Far more than a quest for pleasure, chronic substance use is the addicts attempt to escape from distress. From a medical point of view addicts are self medicating conditions such as depression, anxiety, PTSD and ADHD and many other psychological conditions.

Addiction always originates in pain whether felt openly or hidden in the unconscious. Heroin and cocaine are powerful painkillers and also ease psychological discomfort.

Why the pain?

One should never question why the addiction? but why the pain? when any behaviour becomes an addiction there’s a need to ask “who is in charge here? The person or the behaviour? If it’s the behaviour that become an obsession which puts it in charge of the person, this then becomes an addiction.

Addictions in general are more about the desire and the craving of the said object/drug of choice, not the possession and enjoyment of it. It is this relentless pursuit of the object which thrills and excites the addict. This reminds me of object relations in regards to the anxious ambivalent mother, there one moment gone the next, or good breast bad breast in Kline terms.

According to Gabor Mate’s research, most hard core addicts come from abusive homes. When this research was done in the USA, these groups of addicts tell stories of pain upon pain, rape, beatings, humiliation, rejection, abandonment and so on.

We can feel for the suffering child yet fail to see the child in pain inside the adult who’s soul is fragmented and isolated. Not all addicts and their addictions are rooted in abuse or trauma but there is a belief that addictive behaviours can all be traced back to a painful experience of which a hurt is at the centre.

Early life

The effects of early life stress or an adverse experience on the young psyche directly shapes both the psychology and the neuropsychology of addiction in the brain. It is the psychological isolation often felt when young which drives a person into addiction and this addiction then keeps them in that isolation. The drug becomes the higher placed value on their behaviours and motivations and it is this principle which hooks the person into believing the drug is worth more than anything else, including their true sense of self, and keeps them apart from human contact and the reality of living.

People with addictions grow up unable to have the capacity to be with their feelings and emotions as they have no internal structure strong enough to support them due to early life traumatic experiences. Addicts therefore do not wish to spend anytime alone with their thoughts of feelings, if they do they fall into the void or gap which is terrifying to the addict .

This make them feel unsafe and vulnerable, unconsciously reminding them of said trauma as a child. For the addict the drug of choice provides a route to feeling alive and safe, if only temporary. It is the addict wanting to dull down their senses which is a consequence of an emotional malfunction not of their making. The substance of choice shuts down the internal feelings of pain and vulnerability.

No one grows up wanting or choosing to become an addict. But it is this ability in the brain to shut down when pain becomes too much which protects the child and enables it to repress the painful Emotions and to continue to function and to survive. This however leads to dulling and blocking out the emotional awareness they would then of had.

Most people know it’s better to feel than not to feel but with an addict it is just this feeling which they can’t endure. Their emotional shutdown which protected them when young continues into adulthood making them empty and devoid of life. A drug of choice opens them up and gives them the capacity to engage with life while taking away the pain of living. A drug restores a sense of self and being that was repressed when young.

Many addicts going through recovery feel incomplete and incompetent without the drug of choice to prop them up. The drug has been used as a replacement of their absent coping mechanisms, without it their system is flooded with overwhelming feelings of vulnerability, fear, isolation and feeling unsafe. This is the downside to recovery and a difficult stage to manage; an addict in recovery needs to understand and be willing to sit and be with their feelings and emotions and as such need support in doing so. They become fragile and as the drug subsides from their system allowing the reality of living to be seen, more so than ever do they need to feel safe in order to continue with their recovery until they become strong enough to start self soothing their inner demons.

The biggest block to this is the addict starting to see him self as no longer an addict. With a reliance on his drug of choice his whole self image is intrenched in the world of addiction thus he fears a life without it. Who is the addict without the drug and how can they exist in the world on their own?

The denial state in addiction terms is when there is a refusal to acknowledge your hurting yourself and those around you. In this state the addict is very resistant to asking any questions about their behaviour and habits. So what fuels the addiction and drives it forward creating havoc in its wake?

A passion is generous it makes you feel alive and inspired and is not ego driven. Addiction is self centred and only interests in satisfying its self regardless of others. Therefore an all consuming passion that becomes difficult to resist regardless of the consequences is an addiction.

Addiction in this sense is the shadow side to passion, when passion becomes a sinister drive to feed ones dark side. This is where the addictive sub- personality lurks, guilt ridden in the shadows of the psyche. Yet within holds huge power over the self and ego due to the fractures in the personality and developing psyche when young. The addiction feeds of this fragmented inner child knowing it has nether the strength or resources to resist. The more you offer this addiction the more it wants and the further into the depths of the inner mind retreats the true and authentic self.

So who is the addict without the addiction? A lost and frightened child stuck at an age when a deep hurt of trauma was inflicted upon its being. Without the support and care of adequate parents or care givers the self so young and fragile retreats into their psyche allowing the fragmented ego and personality to run riot. It is this personality which becomes addictive desperately seeking that special something to fill the void/ gap and to make it feel whole. What may start off as a passion becomes an obsession then an addiction and the desperate cycle of destruction and damage takes hold of the shell which pretends to be a person. This is the addicts cycle and not to be confused when talking about OCD which is different; a person with OCD has no craving for the compulsion unlike the addict and gets no kick out of the habit/behaviour.

What then is addiction? In a statement by addiction experts in 2002 it is
” a chronic neurobiological disease characterised by behaviours that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving”. The issue of addiction is not how much or the usage but the overall impact the behaviour has on the individual,and those around him or her. Another analysis is that “it’s not the activity or object itself that defines an addiction but our relationship,to whatever is the external focus of our attention or behaviour”. ( G Mate, chapter 20, 3665 kindle).
Addictions in general are harmful and any repeated behaviour as explained before, which controls and fuels a desire and passion to the extreme are damaging.

This includes Many behavioural and non substance addictions which also affect psychical health, psychological health and personal/social relationships. All these addictions whether substance or behavioural share the same state of mind, craving and shame of which the bi product behaviour is deception, manipulation and relapse.

One thing all addictions do have in common whether it be hard core like drugs and alcohol to nondrug behaviours is that they share the same brain circuits and brain chemicals. All addictions are not just psychological as they all have a biological dimension. It is not beneficial to the addict to purely see their addiction from just either of these view points. Addiction is very complicated and needs to be looked at from a variety of angles such as; biological, chemical, neurological, psychological, medical, emotional, social, political, economic and spiritual. Many other aspects may emerge as time goes on in the understanding of addictions but these are the ones most recognised.

The biology involved with addiction is largely around the brain chemicals in relation to desire, need and tolerance of such drug of choice. This can manifest itself in a dependence which when a person chooses or if forced into abstinence ( intervention and hospitalisation) creates symptoms of withdrawal. This is where the drug induced effects have altered brain chemicals into being dependent on said drug which when taken away produces physical symptoms such as; nausea, diarrhoea, sweats, aches, pains, weakness and in some cases severe anxiety.

Through addictions the prolonged use damages the OFC ( orbital frontal cortex) into thinking and believing that the body needs the drug of choice. This in turn leads to a craving through the release of dopamine which starts at the single thought of using. Because of this damage, the normal function of the OFC is impaired making rational decisions and choices much harder to make.

This dynamic is called salience attribution, and this starts to occur unconsciously and automatically in prolonged drug users. People behave and react and act in a way that is determined by the brain, when damaged this alters the way of thinking.

This doesn’t in any way negate responsibility of the addict in their choice of using and continuous using, however it will after time inhibit their ability to stop, thus limiting their choices and recovery. However research strongly suggests ( G Mate, chapter 15) that the existence of relatively low levels of dopamine in some individuals from birth may be one of the biological bases of addictive behaviours.

Biology aside, we can not blame the addiction on the drug of choice alone and can not look for the answer in the actions of the chemicals involved no matter how powerful they are.

Addiction is very much a human condition, some of us will become hooked on a substance after using it very little and others won’t become addicted at all, why is this? In order to understand the complexities of addiction we need to look at the type of individuals who become addicted easily and ask what is it about them that makes them so susceptible? Are these people already at risk due to other psychological and behavioural issues? Is hurt and trauma experienced when young a pivotal factor in theses individuals capabilities in resisting or having a lower resilience to the power of narcotics, alcohol and non drug dependent addictions? Does a family history genetics and epigenetics also play a part in transgenerational trauma passed down from grandparents and parents to their influential young through DNA, mind sets and learnt behaviours? ( Vietnam veterans study 1972)

One thing is known, that addiction is caused by having direct access to the drug of choice, some more than others have greater addictive potential. The reasons for this lie in deeply rooted and embedded patterns within the neurobiology and psychology of human emotions.
Drugs including alcohol do not make a person into an addict, there has to be a preexisting fracture in the psyche to allow vulnerability to be so threatening that this gives a susceptibility for addiction. It is widely believed that the majority of hard core addicts lived as infants and children under conditions of severe adversity.

It is this environment and inadequate upbringing from the care givers which leaves an indelible imprint on the young self and its development. This is thought to lead to a predisposition to addiction forming and being programmed during their early years.

Addiction stops a person from living life in its fullness, this is caused by fear, the fear of living and loving. To fully live and be in the present there is a requirement to be open to all the emotions of living and feeling. Addicts can’t do this so the process of recovery is to educate and support them in their journey towards this new place of being. It’s a slow and painful journey, however showing the addict the fullness of the life they are missing may encourage them to start that path along with their will to change. This often coincides with reaching rock bottom, or having a major crisis; a very personal point different for each individual when the reality of their addiction clashes with the reality of what their life has become.

The Will to change once engaged is just the start.

In all this the importance of, in Winicottes words “good enough mothering”, adequate mirroring and attachment between mother and infant is extremely necessary in building the emotional stability within the child to self sooth later in life and the building of healthy stress responses. Without this attachment the child moves from infancy to adulthood with a huge void inside leading to the potential for addictive behaviours to take root. The lack of essential biochemistry formed by the mirroring and attachment process in releasing dopamine and oxytocin plus the psychological effect gives the individual an inbuilt vulnerability to the mood enhancing effects of drugs.

” many substance addicts say: they self medicate to soothe their emotional pain, but it’s more than that, their brain development was sabotaged by their traumatic experiences when young”. ( G Mate, chapter 18, location 3376, kindle)



Always word questions and interventions in a nonthreatening a way as possible, bearing in mind that the aim of the group leader is to help the group become self monitoring. Because of this It’s important to try and help the clients understand what material is most relevant to them and why. This will encourages the clients to fully explore their feelings and emotions in relation to those around them and to solidify the alliance within the group of the shared experience of addiction.

Allowing them to be in the here and now and keeping them in the room will engage the clients in their present feelings. Bring back a client into the room if he or she takes a story or feeling out side. Again do this in a non threatening way and affirm what they say by”that sounds good” or ” it’s good to hear you being so direct and honest”.

For the therapist leading or co facilitating a group always think in the here and now if possible. When you start to grow accustomed to this it then becomes easier to steer the group back into the room and their feelings in the here and now. For example; move the focus from outside to inside, from the abstract to the specific, and from the generic to the personal.
Pick up on words such as “should, could and would of” gently challenge the thought on these words as they represent negative thinking and victim mentality, a common trait in addicts.

The therapist must not confuse the means with the end; the means is simply to reduce the anxiety by providing some type of cognitive structure set out at the start by the therapist. This is done to allow the patient/client to participate without crippling anxiety.

When leading a group the therapist must learn to recognises the process in order to help the group understand it to. The group will look to the therapist to lead. This is shown by having a set structure which in turns supports the container of safety which the group will need in order to fully engage in the work. ( pg 66 Yalom Reader on non verbal data to look for in a group). It is often not what is said but what is unspoken, body language, eye contact or not, etc, which is important to notice;

Who sits where,
Who is looking at their watch
Who still has their coat on
Who avoids eye contact with the group or therapist or both
Who is silent, who always talks
Who yawns
Who fidgets most,
Who sighs or makes noises
Who leaves the first etc, ect, ect

As a therapist search in every way possible to understand the relational messages in any verbal/nonverbal communication. Be curious and wonder about certain interactions, the intensity or lack of a response, and remember there will always be tension to some degree within a group. Think here about the family of origin and the dynamics involved in sibling rivalry, the triad between parents and child or the drama triangle of victim, rescuer and persecutor. Each person in a group will unconsciously take up the position they held when growing up in their family of origin.

Another of the therapist goal within a group is to guide the patients towards a point where they can accept one or all of the following;

1- only I can change the world I have created for myself
2- there is no danger in change
3- to attain what I really want, I must change
4- I can change, I have the will to change

Along with these 4 statements is the underlying drive from any therapist to guide the patient/client to take responsibility for his or hers actions in the choices/decisions they have made. In showing them that only they can change themselves and not others, that they are responsible for their past and present life and ultimately their future.

Sometimes a patient will not or can not accept an intervention or interpretation from their therapist. This may be given to them many many times until one day it just clicks, why that day, who knows? Maybe they are just ready to hear what is being said, maybe their defences are ready to come down. One thing for sure is that this will only happen when when the patients relationship with the therapist is just right and it is delivered in a context of acceptance and trust.