Stinking Thinking

People in recovery from addictions who are active in 12-step programs (AA, NA) often talk about their “stinking thinking’”—a reference to a pattern of thinking that, unchecked, can lead to relapse. “Stinking thinking” encompasses everything from actual thoughts of using, outright denial or minimization of the addiction, to beliefs recovering people have about themselves and their relationships with the addiction. There is little doubt that, as an addiction takes hold and progresses, thinking changes, becoming increasingly dysfunctional and destructive. The changes are subtle at first and become entrenched over time. The following example illustrates:

You are invited to a party. Upon arrival, you look around but don’t see anyone you know. The friend who invited you isn’t there yet. Feeling a bit anxious and awkward, you see that someone has set up a bar and drinks are being served. You decide to have a drink since “alcohol is a social lubricant” and will “take the edge off” your anxiety. Having taken a drink, you now feel able to manage your anxiety and begin to work the room.

A great deal of thinking is embedded in this scenario: perceptions and reactions to the party, perceptions and thoughts about yourself in relation to strangers, expectations about social situations and relationships, expectations about what a substance will do, reasoning and decision-making, perceptions and thoughts about “feeling better.” The scenario also points to beliefs: beliefs about the ability to manage anxiety, beliefs about alcohol’s effects, beliefs about yourself and your capabilities. Many of these thoughts and beliefs are not fully conscious but are nonetheless present and have impact.

Thoughts and beliefs certainly impact behavior--and vice versa. One of the most insidious beliefs that many people struggling with addiction have centers on shame and self-efficacy: “I am inadequate and do not have enough strength in me to cope with life without the substance. I NEED________.” Or “my feelings are bigger than me, and I need _________ to manage them.” The addicted person identifies with his/her inadequacy and shame (“I AM inadequate”).

There is a kind of circularity to addictive thinking. Thoughts emerge from beliefs, which are reinforced by addictive behaviors, which leads to additional addictive thinking and further reinforcement of the beliefs. Over time, addictive beliefs tend to become reductive as addictive reasoning develops. Indeed, reasoning becomes less rational and less fact-based as addiction progresses; emotional reasoning (“If it feels good, it must be OK”) is a hallmark of addictive thinking. Indeed, it’s a vicious cycle.

Sadly, addiction ultimately reinforces the shame and beliefs about inadequacy as self-efficacy and control is lost to the addiction.

One of the reasons that “just say ‘no’” (remember Nancy Reagan?) and willpower don’t work as strategies for managing and overcoming addictions is that they don’t address the subtle thoughts and beliefs that persist long after the substance is out of one’s body. I’ve often remarked that, hard as it is to control or even stop using substances, it is much harder to change one’s thinking. And yet changing one’s thinking and beliefs is the essence of recovery.

Psychotherapy is an effective means for identifying, reflecting on, understanding and even changing “stinking thinking.” Among other aims, one goal of addiction treatment is to raise awareness about what one’s thoughts actually are. Many of us are only vaguely aware of what we are thinking at any given moment. Moreover, we are usually not aware of how our beliefs shape our perceptions and thoughts—and our subsequent choices and behavior. Therapy can raise awareness, thereby helping us to find the freedom to make different choices in response to situational challenges. While the therapist will certainly not tell you what or how to think, he/she will hold up a mirror so that you can clearly perceive your thoughts/beliefs in action, and decide whether those beliefs remain valid in your present experience and whether you want to continue to choose the same behaviors.

Psychotherapy is ultimately about helping you find and own your inner power—something that has been lost or even given away through addiction. Developing self-awareness is an important step toward changing dysfunctional thinking. And changed thinking can change your life.

Addiction: Not Just a Behavior...

I’ve spent a good part of my career helping people recover from addictions—whether the addiction is to alcohol, drugs, tobacco, food, gambling, sex, or other compulsive behavior. Whatever the addiction, most of my clients have discovered the same thing: changing the behavior is only one step toward meaningful recovery. Oddly, changing the behavior is the easier step (and even that is not very easy). The harder work centers on changing the thinking and relationships that have evolved in tandem with the addiction. Addictions have a compulsive quality about them; addictive behaviors continue despite the losses that typically accrue as the addiction progresses. Patterns of thinking and behavior develop with addiction; these patterns of thinking and behaving impede optimal functioning and typically eventuate in a narrowing of the addicted person's world. (Loss is a hallmark of addiction: loss of family, friends, money, time, and health are unfortunately only the most obvious losses. There are many, many others.) Neurologically, addictions actually change the brain’s chemistry and make-up. (I recall the first time I saw PET images of the brain of a person who used cocaine, thinking “No wonder addiction is so hard to treat; I can see the patterns of conditioning being laid down in the brain.”)

In and of itself, addiction is an enormously complex problem. Addictions develop for a variety of reasons. Compulsive behaviors always serve a purpose—however dysfunctional it might be—but the purpose may not be readily apparent. For example, many people use substances or engage in a compulsive behavior in order to “feel better.” Whenever I hear a client tell me that he or she uses alcohol, for example, to “feel better,” I usually ask, “better than what?” The answer reveals additional issues: depression, anxiety, social disconnection and isolation, conflicted family relationships, histories of trauma (physical, emotional, sexual), grief, confusion, loss of a sense of self-efficacy and control. However, there are often even deeper issues—issues that go to the core of one’s sense of self and relatedness to the world.

Addictions frequently mask very deep issues--all of which must be addressed and treated. Therapy typically requires work on multiple levels. Understanding the meaning of the compulsive behavior is an important step toward changing it, but it is only a step. Careful exploration of how the addiction has impacted the client’s perceptions, thinking, beliefs, and relationships is the focus of a great deal of therapeutic work. Treating underlying psychiatric disorders is yet another layer of treatment. Helping clients enlarge their perceptions, develop awareness of distortions in thinking, and correct their distorted thinking patterns is a significant part of the work. Similarly, challenging the belief systems that arise from the addiction is an important component of the work. Learning, practicing and mastering new coping skills, and applying those skills to everyday life is still another level of work.

In addition, therapeutic work can extend to intimates and family members: families need help because addiction affects them in overt and subtle ways. Effective clinical work with family systems impacted by addiction often parallels the work with the addicted person. The family must recover too. In fact, it’s been my experience that sustained recovery from addiction can only occur when both the addicted person and the family recover together.

At the most fundamental level, though, therapeutic work must center on discerning addiction’s deepest roots. Such careful exploration and analysis is essential for meaningful recovery, healing, and enduring wellness.

Over the next few blog postings, I’ll reflect on various aspects of addiction. It’s huge, many tentacled issue—and one that affects many more people than might be apparent.