Month: November 2014

Love is the Drug!

Science as we have shown in many blogs has given us unprecedented insight into brain mechanisms implicated in addiction. It has shown us how various neural networks governing reward/motivation, memory, attention and emotions seem to be usurped in the addiction cycle.

Important aspects of “the self” are taken over in other words. It has shown how those vulnerable to addiction seem to have decision making deficits, suffer impulsivity, choose now over later, do not tolerate distress or negative emotions etc. Over react to life!!

It shows how addicts have difficulties in  regulating stress, and that stress systems in the brain are altered to such an extent that they rely for brain function on allostasis not homeostasis.

They show us that various neurotransmitters are also reduced in the addict’s brain such as GABA, the inhibitors or brakes of the brain. We are deficient in natural opioids, dopamine, serotonin etc. Our brains are different to “normies” to “earthlings.

Science suggests the majority of addicts have had abuse or trauma, neglect or adverse experiences while in childhood and this too contributes to addiction vulnerability via stress and emotion dysregulation and a heightened sensitivity to the stimulating effects of drink, drugs and certain behaviors such as eating, sex, gambling, gaming, internet use  etc.

Science also offers suggestions on treatment. It offers the use of chemicals or antagonists to reduce “carving” and it suggest the effectiveness of CBT, Mindfulness and DBT but it seems to know little about how or why 12 step programs work.

Science can’t quite bring itself to believe that laypeople, fellow addicts, can help solve each others’ problems. It scratches it’s head about “spiritual maladies” and “spiritual solutions”; how the 12 steps could bring about such a cathartic change in personality to change someone from a hopeless addict to a person in recovery.

It wonders how helping others and taking fearless and honest inventory can bring about the psychic change sufficient to help some with addiction recover. To be restored to sanity.

 

love-pain1

In various blogs we have suggested the spiritual malady can also be viewed as a emotional disease and that the 12 steps also allow us to process emotions and regulate feelings in a way we could not before.

It helps us process the many negative emotions of the past via steps 4-9 and sets us free by consigning these emotions to long term memory instead of having them swirl around forever in explicit memory, forever tormenting us.

For us, 12 step programs offer a workable definition of the addict. The “spiritual malady” mentioned in the Big Book does however refer to all people, not just alcoholics/addicts, and is borrowed directly from the Oxford Group.  But reading around this, there are many examples of emotional and stress dysregulation in the BB, some 70 plus examples in the first 164 pages  of  how our emotions dominated us and how we were shot through with fear.

It is the description of alcoholics in the BB that highlights we have an emotional as well as spiritual  disease. What is a spiritual disease if not manifest in negative emotional states such as resentments, false pride, anger, jealousy, and so on. The need to control, to be better than, to know best, all also signs of emotional immaturity.  The BB clearly show us alcohol(ism) has made us very emotional irresponsible. We step on the toes of our fellows and they retaliate.

We have a spiritual malady but, from descriptions of ourselves, it seem more extreme than normal people. It is not only in terms of alcohol that “the delusion that we are like other people, or presently may be, has to be smashed.”

The definition is thus workable because it allows one to act in relation to it. For example, if I am aware of the nature of my defects of character I am in effect aware of what cuts me off from the “sunlight of the spirit”, aware of what keeps me spiritually and emotionally ill, what keeps me in a state of unprocessed emotions, of emotional dysregulation, of undealt with distress. Of what keeps me in resentment in a viscous circle of unprocessed negative emotions.

It shows me how this dysregualtion effects other people and gives me the tools to correct my mistakes, to make amends for the mistakes I have made. To relieve distress. It gives me a framework, a program of action which allows me to live with others, on life’s terms, although I might not immediately agree with those terms, which is often the case!

It gives me a choice that I never had before. It says to me you can live with unregulated negative emotions and cultivate your misery or you can choose to use the program to free yourself from these negative unregulated emotions and by processing them be restored to to sanity. It can help me get out of the past/future and into the now, the present.

The solution to my spiritual and emotional malady is this simple. Identify, label, verbalise either to God or to another human being the nature of these wrongs/sins/defects/shortcoming/negative emotions – those factors that trapped me in self propelled distress – and they are quite simply removed. That is my experience. Honesty, openness, willingness, the how of getting out of self. Repeatedly during the day. When I do not do this I suffer emotionally, and others suffer too.

The steps allow me to reduce my distress and this control of distress and stress via the cultivation of serenity, balance, selflessness deactivates my illness for a while allows me to be happy, joyous and free as this appears to be the state of freedom from self, in my experience, this seems to be a state of Grace in other words. The sunlight of the spirit that Bill W mentioned.

It is the solution. I drank to get away from myself. To exhale some air and go “phew!”  I do not not have to even consider that now because I can do that via the steps, by simply taking inventory and letting go. It is our emotions that hold on to negative thoughts, that grow them in the dark shadow of our souls like fungus. Honesty is a light that extinguishes them. By letting go, by allowing my emotions to lower in intensity, to label and identify them and thus allow via, God’ loving Grace, for them to be removed (and stored away where they belong in long term memory).

But there are so many more reasons why 12 step programs work! If the majority of us have had abusive upbringings then it suggests perhaps that there are attachment issues present in many of us. For me my insecure attachment to my primary care giver, my mother, may have caused an insecure attachment which has certainly kick started my later addictions. In fact some observers have gone so far as to view addiction as an attachment disorder.

I will blog on this in the next weeks or two. I will blog on this attachment disorder as perhaps causing that “hole in the soul” that many addicts talk about in meetings.

That not belonging, being separate from. That isolation – these may all stem from insecure attachment. Insecure attachment can shape the brain in a way that makes it difficult to regulate stress and emotion and thus contribute to later addiction. It may cause the differences in emotions mentioned above. It may also point to heart of the problem and why 12 steps groups work in treating addiction.

12 step groups seem to directly treat the “Hole in the soul” by instantly giving an addict a sense of belonging which is particularly powerful after many years in the desolation of addiction. I know that I stayed in AA because I have finally found the club, the tribe, that I belong too. This   like other families is a group of people I love, but sometimes have problems with, fall out with, return to and see in a new light. It is an organic relationship. It has never been wonderful at all times but that says as much about me and my distrust of others, my insecure attachment as it does AA.

I had grown up not even feeling part of my family. The required psychic change happened to me in my first meeting I believe.  Others have commented on how I walked into the meeting a different person from the person who left the meeting. I had a spiritual experience of some sort in my first meeting, purely through identifying with the other recovering alcoholics in the meeting. Not about their drinking, but by identifying with their spiritual malady. I identified with there emotional disease and I realised that if they could find a solution then there was a chance, however small, that I could too. The first flickers of hope happened in that very first meeting.

I knew in my heart I had somehow returned home in a strange way. I had found my surrogate family, those who would help love me back to health and recovery.
Perhaps this is what Science is generally not getting about 12 step groups, the powerful therapeutic tool of talking with someone who has been where you have, who shares your disease and who can help you recovery, as they have. Even now sitting in an AA meeting is the most spiritual thing I do. More so that attending Chapel, visiting monks in isolated monasteries.

Identification with those in the same boat as you is profound. It tells you are not alone. It tells you I need to help you to help me. We are in this together, not you and I. Us, together.

It accepts you as you are, at your lowest ebb, at your rock bottom, your most degraded self. It offers your affection when you are your most unlovable, most wretched.

This for me was the key, being accepted into a group I knew I belonged in. My new home. My new secure attachment. I believe this secure attachment and the love you have for fellowships, sponsees and the love you can now show yourself and your family and friends and people in your life is that solution. To Love and be loved.

I felt in my active addiction I was not deserving of love, that you shouldn’t give me your love. I didn’t know how to give you mine. Now I have so much love inside of me. It is this love that has filled up the hole in my soul.

Okay, it has also increased my natural opioids, raised my dopamine via belonging, raised the GABA brakes in my brain. It has also increase my serotoninergic well being and happiness, it has lower my excitatory glutamate. It has restored more neuro-chemical balance in my head. By prayer and mediation and helping others it restores sanity, fleeting periods of homeostasis, balance, serenity. It most importantly reduces stress/distress, silences my addiction, long enough for me to think of others, help others. And there is not greater buzz that helping others. Love is the drug that I have been thinking off. Love is the solution.

Trust someone enough so that you can begin to allow them and God to love you and you will eventually love them back. A whole new world, full of love and being whole awaits.

The journey is from the crazy head to the serene heart. 

Is the Addicts’ “Hole in the Soul” caused by Insecure Attachment?

Here we cite and use excerpts from an interesting article (1) that suggests addiction is the consequence of insecure attachment to our caregivers in early childhood and that as the result addicts often learn to consume substances, or behave in certain “rewarding” ways such as gambling, hypersexual activity etc to cope with emotional distress. An emotional distress borne out of not being able to regulate our own emotions effectively, a distress borne out of not having the the neural machinery to regulate out emotional states. This impaired neural machinery has not developed as the vital emotional connection between person and primary care giver has been lacking, or the person has had a number of adverse childhood experiences.

It is saying that environment, the most basic environmental stimulus, that of our primary caregiver is actually fundamental to  wiring our emotional brains. What we experience externally is in fact reflected in the internal architecture of our brains like a negative neural plasticity.

The hope for some one who have suffered in this way is a “learned attachment”  via group therapy or 12 step affiliation as we are exposed to a surrogate attachment via 12 step groups which allows us to return from the steppes of our isolation and gain an emotional attachment with our peers.

This appears to be fundamental to recovery, this acceptance of ourselves by others, this filling of the “hole in the soul” by the love of others and eventually by ourselves.  Love is the drug we have all been loving for!

I do not disagree with this idea but later in the conclusion I suggest that although this environmental factor of attachment seems hugely important to many addicted individuals it is not relevant to all. Some addicted people have had secure attachment. Thus they must have inherited a vulnerability to later addiction which is fairly independent of environment. In fact this inherited vulnerability may have certain overlaps with what is the consequence of insecure attachment, namely difficulties in recognising, processing and regulating emotion.

Obviously insecure attachment would perhaps make these deficits more severe and perhaps also contribute to a more chronic addictive disorder?

“Addiction or Survival Mechanism?

The Adverse Childhood Experiences (ACE) Study, research on 17,421 people who were simply asked if they’d had bad childhood experiences, physical or emotional. The study compared their childhoods, to whether they later developed life-threatening physical medical conditions and/or addictions.

Based on the ACE Study statistics, Dr. Felitti said, “The risk factors which can be  attributed to Adverse Childhood Experiences include… about 2/3 of all alcoholism, about half of all drug abuse, and about 3/4s of intravenous drug use (in the U.S.).

“And,” Dr. Felitti continued, “the things that we call ‘risk factors’ are in fact, effecting coping devises.  This is an important idea.

“Many of these things termed ‘public health problems’ are in fact, personal solutions.

“This is what psychoanalysts have been saying for a hundred years; but they’ve been saying it based on two cases or four – and we’re saying it based on 18,000 cases.  One way of describing it would be: you have this large base of individuals with Adverse Childhood Experiences, and most of them are going to be impaired as a result in some way, maybe socially, maybe emotionally, maybe cognitively…

Felitti ACE DVD 3-min Preview screenshot“By the time they become adolescents and have some freedom, they ordinarily will try to do something to feel better, and hence initiate what we call health-risk behaviors, but which might be called more properly ‘self-help behaviors.’  Those, over time, will produced disease and disability in many of them, and a significant portion of them will die early” .

“Swiss psychoanalyst Alice Miller says: ‘The truth about our childhood is stored up in our bodies, and lives in the depths of our souls’,” Dr. Felitti ended.  ” ‘Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions can be shamed and confused, our bodies tricked with medication. But our soul never forgets. And because we are one whole soul in one body, some day our body will present its bill.’

What if the human organism, when subjected to the childhood traumas reported in the ACE Study, reacts with these addictions as a form of sheer biological and physiological necessity?  What if these behaviors turn out to be necessary for the raw survival of each separate traumatized individual being turned loose to fend for his or her self ?

Brousblog1a Perry brains X-secIn 2011 I heard about “Adult Attachment Disorder” at a church meeting (sic), and decided that was me.  “Science has only recently demonstrated that unless kids are given deep emotional connection (‘attachment’) from birth by parents or other humans, infant neurological systems don’t develop well. They can now do brain scans showing that chunks of neurons in some brain regions don’t fire; it’s dark in there,” I wrote.  It’s called “in-secure attachment” or attachment disorder.

March 2013, I was at a conference where Dr. Bruce Perry, MD of the Child Trauma Academy in Houston, showed these brain scans. The scan at above right is of a normal 3-year old; the scan above of a 3-year old with attachment disorder. Parts of it are dark.

I went to attachment and brain science conferences, and bought every book I could get by Judith Herman, Ruth Lanius, Daniel Siegel, Allan Schore, Bruce Perry, Bessel van der Kolk, Peter Levine, and so on.

Humans, from the instant of birth, require a constant stream of “emotional, spiritual, psychological, and physical inputs” from another loving human, says Dr. Mary Jo Barrett of the University of Chicago —  just as we require air, food, and liquid. “Complex or developmental trauma is about traumatic interruptions [of that stream],” she notes. “I from birth…have a series of relationships where I am emotionally, spiritually, physically vulnerable… If my spirit, my emotional stability is endangered, my physical being, is endangered, if I am repeatedly interrupted in the context of these relationships, these repetitions create a person who spends their life in fight, flight or shut down.

A child left without this input stream learns that its own hard-wired biological needs are terrifying.  “I learn that what I experienced internally and expressed externally with a cry, was met by a response that didn’t make any sense to what I needed,” says Dr. Daniel Siegel, MD of UCLA. “The organization of that child’s brain will be quite different, as neurons which fire together, wire together.

“I will have learned: it doesn’t matter what I’m feeling, because people don’t get me what I need. So I’ll learn to live without calling out to other people, and studies show, as I have those experiences over and over again, I will actually have a different way of being in the world.  Ultimately, I’ll become quite disconnected, not only from other people, but even from my own internal bodily self and my emotional experience. ”

The emotional pain and terror are so intense, the child will do anything to distract itself from those screaming needs. “In this distress I can only comfort myself in ways that are often maladaptive – I may bite myself, I may rock myself perpetually, trying to distract myself from my needs,” Dr. Siegel states. Such children “have all sorts of self-regulatory processes that are not interpersonal. They are very isolated.”

We’ve just  detoured to the “attachment” ball park to gather a wider set of data on Dr. Felitti’s original Big Question:

Do so many Americans use alcohol, tobacco, marijuana, meth, IV drugs, food, sex, violence, workaholism,  sports, internet porn, etc. for sheer survival?  Are they compelled to medicate with these to escape an intense fear, anxiety, depression, or anger which if they had to feel it, might literally kill them.

So here’s what Attachment Theory and brain science say about attachment and substance abuse like alcohol.

Harvard Science of Neglect Video screenshot“At birth we are biologically waiting for input from adults around us to ‘serve and return,’ a back and forth interaction that literally shapes the architecture of the infant brain,” report Dr. Jack Shonkoff, M.D., Director of Harvard’s Center on the Developing Child and his colleagues in a 2012 video “The Science of Neglect.”  “It begins when a child looks at something, observers something, that’s the serve. The return is when the parent responds to the child. When serve and return is broken, you literally are pulling away the essential ingredients for the development of human brain architecture… When a baby is not attended to, that is a sign of danger to the baby’s biological systems, so its stress systems are activated. In a brain that is constantly bathed in stress hormones, key synapses, the connections between nerves, fail to form in critical regions of the brain.

And the flood of stress chemicals doesn’t just stop. It can go on for years and decades, biology gone haywire.  Bruce Perry explains it in terms of how the three regions of the brain react. His slide below shows the highest thinking “cortex” level of the brain in blue, the next higher emotional-attachment-relational “limbic’ brain in green, and the lowest survival brain, aka reptilian brain, made up of the cerebellum and the brain stem, the foundation of the entire brain, in yellow and red.

 

So why do people drink?

“We can’t persuade people with developmental trauma with a cognitive argument (cortex brain), or compel them with an emotional affect (limbic brain), if their brain stem (survival brain) is dysregulated,” Perry warns.  “We can’t talk people in this kind of alarm state into doing the right thing, because their thinking brain’s been turned off by the alarm state.  And we  can’t reach their emotional-attachment-relational (limbic) brain if they feel so threatened they get into an alarm state, because they can’t feel reward from relations with people.

“If their brain stem, the foundation of their entire brain as a whole, is completely dysregulated, the only way they can feel reward is from sweet/salty/fatty foods, alcohol, drugs, sex, and so on. They know in their head that it’s wrong to steal from Grandma, and they may love Grandma in their heart – but at that moment, cognitive beliefs, or even human relational consequences, can’t relieve their anxiety.  They are in such distress in the lowest parts of their survival brain that it (survival brain) needs the reward of the drugs too badly.

“In fact, they can get to the point where they can’t feel any reward at all –  reward can’t even reach the lower part of the brain, if they’re so ramped up and anxious. At that point, the ONLY thing they want is to relieve the distress, and the only thing that can do it is to drink.  Alcohol will reduce the anxiety. It also makes us more vulnerable to other unhealthy forms of rewards.”

“Addiction as an Attachment Disorder”

Attachment disorder is surely a major component of many Adverse Childhood Experiences.

Flores, Addiction as Attachment DisorderAs to ACEs and substance abuse, note Dr. Philip J. Flores’ 2004 book entitled “Addiction as an Attachment Disorder.”

Dr. Flores reports that the human need for social interaction is a physiological one, linked to the well-being of the nervous system, as we’ve already seen. When someone becomes addicted, he says, mechanisms for healthy attachment are “hijacked,” resulting in dependence on addictive substances or behaviors. Flores believes that addicts, even before their addiction kicks in, struggle with knowing how to form emotional bonds to connect to other people.

While it’s commonly understood that early childhood attachments to parents and family are necessary for healthy development, Flores says, emotional attachments remain necessary throughout adulthood. It’s not enough, he says, to “just stop drinking. ” To achieve long-term well-being, addicts need opportunities to forge healthy emotional attachments.

Flores reports that this is the reason for the phenomenal success rate of Alcoholics Anonymous over more than 50 years.  When people walk into an A.A. meeting, the whole point is to admit openly that they are an alcoholic and yet to feel fully accepted for exactly who they are, with no condemnation.  What a relief! This experience of, in essence, pure attachment, may be the best attachment experience in their lives – and most people who walk in and experience this, miraculously, stay sober for decades or a lifetime.

Healing the Adult-Child

It took deep emotional attachment to heal the adult me over the last years. It required a broad safety net: an empathic, painstaking therapist skilled in Adult Attachment Theory; support groups modeled on the A.A. principle of total acceptance and emotional attachment for the wounded; and close friends who were serious about staying attached to me because they wanted to heal, too.

As Dr. Felitti told me “After we talked to the very first round of ACE Study participants about their childhood experiences in the results of their ACE questionnaires, we saw a staggering 20% or higher reduction in the number of medical complaints, office visits, and other indicators of physical ailments in the next year alone.  Over and over, people thanked us for simply listening to them and their stories.”

That’s human emotional attachment: being seen, being known, just as we are, warts and all, by another human being – and then being fully accepted, and finally feeling that we belong.”

 

This is a very interesting article but for us it shows the compounding impact of insecure attachment on addiction vulnrability, i.e. it may not solely cause it. I, like my eldest sibling, became an alcoholic. My two middle sisters  did not although we all experienced similar adverse childhood experiences.

Why did my eldest sister become alcoholic when she remembers only happy experiences of childhood compared to me who has memories of many abuses? And what of alcoholics who report a loving upbringing?

Equally my middle sisters have grown up with emotional difficulties but no alcoholism or addiction.  They appear to have a neural machinery sophisticated enough to cope with these negative emotional states, to process them and re-appraise them, without being overwhelmed by them.

Thus for me it is genetic vulnerability which marks us our for later addiction and alcoholism. Insecure attachment however does appear to compound the problem. It appears to create more severe addiction difficulties and may even be more difficult to treat. It may have made my alcoholism more chronic? But I am not sure it created it?

Up to 60% of alcoholics, for example, have genetic inheritance, they got the alcoholic vulnerability from either parents or grandparents, perhaps regardless of environmental influence. Which begs the question what is inherited in this genetic endowment?

For us it may be emotional recognition, regulation and processing deficits, regardless of upbringing.

Obviously attachment disorder is linked to emotional processing deficits such as alexithymia which worsens these emotional processing deficits considerably.

Also the actions of chronic stress, the result of the addiction cycle, can also worsen the addict’s emotional processing, recognition and regulation deficits and appear as a severe form of alexithymia.

To conclude, alcoholics in particular may be born with a sense of separation (perhaps borne out of genetic impairment which results in neurotransmitter deficits,  for example in serotonin which is linked to well being, dopamine linked to negative emotions, GABA linked to inhibition, the “brakes” of the brain and excess stress chemicals all of which could contribute in a “cocktail” of emotions which manifest as feeling separate from others, not belonging)   and emotional problems exacerbated by insecure attachment, adverse childhoods and the neuro-toxic effects of alcohol and drugs on stress and emotional regulation to the point where drugs and alcohol, and other addictive behaviours are consumed or used to “regulate” these troublesome, distressing negative emotions.

What decreases in the addiction cycle is the ability to regulate our emotional selves.

Regardless, the treatment of this emotional disorders appears to be as suggested in this article.

Having some one listen to you without prejudice or censor is a first for many of us, having the confidence to verbalise one’s emotions is in itself a therapeutic tour do force as it helps us identify (recognise), label, process and regulate our emotions and in time allows us to offer the same courtesy to others. In the fullness of time, we become adapt at reading and responding to our and other’s emotional language.

I knew nothing of emotions a decade ago, now I am fascinated my them, research them and use them to converse with others and use them read the world around me. All as the result of going to 12 step meetings where other people allowed me to be myself.

Did this fill the hole in my Soul?  It certainly helped so there must be something to attachment disorder theories too.

 

Reference

http://www.mentalhealthexcellence.org/substance-abuse-survival/

When the Nuggets Lose their Lustre!

Good little animation, although the animation misses the bit about lying and cheating family and friends, the general degradation of the kiwi’s being etc and the frenzied attempts to do any thing to get the next glow, however increasingly dim that glow has become. In recovery we need to watch out for euphoric recall of that glow and also getting that glow in different ways, through different behaviours.

Eating Disorders based on a Body “Feeling State” Confusion?

Here we look at emotion processing deficits in eating disorders and whether the extent of these difficulties can predict treatment outcome three years later.  This would demonstrate the ongoing role of emotion processing, as conceptualised as alexithymia, plays an ongoing role in the pathomechanism driving eating disorders.

This article also had a very good description of the somatic/emotional confusion which creates that unpleasant feeling state we have referred to before which appears to end in compulsive reactive behaviour rather than goal-directed, adaptive, evaluative, action-outcome thinking.

As we have shared before this is due to emotions not be labelled and used as guides to recruit goal directed parts of the brain but rather in their emotionally undifferentiated state they appear to compel us to react rather than consider our long term actions and their consequences.

“Several cross-sectional studies have reported high levels of alexithymia in populations with eating disorders.

However, only few studies, fraught with multiple methodological biases, have assessed the prognostic value of alexithymic features in these disorders. The aim of this study (1) was to investigate the long-term prognostic value of alexithymic features in a sample of patients with eating disorders.

The Difficulty  Identifying Feelings factor of the Toronto Alexithymia Scale (TAS-20), often used to assess levels of alexithymia, emerged as a significant
predictor of treatment outcome. In other words, the results  of this study indicated that difficulty in identifying feelings can act as a negative prognostic ( meaning predictive of something in the future)   factor of the long-term outcome of patients with eating disorders.

eating_disorder_by_ttonny-d2yezty (1)

 

The authors of this study also suggested that professionals should carefully monitor emotional identification and expression in patients with eating disorders and develop specific strategies to encourage labeling and sharing of emotions.

The identification of variables that predict treatment outcome in patients with eating disorders is critical if we are to increase the degree of sophistication with which we treat eating disorders…Among the several psychological features that have been proposed to predict treatment outcome in patients with eating disorders, alexithymia has attracted special interest.
Alexithymia is a personality construct characterized (partly) by a difficulty in identifying and describing feelings.

Several arguments, namely, factor analyses and longitudinal studies, have supported the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon linked to depression or to clinical status [3,4].

Several studies have reported high levels of alexithymia in patients with eating disorders, especially in individuals with anorexia nervosa [5–8]. There are several reasons to believe that this construct could play a major role in the illness course of eating disorders: due to their cognitive limitations in emotion regulation, alexithymic individuals with eating disorders may resort to
maladaptive self-stimulatory behaviors such as starving, bingeing, or drug misuse to self-regulate disruptive emotions.

The results of our study indicate that one of the facets of the alexithymia construct, the difficulty in identifying feelings, is a negative prognostic factor for the long-term outcome of patients with eating disorders. Patients with the
greatest difficulties at identifying emotions at baseline are more often symptomatic at follow-up and show a less favorable clinical improvement.

There are several ways in which alexithymia can affect the clinical outcome of eating disorders: via the negative influence it exerts on the clinical expression of the disorders and on the response to therapeutic interventions.

First, the difficulty in identifying feelings may reduce the capacity of patients with eating disorders to adapt to stressful situations [28]. Such situations generate an emotional overflow that alexithymic subjects apprehend less by emotional and cognitive features than by their associated somatic indexes[29]. This uncertainty between feelings and bodily sensations reminds us of the interoceptive (a sensitivity to stimuli originating inside of the body) confusion proposed by Hilde Bruch [30,31].

Luminet et al. [32] have experimentally observed a dissociation of the components of the emotional response of alexithymic subjects (a physiological hyperreactivity to emotional stimuli associated to a deficit at the level of the cognitive experience), which illustrate the functioning of patients with eating disorders.

Faced with the physiological arousal induced by emotional demands, these patients may show poor adaptive strategies. They may resort to restricted patterns of repetitive and automated behaviors, such as the hyperactivity of anorexic individuals or the binges/purge cycles of bulimic  subjects, which temporarily relieve their feeling of discomfort and restore their inner equilibrium [33,34] but generate, in the long term, a positive reinforcement of the eating disorder. 

Second, alexithymia may be related to a chronic course of eating disorders by its relationship with other pathological behaviors, especially with addictive disorders. We have shown in previous studies that alexithymia is associated
with addictive behaviors in patients with bulimia [35].

Patients with eating disorders may resort to addictive behaviors to relieve the anxious and depressive feelings elicited by their negative perceptions of themselves [36].”

Thus to conclude, eating disorders appear to have the same emotion processing and regulation deficits as other addictive behaviours, particularly emotional differentiation, a difficulty in knowing exactly what one is feeling.

Interestingly eating disorders seem also to be driven by the same negative self perception we have seen in other addictive disorders.

References

1.  Speranza, M., Loas, G., Wallier, J., & Corcos, M. (2007). Predictive value of alexithymia in patients with eating disorders: A 3-year prospective study.Journal of psychosomatic research, 63(4), 365-371.

 

“Eating our Words!?” – Emotion-Processing Deficits in Eating Disorders

In eating disorder patients, an impairment of emotional processing is clinically supposed. As quoted by Bruch (1985), anorexic patients not only show impaired differentiation between hunger and satiety, but they can hardly differentiate their physical sensations from their intimate emotions, which they often cannot describe. Bulimic patients often respond to stress with a bulimic crisis and vomiting, but they can hardly correlate their crisis with any emotional stimulus (Davis, Marsh, 1986).

Several studies suggest that alexithymia is a predominant factor in eating disorder.

Emotional awareness was defined by Lane and Schwartz in the late 1980s as the capacity of an individual to describe his or her own feelings and another person’s emotional experience (Lane & Schwartz, 1987). Lane and Schwartz  conceptualised emotional awareness as a cognitive process undergoing various structural transformations along a cognitive-developmental sequence (1987,
p. 134).

Lane and Schwartz focused on a way to measure the level of emotional awareness an individual has reached. For these authors, the degree of structural organization of emotional awareness is reflected by the verbal material individuals provide to describe their emotional experience. They pinpoint that emotional experience does not require language to be conscious, but that language helps to structure and
establish concepts, and therefore increases the ability to discriminate between differentiated emotional states.

From this point of view, Lane, Quinlan, Schwartz, Walker, and Zeitlan (1990) elaborated the Levels of Emotional Awareness Scale (LEAS), which is aimed at evaluating an individual’s capacity to describe not only his or her own emotional experience but also the emotional states of others. The scoring of this instrument is based on the analysis of the verbal contents the individual provides in response to a series of 20 short stories depicting a variety of emotional situations. The discriminant validity of this instrument has confirmed that the level of emotional awareness is independent of depression and anxiety (Bydlowski et al., 2002;
Lane et al., 1990).

 

Alexithymia was considered by Lane and Schwartz  as corresponding to the lower end of the emotional awareness continuum, that is, the preconceptual level of emotion organization and regulation within their hierarchical model. Indeed, alexithymia can be viewed as a deficit in the cognitive processes involved in the representation of emotional internal and external experiences, characterized by the
persistence of cognitive-affective modalities of the first levels of development, below the concrete operational level (where emotions are experienced somatically).

 

eating-disorder-clinic-300x250

 

This study (1) in accordance with their initial hypothesis, demonstrated that patients suffering  from eating disorders showed evidence of an emotion-processing deficit independent of affective disorders, such as anxiety and depression.

In the current study, individuals with an eating disorder were characterized by a global emotion processing deficit, with impaired ability to identify their own emotions, as well as an impairment in judging others’ emotional experience.

In our study, anorexic patients had a significantly lower level of emotional awareness than bulimic patients, Our results are in line with those
of Smith, Amner, Johnsson, and Franck (1997), who showed a marked tendency of these patients to develop alternative strategies to avoid empathizing.
These strategies are not limited to the restricted use of emotional words. According to the authors, eating disorder patients have good verbal skills, but
cannot use them adequately to describe their emotional experience, indicating a pronounced in capacity for emotional understanding.

The current report is also consistent with clinical descriptions of the types of affective difficulties characteristic of anorexics and bulimics. Indeed, some authors consider the deficits in the processing of the subjective experience and the perception of oneself as the most fundamental difficulties of this type of disorder (Corcos, 2000; De Groot & Rodin,
1994; Jeammet, 1997).

These subjects seem to have a limited access to their emotional life and/or feel easily dominated and overwhelmed by their emotions  (Bruch, 1962). Thus, the ability to take into account one’s own emotions is diminished in individuals  with eating disorders, probably because body sensations cannot be related to affects, or because the perception of undifferentiated body impulses prevents understanding of how affects are elaborated. Lacking knowledge of their own emotions, these individuals are not able to represent another person’s emotional experience.

Because the capacity to differentiate one’s own and others’ emotions in a given context is associated with the ability to tolerate and manage a large number of emotional states, emotions that are not integrated remain global and undifferentiated, which leads to an incapacity to use affects to guide the selection of an adapted behavior (Krystal, 1974),

These emotion-processing deficits induce intense, often uncontrolled, affective reactions. The food related behavioral problems of anorexic and bulimic
patients have been conceptualized as a consequence of the incapacity to control distressing emotions through psychic processes (Taylor, 1997a).

Abnormal eating behaviors would thus represents a way of discharging negative affects.

With the demonstration of increased secretion of cerebral b-endorphin in patients with anorexia nervosa perhaps eating disorders should, therefore, be regarded as addictive behaviours, whose purpose is to control the subject’s affective inner turmoil (Jeammet-1997).

The finding that neither level of emotional awareness scores nor alexithymia scores were correlated with the duration of illness suggests that emotional internal life impoverishment is not due to the severity of the disorder. One may wonder whether this deficit predates the occurrence of the disease, potentially favoring the development of eating disorders. This hypothesis is in line with the point of view of some authors who consider alexithymia to be a predisposing factor in addictive behaviours (Taylor, 1997a, 1997b).

References

1. Bydlowski, S., Corcos, M., Jeammet, P., Paterniti, S., Berthoz, S., Laurier, C., Chambry, J. and Consoli, S. M. (2005), Emotion-processing deficits in eating disorders. Int. J. Eat. Disord., 37: 321–329.

 

Addiction – A Parasite that feeds off your Emotions?

When I was in treatment at a local treatment centre, when we were in group therapy to be exact, one of our facilitators, after someone had given an example of their “powerlessness and damage” while drinking, suddenly described alcoholism and addiction as a being like a parasite that feeds on the addict’s emotions.

I was shocked initially by this remark, feeling that this would be an insidious illness indeed if that were the case. A disorder or disease that fed on one’s emotional state. Not only negative emotions I must add as so called happy emotions such as “elation” can also propel a vulnerable recovering person to relapse.

All emotions which are extreme seem to have the capacity to activate a pathological “wanting” in the brain and can prompt relapse. That is why we are often advised to keep a check on the emotions to make sure they are neither too high or too low. Too extreme. This is also called emotional regulation. When emotions are tempered and not so overwhelming or not too labile (changeable).

We know from previous blogs that emotional dysregulation, not controlling or tempering emotions but reacting to them can heighten a sense or a feeling of “wanting”, so intense it feels like a “needing”, in the brain. This is partly due to having excess stress chemicals in the brain.

In the course of addiction or during the so-called “addiction cycle” the brain’s stress systems become increasingly out of kilter, dysregulated, and this creates a brain allostasis rather than the normal homeostasis. With homeostasis the brain regulates itself within given parameters and within regionalised areas of the brain. An example of homeostatic imbalances, such as high core temperature, a high concentration of salt in the blood, or low concentration of oxygen, can generate homeostatic emotions (such as warmth, thirst, or breathlessness), which motivate behavior aimed at restoring homeostasis (such as removing a sweater, drinking or slowing down).

Allostasis is the process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPA axis hormones, the autonomic nervous system etc.

Wingfield states: The concept of allostasis, maintaining stability through change, is a fundamental process through which organisms actively adjust to both predictable and unpredictable events… Allostatic load refers to the cumulative cost to the body of allostasis, with allostatic overload… being a state in which serious pathophysiology can occur… (Wingfield 2003).

Allsotasis means adaption via change, it is fleeting homeostasis but “at a price”. One of the prices of excess or chronic levels of stress in addiction  is normally a reduction in dopamine, a brain chemical involved in wanting, motivation, reward, learning and memory and habits.

When there is a heighten stress or emotional distress there is often a rise in dopamine and an increased wanting in an attempt to create a homeostasis. In the case of addiction this dopaminergic wanting, augmented by stress chemicals, usually makes an addicted person want what has previously created a temporary “homeostasis” ie drinking alcohol or taking drugs etc to relieve a distress. Hence stress activates dopamine brain circuits involved in attention, memory, emotion, reward/motivation and habit behaviours. Hence heightened stress levels can pretty much activate one’s addiction and the physiological urge to use or drink. This is the reason stress factors are implicated in the majority of relapse situations.

So to summarise, instead of one or more specialist areas of the brain regulating within given parameters the whole brain can be engaged in attempting to create a fleeting homeostasis. The brain becomes global, i.e. different areas and functions of the brain are recruited. For example, previous experience, memories and so on are activated in governing action and behaviour.

In addiction these memories, for example, are activated by excess stress normally caused by negative emotions and failure to regulate them. The brain will suddenly suggests via these memories and previous experience that the previous way to create a fleeting homeostasis while in a negative emotions would be to drink or use drugs. It would suggest this present distress, this alien state,  is solvable and that drug use is the “normal” way to survive it.

In effect the brain is saying that previously we used drugs to regulate these emotions which at a bio-chemical level also created a fleeting homeostasis, or a fleeting resolution to emotional distress.

As we know this is a far from perfect way to regulate emotions. Hence we use more drink and drugs to regulate emotion which ultimately leads to increased emotional and stress dysregulation which leads to needing drink and drugs more and more. It creates a tolerance, whereby we need more of a certain substance (or behaviour) to reach a fleeting ” balance”. The more stress we have the more we need to restore “homeostais” by using more drugs. The more we reduce dopamine the more we need to use drugs to get more dopamine and other neurotransmitters. It is stress chemicals in the brain  that controls addiction in the end.

At endpoint addiction and in early recovery we seem to be left with a whole lot of stress in the brain, emotional and stress dysregulation; so severe we may not even be able to guess what emotion we are actually having and a desire to leave this alien state of sobriety and return to the previously “normal” state of intoxication that is so profound only an addict can really understand it’s overwhelming intensity.

Thus craving is also stress based. If we regulate our stress we regulate our emotions and our illness is quietened and tempered. Hence we suffer from a distress based illness.

Sorry for so much detail but this is important to know.

The article (1) here set us on a research voyage to a large extent as it confirmed to us that one of the reason people relapse is because sobriety is initially so foreign, so alien, so troubling. We do not really have the tools to cope with it. Hence we need a whole lot of help to recovery. Our illness has effectively taken over our survival mechanisms and appears to speak to us with our own voice although it is essentially the motivational voice of addiction imploring us to survive by re-using.

It is like a psychotic care-giver who is convinced the best way to survive is to employ a way of living that is destined to take your life away and then kill you.

This article showed that  the “euphoric recall” often mentioned in recovery circles is not only instantly retrieved from memory but is immediate. The euphoria is actually re-experienced rather than re-called as such. it is re-felt in terms of brain frequency. Thinking about drinking activates a similar brain frequency to actually drinking itself.

Also it may be also that experience of a negative self perception may activate this brain frequency also and instantly remind one of alcohol or drugs as a way to deal with this negative self perceptions, these distressing negative emotions. This brain frequency suggests we consume substances in order to do the most basic of survival strategies, to regulate our emotional states. Our emotions have become the slaves of substance abuse and behavioural addictions. Addiction does, after all, mean to be bound. We are bound to our addictions for the basic of human needs.

This article (1) – which we comment on as we proceed, italics as we feel it is describing allostasis although it does explicitly say so – appears to be saying in scientific terms what our facilitator at the treatment centre was saying from a therapeutic and observational point of view, from great and profound ancedotal evidence. That substances appear to take over our emotional states and regulation. In this case, alcohol seems to have become intrinsic to our emotional regulation.

How can we say this? In this experiment the researchers found that not only does simply thinking about alcohol create a very similar brain frequency in the brain as actually drinking but that this brain frequency is also seen when we are having negative emotions about ourselves (as alcoholics).

To us this means our negative self perception and emotional regulation itself has become absolutely connected to drinking and taking drugs, in other words, negative emotional states automatically give rise to a desire state a need to drink or use drugs. It has become a automatic habitualised and compulsive reaction and response to negative emotions and adverse self perception.

How we feel about ourselves has ultimately driven our addiction. Hence we need to start think differently about ourselves real soon in recovery because for many years our alcohol, drugs or addictive behaviours may have been doing the thinking and feeling for us!

One thing that kept me sober in early recovery was not listening to my self-centred thoughts (as much as I could because these thoughts have your voice attached so are kinda hard to completely ignore!)  as my thoughts were the product of negative emotions which then caused more negative emotions and then brought memories of past drinking etc and the people, places and things attached with this drinking. My sponsor said it is the voice of your illness and this helped immeasurably.

I tell sponsees this now.

Here we go…” Evidence demonstrates that attachment and interactions between parents and child play a significant role in normal development; alternatively,
impaired parental bonding appears to be a major risk factor for development of mental illness, substance abuse and possible substance dependence later in life (Canetti et al. 1997; Newcomb and Felix-Ortiz 1992; Petraitis et al. 1995; Brook et al. 1989) – It is within this context that this study and the Self-Perception and Experiential Schemata Assessment (SPESA) were formulated. The SPESA is designed for sensitivity to negative, average or positive perceptions of self, experiences and self in-experience in three life domains; childhood, adolescence and adulthood.

The SPESA takes less than 10 min to administer and 10 min to score. It provides important insight into the perceptual, visceral, affective and cognitive processes that may preclude the actual physical or psychological substance abuse or dependence. This instrument divulges perceptual information regarding the endogenous and exogenous experiences of the individual; including, physical, sexual or emotional abuse, self-efficacy, self image, view of self in relation to family and peers, in addition to perceptions of alienation and inadequacy .

Individuals with a family history of alcoholism show increased alpha activity (brain frequency) in posterior regions after alcohol consumption and rate it more difficult to resist further drinking than controls (Kaplan et al. 1988). Males at risk for alcoholism show increased low-alpha EEG activity (7.5–10 Hz) after ingesting alcohol as compared to males at low risk (Cohen et al. 1993).
Michael et al. (1993) found higher central alpha and slow-beta coherence in frontal and parietal electrodes in relatives of alcoholics and lower parietal alpha and slow beta coherence in males with alcohol dependence.

Notably, other findings indicate that morphine, alcohol and marjuana increase alpha 2 power in the spectral EEG and relate this to the euphoric state produced by the drugs (Lukas 1991, 1993; Lukas et al. 1995).

Elevated alpha power amplitude is suggested to be a potential threat indicator for the development of alcoholism and men with fathers having alcohol use disorders are more likely to have high-voltage alpha than men with unaffected fathers at baseline or after receiving placebo (Ehlers and Schuckit 1988, 1990, 1991; Ehlers et al. 1989).

We define experiential schemata (ES) as a neurologic progression in human development involving a fundamental self-organization process. This process is based in the formulation of concepts of self originating in perceptions  of self (endogenous) formed through interactions with others and the environment (exogenous). These encoded schemata become the foundation for prevailing emotions, motivations, attitudes, and attributions relating to self and self-in-the-world that are maintained, reinforced and entrenched in neural coding mechanisms formed through dendritic arborization (spreading of neural networks) over the lifespan.

In normal development ES involving experiences, behaviors, learning and organization of self are engrained or reinforced in neural circuits with much of the
acquired information being necessary for social functioning, and overall survival in most circumstances. The drawback to this process is that it can be extremely difficult
to introduce new concepts relating to self—identity to an individual as well as novel learning material.

Based upon critical concepts from a variety disciplines contributing to addiction research, we propose that a common neurophysiological pattern exists in recovering alcoholics (RSA)  when evaluating self and self-in-experience that is significantly different from non-clinical controls.

This is the first study of its kind to evaluate EEG patterns of self-perception and experiential schemata in a group of RSA as well as controls. The significant differences between groups in the SPESA condition may provide insight into a very probable neural pathway which stands to be an idiosyncratic neurologic anomaly for the RSA population  in this study, in addition to a possible antecedent to Substance Use Disorders (SUDs).

The excess alpha activity in SUD when processing perception of self and self-in experience may reflect a state of desynchronization (or an idling fear and evaluator
response guided by maladaptive ES) within the individual, given that alpha is generated in the thalamus (Lorincz et al. 2008) and is known to be involved in both attention and memory processes (Cannon et al. in press-a).

(Obviously this desynchronisation may reflect the allostasis mentioned above also)

This alpha excess possibly places demands on resources otherwise employed for the homeostatic functioning of the individual; including, autonomic, perceptual, attentional, social, cognitive and sensory processes.

(Equally it may in fact relate to allostasis and the recruiting of these various brain function in anticipating homeostatic/physiological need)

Notably, research demonstrates the use of certain chemicals produces widespread
alpha power increases in the cortex thereby, at least for this study group and their reports of ‘using’and ‘drinking’ thought patterns, bringing the brain into synchrony, if only for a very short period of time.

(Again we would add that these thoughts are acting allostatically as a homoestatic facsimile if you like)

We believe this to be the euphoria addicted individuals speak of so fondly and is one possible reason for the difficulty in treating these disorders in addition to the high relapse rates.
The excess alpha activity during the task is possibly attributable to ES and the associated emotions relating to internal and external conflict and confusion distinguishing past from present and the brain’s reaction to re-experiencing the past.

Damasio (1994) discusses  the continuous monitoring of the body by the brain
as specific content and images are processed, exacting not only changes in brain electrical activity but also chemical reactions. Thus, as the brain communicates and orchestrates  the affective state of the individual in response to these contents and images relating to self and self-in-experience; it is plausible that a large scale feedback loop is formed involving not only perceptual processes but relative autonomic functioning. This process possibly reinforces the addicted person to become habituated to an aroused cortical state (i.e. increased alpha/beta activity) and when there is a shift to ‘normalcy’ it is errantly perceived as abnormal thereby increasing the desire or need for a substance to return to the aroused (or perceived normal) state.  

(This for us explains why initial sobriety and recovery feels so alien, the brain is not used to the cortical state of not using or drinking and tries to get the now recovering person to return to this cortical aroused state of using and drinking)

Also this study offers support to the idea of increased the dopamine roduction within limbic regions in addicted populations (Blum et al. 2007; Kohnke et al. 2003) as increased dopamine producion may be reflected in excitatory frequency domains observed.

(although obviously this heightened dopamine production may also be reflective of stress augmented dopamine activity consistent with allostasis) 

The possibility that substance abuse interacts with specific brain regions in
specific frequencies for specific time intervals appears to be a valid concept, noting the paradox that the resulting self destruction and self-deprecation to achieve a desired state or to change or alter an undesired state transcends immediate comprehension.

(again this can be understood in terms of allostasis as survival has been usurped, taken over, by stress systems acting on, among other systems, dopamine systems of the brain)

Many of the individuals in the RSA group with 3 or more years of continuous abstinence report a consistent effort to intervene on their initial reactions to
external cues and seek additional outside interpretations from counselors, peers or family members for suggestions in how to deal with life events, rather than go on their first instinct.”

(again we believe this can also be explained in terms of allostatically driven distressed-based impulsivity)

To conclude this article set us on a train of research which we believe has led to answers to some of the questions implicit in this research. We believe the increased alpha activity of brain frequency and other points mentioned can all be explained in terms of the brain constantly seeking a new homeostatic setpoint. A return to “normalcy” however maladaptive and self destructive that so-called normality is.

Stress systems usurp survival systems in the brain and the alpha activity reflects a drive for homeostasis whereby allostasis via memory and other mechanisms augment dopamine to facilitate the brain to want or need the substance least required in terms of survival, the alcohol or drugs that have usurped via stress means, the survival network in the first place.

The euphoric recall is allostasis sounding it’s bugle, activating the brain to return to former ways of regulating emotion and behaviour.

The increased brain frequency is a siren to a fleeting brain balance, which will give way via drug and alcohol use to even greater stress based wanting and a brain even more out of homeostatic sync.

An endless, fruitless cycle to find an elusive, fleeting balance that comes and goes.

Amazingly recovery offers alternatives to achieving this fleeting homeostasis and even prolonging it. Prayer, meditation and helping others can keep one in balance for as long as you do it.

Now that is food for thought. In helping others we help ourselves more and in a more profound way than we can ever do by ourselves. Being in self activates our illness and being out of self treats it.

Reference

Cannon, R., Lubar, J., & Baldwin, D. (2008). Self-perception and experiential schemata in the addicted brain. Applied psychophysiology and biofeedback,33(4), 223-238.

“Staying in Action” Part 3

In this third part of our blog on the gambling addicts version of “dry drunk” we look at further “symptoms” of this. We hasten to add that a good 12 step program would soon iron out  most of these emotional and behavourial manifestations and maintenance of our “emotional sobriety” via steps 10-12 keep them in manageable order.

Nonetheless, this article (1) gives us good insight into the emotional malady we suffer from without a therapeutic solution, and which can creep up on us in many ways even when trying to “work our program” .

Other manifestations of “Staying in Action” –

Flooding

Gamblers who rely on avoidance as a defense mechanism are frequently flooded with feelings and memories when they become abstinent. This can occur in several ways. Most commonly the gambler becomes overwhelmed with guilt as he or she remembers things that were done, people that were hurt, episodes of lying and cheating. A common refrain is “I can’t believe I did that.”

A similar experience is the sudden realization of time wasted. During the years they had been gambling, their lives had gone on and they are now older. There is an acute sense of lost opportunities, and of lost youth and innocence. Disappointment becomes self-pity and there is an impulse to give up or to punish oneself by a return to gambling or some other self-destructive behavior.

A third kind of flooding involves the sudden remembrance of painful and traumatic memories of childhood—physical or sexual abuse, extreme neglect, disturbed parents. This may occur when the patient stops gambling or quits other addictive behaviors.

(( we dealt with these ourselves in steps 4 through to seven, followed up with amends 8-9)  As we have already blogged on previously the steps 4-7 in particular allow one to process memories from the past via the adaptive processing of emotions attached to these memories as well as the realisation they we were in the grip of a profound affective and addictive disorder.   Also as the Big Book states “No matter how far down the scale we have gone, we will see how our experience can benefit others. That feeling of uselessness and self pity will disappear. We will lose interest in selfish things and gain interest in our fellows. Self seeking will slip away. Our whole attitude and outlook upon life will change. Fear of people and of economic insecurity will leave us. We will intuitively know how to handle situations which used to baffle us. We will suddenly realize that God is doing for us what we could not do for ourselves.”

This transforms our self pity and sense of wasted years into a powerful transformative tool for helping others. It is no longer wasted but the most precious thing we possess in helping others, in sharing our experience, in being there for others because we know what it’s like to feel the way they do, to be where they are at. )

Boredom

According to the description in DSM-IV, as well as the writings of most clinicians (for example, Custer & Milt, 1985, p. 52), the typical pathological gambler is “restless, and easily bored.”  This proneness to boredom has been the focus of two studies (Blaszczynski, McConaghy, & Frankova, 1990; Elia, 1995) that compared pathological gamblers to normal controls; boredom scores were significantly higher for the pathological gamblers.

(Again this ties in with alcoholics without a recovery as per the BB ” being restless, irritable, and discontented”, page xxvi).

For early onset male gamblers, particularly if there have been decades of gambling activity, the gambling was typically how they defined themselves. Without their identity as a gambler, they do not know who they are. Giving up gambling leaves a large vacuum or hole in their lives. They have no other interests, and there are few activities that can compete with the excitement of gambling.

As already noted, boredom can mean understimulated. when they stop gambling and “get off the roller coaster” of strong sensations and self-created crises, they may find the underlying restlessness unbearable.

Patients who are manic also need time to adjust to being normal. What others regard as normal feels like being in slow motion to them, or as if something is missing. They describe it as strange and uncomfortable.

Boredom can mean that individuals cannot be alone because of problems in self-soothing. Boredom can mean that they are left alone with intolerable feelings, such as depression, helplessness, shame, or guilt. There is a need to escape, to get away from themselves.

(as an alcoholic the main reason I gave for drinking was “to get away from myself!”) 

For some, being alone means an intolerable state of emptiness or deadness. Those individuals who did not bond in infancy may carry within themselves an image of parental rejection or disgust, or affects engendered by an overwhelmed mother. Being alone and quiet means experiencing these intolerable affects, which they instead try to externalize through addictive substances and behavior.

Problems with intimacy and commitment

By the time the gambler is in treatment and has stopped gambling, spouse and family members are aware of the debts and depleted finances, the pattern of lying, and other problems. The response is usually one of anger, helplessness, and betrayal. Not infrequently, it is only after the gambling has stopped that the brunt of the spouse’s anger is expressed. This is often difficult for the gambler to understand. The anger is often proportional to the fear of being hurt and betrayed again. Holding on to the anger is a way for family members to protect themselves.

Mistrust of the gambler continues longer than it does with other addictive disorders because a relapse can be so devastating in terms of a family’s financial situation, and also because it is so much more difficult to recognize. As frequently stated, gambling is not something that a wife can smell on her husband’s breath nor observe by his gait or coordination. Nor are there blood or urine tests so that one can detect it with certainty. What we need to emphasize with both patient and family is that reestablishing trust will take time, and that if treatment is successful there will be observable changes in personality as well as behavior.

There are usually problems with intimacy that precede the gambling, in which case they will be there after the individual has stopped. Pathological gamblers often have difficulty being open and vulnerable and depending upon others in a meaningful way.

(I can relate to all of the above too – waking up to an awkward and at times profoundly troubling and distressing emotional illiteracy  is perhaps the last thing one needs in the early days of prolonged withdrawal and feelings of almost overwhelming emotional distress that can sometimes accompany the early weeks and months of recovery)

They have learned to suppress their feelings and to detach from potentially painful situations. Much of the work in therapy has to do with identifying emotions and learning how to express them.

Family members have their own issues which if not dealt with may sabotage the gambler’s recovery (Heineman, 1987; Lorenz, 1989). For example, some of the wives of recovering gamblers will admit that they miss the gifts they received when their husband came home after winning. They confess to a wish that he could have just one more big win, which would allow them to pay off their debts. They may realize they had been living vicariously through him, particularly if he was an “action” or “high stakes” gambler. His optimism and grandiosity were contagious. Initially they may have been attracted to him because he was a man with big dreams, a risk-taker, and big spender. According to Heineman (1987) and others, many wives of compulsive gamblers are adult children of alcoholics or of compulsive gamblers. Living from crisis to crisis may be familiar and exciting for them. In some cases there is a need for the gambler to remain “sick” so that they can take care of him.

Many pathological gamblers were brought up in a home in which intimacy was lacking.  They tolerate financial indebtedness far better than they do emotional indebtedness. Many experience claustrophobia in their personal relationships (Rosenthal, 1986), in fact in any meaningful situation. Commitment is experienced as a trap. They have difficulty saying no, or setting limits. This is related to an excessive need for other people’s approval and validation. When they say they feel trapped by another person, what they mean is that they feel trapped by their own feelings about the other person. They may have projected various expectations or demands on to the other, so that they are overly concerned about disappointing them, or about not being adequate to the task.

Excessive reliance on these projective mechanisms leaves them uncertain as to their boundaries, between inner and outer, self and other. A question they frequently ask themselves: what am I entitled to?

Male gamblers, in particular, are preoccupied with power games (Rosenthal, 1986). Power, as opposed to strength,3 is defined in relation to others, and is invariably gained at someone’s expense.

Relationships take on a seesaw quality, with the gambler battling for power and control.

Due to unresolved guilt about his gambling, a patient felt “onedown” in relation to his wife. He felt unworthy of her and not entitled to be treated decently. He did not verbalize this, but instead provoked fights at home. Similarly, his self-esteem was based on material success. When they had to scale down their lifestyle, he felt diminished. Again feeling like a failure, he blamed others and took it out on those closest to him. Compulsive gamblers are often good at “turning the tables,” so that it is the spouse who feels helpless and inadequate or is apologizing to the gambler and seeking forgiveness. For male gamblers, particularly action seekers, relationships are typically adversarial.

In light of the above, it is not surprising that there are frequent sexual problems (Daghestani, 1987; Steinberg, 1990, 1993). Adkins, Rugle, and Taber (1985) found a 14 percent incidence of sexual addiction within a sample of 100 inpatient male compulsive gamblers. When “womanizing” patterns are investigated, the incidence is closer to 50 percent (Steinberg, 1990, also personal communication). The excitement associated with the pursuit and conquest of women resembles the excitement and “big win” mentality of gambling.

In treating early onset male gamblers, in particular, one typically encounters two patterns of aberrant sexual behavior: (1) celibacy or a kind of phobic avoidance of sexual relationships, and (2) compulsive sexual behavior consisting of promiscuous womanizing, or compulsive masturbation related to various forms of pornography. The two patterns may be mixed.

Success

A closely related problem has to do with difficulties handling success. It may be blown out of proportion. For example, in some parts of the country a GA birthday is a cross between a bar mitzvah and a Friar’s Club roast. Gamblers compete with each other in seeing how many people will attend and who will receive the most glowing testimonials. It is a critical time, in that the achievement of a year’s abstinence, or some other landmark, poses an immediate risk for relapse.

There frequently are unrealistic expectations of what success will mean, so that its achievement leads to disappointment and depression. Sometimes the gambler abstained in order to prove something to someone, in effect to win a mind bet. Sometimes they were doing it for their family or for the therapist, so that after a period of abstinence they feel justified in saying “Okay, I was  good for a year. Now I feel something is owed me so I’m going out to have some fun.” Fun, in this case, of course, means gambling.

 

compulsioncartoon

 

Sometimes their successes are attributed to omnipotent parts of the personality (Rosenthal, 1986). Success can trigger mania.

They get high on their success and grandiosity takes over. Some gamblers are fearful of success, and there is a subset of gamblers with masochistic character disorders. Some of them feel more alive when they are in debt and having to work hard to pay creditors. A critical time is when they are just beginning to get in the black, when they can start to have something for themselves.

The gambler’s relationship with reality may be adversarial, persecutory, or humiliating. The gambler may want to see himself as an exception—exceptional among people, and an exception to the rules. Not wanting to be pinned down, he is looking for “an edge,” or for loopholes. This search for “freedom” is often what gets him into trouble.

Once initial problems have been dealt with and abstinence established, gamblers are often at greatest risk when life starts becoming predictable. Meeting responsibilities and living a “normal” life leads to a feeling of being trapped for those gamblers who have not yet internalized a value system based on facing responsibility. Rather than viewing their new life as a self determined one, gamblers are more likely to see such behavior as externally imposed. Feeling controlled by their own schedule, they experience a need to rebel.

Conclusion

Staying in action is, for the pathological gambler, equivalent to the alcoholic’s dry drunk. It is a way to maintain attitudes and behaviors associated with gambling while superficially complying with treatment and Gamblers Anonymous. After the patient has initially achieved abstinence, it is important to look for more covert forms of gambling and other ways in which the patient may still be in action.

Lasting abstinence requires personality change. At a minimum, there is a need to identify and confront whatever it is from which the gambler is escaping. This would include the intolerable situation and feelings as well as the mechanism of their avoidance. Honesty means more than not lying to others about one’s gambling; it means being honest with oneself about one’s feelings. One learns to take honest emotional risks, rather than those based on the need to manipulate or control external events.

As is true for all addicts, gamblers at the beginning of treatment cannot trust themselves. Self-trust requires self-knowledge, which in turn requires curiosity about oneself. Stated differently, “The key to building self-trust” (Kramer & Alstad, 1993, p. 252) “is the ability to utilize one’s own experience, including (one’s) mistakes, to change.”

(This article (1)  is worthy in addressing the oft unspoken realities of abstinence/sobriety when the emotional dysfunction and emotional immaturity once solely regulated via addictive behaviours seeps into sober life also and the formerly habitualised compulsive approaches to life re-surface in abstinence. There can be quick and profound self transformation in recovery but many of the habitualised behavioural patterns continue to stalk our every day lives, as we ” trudge the road of Happy Destiny”. They are there waitng to resurface. They are normally the consequence of reacting to the world as opposed to acting responsibly in it.

I have an addicted brain and a recovering mind, they do not always mix very well. They pull me in opposite directions and have sometimes heated arguments in my head.

I have to manage my illness. It hasn’t gone away. The drink did not make me ill. It didn’t help but it did not solely make me an alcoholic, some emotional dysfunction worsened by alcohol, drugs and other addictive behaviours did. I had a vulnerability and a propensity to later addictive behaviours. I was primed to go off. If alcohol or drugs were the sole problem I quite simply would have given them up. As I did with cigarettes etc

If I do not try to remain manageable or emotionally sober I can still react and “still go off on one”, on temporary, fleeting dry drunks.

Hey I appear even to have many  “stay in action” similarities and I haven’t gambled since I was 14 years old. Perhaps these emotional and behavioural manifestations have certain commonalities among addictive disorders?  A spiritual malady or emotional dysfunction which activates “old patterns of behaving” ?  

Then again I only gave up gambling on poker machines because I was losing all my drinking money on gambling machines!!))  

 

References

1. Rosenthal, R. J. (2005). Staying in action: The pathological gambler’s equivalent of the dry drunk. Journal of Gambling Issues.