Understanding the Healthy Needs Underlying an Addiction

In prior articles, I've addressed issues related to addiction and recovery.  See my articles:

• People Who Abuse Alcohol Often Don't Get the Help They Need
• Sexual Addiction: Is a Compulsion For Looking at Porn Ruining Your Relationship?
• Sexually Compulsive Behavior as a Split Off Part of Yourself
• Overcoming Grief Gambling
• Learn to Stop Overspending as a Way to Deal With Uncomfortable Feelings   
• Early Recovery: You've Stopped Drinking. Now What?
• Early Recovery: Overcoming Feelings of Loss and Emptiness
• Early Recovery: Focusing on the "People" Part of People, Places and Things
• Early Recovery: What If 12 Step Meetings Are Too Overwhelming For You?
• Boredom as a Relapse Trigger
• Overcoming the Temptation to Use "Liquid Courage" to Cope With Social Situations

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 (917) 742-2624 during business hours or email me.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

Many people who are recovering from addiction don't understand the concept cross addiction, which is substituting one addiction for another (see my other articles about substance abuse:  Recovery: Maintaining a Balanced Life,  "Liquid Courage:" Overcoming the Temptation to Abuse Alcohol to Cope With Social Situations, The Myth About Having to "Hit Bottom" to Change, and Coping With Addiction: Boredom as a Relapse Trigger).

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

The reason it's so important to understand cross addiction is that people who have a history of addiction often switch from one addiction to another, especially when they're under stress.

So, for instance, if someone who has been sober from alcohol for a few years suddenly finds himself under a lot of stress at work, instead of picking up a drink, he might start to abuse prescription drugs or gamble compulsively or engage in some other form of addiction.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

It's easy to fool yourself into thinking that you can dabble with another addiction because it's not your primary addiction.

But when you're under a lot of stress and you haven't developed adequate skills, if you have a history of addiction, you're more likely to either relapse with your primary addiction or engage in cross addiction.

Let's take a look at a fictional vignette to see how this plays out:

Fictional Vignette: Recovery: Understanding Cross Addiction: Substituting One Addiction For Another:

Connie:
Connie was sober from alcohol for two years.  During that time, she struggled to maintain her sobriety, but with the help of her psychotherapist and her sponsor, she celebrated her second year as a sober person.

Soon after she celebrated her second anniversary of sobriety, she left Alcoholics Anonymous and told her psychotherapist that she wanted a break from therapy.

A few months later, her mother fell, broke her hip and had to go to an inpatient physical rehabilitation center.  When her mother got home, she needed Connie's help because she wasn't able to take care other daily needs.

Although Connie and her mother had a conflictual relationship, Connie agreed to move in with her mother temporarily to help her.  She knew that other siblings, who also had conflicts with their mother, wouldn't be willing to do it and her mother really needed help.

The stress of taking care of her mother and working a full time job took a toll on Connie after a few weeks (see my article: Are You Experiencing Chronic Stress and Unaware of It?).

There were times when she wanted to tell her mother to fend for herself, but she knew her mother couldn't be alone, so she tolerated her mother's emotional abuse.

Connie was often tempted to have a drink, but she knew that if she had one, she wouldn't be able to stop, so she refrained from drinking.  But she started using food to soothe her stress, and she gained 20 pounds within a few months.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

When she went to the doctor for her annual checkup, her doctor couldn't believe that Connie had put on so much weight since the last time he saw her.

Knowing that Connie had a history of alcohol abuse, her doctor asked her if she was overeating.  When Connie told him that she was "stress eating" at her mother's home, he talked to her about cross addiction and recommended that she get back into therapy.

Connie had never heard of cross addiction.  Before she saw her doctor, she thought that as long as she didn't touch alcohol, she was doing well.  But when her doctor explained cross addiction to her, it made sense to Connie, and she knew she needed to take care of herself (see my article: Self Care For Caregivers).

The next day, Connie called a family meeting with her siblings and explained to them that they needed to pitch in.  She could no longer take on the sole responsibility of being her mother's caregiver.

At first, her siblings balked, but Connie insisted that either they help her out or she would hire a home attendant for their mother.

None of Connie's siblings wanted a home attendant in their mother's home, so they agreed to work out a schedule so they could take turns taking care of their mother.  Since there were seven of them, they each took a day, and sharing the responsibility made it less stressful.

Once her siblings were involved, Connie went back to her former psychotherapist to deal with her stress eating and unresolved issues about her mother (see my article: Returning to Therapy).

She also resumed attending Alcoholics Anonymous meetings, and she contacted her old sponsor on a daily basis.

With emotional support and reduced stress, Connie was able to get back on track so she could eat in a healthy way again and lose the weight she gained.

She also had a new appreciation for how stress could put her at risk for cross addiction.

Conclusion
The term "cross addiction" refers to substituting one addiction for another.

The fictional vignette above highlights how important it is to recognize your particular vulnerability to cross addiction and also the importance of self care, self help meetings, and getting help in therapy.

Getting Help in Therapy
Setbacks are part of recovery and part of psychotherapy (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

If you've had a setback in your recovery, it's important to get help before the problem progresses (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist, who is knowledgeable about addictions, can help you to get back on track again (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, contact a licensed mental health professional who has an expertise in addictions so you can remain healthy.

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.

I have helped many clients to establish and maintain their recovery.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Why You Can't "Think" Yourself Into Mental Health and Wellness

Understanding and developing insight into your problems is important but, unfortunately, it's often not enough to change your problems (see my article: Healing From the Inside Out: Why Understanding Your Problems Isn't Enough).

Why You Can't Think Yourself Into Mental Health and Wellness

Many people either never go to therapy to deal with emotional problems and many others leave therapy prematurely because they believe they can "think" themselves into wellness (see my article: When Clients Leave Therapy Prematurely).

There's no denying that understanding and developing insight into your problems is important, but it's only the first step.  You use your logical mind to understand and try not to repeat the same problems, if it's in your power.

But when your problems are deeply rooted in psychological trauma, your logical mind often isn't enough.  You need help from a licensed mental health professional to help resolve on the underlying problems that go beyond the logical part of your brain.  You need a skilled therapist to help you deal with the problem on the level of the emotional brain.

Let's take a look at a fictionalized vignette that illustrates these points:

Ed
Ed grew up in a family that was nearly destroyed by his father's gambling.  He saw first hand how the family struggled whenever his father lost money at casinos.

When Ed was 10, his mother threatened to leave the father if he didn't stop gambling, so the father stopped going to the casinos.  Instead, he started drinking heavily.

Ed's mother resigned herself to being in a marriage with a man who came home and locked himself in his "man cave" in the basement and drank every night.  She was relieved that, at least, she could pay the bills.  But they continued to drift apart.

As is often the case when people give up an addiction without getting help for the underlying issues, drinking replaced the gambling and led to the father having a fatal heart attack when he was in his early 50s.

By that time, Ed was a successful manager at a top company in NYC and married to a woman that he met in college.

Looking at Ed from the outside, it appeared to most people that Ed "had it all" (see my article:

But Ed had a big secret that he was very ashamed of:   Whenever he got paid, he made big bets on sports events.

Sometimes he won, and sometimes he lost.  But no one, except the person who placed bets for him, knew about his betting, not even his wife.

Sometimes, to cover his losses, he had to withdraw money from his savings.  Then, he was desperate to recoup his losses and he would frantically place more bets.

Logically, Ed knew that he needed to stop betting, but he couldn't control his impulses.  He kept chasing his losses and if he won, he wanted to win more.

One day, his wife, Nina, happened to look at their bank statement and she was shocked to see such a low balance compared to what had been in the account only a few months ago.

Normally, she didn't look at the statements because let Ed manage their finances.  So, when she saw the balance, her first thought was that either the bank made a mistake or someone hacked into their account.

When Ed got home, she showed him the statement and asked him what he thought had happened.  At first, he hung his head and didn't respond, and Nina began to feel sick.

Reluctantly, Ed told her about his gambling problem and that he had been withdrawing the money.  Nina went into the bedroom and began to cry.

Ed tried to convince her that he had a "good feeling" about an upcoming football game and he knew he would win.  He only wanted to place one more bet to recoup his losses and then he would stop.

Ed and Nina argued for most of the night, and both of them called out sick from work the next day.

After being up all night, Ed promised Nina that he would never bet again.  He apologized profusely for keeping these secrets and betraying her.

Nina responded by telling Ed to seek help in therapy.  But Ed knew what he needed to do--he needed to stop gambling.  He told Nina that he didn't need a therapist to tell him this.  He could do it on his own.

For the next few months, whenever the person who placed his bets called him to find out it he wanted to place a bet, Ed told him that he wasn't going to bet anymore.  Each time, when he got off the phone, Ed felt dejected and tired, as if he was physically ill.

After a while, Ed began to feel bored and depressed.  He was tempted to place a bet on a basketball game, but he told himself over and over that he had promised his wife that he wouldn't do it, so he couldn't do it.  But he knew that he really wanted to do it, so he struggled with this internal conflict.

Then, one day, one of his colleagues, Jim, called Ed into his office and showed him a picture of a sexy, beautiful woman.

Ed knew Jim's family and he knew the woman in the picture wasn't Jim's wife, so he asked him about the woman.  Jim closed the office to his door and told Ed about the woman, who was with an escort service.

He told Ed in a low voice that he saw this woman from the escort service every few weeks and since he started seeing her, he felt on top of the world.  He said she told him that he was sexy and attractive and he felt like "a million bucks."

Then, Jim told Ed that he should call the service and have fun with one of the beautiful escorts.  He told him that they're very discrete and his wife would never know.

Ed laughed it off, but the image of the beautiful, sexy woman stayed in his mind.  He fantasized about how much fun it would be to be with her.  The more he thought about the happier he felt.

When Ed realized that he was feeling so good by just thinking about it, he told himself that he could try the service once and then never do it again.  He wouldn't tell anyone about it, not even Jim.  It would be his secret (see my articles: Infidelity: Married, Bored and Cheating and Overcoming Addiction: Boredom as a Relapse Trigger).

At the time, Ed didn't know about cross addiction and how a person could replace one addiction, like gambling, with another addiction, like sexual addiction.

Months later, his wife discovered an ad for an escort service in the pocket to Ed's jeans as she was doing laundry and got very upset.

When Ed got home, she threw the ad on his lap.  Ed froze and remained silent.

A week later, Ed began therapy with a psychotherapist who specialized in working with addictions, even though he wasn't convinced that he needed to be in therapy.

Over time, Ed learned about cross addiction and remembered that his father stopped gambling and began drinking heavily.

He also began doing the necessary work to understand the underlying issues that were part of his addiction, in addition to the possible genetic component, and what triggered him.

The work wasn't easy or quick but, gradually, Ed began to realize that he couldn't just "think" himself into wellness.  He couldn't just tell himself not to gambling or engage in sex with escorts because that wasn't enough to override the deeper emotional issues that had to be worked through in therapy.

As he worked through the underlying emotional trauma and became aware of his triggers, Ed's impulse to gamble or have sex with escorts began to diminish because the underlying issues were getting worked on.

At the same time, Ed knew that he could never allow himself to become complacent and, along with therapy, he also attended Gambler's Anonymous and worked the 12 Steps with a sponsor.

Conclusion
There's a common misperception that if you understand your problems, you can avoid making the same mistakes.

While this might be true for certain problems, when you're dealing with more complex issues that have involve unconscious underlying issues, just telling yourself "to stop" isn't enough.

You might have the best intentions of never engaging in this behavior again, but it's not enough.

As many people know who have tried to stop engaging in addictive or dysfunctional behavior, it's very easy to replace one dysfunctional behavior with another, as the vignette above illustrates.

Whether it's gambling, sexual addiction or any other addictive behavior, you can get the same dopamine "rush" from many different types of dysfunctional behavior and this makes it difficult to stop.

Until you work through the underlying issues and discover your triggers, you will, most likely, continue to struggle or "white knuckle it" for a while, risking your relationship, your family, your job and everything that is precious to you.

Getting Help in Therapy
It's not easy asking for help (see my article: Overcoming Your Fear of Asking For Help).

It's much easier to be in denial and to tell yourself that you can do it on your own.

Many people wait until they lose everything before they seek help, but it doesn't have to be that way (see my article:  The Myth About Having to "Hit Bottom" to Change).

Taking the first step of setting up a consultation can be your first step in your recovery.

Working with a skilled psychotherapist who has experience helping people with addictive behavior and emotional trauma can help to free you from an unhappy existence.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

One of my specialties is helping clients to overcome the emotional trauma that is creating problems in their lives.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.