Which Comes First, the Substance or the Addiction?

Which Comes First, the Substance or the Addiction?

Posted on October 13th, 2015
Posted in Articles

Substances themselves aren’t addictive, Gabor Maté, MD, said in his bestselling book In the Realm of Hungry Ghosts. “In the final analysis,” he wrote, “it’s not the activity or object that defines the addiction, but our relationship to whatever is the external focus of our attention or behavior.”

For example, Dr. Maté explained that one person can drink alcohol and not become a habitual drinker. He defines an addiction as “any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life or the lives of others.”

The National Institute on Drug Abuse likewise points to the complicated and unpredictable nature of drug addiction. “No single factor can predict whether a person will become addicted to drugs,” says a fact sheet from the agency. “Risk for addiction is influenced by a combination of factors that include individual biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction.”

Cross addictions, or trading one addiction for another, are common because the brain and body might have become accustomed to the flow of neurotransmitters that activate the reward circuit in the limbic system and lead it to crave higher levels of pleasure. When one engages in specific behaviors, such as gambling, shopping or ingesting substances, these substances are released. When a tolerance has developed, the brain seeks higher levels of stimulation.

Even in a person dedicated to recovery, the absence of a particular drug or behavior leaves a vacancy for another. For example, a client in an outpatient drug rehab might put down the bottle, only to hit the casino and lose a few thousand dollars. Or another person might give up a heroin habit but spend hours a day hunched over a computer indulging in Internet pornography.

Meeting a Need

Dr. Maté has compared his shopping compulsion to the extreme and life threatening addictions of the clients he treated for 12 years in a Vancouver clinic. Although, his habit of dropping a few hundred dollars a visit at his local record store might seem clean and safe compared to actions among his patients such as shooting heroin with re-used needles or swallowing someone else’s cheeked and expectorated methadone, he said the process within the brain is the same.

Quite simply, the addiction meets a need. People who experience addiction often desire to mask or ameliorate some type of physical or emotional pain. When they indulge, the body or mind feels temporary relief or some other perceived beneficial response. With each episode of partaking, the pattern begins to set, much like thread woven through a loom.

Addiction to Achieving

A professional woman with workaholism feels an adrenaline rush when she accomplishes everything and then some on her to-do list. She stays up to work despite fatigue. She’s spurred on by feedback from people who notice her achievements. She eagerly anticipates starting work each day, awakening early to begin. She multitasks with ease. Even on holidays, she spends time doing some of the tasks involved in her job. She identifies as her livelihood, even as she’s aware of her patterns. She too is held captive, as surely as Dr. Mate’s patients, even though she doesn’t drink, smoke or use drugs.

The pattern was formed in her childhood with parents who were accomplished and hard working. Although it wasn’t verbalized, she internalized the expectation to be the same. She measured her worth in kudos and nods of approval, as well as good grades. When her performance was less than stellar, she was her harshest critic. She had learned how to bask in the spotlight at an early age. A cycle was created as she adapted to the needs of others to continue the flow of positive feedback. Thus was born a second addiction: codependence. She developed the skills of “reading” others to determine what they wanted and meeting their needs before they voiced them.

Her recovery involves daily introspection and self-evaluation. She incorporates the principles of 12-step programs into her daily life and has accountability partners who encourage her to address her problematic habits when they arise. Admitting to feeling anxiety and frustration when she’s prevented in some way from doing her work, she seeks healthy means of addressing these setbacks. Moderation is an important goal for her.

A Wellness Toolbox

Regardless of your relationship with a particular process or substance, there are many tools to help you make healthier choices:

  • The Cassava app, launched by Elements Behavioral Health, allows users to locate support meetings, log their emotional states and receive inspirational messages.
  • Meditation has been found to help practitioners more reasonably evaluate everyday situations, and it also can minimize anxiety and stress — both triggers for relapse.
  • Spending time in nature — breathing in fresh air, walking barefoot in the grass, dipping toes in the water, digging in the dirt and basking in the sunshine — can have restorative properties.
  • Enjoying the company of sober kindred spirits reinforces the idea that it’s possible to have fun sans substance.

By Edie Weinstein, LSW
Follow Edie on Twitter at @EdieWeinstein1

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