Dear Addiction, We Need To Talk
By Keven Duffy, LCSW
Published in thefix.com 2016
Jen, mid-twenties, came to me, after a genuine but failed suicide attempt following many years on heroin (up to 15 bags daily). One of her first thoughts on her suicide attempt was "I'm such a failure, I can't even kill myself properly." When we looked into her almost ten-year addiction to opiates, she admits that she needs to stop using. However, her glorification of the drug remained. As we flesh it out, I start to feel her descriptions of the drug's impact on her life sound more like a human relationship than that of one with a substance. "I felt whole," "It was always there," "I could always count on it...." One day, my supervisor suggested that I ask her if heroin could text? Would it?
In working in drug rehabilitation for several years, I've discerned that current treatment has little place for symbolism. That is not to suggest that today's best practices don't alleviate the behaviors. Patients are able to identify relapse triggers, develop coping skills to handle these triggers, attend the myriad of support groups available, build a sober network, and a host of other very effective tools that I use regularly in my practice.
However, I have begun to see that fi the patient has the ability to symbolize, to work within a frame that is abstract and personify their substance of choice by naming them, giving them their own attributes and then exploring the "relationship," work can be done. Following, can be insights into object relations, attachment and other traumas that might not have been revealed otherwise.
Often, when in recovery, the underlying feelings of shame and guilt attached to a substance use disorder are hard to approach, as the patient has obviated those feelings in his/her newfound sobriety.
For a cohort of my patients, I have begun personifying the addictive behavior ni order to lessen the feelings of shame/guilt associated with the often-negative consequences of the addictive behavior- the collateral damage so to speak.
Personification allows for a dialogue to emerge where the patient is in control of how they want to portray the behavior (traits, appearances, what the behavior did for him/her) of their substance in a way that creates a safe holding environment. I work with the client to create a human persona around their substance of choice and in doing so, the patient can look at their own negative behavior with a bit of distance or some objectivity. With insight, most people with addictive behaviors will agree that "it" (the substance) is a relationship, not just a drug.
So I ask Jen, "If heroin were a person, who would it be?" "David," she replies, without hesitation. "Not Dave?" "No, David." She describes him as an Adonis like man, perfect in every way. So we begin to flesh out the relationship.
She shares that it was love at first sight. She fell hard and fast. David was always there for her (yes, at the beginning he was a big texter). She readily admits that she had never been treated so well. He was her ideal of perfection: he gave her warmth, and a feeling of connectedness - something she never felt before. He was there when she needed him. They were inseparable. When he went away, she longed for him, and his promises to return were always kept. At this point, David was there to give her pleasure, not mop up her pain.
Before David (heroin), she shared that her relationships with men left her feeling vulnerable. She was somewhat shy, suffered from low self-esteem and was dealing with an eating disorder since age fourteen. Others couldn't see beyond her quirky eating habits and her need to have sex in the dark. With David, she had confidence, energy, and never felt the same hunger she was tormented by in her eating disorder.
After several months, the relationship changed. Jen needed David more than he needed her. However, her love never wavered, it only increased. In relationship terms, she had to admit that she wasn't jealous when she found him in the presence of other women and men with the same attachment to this seeming Svengali. At one point she said, "Nothing mattered but David - I just needed what only he could give me." This is the point of her full-blown addiction when she sees how heroin took over her life.
It was around this time that David started asking her for money she didn't have. She very shamefully admitted that she got David the money however she could. This I knew because she originally presented with a legal issue. She stole money for David to be with him. He had her soul. Interestingly, in our sessions, her affect remained flat in her recount of her ever-increasing obsession with David and his demands.
Then there came the day, when David, using Jen's love for him, asked her ot sleep with other men in order to get money for him. She did it without question. She ended up sleeping with several drug dealers to give David money until one day she just couldn't anvmore. And that's they day that she drove her car away, homeless and on a mission to kill herself. Little by little, she had put aside a bag of heroin ata time until she thought she had saved up enough to overdose.
When she woke up, alive, she recognized that she could no longer do David's bidding and is now in the process of moving away from David. Jen fully embraced this personification, recognizing that she slept with dealers for him (heroin), stole money for him (heroin) and tried to die for him (heroin). To date, she is over two years clean and sober.
We don't always talk about heroin as David. But the work that we did allowed her to move away from any hint of 'euphoric recall.' It allowed her to work out how the drug seduced her into dire circumstances, to see what she did to obtain it, in a frame that was unfamiliar and yet just familiar enough. In creating David, Jen was able to symbolize aspects of other relationships in her life that have manifested themselves into her psyche.
Through her relationship with David, we were also able to look at how her rejection by other men left her with low self-esteem and how David did not. She saw that her life was filled with conditional love. Her mission was to find that long-desired acceptance. David asked no questions, in the end, he just was very needy - he had to be with her all the time.... or she would be very, very sick. That's what heroin does. You go into withdrawal and use more, you use too much and die or you get clean.
Heather, mid-thirties, has an eating disorder. She has recently rejected her 20- year relationship with "Luigi", a balding, out of shape "dude," who unapologetically wears stained wife beaters and talks with his mouth full. Luigi and Heather have lived side by side for all for most of her life. Despite her revulsion for his physical appearance, she knows what an important role he plays in her life: he is Vomiting.
He whispers into her ear the sweet nothings that only a binge/purge food-disordered person loves to hear: those crackers might as well have been a Big Mac, why did you eat five carrots instead of four?
When we discussed the idea of saying goodbye to Luigi, the anxiety it created for Heather was extremely heightened to the point of having to drop the line of inquiry. She needed him. Luigi was an integral part of "the plan." The plan, as we named it, was her overall eating disorder. In examining the nature of what past relationship Luigi might represent, she struggled. It was only when I asked what his voice sounded like? It was her mother who, as Heather began to realize, struggled with her own eating disorder, albeit one of yo-yo dieting and fad diets.
The discovery that Luigi was a facet of her mother opened up a new line of inquiry about her relationship with her mother and looking at her mother as an individual, not just as her "mother." In doing so, she was able to recognize that listening to Luigi was a continued version of obeying her mother. Even at thirty-six years old, she needed to please her mother, otherwise risk losing her affection. We concluded that her mother was a narcissist - one of the "I'm the most special victim” types. Heather saw that she was used as an attempt to meet the perfection her mother could not meet herself.
Once these concepts were integrated into our therapeutic dialogue, Luigi began to take the back burner in our sessions. Weeks then months would go by with no vomiting. Luigi was on the road out. He still pops up now and then in times of stress, but Heather has banished Luigi along with her dysfunctional relationship with her mother. In fact, when she recognized the Luigi/mother connection, she became more assertive in what she would accept from her mother's behavior; the more she gained control of her feelings and of how she interacted with her mother, the less Luigi was around.
What did David and Luigi do for my patients? They try to destroy them. In the analysis of that destruction, we are able to make a reference to past negative influences that perhaps lead them into substance abuse/eating disorder and then look at them though a different lens, one that is more familiar and easy to discuss. "I broke up with David because I was sick of his bad behavior" is much less anxiety provoking than "I was a heroin addict for two and a half years and sold my body and stole money, lived in a trap house to be closer to copping dope." The former allows the patient to flesh out all aspects of what the addictive relationship did to and for them in a non-threatening manner. While the shame and guilt of the latter statement is always in the room and is addressed throughout treatment, it doesn't impinge on the exploration of the reasons the addiction began, the impact of object relations or the underlying emotions/feelings that were being numbed by the addiction when the client personifies their addiction.
Addictions are relationships that exist in lives that can set precedence over human ones. It's interesting to look at just how these addiction relationships play a "role" in an addict's life. Once I asked a group of 10 people in an Intensive Outpatient Group, if when active, they would choose their drug over their partner? All of them said yes.
Authors note: A debt ofgratitude to my supervisor Dr. Nicholas Samstag for his knowledge and guidance.