For several years now I have been doing a psycho-educational dialogue with the families and significant others of addicts. It’s always gone over quite well and, when you have 150 people in a room and they suddenly discover that they are not alone in their experience, it goes a long way toward consciousness raising, the development of compassion, and the quelling of resentment.

Yesterday, I found myself doing the thumbnail version with a client struggling with a family member, and it prompted me to think about writing it all down and presenting it in this forum, as some folks might find something useful in it.

Addiction is complicated. It is one of the most pervasive and least understood of maladies. It’s not that we don’t understand addiction per se, but our understanding is controversial. Is it biological? Is it inherited? Is it a disease process? Is it psychological, or psycho-social, or cultural? Is it a characterological disorder or just pervasive poor judgment?

Well, the answer is yes and no. Talk to ten different people and you’ll get ten different perspectives. There are, however, some constants.

Although this model applies to all addictions — whether it be drinking, drugging, sex, gambling, pornography, love, shopping, etc. &emdash; I am going to stick with the language of alcoholism, as it is somewhat universal.

It’s also important to remember that the behavior attached to an addictive process (drinking, drugging, etc.) is a symptom, and that, speaking psychosocially, addiction itself is a breakdown in impulse control and has something of an obsessive-compulsive dynamic (see [popup url=”” height=”500″ width=900″ scrollbars=”yes” alt=”popup”]Addiction: A Zen Perspective[/popup]).

From the standpoint of psychosocial generalization, addicts lie, cheat and steal. They are deceptive, sneaky, secretive and a bit paranoid. No matter whom they are, or who they present themselves to be, they have only a single motivation – securing their next fix. Harsh? – yes, cynical? – yes — but, by and large, fairly accurate.

Bear in mind that bad behavior does not make for bad people. When we get to the addictive character versus addiction as a behavior, this will become a bit more clear.

The romanticized version of the addict as the skinny, slovenly, unshaven guy with the rheumy eyes in the flannel shirt is not really accurate. I helped a friend of mine kick a 5 bag a day heroin habit cold turkey a few years ago (now, that was an experience) and he wasn’t exactly some junky living in a box. In fact, he is a high school music teacher, dresses in Armani, plays in a major city symphony and, at 53, still takes his elderly Mom to church three days a week.

A genuine, dyed-in-the-wool alcoholic drinks consistently, day and night. They are typically malnourished, and, basically, live on booze. They are never quite drunk and never quite sober. Clinically, this type of drinking is called maintenance drinking, as it supplies a biological requirement that the body develops for a certain level of alcohol in order to function. Many of you likely encounter a maintenance level alcoholic or addict every day, and don’t even know it.

Along with the chronic alcoholic and/or maintenance drinker, we have what I call the cyclical alcoholic. This is the addict who engages their behavior in a consistent timeframe, like not drinking during the day, but coming home at night – every night — and drinking a few bottles of wine, or a twelve pack.

There is also the binge drinker, who may drink socially or not at all during the week, but spends every weekend trashed. Or again, characterized as a binge drinker, goes through periods of relative or even complete sobriety, then falls into a period of chronic or cyclicalalcoholism that can last a few days, a few weeks or a few months.

Some binge drinkers also tends to be what are known clinically as blackout drunks. A blackout drinker gets to a point where they are literally unconscious on their feet. They may appear sober or only slightly “buzzed”, but they are not cognizant of anything that is happening around them, what they are doing or how they are acting.

I must admit to not completely understanding the biological mechanism that drives this, but it is more common than you might suspect. Bear in mind that blackouts are often associated with a particular type of alcohol and, in rare cases, it can be an allergy. I knew a woman in college who would blackout after one or two beers. Regardless, it’s a dangerous condition, as the personality and behavioral changes associated with blackout drinking can lead to some very risky behavior.

There are also reactive drinkers, conditional drinkers and coping drinkers. A reactive drinker is someone who will seek out alcohol in response to a particular emotional state – say, stressor loneliness. This is the guy who keeps a bottle in his desk at work or the housewife who carries a hipflask in her purse. A conditional drinker will engage in their behavior in something of a ritualistic fashion – eating dinner alone, or watching a game on TV, but nowhere else. A coping drinker is someone who hasn’t developed an alternative coping skill and uses their addiction as that, and only that. All of this falls under the category of self-medication, by the way.

Coping drinkers are different than reactive drinkers because the coping drinker falls back into their addiction in response to a particular event, rather that a state of mind.

For example, I had a patient who was 14 year sober. His father, diagnosed with ALS, was dying, and he would drink a few beers in the garage before going in to see him. This went on for about 2 months, his father died, he stopped drinking the day of the funeral and has been sober for about 5 years now.

Did he pick up? – yep; did he fall off? – nope – because his drinking was specific and contained, and it was the only coping skill he had at his disposal for that level of emotional stress.

So, we’ve qualified the variety of addictive ‘styles’, if you will, let’s consider the levels of addiction, again, using the language of alcoholism.

  • Alcoholic – this is someone who engages in a consistent pattern of substance abuse, sometimes to the degree that it interferes with their ability to function effectively and meet the social demands of daily living. The chronic alcoholic, maintenance drinker or cyclical alcoholic who is consistently late, or ‘forgets’ to pay bills, or basically just can’t show up in a responsible fashion falls into this category.
  • Problem drinker – this is someone who engages in an inconsistent pattern of substance abuse, sometimes to the degree that it interferes with their ability to function effectively and meet the social demands of daily living. Again, those same passive-aggressive characteristics and social interference qualities apply, just not so much, so often or with as dire consequence.
  • Dry drunk – this is someone who has ceased drinking, but continues to engage in the behaviors characteristic of addiction, where those characteristics include passive-aggression, social inconsistency, deception, secretiveness, etc.
  • Sober – this is someone who has ceased drinking, and has also begun to change the behaviors characteristic of addiction.
  • Past sober – this is someone who has ceased drinking, changed the behaviors characteristic of addiction and moved past the point of being socially, environmentally or psychologically influenced into returning to addictive behavior. This person is sober and has also gained control over their triggers.

My favorite examples of “past sober” are people who engage in what I call the 13th Step – alcoholics who tend bar or become drug and alcohol counselors, medical professionals with drug problems who return to work in a hospital, or, more commonly, people whose spouses drink socially, can keep liquor in their house, or can go out to a bar with their friends and be comfortable. One young woman I counsel is quite proud of being the Permanent Designated Driver.

So, what is the addictive character? The typical addictive character is, as I noted above, someone who is deceptive, and given to lying or being secretive. In addition, they exhibit a number of passive-aggressive characteristics such as a failure to follow through with responsibilities, a general irresponsibility and failure of priorities, chronic tardiness, money problems, a lack of judgment, unbridled anxiety or depression, a general disregard and lack of respect for themselves and for the sensibilities of others, poor boundaries – the list could be endless, but this is a fair, generalist picture.

With regard to the emotional state of the addict, many times it rests upon a depressive, melancholic or agitated depressive character. This personality style informs a great deal of the addict’s general behavior. I call it “getting to be right”.

Addiction is a veil; it is a tangible mechanism of denial. If you engage in addictive behavior, you create a situation that demands that you ignore the rest of your life. As that life crashes and burns around you, you may finally get to a point where you say, “Enough.” and get sober.

So, you get sober, but your life is a shambles and that sense of being overwhelmed that initially led you to that state of denial, and ultimately your addiction, is still there. You can’t respond. You’re stuck in the same emotional place. You’re sober, but nothing else has changed. As a result, your sense of yourself, your value, your self-worth and your sense of place also haven’t changed. Why? Because you stay stuck and the denial, passive-aggression, irresponsibility and failure of priorities feeds on itself and you “get to be right”! This is also part of the mechanism for relapse.

The cycle of addiction is very powerful. I always tell my patients, “If you can get sober – really sober – then you can do anything.” I honestly believe that there is nothing harder for someone confronted with the social and emotional challenges of mental illness. That’s not because addiction is bigger and badder than, say, Schizophrenia or Borderline Personality Disorder, but it is because drugs and alcohol, legal or illegal, are so imbued in our culture and our way of life that, in addition to confronting the illness, you have to re-socialize and re-acculturate yourself just to survive.

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