The word addict is thrown around a lot these days. It seems everyone is addicted to something. People aren’t only addicted to substances like drugs, they are addicted to people, things, and experiences. Some accuse others of being addicted to their own adrenaline. Is there no end to the possibilities of addiction?
Dictionary definitions don’t tell the complete story. The Merriam-Webster Dictionary says:
Addiction (noun) – A compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects and typically causing well-defined symptoms (such as anxiety, irritability, tremors, or nausea) upon withdrawal or abstinence.
While this defines the word, it does not go far enough. As a medical doctor dealing with all sorts of health issues, it seems to me that there is more to addiction than habit-forming substances and getting withdrawal symptoms. I think there is much more. Let’s take that definition and revise it more generally. After removing all the fluff, we get:
Addiction is a need.
However, we also must consider what is a need. “Need” has an inherent “for what?” attached. You can’t just need. There must be a purpose in a need. “I need to eat so I can live.” Does that mean I’m addicted to food? Perhaps we can add just one thing to it:
Addiction is a need that causes harm.
The Need is the Problem
People who need people are not “the luckiest people in the world.” They are addicted to people. When I was very young, around eight years old, I realized that my parents and brothers could not fill my needs for connection, love, and companionship. I specifically thought about my needs and knew I would have to wait to get that need filled. I was a patient little boy! I looked around and listened, and decided that marriage would fill that need. Other people said it worked for them, so I waited. Fast forward twenty years, I got married, and was shocked that my wife was also unable to fill that need. I didn’t know what to do. I was lost. Without thinking about it I kept trying. It was like trying to fit the square peg in the round hole (her words). I have a need, a hole in my heart that must be filled, but I don’t understand that my childhood assumption is not working. I tried really hard for twenty years, but ended up divorced.
Then, with some hope, I married again, and found that my second wife also wasn’t able to fill the need, but I kept trying – doing the same things that didn’t work the first time. My addiction destroyed my relationships. My need has caused harm to my marriage, my children, and myself. After a long time, I realized that the need is the problem!
So, I looked around and saw this problem everywhere:
People who need money get addicted to cheating, stealing, and gambling.
People who need a substance to feel good get addicted to drugs, caffeine, alcohol, prescriptions. And so forth.
Food is likely the most common addiction. People eat to feel better but eating only briefly raises dopamine levels so they become addicted, and become obese in the process. They get calorie toxicity that manifests as metabolic syndrome (high blood pressure, high cholesterol, and high blood sugar with central obesity) or diabetes, among many other health problems. “When you’re not feeling your best, you might crave comfort foods, like sweets, fried foods, or processed foods. These are often high in salt, saturated fat, and sugar, which can lead to illness over time.”
But this addiction can even take on the façade of “good.” Orthorexia is a term used for people who must eat good food all the time. They get anxious if there is any “junk food” around.
Some people take on all sorts of obsessions to ally their fears and calm their hearts. Some exercise, others have orthorexia, still others are focused on avoiding toxins. It’s not that these are injurious, necessarily, but rather they take their focus away from things that are important, like dealing with their problems. In this sense it is little different from drowning your sorrows in alcohol.
Needing comfort also creates addictions. It seems that just about everyone could be addicted to something because of a need that is not being filled.
SUFFERING
There is a need in the heart, a yearning, a longing. Anything in the world that people find to fill that need can become an addiction. It is literally trying to use a short-term solution to fill a long-term need. Sometimes the need is for comfort, to relieve suffering, which can come in many forms:
• Pain
• Loneliness
• Hunger
• Thirst
• Fatigue
• Stress
• Grief
• Anxiety/fear
• Loss
There are many different ways to fill this need, but the most likely bottom-line is dopamine. Dopamine is a neurotransmitter in the brain that allows us to feel pleasure. What’s odd is that anything that causes us to release dopamine will fill the need -- or seem to.
• Marijuana (That’s why they call it “smoking dope”)
• An argument or fight
• Cold showers
• Massage
• Opiates (Heroin, morphine, codeine, hydrocodone, oxycodone, and so forth)
• Food – especially carbohydrates and fried foods.
• Exercise
• Buying things
• Pornography
• Winning
• A hug
• Shoplifting
• Running a business
• Sex
• Alcohol
• Nicotine (tobacco)
• Amphetamines, ecstasy, caffeine, and other stimulants
• Acceleration/speed
• Danger/walking on the edge
• Power
• Money
Notice that they aren’t all things that are pleasant. Dopamine and endorphins can be released by pain as well as comfort. Some people prefer that way, to feel pain. When they are asked, “Why do you hurt yourself, or enjoy pain?” they answer, “Because it feels so good when I stop!”
The point is, a person could relieve pain by any of them, potentially. However, oddly enough, people are so different that there is nothing that works for everyone. Many people don’t like opiates, they feel more nausea than pleasure. Some never get a “runner’s high.” Others don’t like a good massage. Most people like to eat, but some get no dopamine from it, so it doesn’t relieve their stress. Many people drink alcohol, but relatively few become addicted.
I had a friend in medical school who said, “My mom is an alcoholic, my dad is an alcoholic, and both of my sisters are alcoholics…” That’s a pretty strong family history, so of course my question to her was, “are you an alcoholic?” She answered in the best way possible: “I don’t know, and I’m not going to find out.”
Thus, addictions are highly variable since no two people have the same response to any given stimulus. This is the difficulty of defining the term. It could be that everyone has an addiction in some way – there is something they do or something they take in that gives them a dopamine rush to calm, soothe, comfort, and feel good, that is temporary, requiring constant renewal. Thus, addiction is better defined as:
Addiction is using a dopamine reward to temporarily fill a permanent emotional need.
Curing Addictions
During medical school we were asked to attend a 12-step recovery program for a time. I went to an Alcoholics Anonymous meeting with one of my patients from the V.A. hospital. At the time, I thought it was funny that the people there were recovering from alcohol, but had several pots of coffee brewing as we walked in. There was also a lot of smoking. I surmised that avoiding alcohol required some other habit to take its place. Some smoked. Others drank a lot of coffee, or sugary caffeinated drinks. The program also allows more contact with others – the meeting itself can become the addiction. In AA we were told “once and alcoholic, always an alcoholic.” The desire will always be there, we can just decide not to fill it. Thus, we probably never cure addictions.
A good friend of mine who smoked all his life got laryngeal cancer. Because of throat surgery and radiation, he had to have a tracheostomy tube, to breathe through his neck. I went to visit him at Cottage Hospital after his surgery and he told me, “I’m never going to smoke again!” He had to plug the trach tube in his neck to speak.
“Oh? Where have I heard that before?”
“No, this time I mean it!”
“How do you know?
“Because of this!” he grimaced as he pointed to the trach tube in his neck. “I hate it! I have been praying for years for help to quit smoking, but I would have never stopped if it wasn’t for this. It sucks that this is an answer to prayer!” Years later, still with a trach tube, he had indeed not smoked, but he confided to me that he almost always wants cigarettes. He was not cured of the cravings; despite all he had suffered, and years of abstention.
Studies on addiction seem to indicate that there are two main factors that are required to overcome addictions:
1. Social support. This could be family, friends or groups that encourage and teach.
2. Taking responsibility
12-step programs may provide both of these, but it is not the only way. Most people who overcome addictions do not use a 12-step program. These people find they do have control, that they can overcome, that they have the power within them. They have the outside resources as well, such as family support, or access to a good therapist. Let’s discuss some specifics.
ASSESSING YOUR VALUES:
Once you have acknowledged your addiction, the next step is to appraise your values. What is it you value most? What is important to you. Is feeling good for moments more important than anything? You may value something more such as:
• Health
• Spouse, children, or other close relationship
• Appearance
• Relationship to God or sense of spirituality
• Intelligence
• Standing in the community
• Self-respect
• Job/profession/work skills
• Friends
• Ethical standards
• Something not mentioned above
It is essential that you find something that is more important than the temporary high or comfort you get from your addiction. You will have cravings at times, but your values can help you stay on “the strait and narrow” because you have something more important.
DEVELOPING YOUR ASSETS:
The next step is to evaluate what you have that can help you in your quest to conquer. The resources that improve your ability to overcome an addiction may include:
• Supportive relationships
• Work that is stimulating
• Leisure activities such as hobbies, exercise, art, or travel
• Coping skills like emotional resilience and character
These help you to cope with the vicissitudes of life. You will suffer. You will be uncomfortable at times. There are up and downs. When there are downs, we mostly hang in there and pass through them with the support of others, having other things to do, keeping busy, and just having resilience and character to stay on track in spite of pain and problems.
FINDING A SUBSTITUTE:
Next, you can consider a replacement for your addiction. Whether it’s a 12-step program or any medical program, one thing that works long-term is exchanging the addiction for a different one. It is well-known that people who quit smoking start eating and gain a lot of weight. My cousin was a cocaine addict, and we could always tell when he was off cocaine because he would gain almost a hundred pounds. He would go back on cocaine and would lose it all and be very thin. He’s dead now, may he rest in peace.
Debbie was a young mother who came into my urgent care office from time-to-time because of chronic pain. One day she confided that she was using heroin since high school and was getting pain pills to keep her from going into withdrawals between hits. She wanted help getting off heroin for good. Over a period of about a year we tried everything to get off heroin, but nothing worked for her. A couple of years later I went into a business found she was the human resources director. I asked her, “What are you doing here?”
“Clean and sober for over a year!”
“OK, I gotta know, how did you do it after everything we tried?”
“Have you ever heard of a ‘runner’s high’?”
“Of course!”
“When I need a “hit” I just go for a run, and I can hardly wait to “hit the wall.” I just push through the pain, and the endorphin rush completely relieves the need.” She switched from a harmful addiction to fill her emotional need to a beneficial one. She uses pain to give her endorphins that release dopamine. But, it’s still only temporary, she needs to run frequently to feel good.
Debbie found a beneficial substitution. Some substitutions are not helpful, as they may also do damage, such as the smoker who starts eating. It is essential that you choose what you will do instead. The trigger is the need, and when you feel it you must have something to do instead of the addiction. Choose some kind of art, or creative outlet. Try yoga or exercise. Go for a walk. Clean a closet or the garage. Do laundry. Write in a journal. I have many people do breathing exercises. Try a cold shower! There are myriad constructive things that can be done.
It is normal to have setbacks, but don’t get discouraged, just keep getting up every time you fall. Life is all about falling – and then getting up again. If you get up the same number of times that you fall, you will end up on your feet. That’s ideal! Don’t ever give up!
THE TRIGGER OF LONELINESS
Understand that suffering is a part of life. Buddhists learn to acknowledge their suffering. Sometimes that means hunger, fatigue, or pain, but most often it is loneliness. Studies in rats indicate that being alone is the greatest trigger for addictions. The obvious ones are sex, pornography, and falling in love, but even food, drugs, and alcohol increase with loneliness. Ultimately, we must all deal with the fact that nothing and nobody in the world can fill our loneliness. We must deal with being alone and learn to love ourselves.
Everyone, even if you have hundreds of friends who love you, must deal with loneliness. Many years ago I had a patient who lived on a ranch nearby. One day I was called to see him because he fell on the stairs and had an injured foot. I got there and the foot was rather swollen, so I ordered x-rays. He was very famous and didn’t want to go out in public or call an ambulance, so he asked me to take him to the local hospital. We limped to my little Saturn coupe and stuffed him in. When we got to the gate of his ranch, there were a lot of girls there. He ducked down, practically to the floor so nobody would see him. As we drove by, the girls mobbed the car, trying to look in the windows, and screaming, “WE LOVE YOU…!!!” but we just drove on. He certainly was well-loved! However, he once told me that he had no friends, and there was nobody he could trust, not even his family. He was the most famous man in the world, at the time, known by almost everyone, with millions of raving fans, but had no close relationships. He was lonely. He would call me, his doctor, for minor aches or sniffles just as an excuse to come over and talk. When I said I had to go, he begged me to stay - he was so needy! Despite fame and fortune, he was a very lonely man. Even he needed to deal with his loneliness! But instead, he ended up dying young because of his addictions.
FINDING A PERMANENT SOLUTION:
Exchanging one addiction for another may be an improvement in your life by not causing more pain, but the need is still there, and dopamine is used to fill it -- temporarily. Even being comfortable with yourself may not cure you of addictions. The only way to be cured is to permanently fill the need. The need is the problem. The addictions are just the wrong way to fill the need.
When 12-step programs tried to take God out of the picture, they didn’t work as well. The “Higher Power” seems to be essential to the program. But the program tells you that you are an addict and will always be an addict. On the contrary, I have seen that there is a way to change the heart. Your heart is your most basic wants, needs, and desires. It is the “why” of your life. Your values come out of your heart, as well as everything you think, feel, say, and do; the heart is the bottom-line. We are told that there is no way to change the heart because our foundations don’t change. We can act differently, but that doesn’t change the underlying desires. However, there is a way.
Ultimately, the answer is to discover the underlying need of the heart and fill it. Most humans have an innate need to connect with the infinite. We think that need can be filled by something in the world, but everything in the world is temporary. The reason we get addicted to the things of the world is because they work! Dopamine comforts and temporarily fills the need. Even things that are healthy like good food and exercise only work briefly. But, if we seek to connect with God, He can fill the need permanently. Jesus explained to His disciples:
But the Comforter, which is the Holy Ghost, whom the Father will send in my name, he shall teach you all things... Peace I leave with you, my peace I give unto you: not as the world giveth, give I unto you. Let not your heart be troubled, neither let it be afraid.
(KJV John 14:26,27)
This seems to be the answer to every addiction issue. The Comforter is to comfort us. Rather than seek comfort in something temporary, we can have permanent comfort, and peace, without fear or even a troubled heart. When we have no needs, we will have no addictions. Imagine the peace this would bring! The heart is full, and you are not worried about the next dopamine "hit." You have no needs! You are not dependent on anything in the world to feel whole, complete, or satisfied. You don't need dopamine at all. This is true healing.
When I discovered my addiction, I found there was no way out -- nothing in the world could fill my need. I had to deal with my loneliness and seek a relationship that was eternal to fill me. 50 years after that little eight-year-old boy discovered the need, I have finally found the best way to fill it. Now, I no longer seek anything in the world because I don’t feel like I need anything.
People tell me I have a lot of willpower. I think “willpower” is just permanently filling the true needs of the heart. I have found this in my own life. I don’t need to berate myself for “falling” but rather turn to God and seek the Comforter. I “fall” because I’m empty. When I'm filled, I have "willpower" because there is no need.
SHARING
Overcoming addictions is like growing up. We start out as infants, completely dependent on others, but gradually grow up to be independent as our needs are filled by the Infinite. And then we move forward to be able to take responsibility for those who are newborn and are dependent, like a parent taking care of a child. The 12th step is to become a mentor and bring others up, helping them to conquer addictions. Together we can all help each other grow up to be independent, healthy, and happy. Happiness is connecting with others. The parent-child relationship can grow into a peer relationship, so nobody is alone, or lonely. As each overcomes, and then helps others to overcome, it will spread everywhere, and addictions will disappear from the world.
A Happy Thought for a HAPPY NEW YEAR!
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