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.

 

 

 

Interpersonal Factors in Relapse – Part 1

“Living life on life’s terms” essentially means living with others.

The majority of relapses I have witnessed have been due to interpersonal factors, e.g. arguments at home with family and loved ones, not being able to cope with relationship breakdowns, perceived rejection by loved ones.

Research itself shows that the majority of relapses are caused by an inability to deal with distress (negative emotions) especially in the context of interpersonal relationship.

While neurobiological accounts of addiction suggest the main cause of relapse is due to responding to alcohol or drug cues, an effect heightened in the presence of stress, it does not allow for the main arena in which this stress/distress occurs i.e. with loved ones or people we are having relationships with, or thwarted relationships . Living with others can be difficult for alcoholics and addicts especially as we often found ourselves living in social isolation from others at the endpoint of our addictions.  Especially as many of us, if not the majority, have insecure attachment styles.

So why do addicts and alcoholics and others suffering from a range of addictive behaviours from sex to eating disorders have difficulties with coping with relationships with others?

This point certainly needs addressing as it appears to be a major determinant of relapse!

I do not know about you but there are certain parts of my “personality” that I do not like.

I believe these are mainly do to my insecure attachment – these include the tendency at times to be dismissive, to be needy, look at “me, me me!”, to be wary of others and their motives and to be very rejection sensitive. I have major issues with rejection from others and guard against it. I am also taking action in my personal life to deal with these issues more adaptively, more healthily.

It appears to me increasingly that part of my alcoholism is rooted not only in the genes I inherited from both my parents but in the fertile ground of insecure attachment and childhood maltreatment.

So have any researchers considered these factors? Not many it has to be said but this study (1) certainly did an it is one o the best and most comprehensive studies I have read in relation to these issues.

So in short, is there a sequelae between insecure attachment, rejection issues, low self esteem, interpersonal relationship difficulties and relapse?

“In this article, we review the literature on interpersonal stress and rejection sensitivity and examine how these factors increase the risk of relapse in individuals with alcohol or drug dependence…(to) provide insight into the role of interpersonal stress as a powerful and oftentimes destructive factor that affects individuals in recovery from substance dependence.

Relapse following treatment for alcohol or drug use disorders is a common problem. Studies indicate that 50–70% of patients are unable to remain abstinent during the first year following addiction treatment (1)…(we)  review the constructs of rejection sensitivity, insecure attachment, and low self-esteem, integrating these traits and considering how they influence relapse vulnerability…

Next (blog 2), we review the constructs of expressed emotion, perceived criticism, and marital distress, examining how these negative social contexts can contribute to unfavorable outcomes among individuals recovering from substance dependence.

We conclude with the testable hypothesis that there exists a subgroup of substance-dependent individuals with high trait rejection sensitivity that is particularly vulnerable to relapse in the context of a harsh and critical interpersonal milieu. We propose that high trait rejection sensitivity is a unique risk factor for relapse that can inform research in this area.

rejection images (40)

Intrapersonal Vulnerabilities to Addiction and Relapse

Interpersonal stressors are regarded by many as the one of the most severe forms of stress and can affect an individual’s cognition and behavior. Interpersonal stress is a well-known precipitant of maladaptive drug and alcohol use…we will review the extant literature on the related constructs of rejection sensitivity, insecure adult attachment style, and low implicit and explicit self-esteem. Although not identical, all of these constructs contribute to an individual’s compromised sense of self and an inability to interact comfortably and effectively with others. Further, they all share a propensity to increase an individual’s vulnerability to addiction.

Rejection Sensitivity

Rejection sensitivity (RS) is defined as the disposition to anxiously expect, readily perceive and react intensely to rejection. High-RS individuals interpret ambiguous social cues as indicative of rejection (22,23,24). Individuals entering into a romantic relationship with expectations of rejection attribute insensitive behavior by their partners to hurtful intent. RS also causes people to be dissatisfied in relationships and to anticipate that their partners are dissatisfied and want to end the relationship. High-RS individuals react in ways that undermine their relationships, ultimately serving as “self-fulfilling prophecies” (22,23). High-RS people have lower self-esteem and coping skills than those with low RS…and have higher levels of drug use than low-RS individuals (24).

High-RS individuals may quickly activate a defensive motivational system (DMS), which acts automatically and at a nonverbal level (22). The DMS results in rapid execution of automatic behavior aimed at self-protection, whether the threat is physical or social (22). Although the DMS is adaptive when a quick automatic defense to threat is required, it is maladaptive when a response requires higher reflective cognition (22)….

…thwarting a person’s fundamental need to belong produces cognitive dissonance, leading to a failure to self-regulate effectively, which is manifested in self-defeating behaviors (25).

Insecure Adult Attachment Style

Anxiously attached adults lack self-confidence, are extremely sensitive to interpersonal rejection and lack effective emotion regulation skills, while securely attached adults have high self-worth, perceive that other people are accepting and engage in healthy coping skills (28,29,30). The ability to regulate distressing emotional experiences is theorized to develop during infancy in the context of a responsive and available caregiver (27,28,30). A primary function of attachment, therefore, is the interpersonal regulation of distressing emotional states (27,31). Insecure attachment is marked by deficient mood regulation skills and a propensity to use maladaptive coping methods, such as drugs and alcohol, to modulate distressing affect (27,29,30,31,32).

Anxious attachment, therefore, predisposes individuals to heightened interpersonal conflicts due both to their diminished self-worth and their deficits in regulating emotion.

rejection

Insecure adult attachment is associated with addictive disorders (27,28,29,31,32). Thorberg and Lyvers (30) found that, compared with control subjects, individuals with a substance use disorder scored lower on the “attachment dimension of close” and the “attachment dimension of depend” and higher on the “anxiety dimension” of the Revised Adult Attachment Scale. These measures reflect the extent to which a person feels comfortable with closeness and intimacy, how much they feel they can depend on others, and how anxious they are of being abandoned or unloved. Those with substance use disorders were also more emotionally reactive than controls (30). Another study by these investigators (31) used the Negative Mood Regulation (NMR) expectancies scale to examine the association between anxious attachment and mood regulation. The NMR measures an individual’s ability to regulate and successfully cope with negative affective states. They found an association between anxious attachment and a diminished ability to regulate negative moods and postulated that substance use represents a “mood regulating coping mechanism” (30).

McNally et al. (27) examined the relations between alcohol-related consequences and adult attachment dimensions. They used the adult attachment style conceptualization of Bartholomew and Horowitz, which is similar to that of Hazan and Shaver except that they differentiated avoidant attachment into “dismissive” and “fearful” attachment. Two dimensions exist in this model: view of self and view of others. Securely attached individuals have a positive view of self and others; anxiously attached (renamed “preoccupied”) individuals have a positive view of others but a negative view of self; dismissive individuals have a positive view of self but a negative view of others; and fearful individuals have a negative view of both self and others. These investigators found that individuals with a negative view of self (i.e., those with preoccupied and fearful attachment styles) reported greater alcohol-related consequences, which were mediated by the individual’s desire to alleviate negative affect. The investigators noted that the “individuals’ global feelings of insecurity in relationships and interpersonal interaction, and in particular, their sense of themselves as both inadequate and undeserving (negative model of self) appear to have a direct effect on the motivated use of alcohol to cope with negative affect, and an indirect effect (mediated by coping motives) on drinking-related problems” (p. 1124).”

Negative reinforcement of social rejection is not the only mechanism increasing high-rejection-sensitivity individuals’ risk for addiction and relapse. Because rejection activates the defensive motivational system, these individuals frequently respond with automatic aggressive behaviors, sometimes assuming a passive form of “going out and getting wasted” to “punish” the person who rejected them. Social rejection also impairs self-regulation, further diminishing the high- rejection-sensitivity individual’s ability to employ the strategies and cognitions necessary to avoid relapse.

I call this a “to Hell With It!” relapse! You reject me and I will reject you back! Again this ties in with the emotional immature reactions that we blogged on before, and the direct consequence, again, of insecure attachment.

In Part 2 we will look at low self esteem and interpersonal vulnerabilities to relapse (particularly in family settings).

To be continued.

 

References

1. Leach, David, and Henry R. Kranzler. “An Interpersonal Model of Addiction Relapse.” Addictive disorders & their treatment 12.4 (2013): 183–192. PMC. Web. 30 Jan. 2015.