Author: Marc

I just listened to the first 15 minutes of a lecture by Robert Sapolsky, a renowned biologist and Stanford professor. Sapolsky begins with an incisive lesson on why humans rely on categories. Categories, he says, make it easier to think about complex phenomena. And human social behaviour is nothing if not complex. My friend Tom insisted that this online lecture series was worth viewing, and he’s right. I plan to view the rest. But first, this post.

Take something a little simpler than human behaviour. If a colour falls between orange and yellow, you’ll have a harder time thinking about that colour and remembering it than if it’s either orange or yellow. Yet light frequencies fall along a continuum without boundaries. In other words, we actually invent colour boundaries, and different cultures see colour differently. It’s easier to remember a shape if you can call it a circle or a square than if it doesn’t fit any geometrical category. If the shape is squarish with rounded corners, or blob-like, you’ll have a harder time thinking about it, remembering it, and using it in a conceptual task. (Sapolsky demonstrates these examples on the white board.)

So, okay, categories are tools for simplifying perception and thought. But there are several down sides to categorical thinking. Sapolsky mentions a few, but here’s the one that inspired this post. Remember when 65 was the cut-off between a pass and a fail? (That was the cut point when I was an undergrad.) So you’ve spent much of the week partying, getting high, etc, and here comes the exam, and you cram for it that morning, give it your best shot, and wait anxiously for the result. A week later the prof hands out the exams, or you look up your grade on the bulletin board, and the thing you care about more than anything else is whether you got at least a 65. If you got a 64, you’re shit out of luck. If you got a 66, you’re sailing.

Now how much difference is there, really, between a 64 and a 66? How much information does that distinction actually give you, about your performance, your dedication, your intelligence, or your use of free time?

This isn’t the first time I’ve conceptualized addiction (intensity, duration, riskiness, etc) as a continuum — a continuum that does not lend itself at all to two categories, disease vs. health. Other addiction thinkers, researchers, treatment providers, etc, have also remarked that addiction is a spectrum, a dimension, a set of gradations at best — nothing like an all-or-nothing category. Yet the disease label cannot help but classify addiction as a category. You either have tuberculosis, or diabetes, or cancer, or you don’t. Never mind that, when it comes to addiction, the category label itself can do more harm than good. As soon as you classify addiction as a disease, you draw a line. (There is some discussion of this issue in the commentaries on an article of mine.)

Indeed, the disease labelling trend in the US and elsewhere makes it stupidly easy to put addiction in a wastebasket category. You’ve either got it or you don’t. And if you’ve got it, then free choice, self-control, empowerment, and so many other features of human thought and emotion are neatly defined. Easier to think about, right?

Sapolsky makes other cool points about how categorical thinking obscures real complexity. For example, falling into the same category doesn’t necessarily mean that two things are similar. As we know, two people, both categorized as having the disease of addiction, can be as different as giraffes and field mice (just two animals that came to mind).

Many of my readers will probably agree that categorical thinking, this mental-labour-saving device, misses so much — so much of the real complexity of addiction — that it can’t help but muddy the waters.

………………………..

This is remarkable: four hours after posting today’s post, I found an email in my inbox that contained nothing more than this link. If this man can face his addiction and challenge it, without submitting to the disease categorization, then…that’s all there is to say. The post is electrifying, extremely well written, and deeply moving. I’m honoured that my work figures in his thinking.

 

I’ve been working with a client (I’ll call him Robert) who’s trying to stop using cocaine. We’ve had some powerful sessions lately, emotionally moving for me as well as for him. I really want to help Robert — or, more to the point, I want him to succeed, with or without my help. He’s just so miserable, so alone, so desperate.

And I recognize myself in him. Not because I’m miserable and desperate these days (I’m not) but because I know exactly what it feels like to be in that place. To continue using when the pleasure is gone and the heartache starts to geyser up before you’ve even left the house to score.

One plan that made sense for Robert was to enhance self-compassion as a means for overcoming (a massive glut of) shame…(because, as we know, more shame –> more using). But then it occurred to me that the format of the plan (in therapy or in life) is more important than the content. The content will vary from one person to the next. Yet there may be one maximally effective format for beating addiction: connecting a macro project with a micro project. What I mean is, developing some skill or resource that takes time to build and refine (that’s the macro project), and deriving from it a toolkit of strategies one can activate in the moment (the micro project).

Most important, the two have to connect. What’s going to be most useful in the moment (e.g., when your dealer calls, when you’ve just had a fight with your husband, when your best friend has to go home to his family for dinner) is going to be something you’ve worked on over time.

A case in point: developing self-compassion to beat shame

The macro project: We each have a number of different selves, or voices, or modes or moods, whatever you want to call them. Each is distinct, built on a particular emotion or emotional combo. The shameful self — that’s pretty familiar. Hating to be seen, cringing from being accused or despised by others…and by oneself. Shame is hot, red like a boil, painful, laced with disgust. The shamed self often gives way to anger, the famous fuck-you reaction, or defiance, the equally famous fuck-it solution. Or it opens onto guilt and depression. Omigod, how could I have done that?! What a bastard I am. Then there’s the anxiety about being caught, seen, punished, cast out — as familiar as background music to Robert and to just about everyone I know in active addiction. Often there’s a cascade through several of these self-states that leads straight to using. But each state is also a branch of our personality, stable and familiar — a thicket of interlaced neurons.

Yet there’s another self, built on another feeling. It’s the compassionate self, based on the feeling of nurturance. Nurturance is built into our neural hardware. It’s needed for us (great apes) to effectively raise our young, since they take forever to mature. It’s the feeling we feel when we comfort a child or feed a helpless animal. But, as you probably know, the compassionate self seems a fiction, a fantasy, when you’re in active addiction, especially when it comes to compassion for yourself. Maybe you never learned self-compassion deeply enough because your parents didn’t know how to provide it or feel it or value it. Or maybe you lost it en route. It gets worn thin by repeated bouts of shame and self-loathing.

But either way, self-compassion is pretty much the only feeling that can defeat the self-destructive agony of shame in a head-to-head fight.

In The Biology of Desire I described self-compassion as one way to connect your past self (recognizing how much you’ve been hurt) with your present self (of course I want to get high — that’s how I’ve learned to hurt less) with your future self (we’re going to get to a better place — here we go). Note the use of “we” — and (P.S.) see Peter Sheath’s and Matt’s comments directly below.

Given that self-compassion looks like a field of dead weeds, the macro project is simple. Cultivate it. Grow it. Make it more familiar, more salient, more present. There are several ways to do this. ACT  and self-compassion therapy are obvious choices. Check out other therapeutic approaches suggested by readers here and here.  But what I recommended to Robert was to meditate, just 10 minutes in the morning for now, and start to sense it, like an almost totally blind person sensing light. Feel that first bit of coziness behind your eyelids, in your body, and stay with it, let it warm you. I suggested he try using a meditation app, like Headspace, Insight Timer, or Buddhify. These apps can help by connecting us to a voice that’s comforting as well as skilled. And DO IT every day until it starts to take — usually within a week. Also, just talking to yourself in a kind voice (either out loud or silently) can be very powerful. Try it.

The micro project: Most of us know that just being off drugs or booze for a few days is already a plus. Shame and self-reproach start to recede. Maybe you get a little pride, a sense of forward thrust. Some hope. Some trust in yourself. But stopping, even for one day, can be insanely difficult, so most forms of addiction treatment try to teach mental tricks for diverting or overcoming the urge.

These tricks include “fuck no!” (sort of the opposite of “fuck it” — using defiance for good, not evil). They include distraction, finding something else to do, exercise, sports, prayer, connecting to a friend or sponsor. They include avoiding temptations, focusing on future goals, “urge surfing,” finding a replacement substance that’s easier to quit. These cognitive acts can get you through the night. They’re the things you might learn from CBT, or motivational interviewing, or DBT, or SMART. And they are valuable!

But the one cognitive trick that’s usually missing from this list is, I think, the most valuable: finding your compassionate, accepting self, right here and now, because that softens and neutralizes shame (and averts the rest of the cascade). Now you have somewhere to go that isn’t agonizing, that feels good enough to replace getting high.

And the best way to make this micro project work is to link it with the macro project of finding and cultivating the compassionate self. Which may take weeks or months. It won’t happen overnight.

So my suggestion to people trying to help people in addiction, to people in addiction (like Robert) and to my own self is: Get to work on the macro project of cultivating the compassionate self WHETHER OR NOT there’s a smidgen of “improvement” when it comes to using — or anything else. And then, when it’s time, call on that self, get it on board, at 7:45 on a Friday night or a dreary Monday morning.

But you gotta do your homework, your macro project, first — at least get it started — or the micro project isn’t going to work very well.

 

 

 

 

Hi people. I haven’t posted anything in the last couple of months. My last post went up in mid-July, then there was a guest post, and then…the silence of the tomb.

But I’m still here.

It has been a challenging and chaotic summer. Our planned (temporary) move to Toronto got rescheduled and rescheduled due to a death in the family and our wish to support the person left behind. Which meant a few trips back and forth to Europe for Isabel (my wife) and one extra trip for the kids and me. It wasn’t all bleak. We spent two weeks in the south of France, and there aren’t many places more beautiful than that. But it was surely disorienting.

Now back in Toronto, finally to roost, for at least four more months. But we had to shift from one rental to another. We’re still trying to get settled. And four days before the start of school, we found that our boys (12-year-old twins) weren’t allowed to attend the public school we’d planned for them. Frantic search for a new school — which now seems to have panned out well. Discovered a great ping-pong spot. Life goes on.

Now, with a little peace, I’m tempted to start blogging again. But I ask myself: do I have much more to offer in the domain of addiction and “recovery” or have I covered what I’ve got to say? I’m not sure. I’ve become a little less interested in the neurobiology of addiction for a very simple reason. Short of neurosurgery (and a very few available pharmaceuticals, which were already in use decades ago), there’s not much to do about the neural basis of addiction except to understand it better and then get to work on changing behaviour. So why not go straight to the behaviour? Which of course means the thoughts, feelings, internal voices and psychological background (emotional difficulties at younger ages) leading to the behaviour. I’m more interested in that right now.

This interest is fed by my growing psychotherapy practice with people in addiction (or struggling at the border of it). I am learning a lot. And I hope I’m helping my clients. At the same time, I’m pretty tuned into the gradual evolution of the treatment field, the growing strength of the harm reduction ethos, increasing frustration with the dominion of AA and its offshoots, and gradual changes in the policy/legal/medical/political issues that swirl around the enormous problem of opioid addiction in the US. Not to mention the social and societal factors that make it so hard for many people to quit or cut down. I get what residential rehabs sometimes do right and what they so often do wrong. I get the power of mindfulness/meditation and the various psychotherapeutic approaches (e.g., ACT, mindfulness-based relapse prevention, dialectical behaviour therapy) that incorporate it, along with the best (hopefully) from clinical psychology. So maybe there is more to talk about.

By the way, I still give talks on addiction all over the place and write occasional articles for scientific journals as well as the popular press. And I’m still working on that novel.

I also wonder if I should get more personal. I haven’t done anything illegal in a long time (except when it comes to parking and such). But am I a completely different person than when I was using opiates and coke (and acid and a few other things) and breaking the law almost daily? Of course not. I sometimes still feel incomplete and empty in ways I’ve felt since age 18. I still attach a particular meaning to substances, though my substances these days are pretty benign — and occasional. But I don’t talk about myself much, and maybe I should. You guys share a lot. Maybe I should share more.

That’s it for now. Just wanted to indulge in some speculation, thinking aloud. And I have an excellent guest post coming up in a few more days.

I hope you, my readers, are doing as well as you can. Warm wishes to all.

I promised that I’d come back to the problem of the internal critic — and how it might be constructive or (more often) destructive when it comes to addiction. This was part of my plan to translate Jordan Peterson’s prognostications into practical advice for people in addiction. Now, two months later, I hesitate to refer back to JP because of the ongoing shitstorm that has clouded his online presence and scrambled many people’s attempts to interpret just about anything he’s ever said. It seems the controversy has caught up with and overwhelmed the content, which is a shame. But it doesn’t matter much for the purpose of this post. Thoughts about the internal dialogue and self-criticism didn’t start with JP.

In modern times, the idea of an internal critic goes back to Freud, who envisioned a superego that oversees one’s thoughts and feelings, judges them, and dishes out guilt when it finds that they centre on wishes for sex and murder. Fast-forward to the middle of the century and you’ve got object relations theory, where the superego is just as harsh but a lot more observant. It’s not only sex and aggression that you’re guilty of; it’s also greed and envy. A couple of decades later came “transactional analysis,” a lay-person’s guide to an internal parent in ongoing dialogue with a child-self, with an adult self hopefully emerging in between. Since then? There’ve been all sorts of offshoots, but mainly a more optimistic approach, including the current emphasis on self-compassion, in psychotherapy programs like ACT, mindfulness/meditation, and positive psychology in general.

Addicts don’t need a history lesson when it comes to the internal critic. Just being an addict is enough to earn you a degree in self-judgment, self-contempt, self-hatred, and all their variants. Self-criticism is often (and rightfully) felt to be highly destructive. It arises from the addictive pursuit of drugs, drink, sex, or food (and all the nasty things we do in preparation or in the aftermath) and it feeds back to our addiction. Because feelings of shame and guilt, which are the key weapons of the internal critic, are so painful that they magnify the need for pain relief. And we know how to get that.

Why is the internal critic so focused on our addictive activities? Maybe because they demonstrate a complete loss of self-control, and being in control of oneself is a cardinal virtue from early childhood (you’d better hold it until you get to the toilet!) onward. Or maybe because addiction seems inordinately selfish. Maybe because gorging on drugs or booze strikes us as the epitome of greed, and greed is another sin we are scolded for as children. Or maybe because we fail ourselves, we fail others, we lie to ourselves and others, we hurt ourselves and others, we use up the last shreds of self-respect or “authenticity” by indulging yet again when we have promised ourselves to resist temptation.

Peterson reminds us that self-criticism isn’t all bad. And that’s kind of refreshing. He says: “the self-denigrating voice…weaves a devastating tale…Don’t listen to its exaggerated claims that you’re completely worthless. But don’t ignore it either.” Why not? Because self-criticism is the leading edge of self-improvement. We often have no idea how to improve ourselves except by listening to an internal critic. Or an external critic. Some of you may remember the Bob Newhart skit in which the client tells the psychologist about her irrational fears and then about her dismay and guilt at being bulimic (and other addictive tendencies). Newhart, the psychologist, offers the perfect cure. Check it out.

The trouble is that the scorn and contempt we (addicts) level at ourselves reaches levels of intensity so high that, as I said, the psychological pain makes us desperate for relief or — and this may be just as familiar — we want to punish ourselves for being bad. We know that more drugging or drinking will bring more suffering, so we can combine immediate pain relief with a well-deserved licking, thereby playing the bad kid and the righteous parent at the very same time.

For many people in addiction, self-contempt  is so constant that we assume it’s unavoidable — the brutish background noise of life. But that’s not the case; we can overcome it. When I do psychotherapy with clients in addiction, I try to get the internal dialogue onto the table, and I try to help my clients talk with their internal critic, to participate in the dialogue rather than just taking the abuse.

If I had to specify a model recipe for taming the internal dialogue, here’s what I’d say:

Become conscious of the internal dialogue. Listen to the words (e.g., there you go again, you’re such a loser, such an asshole) and if the words aren’t accessible (because sometimes the critic’s voice doesn’t quite form words) then focus on the tone, the disdain, the contempt, the lip-curling hatred or disgust. Next, try to home in on who’s doing the criticizing. Does it sound like a parent? It often does. We can almost see that glaring, judging, scolding eye watching us. The judgment and scorn are palpable. Who but a parent (or older sibling or teacher) would judge and condemn us like that?

But that doesn’t mean your parent (or sib or anyone else) ever actually spoke to you like that. We have an extraordinary capacity to embellish, distort, and amplify whatever critical messages we might have received as children or adolescents — for being bad, dirty, thoughtless, aggressive, selfish, greedy…all those nasty qualities we’re brandishing again…in our addiction. In fact, the internal parent is NOT a copy or revision of an actual parent. The internal parent is part of ourselves.

So, listen in. Don’t blot out the voice. Get to know it consciously. Then, as I see it, you’ve got four choices.

1. Argue back, wholeheartedly and truthfully. Tell the critic that you aren’t really that bad. Given what you’ve been through, given the challenges you’ve had to face, you’re actually kind of brave. At least you’re trying, and you’re not giving up. And your addiction isn’t all of you. You’ve got a lot of good features (generosity? honesty? perseverance?) as well. Then access the dialogue at least several times a day. Engage in it as a participant. Defend yourself. That can feel liberating.

2. Let the internal criticism pass through you, like cosmic rays passing through matter. This approach has most to do with mindfulness/meditation, or Buddhist detachment. The thoughts you’re thinking and the feelings you’re feeling (e.g., shame and guilt) are just thoughts and feelings. Let them come (don’t duck and pretend) and then let them go. There are many guided meditation apps around (e.g., Insight Timer, Buddhify) that can help you learn to let thoughts and feelings come in the front door and leave by the back.

3. And then…if a space opens up, try to fill it with a sense of affection for yourself. Or do that even if you don’t sense a space. There’s no secret formula for this. To paraphrase Bob Newhart, just do it. Perhaps give yourself a squeeze…literally. Put your right hand around your left shoulder and your left hand around your right shoulder and hug yourself. It’s not as silly as it sounds. There are many methods for trying to increase self-compassion. Google them. But also just try to be kind to yourself. Recall what you’ve been through, recall your good points — as in #1 above. Add a dash of humour. It’s not as hard as you may think.

4. The last thing to try: When you focus on that critical eye or critical voice, look behind the illusion that it’s someone else criticizing you, and you may very well recognize yourself. It’s kind of a 180. The way I do it is through the pivot point of anger. Behind all that contempt and lashing out, the critic is angry, and you can feel the anger right there in your own body. That’s you scowling, judging, condemning…yourself. And why are you so angry at yourself? For all the reasons mentioned above, to be sure. But for a whole host of other reasons. You’re alone, you’re misunderstood, you’ve been abandoned or rejected, by people you wanted to be close with, people you wanted to love you. Never mind that you might have done some pretty dumb things to elicit those reactions. You’ve been blocked from accessing what you need to feel tolerable. Drugs soothe you. What right does someone have to withhold them? What right do they have to punish you?! Your anger is legitimate. In a sense it’s natural and fair. But the crazy thing is that, through some psychological sleight of hand, your anger at other people got turned on yourself. It became the hostility of the internal critic. And do you know who came up with that idea? Sigmund Freud.

If you get in touch with the anger of the internal critic, you can neutralize its destructiveness, because, after all, it’s just you freaking out and being overly strict with yourself. And what’s left, once the shittiness is subtracted, might actually be valuable. Self-improvement is possible. Finding your own self in your internal critic might help specify who you want to become while at the same time providing that lurch of pure self-awareness that makes you feel you’re already halfway there.

 

 

 

 

I’ve been warming up to a post or two on the power of the internal dialogue. But first, as a lead-up, here’s a little patch of last night, a mundane yet eventful exchange with my son. Strangely, it made me think about quitting drugs. So I wrote this down before I went to bed.

Isabel was gone as of this morning, off to California for the week, and I had my twin 12-year old boys to put to bed. They were tired but not exhausted. They could still think, and reason, and certainly argue (the last cognitive function to blink out for any self-respecting preteen). But more than any of that, they could feel.

As often happens when Isabel goes away, they each wanted to sleep in our bed, with me, to cuddle, or just to feel the close company of a parent who loves you completely. This has become our routine when one parent is travelling. I’d likely read for an hour or two while one boy slept beside me.

But a problem presented itself: how were we to decide whose turn it was? Who got the first night?

They each had arguments. Ruben claimed that Julian always got the first night, and if that wasn’t the case, and Ruben had had the first night last time, then Julian would probably have had the last night. Which would mean that it was Ruben’s turn after all. But naturally Julian didn’t agree. He suggested they do a Rock, Paper Scissors. What could be fairer than utter randomness? But that wasn’t okay with Ruben. Ruben said — and he might be right — that Julian wins way more than half the time. The tears were already rising to his eyes and about to spill over. Julian could see that. Julian remained calm. It didn’t seem as critical to Julian, yet there was no reason for him to surrender his right to engage, because…why should he?

So I got Ruben into our room, his voice already huffy with emotion, with need, with the vertiginous sheering of his self-esteem. Soon he was under the covers, even though no ruling had been announced, surrounded by his seal, his other seal, and his alpaca (who’s attained the status of a sacred object). Julian was in his bed, wide awake, waiting for the next move. His demands weren’t spent, just in pause mode. Julian could still win this one, and Ruben would be reduced to soggy rubble.

So I said to Julian: Maybe, just this once, without judging or recording or calculating your advantage, maybe just tonight you could let Ruben have the first night.

Why? he asked.

Simply because…because he really needs it. And you can do this. You have the strength for it. I can see it in your eyes.

But what do I get out of it? he replied, with typical 12-year old logic.

What you get out of it is just the feeling of being good, being the strong one.

I let him think about it and went back to soothe Ruben, who was still at the high-water mark. Then I went back to Julian and I asked him: Well, what’s your decision? Can you let it go…just for tonight?

In a calm voice he said, Okay.

That’s all. He gave it up. I told him I was proud of him, because he’d risen to the occasion. And a minute later I asked him how he felt. And in the calmest imaginable voice he said, I feel good.

That’s when I recognized the moment of reckoning we often face when we quit drugs. When we let it go, when we say, I don’t need to get high tonight. What we get out of the deal is no calculable advantage, no currency exchange, but simply the feeling of being strong and good and right.

How precious that feeling is! I could see it in Julian’s eyes. He was no longer seeking. He’d let the need go because he could. And his reward was this unity, this glow of self-satisfaction, so different from the moment-to-moment, hour-to-hour strategizing that usually occupies his 12-year-old mind. His reward was a sense of peace, of both letting go and remaining stationary, solid, proud that he could do it, and relieved that the cost wasn’t as great as he’d imagined.

That eye in the hurricane, that moment of grace, is the place we find ourselves in when we say, No, not tonight, I don’t need it. And then…an almost shocking sense of calm, strength, accomplishment, at the core of our being. We didn’t know it would be there until we relented, until we let the desire spin off into space and didn’t pursue it. That’s when we found ourselves to be whole, and there’s no better feeling than that.

I think Julian’s final retort was: “Why should I? Why should I give up something I don’t have to give up?”

I could see that all his sparkling 12-year old intelligence was bound up in that question. And all I could say was: “Because you can, and you know you can.”

(He also got a free back rub out of the deal.)

The expression on his face when I left the room was a soft glow of serenity.