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ABSTRACT

The definition of the "alcohol dependence syndrome" given in ICD is identical to that of drug dependence except that the word "drug" is replaced by "alcohol". Although it appears to leave little room for subjective interpretation, it is well known that individual and collective denial plays a critical role in the diagnosis of chemical dependence. A great deal of confusion arises from the fact that intoxication and addiction are obviously two different conditions although their correlation is quite similar to that of smoke and fire: when the former is seen, the latter is never too far. Alcohol intoxication is regarded as a disgrace in some cultural systems while it constitutes a colourful highlight, a comical habit or is even, in a somewhat twisted irony, considered as a rite of initiation in others (Sadoun et al., 1965, p.49).

The WHO definition of drug dependence is expanded below to include other forms of dependence in which there is no consumption of a substance identified as a drug, but where a psychological and sometimes physical dependency is nevertheless established between an individual and another person or a behaviour. Such an extension sheds light on the common denominator of all addictions, i.e. emotional anaesthesia, another name for what is meant in the WHO definition by "to avoid the discomfort of its [the drug's] absence". Although such a generalization of the concept of addiction is decried by some as fostering a hypochondriac or victim mentality, that objection does not hold because addiction is not a modern version of the Black Death since its dynamics is fairly well understood and a wide range of resources are available to defeat it. Addiction is, to put it simply, a widespread and misdirected attempt to avoid anxiety by resorting to behaviours to which individuals can become enslaved. The term "dis-ease" befits such an enslavement since it describes a condition characterized by a departure from a healthy sense of ease and harmony. In order to illustrate the generalized definition of addiction introduced above, a brief examination of the basic components of the human condition may help.

"Desire", in its root-meaning, is fundamentally an experience of psychological darkness marked by increased anxiety. Craving for light is the natural response of the human psyche confronted with darkness. Sometimes, especially when the prospect for a return of the light is not good, an ingenuous response to darkness is the denial of darkness or the numbing of the feeling of anguish that accompanies it. The power of denial is explicit in Ernest Becker's psychological analysis of the human condition entitled The Denial of Death (Becker, 1973, p179) in which he writes: "We call the refusal of reality "normal" because it doesn't occasion any visible problems." The irony is that darkness is even made thicker by the denial of darkness. Furthermore, the darkness or emptiness corresponding to the root-meaning of desire is generally "whitewashed" by a pleasurable sense of craving for what we assume to be the object that will relieve our "desire". Besides the tension between "light" and "darkness" the mythico-poetic works of every culture resort to many other metaphors. Transposed in their acoustic equivalent, "light" becomes "sound" or "spoken word", "darkness" becomes "silence", "desire" becomes "ab-surdity" (from "ab-surdus", meaning deprived of sound), and the "lightning bolt" of "enlightenment" becomes the "thunder-clap" of "astonishment". "Marvel" and "miracle" also come from a root which means "thunderstruck". In yet another range of metaphors based on the concept of "spirit", (from the latin "spiritus" which means "breath"), "darkness" becomes "loss of breath" or "choking" which is precisely the root meaning of "anguish" : "to be choked by a snake", (from the Latin root "angere", from which "anger" is derived).

Psychological theories propose intricate models of human personality development and pathology. It would be outside the scope of this article to enter the labyrinth of such models and the reader is referred to specialized psychological publications such as the extensive discussion of the psychodynamic theories of addiction by Philip Flores (Flores, 1988, Chapter 6). A determining factor in the character pathology ("flaws" may be a better word) predisposing an individual to addiction is described by Flores as a lack of "object constancy". Lack of object constancy is the inability for a child to maintain a mental image of the mother, (and by extension of other comforting objects), when she is not present. As a result, such individuals would be prone to fill their inner void by developing attachments (addictions) to immediately available external or internal objects. Bergeret expresses very similar views when he says: "the addict deprived of his reassuring object behaves like a child who sees his mother leave before he has developed the concepts of time and of return" (Bergeret, 1982, p60). The above psychological model is the scientific equivalent of the "eclipse" metaphor described above. The underlying psychological problem of the addictive personality can therefore be described as the inability or difficulty to cope with "eclipses", (i.e. also with desire) without resorting to short-term gratification and attachment. Most spiritual traditions hold attachment as the root of all human suffering. It is a habit which limits personal freedom and can lead to self-destruction and even to death.

What was said above, using the scientist/philosopher and left-brain/right-brain imagery, can be transposed into a number of other metaphors describing a state of polarization: yang/yin, reason/passion, masculine/feminine, light/dark, rigid/flexible, etc. Some metaphors lose clarity when one has conceded too much power to the words in which they are expressed. For example, the current abuse of masculine/feminine terminology in discussions about power struggle between genders tends to disqualify the words "masculine" and "feminine" in meaningful discussions about human wholeness and about the harmonious integration of the masculine and feminine archetypes.

If addiction is often found in personalities affected by early developmental dysfunctions and childhood trauma, it is also widespread among individuals who, for various personal and cultural reasons, learn to sedate their anxiety as adults. There is usually nothing intrinsically "bad" or "wrong" in the various substances, objects and behaviours used in addictions. The individual and societal penalty paid in the form of hidden denial of self and of reality is the true yardstick that makes addiction (or should make it) acceptable or not. The complexity of the issue of addiction comes from the fact that a key characteristic of addiction is the loss of the ability to appreciate the extent of the penalty an individual or a society pays to remain addicted. When it comes to addiction, appearances may be quite deceiving. For instance, what may, on the surface, be celebrated as "hedonism", (i.e. the cultivation of pleasure) can also be motivated by a deep-seated "anhedonia", i.e. the incapacity to experience the joy and pleasure of wholeness. Superficial excitement often hides a lack of deep enthusiasm. Masochism itself can be motivated by apathy, a loss of sensitivity which amounts to a psychological amputation accompanied by a craving for completeness.

Codependency is, first and foremost, an anaesthetic dependence on a partnership. In short, it is usually the name given to addiction to another person. A codependent person uses others as mood-altering objects. As children, we depend on our parental figures to regulate our physical and emotional needs. As adults, we also live in a state of interdependence with others and with our ecosystem. The line between addiction and healthy interdependence is therefore elusive. The misdirection of dependence to avoid painful self-actualization is difficult to identify until destructive consequences become obvious. In recent years, the severe psychological impact of growing-up with emotionally "numb" parents has been recognized and has led to the development of large recovery movements such as "Adult children of alcoholics" and "Codependents anonymous". Based on mutual aid principles, such fraternities have drawn extensively on the experience of the giant of the alcoholism recovery field, Alcoholics Anonymous, whose philosophy is briefly described further down.

The issue of "covert" versus "overt" sexual abuse (including self-abuse) is only emerging in western societies and progress towards a clear understanding of sexual addiction versus "healthy" sexual expression, except in the most obvious cases, is also very slow. The fact remains that addiction is always self-abuse and is often abuse of others, always so if one considers that one cannot abuse a part without abusing the whole. If one human behaviour deserves to be protected from abuse, it is human sexuality, the behaviour from which each of us originates and which taps the very source of Life.

It is fairly obvious that being human is being as powerless over the forces of sexual drive as over the need to breathe or the weather cycles. This does not, however, exempt mankind from practising powerlessness management in this area just as in other areas. Umbrellas are a sensible answer to the reality of rain. The difference between "addiction" and "healthy practice" always lies in the inner reality of each individual. A characteristic of addiction is that this reality is always concealed under a thick cloak of denial, personal and collective. As William Blake puts it in "Proverbs of Hell": "A fool sees not the same tree that a wise man sees".

The "helping profession syndrome" is another form of occupational addiction leading to professional burn-out (also known as "compassion syndrome"), a very frequent outcome in the "helping" professions. Why can't workaholism be diagnosed before the resulting burn-out is? Without denying the value of some of the services rendered by the compulsive helper, one should remember that the invitation "to love others like oneself" becomes an irony when the therapist- patient or helper-"helpee" relationship is used to anaesthetize one's feelings of inadequacy and anxiety. In such a situation no genuine healing of dependence can take place since the therapeutic relationship is itself a blueprint of codependency. Many other forms of occupational addictions could be added to this brief discussion, such as addiction to television or videotapes. Much could be said also about the popularity of horror movies and thrillers and their role as converters of fear into excitement. By importing filmed scenes of terror into our living-rooms and watching them avidly before going to bed behind carefully locked doors, do we really hope to forget our personal anxieties? Finally, videogames need to be recognized as channels where violence and anger are both released and amplified in a perverse interactive loop of electronic fantasy. Furthermore, "desensitisation", another name for anaesthesia, is increassingly recognized as a direct result of videogame addiction,

Compulsive shopping is an example where not only chronic insecurity but also insecurity resulting from being in a public place (e.g. agoraphobia) are anaesthetized by shopping binges. "I shop therefore I am" is an advertisement read on the side of a bus the day this paragraph was written. If one could truly read the ultimate motive of a compulsive shopper or of some bidders at auctions, the desire to acquire a specific object would often be distant second to the refusal to "let go" or to be defeated by competitive bidders and face the resulting sense of humiliation. This being said, when compulsive shopping (consumerism) becomes the lifeline of a socio-economic system, one touches the true meaning and measure of "collective addiction".

Compulsive gambling is a dependence on money games. As mentioned above, videogames are often used as an addictive activity and cannot be distinguished from compulsive gambling if money earning is the mental focus of the user rather than the audiovisual escape they provide. The highly addictive impact of video gambling machines has started to be recognized in areas where such machines had been irresponsibly allowed in public places like bars, laundry parlours, shopping malls, etc. In a private face-to-face encounter with the machine, individuals who would not dare gambling publicly (say, at a black-jack table) because of shame issues, can try to force the hands of fate in an intimate face to face with machines designed to suck-up their money and, in hours of semi-consciousness, may spend substantial amounts of money directly substracted from their family budget. Among the many governments that allow, encourage and actively exploit gambling and lotteries, some call themselves "social democracies".

Obsessive counting of objects, stairs, tiles, sidewalk blocks, mental rumination of lists and compulsive body language like symmetric gestures, rotations and counter rotations are all manifestations of inner anxiety pacified by ritualized mental anchors and repetitive gestures. They stand somewhere on the continuum of compulsions, between active and passive behaviours, our next and last category to be discussed.

Religious addiction, also called idolatry, is rooted in obsessive thoughts used to deny the earthy plane of existence by focusing on another level. Bakan, quoted by Philip Flores writes about idolatry: "Put it simply, engaging in ritual, painting religious pictures, reading religious literature, and such activities are not idolatrous unless they themselves become the objects of the worship, rather than the means towards the fulfilment of the religious impulse." (Flores, 1988, p274). The line between addiction and religion is therefore the same as between idolatry and spirituality : motive (conscious or denied) is the determining factor. The same holds true for rational addiction found in some "scientific" circles. In this case, the line seems to run directly across the "Corpus Callosum", a part of the brain between the two hemispheres. To quote a voice from science itself, Roger Sperry, Nobel Prize for Medicine in 1981, "there appears to be two modes of thinking, verbal and nonverbal, represented rather separately in left and right hemispheres, respectively, [...] our educational system, as well as science in general, tends to neglect the nonverbal form of intellect. What it comes down to is that modern society discriminates against the right hemisphere" (Edwards, 1989, p29). One should therefore not be surprised that advocates of wholeness and those who claim to experience a reality that escapes rational expression are denounced as "anti- intellectualists" or lunatics by left-brain supremacists.

To sum-up, addiction is another name for habitual anaesthesia of painful feelings, the stereotype of which is anxiety. The result of addiction is a loss of freedom, a shrinking of one's sensitivity and vitality, the accumulation of an existential deficit. Addiction, the number one cover-up of chronic anxiety, amounts to a choking of individual vitality, a progressive regression towards the death of body and spirit. The most brilliant rational intellect is powerless in front of such automatic alienation because intellect is itself involved in the conspiracy of denying conscious access to the experience of pain. It often takes an unexpected surge in pain awareness, such as a traumatic confrontation with severe losses and even death to give the addict an impulse to change. Short of that, the existential deficit that comes with anxiety-numbing requires an ever increasing use of anaesthesia and the addicted person eventually sinks into despair, and loses balance on the thin edge between life and death.

Recovery is the reclaiming of all the denied parts of an addict's life. Such a healing is slow and requires a therapeutic environment which mutual aid is particularly well suited to provide. Let us examine how.

A specific definition of what is meant by recovery is important before proceeding further. Two very different definitions seem to prevail and cause much misunderstanding between those who use them. For some, recovery is the elimination of the specific substance or behaviour around which a dependency took shape. For example, an alcoholic who becomes alcohol abstinent is, according to that definition, a "recovered alcoholic". For others, recovery is the acquisition of a dependence-free lifestyle allowing a former dependant individual to develop his full human potential. The implications of choosing one definition or another are considerable and it would be futile to compare the success of therapies aiming at breaking a specific dependence with that of therapies aiming at addressing the root problem of anxiety management and fostering the human potential. Under the second definition, a "dry alcoholic" is the name given to a person who abstains from consuming alcohol without changing other behaviours although, in many cases, a compensatory increase of other compulsions is observed, whereas a "recovering alcoholic" is someone who has not only stopped using alcohol but has also undertaken to recover his wholeness. Along those lines, a senior chemical dependency counsellor addressing a forum of alcohologists at the 1991 Summer School of Alcohol Studies of Rutgers University admonished bluntly her audience in the following terms: "If you are a recovering alcoholic and are addicted to nicotine, I am sorry, but your recovery is a fraud!" Had she not added, in the same tirade, hopefully tongue-in-cheek, "you'd better be codependent on the God of your understanding, or you are in trouble", her point would have been crystal clear.

Recovery is defined in this presentation as a movement towards non-dependent and mutually enhancing relationships between the recovering person and external or internal "objects", i.e. with oneself, with others and with the entire universe. It is a recovery of personal integrity, the end of personal fragmentation and of denial. It is a movement towards attitudes that foster personal growth. Under this definition, abstinence from alcohol for an alcoholic can be called recovery only if is accompanied by a resumption of personal growth rather than by the replacement of alcohol by other forms of anaesthesia. Ultimately, the decision to call oneself "recovering" belongs to each individual. Recovery, in the context of this discussion, is a weaning of anaesthetics and a learning of life-skills. It cannot be dissociated from the healing of psychological wounds from the past. The severity of these wounds dictates the intensity of the therapeutic support needed to clear the backlog of suppressed pain. Some addictions have a clear pharmacological component due to the particular chemical response of a person to a substance. Some others appear to depend on a more subtle gratification for which science may some day find also a chemical explanation. In all cases, recovery is the road to freedom.

Acceptance is found at the root of all fellowships for recovering alcoholics. Members of Rational Recovery are invited to accept that "their use of these substances is an irrational choice". In the Twelve Steps of Alcoholics Anonymous, words of acceptance are frequent: "We admitted..." in Step one, "Made a searching and fearless moral inventory" in Step four, "Admitted" in Step five, "Were entirely ready" in Step six, "Humbly" in Step seven, "Made a list" in Step eight, "Continued to take personal inventory" in Step ten... In such acceptance- oriented terminology, concrete action is required to implement acceptance and to foster personal rebirth. Of course, a passive interpretation of the Steps veils such understanding when words like "humbly" are given the sado-masochistic meaning of "low" and "debased". The most ordinary dictionary of synonyms lists words like "unpretending, simple, unselfish, unobtrusive, unostentatious, plain, modest", as synonymous of "humble". One can therefore question the tendency to single out in that long list of synonyms the self-deprecating terms like "lowly, abased, meek, submissive, backwards, shy, coy and shrinking". In a context where acceptance is an affirming decision, humility is understood as "affirming one's humanity", nothing more and nothing less. The thirteen affirmations of "Women for Sobriety", an American recovery movement, are called "Acceptance Program". SOS, Secular Organization for Sobriety, starts its suggested "Guidelines for Sobriety" by the following statement of acceptance: "To break the cycle of denial and achieve sobriety, we first acknowledge that we are alcoholics or addicts."

Perceived as the most ego threatening concept, acceptance is actually the most empowering step of recovery as well as of healthy living. This should hardly be a surprise since the bondage of a compulsive ego is the oppressive power that must be defeated in recovery. The amount of personal energy invested in anaesthesia is such that a tremendous surge of power is felt when acceptance takes place. This power can be redirected towards constructive purposes in a context of personal growth. Acceptance amounts to a leap of faith into the unknown of life. "Pack your parachute" is the sound advice given to candidates for such an experience. Indeed, repressed emotions will not fail to rise and to be painfully felt and the importance of the cushioning effect of a support system must be stressed. Experts in the addiction field have sometimes voiced the opinion that addiction, however painful, is the ultimate refuge of many and protects them from suicide. Reference to a death-wish is common in the sharing of recovering addicts. It would therefore be irresponsible for a therapist or for anyone to try to induce acceptance by psychological confrontation or by other means without giving due priority to building first a safe (i.e. supportive) environment for the birth that is to take place in acceptance.

The following interpretation of the Steps is meant to illustrate how different a given philosophy may look when dressed in different clothes or stripped to its bare essentials:
1- We were dying;
2- We wanted to live;
3- We decided to trust life;
4- We faced and acknowledged our addicted personality;
5- We stated and accepted our humanness;
6- We opted for wholeness;
7- We gave ourselves, body and soul, to a process of healing our fragmentation;
8- We examined unsettled guilt from the past;
9- We healed our guilt;
10- We adopted a discipline of wholeness;
11- We adopted a discipline of growth;
12- We practised these principles in all our affairs.
Same spirit, different words.Temporalily borrowing new words is sometimes necessary while old words are being washed or repaired after years of abuse or misunderstanding, "God" is such a "high maintenance" word!

The main features of Twelve Step recovery are :
1- Acceptance of the overwhelming power of addiction;
2- Exposure to ego-deflation by accepting help;
3- Therapeutic transformation through service, introspection and healing of guilt and shame;
4- Personal growth fostered by a spiritual discipline and service to others.

The Steps were written in 1939 and their terminology has been the subject of much criticism especially from those painfully aware of abuse committed under religious or spiritual banners and from feminists circles where "turning our will and our lives to the care of God as we understood Him" (the actual wording of Step 3) resembles too closely a recipe for victimization. It is symptomatic that the Steps are frequently reworded and as frequently rejected in women movements. "I told the others that I either had to reword these steps or stop coming to the group, because to say the traditional steps was to violate myself" is a statement that sums up this reality very well (interview with Dr. Charlotte Davis Kasl, by Jim Christopher, 1993). One may regret that little seems to be done in the AA fellowship to acknowledge this difficulty which is so easy to understand and could be easily overcome were it not of the virtual enshrinement of the wording of the Steps. Claiming that the Steps are incompatible with empowerment somewhat overlookis the fact that they assign very specific and difficult tasks to the recovering member of a Twelve Step group. Each individual has to do the leg-work between denial and acceptance to become sober, to heal and to grow. The fact that "empowerment" is not to be confused with the delusion of "almightiness" but to be understood within the context of human limitations is another matter, vividly described by Ernest Kurtz under the eloquent title "Not-God" (Kurtz, 1991). In other words, the true issue about the spirituality of the Twelve Steps is not as much to determine "who or what is God" as to accept "who is not God". In the Twelve Steps, another implicit word for God is "not-me".

Philip Flores addresses quite specifically six of the most common misconceptions of AA (Flores, 1988, p212):
1- AA promulgates a simplistic, naive disease concept of alcoholism;
2- AA ignores psychological etiological factors;
3- AA is substitute dependency;
4- AA forces members to admit to being an alcoholic;
5- AA rejects controlled drinking on purely ideological beliefs;
6- AA is a religious organization.
His dismissal of these misconceptions does not need to be repeated here and could be matched by an equal number of critical statements by others, all of which do not come from rationalistic and secular circles. For example, spiritual scholar and theologian Matthew Fox writes: "AA can be criticized for its excessively patriarchal religious imagery and language and its almost exclusive emphasis on the "word" as distinct from other kinds of healing rituals that could be employed, as well as for its almost nonexistent political, sexual, and class consciousness. All these weaknesses simply underscore the historical and cultural limits of its founders" (Fox, 1991, p132). Such opinions are a sure sign that AA is a recovery movement of such a stature that it commands debate and criticism (including, as M. Fox points out, by those "who love it enough to criticize it"). AA's wisdom is such that it is also protected by its Traditions from being drawn into public controversy, much to the chagrin of its detractors (The 10th Tradition of AA states: "Alcoholics Anonymous has no opinion on outside issues, hence the AA name ought never be drawn into public controversy"). The existence of divergent views also confirms that complete objective answers are not to be found in AA or in any particular movement or ideology but in the exercise of free-choice by each individual open enough to consider the experience of others. The word con-sider has the same root as de-sire and means "to join under the same light", to expose oneself to whatever shines in a particular experience. The availability of alternatives to AA is, in that sense, very good news indeed and no-one should ever be forced to attend AA meetings.

The 14 "Rational Recovery Concepts" consist of "irrational" statements meant to paraphrase AA's philosophy (as RR sees it) followed by their "rational" counterparts. For example, concept number six (five in some fliers) says: "Because I have committed certain acts, or behaved offensively, or harmed someone, I should therefore moralistically blame and condemn myself and feel worthless and guilty, instead of the rational idea that I am a fallible human being. While I may feel regrets, remorse, or sadness for my alcoholic behaviour, I need not conclude that I am a worthless person." Most recovering addicts in AA, SOS, RR or in other fraternities would all-heartedly agree.

RR views addiction as a conflict between the primitive brain (The Addictive Voice) and the more sophisticated "thinking cap", (The Rational Voice). Addictive Voice Recognition Technique (AVRT) is therefore a key to becoming rationally sober. "There is no requirement of faith in a higher Power, no fearless moral inventories, no self-labelling of yourself as an "addict" or "alcoholic", no sponsor or buddy system, no "spiritual" teaching, and no lifelong commitment to "recovering"". In short, if Ernest Kurtz could summarize AA's philosophy by the title "Not-God" (Kurtz, 1991), RR's philosophy can be described as fundamentally "Not-AA".

RR recognizes nevertheless that individuals are either rationally-inclined or spiritually-inclined and should choose their recovery program accordingly. This distinction is somewhat related to the distinction made above between "the scientist" and "the philosopher", or between left-brain and right-brain perception of reality, with the important distinction that there is ample evidence that both aspects contribute to man's wholeness rather than a single one as RR seems to imply. Against such reductionism of the human intellect to mere logical thinking, it can be argued that full potential for an individual is likely to be more a matter of dichotomy than of lobotomy.

Mutual aid provides a way out of the cycle of addiction by offering an environment where the missing psychological skills can be developed while the protective shell of compulsions is shed. Identification, education, synergy and acceptance are the key components of such a recovery process. Identification cracks the ego armour, education offers new insight and choices, synergy provides much needed support and acceptance is a skill for self-actualization. Such elements appear under one form or another in all mutual aid recovery movements for addictions. Even the most rationalistic theory of addiction as exemplified by RR (Rational Recovery) states in its "13th principle of Rational Emotive Therapy (RET)": "13- Now certain of my own human worth, I can take the risks of loving others, for loving is far better than being loved."