On Addiction

"The first question — always — is not 'Why the addiction?' but 'Why the pain?'"
— Dr. Gabor Maté

It feels fitting that as I sit with my laptop to write this page, I find myself in the same cabin on the same beach in Alabama, on the anniversary of my sobriety, in the same place where I first jumped head first into a months-long detox process. I knew that trying to quit my drug of choice cold turkey would be especially challenging at home, surrounded by triggers and elements of ritual, so I chose to do it in a place of beautiful distraction.

I have, for a long time, held a love-hate relationship with the noun "addict".

On one hand, there is something extremely powerful about looking a loved one in the eye, or standing up in front of a group of other human beings, and stating "I am an addict". This act of bravery is liberating, and empowering. It perfectly embodies the strength of vulnerability, and anyone who has done it can probably remember, even years later, the exact date on which they finally uttered those words of ultimate accountability.

And yet…I also hate the word.

I don't like the word addict because it limits us and it essentializes an extremely complex human phenomenon. Our understanding of addiction needs to be socially constructed, and understood in the context of the cauldron of suffering that formed it for most people in the first place.

So, I am going to share my take on addiction, which differs from what I feel is the norm in the mental health community:

Addiction is a reasonable response to unmanageable suffering.

That's it. That's the whole thing. I am ready to die on this hill: Addiction is actually a perfectly reasonable response for a human being who is experiencing suffering they feel overwhelmed by. Addiction is not a moral failure. Addiction is not something that only happens to weak people.

Are people responsible for their choices? Absolutely.

Are people responsible for the harm they cause others? Always.

Does it ultimately fall to each and every addict to confront their addiction and overcome it? It surely does.

But the part that so many people miss:

The addiction is not the problem, it is the response. The problem is suffering.

Once we realize that the majority of addicts started using their drug of choice in an earnest attempt to alleviate prolonged suffering, we can start to ask the question that Dr. Gabor Maté so eloquently asks: Not why the addiction, why the pain?

Addiction is not simply a physiological process. It is not merely a case of the body and brain becoming accustomed to some exogenous chemical and eventually needing it to function. That absolutely happens in addiction, but the root of the issue is that people have pain they don't know how to process, accept, or heal. Also, not all addictions involve substances. Gambling addiction is responsible for more suicides than any other form of addiction…and there is no external drug involved in many cases of gambling addiction.

You cannot expect someone to hold their hand over a flame and not pull away. Pulling away from pain is something that we are wired to do on a fundamental, animal level. It kept us alive for 200,000 years, and it's written into the lowest level circuitry that our nervous system relies on.

When we accept that, and when we start looking at the pain that caused the addiction in the first place, we actually get to the root of the issue.

I think this is a big part of why relapse is such a common pattern in recovery. We keep looking at the substance use as the problem. We tell addicts they need to quit, and they do…but if we aren't able to help heal the pain that caused the addiction, then addicts will be plunged right back into the same unmanageable pain that they ran from in the first place. When this happens, relapse should be the expected outcome.

It doesn't matter if you have shrapnel in your leg, or trauma in your body that never got processed…the result is the same. Unless we can remove that shrapnel, or help the body learn that the trauma is actually in the past, the material conditions that caused the addiction remain, and the addiction is likely to return.

So what now then? If pain is an inevitable part of life, and if pain we cannot handle causes us to seek remedy wherever we can find it…are some people just destined to become addicts? What do we do here?

I think that one of the primary answers comes from Buddhism, and has been understood in the east for more than 2,500 years:

Suffering is part of the primary experience of life. The key is not to try and avoid our suffering, the key is to learn to suffer well.

Remove the shrapnel. Process the trauma. Reparent your 8 year old self that needed something they never received. And along the way, accept that sometimes zero pain is not an option, and that suffering well is how we transform unmanageable pain into manageable pain. When we do these things, we give ourselves the very best conditions to succeed in recovery.

If you are struggling with addiction, I invite you to enter into therapy alongside whatever substance use program you feel would be right for you. Don't just work on the response to your pain, start working on the pain itself.

When you are ready, we will be here.