Tuesday, June 22, 2021

Substance Abuse: Self-Destructive Behavior

 "The surest way to humility is humiliation” ~ commonly heard saying at Catholic 12-Step meetings in Ireland


It seems like the debate over whether or not substance abuse is a “disease” is never ending, as described recently by fellow blogger George Dawson. I really don’t want to get into the particulars of that, because the debate is almost always a waste a time due to the multiple definitions of the word disease that get employed and continually conflated in such debates.


I’d rather focus on one main issue: How much control do most addicts have over their drug use? My opinion is that the question can best be answered by re-classifying most, though maybe not all, substance addiction behavior as self-destructive behavior. Voluntary. If it were not voluntary, addicts would have next to no control over when and under which circumstances they chose to not indulge, no matter the consequences. Almost no addict is using 24/7 unless they are actively suicidal.


Now, some people might argue that substance abuse might be a form of obsessive-compulsive disorder. When people with OCD who have compulsions do not engage in their compulsion, their anxiety level skyrockets. This may be due to clearly abnormal firing of some nuclei in their brain. While they can certainly choose to let their anxiety skyrocket, this choice is indeed very difficult.


However, skyrocketing anxiety can have another cause besides the clearly pathological firing of brain nuclei. It can also be caused by panic over anticipated consequences of engaging or not engaging in a particular behavior. If doing so might lead to massive invalidation by everyone a person knows and cares about, then doing so becomes very difficult because of kin selection and tribalism, two subjects I have previously blogged about extensively.


Although, due to our current state of knowledge about the brain – literally the most complicated object in the known universe – there is no way of knowing for certain if most substance abusers indulge because of feared consequences of not indulging, or because of abnormal brain firing of some sort. And of course there may be two different types of addicts, so either or even both possibilities may be true depending on which addict one is dealing with.


Based on my clinical experience with all sorts of self-destructive and self-defeating behavior in my psychotherapy patients, I’m going to come down on the side of feared consequences for most of them. So am I saying an addict’s family system needs them to continue to be addicts in some way? Well yes, that’s exactly what I am saying.


If this is the situation, it does not make sense to ask the question of whether or not the addict wants to be an addict, because in fact they would be ambivalent about it (intrapsychic conflict, the primary concept in psychoanalysis – what a novel idea!). While some substance use in moderation in some contexts is indeed pleasurable, the life of an addict is anything but. They hate what the drug does to them. Many no longer even get high from cocaine after extended use, for example. And if getting high really made them feel so good, then why aren’t addicts the happiest people around instead of some of the most miserable? The problem is that the feeling of existential terror due to kin group invalidation feels even worse. So they indulge. Self-destructively.


Now, the family groupthink issue which triggers any given family’s need to have an addict in their mist to remain stable is not always the same, so each family has to be evaluated individually on its own terms. But let me discuss the most common example of such an issue: Puritanism.


Puritans on the whole believe, to put it bluntly, that we are nothing but sinful piles of crap in God’s eyes, and that we have to be sinners because, well, all people are sinners who must therefore ask for God’s forgiveness. So, as clearly stated in the 12 steps, which are based on Protestant conversion techniques, our will must be a problem. If we are willful, we simply must come to a bad end. The only way out is to renounce our will and turn it over to a “higher power” - which is actually the group to which we belong. And do what they want us to.

Did someone mention willfulness there?

I’ve heard docs from 12-Step programs give talks at medical meetings during which they would tell the most humiliating stories about their own crazy behavior when they were using – a public version of what they do in meetings. Essentially, these folks are substituting a less harmful form of self-abasement for a more harmful one. Just like the Irish slogan at the top of this post says rather overtly. I suppose that’s the better of the two options, but it’s still self-destructive. But it makes their conflicted parents feel better about not acting on their own forbidden impulses. While having already received vicarious satisfaction of these very impulses watching their children indulge. Heaven forbid anyone might feel good about doing something selfish.