addiction – The Machine Zone

Addiction and Society

The worldwide misery caused by addiction is immense, striking millions of people. Not only the ‘addict’ but those close to them are devestated. In addition, there are huge economic costs to society and billion pounds costs from crime.

Also, beyond the identification of the most extreme forms of addiction, millions more are affected by less intense effects (including those on a ‘slippery slope’). For example, there is a tremendous toll on those who drink too much without being recognised as ‘addicts’. One unlucky bet from a regular gambler could result in financial ruin and its implications.

For those who seek recovery there are many sources of help (and it is worth remembering that many recover without intervention). Some succeed, some succeed partially, some die. In the wider social and political, medical and support spheres, ‘addiction’ continues to be a central focus of debate and research.

It is generally recognised that more needs to be done. There are insufficient facilities that provide recovery options. Mental health services often relegate ‘addiction’ to being of less than primary concern. In society at large, while things like smoking addiction are accepted as important, the many other killers are less thought about, or thought about very differently. Often, for instance, heroin addiction is thought by many to be associated with moral and character defects. A key right-wing philosophy puts all the emphasis on ‘individual responsibility’. It is, sadly, very common to hear people say things like, ‘It’s their own fault. Nobody made them drink, take drugs, gamble etc.’

Anybody who has made the barest inspection of addiction studies knows that the end result of addiction is the product of many factors. Some of these include:

Individual susceptibility via genetics, peer group behaviour, mental health, poverty, cultural capital, education.
Availability of harmful products.
Multiple and complex needs including the first group above, housing, unemployment, prison and crime, lack of family support.
Normalisation by industry and culture as a whole of harmful behaviours.
Lack of support services and lack of effective strategies for many people.
Stigmatisation. This hangs like a dark cloud over all discussion. Even recovered addicts themselves, usually unaware of how fortunate they are not to have faced any of the difficulties mentioned above, have been known to ‘blame the addict’ (while promoting their own self-satisfied moral strength).
Education has been recognised as an important factor in ameliorating future harms. Alcohol and gambling industries present themselves as concerned about that high percentage of people who are addicts (and from whom most of their profits come), supporting charities and research. They stress that their products are to be enjoyed as ‘fun’ (‘When the fun stops, stop’ is the gambling industry’s slogan). In educational institutions, there have been initiatives in recent years but these tend to be very patchy and under-evaluated: some amount to little more than a few lessons, or a lecture.
Advertising, especially for football gambling, has come in for criticism and many argue that it should go the way of tobacco advertising. Promotion by famous paid sports personalities has also been criticised especially for its effect on young people.
While the psychology of addiction is extremely complex, it is fairly simple to understand why so many people turn to drugs (and, remember, alcohol is a hard drug) to alleviate misery, to numb the pain. While it’s not surprising that this connection is found strongly in people who have the least going for them, it’s very important to remember that there are many varieties of psychic suffering, and addiction curses many high up on the social pecking order.
There is an increasing worry that something in culture and society is causing a stark rise in unhappiness and mental health disorders. Such conditions are breeding grounds for addiction. Many people are ‘self-medicating’ to escape misery, depression and anxiety.

I’ve purposely included in the above some value judgments because these are, like stigma, very common within any discussion of addiction. If you believe that the scourge of addiction and its devestating effects on millions of people can best be addressed by emphasising the responsibility of individuals to change their ways, I’d only disagree 90%. There is, and should be, a role for personal responsibilty, powerless people have to be given that power. But along with that, and along with intense attention to recovery, we need to address as well as possible the factors which encourage addiction in the first place. It’s not one or the other, that would be silly. Neither is it rocket science. If society regulates our food and medicines, the air we breathe, health and safety, then we can ask whether the regulatory frameworks in place for alcohol and gambling are adequate.

It’s not a question of banning or being anti-industry or anti-anything. Regulation is not a very exciting word but it’s crucial. There is a growing movement, for instance, including police officers and politicians, to legalise and regulate street drugs. Such a policy has been found to lessen drugs harm in countries like Portugal. But that’s a different story, and mentioned here only to throw in an other factor to what should be an ongoing debate.

Gambling in the Context of All Addictions

There are several reasons to include other addictions when thinking about gambling addiction:

While the nature of addiction varies between types (as well as between unique individuals) much of the research in substance and other behavioural addictions can throw a good light on the nature of addiction generally.
It seems, in particular, that neuroscience points to common factors across addictions, involving specific neurotransmitters and learned neural pathways.
Many with gambling addiction suffer one or more other addictions.
Addictions of all types are strongly related to specific diagnoses of mental disorders which precede or follow addiction, or which accompany addiction, or all three.
Research into gambling, medical and other professional knowledge and expertise, and public awareness of gambling addiction are relatively sparse compared with more well known addictions. What has been learned and known about the latter can inform ways of seeing gambling addiction.
Debates about alcohol, substance and some behavioural addictions have been ongoing in most cases much longer than current gambling debates. Much disagreement exists beteen professionals, lawmakers, industry, people affected by addiction and the general public. Overviewing these controversies helps place gambling in context as many of the issues are identical. Of particular interest is the extent to which focus has been upon individual ‘pathology’ with lesser attention piad to wider factors which contribute to addiction. In some ways, these debates reflect those in the field of general mental health where an individual is seen as the centre of attention to the detriment of studying social, economic and other wider contributors to mental distress.
The presence of stigma against addiction is best looked at with a broad view of all addictions.
The relative underfunding and research around gambling, and a lack of support services is best understood by examining addictions generally. This will suggest that gambling addiction is particularly under-resourced.
Evidence about what works and what does not work in addiction education – in formal education and public health campaigns – is available for substance addiction, and this can inform developments in gambling education. Although alcohol and drugs education has been around for a long time, there has been no uniform approach to implementing it. Some emerging evidence suggests what doesn’t work – for instance, one’off ‘lecturing’, ‘thou shalt not’ approaches – there is relatively litle evaluation and pointers to good practice. We’ll be discussing this more on our site.
The questions around industry funded research and education have been highlighted with alcohol. For instance, it is claimed that industry funded initiatives may avoid discussion of subjects which cause discomfort to the funders.
Local councils have responsibility for commissioning addiction services (including NHS and Third Sector*) and may be likely to treat addiction generically rather than by type of addiction.
While it is true that addiction can afflict anybody, whatever their socioeconomic background and status, there are strong correlations between different sub-populations. For instance, adults who had adverse childhood experiences are more prone to mental health disorders including addiction. Poverty and other disdvantages also correlate with the likelihood of addiction. Studies across the field of addiction can examine such correlations more fruitfully than framing addiction as simply an individual pathology.
There are no neat divisions between harmful habits, compulsive behaviour, things called addictions metaphorically (e.g. shopping addiction), psychological dependence on behaviours or substances (without addiction), repeated deep modes of distraction (such as immersion in television or other screen activities). Clinically diagnosed addiction develops over time (gambling addiction has only relatively recently been admitted to clinical definitions; some psychologists include ‘internet addiction’). Many ‘normal’ behaviours such as immersion in social media offer distractions from the world. Psychological relief and life patterns provide both escape and security, so perhaps extreme addiction can be formulated as part of ordinary everyday behaviour.

Addiction and Personal Responsibility

One of the hottest topics relating to addiction is the concept of personal responsibility.

Do addicts bring it on themselves? Are addicts morally weak? Do addicts repeatedly fail in recovery because they refuse to take on responsibility?

On the other hand, it can be rightly claimed that all this emphasis on the individual is distorting an understanding of addiction. If, as some claim, addiction is a ‘disease’ how can people be responsible for it? Why is there virtually no alcohol addiction in Saudi Arabia (where alcohol is prohibited by law)? What social factors play a part in addiction? Do some commercial products – tobacco is an example – ‘hook’ some people in the right circumstances?

There is no such thing as an addict; there are only individuals suffering with addiction. Everybody is different, but some groups seem more prone to addiction to others. In the professions journalists, the police, doctors, entertainers, sportspeople and politicians have high rates of addiction. So too do people with multiple and complex disadvantages such as homelessness, poverty, lack of educational and cultural capital, mental illness, criminal background, adverse childhood experiences, trauma – or just one of these.

And people from different social backgrounds seem to be treated very differently when their addictions come to light. Newspaper readers will weep over the death of a pop idol through drugs; a politician will be praised for his ‘brave struggle’ against alcohol. In popular culture – films, books and television – we have come to expect our flawed heroes often to have an addiction problem as one of their flaws, a lonewolf cop bucking the rules and knocking back malt whisky while meditating on a case, a singer in rehab, a public figure making public penance.

Less favourably are seen the ‘scagheads’, the ‘junkies’, the street addicts, the working class addicts. Although victims all their lives of unequal and unjust social conditions, turning to drugs or drink or gambling to escape if only for a moment, it is they who are most harshly blamed and despised for their lack of responsibility – while those with a lifetime of advantages are treated with adulation and sympathy.

In his remarkable book, Good Cop Bad War, former undercover cop Neil Woods charts his journey of increasing knowledge through the ‘low life’ of desperate addicts (in contrast to the venomous gangster business cartels that bring drugs to market). He grow increasingly sympathetic to the friends he makes while pretending to be himself an addict. Apart from their addiction, most are essentially decent, often intelligent, kind and caring. One such friend , Cammy, tells him his heart-felt news that he has heard a good friend has died. Neil asks whether he will go to the funeral to say goodbye and Cammy replies, ‘I’m not going to the funeral. I wouldn’t do that to the family. The last thing they want is some dirty junkie turning up and ruining everything.’ As Woods observes, ‘No matter how society may condemn and look down on the addict, it is never, ever as low a view as he has of himself.’

That internalisation of social attitudes and stigma is something all addicts have to deal with. Part of them remains ‘clean’ and is a constant accusing voice; the addict hates themself. Guilt and shame alone can maintain an addiction – that belief of such utter worthlessness that there is no point in trying to stop, instead seeking that absurd temporary negation of inner torment with a fix.

Of course, those with a lot going for them tend to do better. Not everybody, of course: the nature of every individual addiction, while having common attributes, is unique in the complexities of an individual. It’s probably easier on the whole if you’re, say, a teacher to have three months leave on full pay to attend rehab, or just to get your life together, than if you are without any money, any support, any care, any love, surviving in brutal conditions. Though yes, many who seem to have well insulated lives with all the support in place do succumb, grow sick and die. And yes, too, some at the very bottom recover and flourish.

There are as many as 40% of addicts who recover spontaneously, relatively painlessly, without any intervention by ‘experts’ or support organisations. A well known example of this is ‘maturing out’ whereby young people who have addictive or risky tendencies literally grow out of them when they settle into employment, get married, start a family. Another famous example is how 80% of American soldiers deemed heroin addicted in Vietnam lost their addiction when they returned to the States and their families. Against this, many others in recovery are certain that addiction is a disease for life and that the only way to manage it is by faithfully following a programme such as a 12-steps one.

A word is needed here too about dependence versus addiction. Through force of habit, culture, lifestyle, many drinkers, for instance consume not only health-damaging amounts but quantities which make them physically dependent. The withdrawl from physical dependency can be life threatening and ideally requires medical supervision. Yet many heavy drinkers then go onto just stop or greatly limit consumption: they were heavy drinkers, not alcohol addicts. There is an additional dependence which is separate from addiction – psychological dependence. Partly this is just the force of habit, neural correlates in the brain ‘speaking’ loudly to perform an action when certain triggers arise. Usually one can become psychologically dependent on a substance or activity to avoid stress, negative feelings or often an undiagnosed mental disorder such as anxiety and depression. Dependence can, and often does, lead to addiction but it’s still possible to recognise a dependence and take responsibility for halting it with acceptance of necessary effort and suffering which will vary greatly in terms of time and intensity according to unique individuals in unique circumstances.

Addiction by its very nature, the heart of addiction, disowns the individual’s core self. It disowns the possibility of being responsible for one’s destiny, for making deep choices. No addict will be able to understand what is going on. They are fully aware of the misery they leave in their wake, of their loss of pride, reputation, money, health, relationships, status, children. They desperately want to stop. But they can’t. In the old days people spoke of a demon inside that controlled them. The demon took them over. This degree of inner torment varies from individual to individual. It’s certainly true that there are many ‘highly functioning addicts’ in all walks of life, folk nobody begins to suspect as being an addict, and, of, course, another core attribute of addiction is the addict’s propensity to deny their addiction. It’s for this reason that common wisdom has it that people must ‘hit rock bottom’ before they can start to recover. This is, fortunately, a myth. It may be true that a secret gambler’s addiction only comes to light when the bailiffs arrive to take the family home and he or she spirals into heavy debt, bankruptcy, prison or failed suicide attempts. But in many cases – often in consort with worried others – many are lucky enough to address their addiction before absolute calamity.

The foregoing suggests just a few of the strands in the complexity of an individual’s addiction. If there is a common attribute of addiction it is that to take responsibility for recovery one must already have made a vital move. This vital move, this perception that one is not only the addicted self, is the precursor of recovery. For some, this vital move is totally unconscious and involves little pain and effort, for others it is a lifelong process.

To conclude, to return to the topic of addiction and responsibility. All of us are a product of our environments, probably more so than products of our genes. Children have been sold drugs from icecream vans (dealers do not ask for age verification or advise responsible use of their products) so 12 year olds have become heroin addicts. The vans are part of the environment, behind the vans are networks of the drugs business, also part of the environment. People continue to smoke cigarettes but on the packets is written ‘smoking kills’, and tobacco is more and more restricted by government policies: it’s recognised that tobacco addiction is not the result of weak responsibility in individuals. Campaigns to restrict and limit junk food (itself addictive), sugar, salt, fat are not controversial. People argue about minimum pricing for alcohol, but the argument is not see as being around any bizarre claims. In short, government and industry are seen as having a major role in addressing the damage that harmful products may do to individuals and society, including addictive products.

Current debate about addiction is skewed towards a focus on individual responsibility. Just as a parent is deemed responsisible for feeding their children high doses of sugar and fat (these being by far the cheapest foods to buy for those in poverty), so the addict is held reponsible for choosing their addiction (even if this was motivated by a need to escape misery and despair into 20 minutes of artificial paradise). There are no jackpots, magic fixes that will ever beat the scourge of addiction but government and industry have to stop denying their role and play their part in attenuating it.

(An academic, nuanced discussion of responsibility and addiction is in The Journal of Gambling Issues)

Addiction’s a Jingle Jangle

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Coffee and biscuits in the atrium then the delegates move into the large lecure theatre.Professor McEwan welcomes them, expresses her pleasure that so many experts are assembled in the same venue. She is delighted to introduce the world famous Emeritus Professor Nathan Bronowski, acknowledged as one of the world’s leading authority on addiction. Fulsome applause accompanies his walk to the podium. Then follows an avuncular talk interspersed with good humour which brings ripples of appreciate chuckling from the audience. Beautiful slides on the big screen bring images of complex neural activity, statistics and the chemical structures of the latest pharmaceutical medications which evidence has shown to be efficacious. He is humble enough in his lecture to acknowledge the work of others in the field, but he deftly dismisses their theories almost with sadness.

The day proceeds with further lectures and workshops in which various experts gather by speciality. A delicious banquet is provided in the university’s great hall in the evening, then delegates retire to the several bars. Somewhat ironically, some of them fail to hide their hopeless addiction to alcohol and make fools of themselves. Others, more fortunate, bond in pairs that find their way to the bedroom.

The second day, a little less enjoyable for those nursing hangovers or guilt, ends with Professor McEwan’s rapturous celebration of how successful her conference has been. The delegates disperse. Journalists from the BBC and the world’s leading media send their stories through the ether to sub-editors who will headline them with claims that huge advances in the treatment of addiction have been discovered. Within a week, everybody will have forgotten the conference and the media stories – except for Professor McEwan who will already be thinking about her next big event as she continues her ruthless climb towards the top of the academic tree. So it goes.

The proceedings of the conference are made available in a publication which, like most academic publications, costs a great deal of money to compensate for the fact that there will be very few buyers and even less readers. Perhaps a PhD student will discover it in a few years’ time and refer copiously to it safe in the knowledge that neither his supervisors nor the world at large will have the slightest inclination to examine the primary material. The said student may with equal safety discover and refer to perhaps a hundred or two such dusty tomes in a university library, and go on to produce a thesis which does indeed add ‘an original contribution’ to the field of research, a remarkable tapestry of totally random material made whole and coherent through the application of academic discourse. Such tapestries – and there are very many of them – reveal great skills of weaving and stitching If the successful PhD candidate is lucky and possesses rudimentary knowledge of self-promotion the thesis may be the basis of a reputation such that other academics and journalists will regard him or her as an authority. So it goes.

Those of us who are not academics and who lack the humility to look up to them, are not lacking in access to experts on addiction. Since most people are addicted to something or other these days, not surprisingly there is money to be made. Anybody can set themselves up as a private therapist, for instance. With some capital you can establish a recovery retreat centred around holistic principles and involving a diet almost totally of watercress: you could charge, say, £2000 a week. In publishing, there are so many magazine and newspaper articles, so many books that will cure you in a week, so much drivel on social media (a place people go to when they have lost the capacity to live in the world), so much of it all that I lack the will to say more (although doubtless a different kind of person may find it a rich area for PhD enhancement). Suffice it to say you could end your life still addicted having spent it reading about how to beat addiction or paying a fortune to people to beat addiction for you. Or eating watercress.

But addiction isn’t funny. And though it’s fine to be lighthearted about academia, we acknowledge too that getting a PhD, doing research are not easy. Most are doing their best to add a drop to the ocean of knowledge, most are passionate about their work, many are deeply motivated by wanting to make the world a better place. Like addicts, academics, are human beings first. An addict or an academic may be a murderer or a saint. Anyway, addiction isn’t something to be treated lightly. It’s certainly unlikely too that all the academic research in the world has made or is likely to make any immediate difference to an actual addict, a unique human addict. ‘Expert’ theorists of addiction argue wih other, often vehemently, defending their position and attacking their ‘opponents’. The situation is as bad or worse for us ordinary mortals who equally support this idea and strongly oppose that idea. 12 steps enthusiasts can be unshakeable in their belief of the power of the programme; others have a strong aversion to it. ‘Born again’ ex-addicts can be evangelistic: for them it’s not enough to have recovered, they have a mission to convert those left behind with ‘the indusputable truth of the way’.

In fact, addiction is a messy concept. We can get rid of the cases where it’s used metaphorically such that people say they are addicted to Game of Thrones or chocolate. We can be left with a clear idea of devestating addiction where life is slowly destroyed at many levels, but it’s still a pretty tangled concept. A jingle-jangle as Bob Dylan refers to in Hey, Mr Tambourine Man. The experience, the being, of addiction can’t be categorised neatly, objectively. Like severe depression (which often precedes, accompanies or follows addiction) the experience is different for every person. Even a gifted writer has trouble explaining what it is or was like for her or him, but there are some excellent addiction memoirs which demonstrate the uniqueness of the experience for each unique person. (There are also many more dreadful memoirs. Not everybody has the gift of writing well).

Nevertheless, there are some commonalities which most addicts would recognise. Some of these factors are overlooked, ignored or counted as unimportant in therapy and research. It is much more straightforward to categorise addiction as ‘impuse control disorder’ or to concentrate on the neural pathways involved in orbitofrontal cortical mediation: such precise ‘scientific’ approaches are neat and can be investigated, and do add something to understanding addiction. But they’re not the complete picture by any means. Many of the factors overlooked are subjective feelings which cannot be seen by the scientific gaze.

We could call these factors ‘the human factors’ since they appear in everybody, not only people suffering with addiction (and incidentally, ‘addict’ is a word loaded with negative connotations which is when used here is simply for brevity. The language of mental health is a serious topic in its own right).

In everyday language we are familiar with the word ‘shame’ which refers to a fear of what other people think of our wrong actions The word ‘guilt’ refers to our conscience, it’s a negative feeling brought on by judging ourselves. In addiction, both of these factors are greatly amplified, partly because of the damage caused to self and others, partly because the addicted person’s mind will be hyper-vigilant, in extreme anxiety which over-arouses negative feelings. And partly because of stigma – related to shame, the shame that society stigmatises, ‘casts out’ the class of people with addictions, and related to guilt because of self-stigmatisation. The addicted person as a member of society has internalised the norms and values of the culture, and is then in the terrible situation of ‘casting out’ themselves as worthless, not fit to be in public. It is not unusual to hear of people in such extreme states talk of hating themselves. Yet how can one ‘recover’ if one feels deeply that one is worthless? And, unsurprisingly, it is to be expected that people then feel ashamed of being ashamed like this, ashamed of feeling worthless – so they have to put on some sort of front, a mask just to survive in the family, in public, in the doctor’s office.

In many cases, especially in connection with gambling addiction, it will not be only the guilt, the shame, the loss of dignity and self-respect that goes with addiction. The person may well have done things that anybody would feel ashamed or guilty about. especially theft, conning people, perhaps violence.

Clinically the person will suffer to varying degrees from depression and anxiety. There may be complex underlying mental health issues that have never been diagnosed. Mental distress such as chronic depression may have been what led a person into addiction in the first place, a means of relieving pain through self-medication. Adverse childhood experiences are known to be particularly strongly correlated with not only addiction but other adult problems, and often the person may suffer from addiction as well as developmental problems. In the case of gambling addiction there is an extremely high correlation with alcohol dependence and/or other drug dependence.

People with addictions often present with what are called ‘multiple and complex problems’. Some are mentioned above. Others include imprisonment, homelessness, severe debt and long term unemployment.

We’re a long way from the lecture theatre and the academic research. In each individual any or all of the above factors may ‘cross cut’ through the central problem of addiction. It’s a reasonable supposition to claim that there are many who face a much harder road to ‘recovery’ than others. Reasonable but not always the case. Experience demonstrates that some facing the most severe obstacles not only beat addiction but turn their lives around. On the other hand, some who seem to ‘have everything going for them’ find it impossible to overcome their addiction. Sadly, not everybody does recover. But the majority do, and of that majority most do it ‘on their own’ with little or no help from doctors, support groups, books or social media gurus.

To label somebody an ‘addict’ is wrong not only because it carries a lot of negative stigma but because it misses the point that somebody suffering with an addiction is a unique person first and foremost, with a complex and singular individuality. There are therapists, doctors, psychologists, psychiatrists and others who can relate to the human factors, and through their art (as opposed to their science) provide some help. Help but not a magic wand. Maybe medication is a necessary help. Maybe being housed or helped with money worries. Maybe just being treated with respect and loved.

Anxiety and Time

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Anxiety is a normal and essential part of life. It acts as a motivator. It is a function of the ancient need for vigilance, an evolutionary ‘must have’. As a part of the full spectrum of our lives we feel anxious much of the time. We worry about our children, about having to gave a talk in public, about a job interview. Wemay have lef the house then worry that we have not locked doors and windows, or that we have left the oven on.

However, anxiety goes beyond the normal range for millions of people. Anxiety is one of the commonest mental health conditions. Depression often accompanies anxiety. Anxiety is not simply a ‘mental’ state: it affects, and is affected by, the body and all its organs. . A hangover – which is a temporary illness – often brings severe anxiety to join its unwelcome symptoms. Severe anxiety, apprehension of doom or death, accompanies some heart attacks.

Among clinical anxiety orders is included a diagnosis of generalised anxiety disorder, a chronic unease and state of worry. Anxiety can directly affect the body with digestive disorders, ‘butterflies in the stomach’, irregular heart beat. A very intense and unpleasant experience of anxiety is in panic attacks. In panic disorders one may feel that one is about to die, that something dreadful is about to happen, even that one is abou to die. Obsessive compulsive disorder is classed as a severe anxiety disorder.

There is no neat line between ‘ordinary’ and ‘clinical’ anxiety. Mental ‘disorders’ are best seen as extremes on a spectrum of normal human experience, exremes which have a significant impact upon quality of life and funcioning. Such extremes are treated by medication, counselling and ‘talking therapies’ such as cognitive behavioural therapy.

Some people are more anxious than others because of their constitution, the genetic factors: they are in higher states of arousal, classically the condition of introverts who are uncomfortable with too much social interaction; shyness is a form of anxiety. Others are made anxious by experience. Adverse childhood experience is a key factor: abuse, inadequate parenting, trauma in a young child who lacks all the adult defences may scar permanently. Such childhood experiences can lead to a range of other problems later in life including addiction.

One of the commonest reasons for addiction taking root is given by the self-medication hypothesis. This essential states that a mood of distress such as anxiety is found to be relieved by a substance or behaviour such as gambling. Not all addiction follows this course, but where it does, recovery must take account of the underlying factors.

There are other ways of looking at anxiety than through medical or therapeutic perspectives. For instance, it’s interesting to note that the word itself has its roots in the same Latin word which means anger, and that Latin root itself came from a meaning of choking or strangling. Anger itself is one of our basic emotions, a response to danger which is often immediate and without thought. It’s not hard to feel how some forms of anxiety are experienced as an angry turmoil. Anger is strongly related to fear. Anxiety has been likened to fear ‘without an object’, a vague but very uneasy feeling of fear that something very dangerous but ubknown is very near. When a person is anxious, having no object to be fearful of, they may ease their anxiety by turning it into fear of a specific object. Hatred and social evils such as racism are related to this process wherein a deeply anxious, fearful person projects anger towards an object.

In those many parts of the world where chronic absolute poverty, starvation, war and other horrors exist, everyday life is largely fearful of specifics. Where is the next mouthful of food coming from? Will the soldiers come tonight? But in rich nations here basic material needs are largely satisfied, for many who have everything there remains a deep underlying unease. hen all the material needs are satisfied what is the person left with? Many people prosper and live satisfying lives; many with similar material security do not. A chronic anxiety fills the days. The poet W.H.Auden coined the term ‘The Age of Anxiety’ for a long poem in the 1930s.

The sense of this sort of anxiety – unexplained fear – is accompanied by a sense of emptiness. The experience can be one of racing thoughts all going nowhere, restlessness, inability to be at peace with oneself and the world. One reason that such unease occurs in rich countries is that we have the luxury or horror of facing fundamental human problems. We spend a lot of mental energy, for instance, pushing down the fact that not only are we going to die but e may die in the next moment. We learn to block feelings of dread when people close to us suffer and die. Alone, we seek distractions to stop thinking deeply. Much – much more! – has been written around such cheerful points by philosophers and others, but the essential point is that everyone faces these questions or, more commonly, refuses to face them.

Addicts are no different. When you label someone an addict you often disguise the fact that they are as much a human being as anyone else. If you label someone a doctor, you can forget that more importantly they are a human being. In some ways people who are addicts are extreme examples of individuals who have sought and found a means of escaping a world that is ultimately meaningless. The world escaped from is full of anxiety, suffering, death – and the hard, hard work of getting along with other people (‘Hell is other people,’ the philosopher Sartre wrote). The addictive moment, when an addict engages with the drink or the gambling machine, is also an escape from time. Time is the demon at the heart of anxiety. It is the fear that the future, the next hour, the next minute, the next second will bring something overwhelmingly dreadful. The worst anxiety is Dread.

Starting in the United States, the phrase ‘the machine zone’ was employed to refer to the unique state of being between gambling machine and user. The zone is a time one more than a place one, or rather a timeless zone. All the Dread and anxiety associated with time dissolves. The ‘zone’ is a double whammy. It removes the deep negative anxiety of time and provides a positive experience of intense power, independence from the flow of time, and something akin to those ecstatic moments produced by drugs and some religious rites. The latter themselves may be deemed a form of addiction. To a lesser extent, the ‘ordinary punter’ may escape anxiety by shopping, bargain hunting, social media, internet addiction, hoarding, proud housekeeping, fooball, reading, climbing, exercise, over-eating… Addiction seen this way is an extreme example, a very harmful one, of ordinary human behaviour. Most people have a range of distractions, some healthy and some not, but addicts centre their lives around one major objec of desire.

The wealth of modern rich economies is built less on coal and steel than on consumer products. Businesses that provide these products to a large extent reach the need of customers to chase distractions from the pressures of life, and to fill what would otherwise be a terrible emptiness. Business practice is as much a reflection as a driver of culture, its own practice dependent upon and informed by the culture(s) we all live in. Some business, however, also sets out to exploit vulnerable consumers, and this can be seen in financial products including respectable high street names credit offers. The worst cases are exorbitant interest fees for loans and cheating old people of their savings and homes. In he case of gambling and drinks industries it appears that those most vulnerable to harm are exploited. Cheap high strength alcohol is made available for pocket money prices.

Moving towards a conclusion now, i can be argued that states like anxiety and depression are common experiences and we seek ways to escape them. Some ways are relativelt harmless but addiction brings with it not only severe life and health problems but an increase in both anxiety and depression. Addictive engagement seems to bring about a quick way of switching moods very quickly, that switch is the attraction. This isn’t the case for everybody: addiction is a complex condition dependent on many factors peculiar to the individual. But it’s certainly true that many people have felt ‘lost’, anxious, depressed, unable to concentrate as thoughts race. These feelings are not uncommon in society as a whole. Many who are a long way from clinical anxiety and addiction nevertheless live a life permeated by unease, a vague pervading anxiety. In the case of full blown addiction, this unease is intensely powerful and negative, and the only sure ‘way out’ seems to be the ‘fix’ which will lead, of course, to deeper anxiety, guilt, shame, all the impossible attributes of feeling helpless, powerless in the drive to do the one thing one desperately does not want to do.

Those of us who have known addiction or are struggling with it may acknowledge that we have not learned the coping strategies of facing everyday unease. The psychiatrist Sigmund Freud said that his therapy was designed simply to move people from ‘neurosis’ to ‘common unhappiness’. Even the happiest, most contented people have periods and episodes of unhappiness and unease, but they have found positive things in life against the negative background – family, music, donkey racing, clmbing, music, reading, exercise, volunteering, whatever. Recovered or recovering addicts lapse often because the negative unease persists, and perhaps it’s here that medication or other therapies are most important. But when people do recover they don’t become saints or bundles of joy: they slowly come to terms with the anxiety and unease that is part of the package that all humans have to live with to be alive.

Addiction and Being

The word ‘addiction’ started life in Roman times. A slave was addicted to a master by a formal contract. In mediaeval times monks wre similarly ‘addicted’ to God. In both the case of slave and monk, the whole being was given away. One’s will, one’s desires, one’s idetity were no longer one’s own. Every thought and action was under the sway of Master or God. One had given oneself away, one had lost oneself. All choices, all decisions such as they were in a very limited spectrum were determined by the Other.

Similarly, today, we talk of addicts to substances or behaviours as having lost their self, having given themselves away. All thoughts, feelings, actions are determined by the centrality of the Master, God, Other. Just as every aspect of a slave’s or monk’s life was determined beyond themselves, so the modern addict is enslaved in every aspect of their life to the object of their addiction.

That is why those who talk of the addict’s responsibility and choice are not only cruel, they are ignorant of the nature of addiction. Addiction is a state of being in which one has disowned oneself. A slave would have many moments of hating the Master, of wishing to be free, yet they were bound firmly. A monk may waver in his faith, wish to be free of the strict demands of God, but having given himself over he must endure.

We do indeed talk today of an adict’s being enslaved to the object of their addiction. We may say too, for instance, that alcohol is a drinker’s god.Yet there is a big difference between today’s addicts and the original ones of slavery and monasticism. An addict today can become free.

The experience of most addicts who start on the road to freedom is important. Often, usually, by will power alone they can stop the behaviour they wish to be free of. But then they relapse. Clever scientists suggest that the brain has ‘pathways’ which strongly affect our behaviour. Addictive pathways are literally, biologically laid down in the brain and are powerful. Linkages between the parts of the brain that control impulses are weakened. The good news is that these ‘pathways’ can be altered. The brain is said to be ‘plastic’. It is not fixed, but constantly changing in the light of new learning.

Some evidence suggests that relying on will power alone to defeat addiction can be counter-productive for every time you fight the brain pathways they fight back! There are evangelical claims that such and such a therapy – 12 steps for instance – is the one and only way to ‘defeat’ addiction. Yet words like ‘defeat’ suggest fighting, using yourself to fight yourself. All addicts know this dreadful experience of inner struggle, trying not to do what they don’t want to do while at the same time wanting to do it!

Another aspect of addiction, depending on how long it has lasted, is that every part of life has adapted to it. With the object of desire as the central command all else revolves around it: relationships, work, money, leisure, love. An addict may function in society, have a job and family, but she will place these as second to the object of desire. That is why we hear of ‘trusted’ employees stealing from work, husbands stealing from wives, betrayal, broken promises, bankruptcy. Substance addicts will slowly be committing suicide via the damage to their bodies. Actual suicide may occur in the case of addicts who have struggled so hard for so long against themselves and lost.

An addict who starts young will never learn healthy relationship and social skills, monetary skills, impulse control skills. Recovering from addiction needs much, much more than simply stopping. It may mean learning from scratch what was never learned through natural maturation. On the other hand, those who have been addicted for a short period may have the foundations from earlier life to return to and build upon.

It is often overlooked that there is a strong recognition that most addicts recover by themselves, without any input from specialist services or support groups (and it is sadly worth pointing out too that many who enter specialist services and support groups do not recover. There may be something very naive – if very profitable – in private clinics’ offering 12 weeks ‘recovery’ cures). Young people who are addicted in their energetic teens and 20s are known to ‘mature out’ when they start a family, settle into employment and replace one way of being with a healthier way of being. The famous study of Vietnam soldiers, addicted to heroin in Nam, shows that 80% of them recovered naturally when they returned from the war to their families. A ‘bad’ thing is wiped out by a ‘good’ thing.

One of the great potential benefits of any recovery method is that the addict has taken responsibility for owning their condition. Remember, there are many millions of addicts who deny their condition at first: some will go to the grave denying it. For some, and by now means all, group meetings provide a weekly or daily regularity that has been missing in life. For some, by no means all, the very sociability of groups takes the addict from the well known deep self-centred thinking to the beginning of entering the world of social interaction. These benefits, rather than the particular programme, may be what accounts for their success for some, but by no means all.

There is absolutely no such thing as a typical addict. Somebody with an addiction has a unique history, is a unique person. Yet one may perhaps allude to a certain common problem facing some in the early stages of recovery. It’s almost like dread. You’e done three, six, twelve months but you feel empty, lost, nothing grabs your interest. Not uncommonly there is a state of clinical depression and/or anxiety. Underlying mental health conditions which brought about addiction in the first place may surface. These can be treated clinically. But there is also often a deep unease at the level of being. After years sealed off from life, what is life? What is my life? I’ve stopped drinking or gambling or my sex addiction but my life doesn’t feel any better for it. What’s the point? Remember that such feelings will amost always be accompanied by intense negative feelings of guilt, shame and bitter self-recrimination.

The bad news is that there is no magic answer, whatever evangelical gurus or sellers of this or that method say. Addiction is every bit as devestating as cancer in those cases where statistics show the numbers that sadly don’t make it out. The better news is that most people do recover, more often on their own than not. And one thing seems to help above all others. Whether with or without support, it’s finding healthier, deep meanings to life. The psychiatrist Viktor Frankl survived most of the second world war in concentration camps because he was used as a doctor. He wrote a book* in which his central insight is that the dreadful conditions of the camps brought people to their kneees, physically, mentally and spiritually Yet some died very quickly. Others in identical circumstances survived. Those who survived, he said, had deep within them some core meanng to their lives; for some it was religion, for others it was their family outside the camps, for some it was music or literature or writing, for some it was helping others. This idea of having a deep meaning for being (or reasons to be alive) is seen as crucial to surviving the sufferings life throws our way.

Addicts by the nature of addiction have developed a specific sense of time peculiar to addiction. The time of the ordinary world is filled with boredom or threat, but the immediacy of engagement with the object of desire shuts out that ordinary world. In the ordinary world the biggest dread is not of pain but of meaningless, something much deeper and more intense than boredom. Unease with time is relieved by triggering the addictive process which provides not only a relief from unease but a sharp and powerful pulse of energetic feeling. (This process is described particularly acutely in the experience of playing electronic gambling machines: it’s called ‘being in the machine zone’. Note the word being).

Recovery has to come to terms with recovery from that addictive way of handling time. It means finding meaning in long term feeling, thinking, doing, being. For some it may need no more than becoming ‘addicted’ to the love of one’s children and grandchildren. For others, trainspotting is enough. But after the years of fury, and the early period of srtuggling recovery, it is true that, after all, time heals.

* Viktor Frankl, Man’s Search for Meaning

12% of UK Doctors are Addicts

According to this site for sick doctors, 10% of the general population are estimated to be addicts. The figure rises to 12% for doctors in the UK. These figures refer to drug and alcohol addiction and do not include other addictions such a s gambling addiction. Both figures are probably highly surprising to most people. Addiction is certainly one of the most pervasive of all mental illnesses. The costs to individuals and those near them is huge in terms of grief and suffering; the cost to the nation runs into may billions of pounds.

Doctors and other front line health workers generally work under very stressful circumastances. One stressor must surely be that those they are helping or trying to help often turn against them, blame them, may be even physically violent. This may be true especially among addicts who ahve a tendency before they start on recovery to externalise their pain, and blame whatever or whoever comes to hand. Doctors are often in a position where they can do little for a patient except refer them elsewhere. Often, when recovery from addiction has begun and the patient has gained some ownership of their own recovery, doctors can help with things like depression and anxiety.

However, going back to the figures at the top, if doctors themselves have such a high rate of addiction it seems reasonable to suggest that there is no easy medical ‘cure’ for addiction, no magic pill. If doctors cannot heal themselves, or not easily by use of medication, it follows they cannot offer easy solutions to anybody else. Doctors have to embark on recovery in the same ways as anyone else.

It’s the case that ‘addiction’ is classed as a ‘mental illness’, yet perhaps it’s true also that there is no straightforward and medication based treatment.

It may be that recovery is not a medical matter. Although medicine can help with the complexities of addiction on an individual case basis such as whether a comorbid mental health disorder needs treating initially or during recovery, by and large recovery takes place in non-medical contexts. 12 step programmes (AA,GA,NA etc.) is an obvious example (although as is well known, while some swear by the programme, some evidence regarding its efficacy suggests low success rates, and many people find it is not for them). Psychological therapies are used too, but accessing them can be very difficult, involving a long wait for treatment which is not necessarily successful.

A large number of people – in cases of alcohol addiction, for instance, maybe as many as a third of people – recover with no recourse to doctors, psychologists, 12-steps or any other agency. A well known example is that when soldiers became addicted to heroin fighting in Vietnam, 805 of them recovered without intervention on returning home to America where they were in the environment of family, home and friends. Inversely, studies show that drug addicts who stop using while in prison, sometimes for many years, resume upon release when they return to their old social networks. Environment in its broadest sense seems to play a big part in recovery.

Addiction Musings (2): THE SOUL OF ADDICTION

Everyone’s an ‘addict’ these days if you believe everything you read in an ever increasing number of articles. People say jokingly, of course, things like they’re addicted to doughnuts or Facebook. Ingesting too much of anything or spending too much time on anything may be bad for your health and quality of life but that doesn’t make them addictions.

Certainly, some activities share things in common with addictions. Children whose life revolves around social media, who feel miserable and irritable if deprived of it, are said by some to be ‘addicted’. Yet heavy usage of a substance or activity does not in itself describe addiction. Many heavy drinkers, for instance, are giving a lot of time to drinking, damaging themselves and others, but that doesn’t make them alcohol addicts. A lot of people run into problems gambling: they run into money problems, and a host of other difficulties – but this doesn’t make them ‘gambling addicts’.

Heroin is used ‘sensibly’ by a surprisingly large number of general healthy and financially stable with good employment and quality of life. The substance itself does not contain a demon which guarantees addiction. On the other hand, cannabis which as a substance causes little or no physical dependence, may for some people lead to what is truly addictive behaviours. The characteristic which makes cannabis possibly addictive is its becoming the centre of a person’s life. All else is secondary. The days and weeks are spent ensuring supply, and being in a cannabis induced state (interestingly, one that need not be, and often is not, pleasurable). On the other hand, the vast majority of people who use cannabis represent a spectrum: like alcohol for instance, it may be used occasionally or regularly but without disrupting life: without it, life goes on pretty much as normal.

When it comes to fixed odds betting terminals, there’s a somewhat pointless debate about whether or not they are ‘addictive’. For most people they are not, that’s a fact. For a significant number of people they are. Their design make sthem so. In this respect they are electronically enticing the most vulnerable, which is the basis of campaigns against them. They are unfair and unjust. However, that is a separate issue from the question of what addiction is.

There are thousands of ways of asking and answering this question. One thing that seems agreed is that addiction seems to seriously impact on every area of life. Breakdowns of various kinds, physical and mental health deterioration, misery and so on. Yet what about the concept of the ‘highly functioning’ addict? Somebody who is successful on most measures, thriving, healthy, and so on.

Questions, answers, theories and explainations go round and round ending up in a tangle and a mess. But what follows suggests a description of addiction which many may recognise. It’s not a medical or psychological or other expert viewpoint. It’s abot the being and meaning of addiction in an addict’s life. (In philosophy, questions about being and meaning are ‘existential’ questions). This description applies to both those who have not admitted or realised that they are addicts, and to those who know too well that they are in addiction’s grip, those who feel trapped, enslaved.

Enslavement is actually the original meaning of addiction. In Roman times, a formal legal contract would addict a slave to a master. A slave, of course, has no freedom; his or her identity is simply being a slave. Everything the do, everyhting they think, everything they are is in terms of the master, has the master at the centre. The slave’s life revolves around the master.

Interestingly, in mediaeval times, this meaning was tweaked slightly with monks who ‘enslaved’ themselves to God. This voluntary giving over of one’s whole being to God was also called addiction.

Through metaphor, addictio has come to signify the state of enslavement. Just as a Roman slave’s life was totally determined by the master and the condition of enslavement, and the mediaeval monk’s life revolved around God with all else subsidiary, so the modern addict’s whole life and being revolves around the object of their compulsion. The object may be a substance or a behaviour. While the addict functions in many areas of life or not – employment, family, relationships etc. – these areas are always secondary to the object of addiction. An addict may lie, cheat, steal, do things that they utterly detest doing because their whole being revolves around the object of compulsion.

If this description is on the right lines it offers the intriguing possibility that a ruinous addiction may be defeated not by will power but simply by replacing what is important to being and meaning in life. Certainly there is much evidence that many severely addicted people come to ‘recovery’ not by any method or treatment but by finding meanings and values in life that are more positive. So, for instance, 80% of military heroin addicts in Viet Nam stopped using when they returned home to their families, the latter being the positive meaning and values system that defeated the destructive one. Evidence shows that many young people with addictions ‘mature out’ of them without treatment when they find richer meanings to life, for instance throughs tarting a family or a career.

To employ a somewhat hackneyed word, addiction is holistic. It is a state of being that involves every single part of a person’s life.

– Ade Johnston

A Life Pervaded by Addiction: an interview with Joe

The common phrase ‘problem gambler’ is thrown about very casually as if the compulsive gambling behaviour that so many experience (about 5% of the UK polulation including the 0.7% of life threatening cases). Too often a person is defined as an ‘addict’ or a ‘problem’. People do have problems and addictions but to identify them buy labellig them only in these terms is dehumanising and wrong.

The way we all too often label people needs challenging. Hence we have anti-stigma campaigns. There are many such campaigns around mental health. People should not be labelled for many reasons: one is that it lessens or belittles them; another is that it isolates people by their being seen as ‘different’; a third is that negative labelling deters people from seeking help and support.

This interview with Joe reveals a life of suffering from compulsive gambling. Rather than facts and statistics, academic studies, medical discourses, we think it is essential and in many ways more powerful and relevant to listen to the unique, individual voices of people who face the danger of being boxed into a dehumanising label and stereotype.

What’s also brought out in this interview is that problem gambling involves far more than individuals who gamble. It includes the environment and culture. It also includes the design of gambling machines in our digital age – specifically, in Joe’s case, fixed odds betting terminals and online gambling.

How prevalent is addiction?

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Following on from the previous post, our coffee discussion turned to the prevalence of addiction in the UK. We were both coming from a belief that it reveals an astonishingly large number of people in trouble. We believe it is a massive social problem that is not getting the attention it requires.

Later reflection considers the following:

There is a problem understanding what may be referred to as addiction. There is a very large number of people whose addictions have resulted in actual or potential life ruin involving finance, employment, social status, relationship breakdowns, a range of severe physical and metal health problems, and death.
However, there are many more cases where people are nearing these severe states. There are many whose drinking or other substance dependence are working slowly to take years off their lives. Nicotine addiction is an an obvious case. This applies to behavioural addictions such as gambling also, and statistics for these groups are hard to achieve if at all.
Unknown numbers of people are addicted to over the counter painkillers or prescribed medicines. Unknown again is the number of people illegally ordering prescription only addictive medication online.
There is a range of other addictions which are now taken seriously by researchers and treatment providers such as eating disorders, sex addiction and internet addictions.
Many ‘normal’ behaviours share characteristically common features of addictions. Compulsive shopping, perfectionism, workaholism for instance have similar neural substrates to all addictions.
A research paper has suggested that 47% of Americans are addicts in some sense.
Statistics for all addictions taken together in the UK are hard to come by. Limited statistics are available separately, e.g. for alcohol, opiates, marijuana (usually treated as psychological dependence), gambling, amphetamines, heroin, cocaine.
It is extremely difficult to gather statistics. Since many addictions are to illegal substances and do not get reflected in medical interventions for instance, the true scale of actual addictions to a substance or behaviour can only be estimated.
Nevertheless, what figures there are contribute to an understanding of the prevalence of addiction. 9% of men and 4% of women are dependent upon alcohol. In Scotland there are 50% higher rates. The Gambling Commission also reflects geographical variation:

prob gamb

Such figures cannot disclose current trends nor the breakdown of specifics of for instance, types of alcohol behaviour, methods of gambling. As for gambling, since it is increasingly done at home using online technology, only sources such as publicised personal catastrophes, some suicides, treatment statistics are available. The stigma associated with addiction is that even many severe cases will be attributed to financial ruin or depression etc.
For every addict at the extreme negative end of the spectrum, many more people will be affected, especially children and families. The problems of addiction therefore affect very large swathes of the population.
Besides the immense personal costs and suffering, society as a whole spends many billions of pounds because of addiction. These costs relate to health, crime, lost productivity and the welfare bill.
We aren’t remotely expert or knowledgeable but believe the true rate of addiction is extremely high. It needs much more urgent focus by policy makers across government services and within government, especially:

Researching and acknowledging the scale of the issue as a whole rather than by reference to particular addictions.
Identifying social, environmental, business contributions to addiction and curtailing them. For instance, prohibiting products designed to entice vulnerable people or induce people towards addictive behaviour, such as fixed odds betting terminals, advertising, online design; minimum unit pricing for alcohol.
Raising awareness among professionals and ancillaries; ensuring destigmatisation among support providers and workers.
Not allowing loss of government revenues to be used as an excuse to prevent public harm.
Acknowledge once and for all that addictions represent one of the nation’s main mental health disorders. Integrate metal health services, educate staff, resource much greater treatment provision.
Roll out public health promotion and advertising.
Rethink drugs policy. Seek best practices globally for decriminalisation or legalisation. Emphasise treatment over punishment.
Immediately produce policies and strategies to support the many people who suffer dual diagnosis disorders.