Addictions and Compulsions: Why are we so susceptible?

It’s a peculiar thing, isn’t it? We are such incredibly well-designed creatures; animals that have resulted from a long line of evolution, and yet we are still so susceptible to self-destructive responses that result in addictions to toxins, compulsions to damage our bodies, and limit our lives through inappropriate behaviour. It would almost seem that Darwin’s hypotheses have fallen short when it comes to predicting an overall improvement in our behaviour that will benefit us in our survival. How does this susceptibility fit in?

I’m not writing this as an observer of damaging behaviour, but as an all too aware participant in it, so please don’t assume any superiority in this post. I used to smoke until I found myself unable to breathe, lying in a hospital bed suffering from pneumonia, and returned to it once I was able to drag on a cigarette without passing out! It was the embarrassment of admitting to this that made me give up. I drink more wine than my 7 units a week and can always think of a good reason to celebrate – the drawback of being optimistic in nature maybe, but I’m sure if I leaned towards pessimism I would use wine as something to compensate for “a bad day” instead! Our addictions steer our minds to come up with justifications for our actions, and they are very persuasive.

Whilst it’s understandable that it’s difficult to give up an “addictive substance” such as heroine that causes genuine, unpleasant, physiological reactions, we can experience equally strong withdrawal symptoms when trying to break away from behavioural compulsions that are interfering with our lives. People suffering from Obsessive Compulsive Disorder (OCD) often experience powerful physical discomfort when attempting to change their behaviour.

The truth is, that most addiction- or compulsion-driven people are constantly chasing a level of gratification from their habit that they never, or rarely, achieve. The reality of the “fix” just doesn’t live up to the expectation, forcing the push onto the next one, and then the next … Well, we all know how it goes!

On the other hand, the psychological discomfort experienced when trying to break the habit is intensely out of proportion. Every dieter will recognise how, in trying to avoid certain foods, they will become obsessed with that food to the point of being diverted from everything else. Yes, that’s another one I’ve been guilty of!

How have these responses ever had any benefit to us? What is going on in our brains? And, how can we overcome it?

It all comes down to pleasure and pleasure is a powerful emotion – I don’t think anyone would ever argue with that! If you think about when you have experienced the most extreme pleasure in your life, it will often be when you least expected it, when you were trying “something new”, and / or when you had met or overcome a challenge. It will normally be associated with the fulfilment of a basic need: consumption of food or drink; social interaction; learning a new skill; sex and procreation; providing a comfortable and safe home; to name but a few. In evolutionary terms it’s easy to see how this reward system is beneficial, for example: we build ourselves a shelter for our family unit; we try a new method for doing this and it’s an improvement on previous shelters – safer, more solid, or less draughty; we share the pleasure of our achievement with our family unit; we feel increased pleasure as our esteem builds … and so on.  Our payment for the initial investment of effort is the mounting pleasure that builds, encouraging us to repeat the act with little further conscious thought, and to continue rewarding our curiosity about seeking out new ways and new experiences. When our experiments have had a successful result we get a kick from it, on the other hand when it’s gone badly we shy away from repeating a mistake.

So, what is happening in your brain to produce this response of pleasure and subsequent drive to repeat the action? In simple terms, there are 4 areas of the brain that are involved: the hippocampus; the amygdala; the anterior cingulate; and the dorsolateral prefrontal cortex. To simplify it all further so that we can drop the technical terms, I’m going to assume that you are familiar with shopping online, and more specifically shopping from Amazon!

On Amazon there is an area “My Account” which holds all your personal details including your address, payment details and delivery options that obviously needs completing the first time you use the site. Once you’ve set up your account, and you are browsing products, there is an option to press a “One Click” button that instantly buys a product without the need to complete forms or even move to another page and assumes that you will use all the information as you did previously. In the background of the My Account, there is a section called “Your orders” that lists the details of everything that you have ever bought from Amazon. Then there’s a slightly perturbing part called “Recommendations” that appears on the home page of Amazon and suggests items to you, based on your previous buying and browsing history. So what’s what if your brain was Amazon’s site?

This is how I see it:

  Amazon Brain Function

Conscious

“My Account”  Dorsolateral Prefrontal Cortex Conscious operating centre
“Your Orders” Hippocampus Conscious memory

Unconscious

“One click” Anterior cingulate An automatic system that bypasses the need to consciously employ the operating system
“Recommendations” Amygdala The unconscious and emotional memory

Okay, so you smoke your first cigarette aged 16 or so and feel pretty good about yourself having made this “adult” move and you feel it helps you fit in socially, gives you something to do with your hands when you’re feeling socially awkward and generally has a fair number of positive and pleasurable feelings associated with it. The first time or so you are making a decision to smoke and “My Account” has to be completed each time – that is you have to involve your conscious operating system – it’s a bit of an effort and you’re still weighing up the nausea and health warnings against these apparent benefits. Of course the nausea gets less each time, and you know that your uncle was ancient (at least 50!) when he found he’d got lung cancer, and all you can see are the benefits. You find that smoking happens automatically after a while when you find yourself needing a boost, especially in socially demanding situations. This automatic response involves the amygdala, the “Recommendations” section of Amazon, and the “One-click” shortcut.

Evidently there’s limited intelligence concerning the amygdala – it recognises the pattern of your social awkwardness and alerts you to light up because your previous discomfort was relieved in this way. It sends a message in the form of dopamine along with the emotional charge (possibly embarrassment and / or anxiety in this case) to the “One-click” automatic response. The amygdala, having done its job on this occasion, can then allow the negative emotions to die away and be replaced with feelings of pleasure – further reinforcing the pattern matching that smoking makes everything better. The more powerful the emotional charge, the more urgently the compulsion is felt. It is the equivalent of “Recommendations” displaying all the items on your wish list at the price that you can afford! In the Amazon analogy the account holder becomes the emotional charge that impulsively drives things forward to press the “One-click” button in their enthusiasm and, hey presto, before you know it, the deed is done!

So you are now a regular smoker, and find yourself smoking increasingly more cigarettes each day because not smoking leaves you feeling anxious. It nags at you whether you’re in company or alone. The amygdala has gone a stage further – not only is it seeing that anxiety and awkwardness can be resolved, and pleasure produced by lighting a cigarette in social situations, it has now resorted to producing those negative emotions whenever you’re not smoking! Imagine if Amazon started behaving like old-style book clubs, and sent you their “Recommendations” whether you had requested them or not on the assumption that you ought to like them. Smoking-wise it means that you are constantly craving the next cigarette and always feeling dissatisfied that it has no lasting effect. Amazon-wise – well, my analogy has broken down here, but we can still use it to explain why the habits are so difficult to break!

You recognise that you’re spending too much money on cigarettes, you have a nasty hacking cough and run out of breath as you climb the stairs. You’re closer to 50 than you were but even when you get hospitalised with pneumonia you continue smoking for as long as you can stand! Using your conscious memory and operating system you “decide” that you are not going to smoke again when you get out of hospital, and lack of lung capacity and opportunity makes it easy to stick with that “decision”. On Amazon you look at your Order History and realise you’ve been too impulsive so in “My Account” you change your delivery settings and disable your own address, but leave your sister’s address because it’s her birthday soon and you can get it sent directly. On leaving hospital you feel so much better, you can breathe normally and you start back into your old routine. Your routine has a pattern to it that is recognised by your amygdala, but there is something missing within that routine. The amygdala flags up a memory that anxiety and awkwardness is created without this element in your routine and these negative feelings can only be removed and replaced by lighting up a cigarette. You haven’t even looked at Amazon because you know you’ve disabled your address, but your sister’s birthday’s coming up and you want to get some ideas for her and make sure her present arrives on time. Logging on you’re suddenly confronted with everything you ever wanted to own but never thought you would. In a frenzy of excitement you look at each item and several times come close to pressing the “One-click” button, but resist. Your sister’s forgotten in this frenzy, particularly when you realise that there is a cheese-making kit at 10% of normal cost!!! And you’ll need a recipe book and cheese press to go with it and they’re on offer at 95% of normal price! Well, of course, you need these items! So you merrily click away until you realise that they’ll all be delivered to your sister, so you have to go in and re-enable your address in “Your Account”! And then Amazon knows that you are interested in cheese-making and suddenly “Recommendations” is populated with everything vaguely cheese-related! And, if that wasn’t bad enough, there are adverts at the side of Facebook that are offering Cheese-making courses and artisan holidays. Fanciful stuff? Mmm, maybe!

The amygdala has been sending increasingly urgent messages in the form of strong negative emotions. You feel rubbish. You’re so highly strung, bad tempered with everyone, and you’re sure that the irritating, tickly cough you’ve been left with would be so much better if you were smoking. The anxiety, stress and misery are stacking up, until you’re certain you are going to go stark raving mad. Your partner admits that you’re impossible to live with! You know that one cigarette will relieve this madness and you reason with yourself that surely smoking is better than going mad and losing your partner. So you consciously light up and – the joy – your amygdala rewards you with feelings of pleasure and relief from that misery, and then records and reinforces its resolve to keep you in this state! This reinforcement cycle scuppers you every time you try to resist.

However, one evening, you’ve been invited to a friend’s house. You haven’t seen them since you were in hospital – they saw you at your worst and heard your emphatic declaration that you weren’t going to smoke again because you “like being able to breathe properly”! You’ve had a lovely meal and you’re relaxing and socialising with them, and you reach for your packet of fags, ready to stand outside and enjoy your post-meal smoke. Before you reach the door, your dear friend comments in surprise that you’re smoking again. She’s genuinely concerned and astounded that, despite how ill you were, that despite everything you said, you are still smoking. Sulkily you still head for the door – this confrontation has started to make you socially anxious and awkward, and you know what makes that better!

When you come back inside, with embarrassment you realise that everyone’s still talking about you, your illness and your smoking. You lie to everyone and tell them that you only have 2 a day and your partner tactfully stays quiet despite knowing better, but a glance shows you that it’s not gone by unnoticed. Your friends remind you about your children and how it would be nice for you to witness them growing up, and hopefully their children too. Your discomfort grows intensely – this is an emotional subject that you avoid considering and you’re angry and defensive that they’ve insisted on bringing it up. Then the bombshell! They mention that this is self-inflicted and they can’t believe you’re so selfish and stupid. Having always prided yourself on generosity of spirit and intelligence, this hurts! You insist on changing the subject, but you feel extremely uncomfortable, selfish and stupid and it doesn’t go away.

You don’t have another cigarette that night, but next morning a stubborn part of you still lights up that first cigarette of the day with your morning coffee, even though its appeal isn’t really there. You’re still cringing about the conversation last night, and smoking the cigarette brings back the embarrassment and battered self-esteem. You stub it out half way through and drink your coffee whilst clearing things away instead. The impulse to smoke at points within your routine is still there, but sometimes you find you don’t respond and when you do there’s no pleasure in it. In fact when you smoke you have increasing cringing feelings and avoid anyone else witnessing you doing so. You change your routine because there’s still a vague nagging to do “something” at your usual cigarette moments. Before long you realise that you don’t have any inclination to smoke and can’t remember why you did.

What’s happened? What’s changed? You’ve changed your settings! The pattern matching has changed and your amygdala has started associating negative emotions with smoking. There’s a level of uncertainty to start with where the amygdala recognises the usual routine and urges you to do “something”, but the urgency to actually smoke has gone. Doing so is not just disappointing, but your primitive unconscious memory associates lighting up with some pretty horrible feelings. It starts to send alarm messages to prevent the “One-click” system until you become averse to continuing with that behaviour. As far as Amazon goes, it’s just overdone it in its cheese-related “Recommendations”! There’s only a certain amount you need and what you bought ended up being over-priced (what you saved on buying price, you paid in shipping), and, when you checked out the reviews after you purchased, you discovered it’s pretty poor quality! You go into “My Account” and discover that you can actually reset your “Recommendations” AND disable the “One-click” so that there’s another line of defence!

Often, however, changing the background settings doesn’t happen spontaneously in life and alternative routes need to be found. Many of us hide our destructive behaviours such as bulimia or alcoholism, see them as socially acceptable and the urge to continue with the behaviour is too overwhelmingly powerful. So what is to be done?

  • A first step towards recovery is recognising that your unconscious memory is playing tricks on you and that you’re chasing a moving target.
  • The second, that the discomfort it’s inflicting on you is way out of proportion to the reality. Much of the distress you feel is a mounting anxiety, so discovering relaxation techniques will inevitably help you to resist.
  • Thirdly, change your routine where you can. Recognise those times in the day when you struggle the most, and avoid your normal habits. This will avoid the “pattern matching” response.
  • The fourth is the trickiest – re-programme your unconscious mind. There are some pretty unhealthy ways of doing this and some very healthy ones. The unhealthy ones include replacing one bad habit with another; for instance smoking with overeating; overeating with starvation. This is pretty commonplace! If you were to replace smoking or overeating with exercise, however, it’s obviously beneficial. Aversion therapy where you are “punished” for your bad behaviour can be very effective, BUT self-flagellation isn’t to be recommended literally or figuratively! However, it can be done in a supportive setting, with the intervention from friends or professionals.

Inevitably, of course, I would recommend the intervention of a brilliant hypnotherapist. I know a few if you need a referral! They will be able to access that pesky unconscious so much more easily than you can alone. They will teach you to relax and give you strategies to counteract stressful moments. They will support you through aversion therapy and help you recognise how good you will feel when you’ve conquered your habit. They will help you build new routines where your habit isn’t missed. Best of all, if needed, they will go back to the source of your problem and help you to see that you are no longer 16 with social anxiety, so you no longer need to light up!

That’s enough! It’s 6.00 pm on Friday night – time for a glass of wine in celebration of finishing this blog!

References:

Kahneman, D., 2011. Thinking fast and slow. London: Penguin Books Ltd.

Griffin, J. and Tyrrell, I., 2005. Freedom from addiction: the secret behind successful addiction busting. Great Britain: HG Publishing.

Amazon UK Ltd., 2014. http://www.amazon.co.uk, [Accessed 14 February 2014].

Posted in Addiction, Clinical Hypnotherapy, Compulsion, Hypnosis, Uncategorized Tagged with: , , , , , , , , , , ,

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