Mental Health and Addiction in Context

AddictionnnThere is a popular notion among many of those who think of themselves as addicts (as well as those close to them) that the process of maturation or psychological development somehow ceases or is suppressed as addiction commences.nnThis idea varies in its particulars from one person to the next. For one it may mean that maturation ceased at the first drink or hit of marijuana. For others, it may mean the point at which their relationships began to show obvious wear. For still others, it was the point at which a direct connection might have been made between use and the loss of a job or the beginning of serious problems at school.nnWhatever the appraisal, there are important questions to be asked here: What does it mean to stop developing or growing psychologically or even spiritually? What is it that we are looking for in terms of developmental maturity that we may feel we lack as addicts? Does the answer lie in our relationships? Our ability to reason abstractly? Our spirituality? Is it what we might think of in terms of a growing view of our selves as adults?nThere may be no one set of right answers to these questions but it is important that we consider the questions and their implications nevertheless.nnThe simplest and most straightforward approach (from a "folk psychology" perspective) to this idea is causal. The object of the addiction, whether alcohol, marijuana, painkillers, sex or gambling, is the sufficient, but not necessary, cause of the cessation of development (Not necessary - in the logical sense - because, presumably, one might stop maturing without an addiction as the cause.).nnBut what if we turn this causal model around? What if the stage was set for addiction to begin or continue because maturation or development became somehow arrested or held back? You can see how it might be easy to transpose cause and effect here. Turning this around again in the logical sense we can state that an impaired development is not necessary but is sufficient as a cause (Not necessary this time because of other factors that may present as causes of addiction, i.e., hereditary predispositions, mental illness, environmental/social factors).nnIndeed, if we make a few assumptions about maturation, we can see how support in the process of maturation or self-actualization might prove, if not a cure, at least an aid in the more long-term treatment of addiction.nnAddiction and TraumannThere has been a great deal of research that underscores the relationship between addiction and trauma. The part of that relationship that we are likely most familiar within popular culture lay in what we tend to hear referred to as "self-medication." Simply put, trauma generates, among other things, anxiety and tendencies that may present as components of depression or depression itself. Medicating these states may be attempts to alleviate distress. This alleviation of distress may entail a kind of depersonalization/dissociation or separation of the self from the source of the distress. It may literally be the attempt to prevent the rise to the surface of memories too painful to deal with consciously.nnThis is not to imply that all addiction has its roots in trauma. The roots of addiction are as varied as those who present with those issues. Trauma, as an issue that stands on its own without an addictive component, can take on many forms, deriving from nearly any point in our lives. The most obvious examples of trauma originate in experiences of war, childhood abuse, involvement in or witness of extreme events (those events which may represent a threat to your or another's physical integrity or life), sexual abuse, and domestic violence.nnAddiction and AngernnLike trauma, the experience of anger in an ongoing or extreme sense or in patterns that we come to find consistently troubling, may link to behaviors that seem addictive or have addictive components. Perhaps you see a kind of circular pattern in which anger as a theme continues to arise in connection to drinking or using drugs (though the connection in research has connected anger and alcohol most consistently). Eventually, discussion of either anger or trauma connected to addiction leads us to a kind of "chicken or the egg" discussion that suggests the order in which these problems are addressed. In truth, these things can, and often should, be addressed simultaneously.nnAnger, as something that stands on its own, tends to be looked at somewhat differently than trauma. Popular ideas of trauma suggest that it is something that we experience, in a sense, passively - it is something that happens to us. Anger, on the other hand, is seen as much more closely connected to the idea of character, choice, as an object of control, as something that must be hidden, disguised or "channeled" away from tendencies toward aggression or violence and into avenues of assertiveness. While there is the suggestion of truth in such assertions, those same assertions tend to diminish the important truth of anger as a natural, and often necessary, component of our psyches, just as responses to trauma may be. Anger, as an object of study or a focus of treatment, brings us closer to examinations of how we relate to one another.nnTraditionally anger, as a focus of either individual or group treatment, has been looked at in a very cognitive (and sometimes pedantic) sense that emphasizes behavioral control. How do we stop ourselves before we release the comment that we can't take back or the blow that we, for an instant, believe justice demands? In this context we tend to hear more about "anger management classes" than we do therapy or counseling. Addressing anger tends to be prescriptive on this more shallow level and less about insight, relationship or compassion. It is more realistic and authentic to address anger for what it is - a natural part of being human (not an indulgence in and of itself) and something that brings into sharp relief the realities of how we relate to ourselves and others.nnAddiction and PainnnThe connection between addiction and pain seems obvious here, but may not be as simple as we suspect. Those who suffer serious pain are brought into contact (generally) with more and more powerful techniques used to control or subdue pain. This is generally a thoughtful process overseen by responsible medical professionals undertaken by responsible patients. As pharmacological treatment of pain is stepped up the potential for addictive responses increases in terms of tolerance and dependence. As tolerance increases the subjective experience of pain may increase in intensity, frequency or duration. Tolerance to narcotic medications used to treat pain is common and the potential for tolerance increases the longer such medications are used. Tolerance may eventually evolve into dependence as a drug's effectiveness for treating pain begins to diminish or become negligible and the patient is also becoming aware of the negative effects of not taking the medication (withdrawal). Symptoms of withdrawal may appear cyclical on a daily, even hourly, basis and be thought of as "side effects" that tend to be relieved at the next administration of medication.nnPain Reduction and Pain TolerancennThere are basically two approaches to pain management: pain reduction and pain tolerance. In years past anxiety was believed (not inappropriately) to contribute significantly to the perception of pain. In cases of post-surgical pain anxiolytic (anti-anxiety) medications might be given in order to moderate the experience of pain and serve as an adjunct to analgesic medications, and it often does so quite effectively. So, we might look at anxiety as a component of pain. But what if we look at pain from a functional point of view? What is it for? Recent research has begun to suggest that pain has a significant attentional function. Looked at from the standpoint of design, it is made to dominate our attention. This it does most effectively, as anyone who has dealt with even mild prolonged pain might attest. Many of us cannot reasonably expect the complete elimination of pain - this is where the tolerance component, looked at from the viewpoint of attention, comes in. With a safe and responsible titration regimen where indicated, overseen by your physician, there are alternatives and adjuncts to pharmacological treatment of pain. Manipulation of attention through exercises in mindfulness and relaxation are not necessarily designed to eliminate or cause us to "escape" pain, but rather familiarize ourselves with it, develop a sense of efficacy in manipulating our perception of pain, and make the best possible use of psychological or pharmacological attempts to reduce it.nnThe information and resources listed above are by no means intended to be comprehensive, but they are cogent. Not included are the very important problems of depression and anxiety; obsessive and compulsive thoughts and behaviors and issues related to impulsivity. Also not included are other serious psychological problems such as bipolar disorder, schizophrenia and schizoaffective disorder to name but a few. These can carry with them very serious - even tragic - implications in life and can have very strongly established addictive/abusive components both in terms of substances and behaviors (i.e., sexual impulsivity or addiction, gambling, out-of-control spending). These are not expounded upon above not because they are unimportant but because trauma, anger and pain represent the more common aspects of human experience, if not the most positive. We all come to experience anger, trauma and pain at some point, or points, in our lives. Sometimes all of these aspects of life coincide with one another and the expression of this confluence can be addictive in nature. Whether you come to understand addiction as disease, habit, "excessive appetite," or a function of our environments the fact remains that addictions often co-occur with sometimes serious emotional difficulties and perhaps derive from them.nn