This is the second in series of articles on professionals who have developed an addictive relationship. The first described the importance of matching the treatment methods with the attributes of the person receiving treatment.
Fundamentalism has attracted millions of adherents for centuries, and for a good reason. It elevates and comforts. It provides a sense of meaning and direction to those lost in a disorienting world. Blind recourse to literal truth; the subjugation of reason and judgment to dogma can be exhilarating and transformative. It has led humans to perform extraordinary actions for both good and evil. There is an internal logic to it. If you believe in the rigid principles, it makes sense to conform to each detail and to encourage others to do the same. – Andrew Sullivan
People caught in an addictive trap dramatically over-estimate the ease of escape. After all, once you realize that you are acting counter to your own interests, how hard can it be to get yourself to stop? Incentive Use Disorders — self-injurious relationships with a substance [alcohol, drugs, food] or activity [gambling, sex/porn, shopping] — are deceptively difficult to escape. Initial success is usually followed by relapse.
Those who underestimate the difficulty of escaping an addictive trap tend to make shallow commitments to change and do not prepare themselves sufficiently for the challenge that awaits them. The inevitable failures that result from underestimating what it takes to prevent relapse has the paradoxical effect of causing people to believe that self-control is impossible for them. In fact many people can develop the skills and faculties required to act as intended despite the influence of local stressors and temptations that would motivate them to defect.
As the previous article in this series argued: The key to good outcome is to match the behavior change strategy and methods with the characteristic of the individual whose behavior is to change. Individuals who are cognitively impaired due to chronic substance abuse, head injury, or psychiatric disorder are, in fact, powerless to escape their addictive trap without extensive external control. For them, accepting powerlessness and turning responsibility for change over to an external agent of change is probably the only path to good outcome. The advantages of such an approach is eloquently described in Andrew Sullivan’s comment above.
However, many cognitively intact individuals, especially those who are not chemically dependent or religiously oriented, and have a practical, problem solving mind set are better matched with a strategy of change that focuses on learning methods to cope with the kinds of crises they are bound to encounter.
Two Models of Addiction and its Treatment
- 12—Step [Disease/Spiritual] Model – In North America, the vast majority of treatment programs for addictive disorders are based on the 12-Steps of Alcoholics Anonymous. According to this view, incentive use disorders are diseases. Treatment emphasizes admitting powerlessness over the illness, complying with a plan developed by treatment providers, and adopting the norms and values of a new social group-the support or self-help group-in order to achieve total abstinence, which is the only acceptable outcome goal. The victim of the disease is responsible for neither the cause nor the resolution of the problem. These programs typically provide the best match for persons with the following attributes; physically dependent on alcohol, benefit from the support of a self-help group, and have a religious orientation.
- Bio-Psycho-Social Model – According to this view, you are not responsible for falling into your addictive trap-you had no control of your genes, early conditioning, and social history. However, now that you are an adult you are responsible to do what is necessary to act in accord with your interests and principles. Rather than encourage you to accept powerlessness over a disease, this approach encourages you to develop the power of your will so that you can act as intended despite the influence of local stressors and temptations.
There are always Two Possible Errors
Should you admit powerlessness over your problem and turn it over to an external agent of change [a Deity or treatment provider]? You can make two possible errors: One, believing that you have a disease over which you are powerless when you can, in fact, develop the skills and faculties to change the course of your life. Two, rejecting the disease model when it is, in fact, true for you.
- Individuals who have developed a pathological relationship with an incentive, yet have retained the cognitive faculties to exercise their will, benefit from developing the skills to cope with the high-risk situations they are likely to encounter rather than depending upon an external source of control to help them through it. Accepting the disease model when it does not apply to the individual may exacerbate that individual’s dependence on an external source of control and interfere with developing the skills required to prevent relapse—especially during situation involving great stress and temptation. As is the case with learning to fish rather than being fed by an external agent, when you learn how to solve a problem, the source of control is internal and the change is irreversible!
- Some individuals who have developed a pathological relationship with an incentive have lost, or never possessed, the cognitive faculties to over-ride their impulses. They will always require an external source of control to protect them from relapse. For these individuals to believe they can exercise their will during crises of stress and temptation is an error that will almost certainly lead to relapse.