On the go? Listen to the audio version of the article here:
When considering what drives addiction, there are many misconceptions. Persons with an addiction are not merely lacking will-power. Instead, they are coping with underlying issues through addictive substances or behaviors, causing long-term changes in the brain that make it difficult to escape the cycle of addiction.
As an addiction counselor, this is something I’ve learned both academically and through experience working with clients using addictive substances or engaging in addictive behaviors.
Addiction is driven by neurological changes related to dopamine, the reward center, and the self-regulatory center in the brain. This produces a learned pattern of coping with underlying pain or unmet needs.
Let’s unpack this statement and make sense of what drives addiction in more specific terms.
The Neurological Drives
Although addiction is often called a disease, recent research finds it is more aligned with the brain’s learning mechanisms. Therefore, addiction is a learned behavior, reinforced by the chronic use of a substance or behavior to stimulate pleasure or provide relief from pain.
For example, imagine you regularly carry a high level of stress or anxiety. When getting home from work, you drink a few alcoholic beverages to relax. Over time, this becomes a habit, requiring more alcohol to gain the same effect.
This is an unconsciously learned behavior because your brain discovers that the use of alcohol solves your current problem. The part of your brain learning this short-term adaptive behavior is distinct from the part of your brain in charge of higher reasoning that would rationally know this is not a long-term solution.
Let’s roughly distinguish between two major parts of the brain: the higher brain and the lower brain. This will be a rough neurological sketch, focusing on the main aspects relevant to addiction.
The higher brain is the rational outer layers developed later in evolutionary history. According to research, the most recent area is the pre-frontal cortex, located around the forehead, which is especially developed in humans. This part of the brain regulates emotions, providing impulse control.
The lower parts of the brain are involved in emotions and motivation. The central part involved in motivation is the Ventral Tegmental Area (VTA). The VTA produces dopamine, sending most of it to the pleasure center (Nucleus Accumbens), providing a reward. These rewards are triggered when you solve a problem, reinforcing this particular behavior. This is how behavior is learned and how we can adapt to new or challenging situations.
This learning mechanism in the lower parts of the brain is focused on short-term gains rather than the long-term planning associated with the higher brain. In any area of life, motivation is produced through dopamine production in the VTA when you successfully complete a novel task. This is particularly powerful when the reward is unexpected, as in the case of gambling.
Although this process occurs primarily outside of the upper brain’s higher-order reasoning, the upper brain then gets consulted after the fact. The reward experienced in the lower brain gets communicated to the upper brain, telling it to make sense of this situation and plan for future scenarios where this behavior may need to be drawn on. For example, your upper brain will rationalize why it’s a good idea to continue using alcohol to cope with stress, in addition to planning for continued drinking.
This is a rough outline of the major neurological forces driving addiction. Beyond brain circuitry, the content of thoughts is also important, so let’s consider the cognitive realm.
The Cognitive Drives
Simply put, cognition means the realm of thoughts. This activity occurs in the upper brain and is highly intertwined with the language centers. In the case of addiction, this can refer to the beliefs one has about oneself or one’s behavior.
For example, as previously mentioned, you may develop reasons why addictive behavior is necessary or beneficial. Perhaps drinking after work each evening is justified by the thought that it makes you a better parent since you are less stressed.
Addictions are often based on illusory ideas about unmet needs. For example, alcohol may promise relaxation, gambling may promise hope, opiates may promise love, and cocaine may promise self-esteem. These false promises are reinforced by the short-term effects of the substance or behavior, blinding you from the long-term consequences. Even when these consequences are recognized, the substance or behavior disguises itself as the savior.
Beyond the illusions and rationalizations that drive addiction, one’s thoughts about oneself are also an underlying driver. For example, many people are driven to addictive substances or behaviors to cope with the anxiety produced by the belief that they are not good enough.
These underlying thoughts regarding one’s self-worth may go back to childhood. Whether or not there was a major traumatic experience, many people internalize thoughts about themselves that were reinforced by others around them.
Growing up with the constant thought of not being good enough may escalate throughout one’s life, especially while taking on further responsibilities in adulthood. This can result in underlying anxiety regarding one’s ability to handle future situations, affecting one’s self-esteem as well.
This cascade of negative thoughts regarding oneself can lead to substances or behaviors as a form of short-term coping. As previously discussed, this short-term relief triggers the brain’s reward pathways, reinforcing a long-term pattern of habitual behavior.
The Interpersonal Drives
The interpersonal realm consists of one’s quality of social connection. As discussed in my article, The Impact of Isolation on Addiction, I shared Bruce Alexander’s famous Rat Park Study. He highlights how addiction is a disease of isolation, where substances are used to cope with isolation, producing even more isolation.
Researchers discovered how rats tended to overdose in the Rat Park Study when provided drugs while alone in a cage. These overdoses no longer occurred when rats were kept in the company of other rats.
Human beings are social creatures and isolation causes us deep emotional pain. Social isolation is an often overlooked health concern and recent research suggests it is as dangerous as smoking.
In a TED Talk, Robert Waldinger emphasizes the dangers of social isolation, stating:
“Loneliness kills. It’s as powerful as smoking or alcoholism.”
Physical health issues receive a great deal of attention, while interpersonal health is often neglected. Luckily, social determinates of health have gained traction in the scientific literature. Recent research looked at the impact of loneliness as a risk factor for mortality and found:
“Current evidence indicates that heightened risk for mortality from a lack of social relationships is greater than obesity.”
Coping with isolation through addictive substances or behavior is one-way social isolation can affect one’s physical health. For example, coming home from a stressful day to an empty home may result in coping through consuming alcohol.
Without addressing the underlying isolation and unmet social needs, one’s physical health may deteriorate as the short-term coping results in long-term harm. This can make it increasingly difficult to meet one’s underlying needs in a healthy way in the long-term.
Conclusion
The neurological, cognitive, and interpersonal processes driving addiction are all intertwined. Although it is possible to analyze addiction on multiple levels, addiction is often experienced as a way to gain relief from an underlying source of pain, whether it’s past trauma, anxious thoughts, depressed moods, or the pain of social isolation.
If you want to learn more about the lived experience of addiction, I’ve written more on the topic in the article, What Does Addiction Feel Like?
On the go? Listen to the audio version of the article here:
As a certified gambling counselor, I’ve often been asked how to stop gambling. Some individuals just want to save money, realizing they have been spending too much on gambling. Others are looking to completely stop gambling because they have lost control, and it is causing significant problems in their lives.
In this article, I provide seven ways to stop gambling and save money. I’ve developed these strategies over several years of working within a casino doing problem gambling prevention, helping people who are struggling with their gambling, in addition to working within a hospital setting, providing residential support to persons recovering from problem gambling.
Although gambling functions like any other addiction, there are some important distinctions to consider. Hopefully, this article helps you make sense of the unique features of problem gambling, in addition to providing some useful tools to help you gain back control.
If you specifically struggle with online gambling, you can check out my updated article on How to Stop Online Gambling. It goes into much greater depth, offering practical ways to navigate this issue in the age of digital gambling.
Lastly, you can also check out my recent video on how to stop gambling:
Let go of common gambling fallacies
Unlike other forms of addiction, gambling relies on the powerful force of random reinforcement. Rewards are distributed randomly, causing players to develop distorted thoughts regarding their level of control over the outcome. This is especially powerful if someone had an early big win.
Here are some common gambling myths and reasons why they are not true:
“I have a system for winning.”
This is an illusion of control. Although our minds are built to find patterns and predict outcomes, this is not helpful in the artificial world of gambling where outcomes are random. Seeking the need for coherence and understanding, we develop rigid rationalizations, trying to make sense of the outcomes. We may feel like we have a system, but outcomes in casino gambling are random.
“It is due to pay out soon.”
This is a form of false hope. For slot machines, and several other forms of electronic gaming, outcomes are determined by a random number generator (RNG). It is a computer chip that automatically generates thousands of random number combinations every second and is always running, even when you are not playing. Hitting the “spin” button selects the random number it happens to be generating at that exact moment, converting it to a position on the reels. Therefore, it is never due to pay.
“If I keep playing, I can win my money back.”
This is another form of false hope based on the idea that hard work should ultimately pay off. Although this may be an adaptive rule in real life, it does not apply in the gambling world. Casino games are always configured to take more money than they give back. This is also known as the “house edge”.
Although outcomes are random, the amount of money you get for a win is less than the amount you spend on a loss. For example, it’s like betting $1 on a coin toss and only getting around $0.85 if you win. Since you’ll end up paying $1 roughly half the time and earning $0.85 roughly half the time, you can see how this is a losing game in the long-run. In casino gambling, the longer you play, the more you pay.
“I feel lucky today.”
This is the illusion of control, combined with false hope. Our intuitions may serve us well in everyday life, allowing us to sense subtle social cues and adjust our behaviours accordingly. In the world of gambling, intuition is more like a form of magical thinking.
Other forms of magical thinking include the use of good-luck charms, prayers, or rituals such as touching the machine in a certain way. If this is simply for entertainment purposes, it may be harmless, but if it is an attempt to control the outcome, it will merely lead to further disappointment in the long-term.
These gambling fallacies promise a sense of control and hope for a better future, but they are illusions that actually do the opposite. You may feel a false sense of control and hope in the short-term, at the expense of genuine control and hope in the long-term.
Decide if gambling is really worth it
Deciding to stop gambling ultimately comes down to whether or not gambling is worth it. Even if it’s not worth it monetarily, most people who have problems with gambling say it’s not about the money. You can recognize the financial downside, but still enjoy the sense of escape.
Here are some common reasons people continue gambling:
“Gambling makes me happier”
Even if you know you are spending more money than you are getting back, you may justify continued gambling based on its ability to make all of the world’s problems go away temporarily. Using gambling to escape is one of the most common forms of gambling, especially among those who use electronic games such as slot machines.
Although many people in the early stages of problematic gambling may believe it makes them happier, this illusion is often shattered when their lives become unmanageable. Gambling offers a false promise of happiness, just like it offers the false illusion of control and false hope for a better future. Genuine happiness can be built, only after letting go of the illusion provided by gambling.
“I can make money gambling”
I have heard this several times from persons who engage in professional forms of gambling where a significant amount of skill is involved. For example, tournament poker allows players to gain a slight mathematical edges on one another, making it a game of both skill and chance.
The first question I would ask is whether or not your gambling is actually profitable. Do you keep a balance sheet, closely tracking your wins and losses? Are you treating your gambling like a business? If so, and you are profitable, I would ask you this question: Is it worth it?
Let’s say you’re actually able to make a bit of money. Is this amount of money worth the roller-coaster of stress? Is it worth risking the relationships it is perhaps putting in jeopardy? Is it worth the constant lying, loss of integrity, and resulting low self-esteem?
What do you truly value in life? Is gambling getting you closer or further away from that?
“I’ll be bored if I stop gambling”
Many people looking for gambling support can’t imagine their lives without it. By this point, gambling often becomes a full-time job. Spending so much time gambling, other hobbies and interests go by the wayside. In my years talking to patrons who frequently visit the casino, one of the most common reasons to continue gambling is that there is nothing else to do.
Although gambling may feel like the only form of leisure activity currently, I’ve seen many people adjust to an enjoyable life outside gambling. It may take some brainstorming at first, but given time, it is possible to rekindle old hobbies and find new fulfilling activities to engage in.
This fear of boredom is common in all addictions, so if you’re interested in learning more, check out my article 16 Reasons Being Sober Is Worth It. Many of the lessons apply to gambling as well.
Self-exclude or use a gambling blocker
This is another area unique to gambling addiction. Unlike bars and liquor stores, you can ban yourself from casinos and block yourself from gambling sites. This has actually been a significant part of my role within casinos. When someone decides they want to ban themselves (self-exclude) from a casino, there is a process to sign themselves out while receiving emotional support and information on treatment resources.
GameSense is a larger North American organization dedicated to this form of support. Since I’m familiar with the North American system, I will just speak to my understanding of the process in this context. Also, procedures may vary depending on the casino.
Larger venues owned by major chains often have sophisticated facial recognition software. When signing yourself out, your photo is taken and entered into the system, alerting security if you enter. Recently, I’ve witnessed considerable gains in the accuracy of this facial recognition software.
Self-exclusion provides an immediate deterrent, allowing someone to form new habits. Unfortunately, gambling is now everywhere. Many people who cannot enter the casino may take up gambling online. One helpful application that provides an online version of self-exclusion is Bet Blocker. This is an app that blocks all gambling-related content and can be installed on your computer or mobile phone.
Replace gambling with other activities
Once you’ve decided to commit to changing your habits, it is important to consider healthy replacements for gambling. Since gambling can take up a significant amount of one’s time, self-excluding can often result in boredom, fuelling the desire to return to gambling.
Consider the things you used to do before gambling took over. If these activities are no longer appropriate, consider trying new activities or learning a new skill. If you’re interested in learning something new, I recommend checking out sites like Skillshare. With thousands of classes to choose from, this online community allows you to gain new skills, network with peers, and find new opportunities. Check out their free trial here.
*As an affiliate partner with Skillshare, I receive a commission if you sign up for a free trial.
Identify your gambling triggers
Identifying your gambling triggers means noticing the people, places, and things that make you automatically desire gambling. This may be a specific group of friends, a particular route on your drive, or having access to a particular device.
Many people who regularly visit a gambling venue form friendships around their shared interest in gambling. Although this may be a healthy form of social connection for some, it can be unhealthy for others who feel trapped in patterns of gambling. It becomes even more problematic when people begin loaning money or asking for loans.
Gambling venues have their own internal culture and networks of regular visitors, providing a sense of belonging. It is crucial to notice when the people you surround yourself with are not aligned with your values. If you find yourself lending money to others, it could be helpful to determine if this is a form of co-dependency. To learn more, check out my article, When Does Helping Become Enabling?
When it comes to places that might be triggering, consider where you are when you feel the urge to gamble. Is this along a specific part of your drive? Is this during a particular part of your day? Many people find it helpful to take new routes home or include social supports in specific aspects of their day when they regularly feel the strongest desire to gamble.
Lastly, consider the specific things in your life that trigger gambling. For some people, this may mean getting a non-smartphone or a phone without access to the internet. Since gambling is now accessible everywhere, merely having a smartphone can be a strong trigger in early recovery. If taking a break from your device is not feasible, perhaps it could mean blocking or deleting certain apps.
Uncover what’s driving your gambling
As stated earlier, when gambling becomes an addiction, it is often no longer about the money. Gambling is often used as a way to escape from deeper issues such as stress, anxiety, pain, boredom, or loneliness.
Consider any unmet needs and how gambling is serving as a temporary solution at a long-term cost, taking you further away from actually meeting these needs.
In that article, I delve into the six underlying needs driving addictive forms of coping, offering tips on how to meet these needs more effectively, in addition to providing further resources.
Seek gambling-specific counseling
If you want to gain back control over your gambling, reaching out for support significantly increases your odds of success. Various mental health and addiction professionals may be helpful, but many people do not realize there are dedicated gambling counselors who specialize in this specific area.
If you are starting to think gambling is no longer worth it, I am currently accepting new clients residing in Canada or the US.
Send me a message here to request a free 15 min consultation or click here to learn more.
On the go? Listen to the audio version of the article here:
If you are thinking about addressing your relationship to alcohol or substances, you may ask yourself if being sober is worth it. Sobriety may look boring, difficult, and unappealing, but the drinking or substance use might be starting to impact the rest of your life, making things even more challenging to manage.
It may feel like you have to choose between chaos and boredom. Right now, these may seem like the only options. Fortunately, there is another way forward.
In this article, I share the experience of Stephanie, a fellow recovery advocate. Four years ago, Stephanie could not imagine living in a state of sobriety. Now, she is pursuing her dream of helping others in recovery. Here are her reasons why it’s worth being sober:
Being sober is worth it because you can live a life of meaning and purpose, you feel healthier and more vital, you’re thriving rather than just coping with life, and you’re no longer living in a constant state of guilt and shame.
The decision to stop drinking or using substances can often feel like an internal debate, so let’s consider the arguments for and against each of these reasons.
If you or someone you know is struggling with mental health or addiction issues, you can check out my resource page for suggestions on how to find help.
You can live a life of meaning and purpose
People may turn to substances due to boredom or the lack of meaning and purpose in life. Using a substance to cope with daily life may take the edge off temporarily, but it further entrenches a person into patterns of behavior that make it more difficult to escape.
You get to build the life that you want.
Your mind may argue, “I don’t know what kind of life I want to build anyway…”
Stephanie says:
“You can build any life you want. Sobriety is a rebirth into clear-headedness. You can pick what you want to do and build your goals from that.”
A helpful technique from Acceptance and Commitment Therapy (ACT) requires gaining clarity regarding your values. One way to do this is to think of a particular role model in your life. What characteristics do they have? What do you value about them? How might you live by some of these values in your own life?
Your life is worth living every day.
Your mind may argue, “But my life is not worth living. I’m hopeless, and I’m a burden on others. They would be better off without me.”
Stephanie says:
“Every life is worth something. Addiction makes us think that we are nothing. We feel we have nothing left to offer, and all we have done is hurt our families and friends. When we are not using, we can build more meaningful relationships and build a life we feel is worth living.”
A helpful ACT technique consists of taking a step back from thoughts like “I’m worthless.” Rather than thinking, “I’m worthless,” consider rephrasing it as “I’m having the thought that I’m worthless.” This small change of wording in your self-talk makes a significant difference, allowing you to take a step back and regain focus on what matters.
You get to see your kids grow up
If you have kids, your mind may tell you they don’t notice, it makes you more fun around them, or it’s not that bad.
Stephanie says:
“Addiction tells us we can use so that it can work it’s way in and set roots. Are you sure you are more fun around your children? They may have a very different perspective. We think we can hide our use, but it is not always hidden as well as we think. Think about when a person is drunk and trying to be quiet.”
If you have any variation of these thoughts, it may be useful to take a step back and reconsider what others might be seeing. In ACT, this consists of perspective-taking. Imagine looking into your child’s eyes, and you see them looking back into yours. Put yourself behind their eyes, looking back at you. What qualities do you want them to see in you? What qualities would you want to see in yourself?
You can help the community in a way others can’t.
Your mind may tell you, “what did the community ever do for me?”
Stephenie says:
“Not all of the community is against you, and you have allies. You will not be alone. But no one can help you unless you help yourself first. Although the work is going to be within you, you will need outside support, and with time, you can find that.”
One of the key lessons in Alcoholics Anonymous (AA) is the healing power of connecting with something beyond yourself. For some, this may be connecting with their understanding of a higher power. For others, this can mean connecting with a community.
You’re thriving, rather than just coping
When using substances to cope with underlying pain or boredom, this short-term solution prevents one from achieving a state of thriving. Instead of just getting by, sobriety allows you to strive toward your full potential.
You never worry if your utilities will be shut off.
Your mind may tell you that you don’t have financial problems, so this is not a concern.
Stephenie says:
“…addiction makes millionaires into homeless people. I’ve seen it a lot.”
Even if drinking or substance use does not lead to financial issues in the present, it could result in increasingly putting off financial responsibilities and disorganization in many areas of your life.
You learn to deal with life in a way that isn’t going to kill you.
Your mind may tell you, “It’s only a few beers or a bottle of wine in the evening.”
Stephanie says:
“It starts as a couple on the weekend and then turns into a few a night. Eventually, the party always ends, and the nightmare begins. It always ends the same way, and it’s not pretty. It will kill you; it’s only a matter of when.”
When drinking or substance use gets out of one’s control, it can spiral downward at a rapid pace. The difference between casual drinking and drinking to cope with underlying issues is that the latter eventually gets out of one’s control, causing increasing harms as use escalates.
You’re not living in a constant state of withdrawal.
If you experience physical pain when stopping opioids or constant shakes when stopping alcohol, your life may start to revolve around obtaining the substance to feel normal.
Stephanie says:
“…no withdrawals is freedom for me. That was what held me prisoner. I couldn’t be sick like that.”
Freedom from continually impending withdrawal means having a significantly greater amount of choice in one’s life.
You’re not living in content guilt and shame
Guilt is a sense of doing something wrong, whereas shame is the sense of being a bad person. Both often show up when struggling with substances.
You earn back respect and trust.
Your mind may tell you it’s hopeless and that no one will ever trust you again. It may feel hopeless right now, but trust can be rebuilt over time.
Stephanie says:
“Trust can be built. While it’s harder to build with some and some relationships will never be repaired, we can build new relationships and repair the ones that are fixable.”
When trust is lost, words alone are no longer enough. Trust is built through repeated patterns of committed action over time.
You don’t feel worthless anymore.
Your mind may tell you’re worthless and that you don’t deserve a better life.
Stephanie says:
“We can’t change what others think, but we can change what we think. When we look into the mirror, the person we see in addiction is very different than the person we see in recovery. I am happier with who I see, and I see the people around me change how they deal with me and treat me.”
Changing what we think requires recognizing these patterns of unhelpful thoughts and changing the way we respond to them. Greet the thought like an old friend, telling it that it’s not helpful right now. Then, letting it be, ask yourself what matters right now. Then, move forward, committing to actions that are most relevant to the things that matter.
You feel healthier and more vital
There are many health benefits to sobriety. Although we may often hear this from medical doctors, it is hard to internalize unless we experience it first-hand.
There are no hangovers.
This is the most obvious and immediate benefit of being sober. Hangovers can derail our entire day, taking us further away from moving toward a valued direction in life.
With the increased energy and improved mood, you can focus on more meaningful areas of life rather than merely coping with a state of impaired health and well-being.
You’re more present, focused, and sharper.
Chronic substance use can impair your ability to think quickly, clearly, and retain information. Depending on the substance, the effect can vary, but I’ve personally talked to many people who noticed a significant negative impact on their brain function.
Stephanie says:
“You can see life clearly and find solutions to the issues we would have normally not been able to because drugs would be clouding our perceptions.”
This clarity allows for increased progress in all areas of life. Being sober can lead to improved memory, cognitive function, in addition to an enhanced ability to cope with stress.
You have a better schedule.
When frequently using alcohol or other substances, life can become chaotic, making it challenging to stick to a schedule.
Stephanie says:
“You are not up all night using and sleeping all day. Having irregular sleep patterns leads to us generally feeling yucky and doesn’t help in maintaining a life we can be proud of.”
When regaining a sense of order and healthy habits, motivational momentum snowballs into building a life you can be proud of.
Conclusion
When contemplating sobriety, the voices in your head may be engaged in an endless debate. As described in my article on the Types of Denial in Addiction, our minds can make up many reasons why we don’t have a problem.
If you are thinking about getting sober and are wondering if it’s worth it, hopefully the reasons presented here can help you in your journey. If you would like to reach out to Stephanie, you can find her on Facebook here. You can also check out her powerful story of addiction and recovery here.
Although being sober has been worth it for Stephanie, along with many other individuals I’ve spoken to, there are still some people who may disagree. If being sober is just as difficult as using substances, or worse, this may be a sign that some underlying issues are needing to be addressed.
If this is you, counseling may be a helpful way to work through difficult thoughts and painful emotions driving the urge to use substances. For more information, see my article on The Benefits of Counseling.
As an addiction counselor, I offer online counseling to persons struggling with alcohol, substances, gambling, and gaming. If you would like to discuss whether counseling is right for you, contact me here.
If you are a parent of a son struggling with an addiction, you may often feel frustrated and powerless.
Young men are less likely to seek support for underlying mental health issues, according to research. A study looking at the role of masculinity found that masculine norms act as a barrier to seeking support.
Isolation, denial, and lashing out are common defenses against the fear of admitting to having an addiction or underlying mental health issue.
If your son is struggling with an addiction, how can you help?
Don’t blame yourself
Set personal boundaries
Engage in helpful communication
Find a counselor or support group
Each of these strategies will help you be the most helpful version of yourself while also recognizing your limits. Let’s take a closer look at each of these areas.
Don’t Blame Yourself
All the knowledge in the world cannot prevent someone from falling into an addiction. There are far too many variables involved, and it is impossible to control every single risk factor.
Even though it is unrealistic to take on the weight of self-blame, it is a normal response. In an article in the Washington Post, a mother shares her experience with this guilt and shame as she battled with her son’s addiction:
“…the feelings of guilt and shame are universal. Guilt for what we did or didn’t do, said or didn’t say. Shame for our imperfections and limitations, because even with all our endless expressions of love and concern, we couldn’t wrestle our children free of this demon of addiction. No matter how hard we fought, the addiction always seemed to win, leaving us alone with our anger, frustration, fear, helplessness, hopelessness.”
Although this self-blame is common and expected, it is helpful to step back and decide whether or not this is a helpful response.
Internalized anger only further contributes to the suffering in an already stressful situation.
Addiction is often thought of as a disease that changes the brain over time. It starts as a choice and incrementally becomes less within a person’s control.
How useful are thoughts like the following: “I’m a bad mother/ father… If only I did something differently… It’s my fault.” These kind of thoughts keep you living in the past, focused on hypothetical situations.
To be the most effective version of yourself, staying in the present moment is most helpful. If you find yourself continually struggling with thoughts of self-blame, consider trying some of the techniques I discuss in my article, “How to Stop Living in Your Head“.
Set Personal Boundaries
Setting boundaries can be one of the most challenging areas for parents. As a parent to a child with an addiction, you walk a fine line between being supportive and enabling.
Enabling someone with an addiction means having low personal boundaries, a lack of firm rules, and a tenancy to do things for them that prevents them from experiencing the natural consequences of their behaviors.
For example, if someone has a gambling addiction, enabling consists of paying off debts for the person.
Enabling consists of needing to “rescue” a person, stopping them from the opportunity to grow from adversity.
Addiction is the result of a learning mechanism in the brain. An addictive substance or behavior rewards the individual, taking away short-term pain. If the long-term consequences of that short-term relief are not experienced, it trains the individual to continue the addictive substance or behavior.
Setting boundaries that allow your son to fail can be one of the most challenging and most loving acts. Although enabling feels like a way of showing love, it prevents them from growing.
Consider areas you may be enabling the addiction. Are you paying for food, clothing, cellphone, or other living expenses that allow them to continue spending their extra money on substances, gambling, or gaming?
Depending on their age, it might be helpful to cut them off from certain areas of support. It may not be advisable to make your 14-year-old pay for food and rent, but this situation might change if your son is older.
It is a difficult decision to cut off support, and the decision might take time. There is no black and white parenting rule-book, and these decisions are often fraught with thoughts of “what if…”.
In the end, it is necessary to ask yourself the following question: Are your “helping” behaviors harmful in the long-term?
Engage in Helpful Communication
When talking to your son about addiction, you may face denial, anger, or a lack of clear answers. Young men and boys grow up in a culture that rewards them for their mental toughness. The mask of masculinity often hides deeper emotional realities.
When trying to get through to your son, it might be tempting to give “tough love” or “make” them see how they are wrong. If you’ve ever tried this, you know how it generally goes.
A more effective way to build a cooperative relationship with your son is to use powerful forms of communication. Here is one of my favorite communication lessons from former FBI hostage negotiator Chris Voss, in his book Never Split the Difference. Rather than trying to get them to say, “you’re right,” the goal is to hear “that’s right.”
Although it may sound like an inconsequential difference in wording, it can mean the difference between temporary agreement and lasting change. When someone says, “you’re right,” that person agrees with the factual accuracy of your advice or feedback, or they are just trying to placate you.
When someone says, “that’s right,” they are agreeing with the fact that you have identified how they are feeling. You can make all of the factually correct suggestions in the world, but if the other person does not feel understood, they are not likely going to implement the suggestions in the long term.
The key to lasting change does not lie in your ability to make the other person think you’re right. The key to lasting change lies in getting the other person to convince themselves of their own reasons for changing.
Rather than seeking validation for your suggestions, you should be relatively invisible in the process, so the other person feels like they are coming up with the ideas and action plans on their own.
This listening skill takes a lot of patience, open-ended questions, and statements that show you understand what they are saying.
Although this approach is not guaranteed to succeed immediately, it plants the seed for future productive conversations.
When trying to help someone with an addiction, it is easy to feel alone and become overwhelmed with stress. Getting your own counseling or support group allows you to maintain your own mental health.
Self-care sometimes feels selfish, but it allows you to be more helpful in the long-term. You can’t be useful for anyone else until you’ve become useful for yourself, first.
If you’re interested in attending support groups, Al-Anon and Nar-Anon groups might be helpful and are widely available. Having others you can relate to takes away the sense of being alone in the struggle. Support groups also help you get feedback on your own approach, keeping enabling behaviors in check.
In addition to seeking support for yourself, it is also helpful to have an idea of the services available for your son. If you can develop a strong rapport, you can collaborate on helping your son enter the right form of treatment.
On the go? Listen to the audio version of the article here:
Here is a recording of a live training I conducted on Motivational Interviewing. If you or your organization are interested in setting up a private workshop or one-on-one coaching, you can contact me here.
Motivational interviewing is a powerful counseling style, focused on helping someone gain motivation toward a valued direction in their life. The technique was first developed in the addiction field and is now being used broadly within healthcare settings.
As an addiction counselor, I have attended several workshops on motivational interviewing and noticed a wide range in the quality of instruction. I’ve witnessed persons leaving these workshops with a shallow understanding of the approach, feeling confused, or deciding to give up on the approach altogether.
Since I am passionate about motivational interviewing and love sharing complex ideas in accessible language, I was inspired to create a practical in-depth summary of this powerful approach.
These are the four processes of Motivational Interviewing (MI), a scientifically validated approach to helping someone change:
Engage them through reflective listening
Focus on the main issue they are facing
Evoke their reasons for change
Collaborate on a plan for change
In this article, I delve into each of these four motivational interviewing processes, translating the most practical elements into simple language. Whether you work in mental health, addictions, other areas of healthcare, or are just trying to help a friend or family member, I hope this powerful approach can help.
What is motivational interviewing?
According to Dr. William Miller, the founder of Motivational interviewing:
“Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”
Rather than merely a set of techniques, it is fundamentally a way of being with people. It is tempting to simply try to give people the psychological tools as if simply explaining it to them clear enough will make them change. This is an antiquated learning model, based on the idea that persons are empty receptacles, needing to be filled with knowledge.
As a university course instructor, I quickly learned that merely lecturing people is a highly ineffective way to facilitate meaningful learning. This lesson was reinforced in my work doing problem gambling prevention. Although some people are naturally curious and want to learn more, most people shut down as soon as they feel like someone is giving them advice.
“People don’t resist change. They resist being changed.”
Resistance to change is not personal. Persons are coping with underlying pain, the best way they currently know how. Attempts to change someone are met with resistance since they take away someone’s need for control.
Deep down, people who seem to have no motivation do want to change. Getting to that kernel of desire is the goal of motivational interviewing, and this starts with considering our way of being with them. This entails actually being there with them.
How to be with a person
This is also referred to as the “spirit of motivational interviewing”. It is a way of being that entails partnership, acceptance, compassion, and evocation, forming the acronym, PACE. Keeping PACE with others means meeting them where they are at.
Let’s start by delving into acceptance since it has several aspects.
Acceptance
Accepting another person as they are, while also supporting their growth, is foundational. Although acceptance sounds like a simple word, there are four aspects of acceptance: absolute worth, empathy, autonomy, and affirmation.
Absolute Worth
This means maintaining a nonjudgmental attitude toward people who are presenting difficulties.
When we hear anger or frustration, it is useful to consider what pain might be causing the person to react the way they do. Slow down and see their humanity, despite the challenges on the surface.
This aspect of acceptance from Carl Rogers’ concept of “unconditional positive regard.” It requires setting aside one’s judgments about another individual, empathizing with them, and genuinely wanting the best of them.
When someone irritates us, it can be challenging to have unconditional positive regard, but when we start with empathy, we can understand the context of their behaviors, not taking it personally, and not blaming them for being ‘bad’, ‘lazy’, or ‘stupid’. We can see them as an imperfect individual, like ourselves, striving to live a ‘good’ life. When we have unconditional positive regard, we empower individuals to see the best in themselves, inspiring them to act accordingly.
Empathy
This means actively attempting to understand the other person’s point of view.
We can start by becoming curious about the other person’s inner world. This curiosity allows us to take a step back from our own biases and assumptions, facilitating mutual understanding and respect.
Autonomy
This entails facilitating the other person’s sense of control and independence.
We can’t make people change. We can only help spark their own desire to change. Supporting their autonomy means knowing when to slow down and simply hold space.
Affirmation
This means acknowledging the other person’s strengths and efforts.
We are often quick to latch on to the negative traits a person displays, overlooking their unique strengths, abilities, or efforts. Recognizing someone’s strengths helps us maintain respect for them as an individual.
Compassion
Compassion requires us to actively promote a person’s welfare based on their own needs.
We often feel compelled to judge what will be best for another person. This causes us to direct the focus, assuming we know what they need to prioritize. As we take the reins, we disempower the other person, putting them into a passive role in the process.
This aspect of motivational interviewing was added when the founders, Rollnick and Miller, noticed that their method was being advertised by an “influence coach” selling his book on “How to Get Anyone to Do Anything — Fast!”.
Getting “anyone to do anything” does not require compassion since it does not consider their best interests first. Rollnick and Miller wanted to be clear that their technique is intended to be used with and for the other person, not simply for the interviewer’s personal benefit.
Evocation
Evocation requires us to actively elicit the person’s own reasons for change.
We often feel compelled to make arguments for why someone needs to change. Usually, the arguments for and against change already reside within the other person. It is our job to evoke their ownarguments for change, thereby increasing their intrinsic motivation.
This is the opposite of those all too common “should” statements. Has anyone ever said you should do something? How do you feel after someone tells you this? Evocation elicits the person’s own arguments for change, bypassing this resistance.
Partnership
Partnership requires us to collaborate with the other person to form a plan.
We may feel compelled to dictate what we may consider a strong action-plan, pacifying the other person, leaving them feeling like they have “homework” rather than having a collaboratively constructed plan of action. Partnering with the other person inspires intrinsic motivation to change becuse they feel in control of the process.
This is the foundation of motivational interviewing. Without being with people in this open, accepting, compassionate way, the technical skill will generally be ineffective.
Now that the foundation has been laid, let’s consider the four processes listed in the intro:
Engaging
Focusing
Evoking
Planning
These may occur in the order listed, or the conversation may go back and forth, depending on the situation’s requirements. Let’s take a closer look at each of these processes and how they work.
Engage them through reflective listening
This means establishing a trusting and mutually respectful relationship. In practical terms, it’s how we help people feel like we are someone they can trust and with whom they can share their personal experiences. Engagement can happen instantly, or it can take a while.
The best way to develop engagement is through reflective listening. Reflections consist of responding with a summary of what the person is sharing with you. Our natural tendency when listening is to ask questions continually. Reflective listening is different since it means limiting the number of questions you need to ask.
Reflections are more engaging than questions, helping facilitate empathy and a sense of understanding. To be optimally effective, try to use at least three reflections per open-ended question. For example:
Person: “Yeah… I was doing so well… I hate when this happens!”
You: “And you want to gain more control over your drinking.” (reflection 2).
Person: “Yeah… I’ve been trying a few different things but I don’t know if I should go to treatment.”
You: “And you are still not sure if treatment is a good fit for you.” (reflection 3).
Person: “That’s right… I feel like I have a lot of support.”
You: What do you feel you need right now? (open-ended question).
Notice how reflective listening builds rapport while delving into the person’s underlying needs. Asking too many questions risks maintaining a surface-level conversation. Reflective listening delves into the other person’s experience while using infrequent open-ended questions to guide the conversation gently.
Since there are several different types of reflections, here is a brief definition and example for each:
Simple Reflection
This consists of reflecting the exact words or phrases used by the individual.
Example:
Person: “I feel guilty about my drinking because I often drink too much.”
You: “You feel guilty…”
When using a simple reflection, be careful not to sound like you are simply parroting the other person’s words. If done without a spirit of empathy, it can appear cold and mechanical.
FBI hostage negotiator, Chris Voss, shares he often used this kind of reflective listening by merely repeating the last two words the person said. Although I don’t personally recommend this when helping others, it can be a simple, fun exercise to practice reflection in everyday conversation.
Complex reflection
This consists of finishing the other person’s sentences or paragraphs by guessing what they mean. It is also one of the most powerful forms of reflection. The key to this technique is that the dialogue should flow as if it were a single person speaking.
Example:
Person: “When I comes to drinking, I find it difficult to control myself.”
You: “…and you’re looking to gain back some control.”
Person: “yeah… I miss the way things were before I started drinking.”
You: “… spending quality time with the ones that matter.”
Note that you need to sometimes go out on a limb and take a guess at what phrase may accurately represent the other person’s experience. If you are not on the mark, the other person will correct you. If they correct you, adjust your reflection to fit their experience, maintaining a spirit of empathetic concern or curiosity.
Summarizing
Summaries are reflections that consist of paraphrasing two or more items someone has shared.
Example:
Person: “I tried going to a therapist to deal with my gambling because my partner was frustrated with my spending and told me I had to go, but I don’t think it helped because I keep wanting to gamble, but I also don’t want to upset my partner. I just feel lost and overwhelmed because my relationship is very important to me.
You: “So you’re feeling lost and overwhelmed because you enjoy gambling, but your partner thinks you are spending too much and wants you to get help. You value your relationship so you sought help, but you feel that it was not helpful for you.”
Summaries are most useful at the end of conversations or immediately after someone shared many concerns.
In summary, reflection builds connection and increases motivation by encouraging the other person to continue talking about their reasons for change. Rather than simply listening, asking questions, and offering feedback, incorporating a large dose of reflection into your conversations will help you better connect with others, in addition to increasing their likelihood of making a change.
Focus on the main issue
This consists of seeking and maintaining direction in the conversation. In practical terms, it’s how we help people share their most important concern.
Rather than making assumptions about what they need, focusing is a collaborative process, revealing what is best for them.
Focusing is tricky because we could take the conversation in so many places. How do you focus on one particular aspect of a person’s complex experience and list of challenges?
Open-ended questions are the most useful tools for this process. Some examples might include questions like “What is the most important issue for you right now?” and “What issue is your main priority right now?”
The key to focusing is to never make assumptions. The problem may seem “obvious” in the beginning, but this may or may not be the real issue. Guiding the focus of the conversation through open-ended questions ensures you are focusing on the most relevant aspects of their situation.
So how do you know when you’ve focused enough? Here are some quick tips:
Not yet Focused
The person jumps around between ideas and topics
The person reverts to small talk after disclosing an area of potential focus
The person is still sharing important background information
Focused
Person has directly identified a top area of priority
You have confirmed the focus with the other person.
Evoke their reasons for change
This consists of increasing motivation by evoking the other person’s own arguments for change.
In simple terms, it’s how we help people increase motivation and maintain their commitment to change.
The best map is useless if they’re not ready to take the voyage.
Talking about our why is the fastest way to build motivational momentum. Clinical studies on this technique demonstrate that getting the other person to talk about their own reasons for change correlates with increased successful outcomes. Miller and Rollnick call this “change talk.”
Studies looking at this technique’s effectiveness show change talk is one of the significant predictors of change.
So how do you get the individual to state their own reasons for change? Listen carefully for a reason, and then reflect that reason back to them in your own words, encouraging them to continue talking about it.
Here is a simple example:
Person: “I guess if I stop coming to the casino so often, I could take better care of my elderly mother.”
You: “It looks like your mother means a lot to you…”
Person: “Yeah… she was always there for me, so I really want to be there for her.”
Whatever you reflect, you will hear more. Therefore, reflecting change talk gets you more change talk. Note that this also works in reverse. If you are not selective in your reflections, you may be encouraging more counter-change talk, keeping the person entrenched in past behaviors.
To unlock motivation, keep your ears on alert for change talk, focus your reflections, and encourage the other person to continue talking about their own reasons for change.
The purpose of evoking change talk is to increase intrinsic motivation, reducing ambivalence.
Those seeking change look toward a huge mountain ahead, ambivalent to whether they should make the trek. They want to get to the top, but also have reasons not to take the risk. Torn between these two competing desires, they are stuck.
When someone comes to us for help, it is tempting to start planning for change immediately. Before doing so, we need to take a step back, inquiring into the other person’s reasons for change. Evoking change-talk helps the other person build intrinsic motivation, a key indicator of successful long-term growth.
Special Evoking Technique: The Readiness Ruler
Simply ask the person about their readiness to change on a scale from one to ten.
Ask what made them choose that number instead of a one or two.
Ask what it would take to get them to a number or two higher than the one they chose.
The readiness ruler is not a measurement tool. Rather, it is a technique designed to evoke change talk. Each step is designed for this purpose. It does not necessarily matter what number they say. What matters is how you engage the person relative to the number they chose.
Step number two might seem counter-intuitive. Why would you ask someone about their reasons for not being less motivated?
When asked about their reasons for not being less motivated (a 1-2 on the scale), they will need to respond with reasons why they are motivated. The question necessarily frames them as having some motivation, guiding them to elaborate on it. This elaboration is the essence of change talk. Using continued reflective listening is crucial to this step.
Question number two is focused on evoking, while question number three starts the initial planning phase. Strong change talk goes beyond vague desires, delving into someone’s reasons and deep internal need to change. Turning this desire into commitment and action involves collaborating on a plan.
Collaborate on a plan for change
Collaboration is like a dance. We give and take, meeting the person where they are, guiding the flow of the dance while remaining in harmony with one another. The goal is to guide them toward action, not force them into submission.
To use another metaphor, we must be like travel agents of change. We may be experts on the matter, but we can never really know what kind of trip will be best for the individual until we collaborate with them. Even when the plans are set, and the trip is booked, it is not our job to go on the trip with them. If things get rocky on the trip, they can call us for support, but it is not our responsibility to fly out and rescue them.
People need space to feel empowered when making changes. When we become confrontational experts, we disempower people, making them feel incompetent. When we collaborate with them, guiding the change-process, we empower them to take responsibility for changing, giving them the ability to see small rewards accumulate by their own volition. As these rewards start to accumulate, motivational momentum snowballs into committed action.
Collaboration solves underlying motivational issues by encouraging an active mindset rather than spurring temporary action driven by the desire to avoid criticism.
When helping people change, we are often tempted to take the lead. We want to direct them on making the change, telling them what they need to do, and perhaps even begin doing some of it for them. We may find ourselves working harder than the other person, wondering why they won’t take control over their life. If we find ourselves in this situation, it may feel like we are helping, but we have actually become part of the problem.
Special Planning Technique: Elicit-Provide-Elicit
Our contributions to a plan are better received when delivered in an elicit-provide-elicit sandwich.
This requires asking what they know about an area, providing relevant information (with permission), then asking their thoughts on the information. This technique helps bypass resistance when planning, allowing you to offer feedback without sacrificing collaboration:
You: “What do you think about counselling?” (elicit)
Person: “I think it would help me out a lot right now.”
You: “Can I tell you more about local services? (asking permission to provide)
Person: “Sure!”
You: “X is a great local resource…” (provide)
You: “What are your thoughts?” (elicit)
Common traps and roadblocks
Sometimes our interactions are smooth sailing. Other times, they feel heavy and difficult. You may be getting yes or no answers, “yeah buts…”, no eye contact, or the person may have difficulty opening up. Here are some common ways you might be caught in a communication trap.
The Expert Trap
This occurs when you present yourself as an expert on how the other person should be living. Being too directive creates a power-dynamic where the other person loses a sense of control over the process, decreasing motivation.
The expert trap might be tempting since it is easy to believe we know what’s best for someone. We may feel like we have access to all of the right tools and techniques, knowing exactly what the person needs to do.
The issue with jumping to solutions is that it does not work. How many people follow their family doctor’s expert advice, after being told they need to eat healthier and exercise more often?
Being an expert and presenting yourself as an expert are two different things. The founders of motivational interviewing, Rollnick and Miller, state that a true expert is invisible to the untrained eye.
Rather than creating a power dynamic where you are the expert, and the other person is a passive recipient of knowledge, it is more effective to see both of you as different types of experts. You may have expertise in psychological processes and coping skills, but the other person is an expert on the details of their own lives. As stated in the research here:
“The alliance between you and your client is a collaborative partnership to which you each bring important expertise.”
The Assessment Trap
Similar to the expert trap, putting too much emphasis on assessment places the other person in a passive role, similar to the doctor-patient dynamic. This can be a useful dynamic in many areas of physical health, but it can be a barrier to connection when helping someone with mental health and addiction issues.
Asking too many questions can intimidate and bombards the other person. Rather, it is more effective to evoke their experience through reflective listening. Luckily, process-based approaches such as Acceptance and Commitment Therapy (ACT) have moved away from diagnostic assessments, preferring a functional analysis of the thoughts, emotions, and behaviors, instead. You can learn more about ACT in my article here.
The premature focus trap
This entails trying to immediately solve the person’s problem, jumping to the solution rather than simply listening to build engagement and trust.
There may be times when you want to steer the conversation in a particular direction prematurely. Although we may feel like we have the answer, it is most effective to focus on areas that are right for the other person.
Ask yourself: Whose need am I meeting right now? Am I trying to meet my own need to provide information? Am I trying to gain a sense of importance by fixing the other person? Am I engaging with a spirit of compassion?
The Chat Trap
Although small talk can be engaging, the chat trap prolongs shallow conversation, neglecting focus and direction.
The chat trap lingers between engaging and focusing. The person may be engaged, but you may find yourself in a conversational tailspin, focusing on surface-level content.
This is perhaps most relevant when it comes to conversations with individuals we are highly familiar with. They are successfully engaged and comfortable chatting, so stepping out of this comfort zone takes a bit of courage from both yourself and the other person.
Summary
Motivational Interviewing is a powerful approach to helping people change. It starts by engaging the person through reflective listening, then focusing the conversation. It then consists of evoking their reasons for change and collaboratively planning for the change.
The acronym RULE can summarize motivational interviewing:
Resist the righting-reflex: Avoid trying to correct them or convince them. Understand their motivation: Seek to understand their values, needs, and abilities. Listen with empathy: Listen to their motives and potential barriers. Empower them: Collaborate with them to build a realistic plan.
Reflective listening is a major aspect of motivational interviewing, so gaining comfort with this skill is one of the best things you can do to help sharpen your abilities. Below, you will find a list of resources focused on helping you delve deeper into the practice of motivational interviewing.
Resources
If you are curious about the psychological processes behind motivational interviewing, check out my article, “How Does Motivational Interviewing Work?” where I break down the various aspects of intrinsic motivation in plain language.
For free video demonstrations on how to do Motivational Interviewing, check out these great online modules by the British Medical Journal, here. I highly recommend it!
On the go? Listen to the audio version of the article here:
When considering the root causes of addiction, it is important to look at various underlying contributors. The media is full of oversimplified depictions of addiction, making it seem like substances themselves cause addiction. Working in the field, in addition to looking at the research, I realized this is a myth.
Upon beginning treatment, I often share the iceberg model with my clients. The addiction is the visible tip of the iceberg, whereas the underlying causes are generally invisible but comprise the vast majority of the issue. To effectively deal with the addiction, we must first consider what is causing it. So what are some of these root causes?
Underlying root causes of addiction include trauma, pain, and unmet needs such as purpose, belonging, and self-esteem, which may be amplified by family and genetic factors.
Let’s dig into the research and unpack each of these underlying causes to dispel some popular myths about addiction.
Also, if you or someone you know is struggling with mental health or addiction issues, you can check out my resource page for suggestions on how to find help.
Drugs Don’t Cause Addiction
Growing up, I recall the anti-drug campaigns spreading the myth that drugs cause addiction. The logic was simple: Drugs are so powerful and so pleasurable that once you try them, you’ll be hooked; therefore, “just say no.”
Perhaps this was effective for someone like me. With my cautious temperament, the fear of such powerful substances kept me away from them.
In general, research does not support the effectiveness of fear-based anti-drug campaigns. Also, it leads to further harm by perpetuating a superficial understanding of how addiction works.
Bruce K. Alexander is a popular advocate against the myth of drug-induced addiction. In his address to the Canadian Senate, he cites a longitudinal study on substance use rates among secondary school students, stating:
“In this group, 41% reported having used cocaine at some time in their life… and less than 0.1 % reported using it at least 20 days in the month of the interview. Thus, less than one student in 400 who reported having used cocaine could be considered a current addict.”
He goes on to share a similar finding regarding crack usage:
“…5.1% had used crack at least once in their life… and less than 0.05% had used 20 or more days in the month of the interview. Thus, the ‘most addictive drug on earth’ caused persisting addiction in no more than 1 experimental user in 100.”
These findings dispel the myth that substances necessarily cause addiction. Although substances are involved in addiction, there needs to be a better explanation of why some people become addicted, and others do not.
Bruce Alexander further dispels this myth in his famous Rat Park Study. He demonstrated that if you put rats in a bare cage alone with addictive substances, they will overdose. But if you put them in a cage with other rats and engaging novelties, they no longer overdose.
This study points to social isolation as one of the underlying causes, explaining why some people develop an addiction. The pain of isolation led rats to cope through ingesting the drug, whereas the rats not subject to this form of pain were more resilient.
This leads us to the insightful words of Gabor Maté:
“The question is not why the addiction, but why the pain.”
Early Trauma Can Cause Addiction
Traumatic adverse experiences during one’s childhood is one of the biggest underlying causes of addiction. Adverse childhood experiences may include physical abuse, emotional abuse, neglect, parental discord, and sexual abuse.
According to a report by the Substance Abuse and Mental Health Services Administration:
“When children are exposed to chronic stressful events, their neurodevelopment can be disrupted. As a result, the child’s cognitive functioning and/or ability to cope with negative or disruptive emotions may be impaired. Over time, and often during adolescence, the child may adopt unhealthy coping mechanisms…”
A 2008 study confirms that substances are a key aspect of this unhealthy coping, early on in life:
“…children with particular adverse childhood experiences may initiate drinking earlier than their peers and that they may be more likely to drink to cope with problems (rather than for pleasure or to be social).”
The anti-drug campaigns focused on inducing fear of substances neglects the fact that the most at-risk youth are not primarily using it for pleasure. Rather, they are using substances to escape from pain.
Another study on childhood abuse, neglect, and household dysfunction found that those who had more than five adverse childhood experiences were seven to ten times more likely to report substance use problems. The authors state:
“Because adverse childhood experiences seem to account for one half to two-thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences.”
These findings reinforce the need to redirect public funds away from anti-drug campaigns, focusing on the root of the problem: adverse childhood experiences.
A recent 2019 study summarizing two decades of research on adverse childhood experiences argues:
“Adverse childhood experiences and rearing may generate a public health burden that could rival or exceed all other root causes.”
These early experiences affect the brain differently from experiences in adulthood, resulting in long-lasting neurological changes. Beyond the brain, these changes impact parental attachment, resulting in changes in one’s ability to gain secure attachment in one’s relationships later on in life.
Beyond using substances to cope with these early experiences, a recent 2020 study found that adverse childhood experiences also contribute to mobile phone addiction. Other common behavioral addictions among youth might include internet use, gaming, and various forms of gambling within online games.
The recent recognition of behavioral addiction in the DSM-V further emphasizes that substances are not necessary for an addiction to develop. Although substances are often involved in addiction, they are are not the primary cause.
Various Forms of Pain Cause Addiction
Adverse childhood experiences and other forms of pain may not necessarily come in the form of trauma. The field of psychology defines trauma as typically involving actual or threatened death, or other extreme events involving hopelessness or horror.
A person may never have pivotal experiences that fit the typical definition of trauma but may suffer long-term due to their perception of certain early events.
For example, a person may recall being insulted or embarrassed by a parent. This situation may not necessarily have stood out to an onlooker as “traumatic,” but one’s perception of the event can have lasting effects.
For example, a child may internalize an off-handed comment regarding their weight, and they may carry these words with them throughout their life. These internalized words distort their perception of themselves, resulting in a spiral of further distorted perceptions as they interact with others, filtering others’ responses through this self-stigmatizing identity.
This form of emotional pain can result in core psychological needs not being met. For example, if avoiding social situations becomes one’s primary coping method, one’s need for connection may be unmet. Turning to substances or behaviors is one way someone may cope with the pain of these unmet needs.
The spiral of short-term coping leads to long-term consequences, taking the person further away from actually dealing with the problematic core beliefs.
Another common underlying cause of addiction may be a lack of purpose. When feeling bored, stuck, or tired of the monotony of daily life, substances or addictive behaviors may be used to escape. This is another example of a situation that wouldn’t typically qualify as traumatic but can significantly impact someone’s mental health.
Family and Genetics Increase Risk of Addiction
When looking at the root causes of addiction, many people are quick to point out genetic factors. I thought it would be necessary to consider here since genetics does not necessarily cause addiction. Instead, genetics increases the risk someone will develop an addiction if the above factors are present.
This means your genes do not cause you to develop an addiction. Rather, they may be a risk-factor or protective-factor, offering a particular level of resilience against early traumas and other forms of pain or unmet needs.
In a study looking at pairs of twins, the researchers found
“…genetic factors played a major role in the development of alcoholism…”
Although this is the case, there is no particular “addiction gene.” More recent research argues several genetic interactions are involved. Therefore, it is essential to consider the interaction between genetics and other psychological factors such as trauma. The authors state:
“…it has become apparent that variants in stress-related genes such as CRHR1, may only confer risk in individuals exposed to trauma, particularly in early life.”
Genes may affect one’s baseline resilience, but as stated previously, early traumas, emotional pain, and unmet needs are the root causes.
Also, genes are not the only way a person inherits traits. Effective and ineffective forms of coping may be inherited through social learning within the family.
Conclusion
Addictive substances and behaviors are the tip of the iceberg. The root causes of addiction include adverse experiences in childhood and emotional pain resulting in unmet needs.
Substances or behaviors are used to cope with this underlying pain, offering short-term benefits and long-term costs, making it harder to actually meet one’s underlying needs.
Meeting one’s need for a sense of connection, self-esteem, and purpose requires delving into the underlying forces driving one’s addiction and developing the skills to more effectively deal with the difficult thoughts and emotions driving one’s behaviors.
