A recent conversation between Dr. Michael Hurd and a media reporter re: substance abuse and addiction.
If you think you know someone who is struggling with addiction, what should you do?
If you know them well, ask them, “Can I be honest with you about something I’ve noticed?” Don’t rush in unsolicited. This will foster defensiveness and evasiveness. Be direct, kind, diplomatic yet truthful.
If you don’t know them well enough to do this, then stay quiet about it, but stop short of pretending. Comment on the consequences of the problem, if not the problem itself. For example, “I noticed you looked kind of tired yesterday,” or, “I notice you didn’t come to class/work.” Then leave it at that. This way, you’re not participating in the denial, but you’re not making yourself a hapless crusader, either.
What should family/friends who are dealing with an addict do for themselves?
The basic principle is like I stated above: Don’t participate in the denial or self-destruction, but don’t make yourself a frustrated crusader, either. In the end, none of us has control over what another chooses to put into his or her body. Not even the government does, although the government has waged a war against drugs for many decades with virtually nothing to show for it, by the standard of reducing addiction. If the government cannot alter substance abuse via all its police and armies, neither can a family member. Let it go. Care about the loved one, and refuse to enable, participate in or foster the problem in any way; but accept the one thing which only the addict him- or herself can do, which is alter the behavior.
A lot of the recovery programs seem to be religiously based, do you think that is required for a successful recovery?
Absolutely not. The proof of this are all the agnostics, and even a few atheists I have met, who successfully stop their self-defeating or self-destructive behavior. Some people have found it helpful to think of a Higher Power doing the stopping for them. I don’t try to argue religion with people in the context of psychotherapy, but I will usually say, “You don’t give yourself enough credit. You’re the only one with yourself 24/7. You must have had something to do with stopping.”
Do you approach counseling differently for those who are or are not religious?
No. I respect that people have their chosen paradigm, and I don’t wish to argue with them about it, or support it. I simply look at the facts as people describe them to me, allow them to vent, and then talk and reason with them about those facts, and try to make logical sense of them. Religious or non-religious, we all need reason and emotional ventilation.
What are some of the reasons that people end up addicted?
I don’t think anyone knows for sure, or if there even is one simple reason. The prevailing idea nowadays is that biology is destiny—that biology is everything. So if people exhibit addiction, it must be because a gene made them do it. If we don’t yet know that gene, we eventually will. And then, presumably, some biological or medical intervention (surgery? Pill?) will make them stop.
I see this as oversimplification and frankly fantasy. I can certainly see room for the possibility that people have differing aspects of their physiology which will enable one person to respond one way to a substance, and another person differently. But even within those categories, why do some people quit; some people never start; and some people go all the way with the substance abuse? There have to be more variables than simply biology. I think some latch onto this simplified explanation because they don’t wish to face the fact that they (or a loved one) has any responsibility whatsoever for their self-defeating or self-destructive behavior.
But the way I see it, facts are facts and we have to try and understand the truth for what it is. The truth sets us free, because it places us in contact with reality even when we don’t particularly like it. Also, while it may seem harsh to even suggest that maybe—just maybe—personal choice has something at all to do with substance abuse, the flip side is that choice has something to do with stopping the substance abuse in a sustained way. I wish to give those people who do quit substance abuse credit for the self-respect and admirable accomplishment they have achieved and sustained.
Can you list or tell some of the ways people are affected by addiction—directly and indirectly?
One interesting point I have heard some people make goes like this: “I believed that I needed the substance more than I actually did.” For example, a person describes the sense of warmth and good feeling – euphoria – that comes about from having the drink, or whatever it is. Then, for whatever reasons, they stop. A number of people discover, “I didn’t need that as much as I thought I did. In fact, I didn’t need it at all.” However, this cannot be preached, lectured or legislated into happening. The person has to see this for him- or herself. It doesn’t always happen, I’m sure, but it does happen in a number of cases, and I encounter them with people all the time.
Examples with alcohol include negative consequences such as feeling tired, lethargic, “hung over,” and just generally lacking in motivation and energy levels when contrasted with periods of not drinking. The effects of substance abuse are so insidious or subtle that people don’t always realize them until after they stop them. Sometimes the elimination of these side-effects of substance use are motivation enough to continue to quit, and sometimes not. There are many other variables involved in the “tug” to use substances, and we cannot oversimplify. But we’re all trying to make sense of this widespread human phenomenon, and better understand it.
Do you think permanent recovery is possible? If so, what needs to happen?
We know permanent recovery is possible, because it happens all the time. You talk with people in AA/NA who have been non-using for years or even decades. And I encounter people outside of those circles, all the time, who are the same.
I prefer the term “recovered” to “recovery.” To me, recovery implies that you’re always on the edge of your next drink or drug intake. While that’s often true in the beginning, it’s not always true over time, and I find that people vary widely in this respect. I might talk to one person who hasn’t had a drink in ten years, but still longs for one when driving by a bar or a liquor store. More often, I hear that there really aren’t “cravings” of that kind, and the mere thought of going back to substance use arouses sincere revulsion. There are a whole range of reactions that I hear about, and probably many more I have not yet encountered. Although it’s heresy in certain circles, I opt for the use of the term “recovered” to reflect that some people are done, and know that they’re done, with the substance.
I’ve heard from a number of addicts that the “numb feeling” of a high is the “best part.” Can you explain why that might be a desirable state?
You’d have to ask the particular person for more details. Individual responses vary more than you may realize. In general, I interpret this to mean what’s typically called “self-medicating.” More literally, this means: “I don’t like certain emotions I feel. Rather than feel those emotions, I’d rather numb them, so I don’t feel them.” To my knowledge, this strikes at the core of what substance abuse is for many people, and possibly even most substance abusers.
Some people abuse substances because they find it an “effective” way to repress their emotions. Non-substance abusers often repress their emotions, too, although without the drugs or the alcohol (or with contained usage of these substances). Either way it’s an error, because emotions are part of who we are. They’re human nature. Emotions are not to be dreaded or distrusted, any more than they’re to be followed blindly without reason. Emotions—in my view—are reflections of what we really think and believe about anything pertaining to our lives; you have emotions whether you make yourself aware of them or not, or whether you try to drink/drug them away, or not. It’s best to be aware of them, think about them, and when appropriate even indulge and rejoice in them. I think this is what many people are aiming for in recovery, and it’s a laudable goal, certainly the best possible alternative to repression.
In the piece I’m working on, I’m hoping to offer options for recovery, and what steps people who are interested in recovery could take. Is there anything you’d like to recommend or suggest people consider?
Find alternatives to emotional repression. Cognitive psychotherapy helps people become aware of their emotions, while also applying reason/logic/common sense to those emotions. When people learn to be less afraid or ashamed of their emotions, and more confident in their reasoning minds, they will find it less of a struggle not to drink or abuse drugs.
AA and NA are not the only games in town. Rational Recovery and SMART Recovery are movements designed to accomplish similar things by somewhat different methods. (Information about them is online.) Find what objectively works for you. Don’t listen to anyone’s dogma, most particularly any attempts to intimidate you into a particular point-of-view. Simply listen to what other people have to say, think about it and try to determine what makes most sense to you.
In the end, the most basic issues are self-respect and self-esteem. Create values—important relationships, career options, meaningful work—in your life. In so doing, you’ll have more that you do not wish to lose or undercut via your drinking. Build something in your life to lose, and then you’ll have more motivation not to abuse drugs or alcohol.
Be introspective. Try to have an honest relationship with yourself, where you don’t lie to yourself or rationalize. That’s where a lot of alcoholics and others “in denial” go wrong. And once they go too far down an addictive road, they start to fear that it’s too late to go back. This fear is always mistaken. It’s never too late to reverse course and go down a different road, not so long as you’re alive and conscious. No matter what your views, we can probably all agree on this much. Ask anyone who has reversed course in this regard for inspiration.
Do you have any thoughts regarding the difference between social stigmas associated with heroin that might make it more difficult for addicts to seek treatment as compared with other addictions?
Whenever anything is illegal, there’s an additional level of social stigma right there. Even with pot, which is illegal, there’s a vigilance which users feel that wouldn’t be present if the substance were legal.
When you have to hide something you want (heroin, for example), you still want it. If anything, the need to hide it probably makes it feel more like an adventure than it otherwise would, glamorizing or romanticizing the “underground” nature of a substance which, if left above ground, would not seem so cool or glamorous to those attracted to those feelings.
However, neither the social stigma nor illegality make a major difference in whether a person continues using or not. If you’re hooked, you’re hooked, and the illegality and/or social stigma associated with the substance just makes a difficult situation even more difficult.
People who don’t abuse drugs tend to be naive in their thinking that, “If we keep these drugs illegal, then fewer people will use them than would otherwise be the case.” This is what happened with alcohol during Prohibition, and it’s working out about as well with drugs as it did with alcohol. What only substance abusers, some counselors and ex-abusers seem to understand is that when you’re really hooked on something, then you crave it more, and nothing external is going to stop it. It becomes the most important thing in your life, which is the defining nature of addiction.
In the end, it’s up to the abuser to make a change. You cannot be helped to make such a fundamental lifestyle change (including one with social and legal stigmas, such as heroin) unless you first resolve that you wish to make the change. Once the abuser makes that fundamental decision — whether it’s the first step of AA/NA, or any other context — then all kinds of external help does become meaningful or possible. But not a moment before.
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