Whenever I think about addiction recovery, the tale of the starfish always comes to mind (adapted from “The Star Thrower” by Loren C. Eiseley). A version of that story is when thousands of starfish had been washed up on a beach during a terrible storm, a young girl was picking up each starfish and throwing it back in the ocean. She was admonished by an onlooker who told her it was pointless to do this as not all the starfish could be saved. Her response was to pick up another starfish, hurl it in the ocean and reply: “Well, I made a difference for that one!” There are currently 23 million Americans addicted to alcohol and drugs (or 1 in 10 Americans over the age of 12); only 10% of those get treatment and of those 10% that get treatment, 40-60% relapse. In my private practice, I continue to work with patients who are recovering from addiction as well as a mental health challenge. While many will remain abstinent the rest of their lives, every now and then someone will relapse and our work then becomes about getting them back on track. In this next article, I will highlight the addictive and recovery process and the common roadblocks to recovery.
The addictive process is a recognizable psychological and behavioral syndrome that expresses itself in a particular individual with regard to specific substances or processes but which exhibits a striking similarity and commonality among addicted individuals regardless of their specific circumstances and particular addiction. Addictions may be subdivided into substance addictions and process addictions. Substance addictions include alcohol and various illicit and licit drugs while process addictions include food, sex, gambling, gaming, work, and spending. The essence of addiction lies in the subjective relationship of the addict to the substance or process of addiction; it is the way the addict thinks about the object of his addiction that is the telltale mark of addiction. The modern understanding of addiction is called the medical model of addiction to distinguish it from the traditional and widely held moral model of addiction. The scientific and medical community views addiction as a disorder of brain functioning that is significantly influenced by a wide range of personal, environmental, psychological, genetic and physical factors that may have nothing to do with the addiction itself but which indirectly may advance or lessen its expression in behavior and also influence recovery of the addictive illness.
A major obstacle to recovery is that the addict is deeply divided and doubly minded about his very desire to change his behavior, even when he is perfectly aware that the behavior is damaging both to himself and others. The addict knows that he ought to want to stop engaging in addictive behavior but he is powerless to make himself really and truly want to do so. His intelligence and reason may point him in one direction, that of recovery from his addiction; but the force of the addiction itself point in another, quite opposite direction. The result is a kind of ongoing internal civil war in the mind of the addict.
Other obstacles to recovery from any addiction are dishonesty, shame, guilt, pride, personal exceptionalism, and ignorance. The first casualty of addiction, like that of war, is the truth; the addict lies to himself about his addiction and then he begins to lie to others. The rectification of the evasiveness is rendered far more difficult by the co-existence of the addict’s resulting shame about his addictive behavior and ignorance about addiction and recovery. Ironically, the painful feelings of guilt, shame, and fear resulting from the conflict of addictive behavior with the individual’s own values create states of unbearable inner stress that make it harder for the addict to refrain from resorting for relief to the very addiction that is causing negative feelings. Personal exceptionalism allows the addict to rationalize and justify behaviors because he believes he is “not like those other people” and that “my case is special.” Personal exceptionalism also makes it difficult for the addict to seek or accept help for his problems. One would assume that education about the addictive and recovery process would remedy any lack of knowledge, but individuals suffering from the addictive illness display a remarkable inability to “connect the dots” and to see the big picture.
In order for the increasingly irrational and harmful effects of an addiction not to stop the process dead in its tracks, a complex and sophisticated set of ever-changing rationalizations, loopholes, exceptions and special considerations must be developed to explain away what otherwise would be inexplicable: the simple question that the addict is frequently asked by amazed and bewildered others, “Why do you keep doing it?” This of course is precisely the question to which the addict has no truly rational or even sane answer. But though he has no good answer, the addict is seldom at a loss for rationalizations, justifications, excuses, and explanations for his harmful and irrational behavior. Addictive rationalizations and justifications usually involve denial or minimization of the actual negative consequences of the addictive behavior together with a displacement of responsibility for it. The effect of the various psychological defenses that protect the addictive process is to prevent the addict from grasping what is actually happening to him and thus to prevent him from learning from experience and recognizing the forest rather than the trees. They certainly realize that something is wrong in their lives as the negative consequences of the addictive process continue to mount up—but it is very difficult for them to see that the addiction itself is the chief source of their multiplying difficulties. Only in retrospect, after some period of recovery from their addiction, do they usually begin to understand how pervasively harmful it was to them.
I like to remind patients that when they suffer from the gravest and most dramatic complications of substance use (like psychosis, suicidality, inability to function), they are lucky while addicts without the usual external negative consequences are most unfortunate. How can that be? If an addict is not experiencing adverse external (material) consequences, they imagine they are successfully “having their cake and eating it too.” However, consequences can have a contingent and accidental quality. For example, if a person doesn’t have a car, there is no risk of a DUI or if a person doesn’t work, there will be no job problems. Regardless of the lack of external consequences, addiction is its own consequence as it distorts and stereotypes the psyche by enslaving the self to a false and unhealthy center (addiction); freedom, flexibility, spontaneity, independence of thought and judgement are lost—sacrificed to the interests and demands of the idol of addiction. When you suffer from severe external and internal consequences, you already know your life won’t move forward without recovery so it’s clear what path you need to choose.
There are many paths to recovery but all of them require the capacity of honesty with oneself and the willingness and ability to bear the temporary but often intense discomforts associated with the loss of a love. In a sense, addiction can be compared to an unhealthy, fanatical love and a miscarried, often tragic attempt on the part of an individual who does not feel good to feel better. Addiction acts as a security object without which the addict feels terribly insecure, exposed, and liable to all harms. Thus, recovery is about restoring natural, spontaneous, and healthy regulation of one’s mood and feelings but it is difficult to change any behavior to which one has grown accustomed unless there are powerful and consistent immediate rewards for doing so OR equally persuasive penalties for not doing so. Will power may be effective for some but probably not the majority of the addicted population and I don’t believe insight or genuine motivation are even necessary in the beginning of recovery but develop more so over time. Unfortunately, abstinence by itself is often not enough. What happens is reminiscent of Mark Twain’s famous quote about smoking: “It’s easy to quit—I’ve done it a hundred times” and how easy it is to relapse into the addictive cycle. The fellowship, interpersonal and social learning, and the spiritual and cognitive resources of 12 Step and other recovery programs can be of enormous assistance in helping recovering addicts to learn new coping strategies.
Recovery from addiction is the recovery of life itself and the resultant resumption of healthy inner and interpersonal connectedness and emotional growth. It is about getting back something of value (life), not merely giving up something that it strongly desired (addiction). The addiction, which seems to be the friend and enhancer of life, is in reality its deadliest and incorrigible adversary. The addict is psychologically estranged not only from others but first and foremost from himself. Addiction by its very nature is a form of bondage, even slavery. Recovery is the recovery of life and freedom.
Even though I haven’t worked in a rehabilitation facility for over 15 years, every now then, I still receive a letter from someone I treated back then to update me on their recovery. Some of them had completed a rehabilitation program as many as 8 times before they achieved sustained abstinence. What I’ve learned from them is that it’s very easy to write certain people off but with patience and empathy, people will get back into treatment and miracles do happen. I’ve also learned that people are not their disease. It may be an aspect of who they are but I would suggest they are much more than that. I’ve seen firsthand teachers, writers, doctors, and lawyers who recovered, returned to their lives and shared their gifts with the world.