WHY DO PEOPLE WITH ADDICTIONS SEEK TO ESCAPE RATHER THAN CONNECT? A LOOK AT THE APPROACH TO ADDICTION TREATMENT
Robert Weiss, LCSW, CSAT-S
Consultant. 2016;56(9): 786-790.
ABSTRACT: A strong belief exists among addiction treatment specialists that the primary reason addicts remain addicted is less about pleasure-seeking and more about their need to escape and dissociate from the pain of his or her (often trauma-based) emotional isolation. In short, all human beings crave deeply intimate, dependable, empathetic relationships. Addicts, however, have learned, typically through traumatic experience, that others cannot be trusted to reliably meet their need for intimate connection. Essentially, they learn to fear emotional vulnerability, and they therefore distance themselves from other people, turning instead to addictive substances and/or behaviors as a way to “not feel” their unmet emotional dependency needs. As such, a primary part of treating addicts, regardless of the nature of their addiction, is helping them develop healthy and supportive emotional bonds, initially in a treatment/recovery setting, and eventually in the world at large. This approach—not willpower or babysitters or threatened consequences—is most likely to lead to lasting sobriety, emotional healing, and a happier, healthier life.
Nearly every medical and psychological clinician, regardless of his or her area of specialization, encounters addicted patients or clients on a relatively regular basis. Nevertheless, few health care professionals receive adequate training about the etiology, nature, and long-term treatment of addictive disorders. This article is an attempt to address this shortcoming. In particular, it discusses the belief that addictions are less about the pleasurable effects of addictive substances and behaviors and more about the need to “not feel” the emotional discomfort that arises in response to a lack of healthy intimate attachment.
Put very simply, when addicts face challenges and become emotionally needful—as a result of stress, losses, anxiety, depression, and even joyful experiences—they automatically and without conscious thought turn to an addictive substance or behavior as a source of emotional distraction. (Meanwhile, faced with identical stimuli, nonaddicts typically seek support through emotional connection with compassionate and loving people.) Thus, addicts are most often individuals who lack, fear, and avoid emotional intimacy, and who therefore seek comfort and soothing elsewhere, typically from sources that do not require emotional vulnerability.
After almost 25 years as an addiction treatment specialist, I cannot recall a single client who had not learned early in life (through abuse, neglect, and further traumas) that turning to other people for support, validation, and comfort would leave them feeling worse than before they had reached out. So these individuals learned to avoid the deep relational connections that, for healthier people, bring needed consolation, emotional resolution, and reward, instead finding it easier and emotionally safer to escape and dissociate through the abuse of addictive substances and behaviors. In short, addicts engage in their addictions as an adaptive distraction from their painfully unmet womb-to-tomb emotional dependency needs.
Recognizing this, I will go so far as to suggest that addictions may be improperly classified as “use disorders” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).1 From my perspective, it would be more accurate to refer to (and treat) addictions as what they really are: adaptive coping responses to complex childhood trauma and related attachment disorders.
To be clear, I am not talking about a purely physical dependency, which is something any mammal can and will experience if exposed to an addictive substance for long enough. For example, people who are prescribed heavy doses of opioids can become physically dependent if they take these drugs for a long enough period. But that kind of dependency is readily reversible. In fact, so long as withdrawal symptoms are properly managed, ending that type of substance abuse is a short-term and relatively painless process, and the dependency is not likely to recur. For true addicts, however—that is, those persons whose dependency extends beyond the physical—getting away from the opioids (or whatever the addiction happens to be) is merely the tip of the iceberg. Their lack, fear, and avoidance of vulnerability and emotional intimacy must also be addressed.