Heart of Addiction

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Heart of Addiction

• Displacement

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Lance Dodes

• Lance Dodes, M.D. is a Training and Supervising
  Analyst with the Boston Psychoanalytic Society
  and Institute and assistant clinical professor of
  psychiatry at Harvard Medical School.
• He has been the Director of the substance abuse
  treatment unit of Harvards McLean Hospital,
  Director of the Alcoholism Treatment Unit at
  Spaulding Rehabilitation Hospital (now part of
  Massachusetts General Hospital) and Director of
  the Boston Center for Problem Gambling.
• He annually chairs the discussion group The
  Patient witih Addiction in Psychotherapy and
  Psychoanalysis at the fall meeting of the
  American Psychoanalytic Association.

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Dodes in the news...
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Reversing Helplessness Factor 1

• Take an action that we know will make us feel
  better
• Its an understanding approach
• Making the unconscious / conscious and then doing
  something about it
• I make sense of my behavior

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Addiction

• Virtually every addictive act is preceded by a
  feeling of helplessness or powerlessness.
• Addictive behavior functions to repair this
  underlying feeling of helplessness.
• It is able to do this because taking the
  addictive action (or even deciding to take this
  action) creates a sense of being empowered, or
  regaining control-over ones emotional experience
  and ones life.

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Vignettes Regaining Control
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Vignettes (cont.)
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Paradox

• Addictive behavior behavior is out of control,
  but addiction serves a deeper purpose of
  regaining control - at least internally
• But off course - you eventually create more out
  of controlness
• Dodes believes that helplessness is common, but
  everyone experiences it a bit differently, it
  affects us differently, and the circumstances
  that makes become helplessness and the dynamics
  behind them are psychodynamically unique.

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Explaining the Drive Behind Addiction Factor 2

• Helplessness leads to a feeling of anger / rage
• These feelings come in subsidiary forms
• Identify what things make us feel intolerably
  helplessness
• Root these out, have them expressed

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Displacement 3rd Factor

• Addiction results from a redirection of energy to
  a substitute or displaced action because another
  more direct, action is not considered
  permissible.
• Key is to find that displacement - what is being
  displaced?
• When actions are taken directly to deal with
  helplessness, there is no addiction.

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The Man Who Had No Time Intro

• Frequented Tonys Bar most days
• Recent Visit to Doc shook him up - Youre
  drinking every day again -
• Given Dodes
• Ted did not drink for two days afterwards - but
  returned to drinking for two days afterwards.

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Ted Meets with Dodes

• Ted - been to a lot of treatment I Know that I
  am an alcoholic
• Comes down to will power / stick with the program
  dont drink
• Lost 12 year marriage as a result of drinking
  (painful)
• Lost job as an financial advisor
• Arrested for DUIs
• Considered suicide on a few occasions

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Ted Meets With Dodes Psychodynamic History

• Still drinking when sessions began (wasnt
  causing crisis)
• Only child (father computer programmer mother was
  research assistant / medical lab)
• Ted done well in school (straight As elementary
  through high-school and in sports (football team)
• Pushed himself to achieve I had to accomplish
  things...Uphold something for the family
• Impressive achievement in college gave him wide
  selection to schools
• Went to a college that fit his Dads standards -
  doing the right thing
• Began to drink there heavily for the first time

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Ted and Dodes (cont.)

• College was when alcohol really started to
  interfere... In a way, the problem was really
  time... If Id taken even a quarter of the time
  I spent drinking to do the studying I should have
  done (shaking head in disgust)... And after
  College, just drank more.
• Taking about marriage, fights, spoiled special
  occasions, failed career as a financial advisor,
  accounts hed let slide...
• He kept returning to the time he had lost. If
  only I could have that time back

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Psychodynamic Insights

• Instead of talking about time lost to drinking,
  Dodes began to learn that Ted regretted other
  kinds of time losses
• Theres never enough time to do things- things I
  really want to do...Never time for myself, time
  to do stuff thats really mine
• Insight 1) Realization that Ted was not in
  control of his own life.
• Insight 2) Further sessions revealed just how
  burdened Ted had become (i.e., taking work home)
• Insight 3) Pressure coming from the inside I
  always should be doing more
• Insight 4) Work hard as an adult and be
  good pattern lived out as a child

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A Core Insight

• Pressure to perform at work VALIDATION
• Getting caught in head
• Takes on new project gtgtgt Feel stressed at work
• When I am going to have my time
• I started slapping around papers - then said F -
  IT

Drinking Displaced Anger and Made Up For Freedom
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TED IN A NUTSHELL

• Choice to drink gave him control over his past
  feelings of helplessness
• Ted started to feel better about his helplessness
  the moment he decided he was going to drink
• His rage drove the behavior... Dodes states...
  Qualities of rage at helplessness - an intense,
  narrowed focus, a loss of usual judgement, and a
  temporary blindness to consequences - are
  precisely the characteristics that describe
  addiction...

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Summing Up Displacement

• Addictive behavior at its core has an element of
  emotional health
• We all fight against helplessness - it is
  psychologically essential -
• Suffering with an addiction then, does not make
  you psychologically sicker or less mature than
  people with a wide variety of other problems
• We can learn to use addictive drive as a signal
  that something emotionally wants to be heard,
  felt, and metabolized