What is Addiction?

“We are all going to depend on something!” “What is that giving you that you are not getting?” The former statement is one a colleague shared with me in a conversation years ago, the latter is a question I often think about when I work with clients who have addictions. They both provide a nice segue into the question, “What is addiction and how should it be treated?”

We have known for years that alcohol and drugs can be addictive and our current opioid epidemic reminds us of the serious nature of drug addiction and its consequences. Our collective consciousness has grown in recent years to understand the many things or behaviors to which one can get addicted, including gambling, sex, food, shopping, social media, video games, and people, to name just some. While addictions look very different on the surface, common dynamics are at work.

All addictions include a loss of control. The person is not able to control the amount they engage in the behavior through their own will. So, for example, the alcoholic may think they can limit their drinking to one beer per night, only to find out that they ended up drinking eight. The individual who binges food may tell themselves they will only have two Oreos, only to eat a sleeve of them. Similarly, the person addicted to video games may think they can limit their play to two hours, only to play all night. 

An inability to stop the addiction through one’s own volition is another hallmark of addiction. The individual may cease the addiction for a certain period, only to pick it up again. Sometimes, one can stop for an extended time, but does not address the underlying problems that fuel the addiction. This is commonly referred to as “white knuckling” and includes hurtful behaviors. 

All addictions are cyclical. They often begin with a preoccupation with the object or behavior and lead to certain rituals and behaviors. For example, those addicted to alcohol will be preoccupied about when and how they will drink, and sometimes, with whom. Those addicted to video games will be preoccupied with when and what they will play, leading to the ritual of playing a certain and predictable game for an uncontrollable amount of time. The preoccupation, rituals, and then addictive behavior are inevitably followed by negative feelings and diminished self-esteem which, in turn, starts the cycle all over again. 

Often, I tell clients that addiction is remarkable and clever, for it is a coping mechanism, a way of trying to deal with feelings and the need for healthy dependency and purpose. Yet, the very feelings it attempts to cope with (shame, guilt, depression, resentment, and anxiety) and an unhealthy dependency are what it creates more of. While it is a survival or coping mechanism, it simply does not work in the long run and creates more problems. 

Addictions negatively impact very predictable areas of one’s life. Because the individual is consumed by the addictive behavior, they are less available to relationships with significant others, friends, family, and colleagues. Legal or job problems can occur due to the amount of time spent in the addiction or its consequences. One’s sense of self is also eroded. The individual’s access to their feelings, hobbies, leisure, and general enjoyment of life are dampened and, sometimes, extinguished. In short, the person’s dependency on the object of addiction narrows all aspects of their being and relationship to the world. Addiction is the negative outcome of the dilemma, “We’re all going to depend on something.”

The only lasting way out of addiction is to work through the feelings one avoids and copes with through the addiction in the context of healing relationships. Yet, to do this one must be in a solid position with adequate internal and external resources. The nature, the progression of the addiction, and the individual’s level of support, determine the appropriate level of care. Some may require a period of inpatient treatment for stabilization and to help them gain the ongoing resources for recovery. Those whose addictions are serious, but do not require the most intensive treatment, often find that intensive outpatient treatment can provide the needed support, education, and resources to help them with their ongoing recovery. Often, therapy and 12 Step groups provide adequate structure for recovery and provide the best prognosis for long-term recovery.

Psychotherapy can provide a healthy dependency to counter addiction. Therapy should facilitate an exploration of healthy and unhealthy patterns, their origins, and the underlying feelings that fuel these patterns. It can support the expression of feelings by being the “container” to hold them without concern for repercussions. 

Sometimes, 12 Step groups are needed – they provide a unique function. These groups provide a safe and non-judgmental place to share with others who struggle to learn that one is not alone with the addiction or its consequences. This can help neutralize the feelings that fuel the addiction. Support from a trusted sponsor in the program, someone who has significant recovery from the addiction, can provide tools and a road map to recovery. Working the 12 Steps can help heal aspects of one’s character that contribute to the addiction. The various aspects of the program can provide the healthy dependency that counters addiction.  Both 12-Step groups and therapy can lead to an experience and recognition of what healthy relationships and dependency are, which, in turn, can lead the individual to create healthy relationships and find purpose and meaning in their broader world. 

There is a dialectical tension between healthy dependency and finding one’s place in the world. The healthy dependency created in therapy and 12 Step programs, as they help rework patterns, character, and underlying feelings, inevitably leads to greater satisfaction in one’s broader world. Recovery from addiction in this way can lead to satisfying relationships, relationships that allow for mutuality in terms of sensitivity to one’s needs and feelings and a commitment to work through conflict to arrive at a deeper understanding of the other. 

Recovery can also lead to a newfound or renewed sense of purpose. Being freed from the addictive cycle and the weight of the underlying feelings leads to greater vibrancy and a new vision in whatever one does: parenting, volunteering, working, etc. This successful outcome is captured in the often-shared statement by those who recover, “I don’t need that anymore (the addiction). I’m high on life.” The mood-altering experience, or high, of addiction is no longer needed, as it has been replaced by a deeper satisfaction with loving relationships and accomplishment. This is the “what” the addiction can never give that can be gained through hard work and the right help.

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