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Addiction Isn’t About Substances

Here’s what it really is


The descent into substance use disorder is a lonely path to a dark place of isolation, disconnection and desperation. Words cannot accurately capture, convey or contain the level of pain felt by those of us so afflicted.

It can be easy to look at someone with a substance use disorder and make a snap judgment that their maladaptive overconsumption of substances is the source of all of their problems.

What many don’t realize is that substance use is often just a presenting symptom.

Presenting symptom of what? Pick a card, any card.

It could be an ever-churning molten soup of intrusive anxiety and worries about the future.

It could be the heavy, crushing pressure of hate turned inward (also known as depression).

Possibly, the constriction of our future to a narrow frame of the hopeless misery we see before us.

Maybe a harsh internal self-critic convincing us we are never enough.

Often, it’s deep, festering wounds of trauma, abuse and invalidation that travel with us everywhere we go — always waiting to be activated by others.

What Problematic Substance Use Is

Substance use is an easy, in many cases socially sanctioned, shortcut to avoid the internal desperation that can consume our minds.

In the recovery world, we call them “mood and mind-altering substances” for a reason. They are a cheap exit out of any internal distress that we cannot tolerate or do not want to experience.

I’m a therapist at a very well-known substance use disorder treatment center and work with individuals in early, often days-old, recovery. And, as someone in recovery myself, I can confirm that problematic substance use is typically an attempt to medicate away whatever our internal distress might be.

Depression, anxiety, low self-esteem, OCD, PTSD, difficulty connecting with others, overwhelming feelings of shame, childhood trauma, self-appraisals of inadequacy, fear of social settings, hopelessness, disconnection from our authentic self, or a loss of meaning and purpose. It could be any of these.

For each of us in recovery, the notes may be different but the music is the same.

We used to feel good. Then we used to avoid feeling bad. And, finally, some of us needed to use to avoid withdrawal symptoms, which are terrifying by the way.

Why Stopping Is Difficult

The avoidance of pain is a core reason that recovery is such a challenge and relapse rates are so high (40–60% according to NIDA, but my experience suggests a much higher rate).

Individuals in recovery must contend with psychological and physiological cravings and obsessive, intrusive urges that demand our attention and make our skin itch.

Addiction also rewires the neurocircuitry of your brain in a way that prioritizes the pleasure of substance use over social connection, thoughtful decision making and even the motivation to seek basic needs for human life (food, shelter, safety).

But below those observable layers, the substances enable us to block out whatever we are trying to avoid. When we remove those substances, those in recovery now must tolerate and process exactly what they have been trying to avoid.

And we now must experience that stressor with clarity of mind, in jarringly vivid detail and with the raw, overwhelming emotions that have been numbed out for decades. One of my clients has described early recovery as “living in technicolor.”

Not only must the full pain of the stressor be experienced, but it must be perceived without what has, in many cases, been the only coping mechanism in their toolbox.

Here’s just one example of what the underlying challenges could be and how they could impact the overall person:

Imagine a child whose father was full of rage, regularly became violent when drinking and physically abused their mother. When she shut down and dissociated to protect herself, the father turned his violence on the child.

Growing up in an unstable and unsafe environment is terrifying for a powerless child. It is an experience that shapes the way that child will perceive and interact with the world. Some will adapt by shutting down, others will lash out in angry and others still will learn to people please.

The child can internalize the belief that the world is a chaotic and unforgiving place, that relationships with others are dangerous, that no one should be trusted. The experience can literally be imprinted upon the nervous system in a way that prevents us from effectively self-regulating high arousal states (fear, anger, anxiety)

To compensate, that child learned to self-sooth and regulate their emotions with alcohol. In adulthood, the substance was a solution — until it became a compulsive, self-destructive reliance. Now, when that adult stops drinking, they can be regularly triggered and relive that experience over and over in the form of panic attacks, nightmares and flashbacks.

That sadly common experience contains a lot more than just problematic substance use. The substance is only the tip of the iceberg, and the part hidden below the surface is what catches the current of life.

When that child then experiences invalidation, belittling, bullying or indifference in adulthood, their trauma can heavily influence what they perceive (a repetition of the childhood trauma), how they feel (emotionally dysregulated), how they react socially (fight/flight/shutdown) and how they react physiologically (elevated blood pressure, heartbeat, blood pressure, hyper-aroused nervous system).

Help combat the stigma

Alongside that internal, invisible stressor they are trying to avoid, those in recovery must also contend with the stigma of addiction. While the stigma has slightly weakened in recent years, it is still ever-present. Those in recovery regularly feel judged by others.

Sometimes they are directly judged by family members, friends and colleagues: “You know drinking is destroying your life — so why can’t you just stop? Why can’t you make smart choices and control it like everyone else?”

In my experience, the social stigma is so pervasive that many individuals have internalized it and judge themselves as deficient and defective. I hear it all the time in the therapy group I run. The self-criticism, shame and self-loathing of my clients is profound.

We all can do a better job of bringing nonjudgmental compassion for people in recovery. It can help to keep in mind the potential depth of their pain.

This empathic stance can be particularly challenging for family and friends whose lives have been disrupted by the behavior of individuals during the active use period.

When people admit that they have a problem, accept responsibility for the consequences of their actions and are legitimately trying to change, try to give them a little patience and a little grace. Also, try to remember that the level of anger you may feel toward them is often amplified internally in the form of shame and self-loathing.

Support from family members and friends can help those in recovery maintain their commitment to the path of recovery and lower the risk of relapse.

Ultimately, we all can treat those in recovery like the human beings we are.

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