It is not merely an abuse of an object like heroin

By R. MUNIDASA WINSLOW

THE recent decision to build two Integrated Resorts in Singapore by the Government has drawn a wide range of responses from enthusiasm to numbed disbelief and anger that this could be happening in Singapore. One thing for certain, it has drawn attention to the issue of addictions as never before.


When I first started work with addictions in 1991, they fascinated me. The power in addictions to change people and lives was tremendous, and their destructive power awesome. The amazing changes in the individual and their family that took place when someone decided to do something about an addiction also motivated me to stick with treatment of this difficult group.


Despite this, the medical fraternity still does not teach much about addictions in its curriculum, and it remains a hazy topic to most.


What is use, abuse, dependence and addiction?
There is a fair amount of fuzziness in most people's minds about this. When I first started work with addictions, I thought that there needed to be a substance, like tobacco, alcohol or heroin for people to get addicted. Now our thinking has developed, and we realise that behaviours and processes like gambling and even the Internet can also take on the features of an addiction.


Being brought up in Singapore with its strict drug laws, I used to equate drug use with an addiction. I don't do that any longer. It is not just the drug! There is a spectrum of use and behaviours which extends from occasional use to eventual addiction. If this were not so, every post-operative patient who gets morphine or other opiate-based drugs for pain relief would be an addict.


It is true that some drugs like nicotine and heroin can rapidly lead to neuroadaptation (i.e. the development of tolerance and withdrawal symptoms) and thus are physically more likely to cause dependence. This gives them a higher addictive potential. However, not all who use a drug like morphine misuse it. There would appear to be many factors, both intrinsic (like our genetic make-up, family of origin etc) and extrinsic (like our belief system, our jobs and friends), which can predispose to the development of an addiction.


In the field of addiction medicine, we now know that there are many changes that take place when a person gets addicted to a behaviour or substance. There are actual brain changes, where most research points to stimulation and changes in our brains reward systems. (The brains reward system is important and allows us to experience pleasure and emotions, e.g. after a good meal, or a challenging sermon.) The brain chemical transmitter implicated in most behaviour and substance addictions is dopamine.


There are also a lot of social conditions under which addictions flourish. This is why societies vary a lot in the type and magnitude of their addictions. There are also racial and cultural factors which predispose different groups to different forms of addiction.


Addictions - Moral weakness or illness?
If Christians are to be effective in resisting the pervasive erosion of our social values and reach out with a counter-culture life, we need to understand the nature of addiction.


Addiction has tended to be associated with a lack of willpower and determination. But in recent years with the help of Alcoholics Anonymous, addiction is beginning to be taken seriously by the medical fraternity as a pathological illness where a distinct personality is seen to have developed and takes over the life of an addict. So addiction is not merely an abuse of an object like heroin.


An addict is someone whose obsessive emotional dependence on the object has so consumed him or her that he or she loses his or her identity in it. It's like the saying, "Some people eat to live; some people live to eat." In the case of the addict, it is the latter. The gambling addict only lives when she gambles. For her gambling is not an entertainment, it is being alive.

ENSLAVEMENT OF SIN
'Addictions are symptoms of the enslavement of sin and evil in a man. Christians are the good news that the bondage can be broken with a new creation in Christ.'

Christian experience allows us
to identify with addiction

How does addiction begin?
Psychological theories tend to see addiction as rooted in our fundamental need for intimacy. Intimacy is the desire to meaningful relationship with people that nurtures our inner being. In infancy, intimacy need is understood in terms of pleasure and pain, i.e., the mother's presence that meant suckle and comfort, and her absence, which conjured fear of abandonment. This movement of presence and absence teaches the very basic human relationship of trust.


We learn to trust and distrust people through the primal feedback of pleasure and pain. But the process is so fragile and fraught with dangers that this foundation of trust is distorted, even perverted.


For example, the baby feels hungry, cries (pain) and gets milk and cuddles from mother (pleasure). This pattern is repeated through the growing years in learning to relate to family, self and community. Intermittently, we also learnt to relate to objects that could provide substitute sources of pleasure and comfort in the absence of mom.


So for example, children can be given a pacifier, a bolster, TV, etc. We begin to associate pleasure or emotional well-being with everyday objects that are available to us. As the child develops, she grows out of the pacifier but the child has already learnt that objects are more predictable and stable in providing emotional pleasure than people. People can love but they also can punish. As a result the child also learnt how to promote pleasure and avoid pain in human relationships.


As the child grows older she learns to transfer this emotional dependency from the pacifier to an appropriate object or activity like excelling in school or sports to get the intimacy needs met. Some develop hatred for studying languages like Mandarin because of the stress and pain emotions associated with the subject.


We also often find that a student loves a particular subject because of her teacher's passion. Another student hates the same subject because she feels stupid and inadequate. The tragedy is that the student will embrace this negative feeling to define her self, which says, "I am stupid" instead of "I have a problem with Chinese studies".


This inevitably leads to self-rejection and results in withdrawal from others, which is a breakdown of cultivating healthy intimate human relationships. Under such stress, she will turn to a substitute object for comfort. She thus becomes a candidate for addiction.


Thus addiction has its root in the fundamental human need for intimacy. Just as the object of addiction gives emotional highs in terms of arousal and satiation, so does an infant to the presence of the mother. Stresses and losses in life trigger such regressions.


For example, when faced with stress or loss, people turn to a particular food or place for comfort. It can be "yew char kuay" or the "teh tarek" but we turn to them for comfort because they bring back the feelings of security and happiness associated with them in yesteryears.


A person is an addict when she becomes obsessively dependent on the object or event so much so that she must shop, as in the case of a shopaholic, or else depression and distress overwhelm her. Shopping changes her mood and emotional state of being. It's no longer the buying or even the shopping but the emotional high that is being sought to be repeated.


We live in a "look cool, feel good" society in Singapore. It's not good enough just to have a pair of running shoes. They must be a branded one, not just for recognition but to actually "feel good". While we innocuously call this a "consumer" society, the real implication is that we are promoting addiction, where things, activities, events and even people and God are treated as objects to feed our emotional dependency. The idea is that consumers consume but ironically the consumption consumes even the consumer.


In other words, the addict is sick because her pathology now reduces people into the obsession itself, including herself. Look at any addicted person, they do not look after themselves well, just their obsession. For this reason, addiction must be rejected as a lifestyle precisely because it destroys people around the addict and ultimately consumes the addict herself.


Finally addiction is an illness because the cure of an addict involves nothing short of a profound change of personality in the core of the person. As Craig Nakken in his book The Addictive Personality (p.27) succinctly puts it,
" … recovery is not a return to a healthier self, but a need to develop a new personality." This is because the addict has first to acknowledge the addictive personality inside her. Then she can decide to break not just the obsession with the object but with this personality also. That is why the addict needs a community of supportive relationships and a belief in a Higher Power (in our case, God).


The Alcoholics Anonymous 12-step programme for recovery teaches many Christ-based spiritual truths, which are helpful to general recovery for all addictions. The 12-step programmes are essentially spiritual programmes for recovery, which teach values (eg honesty, open-mindedness) that are essential for change to occur. All 12-step programmes also teach the need for a higher power in our lives.


Challenge: Overcoming and being new creations
The message of the Gospel of Jesus Christ is critical precisely because sin has so damaged man that he needs to be reborn (John 3:3). Christians are a new creation created by Christ through His Cross. There is no other way. In God's judgment, sin can only be dealt with through death. The resurrection of Christ opened a new life in a new world beyond death in this life. We can immediately see the relevance of Christ as the Hope and Healer for addicts.

We do not just treat the behaviour or addiction, but we target the person and in Christ offer a new personhood. This is not far from our own experience as saved sinners. In our daily Christian lives, we constantly struggle with the desires of the flesh that war against the Spirit of God that dwells in us (Gal 5:19-24).


When we sin we are enslaved to sin just like addiction which leads to death and destruction but setting our minds in the Spirit leads us to life and peace (Rom 8:6). In other words, our Christian experience allows us to identify with addiction sufferers. If we humble ourselves and are honest, we can reach out with compassion and model the new personality that Christ has given us.


Addictions are symptoms of the enslavement of sin and evil in a man. Christians are the good news that the bondage can be broken with a new creation in Christ.

Dr R. Munidasa Winslow is Head and Consultant Psychiatrist as well as Director and Senior Consultant at the Institute of Mental Health.