Sep 22, 2023
Sep 22, 2023
What is an addiction?
An addiction is an activity or substance we repeatedly crave to experience, and for which we are willing if necessary to pay a price (or negative consequence). In recent years researchers have considered as examples of addiction both substance addictions (alcohol, cigarettes, food, street drugs, etc.) and activity addictions (gambling, impulsive sexual activity, shoplifting, overspending, etc.). This article discusses techniques and concepts, which can be helpful in coping with both kinds of addictive behavior.
Relatively minor addictions, such as watching too much television, eating a certain kind of candy, or lying in bed on weekend mornings, are often not even considered addictions, because the price paid for indulging them is not high. On the other hand, we tend to use the term "addict" to describe the person who, at least in the eyes of others, continues an addictive behavior long after it may have been clear that the substantial price being paid was not worth the benefit. The individual who has lost career, house, family and friends because of cocaine use, but is unwilling to consider stopping, is an unfortunate example.
Negative addictions range from those with very minor negative consequences, to those as serious as the cocaine addict just mentioned, with much area in between. Although it is sometimes true that a negative addiction grows stronger (i.e., worse) over time, this is not necessarily or even typically true. For instance, most overweight individuals do not keep gaining and gaining weight, but rather settle into a weight range that, if far from ideal, is also not morbidly obese. On the other hand, even a constant level of addictive behavior (e.g., overspending $200 a week) can lead to an increasing level of negative consequences. You may be surprised to learn that addictions can also be considered positive. Positive addictions are those in which the benefits outweigh the price. A common example would be exercise. The price of membership in a gym, the time involved, and any clothing expense, is outweighed by the benefits of better health, energy, self-confidence and appearance. As with negative addictions, positive addictions may not get stronger (i.e., better; greater benefits are obtained) over time, and there is a broad range of how much benefit is actually obtained.
What is common to both positive and negative addictions, and what helps us realize that they are two sides of the same coin, is the urge or craving to engage in the addictive behavior, and the satisfaction that is felt when the urge is acted upon. The urge is a state of tension and anticipation that is experienced as a desire for the substance or activity. The urge is also experienced as uncomfortable, perhaps intensely so, especially if it lasts long enough. Because we experience relief when the urge is acted upon, there is an increased likelihood that we will act on the urge again. One of the primary benefits of an addiction for many individuals is the fact that the urge can be driven away by the addictive behavior. Hunger and eating to satisfy it, provide a good example of a (positive or negative) addiction. We might even describe hunger (along with thirst and sex) as one of the original addictions. Even if there were no other benefits to eating (i.e., nutrition and survival), it would be satisfying to eat simply because eating makes hunger go away. Sometimes addictive behavior appears to be engaged in without the presence of an urge, such as when a smoker is three puffs into a cigarette before realizing that it is lit, or when an overeater is three bites into a chocolate cake before realizing that this is no longer the living room but the kitchen. However, if these individuals were kept at a distance from their substance or activity, such that deliberate effort (rather than behavior so habitual that it is unconscious) were required to obtain it, urges would again be observed. In the examples described the addictive behavior is used to prevent the occurrence of an urge, which would nevertheless appear eventually if it were not prevented.
An addiction is an example of a habit. Like other habits, addictive behaviors are learned behaviors that we acquire through trial and error (e.g., we happen to gamble for the first time, having known little about it, and experience it as exhilarating and captivating), or through observing others (e.g., our parents had cocktails each evening before dinner to relax). If we have ongoing experience with the substance or activity, and if (and only if) we enjoy at least some aspect of that experience, an urge or craving for it gradually emerges after repeated experience. The urge is a way of saying to ourselves: "I know this is going to be good; I will enjoy this." Someone who has never experienced a substance or activity cannot be addicted to it, nor will an addiction develop if the experience is not pleasurable. Because of the uniqueness of each individual, what is pleasurable for one person may not be for another. For instance, many individuals report not enjoying alcohol, even in small amounts. Such an individual would not ordinarily become addicted to alcohol. Paradoxically, in a very strong addiction much of the original pleasure may no longer be experienced. In this case the primary satisfaction comes from driving the (uncomfortable) urge away.
The pleasures of an addiction can be diverse. In addition to promoting an increase in positive mood (feeling more relaxed, feeling more "up"), the addiction may also be a means to decrease negative mood (if I do this I won't feel stressed, anxious, angry, depressed, bored, lonely, afraid, frustrated, etc., anymore). There are many variations on this theme. If I am feeling bad because it seems I am not "fitting in", I can reduce that negative feeling by doing what others are doing (drinking, using drugs). If because of a conflict with someone I am so upset "I can't stand it", I can change this feeling through addictive behavior. Because the pleasure of the addiction can be used to block out or replace an unwanted emotion, an addiction can be a "way to cope". If the addiction is used in this way, urges tend to occur in response to those negative moods for which the individual has few other effective coping methods.
How Does an Addiction Develop?
It is possible to describe phases in a negative addiction:
An addiction could be described as stronger or weaker according to which of these phases it occupied. A similar set of phases applies to a positive addiction. An individual may stop at any phase, or retreat to it after being in another one. Predisposing factors are also essential to the development of an addiction, because it takes more than just curiosity to establish an addiction. Predisposing factors are what enable an individual to experience a certain behavior as pleasurable, and include biological predisposition (enjoying some physical effects of the behavior, being insensitive to others), encouragement from others, acceptance of the behavior by the individual and others, low self esteem, craving for excitement/boredom, high life stress (typically expressed as a specific emotional issue, such as depression, anxiety, loneliness, etc.), and the availability of the substance or activity. For instance, someone addicted to ocean swimming may enjoy the feeling of being "massaged" by water as he swims in it, not mind the coldness of the water very much, have gotten encouragement from his wife (she thinks it's "manly"), accept the activity as part of a healthy lifestyle (as his friends and family do), have a need to prove himself to others (or to feel better about himself by swimming), like the excitement/tension of knowing he could drown, enjoy the respite from the very high anxiety of his sales job, and live near the beach. The presence of all of these predisposing factors is not necessary for addictive behavior to develop.
Once having become a part of our behavior, pleasures (and the habits based on them) continue or die away depending on whether we continue to experience them as pleasurable. Life is a continuing process of developing, revising and outgrowing pleasures. Although we may never entirely abandon a well-established pleasure, the frequency with which we engage in it can diminish dramatically. Each of us can probably remember pleasures from childhood, which were very strong at the time, but are now no longer very pleasurable. For instance, how may adults still routinely look for opportunities to play in the mud, or suck their thumbs, or be praised for using the bathroom instead of a diaper? Consequently, addictions both develop and possibly get outgrown according to the pleasure we believe them to provide us.
To summarize what has been said thus far about the definition and development of an addiction, an addiction is the habit of making an urge (or craving) go away (or preventing it from occurring) by engaging in the desired activity or using the desired substance. The urge develops because past pleasurable experience and related benefits from the substance or activity are expected to reoccur on the next occasion. Urges are uncomfortable, and engaging in the addictive behavior is also experienced as pleasurable simply because (or perhaps only because) the urge is driven away.
There is a broad range of price and benefits for addictions. The addiction is negative if, for that individual, the price outweighs the pleasure and benefits. Various predisposing factors contribute to the development of an addiction. An addiction does not necessarily get stronger over time. If the pleasure expected from the addiction is the reduction of a negative mood, the addiction may, for that individual, be a primary means for coping with stress. In a strong addiction the addictive behavior has become integrated into many aspects of the individual's life. As we mature, the pleasures we crave also mature, and consequently our addictions can change.
Am I "Addicted"?
Although the term "addict" is often used to describe someone for whom the price of the addiction outweighs the benefit, it is impossible to use this term precisely, because prices and benefits are different for each individual. Furthermore, how much bigger than the benefit would the price have to be for me to be an addict? There is no clear answer to this question. It may best to reserve "addict" for describing oneself (as opposed to others), or not to use it at all. In this article, this term will be used as a convenience, to describe anyone with an addiction in which the price outweighs the benefit, no matter how slightly, from anyone else's point of view. By using this definition, probably all of us are (negative) addicts, according to someone.
Better questions may be: Is my enjoyment of this substance or activity causing me enough problems that I want to consider cutting back or stopping? Is this behavior preventing me from enjoying even better and higher pleasures? A careful approach to answering these questions would include discussing them with family, friends, co-workers, and health providers, among others. This outside input is essential because experience has shown that most of us have difficulty arriving at an accurate cost/benefit analysis of behavior that is (or has been) intensely pleasurable, or that in our own mind is indispensable for coping with a prominent problem. A careful approach to answering these questions would also include reading about the common signs and symptoms of the addiction you fear you may have. For instance, in evaluating your alcohol use it would be useful to consider how many blackouts you have had, or to consider your predicted ideal body weight as compared to your actual weight if overeating is a problem. Almost everyone knows one or more negatively addicted individuals who deny or minimize the negative consequences of the addiction. Do you fall into this category for those who know you? For most strong negative addictions, regardless of the type, common symptoms include preoccupation with the substance or activity, loss of self-respect, extended periods of attempting to ignore or minimize the problem, and blowing out of proportion the actual benefits.
Very often, someone may hesitate to conclude that there would be benefits to stopping or cutting back, because achieving that goal may seem like an impossible task. Many individuals prefer not to identify a problem they do not already have a solution for. The concepts and techniques described in this article, in conjunction with psychotherapy as needed, can be helpful in persuading you that solutions are possible.
Sometimes those around the addict may need to consider their own roles in enabling the addiction to continue unexamined. Relationships may need to be altered dramatically, or ended altogether, before some addicts begin to perceive the actual price of their addiction. The term "denial" is often used to describe the apparent inability of the addict to perceive what is so clear to others. Because significant others may not have the communication skills to impart their perceptions without also coming across as hostile or unfairly critical, the involvement of a psychotherapist may be invaluable. Nevertheless, a small percentage of addicts do not alter their behavior in any significant way, regardless of how they are approached, and the addiction may not end until (premature) death.
Regardless of whether you are ready to cope with your addiction, or unsure about whether you want to, the place to begin is with a careful evaluation of what you enjoy and appreciate about this substance or activity. That's right: begin with the benefits and pleasures of the addiction, not the price. Because there is much to consider, it would probably be helpful to write down your answers to the following questions, so you can review and revise them later. You will end up with two lists, the Benefits of Addiction, and the Benefits of Stopping/Cutting Back. If you wish to evaluate more than one addiction, you will need a separate pair of lists for each one.
For the first list, start in a general way: What is it that I like about this substance or activity? What does it do for me? What am I afraid my life would be like if I did not engage in this behavior?
Now get more specific (to make sure you have not missed any benefits and pleasures):
It is important to begin your evaluation of your addiction with the pleasures and benefits of it, because these pleasures and benefits are valuable to you. Cutting back or giving up the addictive behavior does not necessarily mean giving up the experience of these pleasures and benefits, but perhaps only finding other means for obtaining them, or reducing how often or to what extent you obtain them. Coping with addiction is much easier when the goal includes maintaining as much of the addiction benefit as possible.
Before you push ahead, review this list. Are the benefits I have listed ones I actually get now, or ones I merely used to get at one time? Do I actually get these benefits, or are they the benefits others get? How important are these benefits (to me, not to someone else)?
Next, evaluate the price of the addiction, or, as we are now calling it, the Benefits of Stopping/Cutting Back. Start again in a general way: What is it that I dislike about this substance or activity? How does it harm me? What am I afraid my life would be like if I continue to engage in this behavior?
Here are some specific questions to ask.
If I stopped or cut back:
There are many other specific questions that could be asked, depending on the addiction involved. Once you have listed all the benefits of stopping or cutting back, review the list with several more questions in mind: If I stop or cut back, can I actually get these benefits (or do others merely say I will)? Could I get them even if I continued to use or act as I am currently? How important are these benefits to me?
Now compare the two lists. As you compare them, what conclusions do you draw?
For many individuals, the answers to the above questions are clear, and they are ready to push ahead to learning about how to cope with the addiction, or they are confident (and have good reasons to be) that the benefits of their addiction outweigh the costs. For others, these questions may create more confusion than clarity. The resolution of that confusion may require more thought, and discussion with trusted others, including your psychotherapist.
How Do I Cope With An Addiction?
Let us assume that you have decided, at least for the time being, to stop or cut back your addictive behavior. In either case, you are now faced with several problems:
Here are some guidelines for each of these problems:
In addition to helping yourself get the Benefits of Stopping/Cutting Back by developing new habits, this is also a time to consider what is most important for you to experience in the finite but uncertain period that is your lifetime. There is no better time than now to begin moving toward what is most important. As you take small steps toward your ultimate goals - and there is rarely any other way than by small steps - you will also be building positive addictions, and safeguarding against the return of negative addictions. How could a negative addiction again take hold if I am actually pursuing what is most important to me?
Just in case this last question confuses you, consider the difference between means and ends. If someone states that "what is most important to me is using heroin", follow-up questions will reveal that using heroin is actually a means to an end, such as "feeling calm and at peace". It is the feeling calm and at peace that is most important, not the heroin use, and the heroin user can discover ways to accomplish that end by other less costly means. It is not the end that is the problem, but the means. In fact, all of us (including every addict) should give himself or herself credit for pursuing noble ends, and get to work on finding better means.
Thus, this question could be rephrased, how could it happen that a more costly way of getting what I truly want could actually replace a less costly way? Perhaps the only way this could occur is if you believed that your addiction were the only way, or the fastest way, or the only way for you to achieve your goal. With luck you are recognizing that such a belief is highly questionable.
Do I Need To Stop Completely or Could I Just Cut Back?
Just as only you can decide whether one of your addictions is positive or negative, and how much so, only you can decide whether the best way to cope with the problems of a negative addiction is abstinence or moderation. Because the methods of accomplishing either goal are similar, they have not been differentiated thus far in this article, but you may have had the question much on your mind as you were reading.
A common sense approach to the problem of "overdoing it" would be simply to moderate the behavior and cope with the negative consequences (if eating dessert every night makes me fat, I'll only eat it on the weekends, and I'll exercise more). The rationale would be that, in this manner, you could still enjoy the behavior, without suffering the more serious negative consequences. Although, for many years, many have suggested that moderation is not an appropriate goal for someone who is "addicted", there are not widely accepted guidelines for how bad a problem must be for it to be called an addiction. Furthermore, some individuals who by some definitions are considered addicted are nevertheless able to moderate their behavior, and some addictions are of necessity approachable only with a moderation approach (e.g., eating, spending). Consequently, common sense, experience, and necessity (a compelling combination) suggest that moderation be considered.
The following guidelines may help you in your decision. The most crucial factor in adopting moderation, as a goal is whether you can actually do it. Relabeling your out of control behavior as "moderation", but not changing it, does not improve your life. Cutting back for a period of time, but gradually resuming former patterns, is only momentary improvement. Are you moderating most of the time, but still having binges which are very costly, but easy to ignore and rationalize because they are not in a fixed pattern? Any attempt at moderation remains an experiment for as long a period of time as is needed to conclude that danger is past. Because you could never conclude this with certainty (although if it is working, you would have increasingly higher levels of confidence), moderation should always be open to review. No matter how successful you were, there would always be some risk that you would engage in some degree of denial, and slip back to non-moderate behavior. Because such non-moderate behavior could lead to death or ruin, such a risk should not be taken lightly.
If you seem to be having success with moderation, at what price is it? Do you frequently need to cope with strong urges, such that you are wasting significant time and energy on them? Is your substance or activity preoccupying you, in ways other than urges, nevertheless? Are you still experiencing substantial negative consequences, just at a slower rate (e.g., the drinker who is killing off his liver at the rate of 3% a year instead of 5%)?
Because there is no benefit of a negative addiction that cannot be obtained or approximated by another method (which, with proper practice and coaching you could learn), the safest decision remains abstinence, because over the long run you would lose nothing or little by it, whereas with moderation there remains the danger of runaway addictive behavior. However, abstinence can require a greater expense of time and effort up front, if many new skills need to be learned. This expense understandably deters many individuals. However, over the long run abstinence may be "cheaper", because the cost is at the beginning, and the maintenance expense and risk are low thereafter.
If moderation is your goal (actually a sub-goal or means to the larger goal of getting the Benefits of Stopping/Cutting Back), then you may need specific guidance on what moderation for your addiction would be. For instance, up to one drink an hour, up to three drinks a day, up to four days per week, is one definition of moderate drinking. Beyond this amount you would to some extent be losing the Benefits you desire.
Am I Someone Who Has No Choice?
Do I Have To Quit?
There is no one who has to quit an addictive behavior. There may be many benefits to your quitting, it may be quite unintelligent of you not to quit, and your behavior may kill you or ruin you or lead to your imprisonment if you do not, but it remains quite possible for you to continue on (just as many before you have done - even in prison!). Only you can make this decision, and presumably you will do so by examining the benefits of the addictive behavior and the benefits of stopping or cutting back.
If you accept the notion that you are someone who cannot do this, who has to stop, you are very likely setting yourself up to feel angry, resentful, left out, frustrated, like you are missing out, depressed, irritated, bored, and so forth. If you are already using your addictive behavior to cope with various negative feelings, you may use it to cope with these also. To prevent these feelings, it is better to tell yourself what is really true, that you can do this activity or use this substance. The crucial question is whether you truly want to.
Others may tell you that you have to stop, or that you are the kind of person who has to stop. Despite a poor choice of words, they are actually attempting to express their concern for you, and their fear that you are denying the extent of your problems. Unwittingly, they may be creating more problems for you, because most of us react to being forced (boxed in, railroaded, not given a choice) by attempting to prove that we do have a choice. Unfortunately, this reaction leads back to more addictive behavior, which may not be what you truly want. One expression for this kind of behavior is "cutting off your nose to spite your face".
If someone insists that you have to stop, ask for the observations on which this conclusion is based. You can disagree with the conclusion but still learn a great deal from the observations.
You do not need to accept any label that anyone, including this author, suggests to you. If someone asks if you are an addict (or some other term), you can simply say "No, I just thought y life would be better if I stopped (cut back), so I did". If offered your substance or activity by someone, you might in all sincerity reply: "No thanks, I enjoy it too much!"
Do I Need To Attend Group Meetings?
Alcoholics Anonymous (AA) was founded over 50 years ago as a fellowship of individuals with alcohol problems. Through fellowship with one another, and spiritual re-awakening, abstinence was believed to be possible. The AA approach has been beneficial, in one way or another, to millions of individuals. The Twelve Steps (or principles) of AA have been adapted to groups serving most of the major addictions (Cocaine Anonymous, Overeaters Anonymous, Narcotics Anonymous, Debtors Anonymous, etc.). All groups are free of charge, and most are widely available.
Twelve Step groups for substance addictions encourage abstinence from all mood-altering chemicals except caffeine and nicotine. Twelve Step groups for activity addictions encourage abstinence from the activity. Overeaters Anonymous differentiates normal eating from overeating, and encourages abstinence from overeating. Twelve Step groups view addictions as diseases. The central premise of the disease concept (or disease model) of addiction is a paradox: the addict has no control over the addiction, except through complete control by abstinence. From the disease model point of view, moderation of addictive behavior is an unrealistic goal for a true addict.
The available scientific evidence on the question of "loss of control" provides very little support for the disease model. There are many anecdotes that appear to support the disease model, but anecdotes represent a very low level of scientific evidence, and appearances are not always realities. An excellent review of this question (for alcohol) is provided in Heavy drinking: The myth of alcoholism as a disease, by Herbert Fingarette, published in 1988 by the University of California Press. This short but well referenced volume is intended for the general reader.
An alternative approach to addiction is outlined in this article. This alternative model does not yet have a widely accepted name (cognitive model, social learning model, relapse prevention model), but there is already a significant body of research supporting its premises and effectiveness. In this alternative model addiction is considered a bad habit, not a disease. Moderation can be an acceptable goal.
Belief in a "higher power" (another central concept of Twelve Step groups) is neither encouraged nor discouraged: You don't need to go that high to solve the problem! Self-reliance, not reliance on a higher power, is emphasized. The concepts and techniques outlined above can help you build upon the good habits you already have, until the negative consequences of the addiction are resolved.
Perhaps most importantly, an all-or-none approach is not employed in this alternative model. If there are slips along the way, it does not mean that you have lost everything and must start again at the beginning. The slip that has occurred may only be a sign that you have pushed yourself to face a new level of challenge, and somewhat misjudged the challenge or your skill level. This is not written to encourage slips, but to help you recognize that they can be a part of learning. If a slip seems to indicate that your approach is not working, this too is learning, and suggests finding a new approach, or getting more coaching. Over the long term, success is obtained if you prevent slips from becoming total relapse. If a relapse does occur, re-commit yourself to your goal.
Some individuals will not attend Twelve Step meetings because of fears regarding confidentiality, dislike of groups, disagreement with the disease model, lack of belief in a higher power, or other reasons. Nevertheless, these groups may represent an important resource for you. One can accept the social support without necessarily agreeing with all of the concepts presented. It can also be very encouraging to observe others who have coped successfully with a problem you may still be struggling with.
What If I Don't Have Enough Willpower?
There are two main components to accomplishing any task: knowing what to do, and being motivated to do it. Reviewing the Benefits of Stopping/Cutting Back will remind you of your motivation.
However, being motivated is not enough. No matter how motivated you are you cannot perform a skill you have not learned. Practicing the techniques suggested here, and getting the coaching you need, will eventually get you skilled enough to be able to cope with urges and with any other problems relevant to your addiction. Although there may be slips along the way, each slip is an opportunity to identify and learn better coping skills.
You probably know someone who wants to have a skill you already have, but who does not practice it sufficiently, or who stubbornly refuses to take guidance from those who know more.
You may observe this behavior and think: If he (she) would just work at it harder, or be more open to suggestion, eventually success would occur; not to do so is self-defeating. Are you any different?
What Key Ideas Do I Need To Remember?
If, after careful consideration, you have decided that the benefits of stopping or cutting back on a substance or activity outweigh the benefits of engaging in that behavior, then you may have one or more problems to solve, such as maintaining motivation, coping with urges, coping with underlying and predisposing problems, replacing the pleasure of the former behavior, changing unconscious habit patterns, coping with problems left over from previous behavior, and developing a lifestyle of positive addiction. With practice and good coaching, and a continued focus on the benefits, you will obtain by changing your behavior; you can learn the skills necessary to solve these problems, even if at times your progress is not smooth or continuous. In this way, you can move forward to new and greater pleasures and benefits in life, rather than being stuck in repetitive and harmful behavior patterns.
More by : Smitha Chakravarthula