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.