The Myth of “Addictiveness”

In addiction, things are often not what they seem.

Published on December 25, 2010

How common it is for people to say that things are "addictive"! Scratch lottery tickets, pornographic videos, foods, even exercising have all been said to be addictive. But none of them is. In fact, "addictiveness" of any object or activity is a myth. Perhaps surprisingly, that's true even if the object is a drug.

The notion of "addictiveness" is that objects or activities can magnetically draw people to overuse them. But once you appreciate that addiction is a psychological process within people, as I've described in this blog (and in my book The Heart of Addiction), it becomes clear that the idea of "addictiveness" is precisely backward. A case example of this (from my book) was a man who addictively sought prostitutes. It was important to him that they have certain physical characteristics: they had to be big and strong. When he was with them he required that they play out a fantasy in which they took on a submissive role. In treatment we learned that he had been bullied by larger and stronger sisters as a child. This made his addictive act clear. It was a displaced way to reverse the helplessness he had suffered as a child, while also expressing his rage about having been placed in that role. For this man, no other activity would have been as suitable (attractive) to express and (temporarily) resolve the helpless rage with which he struggled. Consequently, this action became a repetitive, compelled behavior. That is, it became an addiction. Neither the prostitutes nor the activity he performed with them were "addictive."

The same reasoning applies to every other focus of addictive behavior. Scratch tickets, for example, are thought by some to be more "addictive" than weekly drawing lottery tickets because they are more popular. But their high sales aren't due to any inherent quality of the ticket. They are popular because they are more attractive for the purpose of gambling addiction. People suffering with compulsive gambling have an urgent drive to win, often because winning provides a temporary reversal of helpless feelings of not being a "winner," or being cheated out of winning in one way or another. Since scratch tickets offer the possibility of getting that win instantly, they are attractive to express the purpose of the addiction. But the tickets do not cause compulsive gambling: they are not "addictive."

I said the myth of "addictiveness" also applies to drugs. Yet, how can that be when certain drugs are, of course, well-known to be physically addictive?

Physical addiction, the capacity of some drugs to induce biological tolerance with withdrawal symptoms when the drug is removed, is quite real, and may be medically dangerous. But it is only a minor factor in the nature of addiction. Even when physical tolerance develops in the course of excessive drug use, it is never the cause of the addiction. It is never the drug's "addictiveness" that draws people to it. This is why people often return to addictive drug use years after their last dose, long after they were last physically dependent. They return because their drug of choice serves the purpose of their addiction, not because of the drug's capacity to induce physical tolerance. Of course, cravings following discontinuance of drugs can make it hard to stop drug use. But that is the least of the problems in addiction. Almost all people with drug addictions have stopped for long enough to end their physical addiction, yet they return to their drugs later. Cravings cannot create or maintain an addiction in a person who does not have a psychological basis for the addiction.

Another way to look at this is to consider whether people can be turned into drug addicts by physically addicting them - which should be possible if drugs are "addictive" in any sense beyond physical tolerance. But this isn't what happens. People become physically addicted all the time to medically prescribed drugs without ever becoming drug addicts. And, as I mentioned in an earlier post, we know from a classic study that soldiers with physical addiction to heroin could not be turned into heroin addicts. Once they were detoxified, 90% of them never used heroin again. A final example is cigarette smokers. When the surgeon general started placing warnings on cigarette packs in the early 1980's millions of people stopped smoking, even though they had a physical addiction to nicotine. The bottom line is that drugs are just like lottery tickets or food or any other object of addiction: they become the focus of addictions not because they are physically addictive, but because they are attractive for the purpose of a particular person's addiction.

This raises one more question. What makes some things more attractive than others as addictive objects? Drugs are a good example here. Since the purpose of addictive behavior is to reverse feelings of overwhelming helplessness, it is not surprising that drugs are a common focus of addiction. They are almost perfect for this job because they allow people to alter their mental state, by their own intentional control. Being able to do this can restore a sense of control over one's life just when a person feels that his control or power has been lost or taken away.

But it turns out that many other activities besides drugs can work just as well for this purpose. Buying lottery tickets, eating, or playing a game online can all serve to reverse feelings of helplessness. What any one person finds attractive may be quite different from another person, which is why addiction may take on so many different forms on the surface. This also explains why people can shift their addictive focus and therefore appear to have a "new" addiction. A different object or activity has become more suitable for the expression of the emotional drive behind that person's addiction.



Treating Addiction a New Way

Understanding the psychology of addiction makes it controllable.

Published on November 15, 2010

In my last post I briefly summarized the psychology of addiction. I said that treatment of addiction has had generally poor results because its very nature, its psychology, has not been well understood. Of course, this raises the next question: How does understanding its psychology allow people to control their addictive behaviors? Here is an example, taken from my book, “The Heart of Addiction.” It is the follow-up to the story of Marion whom I introduced last time.

Marion addictively used the drug Percodan. She lived with, and passively put up with, a domineering husband. On one occasion, when he called and demanded she drop everything and prepare a dinner for him and several business associates, she had quietly agreed, then immediately took some Percodans. I described her addictive action as a reaction against an overwhelming sense of helplessness. Taking her drug (or even just deciding to take it) reversed her helplessness. This worked because even though she had been powerless to stand up to her husband, now she could, and would, do something that was completely in her control, something she believed would make her feel better. In taking this action she empowered herself. And this action was driven by an intense rage at her helplessness. I pointed out that it is this powerful rage at helplessness (which is itself a normal response to feeling completely trapped) that gives to addiction its “addictive” qualities: its enormous intensity, blindness to consequences and apparent loss of judgment. Nobody has good judgment in the throes of rage at being overwhelmingly trapped.

Marion’s story also showed the final piece of the psychology of addiction. When people cannot respond directly to situations of feeling overwhelmingly helpless, they sometimes take a substitute action (a “displacement”) that provides them the sense of taking control of their lives. In Marion’s case, since she felt she could do nothing to deal with her husband directly, she turned to her usual displaced action: taking her pills. It is this final, displaced action that we call an addiction.

In treatment, Marion began to understand all of this. Of course, some of her treatment involved solving the underlying problem of why she was so passive to begin with, which had resulted in her repeatedly feeling so helpless. But even before she had worked out this deeper problem, she could see that her addiction was an attempted effort to reverse the feelings of helplessness that had always plagued her. In fact, she could see that her addictive urges arose precisely in those situations in which she felt the most helplessly trapped. Armed with this knowledge, she began to be able to anticipate when her addictive urges would occur, and to plan in advance to deal with these situations differently so she did not use her pills. She made progress.

Then, one day her husband again called her in the middle of the day to demand she make dinner for him and some others, that evening.

Marion now knew that, to prevent another episode of her addiction, she needed to respond directly to her husband, perhaps telling him to make his own damn dinner. But she couldn’t -- not yet. She found herself drifting over to the medicine cabinet where she kept her Percodans. Then she stopped. She hadn’t been able to stand up to her husband, but maybe she could come up with some action that would deal more directly with her helplessness. Then it hit her. She walked to the phone and ordered takeout Chinese food for dinner. At that moment, her addictive urge vanished.

Marion had found a more direct way to reverse her helplessness, so she had no need to perform her displaced action, her addiction.

Over time, she became better and better at picking up the situations in which she felt overwhelmingly helpless and finding ways to deal with them. Her addiction gradually faded.

Everyone is different. The kind of thing that made Marion feel overwhelmingly helpless is different from what makes others feel so helpless. This is one reason that treatment for addiction must always be individualized. But the underlying psychology of addiction, the way it works, stays the same. Once people understand it they find they no longer need to march blindly into their addiction again and again. They can become the master of their addiction, not the other way around.



The Psychology of Addiction

Why do people perform addictive acts?

Published on October 31, 2010

Marion put down the phone after hearing her husband's command to prepare dinner for him and a group of business guests that evening. Now she would have to shop and prepare instead of go to the gym. As she stood there she felt the familiar, nearly overwhelming, urge to take some of her Percodans. The question is: Why?

In my last entry on this blog I noted that psychology can't be reduced to the biology of the brain  any more than biology (life) can be reduced to the chemicals that comprise it. Like other complex behaviors, addiction  has to be understood in psychological terms. Marion's story provides a good illustration. Virtually all addictive acts are triggered by emotionally significant events, and Marion's situation is typical. She felt that she was in a trap. For emotional reasons of her own (arising from her past) she was unable to defy her husband's insistent demands. But she couldn't simply comply with them, either. The helplessness she felt was too deeply enraging. She had to do something to feel less helpless. For her, that something had always been taking her pills.

I have found that virtually all addictive acts have this form. This psychology that drives addictions can be summarized in three elements:

            I. Every addictive act is preceded by a feeling of helplessness or powerlessness. The issues that precipitate these overwhelmed states of helplessness are unique to each person (correspondingly, treatment must be individualized toward understanding these issues). Addictive behavior functions to repair this underlying feeling of helplessness. It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered--of regaining control--over one's emotional experience and one's life.  Drugs are particularly good for this purpose because altering (and thereby controlling) one's emotional state is just what they do. However, non-drug addictions can be shown to work in exactly the same way, since they are also acts that work to change (and therefore reassert power over) how one feels. The reversal of helplessness achieved by these addictive acts may be described as the psychological purpose of addiction.

            II. States of overwhelming helplessness, such as the feelings that precipitate addictive acts, produce a feeling of rage. This rage is actually a normal response to the serious emotional injury of losing a sense that one is in control over oneself and one's life. This rage is the powerful drive behind addiction. And we know something about great anger at powerlessness: it has the capacity to overwhelm a person's judgment while he or she is in the throes of the rage. It is precisely the presence of this rage at helplessness that gives to addiction its most defining characteristics: great intensity with loss of usual judgment and seemingly irrational destructive behavior.

            III. In addiction, the rage at helplessness is always expressed via a substitute behavior (a displacement). If this feeling were expressed directly, there would be no addiction. For example, if a man were flooded with feelings of intolerable helplessness when he was unfairly criticized by his boss (because the criticism touched on old sensitivities, for instance), and he then charged into his boss's office furiously complaining, there would be no addiction. But if he displaced his need to reverse his helplessness, and instead of charging in to the boss's office he went home to drink, then his drinking would be driven by the same rage he would have expressed toward his boss. If drinking were the way he regularly dealt with states of overwhelming helplessness then he would have a repetitive, intensely driven, apparently irrational drive to drink. We call such compulsive behavior an addiction.

Marion could not take the direct action of telling her husband to make his own dinner, or find another way to directly address her helplessness. Instead, she reacted with her usual emotional mechanism to deal with the emotional trap in which she lived. She suffered with an addiction.

Treatment for addictions has had a relatively poor success record in large part because the psychology of addiction has not been well understood. But once a person understands how his or her addiction works, the way is open to mastering it. Marion was able to master her addiction and I describe her full story, as well as stories of many others, in my book, The Heart of Addiction. I will say more about treatment arising from understanding the psychological nature of addiction in future entries in this blog.



Blowing Up a Myth

Understanding the true nature of addiction.

Published on October 22, 2010

Addiction has been poorly understood for a long time, and recently the problem has become worse with the popularization of the notion that addiction is a "brain disease."

Supporters of this fallacy point to the fact that pleasure centers of the brain "light up" when people use certain drugs. They conclude this must be important to understanding addiction.

It isn't. Everyone who takes certain drugs will have his or her brain activated ("lit up") in the same way. The puzzle of addiction is not which section of the brain is stimulated, but why some people who take alcohol and other drugs feel compelled to use them repeatedly, while others do not. Alas, no imaging technology can explain this central mystery.

That something else is going on in addiction becomes self-evident when we examine the facts. For one thing, not all addictive behaviors involve drugs. It is well-known that people with addictions can shift their behavior back and forth from drug use to non-drug compulsive activities such as shopping, gambling, even cleaning house. Such astonishing variety clearly cannot be attributed to narcotic effect or a "brain disease."

For another, even where physical addiction is present, there are no simple rules. After the Vietnam War, thousands of soldiers who had become physically dependent on heroin stopped using it once they returned home, despite the famously "addictive" nature of this drug. Once they weren't subject to the stress of war, over 90 percent of these veterans readily gave up using -- a result that cannot be explained on a neurobiological basis.

Indeed, a more modern understanding of addiction reveals an interesting fact -- most addicts feel better not when they use the drug, but when they decide to use the drug. That means there is an emotional and psychological element at play here. In fact, the critical moment of decision to perform an addictive act can occur hours or even days before the act itself. It is the emotional content of this moment that is key to understanding addiction from the inside out, and what is important in that moment is a need to remedy a sense of helplessness as I've described in a number of academic papers and my book, The Heart of Addiction (HarperCollins, 2002).

We live in a time of neurobiological reductionism in which we are repeatedly told that the mind can be reduced to the brain. Yet this will never be true. Just as chemicals that make up living things are not alive themselves, cells that make up the brain have none of the psychology that make us human. Our emotional lives come into existence only when billions of cells work together, and what they produce can not be predicted by looking at a single cell and extrapolating. As Nobel laureate Philip Anderson pointed out in a seminal paper on complex systems, "Psychology is not applied biology, nor is biology applied chemistry." Those who study brain biochemistry are doing useful work in understanding biologically-based major mental illness such as schizophrenia . But they make a mistake when they believe they are discovering something about the vast area of conflicts and emotional issues that make up the lives of the rest of us.

If we could take a more accurate image of addiction in the brain, it would encompass much of the history and many of the events that make us who we are. The intolerable helplessness that drives addiction is different for each person, but this much is known -- it is far more personal and complex than a bright spot on a screen. Until we invent a machine that can read our souls, a compassionate understanding of ourselves and talk therapy remain the most effective tools we have.

In subsequent posts on this blog I will describe the psychology that is the basis of addiction.