Addiction in recent years has come to be seen as a disease of the brain. A disease is essentially a progressive problem which can improve with treatment. Addiction progressively results in increasing loss of freedom and ability to abstain. Like most disorders, there appears to be both genetic and environmental factors involved in its development. Over time, and with repeated indulgence, mismanaged emotions, and enabling thinking, the temptation becomes harder and harder to resist until the individual can no longer abstain, other important aspects of life fade into the background, and the individual becomes entirely focused on their next hit. Addiction is a tug-of-war between the frontal executive “thinking, planning, deciding” lobes, and the primitive areas of the midbrain, which is emotional and pleasure seeking.
There is stigma surrounding addiction, where it is seen as weakness or immorality. These stereotypes are the result of a lack of understanding of addictive mechanisms, and seem to acknowledge only the pleasure seeking aspect of addiction. While addictive behaviors are generally pleasurable and rewarding, these behaviors or substances over time become hardwired into the brain as a coping mechanism during times of stress and emotional pain. In other words, the behavior may be considered solely pleasure seeking at first, but it ultimately becomes addictive and out of control as individuals resort to it for relief of emotional pain and suffering.
Addiction should perhaps be seen as a neuro-protective mechanism gone awry. The emotional and pleasure seeking mid brain doesn’t distinguish between healthy and harmful coping, and is attempting to reach out to whatever will end emotional pain and discomfort. While this attempt may work in the short term, it ultimately is unsustainable and may lead to bigger problems than one started with. Much of our overall mental wellness and long-term successes depend upon the efficacy of our coping mechanisms.
For most of us, stress unmasks and reveals our dysfunction to ourselves and others. During these times, do we reach out to trustworthy people for support, faith and spirituality, or participate in healthy recreational activities? Do we journal, go fishing, turn to music or other enjoyable activities? Or do we fall into the allure of dopamine traps? Substances, alcohol, food, sex, pornography, social media, video games, co-dependency, anger, approval and adrenaline seeking, and many other behaviors can be harmful when used as a means to cope with the stress of life.
It is commonly said in recovery circles that the opposite of addiction is connection, not sobriety. Emotional connection is a fundamental human need, and perhaps the most powerful addictive cravings are an attempt to relieve the pain of this need not being met. As individuals become more connected and secure with themselves, in their relationships, and spiritually, their need to resort to addiction is reduced. This is not a simple process, however, and is discussed further under the subheading shame below.
Are there differences between different types of addictions?
Some substances and behaviors are known to be more addictive than others. There is much we don’t know about the brain, but this may have to do with how quickly and powerfully the substance reaches certain areas of brain. In a healthy brain, dopamine should trickle steadily with occasional spikes. Regularly flooding the brain through substance use or behaviors will lead to changes in the brain and adverse effects over time. Some substances like marijuana, while addictive, can be overcome by most individuals who put in the effort. Other substances, like opioids and stimulants, have a high addictive potential and can be exceedingly difficult to overcome. The underlying emotional and cognitive mechanisms of different addictions are fundamentally the same, but there are important neurobiological differences between different substances and behaviors, and a specialist in certain areas of addiction may be helpful.
RISK FACTORS
Individuals also differ in their susceptibility to addiction. Genetic predisposition aside, a strong correlation has been found between addiction and individuals who have experienced trauma. Trauma commonly results in the sufferer experiencing distorted cognitions, beliefs, expectations, perceptions, perspectives, etc. of others, oneself, the world, etc., “I’m bad”, “it was my fault because…”, “people can’t be trusted”, “the world is a terrible, dangerous place”. Sadly, abuse sends a message to the victim that the individual is unworthy of love. Many individuals also experience heightened anxiety and distressing symptoms which affect their emotional states. These challenges can lead trauma survivors to struggle to connect with themselves, others, and the world around them. Many trauma survivors describe a “long uphill battle” in recovering from the effects of trauma. Studies have shown that a substantial percentage of individuals with addictions have experienced trauma in the past, with some studies showing numbers as high as 49%. A good starting point for assessing your trauma history is to take the ACEs (Adverse Childhood Experiences) screening.
It is also hypothesized that individuals with ADHD may be at greater risk of addiction due to a suspected dopamine deficiency. Additionally, persons with ADHD struggle with focus, hyperactivity, impulsivity, completing tasks, following instructions, etc., and often struggle at home and school and may begin to feel like they can never do anything right and are therefore unworthy of love.
Availability and accessibility of a substance is also strongly correlated with addiction. Age of exposure is also suspected to be implicated in the development of addiction.
EMOTIONAL DISCONNECT
Many addicted individuals don’t realize the direct connection between their painful feelings and moods and the resultant cravings. In fact, many addicted individuals aren’t in touch with their emotions, partially due to their tendency to avoid and numb painful emotions, but also because they may never have learned to pay much attention to or prioritize them. They may have a hard time identifying and describing their emotions because it’s not something they do regularly. Addictive numbing behaviors can nullify the need to connect with others in an emotional, vulnerable, healing way, and therefore meaningful human connection and empathy may be uninteresting or be difficult to experience. But the emotional disconnect runs deeper, as individuals with addictions slip deeper and deeper into shame and denial.
SHAME
Shame is a painful emotion which is the equivalent of feeling unworthy of love. It is the essence of low self esteem and is the result of secrecy, concealment, and “hiding in plain sight”. It plays a significant role in human dysfunction, with involvement in trauma, self-harm, suicide, mood swings, chronic depression and anxiety, personality disorders, narcissism, addiction, general unhappiness, approval/attention seeking, perfectionism, anger, aggression, antisocial urges, competition with others, jealousy, cravings, overall maladaptive coping, and the list goes on. If one understands the complicated emotion of shame and its potential manifestations, one understands most of the human experience and humankind’s central struggle for a sense of worth in itself.
Because shame is a painful emotion concerned with one’s worthiness for love, it often leads to fear of the opinions of others, or self-consciousness. These thoughts and feelings can be alleviated through honest and vulnerable disclosure of what’s causing the shame to a trusted person or persons. Because this can be very challenging, and because individuals often aren’t aware of the need to disclose, many keep these things to themselves, and may weave illusions of happiness, success, and confidence.
If we hide out of fear of judgement, we send ourselves the message that we are not worthy of love because of our association with the thing or things we are ashamed of. If this continues, the feeling of shame becomes internalized and we can potentially experience very troublesome emotional and behavioral difficulties. These internalized feelings can lead to many of the dysfunctional coping manifestations described previously if they aren’t dealt with.
Shame and other emotions can become tightly “bottled up,” like a shook-up can of soda, and individuals may begin to feel out of control, acting on impulses, urges, temptations, cravings, anything which will alleviate the emotional pain and tension. People in recovery circles often call it “white knuckling” when an addicted person silently struggles through sheer power of will to resist relapse in the face of overwhelming negative emotion. This control and release cycle is a common and universal human phenomenon. Emotions can be released in a controlled fashion, when connection and other healthy coping mechanisms are utilized, or in an out of control fashion when an individual white knuckles until they can no longer resist the temptation to act out.
Shame is an important element of addiction and is discussed thoroughly in addiction recovery therapies and programs. Addicted individuals may come to feel that the addictive behavior defines them and makes them unworthy of love. They frequently will have thoughts of “if they really knew everything they would never love me.” They may have distorted perceptions of themselves and feel inherently flawed, or ashamed of things they’ve done. Their perceptions of wrongdoing may be distorted and exaggerated. It may become difficult to tolerate any more shame, so criticism may be difficult to bear and the individual may resort to dishonesty or blaming. As discussed previously, the individual may try to hide their actions, struggles, and aspects of who they are, which will only worsen shame and create a vicious cycle.
SHAME AND NARCISSISM – THE OBSTACLE TO CONNECTION
Because shame leads to self-consciousness, one way that people may try to cope with it is by seeking external approval, or validation. External validation is essentially some external reassurance which we perceive as meaning “you are okay, you have value, you matter, you are worthy of love”. It can come from positive attention from a certain person or persons, from the internet, from one’s own ruminative and distracted thoughts, or any other source which sends a message that speaks to our sense of worth in a reassuring way. Reliance on external validation, however, can be an emotional rollercoaster, especially when we weave illusions and try to show only our strengths, or what we believe are our strengths. As we depend on external validation for a sense of self-worth, we will inevitably run into, and are more likely to believe, messages which communicate to us “you are not okay, you have no value, you don’t matter, you are not worthy of love”. Those of us who rely solely on external validation tend to believe it when it comes, whether it’s good or bad.
It may be helpful to make a distinction between intrinsic value vs extrinsic value. Intrinsic value is empowering and fulfilling. It is the value we give ourselves which is independent of all external considerations. It is the ability to say, “I have value regardless of the opinions of others”. Extrinsic value is the value imputed to us by others and society. While it is true that as individuals and as a society we tend to appraise the value of ourselves and others based on superficial considerations, we do not have to accept or believe in these appraisals.
Approval seeking can take many different forms, and may show itself in obvious ways, such as the commonly cited and stereotypical “worldly” infatuations with wealth, beauty, power, intellect, etc., but may also present itself in less obvious ways, such as codependency in relationships, needing specific forms of validation from one’s acquaintances, friends, partners, etc., perfectionism, and even behaviors such as spending, sex, reckless driving, etc. These all can be means by which individuals seek external validation to cope with internal feelings of inadequacy.
This means of coping is maladaptive and does not alleviate shame, because it does not lead to real connection with others. Approval, admiration, positive public opinion, etc. is a powerful motivator, indeed one might even call it “addictive”, because it feels good in the moment, but the need to be seen and heard, known and loved, runs deeper and cannot be satisfied when others are only validating the illusion we want them to see.
Nothing good comes from this type of coping. No matter which way the pendulum swings, whether we are successful in the eyes of others or not, having our self worth tied to superficial things and the opinions of others leads to dysfunction. To do this is to weave an illusion for ourselves and others. This illusion can become a strong source of motivation and temptation, where one feels strongly tempted to further validate it, and feels shame and other painful emotions when the illusion is inevitably and often repeatedly challenged. This “illusion”, or false self, in our modern nomenclature is known as the “ego“. Individuals may feel an overinflated sense of worth when they perceive themselves, or perceive others perceiving them as superior, and shame when equally self-judged to be inferior, both of which can lead to interpersonal disconnect. This creates fertile ground for triggers to occur and the need to resort to maladaptive coping, like addiction.
One additional complication is the extortion involved in this process. We will be unable to fully appreciate whatever superficial thing we are using to boost our self esteem, and we may eventually come to resent it, because it will ultimately be unsuccessful in producing the desired fulfillment.
This means of coping with shame by reaching out for superficial things in an effort to receive external validation is the connection between shame and narcissism — not necessarily the stereotypical extreme narcissism we hear about and see in the movies and may occasionally run into, but the maladaptive narcissism found in most, if not all humans. Therapy can be very important for healing this part of ourselves. Medication will not change this tendency. The more we concern ourselves with the opinions of others in this fashion, the more we may experience shame, and the more we experience shame the more we may concern ourselves with the opinions of others.
It is important to remember that this tendency originates from a deep, unmet need for real connection. Vulnerability is a skill wherein we learn to show our weakness instead of our strength, and it leads to connection, relationships, and our emotional needs being met. Learning to share shameful things with trusted individuals, and gathering the courage to be ourselves is essential. When our true self is seen, known, heard, and loved, our need for connection is met, and shame , along with its associated urges and cravings, dissipates.
This maladaptive reaching for approval is the reason pharaohs of old built themselves burial monuments memorializing their reign, and it is a central theme in ancient scriptural texts known as “pride”, a term which expresses the actions and attitudes of concern with one’s sense of extrinsic value, e.g. the opinions of others. According to king Solomon “the wise” in proverbs 11:2 “When pride cometh, then cometh shame: but with the lowly is wisdom.”
Positive self-affirmations can also be important when experiencing shame, e.g. “I am enough”, “I matter in spite of what they think”, “whatever happens my self worth doesn’t change.”
DENIAL
Shame leads to denial. Put simply, to be in denial is to deny the existence or severity of a problem. It is a cognitive coverup of the truth because the truth is difficult to face, especially when an individual is struggling with shame. This coverup is perhaps the most important consideration as to whether or not an addiction will progress in its severity. There are many ways which an individual may exhibit denial, but perhaps the outward signs are easier to recognize. An individual who is not in denial is careful. They will recognize and try to avoid triggers, they will take note of difficult emotions and situations and reach out for connection and support, they may make important changes in their life which will help them avoid relapse, and they will essentially distance themselves the best they can from acting out again. All of these behaviors demonstrate that the individual recognizes and is able to say, “I have a problem.”
Alternatively, an individual who is in denial is overconfident and acts recklessly. They often will skirt the edge of danger, telling themselves, “I’m in control.” They may indulge in thoughts and fantasies of acting out, or indulge partially or in small amounts with the belief of “I’m in control.” They may engage in ritualistic behaviors they used to perform prior to acting out, confident that they’re in control themselves and avoid relapse. All the while, the desire to act out grows steadily, the denial increases, and the person gets gradually closer to the precipice of indulgence.
Denial is a cognitive poison which enables a person to act out, and some degree can be present in all individuals. It is important for all of us, including addicted persons, to see our problems clearly and be quick to confess, “I have a problem”, “I have a disease”, “I have a weakness”, “I am an addict”, etc. The goal is not to create feelings of inferiority, but rather acknowledge one’s need to carefully avoid whatever one needs to in order to prevent relapse. Until the problem is seen clearly and acknowledged honestly, problematic behaviors will continue to trend in a problematic direction.
Honest admission of a problem is an act of self acceptance, whereas denial is evidence that one is wrestling with their self worth and struggling to accept themself along with their respective problems. Individuals who are caught in the throes of addiction struggle mightily with the opinions of others and may desperately try to hide or conceal their addictions, and may experience intense shame when they are “found out”. The thought of disclosing is often horrifying. Individuals who are in recovery from addiction generally have the strength to share their struggle with others with little or no concern for their self-worth. The further along a person is in recovery, the more they have the inner strength to say to themselves, “my self worth is not dependent upon whether or not others accept me”, and the less likely they are to slip into denial.
OTHER PAINFUL EMOTIONS AND TRIGGERS
Shame is not the only emotion which leads to cravings and addiction relapse. Anxiety, depression, boredom, irritability, fatigue, and essentially any other negative state or mood or painful emotion could result in a craving or desire to use. The strength of a craving is dependent on a number of factors such as the length of sobriety a person has achieved, as well as how much the person may be feeding the craving with thoughts, fantasies, and ritualistic behaviors which provide a steady flow of dopamine to the nucleus accumbens, increasing the drive and temptation to act out. Triggers are very important to identify for individuals who struggle with addictive cravings. Triggers may include people, places, things, actions, etc. that stir up memories, emotions, desires, or whatever else might lead an individual to desire or start to think about acting out. Individuals often have certain ritualistic behaviors they may not be aware of which they perform prior to acting out, like drinking from a favorite glass, using with a certain friend, surfing the internet or visiting certain websites, driving certain routes, wearing specific clothing, etc. It is often recommended to change “people, places, and things”, which may trigger these ritualistic behaviors. Getting out of autopilot and exercising mindfulness can be important in helping an individual to become aware of their rituals and triggers.
12 STEP
12 step meetings can provide a supportive environment, understanding and experienced individuals who the addicted person can connect with, as well as spiritual principles to help individuals to “gain the power” to recover. Data is favorable for 12 step adherence, with some data showing superior abstinence compared with therapy for addiction, and other data showing equal results. Some data has shown that individuals who attend frequently, participate, and work with a sponsor (mentor) from the program, experience superior results compared to less involved individuals. Acknowledgement of a higher power greater than oneself, often acknowledged as God, is necessary for participation in the program, but the higher power does not necessarily have to have a specifically defined form or identity. The principles aim at drawing upon a power greater than oneself to facilitate addiction recovery, and emphasize trust in, connection with, and surrender to the higher power, honesty, confession, forgiveness, awareness and accountability, service to others, and other principles.
Through reliance on a higher power individuals experience the strength to abstain and a change in desire. Many individuals describe finding healing through a newfound relationship with God. The program generally meets weekly and will cover a different step each week. The 12 steps are an ongoing process, or a way of living, and meetings become a way of life or regular practice for some individuals. The program does not promise a quick fix. It is sometimes said by individuals in recovery meetings that “the amount of time you spent getting yourself into your addiction is the amount of time it’s going to take you to get out of it.” Nearly all recovered individuals report being at risk of relapse if they do no continue to adhere to the principles and practices they have learned in 12 step, therapy, or other venues. They frequently use the mantra “one day at a time”.
TREATMENT AND RECOVERY
Addiction needs emotional, cognitive, and interpersonal rehabilitation. Recovery is a process, and slips and relapses may occur. It is important to resist thoughts and feelings of shame and worthlessness, and be patient with yourself. Accountability can be very important, and it may be helpful to have a personal policy of disclosing a slip to a mentor, therapist, partner, or other trusted person as soon as possible, or within a specified time frame. Remember that shame, an essential element in addiction, is associated with hiding and secrecy, so disclosure is important.
Shame cannot endure honest vulnerability and connection. There is an immediate remedy to “in-the-moment” shame, and that is sharing the shameful thought, feeling, or thing with someone you trust. It is important to come to recognize the emotion of shame in oneself and its accompanying sensations, and to try understand where the emotion is coming from. It can be extremely helpful to work these feelings out with others or a therapist. The more we hide our shame, the more dysfunction we will experience, and the more it will spill out into our lives. This is one reason why recovery groups of individuals who understand each other can be important for addicted individuals. If an individual falls in with a supportive cohort of individuals who are honest and vulnerable with each other and working together to overcome an addiction, recovery will be easier. Individuals will be able to vulnerably share their struggles in a supportive environment and ultimately learn the truth about themselves: that they are not flawed, and that their individual worth is great and independent of the opinions of others.
It only makes sense that some of our most painful and problematic emotions are associated with a perceived deficiency in our ability to meet our greatest need, which is to love and be loved. The entire world does not need to love us in order for us to learn and feel that we are worthy of love. Even just one supportive person who accepts us as we are and allows us to share our struggles can make a difference in our ability to dismiss the temptation to concern ourselves with opinions of others. Strong relationships, and consequentially improved self esteem, is forged through vulnerability, not through impressing others with our gifts, talents, beauty, intellect, wealth, having it all togetherness, or [fill in the blank].
Keep a close watch on thinking and behaviors which are indicative of denial. If you find yourself taking risks, realize that you may have persuaded yourself that you are in control of your addiction, and you may have to reaffirm your need to practice avoidance and exercise caution. A person who acknowledges their weakness and recognizes the danger their addiction presents may experience a beneficial sense of aversion or anxiety, a signal of danger from the amygdala, at the presentation of potential dangers or triggers. This may be helpful in avoiding them if one responds quickly.
Strive to connect emotionally with others. Take note of your feelings and sensations, identify the what and why, and share with trusted individuals. Or, talk through these things with someone to help you make sense of them. Frequent, daily check ins with loved ones can be invaluable. During these check ins discuss emotions, needs, struggles and sobriety, give positive affirmations to each other, take ownership for your errors, and include whatever else you feel may be important. A therapist can be helpful for learning this process.
Effective coping mechanisms, discussed previously, are important in times of stress, as well as for recreation and enjoyment. Become aware of triggers and ritualized behaviors performed in “auto pilot mode” which lead to acting out. Practicing mindfulness can help to increase awareness of emotions and sensations, triggers, and ritualistic behaviors. Positive self-affirmations can also be important when experiencing shame, e.g. “I am enough”, “I matter in spite of what they think”, “whatever happens my self worth doesn’t change.”
For some individuals, going to a rehab center is important because the addiction has progressed to a point where the ability to abstain is significantly compromised. Medication can also be helpful for some addictions. There are a few options available for for both alcohol and opioid addiction, and some of these medications may be used to try to reduce cravings in other addictions as well.
Above all, never give up! Addiction recovery is a long and difficult process, but it can be done! Build a support network of people around you, stay motivated, and have faith in yourself. Reach out for professional support when you hit a wall, and consider making faith and spirituality a part of your recovery.
