The psychology of addiction – and why it’s time we reshaped our understanding of it

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  • Having spent her childhood watching her father battle alcoholism, Charlotte Philby has since grappled with her own addictions. Here, she examines what makes people vulnerable and how to overcome the triggers

    Anyone who has grown up in the shadow of addiction knows the power it holds. As a child, you feel it when you’re driven from pub to pub in the small hours, looking for your dad’s car. It is lodged in your chest as you wait to be picked up from school by a parent who doesn’t arrive. You see it in the eyes of the police officer who arrests your father for drink-driving at 3pm in the afternoon. I can still feel those moments from my own childhood, like a stone in my gut.

    Is it any coincidence that children like me, who have grown up with the anxiety, chaos and shame of addiction, often fall into similar patterns later in life? Like many female addicts, I’ve battled everything from heavy smoking to bulimia and, considering my past, the fear of addiction has only been exacerbated by the idea that it is hereditary.

    This month sees the release of Woman Of Substances, a new book by Jenny Valentish, a consultant for Australia’s National Drug and Alcohol Research Centre. In it, the author draws on the latest in neuroscience and her own childhood experiences in suburban Slough and the London indie-rock scene, to Australia where she later ends up in treatment facilities and AA groups.

    Investigating the female experience of addiction, she pays particular attention to early predictors, such as childhood trauma, temperament and teenage impulsivity, and explores specific issues relating mostly to women, including eating disorders, self-harm, and the propensity to be drawn to abusive relationships. The link between these behaviours seems to be related to shame, lack of self-worth and anxiety – traits more commonly found in women.

    ‘One widely held assumption is that addiction is hereditary,’ says Valentish. ‘Sure, it often is – in part – but only that you’ll have inherited poor impulse control, or some features that make you more vulnerable to stress, such as anxiety, sensitivity to rejection and low frustration tolerance,’ she continues. ‘Within our DNA there are “switches” that activate or deactivate certain genes. Sometimes this change of gene expression is triggered by physical development – say, puberty or menopause – sometimes by stress and exposure to a drug. But repeated substance use can cause neuroadaptive changes in the brain that are the basis for craving, binging, tolerance and withdrawal.’

    In other words, it is possible to create the pathway for one destructive behaviour to eventually replace or intersect with another.

    As a classic high-achieving only child, I always felt the weight of the world on my shoulders, that fear of letting people down. In hindsight, smoking, taking drugs and restricting my food intake were ways of simultaneously finding a release and seeking to take back control, which all started around the age of 14 in that dislocating purgatory between childhood and adulthood. By the time I admitted I had a problem and was referred to the Russell Unit eating disorders clinic after two years on a waiting list, I was 26 and pregnant with my first child.

    At the time I believed it was my love for my unborn baby that was a more persuasive catalyst for change than the Cognitive Behavioural Therapy (CBT) I learned in treatment as an outpatient. But still, eight years on, I find myself referring to the tactics I learned then when situations become challenging and my instinctive response is to reach for one of my many tried-and-tested crutches.

    Valentish’s book dismisses that addiction is a disease, the theory preferred by the American Medical Association, Alcoholics Anonymous and Narcotics Anonymous.

    ‘In the US, it is necessary to have substance dependence classified as “chronic relapsing brain disease” in order to have treatment covered by private medical insurance. Also, a disease is, in theory, treatable by drugs, which keeps the big pharmaceutical companies happy,’ she says.

    But in the UK, the NHS defines addiction as ‘not having control over doing, taking or using something that is harmful to you… [although] most commonly associated with gambling, drugs, alcohol and nicotine, it’s possible to be addicted to just about anything’.

    Woman of Substances author Jenny Valentish

    So why do the children of addicts often become one themselves? In his TEDxRio+20 talk, ‘The Power Of Addiction And The Addiction Of Power’, expert Dr Gabor Maté explains that when the German army moved into Budapest during WWII babies started to cry en masse, without understanding what Hitler or genocide was.

    ‘What these babies were picking up on is the stresses, the terrors and the depression of their mothers. And that actually shapes the child’s brain… this is how we pass it on,’ he says, and the same applies to addiction, ‘We pass on the trauma and suffering unconsciously from one generation to the next.’

    Dr Paul Stanford is an addiction specialist who works regularly with opiate (heroin and crack-cocaine) addicts. He says while there are two well-established addiction models –biochemical, which focuses on what is going on in the brain, and social, which is about what leads individuals to be addicted and how their addiction interplays with their environment – much about the scientific causes of addiction is still unknown.

    In terms of the hit the addict gets from their addiction of choice – be it gambling, drugs, sex – much of the reward is about gamma-aminobutyric acid, known as GABA. ‘It’s an anticipation of the reward. For an 
alcoholic, GABA might be released if they see a pub sign, 
or beer being poured from the pump. The problem occurs 
if the release of the GABA isn’t then rewarded with the thing they crave; the contract has to be fulfilled,’ he says.

    Emma* stopped drinking at the age of 27 after she found herself secretly boozing at lunch and regularly having blackouts after nights out. ‘I worked hard to convince myself 
I was just having fun. Our social lives are so often based around the idea of drinking to let go, celebrate or just unwind. The worst thing when I stopped was having 
to always explain to friends why I wasn’t drinking. I had to remove myself from the temptation and the continuous questions by meeting friends in cafes or at home. Like many recovering addicts, I’ve had to train myself to focus on the things I want from life and the things that I don’t. It’s about constantly holding in mind the long view.’

    According to Valentish’s findings, childhood personality and temperament are strong predictors of problematic substance use in adulthood. The Australian Temperament Project has been following the children of 2,443 families in Melbourne since 1983. It found those who are less flexible, more reactive and less able to self-regulate their behaviour were more prone to addiction.

    How we talk and think about addiction is also important – language is key. In the US, terms such as ‘alcoholic’ and ‘substance abuse’ and ‘clean’ are used. In Australia, where drug strategy is based around harm-minimisation, the preferred language is ‘person affected by drug use’ and ‘level of dependence’. Terms, she says, that do not create an us-versus-them divide.

    Valentish is wary of labels that ‘disregard… our multifaceted selves and keep us forever in a box.’ When she decided to quit drinking and drugs seven years ago, joining AA at the age of 34 after exhausting every option, it was an overwhelming relief. But the pain did not instantly stop. As with most addicts she simply swapped one addiction for another.

    Her compulsions mutated, taking the form of bulimia − considered both an eating disorder and a mental-health condition. She also started smoking again after four years without cigarettes.

    When it comes to overcoming addiction, getting specialist help for the underlying causes is key. Marshall* is an NHS charge nurse working in substance misuse. He says, ‘You have to differentiate between the physical and the psychological. It’s fairly easy to treat physical withdrawal, but sadly it’s the psychological issues that present the risk of relapse. Generally, people who cannot stop using substances are self-medicating a deeper issue such as anxiety, childhood trauma, poor mental health or chronic pain. Often, it’s about having control, when you do not have a sense of control or autonomy elsewhere.’

    The best way to remove triggers for relapse is to avoid them, Marshall adds, but if they are internal you cannot avoid them so you need to replace them with something else, whether that’s purpose, self-esteem, mental-health care or pain control. The road to recovery has been a tumultuous process for Valentish, but she says the most successful quitters find healthy habits, sports or hobbies to fill the void.

    For me, recovery has come in the form of counselling, family and a fulfilling career. It’s also come from channelling my addictive personality into more healthy pursuits, such as writing. When triggers like stress or anxiety arise, I find CBT exercises – having a bath, walking around the block, anything that temporarily removes you from temptation and allows you to see how you feel in 20 minutes – really helps. Stress is one of the most dangerous triggers for addicts; it’s also the one thing you can’t avoid. That’s why finding ways to cope with stress, rather than pressing the self-destruct button, is key.

    *Names have been changed

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