compulsion

Denial Ain’t Just A River In Africa

When we get into recovery, regardless of the path we take, it won't be long until someone tells that us we are in denial about something. In fact, the chances are good that we heard that a number of times before we even thought about recovery. But what is denial?

Actually, denial is an important part of coping with day to day living. If we accepted as fact everything unpleasant that someone said about us, we wouldn’t be able to function very well, if at all. If we weren’t able to put aside the tragic reality of a death in the family and tend to business, we’d never be able to get through it. Denial helps us overlook the rough spots in life so that the immediate impact is lessened, and we can deal with the issues gradually. However, it becomes a problem when we use it to help us ignore important issues.

Denial is of interest to addicts (and therapists) when it gets in the way of our recognition of behavioral problems. We alcoholics and other addicts use denial to smooth the path of our addictions, help us ignore the cold, hard facts, and continue doing what our instincts tell us we have to do. It becomes automatic. In order to recover we need to be able to recognize denial, become able to see the effect it is having on our recovery, and adjust our thinking. As the old 12-step saying goes,

Lying to others is rude, but lying to ourselves is often fatal.

There are many forms of denial, and all sorts of names to describe them. We’ve listed some of the common ones, with examples of how we use them to protect our addictive behavior. There are dozens of other examples and names, but denial generally falls into the following categories.

Normalizing: “Everyone has a few drinks on a weekend” (their birthday, to celebrate, during the game, etc.) “A couple of beers never hurt anyone.” (See minimizing)

Minimizing: “I only had a couple! (Of 6-packs). “I only drink socially.” (Five nights a week) “I might have had a couple more than I should have.” (I couldn’t stand up.)

Rationalizing: “I don’t have a problem, I’ve quit for months at a time. I just don’t feel like stopping right now.” “I have to socialize with people, it’s part of my job!” “It’s a prescription drug; my doctor knows what he’s doing.”  “I deserve it!”

Comparing: “Joe’s been married three times, in jail twice, lost his license and has to go to those meetings. That’s what happens when you drink too much. I’m doing fine.”

Uniqueness: “You don’t understand.” “If I go to treatment now, the business will fall apart and fifty people will lose their jobs.” “My family has an exceptional capacity for alcohol. I never get drunk.”

Deflecting is making jokes, changing the subject, angry outbursts that intimidate the opponent, threats, “important” phone calls, blowups when confronted and similar ways to take the focus off the issue.

Omitting: Leaving out information, or telling just enough of the story to satisfy the other person while leaving out the part that will get you in more trouble. “The doc said my health is great!” (Except if I don’t stop drinking I’ll be dead in five years.) Simply ignoring the other person’s remarks falls under this category as well.

Blaming: “If you had to put up with (my wife, boss, kids).” “I was doing just fine until I found George doing lines in the bathroom.” “The doctor keeps giving me prescriptions!”

Intellectualizing: This is coming up with all sorts of explanations that “obviously” anyone who thinks about the matter has to agree with, in an attempt to make questioners feel off base and uninformed. “The latest studies show that a couple of drinks a day are good for you.” It’s also a good way to fool ourselves.

Poor Me: “I’ve tried and I just can’t quit. I can’t do it no matter how hard I try.” “I give up, I’m just going to die drunk.” “My life’s in the toilet, I might as well….”

Manipulating is using power, lies, money, sex, or guilt to defuse the issue. “Remember who you’re talking to here!” “Don’t talk that way to your mother!” “Would I ever say something like that to you?” “Mommy doesn’t need to know about this. Here’s some money. Go shopping”

Compartmentalizing is doing things that you keep separate from other parts of your life. If you find yourself thinking something like “If he only knew,” or “If anyone ever found out,” then you’re compartmentalizing.

If we're honest with ourselves, it probably won't take us long to recognize some of our old — and perhaps not so old — tricks.  And maybe, just maybe, we ought to pay attention to the next person who accuses us of denial.

 

Compulsion

I was thinking about ways to explain addiction to someone the other day.  I spent quite a while thinking about the various characteristics of us addicts, and the one thing that I came up with that seemed to cover us all is compulsion: as applied to addicts, a strong, usually irresistible impulse to do things that are not in our best interest.

I was actively addicted to other drugs and behavior as well, but the one that brought me to recovery was alcohol.  Something else would have, but I drank the longest and booze got to me first.  I remember the compulsion so clearly.

Originally, I didn't notice it.  I drank and drugged when it wasn't an especially good idea for quite a while, and eventually all the time, but I made excuses why it was okay.  I needed to sleep, and a drink or a pill (or both) would help. Those people were such a pain that I needed a drink to mellow out before going to that dinner party.  When I got there, it would have been rude not to have a drink (or a line) when offered.  And of course, after the first couple, the rest seemed like a very good idea indeed.

As the old saying goes, “denial ain't just a river in Africa.”  A good solid dose of that commodity enabled me to justify the things I was compelled to do, and to overlook that fact that they weren’t in my best interest and that I had to do them.

Toward the end, though, it wasn't that way.  Some months before I got clean and sober, the excuses ran out.  The other drug use, which mainly supported my drinking, may or may not have been out of control, but I was obviously powerless when it came to booze.  The times when I tried not to drink, or not drink more and failed, were countless.  I felt ashamed.  I felt hopeless.  I felt as though I was no longer in control of my life — and I wasn't.

I would come home from work determined to have a couple of beers, and kill a six-pack and half a bottle of vodka or rum.  I have absolutely no idea how much I drank or how many drugs I used on my days off.  Knowing that I couldn’t drink on the job (although I eventually did that too), I took pills provided by a helpful doctor to deal with the urge for the eight hours until I could get to a bottle.  I’d tell myself that I wasn’t going to drink — that I couldn’t drink — and yet I always did.  I never got to the point of withdrawal.  I didn't drink or use because I was sick, I did it because I could, and because I had to.  With alcohol and other drugs in my system, I was powerless.  I was unable to stop doing something that I knew was not only not in my best interest, but that I knew was killing me.

Eventually I reached the point of giving up.  I knew I had to drink, had no idea that I could actually quit, and figured I’d end up dying drunk.  Over time — a short time — it became clear that it wouldn’t take much longer.  I carried a gun for a living, and I knew exactly how to use it.

Well, I got lucky and an intervention brought me to treatment and  sobriety.   When I got sober I found that I was no longer powerless over some of my addictions (as long as I didn't use), but that there were other compulsions that needed attention.  Although I was clean of alcohol and other drugs, I still smoked, and I decided that I couldn’t go around calling myself clean and sober unless I finished the job.  It took me three years to kick the most dangerous addiction of all, but a couple of weeks ago I had twenty years smoke-free as well.  Yay me!  And I mean that.  It was harder than getting sober.  I couldn’t have done it without my program of recovery.  Quitting’s not for sissies.

I remember those compulsions.  Do I ever!  The need for a drink.  The need for nicotine.  The need for another pill.  I remember the lies I told myself: that one more wouldn’t hurt; that I’d quit as soon as (insert excuse) was over and I could relax a little.  That I'd cut down. That the next one wouldn’t kill me.  I remember.  It scares me to death.  I like my life too much to take the chance of encouraging those compulsions to return, so I don’t use.  Chemicals controlled my life: where I could go, who I could go with, what I could do, and when.

I like freedom.

When do you know that you don’t want to do any more drugs?

I’ve been skipping over this question for a while, because there is no way that the answer can be anything but subjective. I can’t possibly answer it for someone else. I finally decided that it’s too important just to blow off with an excuse. Someone asked that question because they were still hurting, and someone else out there is too. Subjective it will have to be.

In my own case, I knew it some time before I got clean and sober, but I just didn’t think it was possible. I knew what happened if I went even for short periods without alcohol or a substitute, and there was no way (that I could see) to quit. But did I want to be free? Oh yes, desperately!

That’s the first part of the answer — the bottom that we talk about. The solution was forced upon me by my boss, who had a better grasp of the possibilities than I. After three weeks of detox and treatment, aftercare, a few hundred 12-step meetings and with the help of my newfound recovering friends, I was in fairly decent shape.

But the question still isn’t answered. When did the craving, the need go away? I honestly can’t say. The intensive program I was working kept me so busy that I hardly had time to think about using. At a couple of points down the line I got the impulse to have a drink or use. Looking back, I can attribute that directly to relationship and work difficulties that I still hadn’t learned to deal with in a less self-destructive way. At least one of those was a case of “drinking at” someone (except, thank goodness, I didn’t).

The desire to turn my brain off with drugs just disappeared when I wasn’t looking. At some point, I realized that I hadn’t thought about using for some time, and wasn’t especially interested in thinking about it then — and it’s been that way ever since. I don’t know if I was especially fortunate in that regard or not. Just as one person can never know (nor judge) another’s pain, so can I not relate my cravings, or lack of them, to someone else’s.

What I can do is tell you why they went away. I found better ways to cope with life. My program, the people in the 12-step rooms, the wonderful friends I made, the relationships that I developed with my wife, kids and other family, and the feeling of self-worth I got from helping others were all so much better that I couldn't imagine throwing that all away — again.

I believe there are three stages to recovery. The first occurs while we’re still using, when we decide we want out. The second is early on, when we are taking the first steps toward learning to live without drugs, and the third is the “maintenance phase,” where we keep on doing the things that helped us to begin with, and things keep getting better as a result. That’s exactly the way the 12 steps work, and I reached that point through their help. It’s not the only way, but it has worked for me and a lot of other folks I know.

And I haven’t wanted to do any more drugs for a long time now.

What about you? What was your experience? Please comment!

Why Do Addicts Keep Using Despite The Consequences? — Part 2

Previously we mentioned that the pleasure center is a portion of the brain over which we have no conscious control, and that it can be stimulated by a variety of chemicals — some of them produced inside our bodies and some that we introduce from outside.  We said that the pleasure center rewards us for activities that it interprets as contributing in some way to our survival, whether they be social interactions, exercising, or more prosaic things such as eating.  We also stated that these pleasurable feelings, when pursued too far or for too long can create problems.  Now we need to examine how that happens.

While the actual mechanism of addiction is terrifically complicated, the underlying principles are reasonably simple.

  1. When we use drugs or are involved in pleasurable activities, they stimulate (or cause the stimulation of) receptor sites in the pleasure center and other areas of the brain. This causes us to feel good.
  2. With constant stimulation, the brain begins to adjust to the higher levels of brain chemicals by making physical changes that involve, among others, the growth of additional receptor sites to accommodate the excess neurotransmitters.  This leads to tolerance: needing more stimulation in order to achieve the same effects.  Tolerance is one of the first signs of developing addiction.
  3. As tolerance develops, we reach a point where our brain needs the presence of the stimulation in order for us to feel normal.  If we cease whatever is causing the stimulation, whether it be alcohol, other drugs or stimulating activity, for very long we begin to feel uncomfortable because all those extra receptors are telling us they need to be filled up.
  4. Eventually, we reach a point where any pleasure is short-lived, and we simply need the stimulation to keep going.  When we don’t have it, we experience withdrawal, feelings that, as a general rule, are the opposite of whatever good feelings the stimulation caused.  If we were using cocaine or other central nervous system stimulants, we feel depressed; if using downers, agitated; if we are a thrill junkie, bored and/or depressed, etc.  Because of the changes in other parts of the body there are often other symptoms.  For example, opiate withdrawal is like the worst case of flu you can imagine, doubled, combined with overpowering anxiety, nervousness and generally feeling terrible both physically and emotionally.
  5. At the point of marked, prolonged withdrawal in the absence of the drug or activity, we are definitely addicted.

But why can’t we quit?  We know using is causing us life problems, and we know withdrawal doesn’t last forever.  There are even medications to help.  What’s with the constant failures to stop using?

Remember that we said the pleasure center is a part of the brain over which we have no conscious control.  This part of the brain, because it is survival-oriented, interprets failure to meet its needs as survival issues.  We have created an artificial situation in which the brain needs extra stimulation to feel normal.  Therefore, when it does not get the extra stimulation, it sends messages to our subconscious that our very survival is threatened.  Addicts continue to use because their subconscious, over which they have no control, tells them that if they don't they're liable to die.

Those messages alone are enough to make it extremely difficult to stop using.  When reinforced with physical withdrawal, they are sometimes impossible to overcome with conscious effort because — again — we have no control over the feelings or the symptoms except for the use of more drugs.

Of course there is more to it.  The stresses created in our lives by addiction-related problems (and perhaps problems that preceded the addiction) make it even more difficult for us to allow ourselves to return to reality.  We must first detox from the drug, and then we need a lot of support and help while normalizing our social, emotional and health issues during the first months and years of sobriety.  We also need help getting through the “post acute withdrawal syndrome” (PAWS) that occurs while the brain and rest of the body are rebuilding and getting back to something like normal.  This can take a long time, and the issues associated with PAWS are a frequent (if not the most frequent) cause of relapse.

That, however, is a subject for another article of its own.  For now, understanding that addicts are subject to powerful emotional and physical experiences over which there can be no direct control will clarify a lot about addiction and the problems of getting clean.

Why Do Addicts Keep Using Despite The Consequences? — Part 1

Early in human history there were probably few alcoholics or addicts, because the alcohol content available in fermented fruit was low, and plants that produced other intoxicating substances were relatively scarce.  The development of agriculture created food surpluses, especially of grain, the major ingredient in beer, and a class of workers that was not tied to food production.  These specialized occupations — brewing and raising non-food crops among them — allowed a gradual increase in the organized  production and consumption of mood-altering substances.

A field of opium poppies (DEA)

Brewing beer was widespread by around 6000 BC, and was extensively documented by the ancient Egyptians.  We know that alcoholism existed in biblical times, and that it was common by the time of the Greek and Roman empires.  It is likely that addiction to opiates and other drugs was present too, since images of opium poppies (Papavar somniferum) have been found in ancient Sumerian artifacts from around 4000 BC. The resin of these poppies was also known to the ancient Greeks, from whom it gained its modern name of opium. Humans being — well — human, it probably didn't take long for the abuse of these and other drugs to begin.  Drug abuse has been around for a long time.

For thousands of years, excessive consumption of intoxicants was thought to be a completely voluntary act, and people who used them habitually were believed to be morally weak or deficient.  Around the end of the 19th Century some physicians began to consider the possibility that, beyond a certain point, chronic use of alcohol and other drugs might become involuntary.  Further study confirmed these beliefs, and the American Medical Association declared alcoholism to be a chronic disease in the mid-1950s.  As time passed, the “disease model” of addiction has become more clearly developed, and now many experts view all addictions as chronic diseases with a strong organic component.

Still, why don't addicts stop using when it begins to destroy their lives?  To understand that, we need to look briefly at how the brain's pleasure center functions.

We like to feel good.  We enjoy music, the company of people with whom we feel a connection, good food, a drink or two, maybe a hit or a line.  We enjoy sex, which feels good and satisfies our instinctive desire to bond intimately with another human.  We like to win at sports and other games.  We get a thrill when we hunt.  Our survival instincts are deeply involved with the pleasure center, which gives us positive reinforcement for survival-oriented behavior such as making friendships (allies), winning at games (and war), and successful competition in the arena of business.

We enjoy these good feelings and emotions for themselves, but they also provide a welcome change from the unpleasant aspects of daily living.  Many other activities, such as shopping and gambling, provide pleasure, thrills, and distractions from our humdrum lives.  All of these activities are rewarded by the pleasure center, and eventually we may find that we seek them out too often, or for too long.

So, people use drugs and most other substances — including food — because they make them feel good or satisfy a powerful need (survival again).  Adding certain chemicals to our bloodstreams through natural bodily responses, ingestion and other means causes production of other chemicals that stimulate receptor sites in the brain’s pleasure center. Sometimes the substances themselves mimic the presence of “feel good” chemicals that occur naturally in the body.  Whatever the case, the results are various combinations of pleasure, satisfaction, and euphoria–sometimes all three.  It is important to note that these changes occur in parts of the brain over which we exercise no direct control.  When these good feelings begin to become the focus of our lives, rather than an occasional pleasure, we are well on the way to addiction.

But what is addiction, and why is it so powerful?  We’ll cover that in Part II.  Stay tuned.

What is the difference between psychological dependence and addiction?

Psychological dependence is shorthand, used to refer to situations where there is no apparent physical withdrawal, yet there is a compulsion to continue using a substance or carrying out an act. Sex addiction is a good example, as is the compulsion to eat sugar. Psychological dependence is not a medical term.

There is a gray area, and not necessarily a wide one, between psychological dependence and addiction. For example, some heavy users of marijuana suffer withdrawal when they stop using, which qualifies them as addicted. Others have no obvious physical symptoms, but become psychologically disturbed.  Also, many activities — gambling, relationships, shopping and so forth — are mood altering and actually create changes in brain chemistry similar to those that occur when we use drugs. Likewise, many activities that we associate with good health, such as running and other forms of exercise, produce changes in the levels of endorphins in our brains, stimulating the very same receptors that are affected by opiates.

As far as treatment is concerned, there is no real difference, apart from the possible need to detox from an addictive substance.  We are dealing with the need to change behavior that is causing us problems in our lives, but that we seem unable to stop.  The changes we need to make are basically the same, regardless of what we call the circumstances that caused us to seek help.