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Addition to Adaption to EMDR for Addiction

At some point in a persons treatment or recovery, their addiction becomes a memory. It has a beginning and an end. The relationship to the behavior has changed in some way that they are ready to put this story behind them.

In my first blog on this subject (HERE) I suggested that switching the Negative Cognition (NC) and Positive Cognition (PC) in the EMDR protocol could help desensitize and reprocess positive relationships/associations in addiction. In the process of putting this adaption idea out there to the general public, someone made a comment that it was targetting the “positive affect or positive state.” I don’t disagree with this observation but I think that it does more too. The moment that we fall in love is one of the most impactful moments in our lives. It is something that the brain is going to remember and hold onto in order to perpetuate the species, hence survive. The positive state that arises out of that connection is only part of the story. The full story is that there was a high from the experience (positive feeling state) and the experience makes a deep connection to our emotional being i.e., gave us purpose, helped solve a problem, relieved pain, and/or provided some pleasure by providing a new chapter to the individual’s storyline (declarative/narrative memory systems). This is often representative of an earlier felt experience (often an earlier attachment trauma) Targeting the positive feeling state does allow for this information to come up but this is just another way of conceptualizing it and I believe that it is a way of ensuring that it does. Addressing the beginning of the addiction is allows for the narrative to make sense and allows the brain to store the memory of addiction appropriately.

I warned against the premature use of this in the client’s treatment because the person can start processing their whole addiction and everything that happened in it. If they are not ready for it, then they are likely to experience a strong response to it. Also, if the guilt and shame of the behavior have not been lifted in some respects then it can be a lot for someone to witness either what they did or what was done to them.

So, with that said, here is something that has come up in my work that helps with these issues. Long and short of it… PC, NC, PC. Example…

“Do you have an image of the first time that you fell in love with addicted behavior (i.e. relationship)?”

“What does it make you believe about yourself?” PC: “I am in control.”

“What would you prefer to believe about yourself?” NC: “I was not in control or that is me under the influence.”

Then “What would you prefer to believe about yourself NOW? PC “It is over now. I am in recovery. that was the old me.”

Experienced EMDR clinicians will recognize that often clients will list 2-5 PC once asked this question the first time in the protocol, particularly if you give them a list of PC. One of them is typically a more future tense phrase like the example above.

What I noticed that it was an easier to process, they did digest their addiction, and they had a stronger felt sense in their VoC. If timed right, the consolidation and generalization process in the desensitization and reprocessing provide the opportunity to solidify the new core beliefs in their reprocessing and/or reaffirms their purpose and recovery. The timing should be after they processed the majority of their traumas, themes, and/or core beliefs. I also look at a time in their treatment where they have started to empower themselves in their personal life i.e. speaking up for their needs as a result of their recovery work and EMDR therapy. I believe that clients are more likely to give up this addictive behavior/relationship if they see a new one forming that they believe in. Ultimately, this allows the person, in the memory system, to reprioritize this adaptive coping skill as ineffective, outdated, and something that they used to do.

Another point to make is what can be targeted with this. I have done this adaption with gambling, eating disorders, and co-dependency. I work with a lot of DV survivors and what I have learned, in the cluster or target sequence, is that this is the memory that is stuck but is often not identified by the client as a target. I did this recently with a client who was processing the last of her DV relationships and it was pretty charged cluster with multiple murder attempts, hospitalizations, and ended with a suicide. I decided to direct her to do the moment that she first fell for him as a solution to her being “alone problem.” She did the whole relationship cluster that resulted in a new confidence that was undeniably strong. I believe that the reason for this was that there was self-forgiveness regarding the guilt and shame around her role in getting into this relationship and the subsequent events that followed. It was quite beautiful.

A final point on this, addiction to me has the ingredients of an abusive relationship. There is an abuser and victim dynamic within the parts system. What I have come to realize is that the addiction denial system is really dissociation. This has wide ramifications so there will be more on this in a future blog.

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Our Addictive Personality

As a trained therapist, I often have the opportunity to educate my clients on the nuances of diagnosing. Since I work with a lot of people living with addictions who are trying to figure why they have an addiction or what their addiction means, eventually the conversation comes around to the ever-popular “Addictive Personality.”

Some years ago, I was leading a support group on mental health disorders in a Substance Use Disorder (SUD) treatment setting and a discussion emerged around whether or not there is an Addictive Personality Disorder, which does not exist in the DSM5. In the group setting, it is helpful for people to explore what the topic means for them and for the clients to explore their train of thinking. For these reasons, I am willing to hear out any argument. I countered that there was already a “personality disorder” that addiction would fall under Dependent Personality Disorder. Isn’t addiction is called substance dependence?

I wanted to explore this concept and develop it further here because I sometimes present this idea to clients who could fall under this umbrella. The clients said that they find this helpful because it combines emotional validation and reason. As I see it, addiction is not currently clearly defined on a philosophical level. The relationship between pain and pleasure is not fully appreciated so it is difficult to understand addiction emotionally. Addiction and trauma are matters of emotionality and not rationality. The major point is that when people have an accurate conception and understanding around what they are dealing with, they are more apt to address it. I believe that the clinical, medical definition of addiction and how it impacts the organism is accurate, but the philosophical underpinnings (which are emotionally satisfying) are not highlighted, hence clients might feel invalidated.

This leads us to the addictive personality, but first, we have to explore “personality disorders” in general. “Personality disorder” is akin to “getting your own way.” This is not to minimize people living with personality disorders (not in quotation out of respect), rather to highlight that they can be seen as normative. I view all “personality disorders” as ingrained (untreated) PTSD because the only reason why people create hard and rigid personalities is that they had to. It is a response to an unsafe environment. This is known to many therapists but not often understood by clients. For example, when a client presents to me with Borderline Personality Disorder, I do not dismiss the traumas underneath because I know is that 87% of people diagnosed with BPD are women who have a strong trauma history (van der Kolk, 2014). The etiologies of addition and trauma continue to challenge the diagnosis of personality disorders and for good reason.

In his book, The Body Keeps Score, Bessel van der Kolk (2014) explores the proposed diagnosis of Developmental Trauma Disorder (DTD). This is a valid diagnosis in my opinion, due to the nature of smaller things adding up over time like drops in a bucket. Shapiro called these small “t’s” that create an impact over time (Shapiro, 2001). Now, van der Kolk highlighted research from the foster care system that supported his proposal for a DTD. This diagnosis was not permitted into the DSM5 based on the “evidence.” I believe that if research is lacking to support a diagnosis of DTD, then we need not look any further than people living with addictions.

It is common enough for professionals to say that not all addictions were created by trauma. Addiction is progressive, which means that each problematic use or behavior is a drop in the bucket and is another step away from healthy. If poison is present in the body or self-abuse is occurring, could that be considered traumatic? The developmental nature or “progression of the disease” of addiction logically support this, however, some of the philosophical underpinnings are worth highlighting.

First, the drug is neutral to the organism that ingests it. The drug just does what it does and most intoxicants that we get high on are poison to the body. Second, the body is neutral, in the sense that it has to take care of what is given. It just does what it has to do to get rid of it. The body recognizes danger (and addictive behaviors are a threat to the organism) and sends out biochemical alerts when triggered by the environment. Without education around what the body is saying, an untrained mind has trouble interpreting these body cues. Third, the mind is not neutral. As the mind regulates the flow of information between the internal and external worlds, it associates it with similar experiences and makes inferences and references to help eliminate the introduced toxin. The mind’s “reference points” are what it has experienced before, i.e. memories. Our relationship to our memories is not neutral, especially if they are stuck and causing dysfunction.

Lastly, since addiction lives in the brainstem, which sends signals to the pain/reward system in the brain, we have to acknowledge the relationship between pain and reward but also the relationship of the brainstem to the pain/pleasure system. The brainstem houses unconscious behaviors like blood pressure, breathing, and body temperature regulation. These functions speak to how unconscious our addictions are. We all have a brainstem that motivates the pain and reward system; hence we are all on an addiction spectrum. But we do not all create rigid personalities that get in our way or become addicted. There is a normative bell curve to addiction but that does not mean that falling inside the curve of normal means that the person or addiction is not normal human behavior.

Over time, our met/unmet needs and wants, speak to the creation of our traumas, addictions, and our personalities but also how we develop as a society and culture. Our personality is a collection of stories that we tell ourselves, based on the stories we hear or overhear. We can become addicted to our story, which is what I have come to believe as the most powerful and insidious addiction that we as individuals, society, or culture have to address if we are going to transcend all cycles of abuse and systems of dependence.

This is why I treat mental health disorders, which include addiction from a trauma-informed, trauma-focus perspective, and utilize trauma resolution methods. I treat addiction with trauma resolution because I believe that we have mislabeled addiction and that it is really a trauma, let alone that the trauma story can be addicting as well. Philosophically, I see addiction and trauma as the same process but on different ends of the spectrum of the pain/reward pathway in the brain. Addictions create traumas and traumas create addictions. If this is true, if we can treat trauma with trauma resolution, then we can treat addiction. At the root of both trauma and addictions are our stuck memories. The implications of addiction and abuse (trauma) will be highlighted in my next blog.

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and procedures. New York, NY: Guilford Press.

van der Kolk, B. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York, NY: Penguin Books.

by Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is an EMDRIA certified EMDR therapist/Consultant-in-Training and is trained in Progressive Counting and Brainspotting.

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Abuse and Addiction

With all the recent sexual assaults/abuse/allegations, many have questioned it whether or not these behaviors constitute an addiction. This is probably because the perpetrators have been going to addiction treatment. My answer is categorically a “yes” due to the nature of abuse and addiction, my experience with treating abuse and addiction, and the context in which these abusive behaviors occur.

My therapeutic and personal philosophy is “D) All of the above” because if people believe their answer to be true then I have to be prepared to engage in all answers. Whether their/our answers will stand the test of time is the real measure. As a therapist when a question is asked, the act of asking a question (and how it is presented and worded) sheds light on where the person is at in their psychosocial, spiritual/moral development, and their level of awareness on the topics presented in the question. It is commonly understood by therapists that people already have the answers to their questions but many times people are not conscious of them. So, if people are not aware of their answers then people are more than likely not aware of the outcomes the answers produce.

In America, there is an awareness rising socially and culturally around the topics of abuse and addiction that gives me the opportunity to tie the topics of abuse and addiction together. I believe is worth exploring not only these topics but also the relationship between opposing opposites like pain (abuse) and pleasure (addiction/pain relief), safe and unsafe, healthy and unhealthy, known and unknown, and conscious and unconscious because it is this relationship that produces human behavior. The issue with not understanding the conditions of what is fully going on with the relationship between opposing opposites is that we make assumptions that ultimately create a misinformed opinion.

Abuse and addiction are really the same pain/pleasure process, represented in the pain/reward pathway of the brain. However, two key factors to understanding the conditions of this process are usually missing. First, what fuels this relationship dynamic is our unconscious survival system (fight, flight, freeze, and appease) and secondly that our unconscious survival system is rooted in our collection of unresolved memories that are unconsciously playing themselves out in our lives, particularly in our relationships (Ecker, Ticic, & Hulley, 2012). With these two key factors stated, it stands to reason that it is the conscious choice to pick pain or pleasure and our unconscious processes that produce our behaviors, hence it is our relationship between the conscious and unconscious that needs to be addressed.

My stance is that trauma is addiction and addiction is trauma because they are philosophically apart of the same process. So since abuse and addiction are the same processes then active abuse/trauma and active addiction are both conscious and unconscious processes because they come into being together. The extent of which they go to the extreme is a manifestation of the conditions/environment in which they exist. With an understanding of these two key factors and the conclusions derived from them, they help end the debate of choice vs. disease. For these reasons, I believe that it is the relationship between abuse/trauma and addiction that needs to be better understood in order to heal them individually and societally. Furthermore, since the unconscious is based on unprocessed memories, then the unprocessed memories of where we learned these behaviors is where I believe that we need to be targeting in treatment if we are going to identify ourselves as treating these conditions.

I believe that these abuses that are coming to light are the result of the toxic relationship between abuse/trauma and addiction that we as individuals, society, and as a culture have been living in denial about, particularly, where they originate. Our healthy and unhealthy relationships are learned through our shared experiences (i.e. family, socializing, and culturally sanctioned norms) and when unhealthy behaviors are present it is because we have unmet wants and needs (and the inability to tolerate not getting our wants and needs met i.e. delayed gratification). Additionally, deeper into the denial system is when a want is labeled as a need, which to me is the root of our addictions. So, since any form of abuse is fueled by an unmet want/need, then being abusive can be considered an active addiction. Conversely, any state of active addiction can be seen as abusive.

So then, often enough, the questions of “who, what, why, when, and how” come up when the topics of abuse and addiction are discussed. Many times these topics and answers are deflected or ignored because it is difficult to make sense of all of it all but by avoiding the conversation we end up creating more abuse later and for the next generation. I am going to answer the “who, what, why, when and how to stop them” questions of abuse from this trauma and addiction perspective because solutions to trauma and addiction are available if people are ready to break through the denial system built around these subjects.

Who abuses? Answer: D) All the above… We all do – either directly or indirectly. Abuse falls within the range of human behavior because it happens so regularly that it considered normal. There are varying degrees of abuse so the idea of seeing abuse as on a spectrum is valid to me. The varying degree of abuse depends upon the level of unmet wants/needs and these are created when extreme measures have been taken/modeled to meet unmet wants/needs previously (unresolved memories of abuse).

If we want to hate the game then that is reasonable but it is how we play the game that is in question. However, we have to understand the rules of the game first before we can decide if we want to play and then address how it is being played. These are the rules of the human game as I see it. Our needs/actions will hurt people and others will hurt you in order to get their wants and needs met i.e. in order to eat, something that is living has to die. By existing, we impact others. Everyone has to live together on this giant floating ball of water and rock so if we see that both the perpetrator and victims are somebody’s son or daughter, student, friend, co-worker, or neighbor, we can start to see that the rules of the game are everyone’s responsibility to follow.

So, what is abuse? Abuse is any act i.e. physically, psychologically, sexually, or through neglectful means of creating pain on someone else or oneself. Abuse is any action or inaction that causes intentional or unintentional pain. As pain is a matter of subjective experience, all pain is valid no matter what and is not fixed in time. Abuse can be direct or indirect, hence abuse can be conscious or unconscious, and so abuse is any action, non-action, or behavior that consciously or unconsciously causes harm to the development of an individual. Abuse can be directed towards another or be self-administered i.e. substance ABUSE. It can be presented as a selfish or selfless act and any abuse is present and will continue to be present when there is a lack of understanding, direct and effective communication, empathy, and resources. Culturally sanctioned forms of abuse can take on the forms of a right of passage, peer pressure, and societal influences. Also, like addiction, abuse is progressive and can take a life of its own on when it goes unchecked.

Abuse can come in both positive and negative forms, dependent upon one’s perception. As negative forms of abuse are the ones I just identified, but the not so clear forms stem from our expressions of loving someone/something too much like addiction and enabling. “Too much” is the main qualifier in any form of abuse or addiction. Abuse is also any violation or act of aggression (indirect or direct) of ones right to choose what is right for themselves. Entitlement is the result of enabling and enabling is abusive because it undermines the freedom of choice.

For the individual who is in a state of being abusive, it is a reach for control because they feel threatened or righteous. Reaches for control are based on previously not being in control of another similar situation and now are claiming their right to exert it or are protecting themselves from happening again. All abuse/addiction is a form of transference/projection and transference is a form of trauma re-enactment. Transference is an unconscious process of transferring emotional processes onto someone/something else (Ogden, Minton, & Pain, 2006). Trauma re-enactment is an attempt to resolve a previous unresolved experience through the re-enactment of similar experiences in the present moment (Ogden, Minton, & Pain, 2006). These are very unconscious processes and are reproducing patterns of what was taught/modeled and learned in an attempt to resolve them, hence why abuse/addiction are progressive, cyclical, and why they repeat.

If people were actually conscious of their trauma re-enactments, then they would be able to actually stop them from continuing. More rational people see it as something that someone can stop, but this logic gets turned on its head if I were to ask the rational people to stop rationalizing. It does not make rational sense to hurt the ones you love, but we do. However, when we add emotions to the equation, it does make sense given the fact that there are unmet wants/needs at play. Abuse and addiction are not rational. They are emotionally based, which is why I say that it feels like people can stop using drugs or leave an abusive relationship, but emotionally, they feel justified and are justified. The ability to stop is usually dependent on when the person realizes (becomes aware or conscious) that they are abusing themselves, someone, or something that they do not want to be hurt. They intern struggle with the conflict of getting their needs and wants met in healthy ways from an environment that they see as hurting them. They are aware that they are repeating the pattern in the moment but since their wants/needs are unmet they feel justified to continue the behavior. Factually, yes, they can stop, but emotionally they cannot stop until an emotional need is met. A person can be conscious of it happening but not be fully conscious as to why it is happening. Just like in substance use, the person is consciously aware that they are abusing themselves but do not always have the full context as to why. Without the “why” you cannot get to the “how to stop it” and this is why I see addiction as self-abuse. This take on abuse and addiction reinforces my observations that addiction is trauma and that addiction and trauma are a part of the same process.

So why do people abuse? Answer: i.e. Transference and when abuse/addiction are happening they are attempts to get an unmet want/need through re-enactment. People in a state of abusing feel justified in abusing because they feel that they were abused. In the act of abusing they feel like they are being abused because they have unmet wants/needs. When we have been hurt and are currently being threatened, we respond through our survival response i.e. fight, flight, flee, or appease which are unconscious responses and limit higher order of brain functioning i.e. compassion and empathy, due to the biological process of survival (Seigel, 2011). When judgments, assumptions, or preconceived notions are present we feel protective and feel as though we are being abused or could be abused. Also, people will abuse preemptively because they are anticipating being abused out of fear of not getting their wants/needs met.

Not all abuse is a direct result of re-enacting a specific trauma but rather an associated similar one or one that has become habitual. The mind and brain work on associative properties and the core of the information comes from our previous experiences (memories) that are emotionally coded to help us navigate the associated feelings in order to get the desired outcomes (Seigel, 2011). The root feelings are often fear and love, which fuels an external reach for control. When we understand the fear response and our need to connect we understand the intention. It is the preservation of self and the self is merely a collection of stories that were either told to us or we tell ourselves.

Now it is unrealistic for everyone to have all their needs and wants to be met on every subject and/or everything, but that is rational thinking. However, emotionally we say things like “you deserve to be happy.” When emotions get in the way of rational thinking, the facts become subjective. Any response that is out of portion (positively or negatively) to a normal range (neutral), it can be assumed that there is something deeper and unresolved i.e. a memory that represents an unmet want/need. This is seen as a good thing when it drives positive behaviors like working or loving someone, but when they are applied to negative attributes of human behaviors like abuse and addiction they are shamed and stigmatized.

When do people abuse/commit crimes of abuse? Answer: When they are under the influence of an actual or perceived stress/threat of not getting their wants/needs met. When a stress or threat is present to the observer, it triggers the observer to try and meet their needs through the use of controlling someone else or a situation (abuse) or an unmet need getting met through abusive means (addiction). Stress (positive or negative) or (actual/perceived) threats bring out states of abuse or addiction. Because negative manifestations are seen as violations they are stigmatized but positive manifestations have their root in the same process. There are so many forms of abuse and addiction that it is confusing and all too often a double standard is present that complicate the matters even more. (FYI The double standard is something that we can do something about!) To complicate matters more and for the purposes of furthering the conversation, from a philosophical perspective, acts of abuse and the things that we are addicted to can be seen as neutral because it is our relationship to the want/need/behavior or addictive behavior that is really the issue.

When we take a broader definition of addiction, which includes acts of violence, gambling, Internet, shopping, care-taking, enabling and abuse, which includes jokes, prejudices, verbal aggression, emotional and neglectful means, and self-abuse, then we stand to see that we are all addicted and we are all victims of abuse. The relationship between addiction and abuse (trauma) is the plight of all individuals, organizations, institutions, societies, cultures, and species have to address if they wish to see healthy growth. If there is an inability to make healthy growth, can it be assumed that the reason why is not possible is that they are addicted to the norm? Consequently, this is the point that we see start to see that we are addicted to our story and trauma/drama has become the addiction. I am hopeful that people can find the courage to change and heal because healing is a part of our collective story too.

Coincidentally, we can also look at the solution of addiction recovery to help solve abuse. So, how do we stop it? Change the only thing you can; yourself. This might hurt but hurt and pain are great teachers if one is ready to learn the lesson. To avoid the pain is to avoid the lesson. Since hurt and pain is at the core of our traumas and addictions, what do we stand to learn? If someone is hurting you, they are themselves hurt and are transferring their hurt. When hurt has happened and is happening it is a form of re-enactment. All feelings are valid but it is when people have been un-validated or invalidated that one feels they have to respond in kind.

All of this points us to the question of who is responsible for abuse and addiction? Answer: Every living being that has ever lived or will live. Our collective history and our collective destiny have been transferred to us through the echoes of time through trauma i.e. prejudice, hate, fear, and genocide and addiction i.e. advancement, power, control, convenience, and materialism. We are all players on the stage and all have our hands in the pot. History includes our collective history but also our collective future, so the better question to ask now is, since we have solutions, who is responsible for abuse and addiction continuing? We all are responsible if we are not working a healthy solution.

The “If had I known, I would have done something different” moment is a precious one because this is the moment when reality and truth are no longer matters of perception because the context of the situation has been realized. Reality and truth are a matter of time and place for the observer, but there are eternal truths. One of them is: we are all a product of our environment and the environment is a product of what we produce. We have to choose between healthy or unhealthy, it is no longer a matter of right and wrong. Obviously, these problematic topics go a long way back but more of the question now is when are we going stop the cycle of abuse and addiction within ourselves? In the matters of abuse and addiction, a major issue is with responsibility. It is never the victim’s fault at all but it is not 100% the fault of the perpetrator/person addicted either. The conditions in which these behaviors are sanctioned have their responsibility as well. There are always other forces at work when violence is going on. In the context of historical facts, trauma and addiction are normative and are human realities. Something was done to all of us at some point but when the family, society or culture does not have the means or ability to empathize or support healing, then more hurt will happen.

Abuse and addiction are the symptoms of our toxic relationship to ourselves. The extreme nature of our symptoms speaks to our systems inability to either directly or indirectly protect each other. Our main support systems i.e. families, society, and culture along with our mores, values, and norms are ultimately at fault too. These were handed down to us in the form of stories. The stories that we tell ourselves are powerful and seep deep into the unconscious, just like abuse and addiction. From the unconscious perspective, none of us are fully responsible for our actions but once we become aware of our unconscious patterns and resulting behaviors, it is fully our responsibility to engage in the solution. In general, people, institutions, and systems are perplexed by abuse and addiction because they are trying to rationally understand emotions and unconscious processes. Artists throughout history have been speaking to the dangers of not understanding the relationship of opposites. This is where we are at in our story: awareness of everyday abuses and addictions are increasing thanks to the brave people who are willing to share their story and admit that abuse and addiction are happening. It is the responsibility of everyone else to humbly listen, identify instead of compare, and then apply the moral of the story to his or her own way of living.

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W. W. Norton & Company.

Siegel, D., Bryson, T. P. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Bantam Books Trade Paperbacks.

by Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is an EMDRIA certified EMDR therapist/Consultant-in-Training and is trained in Progressive Counting and Brainspotting.

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Addiction-Informed Care

As I prepare for giving a presentation on Trauma Informed Care (TIC), I am wondering what blocks people living with addictions from getting access to treatment from both sides of the fence. Then I hear reports regarding its “public health crisis” status, how people believe that it is easy to just stop drugs; as if drugs were the only addiction that needs to stop. We can’t advertise our way out of addiction. I firmly believe that there needs to be more understanding around what addiction is on a societal and policy level. So I decided to create Addiction-Informed Care (AIC).

AIC (a term I am coining here) would be built on respect, understanding, and equality. AIC would be similar to Trauma-Informed Care (TIC) but with one key difference. For those who don’t know, TIC is defined as “an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma (2017).” For AIC’s definition, I substitute the word addiction for trauma because I believe they are the same thing because addiction itself is a trauma. TIC already accepts that trauma is at the heart of addiction but addiction-causing trauma is not part of the discussion. Trauma and addiction are in relationship with each other and are inseparable, so philosophically they are the same thing because they are a part of the same process. Trauma can be seen as pain and addiction can be seen as reward/pleasure. They are both rooted in our survival mechanisms because they ride on the pain/reward pathway in the brain but when seen in a social context, they are viewed as out of range of normal behavior. When in fact, since the pain/pleasure (rewards) system is the basic motivator of all human behavior, they are normal responses. Everyone has the propensity to become traumatized or addicted because we all have the propensity to feel pain and pleasure.

Addiction is a dysfunction in the brain caused by a trauma on biological, psychological, social, or existential/spiritual level. As a result of this trauma, a relationship is formed. Addiction is not about the drug or a particular behavior, it is about our individual “need” to have a relationship with the drug or behavior. Since we can form a relationship to anything, we can become addicted to anything that entices our pain/reward pathways. This includes power, control, righteousness, democracy, patriotism, ideals, morals, money, drama, or any desired outcome. Now, since addiction is a paradoxical play on right and wrong, one can become addicted to the other side i.e. humility, compassion, and righteousness.

AIC would be based on a thorough understanding of how addiction impacts an individual, communities, institutions, businesses, industries, systems, and the course of human history and development. AIC would help us understand our current state of the union and the human condition.

AIC would be built on mutual respect and understanding. It would be rooted in how neurological, biological, psychological, social and spiritual aspects of addiction impact our individual lives, communities, institutions, and systems. It would recognize that trauma and addiction are primal motivators for all human behavior, which can be linked to an abuse of power and a (conscious or unconscious) intention to cohesively control and stay in control. AIC would actively engage to confront blatant disregards for facts and observable conclusions relating to all manifestations of addiction.

AIC acknowledges why people, institutions, and systems become abusive, coercive, and dysfunctional. If one cannot stop something, would hurt someone over it, kill, die, or cannot live without for it, you’re in a state of being addicted to it. TIC recognizes the abuse of power but does not acknowledge why it occurs. Before there was trauma, there was addiction. Trauma appears to be at the root of human behavior because we remember the event, but addiction is there too. Addiction is happening in the honeymoon phase of the relationship, the trauma is the abuse. What unmet need/want caused the trauma? What was the need/want that was trying to get satisfied? Examples of addiction can be seen when the greater good is sacrificed for individual gain or self-preservation.

Examples being under the influence: inability to empathize or accept the other sides point of view, lack of concern for greater good, only seeking their needs to be met, unable or willing to listen to reason, and disregard for the law.

Reasons why individuals are unable to change: they are addicted to the outcome of an entrenched belief and can stand no contradiction to what the belief provides i.e. invested interest, and/or they are traumatized themselves, marked by an inability to accept progress or change.

When survival or “us vs. them mentality” are the only rules of the game, then you are either addicted to the game or are being traumatized by it. This is because our higher orders of thinking become compromised by our need for survival. The difference between surviving and thriving is overcoming the relationship between trauma and addiction within ourselves. This view can be extrapolated to societies.

TIC and AIC may seem confrontational but that is not the intent. The intention is to advocate for understanding, change, and to carry a message to those who need to hear this because it is getting to the point of the story (his-story) when the character asks, “what’s really going on here?” The conclusion is hopefully to ask and accept help.

All conflicts come down to a lack of understanding due to lack of information, either by choice or by psychological influence. For those who read this and do not feel that they have an addiction, please know that I believe that you do on some level. Addiction is a matter of degrees. Think of addiction on a spectrum with healthy, neutral, and unhealthy versions. They all end but some will end quicker than others. One can label one’s addiction as love, passion, materialism, or “the good life” but when we define addiction as “a want labeled as a need” or “something that one cannot stop” then a whole new avenue of thinking opens up.

At the heart of human existence, we are either addicted to life or death. From a higher order of thinking, there are no such things as life and death. Life simply fuels death and death fuels life. There is no “right or wrong;” only desired/undesired outcomes because of our addictions. The severity of our need for desired outcomes greatly impacts human development. The best we can do is minimize the impact of our desires on the outcomes and maximize our healthy relationships.

One man’s loss is another man’s gain, however, when future generations stand to lose (or have lost) a healthy ecology, basic human rights, and individual freedom as a result of our addictions, we have to re-evaluate our way of life and adjust accordingly. From a psychological standpoint, if someone is defensive they are protecting what they value. Any perceived value is a judgment and can become a “need.” This relationship over “want and need,” “love and hate,” “right and wrong,” “pain and pleasure,” “attachment and non-attachment,” “clinging and letting go,” has been discussed forever. The difference is that we have a solution for our unhealthy relationships to our addictive behaviors and can make the necessary changes to improve our lives through a process of recovery.

If we truly want to address the addiction crisis, then everyone would be in trauma and addiction treatment. I strongly recommend that each person looks at what is fueling their role in enabling these institutions if they want to see lasting change. Anything we put in front of the individual’s right to chose how they live their life, we stand to lose.

The US opioid/opiate crisis is not about the drug, but rather our nation’s relationship to addictive behavior. I would like to see is more informed policies based on the research and not on political gain, accountability to policymakers and businesses, and treatment options for the people who do not recognize their addiction or their addiction to trauma/drama.

Resources

2017/11/2. Retrieved on http://www.traumainformedcareproject.org/ Frontpage.

by Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is an EMDRIA certified EMDR therapist/Consultant-in-Training and is trained in Progressive Counting and Brainspotting.

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Universal Addictions

Russell Brand’s book “Recovery: Freedom from our Addictions” (Brand, 2017), inspired me to write this blog. As I am sure many have, I have wanted to write that book ever since I returned home from my stay in detox some 8+ years ago. Mr. Brand, you have saved me a lot of time and I really appreciate it. Plus you hit on a major topic for me: Universal Addictions. As Mr. Brand points out, addiction includes food, sex, shopping, success, power, control, relationship, and consumerism. It is our relationship to external validation that is the issue. I also lump “love” into the definition of addiction because, in the brain, addictive behavior rides the same brain highway as love. To me, addiction is just that: toxic love. When I first entered into recovery I wondered where could I learn healthy love, which is mimicking a common question now in our America society, what do we do now to help ourselves heal as a nation? My answer now is that healthy love is conscious and intentional love. Ironically, recovery from my toxic forms of love showed me the way to healthy loving. As I tell my clients, do the opposite of what you are doing and you will be fine (as if it were that simple!)

As a person in long-term recovery, when I came home from my inpatient/detox and was seeing clearer, I noticed my loved ones were exhibiting hurt. I originally thought it was the fallout from my use but I quickly recognized the pain that my loved ones were in was similar to mine before I went into treatment. I had found a solution in recovery and wanted them to know about it. Here are the highlights: 1) Acceptance: You are where you are and you can only change yourself. 2) Reality: Labeling a need a want does not make it so, i.e. the reality is that I only need air, food, relationship/connection, safety/freedom, work/purpose, and play. 3) Compassion: Pain is a great teacher. Everyone has some type of illness and is still in recovery from it.

I think that an important element to a strong recovery is the ability to identify what is ours and what is theirs. All around me I saw people who were addicted, not only to drugs but to the desire for things to be different than what they are. Human behavior centers on addiction because addiction comes down to our pain/reward system and our primal urges to either avoid pain or seek pleasure. Since we all have a brain, we all can be in a state of addiction. The pain/reward system is housed in the lower levels of the brain, which conversely are why addiction is so baffling to the high levels of thinking (moral argument) without the context of what the lower levels are there for. The lower levels are for our survival.They unconsciously perform digestion and regulate blood pressure. They also operate our unconscious psychological processes like our survival responses of fight, flight, freeze, and freeze but also our attachments, emotional development, and ultimately our addictions.

It is a futile argument to me to say that people can just stop their addictive behavior because it is an unconscious process. What would be more accurate is to say, “I feel like you can just stop.” A feeling is not a fact; it is information. The fact is that addiction is a part of our deepest biology and saying that people can just stop is like saying that someone can just stop breathing. Yes, they can hold their breath but can they simply stop breathing on their own? No. Another way of seeing the futility is that telling someone to stop their addiction is akin to telling someone to stop falling in love.

Now, our psyche has a neutral setting too and that is where the power really is. Russell Brand points out that we all are under some program of either conscious or unconscious living. I agree. We believe we are in control of our decision-making but again feelings are not facts and neither are beliefs. In traumatology, we learn about a phenomenon called trauma re-enactment, in which our brain and memory system tries to resolve an issue by replaying it or re-enacting it unconsciously. This plays out in all of our relationships and why psychology is interested in resolving early parental dysfunctions and traumas. Re-enacting is the brain’s way of making sense of what does not make sense to it. This unconscious pattern replay is an important element to the formation of our addictions, housed in our lower level of consciousness and is a process dedicated to survival. This can also be seen universally when we notice that history repeats itself. Those who know their history but who have not learned and grown from it are unconsciously reliving it. And, as they say, those who don’t know their history are condemned to repeat.

When I extrapolate the pain/reward system to local, state, and country, I become a very concerned citizen and feel the need to speak out against the denial that I see. We can be addicted to an idea, cause, their story/past, their pain, their purpose, or their safety. We can be addicted to normal. When people talk about these and appear to be under the influence of them: watch out! It makes it difficult to engage with people in an honest discussion like trying to convince a person who is drunk not to drive. When I see people acting out of hurt and with malicious intent in their words or actions, it resonates with me like active addiction and I wonder what is needed for healing to happen.

Then I started to wonder some more… What if America was my client? How would I approach the client and how would I treat? First of all, upon first assessment… tough client… the genogram is going to be tough… younger sibling with a inferiority complex… and, for better or worse, many strong personality traits…

Whenever I have a new client in front of me, I look for their identified addiction and their unidentified trauma and addiction. What experiences shaped them at their core and how did they cope with the aftermath. Once I find the unidentified trauma and addictions, I find the source of their healing because they have survived both. If they are ready for change then we try and remove some of the obvious obstacles and help motivate new behaviors i.e. what I hear you saying that you are a shining light of Providence, but you have killed and are continuing to kill in the name of Providence. This appears to be in direct contradiction to Providence, Bill of Rights, 10 commandments, and the law…

Having a BA in history, I have a pretty good idea of what America’s traumas are and know that I am dealing with extremely complex PTSD. America had a traumatic birth and had many different forms of complications with early development. When America came of age it became addicted to its story. America is addicted to more. America is addicted to Providence. America is addicted to denial. America is addicted to feelings of safety but fails to recognize its’ role in creating the chaos. America is addicted power, control, and greed. Hence, America’s history is the autobiography of a madman who needs therapy and healing. (Don’t get me wrong, every nation has their history and it more than likely applies too.)

In a paper for my undergraduate history program, I called for an “actual” 4th branch of government. (As the news can be bought and paid for, law applies only to the base of human behavior, the supreme court is run by the law (which is again applies to the base of human behavior), and political parties are tools for the wealthy, so I did not see these as viable or sustainable options to solving issues with equality, racism, bigotry, class, or mass murder.) This new 4th estate was to be run by the social sciences, healers, religious/spiritual elders, or an ethical code to help guide the nations moral agenda from a neutral standpoint. I still believe this is a good idea.

The bad news is that since America is addicted to itself and the wall of denial must be broken in order for reason and common sense to start pouring in. The good news is that there is a solution to addiction but the cost of admission is that one has to have humility, honesty, openness, and the willingness to change. The first step… admit that you are powerless in the face of the awesome powers that surround you. Step 2. Believe that these very same powers can restore you to sanity. Step 3. Surrender: You will gain more by letting go.

In recovery, we know that rock bottom is optional. I see America as hurting right now and needs healing. However, I believe that individual healing needs to happen first and that this will fuel the spiritual revolution needed now to heal us from ourselves.

The good news is that we have access to healing, however, I have not seen or read too much about the successful implementation of communities healing throughout history except 12 steps/self-help. Obviously, the reconciliation periods after the Civil War and Apartheid in South Africa are still having their challenges. Healing in our society appears to come from the arts and is marketed through business models, which then have consequences of their own. There seems to more that could be done on a community level. With that said, again recovery shows us the way. However, Bob Marley’s ‘One Love’ question still remains unanswered by our society: “Is there a place for the hopeless sinner, who has hurt all mankind, just to save his own?” I say: Yes, but only through the process of recovery from our addiction to ourselves.

Brand, R. (2017). Recovery: Freedom from our addictions. New York, NY: Henry Holt and Company.

by Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is an EMDRIA certified EMDR therapist and is trained in Progressive Counting and Brainspotting. 

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Family and Addiction Notes

I recently had the opportunity to have a public conversation around Family and Addiction at my local Recovery-Oriented Service (ROS), Columbia Pathways to Recovery (CPR) and wanted to make my notes public.

First, I wanted to get the point across that any medical condition or disease impacts the family system. So I asked, “What impact does any illness have on the family? What happens to the dynamics?” Here are the highlights: Everyone gets stressed, old wounds open up, the family system adjusts in either healthy or unhealthy way to get through a crisis. It takes time, love, connection, and chicken soup to help aid recovery (if recovery is afforded by the disease). Also, in times of need, we look for accurate information about the course of the disease and what the recovery looks like so we can make informed decisions.

The topic of family is such an intricate part of a successful recovery because it is one of the main roots of addiction. The family is where we learn to create relationships and addiction is really about our toxic relationship to the drug. Our original wounds start with the family, which makes the subject extremely sensitive. In family systems, many of our wounds are inherited and are transmitted so we are not responsible for them but it is our responsibility to not continue to transmit them. This includes our addictions. Moments of vulnerability are opportunities for developing addictions. Addiction starts well before any addictive behavior has started and is learned in the family system or in relation to the people that meet our earliest wants and needs. So, relationship to our addictions can also be seen as a displaced attachment to an unhealthy source.

For this public conversation, I also prepared a list of addictive traits that I am looking for in my own children’s behaviors and development. Here is what I am looking for: shame-based and/or toxic relationship to self or others, how they respond to guilt, how they relate and treat others and their community, unhealthy attachment to external validation, how they handle disease and adversities, avoidant behaviors, risky behavior, short-term thinking, describes feelings of being stuck, obsessive or fixations, inability to ask for help and accept help, and disruptive behaviors in social situation. I watch to see if they ask for and accept help, or do they display depression and anxieties that are outside the norm, style of peer interactions, social and cultural context around pain and pleasure, relationship to “more,” and unhealthy relationship to natural highs. Lastly, I am committed to making sure that they do not lose their childhood because of adult themes.

What I will do to counteract these: ensure a emotionally safe environment where it is okay to learn from mistakes, model healthy with humility, openness, and willingness, have early and appropriate interventions when something is noticed, monitor psycho-social development after the introduction of an illness or disease, provide examples of balance through literature and media, create emotional safety and connection within the family system and community, validate positive and negative emotions, create daily structure and routine, daily play, creative expression, and perform meditation together. All learning occurs through mimicking and non-threatening directives so the biggest thing that I can do is take inventory of my stuff and address my traumas and addictive tendencies.

Here are some resources for creating and maintaining healthy relationships with children but everyone can use what is taught in these books to support their inner-children, change their self-talk, or apply in their current relationships.

Siegel, D., Bryson, T. P. (2012). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Bantam Book Trade Paperbacks.

Siegel, D., Bryson, T. P. (2014). No-drama discipline: The whole-brain way to calm the chaos and nurture your child’s developing mind. New York, NY: Bantam Book.

Brooks, R., Goldstein, S. (2001). Raising resilient children: Fostering strength, hope, and optimism in your child. Chicago, IL: Contemporary Books.

Also Dan Siegel on Youtube… https://www.youtube.com/watch?v=JNNT7loaQAo

by Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is an EMDRIA certified EMDR therapist and is trained in Progressive Counting and Brainspotting. 

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Trauma Informed Twelve Steps

1) We admitted that we are not in power when our needs and wants have become unmanageable.

2) Came to believe that a power greater than ourselves could restore us to sanity by showing how insane it is to believe that our wants are really needs.

3) Made a decision to turn our will over to the care of Good as we understand it, while retaining our need for human rights, common decency, and all matters of respect.

4) Made a fearless and searching inventory of ourselves to understand the exact nature of our human condition.

5) Honored our experience and knowledge by sharing with our Higher Power, another person, and ourselves the exact nature of our condition.

6) Humbly asked our Higher Power to help us with self-acceptance in our daily effort to heal.

7) Humbly asked our Higher Power to help with the ability to recognize and remove our shortcomings.

8) Made a list of people we have harmed and became willing to make amends by learning how and why.

9) Made direct amends, by owning our behavior when it would not cause harm to ourselves or others.

10) When we were wrong in our words, thoughts, and actions, we promptly and non-judgmentally admitted it to ourselves and to others.

11) Sought through prayer and meditation to improve our conscious contact with our Higher Power, asking for the insight and the will to carry the Good out.

12) Having had a spiritual awakening as a result of these steps, we tried to help others by sharing our experience, strength, and hope while practicing these spiritual principles in all of our affairs.

by Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is an EMDRIA certified EMDR therapist and is trained in Progressive Counting. He is aiming to support other clinicians by providing consulting and trainings. 

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Trauma Healing Our Addictions: Adaptions to EMDR and Progressive Counting for Addictions

It has long been understood in the EMDR community that trauma resolution would help with addictive behaviors. It is seen in Shapiro’s early writings and in her encouragements for the development addiction protocols (Shapiro & Forrest, 1997; Vogolmann-Sine, Sine, Smyth, & Popky, 1998; Shapiro, 2001). Now DeTUR (Popky, 2007) and FSAP (Miller, 2012) have been developed to help address cravings and positive states of addictive behavior and/or drug. These protocols are extremely helpful tools that can tackle the felt effects of the drug and impact the relationship to the drug but appears to limit their abilities to address the whole addiction in the context of it being traumatic or a learned behavior. To solve this, these protocols are delivered in a larger context of treatment but more could be done to support addiction treatment, particularly from a trauma-informed perspective. In my practice, I use the Fairy Tale Model developed by Dr. Ricky Greenwald (Greenwald, 2007; Greenwald, 2013).

In my last blog post, I showed how the definition of addiction implies trauma and why targeting the roots of addiction memories is so important when addressing the condition of addiction. However, when I started to use trauma resolution I did not see a direct and effective way of doing this. So I sought out Dr. Jamie Marich for supervision and she simply stated, “anything can be targeted” (personal communication, November 16, 2016). For this clarity, I am grateful but through my own process of addiction and recovery, I knew that there were philosophical obstacles to applying the standard EMDR protocol. After listening to my ideas, she acknowledged that it is important for the clinician to have a firm understanding of addiction and recovery to perform trauma resolution in addiction treatment (personal communication, November 16, 2016). I could not agree with her more and felt that I could provide some practical information for clinicians on what I have had to do to rearrange the trauma healing therapies of EMDR and Progressive Counting to address the whole condition of addiction.

It is not widely known that the actual drug use is traumatic from the body and mind perspective. I invite you to look at drug use as a trauma from a medical, biological, and psychological standpoint. The moment the drug is introduced into the body and mind, it pollutes them like a biological toxin or psychological trauma. Nature wanted us to remember toxic experiences like these so we would not repeat them but also positive experiences that helped us survive and thrive.

I often think of Cameron from the TV show House M.D. when she is messing with Chase’s head about sex. “Sex could kill you. Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets, respiration becomes rapid and shallow, the brain fire bursts of electrical impulses from nowhere to nowhere, and secretions spilt out of every gland, and the muscles tense and spasm like you’re lifting three times your body weight. It’s violent. It’s ugly. And it’s messy. And if God hadn’t made it unbelievably fun, the human race would have died out eons ago (Shore, 2004).”

I have not had a client who could not identify that their drug use was traumatic even though it was pleasurable. In hindsight, it is hard not see the carnage and wreckage that first use represents. It is seen as the beginning to the end or, as I am coining and presenting the term here, the Original Learned Addictive Behavior (OLAB). I define this as “the moment when the toxic relationship to the addictive behavior was created.” In layman’s terms, it is the original “f@$! it” moment when the person surrendered to the “need” of the behavior, drug, or relationship. Underneath this memory is Shapiro’s (2001) feeder memory but with the mental twist of “what feels good is bad.” I struggled to apply EMDR and Progressive Counting because I knew that there was more to the recovery process then just desensitizing cravings or triggers due to the philosophical mind game being played. Utilizing my own path to recovery I had to make some minor but important changes given this context.

Before I present how EMDR and Progressive Counting can assist in addiction treatment, please be make sure that you are trained and experienced in trauma methods, addiction, and recovery before you perform these techniques. The client could start to process their whole addiction (particularly in EMDR), which sometimes can be overwhelming if the client is not well resourced, if they are not truly in an action stage of change/recovery, or if you have not cleared major traumas before addressing the addiction in this way.

Here is how I untangle the pain/reward pathways and over stimulation of addiction with EMDR and Progressive Counting. First, in the history taking, I find the OLAB by asking, “When did you find this (addictive behavior) was the solution or when did you fall in love with this (behavior)?” Second, when the time comes, I have the client perform a floating back from the first drug use to where they first learned to feel like this. Usually, within the processing of OLAB memory, the client acknowledges that they are emotionally substituting the drug for a person, to gain social acceptance, or numb some other type of pain, which is great for addressing the addiction with the context of their life. If there are traumas before the OLAB, I address those first but they are usually entwined on some level. For each trauma resolution method, I treat each drug as a cluster and do first, worst, and last.

In Phase 3 of EMDR (Shapiro, 2001), I simply switch the Positive Cognition (PC) and Negative Cognition (NC). What happens in the processing is that they start balancing out the relationship to the addictive behavior, reprioritizing the importance of the behavior, and then identify that the behavior was not good for them or was an emotional crutch. The processing allows them to separate themselves from the behavior, untangle their mixed emotions about a relationship, add context and perspective, and have compassion for their original “decision”. In Phase 5, Installation Phase (Shapiro, 2001), I keep it the same but usually, they have another belief present that needs to be installed. The PC’s become more like, “Now, I understand,” “I can forgive myself,” and “I can be that without the behavior.”

With Progressive Counting, “For the movie, what would the beginning be, before anything good happened?” and “What would be the ending, after the good part was over?” I find Progressive Counting to be more of a contained method and more of a direct process that has specific benefits for this population. Clients who are addicted are known for being abstract and Progressive Counting helps minimize tangential wonderings. Another benefit for this population is that it is well-tolerated by the client and easy for the clinician to master (Greenwald, 2013).

There are many more nuances to applying trauma resolution in addiction treatment but at the core of the process is trauma healing. What is interesting is that they are processing a “positive” experiences, however, what they find is the truth about their relationship to the addictive behavior and that can become unsettling because the toxic guilt and shame come up. Make sure that they are ready for that part of the process. I have found that by addressing the OLAB first it allows for the person to address the guilt and shame before they tackle their whole addiction. Overall, I find addressing the OLAB first to be safer for the client.

The minor adaptations to these trauma resolution therapies are grounded in my theory that addictive behavior is traumatic because the OLAB impacts the body and mind the same way as event trauma, Szalavitz’s (2016) conception that addiction is a learning disorder, and also Mate’s (2010) stance that the root causes of addiction is trauma. Each client presents with different needs that need to be addressed but they all begin with pain. Trauma healing redefines therapy especially for addiction treatment because it gets the job done. There is urgency in addiction treatment that the client feels and that as clinicians we need to honor. Trauma healing is what clients are expecting when they come to treatment, even though they may not exactly be ready for it. It is our job to get them ready but I will continue to argue that clients in addiction treatment need more trauma-informed preparation, let alone trauma healing. However, many of the clients have been through multiple treatments and are ready for trauma healing but might not know it yet.

Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.

Greenwald, R. (2013). Progressive Counting: Within a phase model of trauma-informed treatment. New York, NY: Routledge.

Marich, J. (2016, November 16). Personal communication.

Miller, R. (2012). The feeling-state addiction protocol. Retrieved on 8/11/17 at

http://www.fsaprotocol.com/microsoft-word—the-fsap-4.pdf

Popky, A. (2007). Retrieved on on 8/11/17 at http://www.emdrtherapyvolusia.com/downloads/lynda_documents/forms_protocols_and_scripts/DeTUR.pdf

Shapiro, F., Forrest, M. (1997). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. New York: Basic Books.

Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York, NY: Guilford Press.

Shore, D. (writer), & Singer, B. (director). (November 30, 2004). Occam’s Razor. House M.D. Los Angeles, CA: 20th Century Fox Studios

Szalavitz, M. (2016). Unbroken brain: A revolutionary new way of understanding addiction. New York, NY: Picador.

Vogolmann-Sine, S., Sine, L. F., Smyth, N., Popky, A.J. (1998). EMDR Chemical Dependency Treatment Manual. EMDR Humanitarian Assistance Programs.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.

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Defining Addictions from a Trauma Perspective

The first time I got high, I came home and my sister asked me “who is she?” She thought I was in love. Well, I was, but with the experience of freedom to different underlying issues that I had been experiencing my whole life. After the drug wore off and the psychological cravings started, then the biochemical reminders of adrenaline and serotonin began and the voids of loss felt like the vastness of space. Emotional confusion was compounded by love withdrawal and this lingered for weeks until I was able to hook up with the drug again.

Addiction is the paradoxical two-way mirror into the human condition and to avoid the reality of it is to deny its’ existence. Addiction takes hold when a “want” is labeled as a “need” and you need more to satisfy it. Addiction is a rollercoaster ride you feel like you can’t escape because it threatens your very existence.

From a psychological perspective, addiction is toxic passion. Passion drives us to get our emotional need met. We all have been in an intoxicated state of passion so we know what it feels like. In the case of addiction, a behavior or substance meets our unmet needs and fulfills the role of healthy relationships. Maybe more accurately, the behavior or substance replaces our basic human needs, supposing they were met before. The question becomes: Why do our needs need replacing?

What I continue to purpose in my blogs is that we are addressing addiction at the root when we conceptualize that the drug use (or learned relief behavior) as a/the trauma. Again addiction is paradoxical in that what feels good is not actually good for you. Now, I know that some will say that trauma is not in root in every case, but I would argue that if trauma is subjective, then no claim could be laid to that. I would agree that not all traumas equal Post Traumatic Stress Disorder (PTSD) however, I have yet found a person with an identified addiction not have a trauma whether it be real, perceived, witnessed, or existential in nature. As Gabor Maté (2010) stated, “not why the addiction, but why the pain.” The main culprits of pain stem from early childhood environment with school, parenting styles, and/or the family dynamics. If miraculously a trauma is not there, then the introduction of the toxin, behavior, or drug to the body becomes a trauma.

Defining addiction is often paradoxical, especially if we do not take into account the trauma that happens in everyday life. When we take trauma into account, defining addiction becomes clearer. Under the lure of security, hope, desire, pain relief, and/or unconditional love, addictive behavior progresses and grows into dysfunction. The definition of addiction appears to be firmly rooted in trauma but it is not widely recognized by people who do not interact with active addiction or people in recovery from their addiction. This blind spot effects governmental policy and perpetuates the stigma of addiction. Ultimately, it affects how we treat addiction because we spend so much time educating on what addiction is, rather than treating the root causes.

American Society of Addictive Medicine state “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors (ASAM Board of Directors, 2012).”

On the whole, I agree with this definition because it reveals the underlying trauma used to define it; but also the solution. “Dysfunction” in the brains “memory and related circuitry” is the underlying trauma. And, the solution is: if the client changes their relationship to the memory, can you heal the dysfunction? The answer is yes; I have done it. And to be fair, ASAM does recognize that trauma and stress are involved in addiction (ASAM Board of Directors, 2012).

In his book Anatomy of Addiction (2016) Dr. Mohammad points to a medical definition of disease and identifies genetic predisposition and excessive triggering of the pain/reward pathway as main ingredients to creating an addiction. To support this position Dr. Mohammad states, “overstimulation of the reward circuitry factor significantly in addiction but it creates false memories of the experience. The brain regards the experience as ‘better than expected,” even when the experience wasn’t all that great. Because the memory is a permanent part of your mental makeup, anything and everything that reminds you of that memory also remind you that the experience was better than expected and triggers an instant desire to re-experience something that perhaps wasn’t anywhere as good as you remember (p. 56).”

If trauma resolution has shown me anything, it is that our memories and relationship to them is anything but permanent. Memories, reminders, triggers, objects, people, places, and things can be desensitized to help stop enactment because ultimately it is our relationship with them that changes. Addiction and relapse are a form of trauma re-enactment and it can be treated more effectively with trauma resolution. Trauma resolution is done through memory reconsolidation (Ecker, Ticic, & Hulley, 2012) and the therapies that exemplify these are Eye Movement, Desensitization and Reprocessing (EMDR) (Shapiro, 2001) and Progressive Counting (PC) (Greenwald, 2013).

Addressing memory in the context of a human beings life addresses the root cause of any behavior. The coping skill of addictive use is what is stuck in the body and brain like a trauma and it can be alleviated through trauma resolution. Addiction alters the brain and its accompanying guilt and shame can be seen as a trauma. People who are addicted, their families, and communities who have been impacted by addiction, know that at some point the addiction becomes traumatic. Addiction is a rollercoaster that you feel like you cannot get off. Actuality, you can, but you have to climb on another one, which also has its twists and turns, its highs and lows. This other rollercoaster is the ride of life.

References

ASAM Board of Directors, 4/19/2011. Retrieved on 8/11/17 at http://www.asam.org/for-the-public/definition-of-addiction

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.

Greenwald, R. (2013). Progressive Counting: Within a phase model of trauma-informed treatment. New York, NY: Routledge.

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. Berkeley, CA: North Atlantic Books.

Mohammad, A. (2016). Anatomy of Addiction: What science and research tells us about the true causes, best preventive techniques, and most successful treatments. New York, NY: Perigee.

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic principles, protocols, and procedures. New York, NY: Guilford Press.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.

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Outpatients are Not Treating Addiction

When a client comes to treatment for addiction, in an outpatient or residential setting, we obviously explore their symptoms. Tolerance, cravings, withdrawal, unsuccessful attempts at stopping, reoccurring dangerous situations, and increased amount of time thinking or obtaining the drug are not typically cited as reasons to come to treatment by the client. These are not symptoms that individuals directly identify with because they are not the most pressing concerns to the client. On some level, clients in treatment recognize these diagnostic symptoms and their drug use as an issue but more often they recognize the underlying emotional issues. If we are to meet the client where they are at, the underlying emotional stress is where it is.

The rollercoaster of diagnostic addictive symptoms seems elusive to the client because they are medical and existential in nature. First responders, ER’s, detox units, and in-patient deal with active addiction. So do families, friends, community members, employees, and employers. “Addiction” is happening at breakfast, lunch, and dinner. “Addiction” is happening on Friday night happy hour, Wednesday night bingo, 2 a.m. coke binge, and at family functions. “Addiction” is happening on a boat, on a plane, on a stage, and in a cage. It is happening in the normal hustle and bustle of day-to-day life. In the outpatient setting, the problem is separating the outside world from the therapy setting. This begs the question: what are we really treating in our outpatient and residential settings?

What are the psychological symptoms that clients experience days, weeks, or months, or even years after their last use? Clients may say “I can’t stop using,” I don’t want to be here.” “I don’t want to go back,” “I can’t cope,” and “I can’t control it.” In other words, they report that they are experiencing intrusive thoughts, avoidance of remembrances, negative alterations in cognition and mood, and alterations in arousal and reactivity. These are post-traumatic stress symptoms.

I prefer to conceptualize active addiction more like Acute Stress Disorder (ASD) because people are not typically in their right state of mind. It is similar to walking away from a car accident. People may be shaky, confused, disoriented, stunned, and/or limited in some way, but could return to a baseline if given enough time away from the event and the ability to make sense of it with their support system. Indeed, we are all “under the influence” of biochemical responses in the body and brain after a life-threatening event and any reintroduction to the stressor would bring us back to the event causing impairment if left unprocessed.

The body and brain know that it is in for a rollercoaster of a ride physically, psychologically, socially, and spiritually when a drug is taken because they remember it. Whether it is actual, perceived, medical, or existential; all drug use is replicating learned behaviors and threatens the life of the organism. The body acts accordingly to any threat or stressor (positive or negative) and each use, cue, or trigger acts as a reset for the body to return back to the original event.

So outpatients are treating the memory of active addiction, which is not an addiction by our diagnostic standard. For the most part, I would say that they are treating the echo of life events i.e. best conceptualized as trauma. However, many outpatients and residential settings are not using trauma therapies or at minimum trauma-informed care directly. They could start seeing better outcomes if they did.

Adam O’Brien LMHC, CASAC, EAS-C is the owner/clinician of Mutual Arising Mental Health Counseling, PLLC in rural Chatham NY. He works primarily with people suffering from their addictions but is also a trauma therapist working with victims of crime. In these freelance writings, he brings a variety of experiences and points of view to entertain and educate. He is currently becoming certified in EMDR and Progressive Counting and is aiming to support others by consulting and training. These blogs are to advocate for trauma services in the field of addiction but also serve as a way of reaching a wider audience.