Claire is frequently annoyed when her parents and friends question her use of alcohol and drugs. She doesn’t use every day. She still maintains her job. Her grades in school have dropped but that’s because of the stress in her life. She finds that an occasional drink or night out with her friends partying helps take the edge off from the pressures in her life. Her father had a really problem with alcohol and behaved out-of-control on a regular basis. She admitted to drinking/drugging and driving. Claire claims that everyone she knows does this and as she put it, “What are the odds of actually getting caught by the police?”
What Claire hasn’t shared is that she has missed several classes at school because she slept through them after night out on the town. She minimizes the significance of this as her way to cope and that she isn’t failing. Interestingly, her work requires random drug tests. When she is out with her friends, her group of friends chills out by smoking a few blunts and every once in awhile uses Ecstasy to make the evening more enjoyable. She lost her last job because she obtained a positive drug test.
Substance abuse can be insidious. No one starts out with the goal of developing a problem with alcohol or drugs. Most teens find that they experiment with life. When you look at the progression that people go through with regards to using mood altering substances; 1. Experimentation, 2. Choice, 3. Chronic 4. Recovery/Rehabilitation or Death. These four (4) stages are reviewed by the graphical display referred to as the Jellinick Curve of Addiction (The Disease Concept of Alcoholism, Jellinick, E. M.). No one does any habitual, repetitive pattern of addiction because of what it does to them. They do this behavior because of what it does for them. Let’s use cigarette smoking as an example. No one begins smoking cigarettes with the goal of developing lung cancer.
The initial stage of Experimentation occurs when the individual tries something new because they are curious, want to fit in, or feel pressure by those around them. There are usually no major consequences that take place at this time. They only experimented when the occasion presented itself.
In the second stage or Choice stage, the individual actively seeks out the mood altering substance. The now know the effects of the drug and turn towards the alterations in the perception of reality. This is when tolerance begins to increase. They also begin to be preoccupied with thoughts of the effect, plans for using and associating with others who normalize their use. They may decrease exposure to people or places in which they could not use. This is the beginning of problems due to their use; lies, covering up, memory problems, etc.
In the third stage or Crucial stage, individuals experience a loss of control. When they use, they use to get high or drunk. When they use, they use till the supply is gone or until they are out of money. Dishonesty, isolated use, consequences (relations, school, job, legal), loss of interest in non-using activities and highly defensive reactions become common place. Use despite consequences, use to feel normal and moral deterioration occur.
The fourth stage unfortunately speaks of individuals who need to use in order to feel normal. They have changed their physiology to such a degree that they are not producing the natural biochemicals and neurotransmitters required to feel normal. Withdrawal occurs when the substance is not used. There is a pattern that is often displayed by individuals with repetitive, unhealthy compulsive behaviors, including addictions. It is referred to as the Motivated Cycle of Compulsive Behaviors (Dr. Paul McHugh, M.D., Director of Psychiatry, Johns Hopkins University Bloomberg School of Public Health). The four steps reveal a cycle that captures the difficulty of managing this individual’s perceived life stress. The four steps are; 1. Perceived stress, 2. Negative intrusive thoughts, 3. Compulsive behavior, and 4. Short- term relief. Even when someone says that they want to stop this behavior, they invariably slip back into the very behavior that they claim is not a problem. Imagine saying that you want to stop petting the neighbor’s dog because he enjoys biting your hand each time your extend it. Yet, at some point in the future, you return to this behavior. This behavior isn’t merely a onetime deal but rather you are now beginning to lose fingers. Imagine saying that you want to stop placing your hand on the hot stove when the warning light is on and yet you kept placing your hand on the hot stove and burning yourself. People who want to stop a compulsive behavior say they want to stop. So at some point, they abstain. They are not engaging in that behavior. They feel successful. However, at some point, they perceive some form a stress. This could be real or imagined, but for that person, it is a perceived reality.
Upon experiencing this perceived stress, they find that they have some negative internal and intrusive thought and emotion. These thoughts and feelings are uncomfortable. Solutions as to how to handle the perceived stress are now the priority. However, due to their history of avoiding dealing with the problem and the history of a predictable pattern of behavior that decreases the stress, though short- term, the compulsive behavior returns. Curious as it is, the individual shifts at some point from thinking abstain to considering the repetitive behavior. When they consider the repetitive behavior, chemicals in the brain are released and a sense of relief or pleasure returns. At this point, though the person has not relapsed by behavior, they have relapsed by thought. This slippery slope leads them inevitably to the promised unhealthy behavior which they previously asserted that they would never again repeat.
Perceived stress (real or imagine) leads to intrusive thoughts/feelings, leading to compulsive behaviors, which provide short-term relief without any long-term resolution. And the cycle continues. Another way of looking at this cycle is that all compulsive, repetitive behaviors occur because of five (5) factors (Cortman and Shinitzky, 2009, Your Mind: An Owner’s Manual for a Better Life). The compulsive behavior occurs because;
1. The behavior Alters your Feelings,
2. It provides Temporary Relief,
3. It Persists Despite Negative Consequences,
4. They take on a Life of the Own, and
5. They follow a Predictable Pattern
If the compulsive or addictive behavior did not change your feelings, there would be no rewards to the system. As described earlier, this repetitive behavior provides short-term relief. Though only short- term, it provides a modicum of stress reduction and therefore is reinforced. Unfortunately, even in light of negative consequences, the compulsive or addictive behaviors continue. Does a cigarette smoker use with the goal of lung cancer or respiratory problems? Does a alcohol abuser continue in order to obtain another DUI and increases in the automobile insurance? In the addiction field, they referred to this behavior as UDC or Use Despite Consequences. When the behavior gets out of control the person might use just to feel normal. They almost seem to lose any personal self control. If the substance is available, they use. They have become the puppet controlled by the puppet master/addiction. In the addiction field, this is often referred to as LOC, Loss of Control. The very reasons why someone may have started (to fit in, be cool, etc) no longer apply. The counterproductive behavior has developed what Gordon Allport called, Functional Autonomy (reference). It develops a life of its own. Lastly, as we have seen, these compulsive behaviors and addictions have a predictable pattern or a motivated cycle which either can be addressed in order to recovery or avoided in order to maintain the unhealthy pattern of behavior.
Many people deny any problems with their behavior. We humans do an excellent job of talking ourselves into or out of a host of dysfunctional behaviors. Take a look at yourself and see if you do any of the following defense mechanisms. These coping skills contribute to continued unhealthy behaviors.
1. Simple Denial:
6. Denial through Explosion:
7. Denial through Implosion:
If you or someone you know is struggling with an addictive pattern or compulsion that is unhealthy, please encourage them to seek help. Provide love and support. Remember no one starts any of these behaviors with the goal of developing a problem. Discuss with them their thoughts. Determine if they are ready and motivated to change their behavior. Look into local resources from AA, NA, community programs, local hospitals, or agencies. Consider working with a professional who has received advanced training in this specialty. Some individuals might discover that they have an underlying medical problem that needs to be addressed rather than self-medicating with their habitual behavior. Again, connecting with a professional to discuss the options would be wise.
Dr. Harold Shinitzky, Psy.D.
Author – Your Mind: An Owner’s Manual for a Better Life