The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors

339 Pages·2016·1.15 MB·English

by  Lance Dodes

THE
HEART
OF
ADDICTION
A New Approach to Understanding
and Managing Alcoholism and Other
Addictive Behaviors
LANCE M. DODES M.D.
To Connie, Joshua, and Zachary
CONTENTS
ONE Time for a Change
TWO The Man Who Had No Time
THREE A Good Woman
FOUR The Secret General
FIVE I Have to Do Something
SIX Hooked by the Mind: Physical and Psychological Addiction
SEVEN The Genetics of Alcoholism
EIGHT Myths of Addiction
NINE When Is Abuse Not Addiction?
TEN The Internet, Shopping, Exercise: How Can You Tell If It Is
an Addiction?
ELEVEN Efforts to Understand
TWELVE Puzzling Cases
THIRTEEN Teens
FOURTEEN Couples
FIFTEEN When Are Compulsions Addictions?
SIXTEEN The Victors and the Vanquished: Compulsive Gambling
SEVENTEEN Sexual Addiction
EIGHTEEN Treatment
Acknowledgments
Index
Praise for Dr. Lance Dodes’s The Heart of Addiction
About the Author
Copyright
About the Publisher
Notes
ONE
Time for a Change
Len, a forty-three-year-old man with long-standing alcoholism, had managed to stay
sober for six months. He couldn’t remember when he had been able to go this long
without a drink. As he stood in his home looking up at the botched handiwork of the
man he had hired to fix his ceiling, he abruptly made a decision. Striding
purposefully over to the refrigerator, he pulled out a beer and began to drink.
It was late afternoon when Susan drove by the convenience store on the way home
from work. Still ahead of her were food shopping, a trip to the vet to pick up the
dog’s medicine, and straightening up for the impending weekend visit of her parents-
in-law. Thinking about these chores, she began to slowly shake her head back and
forth. Although she had sworn to her husband that she would not waste any more of
their money on lottery tickets, she parked the car and with grim determination
entered the store that she knew contained the Lotto machine.
A hard rain made it difficult for Steven to see out the windows of his car. His search
was already hindered by the fact that in this weather the prostitutes would be
huddling in doorways, instead of strutting openly as on most nights. But he had to
find one. Almost every night, he had to find one.
Alcoholism and other addictions are among the most important problems we
face in our society. Yet, if you look beyond pat ideas about their cause, such as
“alcoholism is a disease,” nobody has really had an answer for why people with
addictive behaviors continue to repeat them in the face of their awful
consequences. This book will offer an answer to the core “Why?” question of
alcoholism and other addictions, and will provide the chance for you to do what
so many of my patients have done: use this new understanding and the practical
tools that flow from it to take back control of your life.
You may be concerned about this subject because you are suffering with an
addiction, and perhaps have wrestled with it on your own or have tried one or
another treatment approach, without much success. Or, you may worry that a
behavior of yours is addictive and want to know the difference, beyond simple
formulas and labels, between just doing something too much and having a real
addiction. You might also be concerned about a loved one who suffers with an
addiction and has not been able to get well—or hasn’t found a way to look at his
or her problem in a way that feels safe enough to begin to deal with it. Finally,
you may be interested in a new way to think about addictions because you
provide professional help to people suffering with these problems, and have been
dissatisfied with the help you are offering using the usual traditional approach.
In this book, I am going to tell you things that are very different. In fact, in
some ways this new approach stands traditional views on their head.
For over twenty years, as a psychiatrist in both substance abuse units of
hospitals and in my private office, instead of trying to sell people on a set,
preexisting program, I have spent my time listening to the experiences of people
suffering with addictive behaviors. Often I have been moved by their stories of
struggling with an urge that seemed so much more powerful than they were. It
was after listening to a great many people that I realized I was being told
something new about the very nature of addiction. And with the limited success I
saw with the standard approaches, it seemed to me that it was time for something
new.
This new approach is not a simplistic, one-size-fits-all recipe of quick fixes
that cannot possibly work for everyone. This book is self-help of a different sort.
I will give you the tools to help you understand and master your addiction,
illustrated with many examples of how people have individualized these new
ideas for themselves. I believe that you will find in the stories of these people
and situations elements that resonate with who you are as an individual—and
that these stories and my discussion of them will enable you to thoughtfully and
usefully apply this new understanding of the nature of addiction to yourself. This
is, in fact, just what they did.
A NEW WAY OF THINKING
I first noticed the pattern that I discovered underlies addictive behavior when I
treated people such as Michael Franklin,* a man who suffered with alcoholism.
Michael had been sober for three months until the day he waited, futilely, two
hours for his wife at a downtown street corner. Earlier in the day they had
arranged to meet there, but she hadn’t shown up. He wasn’t worried, because she
tended to be forgetful and this had happened before. But he couldn’t leave,
because she wouldn’t know where he was and she didn’t have a car. In addition,
he had no way to reach her. There was nothing he could do. He paced back and
forth. The rush hour crowds around him began to thin. He was trapped, and he
hated being trapped. Then, on the far corner, he spotted a cocktail lounge. At that
moment, his months of effort to stay sober disappeared from his mind. He
walked across the street, went into the bar, and ordered a vodka martini,
immediately followed by two more.
The next day when I met with him and he recounted his experience,
something surprising emerged. We learned that he began to feel better not when
he started to feel the physical effects of the alcohol or when the first sip of
martini passed his lips. He had begun to feel better the moment he decided to
walk into the bar. The drink itself was almost irrelevant!
We soon discovered that the moment Michael decided to drink, he had already
accomplished something. In making the decision, he had the sense that he had
reversed the helplessness he felt while standing outside waiting. He no longer
felt helpless, because he knew at that moment that he could, and would, take an
action that would make him feel better.
Once Michael realized this, the emotional purpose of his drinking began to
make sense. He had felt driven to drink because he had to get out of his trap.
Drinking reversed his helplessness by placing him in control of how he felt
(alcohol and drugs in general are particularly apt for this purpose—altering how
one feels is just what they do). But he had actually begun to achieve this goal
before he had swallowed a drop. So, although alcohol could change his mood, it
was clear that it was the meaning of feeling empowered that was critical here.
I have heard of experiences just like Michael’s from an enormous number of
people with all kinds of addictive behaviors, and I will offer many detailed
examples of this in this book. But for now, I will simply state my conclusion.
Virtually every addictive act is preceded by a feeling of helplessness or
powerlessness. 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.
Of course, addictive behavior is actually out of control at the same time that it
serves a deeper purpose of regaining control. This paradox is not unusual in
emotional life. It arises because your other goals are temporarily ignored while
you are under the sway of a powerful need to act in the moment. So, if you have
an addiction, while you are trying to create a sense of control, the net effect of
this behavior is all too often contrary to what you want in general for yourself.
The net effect is to be out of control.
Naturally, we all have to live with a certain degree of helplessness in our lives,
and everyone, including you if you suffer with an addiction, puts up with this
annoyance much of the time without having to take a drink or perform another
addictive act. But what I have found is that for people suffering with addictions,
there are quite specific kinds of helplessness, specific to them as individuals, that
set off critical issues inside them that they find intolerable. Once that happens,
the intense need to take an action that reverses the feeling of helplessness takes
over. As I will discuss later, a response to act against helplessness is at heart
actually quite normal. It is just that when the response is an addiction, the results
are typically disastrous.
The action of addictive behavior to reverse helplessness explains its purpose, but
it is only one factor in the new way to understand addiction. The second factor is
an explanation of the drive behind addiction. When anyone is trapped, physically
or emotionally, he or she will sooner or later feel a great anger—a rage, really, at
being helpless. It is this rage at helplessness that is the nearly irresistible force
that drives addiction. Michael’s case is typical. When he described to me a day
later how he was filled with feeling walking into the bar, the intensity of his
emotion was palpable. Nobody was going to stand in his way. He had waited
helplessly for a long time—and now he was going to act. The rage driving his
addiction was evident when he talked about it, and it was certainly present the
day before in the fury of his determination as he walked over to that bar.
When Michael understood the purpose behind his seemingly irrational
decision to drink, and understood the drive that made drinking so irresistible at
that point, he found this to be deeply meaningful. He had never known any
sensible explanation for his drinking. Actually, he didn’t think there could be
any sensible explanation. As a consequence he had always thought of himself as
weak, or selfish, or stupid. But now he had a way to think about not only why he
felt a compulsion to drink, but why he felt it when. He began to be able to
predict the occasions that he would be flooded with the urge to drink, because
they were always occasions in which he felt the particular kind of helplessness
that was critical to him. Once he had identified what sorts of things made him
feel intolerably helpless, he could predict when he was at risk of drinking.
As I mentioned before, the sorts of problems and concerns that make a person
feel helpless in a way that leads to addictive behavior vary from individual to
individual. You will find many quite different examples of this throughout the
book. I expect these will help you to genuinely understand what leads you to feel
compelled to repeat addictive behaviors, and to figure out alternate ways to
manage this drive—ways that are based on the specific factors that lead to the
addiction in your own life.
There is also a third, critical, aspect of the new way to understand alcoholism
and other addictions. It arises from this fact: if the purpose and drive behind
addictive behavior—an effort to preserve one’s power and control against
helplessness—make sense, and if an addictive act is merely a very unfortunate
way to express this sensible function, then it follows that there must be a better
way to achieve this sensible aim. That is, addictions must be substitutes for some
other, more useful actions to respond to the helplessness. Indeed, I have found
that every addiction results from a redirection of energy to a substitute or
displaced action (usually because another, more direct, action is not considered
permissible). In Michael’s case, for instance, it was understandably not
permissible to him to perform the direct action of leaving his wife stranded. So,
he displaced his need to reverse his sense of helplessness to the one option—
drinking—that had leapt automatically and forcefully to mind. But if he had
been fully aware of what was driving this action at that moment, then instead of
having a drink he might have been able to consider other options to reverse his
feelings of helplessness and the rage that accompanied them. Indeed, it would
have been easy for him to find other solutions, ranging from simply thinking the
issue through, to composing an angry harangue to give his wife when she
appeared, to buying a newspaper or a book that he wanted to read, to making a