ELEVEN

Process Addictions:
The Many Other Faces
of Self-Medication

If you can’t get what you want, you end up doing something else, just to get some relief. Just to keep
from going crazy. Because when you’re sad enough, you look for ways to fill you up.

—Laura Pritchett, Sky Bridge

Everyone has some version of occasional self-medication. Richie has a beer to wind down after facing bumper-to-bumper traffic on the commute home. Tina misses her mother who lives in a city far away, so she eats a big bowl of macaroni and cheese because it reminds her of home. Lauren goes shopping to cheer herself up after a breakup with the guy she’s been dating. But when does self-medicating turn from a harmless, occasional pick-me-up into a long-term problem with physical, emotional, and financial ­consequences?

Self-medicating takes hold when we compulsively use a ­substance or behavior to manage and control moods and mental states that we cannot cope with on our own. It happens like this: We have a desire to feel better, and we discover that a certain action leads to the satisfaction of that desire. The more consistently that particular action leads to the state we want to achieve, the more we want to do it. Alcohol and drugs are common mood managers. They are reliable. We learn how many drinks or which drugs work best to achieve the result we want. We prescribe our own dose so to speak—we self-medicate.

When we don’t understand how certain substances and behaviors play with our body chemistry and set us up for addiction, we’re at risk for perpetuating lifestyles that slip into self-medication. We get stuck in hidden addictions.

Compulsive behaviors take hold in the brain because they are highly rewarded; they work with our own brain chemistry to make us feel good, but when we overuse these feel-good chemicals we can head straight into process addictions.

Dopamine, for example, is made in the brain and associated with feeling happy and chatty. It makes us feel calm and connected, smoothing out the rough edges. Food and certain behaviors like sex can also work to alter brain chemistry because they can have an analgesic effect similar to drugs or alcohol. According to Bart Hoebel, a psychologist at Princeton University, “Highly palatable foods and highly potent sexual stimuli are the only stimuli capable of activating the dopamine system (reward circuitry of the brain) with anywhere near the potency of addictive drugs” (Hoebel 2008). But then the crash comes. When dopamine levels drop after a food binge or orgasm, depression sets in and then we
need more food or more sex to get the burst of mood-altering dopamine back. Certain foods affect dopamine levels, and when we overuse them we’re taking that first step toward a process addiction. Sugar and the taste of sweets, for example, stimulate the brain by activating beta-endorphin receptor sites (ibid). These are the same chemicals activated by heroin and morphine. This is thought to be one of the drivers of compulsive overeating.

How Moments of Panic Lead to Self-Medication

Why does a gambler, in just a few minutes’ time, burn through his child’s college fund or lose the family home? Why does a compulsive eater drive through the night to find an open deli where she can load up on sugar and white flour and then try to throw it all up an hour later? What drives a sex addict to humiliate himself and his family and put all that he loves and has worked for at risk? What factors contribute to this mind-boggling loss of impulse control?

We all have a mind/body chemistry designed to nourish, sustain, and keep us safe. When that body chemistry gets thrown out of balance through trauma we have suffered or trauma we’ve brought onto ourselves, it can drive the kinds of behaviors that get us into trouble.

Engaging in risky behaviors can cause us to go into a fear/panic state. Here’s how that cycle kicks in:

When our panic button gets pushed, our emergency systems engage; they go into fight/flight.

Then, our thinking mind (pre-frontal cortex), which is the part of us that perceives future consequences, goes off-line. We freeze in our tracks.

But our emotional (limbic) mind swings into high gear. In that moment of panic, we become all feeling with little or no thought. Oftentimes, in the case of process addictions, it’s our own risky, acting-out behavior that scares us, behavior that may be fueled not only by old pain and a wish to get rid of it, but by fear of our actions of the moment. The food we don’t want anyone to know we crave and have to have now! The sex we don’t want anyone to know about because it could get us into huge trouble with our spouse. The spending that will leave us without money left to pay bills. These ‘’crazy” high-risk behaviors can, and probably should, send us into a panic/shame spiral. That fear presses our panic button; we get flooded with awful feelings of shame and pain (what did I just do?) along with prickly, anxiety-provoking body sensations that make us all jumpy inside. Then there we are, in need of something to make us feel better fast. And we know what that is because we just did it. So we’ll just do it again, this one last time. And it isn’t all that bad anyway, it’s just food, or sex, or one drink, or a little something we’d just love to take home, or one last win. And it’s only just this once.

Emotional Eating: Feeding Our Feelings

It is estimated that fourteen million people are affected by an obsessive, compulsive, or disordered relationship with food. Jenni Schaeffer, author of Life Without Ed: How One Woman Declared Her Independence from Her Eating Disorder, wrote a gripping piece that offers an unobstructed window into the mind of someone with disordered eating patterns. Jennie’s words illustrate how chasing her own dopamine high to avoid feeling her depression led her down a desperate path toward a compulsive relationship with food.

After restricting food for days, I really needed energy. I dared to try an apple. I knew this would lead to eating more and more. Of course, it did. I started baking and bingeing. . . . I drove to a vending machine at my apartment complex, and it was empty. So I drove my car to a nearby convenience store at 2:00 am. Would it still be open? How much money would I have to spend? Realizing I did not have enough money or my cell phone, I went back to my apartment to get both. Then I drove twenty minutes to a fast-food restaurant that is open twenty-four hours. I ordered lots of food at the drive-through and ate it in less than thirty seconds. A guy came running out of the store yelling something at me. Did he know what I was doing? . . . I know it’s not safe driving in my car at 2:30 am with a missing a headlight and a bad engine. But I drove to another fast-food restaurant to get more food. What is wrong with me? I wouldn’t even eat dinner with Amy earlier today. But now, all I can do is eat. I have no control. I still need more food, but I can’t go back to the same drive-through. They will recognize me. So I drive—now at 3:30 am—forty-five minutes to a twenty-four hour grocery store. I buy lots of food that I had avoided eating earlier in the week. (I bought the exact candy that my boyfriend had offered to me and that I had refused.) My binges always equal everything I normally won’t let myself touch at all.

Finally, I am satisfied. That anxious feeling is gone. I drive home. I try to throw up twice. (I’m never very successful at this.) I am depressed.

I feel isolated from my mom and dad, Amy, my boyfriend, and everyone. I don’t want anyone to ask me about my eating. I have to avoid everyone so that they won’t ask. How did it get like this? I feel fat. I don’t want to eat again. My life is unmanageable because of food. But what do I do? I feel helpless and fat. I can’t break the cycle. I just want to break the cycle.

I know what I can do. I won’t eat tomorrow (Schaeffer 2012).

A study from Scripps Research Institute headquartered in La Jolla, California, and published in Nature Neuroscience on March 28, 2010, found that junk food, or foods high in white sugar, white flour, and unsaturated fats, can be as addictive to the brain as cocaine, as it causes similar changes in the brain and sets up cravings for more junk food. In lab tests, rats given unlimited access to high-calorie foods like candy bars and cheesecake not only became obese very quickly, they continued gorging even when this binging behavior led to an electric shock. Obese rats that had their junk food replaced with a healthy diet actually stopped eating completely because the reward system in the rats’ brains changed when they became compulsive eaters. “What we’re seeing in our animals is very similar to what you’d see in humans who overindulge,” says lead researcher Paul J. Kenny, an associate professor of molecular therapeutics at the institute. “It seemed that it was okay, from what we could tell, to enjoy snack foods, but if you repeatedly overindulge, that’s where the problem comes in” (­Johnson and Kenny 2010). Repeated indulgence in junk food changes the brain chemistry to want that soothing, oblivious high, or what amounts to self-medicating, so that the brain and body actually become locked into an addictive cycle that is similar to that of a cocaine addict.

Compulsive Combos: Invisible Addictions

One bad choice leads to another. Sugary foods can become a gateway to self-sabotaging food choices that can lead us straight into compulsive eating. ACoAs who don’t want to think of themselves as alcoholics or drug addicts may be unwittingly manipulating their own body chemistry. Foods that contain sugar and white flour that the body immediately converts into sugar, along with a couple of drinks of alcohol that add to and potentate the sugar effect, constitute a “compulsive combo” that can become extremely addictive.

Holistic nutrition counselor Meredith Watkins writes about how food sets up cravings and increases anxiety levels that lead to self-medicating. “The recovering alcoholic who keeps a daily cocktail of caffeine and nicotine coursing through his veins and keeps white pasta and bagels on regular rotation in his diet . . . not surprisingly has alcohol cravings going through the roof. . . . In this case, the sugar from the white flour products acts in his body in the exact same way alcohol does.” And the caffeine he is drinking with the bagel or muffin “is blocking the production of natural serotonin,” his body’s natural mood stabilizer (2012).

In her book The Mood Cure, Julia Ross talks about the chemical action of sugar and alcohol in an alcoholic’s body: “Alcohol acts just like sugar biochemically, only more so. It contains more calories per gram, and it gets into your bloodstream faster. For people whose blood sugar levels tend to be low (of which research states that 95% of alcoholics are hypoglycemic), this can be irresistible” (2002). “This is why those bagels should be verboten to a recovering alcoholic” (Watkins 2012).

Sex Addiction: Living a Double Life

Mina,

I’m joy that I have a chance to get closer with u.

Friends call me Ira. I like sport, music, and Internet.

I’ve got shiny smile and attractive body.

Write me.

I saw your photos, and I wanna meet you.

Bye!

This was on fourteen-year-old Mina’s computer when she logged on—some weird, Google-translated solicitation that no young girl should have to deal with, along with countless ads using pornographic language to advertise for Viagra, Cialis, and other similar meds.

Mina’s parents are divorced. Her mother works long hours, and her father lives a long distance from her. Feeling lonely, she has gotten into the habit of visiting chat rooms. She met a “boy” online. They got close. Mina felt Don understood her, and he always seemed to ask the right questions. She got into the habit of spending hours each evening chatting with Don. His voice was warm and made her feel secure and cared about. After weeks of becoming closer than she had ever felt to anyone in her life, they decided to meet. When Mina met Don she was taken aback—he seemed much older than he said he was. She felt like a girl and like he was a much older man. Still, she was meeting her best friend. She felt scared, she felt confused, she felt betrayed. But she checked into a motel with him because they were so “close.” After one visit, she told her mother.

A statistic from the Society for the Advancement of Sexual Health estimates that 3 percent to 5 percent of the U.S. population suffers from sexual compulsion disorders; however, this estimate only includes those actively seeking treatment for sexual addiction. There may be millions who are affected, living in the shadows, and not getting help.

Pornography, addiction, and cybersex are forms of sex addiction that have inexpensive and available gateways. Some indication of the extent of the problem is the amount of pornography available and used on the Internet. As of 2003, there were 1.3 million pornographic websites—260 million pages. Cybersex involves a noncontact sexual episode through private chats, either with or without a video connection. Seventy-six percent of victims in Internet-initiated sexual exploitation cases were 13 to 15 years old, and 75 percent were girls. “Most cases progressed to sexual encounters,” according to the ­Journal of Adolescent Health (Dube et al. 2006), and 93 percent of the face-to-face meetings involved illegal or underage sex.

The difference between old-fashioned porn and Internet porn is a bit like the difference between wine and spirits. After hundreds of years as a mild intoxicant, erotica has undergone a sudden distillation. Digital porn is the equivalent of cheap gin in Georgian England: a reliable if unhygienic hit that relieves misery and boredom. And, unlike the old “dirty mags,” it is available in limitless quantities” (Thompson 2012).

And cybersex appears to affect relationships. At a 2003 meeting of the American Academy of Matrimonial Lawyers, two-thirds of the 350 divorce lawyers who attended said that excessive interest in online porn played a significant role in the divorces of that year, where previously it had almost no role (Hagedorn 2009).

Sex Addiction that Begins in Childhood

Raymond’s father is an alcoholic. His parents ran a funeral home and the family lived above it. Raymond was very much afraid of his father, who raged at him, and his mother and brother didn’t offer much companionship, protection, or solace. An employee at the home, Caruso, took a shine to Raymond and spent time with him. He was big, gregarious, and paid attention to Raymond. Caruso often took Raymond to the basement to “train” him in the family business. His father approved. While initially this felt like much longed-for special attention, it eventually became an experience that sowed the seeds for a life-long pattern of sexual acting-out behaviors. In the course of “training,” Caruso terrified Raymond by showing him dead bodies and body parts. He also exposed himself to Raymond and “he got me to do things to him.” He told Raymond that if he told his parents what was going on, he would kill him. And Raymond, being a child and a frightened child at that, believed him. In Raymond’s young mind, sex became fused with terror and abuse, a hand, a body, an erect penis. Sexual pleasure and sexual fear all became conflated in Raymond’s mind.

It is no wonder that as an adult, Raymond himself became a womanizer and turned to alcohol and drugs to deal with the freaky imagery that he lived with and the state of anxiety his past left him with. He has had a string of careers; in his using days he was the owner of a strip club.

The longer the origins of Raymond’s behavior went unaddressed, coupled with his use of drugs and alcohol as his “go to” for managing his pain, the more his sexual acting out escalated. Though some of the details of Raymond’s story are unusual, the gist of this story I find all too common. There are many children in many basements “playing” or “being taken care of.” The Raymond character carries terrible feelings of guilt and complicity. Though these victims were often very young at the time, say eight or so, the sexual liaison may have persisted over time, and they may have both feared and taken pleasure in it. They are left with the feeling that because they did not say no, they are somehow at fault. But trauma bonds make saying no extremely difficult, and the relationship described here between Raymond and Caruso is based on fear and subjugation; Caruso had the authority of age. He terrified Raymond and cut off any access to outside support that Raymond may have had by telling him that he would kill Raymond if he told; the more afraid Raymond was, the more he needed Caroso’s “protection.”

These same features can be part of a less obviously frightening situation if there is a power (age) imbalance, secrecy, and fear of being “found out” and a sense of one person being subjugated by the needs of the other. They are a recipe for a trauma bond.

Sex and Self-Soothing

We use sex for much more than reproduction. Orgasm releases dopamine into our bodies that makes us feel soothed, cared for, and alive. It is one of nature’s great mood menders and bonders. But intense sexual stimulation, such as Internet pornography, can trigger a neurochemical high followed by a hangover or a withdrawal period. As dopamine drops, a sexual satiation neurochemical rises, and testosterone receptors decrease—all of which can radically affect mood for the worse or even bring on withdrawal symptoms. Some of this drop is natural, and if couples are lying in each other’s arms, it can be a soothing and bonding time in which they can enjoy each other and affirm their affectionate feelings. If the drop is severe and a person is left feeling alone and perhaps disconnected, this withdrawal can feel like a letdown where emotions of shame or loneliness can make one want to do something to get rid of uncomfortable feelings, something that can spiral him or her further toward ­compulsivity.

Spending and Debting

We are a nation of consumers; buying is what keeps our economy afloat. Spending and debting are part of our landscape. Between 6 to 9 million people are estimated as affected by pathological gambling, which is now included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Indeed, this seesawing between financial extremes has come back to haunt all of us from megacorporations to small households. Behaviors around money can fly out of balance through overspending, underspending, or a combination of the two. We can binge and purge with money just as with food; we can be financially sober, financially inebriated, or financially anorexic.

The Adrenaline-Endorphin High

Adrenaline, which the body releases when it is in a state of hyperarousal—the fight-or-flight response—rewards the body with a rush of exquisite pleasure and pain relief. When secreted into the bloodstream, it rapidly prepares the body for action. While some people get their adrenaline “fix” from driving too fast or skydiving, others get theirs from gambling, compulsive spending, overworking, or obsessive activity—all of which reflect problems with self-regulation and impulse control. Endorphins resemble opiates in their ability to produce a sense of well-being and are a natural pain killer. Both adrenaline and endorphins are part of the self-medicating cycle.

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Sandra and Dick came to a session with me as a couple; they were beginning to have some relationship issues. They had fallen madly in love at a conference and were married within three months. Dick was Sandra’s fifth husband, and Sandra was Dick’s third wife. As we explored what brought them to see me, it became obvious that Dick was very concerned about the way that Sandra spent money.

“About how much money did you spend, would you say?” I asked.

“Well, not that much really, around well, maybe thirty-five or forty-five thousand,” Sandra answered sweetly.

“Which is it, do you think?” I asked, beginning to get a picture of her reluctance to acknowledge the amount.

“Well,” said Sandra, without as much guilt as I might have expected, “maybe closer to forty-five thousand.”

“How long did it take you to spend that amount?”

“I’m not sure, fifteen minutes maybe . . . maybe thirty,” Sandra said sheepishly and with the look of a little girl who’d just eaten the first piece of someone else’s birthday cake. She was acting like she had simply overspent a bit but that it was somehow not that big a deal.

“What did you buy that you spent that much so quickly?” I asked, imagining that it might be a piece of jewelry she’d been wanting.

“Oh, lots of things. I don’t quite remember. A bracelet, I think, a lizard-skin jacket, some other stuff, some lingerie.” She winked at her husband, who was now shifting his weight back and forth in his chair. The picture was beginning to take shape: a woman running frantically around a store, grabbing breathlessly at items she not only didn’t particularly need, but ones she didn’t even remember buying.

Dick chimed in, assuring me that he already had a plan in place to pay off this debt and that he would have it taken care of in, say, three years. Here is a couple who had been essentially out of control from day one, playing out their lack of relationship sobriety.

We might surmise that shopping engages Sandra in an adrenaline and or dopamine cycle. But when at home alone, sitting in a room with bags full of unnecessary purchases and no audience all that is left is a letdown—and a pile of unpaid bills and sometimes unattended relationships. Then a moment of panic at this self-­created “emergency.” The way for Sandra to feel better is to reengage in the self-medicating “relief” behavior.

The Wealth and Privilege Trap

Gary, who came with his family to a program where I was consulting, loves his work. Most of his waking hours are spent at the office or on an airplane, or recovering from those activities. He loves his family, too, who feel proud of his success and grateful for the money he earns and the many privileges that his success affords them.

Gary’s wife, Katie, loves him. She finds herself, however, increasingly attracted to her contractor who is so much a part of her life. It’s so easy to talk things over with him. He’s nice; he has fun, masculine energy; he’s around. Katie feels guilty, but it’s fun to fantasize about Frank. She misses her husband, but telling him that would do no good. He can’t do anything about his long hours and all the travel. She wonders if he ever goes out when he travels.

Conner and Brooke, their children, wonder if there is a gap growing between their parents. They love them both: Mom’s in charge, but when Dad comes home on weekends or for a vacation, they like spending time with him. But he seems so busy. So far away and so very wrapped up in what he does. Conner worries that he should do this kind of work, too, but at seventeen, he isn’t sure he can see himself working like this or even wanting to. Besides, his dad is so successful, how could he ever get to wherever it is that his dad has gotten to? Conner would love to talk to his dad about all of this, but his dad seems so distracted when he is at home, like he carries the office around in his head even when he isn’t there.

Katie sees Conner withdrawing from his dad but doesn’t want to say anything to insinuate herself; after all, it’s their relationship. And she doesn’t want to think about how Gary is gone—these days, she’s so used to it that she’s not even sure how it would feel to have him around a lot. She is used to being in charge. Used to running things. It’s simpler in a way. But lonely. Thank goodness she and Brooke are so close—she has a built-in friend. What a great daughter. Loads of friends, great grades. And Brooke is always so upbeat.

On weekends Katie and Gary go out with friends. Katie often drinks a little too much these days. And now when Monday comes, well, why stop? Gary doesn’t get home till so late that she barely sees him. She enjoys a glass or two of white wine while she is cooking dinner. And maybe one with dinner to sort of fill the evening and help her to relax with the kids. Sipping a glass as she falls asleep is soothing. Why not?

Sometimes Brooke feels like she is losing her best friend, but when she tries to talk to her dad about her mom’s drinking, he doesn’t do much. He says he’d deal with it, but Brooke isn’t sure. And when she tries to talk to her mom about it, she doesn’t get very far before her mom starts to complain about how much her dad works and tears up, and Brooke feels caught in the middle of two people she loves.

But Brooke and Conner have a lot of freedom and their parents are easy to get around, which isn’t all that bad.

And Mom spends more time in her bedroom.

And Dad spends more time at the office and in front of the computer when he’s at home.

And the house feels pretty empty, but Brooke and Conner can hang out downstairs with their friends or at the pool house and no one ever really bothers them. So it’s cool, that way.

And their parents give them the credit card—money is just around.

This house is beautiful. Everyone who sees it thinks so. And Brooke and Conner seem so lucky. They have everything.

Conner discovers pot. He hides it, which isn’t all that hard. And so what, Conner thinks, Dad isn’t around and Mom and Brooke have each other, and I don’t want to work on Wall Street anyway.

The Trap of Privilege

Children who grow up with privilege can feel confused by their pain. They are, after all, so fortunate. And the world often agrees with them. Their pain is somehow invisible, hidden beneath a veneer of affluence, status, and all that comes with it. Rich surroundings that look and feel full, nice clothes that allow children of wealth to appear to have it together looking, even though they may be falling apart on the inside, can deceive all concerned, including the person in the mirror looking back at his own elegant reflection. They feel deprived of something they want but guilty about feeling it, because what do they have to complain about?

But some of the factors that are part of a trauma-engendering home can be exaggerated in affluent homes. The power imbalance can be greater. If parents are successful, it makes them taller in the eyes of their child. And it sets the bar higher in the children’s minds in terms of their own ability to eventually become as big or bigger than their parent, which is every child’s natural wish. So there can be a sense of defeat, especially if the children do not wish to identify with their parent or if their parent tends toward narcissism and does not want anyone, including their own children, to get as big as they are.

Next there is the trapped feeling. Children of wealth can ironically have less access to outside support than their less advantaged counterparts. Their worlds tend to be circumscribed; their privilege surrounds them and holds them in a narrow orbit within which their parents may have an extended arm of control and power. After all, what teacher really wants to confront a big, powerful person who carries the aura of prestige and success? Or is a major donor and pals around with school board members? This also holds true for other potential sources of outside support, like church, synagogue, tutors, or paid caretakers. And wealth can be isolating with its big houses and property. There is less need to be part of an interdependent community where dinners are family-oriented because it’s easier and cheaper not to get a babysitter and kids get dragged along on parents’ errands or stay with a neighbor or friend. Children with less privilege may paradoxically have more spontaneous freedom, less isolation, and less loneliness.

When families such as these are also alcoholic, they have much to lose by letting the cat out of the bag and may go to great lengths to hide the disease of addiction from their communities and even from themselves. And they can afford it. The addict’s bottom can be very low because the family can financially afford to “sponsor” their use. If the main wage earner is the nonaddict, the using can go on indefinitely because there may be no financial consequences. With privilege goes expectation. Wealthy families are often “looking-good” families; so are many types of successful families at all levels of the social and economic scale. Religious and military families, for example, can have very stringent ­standards, and can trap children in a similar manner if they put rules above personal needs and looking good above being good..

Additionally, being the child of someone whose primary focus in life is that of attaining wealth and/or status can be a ­disillusioning and disheartening experience. The family wealth or status can become a primary source of identity which family members develop a deep dependency. If we grow up with wealth from childhood, that dependency is wrapped around each stage of development. Money can be a great drug, a mood manager, a high. Separating the person from the identity as someone of wealth, privilege, and perceived (and often real) power can be like separating the person from their substance. Children of privilege can despair at ever doing anything that will match the success of the wealth-getter, and the wealth-getter may well only value those sorts of pursuits that lead to amassing wealth.

From Compulsivity to Balance

The desire to manage compulsive behaviors or an inner world that is out of balance reflects a self-affirming step toward personal growth and greater self-awareness. It is important that we understand that these behaviors developed slowly and over time. And that some of the issues that we are avoiding or self-medicating may have begun as far back as our childhoods. It is equally important to understand that our solutions will be slow and require long-term commitment, and to understand that commitment itself will become its own reward—developing each day in us a little more patience, self-awareness, self-love, acceptance, and comfort living in our own skin.

Once we understand that self-medication is an unconscious attempt to manipulate our own body chemistry to feel more pleasure and less pain, to keep our own foot on the “dose delivery” pedal, we can flip it on its head. We can learn to manipulate our body chemistry in self-constructive—rather than self-­destructive—ways.