Scripts for Addiction

• Addiction to Chemical Substances by Steve Colameco, MD, 11/16/97
  
  

My apologies for the delay in responding to this insightful question---during the past month I've been a victim of SCDS (Sudden Computer Death Syndrome) and a variety of technicians has taken an astonishingly long period of time to get me up and running on my desktop unit. I'd like to speak to the guy who said these would be labor-saving devices.

The easy, first part of the answer to the role of affect and scripts in addiction and its remediation is to recognize that all psychoactive drugs work at the level of affect. Alcohol reduces the acute effects of shame, cocaine and the amphetamines increase interest-excitement (and thus help to overcome shame), heroin produces profound enjoyment-joy, lithium salts and the anticonvulsants like Depakote reduce inappropriate interest-excitement, benzodiazepines reduce fear-terror, phenothiazines reduce anguish, etc. No one gets stuck with "drugs of abuse" unless overwhelmed by some unpleasant affective state.

Just because they are available on the street, any of us is likely to try literally any of the chemical agents that work so well to alter mood. I suspect that most of us have discovered that alcohol is a wonder-drug when we are in the throes of humiliation; many have also noted that the chronic down others call "depression" (but which I describe as chronic shame) yields pretty well to cocaine. If you use such drugs on an occasional basis, this is called a "recreational use" of the substance, and most likely not a problem. Yet the very success of such recreational drugs can lead to a very real problem in psychological development, for affect (unless triggered by an inherent biochemical defect) is a message that should point consciousness/attention toward some matter that needs our best thought. Whenever we use a device to erase the affect, rather than solve the problem illuminated or amplified by that affect, we lose an opportunity to learn more about life. Street drugs assist function in the street, perhaps, but they reduce our ability to learn in other venues. Tomkins offered the term "sedative script" for the habitual use of a chemical or behavioral trick (masturbation, compulsive TV-watching) to wipe away one or another affect whenever it appeared. (I suppose that if he were writing now, rather than 30 years ago, he would have called this a "tranquilizer script.") The effect of such scripts is to groove and make habitual our use of a trick to erase an affect whenever it appears, rather than allow that instance of affect to point our mind in some direction where attention and high-level cognition are needed. A good example is the use of alcohol whenever one is embarrassed.

Use a sedative script long enough, and one becomes able to predict with great certainty when one will enter an event where there is a high likelihood of experiencing that affect. The intelligent response? Start using the substance before the event so you won't have to suffer for a moment. Remember the scene in Melanie Griffith's "Working Girl" when she starts taking Valium before a cocktail party because she is so frightened she will be embarrassed in front of Harrison Ford? That is what Tomkins called a "Pre-Addictive" use of a substance, leading to a pre-addictive script through which an individual learns to remediate whatever negative affect (usually fear) that amplifies our concern that the original negative affect (in this case, shame) might occur in a particular event. Those who drink all day or take their drug nearly constantly are using a preaddictive script.

When we get so used to the freedom from negative affect produced by the substance chosen for the preaddictive script, we can begin to worry that some day we may not be able to have enough of that substance around, and begin to develop an Addictive Script. This is characterized by what Tomkins called Deprivation Affect, and remediated by hoarding behavior.

Note that we are far afield from the original affect that required remediation. The angry, dangerous man who will rob or even kill to guarantee his supply of some drug is far, far away from awareness that he got into this mess in order to remediate feelings of shame.

This is why treatment takes so long, and why 12-step groups are so useful. People who have been through the process help each other by recognizing and pointing out signs only they can notice. "Recovery" is a misnomer, for the addicted person has actually lost years of experience managing some negative affect. It is of little use simply to stop using a drug of abuse because once the drug is stopped, the individual must learn how to handle negative affect in a host of situations previously invisible because the illumination normally provided by affect had been turned off.

So the treatment of addiction is radically different from any other part of psychotherapy in that the individual must be taught entire realms of affect management normally learned during childhood. And all this in adults who seem otherwise to be able to function in society, and whose very competence makes them all the more ashamed that they know so very little about real life. AA says that of those who do not go to a meeting every day for the first two years of their sobriety, 95% will go back to drinking. Our group has found that a great number of people who have gone through this process is then ready for intense therapy that allows them to learn a great deal about their affective responses. It ain't easy to be clean and sober, especially when what you see and feel when you're sober is a huge bunch of things that loom large and scary in ways that "normal" people never seem to notice.

Recovery from addiction implies a lifetime of affective learning. But I guess that's true for all of us, isn't it.

• is there also a 'celebration' script? by Martha Frisoli Gibson, 12/1/97
  • Celebrations and Libations by Don Nathanson, 12/2/97
• (No title) by (No author), 1/11/98
  • Why addiction is different by Don Nathanson, 1/11/98