Addiction 101

Addictions are rewarding in the judgment of the addicted person, when he or she is engaging in the addictive behaviour. Addicts will pursue their addiction even when they know, or should know, that their addiction is harmful to physical health, economic potential, social status, and to the survival of supportive, trusting, and intimate relationships. Some addictions alter perception and judgment, and all addictions seem to offer such powerful rewards that the disadvantages and side-effects are disregarded. Psychologists have run a variety of interesting and cruel experiments to see exactly what harm rats and monkeys will endure for different rewards. These studies tend to reveal what kinds of sensory and psychological experiences are inherently attractive to mammals and primates and to provide insights into the psychology of value, but they don’t even begin to measure the harm that human beings can endure and inflict under the influence of addictions.

Only a few of the activities that some people sometimes describe as addictive are basic and necessary to life. Some people believe that eating can be addictive, or sex. To the extent that these activities can provide immediate and intensely rewarding experiences, and to the extent that the urge becomes compulsive and excessive, there is merit to this analysis.
There are intrinsic and healthy rewards for following most routines and acting on many impulses and instincts. We need to eat and drink to maintain our metabolism, and our decisions on what to eat or drink, or when, are often based on routine and impulse. Many impulses are neutral or only mildly harmful – I need to walk away from my desk and have a cup of coffee before I try to write another letter. We can go with those impulses, or defer gratification, or do something else, or do nothing at all.
Addictive impulses are harder to control because the physical, psychological and social rewards are significant, making the impulse intense, compelling and overwhelming against good sense and ordinary will-power. A couple of drinks in good company can produce a sense of companionable well-being. A few more can alter perception and thought, and induce relaxation. Some drugs provide more intense rewards. I don’t have any experience with ecstasy, amphetimines, cocaine or hard drugs, and only minimal experience with marijuana. Some drugs provide a very strong sense of empathy with people or a sense of heightened perception and insight, vivid and gratifying hallucinations or a sense of power or well-being. There is a perverse sense of autonomy in the gratification of one’s own wish and craving. There is a sense of freedom from the influence of various people who have tried to restrict or regulate one’s actions. There may be some rewards in peer approval. The psychological rewards can also be defined in terms of a sense of flow and power.
An addiction is vital to one’s sense of well-being. We may not need it in a direct biological way but it holds our attention. We look forward to it and focus on it. When we do it, we are able to be in the flow of the moment. If we don’t do it, we will think about it until our resistance wears down. The addiction becomes automatic and dominant in our routines and plans. Yet, addicts also report that the direct rewards are not commensurate to the imagined need – it may be good, but seldom as good as we remember or imagine. The rewards diminish with regular use. There are side effects, and as I have said, the physiological and social costs of addiction are very high.
The direct goal of addictions treatment is for the addict to stop using, but it is hard for an addict to give up something that is so rewarding. Some theories of addiction and treatment focus on helping addicts to weigh their choices differently, which can be a long and painful process. That’s what the talk about letting an addict hit bottom, tough love, and letting go, addresses – letting the addict discover the downside of addiction.
Unfortunately addicts often aren’t interested in logical or utilitarian arguments. The addict will usually say that his or her judgment of what he or she needs is superior to yours. Addicts tend to stress the importance of their subjective values, or their freedom in defending their impulses and needs. You tell them it isn’t good for them, and they say you don’t know what you’re talking about or that you have no right to judge their choices. Changing an addict’s perception of rewards and values is critical, but that change can’t be imposed by logic. It has to be learned.
Programs that focus on harm reduction may be more useful than programs with ambitious therapeutic goals. It should be possible to address impulses with a focus on finding why they are rewarding, and providing an acceptable alternative reward. It is important to do something else that uses time and energy and provides its own rewards. Sitting around and thinking about not having a beer is good way to start drinking, even when you want to cut down. In that sense, planning a regime of activity – exercise, sports, art, education – makes sense. It uses time and provides challenges and rewards.