Addiction, Needs, & Compassion

For many people – those working in the addiction field, or those experiencing an addict in their lives – it can feel frustrating that the addict keeps using.  We might feel they are being selfish, lazy, and irresponsible. We ask ourselves, “who would put up with not showering, living on the streets, stealing, selling themselves for sex, injecting their heroin with dirty puddle water, and on and on?”  “Those people are disgusting!”  “I can’t stand addicts!”  “I hate working with addicts, they’re always trying to get something from me!”  These are just some of the lines running through our heads at times.  The last thought is “why don’t they stop?”  The million dollar question.  Some answer through a biological explanation, others an adaptive explanation, others a spiritual explanation, and some a social learning explanation.  It is all of these.  But for this essay I want to focus on a more adaptive explanation and one that is more concerned with an ongoing internal process in the here and now, one that concerns itself with the meeting of human needs.

It’s obviously hard to have compassion for those abusing substances.  But, really, that is the easy reaction to have.  Staying there only keeps one in the dark about the addict and about themselves.  Dr. Wayland Myers, PhD, has written a document about “Defining a Nonviolent Communication Approach (NVC) to Addictive Behaviors.” In this he explains how Marshall Rosenberg, the founder of NVC, tries to approach the addict by using empathy and trying to understand what needs are being met by using.  He does not try and get addicts to stop using.  Substance abusers are usually quite perplexed by his approach because they are used to everyone trying to get them to stop.  His focus is on needs so that he can proceed in helping that person meet those needs in ways that are “more effective and less costly.”  This is not easy for many people in our society as we want to FIX people.  It is tough to give up coercive measures, confrontational approaches, and parental directives.  As helpers or loved ones we can often feel helpless, out of control, and frustrated within the paradigm of judgment and control because it becomes a negative feedback loop. Pushing our goals onto someone else may work in the short term, but usually, though, backfires, and can often perpetuate disconnection, a need all humans value.

 So why do we continue to stay in this place where we NEED substance abusers to stop? Why do we work so hard FOR SOMEONE ELSE?  Why do we feel so out of control? Why do we get frustrated, angry and hurt by their use?  It is usually more to do with our own needs not being met.  As helpers, we must connect with our own needs in order to connect with another’s.  It is also a paradigm that we are in that using is wrong and we must “intervene”, we must “challenge” them, we must, we must, we must.  “They don’t know how to live life”, “they are irresponsible”, “they have mental health issues”, “they have a brain injury”, “they are still a child”, “they experienced trauma” – ultimately we are invading their sense of humanity, their internal world, their “creative adjustment” as described in Gestalt psychology. Using, for many, has been a very creative way to cope, adjust, and stay alive.  It has become an organismic adaptation to life experiences. Why do we want to pull this carpet out from under them so quickly and harshly??

 Instead of making all these assumptions and judgments, we need to “connect” with addicts as in NVC, or make “contact” as in Gestalt psychology. Take away the stories, take away the judgments, and learn what is there.  What need is being met by all this using.  Can we help this person make contact with their own internal world so that they can at least value their own world?  Shame is the result of continuously denying one’s own experience.  We can blast away shame by listening, connecting, and helping those who use to become more in tune with their needs and their internal worlds.  We must remove our judgments and need for control so that we can offer humanity to someone.

 From an existential point of view, it is that person’s responsibility to take control of their life how they see fit.  From a person-centered and gestalt psychology point of view, all human beings are moving toward growth in some way.  We can either help them get there taking which ever roads fit best for them, or we can weigh them down on the road of addiction. The more we focus on getting them to stop the addiction, the longer they only focus there and stay on that path.  The quicker we begin walking with them on that path instead of hurrying them off, the quicker they will want to explore other options.  Once someone feels truly supported and understood they will feel the energy to take on new experiences.

 So, what are their needs? How can you help them connect to their needs?  If you are addicted, how are you not connecting to your self?

 Lastly, I want to make a quick point here about boundaries.  Nowhere in this approach or understanding does it say let substance abusers or anyone for that matter treat you however they feel like it.  You do not have to just sit there and accept all behavior toward you to be compassionate.  It is important for all humans to connect to their own needs and express these honestly.  So if you are feeling manipulated, hurt, taken advantage of, etc, then calmly express this to the person so they understand.  We must meet our needs as helpers as well and do not need to allow dysfunctional ways of relating to hurt us for the sake of “compassion.”  This is not how it works.  The compassion and connecting are to the person and the unmet needs, not to allowing yourself to be treated in ways you don’t want.

The Bio-Psycho-Social Approach to Addiction: An Introduction

Why have an alternative to 12 Step if it helps so many people?  Good question.  It does help many people stop drinking and drugging, but it also has not helped countless others.  The 12 Step approach is quite specific with its focus and quite narrow in its scope.  Addiction is an intensely complex problem that needs a broader, more holistic approach.  The Bio-Psycho-Social model of addiction brings just that – a broader, multidisciplinary approach to the treatment of one very complex problem.

There is no one-size-fits-all approach to treating addcition because everyone has different needs and different history and different personality constructs.  The whole idea of a one-size-fits-all approach is very modern in its philosophical orientation, and our times have changed.  Our world and our thinking is much more complex, with many more options, and new problems, that we’ve had to grow out of a modern way of thinking to a postmodern way of thinking.  Life is not as simple as it was in the 50s, where a simple approach like the 12 Steps may have worked just fine.  Life has changed, and so too has our problems.  With this, we need to see the importance of more holistic approaches to life’s issues, and a broader understanding of our lives today.

The Bio-Psycho-Social (which will be referred to as BPS from now on) approach says there are biological reasons for addiction, psychological reasons, and sociological reasons as well.  Taking this into consideration, we must attack this problem multidimensionally.  We cannot just look at someone’s drinking, or drugging.  We cannot just look at someone’s emotional life.  We cannot just look at someone’s relationships.  We need to look at all these major aspects of human life for some answers to our issues, whether they be addiction issues, or other life problems.

Biological

At the present time, it is still a mystery whether or not there are specific genes passed down that determine whether or not someone will develop a substance abuse problem.  We do know that there are likenesses among the chemical makeup of people with addictions.  We also know that we are chemical people, and that the chemical addiction can become quite strong for an addict.  So whether it’s hereditary or not, doesn’t really matter.  What matters is that we respect the fact that we have natural chemicals in our bodies and messing with that can become harmful.  Also, not taking care of our physical bodies, can lead to relapse, as we may become fatiqued, stressed, or malnourished.  Biological explanations can neither be worshipped, nor ignored.

Pyschological

For a long time, the focus on applying psychological principles to the problem of addiction, has been minimal, if not scarce.  Because many have believed addiction to be a disease, the idea that some of our psychological construct might contribute to addiction has been missed. 

A large percentage of the clients I see everyday have experienced either serious to severe abuse in their childhoods, or, at the very least, a problem of overall family dysfunction to the point of pain.  It can easily be followed that these very individuals eventually turned subconsciously to drugs or alcohol to cope with, or adapt to, the inner pain they felt.  Many people have “stuffed” their emotions, or found ways to block out their pain.  These same people also developed irrational beliefs from the abuse and dysfunction since they were only children and did not know any other reality.  It is to be followed, that one would need to look at the way they have processed emotions, and the way they have developed their core beliefs, in order to better understand themselves.  When they better understand themselves, they can better deal with some of the reasons why they may be using.

Sociological

We are also very social beings.  Whether we hate society and groups of people, or find ourselves craving the attention of others, we are affected by people.  One of the biggest “frustrators”, or stressors, for clients dealing with addictions, is their relationships.  A bad argument, or relationship in general can leave one with a substance abuse very frustrated and exhausted at running into the same “wall,” taking them out to use.

We all see ourselves differently within the society which we are a part.  Some identify as minorities, some as women, some as men, some as lower class, some as upper class, some as outsiders, some as different, some as special, and some as just being a part.  How we see ourselves within the society around us has a very heavy influence on our self-esteem; and our level of self-esteem has a very heavy influence on the contribution to using substances in order to cope or adapt.  

As we can see, life in general for human beings is complex.  Substance abuse is complex.  Therefore, the treatment and understanding of addiction should be complex, or multidisciplinary.

Again, it is not my point to put down 12 Step philosophy, but to express the need for this very effective alternative in an age of ever growing complexity.  The 12 Steps have many helpful steps, and their overall focus of community is extremely important.  There are though, some fundamental and philosophical problems with certain Steps, and I will go further into these as we go along.

Until then, let the idea of an alternative approach sink in for those of you looking for one.