Addiction 105

Addictions therapists and theorists, like addicts, have their stories. It has become fashionable to identify drug use as a (reasonable?) psychological response to the unhappiness and ugliness of life, and addiction as a long term response to emotional pain.

This kind of fashionable nonsense comes from many therapists and writers. For instance I noticed a book review in the Free Press a couple of weeks ago. The book in question was “Lighting Up, How I Stopped Smoking, Drinking and Everything Else I Loved in Life Except Sex” by Susan Shapiro. The author went into therapy with an addiction therapist who is also identified as a “Dr.” Her treatment was a nicotine patch and psychotherapy. The reviewer says that Shapiro wrote that her therapist had a theory of addictions – that substance abuse masks deep depression and an unwillingness to deal with emotional issues. The psychology and self-help sections of bookstores are full of books based on that idea, with variations. Many writers look suggest that addictions are caused by trauma or abuse and suggest that addicts are the victims of the actions of people in their lives.
There is some correlation between depression and addictions, and Post-Traumatic Stress Disorder and addictions, but Depression and PTSD are specific mental disorders with their own symptoms. Some people have mental disorders and addictions. The correlation doesn’t establish causation and the evidence suggess the problems are separate. If addictions were caused by depression, they would respond to anti-depressant medication and regular psychiatric treatment and they don’t. Treating a person with a mental disorder and an addiction presents a number of problems. Can you treat both? Which takes priority? What are the treatment resources?
If a therapist says that in his experience all of his addicted patients are depressed or suffering from PTSD or abuse, he must have a very special or selective practice, or he is using these concepts in an unprofessional way. Of course that’s what’s happening. The label of depression etc. is a fiction. The therapist may sincerely believe that the patient is addicted because she is unhappy, and unhappiness, shame and low self-esteem are serious emotional problems, but the therapeutic label is a bit of preliminary bullshit. There is probably a little marketing or selling here. The therapist is telling the customer that she needs services with the therapist is ready to offer, and reeling in the customer. A writer plays to the patient’s sense of drama and self-importance – I am a lowly addict because I am the unwitting victim of my sad history. Mainly the phony label of depression, trauma and abuse is a trick to encourage the patient to accept addiction as an illness and to start thinking about her life.
The theory that emotional pain causes addiction has some attractions, but it depends on a series of speculative assumptions about the impacts of various events in a person’s life. The sad fact is that a drug addict’s lifestyle is inherently painful, and tracing the pain back to a childhood trauma seems to be futile.
It some sense to help a person identify emotions and confront painful memories if that helps a person to live differently and to avoid poor emotional strategies and compulsions. Talking therapies may help people with depression, PTSD, addictions or just plain emotional pain and existential angst. These therapies depend on the treatment model, the therapist and the patient, but they may help. Some people achieve the insights and learn to act differently without therapy, some people learn in therapy, and some people keep on going.
Unfortunately these therapies often just use up kleenex, or inspire a patient to blame his or her life on parents, siblings, partners and children and to avoid accepting responsibility for anything.