Most people see addictions as negative because they often have dire results for the addicted person and others in his or her life. Alcohol can result in poor health, premature death for the alcoholic and injury or even death for people unlucky enough to be on the road while she or he is driving. Compulsive gambling practically always results in the loss of money, sometimes vast sums. We are now finding that addiction to sugar has very negative effects on health, partially responsible for the epidemic increase of obesity in the US. Compulsive shopping can result in bankruptcy.
But it’s obvious that people develop addictions because they get something very important from them they can’t get in any other way. Unless the therapist explores what the addicted person gets from his or her addiction, little progress will be made in helping that person stop the addictive behavior and grow in important ways.
I have found in my clinical work that the addicted person often doesn’t even know why he or she indulges in the addictive behavior. For example, years ago I saw a deaf person who was a severe pot addict. He was in an impatient treatment setting for addicted hard-of-hearing people, and was the only one there who communicated via lip-reading rather than with sign language. He had had more than one DUI, had lost his drivers license and was in pretty desperate straits. He was even about to be evicted from the treatment center for continually violating their no-drug policy. Yet, when I asked him what he got out of smoking pot, he couldn’t answer me! He had no idea. I had to spend a good deal of time having him compare how he felt when he wasn’t using to when he was. He began to realize it helped him feel less depressed, less lonely and more carefree. And he had never learned non-addictive ways of achieving these states of mind.
Another client, an alcoholic, had a constant sense of anxiety and very low self-esteem. Even though he was very intelligent and successful in handling the investments of his wealthy wife, he hated himself for always feeling inferior to others. He would describe even feeling fearful and inadequate when relating to a supermarket checker. But when he drank, he would feel calm and self-confident. This was the only time he felt that way.
Another ex-client, a driven, successful restaurant owner, wouldn’t use drugs all week but, come Saturday evening, when her work week was finished, she would celebrate by binging on alcohol. That was the only way she knew to escape from the anxiety she felt most of the time about her business. Her outward success couldn’t alleviate the inner terror she felt about her business possibly failing.
A client in the movie business used cocaine compulsively while he was working on an independent film he was producing. He would stay up for days at a time while doing the editing. His cocaine use became so bad that he had continual nose bleeds. He was terrified he wouldn’t finish the film in the time he had promised his financial backers, it wouldn’t be a success and he would lose their financial support.
My advice to all therapists reading this is to try avoiding a judgmental stance with your addicted clients and explore, in a dispassionate way, how their addiction helps them. If you are invested in trying to get them to stop without finding out what they get from the addiction, the client will do one of two things: (1) either rebel against you, often in subtle ways, such as keeping important facts from therapeutic exploration, or, (2) identify with your judgmental attitude toward the addictive part of the self and drive the latter even further from consciousness. Those people with addictions already know what the negative effects their addictions have on their lives. They are probably expecting you, just like everyone else, to have a judgmental attitude toward their addictive behavior and are often very skillful at manipulating therapists into thinking that they are becoming cured of their addiction. Often, those who are AA veterans can “talk the talk” without really experiencing their internal painful feelings. A simple question such as “How does your addiction help you?” or “What does it do for you?” can elicit important information for you and the client. Helping them answer these questions, however, often takes much time and effort. This is particularly true with those who think about indulging in their addictive behavior only when there is a preconscious trigger. This was true of the deaf person I talked about above.
Finally, if the therapist can learn to understand his or her own possible addictions, their clients’ addictions will be easier to understand and empathize with. I will write about the similarity between socially acceptable addictions and socially unacceptable ones in a future article.