I have been working with individuals who have succumbed to and recovered from addictive disorders for the better part of 5 decades. It has been an adventure taking me into the realm of human vulnerability, suffering, and resiliency. The journey has also shown me that addicted individuals have many of the same life experiences we all encounter. In the realm of human psychology, we all face issues of survival and getting along with each other. Our common challenges include regulation of our emotions, self-esteem, relationships, and self-care. Put more simply, to study addiction is to study the psychological challenges we all face. In what follows, I offer some vignettes drawn from clinical experience and daily life that allow us to consider some of the lessons learned from addiction.
The 2-part secret to life
My patients who have experienced the benefits of recovery have taught me the 2 most important ingredients for their success: show up and hang in there.
To run the risk of sounding corny or simplistic, the 2-part secret is an effective guide to dealing with many of life’s problems, and recovering addicted individuals learn this well. There has been ongoing controversy over the past several decades whether 12-step programs are the preferable approach for addictive disorders. Some of this debate is legitimate and some of it polarized and unfortunate. As with most effective therapeutic regimens, when adhered to the results are beneficial. In Alcoholics Anonymous (AA) and related programs, there is a saying, “More meetings more sobriety; less meetings less sobriety; no meetings no sobriety.” I offer a recent clinical example.
Nancy, a 57-year-old patient whom I hadn’t seen for several years, suddenly called me late one night. It was evident that besides being intoxicated, Nancy was frantic about her condition and its effect on her work and career. She asked for help “getting some rest” and getting detoxified from her heavy reliance on alcohol. I gave her an appointment for the next morning for an evaluation and referral to an appropriate program for detoxification and rehabilitation.
When I first saw her the following morning, I was struck by her haggard appearance and rambling manner—a far cry from the poised, attractive, and well-spoken person I remembered. Although she had abstained from alcohol for 9 years and had participated in regular AA meetings, after a divorce from an abusive husband she had stopped going to meetings and resumed periodic drinking. Over the past couple of years, her alcohol consumption increased and she was now drinking heavily. Initially she was resistant to my suggestion that she be hospitalized but finally agreed to self-commit for detoxification. She called me that evening, more lucid and articulate, and expressed relief to be there and mentioned that she had attended a good AA meeting.
At our family Thanksgiving dinner 6 months earlier, I had shared the 2-part secret to life with 10 of our grandchildren. I told them that I had learned the secret from my patients and that I was thankful that their parents adhered to this idea and always showed up for their children, hanging in, for example, by driving them to athletic and social events. I said how thankful we were for our grandchildren successfully sticking with their academic and athletic activities. I reminded them that all of this was not without disappointments and setbacks, but that they were succeeding by persistence, again emphasizing our gratitude for that. I was pleased several days later when 2 of my children mentioned how impressed the grandchildren were with my Thanksgiving thoughts.
I believed that Nancy’s comment about “a good AA meeting” in the detox program might be a hopeful sign that she would get back to the basics of showing up and hanging in there. She needed the connection with others to correct her tendency to isolate, which was greatly amplified by her drinking. She needed to share her shame and guilt for her relapse, to benefit from a caring and forgiving environment, and to be supported by people who could help her work through her feelings about losing control and loss of self-esteem.
I may seem preachy, but more hopefully, instructive in reminding my patients (and my grandchildren) that success in life requires paying attention to the basics, starting with showing up and hanging in there.
Look both ways before crossing the street
Self-care, which some individuals who are prone to addiction lack, involves basic habits of health and safety. More specifically, it affects how individuals think, feel, and behave around dangerous and risky situations. The rule of crossing the street is a basic one—but it likely goes back further than that. Think of the toddler in the family room who bumps into a coffee table. Most parents know enough to comfort and soothe the child and caution him or her to be careful. However, some parents hit the table and say, “Bad table!” That’s the wrong message. The toddler needs comfort and guidance, not a message that attributes the mishap to external environmental hazards.
Too often careless and dangerous behavior of addicted individuals is simply attributed to impulsivity, stimulus seeking, and risk taking, when in fact we fail to consider how such an individual’s guidance systems (technically I refer to it as an ego function/capacity) for self-care and safety are underdeveloped or absent. Patients with addiction disorders think and feel differently in the face of danger, especially those involved with addiction and related behaviors. But these kinds of behavioral lapses and shortcomings are on a continuum for all of us. You need not have an addiction to suffer this kind of lapse. In what follows, I share maddening instances that involved operating an automobile, some of which test the limits of my self-care and safety:
There’s an alley for cars off the parking lot of my office building that leads in and out of the lot. The way out of the alley is a blind corner with no indication of traffic on the exit out of the lot. When I leave, I proceed with extreme caution because anyone driving out of the exit can’t see me. I continue to be dumbfounded by how little attention is exhibited by drivers zipping out of the lot with no thought to caution. It seems to be a clear setup for an accident. I suppose this seems like a minor hazard compared with the wide range of dangers we all encounter on our highways, but it still unnerves me that leaving my office feels like a daily opportunity for a major mishap. Perhaps I fuss too much, but maybe if we all fussed a little more, the world would be a safer place.
Tailgating also puts me and others in jeopardy. I sometimes glibly share my reactions about this with my patients to make a point about safe behaviors. Namely, I say there are 2 types of tailgaters—the mean ones and the oblivious ones. I emphasize the latter, but both greatly aggravate me (usually expressed not so delicately). I lament that there seems to be so little margin for safety with such driving.
But I leave out my own contribution to lapses in judgment when I angrily make some gesture (non-obscene of course) to tailgaters who place me and my passengers in danger. My wife has to remind me, and I have to remind myself, that it is at least as dangerous to react to tailgaters as it is to tailgate.
Dr Khantzian is Professor of Psychiatry, part time, Harvard Medical School in Boston, and President and Chairman, Board of Directors, Physician Health Services of the Massachusetts Medical Society in Waltham, Mass. He is in private practice and specializes in addiction psychiatry. He reports no conflicts of interest concerning the subject matter of this article.