Institute of Imaginal Studies
Drug and Alcohol Abuse
Vladimir Huber, August 1999
1.The most common models of addiction are:
We can view the models of addiction in two basic ways, as mentioned by Darryl Inaba in «Uppers, Downers, All Arounders,» and Stephanie Brown in «Treating the Alcoholic.»
Inaba groups them in three basic models, such as the:
Addictive Disease Model
«This model maintains that the disease of addiction is a chronic, progressive, relapsing, incurable, and potentially fatal condition that is mostly a consequence of genetic irregularities in neurotransmitters, enzymes, and brain tissues which may be activated by the particular drugs that are abused.» 1
This theory places a stronger value on heredity instead of environment for the uncontrolled, compulsive drug use, stating that people with special hereditary characteristics react differently than the rest of the people to the same drug or life experience.
Under this model, the definition of addictive disease comprises the following:
• impulse drug abuse, intoxication, great need to continue use;
• drug takes over willpower of the user;
• attempts to control abstinence fail, and back to compulsive use;
• substance abuse creates physical, mental, or social problems, yet behavior continues;
• problems with the law, at work, relationships, blackouts, or some other disabling or impairing conditions.
Behavioral / Environmental Model
«This theory emphasizes the overriding importance of environmental and developmental influences in leading a user to develop addictive beahavior.»2
Based on several studies, this theory states that environmental factors affect our brain chemistry, mentioning that peer pressure, abuse, anger, and other environmental factors produce physical/emotional stress may promote the use and abuse of drugs. One example is that chronic stress may decrease the brain levels of met-enkephalin (a neurotransmitter) in mice. This makes the normal alcohol-avoiding mice more prone to alcohol use.
The behavioral/environmental model emphasizes the six levels of drug use: abstinence, experimentation, social/recreational use, habituation, abuse, and addiction.
«In this model, addiction occurs when the body adapts to the toxic effects of drugs at the biochemical and cellular level. The principle is that given sufficient quantities of drugs for an appropriate duration of time, changes in body/brain cells will occur which will lead to addiction.»3
This process is characterized by four physiological changes:
• tolerance: there’s an increase in the resistance to the drug’s effects, which creates a need for larger and larger doses;
• tissue dependence: there are actual changes in body cells due to excessive use, creating a dependence on the drug by the body in order to stay in balance;
• withdrawal syndrome: if the drug intake is stopped, there are physical signs and symptoms of tissue dependence;
• psychic dependence: the user wants to repeat the effects of the drug, and these effects reinforce the desire to continue using the drug.
On the other hand, Stephanie Brown’s, «Treating the Alcoholic» has similarities with Inaba’s view of the models, yet the grouping is different. I wonder if some of the differences might be due to the difference of the actual substances, since Inaba is talking about all types of addictive substances, when Brown is only talking about alcohol.
Brown mentions six models, and they are based on Kissin’s (1977) work.
1. Medical Model
This model «is based on the disease concept and therefore designates the physician as the primary therapist.»4 It emphasizes biological mechanisms, without paying much attention to psychological or sociological factors. The use of tranquilizers and medications play a key role.
Behavior Modification Model
«It emphasizes conditioning principles, both in understanding the development of alcoholism and its treatment.»5 In the treatment, this model includes behavior modification therapy, aversive conditioning, and positive reinforcement behavior modification.
Even though in this model Brown emphasizes the subconscious conflict, based on Kissin she includes aspects of the «alcoholic personality,» concepts such as social psychiatry, «the alcoholic’s immaturity, inadequacies of personal and social relatedness, and an unwillingness to face reality.»6
Psychological dependence is the result of social forces, which are the key to this model. Kissin also includes «socio-economic status, ethnicity, subcultural mores, and elements of family intercation.»7 As one of the main factors in the success of AA, Kissin mentions peer approval, and how it has been incorporated into treatment programs.
Alcoholics Anonymous Model
Even though it is not a formal model, Kissin considers it since «it is one of the major treatment systems.»8 Kissin’s purpose is to understand this system and see who are its best candidates.
It emphasizes the validity of the previously mentioned models, promoting the idea of carefully selecting a model and a treatment to fit each individual.
I’m not sure about this definition. I don’t quite understand if it is saying that it will use a variety of models to choose the best parts of each, and then put them all together to treat an individual, or if it will use only one model, the one best suited to a particular individual. I would prefer the first option, which I would call the Eclectic Model.
I agree with Brown when she mentions that all the models are inadequate, such as focusing on the drinking alcoholic, while ignoring abstinence and recovery. Also, seeing the addiction as static, instead of following a progressive path. The main inadequacy for me is that all the models are based on traditional medical, psychological, and social theories, without considering the archetypal influencing of our desires, which I see as the basis of addiction. More of this, on question #5.
2. Admitting powerlessness is essential to AA philosophy.
Because that’s the basic principle of the 12 steps of the AA program, to surrender to a Higher Power, since so far, everything the alcoholic has tried, it just hasn’t worked. Therefore, the power comes from above, not from humans, but from God, according to AA.
On page 59 of the Big Book, the Basic Text for Alcoholics Anonymous, AA states the 12 steps, which are:
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God, as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
Made direct amends to such people wherever possible, except when to do so would injure them or others.
Continued to take personal inventory, and when we were wrong, promptly admitted it.
Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
In giving up human power, the AA members accept God’s power. The basic belief is that humans, most likely, are not able to solve the alcoholic addiction the person suffers, since that person tried many ways and all have failed, so the only recourse left is a non-human intervention, and that can only happen if the alcoholic is humble enough to accept powerlessness, to surrender to God.
3. The ways that an individual’s family can interrelate with the genesis, assessment and treatment of substance abuse disorders (including relapse).
In general, the emphasis is placed on the individual who is considered alcoholic. The other members of the family, unless they are also alcoholic, they are usually not referred to therapy, AA, Adult Children of Alcoholics or any other type of treatment. This is a great mistake, since the whole family is subjected to the behavior of the alcoholic individual, therefore, they are all members of an alcoholic family.
The idea is that only the alcoholic should get better, yet the whole family has a common trait among members of alcoholic families, and that is codependency. Drs. Gay and Kathlyn Hendricks —with whom I studied— in their book, Conscious Loving, page 7, express that the dictionary does not have yet a definition for codependency, but it does have several meanings for dependent. They say that according to Webster’s New World Dictionary, dependent means (1) hanging down, (2) determined by something else, (3) relying on for support, and (4) subordinate.
Drs. Hendricks also state that the first definition, «hanging down» is particularly important, since depression is intrinsically related to codependency. In terms of relationships, they are actually entanglements. They add that it is like a net from which escape is difficult, which limits the freedom of those who are entangled.
Even though an alcoholic family is a painful experience for every one of its members, somehow all of the members are collaborating in the perpetuation of the destructive patterns that make that alcoholic family, as Brown states in chapter 8.
Some decades back, the spouse and the children of an alcoholic were not considered as candidates for treatment, yet times are changing, and now all of the family members are usually referred for one or another type of treatment.
The term «alcoholic family» refers to the family in which alcohol is the organizing principle, as Brown states. The other main ingredient is the denial of this characteristic.
Many of the people who seek therapy for a variety of reasons, such as marital difficulties, depression, anxiety, career problems, and so on, might have a common root cause, and that is to have grown up in an alcoholic family. Until that cause is acknowledged, the therapy work might remain at a superficial level, bettering certain symptoms, yet not grasping the cause of the problems.
Also, the active alcoholic might have grown up, as well, in an alcoholic family, which is possible he might deny, just like his children do about him and the whole family situation. Until he accepts this reality, his treatment won’t advance much towards his recovery and healing.
The spouse goes through dramatic changes as the progression of the alcoholic’s behavior also changes. The spouse might try to cover-up his behavior, yet it could reach a point when there’s no room for covering-up. Then, she must confront the harsh reality that her husband is alcoholic, that she was covering-up for him, and that maybe, as it often happens, her father was also alcoholic, and she just didn’t want to admit it to herself, out of fear of destroying the memories she had of her father, as Sandra tells her story on page 258 of Brown’s book.
Once the family has come to terms with the addiction, and hopefully the treatment gets started, it’s important that not everybody is treated equally, since each member of the family might be affected in his/her own way. It also depends on the amount of damage in its various forms caused to each of the family members, such as abandonment and physical, emotional, and sexual abuse, to name a few.
AA now has centers around the country, and also in many other countries, where people who grew up in alcoholic families may attend, called centers for the adult children of alcoholics (ACA). For the teenagers, AA has groups such as Alateen, yet the younger children might have to attend child therapy, as a way to heal the wounds caused by the years of neglect and abuse. Still, it is considered a positive measure if the members of an alcoholic family attend these groups while also going to individual therapy.
When the spouse, and sometimes, the children, acknowledge the alcoholism, they greatly suffer of guilt, since they have come to terms with a situation they didn’t exactly want to be in, yet they were forced by the circumstances. The spouse feels lonely, since they have abandoned the role of victim and savior. Now they have to acquire a new role in their lives, which they might not be sure as how to go about. They are in uncharted territory. They tend to move back and forth between the old and the new visions of reality, accepting and abandoning their newfound strength to face their new reality, having given up denial.
In terms of relapse, it is something that affects the whole family, each member in his own way. Usually a sense of overconfidence can cause the alcoholic to return to drinking. One of the drugs prescribed as a prevention of relapse is Antabuse, which causes nausea if the person drinks while taking the drug. In order to avoid the nausea, the person must not take Antabuse for three days. It requires a desire on the part of the alcoholic to stop drinking, so he’ll continue taking the medicine.
The more the family members are willing to do their own internal work, the easier it is for the whole family, including the alcoholic, to gradually heal the wounds that caused the addiction in the first place. Of course, like in any type of growth, there are moments of fear of the new reality, since it is a new experience. The members of an alcoholic family know pain and shame, despair and depression well, so when the new reality starts coming into their lives, they might become apprehended, and that’s what George Leonard in his book, Mastery, calls homeostasis, in reference to the physiological process that tries to restore normalcy to the physical body. In the same manner, each member of the alcoholic family might try to restore «normalcy,» the old way of life, in their individual and collectives lives, since the old way is something they know well. Yet, hopefully, through the treatments and the support groups, they might gradually accept the new reality, accepting the healing is taking place in their lives.
Physiological mechanisms of tolerance and withdrawal. The role they play in addiction. Some people develop tolerance and withdrawal to drugs without developing an addiction.
The basic physiological concept is that the body considers any drug is placed into it as a toxin, so several organs, mainly the kidneys and the liver, will try to get rid of it in order to avoid any harm to the body. When the use continues, the body doesn’t react in the same manner, since it is becoming used to this foreign substance, which no longer considers so foreign. Due to this adaptation of the body, the user has to take larger amounts of the drug to get the same effect.
This is related to the homeostasis process mentioned in the previous question.
There are seven different kinds of tolerance, according to Inaba’s Uppers, Downers, All Arounders, on page 54.
1. Disposition Tolerance. It takes place mainly with barbiturates and alcohol, when the body speeds up the breakdown (metabolism) of the drug, to eliminate it. Due to this reaction, more of the drug is necessary to reach the same kind of intoxication.
2. Pharmacodynamic Tolerance. With opioids, more receptor sites are generated by the brain, producing its own antagonist, cholecystokinin. The Pharmacodynamic Tolerance takes place when the nerve cells have become less sensitive to the effects of the drug.
3. Behavioral Tolerance. The person learns to change the regions of the brain being used depending on the occasion, such as appearing sober when stopped by the police, yet drunk again a few minutes after the police are gone.
4. Reverse Tolerance. The trend to become more tolerant to the drug is reversed due to aging or tissue destruction, such as liver tissue, in the case of alcoholics. The raw alcohol is passing through the body time and again, since the liver with cirrhosis is not metabolizing (breaking down) the alcohol.
5. Acute Tolerance (tachyphylaxis). It’s an instant adaptation on the part of the body to a drug, such as tobacco, which starts with the first puff.
6. Select Tolerance. Even though the tolerance to an emotional high increases, the tolerance to the physical effects also increases, yet at a very different rate. That’s why the amount of drug needed to achieve an emotional high comes closer to the lethal dose of the drug. With each drug, the tolerance rate is different.
7. Inverse Tolerance (kindling). After a long time of getting a minimal effect from the drug, all of a sudden the user gets an intense reaction, due to brain chemistry changes.
The withdrawal symptoms can be very painful, emotionally and physically, since the body is trying to adjust to the big change of not receiving a substance that got used to receiving. The use of that particular drug has created tolerance and tissue dependence. All the changes the body created to support the constant presence of that substance, all of a sudden are no longer necessary, yet they are still present, so the body tries to restore its original balance, producing emotional and physical changes, such as aches, pain, insomnia, vomiting, cramps, diarrhea, cold sweats, and sometimes, convulsions and hallucinations.
Some users continue using the drug as a way of avoiding the painful physical and emotional experiences of the withdrawal symptoms.
In terms of tolerance and withdrawal without addiction, it depends on the emotional and physical condition of the person. For example, the levels of use have a lot to do with it, such as the amount, frequency, and duration of the psychoactive drug use. Let’s say that the drug is alcohol, and that somebody has been drinking a six-pack of beer (amount), as Inaba states, twice a week (frequency) for 12 years (duration), yet without developing any problems. On the other hand, another person might only drink on Fridays, yet he doesn’t stop until he passes out. The second person might have more problems with the law, health, and money situation, and I would add, family, as well. He seems to be avoiding issues in his life, so he «needs» to pass out. The emotional component is more difficult for the second person, therefore, the possibility of emotional addiction appears greater in the second man than in the first one.
The first person might still develop some symptoms of tolerance and withdrawal at the physical level, yet his emotions might not be much affected if he stops drinking, therefore, without having significant emotional symptoms.
The thinking regarding prevention of substance abuse. The role awareness of archetypes plays in prevention.
Drug and alcohol use has changed throughout the times, and this depended on the culture of the country, and sometimes, on the culture of the region. Often, too, religion has played a big role in determining the attitude towards the use of mood-altering substances. For example, during the years of Prohibition in the U.S., it was illegal to sell alcohol, so there was a big illegal trade, usually controlled by crime syndicates, distributing alcohol throughout the U.S. territory. This relates to the Puritan vision of life and its activities related to recreation. Still today, in the areas in Utah where there’s a great Mormon presence, it is difficult to find alcohol, due to the opposition of this religion to its use. Something similar happens in areas of Pennsylvania and other parts of the country.
Prevention has also been promoted through government campaigns, by using the media in all of its forms, as well as private and public schools, educating the children on the evils of substance abuse. They usually haven’t scared enough the children, since drug use is at an all time high.
Together with media campaigns and education, law enforcement has played a big role in drug seizures, as well as the legislatures, at the state and federal levels, increasing the penalties in money to be paid and time in prison to be done by the ones who break the law.
Most of the people in prison are there due to drug charges. Prisons have become so overpopulated that sometimes judges order large numbers of prisoners to be released, since there’s not enough room for them. Usually the non-violent ones are released, in order to make room for violent ones coming in. The government has run out of space and money to house all the prisoners, so they have turned to the private sector. Private companies have built and now run government prisons, for a charge. Prison construction is a booming business.
There’s no solution to the drug abuse problem in this country, if enforcement of the law and scare tactics is the only way to promote abstinence from drug use. Culturally, we don’t have a way to satisfy the archetypal desire to go into the imaginal, since most rituals, if any, have been stripped from our cultural practices. One of the few rituals created in our culture is shopping, to the point of people becoming shopaholics, and groups supporting those addicted to shopping have been created.
Other cultures have rituals in which the community shares a moment, or sometimes, days, during which they invoke the presence of allies, ancestors, deities, and other entities who support the community, helping it to come together, as a way of reminding themselves that they are a group of people with a common purpose. During these rituals they contact the limits of the material world and beyond, through different practices, most alien to the White Western culture. These practices, beyond satisfying the archetypal need for going toward the imaginal, also promote a sense of community, which is totally necessary for us as individuals and as a group, since we are social beings, with a deep need for belonging.
The isolation of the individual in this culture, due to the overemphasizing of being independent, as well as the promotion of happiness by the acquisition of material possessions, has rejected any type of creative, spiritual, and healing practices that could heal the wounds promoted by isolation. The purpose is to create a union among the people of different cultural, spiritual, and religious backgrounds, to join forces for a common purpose. In this case, the goal is to help those with an addiction to reintegrate themselves to a productive life.
Until we decide to come together as one people of different beliefs, and racial, ethnic, religious and socioeconomic backgrounds, we won’t be able to diminish the pain that drug addiction is causing in our society. By creating community, accepting our differences as a gift to us all, and going for the imaginal, we will be healing the wounds left by centuries of hurting one another through isolation and fear of relating at a deeper level.
The present attitude towards drugs can’t succeed, since it is fighting nature, the archetypal desire towards the imaginal, the sacred belief that there is something more than the material world in front of our eyes.
1. Inaba, Darryl; Cohen, William; Holstein, Michael. Uppers, Downers, All Arounders. CNS Publications, Inc., p. 66.
2. Ibid., p. 66.
3. Ibid., p. 67.
4. Brown, Stephanie. Treating the Alcoholic. John Wiley & Sons, Inc., p. 5.
5. Ibid, p.5.
6. Ibid, p.6.
7. Ibid, p.6.
8. Ibid, p.6.