and Sorrow:
It is not true that when the heart is full the eyes necessarily overflow; some people can never manage it, especially in our century, which in spite of all the suffering and sorrow will surely be known as the tearless century.
—GÜNTER GRASS, The Tin Drum
ALL ADDICTIONS ARE anesthetics. They separate us from the distress in our consciousness. We throw off our familiar and tired consciousness to assume another mind state we find more comfortable, at least temporarily. Desperate to be out of our mind and unaware, we surrender to the addiction, to be lulled into a walking sleep.
Whether they know it or not, a large number of people addicted to behaviors and substances of various sorts have attention deficit disorder, no matter what their proclivity may be: for gambling, compulsive sexual roving, chronic impulse buying, workaholism, excessive physical training, danger-seeking pursuits like drag racing or for nicotine or cocaine, alcohol or marijuana. As an example, according to some surveys, the rate of smoking among the ADD population is three times that among the non-ADD population.
It is easy to understand the appeal addictive substances would have for the ADD brain. Nicotine, for one, makes people more alert and improves mental efficiency. It also elevates mood, by stimulating the release in the brain of the neurochemicals dopamine, important in feelings of reward and motivation, and endorphins, the brain’s natural opioids, which induce feelings of pleasure. The endorphins, being related in chemical structure to morphine, also serve as analgesics, soothing both physical and emotional pain. (One reason for the amazing resilience of the toddler, cheerfully bumping his head and bruising his knees on sundry objects as he explores the world, is thought to be the abundant presence in the brain of endorphins at this stage of life.) This combination of arousal and soothing enables the nicotine addict, like the caffeine addict, to be an alert sleepwalker. By contrast, the alcoholic lurches about in a state of stupor, his nerve endings deadened. He, as they say, is feeling no pain.
Less obvious but no less physiological are the effects on the brain of self-stimulating behaviors. The gambler and the sexaholic, the compulsive shopper and the man or woman who insists on skiing uncharted glaciers are all looking for the same hit of dopamine and endorphins that the ingestion of substances gives the drug addict. Whatever gets you through the night. Those of us with attention deficit disorder love dopamine and endorphins.
There have been times when my workaholism did not satisfy my need for oblivion. I needed more and found it in pursuits that vicariously fed my creative and spiritual needs—vicariously, because the driven ADD personality has no idea what his true needs are and must find for them some displaced, symbolic expression. My route was the compulsive buying of classical records and compact disks, alternating with—or conjointly with—the frenzied purchase of books. On the surface these may seem like innocent and even admirable pastimes—as they would be if undertaken consciously and in moderation. The addict has no such control. The compulsion beckons; the addict runs to serve it. Gradually, in each orgy of buying, I felt myself shrinking into a ghost of myself, full of self-contempt and apologetic for my existence. I have treated heroin addicts, and I recognized in myself the same vacant and driven look I saw in their eyes. The behavior addict knows, or ought to know, that what separates him from the drug addict’s fate is little more than good fortune.
Over the years, I spent thousands of dollars on compact disks. Dropping a few hundred dollars in an hour or two was easy. My all-time record for expenditure, I believe, approached $8,000 in one week. (I have kept the receipts from that week, as a memento of my driven days.) I was cushioned from economic disaster by the income earned through my work as one of the self-sacrificing—read workaholic—physicians much admired by the world. It was easy for me to justify all the spending as compensation for all my hard work: one addiction provided an alibi for the other. My confusion—and I see this in the ADD addict repeatedly—was that both behavior dependencies represented genuine parts of me, though exaggerated. The addiction to music or books could masquerade in my own eyes as an aesthetic passion, and my addiction to work as a service to humanity—and I do have aesthetic passion, and I do wish to serve humanity.
In itself there would be nothing wrong, by this society’s standards at least, with buying massive numbers of recordings and books.* It’s possible, I suppose, that a man could love music and reading so fervently that he decides, with due consideration, to devote much of his income and life energy to these activities. The truth was that for me, as for all addicts, the excitement was not in the ostensible goal—listening to the music—but in the process of acquiring. Now years down the road, I still have not heard many of the operas and symphonies I bought, let alone the many disks I sold unheard for pennies because some other version that caught my fancy needed space on the shelf.
There is a fine but clearly discernible line between addiction and passion. Any passion can become an addiction. It’s simply a question of who is in charge: the individual or the behavior. The addiction is the repeated behavior engaged in despite the certainty that it harms oneself or others. Passion loves the goal or process that is its object (the painting one buys or the painting one does), but the real object of addiction is the thrill of plunging into the behavior, not the love of it. (The objective of the gambler is not winning, but the thrill of gambling.)
The effects on my family life were devastating, not because of financial privation or even primarily because of the time I spent away from home while haunting the stores. The major effect was that I could not be present—in both senses of being at home or attentive to my family—whenever I was in the grip of the fever. For an addict, morality, truth, devotion to a partner and children can pale into abstraction. I would keep my children waiting or hurry them along to suit my purposes. I lied to my wife, daily, for weeks and months at a time. When the reckoning came, as it always did, I made guilty confessions and soon-to-be-broken promises. I would rush into the house, stashing my newest purchases on the porch temporarily, and pretend to be present. Inwardly, I could think of nothing but the music. Naturally, I hated myself, and the more I did, the harsher, more controlling and more critical I became with my sons and my daughter. We cannot endure seeing the needs of other people, least of all those of our children, when we are preoccupied with serving our own false needs. Perhaps the nadir, but not the end, of my addictive years was when I left a woman in labor in hospital to run downtown to pick up whatever music was then my latest obsession. I would even then have had time to return for the delivery had I not begun to cast about for other recordings to buy. I murmured apologies when I got back, but no explanations. Everyone was most understanding, even my disappointed patient.* After all, I am a busy doctor. I cannot be everywhere at once.
I could not have been more focused when engaged in my addiction. I remembered titles, conductors, record labels, music reviews. My brain was fully alert. I would make appointments to have lunch with two different people at two different restaurants at the same time, but I never forgot to call the store when I wanted to order a recording. My prefrontal lobes were awash with endorphins and dopamine, released by the thrill of the hunt and acquisition. The addiction, in a strange way, makes the addict feel more connected to life. The downside is that it separates him further and further from himself. He is feeding only his appetite, not his hunger.
In biochemical terms, any addictive substance or behavior is self-medication, self-administered emotional pain relief. But the ADD person is also treating herself for a condition she is not even aware of having.
Whatever behavior or substance one is addicted to, the treatment of attention deficit disorder cannot make headway until one accepts the fact of the addiction and takes steps to end it. It is not possible to lull feelings to sleep and hope to be truly awake. When the addiction dominates, the true self—how one really is in the world—slumbers. To own the addiction is to begin to take ownership of the pain. Until that happens, the pain owns the addict and the addiction rules him. “The task of integrating thought and feeling is called striving for ownership,” writes the psychologist and addiction expert Robert J. Kearney:
When people are response-able and not in denial, they are aware … of what they feel and they know … what has gone on inside them to generate those feelings. It is a three-part chain connected by awareness: awareness of events, awareness of interpretation of those events, and awareness of the emotional reaction following those interpretations. If the chain is broken, ownership of the feeling is lost. When the task of ownership is being performed, the chain is solid.1
I read everywhere, I once said to my therapist, that I am supposed to heal myself by “feeling my pain and my grief.” Try as I might, I could not force myself to conjure up emotions according to some formula in a book. Feelings either come or they don’t. So where was my pain, my grief?
“Quite right,” he agreed. “How could you know?” I was spending all my waking hours, as he pointed out, stimulating myself with ceaseless activity, working overtime to keep my brain spinning, gorging it with mind candy—what exactly was I expecting to feel? Where did I leave even a small crack for feeling to seep through?
It has become evident that the brains of people who are prone to addiction are biologically predisposed by some imbalance of brain chemicals. Narcotic addicts, for example, are thought to suffer from a relative undersupply of endorphins, the brain’s indigenous narcotics. People with ADD seem to be short on dopamine, the reward chemical. There probably exist, too, combinations of imbalances. What causes the abnormal brain chemistry? The scientifically simplistic answer would again put the onus on genetic inheritance, although there are also compulsive moralizers who insist on seeing everything in terms of ethically flawed and weak-willed culpability. The moralizers are chewing on a kernel of truth when they reject genetic determinism; the genetic-minded are right to insist on the importance of biology and physiology. And they both miss the point.
The deficient neurochemistry of addiction, like the deficient neurochemistry of ADD, can be traced to events in the first year or two of life, as we know, the brain’s most crucial formative period.2 We saw in chapter 12 that emotional stresses can affect the supply of brain chemicals—recall, for example, that infant monkeys suffer a drop in dopamine levels in their frontal lobes after only a few days’ separation from their mothers. “Social isolation, the early deprivation of emphatic care, causes a permanent reduction of brain opiate receptors,” writes the researcher and theorist Allan Schore.3 The catastrophic incidence of substance abuse that afflicts oppressed minority populations in North America can, in this light, be accounted for by the unbearable stresses society has imposed on family life among the poor and powerless. Yet the media leap with alacrity anytime someone reports the latest rhubarb about the so-called alcoholism gene, for instance.
We see, then, that the pain the substance abuser does not want to feel has as its original source the same experiences that deprived her of the chemical she is trying to replenish by means of her habit. The emotions the behavioral addict is running to escape were imprinted in his implicit memory circuits at the same time as the dopamine circuits were stunted, which now, by his thrill-seeking behaviors, he is trying to stimulate. The harder these people work to compensate for their deficient biochemistry through their respective addictions, the more they perpetuate the emotional emptiness that only the ownership of their problem and the recognition of its causes in past and present will begin to fill.
A significant proportion of the adults I see with ADD admit to substance addictions at some time in their lives, and not a few continue to engage in them into the present. When I find that parents who seek treatment for their child’s ADD have a substance addiction, say, alcoholism, I tell them as gently as I can that little meaningful help can be given their son or daughter unless they, the parents, confront their addiction. A number of times such parents have declined to return. Adults who hope to outgrow their ADD problems need to make a similar choice. While they stick with their addiction, they are being no kinder to themselves than the parents who are unable to give up theirs even to help their child.
There are many potential sources of help for the addict wishing to heal, although too many put the emphasis purely on the addiction rather than the underlying causes. “We so often become so preoccupied with the problem the drug use creates,” write Drs. Hallowell and Ratey in Driven to Distraction, “that we fail to consider what purpose the drug must be serving for the user.”4 While attention deficit disorder cannot be successfully treated as long as the addiction continues to dominate, neither can the addiction be given the appropriate attention if the ADD is ignored and if the common origins of both remain unexplored.
In his novel The Tin Drum, the German author Günter Grass depicts a nightclub where the jaded clientele come to sniff pungent onions to the sound of a frenzied drumbeat. Their tears flow and they feel their sorrow, which otherwise is too deeply repressed in their psyches. What they are addicted to is the artificially induced intensity of deep emotion. As Grass writes, we are far away from our griefs, which are the truest parts of ourselves. There is no path toward oneself that leads away from the pain.
*Except for the glaring contradiction of how people with supposed humanitarian principles can justify such a degree of self-indulgence while only a few streets away others are hungry. This is not an issue I have even come near to resolving. Clearly, I am not ready to deal with it.
*Her name is Joyce, and she has long known this story.