*Originally posted on AlcoholJustice.com on October 22, 2012

On September 21, ABC news show 20/20 aired an investigation program called Intoxication Nation, which pointed out the extreme lengths that some youth in America are taking in order to binge drink, as well as some of the dangerous consequences associated with the underage drinking epidemic in the U.S. Apparently, the Distilled Spirits Council of the US (DISCUS) was unhappy with the program, and didn't think that the DISCUS take on youth drinking - that spirits producers are wholly against underage drinking, are spending a great deal of money to prevent it, and that the alcohol industry is responsible for any decline in youth drinking - was adequately showcased by 20/20. In response, DISCUS immediately pressured 20/20 producers to use the show's airtime to articulate the spirits producers' agenda.*
 
In the end, ABC gave in to the pressures of the spirits producers and issued a completely unnecessary "correction;" one in which 20/20 anchor Chris Cuomo stated that "the industry is totally opposed to underage drinking" and "spends millions each year fighting the problem." Cuomo went on to directly mention rates of youth drinking for which DISCUS and other alcohol industry members are taking credit, linking the industry's fuzzy calculations, ineffective information programs, and public relations campaigns to any positive findings in youth drinking behaviors.

Just another example of money, power, and influence buying the alcohol industry exactly what it wants -  at the demise of public interest journalism and the public's health and safety.

*DISCUS member companies: Bacardi, Beam Global, Brown-Forman, Campari, Constellation Brands, Diageo, Florida Caribbean Distillers, Luxco, Moet Hennessy, Patron Spirits, Pernod Ricard, Remy Cointreau, Sidney Frank Importing, Suntory International

Alcohol Justice is the Industry Watchdog, you can find their full website and blog here.

There is an intervention in every addict's life. It is called Grace. Every minute of every day, Grace is available to everyone on earth. Whether it is received or not is a matter of circumstance. In addiction this is known as the "moment of clarity".  "Oh, my God, I'm killing myself, and I can't stop!" The acceptance of this devastating truth, the admission that there is no control, is the springboard into a spiritual life, a life of happy, joyous freedom.


Bill's delusion was so strong that he did not think that alcohol was a problem. He felt as if he was lying in the gutter looking down on everyone else.  It never occurred to him that he had lost all control.  Every morning he was at the liquor store buying a half pint of vodka which he finished and pitched out of the car by the mailboxes at the end of the road. Then conveniently "changing his mind" he drove to a different liquor store and bought a quart to get him through the day.   Since he was already impaired by the half pint, he was prevented from exercising any control at all. He was doomed.  The obsession made him drink the first half pint and then the physical craving kicked in and he wouldn't stop until he drank all he had bought or passed out.


The mental impairment of the brain with alcohol or drugs was the solution to the problem of fear. It worked every time we did it--it was magic, but magic is an illusion, we could not stay there. It is a lie.  The intervention, the Grace, the moment of clarity is the miracle. A miracle requires positive action.  We can't get anywhere if we don't know where we are, so the realization of where we are is the starting line.   "Dig Deep in One Place" explains the miracle of the Twelve Steps, how to take responsibility for ourselves and stay in love with the world and with life instead of running from ourselves and our fear.

Website: Dig Deep In One Place

Not if you understand the psychology of addiction.


Phyllis and Peter had been married a few years when he started hiding "nip" bottles of vodka in the house. After Phyllis discovered them he lied, saying he had stopped drinking and she'd found the last of them. When a week later she found more bottles, she threw Peter out. "If it had only been his drinking," she said, "I could have stood it. But lying is different. A marriage can't exist without trust." Did addiction have to ruin this marriage?

The story of Phyllis and Peter is taken from my new book, Breaking Addiction: A 7-step Handbook for Ending Any Addiction. The major issue between them is probably the most common way that addictions spoil relationships. Peter's drinking itself was a huge problem of course, but as Phyllis said, it was not the fatal one. Loss of trust was what would kill their relationship, and that would have to be repaired if this otherwise good marriage had a chance. Repairing trust would allow them to work together, creating the time and space needed for Peter to seek treatment for his addiction.

How can this happen if the person with addiction continues to lie?

The answer is that, when it comes to addiction, lying and general untrustworthiness are not quite the same thing. Although people with addictions often lie, nearly all the time their lies are about their addiction. Peter lied about his hidden liquor supply, and he had lied about going to bars on his way home from work, telling Phyllis he was just working late. But he didn't lie to her about anything unrelated to drinking. In fact, Peter was a very conscientious man, the sort of person who would return the money if he were given too much change at a store. Except for his drinking, it wouldn't cross his mind to lie to Phyllis. For the couple to survive, they would have to understand what the difference was between lying about addiction and lying in general.

First, let's consider what Phyllis thought Peter's lying was about. To her, it was a sign that he was excluding her from his life and was no longer treating her as his life partner. He was manipulating her and no longer respected her. Ultimately, his lying meant that he no longer loved her.

But from Peter's standpoint, his lying meant none of those things. He still loved his wife very much, but he was ashamed about his inability to stop drinking, and filled with guilt about hurting her repeatedly when he did. So, he came up with the only solution he could think of. He couldn't stop drinking, but what Phyllis didn't know wouldn't hurt her. He would be less ashamed and she would be less injured if he lied.

However, Phyllis regularly caught him in his lies, which made Peter feel even more guilty and ashamed. On these occasions, he promised never to drink again, and he meant it. But since he was unable to keep his promise, the problem escalated. Now he needed to conceal his drinking even more. In effect, the more he lied the more he needed to lie.

Peter felt trapped. As I've written about before in this blog and both my books, it is just this kind of helplessness that produces the impulse to addictive behavior. Peter's drinking had been, to begin with, a response to entirely separate issues in his life that led him to feel helplessly trapped. But now this new trap added to Peter's sense of overwhelming helplessness, and became a new precipitant to drinking. This new cycle of drinking, shame, lying, and more drinking was devastating, for both of them.

But here is the key point. Peter's drinking to begin with had been about issues within Peter, as is true about every addiction -- particular areas of his emotional life that led him to feel overwhelmingly helpless. His drinking was not about his feelings for Phyllis, even though she suffered terribly as a result. Exactly the same reasoning applies to Peter's lying. Although Phyllis suffered as a result of his behavior, the cycle of Peter's lying and drinking was not essentially about his feelings for her. Her interpretation of Peter's lying as a sign that he no longer loved or respected her, therefore, was not correct. There was an especially sad irony in this, because Phyllis's conclusion that Peter no longer loved her made her feel much worse.

The solution for this couple was to help them to understand both how addiction works psychologically, and how lying about addiction so often becomes part of the addictive cycle. As Phyllis was able to separate Peter's general trustworthiness and his usual respect for her from his addiction, her anger and hurt lessened. The furious tension between them subsided, and Peter was able to get into a good psychotherapy to address his addiction.

Phyllis and Peter found that the better you understand the psychology of addiction, the better you can repair not only addictive behavior but the damage to relationships caused by it.

"Breaking Addiction: A 7-step Handbook for Ending Any Addiction" will be published March 1; the book may be pre-ordered at Amazon.


Lance Dodes is also writing entries for Psychology Today and their website. You can find his entries by clicking here.

- Sandy Fifield

Despite my experience with recovery and the 12 Steps, when difficulties arise I still occasionally catch myself falling into old thought patterns.  Some of those thoughts are a gut level emotional response to the situation.  Some are my attempt to find a quick solution to a problem.  Neither is particularly productive nor useful.  Fortunately, my experience with recovery helps me find my way through those uncomfortable moments back into the light.

Three things disrupted my lovely, tranquil world early in 2012, each devastating in its own way.  

While a friend and I discussed her fifteen-year-old daughter's addiction problem, my immediate temptation was to think that this was unique and different, a special problem that needed to be dealt with in an extraordinary manner.  I thought--there must be some kind of therapy, magic medication or miracle action which could fix the problem once and for all.  Rescue and fix--that's the answer.  These thoughts raced through my head and I'm sure through her parents' minds as well.  How can we make the problem just go away?   

My husband, Bill, was complaining about a floater in his eye that had been there for nearly a month affecting his vision as he was trying to finish a large wood carving.  His balance and driving skills were rapidly deteriorating along with his peripheral vision.  Off to the emergency room where we discovered a brain tumor and possible lung cancer.   This all started on Monday and by Friday he was in surgery to remove an egg-sized tumor from his optic nerve.  Life was looking rather bleak--these are not things I would ask for.   These are gifts wrapped in barbed wire.  Surely, this is unique and special?  What can I do to fix it?

In late March my dear friends lost their beautiful mountain home - one of twenty-seven homes lost - in a sudden and devastating wildfire.   The fire started after a controlled burn got whipped into reactivation during one of the windiest days I've ever experienced in Colorado.  Wind is relentless; it worms its way into the tiniest flaps and cracks to rip apart a seemingly solid structure.  Add fire to the mix and there is real trouble.   The controlled burn had been considered safe and contained since it had been conducted nearly two weeks prior, in winter--albeit an unusually dry winter.  Tragically, a few deep pockets of embers flared during the windstorm that blew through that day.  What is to be done when everything is gone--all the material stuff? Isn't this the worst thing ever?  How do we make this better?

My friends said, "The fear of losing everything is worse than the actuality."  When I asked if we could trade gifts (fire for cancer) they said, "No, we don't want yours."  And rightly so.  Each of us receives the "gifts" we are meant to have -- the experiences our souls crave in this life.  So how do we cope? In truth, there is no magic to keep "bad" things from happening or to "fix it" when they do, but there is something that helps in every difficult situation.  I look to the teachings of Recovery.
 
Why is recovery THE answer?
Recovery tells me that my attitude is the only thing I can change and therefore is the only thing I am responsible for.  The 12 Steps give me a way to change my attitude, although seeing what my real habitual attitudes are can be painful and humiliating.  Step Nine is to take responsibility for my past actions by admitting that they have harmed and disturbed others in my life.  Ironically, these are often things that hurt me more than they have anyone else, and revisiting them is equally painful.  They are the things I don't want you to know about me. 

I don't want to tell you that as my friend struggled with her daughter's addiction, I thought, She at least got to have kids; if that were my daughter, I would have handled it differently - in other words, perfectly!

I don't want you to know that when Bill was diagnosed with a brain tumor and lung cancer, my first thought was, He's losing weight and I'm not! 

I don't want to admit that when my friends' house burned my thought was, They get a new house, what about me?

I share my innermost thoughts and feelings many times in 12 Step fellowship meetings.  It is an incredible and freeing experience and while I wouldn't wish the way I have felt, thought, and behaved in these instances on anyone, it sure is comforting to know that others in the room have at times thought, felt, and behaved just like I have.

Yes, the old, habitual ways of thinking are still there - the petty focus on myself, the desire for a quick fix.  Perhaps it's the human condition that allows the shitty little kid inside of me to whine and complain, or that allows me to think I can solve everything.  But, I no longer simply have to live with the most unattractive parts of myself.  The 12 Steps give me a way to recognize and accept those parts because without acceptance there can be no change.   When I attempt to hide those parts of myself they grow and grow, in the darkness that is my belief in the lie, and I can certainly gather the evidence that the lie is true.  But once I accept them, I can change my attitude and, ultimately, my thinking and my behavior.

Like the old Chinese proverb "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime," the Steps teach me a way to deal with the uncertainties of the universe, my human condition, the shitty little kid and the lie that constantly tries to invade my life.  They teach me how to fish.  

The beginnings of the change in my thinking are detailed in our book "Dig Deep in One Place"   but the change  continues today as I journey on this great adventure finding out who I can be if I just stop believing the lies of  the habits of a lifetime -- that whining, unattractive part of myself.    

Website: Dig Deep In One Place

And the ONE RULE you need to follow to stop it!

The Pre-Game
Teens often indulge in a "pre-game" drinking binge before parties or sports events. Large quantities are consumed quickly in order to sustain a sense of inebriation over many hours. The point of a pre-game binge is to achieve inebriation before an event where access to alcohol and drugs will be restricted.

Pre-gaming is especially dangerous in that it often occurs in a vehicle. Although drinking can occur during the drive to the event, teens may also drink in the parking lot of the event venue. Alcohol can also be smuggled into venues, disguised in water bottles or hidden inside large purses or jackets.

The Parent Game Plan: Before parties and big events, be involved as your teen prepares. When possible, drive your teen and his friends to the venue. As always, be honest with your teen about the dangers of drinking and your stance on the issue.

Working for the Weekend
Some kids work hard all week on academics and sports, but see the weekend as a time to partake in illicit activities and party behavior. This mindset is especially prevalent at competitive high schools. This attitude toward drugs and alcohol equates recreation as something that is rebellious against responsibility and is seen as a reward for good behavior. After working hard, they feel as though they deserve to play hard. This type of attitude can lead to a dependence on drugs or alcohol as a means to relax.

The Parent Game Plan: Explain to your teen that responsible behavior throughout the week does not warrant complete independence. It is also important to teach your teen positive ways to relax. Positive recreational activities and hobbies not only occupy a teen's time, but they also offer a sense of accomplishment and self-worth that alcohol and drugs can never provide.
Social Lubricant
Let's face it. Being a teenager is difficult, and social interaction can be awkward. Many teens drink to feel less inhibited and more secure in social settings. Unfortunately, some teens will drink in response to anxiety about a crush, which heightens the risk of poor sexual decisions. Forming these habits during formative years can have a drastic effect on a teen, potentially making it difficult for her to socialize without alcohol or other substances.

The Parent Game Plan: Teens needs to learn how to face the fears and risks of social interaction in a substance-free environment. Host co-ed movie nights or game nights for your teen's friends and serve as a chaperone. Sometimes teenagers turn to illicit activities because the peer group doesn't accept wholesome activities as fun. It is your job to provide your teenager with a healthy example of "adult" fun.
Another option is to introduce your teen to an older mentor. Encouraging your teen to spend time with mentors with similar interests can help him adapt to a more mature standard of behavior. This will also give your teen the opportunity to talk about embarrassing or difficult situations he may not be able to come to you about.

For the Win
During unsupervised parties, many kids participate in drinking games popularized by college students. While these games can seem as harmless as table tennis to teenagers, the truth is those who participate in drinking games are at a higher risk for developing alcoholism. Once teens accept the rules of these games, the height of tolerance levels is tantamount to strength. These teens think they are winning at a game, but they are actually exposing their brains to toxic levels of alcohol.
Essentially drinking games are a way for teenagers to bond while participating in binge drinking behavior. Unlike pre-gaming, there is no time limit in drinking games. This means that many teens will drink until their physical limits are reached. Alcohol poisoning and black-outs are two immediate effects of binge drinking.

The Parent Game Plan: Teenagers who binge drink will be unable to hide the effects from their parents, which means they will most likely "crash" where the party was thrown or they will stay with a friend who has lenient or oblivious parents. Parents can discourage binge drinking by confirming plans with other parents and enforcing curfews. Let your teenager know that you expect him not only to behave responsibly, but to look out for his friends who may be affected by this social behavior.
How to Stop Teen Alcohol Abuse

Be involved.

Parents who are involved in their teenagers lives - offering support, encouraging questions and providing wholesome outlets for socializing - are following the #1 rule to keeping their children safe from alcohol abuse.

Contributor: Lauren Bailey can be reached for comments at Lauren at blauren 99 @gmail.com.

Join me on Facebook and follow me on Twitter for more information and educational articles on parenting today's teenagers.

Do you need help, visit www.helpyourteens.com. 

What is your gut telling you?

"To thine own self be true" is one of the underlying tenets of recovery. But how do we honor this wise sentiment by Shakespeare? One way is to check in with the "me" that I'm trying to be true to. Checking in can involve slowing down, writing, meditating, and noticing what we are experiencing rather than running on autopilot. Checking in tends to involve tuning in to our body or to our "higher self," rather than tuning in to our "monkey mind" (the running commentary that we are telling ourselves.) It is a subtle distinction, but let's take this moment to see if we can tap into the difference. For the next 10 seconds, turn your attention to what your head is telling you ...

What did you hear?

Now, let go of whatever you heard and without trying to figure anything out, turn your attention to your body. Perhaps you'll do a quick body scan to see if any place in particular would like your attention, or one spot will automatically engage you. Just rest your attention on your physical self.

What did you notice?

For most people, the two tend to be very different experiences. For example, I just did this exercise and noticed that my head was telling me about the TV in the background, thinking that I'm hungry, wanting to get back to writing this post, etc. But when I checked in with my body, I could feel some anxiety in my belly, some tension in my shoulders, and a longing to slow down and breathe.

If I stayed attending to my head, I could run myself ragged working through a to-do list all day. When I checked in with my body, I realized that I could actually use a breather. In this case, I believe that "honoring myself" means leaning towards the latter. The more we practice checking in, the wiser we become about discerning what is happening and how we can best take care of ourselves.

In terms of checking in with your physical self, did you know that the gut is literally your second brain? The intricate network of millions of neurons lining our guts greatly influences our mood and our thinking. The second brain doesn't do much for articulating conscious thought, but it is particularly adept at feeling. This is where the saying "butterflies in the stomach" comes from. For some of us, we need to listen to our gut more often. We sometimes ignore what it is saying because it isn't telling us what we want to hear. But the upside is that when we check in, we gain more opportunity to be true to ourselves, to take care of ourselves, and to live authentically with what is actually happening--not just what our head is telling us.

So, what is your gut telling you?

 

 

Ingrid Mathieu, Ph.D. is a psychotherapist and author of Recovering Spirituality: Achieving Emotional Sobriety in Your Spiritual Practice.

Follow her on Twitter or Facebook for daily inspiration on achieving emotional sobriety.

Find the original post on Psychology Today.

February 2012, the Oglala Sioux Tribe filed a lawsuit against Anheuser-Busch InBev (ABI), SABMiller, Molson Coors, MillerCoors LLC, and Pabst, alleging that they knowingly contributed to devastating alcohol-related problems on the Pine Ridge Indian Reservation in South Dakota. On the reservation, as many as two-thirds of adults may be alcoholics, and one of out four children is born with fetal alcohol syndrome. The Oglala Sioux Tribe has prohibited alcohol on the reservation for the last 180 years. Yet the alcohol continues to get funneled right into the hands--and lives--of tribal members, and ABI is giving a standard denial for playing any role in the resulting harm.

 
Just outside the reservation's borders, the tiny town of Whiteclay, Nebraska (pop. 10) sells more than 4 million cans of beer and malt liquor annually. The town seems to exist solely to sell alcohol to Pine Ridge residents. Alcohol (including ABI brands such as Hurricane malt liquor and Budweiser) is either smuggled into the reservation, or simply consumed on the streets of Whiteclay. When New York Times columnist Nicholas Kristoff visited recently, he witnessed "men and women staggering on the street, or passed out, whispers of girls traded for alcohol."


Kristoff's visit to Pine Ridge and Whiteclay, combined with his knowledge of the industry's tactics, led him to declare that "Pine Ridge's alcohol problem is matched only by Anheuser-Busch's greed problem. Brewers market beers with bucolic country scenes, but the image I now associate with Budweiser is of a child with fetal alcohol syndrome." He declared a personal boycott on A-B InBev's beers and asked other Americans to do the same.


Despite refusing the comment for months while Kristoff was writing his column, ABI hit back immediately after it was published with a pat letter to the editor in which they claimed to "care about the tragic problems of tribal members on the Pine Ridge Indian Reservation and [be] greatly concerned about alcohol abuse there and anywhere." Not surprisingly, ABI denied any responsibility for the gross overabundance and availability of its products in Whiteclay and the nearby reservation.
 

If they really cared about the harm their products cause the Sioux Oglala tribe, ABI--and the other alcohol producers--would stop selling their products in Whiteclay. Instead, per usual, ABI is raking in the profits while denying any responsibility for the repercussions.

Alcohol Justice is the Industry Watchdog, you can find their full website and blog here.

I owe you an apology. I have written two blogs and never introduced myself to you, which I will do now with this blog. I think if you know me, what I will write in the future may make more sense if you knew my background.  One of the first things I learned in my Speech class was to "know my audience" which I do for when I write or speak in front of a group, but how often does the audience know the author?  I have a much different background than the other contributors on this great site, so without further ramblings, here I go.

My name is Michael Gershe and if you go by MADD, I am a victim and survivor of a drunk driving incident that killed my mother and nearly myself when I was barely eight weeks old.   Just about every bone in my body was broken, my skull completely fractured and yet, here I am, a month short of my 42nd birthday.  My mother was 28 when she died due to a drunk driver. She never got to know her son.
I purposely wrote MADD's definition because all to often other people or groups like to define use.  Let me be very clear on this issue, I HATE being defined by someone else. Even though I understand their rationale, I despise being called a victim, because to me a victim is weak and cannot overcome an adversity or an obstacle in their life.  I cherish the word survivor though because that is what I have become over the years despite the injuries I suffered at the hands of a drunk driver.  Survivors accept the challenge to overcome anything they are faced with and to me that is who I am.

I grew up to become a competitive swimmer, even earning a swimming scholarship to college.  I never really applied myself to school, even though I was bright, I had a tendency to be lazy.  I was blessed with a great sense of humor, which was evident as I could always make people laugh.  When I was a teenager, I performed magic and then when I was 18, I did stand-up comedy for the first time. My sense of humor as I discovered was my defense mechanism and it controlled just about everything I did. Whether it was dealing racists people in college to daily life stressors, I felt my humor kept me alive.

In college, I had an internal battle with myself on why I was alive and my mother dead. I was 18 and finally thinking about my own mortality and thinking about life.  Despite my happy go lucky outward appearance, I was angry with the man who killed my mother, I was angry with God, but swimming and my humor got me through it. I wasn't an angry person, just conflicted internally.  I read Og Mandino's "The Choice" and I got a better perspective on life. I feel that if you are grasping for answers to your questions, something out there will eventually help you see the light.

It was shortly after reading the book I realized that anger takes up way too much energy. I didn't think my mother would want me to be angry or vindictive against the drunk driver either.  I became a Peer Educator in college and for the first time, shared my story with an audience.  My friends knew my story, but never total strangers. .  I believe that we all have a calling and now I was on the path to mine. I just didn't know it at the time.

While I was in graduate school, one of my students in the student organization I advised asked me to put together a fun alcohol awareness program for her sorority.  I called it "The Magic of Life" because back then I was still doing magic and used magic to symbolize some of the dangers associated with alcohol.  I used magic, humor and my story for a program that I hoped could make a difference.  That first show was in either fall 1994 or spring 1995 and it was the start of an amazing journey of impacting lives.

I no longer perform magic, but "The Magic of Life" combines comedy, audience participation and my personal story for an entertaining, but educational show about the dangers of alcohol.  It is about a son who is not a victim, but a survivor who overcame a tragedy to make a difference in people's lives.  People laugh, cry and hopefully leave with a better sense of life as a whole, not just what alcohol can destroy in life.  More importantly, it is about a mother's child trying to be a son that she can be proud of.

So, how does this relate to you or this site?  Easy, we are survivors and we live each day to make a difference.  We should not allow others define us, but how we define ourselves.  I cannot relate to you in terms of what you have to do to keep your sobriety, but I definitely understand what it is like to be a survivor and live life wholeheartedly. I understand what it is like to hit rock bottom where you want to end it all, but yet, we don't because we are fighters.

To me, making someone laugh is a dream come true. Every day I hear someone's laugh, it reminds me how precious life is and how awesome it is to hear it.  To talk to an audience member after a show or get an email from them about how my life impacted them is an amazing experience. I never knew that when I developed the program all those years ago, it would be what it is today.

I always say that if I can make one person walk out of my show think differently about their life or view on alcohol or drunk driving, the my job is done. Whether I speak in front of 40 or 4,000 people, I just need one to hear the message. I am honored that I was asked to be a contributor for this site and I hope I can reach just one person so you understand just how precious your life is and that one day I can also hear your laugh.

So, that's enough about me.......

Understanding the psychology of addiction provides the answer.
Published on January 17, 2011 by Lance Dodes, M.D. in The Heart of Addiction

For the past few thousand years people have thought "addicts" were self-indulgent hedonists, lacking in the self-control present in healthy people. More recently people with addictions have been seen as psychologically "primitive," their addiction a sign of early developmental issues or a major personality disorder. None of this is true.

The first mistake, that people with addictions are self-indulgent or pleasure-seeking, arose from looking at addictive behavior instead of the psychology that causes it. As I've described in earlier posts and my book "The Heart of Addiction," addictive behavior is a temporary solution designed to reverse feelings of overwhelming helplessness. It is not at all motivated by a search for pleasure. In fact, it is almost precisely the opposite of a search for pleasure. This is because addictive behavior is always a displaced action, a substitute behavior taken by people when they feel helplessly trapped. Rather than doing something more direct to gratify a frustration, they perform another behavior: their addiction.

For example, in a case taken from my new book "Breaking Addiction" (coming out in March), a man with alcoholism felt trapped by having to work late doing an extra project, causing him to miss promised time with his children. When he learned of the extra work, his thoughts turned to stopping at a bar on the way home at the end of the day, and a few hours later he did just that. In driving to the bar he was in absolute control over his life, doing something he believed would make him feel better. Going to get a drink felt just the opposite of the trapped feeling he'd had at work; he had reversed his helplessness.

At the same time, the great intensity of his drive to drink was an expression of his fury at having been trapped. (In general, it is this rage at helplessness that is the powerful drive behind addictive behavior.) This man's addictive behavior was therefore not a gratifyingly direct response to his helplessness trap; it was a substitute. If he had responded more directly he might have, for example, refused to do the extra work at his job, or done it less thoroughly, or even just argued with his boss to let him go home earlier. The fact that instead of doing any of those things he drank, several hours later, meant that he displaced his response to feeling helpless in both time and space. Instead of marching into his boss's office he waited and went to a bar.

Far from enjoyably seeking gratification in an act of poor self-control, this man inhibited himself, rechanneling the great frustration he felt into a grim determination to drink later. Of course his drinking could be said to be out-of-control behavior, but looking at it from the inside out we can see it as a specific mechanism to manage intolerable feelings, an effort to maintain control against overwhelming powerlessness.

The second mistake, that people with addictions have major mental health problems or "primitive" characteristics, is also caused by a misunderstanding of addiction. Addictions are psychological mechanisms essentially identical to those symptoms we call "compulsions." Yet compulsions are present in people with all degrees of mental health. It makes sense, then, that addictions can be present in virtually anyone, without implying any particular psychological diagnosis. Nearly everyone has some emotional issues and some folks use an addictive mechanism to deal with them. That doesn't separate them from the rest of humanity. A related confusion is to say that some people have an "addictive personality." There is no such thing as an addictive personality because having an addiction is a compulsive symptom; it does not define an individual's personality.

The idea of "primitiveness" in addiction is a holdover from a time when people thought addictions had to do with the drive for food or oral gratification in young children. This notion was fostered by the fact that for most of human history addictions have been associated with drugs, which are usually consumed by mouth. It is only fairly recently that we have understood that addictions have nothing inherently to do with drugs, since they may be focused on non-drug activities such as gambling, food, sex, shopping, the Internet and so forth. The lack of any special significance of drugs in addiction is especially clear when you note that people with addictions commonly shift the focus of their addiction from a drug such as alcohol to a non-drug compulsive activity such as gambling, shopping or cleaning the house. Such shifts would be impossible if drugs or their effects on the brain were essential to the nature of addiction. (I've previously addressed the confusion in our terminology about the term "addiction" that leads many to think that brain effects of drugs cause addiction. The effects of drugs on the brain influence a quite narrow behavior, such as feeling an urge to drink a glass of beer when it is sitting in front of you. That urge may be a biologically conditioned response of the brain when presented with the stimulus of the beer. But, as in my example above, nearly all addictive acts are precipitated by emotionally-meaningful factors, not by the immediate presence of an addictive object, and are usually delayed in time. This usual addictive behavior is psychological in nature, not a physiologically-conditioned brain response.)

While some people who are quite ill psychologically have addictions, it is incorrect to generalize from these examples. As we all know, lots of people with addictions are highly capable, mature, responsible, empathic human beings. They suffer with a particularly maladaptive symptom, but we should not infer from this that they are in their essence different from anyone else.


Lance Dodes is also writing entries for Psychology Today and their website. You can find his entries by clicking here.

Recently I gave a presentation to a countywide group of school social workers in Long Island, New York on the topic of clinical practice with adolescents with substance use disorders. Many of these social work positions were funded by a federal grant to offer school-based prevention and intervention services to the county's middle school and high school students (sadly, one announced that she had been informed that she would not have a position during the next academic year because of funding cuts).

During the question and answer period, we had moved into a conversation about lack of high quality treatment programs and other barriers to effective treatment such as inadequate insurance coverage.  One of the participants suggested that we spur our professional organizations to educate our policy makers at the state and federal levels to effect change in health care coverage for substance abuse treatment for teens. I pointed out that we have compelling research, often funded and produced by government agencies such as SAMSHA but also grants from charitable foundations such as The Robert Wood Johnson Foundation that inform us to what is needed for effective intervention and treatment. We have what is referred to as an evidence/practice gap because it appears that our private and government health care insurers are not aware of these studies, or have not read them, or read them and decided that effective treatment is too costly. Is this being penny wise but pound foolish?

A study conducted by the National Center on Addiction and Substance Abuse (CASA) at Columbia University declared adolescent substance use an epidemic and America's # 1 public health problem. In addition to the human toll, the CASA study found that the financial costs of adolescent substance use disorders per year include an estimated $68 billion associated with underage drinking and $14.4 billion for substance-related juvenile justice programs (where it seems many teens have to end up to receive any treatment). Furthermore, the estimated total costs to federal, state, and local governments of substance abuse and addiction among the entire U.S. population are at least $467.7 billion per year!

Since addiction is now considered a chronic brain disease with origins in adolescence (the CASA study found that 9 out of 10 adults with addiction began using substance before the age of 18) it makes economic sense to provide teens with effective treatment and prevent the progression of substance use into adult addiction or adequately treat those teens who are already addicted to prevent further costs and damage to human lives. But this is not the case.

At our research-informed residential program for adolescent males in Central Connecticut, I work with families trying to get insurance coverage for residential treatment for their sons. The minimum length of stay is 30 days (which we designate "Assessment & Intervention") and the recommended length of stay is minimally 90 days.  We designed the program in this way because research tells us unequivocally that good outcomes depend on adequate treatment length; for residential and outpatient treatment, participation for less than 90 days is of limited to no effectiveness. However, with the exception of self-insured EAP's, it is nearly impossible to obtain insurance authorization for 30 days--even in severe cases. Why? Because many insurers use very stringent criteria to justify residential treatment, typically "imminent danger to self or others" and high risk of relapse and/or overdose does not meet their definition of imminent.  We have experienced many situations in which parents have sought help for their son and convinced him to engage in residential treatment only to discover that based on their insurance policy their son is not eligible for residential treatment because he has not received intensive outpatient therapy first. What this means is that the teen, even when it seems contraindicated, must try and fail at intensive outpatient treatment before he will even be considered for residential treatment. What if we had a similar approach to a person who enters an emergency room with severe chest pains?  "I'm sorry Mr. Jones, we cannot admit you; please return when you are in full cardiac arrest."

Needless to say, all of this is enormously confusing and frustrating for parents, who are often told that they have generous insurance coverage, without being informed about the rigid criteria. Parents then must decide whether to use personal funds such as college savings to get their son helpful treatment which inherently involves an adequate length of stay.  It is similarly frustrating for clinicians who are trying to provide effective care in the context of insurance uncertainty.

The CASA study revealed that only 6.4% of high school students who meet the criteria for a substance use disorder received any formal treatment--and those who did rarely received quality care. This is a travesty because adolescent substance abuse is a treatable and preventable condition. The school social workers I met with recently, who were so passionate about the importance of prevention services were right that we need to involve our professional organizations and our state and federal politicians to fight for rational health care policy with respect to teen substance use and addiction.  As health care professionals, we need to mobilize, raise awareness, and influence public perceptions and health care policy. It just makes sense.

Frank Bartolomeo, PhD, Vice President, Child & Adolescent Services, Rushford


Frank Bartolomeo, PhD. is blogging on behalf of Rushford. You can find Rushford on Facebook and on Twitter.