Everyone coming into contact with addiction whether patient,
family or therapist knows that motivation to stop is the key to success. Yet they are baffled
by why sufferers are so poorly motivated even when experiencing really dreadful consequences of their addiction. It has been
a mystery why treatment is so generally useless but at last current research is begining to find an answer.
At a deep biological level, animal motivation evolved over millions of years out of the need to survive. It
is this system that generates pleasurable and satisfying feelings whenever we have thoughts or actions that promote the
benefit and the survival of ourselves or of the group to which we think we belong. It employs the hormone dopamine to
produce rewarding feelings such as enjoyment, relief, contentment, pride and happiness. (Interestingly, this is the same hormone
that seems necessary for all thinking and that in excess generates psychosis).
o Unfortunately some genetically predisposed individuals, often
in the course of seeking relief from stress, discover substances and behaviors that directly produce this relief and these
dopamine rewards for virtually no effort. Thereafter they become trapped by the memory of achieving this and they develop
a powerful addictive drive to repeat getting their dopamine by this “route one” method. This perverse
motivation can then override their pursuit of health and survival and subvert the whole purpose of their life. Patients
who survive severe addiction describe hitting “rock bottom”. The degradation, discomforts, isolation and semi-suicidal
risks suddenly become too much to bear and they find an alternative way of life albeit with constant risk of boredom or stress
o Others continue on in varying degrees of entrapment, indeed
it has been estimated that the average career of a Class A addict lasts 9 years. An unfortunate way
of coping with stress found in over a third of addicts is the switching off from reality by unconsciously undergoing a personality
change. (See below) Their changed personalities are often amoral, criminal or childishly manipulative and generally
cause increased stress for other people. Irrespective of whether they change like this, nearly all severe addicts end
up running parallel competitive stories of motivation; on the one hand wanting to care for themselves and their families and
on the other wanting to get dopamine directly from their old habits.
o Our CareCred scheme is designed to provide a system of social
intervention alongside medical substitution therapy that helps patients regain and then retain healthy motivation. Its focus
is NOT on reducing the unwanted habits so much as supporting the attractiveness of the wanted ones. A long-term
stress-reductive, non-judgmental clinically supportive relationship is a key to its success. Because addiction
diverts natural love it very often destroys caring family relationships. CareCreds sets up a system of encouragement and earnable rewards
that enable patients to be nudged out of their bad habits into good ones. The theory being that these good habits have a more
fundamental genetic basis that will re-emerge and take over when given the opportunity.
o It relies on a team approach with other local services and
resources. It is focused on re-socialization rather than exclusion and punishment (which despite popular support have proved
completely counterproductive and unsustainably expensive). CareCreds are by no means the perfect solution but they have been
shown to be more effective than other measures and much more economic. Our first target has been to get all patients
off the dangerous use of street drugs and on to legal substitutes. Then instead of leaving them ”parked on Methadone”
we aim to get them reducing and detoxing so that they can start moving back into normal society. With CareCreds many patients
with chaotic unstable street addiction have become clean in 3 years. Although it is clear that some may be so badly damaged
that that the best we can achieve is secure long-term care.
What is Personality Disorder and
how is it linked to addiction?
Although having a personality is
a very important part of being human, as every pet owner knows, animals also have recognizable personalities. Indeed it seems
likely that having a personality has evolved in all higher animals as a way of assisting individuals to join in group collaboration
in the common struggle to survive.
in following our instincts to be attractive and respected etc we create a rich variety of personal styles that are as recognisably
different as our faces, underlying this variety are at least three basically similar personality states. These states are
popularly described as Parent, Adult and Child. They are appropriate to (and are most easily seen) in three social situations
that require 1) Quick (parental) defensive or aggressive "Fighting" 2) Calm (adult) calculation as to what
action might be best 3) The (childish) fear reaction to "recruit assistance" and enable a quick "Flight"
disorder is when someone repeatedly slips into a personality state that is inappropriate to collaborating with others in
dealing with the situation at hand. Typically it results in showing too little or too much emotion in the dialogue with them.
This is known as incongruity of affect. Like substance abuse, personality disorder seems often to be caused by a need to escape
the distress caused by chronic or severe stress. If switching personality relieves stress it becomes habitual, despite its
damaging effect on harmonious collaboration. The commonest personality disorder is inappropriate regression. This means going
back to behaving more like a teenager or toddler when sensible or responsible action is required. The style of personality-disordered
behavior can be elaborate and even bizarre including criminal and sexual deviancy etc. Doctors often can recognize the age
of someone's disordered personality as corresponding to a recorded stressful event in their medical records.
The relationship between mood and thought
is also a key feature of personality. Moods and emotions are the consequence of brain hormonal secretions and they are evolutionarily
much older ways of controlling our lives. The inherited and acquired mood disorders such as psychosis and depression are important
factors in how personalities develop, as indeed are thoughts and memories about the events in life. Thought is mainly an electrical
process but hormonal secretions are also involved at the synapses where our nerves connect with each other. In this way thoughts
can prompt feelings and vice versa.
themselves can be thought of as "roles" in the drama of social life. They develop their own life stories and recurrent
patterns of behavior and appear in dream states as well as consciousness. We most easily recognize we have more than one personality
state when we silently converse with ourselves at night.
Bereavement, losing love etc, indeed anything that breaks our expected or hoped for future, generate
stress. The best way of surviving this is to be brave and to be always prepared to plan and implement alternative ways of
leading a life story. This solves our problems and reduces stresses while addictions and personality disordered behavior just
temporarily avoids anguish but in the long run generates more problems. Fortunately it seems that switching to inappropriate
personality states, like relapsing into substance abuse, can be significantly reduced by problem solving stress reduction,
which is why a CareCred approach to this is of value.
Thus in essence our current personality states
and their attendant repertoire of individualities are actively engaged in telling the story about who we are and what our
life is all about. Through them we have internal and external dialogues that are crucial to our feelings of meaningfulness
and worth. How negative or positive these dialogues are can alter both our happiness and hopefulness - both of which are key
to either avoiding or recovering from addiction. Understanding this and acting upon it, is the way everyone, in particular
the sufferers themselves, can be helped to develop alternative and more enjoyable life stories to solve their problems.
People suffering from chaotic addiction
are often trying to escape from failing personal relationships and their attendant blame and anguish. Typically
whenever they meet up with their former partner they both tend to act like aggressive-defensive children generating a stressful
conflict that encourages the persistence of addiction and often steals the love and attention that is needed by their real
children to develop into happy stable adults. A breakthrough comes with the realization that they are both in the unnecessary
grip of just one of many possible life stories. They can observe themselves and their partners switch personalities and behave
in perfectly sensible ways with other people but somehow cannot see how they can change towards each other. The key is to
refuse to converse with the regressed or inappropriate personality but instead to talk to the appropriate person hidden behind
it. This conversation must be made in an adult and constructive way and never given up on because of initial failure.Just
as "it takes two to tango" allowing a regressed personality in another to bring out the regressed personality in
oneself is worse than useless. There is however always a danger that inappropriate personality performances appear to change
when in fact they are pretending to be adult. This can lead to exhausting and potentially explosive repression of feelings
that are more healthily expressed. The attendant stress of keeping up social pretences may further trigger addictive craving. Our
Carecred approach is to encourage chaotically addicted people to rediscover their sensible positive personality state to
solve interpersonal conflicts, so that they can then achieve permanent freedom from addiction.