The Tangle of Addiction
The difficulties arising from gambling and heavy drinking may be accompanied by debt, poor physical and mental health, relationship and family breakdown, unemployment, loss of status. And sometimes absolute despair, total isolation, utter worthless and self-hatred and ultimately suicide.
A very complex web of interacting factors may lead to addiction in the first place, then reinforce it as the life situation becomes worse. Such factors are referred to as ‘legacy’ of addiction, what starts and continues even if addiction is overcome. But the same factors can come before addiction. A child exposed to ‘adverse childhood experiences’ or traumas is a prime candidate for addiction. Such experiences include violence, divorce, sexual and emotional abuse, being ‘outed’ and bullied by peers. None of this can be ‘cured’ by a pill or 12 sessions of cognitive behavioural therapy. Demands that a person become ‘responsible’ for the welter of externally driven wounds are feeble offerings for those most in need.
Extremes are at the furthest end of a spectrum of suffering and idividual life histories and current contetxs. Everybody is different. For very many the factors impeding recovery are easier to untangle and overcome.
Demands on individuals to take full responsibility for becoming ill and recovering come from those who have a deep lingering belief that we are all captains of our souls. Such attitudes often contain moral judegments and point to ‘character weakness’. It is claimed that none of us are in any way significantly formed and influences by external factors and factors over which we have no control. Often it’s pointed out that the majority in similar or worse situations and histories do not become ‘bad’, and examples of those who have overcome adversities are frequently celebrated in the media. It is true that individuals do often show remarkable resilience and achieve success in social terms, criminals do reform and become community leaders, ex-addicts devote their lives to helping others. It is also true that the majority of people in so-called deprived communities demonstrate immense powers of the very best of humanity. It is also true and must be emphasised that recovery is possible – and achieved by many against the odds. But this must never blind us to the inescapable fact that for those most urgently in need ‘possible’ is empty against the unique individual inner and outer landscapes of the defeated. A collapse in all aspects of a person’s life coupled with the devastating agonies from the experience of addictions themselves suggests that while recovery is very possible, for some it is much more difficult. When ‘reality’ is so dreadfully awful it is totally understandable why a person may turn to one last throw of the dice, one last spin, in a desperate attempt to restore some sort of stability. Or why a person may choose to drink themselves to death rather than soberly acknowledge a state of living death.
Such individuals are at the extreme point of a scale, and it is here also where suicide may be completed. There are far more people in this position than usually acknowledged. Many, though, will be moving towards that state, will have frequent suicidal thoughts, will chase losses gambling, drink to forget. Nobody chooses this. No man in the Possil area of Glasgow is happy that male life expectancy there is just 56. This is the context where highly dedicated health and social care workers operate (themselves, incidentally, at higher risk of addiction than the general population). There are no known solutions. More money is needed but that is not remotely sufficient. When, on top of the intense distress of addiction itself the legacy factors spiral down, we have to begin with a deep, honest and totally sincere vow to eliminate the least shred of blame and the shields of stigmatising we are so habituated to hide behind.
We must be fully aware of the danger of stereotyping ‘addicts’ as only those who have suffered psychological trauma in childhood, poor education, poverty and social deprivation. Many people who have had every life advantage suffer the harms of addiction and possibly suicide. The unique inner life of each unique individual is what is important. Shame, stigma and despair can destroy anybody.
In practice, once again we see the need for reforming services. Although not a complete solution for everyone, helping people separate life issues from the whirlwind of confusion is a start. Integrated service provision has to be able to provide joined-up help with debt, relationships, crime, housing and so forth. It is unrealistic and often cruel to start focusing on employment. Many will be years away from thinking of work if they ever do. (On the other hand, in a genuinely person-centred approach based on the unique individual, work may be a therapeutic option, a restoration of dignity and a basis for addressing financial difficulties). Ideally, there will be a central point of support for integrated services, not necessarily a doctor.
But before, and ideally well before, ‘rock bottom’ and an explosion of collapsed essential life needs, an individual will have the capacity to prevent or minimise harms. In the ‘expert’ addiction field, there is a stage called ‘pre-contemplative’ when a person hasn’t realised or acknowledged or admitted that they may have problems. They may be drinking heavily and gambling but still working even if only pay packet to pay packet with basic household bills going unpaid and delayed. Family arguments may be frequent, so frequent ass to be normal. Physical health may be affected by alcohol resulting in a necessary visit to a doctor; at worst it may be a heart attack taking the person to hospital, Here is where routine screening built into the medical mindset is essential. It will mainly be contact with a doctor who so screens that brings to light problem with gambling and alcohol.
Only when a person has accepted that they have problems with alcohol and gambling, the ‘contemplative stage’, can a happier future begin its journey. Some will have to accept that their marriage has irretrievably broken beyond repair, their partner firmly treating them as ‘bad’. Others are luckier to have a partner who gives support, for better or worse, to differing degrees. Some employers are sympathetic, others are not. Debts can be repaid no matter the amount or how long it takes, and there are great free debt support services. There may be court appearances for draink driving, assault, theft resulting in punishment including prison: this can be handled and supported. Internalised stigma, guilt and shame go with these territory, and good quality support is totally familiar with these and ways to overcome them, even though this may take a long time. It will also take time to recover from long term drinking: after the initial withdrawal stage the brain and rest of the body may take years to be healed. At the stage of acute withdrawal it is essential that medical support is given. Often this is done as an outpatient with a ten days supply of diazepam at decreasing dosage which will prevent possible fits and dampen down unpleasant experiences such as hallucinations. This acute stage will last no more than a few weeks and people begin to feel well although residual depression and anxiety will probably continue for months, gradually getting better.
Gambling withdrawal is very real for many people too. At the start a person may feel extremely tense, anxious and depressed. This passes quite quickly. The acute withdrawal phases for gambling and alcohol are in some ways the easy part. A person still has to deal with the ‘legacy’ consequences, and it is very tempting to drink, to anaesthetise oneself, ‘ reality’. Cravings to gamble or drink present the hardest part of ‘recovery’. There is much advice online, and even whole books, about how to deal with cravings. But probably the majority of those who have committed to stop drinking and gambling will have ‘relapses’. These are not the end of the world but for many just an obstacle on the road to be overcome. By far the best way to deal with cravings is to have human support. This could be an addiction counsellor but for most people it will be a sponsor 12 steps group (Alcoholics Anonymous and Gambling Anonymous) or some other group such as SMART recovery. Being regularly with people who have lived experience, who will support and not judge you is invaluable. Such groups tend to be male dominated and women in particular may not feel at ease in them. Others simply don’t like the idea of being part of a group. However and whoever, it’s important to find a trusted person for support. Ideally this would be the person overseeing the integrated services supporting and treating the individual.
Life is messy for all of us, and any of the negative life factors we’ve mentioned can happen to anyone, addicted or not. But for those who have addictions, a devastating source of emotional distress, coping with them is that much harder. There is, of course, no such thing really as ‘an addict’. There are people who suffer from addiction, but even here every one of them will experience that suffering in ways unique to them. While much on this site refers to people from ‘deprived communities’, surrounded by clusters of industries which exploit them, embedded in cultures where heavy drinking, gambling and drug taking are common, people from every walk of life can, and do, become addicted. Anybody who has studied and worked with middle class young people knows that they too can suffer childhood traumas. Parental abuse is mainly emotional, for instance forcing children never to make mistakes and always come first, punishing them with silent withdrawal of affection, being physically distant and never holding. It’s middle class people who can be obsessed with appearing respectable. They are the biggest part of the ‘worried well’, forever seeking therapies and supplements that are sold by the $4.3 trillion ‘wellness industries’. They can be as deeply unhappy with their lives as anybody. While on the surface ‘having everything’ some are in, or on the road to, the state of addiction. They won’t usually have to deal with the effects of gross inequality, exploitation and injustice others face. They have greater educational, financial, social and cultural ‘capital’ which may mitigate the effects of addiction, but they face the very human risks of being ‘found out’, losing status, being ostracised as ‘bad’, shame and guilt, marital failure. They may even have to deal with intense stigmatisation having been identified as low down, unworthy and immoral (the still common view that respectable people have of those addicts from the great unwashed). Above all, despite our correct identification of the importance of factors such as poverty, commercial exploitation through advertising, etc., the roots of addiction in any given individual are often deeper than we can see. Just as a person from the most deprived community, assailed by fierce social stresses and commercial exploitation, may flourish against the odds, so too a person who seems to ‘have everything’ become prey to addiction.