Sometimes it doesn’t matter how a problem began, it just needs to end. However, many times the phrase those who cannot remember the past are condemned to repeat it, while simplistic, often rings true. This concept is well illustrated in addiction, or substance dependence.While insight is not enough to cure all our ills, it is also not enough to merely change behavior either.
Cigarette smoking: how many people smoke and are unaware of the health risks? Insight is not enough. If knowing smoking kills was all that was needed, no one would smoke. On the other end, how many more people used to smoke before they were aware of the health risks?
With addiction it is important to explore why one’s dependency developed in the first place. Otherwise, life will continue to present the circumstances with which one needs to cope: relationships, grief, employment, family, friends, financial stress, emotional stress, other people using substances. The list can be endless if one does not learn those circumstances that are most triggering.
There are several perspectives on causes of addiction. Environmental: it is the place, people and circumstances around someone that drive one to use substances. Genetic: people are born with “predispositions” that put them at risk of addiction. Learned behavior: using solves a problem or enhances an event in a meaningful way creating the desire to keep using. There are more nuanced variations of each of these, but these are the core principles. Nature vs. nurture. The answer is all of the above, nature and nurture. Our genes, and unconscious drives, and our overt efforts interact constantly to create the interactive versions of us that everyone knows and we know of ourselves. People can be born into the same circumstances and grow up completely differently. People can experience the same event, and because of the history and biological differences, they will have completely different perceptions of that same event. This is why there are some who are able to use drugs and alcohol and not become addicted, and those who are seemingly unable to avoid it.
When working with people who have long term substance use disorders, behavior and insight need to be enhanced. Once use is stopped, or greatly reduced, one’s personal causes of addiction can start to be understood. The behavior protects the present goals and the insight protects the future behavior.
David Aronson LCSW