Executive Director's Column - February 27, 2006

Addiction as a Substitute for Meaningful Living
Geoff Thompson, Ma, CCC
Maple Ridge, British Columbia, Canada

James Frey has been justifiably given a rough time over his book, A Million Little Pieces (2003), when it was confirmed that he embellished key events in his memoir. Frey appeared uncomfortable as Larry King grilled him on his 'facts'. And he was very uncomfortable as Oprah confronted him, declared that she felt duped and lied to, and expelled him from her book club.

Interestingly, many of my colleagues in the addictions treatment field were not so upset. Of course, most had dismissed the book even before the controversy started. After the revelations, they tended to remark, 'He's an addict'. I emphasize that being an addict is not a license to lie. In fact, a fundamental part of recovery is for addicts to accept that truthfulness, facts, and honesty matter. I'm certainly not approving his lies; my intention is simply to highlight his behavior as a springboard to help readers gain an understanding of the nature of addiction.

The addict's life: meaningless, monotonous, and boring

Narcotics Anonymous describes the addict's life as "meaningless, monotonous, and boring" (1982, p. 80). For all the money, effort, and creativity spent maintaining the drug habit, nothing is accomplished-other than lost family and friends, deteriorating health, depression, lost jobs, jails, and hospitals. Most clients enter treatment when the shame and guilt overwhelm them: 'I have so much potential, and I've made a disaster of my life'. An alternative to recovery, suicide, is all too common for addicts.

No one can live a meaningless life for any length of time. The addict uses two tactics to survive: the drug and the drug lifestyle.

Tactic one: The drug-induced altered-state-of-consciousness

One of the great blessings of being high for the addict is that pretty much everything is interesting. Under the influence of the narcotic draft, an addict can spend hours watching grass grow or just sit in a corner. The experience of music is heightened, jokes are funnier, life is more vibrant. And under hallucinogenic drugs, the user is witness to such marvels as the color of music or the sounds of colors.

There are practical benefits of being high. Those who are homeless turn, for instance, to stimulants to keep awake: falling asleep often means getting robbed. At a deeper psychological level, David Lensen (1999) reports research that the drug's appeal for an addicted construction worker is that it inspires the worker to find interest in a job that has, while sober, no personal meaning. Without the drug, the worker would be overwhelmed with boredom and quit.

Tactic Two: The drug lifestyle

The second tactic is the lifestyle. For non-addicts, one of the more baffling dynamics of addiction is the addict's apparent need to live life at the level of a soap-opera. In my last article, I mentioned that this was likely Frey's motivation for distorting the facts. "We made mountains out of molehills," says Narcotics Anonymous (1982, p. 93). When I counsel addicts, I am always struck by the intensity of their lives. Relationships are often rancorous, thoughts of revenge rival any Hollywood movie, facts are embellished to make life-stories more interesting. Even a simple flat tire is used by the addict as proof that God, Himself, has singled out the addict for punishment.

One of my former clients, a professional ballet dancer, robbed banks when he was high. He told me that it was a "rush." Other clients liked to get drunk and then go to the bar to pick a fight. They told me that when they are drunk and fighting, their senses are at peak alertness. As one client reported, "It's the only time that I feel really alive."

Vancouver newspapers and television regularly report that addicts are condemned by poverty and homelessness to live in Vancouver's notorious, drug-infested Downtown Eastside. This is usually followed by demands for more affordable housing. But the media has yet to appreciate that this neighborhood offers a very powerful appeal. One non-addicted resident once put a sign in the window of his apartment that read, "This is better than television!" The Downtown Eastside is filled with intensity, action 24-hours a day. Each year my friends and family provide Christmas dinner for one apartment building in the Downtown Eastside. Even at 8am Christmas morning, sex-trade workers, drug dealers, police cruisers, and ambulances prowl the streets. Visitors to Vancouver are often eager to visit the Eastside because its notoriety has been promoted by television shows and movies.

Addicts are famous for living on the edge of society. The non-addict tends to think that they are pushed to the margin or that they are antisocial. But a more useful way of understanding this phenomenon is to recognize that it is at the fringes of society where life is most intense.

Even in recovery the impulse toward excitement is strong. The residential treatment center where I work is regimented, and clients are busy from 8am to 9pm. There are no adrenalin-producing events, nothing that provides a "rush," just the work of process group therapy. After two or three weeks of this routine, some clients succumb to boredom. Their tactic is very often to create crisis, conflict, and drama. If things are too calm, addicts tend to go out of their way to create excitement. I jokingly tell my clients that if a police cruiser pulled up to the front door of our treatment center, there will be more energy expended in the next 10 minutes than clients have spent in the last two days on issues that may save their lives.

Intensity

Emotional intensity is the key to the addict's life. And addicts don't seem to care whether the emotion is anger, love, hate, happiness, or sadness. As long as the emotion is raised to the level of a soap opera, it's good: "We made mountains out of molehills."

To put it another way: The addict substitutes living intensely for living meaningfully.

There is a theory in psychology known as Flow Theory. Psychologist Mihaly Csikszentmihalyi (1996) created Flow Theory to understand how creativity works in human beings. A common quality of the creative person, artist or scientist or businessperson, is total absorption in her work. When I first read about Flow, I was struck by its similarity to the drug high. All but one of the eight main elements that Cziksmentmihalyi describes about flow also describe the drug-induced altered-state-of-consciousness. For instance, action and awareness are merged, there is no worry of failure, self-consciousness disappears, and the sense of time is distorted.

But addiction lacks the first element of Flow: There are no clear goals every step of the way. Although Cziksmentmihalyi (1996) maintained that Flow results from absorption in an activity that is intrinsically interesting, he emphasized that the activity must be meaningful. The drug-induced experience may be intrinsically interesting, but, for the addict, as Lensen (1999) pointed out, nothing meaningful is accomplished.

The problem with intensity: no substance

This lifestyle is at odds with the natural inclination to grow and become true to the self. Essentially, the problem is that living intensely is all flash and no substance. Think of John O'Brien's alcohol-soaked novel, Leaving Las Vegas. O'Brien, who took his own life at age 34 as a result of alcoholism, highlights the addict's intensity. The protagonist, Ben Sanderson, dramatically plans to drink himself to death in a month. O'Brien chose as his background the city of Las Vegas. It's a good choice. Vegas is famous for its superficiality: making a quick buck, sexual frivolities, finding love in a bar - even Britney Spears married there as a lark. All glitter and no guts. (True to the addict's reality, Ben's death is not celebrated with flashing lights and sirens, but with empty, lonely, silence.)

The appeal of intensity is a major theme for the great alcoholic-writer, Eugene O'Neill. In The Iceman Cometh (1939) the characters who inhabit a flophouse-bar would commit suicide if they truly faced the reality that their lives were meaningless, monotonous, and boring. They survive by distracting themselves with booze, gossip, hanging out with prostitutes, aggression, insults, and playing at being anarchists.

Intensity thus allows addicts to distract themselves from facing the reality of their existence. But this is a dangerous game. Psychologist Rollo May (1953) observed that much of modern humanity was trapped in a meaningless existence: "…the chief problem of people in the middle decade of the twentieth century is emptiness" (p. 13-14). He went on to caution:

The human being cannot live in a condition of emptiness for very long: if he is not growing toward something, he does not merely stagnate; the pent-up potentialities turn into morbidity and despair, and eventually into destructive activities. (p. 22)

May would likely have included addiction as one these "destructive activities." Viktor Frankl (1977) was more direct. He described addiction as one negative alternative people chose because they did not have the resources to find meaning in their lives. "[A]lcoholism…[is] not understandable unless we recognize the existential vacuum underlying [it]" (p. 169-170). Psychologist Jefferson Singer (1997) similarly concluded that addiction is a problem of meaning. Those suffering from "chronic addiction either had never found sufficient meaning in a sober life or through years of addiction had squandered any meaning they had once possessed" (p. 17).

The addict's yearning

What does the addict yearn for, if addiction is a distraction? The same things that any person does: to discover who they are, their place in the world, a sense of belonging, a connection with something that makes life meaningful, the means to transcend their suffering selves.

To put it another way, they seek spirituality. This isn't a new idea, by the way. It is the entire basis of the 12-step program, created in the late 1930s. And I mentioned in an article a few months back that the Greek dramatist Euripides (1981) described the same idea in the fifth century BCE.

Writers who have written thoughtfully about addiction, such as Nelson Algren (The Man with the Golden Arm, 1949/1999), William S. Burroughs (Naked Lunch, 1969), and Eugene O'Neill (1999), emphasize the drug lifestyle as refusing to follow a herd mentality, being true to the self, overcoming self-consciousness, paying attention to the non-rational self, connecting with a greater reality. As AA-cofounder Bill Wilson observed, being drunk is not so much an escape from life as it is the attempt to satisfy the impulse toward spirituality.

Revisiting Frey's A Million Little Pieces

Perhaps it's because I deal with addicts every day, I've grown accustomed to their embellishments, to their crisis, conflict, and drama, to their making mountains out of molehills. In fact, I use these examples of intensity to help clients gain awareness of the dynamics of addiction-and to help them appreciate that a part of recovery is to accept reality as it is.

As I mentioned in my last article, I didn't find Frey's book particularly insightful on the nature of addiction and recovery-he's no William S. Burroughs (1985) or Malcolm Lowry (1971). Like Leaving Las Vegas, A Million Little Pieces is not particularly useful for the author's interpretation of addiction, recovery, or life. Rather, its value lies in being an example of the addict's mind at work.

But, in Frey's defense, he seems to have found a better life, which is no small feat in the addictions field. Most addicts succumb to addiction and die miserable, unnatural deaths. But I suspect that, because of the book's soap-opera quality, Frey has yet to find serenity.

Meaningful living as a foundation for recovery

I also mentioned in my last article that Frey's recovery seems to have been achieved a measure of recovery by making sense of his suffering, finding some sense of connection with others, and achieving this through sheer cussedness.

This process of recovery is typical. Growing research in psychology, 12-step programs, and addicted writers all tell us that a fundamental part of recovery demands that the addict grow psychologically to discover his unique, personally meaningful life.

Most people I know interpret addiction as a problem rooted in the use of drugs. But this perspective tends to detour us into damaged neurobiology and unhealthy habits. To appreciate the role of spirituality in recovery, it is more helpful to interpret addiction as the incapacity of the individual to live comfortably in the world day after day, week after week, month after month, and year after year-without the use of drugs.

There is an emptiness in the addict's life, a lack of meaningful living, a feeling of disconnection with the world, a feeling of being a stranger and not fitting in. The addict turns to the drug precisely because it eases this suffering.

The need for an adjunct therapy

Mainstream treatments pay little attention to the spiritual aspects of recovery. For instance, the 17th International Conference on the Reduction of Drug Related Harm will take place in Vancouver from April 30 to May 4 this year. It's very expensive to attend (US$890), and its principal sponsor is a pharmaceutical company that makes HIV/AIDS medication. The organizing committee members are experts on HIV/AIDS, health care and epidemiology, political drug policy, needle exchange programs, and drug enforcement practices. All of these issues are important. But not one of them focuses on concepts such as living a life that is infused with personal meaning.

The harm reduction approach is focused on pursuing immediate, achievable goals. Any pretense that we can help addicts live productive, contented lives is dismissed as unrealistic; rather, counselors resign themselves to helping clients reduce the harm that drugs have caused.

Christopher Ringwald (2003) laments that most mainstream texts on addiction pay only lip service to the need for spirituality in recovery. He uses as examples a text from the National Institute of Drug Abuse (NIDA), which provided only a single paragraph on 12-step programs, and the 10th special report to the US Congress on alcohol and health prepared by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), which provides only a single page on spirituality out of 492 pages. This seems especially odd, since both NIDA and NIAAA report that research has confirmed that importance of spiritual approaches in addictions treatment.

Many treatments do include spirituality. I confess, however, that I'm often frustrated coming to terms with the nature of this treatment. It is extremely difficult to pin down precisely how the authors define spirituality, the logic that they follow, and their theoretical (and philosophical) foundations. Similarly, despite the fact that research has confirmed the efficacy of 12-step programs, I continue to be surprised by how difficult it is to engage addictions counselors in nuanced discussions on the spirituality in the steps.

Hope for the future of treatment

How refreshing to read Ernest Kurtz's (1992) The Spirituality of Imperfection, Alan Marlatt's (2005) Mindfulness Meditation in the Treatment of Addictive Behaviors, Stanton Peele's (see, for eg, 2000) prolific writings that reach a deeper psychological level rooted in attitudes and existential issues, J. Scott Tonigan's (see, for eg, 1999) scholarly research on the efficacy of spirituality in treatment, Linda Mercadante's (1996) Victims and Sinners: Spiritual Roots of Addiction and Recovery, Jefferson Singer's (1997) Message in a Bottle, and Francis Seeburger's (1993) Addiction and Responsibility.

We will promote these and other ideas at our conference on Addiction, Meaning, and Spirituality in Vancouver on July 21-23, 2006. A growing number of researchers and clinicians are convinced that an adjunct treatment focusing on such issues would transform addiction treatment.

But integrating meaning and spirituality in treatment must proceed from a solid psychological (and philosophical) foundation, based in research evidence, and applied with wisdom-no half-thought ideas or pop psychology.

We need a deeper psychological understanding than James Frey can provide us. The welfare of addicts, their families, and the community is at stake. And the opinions of people such as Oprah and Larry King.

Works cited

Algren, N. (1949/1999). The man with the golden arm. New York: Seven Stories.

Burroughs, W.S. (1985). Junky. New York: Viking.

Burroughs, W.S. (1969). Naked lunch. New York: Grove.

Csikszentmihalyi, M. (1996). Creativity: Flow and the psychology of discovery and invention. New York: HarperCollins.

Euripides. (1981). Ten Plays. Toronto, ON: Bantam Classics.

Frankl, V. (1977). Man's search for meaning. New York: Simon & Schuster.

Frey, J. (2003). A million little pieces. New York: Anchor

Kurtz, E., & Ketcham, K. (1992). The spirituality of imperfection: Storytelling and the search for meaning. New York: Bantam.

Lensen, D. (1999). On drugs. Minneapolis, MN: University of Minnesota Press.

Lowry, M. (1947/1971). Under the volcano. Toronto, ON: Penguin.

Marlatt, A. (2005). Mindfulness meditation in the treatment of addictive behaviors. Keynote address given at the conference on Addiction and Spirituality: Scientific, Theological, & Clinical Perspectives. Center for the Study of Health, Religion, and Spirituality, University of Indiana.

May, R. (1953). Man's search for himself. New York: Norton.

Mercadante, L.A. (1996). Victims and sinners: Spiritual roots of addiction and recovery. Louisville KY: Westminster John Knox.

Narcotics Anonymous. (1982). Narcotics Anonymous (basic text). New York: NA World Services.

O'Brien, J. (1990). Leaving Las Vegas. New York: Grove Press.

O'Neill, E., & Bogard, T. (Ed.)(1999). Complete plays. Toronto, ON: Penguin Books.

Peele, S. (2000). The meaning of addiction. Retrieved January 25, 2002, from http://www.peele.net/lib/moa1.html

Ringwald, C. (June 2003). Spirituality: An evidence-based practice for treatment and recovery. Counselor Magazine.

Seeburger, F.F. (1993). Addiction and responsibility: An inquiry into the addictive mind. New York: Crossroad

Singer, J.A. (1997). Message in a bottle: Stories of men and addiction. Toronto, ON: The Free Press.

Tonigan, J.S., Toscova, R.G., & Conners, G. (1999). Spirituality and the 12-step program: A guide for clinicians. In W.R. Miller (Ed.). Integrating spirituality into treatment (pp. 111-132). Washington, DC: American Psychological Association.