Addiction as Feeling Management

In my previous blog, I said that I would talk more about addiction and why some people become addicts, when most people don’t. I have spent many years working with people who had problems with addiction and many of them talked about how difficult it was to manage abstinence from alcohol or drug use when there was so much of it around. Admitted, staying away from your drug of choice is a good idea during early days of recovery, but it is not possible indefinitely. Recovery from addiction, like all types of therapeutic work is about changing yourself, not the world. We can all feel well, or even great under perfect conditions. We also all know that life is not like that.

The so-called ‘self-medication’ theory of addiction suggests that some people are more vulnerable than others to needing outside sources to help them manage difficult or painful feelings. This theory identifies that the drug of choice selected is one that best manages aspects of the addicted person that they find most difficult to manage themselves. They are drawn to a drug that fills a deficit that they feel within themselves. Opiates, for example, have anti-aggressive properties, so heroin addicts tend to be those who struggle to manage their feelings of rage. A heroin addict in recovery told me that heroin feels like a “warm hug from a loving mother”. It’s easy to see how appealing that could be and how difficult it is to feel rage when that is happening. Cocaine misuse is favoured by those with depression or (ironically) hyperactivity. People who feel bored, empty or that life is meaningless are drawn to these and other stimulants. Those who feel restricted or inhibited are drawn to alcohol or sedatives and people with chronic anxiety are more likely to misuse benzodiazepines (Valium, Xanax etc).

As with all things, the issue is surely one of degree. Everyone feels bored sometimes, or anxious or any of the other feelings that I have described. Not everyone becomes an addict. For some, the all-pervading sense that there is no way to escape these feelings is where the vulnerability lies. Other factors will play a part, but the self-medication theory offers a useful insight into why some people can act is such self-destructive ways. Drug or alcohol use is not about seeking pleasure, it is about providing relief from painful feelings. This has strong implications for treatment, which I will look at in a future blog.

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