Monday, June 3, 2019

Cause, Risk & Rescue Addictions

I just ran into an example of all three about two hours ago. (An excited young "freelance journalist" hot on the trail of a well-known, rural religious sect he believes is building an "armory" and making noises about taking over the county. (It's not the first. It won't be the last. And, yes, There Will be Blood somewhere again, just as there was outside Waco, Texas, in 1993.) 

A conversation ensued. I used some Motivational Interview Techniques to both qualify (or disqualify) the "journalist" for certain forms of attachment to outcomes in general, and to cause, risk and rescue obsessions in particular. He "failed" all the "tests." (Sigh.) And waxed enthusiastic (in somewhat bipolar hypomanic and possibly OCPD fashion) about setting off soon to "immerse" himself into the group as a "spy" to get a better look. (Look. Mr first BA was in journalism. One learns in a decent school to be cautious when doing "investigative reporting." And to make sure one has plenty of informed and assertively watchful "back-up.")  

In a limited effort to "reason" with him, I offered links to a pair of pop psych articles somewhat on the topics here. He didn't "get it." But I discovered that -- at least in the Google realm -- there isn't anywhere near the information on "behavioral process addictions" vs. what one will run into on substance addictions. Given what little I found on the former, it looks to me like one has to dig into such as a Complex PTSD Library (and even deeper into my own list of over 650 "psych" books) to locate much of any substance on non-substance addictions other than the most obvious ones.  Which are gambling, sex, romance, relationship, religion, work and sadomasochistic abuse. But there are many others... and cause, risk and rescue (as well as persecution) are on the long list. 

If one stops to recall one's acquaintances over the course of a decade or two (or three), it won't be that hard to find a "ward-heeling," political, or social welfare, or save-the-planet, or join-the-march-against-whatever (at the front), and/or religious cause addict or two (or three) in there. 

Nor will it be unlikely that there's a risk freak running the gamut from the kid who does 15-foot-high flips on his motorcycle off the humps in the hills... to the one who smokes gange and races drag races with others out on the back roads... to the one who's been raped four times because she keeps going to the bar and leaving at midnight with men you wouldn't be caught dead with in broad daylight... to the one who came back from Iraq in a wheelchair he'll never get out of after volunteering for his ninth patrol in the "bad neighborhood"... to the one who was raised in a bizarre religious cult but left it in a huff as soon as she was old enough only to join an equally bizarre human potential cult known for enslaving hundreds of slave laborers in barbwire-fenced compounds in California and Florida. (I could go on, but I'm hoping the examples are sufficiently clear to illustrate the concept.)

Rescue addicts are somewhat like cause and risk addicts combined, though they get no obvious excitement from their obsessive behaviors. Most of the ones I have encountered are so obviously trying to escape the "victim" corners on their intra- and inter-personal Karpman Drama Triangles. Deeply -- but unconsciously -- conditioned, in-struct-ed, socialized, habituated and normalized to what researcher Martin Seligman called "learned helplessness" and psychotherapist Stanley Block called the "victim I-dentity system," they cannot see, hear or otherwise sense their anxious attachment schemes and dire need to fix others so they can feel "okay" and "secure" themselves. 

All of these behaviors manifest the reward-&-reinforcement schemes of Watson's, Skinner's and Bandura's operant conditioning and Bateson's, Watslawick's, Haley's and Jackson's notions of the "double-bind." The cause, risk or rescue addict may indeed experience cognitive (and emotional) dissonance about their behavior on occasion. But they are so powerfully rewarded by it in the short term of their bias toward immediate gratification that they return to the behavior regardless of its possible long-term consequences. 

How is that any different from the addiction cycle any "drug & alcohol counselor" with an AA degree and a CADC sees in his or her patients at the local rehab? Because once the addict of any kind experiences any form of internal persecution or punishment on his Drama Triangle, he will start back into subconsciously rationalizing the addictive behavior as the means of "rescuing" himself and escaping the "persecution" (one more time).  

BUT... one may ask, how do people get on that cyclical treadmill to begin with? In my experience of knowing thousands of substance and behavioral process addicts since 1977 (and with a bit of schooling since 1987, and with a lot of schooling since 2006), it all comes down to having been conditionedin-struct-edsocialized, habituated and normalized to learned helplessness and the helpless victim identity in early life, usually by the time they were no more than about five years old. 

(World-renowned addiction experts Michael Bozarth, Patrick Carnes, Carlo DiClemente, Lance Dodes, Edward Khantzian, George Koob, Pia Mellody, Anne Wilson Schaef and Harold Shaffer -- as well as child development, abuse & treatment experts Sandra Bloom, John Briere, Christine Courtois, Judith Lewis Herman, Richard Kluft, Peter Levine, Marsha Linehan, Alice Miller, Bruce D. Perry, Frank Putnam, Arielle Schwartz, Ono van der Hart, Bessel van der Kolk and Pete Walker -- and many others have been all over this topic since the 1980s.)

Beyond that, however, it seems to me that the concepts of defense mechanisms in general and dissociation in particular point to the foundation of the dire need to find some way out of the bottom of the Drama Triangle to the socially approved -- however dysfunctional and costly -- "rescuer" corner thereon... vs. the socially disapproved "persecutor" corner at the other end of the top line. The sad fact, however, is that once on the Drama Triangle, there is no getting off without facing the fact of its existence and manifestations in any addict's life. 

See also "Cult Membership as an Addiction Process... and Process Addiction"

Resources & References


Akiskal, H.; Pinto, O.: The evolving bipolar spectrum, Prototypes I, II, III and IV. North American Journal of Clinical Psychiatry, Vol. 22, No. 3, 1999.

Alanen, Y.: The Family in the Pathogenesis of Schizophrenic and Neurotic Disorders, in Scandinavian Archives of Psychiatry, No. 42, 1966.

Andersen, S.; Teicher, M.: Desperately Driven and No Brakes: Developmental Stress Exposure and Subsequent Risk for Substance Abuse, in Neuroscience of Behavior Review, Vol. 33, No. 4, April 2009.

Arsenault, L.; et al: Being Bullied as an Environmentally Mediated Contributing Factor to Children’s Internalizing Problems…, in in Archives of Pediatrics & Adolescent Medicine, Vol. 162, February, 2008.

Arsenault, L.: The persistent and pervasive impact of being bullied in childhood and adolescence: implications for policy and practice, in Journal of Child Psychology and Psychiatry, Vol. 59, No. 4, November 2017.

Arterburn, S.; Felton, J.: Toxic Faith: Understanding and Overcoming Religious Addiction, Nashville: Oliver-Nelson, 1991.

Bandura, A.: Self-Efficacy: The Exercise of Control, San Francisco: W. H. Freeman, 1997.

Barry, D.; Clarke, M.; Petry, N.: Obesity and its Relationship to Addictions: Is Overeating a Form of Addictive Behavior?, in American Journal of Addictions, Vol. 18, 2009. 

Basco, M. R.; Rush, A. J.: Cognitive-Behavioral Therapy for Bipolar Disorder, New York: Guilford Press, 1996.

Basco, M. R.; Celis-de Hoyos, C.: Biopsychosocial Model of Hypersexuality in Adolescent Girls With Bipolar Disorder: Strategies for Intervention, in Journal of Child and Adolescent Psychiatric Nursing, Vol. 25, 2012.

Bateson, G., Jackson, D., Haley, J.; et al: Perceval’s Narrative: A Patient’s Account of his Psychosis, Palo Alto, CA: Stanford University Press, 1961.

Bateson, G.; Jackson, D.; Haley, J.; Weakland, J.: Toward a Theory of Schizophrenia, in Journal of Behavioral Science, Vol. 1, 1956; reprinted in

Berger, M. D., ed.: Beyond the double bind: Communication and family systems, theories, and techniques with schizophrenics, New York: Bruner/Mazel, 1978.

Bauer, M.; Kilbourne, A.; et al: Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms & Achieving Your Life Goals, Oakland, CA: New Harbinger, 2008.

Bayes, A.; Parker, G., Fletcher, K.: Clinical differentiation of bipolar II disorder from borderline personality disorder, in Current Opinion in Psychiatry, Vol. 27, No. 1, January 2014. doi: 10.1097/YCO.0000000000000021.

Bearden, C.; Hoffman, K.; Cannon, T.: The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review, in Bipolar Disorders: An International Journal of Psychiatry and Neurology, Vol. 3, No. 3, June 2001.

Beck, A.; Wright, F.; Newman, C.; Liese, B.: Cognitive Therapy of Substance Abuse, New York: The Guilford Press, 1993.  

Berger, K.; Thompson, R.: The Developing Person, 4th Ed., New York: Worth, 1995.

Bien, T.; Bien, B.: Mindful Recovery: A Spiritual Path to Healing from Addiction; New York: Wiley & Sons, 2002.

Black, C.: It Will Never Happen to Me: Children of Alcoholics as Youngsters-Adolescents-Adults, New York: Ballentine, 1981, 1987.

Block, S.; Block, C.: Mind-Body Workbook for PTSD, Oakland, CA: New Harbinger, 2010. 

Block, S.; Block, C.: Mind-Body Workbook for Stress, Oakland, CA: New Harbinger, 2012.

Block, S.; Block, C.: Mind-Body Workbook for Anger, Oakland, CA: New Harbinger, 2013.

Block, S.; Block, C.: Mind-Body Workbook for Anxiety, Oakland, CA: New Harbinger, 2015.

Bloom, S.: Creating Sanctuary: Toward the Evolution of Sane Societies, London: Routledge, 1997.

Bowen, M.: A Family Concept of Schizophrenia, in Jackson, D., ed.: The Etiology of Schizophrenia, London: Basic Books, 1960.

Bowlby, J.: A Secure Base: Parent-Child Attachment and Healthy Human Development, London: Routledge; New York: Basic Books, 1988.

Bozarth, M.: Drug addiction as a psychobiological process, in Warburton, D. (ed.): Addiction Controversies, London: Harwood Academic Publishers, 1990.

Bozarth, M.: Pleasure systems in the brain, in Warburton, D. (ed.), Pleasure: The politics and the reality, New York: John Wiley & Sons, 1994.John Briere, 

Brazelton, T.; Cramer, B.: The Earliest Relationship: Parents, Infants and the Drama of Early Attachment, Reading, MA: Addison-Wesley, 1990.

Briere, J.: Therapy for Adults Molested as Children: Beyond Survival (Revised and Expanded Edition), New York: Springer, 1996.

Buisman-Pijlman, F.; Sumracki, N.; Individual differences underlying susceptibility to addiction: Role for the endogenous oxytocin system, in Pharmacology Biochemistry & Behavior, Vol. 119, No. 4, April 2014.

Burgo, J.: Why Do I Do That?: Psychological Defense Mechanisms and the Hidden Ways they Shape our Lives, Chapel Hill, NC: New Rise Press, 2012.

Carnes, P.: Out of the Shadows: Understanding Sexual Addiction, Minneapolis: Hazelden, 1989. 

Carnes, P.: Don't Call it Love: Recovery from Sexual Addiction, New York: Bantam, 1991.

Carnes, P.: The Betrayal Bond: Breaking Free of Exploitive Relationships, Deerfield Beach, FL: Health Communications, Inc., 1997.  

Cassidy, J.; Shaver, P., eds.: Handbook of Attachment: Theory, Research and Clinical Applications, New York: Guilford Press, 1999.

Cohen, J.; et al: Identifying, Treating, and Referring Traumatized Children, in Archives of Pediatric and Adolescent Medicine, Vol. 162, May, 2008.

Colom, F.; Vieta, E.: Psychoeducation Manual for Bipolar Disorder, New York: Cambridge U. Press, 2006.

Copeland, W.; Keeler, G.; et al: Traumatic events and posttraumatic stress in childhood, in Archives of General Psychiatry, Vol. 64, 2007.

Courtois, C.: Guidelines for the Treatment of Adults Abused or Possibly Abused as Children (with Attention to Issues of Delayed or Recovered Memory), Washington, DC: The Psychiatric Institute of Washington, 1997.

Courtois, C.; Ford, J.; ed.: Treatment of Complex Traumatic Stress: A Sequenced, Relationship-Based Approach, New York: Guilford Press, 2012.

Courtois, C.; Ford, J.; ed.: Treating Complex Post-Traumatic Stress Disorder in Children and Adolescents, New York: Guilford Press, 2013.

Courtois, C.: It's Not You: It's What Happened to You: Complex Trauma and Treatment, Dublin, OH: Telemachus Press, 2014. 

DiClemente, C.; Addiction & Change: How Addictions Develop and Addicted People Recover, New York: Guilford Press, 2006.

Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.

Dong, M.; Anda, R.; et al: The interrelatedness of multiple forms of child abuse, neglect and household dysfunction, in Child Abuse and Neglect, Vol. 87, 2004.

Drury, S.: Children Under Age Six Are Vulnerable to PTSD, in Clinical Psychiatry News, Vol. 38, No. 5, May 2010.

Elbogen, E.; et al: Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool, in American Journal of Psychiatry, June 2014.

Erikson, E.: Identity and the Life Cycle, New York: W. W. Norton, 1959, 1980.

Erikson, E.: The Problem of Ego Identity, in Stein, M., et al: Identity and Anxiety, Glencoe, IL: The Free Press, 1960.

Festinger, L.: A Theory of Cognitive Dissonance, Evanston, IL: Row, Peterson, 1957.

Firman, J.; Gila, A.: On Religious Fanaticism: A Look at Transpersonal Identity Disorder, in the online stack at Palo Alto, CA: Psychosynthesis Center, 2004.

Fisher, J.: Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation, London: Routledge, 2017.

Fonagy, P.: Attachment Theory and Psychoanalysis, New York: Other Press, 2001.

Frances, R.; Miller, S.: Clinical Textbook of Addictive Disorders, New York: Guilford Press, 1991.

Gershoff, E.: Should Parents' Physical Punishment of Children Be Considered a Source of Toxic Stress That Affects Brain Development?, in Family Relations, Vol. 65, No. 1, February 2016.

Gibson, J.; Welding, P.: Attachment Styles Predict Workplace Behavior, in Clinical Psychiatry News, Vol. 38, No. 6, Jun. 2010.

Gibson, L.: Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, Oakland, CA: New Harbinger, 2015.

Goleman, D.: Vital Lies, Simple Truths: The Psychology of Self-Deception, New York: Simon & Schuster, 1985. 

Golomb, E.: Trapped in the Mirror: Adult Children of Narcissists in Their Struggle for Self, New York: William Morrow, 1992.

Grant, J.: Compulsive sexual behavior: A nonjudgmental approach, in Current Psychiatry, Vol. 17, No. 2, February 2018.

Green, R.; Douglas, K. M.: Anxious attachment and belief in conspiracy theories, in Personality and Individual Differences, February 2018; Vol. 125,  DOI: 10.1016/j.paid.2017.12.023

Grosshans, M.; Loeber, S.; Kiefer, F.: Implications from addiction research towards the understanding and treatment of obesity, in Addiction Biology, Vol. 16, No. 2, April 2011.

Guajardo, N.; Snyder, G.; Petersen, R.: Relationships among Parenting Practices, Parental Stress, Child Behavior, and Children’s Social Cognitive Development, in Journal of Infant and Child Development, Vol. 18, 2009.

Haley, J.: The family of the schizophrenic: a model system, in American Journal of Nervous and Mental Disorders, Vol. 129, 1959.

Heim, C.; Nemeroff, C.: The role of childhood trauma in the neurobiology of mood and anxiety disorders: pre-clinical and clinical studies, in Biological Psychiatry, Vol. 49, 2001. 

Heller, L.; LaPierre, A.: Healing Developmental Trauma: How Early Trauma Effects Self-Regulation, Self-Image, and the Capacity for Relationship (The NeuroAffective Relational Model for restoring connection), Berkeley, CA: North Atlantic Books, 2012.

Henry, J.: Family structure and the transmission of neurotic behavior, in American Journal of Orthopsychiatry, Vol. 21, No. 4, 1951.

Henry, J.: Culture Against Man, New York: Random House, 1964.

Henry, J.: Pathways to Madness, New York: Random House, 1965.

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

(I wanted to illustrate the depth of background that informs my point of view about addiction and its etiology in the first third of the bibliography. Henceforth, I'll limit the list to direct references only.)

Jackson, D.: Myths of Madness: New Facts for Old Fallacies, New York: Macmillan & Co., 1964.

Khantzian, E. J., Mack, J.F.; Schatzberg, A.F.: Heroin use as an attempt to cope: Clinical observations, in American Journal of Psychiatry, Vol. 131, 1974.

Khantzian, E. J.: The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence, in American Journal of Psychiatry, Vol. 142, 1985.

Khantzian, E.J.: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Kluft, R.; et al: Childhood Antecedents of Multiple Personality Disorder, Washington DC: American Psychiatric Press, 1985. (MPD is now called Dissociative Identity Disorder.) 

Koob, G.; Le Moal, M.: Drug addiction, dysregulation of reward, and allostasis, in Neuropsychopharmacology, Vol. 24, 2001.

Koob, G.: Allostatic view of motivation: implications for psychopathology, in Motivational Factors in the Etiology of Drug Abuse, at the Nebraska Symposium on Motivation, Vol. 50, edited by Bevins, R.; Bardo, M.; Lincoln NE: University of Nebraska Press, 2004.

Koob, G., Le Moal, M.: Plasticity of reward neurocircuitry and the ‘dark side’ of drug addiction, in National Neuroscientist, Vol. 8, 2005, doi:10.1038/nn1105-1442.

Koob, G.: A Role for Brain Stress Systems in Addiction, in Neuron, Vol. 59, No. 1, July 2008. 

Koob, G.: Neurobiology of Addiction, in Focus, Vol. 9, December 2011.

Levine, P.: In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness, Berkeley, CA: North Atlantic Books, 2010. 

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Mellody, P.; Miller, A. W.: Facing Codependence: What It Is, Where It Come From, How It Sabotages Our Lives, San Francisco: Harper, 1989.

Mellody, P.; Miller, A. W.: Breaking Free: A Workbook for Facing Codependence, San Francisco: Harper, 1989.

Mellody, P.: Miller, A. W.: Facing Love Addiction: Giving Yourself the Power to Change the Way You Live, San Francisco, Harper, 1992.

Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1979, 1983.

Miller, A.: Prisoners of Childhood / The Drama of the Gifted Child, New York: Basic Books, 1979, 1996.

Miller, A.: Thou Shalt Not Be Aware: Society’s Betrayal of the Child, London: Farrar, Straus & Giroux, 1981, 1984, 1998. 

Miller, A.: Breaking Down the Walls of Silence, New York: Dutton/Penguin, 1991.

Miller, W.; Rollnick, S.: Motivational Interviewing: Preparing People to Change, 2nd Ed., NY: Guilford Press, 2002.

Ogden, P.; Minton, K.: Trauma and the Body: A Sensorimotor Approach to Psychotherapy, New York: W. W. Norton, 2006. 

Ogden, P.; Fisher, J.: Sensorimotor Psychotherapy: Interventions for Trauma and Attachment, New York: W. W. Norton, 2015. 

Perry, B.: Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence, in Osovsky, J. (ed.): Children, Youth and Violence: The Search for Solutions, New York: Guilford Press, 1997.

Perry, B.: Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture, in Brain and Mind, Vol. 3, 2002.

Perry, B.; Szalavitz, M.: The Boy Who was Raised as a Dog…, New York: Basic Books, 2007.Bruce D. Perry, 

Putnam, F.: Diagnosis and Treatment of Multiple Personality Disorder, New York: The Guilford Press, 1989.

Putnam, F.: Dissociation in Children and Adolescents: A Developmental Perspective, New York: The Guilford Press, 1997.

Rollnick, S.; Miller, W.: What is motivational interviewing?, in Journal of Behavioral and Cognitive Psychotherapy, Vol. 23, 1995. 

Schaef, A. W.: Escape from Intimacy, New York: Harper-Collins, 1987.

Schaef, A. W.: When Society Becomes an Addict, New York: Harper & Row, 1987. 

Schaef, A. W.: Co-dependence: Misunderstood, Mistreated, New York: HarperOne, 1992. 

Seligman, M.: Learned Optimism: How to Change Your Mind and Your Life, New York: Knopf, 1990. 

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Skinner, B. F.: Beyond Freedom and Dignity, New York: Alfred A. Knopf, 1971.

Skinner, B. F.: About Behaviorism, New York: Random House, 1974.

Van der Hart, O.; Brown, P.; and Van der Kolk, B.: Pierre Janet’s Treatment of Traumatic Stress, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989. 

Van der Hart, O.; Friedman, B.: A Reader's Guide To Pierre Janet: A Neglected Intellectual Heritage, in Dissociation, Vol. 2, No. 1, 1989.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Hart, O.; Nijenhuis, E.; Steele, K.: The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, New York: W.W. Norton, 2006.  

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory:  Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, New York: Viking Press, 2014.

Van der Kolk, B.: Commentary: The devastating effects of ignoring child maltreatment in psychiatry – a commentary on Teicher and Samson 2016, in Journal of Child Psychology and Psychiatry, Vol. 57, No. 3, March 2016

Watson, J.: Behaviorism, Revised Edition, Chicago: University of Chicago Press, 1930.


No comments:

Post a Comment