If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them. – Henry David Thoreau
We spend our life until we’re twenty deciding what parts of our self to put into the bag, and we spend the rest of our lives trying to get them out again. – Robert Bly
Core issues are a universal feature of being human and afford us all the opportunity for continued growth and development if we are open to exploring their message and meaning in our lives. This is a big “if” because as the popular psychiatrist M. Scott Peck put it “mental health is a dedication to reality at all costs” – and the cost of growth is usually pain.
In fact, he goes on to add that “perhaps the best measure of a person’s greatness is the capacity for suffering.” For many of us we live in a world where avoiding pain and suffering has become second nature. Spacing out in front of the tube, spending countless hours surfing the web, and of course engaging in addictive behavior are all methods of avoiding what we don’t want to feel.
To experience pain is to feel it, and this takes us to the heart of core issues: emotional hygiene. Most people are very naive about the role emotions play in their life, and even more naive about recognizing that emotions are at the root of mental health and successful long-term addiction management.
Although approximately 80% of people suffering from addictive behavior never seek formal treatment, and many successfully decrease or stop their addictions, quite often core issues remain unchanged. One of the more common examples is the “dry drunk” who has stopped drinking but continues to exhibit many of the destructive behavior patterns.
Sadly, even those who seek professional treatment rarely have core issues addressed to any point of resolution. In fact, the lack of effectively treating core issues is among the most significant failures of our current treatment system, and directly related to continued relapse and multiple treatment episodes.
Evidence for unresolved core issues is pervasive and points to a disturbing trend: as a society (whether addicted or not) we are becoming increasingly unhealthy in mind, body and our connection with others. Core issues take many different forms, and can be the result of experiences that happen at any time in life.
More common and prevalent core issues:
Mental Health Disorders
Mental health disorders in large part reflect a breakdown of emotional hygiene. One in five adults meets criteria for a diagnosable mental disorder during the course of a year, with the most common problems being mood and anxiety disorders. Unfortunately, for many the issues remain untreated.
Numerous studies also indicate that both mood and anxiety disorders are on the rise. The National Institute of Health published a study showing the lifetime incidence of depression in adults tripling from the 1980’s to the 1990’s (explained in part by the dramatic increase in antidepressant medication use).
The prevalence of mental health disorders with substance use disorders (called dual diagnosis or co-occurring disorders) ranges from 55-85%. Successful long-term addiction management hinges on appropriately dealing with mental health problems.
Development Deficits & Constrictions
World-renowned developmental psychiatrist Stanley I. Greenspan has outlined six developmental stages that are critical to achieving mental health.
Six developmental stages:
- Ability to self-regulate attention and emotion
- Engage with others
- Show intention and purpose
- Make use of images
- Make use of ideas and symbols
- Think emotionally
In one of his most recent books, The Irreducible Needs Of Children: What Every Child Must Have To Grow, Learn, And Flourish, he outlines seven needs that support the development of the six stages.
Seven irreducible needs:
- Ongoing nurturing relationships
- Physical protection
- Safety and regulation
- Experiences tailored to individual differences
- Developmentally appropriate exercises
- Limit setting
- Stable, supportive communities and cultural continuity
- Future protected
Too often the roots of addictive behavior can be found in the unmet needs of children and teens. Developmental deficits and constrictions are among the most significant core issues that remain untreated.
- Are you able to refrain from alcohol or shooting drugs, but struggle to form healthy intimate relationships with others?
- Do you know how to read the nuances of emotional facial expressions and body language, or translate strong emotions in the body like anger/rage into thoughts that can rationally direct behavior?
If not, the key to long-term addiction management and mental health is addressing the developmental deficits and constrictions.
Core issues are very much related to the ability to initiate, develop and maintain healthy intimate relationships (see previous section).
According to the foremost authority on marriage in the world, Dr. John Gottman,
- 67% of 1st marriages will end in divorce over a 40 year period
- 43% will end in divorce over a 15 year period
These statistics, which have increased over the past few decades, simply reveal what we all know: maintaining a healthy intimate relationship is a lot of work. But the work of maintaining an intimate relationship is also the work of dealing with core issues, because in the end it is the “core issues” that end the relationship.
Divorce trends tell only part of the story. As a society we are becoming more disconnected despite the advent of computer technology. Face to face relationships and interactions are being replaced by e-mail and web cams. Chatting is done on-line instead of at the park or grocery store.
The gap between the “haves” and the “have-nots” has been increasing for years, leading to more gated communities and high-profile security systems. Following the events of September 11th there is evidence that instead of people coming together in more intimate ways, the patterns of disconnect and isolation continue.
Those who struggle with addiction usually find themselves isolated, alone and disconnected from society. Therefore, successful long-term management of addictive behavior necessitates learning to be in relationship with others.
Overweight & Obesity
We are in the midst of an epidemic, with about 55% of the adult American population being overweight or obese. has more than doubled.In fact, in the last twenty years the prevalence of obesity.
What does this have to do with core issues?
In the book Calm Energy: How People Regulate Mood with Food and Exercise Dr. Robert Thayer reviews the research on mood disorders, obesity and exercise and convincingly documents how moods are very often the trigger for overeating. In a review of over 50 scientific studies done by Richard Ganley he concluded that much of obesity is based on emotional eating.
The most common moods preceding overeating include:
Essentially, negative moods (also primary relapse triggers). In many cases these negative moods meet criteria for a mental health disorder. Although weight gain and obesity can often be linked to underlying core issues, there are some who now believe that people can be directly addicted to food.
Evidence of a food addiction link has recently been found by Brookhaven National Laboratory. It is also quite common for people struggling with one addiction to develop a “cross” addiction to food. This frequently occurs with sex addicts. Of course, not all weight problems are the result of unresolved core issues either.
Although trauma is classified as a mental health disorder it really deserves its own place when considering core issues related to addictions. About 50% of all those who seek treatment for substance use disorders have a lifetime prevalence of Post Traumatic Stress Disorder (PTSD), and 25-33% meet criteria for current PTSD.
For women it could be even higher. Also, it is not uncommon for people to suffer from multiple types of trauma that include sexual, physical and emotional abuse, as well as physical and emotional neglect.
Unfortunately, trauma is often missed in assessments and screenings, and when it is found, rarely is it addressed in any significant way. Currently, there exist no practice guidelines for treating trauma in the context of addiction treatment. Following the trauma of September 11th, nearly half the nation reported an increase in the demand for alcohol and drug treatment.
Successful long-term management of addictive behavior requires underlying trauma(s) to be resolved.
Grief & Loss
Giving up a relationship to a substance or a behavior can feel like losing a best friend. The loss, if it is to be sustained, often must be grieved appropriately.
Even more powerful than grief from addiction can be the loss of a loved one:
- An innocent child taken suddenly from the world
- A parent who dies unexpectedly without the opportunity to say goodbye
- The end of an intimate relationship
Often, core issues related to grief and loss are among the most painful and long-standing. If you are serious about successfully dealing with an addiction and have grief and loss issues, it is absolutely critical that they be addressed appropriately.
Core issues may also include:
- Residue from growing up with alcoholic or mentally ill parents who are unable to serve as role models for emotional development and intimacy
- Learning strategies for self-protection as a child that as an adult result in isolation/loneliness
- The emotional toll of taking care of, or growing up with someone who has a serious medical condition (example might be Alzheimer’s)
- A short, often only seconds comment from a trusted care provider that creates a lasting scar
- Multiple deaths or tragedies that lead to the belief that everything worth caring about will not last – so a protective strategy is to not invest emotion into anything
- Not being heard growing up, or as one psychologist calls it “voicelessness”
- Aftermath of a loved one who commits suicide
And of course the list goes on…
Getting Professional Help
There are many paths to resolving core issues, and like addictions, not all paths lead into a therapist’s office. But unlike addictions, resolving core issues is usually more complex. Consider a person who has been divorced four times, and despite the pain of each marriage and divorce continues to marry partners who are abusive.
Breaking a pattern of abusive relationships can be done outside of therapy, but in reality it is extremely difficult due to the “core issues” that remain outside of conscious awareness. How do you change something when you are not even aware of what needs changing (or that something even needs to change)?
Addressing core issues can also be painful work, and it is very often the case that you will have spent years becoming an expert at avoiding pain. When the pain does seep out, the emotion often is mixed with overwhelming FEAR. The response to fear from years of conditioning (and nature) is self-preservation, or survival.
The learned behavior over time is the ability to dissociate the overwhelming emotion by psychologically pushing it out of awareness – locking it away in the body – and ultimately regaining a sense of safety. In truth, the process often is life-saving during a traumatic experience, but it becomes problematic when the response gets generalized to many situations throughout life.
5 steps for creating safety in therapy
To work through core issues requires as a foundation feeling safe. In therapy, safety is created in a number of ways including:
- Developing a trusting relationship with a counselor over time
- Knowing that what happens in sessions is confidential
- The therapy office becomes a “container” or space in which to work – with physical boundaries – that reinforce safety (i.e. the abuser is not in the room)
- Learning how to create safety in the mind and body through various techniques
- Consistency – having a place to go each week that you can count on creates consistency that often is very unlike living in chaos
With a foundation of safety, therapy can progress and core issues can be resolved and healed. It is very important to realize that since these issues are primarily emotional in nature, their solution also is an emotional one. Many folks will spend great amounts of time (and money) in therapy “talking” about core issues and wondering why they never get better.
Talk therapy is very effective for many problems in life, but is limited in its ability to truly resolve emotional core issues. Utilizing emotion-focused therapies are critical for success.
- How to find a good therapist – Brief overview of how to locate a good therapist.
- Healing Trauma: A Therapist’s Reflection on What Works – An article I wrote about my own experience working as a therapist healing trauma.
- Trauma-pages – Since very often core issues revolve around trauma, this site is the most comprehensive one-stop-shop for all your trauma needs. It is an amazing library of information.
- Focusing – Most good therapists will say that the key to any therapy working effectively is focusing. The ideas come from Eugene Gendlin and are among the most researched and widely used of all methods for working with the body. Appropriate for many different core issues.
- How do we heal from emotional trauma? – Dr. Jeanne Segal’s website talks about how to get unstuck from trauma – a good resource.
- In the last decade use of Eye Movement Desensitization and Reprocessing has become one of the hottest new methods for treating trauma, see EMDR Institute for more information.