The National Survey on Drug Use and Health reported that approximately 20% of persons battled a substance use disorder in 2017. Further, 74% of those persons also struggled with an alcohol use disorder. It is estimated drug abuse and addiction cost American society more than $740 billion annually due to healthcare expenses, crime-related costs, and lost workplace productivity. These statistics might alert any person to the relevancy of alcohol or substance abuse in day-to-day life, even when you believe it does not affect you or a loved one directly.

There are many evolving and developing psychological theories that attempt to explain substance abuse. Substances (e.g., marijuana, alcohol, heroine, cocaine, methamphetamine) can serve as effective, accessible and quick agents of relief that provide warm, numbing, exciting, and/or other wholesome feeling states. Morgenstern & Leeds (1993) and Khantzian (2003) surveyed a number of explanations for substance abuse and outlined four primary hypotheses:

1. Substance use serves to liberate an addict from painful and condemning feeling states (i.e., rage, despair, rejection, emptiness, sadness, anxiety) that might otherwise be relieved from internal coping resources.
2. Addiction services to make up for an impaired self-concept, and to fill gaps in how one regulates or protects themselves (i.e., self-medication). Therefore, the role of substances is to fill a gap in one’s ability to care for oneself on an emotional level.
3. Persons who abuse substances view their emotional world as foreign, not having a capacity to name, express and endure complex feelings. This disconnect from the emotional world (i.e., alexithymia) sponsors a struggle to tolerate powerful emotions, thus leading to efforts to sedate or rapidly discharge them by way of alcohol or drugs.
4. Substance use functions in a similar fashion to eating or obsessive-compulsive patterns whereby when one is overwhelmed, instead of becoming aware of feeling angry, anxious, guilty, etc., addicts disperse distressing feelings by way of a substance that either dampens the pain of, or takes them outside of, emotional reality.

A primary theme within these theories is the use of alcohol and/or substances to defend against painful, intolerable feeling states. What is less readily identified within these theories, but is nonetheless paramount for recovery, is the addicts ability to internalize that a supportive, reliable and durable social network is nearby and accessible to them when needed. This feature of recovery is a primary feature in Alcoholics/Narcotics Anonymous groups (e.g., support group, sponsor). Psychotherapy might also serve to aid in this process, alongside these support networks. Psychotherapy of substance abuse tends to focus on enrolling the addict in a supportive-expressive alliance with a therapist who is positively interest, curious and compassionate when facing the addict’s emotional world (Luborsky, 1984; Gibbons et al., 2012; Carlson et al., 2016; Crits-Christoph et al., 2008). This capacity to “sit with” the addict throughout their misery sponsors a sense of trust and faith in others that, over time, is internalized as trust and faith in one’s ability to tolerate his/her own discomfort. Many psychotherapies centralized this aspect in their work with those who struggle with substance abuse, including adolescents (Lewis, 2020).

Most persons who engage in habitual use of substance may reasonably want the pain to stop. Although their scars might not be readily accessible to the human eye, a collaborate relationship with a psychotherapist might aid in fostering capacities to tolerate, name, and regulate painful feeling states. If you or a loved one endures a substance abuse issue, please consider consulting with the clinicians at Town Center Psychology. You are not alone!

References

Carlson, L. E., Beattie, T. L., Giese-Davis, J., Faris, P., Tamagawa, R., Fick, L. J., Degelman, E. S., & Speca, M. (2016). Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer, 121, 476-484. doi: 10.1002/cncr.29063

Crits-Christoph, P., Gibbons, M. B. C., Gallop, R., Ring-Kurtz, S., Barber, J. P., Worley, M., Present, J., & Hearon, B. (2008). Supportive-expressive psychodynamic therapy for cocaine dependence: A closer look. Psychoanalytic Psychology, 25, 483-498. doi: 10.1037/0736-9735.25.3.483

Gibbons, M. B. C., Thompson, S. M., Scott, K., Schauble, L. A., & Mooney, T. (2012). Supportive-expressive dynamic psychotherapy in the community mental health system: A pilot effectiveness trial for the treatment of depression. Psychotherapy, 49, 303-316. doi: 10.1037/a0027694

Khantzian, E. J. (2003). Understanding addictive vulnerability: An evolving psychodynamic perspective. Neuro-Psychoanalysis, 5(1), 5-21. http://dx.doi.org.portal.lib.fit.edu/10.1080/15294145.2003.10773403

Lewis, A. J. (2020). Attachment-based family therapy for adolescent substance use: A move to the level of systems. Frontiers in Psychiatry, 10, 10. http://dx.doi.org.portal.lib.fit.edu/10.3389/fpsyt.2019.00948

Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. Basic Books.

Morgenstern, J., & Leeds, J. (1993). Contemporary psychoanalytic theories of substance abuse: A disorder in search of a paradigm. Psychotherapy, 30(2), 194-206. http://dx.doi.org.portal.lib.fit.edu/10.1037/0033-3204.30.2.194