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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 cultural 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 links all addictions by their common denominator of emotional anesthesia, another name for what is meant in the WHO definition by "to avoid the discomfort of its [the drug's] absence". The generalization of the concept of addiction is decried by some as the spreading of a hypochondriac or victim mentality. Such objection does not hold when addiction is not viewed as a modern plague against which humanity is absolutely powerless but, on the contrary, as a widespread and misdirected attempt to avoid anxiety by resorting to behaviours to which individuals become enslaved. The term "dis-ease" in such a situation is a matter of semantics and describes a departure from a healthy sense of harmony. In order to illustrate the generalized definition of addiction introduced above, a brief examination of the basic components of the human condition is necessary.

"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 prospects for a return of the light are 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) where 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 confused with a sense of craving for what we assume to be the object that will relieve our "desire".

Beside the "light" versus "darkness" struggle, the human condition can be described by many other metaphors as found in the mythico-poetic works of every culture. 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 meaning of "anguish", (from the latin "angere"). The experience of breath, in its deepest sense, is "inspiration", i.e. breathing the spirit whereas breathing one's last breath is to "expire", to die.

Psychological theories propose intricate models of human personality development and pathology. It is not the topic 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 predisposing an individual to addiction is described by Flores as a lack of "object constancy". Lack of object constancy is defined as the inability of a child to maintain an image of the mother, (and by extension of other objects), when she is not present. As a result, such individuals would be prone to fill their inner void by developing attachments (addictions) to 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). Such a psychological model is strikingly similar to the "eclipse" metaphor presented above. The underlying psychological problem of the addictive personality can therefore be described as the inability or the difficulty to cope with "eclipses", (i.e. with desire) without resorting to attachments, a habit which limits personal freedom and leads to self-destruction and ultimately to death.

Rationality, the faculty to divide a continuum of reality into categories and to recognize cause-effect relationships between these categories, has achieved such wonders in liberating mankind from blind dependence on nature that its abstract models have slowly eclipsed the continuum of reality they were meant to map. In a scientific culture, the trees of knowledge hide the forest of wisdom and "left-brain supremacy" has become a modern cult. Reading such blasphemous words, many a grand priest in the temple of rationality will already have torn his robe. The pain of what amounts to a right-brain lobotomy is such that "happiness" is often confused with "relief" by the left-brain supremacists. Anesthesia is a short-term remedy for pain and is one of the most common practices in modern lifestyles, to such an extent that, as will be shown below, it amounts to societal addiction. The irony of such pain-killing practices is that they only mask the symptom and stifle the core of human experience. An-esthesia is, literally, "non-aesthesia", i.e. a loss of sensitivity, the function which differentiates a human being from an "intelligent" computer. Living under anesthesia amounts to passing through human existence without being fully alive, accumulating in the process a deficit in terms of true experience. Jo Numb, 1916-1985, addict, may have experienced not a single year of his life as a whole human being because he was never fully alive. Born in a family where the father had learned at an early age to "be a man" by suppressing his feelings, and where the mother, coming herself from a rigid God- fearing culture, spent her life placing duty and austerity before spontaneity, Jo Numb, PhD, never learned the language of emotions. Alexithymia (from the Greek verb "alexein", to repel et "thumos", the heart) is the name given to such emotional illiteracy. Without blaming parents for one's personality flaws, it is essential to recognize the important role of parenting and of family "culture" in the shaping of the addictive personality. The children of today are the parents of tomorrow just as the parents of yesterday were the children of yesteryears.

What was said above, using the scientist/philosopher and left-brain/right-brain imagery, can be transposed to a number of other metaphors describing a state of polarization: yang/yin, reason/passion, masculine/feminine, light/dark, rigid/flexible, etc. The power of each metaphor depends on the amount of power one retains over 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 these words in meaningful discussions about human wholeness and harmony.

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, regularly sedate their anxiety in a variety of ways. There is usually nothing intrinsically "negative" 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, on the other hand, what makes compulsion (or should make it) acceptable or not. The full complexity of the issue of addiction becomes apparent when one realizes 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. Appearances may be quite deceiving. For instance, the paradoxical result of what may, on the surface, be celebrated as "hedonism", (i.e. the cultivation of pleasure) can be motivated by a deep-seated "anhedonia", the incapacity to experience the joy and pleasure of wholeness. Superficial excitement often covers a lack of deep enthusiasm. Masochism itself can also be motivated by apathy, a loss of sensitivity which amounts to a psychological amputation and is accompanied by a craving for completeness.

The difference between the mental anchoring practised by a genuine spiritual explorer and that of the addict (including the "spiritual escape" addict) is in the motive: the former seeks to filter the mental noise that hinders an intimate communication with the inner-self and the universe, the latter seeks to silence an unbearable inner pain and to escape somewhere else. The "somewhere else" needs not be a pleasurable place, it can even be somewhat uncomfortable, since relief from anxiety is its chief prize. Some depressions are clearly such detours into mild misery. If the "trip" out of oneself can be temporarily experienced as a "high", the more convincing the self-deceit.

Codependency is above all an anesthetic 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 in the alcoholism recovery field, Alcoholics Anonymous which is briefly described later in this article.

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.

It is tempting to suggest that being human is being as powerless over the forces of sexuality as one is over the need to breathe or over weather cycles. This does not, however, exempt mankind from practising powerlessness management in this area just as it has done in other areas. Umbrellas are a sensible answer to the unescapable 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"), very frequent in the "helping" professions. 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 anesthetize one's feelings of inadequacy and anxiety. In such a situation, the therapist embodies a model of codependency and 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, viewing television or videotapes being one of the dominant addictions of the early 90's. Much could be said also about the popularity of horror movies and thrillers and their role as converters of fear into excitement. 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.

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.

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

Religious addiction, better called idolatry, is rooted in obsessive thoughts used to deny the immediate level of existence by focusing on another level. Bakan, quoted by Philip Flores says 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 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 Medecine 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 anesthesia 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 clever 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 crisis, the degradation of anxiety-management skills requires an ever increasing use of anesthesia and the addict sinks slowly into despair, slowly losing balance on a 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. This is the topic of the following section on recovery.

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 a specific dependence. For example, an alcoholic who becomes alcohol abstinent is, under that definition, a "recovered alcoholic". For others, recovery is the acquisition of a dependence-free lifestyle. 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. Under the second definition, a "dry alcoholic" is the name given to a person who only abstains from alcohol without changing other behaviours except maybe for a compensatory increase of other compulsions, whereas a "recovering alcoholic" is the name given to 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 regret to tell you that 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 a 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 conditions that are favourable to 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 replacement of alcohol by other forms of anesthesia, but the decision to call oneself "recovering" belongs to each individual. Recovery, in the context of this discussion, is a weaning of anesthetics and a learning of life-skills. It cannot be dissociated from the healing of psychological wounds from the past and it is the severity of these wounds which 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 obtained by the addict 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 every known recovery movement for 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 decision" in Step three, "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 materialize acceptance and foster a personal rebirth. Of course, a passive interpretation of the Steps veils such understanding when words like "humbly" are given a connotation of domination and degradation. The most ordinary dictionary of synonyms lists words like "unpretending, simple, unselfish, unobtrusive, unostentatious, plain, modest", as synonyms of "humble". One can therefore question the tendency to prefer other synonyms given, such as "lowly, abased, meek, submissive, backwards, shy, coy and shrinking". In the context of this discussion of acceptance as 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, also described below, are called "Acceptance Program". SOS, Secular Organization for Sobriety, another recovery movement starts its suggested "Guidelines for Sobriety" by the following acceptance statement: "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 ego is the oppressive power to be defeated in recovery. The amount of personal energy invested in anesthesia is such that a tremendous surge of power is felt when acceptance takes place. This power can then 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 chute" is the sound advice given to candidates to that living experience. Indeed, repressed emotions will not fail to rise and to be painfully felt. Therefore, the importance of the cushioning effect of a support system cannot be underestimated. Experts in the addiction field have often voiced the opinion that addictions, however painful, are the ultimate refuge of many and protect 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 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 our addicted personality;
5- We stated our humanness;
6- We chose wholeness;
7- We healed 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.

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 used in Step 3) resembles too closely a recipe for revictimization. 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 relatively easily overcome were it not of the virtual enshrinement of the wording of the Steps. Claiming that the Steps are incompatible with empowerment is somewhat overlooking 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 is God" as to accept "who is not".

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.
The dismissal of these misconceptions by a professional 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 sources. 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.

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 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."