Test Yourself With a Real Case of Addiction

In my book, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction, after describing the stories of people with addictions and discussing what each story tells us about the addictive process, I wrote a chapter called "Test Yourself". That chapter has further stories of people with addictions but, unlike earlier in the book, I left out my explanations of what was going on, instead asking readers to see if they could answer the major questions about the case for themselves. For each case, I posed 4 questions:

What are the underlying emotional themes that lead to the experience of helplessness and, in turn, its addictive solution?
What defenses does this person use that keep him or her from seeing the key moment?
What is the key moment on this person’s path to addiction?
What more direct alternative actions could he or she have taken in place of the addictive act?

There isn't enough space in this post to print entire case stories but here is a very shortened version, with answers at the end. For this full case, and others, see Breaking Addiction. (As always, all names and identifying information are fictitious to preserve confidentiality, and all cases are composites.)

Dr. Luke Greene trudged into his office in the Radiology Department of his hospital. Life really was depressing, and always had been. He had started drinking heavily as a radiology resident just out of medical school and now at 40 years old, he was drinking every night. Luke worked hard. He always had, and his current position as Assistant Chief of his hospital department spoke to that. As depressed as he always felt, though, Luke did not like to turn to others for help, because he always felt he could, and should, manage things on his own.

One day his department Chief called him in to say the Chief had to take a leave of absence, and he wanted Luke to be the Acting Chair of the department. When Luke left the Chief’s office he had a strange mix of feelings. This was certainly good news. But Luke felt the old depressive feelings worsening in him. Did he really deserve this? He had only been Assistant Chief for a year and a half. By the time Luke returned to his own office he began to think about having a drink. This made no sense to him at all. He had been abstinent at that point for nearly a month and he thought he was finally past drinking. Besides, why would he think about drinking now? This promotion was very good news. After work, Luke stopped at a liquor store, brought home a bottle of whiskey and began drinking right after he came in the door.

Luke was the third child in his family. Some time before he came into the world, his father lost his long-time job at a shoe manufacturing plant. The family had struggled after that, moving twice when Luke’s dad found work in other cities in his state. They went into serious debt, and for a few months they had relied on what was then the new food stamp program to provide for their two small children. Then, just before Luke was born, his father landed a good job in a growing company. By the time Luke was three and a half years old, they were on their feet. Luke never remembered the hardships his family had suffered; he had been too young to sense the family’s early struggles.

But his family remembered, and though his parents had no intention of hurting Luke, he often heard from them about what they had been through and how grateful he should be for having escaped it. His siblings were more direct. Both of them saw him as unfairly lucky. They never let him forget that he was the “spoiled” one.

Luke got this message loud and clear. Over the years his response was to work hard at school or at chores around the house, to show that he did appreciate how fortunate he was. He became a serious child, not smiling much. Outside the family he earned admiration from his teachers and coaches for his dedication and perseverance. But, oddly to those around him, he never seemed to derive much pleasure from the honors he received. When he began drinking as a radiology resident, it was a welcome relief. He felt a burden was lifted. It was no wonder that it took him so many years to decide that drinking was a bad idea for him; it had seemed like such a good thing.

The day after he finished off half the whiskey bottle he’d bought at the liquor store, Luke woke feeling terrible. Why would he drink now? Like much of the rest of his emotional life, this simply did not make sense.

Answers to the case questions

What are the underlying emotional themes that led to Luke’s experience of helplessness and, in turn, its addictive solution?

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Luke grew up with a sense that he did not deserve what was given to him. Sadly, though his parents had worked hard to provide a better life for Luke, their repeated message that he had a better deal than the rest of his family made his life much worse. He grew up with a burden of unworthiness from which there seemed no way out, and he carried this weight of guilt with him into adulthood.

Drinking, for Luke, was a solution to his lifelong trapped feelings of unworthiness and guilt. In this trap, it had never mattered how hard he worked or how many honors he received, because he believed he did not deserve them. When he drank, he finally gave something to himself. Since this displaced action – drinking – reversed his helplessness to allow anything for himself, it had quickly become an addiction.

What was the key moment on Luke’s path to addiction?

The key moment in this episode was when Luke returned to his office after speaking with the chief. That was when the thought of drinking first entered his mind, though he subsequently worked all day and didn’t start drinking until he arrived home.

What defenses kept Luke from seeing the key moment?

For all his high intelligence, Luke was not an introspective man. When he was most depressed he responded by working harder, just as he had done as a child. Outside his awareness was the thought that if he worked hard enough, maybe he could finally prove that he was worthy of what he’d been given in life, and rid himself of his old guilt. Besides his compulsive working, Luke had another defense: he avoided relying on others. In refusing outside help, he was again trying to avoid feeling guilty for expecting to be given even more from others. With these defenses in place, Luke never considered the underlying issues for which his addiction was a solution.

What more direct actions could Luke have taken in place of the addictive act?

What was important here was not the fact of being offered the promotion, but what the event meant to him. The best thing he could have done was to focus on that. Luke had never thought about his life in psychological terms, but he could have started then. He could have seen that this promotion felt like an honor, and remembered that he never felt worthy of such things. In looking at the meaning of the event, rather than the event itself, he had a chance to not be overwhelmed by it. There were also some practical actions that would have helped him. He could have called the Chief and told him he needed a few days to think it over, or turned to others to talk it over. Of course, doing that would have run into his defensive need to do things for himself -- his avoidance of seeking help. But as he understood what was happening emotionally inside of him, he was able to use his urge to drink as a signal to pay attention to the underlying theme that ran through his life. By seeing how his old emotional helplessness produced apparently inexplicable urges to repeat his addictive behavior, he could turn the tables on his addiction. He could use his addictive feelings to understand how his unworthy feelings influenced his life, and how to master his addictive urges when they arose.