by Tom Horvath, Ph.D., ABPP
This blog is a follow-up to last month’s blog about an evolutionary approach to understanding problematic addictive behavior. To summarize, that blog suggested that addictive behavior is normal human behavior. We all normally crave (desire, have urges for) food, sex and the attention of others. These three primary addictive behaviors are strongly reinforced as pleasurable activities, and they are essential to our survival. The modern world also provides us with other substances and activities that, through experience, we might also learn to crave. These addictive behaviors are not essential to our survival, but sometimes we pursue them as if they were. Although involvement with these secondary addictive behaviors does not necessarily lead to problems, it does in some individuals.
Living in a World of Plenty
We easily control ourselves when we don’t need to! When the environment limits how much we can eat, how much sex we can have, how many people we can get attention from, or what drugs are available, we don’t need much self-control. When these substances and activities are plentiful, self-control is needed. In the modern developed world substances and activities are indeed plentiful.
Consequently, some of the fundamental problems of life have changed. Until recently in human history making sure we had enough food was a primary concern. Now, we need to focus on limiting our food intake (and sexual stimulation, and opportunities to connect with others, such as by texting or social media, and our involvement with a wide range of substances and activities).
We are challenged not to get enough, but rather not to get too much. We are all challenged by this change of circumstances in human life. We evolved to live in a world not nearly as plentiful as the world we live in. The challenge is substantial. Most people in the US are overweight, and many have substance or activity problems as well.
United by the Need to Stop
The consequence of living in a world of plenty is that addictive behavior unites us. The need to “stop” also unites us, whether stopping at moderation, or abstaining. Food, sex and attention call for moderation plans. Other addictive behaviors can be dealt with by moderating or abstaining. We all need to “stop,” whether before the first drink or after the third, or whether before dessert or after only one dessert.
This evolutionary perspective suggests that rather than working to identify addicts and alcoholics as a separate group of individuals, we could recognize that in the modern world all of us need to manage addictive behavior. We manage addictive behavior by stopping (regardless of whether we are moderating or abstaining).
Why do we make a large distinction between moderating and abstaining, when both involve stopping? It’s accurate to state that stopping can be harder if we have “used” first. Craving is usually stronger under this circumstance.
However, craving is a variable experience. Craving is not all-powerful. Craving never forces someone to engage in an addictive behavior. It is striking that individuals who might state that they “cannot” control their eating will nevertheless complete a fast required before a medical test. Individuals with substantial substance problems will control their use under specific circumstances. Craving, while often uncomfortable, is not harmful in itself and does not force someone to do anything. Our own perspective on craving ultimately determines what we do next.
One well-known example of control despite craving is the case of Leroy Powell, cited for public intoxication in December, 1966 in Austin, Texas. He argued that his drinking was not under his control because he was an alcoholic. A psychiatrist testified in support of this argument. An excerpt of Mr. Powell’s testimony is quoted in the appeal court’s ruling (which did not over-rule the conviction for public intoxication):
‘Q. You took that one at eight o’clock because you wanted to drink?
‘A. Yes, sir.
‘Q. And you knew that if you drank it, you could keep on drinking and get drunk?
‘A. Well, I was supposed to be here on trial, and I didn’t take but that one drink.
‘Q. You knew you had to be here this afternoon, but this morning you took one drink and then you knew that you couldn’t afford to drink any more and come to court; is that right?
‘A. Yes, sir, that’s right.
‘Q. So you exercised your will power and kept from drinking anything today except that one drink?
‘A. Yes, sir, that’s right.
‘Q. Because you knew what you would do if you kept drinking that you would finally pass out or be picked up?
‘A. Yes, sir.
‘Q. And you didn’t want that to happen to you today?
‘A. No, sir.
‘Q. Not today?
‘A. No, sir.
‘Q. So you only had one drink today?
‘A. Yes, sir.’
If craving were all-powerful, no one would ever overcome any kind of problematic addictive behavior, but in reality, most people do. Even smoking, which is widely regarded as the “most difficult addiction” to stop, is eventually stopped by most smokers.
To conclude: We all have addictive behavior. We all have craving. We all do not act on craving at times. We all could learn to limit addictive behavior to whatever level we choose, although that learning process might take significant work. Addictive behavior, craving and stopping unite us. If we can accept this perspective, then we might have more compassion for those whose addictive behavior is more substantial than our own, and support them in developing the self-control that is possible for all of us.