Is Addiction an Intimacy Disorder?
In his popular 2015 TED talk, “Everything You Think You Know about Addiction is Wrong,” journalist Johann Hari discusses research into the underlying causes of and effective treatments for addiction, ultimately concluding, “The opposite of addiction is not sobriety, it’s connection.” While Hari is not a scientist and he tends to overgeneralize in his presentation, making it relatively easy to nitpick, his belief that addiction is linked to early-life and adult struggles with emotional intimacy is, in my opinion, right on target. In fact, any therapist who has worked with addicts on a relatively routine basis will recognize the addictive pattern he describes.
Put very simply, when addicts face challenges and become emotionally needful—related to stress, losses, anxiety, depression, and even joyful experiences—they automatically and without conscious thought turn to an addictive substance or behavior as a source of emotional distraction. (Meanwhile, faced with the exact same stimuli, non-addicts typically seek down-regulation through emotional connection with supportive and loving people.) So with addicts we are dealing with individuals who lack, fear, and avoid emotional intimacy, and who therefore seek comfort and soothing elsewhere, most often via sources that do not require emotional vulnerability.
After almost 25 years as an addiction treatment specialist, I honestly cannot recall a single client who did not learn early in life (through abuse, neglect, and further traumas) that turning to other people for support, validation, and comfort would get you hurt, leaving you worse off than before you reached out. As such, these individuals learned to avoid the type of deep relational connections that, for healthier people, bring needed consolation and reward, finding it easier and emotionally safer to simply escape and dissociate through hyper-stimulating and/or hyper-satiating substances and behaviors. In short, they learned to engage in their addiction as an adaptive distraction from their painfully unmet womb-to-tomb emotional dependency needs.
Recognizing this, I believe that addictions may be improperly classified as “use disorders” in the DSM-5. From my perspective, it would be more accurate to refer to addictions (and to treat them) as what they really are—adaptive coping responses to complex childhood trauma and related attachment disorders. And yes, I know that I am sticking my neck out with this statement.
To be clear, I’m not talking about a purely physical dependency, which is something any mammal can and will experience if exposed to an addictive substance for a long enough period of time. For example, people who are prescribed heavy doses of opiates can become physically dependent if they’re on these drugs for a long enough period. That is a given. But that kind of dependency is readily reversible. In fact, as long as withdrawal symptoms are properly managed, ending that type of substance abuse is a short-term and relatively painless process and the dependency is not likely to recur. For true addicts, however, those whose dependency extends beyond the physical, getting away from the opiates (or whatever the addiction happens to be) is merely the tip of the iceberg. Their lack/fear/avoidance of vulnerability and emotional intimacy must also be addressed.
My argument starts with the basics of attachment theory, initially considered and developed as a psychological construct by John Bowlby in the 1940s and 50s. Bowlby studied, among other populations, European WWII orphans, finding that even though these children were provided adequate food, shelter, and general physical care, they did not seem to thrive like normal children. In fact, some of them developed so poorly that they actually died. Based on this research, Bowlby began to think that the development of emotional bonds might be an evolutionary survival mechanism.
Initially, Bowlby’s theories were almost universally dismissed. However, he and a few other psychotherapists conducted further experiments on a variety of populations—war widows, juvenile delinquents, non-orphaned infants, married couples, and even monkeys. And the results were always the same. Those who did not feel securely emotionally attached ultimately became depressed, anxious, and self-destructive.
Today, it is widely accepted that humans, especially children, have an innate, hardwired need for emotional closeness, and we ignore this requirement at our peril. Recognizing this, it is no surprise that we consistently find significant links between early-life family dysfunction/trauma and later-life emotional and psychological disorders. Essentially, when children do not feel safe or as if their emotional needs will consistently be met by their caregivers, they lose their ability to trust and effectively attach. Even worse, they internalize blame for the dysfunction and trauma they experience, thinking there must be something inherently wrong with them that makes them unlovable and unworthy of healthy emotional connections.
Think here of the chronically physically abused child who, showing up at the social worker’s office for his monthly visit, explains his broken wrist by saying that he fell down (instead of telling the truth about what his caregiver did to him). This is not uncommon, as children will often protect their caregivers absolutely, even when they are abusive. They do this because they need those caregivers on multiple levels. So when a caregiver fails them through neglect, abuse, and the like, they tend to blame themselves rather than the adult. They think, “If I wasn’t such a bad kid and didn’t need so much, Daddy wouldn’t yell at me and hit me. So next time I’ll just keep quiet and this won’t happen.” Thus begins a lifelong struggle with shame (feeling defective, not good enough, and unworthy of love) and the avoidance of emotional vulnerability.
Essentially, as attachment and trauma research predicts, neglected and abused children typically fail to thrive (as kids and also as adults). They become shame-based, disconnected, depressed, anxious, angry, fearful, etc. Mired in emotional discomfort and not trusting others to alleviate this discomfort in a healthy or timely way, they automatically seek other forms of emotional regulation. Often, they turn to an intensely pleasurable (and therefore numbing/escapist) substance or behavior—food, cigarettes, alcohol, drugs, sex, etc. In time, they learn that this maladaptive coping mechanism is the quickest and easiest way to not feel the pain of their unmet needs and emotional disconnection. As they turn to this coping mechanism over and over, they become addicted. And as their addiction worsens, they become even more disconnected, increasing their sense of shame and their emotional isolation.
In this way, addiction is a vicious and self-perpetuating cycle—a cycle that typically starts very early in life. In a nutshell, children are emotionally and physically vulnerable, needing healthy and reliable care on multiple levels. If they are physically and/or emotionally neglected and/or abused, they learn that their caregivers (and others) either cannot or will not meet their emotional needs. This creates emotional distress, self-blame, and a deeply internalized sense of shame. In time, these individuals learn to avoid and dissociate from the emotional discomfort wrought by their shame and their unmet dependency needs via an addictive substance or behavior. My colleague Brené Brown describes this process as succinctly as anyone, writing, “For me, vulnerability led to anxiety, which led to shame, which led to disconnection, which led to Bud Light.”
This brings us back to Johann Hari’s claim that the opposite of addiction is connection. Needless to say, Hari is not the first person to characterize addiction (and addiction recovery) in this way. He’s just the first guy to get a TED talk for doing it. The simple truth is increasing numbers of addiction treatment specialists and forward-thinking trauma/addiction treatment programs have operated with “addictions are an intimacy disorder” as an underlying principle for years. In fact, almost everything we do in treatment (and much of what occurs in 12-step recovery programs) is geared either directly or indirectly toward the development of healthy emotional bonds, understanding that this, not willpower or threats of further consequences, is the pathway to lasting sobriety and a happier life.
Addiction treatment specialists have long known that human beings are social animals. Humans enter the world completely dependent on others for shelter, nutrition, and emotional support. And these core requirements do not change as we grow older, though they do become more sophisticated in their expression. Unfortunately, as we move into adulthood our culture tends to discount the need for emotional connection, despite the well-documented fact that individuals who spend their lives “apart from” rather than “a part of” are much more susceptible to depression, anxiety, addiction, etc. And for people with deeply rooted attachment deficit issues, nearly always developed as a result of childhood trauma and other forms of early-life dysfunction, this susceptibility to later-life problems increases.
Knowing this, it seems logical that bringing addicts back into the world and connecting them with safe, supportive, empathetic others would ultimately be the most effective way to combat addiction. And it is.
Typically, this reintegration process starts with individualized addiction treatment, expanded (as soon as the client can tolerate it) to addiction focused group therapy and 12-step recovery. Though the addict may feel more comfortable (safer) in a one-to-one therapy setting, it’s the group settings—where addicts interact on an emotionally intimate level with peers—that are most effective. Without fail, the more people an addict connects with and learns to trust, the better off he or she will be. In time, recovering addicts are able to “earn” a sense of emotional security, greatly reducing their sense of shame, their emotional discomfort, and their desire to escape and dissociate through an addiction. In other words, the maladaptive lessons learned by addicts in childhood can be cognitively unlearned via empathetic and supportive adult emotional interactions.
Importantly, these empathetic and supportive emotional connections need not be limited to the small community of addiction treatment specialists and recovering addicts. Society at large can also play a helping role. For instance, the nation of Portugal, after decriminalizing illicit drugs in 2001, has tried very hard to (re)integrate addicts into their communities, offering not only traditional treatment and counseling but subsidized jobs and social programming. Essentially, Portugal has made a nationwide effort to help addicts connect with the world and the people around them. And it’s working, too. Since 2001 problematic drug use is down, including adolescent drug use, drug-related harms, and drug-related deaths. Admittedly, cannabis use is slightly up, but that may be a matter of people choosing to smoke rather than drink now that marijuana is legal. So in general Portugal’s strategy of connecting instead of incarcerating addicts has been effective.
In the US, our government and our society are not generally as supportive. However, addicts can easily find both professional treatment and non-professional support groups, many of which are cost-free. For instance, 12-step groups “pass the basket” and most people toss in a dollar or two to help defray expenses, but only if they have the money and want to contribute. And many online recovery sites, such as InTheRooms.com, are completely free of charge, offering online meetings for just about every imaginable addiction and even specialist information sessions like my weekly open-ended discussion on sex, porn, and love addiction (Fridays, 6 pm PST).
Frankly, I find it hard to even question that a primary key to overcoming addiction is the development of healthy emotional and societal connections. After all, the human drive to emotionally attach is as innate and basic to life, health, and happiness as the drives for food and shelter, and without this attachment we are certain to struggle. In other words, as my colleague Sue Johnson writes, “We need emotional attachments with a few irreplaceable others to be physically and mentally healthy—to survive.”
Unfortunately, developing these important connections can be difficult for addicts, who nearly always have a history of childhood trauma and other forms of early-life family dysfunction. For these individuals, learning to trust, reducing shame, and feeling comfortable with both emotional and social vulnerability takes time, ongoing effort, and a knowledgeable, willing, and empathetic support network (therapists, fellow recovering addicts, family, friends, employers, etc.) The good news is that both research and hundreds of thousands of healthy, happy, long-sober addicts have shown us that this type of healing is not only possible, but incredibly worthwhile.
Weiss LCSW, R. (2016). Is Addiction an Intimacy Disorder?. Psych Central. Retrieved on April 26, 2018, from https://blogs.psychcentral.com/sex/2016/05/is-addiction-an-intimacy-disorder/