Is There a Common Basis for All Addictions?

In order to explain the different types of addictions, neurobiologists study neurotransmitters, epidemiologists survey psychosocial causes, and psychoanalysts analyze conflicts in the unconscious.
But to those of us who fight the drug war in the rehab trenches-face-to-face and shoulder-to-shoulder with relapsing patients, lovingly destructive co-dependents, ever-decreasing funds for treatment and a capricious legal system-the differences among addictions are blurred by the commonalities. Here are some insights from recovering alcoholics and other addicts:

Doctor: What causes addiction?
Recovering Addict: Nobody knows.
Doctor: What keeps addictions going?
Recovering Addict: Addicts and co-dependents do. Addiction is an inside job.

This may sound flippant or simplistic, but it is clinically sound. Actually, alcoholics and other addicts agree with the National Institute of Mental Health that addictions are a matter of brain chemistry, which is shaped by genetics, psychological strain and personal life events. But with our current limited knowledge, physicians in the trenches and addicts who are in treatment agree that the only things we can address clinically are the addicts' thoughts and addictive behaviors.

The Problem

Addicts are people who have learned how to give themselves a quick chemical fix or achieve an emotional high when they either want to or have to change how they feel, and when they want to ignore real-life problems. Most people do that, but the next morning, they feel sick or foolish. They don't do it again because it didn't work for them.

What makes addicts different is that they are willing-or feel compelled-to do it again and again even though they "know" that doing so will get them into trouble.

As for the "drug of choice" conundrum, any addict will tell you that when the existential squeeze is on, any fix will do because for all addicts the goal is the same: As quickly as possible, do something that changes how you feel, and enables you to ignore reality. Any drug in a storm, you might say.

Here is the pattern:

You are a "dry" alcoholic or a "clean" addict. You just pulled off, broke even on, or screwed up a major business deal. You are elated, bored or humiliated. You feel emotionally out of balance. If you are an addict, the impact of these real-life events on your affect-feeling state is intolerable, so you decide to have a drink or some other drug because you know it will make you feel different.

Within minutes your chemical brain is changing. You feel better or different. So you drink or drug some more until you achieve your goal. You feel high, numb or exhausted. That's why you are called an alcoholic or drug addict.

A neurologist would say your brain is changing because you have just taken neurotropic drugs. But clinical experience shows that addicts are not limited to brain drugs.

Take this scenario:

You are a divorced, middle-aged homemaker. You don't drink or do drugs, but you have a "weight problem." Your daughter just phoned-collect-from college. She thinks she is pregnant, and she doesn't know who is the child's father.

You are elated and humiliated. You feel your emotions are out of balance. You always wanted to be a grandmother, but not like this. So you close the drapes, unplug the phone, turn on the soaps and stuff yourself with junk food. Within minutes you feel better or different. So you eat more until you feel high, numb or exhausted.

That's why you are a compulsive overeater.

A biochemist would say that foods are also brain drugs. But clinical experience shows that if the above homemaker did not have an eating disorder, she might run to the mall and max out her credit cards because she is a spendaholic. She got high, not by using a brain drug but a brain behavior.

In other words, addicts can initiate and maintain the desired emotional high or problem-solving mental state by at least two methods: taking a drug of choice or initiating a behavior of choice. Here is another example.

You are an abstinent gambler. You just pulled off, broke even on, or screwed up a major business deal. You are elated or humiliated. You feel emotionally out of balance. So you phone the Las Vegas casino where you are a "regular."

Within minutes, like a cocaine addict calling his dealer's answering machine, you start feeling better just by hearing the familiar routine: The voice on the other end verifies your credit line. "The next flight leaves your city in one hour," you're told. "A first-class reservation has been arranged; our limo will meet you at the airport."

Even before you hang up the phone, your brain is on a chemical roll-your pulse is up, the blues are gone, the fix is on. In your altered brain you hear the big-shot sounds of the casino, the soothing metallic dings of the slots, the joyful "How've you been?" of old pals, the bouncing roll of the lucky dice, the manic rush of a winning streak.

Because you are able and willing to keep turning that mental trick, you are a compulsive gambler.

Here is how sex can work the same way.

You are a sex addict. You just pulled off, broke even on, or screwed up...etc. a major business deal...etc., etc. So you phone an old girlfriend: "Hon, I know this is short notice, but how about lunch?"

"Sure," she purrs, "but why not spend the afternoon in that little motel, like old times?"

Wow! Your carotid pulses are flooding your brain. By the time you hang up the phone, your chemical brain is going full tilt. You "know" this is gonna get you in trouble again, but you say, "What the..." That's why you are a sex addict.

How Do Addicts Deal With These Commonalities?

Recovering addicts that I have treated accept what I call a unified theory of addiction. The core problem is the desire/compulsion to change-by any means-how they feel. (Any means includes all mind-altering drugs or addictive behaviors. In the addict's lexicon, switching from Scotch to wine, from coke to pot to sex, or from alcohol to benzodiazepines, is like switching decks on the Titanic.)

In other words, they believe that although addiction is initially and ultimately a cerebral-chemical event, the effects-euphoria/sedation, fast/slow pulse, sweaty palms/dry mouth, and so forth-can be triggered either by extrinsic substances that go to your brain after you swallow, inhale or inject them; or by intrinsic drugs that your body/brain manufactures when you initiate certain thoughts or behaviors, e.g., calling Las Vegas, hiring a hooker, or repeatedly cruising past your drug dealer's house.

Their solution is to accept personal responsibility for the drugs and the thoughts they put into their brain; and to learn, through 12-step work and therapy, what other things they can do to handle the urge to fix.

If you're a nonaddict, you probably often ask the ultimate question: Why do addicts keep doing it?

Well, over the past 40 years, thousands of addicts have given me as many answers. Here are my two favorites:

"Doc, I think I get high because I don't want my life to be as boring as your life seems to be."

"Doc, I drink because it makes warts go away-from other people's faces."