another eye opens

ADDICTION

Addiction is a complex psychophysiological process, but it has a few key components. I’d say that an addiction manifests in any behavior that a person finds temporary pleasure or relief in and therefore craves, suffers negative consequences from, and has trouble giving up. So there’s craving, relief and pleasure in the short term, and negative outcomes in the long term, along with an inability to give it up. That’s what an addiction is. Note that this definition says nothing about substances. While addiction is often to substances, it could be to anything—to religion, to sex, to gambling, to shopping, to eating, to the internet, to relationships, to work, even to extreme sports. The issue with the addiction is not the external activity, but the internal relationship to it. Thus one person’s passion is another’s addiction.

Okay, but the whole subject of addictions is shrouded in a certain amount of controversy these days. What do you think is the most common misconception about addictions?

Well, there are a number of things that people often don’t get. Many believe addictions are either a choice or some inherited disease. It’s neither. An addiction always serves a purpose in people’s lives: it gives comfort, a distraction from pain, a soothing of stress. If you look closely, you’ll always find that the addiction serves a valid purpose. Of course, it doesn’t serve this purpose effectively, but it serves a valid purpose.

Lots of people believe that the term addiction has become too loosely applied. So what’s the difference between saying “I have an addiction” and “I have bad habits that give me short-term satisfaction, but don’t really serve me in the long term?”

The term addiction comes from a Latin word for a form of being enslaved. So if it has negative consequences, if you’ve lost control over it, if you crave it, if it serves a purpose in your life that you don’t otherwise know how to meet, you’ve got an addiction…

The notion of trauma is closely tied into your conception of addiction. Why is that?

If you start with the idea that addiction isn’t a primary disease, but an attempt to solve a problem, then you soon come to the question: how did the problem arise? If you say your addiction soothes your emotional pain, then the question arises of where the pain comes from. If the addiction gives you a sense of comfort, how did your discomfort arise? If your addiction gives you a sense of control or power, why do you lack control, agency, and power in your life? If it’s because you lack a meaningful sense of self, well, how did that happen? What happened to you? From there, we have to go to your childhood because that’s where the origins of emotional pain or loss of self or lack of agency most often lie. It’s just a logical, step-by-step inquiry. What’s the problem you’re trying to resolve? And then, how did you develop that problem? And then, what happened to you in childhood that you have this problem?

All we know about the advances in addiction treatment arises out of our understanding of trauma. People often think that trauma is the bad things that happen to someone: trauma is that you were sexually abused, or that you were beaten, or your parents abandoned you, or died, or something like that. But trauma is the internal impact, which is fundamentally a disconnection from the self and from our bodies and our gut feelings. And the trauma is the discomfort, the inability to be in the present moment because the present moment is too painful.

If, as I argue, addiction is rooted in trauma, then the treatment of addiction has to aim beyond just stopping the behavior. That’s where the addiction treatment falls down so miserably. Too often it’s all aimed at behavioral regulation or behavior reform, with the thought that if people stop the behavior, then they’re going to be okay. No, they’re not—and they won’t be fully okay until they deal with the fundamental issues. So the treatment has to aim at nothing less than the restoration of the individual to themselves and to their capacity to be with the present moment, whether the present moment is pleasant or not. That’s what’s too often missing from addiction treatment.

–Gabor Maté, interviewed in Psychotherapy Networker