What
addicts do involves either a substance such as alcohol or a behavior
like gambling, but that’s just the surface. Addicts often describe
themselves as crazy; non-addicts look on in horror and agree. Once
again, however, let’s listen to what the addict is saying and admit
they could be at least partly right because an addiction can be defined
as a state of mind, and not usually a happy one at that.
I’ll be using the term dark feelings
as short hand for the emotional soup in which addictions grow; more
about all that later. The addiction makes this bad thing—dark
feelings—worse over time by undermining beliefs, values and the ability
to reason. Although we don’t like to admit it, addictions are mental
disorders if not medical diseases. An addicted state of mind is far
more disabling than most people want to admit, especially for the
person who happens to own the mind in question.
With long experience, a person gets used to how one is even if how one is
would not be described as a voluntary or happy existence. Even dark
feelings can come to be a kind of security blanket, something that
gives permission to do weird things in an effort to make these feelings
go away for a little while. There is always resistance in making
changes in how we think because many of our thoughts are like
comfortable old furniture; the springs are busted and the padding is
hanging out, but they’re ours and we trust them to hold us up, at least
for a little while longer. One gets used to a certain mental landscape.
New thoughts or ideas can be very scary.
Research
on the human brain shows that addictions can be defined in terms of
brain chemistry. Those advances, however, will not end our search for
causes since scientists will next have to find out how chemistry,
genetics and experience all work together to set the stage for
addiction. They will have to explain how some people with the same
personal characteristics as addicts manage to avoid addiction. Even
with respect to genetics, many who share a family history differ in
their susceptibility to addictions. If we had some magic bullet from
medicine to stop the craving, once the addiction is put away we would
still have to learn new and sometimes uncomfortable ways of thinking
and acting. While we wait for the imaginary magic bullet to do the job
for us, we can and should do something to change our thinking—to change
our minds, if you will. And changing a mind is one of the hardest
things in the world to do, especially if it’s your own mind that needs
changing. This is where programs such as the Alcoholics Anonymous
Twelve Steps work their benefits; they offer the ideas, concepts and
values that are so necessary in the mind changing business.
The
list of possible addictive agents and activities is long, and seems to
grow longer every year. We seem to be devoted to inventing or
discovering new addictions. Over the years Alcoholics Anonymous
inspired such off-shoots as Overeaters Anonymous, Gamblers Anonymous,
Narcotics Anonymous, Emotions Anonymous, Sex and Love Anonymous, etc.
The multitude of different Twelve Step groups is interesting and their
very existence yields insight into the nature of addiction itself.
Psychologists
love to snoop around and walk in the minds of others. We’re generally
pretty harmless, sometimes even helpful. Some years ago, at the Nevada Veterans Administration Medical Center in Reno, Nevada
where I was Chief of the Addictive Disorders Treatment Program, we
developed a measure of overall addictive activity; it was really just a
simple list of all the different possible addictions our patients with
drug, alcohol and gambling problems might have. People coming into our
program usually were focused one only one addiction, the one thing that
was causing the most pain in their lives, or at least the one thing
they were willing to admit to. However, we treated all addictions in a
single program as if each different addiction were but a sign of some
underlying and more fundamental disorder.
When
I came to work on the program it was called the Alcohol and Drug
Treatment Program (A.D.T.P.). I renamed it the Addictive Disorders
Treatment Program and we didn’t have to change the lettering on the
walls since we were still known as the ADTP. See, some government
workers save the people money. Gradually, however, our behavior began
to change as we became more alert to the possibility of important cross
addictions. Our language began to mention addiction more often than
alcoholism or any particular drug.
In
the 1980s, the Reno V.A. was a small hospital that could devote only
about ten beds to the Addictive Disorders Treatment Program, so there
were practical and financial reasons to combine with larger hospitals
that had separate programs with more bed space and different
specialized staffing. But I also had fancy theoretical ideas, ideas
that will be spelled out in as I go along.
[BB]
As
a sad footnote, after several years of admitting a full range of
addictions, our ADTP was closed and addicts were no longer given
inpatient treatment at the Reno V.A. Medical Center.
Homeless and destitute veterans were turned away if they did not have
severe medical problems, so I moved to another facility were inpatient
treatment was still offered.
Below
is the list of substances or activities about which we questioned our
incoming veterans. We asked them to check any item that was a problem
in the past six months of their lives, and we also asked them to check
any items that had been a problem at any time in their lives.
A list of addictive agents and activities:
____ Cocaine
____ Heroin
____ Amphetamine or similar “pep” pills
____ Morphine or related opium-like drugs
____ Gambling for money
____Marijuana
____Pipe, cigar, cigarette, snuff or chewing tobacco
____Alcohol; beer, wine, liquor, whiskey, etc.
____ Barbiturates and similar sedative drugs
____ Hallucinogenic drugs (LSD, PCP, mescaline, etc.)
____Caffeine (tea, coffee, cola beverages, etc.)
____Stealing, shoplifting, petty theft, etc.
____Sugar-based foods (candy, baked goods, ice cream, etc.)
____Fatty, oily or greasy foods
____Salt from the shaker and/or salty foods
____Highly seasoned or spicy foods
____Spending just for the sake of spending
____Work for the sake of being busy
____Anger, fights and arguments
____Trying to manipulate and/or control other people
____Trying to get attention for attention's sake
____Reading for reading's sake
____Trying to get others to care for me and do things for me
____Exercise, jogging, playing sports or working out
____Seeking and having sex with another person
____Seeking and using pornography (sexually oriented pictures, books, etc.)
____Watching television
____Talking just to be talking
____Searching for, buying and collecting certain items
____Lying for no reason
____Aspirin or other non-prescription pain medications
____Controlled (prescription only) pain medications
____Laxatives
____Nasal decongestant sprays and inhalants
____Antihistamine pills or other decongestant pills
____Antacids and stomach remedies
____Fast and/or reckless driving (not including driving under the influence)
____Valium, Librium and related ‘minor tranquilizers ‘
____Physical violence
____Cough and/or cold medications
____Religious activity
If
I were giving this survey today I would add: Internet surfing, computer
games, burning, cutting or mutilating oneself and sun tanning.
Every
one of the items on our list at one time or another was referred to as
an addiction by some authority or by the popular press; society was
using addiction to refer to an ever-longer list of substances or
activities.
No
one can predict how many different addictive patterns we will recognize
in the future. As this is written, we have begun worrying about people
who spend too much time on the electronic communications networks,
i.e., the Internet. Listening to loud music and playing computer games
have been suggested as possible addictions. However, in order for me to
consider something to be an addiction it has to show more than just
frequent use. If we use the term addiction carelessly for any frequent
habit it will lose its meaning.
We
do have one rather well established physical sign of addiction and that
is endorphin release in the body. This chemical is responsible for
feelings of relaxation, calm and anxiety relief. The items on my list,
however, have not all been shown to be endorphin related. Many
different patterns are used in arriving at a final conclusion.
[BB]
If
you personally don’t have a certain problem, it may be very hard to
understand how some activity can become a damaging addiction. However,
the characteristic signs of addiction seem to hold for all of the items
on the list although they are never exactly equal in prominence between
addictions and between individuals. I use the word triggers to refer to
the list of addictives above. It is as if a gun were already loaded and
ready to fire, all it takes is someone or something to pull the
trigger, and this is what the items on the list represent for certain
vulnerable people.
The
list of addictive triggers also reminds us of an important point about
addictions: not all addictions are equally severe or damaging. Let’s
take the excessive use of salt and the love of salty foods as an
example. A salt habit barely makes the grade as an addiction for most
users, but if a heavy salt user is suddenly forbidden the use of salt
because of heart problems and bloating, there will often be resentment
and feelings of deprivation. Severe health problems can result from
ignoring advice to cut back on salt. It is interesting to note the over
use of salt may signal the presence of other, more severe addictions.
If you know someone who is heavily into salt, check that person out and
do a little psycho-sleuthing of your own. What else is going on? Salt
enhances the taste of food, and therefore it is value as a comforter of
dark feelings. Spicy, sweet or fatty foods do that for some people, too.
Addictions
exist at all levels of severity from very mild and almost harmless to
very severe and life damaging. Addictions, then, are never black and
white. Some run in brief cycles while others get used only a few times
during a month or year. Some are unnoticed and some are very prominent.
Here is how we know if something is an addiction for a certain individual:
1. Increased tolerance:
The capacity and desire for use of the addictive increase to very high
levels, levels that in some cases would represent a lethal dose for the
non-addicted individual. The thinking here is that if some is good,
more is better. There is also a physiological habituation in many cases.
3. Withdrawal and rebound: Attempted or enforced abstinence leads to psychological and often physical problems, referred to as a hangover by alcoholics.
4. Mood swings. As
described in the following columns, emotions swing back and forth
between elation and deep depression depending on the amount of use of
an addictive and when it was last used.
5. Distortion of rational thinking: In
an altered state induced by an addictive activity, or in the rebound
phase following heavy use, thinking is altered, often in dangerous
ways. The person does things he or she would never think of doing in a
normal state of mind.
6. Substitution or compensation.
The effect of reducing a favored addictive behavior is often
accompanied by increases in the use of other addictives. When drinking,
for example, is cut back, the person may smoke more, show hyperactivity
or begin gambling. In consequence, what were once minor problems my
suddenly emerge as major new addictions.
Use
of a trigger or addictive does not by itself signal an addiction. Don’t
make the mistake of thinking that because you or someone you know has a
certain addiction everybody who uses it is either addicted or
susceptible to addiction. If you think that please go back and memorize
the list of signs I just gave you. Resist the temptation to become the
Paul Revere of laxatives or coffee. Crusaders are a pain in a bad
place. The only person I can fix is me. You’re no different, so don’t
become a prohibitionist, and don’t over-extend the meaning of addiction
without good evidence. Stick with the known signs of real addiction.
