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My blogging days may be winding down. But if they do, as they do, I want to put more energy into methods for helping beat addiction than ideas for explaining it. It’s critical to understand addiction in depth, and I still believe that linking neuroscience with lived experience provides a potent frame of reference. But lately I’ve been moving on, thinking almost exclusively about treatment. Is there a connection from brain parts to mind parts to effective methods for helping people? Let’s see.

I started this blog with an emphasis on addiction neuroscience. I can sum up most of that brain stuff in a few simple conclusions, but I’m going to add some points of clarification:

-even though brains change with addiction, addiction is not a brain disease, as often claimed. The brain changes with any and all learning, and the more emotional and repetitive the learning events, the greater and more enduring the resulting brain changes.

-habits are inscribed in synaptic networks (networks of connections among neurons). Those networks become the hardware for processing new information: “What fires together wires together.” Thus, novelty gets sidelined by habitual patterns of thought, feeling, and behaviour. That’s the case with love, politics, religion, and yes, addiction.

-the “narrowing” of synaptic networks is mirrored by a narrowing of the social world. Friends, family, finances, legal circumstances all become more limited, more “narrow,” for the person who finds fewer neural avenues for pursuing rewards. You’ve heard that life imitates art? It’s also the case that social change imitates brain change. (See my review article here.)

-the “narrowing” metaphor suggests that the connections between different brain parts become more entrenched, less open to change. But that doesn’t mean that diverse neural regions become fused in some way. The brain retains its functional components (e.g., frontal regions underlying conscious attention versus limbic structures in charge of automatic behaviour) and those components are designed to compete.

So now what? With all we know about the science and psychology of addiction, how do we put it all together? How do we help?

The neuropsychology of addiction is important! It exposes us to many critical concepts, like the biological embedding of habit formation. Yet we don’t generally treat addiction, either in ourselves or others, by altering the brain. At least not directly. We don’t perform lobotomies or lobectomies, nor is it common to use deep-brain stimulation or transcranial magnetic stimulation to help people recover. No, when it’s time to turn from thinking to helping, we turn to talk, often in the form of psychotherapy.

Talk is social behaviour. So the goal is to free up addicted people by expanding their social world, especially the social world they carry around in their minds — the way they talk to themselves, the way they interpret messages from others. At that point the neuropsychology of addiction takes a back seat, as an aid to our clinical intuitions and our capacity to listen. Once again, lived experience, both that of the client and of the therapist, becomes the needed partner for our scientific theories.

Now if both the brain and the social world “shrink” in tandem, then we should be able to “grow” the brain (the realm of synaptic possibilities) by “growing” social-psychological flexibility. How can this be achieved?

(There is one method of acting on the brain directly, bypassing all that messy talk stuff. We can give the addicted person drugs that directly affect their neurophysiology and/or how they think and feel. Antidepressants and antianxiety drugs to target underlying mood states, methadone or naltrexone to nudge drug-soaked synapses out of their ruts. But in my view, psychotherapy — if it works — goes deeper, induces changes that last longer, and provides a sense of well-being that no drug can mimic.)

I find Internal Family Systems (IFS) therapy to be the most effective form of talk therapy available. You’ve heard me rave about it over the last few posts. I’ll end today by pointing out that IFS brings to the table a fundamental experience that most addicts find exhaustingly familiar. For them (and of course I include myself) the internal social world, the voices in our heads, are most conspicuous because they are at war with each other. The internal critic tells you that your wishes and goals are reprehensible. But the childish wishes don’t go away. In fact, they get stronger, fueled by defiance against the internal critic and desperation to meet needs that are hunted down and locked away.

By recognizing this internal duality, this multiplicity of conflicting part-selves, IFS brings empathy and clinical intuition to bear on what neuroscientists already know but never think about. Brains are composed of components that are designed (by evolution) to compete with each other. Frontal inhibition (lateral prefrontal cortex) versus learned habits (striatum), future oriented action tendencies (dorsal cortical circuits) versus preoccupation with threats (ventral cortex and amygdala). These tendencies are supposed to compete. That’s what gives humans their incredible capacity for choice and intelligent action.

How did we psychologists forget that when going about devising treatment strategies?

So, here’s the breath of fresh air provided by IFS. Conventional methods of treating addiction involve training people to “just say No.” That doesn’t work. Mounds of disappointing outcome stats make that clear. Why doesn’t it work? Because it ignores the lived experience of people in addiction and it ignores the way brains actually work. In contrast, IFS trains people to listen to the voices or “parts” that occupy their minds and accept them, welcome them, soothe them, without trying to shut them down. In that sense, it respects the idea that the mind — as well as the brain — is multiple, and it is composed of competing functions.

But that’s enough for today. In my next post I want to be very explicit about the IFS alternative to “Just say No.”

 

Last post I promised to share some ideas for breaking the feedback cycle of addiction. Today I want to suggest a three-part intervention strategy for doing just that. In a nutshell, (1) tune into your emotions, (2) see what “parts” (in IFS terms) those emotions belong to, and (3) help those parts calm down and work together. Help them to understand each other rather than disrupt and hurt one another.

[Please note that I’ve revised this from its original form, posted two weeks ago — 8th November]

This little three-part exercise can be led by a therapist or coach or else pursued solo. Note that this is not classical IFS therapy (which I’m still studying). Rather, it’s a hybrid I’m playing with and continuing to explore. It’s by no means a nicely packaged and approved therapeutic system. Rather, it may point to an approach for helping people who need more direction and guidance (more “coaching”) than IFS normally provides.

Over the past year, and using IFS principles more and more, Maya and I explored the conflictual relationships among her parts. Besides Madam Z, the internal critic, and Piya, the “firefighter,” Maya’s parts included a very sad girl who could not give up her preoccupation with the tragedy of her life (which hinged on her mother’s rejection and self-denigration). Much of Maya’s internal conflict triggered excessive waves of grief and self-rebuke. It would take up too much time and space to explore these themes in a blog post. It took a lot of time to discover them in therapy. But meanwhile, Maya kept drinking large amounts of cheap wine, almost every night, wrecking her health, and reinforcing her sense of hopelessness. It seemed urgent to find an exercise that could help, with me or without me, starting now.

So this is what we came up with:

1.Tune into your feelings — your emotions — as they come and go. (Starting with deep breathing and body awareness is helpful!) This is mostly just standard Buddhist “Vipassana” meditation — the practice of paying attention to whatever arises. But it’s directed toward feelings more than perceptions, thoughts, and bodily sensations. Follow the emotions, surf them, watch them come and go, don’t think about them too much. You might expect oodles of shame and anxiety. Practice your ability to discern, because some of these emotions might be so common that they seem like background noise. There may also be streaks of unexpected emotions, such as bolts of anger when you thought you were generally “nice”. With emotions like anger and fear, which have a definite object, try to be aware of who/what that object is. Is it self or other? Stay at the surface of awareness. Don’t “go deep.” Let the emotions come to you. You don’t have to go hunting.

2. Notice that each emotion may be felt by one or more parts. Which part is revving up now? Anger might go with the harsh internal critic, but anger might also go with the defiant “fuck you” rebel part. Get a sense of which part is becoming activated. Shame probably goes with a very young part — perhaps a part that (in IFS terms) remains an exile…not fully conscious, perhaps actively shunned or rejected. Anxiety also may be felt by young “exiles” — cringing, alone, scared, helpless — or by “managers” (e.g., parts who organize, take care, or judge) when they sense that they’re losing control. These managers can also be young. (A deeper discussion of what these parts actually are has to await a later post.)

Note that anxiety will usually not be experienced by firefighters. They are more reckless, and they tend to feel excitement, desire, or triumph. Notice that parts are sometimes very stuck (unchanging); other times more fluid and perhaps even growing, evolving before your eyes. Notice how some parts reliably trigger other parts. It’s very common for the firefighter (let’s get drunk!) to trigger the internal critic (how could you?! After last night!?!). And vice versa — but that needs to be saved for a future post too.

3. The last step is to act on this internal world, i.e., to guide it as it evolves and changes. This way of framing things deviates from IFS orthodoxy, but the underlying goal and the net effect could be almost identical. Now comes the sense of being a coach…or even a parent. IFS stresses the power of the Self — “Self” with a capital “S”. That’s the part that’s not a part. The Self is viewed as a compassionate, perceptive and aware place within oneself — a centre — that recognizes and accepts the various parts along with their needs and concerns (e.g., their emotions, their goals). So, from this place, you can soothe the anxious child, comfort him or her so there won’t be so much loneliness or dread. You can also connect with the Firefighter, and coax it (in a friendly way) to relax, to look before leaping for that bottle or that pipe. You can help antagonistic parts disengage, lay down their arms for awhile. For example, judging, critical parts can be asked to back off: we can tell them we appreciate their vigilance, but they’re coming on too strong and it’s not helping (e.g., too much shame, augmenting the Firefighter’s urge to drink or take drugs).

The parts can also act on each other directly. For example, Maya’s internal critic, Madam Z, is conscientious and determined. Her eagle eye is tuned to drinking behaviour and related cues, especially late in the afternoon, and she’s full of suggestions as to how to override the urge. “Wouldn’t this be a good time to start your yoga? Stop thinking about the store’s closing hours!” Maya came to realize that Madam Z wasn’t always punitive. Sometimes she was more like an athletic coach, authoritative but supportive. And she gradually learned to use Madam Z’s industrious, exacting manner to organize her behaviour and negotiate with other parts — especially the firefighter, who only wants to drink. Wait! There’s more to do. You don’t have to start drinking now. You can drink as a reward after completing your assignment.

It seems to me (though it deviates from  IFS orthodoxy) that this internal “friendliness” can be understood as a continuum or spectrum of self-care, with soothing or compassion at one end and firmness or self-direction — let’s call it guidance — at the other end. As with good parenting, a balance is needed. IFS suggests that different parts (as well as the capital-s Self) flesh out that continuum, from one pole to the other. In fact, in the mysterious language of the internal landscape, it may be the sense of “we” that’s most beneficial. Parts often feel alone — and in that they are relatively helpless, bound by habits they’re not skillful enough to overcome. But once there’s a we involved — a source of care that’s bigger than just this present-tense state of drive, this wish, this moment — they can feel taken care of, they can feel stronger, more secure, and they can more effectively promote their own well-being.

 

People who use drugs (or drink) addictively are caught in a feedback loop. The addiction makes us feel like losers, blameworthy, perhaps worthless. We carry around this negative self-concept almost constantly — and it’s painful! Perhaps ironically, using or drinking seem the only way to relieve that pain. Yet the net result is that we feel even worse by tomorrow.

This is common knowledge in addiction circles. Yes, the thing that we are compelled to do to get relief is the thing that increases the need for that relief. In this post I want to ask what, if any, additional perspective is offered by IFS (Internal Family Systems) — to help us get out of this cycle.

If you haven’t followed my recent posts, please review, starting here, to get a sense of how IFS works.

The first and perhaps biggest step is to start a dialogue with the part of us that does the escaping. They call it the Firefighter, because its job is to put out the fire of anxiety and self-abuse, as quickly and as effectively as possible, with no regard for the mess it leaves behind. We’re used to reviling that part: that pernicious, irresponsible urge to get loaded, high, smashed. That part is almost always the object of criticism (both from ourselves and from others).

But what would it be like to offer “the firefighter” acceptance rather than scorn?

First, IFS goes looking for the source of the criticism. And there it is! It’s that familiar internal critic, whose job it is to root out and blast everything that’s wrong with us. That wasn’t hard to find. But now we’ve uncovered an internal war that seems unresolvable. Like the Arab-Israeli conflict. So let it lie for now. Let the combatants sit across from each other, the critic glaring at the Firefighter, and the Firefighter looking right back, snide and arrogant perhaps, knowing that it can win every battle, simply by smoking, shooting, snorting, swallowing pills, or drinking. Again. Tonight? Now!?

It’s no wonder people with addictions feel that their internal world is fragmented.

I have a psychotherapy client I’ll call “Maya”. Maya’s internal parts include a Firefighter (whom she calls Piya — again, a pseudonym), and “Piya” came into being (or at least into her awareness) during her reckless teenage years. She was a resident at a dance school in India. Her teachers were strict and the school had a patriarchal, top-down structure. Maya felt trapped and oppressed by all that discipline. So she’d break out at night. Wearing her sexiest clothes, with a cigarette dangling from her lips, she’d hang out with other teens on the street corner. There was drinking, and smoking, cannabis, and sex. Piya took over at night, with the express purpose of having fun, feeling free, and saying Fuck You! to the authorities that ruled Maya’s life.

Now Maya goes straight to the supermarket to buy wine, almost every afternoon, when the anxieties of her day threaten to overwhelm her. It’s Piya, once again, who’s in charge. After she comes back from the store, she goes out on her deck, with a sense of excitement and purpose, and starts drinking. She drinks and smokes cigarettes until, by late evening, she feels sick.

In our therapy, guided by IFS principles, I encourage Maya to do two things: first, notice that Piya is made to feel dirty and blameworthy by a critical voice in her own head. She calls the critical part Madam Z (…not her real made-up name. Yes, even internal voices need pseudonyms) who has the character of a strict school teacher or aunt. Madam Z has much to contribute. We don’t want to banish her. But we don’t need her badgering Piya every time she appears. The second thing is to engage with Piya, not from the perspective of Madam Z but from the perspective of Maya’s peaceful, accepting self. Her compassionate core — what IFS calls Self with a capital-S. That Self becomes more present, more tangible, when Maya takes a few minutes to do some deep breathing, to feel what it’s like simply to be inside her own body, alive and perceptive. Ironically or mysteriously, this Self may the same thing as the non-self identified by Buddhism.

When Maya addresses Piya in this way, she can empathize with her. “Of course you want to get us out of this state. Of course you’re set to take off to the store, buy some booze, and start drinking. It’s effective, it works. In fact, that’s the only thing you know how to do!”

To forgive and embrace the part that’s simply waiting for a chance to get stoned…that’s radical. It flies in the face of conventional approaches to addiction, which demand that we get rid of this part, cast it out, or at least ignore it until it finally shuts up. So what’s the result? Doesn’t that just give us permission to get stoned more often, to drink more, to fully surrender to the addictive impulse? To do more push-ups in the parking lot (an infamous 12-step slogan).

No, that’s not (necessarily) what happens. What happens is that the Firefighter gets some relief — a chance to relax. It’s not used to being accepted. It’s certainly not used to being understood. So when it perceives that that’s what’s coming down the pipe, the urge softens, the strength of the impulse or compulsion is diminished. Now that it’s not being attacked, this part can hang around and explore other options. Now there’s a chance to wait and see. Maybe tonight things aren’t so terrible. Maybe it’s not necessary to douse the flames and make a huge mess that (it knows very well) will make tomorrow even worse.

And there’s a bonus that you won’t really get until you try this approach. Using, drinking, putting out fires, real or imagined, day after day, is a lot of work. The part that rushes into this role, ready to do it all over again on a moment’s notice…that part can use a break. Sometimes, even the crazy parts of us just want to sit back, relax, and do some channel surfing, play a game, browse the net, or take a nap. In the next couple of posts I’ll explore further steps we can take to break the feedback cycle of addiction.

The concept that a person is either authentic or inauthentic (either a liar or not) is based on the premise that people have unitary, coherent personalities. In contrast,  IFS takes the view that people’s inner worlds are made up of parts, or sub-selves, each of which has its own distinct style, motives, and beliefs. Interestingly, this idea corresponds with the idea — quite familiar in psychology — that people’s fundamental attributes (e.g, racist or not, selfish vs. generous, flexible vs. rigid) vary hugely, depending on their social context — who they’re interacting with, whether they feel safe or insecure, what they feel is expected of them. Just having a trusted friend nearby can make all the difference in how one thinks, feels and behaves.

According to IFS, different parts become activated at different times, especially when triggered by painful emotions. When you feel threatened, your scared child self comes to the surface. You become hypervigilant and/or you retreat. When you feel like you’re not good enough, the critical part takes over. You become hard and punitive, maybe angry and controlling, toward yourself (selves?) and/or others.

So maybe the idea of having a unitary personality is just wrong. In which case, there’s no such thing as being an inauthentic person. Instead….there are situations in which it becomes necessary to hide stuff, and that’s when a distinct part comes online.

Instead of seeing someone (or yourself) as inauthentic, try thinking of them as being afraid of rejection, so that the part that takes over is the hiding part — the same part that hid the remains of the cookies you shouldn’t have eaten when you were a kid and mom was in a bad mood. The urge to hide one’s bad behaviour — or unattractiveness, or neediness, or aggression — is not inauthentic. It’s authentic. It’s an authentic effort to stay safe.

(Of course there are other ways to define “authentic”. If by “authentic” or “truthful” you mean someone who should be trusted, then we enter very different conceptual territory — territory defined by social contracts or rules. But if you think that simplifies matters, think again. No one can be trusted entirely, about everything; in other words, we all have secrets. In fact, most people can be trusted about some things and not others — try asking someone about their sex life or toilet habits! — which is why we often make a distinction between people’s private worlds and public worlds. So everyone lies or at least misleads…at least sometimes or about some things. And we end up at the same place: everyone hides what they fear will lead to humiliation, denigration, or rejection. Once you see this, you see that those referred to as drug addicts aren’t more or less “authentic” than anyone else.)

People with addictions are almost constantly struggling to stay safe — safe from other people’s opinions. So it’s not surprising that they try to hide the thing that will make the world even more dangerous.

In IFS terms, the hiding part is not inauthentic. It’s authentically trying to protect you. Whether that works well or not is a different matter.

 

Hello readers. Are you still out there? I haven’t gone near my blog for over two months. So no new posts, a few comments dribbling in, and of course not as many readers. Something had to give. Having to sell our house in the Netherlands, buy a house in Toronto, move goods, furniture, children, etc, from Arnhem to Toronto…all the crap you go through in moving, made so much more complicated by the pandemic, having to cancel services and contracts…in Dutch…was just overwhelming. So I took a break from non-essential duties. And that seemed to include the blog.

More than that, I wasn’t sure I had anything new to say about addiction — the science, treatment approaches…anything. I didn’t want to just recycle earlier topics. So my last post, on Internal Family Systems (IFS)  therapy for people in addiction, was looking like my last hurrah. But lately I started thinking I may have more stuff to share. IFS has changed the way I look at almost everything in psychology. It’s changed how I see emotional habits, “dysfunctional” behaviour patterns of all types, and of course the way I understand addiction. I’ve used it pretty methodically with myself — sometimes as an alternative to meditation. And it’s had a major impact on the way I practice psychotherapy.

So, moving on: the next set of posts will apply IFS theory and related ideas to our understanding of addiction — broadly — and find out where that takes us. If you haven’t read my last post — maybe take a look at that first to get the basic idea.

………………………

I was talking with my wife about how common it is for people to feel inauthentic. It’s a big issue for adolescents in particular (that’s her field — adolescent development). Teens are always trying on different styles — different clothes, ways of talking, ways of seeing themselves. Who are they? Straight, gay, or bi — meaning what? — geek or jock, reserved or outgoing, serious or casual? And as they’re trying on these new identities, they often wonder if they’re being fake or real. It’s a big issue.

For people in addiction, the problem of “authenticity” is amplified and extended. We all know that stupid riddle: How can you tell when an addict is lying? His lips are moving. Insulting, of course, but there’s something to it. We addicts do lie. We lie because we don’t think we’re okay. We know that taking drugs is frowned on, to say the least. We lie because we continue to do something that most others disapprove of. Bye mom, I’m off to score some heroin, see you later. It’s just not something you’re going to hear.

My first big lie to my parents seemed necessary. I’d just used the money they’d given me for a winter coat to buy smack. I was 18, and I was anxious, depressed, and very lonely. Heroin helped. Gradually lying became habitual. I lied to romantic partners, parents, relatives, friends, work-mates, bosses — just about everyone — when the necessity arose. Being truthful about being a drug user — seriously? — is sure to invite heaps of social rejection, scorn, contempt, and often, serious consequences for one’s lifestyle and personal safety.

So addicts (I use that word to describe, not to shame) see themselves as inauthentic or untrustworthy. It’s a self-concept we acquire almost seamlessly. That’s not a great foundation for building self-esteem, and self-esteem can be crucial for developing self-care. In fact, seeing ourselves as inauthentic amplifies the shame and self-doubt that got launched in adolescence and boosted by drug use itself. What a drag.

But what if the idea of “being inauthentic” is just wrong. Like a map from the middle ages, what if it’s just totally inaccurate?

PLEASE NOTE THAT I AM HAVING SOME TECHNICAL PROBLEMS. TO GET AROUND THEM, I’VE DIVIDED THIS POST INTO TWO HALVES, PART 1 AND PART 2.

Please see Part 2 for the rest of this discussion!