Ask 'them' what they Need
Within mental health and addiction, there is a long history of obsessing over what is wrong with people. Maybe it’s bad biology, damaged brains, or bad character and if we could just find the elusive bad gene, we might develop a better pill or a medical device to make them better, more productive citizens. Hmmm. That agenda has not worked out so well.
These messages have been funneled to the public over generations. Despite all the anti-stigma slogans, we have been taught to fear others diagnosed with mental illness as unpredictable strangers who might lose control and harm us at anytime. We must keep our distance because only experts can offer them help. When it comes to addiction, this same undercurrent of hidden madness is present, yet another vital judgement is added: They are doing it to themselves. We are taught that addicted people are manipulative, connivers under the devil’s spell who must repent and mend their ways. They can’t be trusted.
If these medical and religious superstitions were put on hold for a moment, though, and we engage people as people first, many of us come away with an entirely different view. We might hear that the things they need are very familiar and taken for granted by the rest of us. They might tell us that they need physical and emotional safety, meaningful activity, and know that they have a worthwhile place at the table with the rest of us. Instead of wondering what is wrong with ‘them’, take a moment, extend a hand and ask these children, men, and women what they need.
After all, strangers are just fellow travelers who we don’t know yet.
Addiction: What about those Brains?
Addiction – What about those brains?
For nearly three decades brain researchers have promised to explain all human behaviour and provide solutions for everyone to have better lives. While we have incredible detail about how brains work, we are still awaiting the answers. At the same time, other researchers have placed traumatic life experiences near the top of the list in accounting for mental distress in all its forms as well as some chronic physical illnesses.[i]
This tug of war between biological explanations and social ones pervades the mental health world, especially in addiction. The popular explanation of addiction (based primarily on animal research) is dopamine gone awry[ii] to account for preoccupation, cravings, urges, and the dysphoria that comes after stopping: If we could just better manage dopamine, all would be well with our lives. This mechanistic explanation does not tell us why some people become addicted, while others do not, why people in long-term recovery return to alcohol or drug use, or how it is that formerly addicted people seem capable of returning to controlled use of substances or other preoccupations. We have no accounting for human intention and expectations.
Part of the answer seems to come from developmental and trauma research. We know that most people who end up in addiction treatment programs experienced abuses and neglect early in their lives.[iii] Addiction counsellors, social workers, and therapists have known this for decades, but it does not mean that trauma causes addiction, either. These patients learned to suppress the emotional aftermath of things they experienced and they sought out other ways to alter their worlds. They also learned that virtually nobody could be trusted and that they were on their own in an unpredictable, unsafe world.
Why is this important? When they find an experience that captivates them and calms vigilance, they grasp it tightly. Whether it is alcohol, cannabis, food, nicotine, sex, gaming, romantic relationships, each one provides a centering structure for their lives.[iv] Each one is an absorbing experience that offers a sense of control without becoming upset over memories of bad things or unmet longing. They can exist in an alternate world. This is an incredibly powerful incentive to continue the behaviour despite mounting negative consequences. The fear among those deemed addicted, and there is usually incredible fear, is that if they stop, they will be doomed to emptiness with nothing to look forward to or excite them. For those who are marginalized – the forgotten ones – addiction is a needed buffer against the intolerable.
I have worked in addiction and trauma for over 30 years treating people from the streets, those existing in our glass towers, and everybody else in between. I have witnessed this dilemma replay thousands of times. These men and women are not bad people or brain disordered people. For the most part they are isolated, self-critical, and lost people trying to find a place in the world and searching for something else to capture their imaginations and provide structure to their lives.
They are searching for something else to love[v]; something or someone that will absorb them completely.
[i] Felitti, V. J. (2002). The relation between adverse childhood experiences and adult health: Turning gold into lead. The Permanente Journal, 6(1),44–47. Felitti, V. J., & Anda, R. F. (2010). The relationship of adverse
childhood experiences to adult health, well-being, social function, and healthcare, In R. Lanius, E.
Vermetten, & C. Pain (Eds.). The impact of early life trauma on health and disease: The hidden
epidemic, (pp. 77-87). Cambridge University Press, UK.
[ii] Solinas, M., Belujon, P., Fernagut, P. O., Jaber, M. et al. (2019). Dopamine and addiction: What have we learned from 40 years of research. J Neural Transm (Vienna), 126(4), 481-516. doi: 10.1007/s00702-018-1957-2.
[iii] Padykula, N., & Conklin, P. (2010). The self-regulation model of attachment, trauma, and addiction,
Journal of Clinical Social Work, 38, 351–360. https://doi.org/10.1007/s10615-009-0204-6.
[iv] Dodes, L. M. (2002). The heart of addiction: A new approach to understanding and managing alcoholism and other addictive behaviors. New York: HarperCollins.
[v] Peele, S., & Brody, A. (1975). Love and addiction. Taplinger, New York.