What's addiction?

I finished watching yesterday a webinar run by the BACP on Addictive Disorders. It was amusing, and mind-opening to hear different speakers, from a shaman to neurobiologists, present their perspectives on this subject.

One of the things that struck me the most was to hear that addiction can be considered an interpersonal problem (interpersonal meaning relationships and communication between people), rather than an intrapsychic problem (intrapsychic meaning internal psychological processes of the individual). This, of course, can be disputed depending on which psychotherapeutic modality you prefer.

If we consider that our identity is developed in relation to what and who we care about, we can say, as Tim Leighton explained, that identity is about relationships, and that if you don’t care, you don’t feel. In relating to the world, one develops a multiplicity of identities with different hierarchical order which hopefully cohabit together without major distress. Leighton and colleague, Kirby Gregory, affirm that in addiction, ‘the addict identity’ takes over and comes first in the hierarchy of identities, hence removing meaning to most of other relations or possibilities of being. Then, it could be said, that addiction provides a substitute for feeling, and intimacy is achieved solely through crisis and intensity.

Alastair Morday highlights the difference between addiction as a set of behaviours, such as, impaired reasoning, drug seeking behaviour, cravings and poor impulse control and the primary condition which he states to be a dopamine dysregulation and reward deficiency. What does this mean? You may wonder….well, dopamine functions, in the brain, as a neurotransmitter. A neurotransmitter is a chemical released by neurons (nerve cells) which sends signals to other nerve cells. Dopamine as a neurotransmitter plays a major role in reward-motivated behaviour. Dopamine provides a sense of meaning and purpose, attributing a feeling of ‘wanting’ a reward (desire) rather than ‘liking’ of it (pleasure).

Looking at the word desire online, I found it described as a ‘sense of longing or hoping for a person, object, or outcome’, explaining that ‘when a person desires something or someone, their sense of longing is excited by the enjoyment or the thought of the item or person, and they want to take actions to obtain their goal’.  

The problem in addiction can be seeing as a lack of desire, due to poor (dopamine) tone, leaving a person in unbearable states of restlessness, irritability, mind crushing boredom, discontent, and lack of meaning and purpose. Addiction can be understood as a behaviour which boosts and reinforces meaningful and purposeful feelings rather than pleasurable ones.  Quoting Carl Jung on this, he says that ‘man is not seeking happiness, but rather meaning’.

In other words, if there is no desire, there will be no drive, and without drive the body might think is endangering survival. In front of this, the oldest part of the brain, the reptilian brain, sends urgent alert messages to the system. Usually, we learned to regulate these negative emotions from our primary caregivers having done that to us when we were not able to do it by ourselves.  This is ingrained in our memory and learning centre of the brain, the limbic system. However, in adverse childhood experiences, like for example, experiencing a constant lack of response to feeding cry, having a stressed and depressed mother, or due to developmental trauma, these skills might not be acquired. Hence, we might find ourselves during critical periods of neurobiological and psychological growth, like adolescence, for example, looking for substitutes to smooth our aroused system. These substitutes can range from sex, to food, to drugs, alcohol, cigarettes, relationships, etc. The problem is that the brain never forgets what helped it to get into balance, in spite of our safety. This means, that the strength of the survival signalling is so massive that overrides our rational brain (prefrontal cortex) triggering cravings, drug/sex/food/money seeking behaviours, poor impulse control and impaired reasoning. Morday considers addiction as a chronic illness of the brain.

In saying so, Rokelle Lerner, comes to my mind. She spoke of the importance of the process of grieving: to grieve the loss of dreams. What does it mean? Imagine a gap, a gap installed between the primary caregiver and the crying child, a gap filled with unmet needs. This unrecognised needs are left for so long unseen that mutate into an intoxicating feeling, or poor hedonic (dopamine) tone, in Morday’s words. Desire, the sense of longing or hoping for a person, object, or outcome, entraps the unspoken needs, there is no meaning, purpose or pleasure, there’s no care. Unable to cope with this perceived nothingness, the mind becomes a dream of itself: I think who I am, constantly fighting the reality of my unsubstantiated self.

Addiction buys freedom until it face us with our deception: we wake up to realise that the dream has never been there, the primary caregiver will never come, the panic captures me, I am filled with a despairing void, I am going to die. Lerner challenges this view by reminding us of winter: things seem to be dead but actually they are very much alive. They are sleeping, just looking for the right time/conditions to grow back into life.

Kurikindi, shaman and guest at the conference, said that he have met big hearted people in England, however he noticed that they are very disconnected to mother nature. His words made me think if what he means is that we as society are disconnected from the rhythm of life, its natural cycle: spring, summer, autumn, winter and spring again; and not giving the time or space to celebrate in meaningful ways important transitions, such as, childhood to adolescence, adolescence to adulthood, parenthood, etc. This lack of time, may be costing us the possibility for appreciation and meaningful encounter with ourselves and the world.

It was very moving to hear a man from the public say that he was coming to the end of his rehab treatment, and recognised that his addiction was because of disconnection. He said: ‘I drank to feel connected because there was no connectedness in the community’. His words were a reflection on what every speaker in the conference agreed upon: to overcome addiction one of the best tools is social support, the one that is intimate, which provides meaning and relational support. This kind of support, encourages the development of different ways of relating, and re-connects a person to a more fluid multiplicity of identities.

Mordey views addiction as a pandemic of modern society, a nihilistic disorder, and calls for a social pyramidal shift, Kurikindi says that addiction is a man-created illness and the only way through is connecting back to who we are, life itself. These ideas emphasise Rokelle’s words, we need to grieve the lost dreams so the possibility to create a new future can be borne.

I would like to thank the BACP for such a lovely experience and all their guests: Tim Leighton, Kirby Gregory, Rokelle Lerner, Alastair Mordey, Miles Adcox, David Nutt, Bruce Parry, Tamara Russell, Kurikindi, Celia Morgan and Richard Sherry.