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Key points
- Addiction, whether to substances or certain behaviours like gambling, is still widely viewed as a disease, and treated as such by psychiatrists.
- But this classic view ignores the fact that addiction originates in needs not satisfactorily met.
- The "cure," therefore, must include addressing circumstances and beliefs that need to change, not just the substance use in isolation.
Primula* lived at a hostel for homeless people trapped in substance misuse, where I used to offer counselling sessions. She drank bottles of strong lager to “deal with stress,” even though she hated the taste.
Unable to read or write, beset with physical ailments, and blessed with the kindest of hearts, she was cheated by the other residents, who showered her with phony affection and then stole her pension money to buy drugs—or she let them bank money for her, with disastrous results. Even her own grown-up children took advantage of her.
She was 58, looked 10 years older, and started drinking at age 12, when her father advised her to take it up to cope with the vicious beatings her mother gave her every day. She was grateful to her beloved father for that, she told me. To her, it was an act of caring.
Was her addiction a disease? That is the classical view of addiction—substance-related disorders are categorised at length in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, and it is the cornerstone understanding of many rehabilitation programmes.
But as renowned physician and addiction expert Gabor Maté says in his latest powerful book, The Myth of Normal, “Just as I have never met anyone who chose to become addicted, neither have I met anyone whose addictions did not, at their onset at least, provide for some essential human need.”1
He describes how so often alcohol or cocaine initially lubricated the gears of social connection for people who were shy or lacked self-confidence. Heroin could give people a longed-for feeling of safety and acceptance. Sometimes addictive substances or activities represented moments of privacy in a world crowded with demons and difficult responsibilities. It allowed people to feel "normal." As Maté asks, “Who has ever heard of a disease that makes you feel normal?”
He attributes addiction to trauma with a big T or a little t, the first being the kind that Primula endured for many years, and the second the smaller hurts, such as bullying by school friends, unintended harsh comments repeatedly made by parents, being laughed at, not being encouraged, and so forth. Human givens therapists talk instead about essential emotional needs not being met, an umbrella term that encompasses it all. When emotional needs are poorly met, short-term or long-term, mental ill health of some kind or another will ensure. Addiction can be the outcome of living in circumstances that don’t best serve our needs.
And yet that is rarely recognised in conventional treatment, in which the goal is to "stop" with the aid of coping strategies, such as calling a buddy for support if the craving gets too strong. Reaching out in that way is valuable, as it meets the need for community connection (much addiction is solitary). But, as a solution, it falls far short.
Mandy Cooper is chief executive of Bayberry Clinics in the UK, a residential programme underpinned by human givens understandings. As she will be telling the online Overcoming Addiction Summit next month, treatment needs to take account of where people live and who they spend their time with.
“Imagine a goldfish in a bowl that’s filled with murky water and algae,” she says. “There’s no light getting through the grime; the water’s polluted; the food is scarce; and the fish has got sicker and sicker.
"So—we remove the fish and put it into a lovely clean bowl (that’s treatment in this story). It has light, and good food, and pure water, and we treat it with medicines to resolve any poisoning. And it gets stronger, and calmer, and its vibrancy returns and it becomes excited for life once more. The worst thing we could now do is throw it back in the original bowl. But unless we explore a person’s environment, that’s exactly what we’re doing.”
Primula needed to live in an environment where she was not surrounded by people who, because of their own unmet needs, took regular advantage of her (the council eventually found her a more suitable home). She needed to learn new, more effective ways than drinking to cope with stress; help to overcome the trauma experienced in childhood; meet trustworthy people who could be genuine friends; and learn to communicate assertively with her children. It is a story in progress.
And it is one of the extreme ones, which we can distance ourselves from while feeling sympathy. But Maté thinks most of us can fit into his definition of addiction: “Any behaviour in which a person finds temporary relief or pleasure and therefore craves, but in the long term causes them or others negative consequences, and yet the person refuses or is unable to give it up.” It bears much thinking about.
*name has been changed
References
1. Maté, G with Maté, D (2022). The Myth of Normal: trauma, illness & healing in a toxic culture. Vermilion.
