Addiction, Tolerance, and Therapy

Christopher Ryan, psychologist and author of the outstandingly provocative [amazon_link id="0061707813" target="_blank" container="" container_class="" ]Sex at Dawn[/amazon_link]recently interviewed addiction psychologist Stanton Peele for his Tangentially Speaking podcast. The 67-year-old Peele is a well-respected academic psychologist and addictions expert, known for his criticism of certain approaches to addiction.

Peele seems to take a cognitive-behavioral approach toward addiction. From his perspective, treating an addiction or compulsion requires a careful analysis of the meaning of that behavior. It’s not enough to just say, “it’s bad, don’t do it.” In order to change it, you need to fully understand its function.

Say you want to drink less alcohol. What does alcohol do for you? What does it represent? What need does it fill? These are key questions for someone who is trying to make a difficult behavior change.

Peele says that this approach to addiction, is in many ways antithetical to American notions of addiction, which tend to be more severe and moralistic. He notes that approaches like AA can take a zero tolerance approach that can be counterproductive. As he recently wrote about the death of Philip Seymour Hoffman,

Why did Hoffman join that large group of celebrities who died after recently having been in treatment?... [Because] the one and only goal of American treatment and recovery is perpetual, lifelong abstinence. No treatment or NA time is devoted to the essential truth that most rehab grads and AA/NA members will use again, and to prepare them for this possibility.

Peele goes on to argue that addiction issues are fundamentally behavioral (as opposed to biological), and that certain cherished ideas about it (such as the addict’s powerlessness to overcome it) are fundamentally disempowering. He points out that problems with binge drinking are far more rampant in Northen European and North American countries than in Mediterranean countries, where more realistic and laissez-faire attitudes allow young people to learn to drink moderately.

You Can't Control What You Can't Tolerate

In discussing this, Ryan says:

“There’s a Dutch phrase, “You must tolerate something to control it.” That seems so fucking obvious, right? But it’s what is missing in the American approach to whatever: drugs, sex, poverty, crime. We seem to be resistant as a culture into taking that step into understanding the thing we’re fighting because, we’re such a warlike society, it’ll take the fun out of the war. You don’t want to understand your enemy.”

Ryan is talking about our attitude toward problems that are "out there" in the world. But his statement holds true in our inner lives, as well. The lack of willingness to tolerate and examine the unpleasant--to understand the enemy--shows up in the way we tend to deal with our emotions.

Addiction, Anxiety, and Therapy

A fundamental of Acceptance and Commitment Therapy is that anxiety disorders result from rigid attempts to avoid or control anxiety or other aspects of our experience. When we feel bad, we rush to blot out those feelings, when we would do well to permit them. In working with severe anxiety, this is a central theme. As someone said, “If you don’t want it, you’ve got it.” Overcoming anxiety requires you, at some level, to accept and embrace its presence.

Now, I write this with some trepidation, because I know that if you have severe anxiety, this sounds like an impossible thing to do. And that’s just the anxiety talking. (That’s the rub.) But it’s true; you have to accept it to be free from it. And in therapy, we create an opportunity to experience, accept, and examine anxiety in a way that is safe and helpful.

In other words, this pathological process that occurs internally--our desire to neutralize or banish our negative thoughts and feelings, rather than understanding them--is a mirror of what happens in our culture. Our hardwired American tendency to want to fix something, or fight something, shows up in our inner lives, with similarly counterproductive results.