methods of self-soothing; and this also teaches that we are ‘unworthy’ of other people’s care and attention. It’s this latter group of people who often seek external sources of affirmation and validation, which can slip into addictive cycles: if it doesn’t feel emotionally safe to turn to other people for reassurance, then they will seek that comfort from the escapism and rush of sex, drugs, or gambling instead.

Amazingly, many addiction treatment programs continue to focus on only the first of those three issues. They see addiction simply as a psychobiological disease, and they dissect the cognitive, behavioural, and physiological components of this disease, and then set out to replace previous bad habits with healthy new ones. However, they often overlook the crucial factors of social networks and attachment experiences; factors which will be massively influential on a person’s chances of maintaining their recovery over time. I believe a crucial element in treating addiction is to process and repair negative attachment experiences from the past, and then to create new, healing attachment experiences in therapy; so that a client can feel a sense of attunement, and learn that it’s safe to turn to others for soothing and reassurance, rather than having to self-soothe or seek out alternative sources of validation. This process also empowers the client to develop a new sense of worthiness, overcoming internalished shame from past rejection, and recognising that they are indeed deserving of the attention, care, and love of others.

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I spent several years as the Clinical Lead of a substance misuse treatment agency within the NHS in North London, and always made sure that we were taking a holistic approach to our clients’ recovery; addressing all three of the factors I list above. I continue to use this approach in therapy with my clients.

Now, here are the two articles I referred to earlier:

1. A Huffington Post article, titled “The Likely Cause Of Addiction Has Been Discovered, And It Is Not What You Think”.
2. An NPR article, titled “What Heroin Addiction Tells Us About Changing Bad Habits”.

Hopefully you will find them as informative as I did. And if you are seeking information or therapy for issues related to addiction, then please do feel free to contact me.





How To Change Your Drinking: A Harm Reduction Guide to Alcohol

16 12 2011

My review of “How To Change Your Drinking: A Harm Reduction Guide to Alcohol” by Kenneth Anderson:

How to change your drinking front cover

Substance misuse is one of the most common and widely discussed topics within the mental health community, as both clients and professionals debate the most effective ways to deal with addictions and their causes.

In the past, treatment might typically have involved a focus on abstinence as the ultimate goal, through zero-tolerance groups such as Alcoholics Anonymous, or a 12-step program, where clients would be rewarded only for complete sobriety and nothing less.

This has slowly changed over the past decade, though, through the realization that complete abstinence simply wasn’t a realistic or achievable goal for some, and that such a harsh insistence on withdrawal simply wasn’t working. In fact, it is estimated that 60 to 95 percent of clients who enter 12-step programs either drop out or otherwise fail to maintain abstinence from alcohol, and the NIAAA’s statistics suggest that only 7 percent of people who suffer from an alcohol use disorder will typically seek treatment within any given year.

As a result the treatment focus has shifted from simple cold turkey toward an overall emphasis on healthier and safer habits, and lowering risks. This has seen an emerging popularity for modalities such as motivational interviewing, where both the pros and cons of sustaining the negative behaviors are acknowledged. The client is then free to decide how, and at what pace, to proceed.

The HAMS group takes a similar “baby steps” approach. HAMS — the acronym stands for Harm reduction, Alcohol abstinence, and Moderation Support — describes itself as “a free of charge, lay-led support and informational group for people who want to change their drinking for the better.” Founder and CEO Kenneth Anderson is himself a former problem drinker.

In this book, How To Change Your Drinking: A Harm Reduction Guide To Alcohol, Anderson presents a comprehensive summary of the harm reduction approach to drug and alcohol problems, suggesting it could “either be used as a self-help manual for people working on their own or by people who are participating in a harm reduction support group.”

The book begins by introducing the underlying theories of harm reduction, and is written in a nonjudgmental tone that will be reassuring to most readers:

Some folks today want to say that everything fun is an addiction and that everyone had better spend their lives in 12 step meetings talking about their ‘Higher Power’ and holding hands and saying the Lord’s Prayer instead of ever doing anything fun. We beg to differ with these people. Prohibition does not work because there is nothing essentially evil, sinful, or diseased about having fun. There is nothing evil, sinful or diseased about drinking alcohol moderately, and for that matter there is nothing sinful, evil or diseased about engaging in recreational intoxication either.

There is not some specific magical quantity which we can say is too much alcohol – free individuals have the right to make up their own minds about how much they believe is too much for them personally. Occasional intoxication is not a symptom of a disease; it is a choice.

It is this focus on individual choice and empowerment which personifies this book and differentiates it from much of the rest of the substance misuse canon. Instead of focusing on problematic labels or clinical diagnosis as a means of demanding perfect abstinence, the author leads the reader on a step-by-step journey toward deciding what their own goals should be, and offers advice and support on the healthiest ways to achieve and maintain them. There is even a short section titled “Ken’s Story,” where Anderson talks about his own previous drinking problems and near-death experiences in AA. Those led to his resolution to “find a better way” and start the HAMS network.

The opening chapters might seem familiar to many mental health professionals, as Anderson suggests that each reader completes a Cost Benefit Analysis exercise, similar to those used in motivational interviewing techniques:

Miller and Rollnick (2002) say, ‘Often individuals considering changing a problem behavior will concentrate on all the negative aspects of the behavior. ‘I know how bad my drinking is for me,’ they say. In fact, they can often produce a litany of reasons why what they are doing is bad for them. Clinician and client are often baffled by the fact that even with all these negatives, change does not occur. The reality is that if the behavior were not in some way beneficial to the client, he or she would not be doing it. Until the client acknowledges the ‘good things’ about the behavior, they cannot prepare to combat temptation once they make an attempt to change. The decisional balance helps facilitate this process.

It is clear that Anderson has done his research in this field, and even though much of the book features personal stories and experiences, these are all presented within a scientifically supported framework, using clinically proven techniques and offering further resources where appropriate. Later in the book, Anderson explains Prochaska’s “stages of change” model, leading the reader through each stage and explaining the range of thoughts and behaviors that might accompany this process. He offers readers a large quantity of materials to help them along this journey, too, ranging from goal-setting and risk-ranking worksheets, to consumption charts and graphs, to the chemical breakdown of different alcoholic beverages and how they are processed within the body.

The book also addresses the addict’s friends and family. Anderson features chapters on specific topics such as spousal goals, alcoholism’s effects on children, and a study of drinking patterns as affected by ethnic identity and religious affiliation.

There is a wealth of knowledge in this book, but the clear, concise and easy-to-read style ensures that it never becomes overwhelming or difficult to follow. Anderson describes things in layman’s terms and it is doubtless this open, reassuring style which attracts so many of the HAMSters to the harm reduction approach.

As a comprehensive manual to changing drinking behaviors, readers will be hard-pressed to find a better book than this. If you’re looking for support, advice, scientific facts, or recovery tools, you’ll find them all here, clearly laid out for both mental health professionals and clients alike.

4 out of 5 stars.

It is worth noting that alcohol misuse has been a major issue in the British media since I wrote this review; with suggestions of major changes in government policy and the introduction of ‘drunk tanks’ and ‘booze buses’. I have a lot more to say on this topic, and it is one that is close to my heart as I do a lot of work for a substance misuse agency within the NHS in North London; but that’ll have to wait for another time.





Saying No To Naked Women

28 05 2011

I thought I would share some of my book reviews on this blog, as they do contain some interesting themes.

I’ll start with my review of “Saying No To Naked Women” by David R. Yale:

Saying No To Naked Women

In the summer of 1974, Jack Derritt leaves the city and all of his material possessions behind and heads out to the Arkansas countryside, to live in a shack and take stock of his life. Tired of meaningless flings and constant feelings of misery and self-doubt, Jack wants to figure out why he’s never been able to find a stable, loving relationship, and why he never feels good enough for anyone. He asks himself: “Why is there a throbbing hurt inside me that never leaves?”

This is the opening to David R. Yale’s “Saying No To Naked Women; the story of one man’s struggle to free himself from porn values and sexual addiction”. With Jack’s story as an example, Yale’s novel shows us how our childhood fears can continue to haunt us as adults, manifesting themselves as self-doubt or insecurity, and preventing us from living fulfilling lives or maintaining loving relationships.

As Jack attempts to settle in his new home, he comes to realize that there is no escape from his inner monologue, which is often delivered in his father’s voice, constantly reminding him what a failure and a disappointment he is.

“I’ll never produce anything worthwhile. No woman will ever want me – once she sees my terrible faults. I’ve managed to fool people, but they’ll see: I don’t know what I’m doing. My father is right. I’m a parasite.”

We learn that Jack’s parents were Orthodox Jews and Marxists, and that Jack was raised in a climate of fear and secrecy, and taught to hide his identity. His parents never told him they loved him; instead they made him feel inadequate, and different from the rest of the world. The legacy of the Rosenbergs hung over his head, as a reminder of what might happen to his family if their religious and political beliefs were discovered. It’s these feelings of fear which continue to haunt Jack as an adult, as he remains convinced that he’ll never meet anyone who could possibly understand or value him for the man he is, and that he must always conceal his true self if he wants to be accepted.

Jack seems trapped in a spiral of loneliness, depression and paranoia, and at times this can be frustrating to read. Yale’s story takes a while to get going, and his pace is slow to start with. He focuses closely on setting the scene and building up the characters, but it is not always clear where this is leading, or to what end. Readers who find themselves struggling through the first half of this book should be encouraged to persevere, as the second half rewards us with plenty of valuable lessons and the denouement contains a powerful and important message. Yale’s prose is engaging and easy to read, and I found myself deeply involved in the story, once I had decided to stick with it, past the uncertain beginning. After around 200 pages, the story finally takes an interesting twist, as the solution to Jack’s torment begins to unfold.

One day, divine intervention strikes: he gets stung by a bee in the woods, and the resulting adrenaline shot sends him into a feverish dream world. In this dream world, Jack is visited by a mystical mentor, in the form of a Chassid, who begins to lead Jack through a number of conversations and sessions of immersion therapy which transform his way of thinking about himself and others.

This exposition is somewhat reminiscent of “A Christmas Carol” by Charles Dickens; just as Scrooge meets the Ghosts of Christmas Past, Present, and Yet To Come, so too must Jack accompany the Chassid on a journey through his childhood, a summary of his present life, and an enactment of what the future might be like if he continues along his current path. Yale’s novel is a Dickensian fairytale for the modern age, demonstrating the ways in which childhood fears and insecurities can leave many men struggling with the porn values and sexual addictions that are so prevalent in society today.

Jack comes to realize that he views sex as a form of validation. He tells the Chassid, “I feel like there’s something wrong with me if I’m not having sex on a regular basis.” The Chassid then helps him see how this is connected to his childhood, and he how can end this cycle:

“Some of your anger was at your Dad for not teaching you how to be a man?”
“Yes.”
“And you turned that anger against women – the more frustrated you got the angrier your fantasies got?”
“Damn! What do I do now?”
“Learn how to communicate your feelings to women.”

The Chassid requests that Jack repeat a mantra: “I define myself. I do not let others define me. I do not let my parents define me.” Through this mantra, Jack begins to understand that his parents do not control him any more, and that he is able to live his own life. He begins to let go of the fear and secrecy he learned as a little boy, and to set himself free of the doubt and anger that have controlled him for so long.

“You must affirm yourself… Every time you think a negative thought about yourself, you have to confront it, and contradict it… You can’t deal with yourself the way your parents treated you. I forbid you! When you find you’re making harsh, critical judgments about yourself, stop! And then affirm yourself.”

Through these teachings, Jack is finally able to forgive his parents for their shortcomings, and to uncover the happiness and confidence he has always longed for. He begins to feel accepted by others, and understands what it takes to have a healthy and fulfilling relationship; knowing that the sexual fantasies and flings of his past were just a repeat of the anger and confusion he felt as a child. Finally, by the time he awakes from the dream world of the fever, Jack has learned to integrate the Chassid’s teachings into himself, as an alternative to the voice of his father, which once ruled his thoughts:

“I’m sure not used to thinking strategically like this. It’s a new experience.”
“Do you like it?”
“It makes me finally feel like I have power over my own life.”
“Even without the Chassid?”
“Yes. But maybe the Chassid has become part of me.”

Yale’s novel teaches us that we must understand, forgive, and honor both ourselves and other people in order to find happiness, and that, instead of holding on to our anger, living well is often the best revenge of all. Jack’s story is one that many men will be able to relate to, and the teachings of the Chassid will no doubt resonate with them, too.

One criticism I have, though, is that the book seems unsure of its audience. As a fictional novel about a man setting off into the wilderness to reflect on his life, the book might initially seem to fit alongside classics such as Thoreau’s “Walden”, Kerouac’s “Lonesome Traveler”, Pirsig’s “Zen and the Art Of Motorcycle Maintenance”, and Krakauer’s “Into The Wild”. However, what separates this book from those (including its misleading title) is the suggestion that it is some kind of self-help manual. The back cover suggests that this book “unlocks invisible behavior patterns you must understand to solve personal troubles and identify problem people”, and this certainly seems a little far-fetched.

As a systemic marriage and family therapist, I enjoyed reading about the Chassid’s immersion therapy techniques, and recognized the narrative therapy methods employed to help Jack re-write his own story and take control of his life. I’m sure many readers will benefit from Yale’s suggestions of how to find happiness and overcome the demons of the past. But, while these techniques may work well for some, suggesting that this book could serve as a universal guide to love and happiness seems a little extreme. Those who are simply looking for an engaging fairytale about a man in the wild, on a journey to self-fulfillment, will find that this is a story worth reading. It won’t appeal to everyone, but this is a worthy book, and one that should be recommended to anyone struggling to find love as a consequence of painful childhood experiences.

3 out of 5 stars.

In addition to my review, I’d like to add that I agree with Dr Thaddeus Birchard, an expert in sexual compulsivity and addiction, who states that “sexual addiction, like any addictive substance or process, is a response to the pain and distress of narcissistic damage. All addictions have a common underlying psychobiological process. I think of narcissistic damage as the outcome of a disturbance in attachment. The function of an addiction is therefore to anaesthetize the subjective distress created by the narcissistic damage.”

In other words, sexual addiction often forms as a means by which to avoid dealing with the pain that is caused by attachment injuries from the past. And it is only by identifying and resolving these injuries -through successful therapy sessions – that the addiction can be truly cured.

If you currently suffer from sexual addiction – or are in a relationship with someone who you suspect may be a sex addict – I can help you with these issues. Don’t wait for that change – make it happen now!