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Dr. Mike Gropper is an American psychotherapist and marital therapist living in Ra'anana. For full details see bottom of article.
Harry is addicted to TV sitcoms. Not only does he experience withdrawal symotoms if he is unable to watch them, but he always identifies with one of the characters, and tries to emulate him in real life.
People become addicted to many things: alcohol, drugs, including nicotine, compulsive gambling, compulsive sexual behavior, uncontrollable spending and shopping, compulsive eating, starving oneself (anorexia nervosa), TV addiction (couch potato syndrome), internet addiction, workaholism and compulsive spouse abuse.
So what exactly is an addiction?
An addiction is any behavior that an individual indulges in over and over and over again, that becomes so compulsive that this person looses control, that is, the willful ability to cut back on the behavior, and the behavior continues in spite of the fact that it causes psychological, physical, and emotional havoc to the person's life and those closest to him/her. In addition, people with addictions more often than not jeopardize their vocational and career goals, incur serious financial problems and may get into trouble with the law (i.e. getting caught using illegal drugs).
Another hallmark of addiction is the psychological defenses that are employed by the individual in attempt to deny or rationalize the continuation of the behavior and not look honestly at the harm this behavior is inflicting on either themselves or others. Sooner or later, almost all addictions do cause harm.
Judy, a heavy smoker for more than 30 years, has just been told by her physician that she has inoperable lung cancer and only a few months to live.
Jerry enjoyed spending money on visits to prostitutes. Over the years he spent larger and larger sums of money on his addiction until one day he realized he was flat broke.
Eli was employed as a programmer in a hi-tech company. He liked work but could not get through a day without getting high on marijuana. This impacted badly on his concentration ability, something essential for his job. Finally, he was fired.
Guy has spent every bit of money he has on his compulsive gambling addiction. Now he has made a lot of people very angry at him, and his wife is seeking a divorce.
Susie was very unhappy in her 20-year marriage to Yossie. She turned to compulsive eating as a replacement for the lack of love and lovemaking. Her physician is treating her for high blood pressure and high cholesterol and she feels so depressed that she has thought of ending her life.
Nature vs. nurture
Some experts believe that addiction stems from a disease that some people have innately, making them vulnerable to become addicts.
Many other experts argue that people who become addicted are emotionally vulnerable to begin with, and therefore, the addictive experience, which does activate the brains natural pleasure chemicals, is likely be repeated to self-medicate some type of emotional pain or stress related problem. Proponents of this school of thought would add that people who become addicted lack effective coping and problem-solving skills to deal with life's difficulties. This means that a vulnerable individual will learn to rely on his/her addiction as a means of dealing with life's problems, albeit, a very maladaptive solution.
Learning and social influence
Addictions are learned. A person growing up in a family where alcoholism is present has role models to teach the use of alcohol instead of how to solve problems. Often teen are exposed to drugs socially and it becomes a norm in their peer group.
In Israel, smoking is a socially accepted addiction. Coffee houses are filled with smokers and it appears that smoking is the norm. Similarly, the army is another environment that gives social legitimization to smokers who are about 40% of the soldiers in contrast to 27% of smokers in the general population. Many smokers quit after their army service. Many can't quit; they are too addicted.
Why is it so hard to stop an addiction?
Addicts need to be very motivated to overcome their problem. Addictive disorders are difficult to treat because people often slip or have a full-blown relapse to their addiction. In order to understand why it is so difficult to overcome an addictive disorder, think for a moment of the famous Pavlov dog experiment.
Pavlov, a Russian psychologist, was able to teach a dog to salivate to the ringing of a bell after having rung the bell in association with the feeding the animal some meat. The bell, through "classical conditioning," became an independent trigger for the dog's anticipatory feeding response, salivation.
The same thing happens to people with addictions. After repeated experiences, the addictive behavior becomes associated with external cues like people, places, and things, experienced during compulsive addictive behavior or psychological states like negative emotional feelings. Therefore, these associated cues become independent triggers and can elicit the craving to reactivate the addictive experience. A recovering addict is therefore very vulnerable to have a slip or relapse to the addiction because so many cues can independently elicit the craving. In addition, people romanticize their addictions, having positive memories about the activity, and they fail to remember the destructive parts of their behavior. Denial is a powerful psychological defense.
Help for addictions
People with addictive disorders can be successfully treated in spite of the difficulties. Initially, motivation is the key factor. Motivation is high when people are hurt badly by their addiction, and want to change. This opportunity is called a "teachable moment." It is the time when one's denial has given way to letting in the truth and seeking help.
People suffering from addiction need to first undergo a comprehensive evaluation by an addictions specialist. After that, the recommended treatment is relapse prevention, a cognitive-behavioral therapy designed to teach addicted individuals how to self-manage their addictions. In relapse prevention treatment, a client is taught to separate changing the addictive behavior from preventing its relapse. To loosely quote Mark Twain: Giving up smoking is easy, I've done it hundereds of times!
In addition, a 12-step program, such as Overeaters Anonymous, is also essential for a successful recovery. Once the addiction is under control, psychotherapy should be directed towards helping this individual solve some of the problems that put the individual at risk to become addicted.
There is light at the end of the tunnel.
Dr. Mike Gropper is an American trained psychotherapist and marital therapist. Contact him at Golan Center, Ahuza 198, Ra'anana, (09) 774 1913, email@example.com
From November 1, Dr. Gropper will be accepting new clients at the Jerusalem Medical Center, Shalom Mayer Center, Diskin Street 9A, Kiryat Wolfson, Jerusalem. To arrange an appointment call (09) 774 1913 or (02) 563 6265.
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