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If you read my blog you know that I try to post smooth, polished pieces. I try to produce something coherent, even conclusive. This one’s different: a bunch of notes that I recently found in a forgotten file from five years ago. The notes pose questions that intrigue and trouble me as much now as they did back then. I don’t even remember writing this stuff. Probably much of it landed in previous posts and articles. But anyway, here are the questions. Still without clear answers.

I’ve annotated the text and filled in a few spots that would be completely incomprehensible otherwise. I’ve also added tips to more recent work and inserted several links. But the text I started with remains relevant, at least to me. Things don’t change very fast, and I think these are hard questions.

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My drug use began with psychedelics. Then came heroin. They’ve always seemed like diametrical opposites. This is where I get my intuitive feel for whether drugs are good or bad. Psychedelics open you up, heroin shuts you down. But I dropped acid roughly 300 times in my late teens and early twenties. I shot heroin about 30-40 times. Why do l assume that heroin is addictive and LSD is pure sunshine?

The one wedge nearly everyone agrees on is whether a drug is addictive or not. If only it were that simple. Is addictiveness really a feature of the drug? Or a feature of the person and the social surround (Rat Park)? When you take the addict as the unit of analysis, you place him in a cage, and then analyze his interaction with this or that drug. How stupid. How is it that scientists and doctors have become the priests of such stark distinctions?

The boiled-down argument re drugs and addiction: think about Percy Menzies [see his guest-post here] and the idea of chemical hooks (in Percy’s view, the only real cure for heroin addiction is OST, opiate substitution therapy, and he especially likes naltrexone: kill the good feeling and they’ll stop). [The idea of opiates as chemical hooks is also pitched in Dreamland, by Sam Quinones.] Then along comes Carl Hart (High Price) who says “addiction” is just a label used to badmouth drugs, and our only responsibility is to educate drug users. [In his new book, Drug Use for Grown-ups, Hart argues that all drugs, including heroin, can be taken recreationally, and  it’s repressive for governments to ban any drug for personal use by normal, sane adults.] And along comes Johann Hari (Chasing the Scream), who says that the opposite of addiction isn’t sobriety, it’s human connection. All very liberating. But what about addiction?

Addictive drugs: are they neurochemically distinct? Do addictive drugs mimic natural neuromodulation (opioids, dopamine, etc)….vs nonaddictive drugs (like LSD, psilocybin?) that effect perspective change? [But let me add this: last year I went to a neuroscience conference and learned that baby zebrafish will swim toward water laced with Vicodan, an opiate painkiller. I doubt they’d swim toward an LSD solution.] Mind-altering vs. mood-enhancing. Is that what decides? (Though SSRIs are mood-enhancing…and guess what, they’re addictive…sort of.) But behavioural addictions are just as serious, aren’t they? (Gambling addicts can destroy their lives as effectively as any crack-head) Can behaviour also be divided into mood-enhancing vs mind-altering? Probably not. Maybe there are just good and bad addictions…in life, love, and drugs. Oh, and in products. Where do we stop?

Why do we value control so much? Is control the wedge? Or is harm the crucial marker? Control vs harm and the history of antipsychotics…that increase control and kill the soul. Drugs that harm: don’t they require harm reduction? Or is it happiness, well-being, that’s key? Then why prescribe SSRIs when you could prescribe opiates for emotional pain? If you value control, then get this: drugs are a way to control our thoughts and feelings. Yet self-medication often leads to self-harm. How do we weigh the goodness of drugs when control, well-being, creativity, awareness and harm are all simultaneously changing variables?

Drugs and therapeutics…. Psilocybin vs. depression and anxiety. If that’s okay, why not prescribe opiates for those who crave them? The duplicity built into psychiatry: we want what’s best for you. Oh really?

 

Patches to move us from moralism to relativism:

Individual differences  — genetics are the simplest exemplar, but different life experiences matter hugely. Trauma leads to drug-use, not the reverse. Yet, the research shows that kids who never try drugs do worse than kids who do. How do we explain that?

Developmental differences  — the wrong drug at the wrong age might become the right drug at the right age.

Societal differences  — my undergrads at Nijmegen [a rural region of the Netherlands] still see addicts as a different species; in Amsterdam students don’t see it like that. Let’s send Mr Hazelden to an ayahuasca ceremony and see how/whether he evolves.

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A sort of summary:

Why would anyone put ayahuasca in the same category as heroin…isn’t there something intrinsically valuable about perspective change, for its own sake? And what’s the difference between methadone and SSRIs when it comes to allaying depression (yet one is for disgusting addicts and the other is for normal healthy people, like Aunt Mary). But I so disagree with Carl Hart when he says that when your teenage kid wants to try meth your only duty (and your only right) is to educate him/her about safety issues. Are the distinctions between good and bad drugs in the drugs themselves (as we often think reflexively) or in the relation between the drug and the user? We have to really get individual differences. And developmental differences. Binge drinking at 16, not so good…social drinking at age 28 can really help people connect. And what I learned from [my good friend and courageous colleague] Shaun Shelly: Isabel and I often reflect on his description of the unemployable/sidelined teens in Capetown smoking (not shooting) heroin…for social cohesion and a little pleasure. So, put it all together: look at the relationship between the person (of a certain age) and the drug, in the context of the social group and the society at large.

Coda: What makes drugs bad? Is there something simple and primitive like the idea of being too attracted?

Conclusion: I don’t know.

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A number of you posted very helpful comments about what you’d like to see in future posts. We’re working on it. Next, Eric Nada, a past contributor to the blog, will post a piece on psychedelic therapy for addiction. Given the above, I’m aware of possible ironies.

In response to my last post, some of you expressed interest in mindfulness/meditation as a means for overcoming addiction. Today I want to relate the calm centre of IFS with the calm place we find in meditation. They are similar in some ways and very different in others.

There will be more posts on mindfulness, and I promised to visit “Mindfulness-based Relapse Prevention”, a fusion of mindfulness with CBT expressly developed for addiction. But today’s post will be about my personal experiences and thoughts.

Last night I sent the finally-fully-edited draft of my first novel to my agent. I’ve been working on this manuscript for roughly four years, so you can imagine, today I feel this sort of yawning emptiness. Like, now what am I supposed to do? The day seems to lack structure and meaning. I have moments of delicious relief, but at other times I feel confused and lost.

So I did my morning meditation (nothing heroic — just 12 minutes with the Sam Harris Awakening app) and it happened to be an episode focused on emotions. True to Buddhist tradition, Sam H urged us to let emotions come…and go. Anger, anxiety, whatever it is, let yourself feel it, don’t fight it, don’t hold onto it, just recognize it as colouring the field of consciousness. And that’s all, he reminds us. You don’t have to do anything, because consciousness is its own goal. Just be there and be aware.

I figure this is the centrepiece of (Vipassana?) mindfulness meditation. Good stuff, to be sure. Especially when craving is a real problem. Recognizing that craving is simply a feeling, without a particular requirement or needed resolution, can be most beneficial.

But nowadays when I meditate I often go into IFS land. (See my last eight posts if you’re not familiar with IFS, or go online). It’s different. The emotions I felt this morning, while meditating, were mostly a mix of anxiety and resentment, tinged with a wish to rebel or even get high. So…what the fuck’s that about? Simple, according to mindfulness meditation: let the feelings be there without being carried away. Simply let yourself be aware of them. What does IFS say?

In IFS, as I’ve tried to explain, there’s a place they call Self (with a capital-S) which is different from the “parts”. It is a place of being centred, calm, patient, compassionate, accepting, noticing, even welcoming whatever comes. As you can imagine, whatever comes usually involves the “parts” that have needs, concerns, and fears. Now this central place of calm acceptance seems very similar to the calm place you get to in meditation. But here’s the difference. You don’t just sit there in the centre of it, you meet and greet, as it were, the parts that need something. You connect with them, welcome them, follow them to their origins…you can sit with them, and you can soothe them. One form of soothing is to invite the parts to come and be with You (captital Y?) in the present, away from the bleak place where they remain fixated. A mysterious and perhaps mystical process that can work wonders.

So today I went and followed the dissatisfied angry part to get to know it better.

I had an experience of sexual assault in my teenage years. I have never disclosed this publicly, but after listening to Tim Ferriss (a very popular podcaster) disclose his history of sexual abuse, I thought, what am I trying to hide? Many of us who’ve been addicted have experienced something similar. In fact the link between trauma and addiction is well known. I want to understand this link in my own life. To look the other way is unhelpful — both personally and as part of a community.

I’ll leave it at that, without details, for now. The aftermath is what preoccupies me.

My first year in Berkeley, California. It’s 1968-69. The sun is shining, exotic flowers and trees line the streets, the hippie types (including me, sort of) wear their colourful clothes with playful exuberance. There were smiles on many faces. Fascinating men, beautiful women. We felt like we were ushering in a new age of humanity, a real cultural revolution.

But I was lost. I wandered the streets feeling empty and unreal. I didn’t know what to do with myself. Depression crashed down on me every evening I was alone — that is, without my roommate or my part-time girlfriend, Susan. I had a very hard time being with family members, because I felt there was something deeply wrong with me, beneath contempt. I resented the walls of politeness that seemed to shut me out of their lives. I lived in a pool of shame that was almost impossible to sense clearly because it was so constant. I have no doubt that my traumatic experience created or refined this part of me — broken, shamed, empty.

But there was one way to feel better, to feel…vital. Drugs. You can bet there were a lot of drugs available in Berkeley in those days. And they worked. From cannabis I went to psychedelics, acid two or three times a week, riding my motorcycle through thickets of hallucinations, and then from psychedelics to heroin, and then on to pharmaceuticals and crime. Check out my first book on addiction — Memoirs of an Addicted Brain — for the gory details. Two parts of me: one sinking into this sickening, passive emptiness, this incoherent shame, the other energized to find new and more powerful drugs and drug-tinged adventures, to fill up that empty space with magical potency. And through drug use, defy everyone who’d tried to tell me how to behave.

The wounded part never went away. Nor did the defiant part. That’s a fundamental insight of IFS: the parts can evolve, but they don’t disappear. As for the wounded part, its sense of being lost and helpless still hobbles me with a certain anxiety, vulnerability, and hesitation — but not nearly as much as it did. And I have other strong, brave parts with impressive energy. Often they lead — sometimes brilliantly. Now, when my meditation leads me to my wounded parts, I greet that 17-year old kid and let him know that it’s not his fault, that I accept him completely — him and his 12-year spree of crime and self-abuse — and that I love him. I let him know that he doesn’t have to live in that crazy, tilted world anymore. And that’s all he needs, that acceptance and care. It heals him.

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I should mention that Ferriss also interviews Richard Schwartz, the founder of IFS in a recent episode. This is a cool podcast: Schwartz explains IFS succinctly, compares it to aspects of psychedelic (MDMA) psychotherapy (fascinating!), and then does a live IFS session with Ferriss as the client.

Please note, if you saw an earlier version of this post, that my normal email account is now working again. Which means I can also receive mail from the “contact” field by the right margin.

Here’s where I’m thinking of going next with the blog, Feedback welcome! I’ve spent the last 8 posts on Internal Family Systems and related content, using IFS as a model of mind and as a guide for psychotherapy (especially for people with addictions). This followed a half-assed attempt to survey well-known therapeutic approaches that can be effective for people in addiction. I covered ACT, psychodynamic approaches, and I don’t think much else. I was thinking it would also be useful to look at psychedelic psychotherapy (including ayahuasca) as an increasingly popular approach, finally starting to be recognized by mainstream psychiatry. I could also dig around for other approaches that seem promising. Maybe good old family therapy (the standard brand), maybe dialectical behaviour therapy. I’m also gearing up to present a few “case histories” — clients I’ve worked with whose stories I find inspiring. Any thoughts about any of this before I go on?

I could also review mindfulness approaches to therapy for addiction. Or maybe that’s old hat. If you follow this blog, you know that mindfulness/meditation is never far from my mind. But there are modes of therapy that are specifically adapted for working with “addicts”  (as always, I use that term without judgement. It’s just handy). I’m thinking of Mindfulness-based Relapse Prevention, which has been formulated especially for addiction treatment.  Comments? Thoughts?

Lastly, the thoughts that have been gathering in the murky backwaters of my brain involve trying to model the IFS idea of a “firefighter” — the part that just wants to get high, without giving a crap about leaving a mess, the stoner voice, as in Fuck it, let’s just get high (or drunk), completely ignoring the frustrated and exhausted inner critic…to model that in terms of brain activity. Neuroscientists see the fuck-it voice as pure impulse, mediated by one brain system, or as compulsion, mediated by another (closely related) brain system. From a neural perspective, it’s the excess of dopamine reaching these systems that elicits this kind of behaviour. Is that just the brain-level explanation of the sudden appearance of the “firefighter” — the capacity to act automatically, without caring? If so, how does it actually work? IFS points to an emergent part-self that rules for a few hours. Neuroscience points to sensitization (via dopamine release) to particular cues. How on earth could we reconcile these explanations? Or are these fundamentally different mechanisms? Maybe one is right and the other is completely wrong. I’d love to try to figure it out.

That’s all for today. Please give me some guidance as to what you’d like to see in upcoming posts. And I hope you are all staying Covid-safe. The vaccine should be available within another couple of months. Maybe things will get a lot better soon.

 

 

 

One problem with my last post was the implication that shaming and soothing both come from outside, from other people. IFS (and some other therapeutic approaches) take a very different stance. It’s what’s inside that counts.

The comments on last week’s post were great, and I’m sorry I haven’t had a chance to reply yet. But obviously people in the addiction community are very familiar with how shame exacerbates addiction. I ended the post with the (also familiar) observation that connections with caring others is the sure-fire antidote to shame. Yet this is so often a losing battle, because addicts increasingly isolate themselves.

So what happens when we focus on our insides, under the skin, not on the reactions of those around us?

First let’s think about where shame actually comes from. We imagine that it’s other people who cause us to feel shame, through their deprecating remarks, anger, accusations, and so forth. But other people aren’t required. Our own internal critic actually induces shame with little or no validation needed. IFS calls this critic a manager — a part whose job it is to anticipate others’ reactions and try to avert worst-case scenarios. But notice: anticipation is a mental state, not a social exchange. It’s really just a belief we carry around with us.

Second, in addiction, this internal critic grows increasingly hostile and shaming…the longer we continue using. And why shouldn’t it? Shaming children is a powerful (if often flawed) means for getting them to shape up. So try it! Except that now…nobody’s listening…

I spent years researching the emotional lives of young children, and one experiment stands out most in my memory. My grad student Carla and I set up scenarios where 3-5-year old kids would accidentally pull off the arms of a toy doll  — one she’d already prepped with an exacto knife. Then Carla would say “Oh no!” and “Oh my!” (at timed intervals) while gazing at the child’s face. The poor kid would then look away, hide his or her head, and often protest: It’s not my fault! An internal shame-inducing “program” was now at full throttle.

(Just so you know, psychologists aren’t all sadists. Carla took a lot of time to reassure the children by showing how the dolls were pre-cut and then playing with them, soothing and comforting if needed. )

Carla didn’t cause the shame. She helped trigger it. But it was the child’s  spring-loaded shame-inducing circuit that did the rest. And that network stays with us for life, simply adding to its bank of of contemptible deeds along the way.

Cece Sykes is an IFS therapist and Senior Trainer with the Internal Family Systems Institute, who has made it her mission to refine IFS ideas and techniques to help people with addictions. I’ve been lucky enough to engage her as a consultant for my psychotherapy practice. Cece points out that, especially in addiction (but also in abuse survivors), all that shame travels to exactly the wrong (inner) location. As you know from my previous posts, IFS relies on the idea of parts. And the druggie part (what IFS calls the Firefighter — and Cece sometimes calls the Distractor) is much too strong and too smart to listen to this shaming inner critic. I know exactly how to feel better, it says. I don’t have to listen to you. I’ve done this countless times before. See ya.

Defiance feels a lot better than denigration.

So you call your dealer and get some stuff. But what happens to all the shame flowing from the enraged and frustrated critic? It goes to the child part of us, the part that is already overcome by self-doubt, helplessness, despair, and yes, shame — the part that fuels the need to get high in the first place! Cece calls this “a reservoir” that keeps filling up. With shame. Because, as we can see from Carla’s experiment, children (including our inner child) are exquisitely vulnerable even to a hint of blame or accusation. So when that inner critic is lambasting us, we continue to crumble inside. And getting high is by far the most obvious solution.

As noted last week, the addict’s shame is so wounding because of lost connections with caring, loving others. So what’s left? How can we be soothed? IFS is all about establishing and reinforcing connections within us. The theory points to a calm, empathic centre in each of us. The part that’s not a part. They call it Self with a capital S. To me, that centre feels like a warm glow of self-forgiveness or self-compassion or just I’m-ok-ness, though of course words don’t do it justice.

When the inner child is writhing with shame, this self-forgiveness can connect with it, regardless of who’s out there in the world. You can say to that fragile part, I get how ground-up you feel, how long it’s been going on. I care about you. And I can keep you company, so you don’t have to be so alone. I know it sounds almost trite. Oh, that’s self-compassion…we know about that. No, it’s not that simple. This is the act of connecting with a part that has been expelled — innumerable times — because that’s what shame does. A part that’s desperate for compassion…or, at first, at least, a bit of company.

As the child’s shame is soothed and softened, the urge to use or drink may soften as well. But that’s not the whole story. There’s still this druggie/drinker part, this Firefighter, in full regalia, ready for action, laughing at the critic. According to Cece, that firefighter can also be helped by the part that’s not a part. It can be talked to — hey there! — but not by The Critic. Rather, it needs to hear from the Self, which can say: I’ve got your back. I’m not the familiar part that’s always screaming at you, that critic. I’m going to help take care of things. You don’t have to do all this drastic stuff yourself. And just between us, you do leave quite a mess.

When the firefighter actually gets a sense of that kind, friendly and competent person — who You are, despite the crazy gyrations of your parts — it gets to relax a bit, breathe a bit, and slow down. (We don’t have to get smashed every night!) It might also try other outlets. It may welcome the chance to be independent, even sassy, without making such an enormous mess.

The point is, now there are connections, internal relationships, a kind of sharing. When before there were only separated, isolated voices and needs, each with its own quirky strategy. From this place, anything’s possible.

 

 

 

 

 

 

We frequently hear about the intimate relation between addiction and shame, and many of us have experienced it. But what is the subjective feeling of shame that makes it not only very unpleasant but a potent trigger for further substance use? Today I want to explore my own experience of shame and get down to a description of the feeling itself. What is this feeling that we shun, and why does it make us crave more of whatever we’re addicted to?

I studied emotion for many years. According to the books, emotions are experienced in several ways: there is a bodily constellation, perhaps made up of muscle, organ, and joint tensions sending signals to the brain; there is a physiological signature, a specific pattern in the autonomic nervous system; and there is an action tendency, a readiness or an urgency to act in a certain way, to retreat in fear, attack in anger, and so on. The action tendency evoked by shame may be the urge to hide the self. But there is also a purely mental state corresponding with each emotion, a state that might be called the feeling itself. That’s what I want to explore.

Shame is one of the seven or eight basic human emotions. If you’re human, you know how shame feels. But that doesn’t mean you spend a lot of time bobbing in states of shame. Shame is one of the most painful emotions, matched only by profound sadness. Because it is so aversive, we do whatever we can to avoid it or to terminate it once it’s arrived. Very often shame leads directly to anger. Why? Because whether in reality or in imagination, someone has shamed us. Usually a parent or an authority, or someone who reminds us of those figures in our past. Or a lover, someone we reach toward who then spurns us. Shame can be triggered by being shunned or rejected when we are feeling open or vulnerable. Or simply by being observed doing what we’re not supposed to do. But knowing the triggers of shame doesn’t get to the essence of the feeling and the impact of that feeling on our consciousness.

The evolutionary purpose of shame is clear, and it reveals a connection between the human mind and the minds of other animals. Dogs, for example. Shame shapes how we behave in most or all social situations. Parents (or other “mentors”) use shame, often without ill intent, to punish bad behaviour — behaviour that can easily get the child in trouble outside the safety of the nest. And because we’ll do anything to avoid shame, it usually works. The trouble with shame and addiction is that the purpose of shame has been badly distorted, skewed off in a totally unproductive direction. Like cell growth in cancer, shame related to drug use evokes more, not less, of the destructive activity. Why is that?

Last night I had an argument with my wife. Isabel and I have been together for 24 years, and our marriage is generally peaceful and happy. But of course all intimate relationships include episodes of conflict. It wasn’t really very serious. She said something that hurt my feelings, made me feel small, inadequate, and objectionable, when I felt open and loving. That’s all it took.

So instead of letting the feeling pass or doing my best to chase it off, I lay in bed last night trying to identify the essence of this emotion. It wasn’t that hard. The feeling was one of churning or gnashing of my insides. It was a feeling of being shredded or ground up — inside my own body, and that’s the main point. I remembered my days of addictive drug use, and I suddenly understood why shame occupies a loop that both emanates from and returns to the urge to get high. The first half of the loop is clear enough. Using drugs addictively is universally shunned because it epitomizes the loss of control, sometimes viewed as self-indulgence or hedonism. But the second half of the loop is more mysterious.

The shame induced by drug use feeds right back to drug use because getting high — changing the way it feels to be inside your own body and mind — is a highly effective way to cancel out shame. To feel ground up and savaged inside…that’s a feeling that’s intrinsically hard to escape. Because it’s your insides that are fragmenting. What keeps shame in place is the thought that you really are despicable, undeserving of being who you are. The thought “I am despicable” is pervasive because it’s a belief you accept and endorse, deliberately or not, a conclusion that arises from your own opinion of yourself, no longer from the actions of others. And as soon as you start to think, I need to get high (or drunk or stoned or fucked or whatever it is), then the ammunition for self-deprecation rises to the surface. You are despicable, indeed, because all you want to do is more of the bad behaviour.

There’s really only one effective solution for shame, and that is to be comforted, soothed, loved — reconnected with someone who cares for you. But because addiction draws us away from others who might care, this solution becomes increasingly remote. I’m completely in sync with Johann Hari’s famous mantra: “The opposite of addiction isn’t sobriety — it’s connection.” Well the opposite of shame isn’t pride; it’s also connection. That’s no coincidence.

If you want to read some philosophical writings about addiction and shame, check out Owen Flanagan. I think he’s the acknowledged master, and his writing is both accessible and powerful.