Substance Misuse and Addictive Disorders (APA, DSM 5) describe all disorders of addictive behaviours related to substances or activities such as gambling or shopping. Addiction is characterised by a repetitive engagement in a behaviour in a compulsive way, i.e. not being able to stop it, despite detrimental consequences, for example to health or finances.
Addiction can often occur in combination with feelings of anxiety, depression, or obsessive-compulsive behaviour, and is for many people a way of trying to manage those conditions and to maintain social functioning.
Addiction is also very often accompanied by feelings of guilt and shame, about the damage one is inflicting on self or others, and about the feeling of being out of control, and not being able to stop at will.
This can be exacerbated by a general discourse in society of addiction as a ‘weakness’, due to a lack of ‘willpower’. Also, it can be even further exacerbated if societal discourse views any ‘mental health issues’ in the same way, creating negative stigma. Often, people feel then a lot of shame, and continue in cycles of attempting to control their problem, and hiding it from others, respectively.
From a psychotherapy perspective, this does not have to be so.
Addictive behaviours would be viewed as an attempt to manage distressing underlying feelings, such as depression or anxiety, low self-esteem or shyness, or to cope with performance pressure. These feelings usually exist for a reason: for example, they can be the result of social loneliness and isolation, work pressure or lack of praise and meaning at work, financial worries, relationship worries, or social experiences of social exclusion or marginalisation, to name but a few (Flores, 2011; Mate, 2018).
The reason for persistent negative feelings, and a lack of ability to regulate them, can also lie in the past. There is accumulating evidence that experiences of childhood abuse and neglect correlate with addictive behaviours in adulthood (Van der Kolk, 2014; Felitti et al, 2008; ACE). Addictive behaviours are therefore also being linked to experiences of trauma, in form of PTSD, or childhood trauma (Cozolino, 2010; Flores, 2011; van der Kolk, 2014).
Importantly, there does not need to be an immediately obvious past experience of trauma, and many people struggling with addiction remember a happy childhood. However, upon exploration in therapy, complex interconnections of relationships, thoughts and feelings often surface, shedding new light on behaviours which seemed irrational before. This can also be at the root of ‘intergenerational transmission’ of addiction, where addiction seems to run in families (Ruppert, 2013; Cohen & Weegman, 2002).
Psychotherapy can help by providing a safe, confidential space in which addictive behaviours and connected feelings can be explored. Often, once deeper truths are acknowledged, alternative solutions to addiction can be found.
There are also self-help groups available which many people find helpful, and which can also be attended alongside therapy, for example:
www.alcoholics-anonymous.org.uk
www.uk-na.org
www.coda-uk.com
References:
Cozolino, L. (2010) The Neuroscience of Psychotherapy: Healing the Social Brain. New York: Norton & Company.
Cohen, R. & Weegman, M. (2002) The Psychodynamics of Addiction. London: Whurr.
Flores, P. J. (2011) Addiction as an Attachment Disorder. UK: Tantor & Blackstone.
Mate, G. (2018) In the Realm of Hungry Ghosts: Close Encounters with Addiction. London: Vermillion.
Ruppert, F. (2013) Trauma, Fear and Love. Hove: Green Balloon Publishing.
Van der Kolk, B. (2014) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. London: Penguin.