There has been a push to understand and define addiction in our society as a brain disease, primarily because of the strong evidence from neuroimaging studies that have identified clear changes in the brain for those who struggle with addiction. At the same time, others have provided evidence that addiction is an adaptive response to underlying, unresolved, adverse childhood experiences (i.e., the ACE Study). We know the truth is that both are right.
Roughly 80% of those who go down the path of addiction begin prior to the age of 15. So early life experiences are critical to understanding this problem. Although the ACE study provides significant insight into the roots of addiction, we must also factor in to the equation a wide range of risk and protective factors, as well as genetic vulnerability.
Addictions are about 3 relationships
While I support incorporating all of these perspectives into our understanding of addiction, I believe how we understand this challenging problem should link directly with how we treat it. For me, this has led to a reconceptualization of how I understand and define this problem, one that I want to share with you. It involves understanding and defining addiction by three relationships to self, others and our faith.
1) Self
The relationship with Self is best characterized by shame. Early adverse childhood experiences (and other risk factors) set-up a belief system that something is wrong with Self, and addictive behavior over time becomes a powerful way to manage the trance of feeling unworthy. To add fuel to the fire, when attempts to stop addictive behavior fail, shame and feelings of unworthiness deepen even more, creating a destructive cycle that results in great pain for the Self and those around the person struggling.
2) Others
The relationship with Others is best characterized by isolation. Isolation occurs because the developmental capacities necessary to initiate, form, and maintain healthy relationships with others become constricted over time, due to spending considerable time with objects of addiction (e.g., alcohol, drugs, porn, food) instead of people.
In essence, adults who struggle with addiction are childlike in their ability to be in relationship with others. This makes it hard to hold jobs, parent kids, remain in committed, intimate relationships, and build community. It also helps explain why about 80% of those behind bars struggle with addiction, as well as many who return home from war and feel isolated and disconnected from those who have not had similar war experiences.
3) Faith
The third relationship is best characterized by ignorance. Here I use the term faith very broadly, similar to James Fowler’s conceptualization in his seminal book the Stages of Faith (where Faith is defined as the force field of life). Those who struggle with addiction become preoccupied with the Self (and Others) to the point that they remain ignorant of the big picture of life and why we are here in the first place. It’s no coincidence that at the moment of orgasm, the instant the body feels the sensations from a drug, or the second one realizes they have had a Big Win on the poker table, the words “Oh God” come forth. Going deep into addiction is a search for the God in all of us, for the infinite, the timeless, and the true.
Intervention paths
Our interventions should target all three relationships, which I should add, are hardly independent, but linked together in an interdependent system. Work on one relationship impacts the others. There are two broad paths or categories of interventions:
The Path of Action
The first path is often associated with typical interventions and treatments. The path of action happens in our conscious (waking) states, when we “do” things. While there are many things that can help you overcome addiction, instead of providing you a laundry list of options – which I don’t believe to be overly helpful – I have grouped the things you can do into five broad actions, or what I call the 5 Actions. The idea behind the solution is that as you work your way through each of the 5 Actions, each of the three relationships are transformed so that:
Shame becomes Acceptance
Isolation becomes Connection
Ignorance becomes Enlightenment
The Path of Non-Action or Contemplation
The path of non-action or contemplation is equally important, and involves using contemplative practices (like meditation) to detach from objects of addiction and embrace our spiritual nature. If you consider meditation an action, then I guess you could make an argument that perhaps there is only one path. But doing contemplative work in essence is about “just being” which takes us back to a path of non-action. This work can profoundly impact all three relationships, but without question has the power to transform ignorance in all its forms into insight, understanding, purpose, meaning, and yes…if you go far enough, even enlightenment.
As a parting thought on this topic, engaging all three relationships allows us to incorporate all we know about addiction. We can incorporate insights from neuroscience, medications, and healthy living into our treatments and interventions. And, we can evaluate outcomes more holistically when we consider how our interventions impact and change the three relationships.
I was able to take away a lot from the information that you presented. The things that were most interesting were the correlation between the three relationships of addiction and how they relate to prior information that I have learned. The adaptive relationships between individuals and life experiences such as trauma and childhood experiences that had lead to individuals addictions is critical to understand and intervene in ones habits by forms of intervention and treatment. Understanding an addict’s relationship with themselves (e.g. their shame, early childhood experience, feelings of unworthy of worthlessness), others (inability to maintain relationships and responsibility) and all (higher power and 12 step programs). I am a little interested in the likely hood of genetic vulnerability, I have two siblings that are both addicts and it took a lot for them to stop and sober up. I have experimented but never got hooked and or addicted to anything, its weird to think I could have been an addict but luckily didn’t. This information made me think of an AA meeting that I went to for my sister before, during and after the meeting the group participated and embraced in the spiritual side which for some helps. The belief that something/some higher power can give them the strength to overcome addiction and get them through each day. Addiction is a difficult thing to understand and or deal with but I wish there were more studies done to understand why they do what they do.
Those three relationships do neatly sum up addiction! My question is, can one exist without the other? If it cannot, then wouldn’t it make the most sense to focus on preventative care and concentrate on what happens at a young age (before the age of fifteen, when it seems to begin). This would seem to prevent the unraveling of addiction. It does make sense that having a good relationship with yourself can help keep you on the right path. This way, even if you do end up having bad relationships with others for one reason or another, you have good coping mechanisms, not unhealthy ones. It seems like the brain is rewired at a young age, if a traumatic event or abusive home life is present, leading the patient to become more susceptible to drug abuse or addiction. Although all three relationships play an important role, it seems like the one with self, the one that begins at such an early age can help keep the others under control.
Until I read this post I never thought about how relationships play a role in addiction. By reading you post I totally understand Self, Ourselves, and Others. In my opinion I think Self contributes most to addiction. Individuals that I know who have suffered from addiction always blame themselves. They don’t see themselves to be worthy of anyone’s love or company. These individuals usually only have negative thoughts about themselves and don’t that they amount to anything. They have little self-love with I think leads to little self-control. I think having Self relationships is a big hurdle in adolescence. We are trying to find out who we are and get scared if we don’t like who we are becoming. Also at this time you are influenced by many outside factors like friends and family.
After reading this, it gives me a better perspective on what is addiction. I really liked how you explain about the early stages of self is best characterized by shame. I believe many kids today are very insecure with their image and their social standings, which can trigger to substance or alcohol abuse. Then other correlates to isolation, which an addict isolates himself from family, friends and interaction with others, but also wouldn’t the addict seek out others with the same addiction, forming some kind of bond?
That was a perfect summary about addiction. Someone very close to me has just recently gotten over an addiction. I think a huge part to addiction is the distance that the addict puts between themselves and their friends and family. You mention the isolation that develops as the addict spends more time with the object of addiction. What are your thoughts on isolation being caused by the “mistrust” caused by the addict stealing from friends and family as a means of obtaining their addiction? I think this pertains more to drug addiction, but that still proves your point of the three relationships; they are just present in different forms.
This post is a topic in America that is huge right now, and one that I find extremely interesting. The first quote that really caught my attention “(It is no coincidence that at the moment of orgasm, the instant the body feels the sensations from a drug, or the second one realizes they have had a Big Win on the craps table, the words “Oh God” come forth.)” Whenever I win something or have something really good happen I immediately think oh god, or thank god directly after as well, and that same feeling is being recieved by addicts when they use. I also like the fact that the author mentions healthy eating, and living habits also are huge factors in addiction, which I think is the most important to keeping a good lifestyle without addiciton.
I agree with you! Isolation can be a direct consequence to the various ways someone struggling with addiction hurts others. Isolation from true self also happens when shame becomes a dominate theme in a person’s life. Thanks for the feedback.
J
After reading this post on Dr Fitzgeralds blog- I felt like the content of the post shows an understanding of the interrelationship that comes with not only the scientifically based assertion of genetic predisposition but also an individuals personal experiences; both having effect on outcome. I agree with the ‘Self-Others-All concept.’ Treatment approaches need to be holistic and focus on more than just behaviors… we need to look at Physiological, Emotional, spiritual aspects of an individual in order to access and do the core work necessary to stop destructive drug abusing (Self-Others) behavior. The social and cultural aspects also need to be addressed. When ones life revolves around the getting, using and finding ways and means to get more of the desired substance—the time spent in these activities needs to be replaced with healthy, supportive, constructive, positive and reinforcing forces. New behaviors need to be acquired as well as tools for dealing with the challenges of daily life. Coping skills….
Thanks, glad you liked my conceptualization!
I found this particular blog very enlightening. I have always concluded based on my own experience that there are more factors than just biological factors that lead to addiction. I think this correlates with my own experiences and my observations of others experiences in their struggles with addictions. I appreciate how you seem to take a holistic perspective towards your view of addiction. Often where many people fail is by focusing on one or two aspects of addiction instead of the whole picture. I like how you talk about all the other factors like life experiences contributing towards the likelihood of a person to struggle with addiction. I have found that people who struggle with a very tough childhood are more likelihood to turn towards addictive substances even if they do not have a biological imperative. I am still in the beginning stages of learning about addiction in both my Drug Education Course and my own personal struggles but I look forward to reading your blogs slowly over the course of the next few months.
Great! Thanks for the feedback and I will do my best to add a few more entries in the weeks ahead.
J
The information you presented in class really hit home. I started to thinks about addiction and friend’s of mine growing up that have always struggles with addiction. I would see how they would end up in the system then released to take a class on drugs or something of that nature. Once their 40 or 50 hours were up then they would be right back to their old self destructive ways just waiting to end back up in the system. After learning about the correlation between the 3, self, other and all, and how they are about shame, isolation , truth and love. It made me really thinks about the fact that their addiction obviously goes much deeper and more complexed. That the help they would receive from the state wasn’t hitting on the issues that might have helped them get through their problems to be successful before sending them back out into the world. The presentation you gave really touches on the fact that we must provide the right therapy and touch the right issues or people are doomed to fall right back in the destructive line they were following in the first place, and therefore it was all for nothing.
Thanks for the nice feedback John, glad the information was helpful.
J
I was able to take away a lot from this post. I completely agree that addiction stems from so many underlying issues that aren’t going to be so obvious. All of these aspects and potential triggers for addiction need to be taken into consideration during treatment and they all need to be targeted in order to have a positive outcome. Self, others and All makes a lot of sense to me and has really helped me understand addiction better. Another thing that really caught my attention was genetic vulnerability. I think this is a very interesting concept because I’ve never thought of it as a vulnerability until you stated it like that. Addiction is not something that you can just get over but its a lifetime fight that will always be something that one must face when there are triggers or reminders. So it is important to target and indicate what these types of triggers in our lives can be.
It was really interesting to read this article as I 100% agree that relationships have a lot to do with addiction. Although I am not really familiar with addiction, I do see your points when it comes to my fiance’s addiction. I believe that the reason why he is addicted to alcohol and opiates are largely due to his childhood growing up. I can see how all of the traumas he’s experienced may have led him to being addicted to these substances and it makes more sense to me now.
Thanks for the feedback Victoria. Childhood has a lot to do with the development of addiction, and while I think it’s important to understand its influence, change happens in the NOW – in the present. Much of the work of change is learning how to just be at peace in the body. Mindfulness practices, yoga, exercise, choosing healthy foods for the body, and nourishing the soul by engaging in creative endeavors are the bedrock of overcoming addiction.
J