This ice cream is addictive!

You need to watch this new show on Netflix. I’m addicted to it!

The word “addiction” has entered our vernacular in a variety of ways. It gives us a way to earnestly, sometimes humorously, express that we are really into something, or that something is very, very good.

I’m addicted to Shimmy Feintuch’s blog, Spiritual Sofa. I can’t stop reading it!

But the truth about addiction is much more dark and insidious. If you were truly addicted to a TV show, or to ice cream, you would probably not share that fact with other people. You would do your best to deny that you had a problem.

Netflix is good. I like it. But I don’t need to watch it. I just like to use it sometimes to relax. It’s not a problem. Stop bothering me.

The reason you would do this is because part of you – the healthy part – may suspect that you have a problem. But the unhealthy part – the addict part – doesn’t want you to know that, because then you may do something about that fact. So the addict in you will use tools like denial and rationalization to prevent you from seeing yourself clearly.

Let’s dig a little deeper to understand more about how addiction works.

For a non-addict, addictive behavior is hard to understand.

Why can’t he just stop drinking?

If she wanted to keep her job, she would have made sure not to smoke pot anymore. Obviously she didn’t want the job anymore.

Why do you watch pornography? Aren’t you attracted to your wife?

If you’re doing something that is harmful, and you’re starting to suffer consequences, then logic would dictate that you stop. But if you have an addictive personality, the ability to take care of yourself in that way is severely limited.

Addiction is often misunderstood. To some, a person who returns to a substance or behavior time after time despite severe consequences is just lazy, unmotivated, or weak-willed. Some like to name-call and think they understand, using words like “pathetic” and “bum.” This is usually a sign that some education is necessary.

A frum middle-aged couple sits into my office. Adam, their son, is 32 years old, single, and living in their basement. He is hooked on all kinds of drugs, gambling, and compulsive spending. He works from home, making barely enough money to support his habits. His mother complains about how Adam is “lazy, can’t get his act together.” His dad mentions that, “If he could find a new Jewish girl, she’ll straighten him out.” I smile and say that I’ll try to help.

What is Addiction?

Addiction is the pursuit of a behavior or substance which continues despite the suffering of consequences. The addict suffers physical and emotional withdrawal when refraining from the drug or deed, and over time has to increase its frequency or intensity to achieve the same effect.

Addictions come in many forms. People can be addicted to illegal drugs, painkillers, alcohol, compulsive eating, sex, shopping, use of electronics, gambling, or video games, to name just a few.

Eventually the pursuit becomes compulsive, which means that the urge to use drugs, for example, becomes overpowering and is very difficult to stop. Here’s where some of the confusion about addiction sets in.

Addicts say they’re powerless over their addiction. What a bunch of hogwash! If they really wanted to, they could stop.

Addicts say they can’t stop. That’s just an excuse! I quit smoking without any help. If I can do it, so can they.

When you’re outside of a situation, you can see the foolishness and folly of returning to a behavior that is harmful. That’s why addiction is so hard on friends and family. Those nearest to the addict suffer the most when they see their loved one reaching once again for that blasted bottle of beer. It’s so clear that it’s a bad idea. Why won’t he just stop?

I start with Adam’s parents, offering some education about addiction. I help them find some compassion and gain some insight into Adam’s struggles. Slowly, his parents start to offer Adam support instead of criticism. Eventually, Adam agrees to see me.

Inside the Mind of the Addict

Most addicts experience a deep sense of shame and unworthiness, along with emotional isolation. The addict sees herself as a fundamentally flawed person. She cannot share the “fact” of her imperfection with others, lest they be disgusted and turn away. She retreats into herself emotionally. Eventually, she finds something – a drug, a behavior – that makes the pain go away. That experience provides such a deep sense of relief that she returns again and again. Soon, she starts to suffer consequences: she is missed at home or at work, or she’s spending a lot of money.

Here’s the crucial part. Our addict is now faced with a terrible choice. She can attempt to stop her compulsive behavior and return to the pain of her previous life, leaving behind the one thing that made her feel good. Or she can continue to pursue that relief and pleasure, and suffer the consequences when they come. And they do come. What a terrible bind! 

If you read the above and started to feel terribly trapped, you’re getting the idea.

Adam opens up about his troubles, and it’s clear that he is in a bad situation. He’s addicted to multiple substances and behaviors. After consulting with Adam’s family and his psychiatrist, I suggest that Adam go to rehab for one month. Adam protests that he can’t go away because of his business. He checks into a four-day detoxification at a hospital, and we agree to give therapy a try. If Adam continues to struggle with his addiction, he will have to go to rehab, so he’s motivated to work hard.

How Does Addiction Happen?

Addiction, like any issue, has many contributing factors:

• Addiction runs in families. There is evidence of genetic predisposition to addiction. (This doesn’t make the child of an addict doomed in any sense, but it does increase the likelihood of developing an addiction. Knowing this can help parents intervene early.)
• Family dynamics and upbringing play a role. Did the child learn how to regulate his emotions? Was he taught that he’s allowed to have feelings, that he’s allowed to make mistakes? Or did he internalize messages of shame, that he is not good enough?
• Untreated mental health issues like ADHD and anxiety. For example, if a child has bona-fide ADHD, he needs both medication and appropriate therapy. Medication alone is insufficient.
• Internalization of shaming cultural messages like negative body image, external focus, and perfectionism.
• Environmental factors like the pursuit of constant stimulation from electronics.

A child with the wrong mix of these factors is primed for addiction. All it takes is exposure to an addictive substance or behavior that finally provides relief. Different things will “work” for different people. But once that relief sets in, the potential addict will do everything he can to feel that relief again.

An extensive family history turned up multiple addicts in Adam’s family. His grandfather and uncles are alcoholics, and his mother suffers from compulsive overeating. Adam was diagnosed with ADHD at age seven. His psychiatrist gave him medication for it, but therapy was not considered. At age 12, Adam started stealing his mother’s painkillers from the medicine cabinet. At age 16, he got a new psychiatrist, who prescribed a new ADHD medication, a stimulant. Adam quickly became hooked on the pill. When he first came to see me, he was taking six times his daily prescribed dose, buying the extra on the black market.

Adam was relieved to hear that there were many factors that led to his addiction. He was not a bad person, he was just facing a difficult challenge, and there was a lot that he could do to get better. This realization gave Adam the strength to fully engage in his addiction recovery.

Treatment of Addiction

The first step of treatment is assessment. It’s important for this to be done by a trained addictions therapist, as addictions work is different from standard psychotherapy. After the assessment, the therapist will have some recommendations. Sometimes a stay in a hospital detox or an inpatient rehab is called for, to help the addict stabilize and get some time away from the addictive behavior.

For any addiction, attending a twelve-step program is a good idea. Meetings provide the acceptance and social support that an addict sorely needs. Working the Twelve Steps will address some underlying issues and will help the addict tap into a source of spiritual strength to overcome the addiction. (For those with religious misgivings about twelve-step programs, I encourage you to read Rabbi Shais Taub’s excellent book, God of Our Understanding.)

A skilled addictions therapist will be able to help the addict shatter the walls of denial and rationalization, leverage motivation to make changes, and learn skills to prevent relapse. Diagnosing and addressing underlying mental health issues is crucial to maintaining long term abstinence. Family therapy can be helpful to support the addict and help the family heal. A psychiatrist can assess if medication is needed.

Adam jumped into his treatment with both feet. He absorbed all of the skills that he learned from his sessions with me, and he practiced them daily for homework. He finally learned how to manage his ADHD symptoms, and made some changes in how he approaches his work and home responsibilities. He started attending twelve-step meetings, got himself a sponsor (a Steps mentor), and works his Steps on a regular basis. He gained an understanding of the impact of wellness, and started exercising and eating healthy meals. He cut back on his phone use and began practicing mindfulness.

As of this month, Adam has been abstinent from all substances and addictive behaviors for one whole year. His parents proudly attended Adam’s one-year celebration at his twelve-step meeting. Their boy had come a long way, and G-d willing would continue his growth for the rest of his life.

Adam is a clear success story, and a good model for what we aim for in addiction treatment and recovery. If you or someone you know is struggling with an addiction, don’t wait. Call an addictions therapist today.

Shimmy Feintuch, LCSW is a psychotherapist with a private practice in Brooklyn, NY. He specializes in treating human beings, including those with addictions. He is also a therapist at The Safe Foundation, an addictions outpatient program. His weekly blog, Spiritual Sofa, is featured on nefesh.org. To contact Shimmy, call (530) 334-6882 or email shimmyfeintuch@gmail.com.