In this article Dr. Amen helps you take a look at the biological, psychological, social, and spiritual issues that could be contributing to your addiction.
The Four Pillars of Addiction and Healing: a Bio-Psycho-Social-Spiritual Approach
Simple answers are not sufficient. It’s never just one thing.
Maria, 47, had always enjoyed a couple of glasses of wine with dinner. The mother of three felt it helped her relax after a busy day shuttling the kids to school, soccer practice, tutoring sessions, and piano lessons. When Maria turned forty-nine, her mother-in-law was diagnosed with Alzheimer’s disease and moved in with the family. That’s when Maria started having a glass of wine while she prepared the evening meal and then another couple glasses with her meal. Over time, she noticed that almost the entire bottle would be gone before she finished making dinner and then she would polish off another half bottle or more with dinner. She never felt drunk or out of control so she didn’t see it as a problem. When her husband expressed concerned about her drinking, Maria admitted she was drinking more than she used to but blamed it on the added stress of having her mother-in-law in the house.
Rita, 33, hated the way she looked. Since high school she had been a binge eater, and the late-night refrigerator raids had added about ten pounds a year to her five-foot-three-inch frame bringing her to her current weight of 270 pounds. But Rita didn’t feel like there was anything she could do about her weight—after all, nearly all of her relatives were obese. “It’s my genetics,” Rita would tell herself. “I’m doomed to be fat forever.”
R.J., 20, wanted to get into the best law school, but his grades at college weren’t quite good enough so he started taking his friend’s ADD medication Adderall to help him focus and be more alert. It allowed him to stay up all night and his grades improved. But the drug gave him the jitters and he eventually started taking prescription sleeping medication or drinking excessively when he wanted to calm down. Eventually he was hooked and blamed law school requirements for his addiction.
Jake, 37, owned a large Internet company when he came to the Amen Clinics for addiction to alcohol and cocaine. Jake had always been focused on making money… and lots of it. It was the only thing he lived for. When his company took a downturn when the economy slumped, he felt like a failure and turned to cocaine and alcohol. The hard-charging entrepreneur was certain that his financial problems were the cause of his addiction.
Maria, Rita, RJ, and Jake all have something in common besides having addictions. They were all searching for simple answers to explain why they had become enslaved to their behavior. But when it comes to addiction, there usually are not simple answers. Rarely can we blame addiction on one thing. There are usually a number of factors involved.
For Maria, the problem wasn’t just her mother-in-law. Her husband had just been diagnosed with a recurrence of cancer, her mother was getting a divorce, and her best friend had a brain tumor. Plus, she had started experiencing the effects of perimenopause—hot flashes, night sweats, and fluctuating hormones that increased her feelings of anxiety and irritability.
In Rita’s case, genetics weren’t the sole reason for her weight issues. Lying to herself about why she had been binge-eating for fifteen years was a big part of the problem. Low self-esteem, low thyroid levels, and sexual abuse when she was a teenager also contributed to the problem.
RJ blamed his addiction on the fact that he needed to get better grades to get into the law school he wanted to attend. But the fact was that many other social and work obligations were taking too much time away from his schoolwork. He spent about thirty hours a week working as the editor of his college newspaper, devoted at least fifteen hours a week to a student political organization, was taking a double class load in an effort to graduate in three years instead of four, was dating three different girls, and liked going partying all night with his fraternity brothers. In addition, he was trying to live up to his parents’ expectations and follow in the footsteps of his older brother who had gotten accepted to the top law school. All of these things played a part in his addiction.
Being financially strained wasn’t the only reason Jake had turned to drugs and alcohol. He had a family history of alcoholism, slept only a few hours a night, drank diet sodas all day, grew up in a family with lots of emotional distance, and had no sense of meaning or purpose beyond making money. His addiction resulted from the combination of all these contributing factors.
After working with thousands of patients, we have discovered that there are usually many combined biological, psychological, social, and spiritual factors that lead to addiction.
For example, you may have heightened vulnerability due to a family history of addiction, then you fall off your bike as a child and suffer a head injury, and grow up with some sexual abuse as a teenager. Then as an adult, when your boss starts dumping extra projects on your desk, your child starts having trouble in school, and your savings are wiped out in the bad economy, it finally pushes you over the edge into addiction.
In order to understand and successfully treat addiction, it is best to take a bio-psycho-social-spiritual approach.
This all-encompassing approach addresses all of the biological conditions, psychological issues, social influences, and spiritual factors that may be contributing to addiction. This approach is the most comprehensive, yet easiest, way to think about understanding and treating any addiction problem, any other mental health issue, or any medical condition for that matter.
Just think about diabetes.
It involves biological conditions, such as a family history for the disease that makes you more vulnerable to it. There are psychological issues at play, including lying to yourself about your risk: “I’m only twenty-five. I’m too young to get diabetes.” Social influences can drive you to engage in behaviors that increase your odds of getting the disease or preventing you from keeping it under control. For example, if your mom gets insulted if you say no to second and third helpings of her famous beef lasagna and chocolate mousse cheesecake, it makes you more likely to indulge in foods that are not diabetic-friendly. Lastly, spiritual factors — having a sense of meaning and purpose in your life — are more important than you might realize. If you don’t feel like your life matters, then why take care of yourself to control your diabetes?
As with diabetes, all four of these areas come into play with addiction. In order to understand why you are addicted and to break free from your addictions, you must address all four pillars. You must look at the underlying biology of the problems, as well as your psychology or mind set, the social situation you find yourself in, and your spiritual beliefs. If you miss any of them, you will not be able to heal effectively. In this chapter, we will show you how each of these factors can contribute to the problem of addiction and how the path to healing lies within these four pillars.
Pillar 1: Biology
Biological Factors That Make You More Vulnerable to Addiction
Your biological makeup and the health of your brain and body can either drive you to give in to your temptations or provide you with good judgment and stronger willpower. In regards to biology, we need to look at brain function, genetics, physical health, and the dietary issues underlying your addiction. Understanding what may be contributing to your problem is key to learning how to recover from your addictions.
- Brain Function
The way your brain is wired and its overall health play a primary role in addiction. When your brain works right, you work right and are better able to resist temptations. When your brain is troubled, you are more likely to have trouble with addictions. There can be many reasons why your brain isn’t functioning optimally, including head injuries, blood flow problems, allergies, and exposure to environmental toxins.
- Genetics
Your family history matters. According to the National Institute on Drug Abuse, genetic factors account for 40 to 60 percent of a person’s vulnerability to addiction. With early onset addiction prior to the age of fifteen, it is commonly 60 percent genetic, 40 percent environmental. When addictions set in later in life, genetic factors often play a smaller role. Remember that genetics is only part of the problem. Trying to blame your addiction solely on your genetic makeup will jeopardize your recovery.
- Medical Conditions and Medications
When your body isn’t healthy, it takes a toll on your brain, which can raise your risk for addiction. Conditions that cause chronic pain, such as fibromyalgia, cause changes in the brain and can lead to dependence on prescription painkillers as well as other unhealthy coping mechanisms. Having severe PMS, chronic fatigue syndrome, and many other conditions can also impact brain function and influence your habits. Low blood sugar is another problematic condition because it decreases brain activity and effectively lowers your ability to say no to unhealthy substances and behaviors. Hormonal imbalances can wreak havoc with brain function and leave you more vulnerable to addiction. You also need to be aware of the prescription medications you are taking. A number of medications can affect brain function in a negative way and increase your odds for addiction.
- Poor Nutrition
You are what you eat … and drink! If you eat a junk-food diet, you will have a junk-food brain that increases your risk for addiction. You are also more likely to be overweight or obese. For some people, putting on too many pounds leads to taking diet pills or speed to suppress the appetite. Then they may feel the need to drink alcohol to calm the effects of the stimulants. It is a vicious cycle.
What your mother ate while she was pregnant with you matters, too. If your mom didn’t consume adequate amounts of omega-3 fatty acids during pregnancy, then your brain suffers for it. Omega-3 fatty acids, found in foods like wild salmon, avocados, and walnuts, are rich in a type of fat called DHA. Why is that important for brain function? Did you know that 60 percent of the solid weight of your brain is fat, and a significant amount of the fat in your brain is DHA? Without enough of it, your brain can’t develop or function normally.
- Lack of Exercise
Lack of physical exercise negatively affects blood flow in the body, and subsequently to the brain. Low blood flow equals low activity, which equals lowered self-control. In a fascinating study that was published in a 2006 issue of Pediatrics, researchers found that teens who avoided exercise and instead spent a lot of time watching TV or playing video games tended to be at higher risk for risky behaviors like drinking, smoking, and doing drugs.
- Lack of Sleep
Skimping on sleep is terrible for your brain function. Getting less than six hours of sleep a night has been associated with lower overall brain activity, which can affect your judgment, thinking, and self-control.
Pillar 2: Psychology
Psychological Factors That Make You More Vulnerable to Addiction
From a psychological standpoint it is important to look at how you are shaped by your thinking patterns and past experiences. Negative psychological factors may drive you to seek solace in unhealthy substances or behaviors. Some of the many psychological issues at play include how you talk to yourself, any past emotional trauma, past successes and failures, and your upbringing, self-image, and outlook on life.
- How You Talk to Yourself
The way you talk to yourself can keep your brain chained or help you break free from addiction. Negative thinking causes negative brain changes that keep you trapped in your bad behaviors. Explore killing the Addiction ANTs in our Change My Thoughts section.
- Past Emotional Trauma
People with addiction problems are often dealing with a lot of past physical, emotional, or sexual traumas. Having endured some form of physical or sexual abuse, which is especially common in women, significantly increases the risk for substance abuse. In many cases, people who have suffered abuse use alcohol, drugs, food, or other unhealthy behaviors to suppress negative emotions. Dealing with past traumas is essential to the healing process.
- Upbringing
Being raised in a chaotic environment without a lot of affection and nurturing damages your psychological well-being. These early hurts can be long-lasting and can influence your behavior into adulthood. Having demanding parents who put excessive pressure on you to succeed can also be harmful to your psyche. Trying to live up to someone else’s lofty expectations, even your own, can create an enormous amount of stress.
- Self Image and Outlook on Life
The way you view yourself and your body can seriously impact your risk for addiction. People with a negative self-image are far more inclined to engage in unhealthy behaviors. If you hate the way you look or feel like you are a failure, then you may feel like it doesn’t matter whether or not you take care of yourself or that you don’t deserve to treat yourself and your body with the respect and care it needs. Similarly, if you feel like you have no control over your life or that there is no hope for a brighter future, then you are more likely to go down the wrong path. You may turn to unhealthy behaviors to suppress the negative emotions you have about yourself and your life.
- Past Successes and Failures
People who see their lives as littered with perceived failures have a tendency to use food, alcohol, drugs, or other behaviors to deal with this negative view. Focusing on your successes—at school, in relationships, in sports, or at work—can mitigate any failures and help keep you from feeling the need to overindulge.
- Dealing With Grief
When a loved one dies or when a significant other breaks up with you, it can be emotionally devastating. But why are some people able to bounce back quickly and resume their daily lives while others get mired in their grief and feel like they can’t go on? It is likely due to a concept called brain reserve. Brain reserve is the cushion of healthy brain function we have to deal with stressful events or injuries. The more reserve you have, the better you can cope with the unexpected. The less you have, the harder it is for you to handle tough times and injuries, and the more likely you are to smoke, swig alcohol, or chow down on an entire bag of chocolate-covered pretzels as a coping mechanism.
Pillar 3: Social
Social Factors That Make You More Vulnerable to Addiction
From a social perspective it is important to look at the current stresses in your life, including relationships, work, school, and finances. There are many life events and stresses that can trigger the inclination to overindulge or develop bad habits. Often they result from some sort of relationship difficulty or loss, such as a breakup or divorce. Financial troubles can also eat away at you. Overwhelming responsibilities at work and home can make you want to find a way to escape from life’s daily stresses. Even your daily habits and hobbies can alter your brain chemistry and make you more prone to addiction. In most cases, it is when a number of stresses start piling on at the same time that you become more prone to addiction.
- Relationships
Your relationships with your parents, grandparents, siblings, children, significant other, friends, and coworkers are so important to your health and well-being. In today’s mobile society, however, it can be difficult to develop meaningful relationships. Many people move away from their hometown to find work, commute long hours from home to work, or move around a lot, making it harder to forge lasting friendships and strong family ties. The high rate of divorce in our society also splits up families and abruptly severs friendships.
A lack of social connections causes negative changes in the brain that can lead to trouble in your life. The quality of the relationships in your life is just as important as the quantity. Difficult relationships that are a source of stress, anger, and negative emotions are damaging to the brain. Many people with addictions have troubled relationships with the people in their lives or have few social connections.
Brianna, sixteen, played on her school’s volleyball team and counted her teammates as her best friends. They did everything together—going to the movies, shopping at the mall, listening to music, and just hanging out. But all that changed when her teammates found out that Brianna had gotten drunk at a party and had sex with one of the girl’s boyfriends. Brianna got kicked off the squad and the team shunned her. Brianna’s entire social circle evaporated, and she was unbearably lonely. Desperate for friendships, she started hanging out with the “losers” and adopting their bad behaviors, which included drinking and doing drugs. Granted, Brianna’s bad judgment while drunk initiated her expulsion from the group, but the social isolation drove her deeper into addiction.
Even if your life is filled with people you love, you can still experience a lot of stress from your relationships. If your husband is fighting cancer, your daughter has decided to drop out of high school, or your mother has been diagnosed with Alzheimer’s disease, it can affect your life too. We are social beings and the health and happiness of our loved ones directly impact our own sense of well-being.
- Work and School
Mean bosses, rude customers, backstabbing coworkers — the people at work can make your life miserable. Having a demanding workload or performing a job you hate can also add to the stress in your life. Similarly, problems with classmates or teachers at school can cause problems with self-image and confidence. Trying to “do it all” at work, at school, at home, at church, and in your relationships can sap your energy and leave you feeling frazzled.
If you feel overwhelmed by your obligations, you may be inclined to take drugs that enhance performance. This has become an increasing problem on college campuses nationwide. A fascinating article in a 2009 issue of The New Yorker detailed the growing use of “neuroenhancers,” drugs that young people believe will help them do it all: get better grades, work longer hours, stay up late partying with friends, and more. In the medical literature, statistics about the off-label usage of prescription stimulants on college campuses vary from about 7 percent up to almost 53 percent of the student body. In one survey of 390 college students in the Journal of Attention Disorder, 60 percent of those surveyed reported knowing students who misused prescription stimulants and 50 percent said that the drugs were easy to get on campus.
- Finances
Financial problems can be a tremendous source of stress, and many people blame money woes for their addictions. Often, people suffering from economic hardships turn to substances and behaviors that temporarily help them forget their troubles. Unfortunately, many of the things people do in an attempt to escape from their problems end up worsening their financial situation. The cost of buying alcohol, drugs, or even cigarettes or snack foods adds up fast. People with addictions tend to miss more days of work and get fewer promotions, which lowers their income potential.
- Thrilling Behavior
In his intriguing book Thrilled to Death: How the Endless Pursuit of Pleasure Is Leaving Us Numb, psychologist Archibald Hart warns that text messaging, email, video games, and television can overstimulate our pleasure centers in the same way cocaine does. We all know people who are so glued to their BlackBerry that they call it a “CrackBerry.” For these people, every time their mobile device pings to signal a new incoming message, it causes a release of dopamine in the brain. With video gamers, dopamine is being released constantly throughout the game. And with television, the quick-cut, high-intensity action is overstimulating.
These technologies are effectively wearing out our pleasure centers. In effect, our fast-paced, pleasure-seeking lifestyle is robbing us of the ability to experience joy from the simple things in life. Things that used to make us feel happy leave us feeling numb. Hart goes on to suggest that our excessive pursuit of constant thrills may contribute to emotional problems, such as depression and anxiety, as well as addictions to drugs, alcohol, Internet gambling, pornography, or compulsive shopping.
Pillar 4: Spiritual
From a spiritual standpoint, it is critical to look at what your life means and if you have a sense of purpose or a connection to something greater than yourself. Spiritual factors also tie in to you core values and sense of morality — what is right and wrong in your eyes. If you don’t feel like your life matters, you are less inclined to take good care of yourself. Similarly, if you don’t feel connected to something larger than yourself, you may not feel accountable for your actions. After all, if you don’t believe that you are accountable for your actions, then why should you do the right thing?
Let’s look at how spiritual factors played into addiction for Jake, the entrepreneur mentioned in the introduction to this chapter. He felt absolutely no connection to anything other than himself and had no purpose in his life other than making money. Although he was very good at building his financial empire, it didn’t bring him the satisfaction he thought it would. This was part of the problem that led him to abuse cocaine and alcohol. As part of the healing process, he became a philanthropist and joined the boards of several charities that help people with substance abuse problems. This made him feel like he was doing something important with his life, something that mattered, and it filled him with a sense of purpose that has helped him stay away from drugs and alcohol.
The Road to Healing
In order to heal, you need to address all four pillars. If you discover that you have ADD and treat it but don’t deal with the negative self-image you developed due to doing poorly in school (likely due to your ADD), you will never get completely well. By getting on a brain healthy program, taking care of any brain problems, dealing with your emotional issues, developing a strong social support system, minimizing the stresses in your daily life, and developing a sense of purpose and meaning in your life, you can get on the road to recovery.
Use these 10 steps to unchain your brain so you can break free from your addictions:
- Know your motivation (spiritual healing)
- Get the right evaluation (biological, psychological, social, and spiritual healing)
- Know your brain type (biological healing)
- Boost your brain to get control (biological healing)
- Craving control (biological, psychological, and social healing)
- Eat right to think right and heal from your addiction (biological healing)
- Kill the Addiction ANTs that infest your brain and keep you in chains (psychological healing)
- Manage your stress that triggers relapse (psychological and social healing)
- H-A-L-T plus: overcome the barriers that keep you from conquering your addictions (biological, psychological, social healing)
- Get well, beyond yourself (social and spiritual healing)
UNCHAIN YOUR BRAIN CHECKLIST:
- Know the biological contributors to addiction.
- Know the psychological contributors to addiction.
- Know the social contributors to addiction.
- Know the spiritual contributors to addiction.
- Heal any biological problems.
- Heal any psychological problems.
- Heal any social problems.
- Heal any spiritual problems.