Susan Brown, LCSW
 "No-nonsense to-the-heart-of-the-matter approach"

Addictions

Addictions And Other Compulsive Behaviors

"The important thing is this: To be able at any moment to sacrifice what we are for what we could become."   
-(Charles du Bois)
Addictions as a Misguided Solution to a Problem 

The relationship between trauma and addiction is well established in the literature. The most well known, large-scale, epidemiological study demonstrating this relationship is the Adverse Childhood Experiences (ACE) Study, conducted collaboratively between Kaiser Permanente San Diego and the Center for Disease Control in the 1990's, now known world-wide. It is believed that addictive behaviors start out as solutions to a problem: the problem of defending against the intrusion of underlying trauma and other disturbing life experiences leading to overwhelming negative emotions, beliefs, and internal states. It is easy to understand how the initial relief and rewarding states offered by substances and other behaviors (food, pornography, gambling, sex, etc.) can "hook" someone; however, once the behaviors become excessive and compulsive, they will then be the biggest problem of all. According to this view, addictive behaviors are seen as protection from the underlying, unprocessed trauma, negative emotion, and inability to cope with internal states and external challenges. EMDR therapy targets and reprocesses this underlying disturbance efficiently and effectively.

How Addictions Progress

Once the addictive process sets in, the person tends to experience considerable loss of control over the substance or behavior. Even in the face of disastrous relationship, legal, professional, and financial consequences, the person persists in the behavior, which appears completely irrational. But then, all addictions defy rationality. Addicted individuals may look like “Jekyll and Hyde,” as if there are two people instead of one: the one who “uses” and the one that doesn’t. Dishonesty about one's behavior, craving, needing “more” to get the same feeling, and continued use despite severe consequences, are several hallmark symptoms of addictions and compulsions. Food compulsions are particularly insidious because we have to eat; we don't have to gamble, drink, or do drugs. It is believed that with regard to their origin and development, all of these substance and behavioral addictions and compulsions are considered more alike than they are different.

Addiction as a Disorder of Learning and Memory

We tend to remember whatever has the greatest emotional charge on it. Addictions to substances or behaviors can develop when a desired feeling and a substance or behavior get 'wired' together, especially where there is a trauma history (or adverse childhood experiences) in addition to a pre-existing biological or temperamental vulnerability to addiction. For example, the euphoria and relaxation that may be experienced when alcohol or other drugs are ingested, can result in a linkage between drinking and social lubrication for an awkward or shy person. Adolescence is a particularly vulnerable time for this experience, when 'belonging' and 'fitting in' are the most important goals in life. If a young person learns to feel confident and desirable by associating those feelings with drinking alcohol or using drugs, they learn and remember that this feeling can be recreated any time by drinking. Any feeling can be connected to any behavior; there is no one formula for what positive and rewarding states will be connected with which behavior for each individual person. For example, a social gambler who hits a big win can experience such an intense feeling of being a 'winner,' that the behavior and the feeling can become fixated together and begin to feel “necessary” to repeat, regardless of the consequences (addiction). The person's desire or need for that feeling is an important part of an addiction. In addition, the behavior must be effective at defending against the intrusive, underlying trauma material. 

Using pornography as another example, a person's pre-existing loneliness and sense of disconnection with others can become the crucible for addiction. That particular history leaves one with an excessive (compulsive) desire to feel accepted or desirable. Looking at pornography and fantasizing can activate the specific states being sought. But of course compulsive viewing of pornography is not true intimacy, just a fantasy, but one with great sensory power, easily fixated, given the right conditions and the right level of internal need or longing. In addition, the intense thoughts, feelings, and sensations associated with sexual images and behaviors are extremely hyper-stimulating and memorable in their own right. These memory networks can become very difficult to untangle as they begin to take over and hijack the person’s attention, focus, and motivation within actual brain circuitry, usually reserved for healthy “life pleasures and needs.” 

Addictions Treated with EMDR Therapy and Addiction-Specific Modifications

Substance and behavioral addictions and compulsions (alcohol and drugs, including nicotine), gambling, pornography, compulsive eating, sugar, shopping, self-harm (cutting, hair pulling, skin-picking), sex addiction, and love addiction (the addiction to a person), can be part of a comprehensive treatment plan that includes standard EMDR therapy integrated with several modified EMDR approaches. In the 1980's Desensitization of Triggers and Urge Reprocessing (DeTUR) was developed by A.J. Popky to target the triggers and urges associated with addictions. Jim Knipe introduced targeting the "Positive Affect" associated with addiction and/or the "Urge to Avoid" (feelings, actions, people, etc); Miller introduced similar positive affect targets he called “Feeling-States.” CravEx, developed by Michael Hase, targets other addiction-specific memories such as relapse and loss of control. The combination of standard EMDR therapy to process unresolved trauma that pushes addiction, combined with the addiction-specific targets noted above, could provide more comprehensive treatment and relapse prevention.

How EMDR and Addiction-Specific Targets help the brain regain balance and health

Vulnerability to over-reactivity or over-identification with an intense positive event is pre-dated by an emotional deficit, trauma, or need for a particular feeling, emotion, belief or sensation, as noted above. EMDR therapy breaks the connections between negative traumatic memories and present day triggers and cues, allowing the person to be totally calm when thinking about the memory, knowing it is in the past. Targeting the positive, idealized, and/or euphoric addiction memories helps break the fixation between the intensely positive feelings and the behavior, just as EMDR therapy breaks the connection between negative traumatic memories, allowing linkage with the more adaptive networks in the brain. After processing the cravings, urges, positive or idealized feelings associated with the drug or behavior, the person experiences either diminished, or no further desire to do the behavior or engage in the substance. The fixation becomes desensitized (unlinked) and the person appears to regain their more rational state. They begin to see and connect at a deeper level with the adverse consequences associated with the addictive behavior; they are then able to connect with what prompted the addiction to become a solution for managing distress, although ultimately maladaptive. The early disturbing memories that pushed the addiction are reprocessed with standard EMDR therapy in addition to the negative beliefs the person has about him or herself as a result of becoming addicted (such as, “I can’t do anything right,” "I'm a loser," “I’m permanently damaged,” “I’m shameful”). Standard EMDR therapy plus addiction-specific targeting, is a powerful, comprehensive, integrative approach to the resolution of co-occurring trauma and addictive / compulsive behaviors.

It is important to remember that addictions are highly complex disorders in need of a comprehensive treatment plan that should include family involvement, recovery group support, exercise, diet, and other healthy life management skills. No one size fits all. EMDR therapy, including the reprocessing of underlying trauma, euphoric recall, triggers, urges, relapses, and loss of control associated with addictive behaviors, is recommended as an important component of all addiction treatment.
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