Extracts from The Heart of Addiction by Lance Dodes

[bigsister987]

I posted these in my diary, but thought it might be easier to find them if I copied them here:

I have started The Heart of Addiction by Lance Dodes, and I really like it so far. He started from the premise that while current treatment methods, e.g. AA and other 12-step programmes, work for some, most people do not manage to give up their addiction, and the current framework holds that the person is at fault rather than the treatment. For example, you haven't reached your bottom yet, or you just don't want to give up hard enough. He is not completely dissing AA, but says that a one-size-fits-all method is not appropriate when treating addiction.

Some quotes in the book so far:

"Virtually every addictive act is pre-ceded by a feeling of helplessness or powerlessness. Addiction behaviour functions to repair this underlying feeling of helplessness. It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, or regaining control over one's experience and one's life."

"It is this rage at helplessness that is the nearly irresistible force that drives addiction."

"I have found that every addiction results from a redirection of energy to a substitute or displaced action (usually because another more direct action is not considered permissible)."

He has some interesting summaries of genes, physical addiction, and personality. He is addressing why people seem to manage to struggle through withdrawal, be addiction free for months, and suddenly capitulate back into the addiction, seemingly without reason. Given this is a lot of people's experiences here I think it is worth a look.

[bigsister987]

Anyway more from the Dodes book:

…”avoiding noticing when you are angry, or trying not to feel angry when you are, is just the kind of thing that can launch the drive towards addictive behaviour. In fact this bit of advice might be one of the worst recommendations one could offer to anyone suffering with an addiction.” I think this needs to be read in conjunction with the previous quotes regarding the drives to carry out the addictive behaviour.

He makes some interesting comments about physical addiction as “a state in which both tolerance and withdrawal are present”.

He then talks about non-drug addictions like gambling and how they are often combined with, or alternated with, alcohol/drug addictions. Remember that he says “the drive behind addiction is a psychological compulsion to perform a particular action such as using a drug, regardless of type.” Many people switch between drugs of differing pharmacological types, e.g. alcohol and cocaine. This switching would be impossible if physical addiction to one drug were essential to the nature of the problem.

He also uses the example of binge drinkers who may drink in a way that ruins their lives, but they don’t drink for long enough to allow their bodies to build up a tolerance, or to produce a withdrawal reaction when they stop. “The have alcoholism but they have never become physically addicted to alcohol.” He gives some other examples and summarises “that there are many addictions, including some drug addictions, in which physical addiction plays no significant role”

“All too often people feel that they are bad or weak because of their addiction…. The idea that addiction is a physical problem may, then, provide some relief from guilt and shame,” which of course “serves as a powerful reason to hold onto this idea.”

“The essence of human psychology lies in not simply what is in awareness, but also in the unconscious thoughts, conflicts, and feelings that drive much of our behaviour, especially actions that are problematic and irrational. Ironically, and sadly, when people reject a psychological explanation because they confuse this with a challenge to their willpower, they do not permit themselves the relief from unrealistic self-blame that would come with truly understanding what drives their addictive behaviours.”

He includes lots of case studies which are really interesting and flesh out the theory well. Some might find these ideas controversial. Don’t shoot the messenger!! However if you want to clarify a point, mention it and I will look up the book to see if he addresses it.

[bigsister987]

More from the Dodes book:


Teens


“At the same time as being faced with feelings of weakness and vulnerability in so many areas of life, it is of great importance to teens to feel empowered. To be able to assert yourself as an independent person with your own place in the world, respected as an equal by adults, and able to fend for yourself on your own, is, afterall, a good deal of what adolescence is about. The unavoidable discrepancy between this need to feel empowered and the powerlessness inherent in this stage of life makes teens ripe for the development of behaviours whose emotional purpose is to manage feelings of powerlessness.

Partly, this results in behaviours that are not true addictions, but rather are normal teenage experimentation. For example, teens often try out new identities, especially those that create a sense of separation from their old childhood identity, or from the identities of their parents. …. To make a clear symbolic statement of how different one is from the way he or she was in the past, and how different from at least some of the values and mores of the parents.

Teens are also more at risk of dealing with their struggles through the development of true addictions; particular displaced actions that restore a sense of empowerment against the many aspects of their emotional lives that leave them feeling disempowered. A need for displacement may be especially necessary in adolescence, because direct actions that are available to adults may be very difficult or impossible for a teenager.”

[bigsister987]

More from the Dode's book:

Couples

What happens to the person in a relationship with someone who has an addiction? Because the addiction is driven by internal purposes and drives it tends not to respond to external factors. Therefore the addiction continues despite the objections, concerns, and even threats of one’s partner. “The repeated displaced expression of power through the addiction, which is unable to be altered by the partner, therefore leaves the partner with the opposite result. He or she is rendered powerless by the addiction.”

In addition addictive acts are often experienced as rageful by those around the person with the addiction. “Said another way, people in contact with someone with an addiction accurately pick up the rage present in the addiction and, when the addiction affects them, they become enraged in return. This is an understandable response. When added to the powerlessness of the partner to affect the behaviour, it is usual for partners to be furious with the person who has the addiction.”

“If you are the spouse of somebody with an addiction… and you find yourself feeling terribly guilty for not being more patient with your partner, it may be that you have been induced by the nature of addiction to be less patient than you usually are. You should not feel that the loss of your usual forbearance is a sign that you have become less tolerant as a person.”
…..

If you are the person with the addiction, bear in mind when deciding whether to keep your actions secret, “your partner may be a lot gentler than you are with yourself, and it may be your own severe self-criticism that you imagine would be your partner’s attitude toward your secret.” This is a process know as projection.

“Sometime you may feel that you have to keep your addictive activities secret because, like the addiction itself, this becomes an important way to retain a needed sense of power and control. The ability to keep secrets, after all, is quite significant – a part of one’s normal sense of self-control and autonomy. Telling someone that you have done something that you yourself find embarrassing, or worse, means giving up this boundary between you and the world.”

[bigsister987]

Final quotes from Dodes:

Treatment

“I have tried to show how you can take control over an addiction by understanding its psychology – using that knowledge to turn the tables on the urge to repeat an addictive behaviour by using the urge itself as a signal. I have tried to show that, using this signal, you can find an alternative solution that more directly addresses the underlying purpose behind your addictive act.”

…”the understanding I have described here will by itself – with some practice – be sufficient to gain control of your addictive behaviour. However, there will likely be many of you who will use this knowledge as a springboard to pursue treatment in a professional setting.”

…”A well-known study that looked at prediction of treatment outcome in people with addictions found that the most important prognostic indicator of these people was the level of their emotional strengths, not the level of the severity of their addiction itself. There is in fact a big difference between people who are trained to think about your problem psychologically and others who mainly know the 12 steps of AA. Of course, it is valuable for otherwise well-trained therapists to be familiar with the psychology of addiction, and not every therapist has been trained or experienced in this field.”

“On the whole what allows people to succeed in treatment is a capacity to be thoughtful about themselves, even if they are not aware that they have this capacity when they begin. People who truly cannot think about their own thoughts and feelings, or cannot attend to the therapy in any significant way may be better off in another form of treatment that does not look at individual factors.

“How do you find a good therapist then? What you want is someone who has a sound background in treating and understanding emotional issues, and who also has an interest, or experience in treating addictions. Admittedly this can be a hard combination to find.”

“…there is nothing wrong with combining a traditional counselling or a twelve-step program with psychotherapy. In this case you want to be sure that the therapy includes trying to understand the addiction, and the nonpsychotherapy component is pitched toward being supportive without interfering with your efforts to understand yourself in therapy.”

__________________

[jonesing]

thanks

i wondered why i was smoking so much more

[Mareu]

Thanks for posting these Bigsis. As you say, this book is well worth a read.

[AnnieBodie]

Oh Hello! Where is my brain?! It's only after reading your post, Sis, in Mareu's diary that I now understand (and found this thread) why it was so easy to find your extracts about Dodes' book in my Search:rolleyes:.

I'm going to add my own post that I made yesterday, if that's all right?

I posted what follows in my diary:

I finished reading The Heart of Addiction by Lance Dods the other day, it’s an excellent and easy read. Big Sister wrote about it when she was reading it, I found what she wrote in her diary (Thank you Sis) so I’m posting the link here.

http://wqd.netwarriors.org/showthrea...ion#post619811 (http://wqd.netwarriors.org/showthread.php?p=619811&highlight=the+heart+of+addiction#post619811)

Quote:
"Virtually every addictive act is pre-ceded by a feeling of helplessness or powerlessness. Addiction behaviour functions to repair this underlying feeling of helplessness. It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, or regaining control over one's experience and one's life."

"It is this rage at helplessness that is the nearly irresistible force that drives addiction."

"I have found that every addiction results from a redirection of energy to a substitute or displaced action (usually because another more direct action is not considered permissible)."

One of the many things that really struck me was in chapter 8 – Myths of Addition. I ’ve Googled but unfortunately couldn’t find it written out and as it’s very long, I’ll just wrote the headings and a brief summary.

1You are addicted to things that are “Addictive”

He argues that while some substances can produce physical addiction, this is actually easily over come, it is the psychological addiction that is true addiction, be it to an “addictive” substance or any other substance or activity.

2 You have to hit bottom before you can get well

He says that this myth is both silly and destructive, silly, because “bottom” is knowable only in retrospection, and destructive, because it is a thinly disguised way of moralising, suggesting that only when you have suffered enough, will you learn your lesson. Implying that you are stupid or unable to learn from experience, that addiction is a conscious process that is allowed to continue through weakness of will.

3If you have an addiction, you are self destructive

The commonly held belief that people with addictions want to hurt themselves, that they have a self-destructive nature, “is precisely backwards” “addictions are an attempt to preserve control over your feelings and your life and respond assertively to helplessness”

4You need to surrender

This is based on AA – “Our whole trouble has been a misuse of willpower” Suggesting that we surrender that power. While he says that this concept can work for some people, it’s does not work for everyone. Dodes says it’s wrong and hurtful, because according to this, addiction is a sign of your failure so you should give up the belief that you can manage your own life. He says that “addiction is a displaced effort to exercise a necessary, healthy power against helplessness, and is a sign of inhibition of the direct exercise of power.”

5You should count your days of sobriety

Again, this is another AA tradition and can work for some, the idea is to reward accomplishment and remind you of what you can loose if you drink- returning to day one.
He dislikes the strong moralistic overtone- success and failure and punishment. He argues that if you are trying to remain sober and slip, you are still doing well, and while they are not desirable, slips should be thought about carefully and learned from.

6You should be treated by someone who has a addiction

The idea behind this is that only someone with an addiction can understand, and while this is true to an extent in the general population, and the support is very helpful, it is not taking onto consideration the true nature of addiction; the psychological conflicts. It follows that those best suited to treat addiction are those trained and knowledgeable about the psychology of addiction. One does not have to have a cold to treat it. The harmful side to this myth is that it is insulting to addicts, it implies that addicts are different to the rest of the human race, they are not!.

7Addiction is basically a problem of brain chemistry

This comes form the confusion between physical addiction and psychological addiction, which he calls true addiction. The misunderstanding coming from the misinterpretation of brain imaging studies that show where drugs work, not why some people us them addictively.

A different kind of basis for the brain chemistry myth is the mistaken idea that people take drugs because it gives them a “high” and the fact that recent research shows that alcohol and drugs increase the neurotransmitter Dopamine has been misunderstood to support the idea. It just supports the old myth that addicts are pleasure-seekers. As we know, addiction is an unhappy compulsion, not an effort to seek rapture.

8People with addictions have an addictive personality

This myth confuses the use of a specific psychological way to manage certain feeling states – the psychology of addiction with the concept of personality. Basically addicts have very different personalities, what they have in common is the use of addiction to manage certain feeling states. Confusing this with an entire personality has 2 regrettable consequences: 1, it incorrectly suggests that people with addiction are fundamentally different from everyone else and 2, suggesting that the issue in addiction is a problem of character, it is too close to the moralistic term “character defects”

9People with addictions are impulsive

Here, the confusion is in the meaning of the words “compulsive” and “impulsive” He says that addictions are generally not impulsive at all, they arise as a consequence of inner conflict at a particular moment but are frequently delayed until the addictive action can be put into effect. The urge to do the addictive act coming often long before the act itself.

10Denial is a failure to recognise reality

The myth arises from the surface appearance of denial. At the heart of addiction is the necessity to defy helplessness. But if someone is asked to admit that they are an alcoholic he feels he is being asked to admit that he is helpless to control his own behaviour. This smacks directly into the problem with which he is trying to deal: Helplessness. And needing to control his life, therefore if we see the question from his interpretation, we see that it is not a problem of knowing reality but a problem of toleration the meaning of what is being asked.

I would recommend this book. There is obviously a lot more than what Sis and I posted.

Have great sober day everyone!!

Annie

[wame]

sounds like a great book! I need to find it....

I totally can relate to all that you both posted, but, especially the physical vs. psychological addiction....I haven't had a drink since June, so, obviously I am no longer physically addicted....however, sometimes the urge to drink comes over me and it's pyschological in nature....

Very interesting....what is his background? Psychologist?

[AnnieBodie]

Hi Wame, nice to meet you:). It's a very good book, well worth the easy and short read that it is. Lance Dodes is a psychiatrist, he has a site here: http://www.lancedodes.com/

You can find his book quite cheaply on Amazon: http://www.amazon.com/Heart-Addiction-Understanding-Alcoholism-Addictive/dp/0060958030

He makes the distinction between physical addiction, which can happen with some drugs and obviously alcohol, and psychological addiction, which can exist for any and all of the afore mentioned, but also for non addictive substances or activities, for example gambling, sex etc... Psychological addiction is what he call true addiction, and is the hardest to overcome, as we all know, having gotten through the initial physical withdrawal from alcohol and other substances.

Congratulations on staying sober since June, that's fantastic!

Annie

[greengirl32]

This book was helpful to me in realizing how I get to that "f-it" stage. Bored, angry, helpless, etc. Good read, like any book, though, was not the Be-all, End-all on addiction.

[Gemini]

I found this book to be very beneficial. Indentifying feelings of helplessness and frustration are paramont to me now because I know that this is what leads me back to alcohol. Being patronised or undermined are huge triggers for me and because of what I learned from this book I go straight to red alert in my mind and do some healthy self talk to re-adjust my negative thinking. It has stopped me from reaching for the bottle many times.

Thanks for posting this. Gem.

[wystan1000]

Thanks - I have ordered this book. It seems smart, unlike Carr's book which is helpful at reaching a certain end, but clearly a rhetorical excercise and, as such, not worth much to someone who likes to think about things.

So in the meantime, anyone want to share with me some of the author's recommendations for what to do with feelings that lead one back to drinking, once identified?

Thanks,

Michael

[bigsister987]

Dodes says that when you experience the urge to drink (or carry out any other addictive behaviour) you can use this signal to find a better way of directly addressing the underlying purpose of your addictive act. He says:

"I certainly hope that if you do have an addiction, the understanding I have described here will by itself - with some practice - be sufficient to gain control of your addictive behaviour." He goes on to say that you may use this knowledge as a springboard to professional treatment.

"On the whole, what allows people to succeed in treatment is a capacity to be thoughtful about themselves, even if they are not aware that they have this capacity when they begin."

I often find the case studies in books like these not very helpful, but in this book I found them very illustrative. They helped to flesh out the points he makes (as quoted in other posts on this thread).

I hope you enjoy the book.

[AnnieBodie]

* bump *

Annie

[bigsister987]

Types of behavioral therapy include:


Rational Emotive Behavioral Therapy (REBT, the basis of SMART Recovery (http://www.smartrecovery.org/in/indexa.htm))
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)


And ACT which is the theory behind the book I quote in this thread:

http://wqd.netwarriors.org/showthread.php?t=13121


That's a fab post Ronnie. Thanks

[AnnieBodie]

I realize this is an old request, but the issue is timeless. In my opinion and experience, one must learn to separate feelings from (re)actions. The feeling that triggered me to reach for a glass of wine may still arise, but I can learn to interpret and respond to that feeling in another way. A number of possibilities:


The feeling and my interpretation of the feeling are both valid, but the drinking reaction is self-destructive. Some examples:

I am exhausted and overwhelmed. I need a drink.
I am angry. I need a drink.
I am celebrating. I need a drink.


The feeling is real but my interpretation of the feeling is twisted by catastrophizing, generalizing, mind reading, fortune telling, all-or-nothing thinking, etc. By re-interpreting the feeling, I can reshape my response. Here are examples of twisted thinking leading to drinking:

I feel awful! I got a ticket. I can't afford higher car insurance rates, so I'll lose my home. It is already hopeless, so I may as well drink. (catastrophizing)
I was anxious at my first non-drinking social engagement. I will never be able to have fun without drinking, so I have to drink. (generalizing)
My husband will think I'm boring if I'm not the life of the party. (mind reading)
When my (10 y/o) daughter gets married, she'll want me to toast her with champagne, so I may as well drink now. (fortune telling)
I had one drink, so I f'd up my quit. I may as well get hammered. (all-or-nothing)



It takes practice, but one can learn to recognize "automatic thoughts" and defuse them. But one can't do that while actively drinking. Drinking muddles our minds, blocks self-awareness and reduces motivation -- all things one needs to identify and change deeply ingrained feeling/thought/action patterns.

Behavioral therapy helps one frame issues like the ones above. Very different from psychotherapy, behavioral therapy is practical, focused on becoming aware of feelings and identifying thoughts about feelings that lead to negative behaviors. Types of behavioral therapy include:


Rational Emotive Behavioral Therapy (REBT, the basis of SMART Recovery (http://www.smartrecovery.org/in/indexa.htm))
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)



Wow, great post, Ronnie!

I'd just like to say that since reading this book I've turned my drinking urges around. Now, if I think about drinking or feel like drinking, it immediately tells me that something is bothering me, I am feeling a negative emotion, something is out of my control... this in turn leads me to analyse how I am really feeling: frustrated?, angry?, sad?, lonely? What? Why am I feeling like this? what sparked it? What can I do about it?

That sounds so simple written in black and white, but in reality I find it very difficult to identify my emotions, probably because as soon as I felt something in the past, I'd "drown" it so I never really knew what was "wrong" with me...

I've learned from Dodes, that I never want or need a drink, I need to figure out what's eating at me and I use the urge to drink as an impetus to figure it out.

Annie