The deleterious effects of alcoholism are devastating; it destroys lives, families, and marriages, wrecking havoc upon every facet of a person’s and their family’s life. Even 
worse, it can often lead to death. Heavy drinking is the third leading preventable cause of death in this country. By conservative estimates, it is directly related to approximately 80,000 deaths each year, and is the seed of a broad range of diseases.
Quite clearly, the treatment of alcoholism and substance abuse is a serious and urgent issue, and clinicians should ideally utilize the most thorough and effective methods of treatment. For this reason, one should look with a skeptical eye at any alcohol treatment model that does not equally address the “bio”, “psycho” and “social” aspects of addiction. All facets of the person need to be treated for the best possible outcome, and this is only possible from a BioPsychoSocial perspective.
Part II of this blog will address the “bio” and “social” understanding of the disease as well as how it is treated from a BioPsychoSocial perspective. For the purposes of Part I, we are only interested in some of the psychodynamic understandings of chemical dependency, i.e. the “psychological” element. This is not to underplay the “bio” and “social” aspects of addiction and alcoholism, or the treatment of the disease, but to do justice to these matters I have saved them for Part II.
Understanding the Ego Deficits
Poor Emotional Regulation
Addicts exhibit ego deficits that predate the addictive behavior, interact with it, and re-emerge in full force in abstinence. One such ego deficit is the inability to experience and process his or her emotional experiences, with the individual often experiencing emotional numbing or flooding. There can be an internal sense of emptiness along side a fear of the outside world. Overwhelmed by both, the user seeks solace in a drug-induced state. Drugs are selected by the differing abilities to sedate, excite, numb or energize, making one’s drug of choice neither random or accidental.
Emotional Dependency
Alcoholics have profound dependency needs that are usually acted out through familial or relationship psychodrama. Addicts often do not have the psychological structures to self-soothe, and as such induce a short respite from this emotional pain through drugging and drinking. Without being conscious of it, they recreate their family dramas by trying to get the love that they never received as children, manipulating others around them to take care of them. They are often masters at half-truths, manipulation, and lying, selfishly fostering a false sense of responsibility in others for their personal good. Family members and loved ones often pay rent, bail money, lawyer fees, and credit card debt in a misguided attempt to protect the user from the terrifying consequences of their behavior. Since the addict cannot experience the needs and wants of their loved ones as real, they exhibit tremendous narcissism and grandiosity. As such, the alcoholic is unable to experience his or her own failures and successes as an adult, making it difficult to have authentic and meaningful connections with others.
Magical Thinking
By avoiding personal responsibility for their actions, addicts and alcoholics demonstrate a fundamental fantasy- The Fantasy of Life Without Consequences. In general, alcoholics do a very poor job of taking care of themselves, and instead manipulate others to do it for them. It is believed that childhood rejection, overprotection, or conversely premature responsibility leads to the unconscious desire for nurturance that cannot be met in an adult reality. In turn, this leads to feelings of abandonment and anxiety that get washed away with more alcohol.
Low Self-Worth and Self-Concept
Alcoholics have serious deficits in self-worth and self-concept. Feelings of low self-worth that were probably present from as far back as early childhood are reinforced by social, educational, and vocational failures in adult life, and often compensated for with narcissistic entitlement and pompous grandiosity. Their repeated failures and social rejections leave them feeling profoundly alienated from mainstream society, creating a vicious cycle that leads to greater despair, and more self-hatred. The addict must acknowledge and challenge their dependency by taking on the adult task of sobriety. Then the pride of genuine accomplishment can improve their self-worth and lead to a more positive self-concept.
Common Defense Mechanisms Use by Addicts and Alcoholics
For the alcoholic, primitive defensive structures keep the individual trapped inside of his or her own developmental deficits. Addiction can become an autonomous process that takes on a life of its own. Despite the good intentions of family, friends, and rehab facility staff, at some point each addict must work through their defense structures if growth is to occur. Addicts and Alcoholics have the same defense mechanisms as everyone else, but these appear to be the preferred defenses of addicted people.
•Denial: Denial is considered the most primitive of all of the defenses. The addict actually believes his or her distortions are essentially correct and that it is the rest of the world that is experiencing the faulty perception, especially regarding their drinking or destructive behaviors. Sometimes direct assertions are needed to break through this defense, as facts do not seem to affect the alcoholic’s psychic structures.
•Projection: The addict often attributes unwanted and/or unacceptable parts of themselves to others. One example would be feeling incredible discomfort in an AA meeting because they feel that they are not like the rest of the people in the meeting, and that they are superior and above them.
•Rationalization: Addiction can be defined as indulging immediate gratification followed by delayed negative consequences. Addicts are able to rationalize just about anything to avoid contemplating the many negative consequences as a result of addictive behavior.
The following are maladaptive behaviors often seen in addicts and alcoholics
- Isolation from others: Addicts tend to retreat from socialization when they are in the addictive phase of their disease as feelings of shame, self-loathing, and guilt well up.
- Lying and Manipulation: Addicts often live from hand to mouth, and their coping skills involve stealing, cheating, and lying from both strangers and loved ones.
- Obsessiveness: Alcoholics and drug addicts not only become obsessed with their drug of choice, but also narcissistically focused on money, success, and sex. In fact, newly sober people often shift their obsessive thinking into becoming sober.
- Self-Centered Thinking: Addicts and alcoholics have difficulty empathizing with others, are self-referential in their thinking, and are obsessed with how the information at hand relates to them. They can be rigid and resistant to feedback that feels at all critical, and ignore information that does not conform to his or her distorted self-concept. Another way to describe this phenomenon is that they are very sensitive to “narcissistic injury”, while at the same time devaluing the self-worth of others.
- Placing Blame on Others: No matter how self-destructively they have behaved, there is always someone else, or some other circumstance, to blame.
- Dangerous Risk Taking: Addicts and alcoholics are far more likely to engage in risky behavior such as committing crimes and engaging in unsafe sex.
Jennifer De Francisco, MPA, MSW, LCSW works in the Newport Beach, Irvine, and Orange County areas. She specializes in marriage counseling, relationships and depression. Jennifer also has significant experience in the treatment of alcoholism and substance abuse disorders.
If you are interested in making an appointment, please call her at (949) 251-8797.
