Psychotherapy - Addiction The Hole In The Soul
by Anita Anand
The Mark Twain quote is rather descriptive of the nature of addiction. According to Wikipedia, addiction is a recurring compulsion by an individual to engage in a specific activity, despite harmful consequences to their health, mental state, or social life.
“Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times.” – Mark Twain
Addiction can be caused by genetic, biological/pharmacological and social factors. There are degrees of addiction – from mild addiction of one or two cups of coffee or a few teaspoons of sugar to two to three litres of caffeine drinks with more significant amounts of sugar. At the other end of the spectrum are addicts drinking a great deal of alcohol every day, shooting heroin, and doing large amounts of ‘hard’ drugs – psychoactive drugs or psychotropic substances – chemicals that act primarily upon the central nervous system where they alter brain function, resulting in temporary changes in perception, mood, consciousness and behavior. They can be used recreationally to purposefully alter one’s consciousness; as entheogens for ritual or spiritual purposes; as tools for concentration or therapeutically as medication.
Because psychoactive substances bring about subjective changes in consciousness and mood that the user may find pleasant (e.g. euphoria) or advantageous (e.g. increased alertness), many psychoactive substances are abused – used outside of the guidance of a medical professional and for reasons other than their original purpose. With sustained use, physical dependence may develop, making the cycle of abuse even more difficult to interrupt.
Drug-use dates to prehistoric times. There is archaeological evidence of the use of psychoactive substances dating back to at least 10,000 years, and historical evidence of cultural use over the past 5,000 years. While medicinal seems to have played a very large role, it has been suggested that the urge to alter one’s consciousness is as primary as the drive to satiate thirst, hunger or sexual desire. Others suggest that marketing, availability, or the pressures of modern life are why humans use so many psychoactives in their daily lives. However, the long history of drug use and even children’s desire for spinning, swinging, or sliding indicates that the drive to alter one’s state of mind is universal.
The use of chemicals to alter the way we feel and see things are one of the oldest activities of the human race.
In substance addictions there are underlying metabolic malfunctions common to all. Sugar is the foremost “addictive-yet-legal” substance today. Drugs such as amphetamines, psychedelics, cocaine, caffeine, and nicotine temporarily increase the release of sugar into the bloodstream; this creates a “high” through a metabolic process similar to that involving sugar and alcohol. These drugs also duplicate the mood-inducing effect of the body’s endorphins – chemicals which transmit messages to the brain that help to relax the nervous system, or make it “smile.” But perhaps one of the most serious addictions today is the widespread attraction to pharmaceutical drugs, and these come in many forms – as general anesthetics to block pain and other sensations; painkillers to manage pain; psychiatric medications prescribed for the management of mental and emotional disorders; and recreational drugs such as caffeine, alcohol, cocaine, LSD and cannabis.
Addiction begins as abuse and can be physical, psychological, or both. Physical addiction is when a person’s body becomes dependent on a particular substance (even smoking is physically addictive). They build tolerance to that substance, so they need a larger dose every time to get the same effect. When they stop using a substance like drugs, alcohol, or cigarettes, they may experience withdrawal symptoms. Withdrawal can be like having the flu – common symptoms are diarrhoea, shaking, and generally feeling awful.
Psychological addiction is when the cravings for a drug are psychological or emotional – and there is an overwhelming desire to have a drug. They may lie or steal to get it. People cross the line between abuse and addiction when they are no longer trying the drug to have fun or get high, but because they come to depend on it. Their whole life centres on the need for the drug. An addicted person – whether it’s a physical or psychological addiction or both – feels they have no choice in |taking a substance.
However, some argue that the term and concept of addiction is counterproductive in psychotherapy as it defines a patient’s identity, and makes it harder to become a non-addict. Others believe that humans always have a choice, and they are not ‘addicts’ just because they prefer a drug-induced euphoria to a more popular and socially welcome lifestyle. Therefore, being ‘addicted’ to a substance is no different from being ‘addicted’ to a job at which you work every day. Professor John Booth Davies at the University of Strathclyde, Glasgow, has argued in The Myth of Addiction that ‘people take drugs because they want to and because it makes sense for them to do so given the choices available’ as opposed to the view that ‘they are compelled to by the pharmacology of the drugs they take’.
Professor Charles O’Brien of the Philadelphia University Medical Center, a leading American expert on addiction, says it is a result of the way our brain works; it involves the ‘reward system’, the part of the brain that makes a person feel good after accomplishing something. It’s what makes us want to ‘do things’. Drugs and alcohol have an immediate effect on the brain, and produce happy feelings in a short-circuited way.
The problem is that our brain is very good at remembering ‘good times’, and soon everything related to the drug in question will trigger an intense desire to get satisfaction ‘no matter what’. This is ‘craving’. O’Brien was one of the first to identify this particular phenomenon, which led him and his colleagues to set up lab experiments. The tests corroborated the theory of cues and craving: the desire for any kind of drug, whether it is alcohol, or nicotine, or cocaine, or whatever, makes certain brain cells ‘fire’ and they light up in the brain scan.
When addicted persons are presented with objects, sights, sounds or smells which remind them of the drug in question, the same brain cells light up again, and will still happen years later. Thus the clinking together of two wine glasses can cause an alcoholic to want to drink again, and the sight of an ashtray can produce an overwhelming desire to ‘light up’. O’Brien proved that addiction is, in fact, “an over-learned memory, something like riding a bicycle. You may not ride a bike for decades, but as soon as you climb on, you know what to do. It’s that strongly engraved in our brains, it’s physical and permanent. This involuntary nature is the essence of being an addict.”
Dopamine is a hormone and in the brain functions as a neurotransmitter. It is commonly associated with the pleasure system of the brain, providing feelings of enjoyment and reinforcement to motivate a person proactively to perform certain activities.
Dr. Daniel Weinberger, chief of the Clinical Brain Disorders Branch of the National Institute of Mental Health, USA, works on the genetics of brain chemistry and of mental illness. He describes dopamine as ‘a chemical in the brain that sends messages from one cell to another’. What makes dopamine interesting to neuroscientists, psychologists, psychiatrists, and neurologists is that it seems to be critical for reward reinforcement and motivation behavior, and this translates into abilities and difficulties in many different areas of life, from drug addiction to thrill-seeking to sex-seeking to psychosis to Parkinson’s disease and probably to anxiety and mood as well.
Signs of Addiction
The most obvious sign of an addiction is the need to have a particular drug, substance or engage in certain behavior. Psychological signals could be use of substances or a behavior as a way to forget problems or to relax; withdrawal or keeping secrets from family and friends; loss of interest in activities that used to be important; problems with school and work, such as slipping performance or absences; changes in friendships, such as hanging out only with friends who have the same addictions; stealing or selling belongings to be able to afford the addiction; failed attempts to stop taking the substances, and anxiety, anger, or depression and mood swings.
Physical signals could be changes in sleeping habits; feeling shaky or sick when trying to stop; needing to take more of the substance to get the same effect; changes in eating habits, including weight loss or gain.
Who is most at risk? Cultural and social factors such as growing up in a family where there’s alcohol or drug abuse increases the risk; poverty, lack of education and unemployment can increase risks. A stressful environment, significant life events, and inner world turmoil, not receiving adequate nurturing as children or emotional sensitivity may create susceptibility. These factors won’t always lead to substance misuse or dependency or any other addictive behavior, but can increase vulnerability.
Both the patient and the therapist must realize that addiction is chronic. It will never go away, and even in the very long run, relapses may occur. Intense treatment will be needed in the beginning, and after stabilizing, maintenance may hopefully be enough.
Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse, if it occurs. When a person’s drug-related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Most large hospitals in India offer de-addiction therapy.
For other addictions, many treatment programmes recommend or include the Twelve-Step programmes of Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, or Codependents Anonymous. The philosophy of much of this is based on the ‘Higher Power’, the real healer of the Twelve-Step approach. It promotes cooperation and dependence on a support group.
In any addiction, recognizing that you have a problem is the first step in getting help. Then, sharing it with friends and family is essential. It’s not a sign of weakness if you need professional help from a trained drug counselor or therapist. Most people who try to kick a drug or alcohol programme need professional assistance or treatment programmes to do so. Once you start a treatment programme:
• Tell friends about your decision. Your true friends will respect your decision. You may need to find a new group of friends who will be 100 per cent supportive.
• Ask friends or family to be available when you need them. You may need to call someone in the middle of the night just to talk. If you’re going through a tough time, don’t try to handle things on your own – accept the help your family and friends offer.
• Accept invitations only to events that you know won’t involve your addictive behavior. Say no to a party until you’re feeling more secure. Plan activities that don’t involve the things you are addicted to. Try movies, a walk, or take a class with a friend.
• Have a plan about what you’ll do if you find yourself in a place with the substance you are addicted to. The temptation will be there sometimes, but if you know how you’re going to handle it, you’ll be okay. Establish a plan with your parents or siblings so that if you call home using a code, they’ll know that your call is a signal you need a ride out of there.
• Remind yourself that having an addiction doesn’t make you bad or weak. If you backslide a bit, talk to an adult as soon as possible. There’s nothing to be ashamed about, but it’s important to get help soon so that all of the hard work you put into your recovery is not lost.
If a friend has an addiction, these tips can help them as well. You can also help by providing tools to resist craving. A nicotine addict shouldn’t have ashtrays at home. Friends and family of an alcoholic should never say: “One glass won’t harm you!” Because it will.
A large number of individuals who seek treatment for alcoholism or substance abuse may relapse. Under guidance of a programme and their motivation relapses can be avoided. Most therapists say that relapse is part of the learning process. The individual learns what they can and cannot do, and that learning eventually leads to recovery.
“Addiction doesn’t demand a scientific solution.” -- Bruce Alexander, Emeritus Professor of Psychology, Simon Fraser University, British Columbia.
The medical profession has turned to alternative and complementary therapies to treat addictions. At the core of these therapies is the belief that the whole person needs healing. Practices such as meditation are also popular as part of therapy.
Therapies and techniques focusing on the cognitive/mental, emotional, physical, social and spiritual help in balancing and expanding these factors in a person’s life – so that events and activities flow more smoothly, and relationships with self and others are healthier and more confident. In addition to the more familiar talk therapy of traditional therapies, these focus on body awareness, trauma processing, creative activities, and nature. All forms of energy healing – acupuncture, massage, crystal healing, relaxation techniques – assist in helping individuals find their true self and maintain a good balance in life. Hypnotherapy and focusing on past and current life regressions can treat most addictions except drugs.
Buddhists believe that tanha (craving) is the root cause of all addictive behavior. Through Vipassana, the meditator realizes that the addiction is because of the negativities in the mind like passion, anger, egotism, etc. With awareness of impermanence, equanimity rises, new conditioning is produced, and layer after layer of the old accumulated conditioning get eliminated.
In May 2006, the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology in the US, hosted a conference – a celebration of the new ways scientists and addiction researchers are conceptualizing and seeking to treat addiction.
A recovery advocate who had been free of alcohol and cocaine for 12 years said, “I have an illness with origins in the brain…but I also suffered from the other component of this illness. I was born with what I like to call a hole in my soul…A pain that came from the reality that I just wasn’t good enough; wasn’t deserving enough; that you weren’t paying enough attention to me all the time; that maybe you didn’t like me enough. For us addicts, recovery is more than just taking a pill or maybe getting a shot…recovery is also about the spirit, about dealing with that hole in the soul.”
Anita Anand is a Delhi-based hypnotherapist and crystal healer.
She can be contacted at email@example.com.
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