Blog

Here come two posts, the first one is more of an idea, the second a suggestion for practicing what the idea is about. My question for today: How can we (who struggle with addiction) reconcile our radically different self-narratives, some of which seem so ugly, and arrive at self-acceptance and self-compassion?

We know that self-anger, self-disgust, shame, and the accompanying frustration and depression are among the greatest challenges to overcoming addiction. We feel fragmented, made of pieces that can’t possibly fit together. We crave, we choose to use, we take care of ourselves at the expense of others, and we lie (without hesitation) to protect our habit. Yet we can’t let go of the sense that we are also good, or at least have been good. We are caring, and generous, and smart, and very often responsible. How can we possibly fit these views of ourselves together?

According to thinkers and researchers in developmental psychology and adolescent development, we just lost the game of growing up. In fact philosophers and writers down through the ages have come to the same conclusion. The main task of growing up is to create a coherent narrative about who we are. A coherent self-narrative. Yet that seems to be very difficult for addicts.

A big part of our sense of self, our identity, the “me” we show others, is in fact a narrative, a story. This is who I am. This is where I came from. This is what happened to me. That caused me to do such and such. And then this happened. And now, this is where I am, this is who I am, and — most important — this is where I’m going.

I’ve written (especially in The Biology of Desire, last chapter) about how difficult it is for addicts to create and hold onto a coherent self-narrative. I’ve suggested that addicts can be helped, or can help themselves, by solidifying that narrative and (most important) extending it into the past and the future. Because of the pull of the present moment (“now appeal” — e.g., wanting only to get high today and forgetting about tomorrow) it’s crucial to stretch the time-line. We should try to extend the narrative into the past, to understand how we got to be this way, and into the future, so we can begin to imagine being someone different, someone freer and happier, and aim ourselves there deliberately. I’ve suggested that scaffolding (by therapists, friends, loved ones) can help create and maintain this extended narrative. It’s too hard to do it alone.

But it’s damn hard to do even with the best of help! Here’s why. What most of the experts miss is that we are made up of more than one narrative. We often have two or three or four going at the same time. Psychologists sometimes talk about parallel identities: e.g., I’m a parent, but I’m also an American, or I’m also a plumber, or I’m also hot! Okay, but that stuff is easy. Multiple self-narratives are particularly challenging for addicts, because they fit together so poorly. There’s the self that often gets called the “addict self.” There’s this me who was abused, or thrown out, or traumatized in adolescence, and all I could find to feel better was this or that drug, so that’s what I go after. That’s one “addict self.” There are others that aren’t so benign. There’s the “I’m such a loser” version — very common, very hard to shake. Or its close cousin: “I’m just a teenage dirt-bag.” In other words, a piece of shit. When I (Marc, personally) was addicted, I saw myself as sneaky and determined and defiant, all of which fit into one narrative…which didn’t resolve for years.

But addicts also have self-narratives that are positive, even admirable. We may see ourselves as nurturing and compassionate, especially if we are parents (or lovers). Those are real narratives too: I had this baby and I learned to take care of her and I love her so much and I’ll continue to do anything for her. We may have self-narratives in which we are heroes or rebels, not beholden to others. Or simply victims.

The point is that these narrative threads really don’t cohere. They don’t jibe, they don’t reconcile. They are just too different to blend into a single story line. So we get torn apart by the tension between one self-narrative and another. From an email I recently received: How can I have gone back to meth, when I know that I’ll never get custody of my child now! Not ever! I hate myself so much. Or: How can I steal money from my own mother and still see myself as loving her and caring for her?! How can I be worthy of being drug-free when I’m so indulgent, so weak?! These stories cannot be merged. They are too discrepant.

So here’s what I want to suggest. Bump up a level. Recognize that you do contain distinct, incompatible self-narratives. Create an uber-narrative that allows for each component narrative and doesn’t have to shut any of them down. Now you can let yourself get to know each of these self-narratives. Make each one conscious, talk it out, recount the plot-line, to yourself or others, write about it. But realize that they will not blend into one nice story. Bump up a level to a more insightful, wiser self who recognizes each of these radically different story lines as real…and lets them coexist.

Try it. Pull yourself up to the level of the overseer. Be a real author, a real choreographer, who can shift from one plot-line to another and accept that they are not ready to be stitched together. Not yet.

I think there are at least two benefits to be had. Number 1: When you stop trying to reconcile your “addict self” with, say, your “caring self,” you release yourself from an enormous amount of tension and frustration. You are both of these. Accept them both. Number 2: By accepting each of these self-narratives as real and maybe even inevitable, and by making them conscious, you provide a space for true self-acceptance. Self-compassion. Even self-love.

………..

Next post: how this “retelling” might relate to that squishy idea we hear so much about — mindfulness.

I seem to have become a movie critic.  A month ago I posted on Ben is Back and yesterday I watched A Beautiful Boy on a flight home from San Francisco. And what I get at the end of each movie is a big fat nothing. There is no conclusion, no understanding, no ground from which to move forward.

With Ben is Back, there was Julia Roberts’ compelling angst, and now, with A Beautiful Boy (which I also read), we feel that intense heartbreak of a parent who can do nothing more to help. Only to keep loving…and losing…as if his son had cancer or leprosy. I guess I’m mad and that’s why my words are coming out this way. There is something fundamentally wrong in these portrayals. Yes, they get the drama, the heartbreak, the power of drug highs. They get the agonizing schism between the teen or young adult lost in drugs and the (generally divorced) parents who still love their kid intensely. All that is worthwhile and important. But what they don’t get is the experience. They don’t even try to approximate, to estimate, to guess at what these young drug addicts are experiencing (other than deep sighs and stretches and rapturous smiles). Why is this so opaque?

I mean, if we can create film after film about the Vietnam War and experience the shame, guilt, and horror of soldiers watching their friends die and their deepest values twisted inside out, why can’t we even come close to portraying — not what the parent is feeling — yes, that’s important too — but what the young addict is experiencing? What could be more dramatic than that? (And isn’t that supposed to be the crisis of our time?)

With Ben and Nic, there are plenty of scenes that broadcast, almost prostitute, the sense of shame that these young men feel about their addictions and the deep hurt they cause their parents and siblings. Okay…shame. We get that addiction confers shame, which makes it harder to stop and harder to connect. But there’s so much more that’s missing. What is it that gets these kids to go back to their dealers and using buddies and half-empty girlfriends to do it again? To throw it all away, even after a year or more of “sobriety?”

In an online interview, Nic Sheff, the “boy” on whose story the book and movie are based, describes meth as providing “the feeling I’d been looking for my whole life.” We hear that a lot in stories of hard drug use (heroin and meth), and these movies actually provide skittery sci-fi sounds suggesting that the drugs are broadcasting an irresistible homing signal. But that’s way too easy. Rather than imagine that this was our singular goal since first grade, we need to look at the cluster of feelings that we have been trying to get away from.

This word “sobriety” might be a way in. What feels so miserable about sobriety (the kind that’s required rather than chosen)? I can tell you, in case you’ve never been there. It’s the boredom, the emptiness, the contrivance, the feeling of being who you’re supposed to be…which requires leaving  behind the compelling drive to explore your own identity, choices, and consciousness. Who in Hollywood tries to portray that? The intensely creative moment of throwing out the norms and choosing, at the risk of one’s own existence, to reach for moments of awareness defined completely on one’s own terms.

There’s nothing moral or immoral about it. Taking powerful drugs can be a creative act, often with dire consequences. It’s not about the skittering sci-fi sounds of what is supposedly happening to your brain. Or the kiss of thanatos that inspired Freud and the Velvet Underground both. It’s the reach…for something so very different…from the monotony of living in our TV-tailored culture and obeying the commandments of family and love without ever having created either one. Yes, we want that. But at 18 or 20, we can’t create it. We can only rent that property from parents who settled there and established a home there. We can only copy, and please, and behave ourselves, trading our youthful energy for the security we could never find elsewhere. And guess what: that’s not enough.

So we find our own kind of creativity and culture: the powerful technology of present-day drugs and the immensely attractive inclusion of like-minded venturers…and that moment of going  back to being entirely unbound…that’s what we seek, and often find. And sometimes that’s what destroys us…and perhaps our families too. It just disappoints me hugely that all the power and skill of Hollywood has not even ventured there, not even peered under that rock…at least not lately…in the black-and-white disease-minded culture of “you’re either one of us or you’re some unfortunate mutant.” What the fuck? We can do better than that.

(I’m aware, in re-reading this, that it’s only one slant. My target here is the middle-class confusion and emptiness that often promotes drug experimentation in teens. That’s the setting in both films. Intense socioeconomic hardships can also propel drug use, as can trauma, loss, depression, and other challenges. And yes, drugs can be addictive — which is a causal force in itself. These other drivers of addiction are discussed in many other posts by me and my guest contributors.)

…by Eric Nada…

This remarkable guest post dives back into the controversy surrounding the rigidity of the 12-step approach.

………………………………..

I left 12-step involvement after 20 years of committed membership. It was surprisingly difficult. Of course, it was difficult to stop shooting heroin too — so difficult that I eventually stopped trying to stop. By then, the course of my life was almost totally dictated by my rigid attachment to the heroin itself and by my overwhelming fear of withdrawal. By the time I finally quit, 24 years ago, I was homeless, panhandling for hours a day, supplementing my begging with daily theft, and facing a mandatory prison sentence on felony distribution charges. I had attended over a dozen rehabilitation and detoxification centers but made no progress with recovery — until I begrudgingly committed myself to the 12-step program. And while this worked, at least insofar as helping me break my bond to drugs, it did so at a cost: I had to join a powerful subculture that required me to ignore key elements of my personality and my beliefs.

(See Eric’s Guest Memoir, which conveys the details of his experience.)

In the beginning, I thrived through the social connections I developed. I felt understood, and supported for the first time in years. Following this initial connection to its members, I slowly began to accept other elements of the 12-step philosophy, allowing them to influence and shape my views on the nature of addiction and, in some ways, on my approach to life.

I estimate that I spent at least 5800 hours in meetings, not to mention the hours I spent both in sponsorship and casual conversation with other members. Meetings were spent in repeated discussions extolling the validity and certainty of 12-step truth — an almost daily feedback loop of self-reinforcement. This was carried out with others who, by the very nature of selection bias, were guaranteed to agree with me. Within a year, I was thoroughly conditioned. I came to believe that I was plagued by a fixed condition that required a very particular solution — a solution that didn’t evolve and was unaffected by any personal changes I might make along the way. It’s not an exaggeration to describe the basic 12-step formula as follows: You have an unchangeable condition, X, the cure for which is Y and only Y. If you stop doing Y, you will eventually die of X.

For almost two decades I believed in and applied this formula. But as I matured and grew, expanding my understanding of the mechanics of addiction and emotional development, I couldn’t help but begin to question its certainty. Eventually, I realized that I had developed a very real dilemma which pitted my evolving instincts against my 12-step training. I found myself at a crossroad: do I trust myself or do I continue to trust the 12-step message? Ultimately, I decided to trust myself.

The program had “programmed” me and I needed deprogramming. This was actually a precarious process and one that is rarely discussed, let alone studied. Immediately upon leaving, I felt a great relief. But any positive and encouraging feelings I had were initially accompanied by feelings of guilt, shame, and self-doubt. I became aware of a deep internal message that challenged the idea of trusting myself over the 12-step dogma I had lived by for so long. Also, from deep inside came a haunting temptation: to play out the scenario of relapse and a return to out-of-control drug use, viewed as the inevitable consequence of leaving the 12-step fold. It was an established meditation practice that helped hone my awareness. Only through the use of mindfulness was I able to decipher the 12-step message and avoid its prophecy. I also spent much time online scouring the internet for stories and forums written by others who had made similar moves. It has been over three years now, and although it is no longer acutely difficult, I am still sorting out and ridding myself of the last tendrils of doubt and conditioned 12-step messaging.

We are born to be conditioned. We are, indeed, conditioned even before we are born — molded by the experiences of the woman carrying us in her womb. Without conditioning there would only be chaos. There would be no tribe or community, no culture or customs. Our human egos need these containers to make sense of and navigate daily life. But obviously not all conditioning is healthy or optimal. We need to examine and upgrade our conditioning continuously as we grow and require different versions of containment. I have never been so conditioned, obsessed, or emotionally rigid as when I was using heroin. And certainly the conditioning I developed through my 12-step membership aided in breaking through this rigidity. It was a definite upgrade. But as I continued to grow, I didn’t take regular stock of whether I was still benefiting from my 12-step involvement; because, by its own definition, the 12-step approach can’t be outgrown.

I have often heard discussions suggesting that 12-step recovery would be more effective if it weren’t so rigid, if it were truly permissible for members to come and go without judgement. But I don’t think it would work. It’s the underlying rigidity that accompanies 12-step involvement that makes it potentially effective. Unfortunately, I commonly see this hard-lined rigidity follow long-term 12-step members into other areas of their lives.

Optimal mental health is found neither in rigidity nor in chaos, but in the nuanced flexibility that lies between these poles. Recovery, too, can be nuanced. There just isn’t a one-size that fits all, and recovery needs room to evolve, especially after the initial bond between person and drug has been broken. I still have moments when I deeply want those 20 years back, to live fully, untethered from the “program” that scripted so many precious hours of my life and prescribed so many of my relationships and personal interactions. I do not condemn the 12-step approach to addiction, and there are certainly other positive components that could be discussed. But ever-present is its underlying rigidity. And as I look back at its stifling influence over half of my life, I have yet to decide whether the benefits were worth the damage.

Yesterday I watched “Ben is Back” — a recently released feature film about a heroin-addicted young man (Lucas Hedges) and his heroic and tenacious mother (Julia Roberts) who tries her best to keep him “clean.” Ben is around 20 years old (at which age I too was also shooting heroin). He scams a trip home from his residential rehab so that he can spend Christmas with his family.

Ben seems to be trying with great determination to keep away from drugs. Yet the demon of addiction is doing pushups in the parking lot, just as they warn at the 12-step meeting he attends with his mom. He finds a bag of dope in the attic, but manages to avoid taking it and gives it to his mother instead. He looks the other way when dealers and drug buddies from his former life show up magically on elevators and at car windows. He bravely endures the cultural ambiguity of an American Christmas and tries his best to connect with his sibs and step-sibs. He’s a good guy, and he fights the good fight, but…well I don’t want to spoil it in case you decide to watch it.

I thought it was a pretty good movie (I love Julia Roberts) with a half-assed ending, but there were a few impressions I want to share with you — impressions that epitomize a lot of what’s wrong with the mainstream perception of drug addiction.

Although the subtext of the movie is clearly the overdose epidemic, there is hardly a wave at the real causes of overdose deaths: fentanyl in street drugs, drug/alcohol/drug interactions among pharmaceutical users, and impediments to getting methadone or suboxone when needed. (However, to its credit, the film provides a snapshot of the lunacy of pharmacies unwilling to dispense naloxone.) See Maia Szalavitz’s excellent synopsis of what we’re thinking and doing wrong.

Instead, the usual “Reader’s Digest” simplifications are offered. For example, Mom meets the doctor who first prescribed pain pills, which got Ben “hooked” years ago, and says she hopes he dies a horrible death. We know that the OxyContin surge in the 80’s and 90’s did increase exposure to opiates and fueled increased rates of addiction. But to continue to blame doctors is insane. As Maia Szalavitz (and I) have made clear with arguments and statistics, doctors aren’t the problem, and the result of blaming them is the cutback of pain meds for people who really need them, while driving addicts to the street — to heroin that’s laced or replaced with fentanyl.

The 12-step presence is portrayed somewhat accurately. Both the good (fellowship, honesty, and mutual respect) and the not-so-good (brain washing, propaganda, and the all-or-none trappings of the disease model) correspond well enough with reality.

There is some recognition that addicts have choices. Ben fights his impulses bravely, and he makes sensible choices to avoid contact with the people and places that serve as triggers. And yet there is this creepy sense of fatalism sneaking up on Ben and other addicts. As though whatever choices they think they’re making, they’re bound to succumb. By the way, addiction isn’t referred to as “a disease” in this movie. Yet the miasma of an alien presence or infection lurks behind much of the dialogue and plot.

Junkies are portrayed as zombies. They are the opposite of clean. They’re dirty. They hover in alleyways, under bridges, around trashcans brimming with burning litter. It’s a classic and grossly overdone stereotype. When I was shooting heroin or morphine in my twenties , garbage-strewn alleys and river banks were not my preferred home away from home.

Despite the biases, stereotypes, and omissions, the movie does portray the struggle to avoid temptation rather well. And despite the Hollywood heroism and unlikely confrontations between good and evil, the plot and characters are engaging. The movie may well be worth seeing.

But here’s my biggest beef. People who take drugs are shown to be occupied by some demonic force (or disease, or what have you) that makes them another species. They are not anything like normal people. They live in a different world, they’re not to be trusted, and they ought to be sent away to residential rehabs (where they won’t infect the rest of us) until the demon is exorcised — itself a rare event. This dichotomous “us vs them” perspective is the real message of the movie.

An alternative message, which I hope you’ve encountered in my posts and the comments and guest posts of others on this blog, is that people who use drugs are so crushed by emotional confusion and pain, much of which is served up by American culture itself, that they seek and sometimes find substances and activities that help them turn down the volume of their anxiety and depression and bring a semblance of balance to their lives — what I referred to as “substance” last post. The cause of addiction can be found in mall culture itself (portrayed in the movie as a sort of heaven on earth), the rampant commercialism that sucks meaning out of day-to-day life, the often immutable stamp of privilege vs. poverty and the stultifying dead-end lives of those who don’t make the cut. Not to mention the sheer hypocrisy of a society that proclaims Christian values but rewards self-serving, self-protective priorities. I wonder if Ben was infected by these horrors rather than a magical drug high, and whether that’s what made it so hard for him to quit.

The word “substance” may have a double-meaning when it comes to addiction. The basic meaning is obvious: the substance is a chemical that we want badly and pursue relentlessly. But the second meaning of “substance” is suggested by a well-documented phenomenon: the parallel between substance addictions and behavioural addictions.

The feelings, actions, and brain changes seen with compulsive gambling, sex addiction, porn addiction, and many eating disorders (e.g., binge-eating disorder) look very similar to those seen in substance addictions. The feelings and behaviours include craving, gorging, risk-taking, reduced inhibition and compulsive repetition. The brain changes include sensitization of the dopamine system and reduced interaction between the prefrontal cortex and certain subcortical regions (in specific contexts). Because attractive drugs and attractive activities are craved and pursued in similar ways, it might not be too far-fetched to give “substance” a second meaning. The substance common to drug addictions and behavioral addictions may be the feeling of wholeness, once lost, now regained.

A substance is what fills up a space. The lack of substance equals, well, nothingness. When people talk about their addiction they often talk about a sense of profound emptiness, a psychological void, that gets filled by a something they can only get from what they’re addicted to. To replace a sense of nothingness with a sense of somethingness (what else to call it!) is more powerful than words like “pleasure,” “relief,” or “satisfaction” can possibly convey.

At first glance it seems that chemicals provide pleasure directly while certain behaviours provide pleasure through taking action, and that’s the whole story. But in real life, you need to take action to get those nice chemicals, to put them into your body, and that’s what the dopamine system is triggered by: not just reward but reward-seeking. Hundreds of studies have shown that dopamine release in the “craving centre” (the ventral striatum or nucleus accumbens) corresponds with effortful action, not with pleasure per se.

So whether we think we’re addicted to chemicals or to actions (behaviours) doesn’t much matter to the brain. Actions (like gambling) release dopamine because they are pathways to a monetary reward. Actions like shooting heroin release dopamine because they are pathways to a chemical reward. In both cases, the hook is a feeling state that springs from an action more than an outcome. To put it another way, it’s not really the heroin that you get addicted to. Heroin will bequeath satisfaction or pleasure. But what you get addicted to is the feeling of acquiring this special something: anticipating it, going after it, and getting it.

One of my favourite models of addiction (and one highly regarded in the field) is Robinson & Berridge’s theory of “incentive sensitization.” This phrase means that dopamine release in the brain (e.g., in the striatum) gets triggered, more and more predictably, by cues connected with the thing you’re addicted to. These authors specify that dopamine uptake signals wanting, not liking, a drug or other reward, and this has been a major contribution to our understanding of addiction. But to bring this understanding home, we have to clarify what incentive we’re talking about. Does “incentive” just mean urge, attraction, or motive? Just “wanting”? No, the incentive that powers addiction — what the brain gets sensitized to — is the availability of something you not only want but feel you need.

Berridge has compared this urge to the desperation of a starving animal seeking food. So it may be useful to view substance and behavioural addictions as fulfilling biological needs, or at least their psychological expression. Whether we take pills, snort powder, smoke, or inject, we are putting something into our bodies. This “inputting” is a behavioural prototype. It’s primal. It’s how we eat. In the case of binge eating, the target of the behaviour makes obvious biological sense. But perhaps all behavioural addictions relate to biological needs: e.g., winning against competitors (gambling), sexual needs (obviously sex and porn addiction), even social inclusion (internet addiction) and resource acquisition (compulsive shopping). In my book, The Biology of Desire, I make the case that addiction serves symbolic goals. For example, the warm feeling you get from opiates symbolizes the warmth that comes from being hugged or cuddled (no small matter for us mammals).

This may all sound a bit abstract. But the feeling of emptiness we (addicts) feel when we don’t have, or can’t do, or can’t get the thing we’re addicted to is very concrete, and very palpable. It’s the feeling of an empty day that can’t be filled. It’s the total eclipse of purpose, when there’s no point in doing anything. This is what I mean by the absence of substance.

Many see addiction as an attempt to repair a rupture in attachment (as in child-to-parent attachment) or care (by a parent, lover or even oneself). Certainly these are biologically-grounded needs. Gabor Maté’s study of addicts in downtown Vancouver, mostly aboriginal, mostly from foster homes, mostly abused or neglected in childhood, highlights the enormous holes in the lives of people with devastated attachment histories — holes filled by drug use. Bruce Alexander extends this idea of loss to groups cut off from their cultural roots and resources. What’s lost for these people isn’t just pleasure or relief; it isn’t just something they like or want. Rather, it’s something they feel they need. In the words of Johann Hari, it’s connection itself. People who have lost this “something” walk around with a sense of their own emptiness, and it hurts like nothing else. By filling that emptiness, a drug (or habitual behaviour) becomes the main source, maybe the only source, of the substance they have gone without.