As a trauma and addiction clinician and a person in long-term recovery from my addictions, I recognize my, and the clients I serve, need to answer the question “what is addiction?” I find that most people struggle with making sense of addiction initially because it is often paradoxical but when I share my perspective on addiction, people readily and agreeably understand. So, this led me to the question of “Can Addiction be Made Simple?” In my quest to answer this rather large question for myself, (before heeding Dr. Jamie Marich’s warning in her chapter “The Addiction Imperative” from Trauma Made Simple (2014) that she has seen many people go down as a result of chasing this answer), I found that simplifying addiction through philosophical understandings and reframing the psychological symptoms of addiction through a trauma-informed perspective offered the answer that addiction is a series of stuck memories i.e., trauma. As a result of this finding, it is clear to me that addiction and trauma are inseparable because they are a part of the same process.
As I began to better understand trauma and how the memory systems work in the brain and mind, I saw addiction present itself in a way that was relatable. I believe the journey I took to answer this question and the conclusions I have drawn will help others define addiction for themselves but also provide insight into how we conceptualize, categorize, and diagnose mental health disorders.
From a philosophical point of view, the question of “what is addiction?” revisits the age-old question, “Is the essence of human nature good or bad?” In the ever-telling pursuit of truth, the answer lies in the journey as the philosopher sits patiently and waits to have you quantify two extremes. “Who is asking the question?” the philosopher asks while waiting to observe a spark of enlightenment. Any two extremes exist in contrast to one another; hence they are a part of the same process. For example, night and day are relative to the observer and the truth of the answer lies in timing of the question. Pain and pleasure, an obvious example of opposites, are understood by reference to one another. This is illustrated in the Taoist concept of Mutual Arising and the Buddhist concept of Dependent Origination (Watts, 1975). Both of these concepts imply that you cannot have one without the other - if one ceases to exist, so does the other i.e., existence and non-existence must co-exist.
Here we enter into the paradox of addiction. What feels good is actually bad. The addicted person’s “choice” to pursue a course of action that is ultimately harmful isn’t logical! The person who is addicted and the outside observer understand addiction from different perspectives. Both understandings are right since the context of each perspective is important for shaping the ways in which we come to define, know, and treat addiction: The person who is in an addicted state is much more feeling or emotionally oriented, while the outside observer is more focused on the illogical nature of the outcomes. These are often the result of short-term vs. long-term thinking, hence adding to the dualistic nature of opposites.
Addiction’s Paradox in the Brain
These two perspectives come from different sides of the brain. The left side of the brain houses logical processes that use verbal language and the right brain houses emotional processes that use non-verbal communication (Siegel & Bryson, 2011). The different sides of the brain speak two different languages and represent the argument of “choice or disease.” The choice argument, associated with the logical or left side of the brain, is correct in saying that there is a choice in any behavior. But I had to ask myself, where does the brain get the information to make those choices? The answer lies in memory systems, which include our unconscious reptilian brain. The reptilian brain has one mode and primary function: survive by any means necessary and is only interested in short-term outcomes. Survival needs include staying alive in dangerous situations (pain) as well as ensuring that procreation happens (pleasure). The fact that pleasure is a survival need means that pleasure is a main motivator for addictive behaviors.
Survival mode fluctuates due to environmental stresses and stimuli, but also it is not alone in processing information. There are higher levels of brain functioning like decision-making processes that take place in the neo-cortex and mid-brain and with which the survival brain must communicate. However, when the survival brain is activated, it dominates the higher levels of functioning by controlling the information through regulation of the blood flow in preparation for fight, flight, freeze, or appease when a perceived danger or opportunity for pleasure is present. So, the innate drive to survive is what informs our decision-making process or “choice”, particularly when confronted with danger or our need to satiate with pleasure to ensure procreation.
So what are the physical and psychological symptoms of addiction (pleasure)? Intrusive reminders, dreams about the experience, mood irregularities based on whether or not the pleasurable experience is going to happen, strong emotions related to everything, and distorted beliefs about anything and everything… “Wait a moment, trauma, is that you? It is like I am looking in the mirror and it is me but not me.” “Yes. It is me, trauma. I have been hiding in addictive behaviors.” So, trauma and addiction are a part of the same process and that is why I say that addiction is trauma (in its positive form and relative to the observer). Conversely, I can also say that trauma is addiction but will have to save that twist until the end.
In order to see how addiction is traumatic, we have to see beyond the idea that addiction is a choice (which ultimately implies fault and produces the stigma of addiction) and the disease argument. These are not the only options. If we attempt to observe addictive behavior without the “addiction is a choice or disease” framework, what is happening? The body is being injected with poison, smoke is in the lungs, neurological systems are being physically stressed by being overloaded and flooded with neurotransmitters, or one is drowning oneself with something flammable – the survival of the organism is being threatened and it likes it. The body remembers experiences like chicken pox or environmental toxins because it might have to defend itself again, just like it remembers the addictive behavior and the effects of the behavior as means of survival. In this sense the body is practical and functional in performing this neutral action and as Deb Dana (2018) points out, the autonomic nervous system does not calculate “good or bad” it just performs its obligation to survival. With respect to understanding addiction as a disease, we must see how addiction behaviors produce trauma in the organism and create traumatic memory. At a symptoms level, active addiction is more reflective of Acute Stress Disorder (ASD) or Post-Traumatic Stress (PTSD), which boils down to unresolved traumatic memories (Shapiro; 2001, ver der Kolk, 2014; Ecker, Ticic, & Hulley, 2012).
Body and mind meet when memory is formed or accessed. Both the body and the mind access memories to guide their decision-making process and when these experiences are referenced; this is what informs the decision-making process. There are different types of memory and they perform different tasks with different responsibilities to help us get through the day. What in our understanding is not based on memory? Genetics, language, and the entire universe are all series of events, remembrances, and links in a chain connecting the present moment to the past. Both trauma and addiction create stress in the body and mind. Positive stress is still stress. Biological symptoms of addiction speak to withdrawal, cravings, and triggers but these can be understood as physical manifestations of PTSD symptoms because bodily operations and responses are a form of memory. Yet if there is a disconnect between the higher and lower functioning’s of the brain or the lateral exchange of logical and emotional content then there is going to be dysfunction. So, fundamentally addiction should be understood as a manifestation of PTSD. Moreover, Addiction and trauma can be understood as two poles on the spectrum of dissociation
Dissociation is the Relationship Between Addiction and Trauma
Van der Hart, Nijenhuis, and Steele (2006) cite Pierre Janet’s early observations from 1887 that dissociation is a “division of the personality or of consciousness” and that these include “systems of ideas and functions that constitute personality (2006).” In essence, dissociation is the process of disconnecting from the conscious or present moment due to a stress and acts as a defense mechanism for the “personality.” Both addictive behaviors and occurrences of trauma induce dissociation due to the impact on the state of consciousness that occurs during the response or act. The types of events and frequency ranges from a single incident to way too many to count, so they can be seen as on a spectrum as well. Ross (2013) sees PTSD as on a dissociation spectrum but does not identify addiction as on the spectrum of trauma-related dissociation. Yet Ross and others miss the point that the body is neutral when a toxin, which creates a trauma, invades the body, mind, and memory system. To include addiction on this spectrum, even if it is induced-dissociation (which I think that there is more to it then just that), means that we have a fuller picture of our pathology and of human behaviors like self-harm, sexualized behaviors, all forms of abuse, dependent issues, obsessive-compulsion, suicidal ideation, eating disorders, perfectionism, entitlement, abuses of power, and personality disorders.
I propose, as Ross suggests (2013), that trauma is really on a dissociative spectrum but I would also like to include addiction-induced dissociation because the impact is similar on the psyche i.e., Dr. Jekyll and Mr. Hyde as different aspects or parts of the personality emerge when under the influence. All addictive behaviors mimic existing states in the body and mind (Inaba & Cohen, 2007) and so dissociative states are going to be produced in addictive behaviors. This is why I believe that we should be focusing on trauma and dissociation when understanding, treating, or making addiction simple enough to understand.
Traumatology has provided a roadmap for categorizing mental health disorders. I feel that a better understanding addiction would lead to a similar understanding, i.e. would create more space for trans-diagnostic treatments. Over the past two decades, Traumatology and Trauma-Informed Care has greatly increased our understanding of trauma but has not identified one core ingredient as its cause. We still must ask, under what conditions do most traumas occur? I would suggest that our addictions (being in a state of trying to satiate unmet survival needs via harmful behaviors) are an answer to that question. Here we can see the intimate relationship between trauma and addiction, wherein addiction is a function of trauma, and the core ingredient of trauma can be understood in terms of addiction. This is why our human drama unfolds the way it does. We become addicted to our stories and our stories become addicting and create the traumas from which we can heal. At its core, our addictions are wants labeled as needs. The results of trying to get our mislabeled needs met, we creates trauma. Our addictions are traumatizing to society and culture and represent a major disconnection between our logical and our emotional world.
To make addiction simple, we simply need to look at it as if it were a trauma because they are a part of the same process. To redefine addiction in this light we see that it is the relationship between trauma and addiction that needs to be defined and determined whether or not it is healthy for ourselves. When we define addiction accurately and categorize it appropriately we find that it is traumatic and produce ASD/PTSD symptoms and dissociation. Luckily we have effective treatments for addressing both, we just need more clinicians experienced in treating all three.
Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. New York, NY: W.W. Norton & Company.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.
Inaba, D., & Cohen, W. (2007). Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Sixth Edition, Medford, OR: CNS Publications, Inc.
Lanius, U., Paulsen, S., & Corrigan, F. (2014). Neurobiology and treatment of traumatic dissociation: Toward an embodied self. New York, NY: Springer Publishing Company.
Marich, J. (2014). Trauma made simple: Competencies in assessment, treatment and working with survivors. Eau Claire, WI: Pesi Publishing & Media.
Ross, C. (2013). Structural dissociation: A proposed modification of the theory. Richardson, TX: Manitou Communications, Inc.
Siegel, D., & Bryson, T. P. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Bantam Books Trade Paperbacks.
Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York, NY: Guilford Press.
Watts, A. (1975). Tao: The watercourse way. New York, NY: Pantheon Book.
Adam O'Brien LMHC, CASAC (EMDRIA Approved Consultant through ICM) - is a Licensed Mental Health Counselor and Credentialed Alcohol and Substance Abuse Counselor in New York State. He is in the certification process to become a Certified Expressive Arts Therapist with Dr. Jamie Marich. Located in Chatham (Albany/Hudson area) where he maintains a private practice. In his writings, he is actively seeking to destroy the stigma of addiction.
One of the great blessings of my life is to have a Jewish mother and a Jewish family in Squirrel Hill. When I heard the news of last week’s massacre at Tree of Life Synagogue in Squirrel Hill (the hub of Jewish life in Pittsburgh, Pennsylvania), I was in Montana leading a clinical training in EMDR therapy, the trauma modality that brought Sharon Saul—my Jewish mother—and I together. Although the news revealed to me that the synagogue attacked was not Sharon’s, it is in close proximity to her home in a community that is very tightly knit. Until I was able to get to Squirrel Hill myself on Tuesday morning and give Sharon a hug, something was unsettled within me. Although Sharon and I remained in touch via text and telephone after she turned hers back on following Shabbat, seeing her was the balm my soul needed. In our communications, she relayed the multiple messages defining the vigils and prayers she attended: The answer to combating all of this hatred is to fight the darkness with light, and to increase our acts of goodness and kindness.
The connection that Sharon and I share is an example of how two very different people can unite in a spirit of goodness and kindness, which is why I feel led (with Sharon’s blessing) to share our story. On Thursday night we sat in her home, a place that's become a haven to me over the years when I offer trainings in Squirrel Hill (about an hour and a half from my home base in Ohio). We were both awestruck by the workings of HaShem in bringing us together. HaShem is a Hebrew name for G-d (literally meaning "The Name") that I’ve come to use in many of my references to Divine presence. Our friendship is, of course, a beautiful Institute for Creative Mindfulness story which is why I’m posting it on our blog. I hope others may also draw some inspiration from our message and our story.
I first met Sharon in Monroeville, Pennsylvania sometime in 2013. I was still working the national circuit for PESI, an educational company, teaching general trainings on trauma-informed care. In this 2-day course, presenting a live clinical demonstration in eye movement desensitization and reprocessing (EMDR), my method of choice for treating trauma-related concerns, was part of the syllabus. As I did dozens of times before and have done hundreds of time since in my teaching, I asked for a willing volunteer for the demonstration, inviting them to come up and see me over break for screening. This lovely, traditionally dressed woman raised her hand immediately. During our screening, as we talked about her background and the issue she’d like to work on, Sharon revealed that she is an Orthodox Jew. Although she seemed to be connecting to what I taught in the course, I experienced a bit of an internal struggle, wondering if someone so traditional would respond to what I had to offer. I’d long identified as rainbow flag-waving tattooed rebel dismissive of most things connected to organized religion or anything traditional. Yet something inside told me immediately that I loved this woman and her willingness, and I was delighted when Sharon responded so well to her work in the demonstration.
Afterwards, in amazement, Sharon declared, “I have to learn this!”
She went on to explain her frustration that every EMDR training she ever found took place over the weekend which would not work for her as an Orthodox Jew. Specifically, Sharon is a Hassidic Jew in the Chabad-Lubavitch movement with a strict adherence to Shabbat observance. Training over a weekend just wasn’t an option for her, even though other folks from religious traditions have missed weekend services before to come to trainings. Sharon began traveling to Ohio to learn from me as I developed my initial training models and ideas around teaching EMDR therapy, expressing only gratitude that she was able to engage in this study during the week and in a mindfully delivered, intuitive way that matched up with her almost forty years of experience as a hypnotherapist. The more she studied and consulted with me, the more I began to trust her as a clinician and to truly love her as a person. The questions she asked helped me to grow as a clinician, and I developed an even deeper sense of wonder about Jewish faith and traditions.
In 2015 when I became officially approved by the EMDR International Association to offer basic trainings in EMDR therapy, Sharon immediately courted me to come to Squirrel Hill where she practiced and lived. She said something like, “I can get you every Orthodox therapist in Pittsburgh to come to the training if you can offer it during the week.”
When one of Sharon’s colleagues first met me, I got the once over, punctuated with the commentary of, “You’re the Jamie, Sharon’s teacher? You’re so young!”
Although I’ve gotten my fair share of the “you’re so young,” comments throughout my career, this one did not impact me with any insult. Rather, it helped me to understand why I respect Sharon so much. She is constantly willing to learn something new, especially from those of us in the younger generations. I watch how her grandchildren teach her new ways of seeing the world, and I hope that I can emulate this spirit of hers to constantly be a learner as I grow up into the example she is setting. And although I started as her teacher, it’s safe to say that we have both been each others’ teachers as our friendship has grown.
Coming to Squirrel Hill to train was a good fit for all of us—for Sharon’s community of clinicians in the neighborhood and for the growing Institute for Creative Mindfulness wanting to establish a base in Pittsburgh. When I visited Squirrel Hill for the first time, some tears filled my eyes. There are moments here when I feel like I’m in Eastern Europe, where I spent a great deal of late teens and early twenties studying and working, primarily in my ancestral homelands of Croatia and Bosnia. There’s just something about the vibe of Squirrel Hill and its Jewish soul, beautifully blended with other cultural influences in the container of Pittsburgh, its own cultural wonder, the visceral epicenter of our region’s heartiness. Something magical happens here at this area around the intersection of Forbes and Murray Avenues. In the past three years I’ve adored working with the people of Squirrel Hill and I enjoy spending time here with both friends and Sharon’s family. Sharon has always taken great care to assure that a guest bedroom in her home that is set up to accommodate her large family for holidays is always ready for me when I come to town. I typically stay in one of the basement guest rooms and sleeping down there feels like I’m in a warm cave being blanketed by an entire house that’s full of tradition and love. I’ve said for several years now that Squirrel Hill is truly my second home.
Sharon has seven children and a slew of grandchildren (I can never keep count). I’ve had the privilege to get to know many of them and their spouses, including one of her sons who is now a budding therapist and has trained with me. I attended the wedding of her youngest son and considered it the greatest honor ever when Sharon began caring for me in a way that led her to declare, “I’m sorry, I can’t turn off the Jewish mother in me.” The first time is when we were leaving her house in Squirrel Hill—it was a rainy morning and we were crossing the street to my parked car, on our way to the training site. A car came unexpectedly whizzing down her street and she brought out the infamous “mom arm” to protect me. Later that year, Sharon and I roomed together at the EMDR International Association conference in Minneapolis. While I’ve enjoyed a wide array of roommate experiences as I’ve traveled for work over the years, Sharon’s attention to detail in making sure I didn’t forget things and that I had a sounding board for things going on at the conference warmed my heart. She once again said something like, “I can’t turn off the Jewish mother,” and I thought to myself, “Nor do I want you to.”
My entire life I’ve struggled with feeling accepted by the people closest to me, especially in my family of origin, because my beliefs and way of being in the world is so different from their traditional (Christian) views. Sharon’s acceptance of me, even as a religious woman, includes a full embrace of my soul and my questions, even when we disagree on certain approaches to life, faith, and identity. While I wish that more devout people from all faith traditions would learn from Sharon’s example of acceptance, knowing her gives me hope that the healing power of what St. Benedict called radical hospitality is possible. Sharon’s willingness to bring me around her family and feel the warmth of their friendliness and the candidness of their interactions with me—even though they are all religious and I am more of a liberal hippie, “spiritual but not religious” type makes me know in my bones that we all have more in common than not. Knowing Sharon Saul and having her as my Jewish Ima (mother) is nothing less than a corrective experience in attachment. And it’s restored my faith that getting to spend substantial time with people from faiths and cultures other than our own is a big part of the answer to bringing about the healing of the world.
So, it’s little wonder that I wanted Sharon to join our Institute for Creative Mindfulness team as both a consultant and a facilitator as soon as she was eligible. In the midst of this Squirrel Hill tragedy she referred to EMDR therapy as “God’s tool for healing,” and I cannot disagree! She is a fabulous educator and mentor and serves our EMDR trainees well. Sharon is responsible for building enthusiasm about EMDR therapy in Squirrel Hill, working very hard to find us good spaces to train during the week. So many of the therapists we have trained here are now on the front lines of working with the community this week and will be in the coming weeks as the people of this neighborhood seek answers and healing.
But even if Sharon didn’t work with me in this professional capacity, I would still want her to me my friend… and of course, my Jewish mother. Even in the midst of debriefing her own experience of this week’s tragedy with me, Sharon still offered me spiritually on point advice about my own love life and my career path, as any attuned mother would. As we sat together the other night in our moment of awe at the Divine dance that brought our lives together, it dawned on me that a friendship like ours and everything it represents is the answer to the madness in which we find ourselves in this modern world. This isn’t something, even as a writer, that I can put elegant syllables together to explain. I simply challenge you to experience it if HaShem ever gives you the chance, because HaShem will.
In her infinite, faith-filled, maternal wisdom Sharon declared, “HaShem, you have a view of the bigger picture. I trust you when I can only see the parts of that bigger tapestry.”
Sharon and I both had the opportunity to do trauma response work this week in Squirrel Hill and were amazed at how this tragedy is bringing other things to the surface for people that have long needed healed. This poses, once more, the age old question: Is tragedy’s hidden gift the sparking potential it holds to stir us into action, first within ourselves and then in our communities? The idea of changing the world can feel overwhelming and impossible, especially with the hopelessness and hatred that seemingly paralyzes our existence. Perhaps the real answer is to heal ourselves and then make a difference on a one-on-one relational level, as Sharon and I have done with each other. When the small pearls of these healings and interactions string together, we create a valuable and beautiful force that will transform the world.
After working together today at the Jewish Community Center here in Squirrel Hill Sharon continued with her teaching for me that began the night before on the importance of the bigger picture: “It just feels like the redemption really is at hand and all of us good people doing all the good we can and all the healing we can it’s our job to just tip it. It feels like we’re almost, almost, almost there.”
Institute for creative mindfulness
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