Month: July 2015

There is a map of Emotional Responding Tattooed on my Heart.

When I was doing my step four inventory as part of my 12 step programme of recovery  I did it pretty much as suggested in the Big Book.

My sponsor at the time asked me to do an additional part that is not explicitly mentioned in the Big Book.

He said to list all the negative emotions (or defects of character) that I had been in the grip of and exhibiting in relation to my various misdemeanors and the resentments I had held against various people and institutions over the preceding decades.

This turned out to be a brilliant idea for two reasons.

First it showed me that  I held a multitude of resentments because I had a problem of emotion regulation.

I did not realise that the engine driving this emotion dysregulation was chronic shame.

I realised when doing my step 4 that that I had not previously been able to leave various supposed slights and abuses from my past in the past because I did not have the emotional maturity to look at these episodes reasonably and objectively.

In other words, I had not processed these episodes emotionally and embedded these events in my long term memory like healthy more emotionally mature people do.

Hence when I came into recovery I had hundreds and hundreds of resentments swirling around my mind, poisoning my thoughts and sending constant emotional daggers into my heart.

My past constantly assailed me emotionally, randomly attacking my mind.

My step 4 and then 5 showed me that I did  not have the natural ability to deal with my negative emotions.

Secondly, listing all the negative emotions I had when I held a resentment against someone was very revealing in that when I held a resentment, any resentment, and against a wide variety of people, the negative emotions listed where generally the same! In fact they were all interlinking in a pattern of emotional reacting, one activating the other. It was like a emotion web that ensnared one in increasingly frustrating states of emotional distress and inappropriate responding.

This was quite a revelation!? That I respond in exactly the same way to my sense of self being threatened?

That there was a map of emotional responding tattooed on my heart.

I was drawing up a web of my emotional dysregulation, a route map of all the wrong ways to go, to emotional cul de sacs.

It was a list of the negative emotions which appear always when I felt anger and resentment against someone for hurting me and my feelings.

Just as revealing where the negative emotions listed which clearly showed how  I react, and can still react to people who I believe have caused my hurt or rejection.

In fact it seems now that I treat all insult, intentional or otherwise, in a very similar way.

I have spent years trying to work our why?

I got as far as deciding it was an inherent problem with processing negative emotions, which it is.

However, there seems to be a problem specifically with a patterned mesh of negative emotions which are activated when someone upsets me.

In fact I think this pattern of interlinked negative emotions occurs simply because of inability to identify, label and share the simple fact that I have been upset  by what someone has said or acted towards me.

“Shame is a fear-based internal state being, accompanied by beliefs of being unworthy and basically unlovable. Shame is a primary emotion that conjures up brief, intense painful feelings and a fundamental sense of inadequacy. Shame experiences bring forth beliefs of “I am a failure” and “I am bad” which are a threat to the integrity of the self. This perceived deficit of being bad is so humiliating and disgraceful that there is a need to protect and hide the flawed self from others. Fears of being vulnerable, found out, exposed and further humiliated are paramount. Feelings of shame shut people down so that they can distance from the internal painful state of hopelessness.”

“… unacknowledged thoughts and feelings become repressed and surface later through substitute emotions and dysfunctional behavior. Other emotions are substituted to hide the shame and maintain self esteem. Anger, exaggerated pride, anxiety and helplessness are substituted to keep from feeling the total blackness of being bad. The buried shame is expressed through defense mechanisms that shield negative unconscious material from surfacing.

Anger responses are modeled and learned in some families. The anger response is more comfortable than feeling the shame for some individuals. Families where coercive and humiliating methods of discipline are used develop children who are shame prone. Behavior become driven by defenses that function to keep from feeling bad. Reality becomes distorted to further protect the self from poor self esteem. The transfer of blame to someone else is an indicator of internal shame.

Children who live with constant hostility and criticism learn to defend against the bad feelings inside and externalize blame on others. External assignment of blame is a defense against shame. People who are super critical have a heavy shame core inside.”

I was working with someone last year and we had a disagreement and this guy said to me “I am upset” and “You have hurt my feelings” I was taken aback. I thought I never say things like that. This guy was an Olympic champion at expressing how he feels compared to me. I never say I am upset because it also seems to be an undifferentiated emotion that I have trouble accessing, mentalising and expressing.

I have not been taught as a child or since to simply say I am upset.

Instead of acting on my upset by saying to someone,  you have hurt my feelings  I do the opposite,   I react and attack them in my head, my thoughts, my words and sometimes in my actions. Sometimes I “get them back” somehow. I make them pay in some way.

Honesty is the heart of recovery and I am being honest. The years of recovery reveal many different things, some of them not so palatable.

I grew up in a family that did not express emotions like the ones I had mentioned. We reacted via anger and put downs hence I have grown up to be dismissive.

My dismissiveness and my arrogance are parts of defence mechanism against rejection, they guard my inherent sense of shame. I am full of shame, more so than fear, although these two overlap. Shame is in fact fear evoking.

I hide my shame away under an anger of emotional hostility, stay away or else! I will get you back somehow. Sometimes I am in shame and offend via my attitudes.

I also have other ways of reacting in an emotionally unhealthy way that my step 4 showed.

If someone hurts me, according to my step 4, my angry resentment of what they have said or done makes me ashamed. This can quickly prick my sense of self pity (uselessness and hopelessness) which is something I have always rage against (rage is an essential part of shame plus I rally against this feeling of powerlessness) and I retaliated via excessive pride (I am better than you, I will put you down and see how you like it!) I put you down in my mind or through the words uttered from my mouth by arrogance, dismissiveness, impatience and intolerance.

I do so because I am being dishonest and fearful.

I do some because I am self centred and selfish.

These are all parts of my emotionally entangled web that is spun when I react to some sense of rejection.

Sometimes the shame persists for some time and I try to relieve it by behavioral addictions, too much shopping, too much eating, too much objectification of the opposite sex.

Not enough action, or effort to change my feelings in a healthy manner.

My step 4  showed me this is the unhealthy fruit of my greed, gluttony, my lust, my sloth.

My spiritual malady.

Add in perfectionism because that is the quick way to do nothing, a fear of failure  that paralyses.

These are my main negative emotional  reactions to the world that often scare me and make me feel ashamed.

I have felt powerless via your comments so try to to steal some power back by making my self seem more powerful over you.

I respond to feelings of humiliation by humiliating you, I react to my chronic shame by attempting to created shame in you.

Some days I react more adversely than others.

For example, this family have just moved into my neighbourhood, they seem wild and out of control.

I am not only fearful (leading to dishonesty in my thinking, catastrophizing, intolerance of uncertainty about how they will behave etc) I have reacted to their arrival via shame based defence mechanisms and reactions. I am shamed and disgusted that my neighourhood has come to this. I am dismissive of them, intolerant, impatient and arrogant towards them. All shame based reactions.

Last night the police were called to their home and one of them was handcuffed and put in the back of the police van.

My head went “I told you so!”

It was a very shameful scene for the whole family.

When things had died  down and calm restored I spent the evening not in my fear or shame but in empathy and compassion.

How embarrassing for them how shameful.

I relate to them as they are out of control, my family was at varying times completely out of control too, traumatic and this is what has created a chronic shame in me, even still now after 10 years of recovery!

My shame responded and related to their shame.

Nobody wants to be out of control, to be teetering on the verge of the next disaster, the next moving of home, the next calling of the police,  the next swirling carousel of unmanageabiilty.

No one.

I related and all my negative emotions retreated to source like a evening tide on a beach.

I relate to my fellow human beings when I am not in fear or shame.

When I am in fear and shame the same pattern of negative reactions entrap my heart in its’ poisonous grip and I react in a way I would not choose to, if more reasonable.

This is what the heart of my alcholism looks like. Not a pretty sight some days.

The most beautiful thing about me most days is the fruits of my recovery.

Now at least I can see how I react and can take steps to deal with it.

I have a spiritual tool kit that deals with this emotional disease.

Whether  I stay in fear or shame is now my choice. A choice I once did not seem to have.

This is what recovery has given to me.

I do not have to cultivate my own misery through blind reaction.

Via an Amazing Grace I can now see what ails me.

Via AA I now have the tools, never taught to me in my family or in my troubled home environment.

I have gone home in AA. I learnt an attachment to those in AA and others.

I share my feelings of shame with those who know what that feels like.

Together we share our pain and we recover.

Reference

1. http://www.angriesout.com/teach8.htm

 

The Discordant Echoes of the Past

The last six years of research has been dedicated to trying to understand a fundamental part of my illness of addiction, of me.  People often say there is more to you than addiction.

To which I normally answer yes, there is also recovery.

I don’t mean to be smart arsed by this but I view recovery not only as a healing in many ways, physiologically, physically, emotionally, cognitively and spiritually but also as a ongoing process of learning about me, the various strands that have contributed to my illness and the various aspects of my recovery which also give insight into what was wrong in the first instance.

If certain aspects improve in recovery there is a fair chance these were impaired in the addiction cycle. I believe there is a lot more to addiction that the end product of addiction, namely chronic pathological addictive behaviour.

Various aspects have contributed to the need to externally manage troublesome and painful internal feeling states.

Recovery according to my wife has made me a nicer person, more loving and considerate and easier to live with. Better company,  more mature in my emotional reactions and more responsible. I hasten to add that I have some way to go still in some respects. In simple speak, I have become less selfish, self centred and less me, me me!

These to me seem like the traits of addiction, this self obsession.

Other factors have fed into this manifest self obsession too however.

Recovery has been a continual process of learning how to do life in a more healthy, emotionally mature way, in simple terms. I have had to learn so many things, the things  more healthy people take for granted and learnt years ago.

Somehow I never learnt how to do some basics, was never properly taught these basics or always had inherently difficulties with certain basic, developmental skills.

For example my emotional life was a complete failure, continually running away from my feelings, avoiding them as if they were actually injurious to the self!

I have spent years trying to work out why I ran away from my feelings and from a very early age. I have that type of curious head.

In early recovery I was astounded that I could not feel what emotions I was having, could not generate a mental perspective on what emotions I was experiencing, could  not identify and label and thus use as a way to make effective decisions. My decisions were always based on the “distress” of not knowing exactly what I was feeling, actions were taken simply to escape this distress.

I had in effect an emotional disorder and that this emotional disorder seemed to precede, initiate and propel by addictions.

Addictions were the place I went to in fleeing me and my negative emotions. They were the tools I used to regulate my negative moods, emotions and negative sense of self.

Me overwhelmed Me – I appeared to need help regulating Me so I chose and used stuff outside of me which seemed to work originally in provide escape but increasingly contributed to this escalating problem of my inability to live with me.

Someone described the spiritual awakening which results from doing the the 12 steps of AA as fundamentally changing how we think and feel about the world and our place in it!

So what do I think and feel about the world and my place in it?

And has this changed in recovery?

Generally I would say I have had a revolution in how I relate to the world, it no longer scares me like it did, I am no longer to ashamed take my rightful place in it.

That does not mean I no longer struggle with fear and shame. In fact the longer I am in recovery I see these two factors as contributing most of the distress I can feel in recovery.

Fear I have always been aware of – we have a fear-based illness it is often shared in AA meetings but shame?

Six years of academic research has clearly shown me that this fear based illness is a distress based disorder. Neuropsychology has shown that the experiential wisdom and insight of 12 step groups has always been correct.

Fear/distress causes me problems via certain avenues such as catastrophic thinking, fear of an uncertain future, distorted /dishonest thinking.

Fear can lead to a wide range of other negative emotions. But honesty is often the first port of call for fear.  I find fear leads immediately to distorted dishonest thinking. Honesty comes from the ancient Greek “to be in (one with) God” so I guess dishonesty is not being in God which is the opposite to being in fear. Interestingly the Christian Bible refers to the Devil as the Father of All Lies!

I had not however realise that shame creates just as many emotional difficulties and emotional pain as fear!

Shame and fear certainly effect each other but both can take the lead.

Fear is referred to in the Big Book of AA “This short word somehow touches about every aspect of our lives. It is an evil and corroding thread; the fabric of our existence was shot through with it.” but shame is rarely mentioned!

This is not surprising as there was little research into the effects of shame of illness back then in the 1930s, in fact research into shame is relatively recent, in the last 25 years. Interest in shame came form an academic article which called shame the “master emotion!” which can effect and amplify all other negative emotions. Thus it has just a profound effect on emotional well being as fear!

I was delighted to come across this research recently as I have always been looking for answer to a vexing question, ever since early recovery in fact.

In early recovery, and since, I have always wondered when someone hurts my feelings, intentionally or otherwise,  I suddenly have this warm sensation, this spreading dendritic/branching type feeling in my heart which when activated captures my heart and pollutes my head with negative thoughts about me.

I suddenly feel hurt, upset, less than, smaller, weaker, hunched over, feeble, and then I get these other voices suggesting the person who upset me is right, I am worthless helpless, useless. Who the hell was I thinking I was, sure I was kidding myself?

I feel that I have been assailed, my head swoons, I lose my bearings. I am under some seemingly grievous emotional attack!

These feeling and thoughts multiply against the audio soundtrack of my tormenter’s voice which then blends into orchestra with my own and other voices of negative self perception.

I am suddenly strangely paralyzed by this emotional avalanche.

Other negative emotions are detonated such as self pity, the ever present sense of “poor me”.

Eventually other emotions may get activated too like fear and dishonest thinking.

I can work myself into quite a emotional state replaying the scene of my supposed insults via resentment and the re-sending of situations, feeling and thoughts from this and other previous episodes in my  life. Other negative mood congruent memory is activated and soon there are other similar memories of similar insults supporting this insult and my increasingly sense of low self esteem and self worth.

I found it impossible for years to stop this spreading emotional feeling and distorted thinking after it was first activated.  It simply continued  against my will. When activated it takes ages to reduce. In fact the intensity of the emotion always seems to get worse before any hope of it getting any better!

I usually need the help of a loved other to help me through it.

It feels as if there has been an emotion explosion in my heart?

One emotion explodes and it then detonates other emotions is the best way I can explain it.

These leads to increased negative thoughts about self and the reinforcing of a negative self schema ingrained in memory from childhood on.

It seems to confirm all the worse things about myself.

Chastises me for having thought any differently!

All because I took a slight at what someone may have said to me!

Often I have found out afterwards that I had misheard and misinterpreted the words and that no insult was intentionally given in the first instance!

My fear-based misinterpretation led to all these negative emotional reactions and cognitive distortions which all then ran away with themselves.

Now in recovery I feel that shame has just as profound an effect on my negative emotions as fear – in fact shame can lead to fear and vice versa. But to me now, it seems that shame is that negative emotion that detonates the other emotions that spread dendritically across my heart.

I have finally found out what has been at the heart of my emotion dysregulation –  shame.

Shame and fear also have similar parents – namely trauma /abuse, insecure attachment as a child to a primary caregiver.

Addiction doesn’t exactly help with shame either!

The trauma incidents I experienced in childhood have led to a fear based responding to the world and what I would call chronic or toxic shame.

A knawing feeling of being less than, not good enough.

An emotional achilles heel.

The above feeling of shame and the resultant negative emotions and thoughts that it detonates are the result of what is perceived  as insult and rejection. It is often said in recovery that the recovering person fears nothing more than rejection, as it brings that damning emotion of shame.

At least fear can activates action, shame always paralyses. Fear can embolden, shames weakens.

We sufferers of toxic shame thus very vulnerable to this type of “putting us down” or the feeling of being rejected or even “found out”.

We spend our lives constantly guarding against it, although we are often unconscious of this.

I sometimes wonder if the “hole in my soul” was shame-shaped?

This is why shame inspires the constant use of defense mechanisms, the myriad of self defence mechanisms that we use against shame, rejection and which I will discuss next time around.

As for the solution to the above perceived insult, pray for forgiveness or simply forgive the person who allegedly insulted you as it exonerates him/her of being a imperfect human being while doing the same thing for you at the same time.

Accept the gift of our communal and very human imperfection when you can.

 

 

 

Shame

little prince download

 

In the next few weeks we will be looking at Shame and Addiction – nicely summed up here in this quote from  The Little Prince.

“- Why are you drinking? – the little prince asked.
– In order to forget – replied the drunkard.
– To forget what? – enquired the little prince, who was already feeling sorry for him.
– To forget that I am ashamed – the drunkard confessed, hanging his head.
– Ashamed of what? – asked the little prince who wanted to help him.
– Ashamed of drinking! – concluded the drunkard, withdrawing into total silence.
And the little prince went away, puzzled.
‘Grown-ups really are very, very odd’, he said to himself as he continued his journey.”

― Antoine de Saint-Exupéry, The Little Prince

Phew! So it’s going much better than I thought!?

I have often written about all the difficulties I have had with reading my emotions. Especially in early recovery when I could not even identify and label the most intense negative emotions.

That experience has set me on a near decade-long search to better understand emotions and the way a lack of awareness of emotions plays in addiction and in recovery.

Today I would say the effective and rational/reasonable control of emotions is one area that has become noticeably better.

I tolerate negative emotions better, their intensity is much reduced compare to early recovery, the duration of these emotions is much much shorter than before. I seem to also make better decisions in my life based on not being overwhelmed by my emotions, particularly negative emotions.

It is said by much research that addicts, alcoholics and those with behavourial addictions have something skin to alexithymia, an impaired ability to read emotions and act on them in making decisions.

Humans seem to use emotions to make decisions which is something I never realized before.

When I ask my wife how have I changed she always says I have become more considerate and more mature in my emotional reactions.

This to me shows recovery as a process of handling emotions better, in a more emotional mature as opposed to immature way.

I also have looked at lots of research that says this emotional immaturity is there for many pre-using drugs or alcohol or engaging in unhealthy behaviours. So it may be a part of the aetiology of addictive behaviours.

When I first came into recovery I remember my wife would drive me to AA meetings. This was before my sponsor said I would be either walking or getting the bus from now on!

I was mortified?

ME!? Doesn’t he know who I am?

I have chauffeur, thank you very much?.

I had become so emotional dependent on my wife. It was like another addiction/dependency.

Recovery has been a long, at times painful, process of growing up, however reluctantly at times!

I was not only powerless over alcohol but fairly hopeless too when it came to living life on lives terms.

The more chronic my addictions became the more I regressed emotionally.

The more I recovered the more I matured emotionally,  is my point.

Even today I often have to “talk my emotions out” to see what I feel really, before I can label and identify what I am feeling really.

Before I can act maturely on what I am feeling instead of emotionally reacting which is what I always used to do.

As a fellow recovering person said in this article (1)  . . “. sit down with people and bounce some ideas off each other and get it off your chest and stuff. That’s very helpful and that kind of helps me, like saying it out loud to identify where I’m actually at.”

This is why ringing sponsors and talking to fellow recovering people is essential  especially in early recovery.

We do not how we feel clearly what we are really feeling otherwise, delude ourselves everything is fine, continue to make poor decisions to the point of becoming emotionally  drunk and then often relapsing to physically drunk.

We do all of this sometimes not because we want to drink but because we think we can do it alone when we cannot.

Sometimes in early recovery we haven’t go a clue what is going on, our arrogant pride however resists this idea and keeps missing the point of what is really going on.

Our errant emotion processing does not result in clear thinking, it results in negative, strangely deluded thinking.

By deluded I mean divorced from the reality of things as they really are. It takes some weeks and months to realize we cannot fully rely on our own thinking and this can be a blow to the pride.

The concluding part of this study (1) was very revealing to me and explained part of the “feeling” that often accompanies early recovery, the feeling of not recovering fast enough of not recovering NOW!

Addicts and alcoholics want everything NOW even recovery, they want the recovery of ten years in ten weeks!

” …some  participants interpreted negative feelings as global markers of overall emotional ill health and poor progress in recovery, for example, “I think I should be feeling better now” and “I thought I was progressing but in a lot of ways I haven’t and that’s not good.”

Here, participants realize they are experiencing negative feelings and understand it as suggestive of a larger negative phenomenon, for example, that they are not “better now” and not “progressing” as previously thought. This type of negative globalization is a type of cognitive distortion.”

A cognitive distortion is a deluded thought like those mentioned above. Our errant negative emotions produce distorting thinking.

Our negative feelings rarely tell us the truth. They give some jaundiced view of reality.

This is why we need to have constant contact with others in recovery to offload these negative feelings.

Just as with sharing with a sponsor or a friend to find out what we feel, we need to share with others to undistort our negative thinking. Negative emotions often give rise to negative thinking.

“As one participant said “And I know [recovery] is not a magic fix either because I didn’t expect, if you get sober to be all of a sudden everything is perfect. That’s not the way it works. . . . So it’s going to take you a little longer to feel better.””

I would add to this that it is  progress not perfection.

I would also add that we can feel better quicker than we think on a basis, one day at a time.

Ring someone, talk to someone and try to verbalise how you feel.

This straightens out your thinking and you will feel better right away.

We drank to go “phew!” a release from our thinking and negative heads, now we “share” with others what is really going on with us, to get to understanding what emotions ail us and this leads to the same feeling of release, to the same feeling of “phew!”

We never have to drink again to go “phew”, talk to someone instead.

We will discover things are never as negative as our thinking has lead us to believe, and are usually a whole better in fact!

We recover together.

 

References

1. Krentzman, A. R., Higgins, M. M., Staller, K. M., & Klatt, E. S. (2015). Alexithymia, Emotional Dysregulation, and Recovery From Alcoholism Therapeutic Response to Assessment of Mood. Qualitative health research,25(6), 794-805.

You are Enough, We are Enough!

“The wounded healer” refers to us, who suffer greatly from shame, helping others via love, tolerance and understanding who also suffer greatly from shame.

We can help others and be helped because we all know what it is like to feel the chronic, toxic shame the drives addictive behaviours.

Our understanding of shame is not out of a book it is real, lived experience. We know how it can drive one into chronic addiction and we know how to recovery from the persistent effects of this shame.

The main thing that struck me when I first went to AA was a lack of judgement which was amazing considering I was very jaundiced at the time.

I was accepted in the group without  reservation. This greatly helped my damaged sense of belonging, my not feeling part of.

It made me feel that this is the place I need to be. Have always needed to be?

The “shares” or testimonies of other recovering people made we realise they suffered the same shame as me and had worked to overcome it via the steps, via having fellowships, people in their lives who understood and who helped them. They told me of their triumphs over their emotional difficulties, over their chronic lack of self esteem, over not feeling good enough, of feeling less than.

A failure –  they talked about me and how I felt about me. How I had always felt about me!?

I had never been in a group of people who had talked so openly about their intimate feelings which was amazing. In doing so they were talking about my intimate feelings too. This gave me a sense of not being alone anymore. They seemed to be shining a light of hope into the dark recesses of of my shameful psyche.

It addressed my sense of isolation right away.

I had spent my life feeling not good enough, bad, l had that knawing feeling of less than, that hole in the sole.

I was like these people. They were like me.

I felt and continue to feel more like these people than I do my own family.

They became my surrogate family, my newly learnt attachment.

They were like me. They had not learnt this stuff out of a book, by professional observation but by having been through this stuff themselves. This was real not learnt.

They had been there. They were here now for me.

They knew what they were talking about.

This was the beginning of my psychic change. A person who was to become by therapist at the local treatment  was at my first meeting and he later said that he felt I had a psychic change at that my first meeting.

I had come in utterly beaten, at  death’s door and had left with hope.

The journey started with hope.

I had found a portal in the universe – it was Alcoholics Anonymous but from the shares it might have been called Shame sufferers Anonymous.

Shame ran through every share. They say fear is the corrosive thread which ran through our lives but it is equally the case that shame does too and causes just as much distress and damage.

It is difficult to live life when you do not have your own back, believe in yourself as  worthy of the good, healthy, things  in life. That you are not worthy them. That these things happen to others. Not you as you do not deserve them.

Why recover at all when you are not worth it?

This is how many of us feel? We are not worth it, this recovery.

The truth is the opposite, we are worth it. We do deserve it.

We are heroes who suffered so much and come through so much. We deserve happiness more than most! As a result we have  so have so much to offer others. We are all wounded healers.

We are here to help others like ourselves, in a way that only we can!

It was via others, like parents that we have this shame and these negative self schemas.

It is through human relationships that these start to heal. Shame is a social emotion which needs a social treatment.

We need to reconnect to overcome the isolating force of shame.

You are enough! We are enough!

The Wounded Healer

 

 

Here is a video of Ernie Kurtz, academic historian on the subject of recovery, principally 12 step recovery, being interviewed by William White. They discuss shame and how 12 step recovery helps treat the shame that often drives addictive behaviour.

Below is also a link to Ernie Kurtz’s book on “Shame and Guilt” which is freely available online at Ernie Kurtz’s behest.

Shame and Guilt

 

Kurtz is interesting in asserting that some of the 12 steps principally deal with guilt whereas others help deal with the ongoing struggle with shame.

Guilt seems to be about events and specific actions whereas shame is a process of healing, of coping with and challenging a negative self schema inherited from childhood and sometimes reinforced since then.

 

The Shame at the Heart of Addiction

For me, over the last ten years,  it has become very clear that the toxic shame ingrained in my brain, from early childhood maltreatment, is at the core of my addictive behaviours.

Over the next weeks I will be posting on the role of shame in addictive behaviour and how to address shame in recovery.

This video is the fifth out of six videos  and brilliantly describes how shame activates and maintains addictive behaviours – I urge you to watch all of these videos.

The psychic change as continual behavioural change?

When I came into AA I remember hearing the words “the need for a psychic change” which was the product of a spiritual awakening (as the result of doing the 12 steps) and that the 12 steps are a program of action!

The Big Book of Alcoholics Anonymous clearly states this need “The great fact is just this, and nothing less: That we have had deep and effective spiritual experiences* which have revolutionised our whole attitude toward life, towards our fellows and toward God’s universe.”

The question is whether this spiritual change is the result of behavioural change?

As I was told when I came into recovery that if I did not change my actions, and how I acted in this world, my actions would take me back to where my actions had taken me before – back to drinking.

This is the cornerstone of AA recovery; thinking, feeling differently about the world as the result of acting differently in the world, as to when we were active drinkers.

Otherwise one does the same things and ends up in the same places, doing the same things, namely drinking. It is a behavioural revolution; a sea change in how we act.

In line with this thinking, it is we that need to change, not the world.

According to one study (1) which examined whether personality traits were modified during prolonged abstinence in recovering alcoholics, two groups of both recovering and recently detoxified alcoholics were asked via questionnaire to  see if they differed significantly from each other in three personality domains: neuroticism, agreeableness and conscientiousness.

The recovering alcoholics were pooled from self help groups and treatment centres and the other group, the recently detoxified drinkers were pooled from various clinics throughout France.

Patients with alcohol problems obtained a high “neuroticism” score (emotions, stress), associated with a low “agreeableness” score (relationship to others).

In the same vein, low “conscientiousness” scores (determination) were reported in patients who had abstained from alcohol for short periods (6 months to 1 year).

In this study, recently detoxified drinkers scored high on neuroticism. They experienced difficulty in adjusting to events, a dimension which is associated with emotional instability (stress, uncontrolled impulses, irrational ideas, negative affect). Socially, they tend to isolate themselves and to withdraw from social relationships.

This also ties in with what the Big book also says “We were having trouble with personal relationships, we couldn’t control our emotional natures, we were prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were unhappy, we couldn’t seem to be of real help to other people.“

In contrast, regarding neuroticism, they found that recovering persons did not necessarily focus on negative issues. They were not shy in the presence of others and remained in control of their emotions, thus handling frustrations better (thereby enhancing their ability to remain abstinent).

Regarding agreeableness (which ties back into social relationships), the researchers also found that recovering persons cared for, and were interested in, others (altruism). Instead, recently detoxified drinkers’ low self-esteem and narcissism prevented them from enjoying interpersonal exchanges, and led them to withdraw from social relationships.

Finally, regarding conscientiousness, they observed that, over time, recovering persons became more social, enjoyed higher self-esteem (Costa, McCrae, & Dye, 1991), cared for and were interested in others, and wished to help them.

They were able to perform tasks without being distracted, and carefully considered their actions before carrying them out; their determination remained strong regardless of the level of challenge, and their actions are guided by ethical values. Instead, recently detoxified drinkers lacked confidence, rushed into action, proved unreliable and unstable. As a result, lacking sufficient motivation, they experienced difficulty in achieving their objectives.

Recovering persons seemed less nervous, less angry, less depressed, less impulsive and less vulnerable than recently detoxified drinkers. Their level of competence, sense of duty, self-discipline and ability to think before acting increased with time.

 

images (23)

 

 

The authors of the study concluded that “these results are quite encouraging for alcoholic patients, who may aspire to greater quality of life through long-term abstinence”.

However, in spite of marked differences between groups, their results did not provide clear evidence of personality changes.

While significant behaviour differences between the two groups were revealed, they were more akin to long-term improvements in behavourial adequacy to events than to actual personality changes.

This fits in with the self help group ethos of a change in perception and in “taking action” to resolve issues. In fact, 12 steps groups such as AA are often referred to as utilising a “program of action” in recovering from alcoholism and addiction and in altering attitudes to the world and how they act in it.

The authors also noted the potential for stabilization over time by overcoming previous behaviour weaknesses, i.e. in responding to the world.  Hence, this process is ”one of better adequacy of behaviour responses to reality and its changing parameters.”

In fact, treatment-induced behaviour changes showed a decrease in neuroticism and an increase in traits related to responsibility and conscientiousness.

In line with our various blogs which have explained alcoholism in terms of an emotional regulation and processing disorder, as the Big Book says ““We were having trouble with personal relationships, we couldn’t control our emotional natures”  the authors here concluded that  “rational management of emotions appears to be the single key factor of lasting abstinence”

If we want to to recover from addiction we have to change how we behave.  We have to start by following a recovery program of action. 

No by thinking about it, or emoting about it but by doing it!

Action is the magic word.

References

Boulze, I., Launay, M., & Nalpas, B. (2014). Prolonged Abstinence and Changes in Alcoholic Personality: A NEO PI-R Study. Psychology, 2014.

Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

 

From a Drinking Problem to a Thinking Problem?

 

In early recovery I was amazed that some people in recovery said they never thought about alcohol after a few weeks into recovery. Or rather than thoughts related to alcohol rarely drifted across their minds.

I was alarmed by this as thoughts of alcohol rarely left my mind in early recovery.

They came to me rather than me actively going to retrieve thoughts about alcohol myself, consciously or deliberately.

I now realise that this was due to two main reasons.

First of all, fear of drinking is a distress which activates thoughts of alcohol as distress and negative emotions (and negative self perception/schema) seem to automatically retrieve thoughts of alcohol as there has been some habitual fusion of negative emotion with urge to drink in the alcoholic brain.

This is because my alcoholism resulted in compulsive drinking, i.e. my drinking was mainly to do with relieving distress, and that is what compulsion is, automatic behaviours that relieve distress.

Secondly and tied to this point, is that this compulsive drinking in itself is also linked to how chronic my drinking became.

I was completely addicted to alcohol at the end of my drinking so my alcoholism is very chronic.

In terms of neuroscience this means any distress activates a motoric part of my brain, the dorsal striatum,  a part of the brain that deals with stimulus response or automatic response the internal stimulus of distress, which activates an automatic approach or preparation of movement towards getting a drink.

This is expressed in terms of instruction in the brain as automatically occurring intrusive thoughts about drinking alcohol. This is also called an alcohol use schema because as a schema it is procedural way to deal with distress, i.e. have distress automatically deal with it by drinking.

I still find it fascinating that even automatic behaviours have thoughts that accompany them. Although nothing is completely automatic and we have a brief period of time in which to react or not.

By not reacting or acting on this thoughts they appear to lessen in intensity.  The more we do not react the less intense these thoughts become. Finding new ways to cope with distress lessens their grip on us too and eventually they practically disappear.

I have found I have to be very very distressed in recovery for thoughts of alcohol to come revisiting my mind.

This involuntary retrieval of drug related thoughts is thus a hallmark of addicted populations as it happens automatically, implicitly without you having to consciously and explicitly retrieve these thoughts and associated images from your memory banks. They just pop up without your permission.

The intensity of obsessive thoughts about alcohol is said to predict relapse rates (1), with addicts motivated to use drugs to “silence” obsessive thoughts (2).

The idea that abstinence automatically decreases alcohol-related thoughts is challenged by research (3) and supported by clinical observation that among abstinent alcohol abusers, alcohol-related thoughts and intrusions are the rule rather than exception (4).

Modell and colleagues (1992) highlighted symptomatic similarities between addiction and obsessive compulsive disorder with subjective craving for drugs or alcohol characterized as having obsessive elements. (eg, the compulsive drive to consume alcohol, recurrent and persistent thoughts about alcohol, and the struggle to control these drives and thoughts) similar to the thought patterns and behaviours of patients with obsessive-compulsive illness (5).

Modell et al. also point to the potential similarities in underlying neural pathways implicated in the two disorders, suggesting that they may share a similar aetiology.

The Obsessive Compulsive Drinking Scale (OCDS) implies that as the severity of this illness progresses, so does the intensity of the obsessive thoughts about alcohol and the compulsive behaviours to use alcohol.

Kranzler et al. (1999) showed relapsers who scored higher in ‘obsessions’ craving measured by the OCDS predicted relapse in the 12 months after treatment completion (6).

This may also be a reflection of addiction severity too! As addicts and alcoholics become more addictive brain imaging shows a shift in “reward processing” from the ventral striatum to the dorsal striatum.

The DS as stated above is in charge of more automatic, compulsive reaction.

This shift from VS to DS  may also be marked by an increased emergence of automatic thoughts, which the authors also suggested as the cognitive thoughts and images of automatized drug action schemata (2).

In fact, this is demonstrated by correlations indicating that dorsal striatum activation is lowest in participants with low OCDS scores. And vice versa, highers OCDS scores with increased DS activation.

 

This means, in simple terms, that more severe addiction may be associated with more intrusive/obsessive thoughts and less severe with less thoughts.  

So if you are in a meeting or in other treatment environments and someone in recovery says they never have any obsessive thoughts or intrusive thoughts consider the possibility that their addiction did not become as severe as your addiction?

Either way these thoughts are not your own but the automatic thoughts of addiction so be careful not to react to them.

They are frightening at first, but gradually becoming irritating and annoying before occurring less and less as recovery and your non reaction progress.

If you learn to habitually not to react emotionally to them they start to lose their grip and become less severely intrusive.

Most days I do not have any intrusive thoughts. This is because my recovery has progressed.

In many ways, recovery usually goes in the opposite direction to addiction.

References

1.. Bottlender, M., & Soyka, M. (2004). Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment. Alcohol and Alcoholism, 39(4), 357-361.

2. 6. Tiffany, S. T. (1990). A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes. Psychological review, 97(2), 147.

3. Caetano, R. (1985). Alcohol dependence and the need to drink: A compulsion? Psychological Medicine,
15(3), 463–469.

4. Hoyer, J., Hacker, J., & Lindenmeyer, J. (2007). Metacognition in alcohol abusers: How are alcohol-related intrusions appraised?. Cognitive Therapy and Research, 31(6), 817-831.

5. Modell, J. G., Glaser, F. B., Mountz, J. M., Schmaltz, S., & Cyr, L. (1992). Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire.
Alcoholism: Clinical and Experimental Research, 16, 266-271.

6. Kranzler, H. R., Mulgrew, C. L., Modesto-Lowe, V. and Burleson, J. A.
(1999) Validity of the obsessive compulsive drinking scale (OCDS): Does craving predict drinking behavior? Alcoholism: Clinical and Experimental Research 23, 108–114.

7. Vollstädt‐Klein, S., Wichert, S., Rabinstein, J., Bühler, M., Klein, O., Ende, G., … & Mann, K. (2010). Initial, habitual and compulsive alcohol use is characterized by a shift of cue processing from ventral to dorsal striatum.Addiction, 105(10), 1741-1749.