The Challenge of Addiction Treatment
Anyone who has worked for many years in the treatment of addiction knows that treatment is complicated and multi-faceted and that the rate of relapse is high. The most effective solutions control the most variables for the longest amount of time, which basically means either voluntary or involuntary confinement for extended periods. Clinicians also know that prevention is far easier and less expensive in the costs to human lives and society as a whole, and that discrete addictions, such as smoking, are relatively easy to manage, if not treat, than are pervasive ones, like severe alcohol and drug addictions.
Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.
A key insight of the two major Indian traditions, Hinduism and Buddhism, is that addiction is caused by attachment (upadana) and craving (trishna, tanha). In Hinduism the problem is defined as identification with an illusory self instead of the real self. In Buddhism, the problem is defined as identification with an illusory self. There is no real self. In Buddhism, the fundamental addiction is to our sense of self, and all other addictions support it. The entirety of Buddhism can be thought of as an addiction rehabilitation program, with elective in-patient treatment (monasteries) recommended for those who really want to get well. Focus is placed on the underlying, root addiction, in the belief that when it is removed the cravings that associate all other addictions will end.
Clearly, these Indian traditions define addiction much more broadly than do contemporary Western traditions. This is because Western medicine defines disease as deviation from social definitions of normalcy while Indian traditions define disease as normalcy itself. In other words, the Indian approach to the treatment of addiction is a frontal assault on basic assumptions of what it means to be addicted and what it means to be healthy. In the West, health means freedom from pain and societal adjustment. In these two Indian traditions, control by any form of attachment or craving is addiction, and the most fundamental of these is addiction to our sense of who we are. The corollary of this is that we are controlled by our fear of non-existence. All other addictions are viewed as symptoms or secondary outpicturings of this core addiction. Consequently, in the Indian perspective, pursuit of prosperity, health, and social status are addictions, whether they are supported by society or not, because they do not produce enlightenment or freedom from identification with a false sense of self.
The reason why this Indian definition has not been widely adapted in Western clinical models is that most people with addictions just want a return to “normalcy,” as does the greater society which underwrites much of the cost of treatment. It is more than enough if only an addict can once again work, support a family, and not cause societal disruption. Consequently, there is not much support from either social systems or patients for an expanded definition of addiction. However, the high percentage of relapse associated with treatment using present models is forcing a movement toward broader models of addiction.
The model discussed here is not based on either the Western allopathic or the Indian models of addiction. It is derived from a concept from Transactional Analysis, developed by psychiatrist Eric Berne in the U.S. in the 1950’s, called the Drama Triangle.
Transactional Analysis has developed its own choice-based model of treatment of addiction;
the one presented here is not derived from it.
We will call it the “Drama Model” of addiction, and it states that the core addiction of humans is not to substances, attachment, or craving, but to drama. People can be dramatic, as when they act in a play, go to a masked ball, or exaggerate a point, and not be doing drama in the sense that it is used here. Following Berne,
drama is a transactional game, which means it has a covert motivation and a payoff. While all games are not destructive, those that are played within the context of the three roles of the Drama Triangle are.
In the Drama Model, substances, attachments, and cravings are not in themselves problematic; you can use substances and experience both attachments and cravings with or without drama. Without drama, these are less likely to become addictive, although some highly addictive substances, like tobacco, are wise to avoid. However, many things can be used or done beneficially when there is no drama accompanying them. For example, there are many benefits associated with attachment to health and cravings for a balanced life. It is only when drama is introduced that they become addictive and harmful. This is a threatening model to many clinicians and users, because it refuses to portray some substances or experiences as bad and others as good. It does not because doing so turns them into persecutors in the perception of the subject or client, thereby putting treatment into the role of rescuer, and the entire model within the context of the Drama Triangle. When you fight an addiction you are fighting with yourself. When you fight with yourself, you divide your energies against yourself, alienating yourself from that part of your life force and internal resources that your addiction represents. In other words, you increase the likelihood that you will lose that fight, because you deprive yourself of resources you need to integrate, transcend, and include.
The Drama Model addresses addiction in three dimensions of life, waking relationships and behaviors, cognitive processes (thoughts and feelings), and dreams. It views waking relationships and behaviors as the external, objective realm that is easiest to see and treat. Cells and molecular behavior and treatment is also parts of this external, objective realm. The intermediate realm, dealing with thoughts and feelings, is treated by a number of modalities, but most commonly and effectively with cognitive behavioral therapy. The third realm, dreams, is by far the most internal and subjective dimension. It is largely ignored for two reasons. First, the contribution of dreaming to both the maintenance of addictions and to health is poorly understood, and secondly, no effective methodologies for working with dreams in the treatment of addition have been popularized.
Why would we want to eliminate drama in dreams? The waking residue of anxiety from nightmares and post-traumatic stress disorder nightmares, which can be extremely disruptive, undoing waking therapeutic progress, is well known. For every nightmare and anxiety-provoking dream that we recall, how many remain below the threshold of awareness? Do those not remembered have any effect on waking coping? Whether we remember a dream or not the emotional residue of the state lingers, particularly through the activation of the General Adaptation Syndrome in the dream state, producing powerful hormones that measurably activate the parasympathetic branch of our autonomic nervous system, whether or not we remember a dream. Secondly, the dream state tends to be regressive, meaning that we tend to use earlier, more primitive coping skills than we do in our waking life. We are more likely to react than respond, and to get caught up in drama than we are in our thoughts or our waking life. Consequently, dreaming reinforces drama and addiction, whether we remember our dreams or not.
How can we eliminate the drama in our dreams? It is a four-part process. We can learn about the Drama Triangle and outgrow it in our waking life and our thoughts. As a result, we are less likely to get into drama in our dreams. Secondly, we can access and become parts of ourselves that are not addicted to drama and whose influence will free us from our own. Third, we can practice dream incubation: we can set our pre-sleep intention not to indulge in our addiction during our dreams, whether or not we remember them. This is a relatively simple process and one that can easily be added to any addiction treated protocol. Fourth, we can opt out of drama in our dreams while we are dreaming. You will be able to tell if you are doing so by checking for drama in those dreams that you do remember. Let us look more closely at these four strategies.
In order to eliminate the Drama Triangle in our thoughts and feelings we must first become aware of when we play the victim, persecutor, and rescuer to ourselves in our own interior processes. Whenever we conclude that we are helpless or powerless we are in the role of the victim. Whenever we think, “I’m stupid.” “I’ll never succeed.” “I’m ugly.” “I’m not as talented as she is,” we are in the role of persecutor. Whenever we beat ourselves up for succumbing once again to our addictions we are in the role of persecutor. Of course when we think such thoughts about others we are in the role of persecutor as well. Whenever we indulge in our addiction or seek out a distraction to either run from it or numb us to it, such as TV, the internet, or sleep, we are in the role of rescuer. The problem with the role of rescuer is that it is disempowering. It says, “I’m not OK for who I am, and I won’t be OK until I drink or eat this, talk to that person, read this book, or go to sleep.” Another way of telling if you are in the role of rescuer is to ask yourself, “If there was something I was avoiding right now, what would it be?”
Eliminating cognitive drama involves a combination of self awareness and cognitive-behavioral therapy. You change how you feel by changing how you think; your thoughts themselves are no longer rooted in addiction to the Drama Triangle.The process of eliminating addiction to waking drama is similar. First you learn to identify when you are in the Drama Triangle. You also learn the price you pay when you build your life around drama. The focus is shifted in the Drama Model from treating the addiction, which tends to turn the addiction into a persecutor to fight, to recognizing and choosing not to get into the Drama Triangle, wherever it appears in our life. We cannot change what we are not aware of. The clearer is our awareness of the price we are paying for being in drama the more likely we are to consider alternatives.
Most people who suffer from an addiction cannot imagine a happy, balanced life without it. This includes drama. People who are addicted to the Drama Triangle, and that includes most of us, have a very difficult time imagining that they could have an interesting, exciting, fulfilling life without it. Until this changes, their addiction to drama will fuel their addiction, whatever it may be.
How can you access and become parts of yourself that are not addicted to drama and whose influence will free you from it? Integral Deep Listening is one process by which to do so. Developed by the author in 1981, you “become” or imaginatively identify with, characters from your dreams or the personifications of your life issues, such as your addictions, physical pain, an emotion like fear, or anger at someone or some life situation. Some of these will score high in qualities that are highly correlated with an addiction-free life, such as confidence, compassion, wisdom, acceptance, inner peace, and witnessing. Becoming these during the interviewing process awakens the potential for a non-addicted life, as approached from a specific innate potential perspective. Repeated interviews strengthens the identification with an addiction-free identity as you become many different self-aspects that are not locked in drama.
These self-aspects make recommendations, which when followed, generally build trust in your ability to outgrow your addiction. One common recommendation is to become this or that self-aspect in one or more specific life situations: when you have the urge to use, while you are falling asleep, when you get anxious. Other common recommendations include meditating and recalling dreams to interview occasionally. Such recommendations constitute a powerful feedback mechanism by which anyone can test the utility of the methodology for themselves.
Third, you can practice dream incubation: you can set our pre-sleep intention not to indulge in your addiction during your dreams, whether or not you remember them. Reading over an interview before sleep is a common recommendation often made by interviewed self-aspects. This is a relatively simple process and you that can easily be added to any addiction treated protocol.
Fourth, you can opt out of drama in your dreams while you are dreaming. You will be able to tell if you are doing so by checking for drama in those dreams that you do remember. If you are being chased by a monster and are scared, you’re in drama. If you are wandering around, looking for your lost keys, you’re in drama. If you are fighting or sad, you are probably in drama, which means you are feeding the life addictions that keep you from taking off in your life.
Description of a treatment protocol
Integral Deep Listening teaches clients to identify the Drama Triangle in the waking, cognitive, and dream dimensions of their life. It also puts them in contact with aspects of themselves which are not addicted. As they repeatedly experience becoming non-addicted parts of themselves they slowly grow into a self-definition that transcends and includes drama. What this means is that cravings diminish. At the same time they begin to grasp how they not only could be happy without their addiction but how they are likely to be happier. This is not primarily a cognitive realization, nor is it primarily an emotional catharsis. It is a direct experience of the living potential for an addiction-free life that exists within us right now.
One lady had smoked for over thirty years. One day she realized that she was dependent on cigarettes and nicotine. While she undoubtedly had that thought before, this time it hit her in a way that caused her to stop cold. She never picked up another cigarette. However, thereafter she continuously had cravings. She wanted to smoke! While she didn’t give into the urge, she was basically a “dry drunk,” and therefore subject to relapse at any time. One night she had a dream, one that she had had many many times before. In it there were other people smoking, and she was smoking too. However, this time in her dream she thought, “I don’t have to smoke just because these other people are smoking. I made a decision to stop smoking. I’m not going to smoke.” She never had a dream of smoking again and what is much more significant, her cravings went away.
When I have told this story to others I have received comments like, “One in a million.” I don’t believe that. The principles discussed here do not have to be believed but they do have to be tested. You can perform simple experiments for yourself in your own life with your own cravings. See if you can interrupt them in your dreams. See what difference, if any, that has on your waking addictions.
Integral Deep Listening is only one element of what must be a multi-pronged approach to the treatment of any addiction. What it can uniquely offer is direction of treatment by the inner compass of the patient and a depth of intervention through addressing the Drama Triangle in the three realms, that offers the possibility of reducing multiple addictions at the same time.