It’s better to stand by someone’s side than by yourself–Jack London —
A study that will be published online on April 14 in Alcoholism: Clinical & Experimental Research found that patients who receive anti-craving medications first, and then psychotherapy, had a reduced or delayed relapse to heavy drinking when compared with patients who received medication and medical management only. (http://www.medicalnewstoday.com/releases/269087.php) I posted a link to this study in an online forum for addiction professionals last week and one colleague observed that even greater benefit might be achieved if addicts combined medication, individual therapy and a community-based support group. He is, of course, absolutely right.
Addiction is a disease that disrupts functioning in multiple dimensions of an addict’s life, including, but not limited to the physical, cognitive, social, psychological, spiritual, familial spheres. Especially in late stage disease, it is unlikely that an intervention aimed at a single aspect or symptom of the disorder will be enough to lead to stable sobriety. Last week, I wrote about the profound changes that occur in the reward centers and executive control regions of the brain as the disease of addiction progresses. Anti-depressant medications and anti-craving drugs like acamprosate and naltrexone can help to reduce the physical and emotional pain that result from these changes and that can become intense when addicts try to curtail their use of drugs and alcohol. However, there are many other problems associated with substance abuse and dependence that medications do not directly address, and these difficulties can also undermine the quest for sobriety. Among these difficulties is the social and emotional isolation of addicts. Their isolation and alienation from others is often extreme, and it can be hard to address, because, as addicts become progressively more oriented to drug rewards, they become less interested in and responsive to social relationships.
This phenomenon has been documented by recent research. For example, one study found that cocaine users are less responsive to social rewards than other people (http://www.leonhardschilbach.de/home_files/PNAS-2014-Preller-1317090111.pdf). The results of this investigation added to a growing body of research which shows that, as the brain re-models itself in response to drug rewards, all other rewards become less meaningful to addicts. The researchers who studied cocaine users suggested that impairments in social competence might explain why the social consequences of drug use, such as “imprisonment or familial problems” don’t prompt addicted people to quit using, and they stressed the importance of treatment interventions that are aimed at increasing social skills and competence and re-orienting addicts to social rewards.
Individual and group therapy, as well as community – based support groups like Alcoholics and Narcotics Anonymous , support sobriety in a number of ways, but a principal benefit is the creation of a relational framework in which important feelings and conflicts can be revealed and validated. This experience is particularly important for people who began using alcohol and drugs at a very early age and for people with a significant background of trauma. People who begin using substances or engaging in compulsive activities during early adolescence miss crucial developmental experiences, including important peer interactions, that foster the self-awareness and social skills that are needed to establish constructive and rewarding relationships. Survivors of chronic and severe childhood stress and trauma often grow up with similar deficits, and they may also be extremely skeptical about the value of close personal relationships.
I mentioned last week that genetics, trauma and biochemistry are the “usual suspects” when addiction develops. Trauma is a very big player in the addiction scenario, especially trauma that occurs early and often in an individual’s life. People who grow up in traumatic family circumstances may fail to develop any sort of confidence that engaging in emotionally intimate relationships with others will be soothing or helpful to them in life. On the contrary, they have learned that close relationships usually lead to great pain. These folks are extremely vulnerable to addictive substances and activities because they have no other means of relieving suffering. As one psychoanalytic writer observed, in terms that will be familiar to addicts and addiction professionals alike, a trauma survivor who enters treatment soon comes to the disturbing revelation that he is being cured “ by means of a hair from the tail of the dog that bit him” –that is, examination of his pain in the context of a human relationship (Fairbairn  1981, 75) . It is likely that many members of 12-step groups rapidly come to the same unsettling conclusion!
A special thanks to Julie Buckles for the use of this beautiful photo of Jacques and Flin Flon and for the inspiration from Jack London. If you are weary of reading about addiction and recovery now, and would like to take a break, bask in nature and grab some terrific recipes, visit Julie’s blog at http://www.juliebuckles.com/. Better yet, read her new book, Paddling to Winter, available on Amazon.com. It’s a true story of physical adventure… and the rewards of deep human connection.