withdrawlI’ve been writing about will power for the past couple weeks in response to these comments from a reader:

Everyone’s will power varies. The simple fact is, the worse withdrawal is, the more likely that person is to not want to go through it again, meaning abstinence. The easier withdrawals are, the more likely those persons’ mindset will be “one more can’t hurt”. Pain builds you; it builds character, personality, and maturity.

In part one I talked about the value of powerlessness and belief in a higher power.  In part two, I suggested that belief in will power may, from a logical analysis, contribute to relapse.

One remaining aspect from the reader’s comments deserves a closer look.  Does more severe withdrawal offer protection from relapse?  Can bad withdrawal serve as an aversion to using substances, just as an electronic shock collar keeps a dog from wandering into the more interesting yard next door?  Does pain truly build ‘character, personality, and maturity?’

I have to tell you—those collars DO work.  And before everyone tears me apart for using a negative correction, the pay-off in terms of freedom to roam off-leash has been a great thing for them.  Besides, our smart dog, Lilly, has never been shocked at all, learning the whole deal by watching the misadventures of our less bright dog, Eddie—who has either an impulse control disorder or a tendency toward masochism! (check them out here!)

As much as I love our dogs, their conditioning to avoid an underground fence is much less complicated than the factors that go into human addiction and relapse.  I am familiar, of course, with the phrase ‘that which doesn’t kill us makes us stronger.’  But is that ALWAYS true?  I didn’t have that impression as a psychiatrist in the state prisons, when I met some people whose primary, incurable problem was that they had experienced too much bad stuff in life; too much misery, too much shame, and too much loneliness.

Or I think back to my experiences learning to place labor epidurals in the late 1980’s, during my anesthesia residency in Philadelphia. The nurses on the labor floor wouldn’t let me put a labor epidural in a 14-y-o girl until she suffered for awhile— until she had a bit of what they called ‘punitive labor.’

They assumed that her memory of the pain of labor would keep her legs together for the next few years. But I questioned the logic of that approach. What if the girl was having sex at a young age because she had a rough life, beaten down by one person after another, and more pain only made her need more closeness—however she could find it?  Or what if she wanted to have a baby because of a desperate, unconscious desire to find intimacy, in an effort to stop her own emotional pain? In such cases ‘punitive labor’ would make her burden greater, and make another pregnancy more likely.

I don’t buy the argument that worse withdrawal provides protection from relapse for yet another reason.  People don’t remember pain very well.  If you try right now to remember something painful, you will see my point.  We remember our reaction to the pain—our wincing, our crying—but we cannot feel the pain itself, or recreate our suffering.  Our inability to remember the severity of pain is probably a good thing, as otherwise many of us would have no siblings!

I don’t remember the pain of my worst withdrawal episode.  I know that the last one, the final detox before treatment in 2001, was pretty horrible– but I can’t ‘feel’ the misery anymore. And even if I did, would it make me avoid using? Or would it worsen my chances—for example by leading me think that the pain built me up, and gave me character, personality, and maturity… so that (similar to my thoughts about ‘learned will power’) I think I’m a stronger person now– so strong and so full of character that I don’t need to go to meetings, as I can handle it on my own.

Yeah, that’s the ticket!  What didn’t kill me made me stronger—yeah, that’s it!  In fact, I am such a strong person that I could probably take some codeine for this darn cough that has been keeping me up… I’m probably strong enough now to take it just once, and then stop…

Tricky business, dealing with opioid addiction… Can you see the problem with thinking too much? That is why to avoid relapse, I choose to stay afraid.  When it comes to addiction, fear will keep us safer than will power and character, in my opinion.  Don’t get me wrong– build your character too!  But don’t think that good character will keep you from using—it is MUCH more complicated than that!

Photo by Jacqueline Leigh Frasca, available under a Creative Commons attribution license.