She finally found the courage to broach the subject. She admitted she had a problem with alcohol. There. She said it. The subject was now on the table.
After all the work we had done there had been no indication, no warning sign, not a flutter that this might be something troubling her. On the contrary she often mentioned the good times she spent with friends, picnics, meals, having drinks, dancing. Alcohol was just a side dish in the brighter side of her life. So naturally it was a surprise and a sense of time coming to a halt when she made this declaration. She took a deep breathe. The invisible sound of breaking through shame.
During the week she never drank, only on weekends. The problem she admitted was that once she started it was difficult if not impossible to stop. Open a bottle of wine and she would drink until it was empty. No question of putting back on the cork and leaving the rest for another day. Once it starts, she couldn’t stop. Something compulsive.
So we explored the negative consequences drinking on her physical health, her sense of herself, her relationships with other people. And then we explored that sense of craving which took over and left her feeling there was no other option other than to finish the bottle.
She also remembered when this craving first entered her life. It was in a group context where all her colleagues and friends were highly stressed. Alcohol became the way to regulate. We found an access point for both of the negative consequences and the craving and she processed off both points. By the end of the session, the sense of craving had abated and the lucidity of the negative consequences had became more real to her.
In the follow-up session she reported significant positive change. She began running again on a regular basis and found a friend who had agreed to go to the pool with her once a week. Incredible. She couldn’t really explain why all of this had happened. Whilst it was all good, she could still feel she was under the spell of alcohol. She could still feel the compulsion lurking.
She paused to reflect on what she had said. There is a pattern to it, she said. It comes out of a feeling of boredom. And there is also a feeling of emptiness. She sat forward with her hand against the middle of her chest, pushing against it, as if her hand was searching for something inside.
It’s a sensation I’ve also had in the mornings when I wake up. My heart is racing and I am feeling afraid of something for no obvious reason. And a few moments later it disappers. Vanishes into thin arie. And then I get on with my day.
So we looked for an access point in her visual field where this sensation of boredom and emptiness was most active. Almost like the word itself a heavy silence fell on the room as she settled into the process, remainging unusally silent. From time to time she sighed, shifted in her seat; her face a pure expression of boredom itself.
And then out of the blue, she remembered something. A faint smile rippled across her face as she relished some distant memory. Then it became a chuckle.
“It’s curious,” she said. “I remember as a child being so bored. Even when my parents were around. To kill the boredom I would draw something on a piece of paper and then stick magic stickers on it. I remember those stickers. I was so bored I did that over and over again. I still have one of those drawings on my wall at home today.”
Then a few moments later the rediscovered delight transformed across her face into a twisted expression of incomprehensible pain.
“My parents left me on my own most of the time,” she sobbed. “They barely took an interest in what I was doing”. Streams of tears were now pouring down her face.
“Can you still see that child drawing and sticking the magic stickers? I asked.
She nodded in acknowledgement while gazing at the access point.
“And what kind of connection do you feel with that child right now? I asked.
“I want to take her into my arms and hold her,” she replied as she spontaneously folded her own arms so that she was now holding herself. Another wave of tears poured down her face. “Before I detested that child with the stickers. I’ve seen her here before is the therapy room many times in the past. But I never wanted to mentioned it. I didn’t want her to be here messing up my life.”
There was another pause.
“Now I can feel the child resting against me.”
“And how is that for you?”
“It feels good.”
“And how is it for the child to rest against you?”
She looked up at me through piercing, squinting eyes, my question landing in some unknown, unexpected painful place inside.
“You are so right,” and she cried deeply once again. In between the waves of emotion she struggled to find words. Then she clutched her belly with both arms, squeezing herself tightly once again before looking up at me.
“I feel reassured and full up inside at the same time.”
And then she laughed.
Four processes in addiction
Addiction is a social phenomena. Addictive behaviours have become endemic in modern societies when we extend the notion of addiction beyond alcohol or substance abuse. Twenty years ago travelling on a bus or a train, people would be either talking to each other or looking around or out the window. You would be able to catch people’s eyes if only briefly and gain a sense of the life around you. Today on the same bus or train most people are glued to portable telephones or computer screens bearing a glazed over look as they escape to somewhere else. The shift has been enormous and the sense of being alone in a crowd never so palpable.
Addictive behaviour of whatever kind is an unconscious attempt to deal with some kind of underlying suffering (trauma). And while that addictive behaviour generally delivers on the unconscious promise you won’t feel the suffering anymore, the behaviour itself generates a new set of problems. Not until the inconveniences begins to outweigh the benefits are people willing to question such behaviours.
In other words addiction is just the surface some kind of loss of connection which requires healing.
By definition addiction is something which becomes deeply ingrained, sometimes slowly over time, sometimes in an instant and is tenacious in nature. It feels stronger than yourself. From a neurological point of view, there are at least four processes underlying the addictive behaviour.
1. The sensitivity to stress (you can’t bear the stress)
2. The motivation to use (you want it)
3. Impulsivity (you start doing things too fast)
4. Compulsivity (you can’t stop)
There are four different brain circuits which work together to control urges and regulate behaviour.
1. Drive/Motive (Nucleus accumbens/ventral palladium)
This system works on rewards and predictions of pleasure. This is where compulsion is located.
2. Emotions (Hippocampus/Amygdala)
People with a high sensitivity to stress will find emotions hard to bear. Addictive behaviours are used to suppress these emotions. But in turn the addictive behaviours can also become stressful in themselves.
3. Decision Maker (Prefrontal Cortex)
This is your centre of cognitive control where you make the decision to do or not to do something. This is where you control and regulate impulses.
4. Action Taker (Orbitofrontal cortex)
This is point to take action. It is controlled by the Decision Maker circuit.
These four circuits are interconnected and influence each other. In a balanced non-addictive brain, the Decision Maker controls the point to take action. If you decide to have a glass of water, the action taker will go and do it.
In the addictive brain, things work differently. Because of the internal imbalance you end up doing something you don’t want to do. Sometimes the Decision Maker has become weaker, perhaps due to drug use, and so the Action Taker is less constrained. Other times the Drive/Emotion is so strong it over-rides the Decision Maker. Or maybe the Drive/Motive is being fed with so much Emotion, the addictive behaviours help to suppress the emotional charge.
Recent research at Imperial College, London showed that alcoholics have more connectivity between the emotional and the drive/motive regions in the brain. In other words, enhanced emotional drives are associated with alcohol misuse.
