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How to Treat Addiction: How Can Therapy Help?

Kay Cohen

Kay Cohen

Tuesday, 15th January 2019

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The word “addiction” is derived from a Latin term for “enslaved by” or “bound to.” Anyone who has struggled to overcome an addiction - or has tried to help someone else to do so - understands why.

The addicts brain processes impulsive urges differently to the normal brain, and the urge to act on impulse - without considering the consequences - is much greater in the brain of an addict.

Compulsive urges come from the need to relieve anxiety – whatever we’re craving makes us feel safer, better and stronger!

The compulsion is the action – when the behaviour is activated – and we are ‘acting out our addiction’; our solution to the discomfort of these anxious feelings.

In an addict, the prefrontal cortex is ‘wired up’ slightly differently.

How addiction changes the brain

If we speak about autism we would say the brain works differently for the autistic person.

But there is a large amount of stigma attached to the word addict. A common theme for those who are living with an addiction is denial.

An acronym for denial



Above I have shown the Limbic brain – or the monkey brain. This is the part of the brain where the addiction manifests. This is also the part of our brain responsible for fear and anxiety.

According to the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to hijack the brain’s system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival (such as eating and sex) with pleasure and reward.
The reward circuit in the brain includes areas involved with motivation and memory as well as pleasure. Addictive substances and behaviors stimulate the same circuit—and then overload it.

Repeated exposure to an addictive substance or behavior causes nerve cells in the nucleus accumbens (monkey brain) and the prefrontal cortex (the higher part of the brain – the thinking brain) to communicate in a way that couples liking something with wanting it, in turn driving us to go after it. That is, this process motivates us to take action to seek out the source of pleasure.

The monkey brain cannot think or make decisions – it only wants!

However, when we start repeatedly rinsing the monkey brain of chemicals this causes a glitch in the higher functioning prefrontal cortex part of the brain. And this where irrational thinking can come into play.

The addict should always be encouraged not to trust their first thoughts, and instead check-in with a trusted support system. This might include counsellors, other recovering addicts, and mutual aid groups.

How the addiction manifests

As their addiction takes hold, it is common for the addict to start fearing everyday situations. This might include:

  • Avoiding close relationships - talking to their partner, friends or family who might ask questions about money or time they’ve spent on the addiction.

  • Keeping on top of daily admin - for the addict opening letters can feel scary, especially with the knowledge that they are usually from authoritative figures such as the taxman, council tax, or GP.

  • Answering the phone - even answering the phone can feel overwhelming, especially if they think they might have texted or called someone in the early hours whilst under the influence.

Sadly, this can lead to a vicious cycle. The more we hide away from situations the more our fear grows, and the more we need to use the addiction to anesthetize our feelings.

What are the signs of addiction?

Addiction isn’t straightforward. And admitting it isn’t easy, largely because of the stigma and shame associated with addiction. But acknowledging that you have a problem is the first step towards recovery.

A “yes” answer to any of the following three questions suggests that someone might have a problem with addiction and should—at the very least—consult a health care provider for further evaluation and guidance.

1. Do you use more of the substance or engage in the behavior more often than in the past?
2. Do you have withdrawal symptoms when you don’t have the substance or engage in the behavior?
3. Have you ever lied to anyone about your use of the substance or extent of your behavior?

Unfortunately, we cannot just ‘think’ our way out of addiction because addiction causes our thinking to become irrational. And many people hold back from asking for help because they don’t want to be seen as a ‘fool’. It’s important to stress that addiction has nothing to do with intelligence. Most addicts have high levels of intelligence - something that can further complicate the process of recovery.

Addiction is powerful - it’s like trying to fight Mike Tyson on a daily basis. We can’t and shouldn’t have to do it alone. The first thing we need to do is admit that we have a problem, ask for help and seek support from a qualified addiction counsellor.

Coping with cravings: an exercise

Below are three questions to check-in and ask yourself when cravings strike:

1. What do I want?
2. What am i doing to get it?
3. How do I feel about it?

So, for example:

What do I want? “To be abstinent”
What am I doing? “Drinking wine - smoking - eating chocolate”
How do I feel about it? “Guilty and depressed”.

If you're not doing what you need to get what you want – what do you think you could be doing differently?

Here's an analogy.

I decide to start eating healthily. I’ve had a stressful morning at work and by lunchtime I really want a donut. If I eat the donut I’m going to end up feeling remorseful and guilty. If I have some fruit, on the other hand, I’m going to feel really good about myself.

We need to run the feelings tape forward. And instead ask ourselves, if I do this behaviour, how am I going to feel afterwards?

Kay Cohen

Kay Cohen

Kay is a Senior Integrative Therapist specialising in addiction. With 10+ years working with addictions, Kay works in a rehab clinic alongside volunteering at domestic abuse services.

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