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Monday, May 7, 2018

Understanding the Healthy Needs Underlying an Addiction

In prior articles, I've addressed issues related to addiction and recovery.  See my articles:
In this article, I'm focusing on understanding the healthy needs underlying addictive behavior.

Understanding the Healthy Needs Underlying an Addiction

Why Is It Important to Understand the Healthy Needs Underlying an Addiction?
People who are involved in addictive behavior, whether it's drinking, drugging, gambling, sexual addiction, overspending or any other addiction, tend to feel shame and guilt about their behavior.  This is often exacerbated by well-intentioned loved ones who don't understand and tell them, "Why don't you just stop?" 

As a result of the guilt and shame they feel, many people who engage in addictive behavior don't get the help that they need, which often leads to an eventual downward spiral.  When they're not feeling guilty and ashamed, they might be in denial about the extent of their problem, colluding with their well-intentioned loved ones by telling themselves, "I can just stop whenever I want to."

In addition to shame and guilt often creating obstacles to getting help, these feelings frequently get in the way of any self exploration about the underlying issues related to the addictive behavior. Or, the person who is abusing substances attributes only negative reasons for the abuse, "I'm a bad person" or "I'm unworthy" or "I'm unlovable" and so on.

Understanding the healthy needs underlying the addiction enables the person engaged in addictive behavior to have more self compassion and begin to explore other ways that s/he could satisfy these needs.  Secondarily, it can also help loved ones to have more compassion for the person struggling with an addiction.

Fictional Clinical Vignette: Understanding the Healthy Needs Underlying an Addiction
The following fictional clinical vignette illustrates how understanding and separating the healthy need from the addictive behavior helps the client:

Jack
Originally, Jack started psychotherapy to deal with longstanding anxiety and feelings of low self worth (see my article: Overcoming Feelings of Inadequacy).

Jack told his psychotherapist that he couldn't remember a time, even as a child, when he didn't feel anxious.  As the oldest of four children, Jack was his mother's confidante even when he was five or six years old (see my article: Children's Roles in Dysfunctional Families).

His mother tended to be anxious mostly about the family's financial well-being.  She worried that Jack's father's gambling problem would be the financial ruin of the family, and she tended to lean on Jack for emotional support, which was developmentally beyond what he could do.  All of this was emotionally overwhelming for him.

Jack attributed much of his longstanding anxiety to worrying about his parents and siblings and feeling inadequate for being unable to be the kind of emotional support that is mother needed.

In hindsight, as an adult, Jack understood that a young child wouldn't be able to take on such an emotional burden.  But this was an intellectual understanding.  On an emotional level, he continued to feel that he should have, somehow, risen to meet his mother's needs.  So, there was a split between what he knew intellectually and what he felt emotionally, which he acknowledged.

Jack had been in therapy before and he achieved insight into his problems, but it didn't change how he felt, and it didn't change his struggle with anxiety.

That's why when he decided to attend psychotherapy again, he chose experiential psychotherapy, as opposed to regular talk therapy, with the hope of having a different experienced in therapy and a possible resolution to his struggling with anxiety.

As a start, his experiential psychotherapist worked with Jack to help him develop better coping skills and internal resources to deal with his anxiety, which was helpful.  

Then, they talked about how to help him with his unresolved childhood trauma, which resulted in Jack's posttraumatic stress disorder (PTSD).  His psychotherapist provided Jack with psychoeducation about the various therapeutic possibilities in experiential therapy, including Somatic Experiencing, EMDR therapy, and clinical hypnosis.  

This was a few months into the therapy, and it was around this time that Jack admitted to his therapist that he had been smoking marijuana for over 20 years--since he was 13 years old.

He felt so ashamed and guilty about smoking marijuana that, originally, during the initial consultation when his therapist asked Jack about addictive behavior, Jack denied it.  But now that he had more of a rapport with his therapist, he wanted to be honest with her (see my article: Why It's Important to Be Honest With Your Psychotherapist). 

He was also understandable concerned about the affect of doing trauma work on his addiction and vs. versa.  

His psychotherapist told Jack that she appreciated how difficult it was for him to admit to her that he abused marijuana and that he wasn't forthcoming about it initially.  She also told him that, in addition to understanding the harmful effects of chronic marijuana use, it was important to understand the healthy underlying needs related to Jack's addiction.

Jack told his psychotherapist that during his annual medical check up, he had recently spoken to his doctor about his marijuana use, which consisted of smoking 2-3 blunts per day several times a week, and his doctor told him that the marijuana was probably contributing to Jack's anxiety.

His doctor explained that chronic marijuana use increased the risk of anxiety and depression because it appeared to inhibit the chemical dopamine in the brain.  He also provided Jack with information about the research that substantiated these facts.  In addition, his doctor recommended that Jack stop using marijuana and tell his psychotherapist about his use.

Jack said that, until he tried to stop on his own, he always believed that he could stop smoking marijuana whenever he wanted to stop.  That's what he told himself and his wife,who wanted him to stop.  But when he attempted to stop on his own, he discovered that, although he didn't have a physical addiction to the drug, he realized that he had a psychological dependency, and he couldn't go more than a day without smoking marijuana.

Initially, Jack was focused on the negative consequences to his addiction:  He feared making himself more anxious and developing depressive symptoms; he noticed some problems with his memory,which he and his doctor attributed to long-term marijuana use; he was tired of "being in a fog"most of the time; he was concerned that his wife might get fed up with his addiction and leave him; and he was also concerned about how much money he was spending on marijuana, which he would rather spend on other things that he and his wife wanted to do--like saving for a down payment on a house.

In addition, Jack was aware that he and his therapist wouldn't be able to work on his unresolved trauma until he was sober.  His therapist explained that until he had a period of sobriety, it wouldn't be wise to start trauma therapy because when disturbing issues came up in therapy, Jack might feel an increased need to go home and smoke marijuana.

Also, even if Jack gave up smoking marijuana, his therapist explained, he might take up another form of addiction, like drinking excessively or gambling or some other form of addictive behavior (see my article: Understanding Cross Addiction: Substituting One Addiction For Another).

His psychotherapist acknowledged that these were all very important factors for Jack to consider.  In addition, she also asked Jack to consider what he got out of smoking marijuana.  Jack said he had never thought about this before. But, as they continued to explore what he got out of smoking marijuana, Jack realized that it used to help him to feel more comfortable in social situations--although, lately, it wasn't helping him as much because the chronic use made him anxious.

Jack and his psychotherapist continued to explore this healthy need underlying his drug abuse.  At first, it was difficult for Jack to separate the healthy need from the unhealthy consequences of his using the drug.  Whenever they began to explore how important it was for Jack to feel connected to his friends and what he got out of these friendships, he would revert back to shaming himself about his addiction.

It took a while before Jack could set aside his guilt and shame to separate out the healthy need from the unhealthy use.  His psychotherapist would continuously bring Jack back to separating out the healthy need--what Jack was attempting to accomplish by using marijuana.

Eventually, when he was able to put aside his guilt and shame, he began to appreciate the healthy need while, at the same time, acknowledging the unhealthy aspects of abusing the drug.

As he developed a deeper and more self compassionate understanding, he became less judgmental about his use and more open to discovering other ways to become feel more comfortable socially.  In order for Jack to get to this point, it was necessary for him to work with his therapist to reduce his shame and guilt.

Once Jack had a sustained period of abstinence and he didn't engage in any other addictive behavior, he and his psychotherapist began to work on his unresolved childhood trauma.

Conclusion
People who engage in addictive behavior are often, initially, in denial about their problem.  Once they are no longer in denial, it's not unusual for them to experience guilt and shame as they deal with the consequences of their abuse to themselves and their family members.

If they remain stuck in guilt and shame without appreciating the healthy underlying needs that contribute to the addiction, it's usually harder for them to stop the addictive behavior because they get caught in a cycle of shame and abuse.

With the help of a skilled psychotherapist, they can begin to separate out the healthy need from the abuse.  An appreciation for the healthy need helps the client to be more self compassionate with less guilt and shame.  It also usually provides an opening for healthier behavior to take care of those needs.

Getting Help in Therapy
If you're struggling with unhealthy addictive behavior, you could benefit from getting help in psychotherapy (see my article: The Benefits of Psychotherapy).

A psychotherapist who has experience with working with addiction and helping clients to understanding their healthy needs can help you to overcome addictive behavior (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, seek help from a skilled mental health professional.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more from me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.



























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