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Why Do People Become Addicted?
Joseph R. Sanok, MA, LLP, LPC, NCC

Why Do People Become Addicted?

By: Steve Greenman, MA, LPC, NCC

 

“Every habit he’s ever had is still there in his body, lying dormant like flowers in the desert. Given the right conditions, all his old addictions would burst into full and luxuriant bloom.” Margaret Atwood

When discussing an addiction or dependency, most standard beliefs center around the continued repeatability of use of a substance and/or behavior, in which the user loses site of the ramifications of his/her actions. The user can become so attached to substances or an action (pornography, gambling) that the instant gratification of the moment far overrides the consequences.

It is like having a little voice on your shoulder telling you everything will be fine–go ahead–just one more. Someone who is fighting an addiction or dependency is fighting both urges from the outside world and a battle with voices inside of themselves.

Negative Reinforcement: I am Worthless Because You Say I Am

Many of my clients have suggested their addictive behaviors began with the need to escape or numb from the world around them. They understood the consequences of their addictive behaviors, but the pain—through either anxiety or depression—was so intense they could not seek any other alternative.

To someone overwhelmed in the moment, long-term recovery seems as difficult and tedious as climbing a mountain. On the other hand, their addictive behaviors can be instantly satisfying.

All of the judgment and opinions from friends and loved ones in fact become reinforcement to continue. To a certain extent, it is socially acceptable to use alcohol, gamble, or shop when emotionally stressed, as long as you don’t cross certain social norms. When a user does violate those norms, the reaction of others reinforces the feelings of weakness, worthlessness, and being out of control. So, he thinks, I might as well keep using.

As Robin Williams once stated in Weapons of Self-Destruction: “As an alcoholic, you will violate your standards quicker than you can lower them.”

When talking about any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure, and that addiction has nothing to do with one’s morality or strength of character. Experts debate whether addiction is a “disease” or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction.

Pleasure Principle: This is Your Brain on Drugs

The brain registers all pleasures in the same way, whether they originate with a psychoactive drug, a monetary reward, a sexual encounter, or a satisfying meal. In the brain, pleasure has a distinct signature: the release of the neurotransmitter dopamine in the nucleus accumbens, a cluster of nerve cells lying underneath the cerebral cortex. Dopamine release in the nucleus accumbens is so consistently tied with pleasure that neuroscientists refer to the region as the brain’s pleasure center.

All drugs of abuse, from nicotine to heroin, cause a particularly powerful surge of dopamine in the nucleus accumbens. The likelihood that the use of a drug or participation in a rewarding activity will lead to addiction is directly linked to the speed with which it promotes dopamine release, the intensity of that release, and the reliability of that release.

Even taking the same drug through different methods of administration can influence how likely it is to lead to addiction. Smoking a drug or injecting it intravenously, as opposed to swallowing it as a pill, for example, generally produces a faster, stronger dopamine signal and is more likely to lead to drug misuse.

Is it a wonder that a depressed individual would seek out this pleasure—any form of relief from the darkness that surrounds their soul?

Diagnostic Criteria for Addiction

Based on the criteria by the American Psychiatric Association (DSM-IV) and World Health Organization (ICD-10) an addiction must meet at least three of the following criteria:

  • Do you use more alcohol or drugs over time?
  • Have you experienced physical or emotional withdrawal when you have stopped using?Have you experienced anxiety, irritability, shakes, sweats, nausea, or vomiting? Emotional withdrawal is just as significant as physical withdrawal.
  • Limited control. Do you sometimes drink or use drugs more than you would like? Do you sometimes drink to get drunk? Does one drink lead to more drinks sometimes? Do you ever regret how much you used the day before?
  • Negative consequences. Have you continued to use even though there have been negative consequences to your mood, self-esteem, health, job, or family?
  • Neglected or postponed activities. Have you ever put off or reduced social, recreational, work, or household activities because of your use?
  • Significant time or energy spent. Have you spent a significant amount of time obtaining, using, concealing, planning, or recovering from your use? Have you spent a lot of time thinking about using? Have you ever concealed or minimized your use? Have you ever thought of schemes to avoid getting caught?
  • Desire to cut down. Have you sometimes thought about cutting down or controlling your use? Have you ever made unsuccessful attempts to cut down or control your use?

Many people with addiction issues who I have spoken to shared how they had a high tolerance, and could drink more than peers when in their early stages of drinking. At the time, one who could chug the beer and down the shots and still be able to stand was regarded in high esteem. Many clients have told me, though, as life went on, having a high tolerance for booze became a curse as it became a thirst that could not be quenched.

Relapse and Recovery

Symptoms of addiction include tolerance (development of resistance to the effects of alcohol or other drugs over time) and withdrawal, a painful or unpleasant physical response when the substance is withheld.

Many people who are addicted deny it. They often emphasize that they enjoy drinking or taking other drugs.

People recovering from addiction can experience a lack of control and return to their substance use at some point in their recovery process. This faltering, common among people with most chronic disorders, is called relapse. To ordinary people, relapse is one of the most perplexing aspects of addiction. Millions of Americans who want to stop using addictive substances suffer tremendously, and relapses can be quite discouraging.

To appreciate the grips of addiction, imagine a person that “wants to stop doing something and they cannot, despite catastrophic consequences,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse. “We’re not speaking of little consequences. These are catastrophic. And yet they cannot control their behavior.”

Many in the addiction recovery field suggest that it takes more than just “not using” to fully recover. Recovery needs to come from the heart and the way one perceives him- or herself.

The following are important points your clients in recovery should know:

  • Check into your values; what’s important to you. What are the things that mean more to you than remaining addicted.
  • Develop and practice the skills you need to manage your life without relying on your addiction
  • Learn how to control addictive urges through mind management techniques
  • Find and appreciate the rewards that come from a “sober” (non-addicted) lifestyle
  • Build and appreciate personal relationships and turn to positive communities for support and companionship
  • Find your purpose and plan a future that leads to accomplishing your life goals
  • Mature into a new, non-addicted you — a person who simply and naturally rejects addiction in all forms

“I am spinning the silk threads of my story, weaving the fabric of my world…I spun out of control. Eating was hard. Breathing was hard. Living was hardest. I wanted to swallow the bitter seeds of forgetfulness…Somehow, I dragged myself out of the dark and asked for help. I spin and weave and knit my words and visions until a life starts to take shape. There is no magic cure, no making it all go away forever. There are only small steps upward; an easier day, an unexpected laugh, a mirror that doesn’t matter anymore. I am thawing.” Laurie Halse Anderson, Wintergirls 

 

Steve Greenman, MA, LPC, NCC is a counselor at Mental Wellness Counseling in Traverse City, MI. He specializes in helping families dealing with complex family situations, addictions, and transitions. Steve is also helping clients through the Intensive Recover Program, which helps with recovery treatment, alcohol treatment, and other addictions treatment. Contact Steve at 231-714-0282 Ext. 701

Steve Greenman Traverse City Counselor
Steve Greenman, MA, LPC, NCC | Thoughtful Experience
Conquering Codependency
Joseph R. Sanok, MA, LLP, LPC, NCC

Conquering Codependency

By: Steve Greenman, MA, LPC, NCC

I remember the ice hitting the glass.

After working all day and sitting down in the living room, I would hear the noise of the ice from ice maker entering the glass. The hair on the back of my neck stood straight up. My mind raced to what may or may not happen. Would I have to cancel the evening plans? How were the boys? I wonder if anyone noticed we have been missing at meetings? When was the last time my then-wife did not get into an argument, prompting the boys to ask if everything was all right?

I had known for some time that I needed help dealing with my wife’s drinking. I had been trying to control it and always labeled it under the heading “what was best for the kids.” What I was forgetting in all this was the toll the drinking was having on me personally. I was depressed, feeling alone, and just plain tired of it all.

Life changed dramatically when my wife took a second-shift job. Night brought a quietness and peace I had not felt for some time. I had previously tried to control the use of alcohol by screaming, pleading and trying to ignore the triggers. None of it worked. Once my wife went to evening shift, the drinking took place in the early morning hours, when the rest of us were sleeping. I realized the difference was not allowing the drinking to dominate my waking hours. I needed to take this one step further. After many years of threatening, I finally attended an Al-anon meeting.

Powerless against it

Strength, not weakness. Allowing the controlling aspect of alcohol to dissipate was beginning to slowly enter my mind as I listened at my first Al-anon meeting. Powerless? You mean I did not have the duty to control, enable and cover up any more? I did not have to carry the burden of the disease? I could think about myself?

I could begin to see what alcohol was doing to me. I was dealing with the same urges as the drinker, but didn’t have the release of alcohol to numb my pain. I was in many ways the dry drunk in the family. My reaction to the situation was affecting my 8- and 14-year-old sons more than the actual drinking. I thought I was protecting my boys, but actually I was adding fuel to the fire by creating the environment to drink.

Those at the meeting shared their stories of their first time in attendance. They spoke of being scared; of being too good for this silly program; and that they were not the one with the problem. Each person expressed that control was not an option. The act of controlling was destroying more than the drinking. I was not leading a healthy lifestyle. For once it was all right to think about myself and review my own feelings.

Codependent Relationship

In a codependent relationship, feelings are often painful. You may have cut off the following feelings:

  • Anger. Are you having one crisis after another? Do you feel you’re doing all the work in the relationship? Are you angry you’re covering up for your partner?
  • Isolation. Do you stay home because you’re not sure whom you can trust? Do you feel you have to hide your feelings because things will never change?
  • Guilt. Do you feel no matter how hard you try it’s never good enough? Do you think that if you were a better partner things would be better?
  • Fear. Do you fear confronting your partner because they may abandon you? Do you fear physical or sexual abuse? Do you fear the loss of your home and security?
  • Embarrassment. Do you avoid bringing people into your home because your partner’s drinking is unpredictable? Do you avoid social gatherings where drinking may occur?
  • Despair. Do you feel helpless and trapped at times? Do you feel it will never change so why bother to confront? Do you spend most of your energy worrying about his or her drinking?

The more that was shared, the more it felt I was beginning to break up that wall in my heart. It was all right to take care of myself; it was all right to focus on me for a change.

How to take care of yourself

It is natural to want to protect the people you care about. But in a codependent relationship, how do you begin to take care of yourself?

  • Recognize you have a problem.
  • Start to focus on your needs.
  • Begin to educate yourself on codependency.
  • Start setting limits.
  • Start trusting and get supports.
  • Understand recovery and the process for everyone.

I felt a bit lighter when I left the meeting. I had shared my thoughts with others and I was able to speak freely about control. I was beginning to make a crack in the wall. I was actually telling someone else that we had a pink elephant in the room that in itself was a huge step forward. I was beginning to understand to cover up pain and shame in the family dysfunction. I needed to learn to respond to an outer reality instead of my own inner reality.

Steve Greenman Traverse City Counselor

Steve Greenman, MA, LPC, NCC is a counselor at Mental Wellness Counseling in Traverse City, MI. He specializes in helping families dealing with complex family situations, addictions, and transitions. Steve is also helping clients through the Intensive Recover Program, which helps with recovery treatment, alcohol treatment, and other addictions treatment. Contact Steve at 231-714-0282 Ext. 701

 

The Family’s Role in Addiction and Recovery
Joseph R. Sanok, MA, LLP, LPC, NCC

The Family’s Role in Addiction and Recovery

By: Steve Greenman, MA, LPC, NCC

“It is one of the most beautiful compensations in life that no man can sincerely try to help another, without helping himself.” Ralph Waldo Emerson

Stephanie Brown, in her book The Alcoholic Family in Recovery, discusses four distinct stages that the alcoholic and the family surrounding him or her must go through to achieve recovery:

The 1st stage is the Drinking Stage and is highlighted by the family denying that any family member has a drinking problem, while at the same time giving reasons to anyone who will listen why the drinker has the right to drink.

The 2nd stage is labeled Transition, and the focus is the beginning of abstinence for the drinker. This is a time for the family of the alcoholic to finally come to the realization that the alcoholic cannot control his/her drinking and the co-alcoholic cannot control the drinker. (A co-alcoholic is defined as the person(s) who enables an alcoholic by assuming responsibilities on the alcoholic’s behalf, minimizing or denying the problem drinking, or making amends for the alcoholic’s behavior [Drugs.com, accessed 4/28/2015].)

The 3rd stage, called Early Recovery, is when this couple works on individual healing, versus the healing of the whole of the family unit.

The 4th stage is Ongoing Recovery, where “individual recoveries are solid and attention can be turned back to the couple and family” (Brown, 1999, p114).

 Stage 1: The Drinking Stage

Therapists working with the family in the drinking stage must focus not only on the drinking behavior of the alcoholic, but also the distorted belief system of the rest of the family that emotionally and physically supports the drinking. The family must quit denial and support of the drinking, and begin to find avenues to reach out for help.

For the therapist dealing with a drinker in the drinking stage, the imperative is for the drinker to begin abstinence. Attempts are made to help the drinker gain insight into why life has become for so many in the family unit unstable. However, in the final analysis, it is up to the drinker to begin the process of recovery. The therapist helps to break down the walls of defiance in the drinker’s belief system that they are in total control.

Stephanie Brown describes the insanity of the drinking stage in being like a dance: “The drinker leads and the co-alcoholic follows in a way that keeps them dancing. The leader may stumble, drift away, step all over the follower, or even break up the dance by changing partners. The co-alcoholic’s only response is to try and keep the dance going” (Brown, 1999, p 171).

The therapist must encourage the family to help the alcoholic end the dance by realizing they cannot control and enable the drinking and that only when they reach out for help outside the family system may they be led into the stage of transition.

Stage 2: Transition Stage

The transition stage is a complex ebb and flow during which the alcoholic works through no longer drinking, and the family struggles with the transition of living through the end of the drinking to the beginning of abstinence.

The environment within the family at the end of drinking is made up three distinct variables:

  • Increasingly out-of-control environment
  • Tightening defenses to prevent or forestall systems collapse
  • A last ditch attempt to maintain denial and all core beliefs

The therapist has a multitude of functions in the beginning stage of transition. The therapist must help guide the alcoholic to realize the loss of self-control with their drinking and, with this understanding, help the alcoholic realize that they must reach out to outside help (ie, AA) to have any realistic chance to stay sober.

In the meantime, the therapist has to help the family—who has been dealing with supporting the drinker’s world that is now beginning to crack and crumble—realize their need for help (ie, Al-Anon) in handling how the denial, core beliefs, and out of control behavior made them, as much as the alcoholic, a prisoner of the drinking.

The therapist is a guide to help find sobriety, and a place to go for information when life is a bundle of confusion. “Are you going to meetings?” “How are you feeling?” “Take it one day at a time, first things first, and set priorities” are statements repeated by the therapist until the client can recite them for themselves.

As the family begins to move from drinking to abstinence and to the later half of the transition stage, Brown describes four focal points the family must be aware of:

  • To focus intensely on staying dry
  • To stabilize the out-of-control environment
  • To allow the family support system to collapse and remain collapsed
  • To focus on the individual within the family

The therapist, after seeing that the family is stable enough and has lifeboats in place (AA & Al-Anon), can begin to investigate underlying feelings that may be triggers or causes of past and current drinking relapses. The therapist must also be attentive to how children in the family are being cared for and if they are handling the changes to the family structure.

Forward movement is the key and the best way to help clients reach for and know when is the right time for the family to move to the next stage: Early Recovery. In reality, this may take years based to severity of the past drinking.

Stage 3: Early Recovery

The main difference between the transition stage and the early recovery stage is a general lessening of the physical cravings and psychological impulses for alcohol. The therapist must always look for potential relapse signs, but this factor lessens as time moves forward.

An item the therapist must address in the early recovery stage is continual support within the alcoholic’s family to stay focused on their own recovery. By this stage co-alcoholics, if they are not getting support of their own, may become weary of the lack of attention from the alcoholic who is busy trying to gain support (AA) to stay sober. The co-alcoholic may have been the controller of the drinker and now has to live with decisions of the family being completed by committee. It is imperative that the therapist is able to construct support for both the alcoholic and the co-alcoholic; each has issues that must be addressed so that recovery can continue.

As recovery moves forward, hidden and latent issues that fostered drinking or was created by the trauma of the drinking environment may need individual attention. Not only does the therapist become the guide for the family, but also the provider of information in this stage.

The therapist must:

  • Continue to teach abstinent behaviors and thinking;
  • Keep families in close contact with 12-step programs and help them work on the steps;
  • Keep focus on individual recovery, seeking outside supports for the family;
  • Maintain attention for the children in the recovering family; and
  • Keep a continual eye on potential issues, such as the onset of depression, emotional problems, sleep problems, fear, and/or helplessness.

Stage 4: Ongoing Recovery

This final stage is relatively stable in comparison to the earlier three stages. This is because recovery is now solid, and attention can be turned back to the couple and the family.

The family focus lies in the area of staying on task (sobriety) and committed to recovery, and building up the structure of the family after it had been torn down in the earlier stages. The family had reached for outside help (AA, Al-Non, therapy) and now, after finding themselves and actually liking what they see in the mirror, it is time to do the following:

  • Heal the emotional separation issues
  • Look in-depth at what damage had been done to the family due to drinking
  • Study the underlying causes of the drinking behavior

The ongoing recovery stage is a time for the creation of healthy relational dependence within the family and the understanding that recovery is a process, not an outcome (Brown, 1999).

The therapist’s main functions in this stage are:

  • Make sure family is continuing abstinent behavior
  • Expand the family’s alcoholic and co-alcoholic identities
  • Ensure that everyone maintains programs of recovery (work the 12-steps and internalize 12-step principles)
  • Focus on the couple and family issues
  • Explore spirituality issues and past childhood and adult traumas

 Final Thoughts

As I constructed this article, I was struck in many ways how involved and complex the role of the therapists is during an alcohol recovery process. It is more than being a listening ear in the background; it is a juggling act of many aspects of recovery.

The therapist is one step ahead of the family—guiding the family and the drinker to realize the importance of changing behavior; all the while wondering if what they are trying to accomplish will actually work.

The family and the drinker must come to a point in their lives that only when heartfelt change is ingrained will real change occur in the family. In truth, the magic of recovery is with the drinker and the family, not the therapist.

Steve Greenman Traverse City Counselor
Steve Greenman, MA, LPC, NCC | Thoughtful Experience

Steve Greenman, MA, LPC, NCC is a counselor at Mental Wellness Counseling in Traverse City, MI. He specializes in helping families dealing with complex family situations, addictions, and transitions. Steve is also helping clients through the Intensive Recover Program, which helps with recovery treatment, alcohol treatment, and other addictions treatment. Contact Steve at 231-714-0282 Ext. 701