Demoralization: The under-recognized “engine” of addiction
Michael D Lukens, PhD © 2016
Anxiety and depression underlie most addictions; as painfully troubling and enduring conditions they are primary motivating factors. Ask any gathering of addicted or recovering individuals if they believe that a major part of what motivates them to use is to try to control their anxiety, their depression, or both . . . and they will almost all say “Yes.” I know this is the case as I do this routinely in my work with addicts in recovery.
In general, the struggle people have with these two common mood states forms the basis of the emotional process that makes people feel the need to self medicate. When you have a bad headache, you self medicate with aspirin, ibuprofen or acetaminophen, and if they don’t work you look for something stronger — whatever will take away or reduce the pain of the headache.
Heartaches or “mind aches” are similar in this way — when we’ve got them we feel the need to get rid of them, just like headaches. And we are driven to do whatever it takes to make these kinds of pains go away.
There is no “gateway” analgesic phenomenon — you don’t go down the line through progressively ‘harder drugs’ all the way to opiates if aspirin gets rid of your headache. That is, if in fact, getting rid of your headache is your real goal (secondary gain and other issues emerge to confound the “real goals” picture — people ‘use’ for multiple reasons). When it comes to medicating your headache you simply keep searching for stronger versions of pain relief until you get pain relief. Similarly, when you have a “heartache” or a “mind ache” (perhaps you’re already recognizing the links to anxiety or depression) you feel the need to do something or take something that will help with that kind of pain. When you find the best “something” for the job, you use it. By doing so, you’re not an idiot or a miscreant, even if you are an addict-in-the-making. And rather “sensibly” you keep using that something if the pain is recurring, or unrelenting. This is the essence of Ed Khantzian’s original Self Medication Hypothesis.
If you’re a toddler you self-soothe with your pacifier — life can be tough even for the youngest among us. And your thumb can serve as a substitute when parents “prematurely” take your binkie away from you (triggering early onset symptom substitution?). If they had the wherewithal toddlers would lie, cheat, and steal to keep their favorite stuffed animals, blankies, or binkies. “Moral decay” does not tend to accompany the blanket addiction process for toddlers because they don’t have the skill sets or the access that would make these action patterns viable or available. On the other hand, they do get rather compulsively attached, much like the adult addict, and they experience painful “emotional withdrawal” if forced to give it up. And they do find ways to put pressure on moms and dads to let them keep “using” — begging and pleading and being obstinate or acting out in some way.
Babies’ brains have not been modified by extensive use of the binkie so that they eventually lose their self control. They don’t have much of that self control stuff in the first place — they don’t need it and don’t have what it takes yet to make self reflection happen. Ironically, adult addicts are predictably stuck in a regressive mode that is lacking self reflection.
The babies’ reward centers in their brains are not running abnormally amok. They like what they like, and they like some things a whole lot. Feeling soothed and comforted and secure are high on the like list. They are not “diseased” or even “deficient” in the strictest sense of those terms. Most, if not all infants, are already emotionally and neurologically wired to get very “compulsively” attached to things that make fear go away or that can create a sense of being soothed when they’re lonely or their feelings are hurt. Turns out most adults are wired similarly — viz., wanting to make anxiety and depression go away — it’s just unfortunate that so many of their soothing and security producing devices are vices with great harm potential attached to them.
Dissociation is not a side effect of “using” behavior . . . it’s the intended effect. The “high” is the sought after effect of deliberately altering one’s mood or feeling state. When a person experiences life itself or some major aspect of living as causing “emotional inflammation” — a persisting dispiriting of the mind or the soul — then there is motivation for dissociating. We feel the need to seek some form of emotional relief. This is a desire to feeling-wise remove one’s self from an emotional experience that one does not want to have . . . either an experience that may happen (connected with anxiety) or an experience that one is already having (connected more to depression). This kind of dissociative activity is always willfully engaged in. Willful does not necessarily mean pre-planned or consciously deliberated. When we act impulsively it is our will making us do the acting, even if it doesn’t feel that way to us at the time. Using behavior is not happening by accident; Nor is it by dint of some sort of disease. When being in touch with “what’s real” or “what may be” is unwanted in a committed enough way, we find means to “check out” instead. The toddler is taking the edge off of fear or loneliness or boredom or frustration; and the adult addict is pretty much doing the same thing.
Substances and addictive behaviors (eating, shopping, sex, gambling, video-gaming, religiosity, exercising, etc.) are vehicles or “tools” for creating people’s preferred forms of dissociation. When fantasizing or daydreaming is not enough, teens and adults, like little children, will get “hooked” on whatever “thing” manages to soothe them or effectively reduces their pain.
Depression and anxiety are painful and they themselves are surface manifestations of underlying unresolved pain or discomfort in living. As Scott Peck said at the very beginning of his book “The Road Less Traveled” — “Life is difficult. This is a great truth, one of the greatest truths.” He’s right . . . life is hard, and it almost universally produces some anxious and/or depressive mood states (many of which we don’t identify, detect, or diagnosis) so we are predictably motivated to make it “FEEL” less so by dissociating from our experience of living.
No One Escapes the Drive to Escape
The implicit assumption that non-addicts are living pain free lives, or that some of us are living so “well” that we are immune from demoralization is patently false. Positive thinking is not the ultimate answer to grief and loss, and it’s likewise real hard to come by when your self esteem is in the crapper. Since life is difficult for all of us at times, and especially difficult a lot of the time for a great many of us, we should not be surprised that depression and anxiety would be so ubiquitous, to the point where they are statistically more “the norm” than the exception. We also should be humbled enough by our recognition of this to acknowledge we are all at risk . . . for anxiety, depression, and the attendant drive to dissociate and/or self-medicate.
Anxiety and depression are conditions that persist over time and across situation, by technical definition, and are not merely momentary, passing feeling states. Both of these are conditions that are formed by meaningfully significant demoralization experiences, and then they both, in turn, give rise to increasing demoralization over time. This is the deeper structure of the engine that constitutes the vicious cycle of addiction. It seems to be the case that some people are temperamentally predisposed to develop depressive and anxious response patterns as they go through life, and so they may be more “at risk” for falling into or “falling for” addiction. But all of us are at some risk due to the predicaments and painful experiences that are really a “natural” if not inevitable part of our human existence.
Why Do the Behaviors Become Compulsive?
Over time, the pain relieving solution — the addiction behavior pattern — becomes a contributor to the problems and pains getting worse, and yet the behavior pattern is very hard to change. Why are these sorts of “bad habits” so hard to change? The compulsivity develops because the short-term prospect of potential soothing of pain in the moment is more salient a motivating force than the longer term costs or pains that accrue to addictive use. This is the time honored human dilemma we could call the “self-control vs. impulsivity conflict” in which longer term payoffs, that may be so clearly greater “on paper” than their short term counterparts, simply do not have the same level of motivational pull as the “right here and now reward” of our being potentially able to make ourselves feel better. We may think of this as our being “irrational” on some level, but it is, organismically speaking, “systemic common sense” on some other level.
The mature individual, unlike the infant, can sometimes override this short-term pacification impulse. Things like “higher purposes” and “selfless commitments” help make such ‘overrides’ possible. Nevertheless, there are no adults that I’ve met that you could say 100% of the time find they’re able to forego the pain-relieving “candy” in front of them for the sake of their self esteem or longer term goals. Of course, some people are better at it than others. The immediate question is “why” and the followup question is “why not?” as in why would we expect it to be otherwise? Most addicts can recognize some form of developmental “arrest” in their earlier life. The immaturity shows up in common forms: struggling to tolerate frustration and pain, and difficulty delaying gratification.
These two abilities are hallmark features of adulthood. Demoralization and addiction both stunt emotional growth. Differences in degree and type of demoralization sit right in the middle of what explains these important individual differences. Children don’t have the “structural maturity” to dedicate themselves to higher callings, which is why we see their egocentrism as par for the course in terms of their development. People who’ve been traumatized or abused as children would be expected to be more addiction prone for some obvious reasons. One unobvious reason is that it is hard for the person to set goals and follow through with applied extended effort if there is no expectation of having enough worth or personal power to start with.
If life is bad enough and if in our history the promise of future rewards has not been kept or the payoffs, for whatever reason, fail to get delivered, we are then even less inclined to “hold out now for more to come later” — we are built or structured in such a way that we learn to more consistently take the reliable payoff of the short term “fix.” You can see how these were meta-learning events, based on some interpersonal trauma or pain-involved learning experience — make it harder to trust fate or people. This process can produce a kind of learned helplessness. It involves a “fool me once, shame on you; fool me twice, shame on me” sort of learning based conclusion about life.
It is my contention that in all cases of genuine addiction some form of demoralization accounts for the motivation to begin to play this form of Russian Roulette (RR) with substances and behaviors. The RR aspect of the addiction process is not necessarily intentional (it clearly IS in some cases) — it just goes with the territory of high potency/high risk pain relief. If you had a migraine and you knew the medication that would sometimes relieve it was likely to cause stomach ulcers, would you take the risk just to get rid of the headache? The headache is here and now, while the potential for bleeding is far from here, existing in the abstract in some later time. Most of us would act, or be strongly tempted to act impulsively given a situation with no better alternative available. In fact, a large number of people would persist in taking the pain relievers even after there was copious and prolonged bleeding. This behavior may seem mind boggling, paradoxical, ludicrous or irrational — if it’s not your headache.
Addictive payoffs are what make the behaviors goal directed, even if addicted behaviors at some point seem totally compulsive, or even trance-based. The motive for using is to achieve that experienced payoff. The motive can exist inside a ‘trance’ and the motive can energize enormous cravings. The payoffs are intermittent, as noted, and this makes the search for the payoff something that would be sustained long after the payoffs actually stop. A little lesson in behaviorism 101 might help explain. The slot machine keeps people glued to the machine BECAUSE the payouts are potentially quite large and BECAUSE they happen infrequently without specific predictability. If this quarter didn’t lead to a payout, it might be the next one, or the next one, and the one after that. Littler payouts happen with a bit more regularity to fill the frustration gap between the last big payout and the next. Watching others nearby get big payouts further supports this in being a “sticky” behavior for the casino fan.
Demoralization also accounts for the continued drive to play RR once the risk-taking takes on lethal proportions, as it represents a game of chance being willfully played with life itself. When life consistently hurts, people are more inclined to develop a passive death wish — such as hoping to not wake up in the morning vs. actively plotting to suicide.
Demoralization accounts for the triggering of relapsing regardless of how long a person is “in recovery.” Consider the recovering person saying to him or herself “I’ve been doing so good and trying so hard . . . and now THIS happens.” This would be a sudden disruption of sobriety/recovery due to the relatively major demoralizing event. Very often, however, the relapse trigger is more like the straw that breaks the camel’s back: “That does it, just too many damn things not going my way!”
Some form of demoralized state must exist as part of the context, the meaningful landscape in which a person lives, or there would be no motivation to move the person into addiction. Going down the rabbit hole is not a choice made by people with high morale . . . they just are not at all inclined to do that. In fact, most tend to eschew even recreational use or misuse since they are appreciative of and protective of the high morale they have about the game of life as they are currently experiencing it.
When and where recreational experimentation becomes committed addiction it is only and always through a pathway that is already lined with demoralization. I would argue that even the inkling to try drugs and alcohol experimentally is sourced by low levels of demoralization. Happy teenagers (which may be something of an oxymoron, recognizing how few of them there ever are in any given community or culture) want to stay happy, they don’t want to mess with the good thing they have. They do not as easily or readily succumb to peer pressure, which has its effect so much more prominently on those with pre-existing morale issues (or those with “heartaches” or anxiety or depression — of course I’m including even the subclinical kind).
In theory, the omnipresence in our culture of addictive substances and activities means that those who do not “go there” are not inclined to go there. They do not find themselves at a never-ending temptation juncture fighting the competing urges to use or not to use. Drugs, alcohol and other addictive behaviors are “everywhere” and so easily accessible, but if they don’t call your name you don’t have to fight the urge to indulge.
If we look at what “turns” one of these non-addicted persons into someone who is “flirting” with it, we see demoralization of some kind has played a role in this shift. When we then see someone go from a mere flirtation to full blown addiction we may see a convergence of pre-existing demoralization, fresh addiction-related demoralization, and a marriage of sorts between the lowered morale expressed by the will and the addict’s “choice” of lifestyle. The bonds in this relationship are hard to break even if it is hell on earth and despite the well known risk that it could become a lethal affair. Demoralization is part of the “glue” that makes these bonds so strong.
Demoralization can occur as a momentary experience, when there is a sudden “downdraft” of spirit, a drop in the quality of one’s appreciation for or “good faith” participation in the game of life. I’m talking about a pain producing roadblock that utterly spoils the process (or our expectations for the process) of the quality of our experience of living; whenever the “acceptable enough” status quo of our journey through life is sufficiently trashed. This can be enough to kick off a case of the “Fuckits” — a term that captures or expresses one’s reaction to the spike in demoralization in the vernacular.
One reason this is frequently unrecognized as an “engine” sourcing addiction is the fact that for many people the status quo is already consistently a “not so good faith” relationship with the world in the first place. Growing up with abuse, or poverty, or invalidation and oppression means there’s a very good chance demoralization becomes unseen due to its being such the experienced norm. Demoralization can be a backdrop that is cloaked due to its subtlety and its chronicity. Think of having the experience of being in your kitchen just at the moment you recognize the sound of the refrigerator in the background simply and only because it finally turns off for a minute. This chronic form of low level demoralization is like that refrigerator noise, always there and yet, by and large, going unnoticed because the person is so accustomed to it.
Despite the compellingly robust findings from the ACE study , we are still trying to explain its results in simple terms: How do early childhood traumas lead to the so-called “choice” to experiment that then eventually progress to the point the person begins in earnest the habitual use of addictive substances and/or frequent engaging in high risk behaviors? The chronically demoralized young person is ‘ripe’ for falling into the rabbit hole as he or she gets introduced to the substance that will flip the unwanted chronic feeling states on their heads (or hold enough “promise” of doing so). If an experience comes from the using that provides the antidote to the demoralized feeling state(s) then “we have a winner” — the DOC (drug of choice) fits the felt need well enough — and the engine of addiction is turned on.
A teenager with a large chip on his shoulder is not likely to find that smoking pot is “enough” to calm his anger and help him tune out. So pot is not the DOC for him or her. Another teen, with only a tiny chip on his shoulder may get enough “defiance payoff” from occasionally drinking stuff taken from his dad’s liquor cabinet, or throwing a party when his parents are out of town. If self esteem is horribly low a person is not likely to adopt a more socially engaged usage pattern, but if their self esteem is just slightly “below sea level” a few drinks may be enough to help a whole lot.
The overpowering emotional payoff from this negative reinforcement — temporary escape from feelings associated with low self esteem — is hard to resist; notice how it tends to take on the aforementioned pattern of intermittent payoffs, a schedule of reinforcement that B.F. Skinner himself noted is particularly robust and hard to change, producing a more powerful and lasting form of ‘learning’ that tends to develop into a habit.’ This can explain why addiction continues “long after the thrill is gone” and despite such a toll being taken. The lingering hope for, or the expectation that the payoff will still happen is enough to make the engine keep running. This is commonly referred to as “chasing the dragon.”
Musings About Typologies
There is the more sociopathic forms of demoralization that leave one predisposed to engage in socially frowned upon modes of conduct, and more socially condemned forms of substance use (hard core DOCs). There is a sizable ‘chip on the shoulder’ that represents some form of resentment or contempt that makes the F*** YOU part of using it. So, for instance, Heroin, Crack, and Meth, are the “better fitting” DOCs for the group who strongly identify with and simultaneously resent their social disenfranchisement.
At the other end of the spectrum there is “The Good Girl Drug” — food — which is the selected dissociative “device” for so many women and a growing number of men. This may be because either resentments are not ‘allowed’ or they are accompanied by overpowering guilt. In some cases anger is simply not prominent among the major contributing forces fueling this type of engine.
There is also, of course, the more socially acceptable “adult drug,” alcohol, and its anti-anxiety properties, which provide a reliable way of easing the process of socializing that is otherwise blocked by shyness or shame. And since it’s “legal” and so incredibly available it has very little stigma attached to its general use. You can “fit in” and drop out at the same time without a high risk being “outed” or ostracized. The antisocial user drops out and wants to make it clear (in a defensively reactive manner, of course) that fitting in was not ‘desired’ in the first place. Ironically, they then tend to transfer all that “fitting-in angst” to the local non conformist group they belong to.
There is the grief stricken young person who has a strong felt need to medicate sadness who feels terrible about letting others down in the process. Their self esteem damage comes after the addiction engine is turned on, not before. Addiction only adds grief to the grief process, so this can readily become an accelerating downhill spiral. The more adult grief-driven addict is likelier to take the slow road to early termination of the game of life, recognizing the accumulation of negative health consequences and not giving a damn about their occurrence. Consider this a latent, or passive death wish.
Then there are those whose self esteem has been damaged who turn on the engine in order to feel less shame and guilt and self loathing. The self esteem wounds predate the addiction, and can be seen as a source motivation — the significant demoralizing pain that needs to be medicated. This tends to involve a need to numb to the prospect of internal and external invalidation. The internal critic, which is just a spokesperson for the expectation of derision and rejection that shame tends to conjure up for us, in conjunction with the actual interpersonal or institutional “rejection” we encounter “for real” in life, can deeply and profoundly wound us at the core of our identity. You can’t get enough numbing to stop this fully, and then the addiction only adds to the shame and damaged self esteem, so again, a vicious cycle is set in motion. Numbing on top of numbing, or numbing more instead of facing the cost of numbing, becomes the dissociative commitment that I describe as “Full Mental Jacket” — a total anesthesia effect is being sought — so that eventually the idea of not being numb becomes impossible to consider. Dreams and plans for reclaiming self esteem eventually die off, and so does the motivation to try to recover them or recover from addiction.
Cure at the Core
Love is the only genuine antidote for the self esteem medicating group. Love also has to be part of the support that the grief-stuck addicts require if they are to “complete” their grief and make their morale whole (enough) again.
This is not as simple as it sounds, since we really don’t understand love very well — we’ve confused ourselves about love in all sorts of ways through the ages. It’s time to clarify what love is, and the role it plays in changing and healing. People are busy using the word love all over the place having fuzzy ideas about what it is, what it means to us, how it works, and how we can enhance our access to it and our substantively improve our “use” of love. If we could clarify what Love IS, then we should be able to implement strategic solutions that hit the mark much better.
Looking at love’s opposite — contempt — and recognizing it fits in so well with the general theme of this demoralization process, we see indirectly how contempt is key. The emergence of contempt in those who are largely disenfranchised and institutionally invalidated motivates an unfriendly form of acting out in the face of demoralization — this contempt drives many young people to take the direct “fuck everything and everyone” route down the higher risk rabbit holes. For those less angry, it is major disappointment and frustrations due to the loss of a dream or an entitlement, or being on the crappy end (subjectively perceived) of a bad contract with the world that form the structural components of the engine of addiction. This is ‘softer contempt.’ The person is angry, but unclear who to be angry with or what to be upset about. This original idea was first proposed by Nicholas Cummings, former APA president, responsible for groundbreaking ideas and methods for treating addiction. It was over 35 years ago Cummings first wrote about this kind of identifiable disconnect from important personal goals that apparently “kick started” the addiction process for many of the addicted people he worked with.
The Good News
I’m not alone in suggesting that the definition of addiction as a disease has a real problematic downside to it since it takes our attention off the “engine parts and processes” that we should be working on. Lance Dodes, Stanton Peele, and Gabor Mate (among others) have long been arguing for very similar understandings of the addict and the process of addiction.
The conclusion that we are motivated to act out of a sense of demoralization by feeling a strong need to dissociate somehow is “pretty bad news” in the sense that we should expect that addiction would be rampant and recalcitrant. Since demoralization is so common and so under-addressed it makes sense that there would be an addiction problem of epidemic proportions given how things are as they are for people in our modern world. The “Good News” is that once we see the power of this cause-effect linkage between morale and addictive-proneness we are called to take action that could help to (a) prevent addictions from developing in the first place, and (b) achieve a much higher rate of success at recovering from addiction than is now the case. Finding ways and means to focus our efforts on “morale building” and “morale repair” should significantly help us win the war on addiction.
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