Will the Addict Ever Stop Using Something if He or She remains Depressed, Anxious & Belief-Bound?

"Alcohol and drugs can modify troubled feelings without influencing their cause, augment confidence by blurring reality and reducing sensitivity, and silence the inner voice of self-contempt, or at least make it nearly inaudible." -- Sharon Eklberry 

I've been at this for a while. C&S since 1984, I went back to school again and again to dig into the title question. (Ten years worth, actually.) A modified point of view is always a possibility, of course. But at this point, my answer is, "It doesn't look that way." And here's why:

Exogenous neurostimulants and neurodepressants elevate limbic emotion regulation system dopamine levels in different ways that effect cascades of other chemical flow and interaction -- and vice-versa -- causing either atypically (like "un-usual-ly") intense relaxation, intense analgesia, intense dissociation, intense euphoria and/or intense motivation, all of which are experienced as "rewarding." (See Edward Khantzian below.)

So. When those who are depressed, anxious and/or belief-bound seem to remain stuck in their unprocessed, undigested and undischarged neuroemotional energy needing some way to get off the not-so-merry-go-round the pros call the cycle of addiction. Take away drugs. Take away alcohol. Take away food (or lack thereof). Take away risk. Take away sex & romance. Take away codependent relationship. Take away workaholism. Take away excessive exercise. Take away almost everything that can be used to temporarily masque off the icky sensations of Learned Helplessness, Dread & the Victim Identity, and one has just that: Untreated Learned Helplessness & the Victim Identity. (If interested, look up Martin Seligman, Edward Khantzian (and his self-medication hypothesis), George Koob, Harold Shaffer and Gabor Mate on how LH & VI drive addiction; or see the References below.)

A regular in AA and NA since 1983... and at least a semi-regular in Al-anon and Nar-anon since 1986, in CoDA and ACA since 1990, in SLAA since 1991, in EA since 2006, et al, et al, et al, as well as from a perch in several treatment facilities, I have been able to observe thousands of addicts in the long as well as short term. Along with the people named above, as well as those named or referred to below, I am fully convinced that addiction of one sort or another -- even if it is to "righteous victimhood" in the manner described by Richard Schwartz's "obsessive protector" (see the Internal Family Systems Model) -- remains the number one go-to for those who haven't digested and discharged something 80 percent of their reactive rage, existential fear, shame, guilt, worry, remorse, regret, morbid reflection. (Bill Wilson's articles in the AA Grapevine in the 1960s -- including those reprinted in the little book, The Best of Bill -- seem to me, at least, to strongly support this assertion.)

The millennial-era study of the neurobiology, neurochemistry and neurophysiology of depression and anxiety utilizing computer-aided tomography (CAT), magnetic resonance imaging (MRI) and small-particle (SPECT) imaging have conclusively demonstrated that a) depression and anxiety have clearly identifiable "images" in the brain's limbic (emotion processing) system, as well as the HPA Axis and its connections to the body's autonomic nervous system. Anyone who understands all that and the operation of the Fight / Flight / Freeze / Faint / Feign (or Fawn) Responses that can lead to Fry and then Freak, can see the relevance to addictive "defenses" in a hot second.

As a result, addiction professionals at such renowned, "Class A" clinics as Hazelden, Betty Ford, The Meadows and Sierra Tucson began to move recovering substance and behavior abusers into examining the causes of their addictions about 25 years ago. And began to bring on board people like those listed in the first paragraph of this Reddit post. (Skip all the borderline personality disorder stuff unless it seems relevant, which, btw, it is for many substance and behavior abusers).

Make no mistake: AA, NA, MA and all those other A's are still viable. In fact, the vast majority of addiction treatment professionals see them as crucial to recovery because they help to keep the as-yet-unfinished product of the complete recovery process away from the worst of his or her temporary, but ultimately worse than merely ineffective, emotional fixes.

But, in 2019, it looks like the limbic->-HPA axis->-autonomic "gas bag" has to be punctured and emptied to put the nails in addiction's coffin. To that end -- and for those who remain interested after all this admittedly challenging edification -- may I offer sections 7a, 7b and 7c of that same Reddit post? Because section seven rolls out a list of the most widely used and accepted methods to puncture that gas bag, including Choiceless Awareness for Emotion Processing.

My Personal Experience 

Clean & dry from 1984 to 1997. But without my "medications" (see Khantsian's "self-medication hypothesis" below), and as the direct result of addiction switching to sex, romance and other forms of distracting over-stimulation -- and not dealing with the causes of my need to use -- my PTSD symptoms became intolerable, went to SUDS level 9 24/7, and I ate the medicine cabinet in 1997.

I thought Alcoholics and Narcotics Anonymous would be sufficient to get the job done on that until I did it again in 2002. Never drank. Never used a drug to get high. Did take a bunch of them (mostly stolen benzos and pain killers) one night to try to get OUT of relentless anxiety hell. Permanently. Woke up two days later (like the first time) in an ICU. Feh.

Returned to psych school in 2004. Found several versions of The Grail and haven't really looked back since 2009.

Added 01-10-2020: Hadn't yet seen this journal article or this medical media piece about it when I drafted this tirade a few weeks ago. But they do seem to lend credence to it, don't they?

Added 08-21-2020: Further "testimony." 

References

Afuseh, E.; Pike, C.; Oruche, U.: Individualized approach to primary prevention of substance use disorder: age-related risks, in Substance Abuse Treatment, Prevention, and Policy, Vol. 15, No. 1, August 2020. DOI: 10.1186/s13011-020-00300-7

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.

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.

Dorison, C.; Wang, K.; et al: Sadness, but not all negatiuve emotions, heightens addictive substance use, in Proceedings of the National Academy of Sciences, Nov. 2019, DOI: 10.1073/PNAS.1909888116.

Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus (online), 2000. 

Ekleberry, S.: Integrated Treatment of Co-Occurring Disorders: Personality Disorders and Addiction, London: Routledge, 2009. 

Hamilton, L.; Timmons, C. R.: Principles of Behavioral Pharmacology, Englewood Cliffs, NJ: Prentice-Hall, 1990. 

Kannon, J.; et al: Narcotics Anonymous, North Hollywood, CA: Narcotics Anonymous World Services, 1983.

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.

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. 

Mate, G.: In the Realm of Hungry Ghosts, Berkeley, CA: North Atlantic Books, 2010.

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.

Wilson, B.: The Best of Bill, New York: AA Grapevine, 1955.