Addiction and psychotherapy 1 – Introduction

This is the first in a series of posts about addiction and psychotherapy. The posts are aimed at general readers who want a better understanding of addiction, including people who are concerned about their own possible addiction or about someone else.

My ideas are based upon the experience of working in the field of addictions for over thirty years. This is a field in which various different points of view are strongly held and often strongly contested. There is no consensus about how addictions are caused or how best to treat them. My belief is that there is no single model of addiction that can explain the unique and varied experiences of all the individuals who struggle with this issue. What I present here are some ideas that make sense to me and that have helped people I have worked with. I recognise that there are other approaches that people have also found useful.

There are many behaviours that can become addictive – including using alcohol or drugs, gambling or having sex, to list a few. What these addictions have in common is a compulsion to keep on repeating something beyond the point at which it starts to do us harm. The question is: why do we carry on with behaviours that are risky, taking them to a stage where they are hurting us, and then carrying on some more? In these posts I shall look at some ways to understand this behaviour and, in later posts, look at some treatment issues.

First let’s try to be clearer about the subject. The word ‘addiction’ has been used in the more restricted sense of a physical dependence upon a substance, where stopping the use of the substance results in physical withdrawal symptoms. In that sense we can talk about a physical addiction to alcohol or to other addictive drugs, including nicotine. The body has made an adjustment to the presence of the substance and will be thrown out of balance if the substance is then withdrawn. Physical addiction can also involve increased levels of tolerance, where more and more of the drug is needed in order to get the desired effect.

However, the term addiction has come to be more widely used, to describe other forms of compulsive behaviour which do not involve drinking alcohol or taking drugs. We talk about being addicted to gambling or to pornography, and even about being addicted to exercise. While these activities may not involve taking a drug, they can have a marked effect upon our brain chemistry, including the creation of internally-produced opiates. We can also develop a psychological dependence upon certain behaviours, where stopping them leaves us feeling insecure and anxious, in a similar way to some of the withdrawal symptoms of physical dependence. Strictly speaking this wider group of behaviours may be better described as obsessive-compulsive or impulse control disorders, but they share many characteristics with addictions and in everyday language that is often how we describe them.

There is at least one significant characteristic that is shared between several of these behaviours, including both the substance addictions and the other, addiction-like compulsive behaviours. That is that many people would share in those behaviours, albeit at a lower level, without significant harm and in ways that we would not call addictive.

So with such a wide range of behaviours that can be addictive and with many examples of the same behaviours being undertaken non-addictively, what are the defining characteristics of an addiction?

In these posts, in talking about addictions I am thinking of behaviours:

  • Which are persistent and repetitive – we keep on repeatedly doing these things. Even if there are gaps between the behaviours, they begin to dominate our lives. We may only visit pornographic websites every other day, but between sessions we begin to think more and more about the next visit.
  • Which are compulsive – we feel as if we have no choice in the matter. We may decide to stop drinking, but feel that we constantly give in to the compulsion against our will.
  • Which involve physical or psychological dependence – stopping the behaviour or foregoing the drug leads to withdrawals. These could be the physical withdrawals associated with alcohol addiction or the anxiety and discomfort of a psychological dependence.
  • Which we know have seriously negative consequences – we know that the behaviour is hurting us. Our experience tells us that this is going to end badly, but we carry on regardless or pretend to ourselves that it will be different this time.

I wouldn’t use the term ‘addiction’ unless all four of the above characteristics are present.

Of course, such a wide definition of addiction means that several very different types of behaviour are being considered together – behaviours involving physical and psychological addictions, legal and illegal activities, and short-term and long-term damage. There are also social and cultural differences to be considered, where some behaviours are considered more acceptable in certain contexts and not in others.

Each addictive behaviour has its own specific issues and contexts; just as each individual is different, too. A person who is struggling with an addiction needs to be met as a unique individual, with their own personal story. Nonetheless, there are some issues that do emerge as fairly common themes within this experience. The next few posts in this series will explore some of these common factors in the addictions and in their treatment.

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