Those who treat clients who face addiction; whether it is substance or behaviorally oriented come up against entrenched beliefs about what creates, feeds and sustains the insidious patterns and habits that devastate relationships, damage reputations, clean out bank accounts and obliterate lives. As clinicians, we too may have our biases, based on who walks through our doors.
They have gotten entangled with the law
They end up robbing loved ones
They ignore personal hygiene
They are chronically unemployed or underemployed
They are poorly educated
They are financially bereft
They are homeless
They have an inability to maintain relationships
They are revolving door clients/patient
They are younger people
Once a drug addict, always a drug addict
Someone always has to hit rock bottom before rising to recovery
Counter to That Image
Are high functioning
Are gainfully employed
Have family and friends who love them
Have active social lives
Have not stolen to maintain their habit
Are well groomed, with good hygiene
Help out in their communities
Have not gotten in trouble with the law
They may be any age
Present as successful
According to Gabor Maté, MD, author of the bestselling book “In the Realm of Hungry Ghosts.”
“In the final analysis, it’s not the activity or object that defines the addiction, but our relationship to whatever is the external focus of our attention or behavior.”
Dr. Maté explained that one person can drink alcohol and not become a habitual drinker. He defines an addiction as “any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life or the lives of others.”
The National Institute on Drug Abuse indicates the complicated and unpredictable nature of drug addiction. According to a fact sheet from the agency. “Risk for addiction is influenced by a combination of factors that include individual biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction.”
Cross addictions, or trading one addiction for another, are common because the brain and body might have become accustomed to the flow of neurotransmitters that activate the reward circuit in the limbic system and lead it to crave higher levels of pleasure.
When one engages in specific behaviors, such as gambling, shopping or ingesting substances, these substances are released. When a tolerance has developed, the brain seeks higher levels of stimulation.
Releasing one behavior leaves a vacancy for another. For example, a client in an outpatient drug rehab might put down the bottle, only to hit the casino and lose a few thousand dollars, while another person might give up a heroin habit but spend hours a day hunched over a computer indulging in Internet pornography and still another might go on a spending spree without concern about racking up credit card bills that they may not be able to pay.
Meeting A Need
Dr. Maté has compared his shopping compulsion to the extreme and life threatening addictions of the clients he treated for 12 years in a Vancouver clinic. Although, his habit of spending a few hundred dollars a visit at his local record store might seem clean and safe compared to actions among his patients such as shooting heroin with re-used needles or swallowing someone else’s cheeked and expectorated methadone, he reminds readers that the process within the brain is the same.
Pure and simple, the addiction meets a need. People who experience addiction often desire to mask some kind of physical or emotional pain. When they engage in addictive behaviors, the body or mind feels temporary relief or some other perceived beneficial response. With each episode of partaking, the pattern begins to set, much like thread woven through a loom.
Addiction to Achieving
A professional woman with workaholism experiences an adrenaline rush when she accomplishes everything and then some on her to-do list. She stays up to work despite fatigue. She’s spurred on by feedback from people who notice her achievements. She eagerly anticipates starting work each day, awakening early to begin. When she can’t sleep, she writes. She multitasks with ease. She identifies as her livelihood, even as she’s aware of her patterns.
She too is held captive, as surely as Dr. Mate’s patients, even though she doesn’t drink, smoke or use drugs. This behavior led to a series of health crises that had her recognizing the severity of her addiction. She is aware that workaholism is the only addiction that is encouraged by many cultures.
The pattern was formed in her childhood with parents who were accomplished and hard working. Although it wasn’t verbalized, she internalized the expectation to be the same. She measured her worth in kudos and nods of approval, as well as good grades.
When her performance was less than stellar, she was her harshest critic. She had learned how to bask in the spotlight at an early age. A cycle was created as she adapted to the needs of others to continue the flow of positive feedback.
Thus was born a second addiction: co-dependence.
She developed the skills of “reading” others to determine what they wanted and meeting their needs before they voiced them. Even though she is painfully aware of her patterns, they still sometimes take her by surprise.
Her recovery involves daily introspection and self-evaluation. She incorporates the principles of 12-step programs into her daily life and has accountability partners who encourage her to address her problematic habits when they arise. Admitting to feeling anxiety and frustration when she’s prevented in some way from doing her work, she seeks healthy means of addressing these setbacks. Moderation is an important goal for her.