Five Uneasy Pieces

You don’t decide to be an addict. One morning you wake up sick and you’re an addict. William S. Burroughs

During assessments of co-occurring clients, I’ve discovered five common factors underlying the psychological motivation for substance-related disorders. At least one of these components has solicited subjective agreement from clients regarding the causation and perpetuation of chemical dependence. However, none of the following “rationalizations” are exclusive, and many people suffering from addiction have identified with all five. This list is meant to be a supplemental heuristic for investigating the etiology of alcohol and drug addiction while examining how destructive behavior becomes psychologically embedded through memory, association, and dynamic psychosocial patterns.

  1. A perceived lack of control. Whether it’s a belief or an experience, the feeling of not being in control of oneself, others, or circumstances is a predominant theme when assuaging the anxiety of helplessness via substance use. Intoxication can provide a sensation of safety and ascendancy.

  2. Escapism. The desire to be someone else, or to be somewhere else, is alluring if one’s current predicament is less than peaches and herbs. Escaping a traumatic past, or fantasizing about a euphoric future, is often accompanied by excessive drug use. Likewise, anesthetizing the agony of chronic pain, stress, or grief often leads to equal-opportunity escapism by any means necessary.

  3. Compensatory Adaptation. Although prolonged substance use is maladaptive, the initial stages can feel like an effective substitute for intimacy, or a confirmation of loneliness. Ongoing interpersonal problems, a lack of secure attachments, resentment, and other deficits are temporarily placated by the illusory comfort of substance use. Likewise, ongoing fears are suppressed with synthetic anodynes to subdue emotional vulnerability.

  1. Hedonism. Sometimes self-indulgence becomes a chronic inclination. For example, everyone’s familiar with the party aficionado who remains in a state of arrested development, or the “weekend warrior” who’s missing in action on the battleground of endless gratification. This category is generally reserved for those who want to sustain a champagne-drenched lifestyle that no longer wants to sustain them. Apologists for hedonism desperately believe that nothing says success like excess.

  2. Situational Insecurity. Certain people and situations can cause one to feel uncomfortable in their own skin. Anxiety is a complicated state of mind, and insecurity is often triggered by interpersonal interactions. Until the identifying factors of anxiety and self-doubt are closely examined, the tendency to “self-medicate” only requires an intimidating backdrop with access to an open bar.

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