Q & A – General Addictions and Compulsions Issues
General Addictions and Compulsions Issues
Q: What is an addiction?
An addiction usually involves a substance that we have some sort of physical dependency on. We talk about being addicted to coffee, cigarettes, chocolate, alcohol, cannabis, cocaine, heroin etc. We regularly use the substance because of our belief that it improves the way we feel physically (and emotionally). We believe that we must regularly satisfy our need for the particular substance in order to change the way we feel. In other words, when we don’t get enough, we start to feel physical discomfort. For example, any readers who drink coffee every day should try not having any coffee for just one day. You will most likely experience a range of discomfort (called withdrawal symptoms) including headaches and irritability, indicating the presence of a coffee addiction.
Apart from physical withdrawal symptoms, another sign of an addiction is an increasing consumption of the substance as time goes on. We all know of people who have started smoking cigarettes by having one a day, then two, then four etc. Over time, more of the substance is needed to get the required physical result.
Some experts therefore say that it is impossible to call gambling an addiction – there are no physical needs being satisfied as there are with food, alcohol or drugs (see below for an alternative view about gambling).
Q. What is a compulsion?
A compulsion is when we have an irresistible psychological/emotional urge to do something For example, for some people gambling is a compulsion – at certain times some people have a strong need to gamble. Other people feel a compulsion to buy clothes, or to eat an ice-cream while at the movies. When this need is all the person can think about the person is also being obsessive. For example, a person may be constantly preoccupied with thinking about cleaning the house – they are obsessively thinking about cleaning. If they often respond to strong urges to clean and spend a lot of time actually cleaning, they are cleaning compulsively. A person acting compulsively feels driven to act, they have to act in response to an overwhelming urge. The urge can often be triggered by obsessive thinking, but may have other triggers as well.
Q. What is the difference between an addiction and a compulsion?
Any addiction involves a compulsion. When a person is addicted they constantly have irresistible urges that they act on. I usually tend to see an addiction as involving physical issues and a compulsion as involving psychological/ emotional issues. However the dividing line can be very blurred.
This is because addictions involve a psychological and emotional dependency as well. An addicted person thinks and feels that they need the source of their addiction. Without their addiction being satisfied the person thinks anxious thoughts and also feels very anxious. Thus in my opinion, gambling is definitely an addiction.
Dependency on gambling, internet usage, shopping can all lead to addictions because they can become a person’s primary focus on satisfying a range of psychological and emotional needs.
Q. How do people become addicted?
There are four general stages on the path to any addiction – experimental usage, recreational usage, problematic usage and addiction:
Experimental usage – this occurs when a person tries something a few times to see what the affect is – a drink, a smoke, a poker machine. The person experiments with behaviours that may be socially acceptable (eg playing cards, or shopping) or socially disapproved of (getting drunk or stoned). In particular, the more disapproved of or illegal the activity is, the more likely some people are to experiment with it.
Recreational usage –the person chooses to perform the activity more often, as part of their relaxation time, and usually with friends.
Problematic usage – the number of times increases, often while alone, and this begins to cause some problems. These could be financial, social, work related or legal. The person is losing their ability to choose and instead of saying, “I want to…”, they increasingly say, “I have to…”. The person starts to think obsessively, and begins to respond to strong urges in an increasingly compulsive way.
– the person must perform the activity, otherwise they feel a range of psychological and/or physical discomfort. They have lost their ability to choose not to gamble, shop, smoke cigarettes, drink, drug etc.
The dividing line between these stages is unclear, but a few of the clues that an activity is becoming problematic are:
· If you start to think about it often.
· If you start to do it more often.
· If you start to do it when alone.
· If you crave to do it at a definite time daily.
A few signs indicating that alcohol or other drugs are starting to become a problem are:
· If you tend to do it because you are shy or uncomfortable with other people in other ways.
· If you start to do it in ways that cause problems in your relationships.
· If you start to use more of the substance to get the same effect.
· If you regularly need to use the substance to sleep.
Q. Are there any other significant psychological or emotional signs that indicate if use of alcohol or other drugs is becoming problematic?
Yes there are. Some of these are:
· If you feel more often that you have to drink/drug to cope with your feelings.
· If you often drink/drug to escape from worries or troubles.
· If you start to notice that you are depressed more often.
· If you start to drink/drug more to cope with feeling depressed, but you end up feeling even more depressed.
· If you drink/drug to reduce your anger, and find that are becoming angrier.
· If you drink/drug to reduce your anxiety, and find that are becoming more anxious.
In fact, anxiety, anger and depression are often key factors underlying addictions. More about this later.
Q. So does this mean that anyone who experiments (eg with alcohol) will become an alcoholic, or that marijuana usage will automatically lead to heroin usage?
The short answer is ‘No’. The longer answer is that people become addicted to an activity if that activity becomes the main way the person satisfies certain needs (see later). People who become addicted have often been searching for their “activity of choice”, the one that “hits the spot”, and stop searching once they have found it. For some people a chocolate addiction is enough to help them cope, for others cigarettes are what is needed, while others need alcohol or cannabis or…. There is no automatic progression. Every addict starts off drinking milk as an infant. Does that mean that drinking milk necessarily leads to addiction?
Q. Do all alcohol drinkers become alcoholics or do all gamblers get into trouble?
The research indicates that the overwhelming majority of people can practice a range of mood-altering activities without developing a problem. For example, many people drink alcohol, but not all of them are alcoholics. This means that the problem is not with the substance/activity, but with the person. A potential addict experiments until they find the substance/activity they need – caffeine or cigarettes or alcohol or gambling or ….
The people who do eventually develop an addiction are people for which the substance (alcohol or other drugs) or activity (gambling, shopping, internet surfing etc.) is the thing that satisfies particular needs. The addicted often think about the substance or activity obsessively and then act on their urges compulsively.
Q. What is the professional view on why some people develop problematic addictions, while others do not?
There is not one opinion about this – in fact there is a range of beliefs.
One widely held view is that addiction is a disease caused by a chemical imbalance. Some believe that this imbalance is inherited at birth, while others also believe that it can result from the influence of environmental factors.
This belief also says that once an addict, always an addict – the only choice is whether to be a practising addict or a non-practising one. It is believed that here is no cure for addiction, only abstinance (not using substances or stopping the compulsive activity completely).
This belief is the basis of the self-help “twelve step” fellowships such as Alcoholics Anonymous (A.A.), Narcotics Anonymous (N.A.), Gamblers Anonymous (G.A.), Overeaters Anonymous (O.A.) etc. The twelve steps are the core beliefs and practices followed by the membership. For example, the first step is “We admitted that we were powerless over our addiction, that our lives had become unmanageable”. It is only by realising that a person is powerless and out-of-control can they take the first step to gain control over their life! The only requirement for membership of a twelve-step fellowship is the desire to stop the addiction. Meetings are held on a daily basis all over the world and are organised and led by the recovering addicts themselves.
Information about meetings of a particular fellowship can be found on the internet.
Q. What is another view on why only certain people become addicts?
My own view is that a person who develops a dependency on a substance (eg alcohol or another drug) or an activity (eg gambling) does so because s/he is dependant on using that substance (or activity) as a protection/defence against very upsetting/disturbing/painful interpersonal relationships, memories, thoughts or feelings. The person is self-medicating to try to feel better. The substance (or activity) initially does help them feel better and the person eventually uses it each time they feel bad. In fact, the bad feeling reminds them about the substance (or activity), so the person begins to use it almost automatically. This is the way that an addiction develops.
The substance/activity becomes the main way that the person uses to cope with their major difficulties. So telling a person that they should “Just say no!” is unrealistic, because this potentially leaves the person defenceless, unable to cope. So, ending an addiction requires the person to find other ways of coping and managing their feelings, their obsessions and their compulsions. Also, conquering an addiction is a lot more complicated than just an issue of strength. The addicted are not weak people. They are people in pain whose current coping mechanism involving an addiction has created its own set of problems.
Q. What are the main feelings that people protect themselves against?
The most common feeling that people have difficulty coping with is anxiety. Anxiety is the feeling we have when we worry about a potentially dangerous situation. Our heart beats faster, we start to sweat (on our faces or even our hands), we breathe quicker with shallower breaths, our blood pressure increases and we can feel “butterflies” in our stomach. Adrenaline rushes through our body. We feel worried, and think worried thoughts.
All human beings are born with the ability to feel anxiety. It is the way our body prepares to deal with potential danger. We get ready for fight or flight – to deal with the potential threat or to escape from it. Anxiety is normal. As we grow we usually learn ways to deal with our anxiety, to stop it overwhelming us. However some people feel more anxiety than others, and may have more difficulty than others in managing their strong feelings. Other people were not able to learn how to cope with their anxiety because of difficulties experienced at a young age.
A major source of anxiety is feeling disconnected from those we believe love us, or those we love. When a child withdraws into her/himself for an extended period of time (for a variety of reasons) they can end up feeling disconnected from their parents. This leaves the child feeling highly anxious. When parents are consistently emotionally unavailable for their children (for a variety of reasons) for an extended period of time, the child can also end up feeling disconnected and highly anxious.
Anxiety is normal. Children (and adults) normally feel anxious at certain times. Anxious children demonstrate their anxiety in a variety of ways. They may be frightened to be left alone in a room after a parent walks out, wet their bed, be worried about others, or worried about things not being in their right place. These are all normal, widely occurring responses.
Parents may respond in ways that do not help the child learn to manage or contain their anxiety. They may make fun of their child for carrying a favourite toy or for talking about feeling frightened by thunder, they may be angry with their child for “showing weakness” when the child shows their anxiety, or the parent may be overly anxious themselves and not show/model any coping skills. If a child has a traumatic experience that is not acknowledged or dealt with by adults, this too interferes with the child’s ability to manage their own anxiety. All of these parental responses can increase the child’s sense of feeling different, disconnected and unable to manage their own feelings.
Such a child learns to feel bad about feeling anxious, which then increases their anxiety levels – they can become anxious about feeling anxious. They secretly look for things to help them feel better. This is the start of the journey that could lead to smoking, drinking, gambling – becoming obsessive about something. Obsessions and compulsions are ways people develop to cope with high levels of anxiety (more about this, as well as other important causes of anxiety, later).
Q. What are the main methods that people use to cope with these feelings?
We can protect ourselves from these feelings by developing some obsessive and/or compulsive characteristics. We can obsessively think about certain issues again and again – the tidiness of the bed room, the characters in a TV show, the cleanliness of our clothes, the problems of our friends or family, the never-ending list of what we should be doing etc. etc. This constant thinking about the same issues again and again helps our anxiety levels by giving our anxiety a focus so that we have something tangible to be anxious about and also by allowing us to use our thoughts as a barrier/defence against our high level of anxiety and its causes. If we are busy thinking, then our feelings are less noticeable.
We can also start to do things compulsively. We may clean things again and again, constantly ring our friends/loved ones, watch hours of TV (have a long list of favourite shows), feel driven to do certain things and feel really uncomfortable if we are interrupted and have to leave the task incomplete. We may also feel that we have to do things perfectly. The benefits of these sorts of acts are similar to the benefits achieved by thinking obsessively – our actions give our anxieties a tangible focus and also act as a defence – if we are busy doing, then our feelings are also less noticeable. To understand the difference between the two words, remember that we think obsessively and act compulsively.
Thus if someone develops obsessive and compulsive characteristics, they then have a double defence against anxious feelings. I am constantly amazed at the way the human being can adapt, cope and defend against problematic feelings. Without defences, we would have difficulty coping with our stronger feelings, and so could end up feeling overwhelmed!
At times, we all find things to think about and to do to distract us. Defences involving the use of obsessions and compulsions are normal.
Q. If being obsessive and compulsive is normal, why are those words used to signify problems (eg in the phrase OCD – Obsessive Compulsive Disorder).
These defences only become problematic when we lose the ability to control them – when they control us. Some people develop such strong anxiety levels that they are constantly thinking obsessively and acting compulsively. These defences then become rigid habits which are automatic and repeated with greater frequency. A person with OCD has to constantly repeat certain actions or else face extremely high levels of anxiety. They lose the ability to make choices over their actions. The defence against a problem has become a new problem in itself.
I have been specifically writing about anxiety, but other strong feelings also may need to be defended against. For example people with high levels of anger, depression, powerlessness, or disconnection from those important to them usually need some sort of defence against these feelings. The stronger the pain, the stronger the defence needed against that pain. That is why some people need cigarettes, gambling, shopping etc., while others need heroin.
Q. What is the connection between obsessions, compulsions and addictions?
What must always be remembered is that an addiction develops as a result of a person needing to protect themselves against very strong feelings, to help themselves feel better. The addicted are often very anxious people who have found a way to deal with their problematic anxiety, but then find that their defence itself becomes problematic. Obsessive thinking and compulsive actions are fuelled by anxiety. The more often a person thinks obsessively and acts compulsively, the more likely they are to become addicted.
Q. What happens if a person improves in their ability to cope with strong feelings?
I recently began working with a woman who came to me because she wanted to stop a 19-year marijuana addiction. As our work progressed, she was gradually able to reduce her constant usage of that drug. She began to increasingly feel the sadness that she had suppressed for many years, the sadness that she had been blocking with marijuana because as a teenager she had felt unable to cope with the enormity of her hurt. As an adult, she was no longer as scared of her emotions and was gradually allowing herself to cry and mourn her losses. She learnt that the way to deal with uncomfortable feelings is to allow those feelings. She learnt that blocking feelings does not get rid of them. They grow in the background, needing an outlet.
We develop major problems when we do not like how we feel or think. If our response to a certain thought or feeling is very negative, we try to block that thought or feeling. Blocking feelings leads to a “pressure cooker” situation where the feelings build over a period of time until they explode.
Also, when we feel bad about our thoughts or feelings, we get angry with ourselves for having those thoughts or feelings. For example, if we don’t like being angry, when we feel anger we become angry with ourselves for feeling angry! Our anger is then increased and our self-esteem decreases because we feel bad about feeling bad!
Many of us have had experiences where our feelings have caused problems for us. We have been punished for feeling angry, ridiculed for feeling sad, or told to get over it when we are grieving. We have learnt that there are good feelings and that there are bad feelings. Questions for the reader – which of your feelings do you consider good? Which are bad? Why?
As we reduce the amount of time that we fight our feelings, we begin to become more accepting. Being more accepting and less judgemental is the beginning of the path to feeling more at peace. We develop the ability to feel peace without having to buy it!
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