About Addiction

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood. - Alice Miller

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If only we acted according to what is best for us. How much easier our lives would be! There’d hardly be a need for therapy. Awakening, enlightenment, an actualized life— whatever name we give to flourishing—would be a matter of educating ourselves. Once we realized we were drinking or eating too much, misusing our devices and media, or otherwise developing an addiction, we’d just dial back our behavior to the optimal range.

But as everyone knows, even when we seem to know what’s best for us, we often don’t do it. Addiction is an example of acting contrary to our best interests, and one to which we can all relate. It is well defined as any behavior we engage in compulsively, despite its negative consequences. A show of hands, please?

Of course, some of us have an easier time regulating compulsive behavior than others. And most of us have an easier time regulating some of our behaviors than others. It may be easy to say no to a second drink, but harder to say no to a second dessert, to scrolling on Instagram, to gaming, to working obsessively, and so on. Addiction looms whenever our compulsion has harmful consequences.

Not so long ago, addiction was seen primarily as a failure of willpower. It’s true that this describes that strange moment when—despite knowing better—we opt for what is worse. Yet, it begs the question of why our willpower failed. It also misleads us into thinking that the root of the problem lies in the individual. A major advance in understanding and treating addiction has come from identifying its link with adverse early childhood experiences.

Like most forms of psychological suffering, addiction has a large social aspect. If you happen to have been reading these notes, you won’t be surprised. As part of thinking about how we can help others, I’ve pointed to how we live in an interdependent, deeply social world; and how the power of self-regulation develops from early experiences of limbic resonance and co-regulation. In such a world, it’s no surprise that individuals suffering from serious addictions also suffered childhood abuse and neglect. As Gabor Maté writes, “The question is never ‘Why the addiction?’ but ‘Why the pain?’ The research literature is unequivocal: most hard-core substance abusers come from abusive homes.”¹

Now we can see that the “failure of willpower” points to larger familial, communal, and sociopolitical failings. A more accurate motto, currently being adopted, is that “addiction is a disease of isolation whose cure is connection.” Attachment theory and interpersonal neurobiology are providing a powerful, empirically based framework for understanding the origin of addiction, and its “cure”. This is not to say that as individuals we don’t bear responsibility for our behavior. Nor is to deny that genes and neurobiology play a part in susceptibility to addiction. But it is to say that these factors are not as central as many think.

If only it were an individual and biological problem—a matter of moral fiber, willpower, genes, and neurochemistry. Then we’d have the quicker cheaper fixes we (and the insurance industry) understandably crave: medications, medical treatment, focused short-term therapies (that actually delivered the results they promise). Whereas in fact, there are rarely quick fixes, and the help of others is needed. But the good news is that now more than ever we know what’s needed, and we know it usually works. Unfortunately it’s not cheap or quick, and it’s not (just) an inside job.

Most psychotherapists recognize that psychoeducation and technique, by themselves, won’t heal serious addiction. (This is why the intervention I described with my patient was not a key part of her therapy.) Psychotherapy exists because insight and information won’t save us from suffering, much less from doing what we know harms us! What does seem to help are trusted, reliably attuned connections, made over time. To a surprising degree, as we shall see, the “cure” is connection itself.

1. In the Realm of Hungry Ghosts: Close Encounters with Addiction. Vintage, 2009.