CHAPTER 9
Joe was a star country footballer. Like most of the guys he played with and against he didn’t see that he was an addict, and that his addictions were making his life worse than it needed to be, and his family’s lives worse than they needed to be. During his occasional conscious and mindful moments Joe realised that maybe he was addicted, to the alcohol that he and his team-mates toasted their successes and consoled their losses with; but Joe didn’t work out that what he was really addicted to was a dream.
Joe’s dream was his idea that he was only worth anything when he was winning; this was when he could show a usually hostile and uncaring world that he was worth watching, worth something. Joe’s dream idea of himself was a lot more fun than his usual idea of himself, as somebody who didn’t really matter when he was not on the football field, or better still, in the pub with his team-mates after a win. Joe didn’t really like his job of selling cars, even though he was sort of interested in them and he didn’t mind talking to his customers about them. Most of the time, though, he didn’t really tune in to what his customers were telling him, or even to what his family was telling him, unless it was about last weekend’s game.
The only time Joe felt good about himself these days was when he saw himself as Joe the footballer, Joe the champion, Joe the guy people thought was cool. The only problem was that life’s worthwhile bits only happened occasionally these days, and he still had to live with himself constantly. Joe’s way out was to realise what he was really addicted to—a dream of champions. He would finally overcome his addictions and find real happiness, real peace, when he woke up to what he really was and had now.
The Macquarie Dictionary defines addiction as: ‘The state of being addicted to some habit, practice or substance, particularly narcotics.’[1] The great psychologist and philosopher Carl Jung said that: ‘Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism.’ Incidentally, the syphilitic eighteenth-century French poet Charles Baudelaire came out in favour of addiction, with some practical advice that perhaps his poetic licence allowed him: ‘Be always drunken, with wine, with poetry, or with virtue, as you will!’ Maybe he wasn’t quite ready to deal mindfully with his habits.
Maybe there’s a common source of all addictions: the hellish craving for more than what we have. Like the donkey chasing the carrot, the lasting happiness we seek as addicts to anything is always just out of our reach. If we assume that happiness and pleasure are the same thing, then we might seek pleasure as a way to happiness. If they are not the same thing then that’s a dangerous mistake. Shortcuts to happiness can turn into highways to hell.
We all have ‘pleasure centres’ conveniently located in our brain. This is sometimes called our ‘reward system’, or for those who like technical terms, the mesolimbic reward system. This is what makes what we need for survival pleasant, like food and sex. If they weren’t pleasurable then we wouldn’t do them and we wouldn’t survive. Pleasure, then, isn’t a bad thing in itself—it’s a natural part of living. When our pleasure centre gets carried away by our pleasure-seeking behaviour, however, we get into a cycle of demanding more and more stimulation, for the same level of satisfaction. In the long run this actually ends up blunting our enjoyment centre and lowers our mood. Soon, if it’s not being stimulated, it also starts to fire off anxiety messages when we think we’re missing out on something, and then we’re addicted.
Our search for happiness through pleasure can soon degenerate into a restless retreat from anxiety over which we have less and less control. This is a recipe for disaster, not happiness. Trying to suppress our desire to pursue the object of our addiction is fraught with tension and fear. This is quite aside from the fact that any particular substance, like alcohol, nicotine, heroin or even Big Macs can have its own chemical addictive properties. Some people, due to their genetic make-up, can have an inherited tendency to addictions. This means that it doesn’t take much exposure to stress or substances to fire up their addictive cycle.
The flip side of chasing pleasure is running away from pain, whether physical or emotional. For example, if we experience emotional pain in the form of significant stress, anxiety or depression, then it’s natural to want to be free of that pain. If we have constructive ways of getting to the cause of the emotional pain—such as improving how we think, live and relate to others—then all is well. If we just want to cover up our experience with a dangerous drug or activity, or ignore it, then it festers and becomes an even bigger problem.
Improving our mental health, learning to deal with anxiety and being able to ‘surf’ our addictive urges—to mindfully go with their flow—is an important life skill to learn. To do this we need to be mindful of our habits. When we do something again and again and again it very soon wires itself into our brain. This makes it more likely that we will do it yet again, especially if the behaviour is associated with a pleasurable experience. This is conditioning, which means that circuits in our brain get deeply reinforced, like a bush track etched with deep ruts—it gets hard to turn our wheels out of them and go in a different direction.
Maybe all of our addictions, physical and psychological, start with our lack of mindfulness. Maybe all addictions are simply cravings for something that we think is better than what we have—reality. This mindless craving is ultimately extremely harmful because it results in addicts trading in the reality of now, for the unreality of something better, later. This is always in another time, another place, another self. When we start craving, our imagination starts to fire up: ‘How happy I’ll be if...’ This is a long-running theme of advertising and popular movies, novels and stories including Jack’s famous swapping of a perfectly good and real cow for the nursery-rhyme equivalent of a handful of ecstasy—magic beans to take him away from his real life and into a fantasy world of giant problems.
Addiction is a huge and rapidly growing global health problem. According to recent figures from the National Institute on Drug Abuse in the United States, which leads the world in drug addiction, more than 22 million Americans have a drug or other substance-abuse problem including alcohol. In Australia the estimated annual cost of alcohol and other drugs to the community is $15.3 billion, including crime, violence, treatment costs, loss of productivity and premature deaths.[2] The human cost is, of course, far higher. Around 10 per cent of adults have an official drug-abuse problem in ‘developed’ countries such as the United States, United Kingdom and Australia. Many more people, however, have an unofficial or potential problem.
More than 3.7 million Americans over the age of twelve have tried heroin at least once, over 10 million have tried methamphetamines such as ecstasy, and over 36 million have tried cocaine. These figures are similar in the United Kingdom, Australia and other developed countries. Developing countries such as India are starting to develop a similar problem. If we add prescription-drug addiction to the addiction epidemic figures, we need to add another 6.4 million abusers of mostly painkillers, tranquilisers, stimulants and sedatives, just in the United States. If we add non-prescription legal drug addiction, the mounting addiction toll gets even more alarming. Approximately one in five adults in developed countries smoke and approximately one in two adults regularly drink alcohol. Addiction is a modern plague.
What if we include addictions to potentially harmful behaviours as well as substances? These include gambling, food and even sex. The number of people who are addicted to at least some behaviour that isn’t good for them is scary. According to the National Council on Problem Gaming in the United States, approximately 85 per cent of adult Americans have gambled at least once, and approximately 3 per cent are problem gamblers. These figures are again similar in other developed countries. According to the Centre for Gambling Research total annual expenditure on gambling in Australia rose from approximately $4 billion in 1978–9 to approximately $16 billion in 2003–4.
The Australian Bureau of Statistics estimates that in 2005 approximately 54 per cent of the Australian adult population was overweight, up from 45 per cent in 1995. If all of that doesn’t tell you that you that might be more addicted than you think you are, the Society for the Advancement of Sexual Health estimates that 3–5 per cent of adults suffer from an addiction to sex! Any addiction, even to sex or chocolate, eventually causes suffering because any addiction involves a mindless compulsion to keep doing something even though it hurts ourselves and others.
Why then all this tendency for us to abuse drugs and other potentially toxic substances and activities in our modern world? Well, self-medicating with substances to make ourselves feel better, or cope better, or perform better is an understandable response to problems when we don’t have better solutions. Using anything outside of us to make us feel better just covers up our problems, rather than gets to their cause, and only creates even worse problems than we began with.
When people abuse illegal or legal drugs, the obvious toxic effects of these addictions include loss of wellbeing because of their harmful effect on our mood and ability to function well. This substance abuse can cause acute and chronic ill health, from liver to brain disease. It can lead to disability, premature death including by suicide, lost productivity, and crime including property damage and assault. Addictions to food or social acceptance or power might not be as obvious as addictions to heroin or nicotine, but they can be as lethal. So why do we do this to ourselves and to others?
We are all potential addicts, although some of us are more vulnerable than others because of our environment and our genes. It seems like there’s a huge range of addictions, and an even huger range of theories to explain them, but addictions all actually only have one basic active ingredient: the compulsion to do something that’s ultimately harmful, even if we know it’s harmful. Mindfulness can profoundly help people with a wide range of addictions because it offers the exact opposite of what the addictions take away—conscious living.
Addiction is a much bigger problem than most of us realise and it’s a much bigger problem than most addicted people realise. The compulsion of a drinker to drink or of a gambler to gamble may not be so very different from the compulsion of a perfectly ‘normal’ person to run a red light or to say, ‘Yes please!’ when somebody with a frozen grin and a silly hat asks them, ‘Do you want fries with that?’ We don’t just get addicted to drugs and alcohol, even though these are massive and high-profile problems. We don’t just get addicted to the many other illegal and legal toxic substances that are now so common it is almost impossible to avoid them, whether they’re cannabis, junk food or ecstasy. We even get addicted to invisible things, like the increasingly strange and scary chemicals infiltrating our food to make it seem to taste better, last longer or look better.
We can get addicted to harmful experiences that don’t seem addictive, as well as to harmful substances that don’t seem addictive. This includes getting addicted to stress, such as the stressful lives that can motivate and harm business executives, or the stressful adrenaline rushes that can motivate and harm elite sportspeople, criminals and sex junkies. There are more adrenaline addicts than heroin addicts. Perhaps obvious addictions are only the tip of the addiction iceberg.
So what can we do if we are addicted? Our addiction might be to a drug, or to alcohol or to smoking, gambling, driving too fast, using a mobile phone too much, or anything else. How can a manically unmindful business person or sportsperson see a connection between what they do and how they feel? How can we see a connection between what we do and how we feel?
Imagine that you are a smoker. If you are or were one then that shouldn’t be hard. If you aren’t a smoker then imagine something else you’re drawn to so deeply that you can’t seem to escape its gravity, even though it might be killing you, no matter how slowly. Maybe this is chocolate, or computer games, or gossip, or any of the million and one other things that ‘do us’ rather than ‘us doing them’. The first step out of any addiction is to realise we are addicted.
Once we realise that we are addicted we can clearly see that our addiction is causing us more problems than we need, such as coughing in the night more than we need to if we smoke, or living with a higher chance of getting cancer than we need to, or paying a voluntary cigarette smoking tax that we don’t need to. Imagine that we get so disturbed by our new insight that we decide to actually do something meaningful about ending our addiction. What?
Maybe we can instantly cure ourselves of our addiction to smoking or late-night chocolates or texting by working ourselves up into a steely resolve to just quit, right now, and never smoke a cigarette, or eat a chocolate, or text somebody who is in the same room with us again—cold turkey. Alcoholics Anonymous uses this strategy: ‘Hello, I’m Joe and I’m an alcoholic!’ The key idea here is that addictions are never really cured and we have to keep them permanently dormant by never exposing ourselves to what we’re addicted to. That’s one way.
Maybe we’re keen to try gradually weaning ourselves off our addiction by substituting something less harmful for it. This strategy is used in methadone programs where people who are addicted to illegal substances like heroin are legally given something similar but less addictive. These programs haven’t been hugely successful in weaning people off heroin, but some experts argue that they reduce overall heroin-related harm by reducing heroin-related crime.
Nicotine patches are another substitute-and-wean approach to treating addiction. The crucial idea here is that most people aren’t just addicted to a substance, they’re addicted to an experience. This includes the apparently profound pleasure of sucking in hot smoke and then blowing it out again. With the substitute-and-wean approach we try to pluck addictions out by their psychological roots. The nicotine patch eliminates the thrill of sucking, then reduces and finally eliminates the actual addictive substance—nicotine—by reducing and eventually ceasing the patches. These programs are effective for some people, but you could say that the real roots of addictions are even deeper than our craving for experiences.
Maybe we can distract ourselves from our addiction by getting really enthusiastic about something else. This is a similar strategy to that used by many parents. It’s just too sad for everyone to snatch away the small plastic toy car that our precious child is playing with because they just might choke on it, without giving them something to replace it with, such as a toy truck that is too big to choke on. Maybe we can give up smoking by joining an indoor rugby team or taking up kayaking. Physical exercise is potentially very useful for addiction substitution because it creates wellbeing via the release of endorphins—happy chemicals in our brain. Physical activities can also improve our feeling of life mastery, as well as distract us from our addiction.
Distractions may not actually cure addictions, though. James Thurber wrote a story in The New Yorker about a bear who was addicted to alcohol and often came home late at night drunk, and terrorised his wife and cubs by falling all over the floor as a result of too much booze. One day the bear insightfully realised that he had a problem and took up gymnastics to channel his drinking energy into something more positive. After a while the newly disciplined bear developed such proficiency in his gymnastics that he often came home late at night, and terrorised his wife and cubs by falling all over the floor as a result of too much positive energy.
As with most conditions—physical, mental and spiritual—if you can’t get enough relief from them by coming up with your own solutions, or by reading self-help books, or by mindfully changing your life, it might be a good idea to find a suitable therapist. There are plenty of therapies available for official addictions, although not so many for unofficial ones. There are therapies based on the above treatment principles of harm minimisation, and there are more serious treatments that force people to change their lives, at least temporarily, such as the detoxification units for people with serious alcohol and other addictions where they are forced to withdraw from them.
There are general therapies available to help people with addictions, especially easily recognisable ones, such as cognitive behavioural therapies (CBT), which attempt to treat addictions at the root level of the actual addictive thoughts and behaviours as well as by raising awareness about the life cost of addictions. These addictive thoughts and behaviours often end up creating a vicious circle. Addictive behaviour leads to low self-esteem, which leads to craving for the temporary escape from self-tormenting thoughts offered by the false friend of whatever addictive substance or experience we can get our hands on, fast. Therapies like CBT can be reasonably effective in reducing addictive symptoms but can be difficult for the people doing them to understand. People can also feel stigmatised by seeing themselves as being ‘in therapy’ and therefore lacking in some way. Also, not everybody is suited to changing their addictive behaviour by changing their addictive thinking patterns. This is especially true of people in potentially unreceptive mental states, such as those just out of a drug detoxification program.
Drug treatments for underlying causes of addictions such as depression and anxiety can be reasonably effective when there’s a close link between a negative emotion and an addictive behaviour. These drugs include anti-anxiety medications and antidepressants, but they produce physical side effects such as drowsiness and agitation. They can also worsen the feelings of inadequacy that lead to addictions in the first place, when a treated person sees themselves as ‘on medication’ as well as ‘in treatment’. Medications can even replace other addictions, rather than cure them.
Aversive therapy is sometimes used to help people with addictions, and it can be almost as painful as it sounds. One of the first R-rated movies— A Clockwork Orange—graphically showed the potential dehumanisation of this approach to mental health when Alex the juvenile delinquent was ‘cured’ through classical aversive conditioning. His violent and sexual tendencies were paired with electric shocks, which destroyed his aggression but also his ability to love music and life, as symbolised by the beauty of Beethoven’s Ode to Joy, which was played while he was being shocked.
Mindfulness strategies and therapies are becoming increasingly popular ways of preventing and treating a wide range of psychological problems, including addictions. They are particularly effective at treating addicted people because they directly target an addiction’s root cause. Also, they build on people’s wellness, rather than merely responding to their problems.
There is a clear link between stress, negative emotions and addiction, so it’s therefore likely that a technique that’s highly successful at reducing stress can also greatly reduce addiction-related harm. Many substances and addictive behaviours are attempts to self-medicate the pain associated with stress.
Mindfulness has important advantages over CBT in that it is simple and natural. It has an important advantage over drug therapy in that over time it leads to positive side effects such as relaxation and deeper happiness, rather than negative side effects. A potential downside, if you can call it that, is that mindfulness takes patience, practice and sometimes a bit of courage. In time the apparent downside winds up being an upside because it can help us enjoy the benefits of patience and courage in our whole life.
We can learn mindfulness or undertake mindfulness therapy regardless of the state of our mind, or mindlessness, although it’s difficult to engage properly with the process if we’re acutely intoxicated—with anything. Mindfulness practice can profoundly improve our life if we have an official addiction, an unofficial addiction or a potential addiction. The first step in this process is to recognise that we might be addicted or heading in that direction. Mindfulness can give any addicted or pre-addicted person a life strategy or therapy that offers the combined benefits of CBT and drug treatment. It will eventually improve addicted people’s thinking, behaviour and brain chemistry, without actually targeting any of them.
Once we become aware of an addiction, mindfulness can improve our life by encouraging us to be fully aware and accepting of it, warts and all—all by simply helping us develop more awareness of the sensations in our body without judging them or reacting to them. Fighting and suppressing our urges usually makes them worse, not better. Learning to notice these urges in a more detached way helps them come and go without our getting caught up in a mind war.
Mindfulness practices and therapies are a valuable self-development process (actually a self-re-development process) that offer us a gradual return from our stressed and addictive state to our more natural and happy state. We can all learn mindfulness and gain its benefits, whether or not we’re suffering from an official or unofficial addiction. Mindfulness offers us a reunion with reality—now—and this can greatly help us recover from addiction or addictive tendencies by replacing our blind anger, anxiety and restlessness with patience, empathy and consciousness.
There is rapidly growing scientific evidence that demonstrates the usefulness of mindfulness for reducing addiction-related harm, including evidence that it can prevent relapse. Scientific studies such as that undertaken by Dr Katie Witkiewitz and others at the University of Washington in Seattle have clearly demonstrated the ability of mindfulness therapy to help prevent substance-abuse relapse.[3] Dr Witkiewitz described her results as showing that ‘the meditative tortoise wins the race’.[4] These researchers suggested that because of the strong relationship between craving and negative emotions, mindfulness is particularly useful to people with addictions because it treats negative emotions and substance abuse simultaneously. If the underlying driver for resorting to a substance isn’t dealt with then a potential vulnerability remains. Applying the principles and practices outlined in the anxiety and depression chapters are therefore also very relevant to managing addiction.
A small but encouraging study recently published in Substance Abuse showed that a mindfulness program improved the happiness, stress levels and mindfulness level of alcohol-addicted people, as well as reduced their craving.[5] This study specifically explored the relationship between mindfulness therapy and alcohol abuse, and the researchers concluded that addictive behaviour arises from a deeper psychological condition—unhappiness. Too many people who are ‘cured’ of their addiction soon revert back to their previous addiction-use levels. Mindfulness is a therapy that recognises and resolves the deep-rooted psychological or existential maladies that underlie addictions, and therefore it offers a more permanent cure than do other approaches.
A recent study provides important evidence that mindfulness therapy can effectively reduce the stress that may well be the real cause of addictive behaviour.[6] This was shown in a potentially highly difficult population: prison inmates with a long record of substance abuse. An intensive program of Vipassana mindfulness meditation practice over ten days was offered to prison inmates. The program resulted in ‘significant reductions in alcohol, marijuana, and crack cocaine use and decrease in alcohol-related problems and psychiatric symptoms’ after release from jail.[7]
Apart from the general principles of mindfulness outlined in previous chapters, there are some particular points worth making that can help an addicted person manage their addiction. A few of these are summarised below.
Joe’s wife Jane realised sooner than Joe did that they needed some help to improve their life together. Jane knew that Joe would resist going to a health professional such as a psychologist about his drinking problem, because that would mean admitting to himself and others that he had a drinking problem. So when a friend told Jane that she had done a course in mindfulness that helped her give up smoking because it helped her cope with her cravings, Jane began to hope that this might help Joe, if only she could convince him to try it. Jane didn’t tell Joe that the mindfulness course would help him drink less, she told him that it would help him enjoy life more—the way that he used to. They did the course together. After a few weeks Joe woke up one morning feeling enthusiastic about the day ahead, rather than feeling like trying to go back to sleep again. He realised that this was the first morning in a long time that he had really woken up—to himself, to Jane and to his life.
Not so helpful
• Lie to ourselves or others by thinking that what’s hurting us is normal or okay or unavoidable.
• Wait until everything is going well before we are happy and comfortable enough with ourselves to not crave anything else.
Helpful
• Be aware that something we want badly might be an addiction or the start of one.
• Be aware that we can be addicted to things that aren’t usually thought of as addictions. Anything that does us rather than us doing it is unmindful, unconscious and unnecessary.
• Be aware that if we keep living in a stressed or unfulfilled state we risk developing new addictions or re-inventing old ones.
• Follow the mindful living practices discussed in earlier chapters. These will make us less anxious, less depressed and more able to really concentrate on and enjoy what we’re doing, right now.
• Understand that we can start on the road to recovery before we reach our front gate. We can peacefully accept what’s happening inside our bodies, as well as outside them.
• Reach out and join something and somebody real rather than turn to alcohol or fast food or thrill-seeking as a substitute. Talk to somebody. Join a support group.
• Consider doing a mindfulness class or therapy.
• Accept now what’s good in life, don’t except it. What we give our attention to grows—whether that’s flowers or weeds!