-IBIS-1.5.0-
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guidelines (Mind/Body)
addiction: psychosocial approach
psychospiritual approaches

definition

psychosocial approach to addiction:

"The belief in addiction encourages a susceptibility to addiction." By convincing people that such a thing as physiological addiction exists (a premise the author disputes and refutes), that there are drugs which can take control of one's mind and body, society makes it easier for people to relinquish themselves to a drug's power. In other words, the American conception of drug addiction is not just a mistaken interpretation of the facts, it is itself part of the problem - part of what addiction is about. Its effects go beyond drug dependencies per se to the whole issue of personal competence and attitudes in a confusing and technologically complex world. We must acknowledge that people respond to powerful drugs, even regular doses of them, in different ways. At the same time, people respond to a variety of different drugs, as well as experiences that have nothing to do with drugs, with similar patterns of behavior. Thus, we need a concept of addiction that emphasizes the way people interpret and organize their experience. The larger question is why some people seek to close off their experience through a comforting but artificial and self-consuming relationship with something external to themselves. Anything that people use to release their consciousness can be addictively misused. The choice of object is irrelevant to this universal process of becoming dependent.

Lack of self-assurance and related dependency needs determine the pattern of addiction. In "Addiction and Opiates," Alfred Lindesmith states that addiction is more regularly a consequence of heroin use now than in the 19th century, because, he argues, people now 'know' what to expect from the drug, and there is a greater willingness to be overwhelmed by the effects, to surrender. Lindesmith further notes that even when medical patients do experience some degree of withdrawal pain from morphine, they are able to protect themselves against prolonged craving by thinking of themselves as normal people with a temporary problem rather than as drug addicts. Many GI's returning from Vietnam were able to discontinue heroin use when removed from the unbearable conditions of war. Significantly, army units each developed their own specific withdrawal symptoms. The symptoms tended to be uniform within a unit, but varied greatly among units. In "Drugs and the Public", Zinberg and Robertson also note that withdrawal was consistently milder at the Daytop Village Addiction Treatment Center in New York City than it was for the same addicts in jail. Heroin and morphine do not always produce the 'physical' symptoms that we associate with addiction, but these symptoms can and do occur with other drugs such as cigarettes and coffee, depending on the user's cultural background, expectations, mood, and emotional needs.

If many drugs can be addictive, and if not everyone gets addicted to any particular drug, then there can be no single physiological mechanism which explains addiction. Something else has to account for the variety of reactions people have when different chemicals are introduced into their bodies. The signs which are taken as indicators of addiction - withdrawal and tolerance - are affected by a host of situational and personal variables. The way people respond to a drug depends on how they view the drug; that is, what they expect from it (their 'set'); and on the influences they feel from their surroundings, which comprise the setting. Set and setting are in turn shaped by the underlying dimensions of culture and social structure.

Addiction is not a chemical reaction. Addiction is an experience - one which grows out of an individual's routinized subjective response to something that has special meaning for him - something, anything, that he finds so safe and reassuring that he cannot be without it. If we want to come to terms with addiction, we have to stop blaming drugs and start looking at people, at ourselves, and at what makes us dependent. We still find that we learn habits of dependence by growing up in a culture which teaches a sense of personal inadequacy, a reliance on external supports, and a preoccupation with the negative and the painful rather than the positive or joyous.

Addiction is not an aberration from the norm in our society; it is itself the norm. The dependency of addiction is a mirror-image of more basic dependencies that we learn at home and in school. The addict's search for a superficial, external resolution of life follows directly from the superficial, external relationships we are led to have with each other, with our own minds and bodies, with the physical world, and with learning, work, and play. Addiction can be inescapable, when a person is denied the means to resolve problems. It can also stem from the protection from reality that an overly supportive environment provides. The seeking of solace in drugs is only the expression of tendencies that were always present in acceptable guises in our home and school lives.

Our families have a tremendous impact on our addictive, or nonaddictive, potential, since they teach us either self-confidence or helplessness, self-sufficiency or dependency. Outside the family, organizations such as schools form much of our social environment and can instill serious doubts about our capacity to manage our own lives, let alone to interact creatively with the rest of the world. Excessive parental supervision, artificial criteria for learning, and a reverential attitude toward established institutions combine to leave us without moorings in our direct daily experience. In keeping us from developing personal capacity to the fullest, the impulse toward escape and dependency arises.

The addict is a person who never learns to come to grips with his world, and who therefore seeks stability and reassurance through some repeated, ritualized activity. This activity is reinforced in two ways - first, by a comforting sensation of well-being induced by the drug or other addictive object; second, by the atrophy of the addict's other interests and abilities and the general deterioration of his life situation while he is preoccupied with the addiction. As alternatives grow smaller, the addiction grows larger, until it is all there is. The addict, heroin or otherwise, is addicted not to a chemical, but to a sensation, a prop, an experience which structures his life.

The heroin or morphine high is not one which in itself produces ecstasy for most people. Rather opiates are desired because they bring welcome relief by dulling sensations and soothing feelings which the addict finds unpleasant. Paradoxically, the excitation of the nervous system by a stimulant drug serves to shield the habituated user from the emotional impact of external events. Thus the stimulant taker cloaks the tension he feels from dealing with his environment, and imposes an overriding constancy of sensation in its place. What causes these habits to become addictions is that they make it more and more difficult for the person to deal with his real needs, thereby making his sense of well-being depend increasingly on a single, external source of support. Addiction is not a mysterious biochemical process; it is the logical outgrowth of the way a drug makes a person feel.

Addiction does exist, and it is an important issue. Addiction can be considered a pathological habit to which we repeatedly return. It occurs with human necessities, such as food and love, as well as things which people can do without, such as heroin and nicotine. Just as a person can be a compulsive or a controlled drug user, so there are addictive and nonaddictive ways of doing anything. When a person is strongly predisposed to be addicted, whatever he does can fit the psychological pattern of addiction. Unless he deals with those weaknesses, his major emotional involvements will be addictive, and life will consist of a series of addictions.

If a person cannot cease after being sated, or if he cannot be sated, he is addicted. Fear, and feelings of inadequacy, cause an addict to seek constancy of stimulation and setting rather than to chance the dangers of novel or unpredictable experience. Psychological security is what he wants above all. He searches for it outside himself, until he finds that the experience of addiction is completely predictable. At this point, satiation is impossible, because it is the sameness of sensation that he craves. As the addiction proceeds, novelty and change become even less tolerable, as they are associated with a high fear of failure, and the addict seeks to reduce life to safe routines and rituals. The addict lacks achievement motivation, the desire to strive, explore, and grow. The ability to derive a positive pleasure from something, to do something because it brings joy to oneself, is a principle criterion of nonaddiction.

Since a reliance on simple, universal solutions to life is the problem we are dealing with, the use of a similar program for curing it would just amount to replacing one addiction with another, which addicts do all the time. Since the problem stems from lack of secure underpinnings in life - a paucity of life experience, contentment, and self-fufillment - any real solution will of necessity be a complex one. Such a solution will certainly entail the development of internal capacities - interests, joys, competencies - to counteract the desire for escape and self-obliteration.

One constructive alternative is to accept that we were each given our own set of psychic and personal limitations to resolve; these limitations are a condition of human existence. There is an ideal of autonomous self-realization that we are working toward when we analyze our dependencies and untangle oppressive involvements, but this is only an ideal. We must employ a more utilitarian approach to addiction, rather than attempting the herculean task of remedying our defects, or of blaming another generation for circumstances which they too did not create.

The process of extricating ourselves from addiction is modeled after the constructive drug and food addiction therapies, and uses behavior modification programs to change habits. These therapies attempt to give a person mastery over compulsive reactions by making him conscious of them. A person may be asked to record when, where, what, and how much he eats, and how he feels at the time. In this way, he may discover that he eats mainly when he is angry, or that he overeats in certain locales. An analogous treatment plan for smokers requires a person to rate the pleasure he anticipates whenever he reaches for a cigarette. If the rating is below a certain level (which is increased each week), he is to forego the cigarette. It is a process of examining every part of life and discovering where, how, and why we are addicted. It is also a process of clarifying goals and initiating behavior necessary to reach those goals. Armed with a consciousness of why s/he indulges, the compulsive person can determine new patterns for it, instead of passively being directed by outside stimuli and unknown emotions.

The most common mistake for a treatment program is to substitute one addiction for another, as we do when we start smoking heavily to keep from overeating, or overeat to stop smoking. The therapeutic use of methadone for heroin addiction is an example of a cultural tendency to resolve complex social problems with drugs and drug-like panaceas. Something akin to this takes place in drug rehabilitation programs, even those which are otherwise constructive, when an addict is allowed to become so dependent on the support of the group that he transfers his addiction from the drug to the group. Thus, if he is forced to leave the group, he is likely to resume taking drugs.

The substitution of social dependence for drug dependence is commonly observed in Alcoholics Anonymous, a rehabilitation program which is explicitly social in nature. Members of AA gain strength both from receiving the encouragement of others and from seeing that they can play a positive part in a group setting. AA has been a refuge for people whose drinking habit has left them desperate, and its success in keeping many of these people from returning to drink is not to be denigrated. But the alcoholic is still left with the crucial task of expanding his new feelings of worth and self-control to other social contexts besides the AA group itself.

Overcoming addiction is as much a matter of encouraging positive involvements as it is of withdrawing oneself from addictive attachments. In each case there is the painful emotional struggle of accepting the need to change, then the resolution to launch a new course, followed by stages of discouragement, and of accepting that improvement may be slow, and that backsliding is inevitable. It is paradoxical that when we convince ourselves of our inherent worth, we are most willing to change. It may help us to persevere if we remember that the only instant gratifications are in addiction. The model of a nonaddicted individual encompasses several qualities - maturity, to handle the inevitable conflict between our desire for connection with others and our own individual separateness; connectedness; self-acceptance; autonomy; and freedom of spirit, or soul.
(Peele, p. 2-3, 6-7, 17, 23, 30-31, 34, 44-49, 51, 59-60, 68, 232-4, 243, 252, 283)

also see:
behavior modification techniques
hologram of an alcoholic
meditation: forgiveness
obesity: treatment approaches
process paradigm
recovery: precautions with AA programs
recovery: stages of treatment
recovery: twelve step programs
state-dependent learning
subjective inquiry approach
the shadow and physical symptoms


footnotes