TEN

Self-Medication: Misguided Attempts at Mood Management

There is no greater agony than bearing
an untold story inside you.

—Maya Angelou

Many addicts, whether they self-medicate with drugs, alcohol, food, sex, or spending, are ACoAs. Just as someone with a physical injury can become addicted to the medications that bring them relief from their chronic physical pain, an ACoA can become addicted to the “pain meds” (alcohol, drugs, food, sex, money) that bring them relief from their chronic emotional pain. When ACoAs cannot cope with the pain they are in, they often reach for some sort of mood-altering substance or ­behavior to do that for them.

The habit of self-medication can start very early. One of the misconceptions about addiction is that when the substance is removed, the addict’s troubles are over. But we don’t learn what our pain is trying to teach when we silence its voice. Addictions to mood-altering substances such as alcohol and/or drugs are called substance addictions. Addictions to mood-altering behaviors or activities, such as sex, eating, spending, and/or gambling, among others, are called process addictions.

Making Recovery Real: Sandy’s Story

“I know I look together on the outside,” Sandy says, “but on the inside, I feel like I’m falling apart.” I observe this elegant young man as he dialogues with an empty chair and struggles to find the words to describe what has been festering inside of him, unarticulated and unspoken, for so long.

“Who are you?” Sandy asks the empty chair as he begins his role play. He is talking to that little boy who lives inside of him, the one he still wants to shove down. “I can’t even find you. No, that’s not really true. I don’t want to find you. I’m ashamed of you. I don’t want to look at you.” He lifts a flat hand of rejection toward the chair that is representing the part of himself that he buried in a bucket of ice cream, then later in six packs of beer, and eventually in drugs. His inner child . . . adolescent . . . teenager.

“I just look at you and . . .” At this point he drops his head into his hands, and tears begin to flow down his cheeks. “I know how lonely you are, how different you feel, and I want to say I’m sorry. God, I’m so sorry that I stomped you down for so long, that I fed you drugs instead of food, that I dragged you to all those dark places. I’m sorry that I ignored and hurt you and made fun of you just the way they did to me. I’m sorry I hated you. I look in the mirror and I see you staring out at me.”

As I watch his drama unfold, I am stunned. I am a therapist. I deal with this every day and still, these moments of self-disclosure take my breath away. What is it that makes us so vulnerable when we are small? How can it be that we don’t forget about all of this: the old complexes about being left out of family conversation at the dinner table, humiliated or criticized by a father, or ignored by a mother whose love we want so desperately? How can this stay with us all our lives? Why do we want to hide from our needy sides that yearn for love, connection, and attention—indeed, from our basic humanness?

Sandy is well-groomed, well-educated, and from a well-heeled, liberal Boston Brahmin family. He first came to see me when he was thirty-seven, a year or so after a serious breakup with the woman he planned to marry. When his engagement ended, he felt as alone as he’d ever felt; vulnerable and in need of a way out. With his very social friends, that “out” was easily found; there was always a house to go to and a place to party well into the night after all the other parties had broken up. Those who felt so inclined could sniff and smoke and drink their way into oblivion—in style and comfort. Drugs and alcohol provided Sandy with not only immediate relief from emotional pain but also a ready group of loyal comrades to keep him company—until, of course, he got sober. Then all the music and laughter stopped, and he felt alone with just the relentless pounding of his own heart to fill the void in which he found himself.

The Trigger Event Relationship

“I thought we would always be together,” said Sandy about his fiancée. “I really loved her and I let myself trust her, but I pushed her away.”

Thinking back on when Sandy first started working with me, I recall that his breakup had clearly plunged him into overwhelming and confusing pain. It also turned what was previously social, diversionary drinking and occasional pot-smoking into full-blown addiction. Sandy’s problems with full-blown addiction were short-lived; his pattern of self-medication, so common among ACoAs, had deeper roots. Unknowingly, Sandy had been trying to drown the pain not only of his breakup, but the deeper, earlier losses that were now getting triggered and mixed up with his present pain.

More backstory . . . let’s look back at when I began seeing Sandy; his intake went something like this:

“Do you drink much, Sandy, or do other drugs?” I asked.

“No, not really,” said Sandy, raising his hand to his chin in reflection and leaning back in his chair. “I party with my friends on weekends but I don’t get out of control. We all indulge.” He rolled his eyes slightly, which I wasn’t sure how to interpret.

“Would you say that you drink when you’re feeling depressed?”

“No, mostly socially, when I go out.”

“Do you ever drink or drug alone?” I asked.

“No, always with my friends, only when I’m out,” said Sandy. “But I can always stop. I don’t think alcohol or drugs are my problem. I think it’s this other stuff—that stuff from when I was a little kid that I can’t seem to get at.”

It was hard to tell how much Sandy had been using drugs and alcohol to numb the pain of losing his fiancée and their plans for a future together. One indication that this might be the case was that he couldn’t move through the anguish from his breakup, but I believed him when he said that his main issues were related to CoA trauma. Sandy came to group but found connecting difficult, and it became evident after a few groups that he would need to abstain from drugs and alcohol in order to process feelings. Yet he was not ready to admit this to himself.

When Sandy missed a group, no one was too surprised. “I got a call from London,” he said. “I think I may have missed a group. I’ve met a girl. I really have to give this a chance. I haven’t felt this way in a long time. I won’t be there this next week either.”

The next week I got another call: “Missing another group, so sorry, things taking a little longer than expected . . . work possibility I need to check out, hope you can understand, apologize to everyone, see you next week. . . .”

His next communication was by e-mail: “Please forgive my unexcused absence. I know I committed to a year in group. I’m just not sure this process is, well, working for me at the moment. I’m feeling a lot better. I think the work is so important, but I just don’t think I’m ready for it, just not right now. Sometime, though. I know I need to do it.” He was doing the whole thing all over again, re-creating his painful history of loving and losing in a matter of weeks. He was falling in love, breaking up, drinking and drugging to get over it. It was the same script, just accelerated. But unlike so many who start and stop recovery, Sandy wasn’t blaming the group or me for why he was leaving. He made it clear that he felt he needed to do this work but that he wasn’t ready. That was actually very sane—maybe ambivalent and fraught with anxiety, but sane. And also kind and well-related: he did not wish to hurt or alienate anyone. He needed to get to know himself, but he already knew a lot.

Six months later I heard from him again. “I’m sober. I’ve been sober for six months. I know I need this work. Will you let me back in group?” I asked him if he was going to AA.

“No, I tried a couple of meetings, but I don’t know, they’re just not for me.” Even though this was a phone call, I could almost see him wincing. “The God stuff—I just can’t get into it. And I don’t need it to stay sober.”

“If you come back to group, you will need to go to AA.”

“I’ll give another meeting a try. I can’t promise anything; I want to be honest.”

“Sorry, if you come back to group you need to be in AA and seeing a therapist one-on-one. You need safe places to process all the feeling that will inevitably come up as we examine what’s underneath your self-medicating, why you wanted to drink and drug in the first place.”

“I thought once I got sober I’d feel so much better, but I feel worse.”

“You’re feeling the pain that used to make you want to pick up and use.”

“I don’t like it.”

“I know, no one really does.”

“I feel like I got my appendix out and the medication is wearing off and it hurts like hell.”

“You were medicating your emotional pain with drugs and alcohol. Now you’re sober. You’re feeling it.”

“I thought when I got sober it wouldn’t hurt anymore.”

“I know.”

“So can I come back to the group?”

“I need to check it out with everyone, to make sure they are willing to reinvest in your recovery, Sandy. You disappeared, remember? Groups don’t like that much. Can you give me a few days?”

“I’ll think about it.”

“You think about it.”

Six weeks later I got another call. Sandy was going to two to three meetings a week and willing to go to more if his emotions got rocky. He’d find a therapist. Did I have any ­recommendations?

“I just know I need this work. It’s the only thing that feels hopeful to me. I’m not worried about relapsing. Sobriety is okay, but I’m emotionally relapsing, if that makes any sense. I’m all over the place.”

“Welcome back, Sandy. I’ll see you on Monday.”

The Bottom of the Iceberg

As he was growing up, Sandy spent the bulk of his time with a young Irish nanny named Deirdre whom he grew to adore. His memories of her plunge him into a mixture of feelings both divine and downhearted. “I just remember being this happy little kid with her. I’m sure I wanted to be with my mother, but honestly, I was completely bonded to Deirdre. Sometimes I wonder if I thought she was my mother. She was just this warm, loving, wonderful woman.” In his mind, Deirdre was his first love. His own mother had returned to a high-powered business job so quickly after Sandy’s birth that he hardly knew her. As a newborn, Sandy had enough bonding chemicals coursing through his little brain and body to ensure an attachment powerful enough to hold him to his birth mother until maturity. But the woman he primarily bonded with was Deirdre. Still, this was okay. He was getting what he needed to develop a sound little emotional infrastructure, to feel loved and valued. He adored his surrogate mommy, and the feelings were mutual. He belonged somewhere and to someone. He felt happy and whole.

The real trouble for Sandy began when his mother “suddenly” realized that her now-four-year-old son was much more attached to Deirdre than he was to her. “My mother just came home and fired Deirdre one day. She took six months off and poof, Deirdre was gone, no more, like she’d died or something.” This traumatic rupture forced Sandy to attempt to re-bond, however anxiously, to his own mother. “I was getting the person I’d probably wanted in the first place, but I was always so anxious she’d leave, I guess, so I literally clung to her. Maybe I missed Dierdre, too, I must have. If my mom had stayed, it would probably all have been fine; I loved her.”

But in six months, partly because of money pressures, and perhaps feeling smothered by motherhood and seeing her own chances at a career slip away, his mother sent Sandy off to kindergarten and returned to work. Sandy had “lost” two mothers in the space of six months. And his father was slipping further into an alcohol addiction. Sandy returned each day from school to a housekeeper who was preoccupied with cooking and cleaning and had little time for him. His mother returned home most nights for a late dinner, but he spent very little time with her. He did, however, have his brother, Malcolm, seven years his senior, who then became his salvation and his hero. But eighteen months later Malcolm, who he worshipped and tagged around with every afternoon, joined their other brother Freddie at boarding school. No one really prepared Sandy for Malcolm’s departure or helped him find activities to fill his now empty afternoons.

Sandy lost access to his two mommies and Malcolm all in the space of three years. Sadly, the magnitude of these losses didn’t register with any of the adults around him. They didn’t recognize that he had lost anything at all. Acting as though nothing had changed, Sandy was told by his parents to come home from school, do his homework, and wait for them to have dinner. But he couldn’t concentrate on anything; the words swam in front of his eyes. Sandy’s parents tried to keep the trouble that was brewing within their own relationship from showing. When Sandy tried to reach out for some kind of help, he was told that ­everything was all very fine, that he was the only problem. He needed to study harder, be a better boy, stop worrying. To make life even more isolating, he lived far away from all of his friends and couldn’t solve his loneliness by passing his afternoons at other people’s houses.

So Sandy did what most kids do: he found a childlike way out of his emptiness. “I just dug into cartons of ice cream that I swiped from the kitchen when the housekeeper wasn’t ­looking. Sometimes I stole candy from other kids or from the corner store. I obliterated my feelings with sweets. When I was supposed to be doing my homework, I just sat there stuffing my face and watching TV in the dark, then I’d race out of the room when I heard my parents come home.” This is when Sandy’s pattern of self-medicating began; treats and TV became his solace, and the gulf between himself and his parents widened. The gulf between himself and his real feelings widened, too.

Sandy and his parents ate dinner together most nights, though it was rather late for Sandy. At the dinner table, which perhaps could have offered a place for reconnection at the end of the day, Sandy just found more isolation. His brothers were gone and his parents were tired and preoccupied, barely paying any attention to him and probably avoiding talking about anything because talking about anything might lead to talking about everything, which could lead to breaking apart the whole lie they were living. Then what would happen? His mother was invested in maintaining appearances and being the center of attention, while his father was invested in not being called on his increasing alcohol use. Sandy sank further into his little hole.

“I remember sitting at the table one night and I was just so excited. I’d hit a game-winning home run against our rival school—and I mean I wasn’t that great at baseball ’cause I was sort of a fat kid. I spent more time on the bench then playing, but the coach gave me a shot at the end of this game and I’d hit this home run. The whole team made a big deal out of it—it was a huge moment for me; I went from outcast to hero. It made me so happy and I was so excited to tell my parents.”

“Were they at the game?” I asked.

“I didn’t even think of that. No, they weren’t. And at dinner, I waited until my mother had told us about her day and then, when she finally asked me about mine, I gushed about it, telling them every detail. My dad tried to say some nice things and my mom just barely heard it. It was like a, ‘Oh good, pass the salt,’ kind of thing. I remember running to my room and being so upset and they didn’t even know why. They were just so not tuned into me; I was just this kid running around their house. I think I just gave up ever trying to connect with them or please them after that.” Like so many CoAs, Sandy thought he was the problem. He had no idea that his parents had problems they were barely managing.

When Sandy turned thirteen, what felt like a minor miracle occurred. “I just went from being this pudgy, short kid to being the height I am now, six feet three inches, and thin, and suddenly good-looking (he blushes). It was so great in some ways. I mean, it was incredible, but in another way it pushed this hurting kid inside of me even further down, you know what I mean?”

The pressure was now on through his teenage years. He became much more athletic, a better student, and had many friends, both male and female. “But now, maybe because I finally looked like I was supposed to, my parent’s expectations really kicked in. I tested super-high, so everyone knew I was smart, but I still couldn’t concentrate. I was sort of split—big on the outside but this screaming little kid was still on the inside. And because I was now expected to do so well, I had this constant thing hanging over me, nipping at my heels. I had such high expectations but no one to support me, to teach me how to get there. So I became super anxious about failing. And I had this recurring nightmare that I’d wake up one day and be this freckled-faced, fat kid all over again. I guess that’s when I found pot and alcohol. I just wish I’d had someone—anyone—to talk to. Every time I tried to talk to my mom she just told me I was fine, and my dad tried to understand, but, I don’t know, he just didn’t really stand up for me or for himself or for anyone, really. I just pushed it all further down and thought there was something wrong with me that couldn’t be fixed. I just blamed myself and got high and hid it from my parents—which wasn’t really all that hard.”

Sandy walked around feeling like a wounded little boy submerged in the body of a handsome young man. He was hurting and confused inside with no one to help him with it, so he came up with his own solution, a way to make his anxiety more manageable. Food wasn’t working anymore, so he looked for something stronger; drugs and alcohol did the trick. Not only did they soothe and quiet his fears but they gave him the sense of confidence that he lacked. They made him feel capable of facing his life. They gave him a false sense of feeling full instead of empty, calm instead of anxious, social instead of withdrawn, and happy instead of sad. But when the effects of the substances eventually and inevitably wore off, he’d crash and have to face reality. The painful feelings he had temporarily numbed would re-emerge, only they would be even more confusing and disturbing to him now because of this constant cycling between false confidence and gaiety back to sad and lonely. And physically he felt increasingly lousy after using, which really intensified all of his bad feelings. So the next time he’d need even more alcohol and drugs to make his feelings go away again. Thus began his dance of addiction. His only way to attain emotional comfort was through synthetic means; he had no idea how to get there on his own.

Breaking the Chain: The ACoA Under the Addict

Today Sandy successfully abtains from drugs and alcohol, but the emotions that he used to manage with them are confusing and difficult for him to deal with since he’s had little practice to date. For starters, it’s hard for him to even distinguish one feeling from another: hurt quickly turns into rage, frustration into hopelessness, and excitement into high anxiety or preoccupation. Once these feelings get hold of him, he tends to become easily overwhelmed and frightened by the intensity of his own, somewhat unfamiliar feelings. Drugs and alcohol used to be his emotional brakes; now he doesn’t have them.

Sandy’s situation is typical of addicts during their first year of sobriety. When the initial thrill of abstinence wears off, the realities of life sink in, and old, unfelt ACoA-related emotions reassert themselves. Sandy’s sobriety was well-established. Now began the recovery process from his ACoA/PTSD issues. He began reconnecting with the child—the screaming little, hurt, and vulnerable kid living inside of him.

“I’m so sorry I tried to forget about you and pushed you back into the depths of my memory, that I tried to pretend you don’t exist. I get now that this is exactly what everyone else did to you all along and must have made you hurt even more and made you feel even more forgotten and alone. I didn’t want to hear your screaming in the dark. I didn’t want to know about how much you hurt inside, but now I want to change that. I want to protect you and help you feel good about yourself, to calm the hurricane of emotion you always felt but could never express. You tried for so long to do this on your own, but it was like building a foundation on quicksand, and you were always sinking back into it. Those days are over: you are not crazy. I am here now, and I’m going to help you find solid ground.”

Don’t worry, Sandy, I think as I sit here, you will be okay. You will know a freedom you have never known before. You will find yourself. And in finding yourself you will find everything else.

Your life is waiting for you. Go get it.

Frozen Feelings: Fear and Trauma

It can be difficult to access trauma “memories” through reflective talking alone (van der Kolk 2004). For this reason I find psychodrama, which allows memory to emerge through action and role-play, an ideal form of therapy for trauma resolution if done simply and with no “script” or agenda coming from the therapist. Role play accesses the limbic world, the world of powerful emotions and imagery that is pressing to come forward. We cannot describe what we cannot feel.

When someone who has walled off his feelings is asked to “tell his trauma story,” he might stare blankly, he might try to come up with a story, or even worse, might adopt a therapist’s story as his own. He might be put into the embarrassing position of freezing all over again. He is at risk for telling a story that is not grounded in his own feeling and relevant, personal meaning. A story that therefore never gets experienced and processed remains intellectual and repetitive. He gets stuck in his own story but the exit door alludes him. Role play does not put someone in that bind; it simply says, “say what you’d like to say to so and so,” the story pours forward, and words are found along with relevant emotion as meaning becomes clear. The limbic system operates with split-second speed; we’re designed to feel first and think second. Role play works with this natural flow and allows for the feeling and sensory story—the limbic story—to emerge first and then be translated into language; thus feeling, thought, and sense impressions integrate easily. Role play immerses the being in his own experience, and while being in it, he finds his own way out of it, and the brain as well as the body forms new neural wiring, their own path out of pain, that frees him from the repetitive, recycling encapsulated trauma mind trap.

This is how it works for allowing historical pain to emerge. In normal day-to-day living, we also experience feelings faster than thoughts. But once we’re aware of what we’re feeling, our thinking mind becomes our best friend. Through awareness, we can gain balance and insight and make choices based on our understanding of needs, wishes, goals, and our self.

Sandy’s emotion came up much more naturally talking to an empty chair representing a part of him than trying to find adult words to describe frozen child feelings. Though he is amazingly articulate, there is more immediate emotion that emerges in a role-play talking “to” himself than if he were talking “about” himself. It is more immediate and direct and has the added benefit of beginning and strengthening an inner dialogue between his adult self and his child self. Then, when I invited Sandy to reverse roles and momentarily become his child self, he had greater access to the words because he was, in fact, sitting in the feelings and the role of his inner child. As Sandy allows the child feelings to emerge, his adult mind looks on or “witnesses” and he is able to look at himself with new, more compassionate and mature eyes. He is able to take his child self by the hand to walk slowly with him toward maturity. He takes this innocent, lively, and creative part of himself with him instead of leaving him behind, frozen and mute.

Progress Toward Emotional Sobriety

Sandy’s first year of sobriety can only be described as tumultuous. He arrived each Monday at group alternately feeling elated or desperate and confused; all of the emotions that he had been medicating for years were crowding in on him and he felt overwhelmed and burdened by them—but he had hope and he had commitment.

Many evenings, Sandy was filled with rage and ­recrimination for his parents, for his siblings, and for himself. It was amazing to observe him try to hold onto himself while he experienced what he called “the hurricane,” the swirl of intense emotions that used to feel so overwhelming that he ate, drank, and drugged them away. He literally held onto his chair and winced as those foreign feelings pushed their way toward the surface of his mind. He had been so used to silencing them that feeling them represented a strange, new world.

What is happening from the trauma point of view is that the body and mind are caught in an interplay that make us feel that we’re spinning into a black hole. The disturbing and sometimes painful body sensations (heart pounding or tightness, sweating, shortness of breath, dry throat, and so on) that accompany anxiety and fear trigger feelings and fragments of trauma-related imagery—scary scenes. Then the scary mental pictures that are racing through your mind trigger more disturbing body sensations and emotions. This becomes an internal combustion that can become explosive. It’s why learning the skills of deep breathing, relaxing, and slowing down are so important. Guided imagery and meditating can be very helpful here, along with sane forms of exercise. Sandy took up meditation, painting, walking, and racquetball. In his second year of sobriety, he bought a dog and fell in love with her.

As I work with Sandy, I have the sensation that I am watching a child grow up and discover the world as he experiences both the joy and terror of growth. And as I witness the transformation, I ask myself, How did we get here? How did this young man turn from brooding and self-destructive (albeit always with his intelligence and humor intact) to this amazingly sweet, balanced, and engaging guy? Then I remind myself that the magic isn’t in any one moment or any one insight, but in a symphony of small moments, of small insights that weave themselves together into a new picture, a new, integrated body/mind story, and thus a new body to live in.

It is dazzling, really, and very moving to be a part of someone’s awakening into his own being and his shaping a new version of himself. Over the second year of Sandy’s sobriety, I have found it remarkable and inspiring to watch him take hold of his inner world and reshape it. He has prioritized his physical and emotional sobriety and adopted the necessary life changes to make it real. While Sandy used to fidget in his chair, tap his hands and feet, and shift position constantly, now he sits at ease, limbs long and fluid. While his legs and feet used to turn in with tension and fear, now they stretch out in ease and comfort. His limbic system is healing before my eyes, and his body tells of a different man living inside of it. Sandy used to have a somewhat brooding, dark expression cast across his handsome young face. Now he is open and cheerful. He has a ready laugh; his humor often penetrates to the quick and is always welcome with group members, who he regularly sends into gales of laughter. His insights are unusually perspicacious for a man his age. He is able to wrap his mind around ­complex personal and interpersonal issues and translate them into words in a way that is worthy of a mature and deep person. He is developing the ability to marshal his excellent mind and bring his powers of observation within his control. Because of his hard work in recovery and his willingness to make significant and healthy lifestyle changes, Sandy has greatly accelerated his personal growth. He has changed in time so that he can alter the course of his life.